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Home My WebLink AboutCAMPBELL HEIGHTS BLK 4 LT 13A Selfs Water Wells Anch. Ak. Lot 13A Blk. 4 Campbell hts. 0-18 ~%nd & Gravel 18-38 G~avcl & Clay 38-51 glay 51-69 Gravel 69-73 Silt 73-75 Water ~and & Gravel Bailed 10 Gal. per bin. 20 Ft. Water in Well S~ned by/Driller Nov. 27 F'ERMIT NO. " LOCRTION ET,R. SPRUCE I LEGRL LT:I._-R BLI-(4 HTS :.tOO FEET FOR FI PRt',,,'RTE P.!ELL OR ::L50 TO 200 FEET FROM F! PUBLIC PlELL DEPENE:,ING UFufl THE TYPE OF PUBLJ:C I,,.tELL. Plt!'-,IIMUM [.ISTRNCE FROMi' R F'RIVFiTE P.IELL TO R PRt',/FITE _-,Et. IER LINE IS "':'~ FEET T~z~ IR C]MMUNIT¥ SEP.IER LINE t-.-'-; --"~, ._ FEET. -',=' REC, UIREp RN[:, MUST -'- RETURNE[:' TO THE [:,EF'FIRTMENT P.h. THI,-4 'T':O P.~ELL LO~=-, RRE ' OF THE t,.!ELL COMPLETION. FiF'PL'¢. ,,-, SF'ECtFIC:HT.tUI'-4'-, RN[:, L. UfL, TRUE. TtO~! [:,IRGRRi"I$ OTHER RE6¢J l REMENTS MFI¥ FtVFIILFIBLE TO INSURE PiROPEF.. INSTRLLRTION. ±: t RM FRMILIFIR NITH~ THE R.E~PJ!REMENTS FOR ON-SITE - ~ -- '::' RS; FORTH B'¢ THE PIUi',IICTF't~LtT'¢ OF RNCHORFIGE. ;2: I 1.4ILL tNSTFILL THE =,¢_,TEM II',l PI;~CF~RDFiNC:E !.,.IITH THE CODES. _. 4... :.'LOF'~OO _-'SQUFIRE FEET oE .,:,-- .~-;:- ,,,~ ,-. ~ · -, .... :., MUNICIPAEITYOFANCHORAGE,O,t,,..:,O.~,~./ff~.:T~I.,,.~,.~td~.,~. ". ~ -;':.~, -.:- :,: .~ .;' .~ [~' DEPARTMENT OF H~LT~ & HUMAN SERV CES'~"~';:~-,.'~J~"~'~: [.. :..: ..,t . -., ' ~j/ -. UIVISIO~ Ol ~nvlronmental ~e~lces.,,. , · ~: _~, . .. · - . ;-, · * .-. · . ~-.... -.. ~: ,.. ~ ~,?.~ ~ ~a I..,,.f,~ a o;~} ~.O}.Box 49~ ~ }Anchorage~laska ~( ~51946501~ ,.,~.~¥ DF...,...: :;;... ,,., ;,~ ....... , '~' -. -, , . ~..; , >..,, .~APPROVAE FOR A S NGE~FAM LY DWEEL NG ;~ ..... .,,,;. :~ , ~. · -. , ~ '.;. -'.~ . 1,,?:GENERAL INFORMATION .~.-. . ,~ ~ .... ~ ....... . ,-.., ._~" ~.;:_::-:.:Prope~y owner~-..A.~-L,.~.- ~111~0 .......................... Day phone ...... --:--:(:.:2Len~ngagency?''-~ '"~,'~"" ':' · ' ' ~ '-Dayphone~'' ..... · ..... ... ~. .~..:~,, .,-d,.T: ;. :.r..;;.',.,:(.~?2:'.'~: . .'7-~'~?~.~: Ma~ling address-'- - ..................... : ..... · ....... ::~..,; :r- ;"Address* ~O00R S~..An~0~g~,_R~ .99503 . ..; ..¢: ...:.,,, ,,~ .... ~. _~.Unless othe~se.re uested, H~ wll/ be held for icku ,.. ...... . .... 2, NUMBER OF BEDROOMS .... ..,, ..........-..,-,, , ....o,, . '.-~.~. J ¢..,) ..... .. ,.. ,,- ....... . .. ; .... ., , . , .~ .... , .....;.~. ~. ,, ~J . .... 3.. ~PE OF WATER SUPPLY ........... ._ ..................... ~ ...... . . .... , .... - ........ Ind~wdual well ............... ~ .................. ~ · , *-2- -,...~ NOTE.,. If communit~ we~l system, prowde wn~en confirmahon from State ADEC attest-; :. ~ ..' ,,: ......... Ino to the le~ahty and status of svstem -?, ,,. ~ .~ _ , ....... ; · , . ':,..- .~ .:,~;,?~l~r,t:,~~ ' :--'~- -* ~'~loet~~l;~o~z*a~ ~cc~,~.~.n:~ - - . · ',.~., ~',' ;,' :-?. NOTE:: '; If commu~~~b~rde ~rltte~'conhrmat~on from 'State ADEC;~ :. ~ .... Municipality'ofAnchorage . Department of Health & Human Services HEALTH AUTHORiTy APPROVAL CHECKLI,~'~I=~';~ Legal Description: ~ _~ I~"~'i ~//~'g; ~n ~,~ ~"~.!