HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 2 LT 44
PERMIT HO.
8PPLICSNT ~E SULLIVAN.
LOCRTION ESGLE RIVER
LEGRL
I"IL;~-I I C I ~-]L I TY i_-IF R~-ICH~DP:F~GE
DEP8RTMENT OF HEALTH 8fiID ENVIRONMENTAL PROTECTION
8.25 "L" STREET, Rr. ICHORRGE, RF.. B950i
264-4?20
I.IELL PER£'I I T
L44 ERGLE RIVER HEIGHTS
SR BOX
LOT SIZE 16000 SQURRE FEET
MINIMUM DISTRNCE BETI.IEEN R NELL RHD RNY ON-SITE SEI.IRGE DISPOSRL SYSTEM IS
40£'~ FEET FOR R PRIVRTE NELL.; OR
450 TO 2r. do PEET PROM R PUBLIC NELL DEPENDING UPON THE TYPE OF PUBLIC NELL.
NELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT NITHIN 30 DRYS
OF THE NELL COMPLETION.
OTHER REC4UIREMENTS MRY RPPLY. SPECIFICRTIONS RHD CONSTRUCTION DIRGRRMS RP.E
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
PERId I T EXP I RES DECEf"IBER ~-1 , 29?8
I CERTIFY THRT
I RM FRMILIRR NITH THE REQUIREMEHTS FOR ON-SITE SENERS Rf'ID I,IELLS RS SET
FORTH BY THE M~IICIPRLITY OF RNCHORRGE.
2: I I.,ILL IN.~.~L THE S~-~M IN RCCOR[,RNCE WITH THE CODES.
/ RPPLICRNT LEE SULLIVRN
.....
V-~. 2
DRILLING £OMP NY
BOX97, EAGLE RIVER, ALASKA 99577 · TEt. EPHONE694-2588
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
PERMIT NUMBER
DEPTH OF WELL I ~ c~
STATIC LEVEL OF WATER FT.
DRAW DOWN ~. ~.~
GA~.PER HR ~ oo
KIND OF CASING ~ ~ O~
KIND OF FORMATION:
From O Ft. to '~ Ft "Ou~< qa,~7~-~.,,,~ ,From
From tg Ft. to ~/ Ft.. ~ ~d~ From.~
From ~6 Ft. to ~ Ft. T~O ~ ~ From~
From.~_Ft. to Ft. From~
From Ft. to FI, From
From Ft. to Ft. From
From Ft. to Ft.. From
From Ft. to FI, From
From Ft. to Ft, From
From Ft. to Ft. From
From / Ft. to Ft. From
From ~ Ft. to Ft. From
From Ft. to Ft. From
FI. to Ft.
_Ft. to Ft.
.Ft. to Ft.
.Ft. to FI.
.FI. to Ft
_Ft. lo Ft.
FI. to Ft.
.Ft. to Ft.
FI. to Ft.
FI. to Ft.
FI. to ' Ft.
FI. to Ft.
FI. to Ft.
Ft. to Ft.
FI, to Ft.
Ft. to Ft.
FI. to__FI
MISCL. INFORMATION:
As_BUiLT
I hereby certify that I have zurveyed'the following
,~=i~d ~,~e~'-~°~ ~, ~/~,~'"
Anchorage ~cording Prec~nc~ Ahsk~ ~nd that the
improvcmenU ~ituat~ thercon are ~t~ the propemy
lines and d9 not overhp or encroach on the ~ope~y
lying odja~nt thereto, thnt no im~rovemen~ ~n p~
erty ly~g ~d~acen~ thereto en~0~ch on the ~cmi~s.
lines or uther visible easements on ~atd ~o~y except
~ indicated hcr~n.
Dated at Eulle ~ver, AI~
I{OBER~C. JOIINSON ~"~
eo~T r* · }'e ~'ered Land Su~,e~*or
I" = ~ I~ox 45~I. E~rle River. Alaska
Phone ~94-2513
( erlifie rilli g fiog
DRILLING COMPANY
BOX97, EAGLE RIVER, ALASKA99577 · TELEPHONE694-2588
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION Z'o?'
DATE-Started ~/'~ o//~'~' Ended
PERMIT NUMBER '~' O
DEPTH OF WELL I t~ ~,~
STATIC LEVEL OF WATER FT.
DRAW DOWN ~.
GA~. PER IIR
KIND OF CASING
t ti
/
KIND OF FORMATION:
From O FI. to ~ Ft
From '~ FI. to } ~' Ft.
From I~' FI. to ~'1 Ft.
From.~_Ft. to 'o~'/~ Ft.
From ~"/'~ FI. lo ~:0'~ .Ft.
From t~ Ft. to~'~ Ft.
From (~t FI. lo
From Ft. to__Ft..
From __ Ft. lo FL
From __ Ft. lo 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.
rrom
From
From
From
From
From
From
From
From __
From
From
From Ft. to Ft.
