HomeMy WebLinkAboutPARADISE VALLEY BLK 7 LT 1Paradise Volley
Block 7
Lot 1
#020-413-20
Jan 27 20 11'17a AnQhorage We!! & Pump Set- 90724'0742 p.2
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til'+J'.n. Ei!ysore Pond =r.
P.O. l�..Q:C 1?6UrU
`�- S A T
Mark Sec
ich f; 1G17r t!C e, =+1 7 9950, 7
Mayor »,r MUM 01 11o(Ls T:
9C7) 343-7902
Pump Installation L®g
Well Dritiing Perwit Number: SW .Date of Issue:
11"arcel Identification Nvmber:090— `7 1 3 ` �2 0
Legal .Desc'riptian Pru erty Otync:r ]Vamp: &: Address:
}Pump installation Date: —
9-,f/
Pump Intake iieprh Below Top oi'Well rasing: /�O feet
Ptimp 1VI2nufacturer'svName: � j / i zi) j d—
Pump Model, -L,5–
Pump Size 1&fl-p
74
Pitless Adapter Burial ]Depth; � feel
Pitless Adapter Man nfaciu;•er's Name: vktw- 1 �,ral
Pitless Adapter Insc:aIXer:
Well Disinfected Upon C'cm 2leticn:' •'+✓� I'es No
I l �• t�
Method of Disinfection: J�
Cowraeuts:
Pump Instalmr Name:
6'!6,(") by'l c �✓ �N� r �—'•��^�� `tom✓ 'v)41, .
Attention: The pump hiss?.]ler shall provide a pump instaltation log to the DSD within 30 days of pump ilnstal'.ation,
I
.MUNICIPALITY OF ANCHORAGE
t i:r�t DEPARTMENT OF HEALTH & ENVIRONMFNTAL PROTECTION
11
, ENVIRONMENTAL ENGINEERING DIVISION
825 L Street • Anchorage, Alaska 99501 Telephone 2644720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION
NAME
REPORT
t
_ s!
1(At
�7 K
PHONE - W
MAILING DDRESS
o7 — ❑UPGRADE
LEGAL DESCRIPTION
vn4e (/
LOCATION
c (tiIGN f
f f/
NO. OF BEDROOMS
DY DISTANCE TO: We1N0 Absorptio area , Dwelling r A-
25
PERMIT O.
1-2 Manufacturer
a Q Material
in F• Q Q
T!N
No, of c artments
Liq. capacity gallons inside length
IF OMEMADE:Wroth
Liquid depth
-lOZ
DISTANCE TO: Well Dwelling
PERM IT NO.
Manufacturer Material
Liquid capacity in gallons
w=
DISTANCE TO: Well d �� Foundation Nearest lot Irne
PERMIT J.
F Z W
No. Of lines Length of each line Total length of lines Trench width
.... --
Distance between lines
Q H
Top of tile to h ish rade inches
% g Material beneath (rte
o
inch s
Total a ective a corp Ion area
W
u
Length
9 Wrdlh Depth I
6-7 eover
PERM17 .
d
( t
Type of crib Crib diameterCrib
depthTotal effective a sW orpti
� f{
real
Vs
DISTANCE TO: Well T h Building foundation Nearest lo[ line
/
v
f
W
Class Depth DrillerDistance to lot line
PER
"Fat'b '74;,,3
3
DIS C Building foundation Sewer line Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
SOG G
IL TEST RATING
�
INSTALLER
cue 6wti Ali'
�
REMARS r
Jilt
es
--•�'--SFr.*—ieyt
S
APPROVED DATE
LEGAL
I
n A
�\
13 IRe 3/78)
y 4 -OT . 1/ PIF- /01 %araj'l5e Vhj1,,5" `x,&M
r .__,-WATER WELL RECORD
STATE OF ALASKA
- - DEPARTMENT OF NATURAL RESOURES
Division of Geological & Geophysical Surveys
LOCATION OF WELL (Please complete either la, to of lo.)
Plam Screw Suberr;El _ Lot Block 1/4 q fs.
PA iz IJ ISL
It,
I IC. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
p rill ins Firwl/ Ne.
A.D. L. We.
$$oilen No. To.nsap NQ I Renee SQ I World'"
B❑ WQ
S. OWNER OF WELD '
Address: CHARItS CHk'15TIA14
PG 6&4.9
Street Address ane Arco of Wall Location
2. WELL LOG
Material Typa
Fast Selo.
Feast
lobo
Teo Beffem
�. WILL OC►TH* . ( Ileal)
2f <• el
S. ?DAT`E L OF CCOMPLETIOON',
.. 1 S,(-
A) 'll 4 AIM
'/ 1�
6. (3 Cable tool ®Rotary 0Drlfon (3 Dog
❑Auger Jotted ❑Bored ❑ other s
'I 4 fG tt OF PI iv �f d'
h 1 II C
A
?.USE. 0 Domestic. ❑ Pvblic supply ❑ Industry
❑ Irrigation C]Recharge❑ cemmaticel
[3 Toss Wall ❑Other:
wnsiL
I/h 7A ' 1 17 'tf nr // %
11A I P SF,(1)5T r/' f7"0'0
t /le (; k (le, / 17 E Y W
S. CASING: ❑ Threaded ® Waded
did.. I- te_.21_ft. Depth Weight lbs./a.
In. to—fl. Depth Stickup fl.
?rfi,1174 tPF '/ 11 IV1fP4FV
I 1 12 AT IrN,diem.
IS HAI f IgiZ j,W w 6 12 F s
Ld r H 11,(
B. FINISH OF WELL:
Tyra: Dlemaer*
Slot/Mo.k Sisa: length:
$al betvat" it. and ft.
Backtl(ling �— gravel path
f r I
10. STATIC WATER LEVEL* 44 11. 11 JT
❑ Above H ❑Sao. lone rerface Dole
Equipment goad:It f?,
'
._
Of
11. PUMPING LEVEL Bapw lend surface and VIELD
j_II. after_L,?%- .. pumping
after Nrs. pumping—S.r. M.
12.4ROUTING Well aroutea: ❑ vas E) No
Material: ❑ pact Cement ❑ Other:
IS. PUMP: (If available) NP
Longth of Drop Pipe fl. capacity g.p.m.
❑ Subm. ❑ dal ❑ Contrificol [3 Other
14. REMARKS:
Nil -l' LIFT VVI'11'(1�1lr
16 WATER WELL CONTRACTORS CERTIFICATION:
IS. Water Temporal.,. ❑ F ❑ C
This pit rat dril.e: under my Ivrioercllan sad this report Is Trus to fns baa of my knowledge oma belief; _ -
AAI(LWIIITf we11 1,71,tlj1ple, A-Nt74r
Rog-mte e: Business Nams Contract Lltewse Number
Ad:r:11:_.3 i2i IA I _ij`1 N ld T ' I'L v f Irfpie{ 1 1) IC. c14 TIC 9
S�gnea: / Data' 7,t! /Y7 �4-
A.Ihorlsed Repleteetoliva
form 02•Waw (u/Ail Copy Dretrlbv1.v1: WHITE -$fall DOGS, PINr•Ddller. CANARY-C.aeme.
• MLFN I C I PAL I TY OF= Fn kNCI-IC3FzAGE
/ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCF{ORAGE, AK 99501-
264-4720
ON—SITE SEWER Y1 WI=L-L •PERM I T
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
840923 HAND WRITTEN
10/31/84
CHARLES CHRISTIAN
P 0 BOX 6648
ANCHORAGE, AK 99510
274-8286
LEGAL DESCRIP: SUBDIVISION: PARADISE VALLEY
SECTION: 11 TOWNSHIP: 11N
LOT SIZE: 26600 (SQ.FT. OR ACRES)
LOT LOCATION: GOLDENVIEW AND ROMANIA
LOT: 1
RANGE: 3W
BLOCK: 7
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the.Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and'regulations,
and in compliance with the design criteria of this permit.
I will adhere to all MOA and State of'Alask:a requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION•MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORE; MUST.BE DONE BY A LICENSED ELECTRICIAN.
