HomeMy WebLinkAboutBENITO BLK 2 LT 11enito
lock
Lot 1 1
0§0- 272
-01
er. ifieil Drilling
by
3. & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588
OWNER OF LAND
ADDRESS
DATE - Started Ended
DEPTH OF WELL '~ ..%
/(( ~STATIC LEVEL OF WATER FT.
DRAW DOWN FT. / (7
GALS. PER HR ~ ,~ '
KIND
KIND OF FORMATION:
From-- --Ft. to ' Ft.
From_ ..i ..... Ft. to i ~ Ft.
From i ",) ,,Ft. to ".~ ,Ft..
From ; 3 Ft, to J ~ Ft.
From ~ 55 ,Ft. to_ Ft.
From. ~,) '~]' _Ft. to. LJ :~- Ft,
From Ft. to ._Ft,
From____Ft. to _Ft.__
From Ft. to ~Ft.
From_____Ft. to__Ft
From Ft. to , Ft,__
From .... Ft. to., Ft,
From__ , Ft. to .... Ft
From .... Ft. to Ft.
From ...... Ft. to. . ~ Ft.
From~_Ft. to Ft.
From .... Ft. to_ _Ft.
From
From__
From_
From__
Ft. to___Ft.
___Ft. to __Ft.
Ft. to Ft
Ft. to_ _Ft,_~___
Ft. to Ft
· / ' "~rom ....
From
From
From ....
From__
From
Front____
Ft. to~
Ft. to_,
Ft. to
.Ft. to___
Ft. to ...... Ft
Ft. to__ Ft.
Ft. to ..... Ft
From __Ft. to ,,~t.
From Ft. to_. Ft.
From .... Ft. to Ft.__
From Ft. to____Ft.
From____Ft. to_ _Ft
, Ft._
Ft ......
_Ft ........
Ft.
MISCL.
INFORMATION:
I)EF'FIF. t'T'f'IENT ,...,~.. HEFIL'T'H R1'.,t[::, E1'4, I R. Ni'IEN 1 HL I'.Y'I"EIS:T I FIN
,...,...',~; 9950:t.
,:,,~... "' L.'" STREET'., FI1'.4CHOF.:FIGE., FIK.
· -," ," ,21 -- '":, ~ 4 4
I-.41E b 1_ F"E.R.i'I ::1[ qf'"
PEF~fl',t1.T NO. ( 7'774:1. )
FIF'PLTCFINT' EE:, NORHRN
L_OC:R"[' 1. ON BFIRCINOF R',,,'E
L. EGF:IL L..OT :1.~.. BI_ 2 BEN ITO SUB
6949~1.44
LOT S1.ZE :.t. 7694 SOt_iRF.:E FE:E'I"
PIlN:I:MUH DISI"A1"4CE BETWEEN FI NELL FIN[) ANY ON-SI"I"E SEWFIGE [::'ISPOSAL SYSTEM 1.5
:I..OO FEE"f' F'OR Ft PRI',,,'ATE NELL OF..' 200 FEET FOR A PUBLTC WELL
14ELL. L. OGS ARE REOU1.RED FIN[) HUST BE RETURNEL':, TO ']'HE I~:,EPRF..'TMENT NTTH1.N ~:0 DRYS
OF' 'THE NELL COf'IF'LEI"I'0N.
OTHER F.:E:('.;!U1'REHENTS MAY APPLY. SF'EC:[F]:CFtT1.ONS AND CO1'.4STRL.ICI"1.0N D1.RGRRHS FIRE
RYR]:L..FIBL. E TO 1.NSURE PR(:~PER 1'NSTFIL. LAT1.ON.
]; CERTIFY "f'HAT
t' I AP1 F'FIP'IILIFIF.: WITH THE REg!UIREHENTS FOF.: OI'4-SITE SEWEF.:S AN[:, WELLS AS SET
F'OF.:TH E:Y 'T'HE HU1'.4 :[ C I F'RL I TY OF FINCHOI;::FI~3E.
_, ~ = TEll 11'4 RCCOF.:DFINCE ~,.I I ]"H THE CO[:,ES.
;.:.:'. · I t.,.I ILL I NSTFII..I_ 'THE '::" "-" '
RPF'L. 1. CFINT EE:, ¢~F.'I"IN1',I
]' :,;:';',:~; I.J E [';, , .._L.~3.¢
Municipality of AnchOrage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak, us
(907) 343-7904
CERTIi~iCATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-272-01
GENERAL INFORMATION
Complete legal description Lot 11, Block 2 Benito Subdivision.