/~¢['4~Parce I.D. A. WELL DATA Well type ~ If A, B, or C, attach ADEC letter. Log present (Y/N) ~ Date completed Total depth ~' ~' Cased to '~ 0 1' Sanitary seal (Y/N) ~DEC ware;system num~e~,J/[_/~ ''' ' I I - 2 "~ -~ I Driller_-~~CJ&~$ Casing height ! ~ ~"~' Wires properly protected (Y/N) c~ FROM WELL LOG Date of test Static water level Well flow Pump level ~,) ~" AT INSPECTION ~ -- 22 -~'0 g.p.m. ,' ~'- ~) O.P.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer maln Public sewer service line ; On adjacent lots On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Date of sample: ~_~ _ ~ .~_. Other bacteria Collected by: ~-~ ~' ~ B. SEPTIC/HOLDING TANK DATA Date Installed /,,)/~ Tank size !1/~ Compartments Cleanouts (Y/N) /J~ Foundation cleanout (Y/N) .~ Depression (Y/N) High water a!arm (Y/Ni ~/~ Alarm tested (Y/N) Date of pumping '~ /~i/J/3~ ~.._~ I,*~'. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot f,J/i~ To property line tO Surface water/drainage On adjacent lots Absorption field / /diP' Foundation Water main/service line ~2-o~e (n*,,.3~9 ~m.t uo^2~ CONTINUED ON BACK PAGE C. LIFT STATION ,,~'~ * ~ -' * ' * * ' ' Date installed.-" ~** Manufacturer ~nt (~ ~' .~,~V '*,u~p o~=v~ at __ . _ ~"Pu=~ 0," ~v~ ~t. Meets MOA electrical c6des (Y/N) SEPARATION DISTANCE FROM LI~ STATI Well on lot On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed Soil rating ' ' Length Gravel thickness Depression over field (Y/N) ' · S. y, stem type * Total depth Cle~nouts prese,nt (Y/N) Width' "~' Total absorption area '%~ Results (pass/fail) for Peroxide treatmen, t (past 12 months)(Y/N) ~X~,%~ Date of adequacy test bedrooms If yes. give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foun,dation On adjacent lots Surface water Curtain drain E. ENGINEER'S CERTIFICATION acent h~ts " , "Propertyline . To existing or abandoned system on lot * Cutb~.~'~ Water main/service line _ Drivew~, park, lng/vehicle storage area ~ I certify that I have checked, verified, or conformed to all MOA and HAA guidefines in effect on the date of this inspection. ;,';*;~'~'~'~x- ' ,- / · ,,. .,.." Signature' 17034 Fagle River Loop Road No. 204 Engineer's Narrow!: HAA Fee $ ' '/'~"~ ~ Date of Payment .z/.. /~--_ ~ / Receipt Number '=~':'~// Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. ~91) ~ack MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE. ALASKA99518 TELEPHONE(907)562-2343 FAX: (907) 565*5301 Date ][sport P~tnted: IPI~ 3 91 ~ 17:17 Client ~aaple ID:Lll'I' B4 CAi(BILL H~IGHT3 PW~ID :ill Collected MR 26 91 I 13:30 ~ocoivo~ ~ 27 91 I 15=25 P~fforvo~ ~ith :A~ Analysts Coupleted :IP~ I 91 Client NaM Client lcct IPO B ~0 B Se~ Seportt to: 2) Chemlab lei !: 911099 Lab Sapl ID: I ~tzix: lllovable Parameter Tested ~os~t U~tts Nethod Limits NITRATE-N b~(0.10) n~/1 EPA 353.2 Taste PozfOZMd See Special Instructions lbova UA-Unavailable None Detected o. See Seaple ~eMzkt there Not insly~ed LT-Lote Than. ST-$~eata~ Then MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING HAA # ~ {:~q,'"tm ~ ~ \ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot ISA; B~ock 4; Ca. rnpbe~.