SIGNED
APPLICANT: CHARLES CHRISTIAN
ISSUED BY
DATE:
DATE:
MUNICIPALITY OF ANCHORAGE
a,,W. Department r:-alth and Environmental�ection
825 f greet, Anchorage, AK.
264-4720
Permit $ * * * HANDWRITTEN PERMIT
WELY ANDD ON-SITE SEWER PERMIT
Applicant: �� Address:
Location: Phone Number:
Legal Description: LQ I— / n•-7 yT
Type of Soil Absorption System Is:
Trench:" Drainfield: % Seepage Bed: Holding Tank:
Maximum Number of Bedrooms:_ Soil Rating(sq.ft/br) �c5-a
The Required Size of the Soil Absorption System Is:Pc: s ,90
DEPTH 6'6, LENGTH 630" . GRAVEL DEPTH .1-0/- WIDTH -T- 0r
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = lDGALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* *.* TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection.and approval by this departmen-
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
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 this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 q
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 in accordance with codes.
(3) I understand that the on-site sewer system may re ire enlargement if
e residence is remodeled to include more that ed ooms.
r
Signed: Issued by•
Applicant
Date:
SWP/024(1/81)
MO OILS LOG
• MUNICIPALITY OF ANCHORAGE -
• DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O PERCOLATION
825 L. Street, Anthorpa, Alaska 99501 2641720 TEST
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: GGO:^//I/<. l^_�t'r:s 1PN DATE PERFORMED:
LEGAL DESCRIPTION: LoT 1, H/f %) , �•� �y SUJ.
WXX Pf Pe4tIOR W(C %ytT
1
ML 5AV4Y sur
2 I 6eow,,, sof I der
—� sM 611ry SA)UO
• brow.,, deals, e'irr
,0 • . .
GP SANG Y GRAVED. II
,' j brown, vtry .iiNSc, MoisT
5 W,fk ;radu ec /&/- r,,ck "cry
6 !• or' o/Ntik/a�/r fuck TO -60,1
• �' ivy c7KJwte4 &4404 c1"95
7 f4rou94wA d,TIY �ul�
e 3.0, Io ILO, al /SO a/(x�
9
•
10
11 /I c
)ENCOUNTERED?
GROUNDWATER S
TtJ$a)ENCOUNTERED? /10 O
12
13
14
15
16
17
18
19
20
PERFORMED
72-008 (6/79)
P
J// //
:1neC �faclt, IF YES, AT WHAT E
DEPTH?
Q
C. Reid, Jr.
.2251•E _:
51TL PLAN
®®mmmt.
___�oj
mI'_'_i
__m
WE
_
__/___
-'____
'-____
JPERCOLATION RATE (minutn/inch)
TEST RUN B TWEEN FT A�JD FT
1riULt[IV rQ L 3,01 4n If.Or o/ GP = ia� 97AoJce Q c
nl `Fn /F/i I7va'." �iriw �n r�r...wi rwriSIf /. CaG]( "
CERTIFIED
DATE/.Z >,6f.;,_
mf
Municipaii cy
of
Anchorage
P.O.80k 6650
ANCHORAGE, ALASKA 99519-6650
(907)343-4200
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
October 2, 1987
Charles Christian
P.O. Box 6648
Anchorage, Alaska 99502
Subject: Lot 1 Block 7 Paradise Valley Subdivision
Waiver Request WR86-065
Dear Mr. Christian:
This department has reconsidered its position on your Health
Authority Approval and waiver request for the subject lot.
This department is willing to waive the 100 foot separation
required between your septic system and the drainage course
fronting the subject lot along Romania Drive to 71 feet. This
reconsideration is based upon the unique circumstances involved
in this case. This department recognizes that the quantity and
frequency of flow in this drainage course has been increased
through no action of your own and the septic system itself is
unchanged from its initial approval. For this reason, and the
fact that the septic system has a very low probability of
contaminating this drainage, this waiver has been granted.
The Municipality of Anchorage will be conducting periodic
monitoring of the drainage ditch in order to determine whether
bacterial or chemical contamination is occurring. Samples will
be taken both upstream and downstream of your property in order
to determine if your septic system is contributing to the
pollution of the Romania Drive drainage course. This sampling
will be part of a larger sampling program for the Paradise
Valley Subdivision. If this sampling indicates that your
septic system has increased the levels of bacteria or chemical
contaminants in the drainage, you must agree to allow the
Municipality or its designee the right to enter the subject
property for the purpose of conducting inspections of the
on-site sewage disposal (septic) system to further investigate
the source of increased bacterial and/ or chemical contaminants
in the drainage.
If, in the opinion of the Municipality, the septic system on
the subject lot is found to be contaminating this drainage
course, the owner of the subject lot must bring the wastewater
disposal system into immediate compliance with State and
Municipal wastewater disposal regulations.
It is understood that upon completion of the inspections, the
premises will be restored to as near as possible to the
original condition by and at the expense of the Municipality or
its designee.
Sincerely,
.foe Robert W. Robinson
On-site Services Program Manager
I agree with the conditions above and hereby grant the
Municipality or its designee Right -to -Enter the subject
property if monitoring indicates that my septic system is
polluting the Romania Drive drainage.
Signed:
Charles A. Christian
POD 1906648
Anchorage, Alaska 99517
December 30, 1986
Municipality of Anchorage
Department of Health R Human Services
POD 1906650
Anchorage, Alaska 99519-6650
Attention - Jewel Jones
JAN 0 7 1987
Subject: Lot 1 Block 7 Paradise Valley Subdivision
Request for Reissue of Approved Septic Health Authority
Dear Jewel Jones:
This letter is in reference to my continued imossse with your department.
May I remind you, the application for reissue of my said health authority
is dated April 29, 1986.
I had hoped this matter was brought to a final and sati=.factory end,
per my meeting with Robert,Robinson and Steve Morris. MGA reconsidered
its position on this matter. First, it was requested that I be responsible
for installing a culvert system along Romania Dr. I disagreed with this
and appealed. MOA reconsidered its position on this matter. It was there
requested that I pay half the cost of a monitoring test hole and water
samples from Romania Rd. ditch. I disagreed with this and aopealed.
I suggested to Mr. Robinson that it was very much premature to protect
this road ditch in such a costly and wasteful manner as tneir is no proof
of cdntamination to this day. I then suggested that my authority be
reissued and the MOA should test the road drainage for bacterial count,.
They would sample at the east side of my property line and at the west
side of my prooerty line. If they found from the testing a dangerous
increase of bacteria form one side of the property to the other, then I
would be responsible for bringing my lot into compliance. Our agreement
was not conditioned to allow a Right To Entry as stated in your letter
dated October 23, 1986, nor is it necessary as the samolinc of Romania
Road drainage will determine if any health hazard exists.
1 have been ranitorinc the Romania Road drainage closely since this
matter ste.rtvt. I have found water drainage during spring breakup and
durin^ rainy weather. No dreinage occurs curin2 dry "ontncr, n. _n,:
the cold winter months. No water is flowing to date. In my opinion one
my enrineer, Lee Reid, Alaska Environmentai Control Services, tnis d"e&
not constitute a stream.
1
December 30, 198E
Health and Human Services -Jewel Jones
page 2
May I also remind you, that this matter resulted from the overs3cht of
the public Works Department allowing the diversion of water from its
natural course to flow along R3mania Road impacting mlv property. 7o date
Public Works Department, Susan Metcalf, has riot responded to the
Oot)udsrnan's request for information as to the liabilty and rescoraibility
of the departmerit's mistake or to my own requests.
if you or your staff can rot anree with my position, them I am rec!restiny
for an independent hearing officer, to be jointly approved by both parties
to review and make an indeoaridesnt evaluation.
Sincerely.
Charley A. Christian
E
P24 2800266 (001N
COCEIPT FOR CERTIFIED MAIL
NO IN�y:rFdCE COVERAGE PROVIOEO— J ity
FOR INTERNATIONAL MAIL
Ea (See Reverse) OQ
SENTTO j
Charles_ Christian
STREET AND NO. P. O. Box 6648
PO.. STATE ANDZIPCODE—�
Anchoraqe, Alaska !