Location (s!te a~ldre_ss' or directions)
Expiration Date:
17208 Baranof~ Eagle RiVer~ AK 99577
Current Property owner(s), Earl & Gwena Evers Day phone 694-4026
Mailing address 17208 Baranof~ Eagle River~ AK 99577
Lending agency
Day phone
Mailing address
Real Estate Agent
Jo~ Perrozzi/ReMax of Eagle River ' Day phone 244-8086
Mailing Address
16600 Center Field Drive~ Ste. 201~ Eagle River~ AK 99577
Unless otherwise requested, HAA will be held by DH,H...S for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS: 3~'
TYPE OF WATER SUPPLY:'
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
~] Individual On-site
Fl Individual Holding tank
[--I Community On-site [--I
FI Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by ;iri"independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with
new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A
or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
(Rev. 11/99)
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation
based on procedures outlined in the Health Authority Approval Guidelines for this Health Authority Approval
application shows that the on-site water supply and/or wastewater disposal system is ~;afe, 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 applicable Municipal and
State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Enq. Svc. ' " Phone 272-8218
Address P.O. Box 102954, Anch, AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date 10/171200i
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious
cngilleeling analysi~ Of thC system ill accordance 'with MOA DSD Guidelines & Regulations The ~ ~%, LJF /q,/ .,~ ~,, .
reported resttlts d~Tibe the performance of the system under the conditions encountered at the time of..
the,e m ,o The o tio ,,re or
wel.ls und septic systems depend °n the l°cal s°il c°nditi°n' ground water levels that may fluctuate
dm'rog the y¢ar, and the water nsage nfthe family ~ served by the systerm These conditi°ns are .. ~_',,,,'.%,~.. ~_,,~,,~,._~,..'~ ......... .~.,,,~
outside the control orthe ewaluatm- ofthis system. All systems evcatually fail and satisfactory test ~
~t~ do not ~.t~ rathe ~-~ro.=nc~ or the ~ noy do they ~.~.tee ~t*ere are ao · . ~ ~..'._. ............
hiddendefeets~ren~roac~nents.PEscanther~ronotprowdeanywarrantyferfutureperf~rmanc~ ~,~ [?even a. Ponnone..-,~
nor g~vc any estimate orhow long the system will continue to meet the operational requirements 0fthe
ADEC or MOA DSD. The content of this report is for the sole benefit of the ogler listed above. Any
rehance upon or use of this report by any other person or party ~s' not authorized' nor will it confer any
legal right whatsoever. ' .
· 6 DSDSIGNATURE
I,,''/ Approved for .~ - bedrooms. .. ~.--
DisapProved. ... -
Conditional approval for bedroOms, with 'the following stipulations:
Additional Comments
Attachments: HAA Checklist
Septic System Advisory
Well Flow Advisory
Expiration Date:
(Rev. 1,/~91
X
Maintenance Agreements
Supplemental Engineer's Report.
Other
Odginal Certificate Date:
Reissue Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650 ·
www.ci.anchorage.ak.us ..
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot tl, Bk 2 _Re_qito Subdivision
Parcel I.D.: 050-272-0t -
A. WELL DATA
Well type P _, -- If A, B, or C provide PWSID #
Date completed .8J~/¶977 Sanitary seal Y
Total depth 93.4 ft Cased to fl
FROM WELL LOG
Date oftest ~ 1-7-'/
Static water level 70 ft
Well production <:~.~ ' C~') g.p.m
WATER SAMPLE RESULTS:
Coliform ~lonies/100 mi
Date of sample: 1011712001
Well Log _Y.
Wires propedy protected Y_.
Casing height (above ground) 27
AT INSPECTION
1011 ?12001
70 fl
· 6.3+ g.p.m
Nitrate /r ~ mg/I "' 'Other bacteria ~ ~'~
Collected by: i..nurn'Pannone
· in.
L~olonies/100 mi
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material NIA Public Sewer Utility
Date"l~lled Tank size gal Number of Compartments :
Cleanouts ~ Foundation cleanout Depression over tank ____ High water alarm
Date ofpumping~~ Pumper "' · .
C. ABSORPTION FIELD DA~"I~
Date installed ,- ' ~~" Soil t~,~ (g.p.d./ft~ or ft2/bdrm) System type __.
Length __ ft Widfl~_ . It · Gravel below pipe fl
· . Effective absorption area______.~ Monitoring tube Depression over field
Total
depth
ff
Date of adequacy test Results (Pass/Fail) ~ For bedrooms .
