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Home My WebLink AboutDORA LT 1 ."...n c h or Dz':Llling l'..~ov. 1, 1951 Thom t;'is~her Lot i;.~,'! 1 Dora Subdivision Anchorage, Alaska MUNICIPALITY OF ANCHORAGE _RECEIVED 0 ............. ]2 ft. Ga.'nd .'f,: Gravel 12 21 £t. Clay 21 [56 ft. Gra. w~d. Z6 /4-,9 .'["tsClay i'~ Gravel /+9 ........... 61 ft '~"lt, ._ . '~ ' ~' " water 61 --6~ ft. boar,se G.r,:~vel, Bailed 10 GPM 15 ft. water :Ln well. ;Sial. ney ~.. :'Jell Owner, Driller F'ERMIT NO. r" F.].U~. b .... ~ I ON [:'EF'Pff;:THEN'T OF 14ERL'I"H FINE:, E?.I',.,'IF.:FNMENTP, L '""-' 825 "L" 'STF.:EE'r',, FII'-4CHORRGE,, RK, 264-4720 i~...li E~: b. !fL .... ':: 6.'~2'C~E~54 ) RF"PL I C:RNT L. 0 C Fl'T' I 0 N i....EGFtL THOM FISHER ]: 2 C1Ei E I::t'5 T S 4 'T H. LOT ± [:,OF.:R SUB BCff-':: LOT' :~;!ZE FEE']" MINIMUM DIS'T'RNCE BE'T'F.!EEN F! f.,.IEL. L FINE:, RN"r' ON-SITE "-:;EWAGE DISPOSFIL. :5'¢:5TE!"1 I:5 i.E~.:'~ FEEl" FOR FI PRI',,,'FITE [,]ELL OR :1.5El TO 2C',~F.'~ FEET FROM F! PUBLIC NELL [>EPENDING UPON THE 'T"?F'E OF PUBLIC FIE:E_[_. MINIMUM DILE;TF!NCE FROM Ft PRI'¢H'TE .WELl_ TC' F4 PRI',..,'F1TE 'L"]EF.IER LINE IS 25 FEET FINE:, TO R COMMUN!T'¢ '_::.EWER LINE ]:S ';~D F[:'ET. WEL. L. L. OG2'; FIRE RE(:..'iLI!RED FIN[) MUST BE RETURNEE:, 'TO ]"HE DEF'FIR]"MENT WITHIN ]:Ei [:'R"r'S OF THE WELL COHF'LETION. OTHER REQUIREMENTS MFI'¢ FIPF'L.'¢. :SF'EE:IFTCRTION% F','N[:, CONSTF.:UCTION DIRdiRF!M,':~ FIRE F¢','"F[ILRBLE TO INSURE PROPER INS"f'FtLLPtTIEfN. ! CERT!F'"r' ]?aRT :~.: ! FtM FFtMILIF'tI:;.: !.,.I!T'H THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS RS SET F'OF,.tTH. B"r' TFfE i"lUl",l I C I PRE I -f.'? (::iF' Rt",iC:!"~ORRGE ;;2' I I.,.tI. LL~L~IN!~.';TFILL. "" _; .'--~:~'.'}.]iTEH IN RC:COF.~[:,FII'..tCE !.,.lI'f'H THE ',]O[:,ES: ! '.:' 'F; .. 'Z[:, }:: ~.._'_- :_'__L~ -),=':_- ..... :"'~--'fC~ ............................ ~ ............................ V4. E~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Prope~y Owner ~ ~ ~ ~ Telephone: Home Mailing Address Business (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Telephone Address Telephone (e) Mail the HAA to the followina address: or: Check here/~ List contact person and day phone number below. '[/ if hold for pick up. TYPE OF RESIDENCE Single-Family,J~ Number of Bedrooms 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. SEWAGE DISPOSAL Onsite [] Public/[~' 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 fRev 8/86~ Front ENGINEERING FIRM PROVIDIN,.~ INSPECTIONS, TESTS, FILE SEARCH, DA, ,4 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 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 of Firm ~~. Telephone Address Date t~~ /0! / ~ DHHS APPROVAL Approved for ~'~"~'d¢ bedrooms by ~'~' '~~ Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates 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 72-025 CRev 8/861 Back Well Classification Well Log Present (Y/N) Total Depth ~ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: /-4~-T If A, B, C, D.E.C. Approved (Y/N) Date Completed [ °15 ~ Yield Cased to ~ ~ Depth of Grouting No kl ~ Static Water Level ~-~> Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Pump Set At '~ ~ TT'O Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot I~//'~'r' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ly'/~. ;On Adjoining Lots To Nearest Public Sewer Line ~/'~' To Nearest Public Sewer Cleanout/Manhole Il ~ '¢' To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Stand pipes (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 Size No. of Compartments Air-tight Caps (Y/N) 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 I 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 Type of System 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) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments 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 certify that I have checked, verified,.qr conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed T~~ Date / Company MOA No. Receipt No, J ~) (~ / ~ ~ ~:::~ Date of Payment Amount: $ ,,/L~)~'-'''~ Page 2 of 2 72-026 (11/84) Engineer's Seal 203 W. 15th AVE "C" SUITE 203 ;'.;.. ' ANCHORAGE AEASKA 99501 TELEPH ONE (907),279-3916-.. · ~.: .:-. RESIDENTIAL· WELL LOT 1, DoR,K"SUBDIVISION INSPECTION. OWNER': :::!;.:;:~.WELL.--LOG AVAILABLE.- ~. YES'-i .......... · INSTALLATION.REQUIREMENTS MET= YES ' ' ALASKA HOUSING FINANCE CORPORATION - WELL..~I. EbD. FROM WELL LOG: 10 GALLONS PER MINUTE 8.5 GALLONS PER MINUTE MARCH 9, 1987 WELL WAS PUMPED AT A CONSTANT RATE OF GALLONS PER MINUTE WHILE THE DRAWDOWN WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL PUMP-YIELD: DATE OF INSPECTION: TEST PROCEDURE: MONITORED 8.5 WAS THE FEET ':-7 DRAWDOWN STABILIZED· STATIC WATER LEVEL WAS FOUND AT 43 BELOW TOP OF CASING. AFTER 26 MINUTES OF PUMPING THE WATER LEVEL STABILIZE 'AT 0-..FEET. TOTALWELL.DE T is '330 GALLONS WERE DRAWN IFORMS: WATER WAS ..:TESTED FOR COLIFORM -BACTERIA- ON .... · ' ; ....... MA~CH 10 1987;',;-.:TEST WAS NEGATIVE TEST::':RESULT= .... THIS WELL 'MEETS THE REQUIREMENTS OF THE ...... MUNICIPALITY OF ANCHORAGE. '~...!i~The~i.~Mu~i~pal requirement for well ft°w'?iis 150 gallons of water -i.;i~:'.P~r~LedroOm. per 24 hours-This well surpasses this requirement. .~'.~ ~Th~:~'S'~'e~Sment of the' condition"of this-well applies only to the c6hditions as of this date. The-flow rate of the well may change .due~'~'to subsurface conditions ithat may. not be observed from the surface., and changes in land use and other factors that may the conditions of the aquifer feeding the well. r:~ate Date Date Inspector Inspector Inspector Comments 'Conditional Approval' Dato Sew°r Installed Permit No. Ssptl¢ Tank $1~a Holding Tank Sl~e Soils Rating Welt ~o Absorption Area~ ' Well Log Received Well to Tank APPLICANT FILL OUT LO ER HALF ONLy Lending Instltutl~ Phone Address ~ ~ . ~ Realty Co. & Agent . ~ ~- Phone Address Street Location ~ ~1 ' Ty~Resldence ~ ~ · ~Slngle Family_~ · D Multiple Family No. of Bedrooms D Other . ~ndlvidual A~ACH W~L LOG. A well log Is required for all wells drilled since June D Community 1975. For w~ls drilled prior to that date, give well depth (attach log If D public Utility available.) ~ ~, S NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.