CERTIFIED FEE
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SPECIAL DELIVERY
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RESTRICTEODEIIVERY
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POSTAGE ANO FEES
Dear Mr.
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
I \ Cr• ,
age TONY KNOWLES.
MAYOR
DEPARTMENT OF HEALTH a HUMAN SERVICES
► Hearing Regarding Health Authority
E1
Paradise Valley Subdivision
An Administrative Hearing has been scheduled for 9:30 a.m.,
Friday October 24, 1986 for the purpose of determining whether
your Health Authority Approval was denied in accordance with
AMC 15.05.100 regarding Health Authority Certificates.
This Administrative Hearing is being held at your request under
the provisions of AMC 3.60 and 15.050.90. Copies of Title 15
and AMC 3.60 have been enclosed.
Sincerely,
ez
d�ren
Program Manager
Environmental Services Division
.V
Charles A. Christian
P. 0. Box 6648
Anchorage, Alaska 99502
September 5, 1986
SEP 16 1986
MLmicipality of Anchorage
Department of Health and Hunan Services
Office of The Director—Jewel Jones
825 L Street
Anchorage, Alaska 99502-0650
Dear Jewel:
This letter is to confirm the hearing held August 21, 1986 for the reissuance
of my septic health authority. I also give notice of total dissatisfaction of
Dr. Wilson's offer to negotiate my said heatlth authority.
In reference to the written regifest I sent you certified mail, not one person
had reviewed this information at the time of the hearing. the request to have
your engineer visually reinspect the problem area was also ignored. Considering
the fact that I had previously an approved health authority and this recent
denial is caused by the impact of the MOA Public Works Department, I find it
incredible the lack of responsility shown by your Department.
Also, to this date I have not received any state regulations that clarify what
a stream actually is, and an outline of the stream boundaries that are affecting
the homeowners in Paradise Valley. I suggest that all homeowner's adjacent to
this newly created stream be informed by the MOA of the new status of their
In concluding this letter, I am requesting an appeal by a totally independant
body to review my application and render just decision.
WV1%Z`CNMENfPL P.CILUON
RECEIVED
S nce ly yours,
�.
Charles A. Christian
DEPARTMENT OF HEALTH i HUMAN SERVICES
Office o1 the Director
825 V Street
August 22, 1986
Charles A..Christian
P.O. Box 6648
Anchorage, Alaska 99502
Dear Mr. Christian:
The department will issue a waiver and a Health Authority
Approval for your septic system on Lot 1, Block 7, Paradise
Valley Subdivision provided that you place a monitoring tube
downslope from your drainfield to a level just above bedrock at
a point just above and near to the ditch along Romania Drive
(the exact location to be agreed upon later); and that you test
water, if any, from the base or bottom of the monitoring tube
for fecal coliform bacteria 3 to 4 times annually (approximate
dates to be agreed upon later).
The department will share the initial cost of placement of the
monitoring tube with you, fifty-fifty. The cost of laboratory
tests on samples from the test well will be borne by you.
The basis of this offer is that the department considers that
it is likely that your septic system is safe, but that because
it is 71 feet from a ditch that at least intermittently has
running water in it and therefore, in the eyes of the State of
Alaska, is a stream, the department must know with more
certainty that contaminated water from your system is not
reaching the ditch.
The requirement to test will continue until there is some other
solution individually for your lot or for the drainage problems
of the entire subdivision. .
If this offer or some mutually agreeable modification of it is
acceptable to you, we will immediately issue the waiver and
Health Authority Approval.
If -it is not acceptable, your recourse within this department
is to ask Director Jewel Jones in writing for an
Administrative Hearing. This will be scheduled within 20
days. A hearing officer is supplied from outside the depart-
ment. If the hearing officer's decision is not acceptable, it
may be appealed to the newly created On-site Wastewater System
Technical Review Board.
Sincerely yours,
Rodman Wilson, M.D.
Deputy Director
Department of Health & Human Services
Charles A Christian
August 1, 1986 P.O. Box 6648
Anchorage, Alaska 99502
(907) 345-5366
Municipality of Anchorage
Dept. of Health and Enviromental Protection
p� ATTN: Jewel Jones
Division of Enviromental Health
e4 P.O. Box 196650
C Anchorage, Alaska 99519-6650
a
1 \ SUBJECT: Lot 19 Block 7, PARADISE VALLEY SUBDIVISION
p 6 Certificate of Inspection for Health Authority
1 of on-site sewer and water facility.
ti
Q Z Dear Ms. Jones:
4 The MOA has denied my application for Certificate of
Inspection for Health Authority. Application date-April
o ; 29, 1986. I received a first written denial dated May 31,
1986. Susan Oswalt stated system is to close ti idenified
year round surface source.
This matter was brought to my attention previously by a
c real estate agent who is negotiating the purchase of my
said home for a new buyer. This new finding terminated
the negotiations until approval of Health Authority.
I completed constuction of my new home on April 1, 1985.
The approved certificate of health authority is dated
October 8, 1985.
The cause of this problem stems from the MOA permitting
3 "the diversion of water runoff to construct new homes along
I.Romania Drive. The soils along these new homes have
surface groung water year round. This water has been
diverted along the utility easements and finally into
the northern side of th ditch along Romania drive. A MOA
Right of Way Permit #3817 was issued by Public Works on
June 21, 1985 for the removal of one culvert and installation
g of a new culvert to divert the water runoff from a previous y
Nb direction along Romania Drive. At this time no water is
\ Q , running past my property. It did flow past my property
during break up as all of Anchorage road ways do. Photos
submitted to the DEC show no water exsiting along my
property. The DEC declined taking a position overriding
the MOA, even though the MOA stated per denial that the
DEC is responsible for overridding MOA denials.
r
page 1
i
I
I
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n
The originalydiversions of water via permit of new
construction and permit of culvert change is illegal
under Paradise Valley Subdivision Covenants.An
enviromental impact study was not issued nor any
Public hearings.
In concluding this letter, I stress that immediate re-
view and proper action be taken to correct this problem.
,,First, having your engineer visually review the problem
area with me, seeing the diversions further up the
road to obtain accurate information before denying this
application that has already been approved prior to all
of these developments. There is also ,no evidence that
my septic system will or is leeaching bacteria into
the road ditch that the MOA clarifies as a stream.
This process has taken four months of my time and my
money to resolve. Any further inaction or nonperformance
of MOA duties will result in further damages warranting
litigation. Please let us spare needless fees and come
to a timely and just solution. Thank You for your time
and cooperation.
Charles A Christian
page 2
• •, -PG IN A CONSPICUOUS PLACE- ('31
RIGHT OF WAY USE PERMIT ND.
i APPIICATION AND PERMIT
rAw—. OF ANCHORAGE — 5500 TUDOR ROAD
Vtj "ONE 7861175 FOR INSPECTION
ISSUE DATE.
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PlPMn IlE
BONG OR LICENSE
ADDRESS
PAVEMENT BREAK
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CONIPACIOP
AS BULL P[00 Orli
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ADDRESS
AS SLAT PEO D O v!S
ONO
CONSTRUCIN)" 6.024A
TVH OE pet
AMOUNT
MARPANTT PERIOD
D 00
APPPOVED DRAMING NO�
FRtD MSKCTION AND NOTICE PEOUPED 4 HOURS
/
IN ADVANCE
vf
COMPLETED A INSPECIED By
DATE
PEFUNDABLE
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DEPOSITS PEI 9)
1
SA�•NwwM pbNe.eLin•I mlRwna.!
REMARKS'
CHARGES FOR SiLtMO TO KAMIl1Et
•
CALLS BACK
SIAN.IIOLIDAV
OTHER
TOTAL
FEES PECEIVto By
DATE / A
IHAVE RE T 80VE PI ATIONJt KNOW THE CONTENTS THEREOF.IHESAME ISTRUE AND CORRECT. IFURTHER
ACRE T VE WO ( L I N IN ACCOR TRE
WITH ALL STATE AND MUNICIPAL
LAWS AND ORDINANCES.