~ HeZg~t6 Su. bd. ivi6ion; Location (address or directions) 3451 Eclat 61.th 'Ancho~tge, (b) Property owner A.H.F. C. # 111560 Mailing Address Telephone: (home) Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address 3000 A Str¢~t~ Anchoraq¢, A~6b.c. 99505 FORTUNE PROPERTIES,INC. ATTN: K~th Lind6~ Telephone 562-1655 (e) Mail the HAA to the following address: (or check here,1~ if hold for pick up.) List contact person and day phone number below: 5 & 5 ~:~'4GI~EF.R!NG 17034 Eagle Klver L~ap R~.~ No, ~ Eagle River, Alaska 995~ 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3. WATER SUPPLY Individual Well Community r"l Public r-I Nole: If community well system, must have written confirmation from the State Dep~rtme~t of Environmental 'Conservation'attesting to th legality and status. 4. SEWAGE DISPOSAL On-site I-I Public CX~ Community I"l Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th Health Authority Approval shows that the on-site water supply 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 and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Telephone ~ ~"~,,' "Z~/~,~ ~ 17034 Eag!a River Loop Road No. Eagle River~ gia~ Name of Firm Address Date 6. DHHS APPROVAL Approved for_~' bedrooms by Approved .~ Disapproved Torres of Condltional Approval Conditional Date /~'.,~,/,~"-~) The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 :343-4744 Legal Description: _~.c,-.r- Well Classification -~---~,~t ~;::x'~ Well Log Present~l) '~ Date Completed ~\-'7---JI-' Total Depth~ ~ Cased to ':~ Depth of Grouting Static Water Level ~,d;.' Pump Set At · If A, B, C, D.E.©. App;°ved (Y/N) Yield [~,~ (.~'~ t,~ Casing Height Above Ground*- Electrical Wiring in Conduit~N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line _,~ To Nearest Sewer Service Line on Lot Casing ~',J) Sanitary Seal on Depression Around Wellhead ; On Adjoining Lots ' '""" I,J [.~.~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by '~'~ '~-.~--~'--~R--~-~-,tl,&lm ;Date c.~_-/_.\_c~ Water Sample Test Results %/,.c~--~-~/~,-~¢-b~_~ - ~_..~"~. ~ I'~ ,w.-c, ~'-~'. Comments ~ B. SEPTIC/HOLDING TANK DATA Date Installed Size No. of Compartments Standpipes (Y/N) ' Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped ~/'- P~mping/Maintenance Contact on File (Y/N) ~'""/;f°r Holding Tank High-Water Alarm (Y/N) .,---'"'"~emporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FR~DING TANK: To Water-Supply Well _,~- To Building Foundation TO ProPerty Line / To Disposal Field To ~ervice Line To'Stream, Pond, Lake or Major Drainage Course Comments '"~'3~..~ C.... ~'.'~.~,~ - ' Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field, ' " Square Feet of Absortion Area Depression over Field (Y/N) ~ ~ Type of System Design '~ , '. : Length of Fi'eld Depth of Field , ' '. Gravel Bed Thickness t'/''~''~ Ill,'~ - " Stat~ nt (Y/N) · D of Last Adequacy Test ~;sults of' Last'Adequacy Test ~f Las"t A'dequ~' ' SEPARATION, Di?TANCE FROM ABS~IELD: ., ToWater-su~pl~"Well ' - / '- ' To Property Line To Building Foundation~-" ~ ' : '~ To Existing or Abandoned'System on Lot/"' ; On Adjoining Lots' ' To Cutba.ck (if present) To Water Ma~iJ~fSe~ice Line. ' ~: : To ~f-n, Pond, Lake, or Major Drainage Course _ To'Driveway, Parking Area, or Vehicle Storage Area Comments. '~;,~A C_. .