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Home My WebLink AboutQUIET WOODS LT 6BQuiet Woods Lot 6B #050-281-47 n 0 IEEE i.G:, F's Q DULLING CO. -TifS4"/r -41 CA�•"�`f' F/e..t Ci✓ce.rp DRILLER�%�� hli7?.4a t t TYPE OF RI'O %� ST,+.P DATF ,FELL CO?IPLETED A i 1JELL OrkiEa NEATEST COI MJITy 1c ir` WELL LOCATION: ( ADDRESS & L^ AL MSCRIPTION /e T a< B 71e4A LDS CAvpclr DF -PTI; OF WELL &2 -Pr. CASINO: DEpTil -AA'L-FT. DIAl-% -4IN. STATIC WATER LEVEL 1"V -FT. ( ADDVE, DFLCIJ ) LAND SURFACE. DATE 1pg kAy 137f'Z FINISH OF WELL: ( OPE7!-^dD, PE'RFURATED, OPEN -BOLE, OTILER ) DES,RIBS INTERVALS AND SIZE: GolAse si+,✓d -? 24AyeL _ WELL YIELD TESTED BY ( PUMIN",, BAILIN-,, AIR ) AT f To /o GALIMM. FOR oZ HOLTHS V -P i(- =i'T. OF DRA;JD0': N FhUM STATIC L'^JcL. DILL -1; IS MA.TERILL LO! DEPTH B L7W LAND _ {... SLiiFACE'IN FEwT " r' GIVE' DESCRIPTION OF STRATA PE ]TRATED ,`( SIZE OF MATERIAL, COLOR, HARDNESS OF DRILLIN AND WATER C011TENT .i To e e 1 di ✓ /dC c �NrGPAL1 •. 'o i p. OPAGE .Cw✓c r.:A. A • p�° /0 r✓ 3o HAtd 0- ejolIeAs f S2 3 o To f0.210.0 0 /de Ar J/.L ne EO /lAzd Ai! v, op /dee-r Lo n, Qo C/A -r BivI-e.rs 8° ro A /e 9° ro H00Ad N -440A.4✓ 9s ro 9q NAAdPA*✓r Z.u/deAs O CO AAxe SA.✓./ v q,e4Ile Z w.Te c Ar 9y r PERMIT NO. ( r•y �_l r -a I NZ: I F' n L I -r- -T o f FI r -a DEPARTMENT n HEALTH AND ENtiiIRONMENTALi��rE 825 ,L_ TECTIOt4 STREET, ANCHORAGE, AK. 99to1 264-4720 1•TELL F'EF t1 I T 820400 � APPLICANT HARRY A MACKEY SR02BOX 6365 CHUGIHk' LOCATION WILDNOOD ST ER 688-2813 LEGAL LGB 62 QUIETWOODS LOT 522E 13060 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON'THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'EF'ty I T E: ;F• I FRE=. C-ECEoblE3E=FR = 1s nLIPE A I CERTIFY THAT 1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IW ACCORDANCE WITH THE ADES. SIGNED:�u CF, APPLICANT HAP.R.'V A MACKEY ISSUED BY_ lill_. V4. 0 ti 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 Application Date —Eyn 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) l to t< T -IL. - 6 ��.1 % G S �oa�S '' 6 Location (address or directions) (b) Applicant Name s -e ca o Telephone: Home Business 6_f L r 9 f Applicant Address 3R 60A 12 6 E'ste_LJff %tau_ 4S.r77 (c) Applicant is (check one): Lending Institution ❑ ; Owner/bui[der ❑ ;Buyer ❑ ;Other ❑ (explain); (d) Lending Institution Telephone Address A -re (e) Real Estate Company and Agent z Address — e� Telephone (f) Mail the HAA to the & S ENGINEERING EAGLE RIVIEF, AK 9957 7 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms a 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. 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 72-025 (11.e+) n, n 5. ENGINEERING FIRM PROVIDING, .ISPECTIONS, TESTS, FILE SEARCH, DA1 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 Insp�c oPIENGINEERINGq Name of Firm —S Telephone gi i! 2-y7 9 Address EAd, r AK 995" Date 6. DHEP APPROVAL1iJ' Approved for bedrooms by A A�lG Date Approved Disapproved Terms of Conditional Approval Conditional CAUTION s.n A. $%&tor µa W74 i The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) Issues Health Authority Approval certificates based solely upon the representations given In paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 01,84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) IL';;)clU burr cp(kuv - FEBRUARY 1984 C,Fi. CF I��,. .i r. 284-4720 ENVi..O,-Nh;ENT/-A F;:CTECT:py Legal Description: -1-,2r b(G '$�• 0 �., u1996 q,1,� ��D��s s►o A. WELL DATA RECEIVED a Well Classification I ao\ ✓ t o,:> e. If A, B. C, D.E.C. Approved (Y/N) A Well Log Present &N) Date Completed J'0- Io - fes) Yield (0•7-- 6?e" -4- Total Depth -AS r Cased to `j 5 r Depth of Grouting — Static Water Level '7r>' t3 n Pump Set At J , 1" Casing Height Above Ground Zoe - Sanitary Seal on Casing PDN) Electrical Wiring in Conduit CCN) Depression Around Wellhead (YQ 4 Separation Distances from Well: aJ To SopOeA4*1*101 Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot thl On Adjoining Lots ton 1-4 To Nearest Public Sewer Line 15 "1- To Nearest Public Sewer Cleanout/Manhole � ' -� r � To Nearest Sewer Service Line on Lot Z -S'}" Water Sample Collected by 457 S 1'-+J G 1 fJ 'E� en ; Date V5 ` S Water Samp Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size No. 01 Compartments Standpipes (Y/N) Air -tight Caps (Y/NFoundation 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 Well To Property Line To Water Main/Service Line To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field ravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test 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 To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Comments Go rSFs `%,72 t'.�Px—� e- `�-`- 1.3 ` - D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments 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 S & S ENGINEERING Date g�7�� C SR B 196X Comp a MOA Nozr IVER AK'�P�6 • A`11S9 Receipt No. Obrl Date of Payment - g �� •t� Amount: $ to ch jpb.i a $MAN W6 14474 Page 2 of 2 72.026 n 1,84) r Time APPLIC~NT FILLS OUT UPPER HArONLY Time Prop .1y Dwner C W1 w.T5 cc/V57— L.- v Phone lfa��:4 Mailing Address P Zip Code 41 C, 't�- -7 -.7 Buyer V I Pvc1q, n-_5 Address N 44 ri r Zip Code Lending Institution C n ` �� .�- A' . C. / 1 L 1 ` Phone Address Zip Code Date Realty Co. d Agent 1 1 O _1 Gl. L'ro Phone L:� a76 '71 &- Address Q Zip Code Legal Description / 1_CT 611 Inspector Street Location — �- �aQS Type of Residence VZ Single Family Field Notes: — ❑ Multiple Family '7 No. of Bedroom IZL 41 . AD� ❑ Other Water Supply RECEIVED Individual 'CONDITIONS OF APPROVAL ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log If available).- ❑ Public Utility DATE Sewer Disposal O Individual Year Individual Installed: Well To Absorption Area 'Q Public Utility When Connected to Public Utility: �[] Holding Tank Well to Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time ott+,,An Date Date Date Date - ^-�, Inspector Inspector Inspector Inspector Field Notes: — MUNICIPALITY Ut C'' Ir.•iT 1 P. IZL 41 . AD� CFPT. ENVIF.711.:_r.:o._ ;.,u.ECncN GCT 2 9 1932 RECEIVED ( 'APPROVED BEDROOMS3 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL ROVAL DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank rza» cm