A.1 a a o
S I we of Permmee or I—
fof'&_JFe SNI
ALASKA RUl00f1 nTAL COnTROL SCRUICCS, IX
r�) Enginterinq 6 Environmental Studies !i
July 9, 1988
Alaska Department of
Environmental Conservation
437 E. Street
Anchorage, Alaska 99501
Attn: Steve Eng, District Engineer
Dear Steve:
Attached Is a packet of information on a request for a waiver for a Mr.
Charles A. Christian. Block 7, Lot 1, Paradise Valley Subdivision. When
the sewer system was installed in 1984 the road ditches on both
\ Goldenview and Romania were dry. They were not streams. They were a
\D ditch. The drainage from this area came from down Austria and some came
from Romania through a culvert where Austria butted into Romania. The
culvert carried very little water, if any, except during high run off
ij periods. The bed Is located 77 feet north of Romania but Is at a depth
such that the top of the bed is above the road ditch on Romania. Please
refer to the waiver request that I have attached.
The sewer system wee Installed in October 8, 1984. There was no waterer V �JO
In the ditch at the time and there was no evidence that water other than
normal runoff was in the ditch. On August 1, 1985 a conditional was
removed for a Health Authority that was prepared and approved in April
3, 1985. At that time there was no question about the system being near
a "stream". However, In April 24, 1988, when a request for a Health
Authority was submitted as Mr. Christian had decided to sell his house,
It was disapproved because a stream now flowed parallel to Romania and
would be within 100 foot of the on-site sewer system. The "stream", If
you want to call it that, Is a result of the installation of the culvert
located farther east on Romania that drains the water to the point where
a culvert goes under the road at the intersection of Coldenview and
Romania. Attached is the permit from the Public Works Department. On
May 7, 1988 I requested a waiver of the distance from the absorption bed
to the road ditch. We requested the waiver of 71 feet until the Issue
of drainage in Paradise Valley Is resolved. The waiver was denied.
Attached is the Information.
Also, attached are some photographs taken of the "stream". The
photographs are dated. The first photographs shows the outfall from the
sewer located at the intersection of Austria and Romania. The ditch is
flowing towards the Christian's home. The next photograph shows as the
culvert flows underneath the Christian's driveway that goes from Romania
Into his home. The quantity of water flowing down the ditch is very
slight to nil. At the top of the photograph is the culvert as it
crosses Goldenview at the intersection of Romania and Goldenview. At
this point the ditch is dry, all the water that was coming through the
culvert has now soaked into the ground.
... ,.. .. . , e A A . R. . ..... ♦...I .......
On June 30, 1986, Mr. Christian took another series of photographs of
the ease approximate location. Photograph 1 is a picture taken at the
Intersection of Goldenview and Romania looking eastward toward the
mountains. The culvert in view at the low center of the second picture
Is the culvert that goes under Christian's driveway. The culvert is dry
at this point. The next photograph to a closeup picture of the culvert
on the uphill side of the culvert showing the ground to be dry. The
I third photograph is a picture of the culvert as 1t goes under
I Goldenview. There is no water at this point either. The fourth picture
Is a photograph of Christian's hose taken from low on Romania. One of
the standpipes for the sewer system can be seen at the edge of the
circular window. Since the system was installed, the homeowner has
brought in considerable amount of fill to raise the yard level.
On July 8, 1986 there was water flowing through the culvert at Austria
at a rate of 0.9 gpm (0.002 cfs). There was no water flowing Into the
culvert at the corner. It had percolated into the ground, even before
It had completely passed the culvert on Christian's lot.
In summary, I do not think that this 1s indeed a stream but in reality
Is a road ditch that takes seasonal runoff from the drainage of Austria
and possibly parts of Romania drive. I feel that the classification of
this as a stream is not in accordance with Alaska statutes. I
therefore, request that the refusal of a waiver by the Municipality of
Anchorage be overridden or that you declassify this as a stream so that
the homeowner is not faced with a constant threat of this "on again, off
again" classification as a stream.
The homeowner is attempting to sell his property so a quick resolution
Is requested. Thank you for your consideration.
If you have any further questions please do not hesitate to give me a
call.
Sincerely.
JW lrl `..... OF qtqLeroy C Reid Jr., D., P.E.
.'
..•
�r✓j t •,•�f-�, Preside t
ROY C REID, JR,
CE -2251
� •. a ••••• � �
Municipality
of
Anchorage
«CI.C:IC LJ awn 0 Iy00
P.O. BOX 196650
ANCHC,�)GE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES.
MAYOR
It DEPARTMENT OF HEALTH S HUMAN SERVICES
j June 4, 1986
I Leroy Reid, Phd., P.E.
Alaska Environmental Control Services, Inc.
1200 West 33 Avenue, Suite B
Anchorage, Alaska 99503
Subject: Lot 1 Block 7 Paradise Valley Subdivision
Waiver Request, WR86-065
i
Dear Dr. Reid:
This department has reviewed your request for a waiver for the subject
lot, and upon consultation with the State Department of Environmental
jConservation (ADEC), your request has been denied. Your request was for
a waiver of the 100 foot separation distance required between a stream
and absorption field. This "stream" is located 71 feet away in the
drainage ditch along Romania Drive.
ADEC has defined surface water (waters requiring a 100 foot setback from
septic systems as stipulated in 18 AAC 72.021 (e)) as any surface water that
Is not directly attributed to rainfall or snow melt event. In a letter
dated February 10, 1986, Mike Lewis of ADEC specifically references this
definition to this "stream" as it impacts setback requirements in Paradise
Valley. It is apparent that because this "stream" along Romania Drive
flows through most or all of the non -winter months, it must be considered
a surface water requiring the appropriate setbacks stipulated in 18 AAC•72.021
(e)• -
You have asked that the department provide options to your client, Charles
Christian, so that a waiver may be obtained. The department has discussed
the possibility of enclosing this stream in solid culvert with ADEC. This
option is acceptable, in concept, to both this department and ADEC. Engineering
plans for such an option have to be reviewed prior to approving a waiver,
however.
Sincerely,
�
��,
Stephen S. Morris
Civil Engineer
On-site Services
cc: Charles Christian
P.O. Box 6648
Anchorage, Alaska 99502
Code #4
•_.
Sb.
-\ Municipality of Anchorage
1�1I;•'�• B4.
• Development Services Department <
Building Safety Division
On -Site Water and Wastewater Program r
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. b20— tll3- ao HAA# 0yogb/
Expiration Date: ja?/�l0f-)
1. GENERAL INFORMATION
Complete legal description 3�a-(-A c` i5 a K —1 1..0 i
Location (site address or directions) 18011 Ca o LI) MN fi/ I L= W 1b Q_ _
Current Property owner(s) VOr4 141 H Day phone N 4 I— 1 o z 1
Mailing address
Lending agency
Mailing address
IPic) 11 6aL-DLN t/ikt.Z, V2
Day phone
Real Estate Agent r_ 141215 5 V11 1E l2 S, Day p 4
��llhone 3 3 8- A2L
Mailing Address (Gt7C 0.0 t?o f -W ✓ y
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
_3
TYPE OF WASTEWATER DISPOSAL:
[�
Individual On-site
;J
❑
Individual Holding tank
❑
❑
Community On-site
❑
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) 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(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm_ I afebra 3nvrkhuNd P Phone 279-39/1,
Address ,so 3 LFA/ 1 ti 144 N U S
Engineer's Printed Name
5. DSD SIGNATURE
1 nL,�7arr S'
_jef:0_0�' Approved for _'15_ bedrooms.
Disapproved.
Date g- Z -o -o q
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
V
By: _o a s k 4 , , � Original Certificate Date:
(Rev. 01=i
T. SPURKLAND P.E.
203 WEST 15TH. AVENUE SUITE 203
ANCI IORAGE, ALASKA 99501
(907) 279-3916
Fdr (907) 276-6013
September 20, 2004
Julie Makela P.E.
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw St
Anchorage, Ak 99519-6650
Subject: Paradise Valley Bk 7 Lot 5 Pink Sheet
The stand pipe has been glued. Please issue an unconditional HAA.
Yours truly,
Tobbe purklandP.E.
Municipality of Anchorage
• Development Services Department
111lI
� Building Safety Division
4
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL _
I FOR A SINGLE FAMILY DWELLINIS °C i
Parcel I.D. 0',2.0 413 —,10 ,HAA # b y ai la
Expiration Date:�Lo 1 f�lnr.cl
1. GENERAL INFORMATION —T�-�—
Compete legal description t?arQ2is
Va\1Q4
BKJ Lk:
Location (ete addressor directions)
_IS011 Geld
"' Vi Drive,
Current Property owner(s)
Toor,
Viol Day phone _ 1491- 1021
Mailing address l8c)11 C -t o
lH V LtW I)yf
Lending agency
Day phone
Mailing address
Real Estate Agent
$warps
Day phone
338- 82gZ
Mailing Address Ze-g"
e
,tGbp Lie-40"Ici
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER
DISPOSAL:
Individual Well
®
Individual On-site
R
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown below. I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. 1 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(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of
Address
Phone 2-}9—Wto
Engineer's Printed Name -robben S ur tt cL"C\
5. DSD SIGNATURE
_14::f
Approved for bedrooms.
Disapproved.
Conditional approval for �— bedrooms, with the following stipulations:
Aboveground section of post–tank cleanout pipe must be permanently attached
—_—_to.the.below_ground_portion_of_the_pipe_.before an.unconditional.approval
is issued. Conditional approval expires on 9/30/2004.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X Maintenance Agreements
Supplemental Engineer's
Other
By: Original Certificate Date:
(RW.OVO2)
OFQf(,
r.
AND
E WA7EK
WASTE
nor)rPAM
trt
lo•� ` •f
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bregaw, St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Parc-di c0 y1ilt, SIA1 Lt I Parcel ID: 0,P- Lb 3 ;10
A. WELL DATA
Well type �4�c If A, B, or C provide PWSID # �lA Well Log (Y/N) Y
Date completed 123-0- 1964 Sanitaryseal (YIN) Y Wires property protected (YM) Y_
Total depth aof ft. Cased to -aL-ft. (8.1 pock) Casing height (above ground) _33f _in.
FROM WELL LOG AT INSPECTION
Date of test 10-30-141%4 -a3-am
Static water level by ft, 5(p ft.
Well production 1.5 g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform -�.colonies/100 mi. Nitrate Qjg.,3 mgA. Other bacteria ti1(i colonies/100 min.
Arsenic: VmgA. Date of sample: A—.5/0 Collected by: _�.. P&, r k let i.tdC
B. SEPTIC/HOLDING TANK DATA
TankType/Material Anr.�erma T'..y I Steel. Dateinstalled_�O-R- A4
Tank size I-ASo gal. Number of Compartments -2L Cleanouts (YM) y
Foundation cleanout (Y/N) ii Depression over tank (Y/N) � High water alarm (YM) WA
Date of pumping -!-CW03 Pumper A
C. ABSORPTION FIELD DATA l50 TS
Date installed 1011 F4 Soil rating (g.p.d./fe or fe/bdrm) ,�d�' . t; System type &A
Length 36 ft. Width 10, ft. Gravel below pipe O.S ft.
Total depth 5 - (V ft. EH. absorption area %8F{ft2 Monitoring tube i Depression over field N
te.y
rS.
Date of adequacy test B- a3 - 4�1 Results (Pass/Fail) � For) bedrooms
Fluid depth in absorption field before test! in. Water added60Vgal. New depth_ in.
Elapsed Time: Q' min. Final fluid depth _� in. Absorption rate >= S Soco g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) Alone known If yes, give date --
I
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
'Pump on" Is at _ in. 'Pump ofP level _ in. High water alarm lev in.
Datum Cycles le Meets ala rcuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot —LOA—'— On adjacent lots 115'
on adjacent lots 135'—
Absorption field on lot (ty i
Public sewer main Nf'� Public sewer manhole/cleanout
Sewer /septic service line 84� Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
I pe > D
Building foundation $ • r.� Pro Irne
rty '
Water service line > 50— Surface water /✓ �•
Absorption field r% t
Water main
Wells on adjacent lots (�_
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 7 10 Building foundation > 10 Water main
Water Service line — Surface water /1s', Q • Driveway, parking/vehicle storage > 10
Curtain drain N. O. Wells on adjacent lots _
lail
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in etfecctt on this date.- '0
Engineer's Printed Nam�ne1 �1 C (abert 4aV
Date ---- a� otb0�
HAA Fee S
Date of Payment__2 5�
Receipt Number rJ 7 �� Yt1h
(Rev. 12101)
Waiver Fee $
Date of Payment
Receipt Number
09-03-04 O9:ITAW FR011-CTIE Ell, SCS ENV SERVICES
,R.rvs
SCS Ref*
1045382001
Client Name
Tobben Spurkland P.E.
Project Name/to
Paradise Valley B7, LI
Client Sample ID
Paradise Valley B7, LI
Matrix
Drinking Water
Supple Remarks:
9075615301 T -19C P.02/03 F-553
All Dates/Times are Alaska Standard Time
Printed Date/rime
09/02/2004 9:19
Collected Datdrlme
0823/5004 15:30
Received Datomw
08/23/2004 16:03
Technical Director _
StephAAC. Ede
Puamuer ltn'ks PQL Units Method Conounor ID Ali enable Prep Andyna Ink
Waters Departmortt ,
Nitratc•N 0.630 0.100 mvt EPA 300.0 B (<-10) 08/213/04 JIB
Microbiology Laboratory
Total Coliform 0
COVIODmL SM209222B
A (v'1) 0&73/IW DKC
09-03-04 09:1SAN FROM-CTLE ESI. SCS ENV SERVICES 9CT5615301
-� SGSICTBE ENVI�}AIpjNTV §ERVICEs
Drinking Water Analysis Report for Total Coliform Bacteria
' MAO INSTRUcrdw oN R wmw siou BQatR cmmcnm aAmj
MUST BE COMPLETED BY WATER 8UPPLIER
❑ PUBLIC WATRR SYST110 lie
CILMWATE WATER SY"M
❑ W 4 MONAS 0 New t+vabe 0 saes RMAS
SAMPLE COLLECTION: _
M1.�'wl.. wIy
Oew Dn
SIMPLE TYPE:
T-990 P.03/03 T-553
200 W. POTTER DRIVE
ANCHORAGE. ALASKA 99318
Tal: 9U7-882.2343
Fax 801.881.5301
r Leb M Ne.
�
10��uII453�jjppIIrC8r2 %--t�-
1
0swwbrow"
xFowne ❑ Treated Water
Report sampia +IzUrM»aledWatar
(nlar to bb no. 1
spacial Purpose
TnneraM
a tab DY. lAftma as ooReeter ON»r
TO BE COMPLETED BY LABORATORY '
Sample ReceidnB:
Date: -23 t`1% {]a.RM.ev«Toh wcw
TNr)e: v PA@.M may be.rvdMM
II
Tamp: aua ❑ w mw" -m
Delivery MetC{ �/� FW R
Received BY: fs . S -r
Conon• w
❑ RUSH SAMPLE.
Photo is
Fax R.
..........................................................................................._...................................................
Pact��olooleal Water Analysis RectorSWde ADM
M104WO(P/A) MSULTS: ANC FBK NN
AnaITeN R.yn��33����o Taw Corton: 10awTm-,
Analyst E Cat:
Anelyecel Wtbad:
Membrane FNer
MMOaMUG (P/A)
MIMBRANR FILTER REaULTa:
Cm Cant � � Czar 00rnL
vennmmn:
eco:
Sent r tient
Phoned [] Razed 0
D.rnRM:
3ooie.el7r
® Satisfactory
❑ Unsatisfactory
TNTC.Te. n..w.rsat
Reported BY: I, Detert(me:qE4#-q ll�' w •on..e..r...
34n....
Forma FW 009 12A7103
�t ��
Municipality of Anchorage .....
Development Services Department
Building Safety Division
Onsite WaterWastewater Program
4700 Soo uthS
P.O. Box 196650 Anchorage.
