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Home My WebLink AboutDORA #2 LT 10 Jul 15 22 08:18p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE Development Services Department,- Phone: 907-343-7904 On -Site Water & Wastewater Section \, '� Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Parcel Identification Number. 014 251 27 Legal Description Block I Lot DORA #2 I 1 10 Pump Installation Date: os - 24 - 2022 Pump Intake Depth Below Top of Well Casing: 70 Pump Manufacturer's Name: MYERS Pump Model: 3N FL52-8-P4-02 Pump Size: .50 hp Pitless Adapter Burial Depth: 10 Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: feet Date of Issue: Property Owner Name & Address: ANGNABOOGUK BERTHA P 8440 ROSALIND STREET ANCHORAGE, AK 99507 UNKNOWN Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: PELLETS Comments: Pump Installer Name: Company Mailing Address: feet ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET ANCHORAGE, AK 99518 907-243-0740 State: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. r ; ! I I I F'ERMtT I'.,I0. DEF'"!::!R].'ME!'.,tT .. HEFILTH F'II'.,t[> ENV i RO!'.,!MEI'.,Ff'R!. .... 410'TECT ! ON 8;,E~5 '"L" ::.:;T~:EET., FINC:HORf.:IGE., BI.:.'.'. 264-4.7'20 Ib..i~ E:.' IL ii. ..... F* E"Z P... tr"'l ~.. '"If"' ( 8:.t.::t..05::L :) I:IPPL. I CFINT LOCF:tT I ON L. EGFIL T. STEt.,.IFI.r.~:T CONSTRUCT I ON L±~3 DORFI 2 842¢ N!I_L. tNFI CIRCL. E L~'"~T S I Z E :~:;;~: :::.~:-. E~ E; S 4 ;2000E~ SQUFtRE FE:ET MINIMUM [:,ISTFtNCE BETI.,.tEEN FI t.,.IELL RI'.,IE:, FIN'-? ON-SITE SEI.,.IFIGE DISi='OSFtL S"r'STEM :tE~O FEE].' FOR R F'F.:IVRTE 1.4ELL OF..' :1.50 TO 200 FEET FF::OM F~ PUBLIC I.,.IEL. L DEPENDING LfPON THE T"r'PE OF' PUBLIC NELL. MINIMUM DISTFINCE FROM FI F'F.~IVflTE NELL T'O FI PF..'IVRTE SEt.4ER LINE IE; 25 FEET RNr::, TO FI COI',IMUNIT'¢ SEI4ER LINE :IS 7.5 FEE"i". !.4EL. L. LOGS FIRE F.:EQUIRE[.'.', FIND MUST E:E RETURNED TO 'THE r.:,EPFIRTMENT NITHIN ]:E~ OF' T'NE 1.4ELL. COMPLET.t:ON. OTHER F.~EQUIF.~EI',IENTS MFI'¢ RPF'L'.-?. SPECIFICRTIONE; FIND CONSTF..'UCTIOF, I DIRGRRMS RRE FIVRILFIBLE TO INSUF.:E PROF'E.F.: INSTFILL. IR"I"ION. I CERTIF"¢ "FHRT :.1..: I FIM FRMIL. IRF.: I.,.IITH ]''HE REQUIREME:NTS FOR ON-SITE SEI.,.IERS FINE:, NELL'..=;., FI:.T.', SET' F'"OF.'.'T'H BY THE MUI'.,I I C I PR[_ I T'¢ OF' RNCHOF..'FIGE. V4. N As-Butlt I hereby certify that a 6urvoy o! the following ~o~cribod property ...... : '- ':'-~-x~.~': ~os made on /~.L~I r.~):" /"" },')'.' / and thor tho improvements ~h~ property liflot and do no[ overlap or encroach on t%o property adjacent ' ~le~thal no Improvements on property ',yi~ adjacent thereto encroach on the ;les In quo=lion eno that there are no roodwoys~ transmission lines or other easements on said property except as Indicated hereon. ~'et ~chorage,Aloska, this: ~'~ '~' -' ~CTING ENGINEEES ~ AgSOC. Inlernational Airport Road rage, Alaska 9950Z MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # _~.~/-//-~-~,")"-/-- ,~,'~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) (b) Property owner Mailing Address Location (address or directions) Telephone ' (home) Business. (c) Lending Institution Telephone Mailing Address (d) (e) Real Estate Company and Agent Address./~ ~ ~ Telephone ~ Mail the HAA to the following address: (or check here,~if hold for pick up.) List contact person and day phone number below:. S & $ ENGINEERING Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family,[~ Number of bedrooms 3. WATER SUPPLY Individual Well~[' Community [] Public [] Note:If community well system, must have written confirmation from the State Department of Environmental consei;vation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [] 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. 72-025 (Rev. 7/88) Page 1 of 2 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 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 Address Date S & S ENGINEERING 17034 Eagle Ri~er L~op Road No. 204 Eagle River, Alaska 99577 Telephone 6. DHH$ APPROVAL Approved for --~ bedrooms by Approved Disapproved Terms of Conditional Approval Conditional ~fllJl II Is] ~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph $ 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. 