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Home My WebLink AboutDORA #2 LT 20Z Z Apr 24 20 1 0:'_3a Anchoraci-e \Ne!! & Pirnp Ser 907/2430742 p 1 Legal Description Fr,.-Optrty wner INIrase & Address: —dwkrr� bo ro- 2- 1 20 ic:-- -19 Pump Installation Date. /'90 PLtmpt-Dtakel)tpt)kC-elowT4)ri>FWeUC'asin-,:63 feet Pump Manufactarer's NanteA Pump Model: �'fJ . 7v I Pump Size `s Adapter Barisal Y)Ppfh.. htless Adapter Manufacturer's Name: Pitless Adapter Installer: rR Well I)Lsinfected Upon Completion'? Yes 'l7 is"o, Method of Disinfection: Comments. Pump Installer Name: Attention: Thepuinp ilistallsr sliall vrov:;dc a pump Installation, lob; to the DSL) whh-In 30 days of puri; installation, S�e-V;Czs 0.0, B -,x 1966E.'O bfafk Begl:lh An ch c v c: cc,hti 99,507 pl,a)lcr Pump Installation Log Well Driltina Permit N timber; SW._.___ Date of Issue; Parcel Identification Number. Legal Description Fr,.-Optrty wner INIrase & Address: —dwkrr� bo ro- 2- 1 20 ic:-- -19 Pump Installation Date. /'90 PLtmpt-Dtakel)tpt)kC-elowT4)ri>FWeUC'asin-,:63 feet Pump Manufactarer's NanteA Pump Model: �'fJ . 7v I Pump Size `s Adapter Barisal Y)Ppfh.. htless Adapter Manufacturer's Name: Pitless Adapter Installer: rR Well I)Lsinfected Upon Completion'? Yes 'l7 is"o, Method of Disinfection: Comments. Pump Installer Name: Attention: Thepuinp ilistallsr sliall vrov:;dc a pump Installation, lob; to the DSL) whh-In 30 days of puri; installation, PERMIT NO. RF'PLICRNT 'T. STEWRRT C:ONS]'. LOCWF Z ON LEGRL L20 DCIRFt 2 8420 NIL..LINR CIRCLE LOT SIZE 3:":::3-8684 20000 SQURRE FEE'T MINIMUM DISTFINCE BETHEEN FI [;~ELL RND F~NY ON-SITE SEWRGE DISPOSRL. S'T'STEM IS lOEI F'EET FOR FI PR I ',,,'RTE WELL OR t50 TO 200 FEET FROM R PIJBLIC P.IELL DEPENDING UPON ]'HE T'¢PE OF PUSL. IC WELL... MINIMUM DISTf~NCE FROM R PRI'v'FITE WELL TO R PRI'v'BTE SEP.IER LINE IS 25 FEET 8ND ]'0 F~ COMMUNITY SEWER LINE IS ?5 FEET. t.,.IELL LOGS 8RE REQUIRED RN[:, MUS]' BE RETURNED TO THE DEPRF.'.TMENT 1.4ITHIN S":O DR'CS OF THE HELL COMPLETION. -I .... ~ ~-- ~-"" - ~" " · -'~. ~ ..... ' .... L IHEF.. REQLtIF~:'EMENTS MRY RF'F'L'¢. :.,FEL. IFICRTIUN:, RND L. ON_,TF..LIC[ILIN [ IMBRHtl..-.', FiRE RVRiL..RBL..E TO INSLJRE PROPER INSTRLLRTION I CER]' I F"r' THf:IT 1: I RM FF'tMIL. IBR WITH THE REQUIREMENTS FOR ON-SITE SEWERS F~ND WELLS RS SE]" FORTH BY THE MLINICIF'BL. IT'¢ OF RNCH(~GE. 2: I I.,.tILL I~TRLL THE ~YS~'I ~IN ~:I~]IRDRNCE NITH THE CODES. ....... ~ ..... 7 .... ~ ..... ~ .................................................... RF'PL. IJ ~NT ]'. STEHRRT ]CNST. V4, 0 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) (b) (c) Application Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) , . Applicant Name >G C~7 (~r~"f Telephone:Home ~F7-~~' applio~m is (oheok one): Lending Inmim{ion ~; Owner/builder ~; Buyer ~; O~her~ (explain); ~ E~ (d) Lending Institution Telephone Address (e) (f) Address telephone 5~-~2'- 9 ~ 5~ Mail the haa to the following address: TYPE OF RESIDENCE Single-Family.~ Multi-Family [] Number of Bedrooms ~ Other 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 Bi Community [] Holding Tank'1~1 · 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 72-025 01/84) 5. ENGINEERING FIRM PROVID,..,.~ INSPECTIONS, TESTS, FILE SEARCH, L,,-, FA 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 Seal 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~doe,s~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) WELL DATA Well Classification Well Log Present (Y/N) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 L, ga Descrpt,on If A, B, C, D.E.C. Approved (Y/N) Date Completed ~'/~?