L
AK 99519-6650 s
www.cl.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-413-20
1. GENERAL INFORMATION
�t.I sH- `lam
O~�
RE–ISSUANCE OF HAA 010628
HAA# 0.17 012 Jq
Expiration Date: g – 8 ' O �–
Complete legal description PARADISE VALLEY: LOT 1. BLOCK 7
Location (site address or directions) 18011 GOLDENVIEW DRIVE ANCHORAGE, AK 99516
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
CHARLES TREINEN Dayphone 345-2414
18011 GOLDENMEW DRIVE ANCHORAGE, AK 99516
Day phone
BETH WEISER m PRUDENTIAL JACK WHITE Day phone
3201 'C' STREET SUITE 200, ANCHORAGE AK. 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
N
Individual Water Storage
❑
Community Class—Well
❑
Public Water System
❑
563-5500
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
N
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of
up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B
wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineers work.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $335.00 at, or prior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As,certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) 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(are) in compliance with all applicable Municipal.
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER do WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, SURE 2B • ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AWWC, Ina attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Phone 337-6179
Date
bedrooms, with the Blowing stipulations:
l/ Manitenance Agreements
Supplemental Engineer's Reort
Other
fr A. A Wess
-7953 :,
N
'ap
�
Pro lee elo��e
ON-SITE -
WATER AND
WAST WAT R
PROGRAM
By: (L �%X /�� �C / —�� Original Certificate Date: �' - .�. ' G
��-77�
(Re,. 12101)
I' Municipality of Anchorage
Development Services Department
Building Safety Division `
On -Ste Water b Wastewater Program ' I
4700 South Bragaw St.
P.O. Box 1966W Anchorage, AK 995198&50
www.ci.anehorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: PARADISE VALLEY, LOT 1. BLOCK 7 Parcel ID: 020-413-20
A. WELL DATA
Web type PRIME If A, B, or C provide PWSID# N/A Well Log (YIN) ' YES
Date completed 10/30/84 Sanitary seal (YIN) YES Wires properly protected (YM) YES
Total depth 208 ft. Cased to 22' (TO BEDROCK) ft. Casing height (above ground) 18'+ in.
FROM WELL LOG
Date of test 10/30/84
Static water level 44 ft.
Well production 1.5 9—
p.m-
WATER SAMPLE RESULTS:
Coliform --OL colonies/100 ml. Nitrate 0' zmggJL.
AT INSPECTION
11/8/2001
51 ft.
1.5+ g.p.m.
Other bacteria --O— oolonies/100 ml.
Date of sample: 5/22/02 Collected by. AWWC. INC.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date Installed 10/8/84
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES
Foundation cleanout (YM) YES Depression over tank {YM) NO High water alarm (YM) N/A
Date of pumping 11/8/2001 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA
Date Installed 10/8/1984 Sob rating (g.p.dJflbrtto�) 150 System type BED
Length 36 fL Width 19 ft. Gravel below pipe 0.5 ft.
Total depth 5-6 ft. Eff. absorption area 654 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 11 /8/2001 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth In absorption field before test 0 in. Water added750 gal. Now depth 0 in.
Elapsed Time: = min. Final fluid depth = in. Absorption rate >- 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (YIN 6 type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at
Cycles tested Meets alarm 8 circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhola/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'
Water main N/A Water service line 10'+ Surface water e90'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water e71'+/— Driveway, parkinglvehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS a 8/22/86 DHHS wArvER TO FIELD (TANK?).
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspectfons and
review of Munkipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Prints/ N�amfe JEFFREY A. GARNESS
Date t; `moo Z
HAA Fee $ RL61Je e •_J 150 o0
Date of Payment 5 -ay "oQ
Receipt Number dac @&3
(Rev. 12100)
Waiver Fee $
Date of Payment
Receipt Number
MY -23-02 04:06P11 FROWCUE ENVIRONIENTAL SRV
ALCT&E Environmental Services Inc.
rr�rirrrrrrrrrr�rrrr�
CUE Ret. o.
Client Name:
Project Name:
Client Sample ID
Matrix:
PWSID
Sample Remarks:
1022896001
AK Water 8 Wastewater Cons.
Paradise Valley 1-7. 87
Outside Hosebib
Drinking Water
n/a
9075615301
Client POA:
Printed Date/Time:
Collected Date/Time
Received Dale/Time
Technical Director:
T-975 P.02/02 F-502
rva
0523102 16:00
0522/02 14:25
0522/02 15:30
Stephe de
Allowable Prep Analysis
Parameter Results POL Units Method Limits Date Date Init
Nitrate 0.287 0.200 mg1L EPA 300 10.0 0522/02 JDT
Total Coliform (MF)
0 cov100 ml SM9222O
0228/02 SON
5-23-02;16:06 ;CT and E
JAP. CT&E Environma
LITHM Laboratory Divisior• o
y%
Drinking Water Ana' rpt timet.
READINSTRUCT t. ell ,�� `•�
MUS ro%e G A
W,PUBLIC-
O PRIVATE P
Aw C
i otal Colifon
d BEFORE COLLECTIM
ER SUPPLIER
O Send Reines Sead lnrolcr
.!. r.w. r +• an.u...
N Yrn !! al 1W !!
d�
♦Y 1.. p !
O Send Re+ulrt O Send lnvaJes
rw rL
v
SAMPLE DATE:
Month
/�S "AMPLE TYPE:
fQ� Routine
O Repeat Sample (for routine sample
with lab ref. no. )
O Special Purpose
SAMPLE LOCATION
1 C!I idl:s ��e L.1 7 tai
Comments:
22 0M
Day Year
O Treated Water
O Untreated Water
Time Collected
Collected By
1
:6616301
s 6/ 6
200 W. Potter Drive
n Bacteria Anchorage, AK 99518.1605
Tel: (907) 662-2343
F SAMPLE Fax: (907) 561.5301
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
Satisfactory
O Unsatisfactory
O Sample over 30 hours old, results may
be unreliable
O Sample too long in transit, sample should
not be ovcr3 Vhours old at examination
to indicate reliable results. Please send
new sample via specia deli ery mail.
Date Received 622 167 -
Time Received +� so -
Analysis Began (.01'17
Analytical Method:Membrane Filter
O MO -MUG
• Number of colonies/100 ml.
Lab Ref. No. Result" Analyst
1622$`tly
Sent to A.D.EC. Anch Fbks dun ❑
Faxed
Date: Time:
Client notified of sat y results:
Phoned Spoke with reed
Date: Time
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUC Result: Total Coliform E Colt
Membrane Filter, Direct Count C)Colonics/100 ml
Verification: LTB
rGB
COLIFIRM TNTC -Tea N..#,", To Cr..,
Fecal Collform Connrmatlon
Final Membrane Filter ResullttsColiform/100 ml
Reported By
U1- Tlme
,�`— ffate 7i _ hrs
03 • O1An aerarw
H
IrG %'s13s Member of the SOS Group (SucidtdGdndraledeSurveillance)
ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
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440 WrST RI'NSON BLVD. 0 103 (10.) 561-6676 LOT 1 / BLOCK 7/
ANCHORAGE. ALASKA 99503 (907) 562-529t
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N UCTION 4RVE7ORS-PLANNERS-ENGINEERS ASBUILT OC: Rf/I+/R60w^oN 1��rte ins- -S
440 WrST RI'NSON BLVD. 0 103 (10.) 561-6676 LOT 1 / BLOCK 7/
ANCHORAGE. ALASKA 99503 (907) 562-529t
"'T 23 ,°°' -: '" F" PARADISE VALLEY SUBDIVISION
2002rLr187A cn` o D 36m AEF: 64L7af
Municipality of Anchorage.,
Development Services Department
Building Safety Division , . ...
Onsite Water S Wastewater Program
4700 South Bragaw, St
P.O. Box 196650 Anchorage. AK 99519-6650
www.d.andwrage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL Iz. 1e •I
FOR A SINGLE FAMILY DWELLING
Parcell.D. 020-413-20 HAA# %1)4-151610
1. GENERAL INFORMATION Expiration Date: 2-10—o2'
Complete legal description . PARADISE VALLEY: LOT 1, BLOCK 7
Location (site address or directions) 18011 GOLDENVIEW DRIVE ANCHORAGE, AK 99516
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
CHARLES TREINEN Dayphone 345-2414
18011 GOLDENVIEW DRIVE ANCHORAGE, AK 99516
Day phone
PEGGY FRENCH w/ REMAX Day phone
2600 CORDOVA STREET ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
■
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
242-6121
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or
water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up
to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B
wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,110.00 at, or prior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site wafer supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. I further verity 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(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Finn ALASKA WATER & WASTEWATER CONSULTANTS. INC. Phone
Address 6901 DEBARR ROAD. SUITE 28 • ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines ti Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will K confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
337-6179
Date 11 Zo 01
Conditional approval for bedrooms, with the filowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineers Reort
Other
A. Garness;
—7953 e,
taPG
ON—SITE ••'ri;
—�NA.T€R Pls1D — M-
WASTEWATER
• oonr_onee _
By:7 Z.e-�,/ Original Certificate Date: I ✓Z ' % I
(R". ravo)
Municipality of Anchorage
Development Services Department
O"bwalarkwatswaterprogratri
471)0 South Bragew SL
P.O. Sox 108850 Affdrorage, AK 085168850
wwWAmichorege.ak us
(907)343-7004
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: PARADISE VALLEY: LOT 1, BLOCK 7 Parcel ID: 020-413-20
A. WELL DATA
Web type PRWATE N A. B, or C provide PWSID# N/A
Data completed 10/30/84 Sanitary seat (YM) YES
Total depth 208 It. Cased to 22' (TO BEDROCK) R.
FROM WELL LOG
Date o}test 10/30/84
Static water level 44 S.
Well production 1.5 —g.p.m.
WATER SAMPLE RESULTS:
Web Log (YM) YES
Wires properly protected (YIN) YES
Casing height (above ground) 18"+ in.
AT INSPECTION
11/8/2001
51 fL
1.5+ g.p.m.
Coliform 0 colonieaM 00 ml. Nitrate 0.5 mgJL. Other bacteria 0 coloniesl100 mi.
Date of sample: 11/8/2001 Cogen by. AWWC. INC.
B. SEPTICIHOLDING TANK DATA
Tank TypelMaterlal STEEL Date installed 10/8/84
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YM) YES
Foundation cleanout (YIN)YES Depression over tank (YM) NO High water alarm (YIN) N/A
Data of pumping 11/8/2001 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA
Date installed I0/a/19a4 Sog rating (g,p,dm'o�)150
Length 36 fL Width 19 fL
System type BED
Gravel below pipe 0.5 It.
Total depth —L--6—fL Eff. absorption area 684 ft' Monitoring tube YES Depression over ffetd NO
Date of adequacy test 11 /8/2001 Results (Pass/Fall) PASS For 3 bedrooms
Fluid depth In absorption field before test E in. Water added 760 gal. New depth o in.
Elapsed Time: = min. Final Auld depth= In. Absorption nate x 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN K yes, give date —
D. LIFT STATION
Date installed
'Pump on' level at n.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level
Cycles tested Meets alarm is circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tan0ft station on lot 100'+
Absorption fleld on lot 100'+
Public sewer main N/A
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/deanout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'
Water main N/A Water service One 10'+ Surface water •90'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property One 108+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water '71'+/- Driveway, parldng/vehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent Its 100'+
F. COMMENTS ' 8/22/86 DHHS WAIVER TO FIELD (TANK?).
G. ENGINEER'S CERTIFICATION
1 certify that I have detennined through field inspections and
review of Municipal records that the above systems ere In
cordormence with MOA HAA guidelines in effect on this date.
Engineer's Printed/Na%� JEFFREY A GARNESS
Date is / 7-70,
HAA Fee $ 100 • "
Date of Payment IQ— r%- O
Receipt Number 0/,3 095
014W. 12=)
Waiver Fee $
Date of Payment
Receipt Number
f� MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PR(, (ECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
/ r . f n. • i / If // -
Location (address or directions)
rv�// ��: /nen r/e'er•
...........
(b) c Applicant Name ��
-,Applicant Address
(c) Applicant is (check onb): Lending Institution ❑
Telephone:
Owner/builder Cg; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate_ Company and Agent
Telephone - r
(t) Mail the HAA to the ollowing address:
v Clt c� is !� t -,c
AcIt r -aye .¢K 99J'/9
2. TYPE OF RESIDENCE
Single-Familyl Multi -Family ❑ Other
_ 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 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 (11,54)
5. ENGINEERING FIRM PROVIDING SPECTIONS, TESTS, FILE SEARCH, DAI 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 5- Telephone
Address h cT ? 4 f� �
Date 94/j 4 7
•'
2
OY C Rat), JR.(`' f
i"r'S�Seial;
+,1
'
jr'•......••• �p�
��*`7= ioy�•�
6. DHEP APPROVAL
Approved for �3)bedrooms by e `^ �""� Date �o—Z-3yz
Approved Disapproved Conditional
Terms of Conditional Approval
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 11 vBp
MUNKIPALITY OF AN040RAG!
DEPT. OF HEALTH 6
ENVIRONMENTAL PROTECTION
OCT 21987
A. WELL DAT RECEIVED,
r1
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Le/gal Description: //L>,-"o/L>,-"o/
<U 5 /
Z_;e / //l%irK % �JfD tai rP L1r//ft.
Well Classification V" If A. B. C, D.E.C. Approved (Y/N)
Well Log Present( N) Date Completed /rLq/R SY Yield S•3;�/"s ��Te�J
Total Depth Q n S" Cased to ZZ- Depth of Grouting u^ k
Static Water Level rr' Pump Set At v^k
i
Casing Height Above Ground Sanitary Seal on Casing 67N)
Electrical Wiring in Conduit (ON)
Separation Distances from Well:
Depression Around Wellhead (Y16P
To Septic/Holding Tank on Lot ,/ 0 3 ; On Adjoining Lots /00.1,
To Nearest Edge of Absorption Field on Lot 3 y ; On Adjoining Lots
To Nearest Public Sewer Line /t/1.y To Nearest Public Sewer
Cleanout/Manhole 6V_2t To Nearest Sewer Service Line on Lot NVQ
Water Sample Collected by 4 • A7� • ,( ; Date
Water Sampl
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed w Size / Z SO No. of Compartments y
Standpipes( /N) Air -tight Caps#?N) Foundation Clean/'out 6N)
Depression over Tank (Y6P Date Last Pumped (eC 1?27
Pumping/Maintenance Contract on File (Y/N) N�� ; for
Holding Tank High -Water Alarm (Y/N) NSA Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank
To Water -Supply Well / V.3 To Building Foundation
To Property Line 79 To Disposal Field 5
To Water Main/.Service Line t) To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72-026(11/67(
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata / Sy Type of System Design
Date Installed /0 /f -/I- Y Length of Field -3G
Width of Field f / Depth of Field s '9L 7b Axe
Gravel Bed Thickness 0'5
Square Feet of Absorption Area G K Standpipes Present (9N)
Depression over Field (Y(p Date of Last Adequacy Test %�`�g 7
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well
i
To Property Line 77
To Building Foundation 3 Y. r To Existing or Abandoned System on
Lot NSR ; On Adjoining Lots > �yo�
To Water Main/Service Line �,� n
To Cutbank (ii present) 3Jr-
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments.' 6// 'Ks h<W cKrrGs s/o/e Syr .-.
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
:=Vent
"Pum Level at
Vent(Y/N)
•• Check Permitted Bedroom Rating Against HAA Request ••
Pumping Cycles during Adequacy Test. Meets MOA
Icertify that Ihave ecked,verif1 d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date 2
Company c T e_ MPA No.%`O ZY -VO.AL.1 cit+
Receipt No Ni/ r,,;0C
0Date of PaymentAmount: $ i-- ,•;�' jr
�a+1i1 ,.•.ci�ar
Page 2 of 2
72-026 tl 1,84)
rhi MUNICIPALITY OF ANCHORAGE
DEPARTM_..r OF HEALTH AND ENVIRONMENTAL Pt 1ECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date Z re'
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
L eT / BLOM 7 ?RA -015,5_ 1111"il -7-//.,/ 23d 5a!- /
Location (address or
(b) Applicant Name C4W_W 0410f71911/ Telephone: Home 3j'5-53GG. Business _
Applicant Address W.O. &V GG44 AAlell - '�qX• %is1
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain);
(d)
Lending Institution �� Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑ Other
Number of Bedrooms 3
AAr-lZ.s A.