Front Ft. to__Ft.
From__Ft. to Ft.
From Ft. to Ft.
Front Ft. to Ft.
Ft. to FI,
__.Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. t o.__~_Ft.
Ft. to Ft.
Ft. to Ft,
Ft. to FL
Ft. to Ft,
.Ft. to Ft.
Ft. to Ft.
Ft. to Fl
MISCL INFORMATION:
DRILLER~J NAME
MUNiCiPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION '
ENVIRONMENTAL ENGINEERING DIVISION ' i
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTION~: Cemplete all parts on page 1. Ineem~mm rmlum~ will net be pmgm~d. P~ee~e allow ten (10) paVS for procming.
PROPERTY RESIDENT Ill difft~r~lnt from a~ve) --
PHONE
MAILING ADDRESS
ADDRESS
REALTOR/AGENT
MAILING ADDRESS
PHONE
IPHONE
6. LEGAL DESCRIPTION
STREET LOCATION
~. TYPE OF Rrr~IOENCE NUMEER OF BEOROO~
[~SINGLE r-I One ~'- Four
FAMILY
I--I Two I-'1 Five
I-1 MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATE~IJBY
INDIVIDUAL*
[~] COMMUNITY
[] PUBLIC UTILITY
~. SEWAGE DIS~N)SAL EYSTEM
[--I INDIVIDUAL/ON-SITE**
[~BLIC UTILITY
· ATTACH WELL LOG. A well log is required for all walls drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
**If individual/on-site, give installation data
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
724) 1013/781
,i; THIS SIDE FOR OFFICIAL USE ONL% " " '
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
i i NSFE'~.~-OR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOM~
~] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SlX
2. WATER SUPPLY PERMIT NUMBER
[-'1 INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[] PUBLIC UTI LITY
Connection Verified
INSTALLER
[--]Septic Tank or I-'lHolding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AflEA MATERIAL
5. COMMENTS
[~-"APPROV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (Ie~ter must accompany certificate)
~ept~-~ber 1, X97~
L~[ay Constru:tion Cc~.pany
~ox 935
]~91e P~ver, Alaska 99577
SubJectl Lot 4~ Dlock 2 ~n~lc River ~i~hts Subdivision
Lot 16 ~lock 2 Ea~le River ]{cight~ Su-division
A water sampla ~:a= obtained from Lot 44 Bleck 2 Ea~le River
~eiqht~ $ ~ubdivision. I was ~n~ble to locate the weX1.
Therefore, b~foro approval =.ny be 9rauted tho well on ~oth
lots ra~=t be acceszib!~ for our inspection.
~';e also must have adequate direc~lon~ to Lot 16 Block 2
~.~1o P.~v~r l~ight:, ~o ~hat a water ~m~?le m~y be
If there arc ~ny quention~, please contact t!~s office
at 264-4720.
~Inccrely,
Robert Co Pratt,
Sanitarian
People= B~nk and T~ast
}~rtgaga Loan Saction
Pouch 7-007 99510
ClL:-t£;'C~J-Q (~EOLOeICP& L~O2J~¥OR["~ 07 AL~8[~., IL'C.
P.O. BOX 4-1276 ANCHORAGE. ALASKA 9-3509 4649 BUSINESS PARK BLVD.
Drinking Water Analys;s Report for Total Coliform Bacteria
TELEPHONE
(~37) 27D~4014
TO BE COMPLETED BY WATER SUPPLIER
PUBLIC WATER SYSTEM:
I.D. NO.
..~,~_/],IdY ¢_,.¢_//__.S7:
Public Water System Name
Mailing Addraal
City- Stele Zip Code
Mo. Day Year
SAMPLE TYPE:
i-I Routine
[] Check Sample (for routine sample
with lab ref. no. .)
[] Special Purpose
[] Treated Water
I-] Untreated Water
SAMPLE
NO. LOCATION
Time Collected
Collected By
TO BECOMPLETED BY LABORATORY
LABORATORY:
._.CH EH & _..6 EO_I..~B S~_.[NC..
NAME
4649 BUSINESS PA~K BLVD.
ADDRESS
ANCHORAGE, ALASKA
CiTY
Time Received / ~'~,,0
Analytical Method:
[3 Fermentation Tube
.~Membrane Filter
Lab Ref. No. Result*- Analyst
J CD
] I--I-I
I I-i-I
I rTl
READ INSTRUCTIONS
BEFORE.
COLLECTING SAMPLE
Form No. 18.310 (3.78)
064220 lb) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1978
o,,. co,,.,,., 9=19_-7__8_ sou,,.