Fluid depth in absorption field before test in
Elapsed Time: 0 min Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Wate e'~~ gal. N~wdepth_2in.
in '~~on rate >= g.p.d.
; If yes, give date
(Rev. 11~9)
D. LIFT STATION
.- ': .'Date insta . Size in gallons
""Pump on" level at level at
Datum Cycle~~....
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift Station On lot N/A ,
Absorption field on lot NIA
Public sewer main 100'+
in'
Manhole/Access
High water alarm level at,
in
Meets alarm & circuit requirements?.
t00'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/Cleanout
Holding tank 100.+
.¥-,..~
Sewer/septic sen/ice line 25'+
SEPARA'~ DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building found~,.. NIA prOperty line. Absorption field
Water main. N,,. Water service line ' Surface wat'er
Drainage ' N'~ Wells on adjacent lots
SEPARATION.DISTANCE FR~BSORPTION FIELD'ON LOT TO: ' ·
Property line . Bu'lk~ foundation __ _ . Water main '. ~ .
Water Service line '' .S_ ~ace ~3~-- Driveway, parking/vehicle storage
. Curtain drain Wells on adjaC~
F. COMMENTS
G. ENGINEER'S CERTIFICATION
· ! certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone~ P.E.
Date / ~ [/~-/c2(
Pannone
8149
HAA Fee $ .._~O
Date of Payment [C~,/~//(~/'
Receipt Number. / / t~'/~..~ y
(R~. 11~)
· .Waiver Fee $
Date of Payment
Receipt Number
OGT-Z~-01 15:Z5 ~-CT&E ~NVIRC~NTAL
CT&E Environmental Servlc-- Inc.
90?5615301
T-16! P.OZ/O~ ~-;=~
O.SO0 mS/L
Limits
I~'A 3 00.O
(<i O) lO/l?/{ll SCl.
?o~d Co~orm
col/lOOmL SMIB 92_Z28
(<1) 10/17/01 SBH
MUNICIPALITY OF ANCHORAGE
DMSION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ~NAfIRONMENTAL PROTECTION
APPLICATION FOR HEALTH ALrPHORITY APPROVAL CERTIFICATE
1. General Information Application Date Ju~e,~ 6,, ..~..984
(a) Legal Description (include lot, block, subdivisiom, section, township, range)
.Lot l!.,..Blk ~, Benito Subdivision .
Location (address or directions)
2].08 Baranof
694-3503 Wk.
(b) Applicants Nam~ Dawn Evers Telephone 694-4026
Applicants Address 2109 Baranof
(c) Applicant is (check or~) Lending Institution ~ ; Owner/builder ~;
Buyer ~ ; Other ~ (explain);
(d) Lending Institution city Mortgage Telephone 563-0700
Address 405 w. 36th Ave., Ste 100
(e) Rmal Estate Co. & Agent
Address
Te le phone
2. Type of N~sidence
Single-Family
Multi-Family ~-~
O~er (desalt)
Number of Bedrooms 4
3. Water Supply
Note: If community ~11 system, must have written confirmation frcm the State
Department of Environmental Conservation attesting to tb~ legality and status.
Is the ~11 adequate for the number of bedrocms specified in this HAA (Y/N) Y
4. Sewage D_isposal
O~site ~ Public ~ ~nity ~-~ Holding Tark ~-~
Is the wastewater disposal system adequate fc~ the number of bedrocn~ !Y./N)
Y
[Page 1 of 2]
2-15-84
5. Engineering Firm Providinq Inspections, T~sts, Data and Information
I certify that I have., checked, verified, or conformed to all MOA HAA Guid~li~.es in
effect on the date of this inspection.
( ENGINEER SEAL)
6. DHEP Approval
Approved for
Approved ~
Date
Telephone
Disapp~o~d ~--] Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Environmental Protection do~s
not guarantee the continued satisfactory performance of the water supply and/or t~m
wastewater disposal system. This approval indicates 'that, as of the validation date
shown above, based on the data and information furnished by an engimer registered in
~he State of Alaska, the water supply and wastewater disposal system is safe and funm~
tional for the numbe~ of bedrccms and type of structure indicated.
(~PSEAL)
7. ~il the [~ to the foll~ing ~e~:
KB2/d5/s
[Page 2 of 2]
A®
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
NOIID310~d 1VIN:::IV',/N O~ IAN::I
~ HI1V::IH JO 'Id]ti
~i-D~OHDN¥ -IQ ,,U. IIYdlDINn~
LEGAL: Lot 11, Blk 2 Benito Subd.
Well Classification Individual
Well Log P=esent (Y/N) Y
Total Depth 93' 4" Cased to
Static Water Level 70'
Casing Height Above Ground 12" +
Electrical Wiring in Conduit (Y/N)
Sepa=ation Distances f=om Well:
To Septic/Holding Tank on Lot N/A
TO Nearest Edge of Abso=ption Field on Lot
To Nearest Public Sewer Line
Cleancut/Manhole 100' +
Water Sample Collected By
Water Sample Test Results
Cc~m~nts
If A, B, c~ C, D.E.C. Approved(Y/N) N/A .-_ -,
Date Completed unknown ~fg]Y . . Yiel~~
unknown Depth of Grouting unknown
Pump Set At 83'
Sanita=y Seal on Casing (¥~N) Y.
Y Dep=ession Around Wellhead (Y/N) N
N/A
; On Adjoini~g Lots N/A
; O~Adjoining Lots N/A
TO Nea~estPublic Se~r
100' +
TO Nearest Se~r Service Line on Lot
D. Maney ; Date 6/6/84
~atisfactory for Total Coliform /'
Well pumped for 100 minutes at 6 gpm with a 2.5' drawdown ~,/
25, :
B. SEPTIC/HOLDING TANK DATA N/A
Date Installed Size No. of Ccmpa=tmsnts ,,
Standpipes (Y/N) Air-tight Caps (Y/N) Foundation Cleanout (Y/N)
De~ession ove= Tank (Y/N) Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ; for
Holding Tank High-Water Alarm (Z/N) Temporary Holding Tank Permit (Y/N)
Separation Distances f~cm Septic/Holding Tank:
To Water-Supply Well To Building Foundation
To Property Line To Disposal Field
To' Water Main/Service Line To Stream, Pond, Lake, o~ Major Drainage
Cour se
Comments
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA N/A
Soils Rating in Absorption Stmata
Date Installed
Width of Field
Squa=e Feet of Absorption A=ea
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes P=esent (Y/N)
Date of ~ast Adequacy Test
Separation Distance f~cm Absc=ption Field:
To Water-Supply Well
To Building Foundation
Lot
TO Water Main/Service Line
To P=operty Line
To Existing cr Abandoned System cn
; On Adjoining Lots
To Cutbank(if present)
To Stream/Pond/Lake/c~ Major Drainage Course
To Driveway, Parking A~ea, c~ Vehicle Sto~age A~ea
C~%~nts
D. LIFT STATION
N/A
Date Installed
Size in Gallons
"Pump Oni, Level at
High Water Alarm Level at
Tested for
Elect=ical Codes(Y/N) ,
Cc~ments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent
Pumping Cycles du~ing Adequacy Test.
Meets MOA
Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, c~ confc~red to all MOA HAA Gu_~..~delines_.in effect
2-15-84
DATE RECEIVED
'. INSPECTION APPOINTMENTS
TIME TIME TIME
:)ATE DATE DATE r){~
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH &
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION
ENVIRONMENTAL SANITATION DIVISION OCT 2~ 8 1980
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERR/~'Jl~ E D
)IRECTIONS: Complete all parts on page 1. Incomplete requ~ will not be proce~ed. Please allow ten (10) days for processing.
1. PROPERTY OWNER PHONE
MAI LING ADDRESS
PROPERTY RESIDENT (If different from above) ~ PHONE
2. BUYER / PHONE
MAILING ADDRESS
3. LEN~NG~~ ~~NSTITUTION ~~/' ~ ~ ~ 0~. PHONE
4. REALTOR/AGENT -- ~ ~~ ~ ~PHONE
5. LEGAL DESCRIPTION
STR E ET.~CATI ON
6. TYPE OF RESIDENCE '~ NUMBER OF~BEDROOMS
[] One [] Four
,~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
[] Other
7. WATER SUPPLY
iNDiVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL 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.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTI LITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVI DUAL/ON -Sl~..~,~_.
[]PUBLIC UTILITY
Connection Verified
I--ISeptic Tank or []Holding Tank
Size:
give dimensions:
If Tank is homemade
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
15. COMMENTS
THIS SIDE FOR OFFICIAL USE ONLY
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SiX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
-INSTALLER
SOILS RATING
MANUFACTURER
MATERI AL
Septic/Holding Tank IAbsorption Area
ISewer Line
OTHER
[Z~-'"'APP ROV ED FOR
--~ · BEDROOMS
CONDITIONAL APPROVAL (letter must accompany certificate)
DISAPPROVED
72-010 (Rev. 6/79)