HomeMy WebLinkAboutSCHROEDER LT 84�
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Elosim ,
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SULLIVAN AT LS
P. O. BOX 272, CHUGIAK, ALASKA 99567 a TELEPHONE 688-2759
OWNER OF LAND
ADDRESS _-_-_-_--
LEGAL DESCRIPTION--___
DATE. -Started —
PERMIT NUMBER
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MISCL. INFORMATION
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DEPT 11 OF WELL
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1,4 10,IN`13
jt011 � �1 d3Ho �lt vd1�INRw
�O�OH�Ny
DRILLER'S NAME
R -H U V-4 T :1!���T* �C`3 IEH-.:
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STRET, ANCHORAGE, AK 99501
264~4720
PERMIT NO: 840694
DATE ISSUED: 08/13/84
APPLICANT: ROYCE BM#w-FH
ADDRESS: P"O^ BOX 773326
EAGLE RIVER, AK 99577
CONTACT PHONE: 694~^4217
LEGAL DESCRIP: SUBDIVIGION: SCHROEDER LOT: 84 BLOCK: NA
SECTIONX 2 TOWNSHIP: 14N RANGE: 2W
LOT SIZE: 10500 <SQ^FT^ OR ACRES)
I certify that:
1" I am familiar with the requirements for on --site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of' Alaska.
2" I will sygtem in acccjrdance with all MOA codes and regulations�
and in compliance with the desiqn criteria of this permit"
3" I will adhe)re to all MOA and State of Alaska requirOND OtS foP tha scit bk
distances fro0 any existing well, waiiitewater diSpDFal system Dr �ubli�
sewerage t djE[eOt or nearby lDt"
SIGNED J//' DATE:
APPLICANT: ROYCE ��MARTH
ISSUED BY DATE:
MUNICIPALITY Or 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
Application Date
1. GENERAL INFORMATION
(a) /egal�Description (in�lude lo�(ilock, subdivision, 'section, township range)
/ ) / ) I'T �� -i
Location (address or directions)
U
(b) Applicant Name �����_AI_ Telephonne: Home �a?!-!/ Business
Applicant Address IJI�ZIL/ll����
(c) Applicant is (check one): Lending Institution 0 ; Owner/builder;9 ; Buyer 17 ; Other E] (explain); _
(d) Lending Institution Y/7Vl�fLTelephone L_( -21
Address ,---L r i�_� Q.� P -
(e) Real Estate Company and Agent
Address _--- --__-- — _ -- ---
TRlpnhnnp
2. TYPE OF RESIDENCE
Single-Family,L�'( Multi -Family El Other
Number of Bedrooms .J-
3. WATER SUPPLY
Individual Well P� Community C7 Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite El Publicp Community ❑ 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 72-025(11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH DA1 « AND INFORMATION
f.
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 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 arid State codes ordinances, and regulations in effect on
the date of this inspection. Al_ )y 4'4 `62 i /-?J /, .5' / '<> r � i�c, `�a �i {LI mea Ye� ✓r_,5 ,
Name of FirmG� e o�ici4, v) fS '�� ,irzTelephone
Address--�2i V �� Q V A V
Y -- --- --
Date _L7_
DHEP APPROVAL \ )
Approved for _/ bedrooms by Date �' a
� // ,f
Approved _ Disapproved`) — Conditina�f`____
---- -
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
72-025 (11,84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MUNICIPALITY OF ANCHORAGE. 264-4720 c
DEPT. OF HEALTH & L S `r/ SC�6 Y 6e'deV J �,
ENVIRONMENTAL PROTECTION Legal Description: _
15 Z., 7-1
A. WELL DATA DEC 2 3 1985
Well Classification Y I"Y If A. B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N)_ Date Completed T ~ 6y — Yield /0"'7
I . it
Total Depth e Cased to y% `? D th f G 4)A
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
z. �4
Separation Distances from Well:
To Septic/Holding Tank on Lot t�/ h
To Nearest Edge of Absorption Field on Lot All !11�
ep o routing
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
r
To Nearest Public Sewer Line L To Nearest Public Sewer
p
Cleanout/Manhole y To Nearest Sewer Service Line on Lot
Water Sample Collected by (fo4sl' G �J Y,5 T ; Date Z - Zo
Water Sample Test Results 14 2c4e, d
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N)
Depression over Tank (Y/N)
Size
Air -tight Caps (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 Property Line
To Water Main/Service Line
No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped
; for _
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
N
To Stream, Pond, Lake, or Major Drainage
Course
Comments 7717 rs A-/ .5'a Yve,d
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of 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 ��y �
�c,, Sews'
D. LIFT STATION Nlfq
Date Installed
Size in Gallons
"Pump On" Level at --
High Water Alarm Level at
Tested for
Electrical Codes (Y/N) —
Comments —
Type of Systern Design
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)
— Dimensions
Manhole/Access (Y/N) —
"Pump Off” Level at
—_ Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request "*
I certifyth '�fj�eckod, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
(
Signed Date
_— .,
Company ��Sa� G/JS%�5 MOA No.
E
Receipt No. _ c„_' 1
Date of Payment
Amount: $ -(a-' !7D 14
Page 2 of 2
72-026 (11/84)
HENRY WILSON
91501 BUDDY WERNER DR.
ANCHORAGE, AK 99516
(907) 3462000
Constructing Engineers, Inc.
-- Engineers, Surveyors CHARLES A.LANDERS
SR BOJ( 192•A, MYRTLE DR.
EAGLE RIVER, AK 99577
(907)694.9098
December 23, 1985
MUNICIPALITY OF ANaIORA07F
CFPT. OF HEALTH &
ENVIRONMENTAL PROTEOI'I09
ON 2 ;1985
Re Lot 84 Schroeder_ S.D.
� E � Waiver Horizontal Sept-
ration between well. F<
Absorption Field for IIAA
Municipality of Anchorage
Div. of Environmental health
825 L Street
Anchorage, AIC
Gentlemen:
Subject property is being refinanced. Attached is
the information that was supplied to the State DEC
when the home was built, as well as a copy, of the
waiver issued by the State DEC at that time.
If any other information is needed, please contact us.
Very truly yours,
CONSTRUCTING ENJGINNEERS, INC.
Henry II. Wilson
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
I. General Information Application Date
(a) Legal Description (inc de lot, blpck subdivision, section, township, range)
'`r � i,� ,i:L�s:� ' -% /_ ` ) .1J._ I •;- _�Eaf�iOb� �'.... Tl[l A� `�) '7 L11 �.:.I1 1
Locat on
rections)
(b) Applicants Name%' ' ��%l/ `f �� Telephone - IIom 'vusiness
Applicants Address {X(�-Jd(%� I I.,,`_, ._r
4 -
(c) Applicant is (check one) Lending Institution = Owner/builder
Buyer = ; Other (explain);
(d) Lending
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
IAhl fl(
CA
2. Type of Residence
Single -Family �Z Multi—Family Other (describe)
Number of Bedrooms V
:3. Water Supply
Individual Well Community � Public
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
G. Sewage Disposal
Onsite Public Kl Community Ej Holding Tank El
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)
ss��
C
5. Engineering Firm Providing Inspections�Teats, File Search Data and Information
As certified by my seal affixed hereto and
as of the
verify that my investigation of this Health Authority vApproval nshows thatnthelowon-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, an re ula-
tions in effect on the date of this inspection. 11sf�• L'tivi..nai ,v a.t �.,_ ��rC
Name of Firm
Address c
rQr L ( / �r.(,t�e> r-_1�1eve,
Date
6. DHEP Approval
Approved for yZ� bedrooms
Approved
(ENGINEER SEAL)
o: ,pf �`: x'60 ` • ,., l,1
9" ¢+ ur -•v,.' nuc., •.�e. s.i• r
rano onrr v..o opnanu.c �- ',�
)"no n' i vaa
ate
Disapproved
Terms of Conditional Approval
CAUTION
Conditional
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
PROTECTION
REPRESENT--
REGISTERED
HOMES AND
REQUIRE -
BEFORE A
FOR ERRORS
[Page 2 of 21
7-19-84
A. WELL IATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
iloV 2 0 1934
1 10 I
Legal Description: _ tL.88 S(-hr0eA--r" 5�
Well Classification �PcIyla`Tc-, If A, B. or. C, D.E.C. Approved(Y/N) _
Well Log Present (Y/N) Date Completed 5r=?i- Yie1d 2 02' `
Total Depths i `Z'' Cased to t� 17Zi, Depth of Grouting
Static Water Level �� Pump Set At
Casing Height Above Ground Zq Sanitary Seal on Casing (yLNNe>
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) N�
Separation Distances from ill:
To Septic/Holding Tank on Lot N �' �; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot N ,A. ; On Adjoining Lots 96
To Nearest Public Sewer Line zl��� To Nearest Public Sewer
Cleanout/Manhole 'Z`141 To Nearest Sewer Service Line on Lot
Water Sample Collected By ; Date
Water Sample Test Results `Sz i s ,C -:_c4 0 r/
Com ents Wet( to - Cklvm L -a 1 't—es ahh
B. SEPTIC/HOLDING TANK DATA
Date Installed N ' P' Size
No. of Coapartments
Standpipes (Y/N) Air -tight Caps (Y ) , Foundation Cleanout (Y/N)
Depression over Tank (Y/N) Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) �; for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Nbll To Building Foundation _
To Property Line To Disposal Field
To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage
Course Y'
Comments
[Page 1 of 21
2--15-84
BILL SHEFFIELD, GOVERNOR
DEPT. OF ENVIRONMENTAL AL CONSER"'I'ION Telephone: (907)
Address:
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
November 19, 1984
Constructing Engineers, Inc.
9601 Buddy Werner Drive
Anchorage, Alaska 99516
274-2533
SUBJECT: Waiver Horizontal Separation between Well and Absorption
Field, Lot 84, Schroeder S/D
(8521 -.WA -066)
Dear Mr. Wilson:
The Department has reviewed the subject waiver request and hereby waives
the horizontal separation between the well and septic tank to 96 feet
on the subject property for a 2 bedroom single family residence only.
Sincerely,
ruce E. Erickson
District Engineer
BEE/dd
_ Construou lsneers, Inc.
HENRY WILSON Engin ; purveyors
9601 BUDDY WERNERDR.
}{"�y R-, CHARLESA.LMIDFRS
} , SR 80%,192-A, MYRTLE OR.
ANCHORAGE. A000 K 99516 r E4C_0RWAN99577;-
October 230 1984
Alaska Dept. of Environmental
Conservation
Anchorage Western District Office
.437, r, Street
Anchorage, Alaska, Re. L84 Schroeder,,,,S.ubdivis,on w
Sec 2, T14N R2W 'SM:
Attention of Mr. Druce Erickson Waiver Request
Gentlement ,,-_
We, havebeen retained.to obtain Health Authority Approva,i forithel
home on the subject -property which is a two-bedroom frame home ung
der construction.
Subject .property is served by a new drilled well 47 ft. ,deep,
yielding 30 gpm.. The well log (Exhibit C) shows an impervious {
strata (clay ,and grave].) from 25' to 43.' below grade. Water is t
drawn from beneath 1:his impervious :strata.
subject property iss('rved by publir.''sewer. The well has proper ' =f
separation distances from the public sewer as shown on Exhibit B.,
Lot 83 which is adjacent to the subject lot (see.Exhibi,t`A)'is-
served by an on-site a,:ic system. The crib pipe of this system,'
is 96 ft. from the wet casing on subject lot,,.rather than the reg
quired 100 feet
Due to the small amount lacking in the separation distarioe (4 ft.')
and the fact that the well draws water from beneath an impermiable:
soil layer 16 ft. thick, we recommend and request a waiver for this
separation distance.
If any further,information is required, please contact this office.
Very truly yours, 4%
Henry
f
Henry H. Wilson
AVP
:J�� �},I
k, QNAt.� tip