D.t...~,~.<~q-lO-7R 'r=,..~.,.,~ '1520 '""' ~.,,~:,o. 8754-1
~resumpt lye lOml ]Omi ]Omi lOml ]___O.mi ].Omi O.lml
I
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
GENERAL INFORMATION
(a)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ~uJ'J'
Applicant Address ~/740
(c)
Telephone: Home ~' ~4,'- ~/~,v'$-- Business "~".~
Applicant is (check one): Lending Institution r"l; Owner/builde, g~.;.Buyer I-I; Other I-1 (explain);
(d) Lending Institution ~,,"/.,'}' Telephone
Address
(e) Real Estate Company and Agent. ~:~,~ ,~, /4,/,,~-~ ,~ ¢, / ~
Address . ~q~ ~ ~
Telephone ~ ~ -- ~ ~
(f) Mail the H~A to the following address:
TYPE OF RESIDENCE
Single-Family,~ Multi-Family I-I
Number of Bedrooms
Other
WATER SUPPLY
Well,~ Communityr'l Public.~ .
Individual
Note: If comm unity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status. * *
SEWAGE DISPOSAL
Onsite I"l Public'~ Community r-I 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 I of 2
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 this 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 obtaine~
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.
Name ~f Firm · ~ RIVER I~[J~EERING ~ERVICES
,'~uu~ tuvc~, ~,'~ ~5~* Telephone
Address p. _n_ Rtt¥ 77.1~94
Date ~ 694-5195
Engineer's Seal
DHEP APPROVAL
Approved for ~..~-~ bedrooms by Date
Approved ~ Disapproved,' Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST o FEBRUARY 1984
264-472O
Legal Description: ,/-o ~' /-./4/
WeiI Classification fl', I/'r4
Well Log Present (Y/N) y
Total Depth /~'~ / Cased to
Static Water Level ~-'~'"
Casing Height Above Ground ,'~ ~ '"'
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot "f"'/~'~
To Nearest Public Sewer Line /~c3 ·
CleanouVMa~hole /~ '"
Water Sample Collected by ~'~.~
Water Sample Test Results .2
It A, B, C, D.E.C. Approved (Y/N)
Date Completed ~"/~ o_t/'7 E' Yield
Depth of Grouting /['/',/~
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
E.¢EIVED
; On Adjoining Lots
; On Adjoining L~)ts ~'~"~ ~-
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot ; Date ~',/$/~'
Comments
SEPTIC/HOLDING TANK DATA
· Date Installed Size
Standpipes (Y/N) Air4ight Caps (Y/N)
Depression over Tank (Y/N}
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Properly Line
To Water Main/Service Line
Course
No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake. or Major Drainage
Comments
Page 1 of 2
72-026(11~84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Type of System Design
Date Installed
Width ol Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Length of Field
Depth of Field
Gravel Bed Thickness .
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N}
Dimensions __
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
'* Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, or conformed to all MOA and HA~ guideIines in effect on the date of this inspection.
Company ~"~_~.~'~' "'~'~ ~E'-"'~.s"~"'~;~MOANo. -~7 -- .~J"'
Receipt No.
Date of Payment (-" -~'' ocli"' ,.,
Amount: $ /./~"o'~ Engineer's Seal
Page 2 of 2
72-026 (11,84)
Date
O~to
Date Gewer Instamm~ Permit No. ~eptmc Tank Glze
Holding Tank Size
~m~ Rating Well To Absorption Area Weml L~ Recemved
Weml to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Prope,y Owner ~6~ ~ ///7~Y/)/~ Phone
Buyer
Address
Lending Institution P~one
Address
Realty ~. & Agent ' ~ P~one
Address
Type~ Residence
~Ingle Family
~ Multiple Family No. of Bedr~ms
~ Other
Wat~upply
A~ACH WELL LOG. A well log Is requlr~ for all wells drlll~ since June
~lndlvidual
~ ~mmunlty 1975. For wells drilled prior to ~hat date, give well depth (attach ~g If
~ Public Utltit~ available.}
Sewage Disposal
~ndividual Year Individual Install~:
Public Utility When ~nnected to Public Utility:
~ Holdln~ Tank
NOT~ THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL ~CENTER
' .~ 274'3364 ~ 5633 8 Street I .' ~1 ~ ~o ~
Drinking Water Analysis Report for Total Coliform Bacteria ~
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name P~o~e No.
SAMPLE TYPE:
n Routine
I-I Check ~mple (for routine umple
with lib ref. no.
r'l Special Purpose
C:] Treated Water
cz Untreated Water
SAMPLE
NO.
1
2
3
4
5
1
I
Time Collectod
Collected By
TO BE COMPLETED BY LABORATORY
A,nalysis shows this Water SAMPLE to be:
'~]~atisfactorY
[] Unsatisfacto~/
[] Sample too long in transit; sample should
not be over 48 hours old at examination
:1o~ indicate reliable results. Please send
new sam ~le.
-...,
Date Received ~ - ' ~ ''?'~'
Time Received '/{? [; ~
Analytical Method:
-. O Fermentation Tube
· F~Membrane Filter
Lab Ref. No. Result* Analyst
I
I ICI
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD