HomeMy WebLinkAboutJERRY A HILL LT 2B010
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. 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, too~.nship, range)
· ,,'Location (addreSs'or directions) ' ,
· (~) 'Appli6an'f Na'me ~z'~'¢ :,. P¢~'* Telephone: Home 6~,~-
(c) 'Applicant.is (check on??Lendmg Institution ~ ' Owner/builder~; Buyer ~; Other ~ (explain);
Institution ~[ ~ ~ ~ ~~ Telephone
(d)
Lending
Address
Business
(e)
(f)
Real Estate Company and Agem
Address ]"~/J~
Telephone
Mail the HAA to the following address;
TYPE OF RESIDENCE
Single-Family~ Multi-Family []
Number of Bedrooms ~
Other
I ':;~::.i- i..--'~ 3.. WATER SUPPLY ·
'::":;': ':-i ::'-i;; ,::-indiVdt~a well~ Communityl-I PublicU., ' ::"r. '
_'.'- ::... i-, ~'. .~-,~ ... .- .. -' . . ~,:.'
'. :'"-'*. '}'i~' i!".,-' NOte' J com~ ty we system must have wr tten conf rma~?p.ffom the State Department of Environmental Conservation
J ;.¢:~/;?}~?;?¢;5?::~ite'~{i~g t0 tb.o .legality and status. ,:
~45~?,¢~¢~} Note:,lf community wel system must ha~e written ¢ouhrmat o0 from the State Department of Enwronmental Conservation
L:"::, ':.. '.,t '~;ge:1' ;~.~ '. '~" - ' '. "", - 72-0,5(il/84)
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 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
': · ~ii:i. from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
· i ~- ~ wastewater disposal system is in compliance with all Municipal and State codes, ordinances~ and regulations in effect on
the date of this ir~spection.
Name ~f Firm
TelePhone ~'~ ~ ~C.~
6. DHEPAPPROVAL
Approved for /./~.-'-~.;.i) bedrooms by
Conditional '~. /
Approved Disap~p)r. oved ~ _ , ._ ~.
Terms of Conditional,Approval -'' :7 ..... /~ ....... :" 'Z/~"~' ('"~'~-¢J~/~-
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
instituti(~ ns 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 oi 2
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description:
Well Classification t01h' o,¢t ';4'
Well Log Presen (~)
Total Depth ~' [(~ Cased to
Static Water Level ~O
Casing Height Above Ground
Electrical Wiring in Conduit Y~)
Separation Distances from Well:
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~/'~ ,~-~ - ~'¢-~ Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing(~)
Depression Around Wellhead (Y~
To Septic/Holding Tank on Lot /¢-,/4 ; On Adjoining Lots /~O¢~ F..~
f sor tlon Field on Lot /J/"qL On Adjoining Lots
To Nearest Edge o Ab p ' ¢.~ / ,' . /~ ~
To Nearest Public Sewer Line ' ~ ~ ~ To Nearest Public Sewer
Cleanout/Manhole ~ ~ ~i . ~/~
~To Nearest Sewer Serwce Line on Lot
Water Sample Collected by ~' ~¢~ ~ I ; Date ~ ~/~ ' ~ ~
Water Sample Test Results ~¢'fi'¢ ~' ~
comments ~ ~¢~,/'¢~¢ ~ ~¢¢~ ', ;%
B. SEPTIC/HOLDING TANK DATA
Date Installed Size
Standpipes (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 Property Line
To Water Main/Service Line
Course
No. of Compar
Air-tight Caps (Y/N)
~dation Cleanout (Y/N)
D~ Pumped /
; for
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(11t84) ,,
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 Drai~e Course
To Driveway, Parking Area, or V/eflicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field __
Gravel Bed Thickness
Standpi (Y/N)
Date of L~ y Test
Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dime~
Man ho, Cee'Access (Y/N)
,~///~"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted,~edroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~ ~ Date
Company ,"'~&?~'~ ~¢~-c' MOA No.
ReceiptNo. ~'~ /
Date of Payment ~ '~ '~
Amount: $
Page 2 of 2
72-026 (11/84)
ALASKA BnUIROFImeDTAL COFITROL Sei dlCES, IDC.
~n§in¢¢rin§ 8 ~nuir0nmcnlal $Kmdics
· NO, RflRAfllq. AI,A~
99501
60074
LEGAL:JERRY A HILLS SUBD/LOT 2B
FLOW TEST ON WELL
WELL FLOW DATE-FEB 18 1986
A FLOW TEST WAS PERFORMED ON THE WELL. 710 GALLONS OF WATER WAS
PUMPED AT A RATE OF 6 GPM OVER A DURATION OF 2 HOURS.
THE DRAWDOWN WAS 42.6 ' WITH A RECOVERY TIME OF 59 MINUTES
AND THE STATIC WATER LEVEL WAS 60 FEET.
THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME.
IMUNIC1PALIT¥ OF ANCHORAor.
DEPT. OF HEALTH &
~NV~oNM~T^L PP, oTECnO~
-' ') ..5 Ig86
RECEIVED
1200 LUcs! 33r~ Au¢~u~, Suite [~ '~ A.chora§¢, Alaska 99503 ,[907) 561-50/40
February 24, 1986
To Whom It Nay Concern:
In regards to the well certification on lot 2B, Jerry A. Hill
Subdivision. The well is serving the house on a temporary basis
until summer of 1986 mhen city mater can be hooked up.
I am trying to close a loan on the house immediately and can not
do it mith out the mell recertification. I mould appreciate a
conditional recertification until July 15th.
David W. Pearce
Notary Public in and for the State of Alaska, residing at
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTIOi',~[
8 2 5 1986
RECEIVED
C'~t' ~';l-w DRILLING, Inc.
P.O.'Box44224 · 1310C International Airport Road
(907) 274-461 !
ANCHORAGE, ALASKA 99509
DRILLING LOG
[]01o ]),~VO J.o?m::u~. I: Use of Well
re11 Owner.
Location (address of: Township, Range, Section, if known; or distance main road Lob 2 Je'~'~:y ].!i.J-], S.lb(!,i~vjg:i.O[l' Aucb. orage
ize of casing
ttatic water level
Screen ( ); Perforated ( )-
Describe screen or perforation
Yell pumping test at-6 .gallons per (~'~'r)
of drawdown from static level.
~ate of completion
1.1] , ~ feet
].]. 3 Cased to.
_Depth of Hole feet
()U ._ft. (ai~'~) (below) land surface. Finish of well (check one) open end ( : ~ '
);
(minute) for ]' hours with ]' (' ()?;~ .fi:"
WELL LOG
Depth in feet from
cound surface
Give details of formations penetrated, size of material, color and hardness
5 .TO. 7
7 .TO_
L9 _TO. 2
21 TO_ 26
27; TO 39
tq .TO.
/' ~ _TO_
(' rt _TO_ ' ''~
~ 5 _TO. ~{ 2
?2 .TO.
]_00 .TO_
i 96 113
.TO~
.TO
Casing
Oratm! F
Organics --
Silty ,~. .....
~O]~'/CIPALITy O? -
Wet; '~ ~RO~CTIot,I
o 1986
Sandy g~ ave 1:
hard pan: gravelly
f~ravel: wet
REC£11/ED
Sill.
5 o,!"' NWWA Certified Contractor
3 -- CONTRACTOR
TO:
FROM:
SUBJECT:
:5
Community Planning Department
Health and Human Services Department
Cases Dne for Review - June 7, 1985
S-8158:
S-8159:
S-8160:
S-8161:
S-8162:
The Environmental Health Division of the Department of Health and HUman
Services has reviewed the following cases and has the following conm~ents:
S-8157: Lot lA Block i Queensgate Subdivision
No objection. Public sewer and Water available.
Tracts B-l, B-2 Lampert Subdivision #$
Extend public sewer to tracts.
Lots 2A, 2B, 2C Jerry A. Hill Subdivision
Extend public sewer and water to all lots. On-site sewer
system on Lot 2B must be properly abandoned and connection
made to public sewer prior to fi '
remain if applicant c ~ .... nal plat. Well on Lot
an .... ~ adequate sen ~o~- ~ 2B may
~a~oa ~rom public
sewer line and manholes and if house remains single family
dwelling.
Tract 01Huffman Business Park Subdivision
Public sewer and water available. No objection.
Lots 3A, 3B Ginami Iiills Subdivision
Applfcant must demonstrate that each lot has three(3)
potential sewage disposal sites prior to final plat.
Tracts F-2-A, F-2-B, F-2-C Athenian Village Subdivision PubJic sewer and water available. No objection.
Susan E. Oswalt
Engineering Tech III
SEO/ijw
. ',~ · CHEMIC,,AL & GEOLOGICAL LABORATORIE$ OF ALASKA, INC.
?~J~,%X ' ' "'~:' ..... TEI"~EPHONE (007)'562-2343 5633 B Street
//~=~___~o~ ' '~ . :'': :. "; . . Anchorage, Alaska 99518
~ ...... ~ DrinMng Water Analysis Repo~ for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
n PUBLIC WATER SYSTEM I.D.#
[] PRIVATE WATER SYSTEM
Name
Phone No.
Mailing Address
City State Zip Code
Mo. Day Year
SAMPLE TYPE:
.l~outine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
) [] _.T. reated Water
~E~ Untreated Water
SAMPLE Time · Collected
NO. LOCATION Collected By
MUNICIPALI['( O, ANCI-,ORAG~
I
3 [ DF, PT, [OF HEALTH &
FNViRONMiNTAL PROTECTION
RECEIVED
TO BE COMPLETED BY LABORATORY
Date Received
Time Received
Analytical Method:
Analysis shows this Water SAMPLE to be:
-oatisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No. Result*
I/,99('-/El~
I ~
I I-1-1
I FT-1
I ICI
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter:. Direct Count Collformll00ml
Verification: LTB BGB.