72-025 (Rev. 7/88) Back Page 2 of 2 ,,,~'i':~ ¢,,M~'t~'tCI PALITY OF ANCHORAGE (MOA) . Well Classification Well Log Present~) ~ Date Completed lotalDepth ~[~ Static Water Level Legal Description: Casing Height Above Ground Electrical Wiring in; Conduit (~N) 1 If A, B, C, D.E.C. Approved (Y/N) ,~ - 'Z-"~, ~ ~::, ~ Yield '~_,~ ~'~ Depth of Grouting Pump Set At Sanitary Seal on Casing(~N) ~ -" Depression Around Wellhead (Y~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on' Lot ! To Nearest Publ!c Sewer Line '"~' ~ To Nearest Sewer Service Line on Lot ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by ~'~ '~ I~c:~t-.-~G- ;Date Water Sample Test Results ~~,¢-~-~c-~s~-~ ~-~ ~ Comments I- B. SEPTIC/HOLDING TANK DATA D'~stalled _____ Size /~-' No. of Compartments Standpi~N) _____ Air-tight Caps (Y/N) __ Foundation Cleanout (Y/N) Depression ove~) __ __ __ Date Last Pumped _ Pumping/Maintenance Co~ __ ____ ;for Holding Tank High-water Alarm (Y/N) ' ~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDI To Water-Supply Well To Building Foundation ~ To Property Line To Disposal Field ~ To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 .~C. ABSORPTION FIELD DATA 'l~ing in Absorption Strata Date Ins~__ Width of Field "'--.. Type of System Design Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area -"'---.. Statndpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test Results of Last Adequacy Test ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: r~-°pertyLine ~'''''''--- To Water-Supply Well To P or Ab~"'~ m To Building Foundation To Existing on Lot ; On Adjoining Lots To Water Main/Service Line To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ostalled ns "Pump On" ~~ High Water Alarm Level at ~ Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, **Check Permitted Bedroom 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 Company Date MOA No. 5 ~_ $ =_HG!NF;gtNG 17034 Eagle River' Loop Road No. 204 Eagle Rive~, Aia~ka 99.~'/--~' / Receipt No. ,~,~ ~ ~"'"-- _) [ ate of Payment Amount: $ /"..,~ ~ .,. ~ d Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev, 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~''~X~ASO~,^TO,,,ES ~ FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 10713 Date Report Printed: DEC 5 88 @ 12:24 Client Sample ID:LiO DORA S/D Client Name : S & S ENGINEERING PWSID :UA Client Acct: SNSENGP Collected DEC 1 88 ~ 11:55 hrs. P.O.# NONE REC'D Received DEC 1 88 @ 14:00 hrs. Req # Preserved with :NONE Ordered By : Analysis Completed :DEC 2 88 Send Reports to: Laboratory Sup~yi?rl :STEPHEN C. EDE 1)S & S ENGINEERING Released By : Special Instruct: Chemlab Re£ #: 3613 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N ND(O.iOJ mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: 1 Tests Performed ' See Special Instructions Above UA=Unavailable ND= None Detected "See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greate~ Than MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRON%IENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date J 2/27/~-.%4- (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 10 Dora II Subdivision Location (address or directions) 8440 Rosalind (b) Applicants Name Oohn Craft 349-1 71 6 -243-4575 Telephone- Home Business Applicants Address 8440 Rosalind (c) Applicant ~is (check one) Lending Institution ~-~ ; Owner/builder ~ Buyer ~-~ ; Other ~ (explain); (d) Lending Institution isfNa~ional Bank of Anchorage Telephone Address (e) Real Estate Co. & Agent,: Address (f) Telephone Mail the HAA to the following address: will pick up 2. Type of Residence Single-Family~ Number of Bedrooms 3. Water Supply Individual Well~ Multi-Family~ 3 Other (describe) Communtty~--~ 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 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] 5. Engineering Firm Providing Inspec~ons~ 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 from the M~nicipality 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 regula- tions in effect on the date of this inspection. Name of Firm Barter and Associates Telephone 563-71 64 e Address Date DHEP Approval Approved for Approved ~v 5331 Tudor Top Circle ~ ~.........;~&;...;.~..t.- · ~ (ENOI~ER S~) ~{~,, ~~~, ~ December 27, 1984 bedrooms Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A® WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: Well Classification Well Log P~esent (Y/N) Total Depth 111 Static Water Level 44 private Y Date Completed Cased to 40+ Pump Set At Casing Height Above Ground Flush ** Electrical Wiring in Conduit (Y/N) Y If A, B, or C, D.E.C. Approved~/N) 4-22-81 Yield 3.5 gpm Depth of Grouting NA Btm Sanitary Seal on Casing (Y/N) .y Depression A~ound Wellhead (Y/N) N Separation Distances f=om Well: To Septic/Holding Tank on Lot NA To Nearest Edge of Absorption Field on Lot To Nearest Public sewer Line 1 00+ NA ; On Adjoining Lots NA ; On Adjoining Lots NA To Nearest Public Sewer Cleanout/Manhole 100+ To Nearest Sew.= Service Line on Lot 25+ Water Sample Collected By Tony D. Barter ; Date Water Sample Test Results Ccn~ents.~4 Well is approximately 20 i~hes from foUndation. Owner has landscaped the lot to facilitate runoff away from the wellhead and foundation. This measure was taken to eliminate a low spot at the well SEPTIC/HOLDING TANK DATA which collected a majority of the runoff in the area. Standpipes (Y/NT~ Air-tight Caps (Y/N) Founda~Qn-Cleanout (Y/N) Depression over Tank~ Date Last Pumped ,.-' ,, Pumping/Maintenance Cont~act~(Y/N) ,; f~'/ ._ Holding Tank High-Water Alarum (Y/N) ~~y Holding Tank Permit (Y/N) Separation Distances f~om Septic/H~9'Tan_k: .... ~.. To Water-Supply Well / . TO Bui dl ing Fountain_ . ~ TO Property Line // To Disposal Field ~'-~_ , Main/ ice Line To Stream, Pond, Lake, or Mange [Page 1 of 2] Receipt $ Date PaW: Amount: ~ ~,' ~ ~Q- 2-15-84 C. ABSORPTION FIELD DATA lng in Absorption Strata Date Width of Field Length of Field Depth of Fie Square Feet of Absorption Depression over Field Results of Last Adequacy Test Separation Distance from Absc~ption To Water-Supply Well To Building Foundation Lot To Water Mai] To To P~esent ,(Y/N) Last A~quacy Test ld: To P~operty Line ~Existin9 or Abandoned System ; On Adjoining Lots~. Line To Cutba~ p~esent) Major Drainage Course Parking A~ea, o~ Vehicle Storage A~ea STATION Date Installed Size in Gallons "Pump On" Level at' High Water Alarm Level at Tested for Electrical Comments Dimensions (Y/N) Off" Level at Pumping Cycles du~~cy Test. -....,' ** Cheek Permitted Bedrocm Ratin9 Against HAA Request ** I certify that I have checked, verified, o~ conformed to all MOA HAA on the date of this inspection. Signed .~ ~ Company KB1/d5/s Meets MOA ~Gu~_~d~_~?es in effect [Page 2 of 2] Date ../c~ -o%7- ~. - ~arter and Associates MOA No. ST8$-208 2-15-84 · DATE RECEIVED ~ ~ ' INSPECTION APPOINTMENTS DATE DATE INSPECTOR, INSPECTOr. ~~ ' , ,NSPECTO~~ ~UNICiPALI~ OF ANC~ ~UNIOIPALITY OF ANOHO~A~E DEPT OF H~LTH ~ D[P~tM~tO~ HEALTH · ~NVI~ONMENTAL PROTEaTIOmV %~ ~j ENVI RONMENTAL SANITATION DiVIS!ON ~ ~ Telephone 264-4720 _ _ _ DI R EGTI ONe: Complete ~il p~t~ o~ p~ge ~, I n~omplete re~u~ will not be pro~ed, Plea~e allow ten [ ~ O) days for ~roce~ng, 1. PROPERTY OWNER , ~ PHONE MAILING ADDRESS · r PROPERTY RESIDENT (If different from above) r J ' PHONE 2. BUYER ~' ~ ~ ~ PHONE MAILING ADDRESS ' - 4.' REALTOR/AGENT ' ' J PHONE iS,~' rLEGAL DESCRIPTI~)N ' ' STREET LOCATION ~ · -- ~ SINGLE FAMILY ~ One ~ Four ~ Other ~ Two ~ Five ~ MULTIPLE FAMILY ~. ~AT[R SUPPLY ~ INDIVIDUAL" r-t. Three [] Six ' ' I ATTACH WELL LOG. A well log ~s reqmred for a I wells drilled [] COMMUNITY [] PUBLIC UTI LITY 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** PUBLIC UTILITY since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY THIS SI'DE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] OTHER [] TWO [] FOUR [] SiX 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK '~OTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL 5. COMMENTS DATE [~PPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) Niunicipalit3[ Anchorage 825 "1/' STREE 1' ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION November 23, 1981 T. Stewart Construction 8420 Williwa Circle Anchorage, Alaska 99504 Approval for the following properties cannot be granted until the following items have been completed: Lot 5 Dora II Subdivision: At the time of the scheduled inspection, the water was too turbid in order to obtain a sample. Lot 6 Dora II Subdivision: The well needs to be exposed for our inspection. The water report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. Lot 10 Dora II Subdivision: At the time of the scheduled inspection, the outside faucet was not on in order 'to obtain a sample from. The well needs to be exposed for our inspection. ~--~ .~~ Please notify this office for a reinspection when the noted descrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw