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Home My WebLink AboutCAMPBELL HEIGHTS BLK 3 LT 1o.l - o?a 4o Well Log Fo~ ...... ...((..C.:....~..Z..~.:f. ........ q_~..... ....................... ~ ............... '....'....[..: ......... Location.....42.~ ...... ./. ..... ..~....[.~.~..~.~../....~..~..~:..~..~.~...~r.~:...~.......~...~.4..:..~...~..~.~..~..~:. ................ Date comCeted ........ .f(.=..~.¥.=...~ ............................. ,.~,~,~,~.~,, ......................... w ~;z~, ............................................................................... :.'~l &~O.~'.L.~f jOBt. ..... s~e o~ ea-~ .......... (~ ......... i ..................................... i ....... ~,....~..O..V..~:...:~ ............ D~,~o~ ~o ~er..~....~..~...~E...~.( ........... ,R. EC..EL~J~q. ......... of ...... ...~.q...~. ................... ~llons per.hour.(~ Formation fromJ to 0 J /0 /~ I/2' ~-~ IlEAL'IH & D.a T. REICEI I Driller DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE. ALASKA 99507 PERMIT'NO. ( r,li. Jl--.I T C m pi=iL m '"rY OF i:::ll'-,IC:l-I ORFIC-iE DEPARTHENT g~ HEALTH AND ENVIRONMENTAL ~-~OTECTION 825 '[.;~STREET, ANCHORAGE, AK. 264-4?20 WELL PERrq I T APPLICANT LOCATION LEGAL BRYAN R. LOHE 4143 ERST 6?TH. AVE EAST 66TH & RUTH LOT'I~'BLK~3CRMPBELL'HT$.' ~U~ LOT SIZE 344-005~ 23000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 400 FEET FOR R PRIVATE WELL OR 450 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS ?.5 FEET. HELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T E×P I RES DECEl..1BER ;~:-I , :1._~ ~0 I CERTIFY THAT l: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. S I GNED: RPPLICA~ BRYAN R, LOWE V4. 0 HUNIClPALITY OF hNCHORAGE DIVISION OF ENVIRO~fl~NTAL HEALTH DEPARTMENT OF HEALTH A~D ENVIROb~ENTAL PROTEOTION APPLICATION FOR }F. ALTH AUTHORITY APPROVAL CERTIFICATE General Information Application Date 11/5/84 (a) Legal Description (include lot, block, subdivision, ~ectiT}~~ to~.ship, range) Lot 1~ Blockier Campbell Heights /9 , ,[,~ ~f~V[( Location (address or directio~) ' ~ [~[~¢~ . ~ 4140 E. 66th DCSi~f ~-~-~ (b) AppZican~s Name ~ry~ ~,~ Telephone - Home549-6~nes~66-6224 Applican~s Mdress ~1~O E. 66th (c) Applican~ is (check one) Le~lng Insci~u~ion ~; ~er/builder~; Buyer~; 0=her~(~plain); (d) Lending Ins~i~u~ion ..~lr~ ~attoual Bank of Anch. Telephone 276-6~00 Address 5~05 E. northern Lights (e) Real Es=ate Co~ & Agent Address Telephone (f) ~ail the HAA to the following address: Call~~-~for pickup 2. Type of Residence Single-Family~ .ulti-Fam~,l--'[ Other ~deseribe) Number of Bedrooms, Three 3. Water Supply Individual Well ~ Co~muni~y ~--~ Public ~ Note: If co~munity yell aystem, must have written confirmation from the State Department of £nvironuental Conservation attesti~ to the legality and status. i. Sewase Disposal Onsite ~--~ Public ~ Community ~ Holdin~ Tank Note: If community well system, must have written confiruation from the State Department of Environmen=al Conservation attesting to the legality and status. [Page I of 2] 5. En$ineerin$ Firm Providing lnspections~ Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, l verify that my investigation of this Health Authority Approval shows that the on-site water aupply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation had inspection, the on-site water supply and/or wastewater dispesal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Barter and Associates Telephane 563-7164 Address Date 5331 Tudor Top Circle 1/-o5/84 DHEP Approval Approved for /~mr[a/bedrooms Approved y Disapproved Coaditiona~ Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTHENT OF I~ALTH AND ENVlROI$1ENTAL PEOTECTION (DHEP) ISSUES ~EALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TEE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONA~ ENGINEER REGISTERED IN TIlE STATE OF ALASKA. THE INtEP DOES THIS AS A COURTESY TO PURCHASERS OF H0~S AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDEP. AL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY.OF ANCHORAGE IS NOT RESPONSIBLE FOR ER/~ORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/e~/DlS [Pase 2 of 2] 7-19-84 [NVIRONM£NTAL NOV 1984 Well Classificatic~ private Well LoG Present (Y/N) Y To~al Dep~Jl 77 ft. Cased to Static ~atar ~evel 30 ft. Casing Seight Above Ground 24 in. mlec~tcal Wi=lng in Cmduit (Y/N) Y Sep~u:ation Distan~s f=~ Well: To Septic/Holding Tank cn Lot na To Nearest Edge of A~scz-ption Field c~ Lot To Nearest Public Sewer Line 100+ Clear~u~YManhole 100+ wate~ Sample Collected By TDB Water S~le Ua~e Cc~Dleted 77 ft. Pure9 Set At Lot I f Block~'lCampbell tlei~hts If A, B, C= C, D.E.C. ApD=OVed(¥/N) ..... 11/26/80 Yield 6 gpm Sep~h of ~ti~ na btm. ~ ~al ~ ~f~ (Y~) Y ~essi~ ~ ~l~ad (Y~) N ~ O~ ~jo~nin~ Lo~s, na na ! O~ A~joining Lots, an To Nee=est Public Sewer ~ 0ft To Nearest Sewer Service Li~e on LOt To Cat~ (Y/N) F~undati~ t~t PumL=ed 8olding Tank ~e~mit (Y/N) Building To Disposal Field To Strewn, Pond, I,ake, Receipt S Date Paid: Amount: [Pa~ 1 of 2] 2-15-84 Ce 2-15-84 November 5, 1984 Mr. Bryan Lowe 4140 E. 66th Anchorage, Alaska 99507 .RECEIV. ED ~. Tony Barter, P.E. Borter and Associates 5331 Tudor Top Circle Auchorage, Alaska 99507 Re: Lot 1, Block l, Campbell Heights On November 4, 1984, I visited the subject property to perform a well yield test to obtain Health A~thority Approval. The well is capped with a sanitary fixture andTgraded so that runnoff flows away from the casing. My original inspection revealed that the electrical wiring was exposed. Thc owner corrected the deficiency. A sample of water was taken from the kitchen tap. The water was runfor approximately three minutes before the cample was taken. Water was allowed to flow from the outside spigot for approximately one and one-half hours at 6.5 gpm without showing any signs of stress. The sample was taken to Chem Lab for analysis. Sincere~ T~ony~D. Barter, P.E. )ATE RECEIVED ~-" INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE :)ATE DEPT. OF H'.ALIH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL ;~;,OTECTION , DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street * Anchorage, Alaske 995~1 · ENVIRONMENTAL SANITATION DIVISION RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page I. Incomplete ,equests will not be processed. Please allow ten (10) days for processing. PROPERTY RESIDENT Jif dilferent from abo~) PRONE 2. BUYER PHONE MAILING ADDRESS MAILING ADDRESS 4. REALTOR/AGENT I PHONE MAILING ADDRESS 16. TYPEOF RESIDENCE ~ SINGLE FAMILY I-"l MULTIPLE FAMILY 7. WATER SUPPLY ~ INDIVIDUAL' r-'l COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISFOSAI. SYSTEM [] INDIVIDUAL/0N-SITE*' PUBLIC UTILITY NUMBER OF~BEDROOMS [] One [] Four [--I Other [] Two r-'l Five ~ Three [] Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled .ePth prior to that date, give well (attach log if available.) YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) _ · THIS SIDE FOR OFFICIAL USE ONLY - - 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS I--I SINGLE FAMILY r-'l ONE r-] THREE r-1 FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL : DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPT,ON AR EA MATERIAL 4. DISTANCES WELL TO: Septic/Ho,drag Tank 1Absorption Area JSewer Line I Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [Z~PPROVED FOR -.~ . BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) 1--i . DISAPPROVED ./~ DATE BY 72-010 (Rev. 6/79) ! Iv uniCipMitYo Anchorage 825 "L" STREET ANCHORAGE, ALASKA 995 10~..~ - (907) 264-4111 GEORGE M.$ULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION January 6, 1981 Bryan R. Lowe 4041 East 67th Avenue Anchorage, Alaska 99507 Subject: Lot 1 Block 3 Campbell Heights Subdivision Approval for your individual sewer and water facilities cannot be granted until the following items have been completed: ) (2) (3) The water analysis report needs to be delivered to this office from the Chem Lab, 5633 B Street, for our review. A well log submitted to this department for our review. The depression or pit around the well casing needs to be filled with impervious type soil so that it slopes away from the well casing. (4) Exposed electrical wires to the well head are in violation of the Municipality of Anchorage codes and need to be encased in conduit. Please notifty this department for a reinspection when the noted descrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Assoicate Specialist RCP/ljw % cc: First National Bank of Anchorage Post Office Box 4-2090 99509