Final Membrane Filter Results . ~ -- Collformll00ml
Time: a.m.
p.m.
TNTC -- Too Numberous To Count
OB = Other Bacteria
0
Z
0
/
/
/
I /
I
EASEMENTS OF RECOR~OTtlER THAN
-"~0 S~ ~COR-~E D
PLAT, ARE NOT SHOWN HEREON.
I &
G
PLOT PLAN
LOT 2 B L OCltxx~x](x~xxx
J~..RRY A..ILL GUBDIVIGTON
ANCHORAGE RECORI)IHG DISTRICT
,l~P~Eo BY: DOWLING ~ fl~[SOClATE$
~04 EAST 15th Ave. 3'!J:]:1~ 2
NCHORAGE, ALASKA 99501
~'TE:7 April :]_980 ~CAJJ~: 1" = 30'
DATE:
~ PROPOSED'HOUSE LAOCATION
%g'0'80-042 (Misc) p27 ~lJll): 2234
BY ¸
PERMIT NO.
RPPLICRNT SOLO DEV CONST
LOCRTION 84&NRDINE
LEGRL iLT 2 JERRY HILL
Pll_l~-~ I C:i%~I~LIT~' I]k
DEPRRTMENT OF HERLTH RND ENVIRONMENTRL PROTECTION
825 ~L~ STREET, RNCHORRGE, RK. 99501
264-4?20
NE[_L F'ERt'i IT
( 80006? )
~'~4 E 15
LOT SIZE
±50000 SQIIRRE FEET
MINIMUM DISTRNCE BETWEEN 8 WELL 8ND RNY ON-SITE SEWBGE DISPOSBL SYSTEM IS
i00 FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTBNCE FROM R PRIV8TE WELL TO ~ PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED BND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MRY 8PPLY. SPECIFIC8TIONS 8ND CONSTRUCTION DIRGRBMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION~
I CERTIFY THRT
l: I RM FRMILIRR WITH THE REQUIREMENTS FOR ,DN-SITE mEWER_ RND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I WILL INSTRLL THE SYS.TEM IN RCCORDRNCE WITH THE CODES.
~RPPLICRNT SOLO DEV CO~ST
-/
/
V4. 0
CHEMICAL & G~OGICAL LABORATORIES"~' ALASKA, INC. ~
TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER
274-3364 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name
Mailing Address
I.D. NO. ,(
Phone No,
,:, .,~ ~/.!,L~1
State
City
Mo. Day Year
Zip Code
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
Treated Water
Untreated Water
SAMPLE
NO.
I
I
l
I
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analys~s snows this Water SAMPLE to be:
E~], Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please sene
new samole.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
.'~ Membrane Filter
Lab Ref, No. Result* Analyst
I CT-]
I
I
READ INSTRUCTIONS''~
BEFORE
COLLECTING SAM PLE
06-1220 (b)
Rev. 1978
BACTER I0 LOG ICAL WATER ANALYSIS RECORD
Date Collected Source
Ired Lab. NO.
Presumptive ].Omi ZOml ZOml ZOml ZOrn! Z.Oml O.Zml
24 Hours
48 HOURS
Confirmatory
24 ~-Iours
48 Hours
EMB Broth 24 hours:
Membrane Filter: Direct Count
Final Membrane Filter Results ~ / '
Broth 48 hours;
1Omi Tubes Positive/Total 1Omi portions
CoHform/%OOml
BGB
Coll,fqrm/lOOml
Date ',, :) '*.';'/ ~/ ) ' f "
DATE RECEIVED
, INSPECTION APPOINTMENTS
TIME ~ TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR I NSPECT~, ~
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
825 L Street - Anchorage, Alaska 99501~WKgh]v ~;-Q;:,L J:;.~'] ~CT[ON
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
~fiO~fiST FO~ ~PP~OV~L OF I~DIVID~k ~TE~ ~D S~ I
DIreCTIOnS: Comol~to all parts on paso 1. Ineompl~to roquosts will not b* proco~d. Please allo~ ten (10} dags for processing.
1. PROPERTY O~NER ~ONE
MAILING ADD~ESS
PRbPERTY R~IDENT (If differen~ ~rbm a~ove).~
MAILING ADDRESS
3. 'LENDING INSTITUTION .~0
MAILING ADDRESS
4, REALTOR/AGENT J PHONE'
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET ~CAT~O~
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four [] Other
.~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [~ Three [] Six
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
* 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)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] 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 UTILITY
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. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
PPROVED FOR .~' BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
72-010 (Rev. 6/79)