~"~/~/ Yield 7/-~ /'~/ Static Water L~vel Pump Set At' /2 /j Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) f Depression Around Wellhead Separation Distances from Well: To Septic/Holding Tank on Lot _~./~ . .~./..~_!~ ~; On Adjoining Lots To Nearest Edge of Absorption Field o~ Lot. / ~ ; O~ Adjoining Lots To Nearest Public Sewer Line ~[~. To Nearest Public Sewer Cleanou~Manhole /~'/'- -- To Nearest Sewer Service Line on Lot Water Sample Collected by~ ~/~/~~ - - ; Date ..... ' V'E' I. /J / Water Sample Test Results ~~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed 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-Su pply Well To Property Line To Water Main/Service Line Course Air-tight Caps (Y/N) Size 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) 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) 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,~r conformed, to a~l MO~, and HAA guidelines in effect on the date of this inspection. Signed ~"~~ Date ~;~ _~/~ Company - - / M~OA No. - Receipt No. ~bb t - b~o~_ Date of Payment Amount: $ . Page 2 of 2 72-026 (11/84) Engineer's Seal CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: LOCATION: OWNER: TYPE OF WELL: WELL LOG AVAILABLE: LOT 20 DORA II 8521 ROSALIND SCOTT CARNEY FOUR BEDROOMS YES SINGLE INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 10 GALLONS PER MINUTE PUMP YIELD: 7 GALLONS PER MINUTE DATE OF INSPECTION: AUGUST 28, 1986 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 7 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND AT 61 FEET BELOW TOP OF CASING. AFTER 15 MINUTES OF PUMPING THE WATER LEVEL STABILIZED AT 75 FEET. THE WELL WAS PUMPED FOR AN ADDITIONAL 45 MINUTES WITHOUT ANY FUTHER DROP IN WATER LEVEL. WELL RECOVERY WAS MONITORED FOR 10 MINUTES. FEET OR 71%. WELL RECOVERD TO 65 TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON AUGUST 29, 1986. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. ~ INSPECTION APPOINTMENTS ~ 'TIME TIME TIME -~//~ DATE ' DATE DATE iNSPECTOR INSPECTOR.. ' INSPECTOR \ ~~ DEPARTMENT OF HEALTH & ENVI RONME~AL PROTEETIO~~ ..... ~ ........ ~ ,~,,~,~ /~ ~% 8=s ~ st..t - ~.=hor,., n~,,k, ~0~ ' ~ Telephone 264~720 - ,, EEEEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page I. Incomplete requ~ will not be proc~d. Please allow ten (10) days for processing. 1. PROPERTY OWNER - -- I PHONE PROPER T (If di om above) ' PHONE 2. BUYER ' ' ' MAILING ADDRESS ~ ,/ / ' ~ . 3. LENDING~STITUTION ' ' I PHON~ " ' 6. TYPE OF RESIDENCE ' SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM ~_~Z/, INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. /~ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010 (Rev. 6/79) NUMBER OF~BEDROL0~$ [] One ~ Four [] Other. [] Two [] Five [] Three [] Six * 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.) T¥.E OF .ES DENCE [] S NGLE;F^ tLY [] MULTIPLE F~,MI [;Y 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC-UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] I N DI VI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified I--ISeptic Tank or [] Holding Tank Size: , If Tank is homemade give dimensio ns: TYPE OF ~ANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO, [~, FOUR [] SlX PERMIT NUMBER [] OTHER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED "-INSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank IAbsorption Area ISewer Line INearest Lot Lin~ 5. COMMENTS DATE APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~-~Y ~ 72-010 (Rev. 6/79)