~ ~_,A~..~__. D. LIFT STATION Date Installed Leve r'a~'--~ "Pump On" Dimensions "' ' '" " Manhole/Access (Y/N) "Pump~ .,-~/ent (Y/N) High Water Alarm Level at~"~'~.-~__ Tested for Meets MOA Electrical Codes (Y/~.~''''/ ~ Pumping Cycles during Adequacy Test. Comments j **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or cc~nformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. s & S ENGINEERING 17034 Eagle River Loop Road No. 204 Receipt No. 0 Date of Payment Amount: $ 72~)26 (Rev. 7/88) BaCk Receipt No. :' Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633BSTREET- ANCHORAGE, ALASKA 99518 · TELEPHONE (907)562-2343 FEDERAL TAX I.D. #92-0040440 Dote Report Printed: $EP 27 90 ! 00:42 Cliont $onplo ID:LOT 13A. 8LOCK ~, CA.BELL ~I$H~$ $/D Collected iEP 21 90 ! 14:38 Received $EP 21 90 I 16:20 h~s. Client lcct Ordered Analysis Completed :$£P 24 90 Laboratory iupervl~HEg C. Special Instruct: ierd Reports to: 1)$ ~ $ EK¢]n£RI~: 2)A0~C Chemlab Re[ t: 903802 [ab $mpl ID: I Mltril: MAT[K Allowablo P&rameteI Tested Result Units Method Limits KITRIT~-N KD(O.iO) m~/1 EPA 353.2 lO ~ample ROUTIKE SAMPLE ~AMPLE COLLECTED Remarks: Tests Performed See Special Instructions Above UA-Unavailable None Detected "See Sample Re.rko Above Not Anal~ed LT-Less Than. GT-$reotor Than DAlE RECEIVED .-~ " INSPECTION APPOINTMENTS TIMI~ TIME TIME DATE DATE DATE ,NSPECTOR ,NSPECTO.~ ~-~-9,,, ~ ~.,-., MUNICIPALITY OF ANCHORAGE D[PT. OF Hc~ALTH & F~,:oI£CTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~ONMENTAL /~, 825 L Street · AnchorNle, Al~ka 99501 NOV 1 9 1981 ENVIRONMENTAL SANITATION DIVISION · / RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts o, page 1. Incomplete requests will not be proc~. Please allow ten (10) days for processing. t. PROPERTY OWNER PHONE MAILING ADDRESS PROPERTY RESIDENT Ill different from~bov~) / J PF~ONE 2, BUYER PHONE MA'L'NO"DDRESS'uQ, ""ONE MAILING ADDRESS 4. REALTORJAGENT PHONE MAILING ADDP~S~ / / .~ LEGAL DESCRIPTION Z¢, 12 A STREET LOCATION ~"-- 6.~2__~ 6. TYPE OF RESIDENCE ~ SINGLE FAMILY i--I MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL' COMMUNITY r-I PUBLIC UTILITY S. SLmWAGE DISPOSAL SYSTEM r--I INDIVIDUAL/ON-SITE** ~ PUBLIC UTILITY NUMBER OF~BEDROOMS I'--I One r-I Four r-1 /'Two r"l Five ~ Three [] Six I-3 Other · ATTACH WEfL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date. give well depth (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 i 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY I--I ONE [] THREE [] 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 [] INDIVIDUAL/ON -SITE DATE INSTALLED [] PUBLIC UTI LITY Connection Verified iNSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding TankIIAbs°rpti°n AreaIIsewer Line I Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ~-~'APPROVED FOR ~'~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72.010 (Rev, 6/79)