D6 ox
Iitckioret<.c
L k I- IS 41
G14'9
4 l c �I c`17 !r -
3. WATER SUPPLY
Individual Well' Community ❑ Public ❑
Note: It 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 (11/94)
L/ G 7 Y/J'C'fe t. Yptta y
5. ENGINEERING FIRM PROVIDI'*INSPECTIONS, TESTS, FILE SEARCH, D^1 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 OFI""
Address
Date -'9 nir
6. DHEP APPROVAL
Approved for
Approved
Terms of Conditional Approval
Wt't-c'- �
Telephone . SW SG 1/0
%73`v�
A:f+-4
m
OF At
ome r' al
C. REID, J2.
-2251 a
�a�
AF
'Pmles%w_-
cu-c-a-�' / Ka -ry mate � ��
by
Conditional
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
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)
MUNICIPALITY OF ANCHORAG:
t DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984 APR 3006
264-4720
Legal Description: 1-D•T/ Btcee A �VEQ
0= T//A/ R31 -i sez i/
A. WELL DATA
Well Classification ��/IIf A, B, C, D.E.C. Approved (Y/N) W/A
Well Log Present�N) Date Completed 10'30-T`f Yield /•s 6iN
i e
Total Depth ZOS C�aL ed to ZZ Depth of Grouting ^�
Static Water Level 'f Pump Set At 1 f4
i
Casing Height Above Ground Sanitary Seal on Casing Y N)
Electrical Wiring in Conduit (Y N) Depression Around Wellhead (Y�
Separation Distances from Well:
To Septic/Holding Tank on Lot < ; On Adjoining Lots �� f
To Nearest Edge of Absorption Field on Lot /7-0 ; On Adjoining Lots
To Nearest Public Sewer Line W114 To Nearest Public Sewer
Cleanout/Manhole _ 64A To Nearest Sewer Service Line on Lot gs,
Water Sample Collected by /CS �' ; Date
Water Sample Test Results SSf/i�TK'�
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed O" .g Size /Zsn 61ft' No. of Compartments 71—
Standpipes&) Air -tight Cap (Y ) Foundation CleanoutY/ )
Depression over Tank (Ye Date Last Pumped 0
Pumping/Maintenance Contract on File (Y/N) ; for 7
Holding Tank High -Water Alarm (Y/N) W14 Temporary Holding Tank Permit (Y/N) �014
Separation Distances from Septic/Holding Tank:
To Water -Supply Well /� S To Building Foundation
To Property Line S� To Disposal Field s
To Water Main/Service Line A To Stream, Pond, Lake, or Major Drainage
Course 7J' f -ON blydd a / PcfuW,A ST•
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata %'y Type of System Design $tD
Date Installed /0—g - s/ Length of Field 36 /
Width of Field /9 ' Depth of Field 3 s' +
Square Feet of Absorption Area
Depression over Field (Y N9 _
Results of Last Adequacy Test
I Gravel Bed Thickness
�8y StandpipesPresent(9N)
Date of Last Adequacy Test �✓,�/�
Separation Distance from Absorption Field:
To Water -Supply Well 17-0 To Property Line
To Building Foundation
Lot
To Existing or Abandoned System on
i
On Adjoining Lots �'
To Water Main/Service Line /Q To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course 7/ A/TG/ et/ 2ch1h✓14
To Driveway, Parking Area, or Vehicle Storage Area S t
Comments
D. LIFT STATION
Date Insta
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)
•• Check Permitted Bedroom Rating Against HAA Request •.
Cycles during Adequacy Test. Meets MOA
Icertify that lh/a h ed,v tied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed `^�l L — Date
Company
ARC'S IA& - MOA No. �3'S—oas! •E OF AJ 4s.
7
Receipt No. 3s Op. ---, 1 'l
Date of Payment y' 3b'��
Amount: $ "S`,'
Page 2 of 2
72-026 (11,94)
r)
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
July 21, 1986
Alaska Environmental Control
Services, Inc.
ATTN: Leroy C. Reid, PE
1200 West 33rd Avenue, Suite B
Anchorage, Alaska 99503
SUBJECT: Lot 1, Block /C, PARADISE
Anchorage, Alaska Lof
Dear Mr. Reid:
BILL SHEFFIELD, GOVERNOR
274-2533
a3A13J38
9961 z z 7%
"OUD310dd 'rvlN3onr
y1V3H i0 1d3o ArV3
d0 44Wd01NnW
VALLEY SUBDIVISION `,
T3/0G� ?.-%wi-�.wn+Ft. � Itvy
The Department has reviewed your July 9, 1986 letter on the
subject project in which you requested that a waiver denial by
the Municipality of Anchorage be overridden by this office.
This office is not in the position of being able to overturn a
waiver denial by the Municipality of Anchorage unless it is
found that they have not been stringent in enforcing our
regulations.
The definition of a small stream is a difficult one to
ascertain at times. Ue have conferred with the Municipality of
Anchorage on this issue and agree with them that this be
classified as a stream because of its continuous flow even
though the flow is low as you have indicated at 0.9 gpm, and
the stream goes underground in certain areas.
Ue regret that we cannot help you in this instance. Appeals
for denial of the waiver will have to be filed for through the
Municipality of Anchorage.
Sincerely,
teve�n PE
District Engineer
SUE:pkk
cc: James Hayden, ADEC, AUDO
Bruce Erickson, ADEC,_Anchorage._.._.._.,...._,
Steve -Morris, Municipality—of Anchorage,
Municipality
01
Anchorage
June 4, 1986
e".
P.O. BOx 196650
ANCHORAGE. ALASKA 99519-6650
(907) 2644111
TONY KNOWLES.
MAYOR
DEPARTMENT OF HEALTH 8 HUMAN SERVICES
Leroy Reid, Phd., P.E.
Alaska Environmental Control Services, Inc.
1200 West 33 Avenue, Suite B
Anchorage, Alaska 99503
Subject: Lot 1 Block 7 Paradise Valley Subdivision
Waiver Request, WR86-065
Dear Dr. Reid:
This department has reviewed your request for a waiver for the subject
lot, and upon consultation with the State Department of Environmental
Conservation (ADEC), your request has been denied. Your request was for
a waiver of the 100 foot separation distance required between a stream
and absorption field. This "stream" is located 71 feet away in the
drainage ditch along Romania Drive.
ADEC has defined surface water (waters requiring a 100 foot setback from
septic systems as stipulated in 18 AAC 72.021 (e)) as any surface water that
is not directly attributed to rainfall or snow melt event. In a letter
dated February 10, 1986, Mike Lewis of ADEC specifically references this
definition to this "stream" as it impacts setback requirements in Paradise
Valley. It is apparent that because this "stream" along Romania Drive
flows through most or all of the non -winter months, it must be considered
a surface water requiring the appropriate setbacks stipulated in 18 AAC 72.021
(e).
You have asked that the department provide options to your client, Charles
Christian, so that a waiver may be obtained. The department has discussed
the possibility of enclosing this stream in solid culvert with ADEC. This
option is acceptable, in concept, to both this department and ADEC. Engineering
plans for such an option have to be reviewed prior to approving a waiver,
however.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
cc: Charles Christian
P.O. Box 6648
Anchorage, Alaska 99502 Code 04
Lef ( BQ.ak 'r
n
��
Cl/-,-.- r
-7/ /
—Lill co C> J,
au.._�e
r_I
Alt Vv,grrfz rA2&_E
IN 01 cA TL`D
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rr I ^2
r
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n n,
ALASKA CHUIR0f1 nTAL C0nTROL SNICCS, IX
Engineerinq 6 Enuironmental Studies
May 7, 1986 MUNICIPALI7y OF
Municipality of Anchorage ENVI N
DEPT OF HEALTH,,DRAG`
D-partment of Health b Human Services ON E qPROTECTION
825 L Street 119pY �
Anchorage, Alaska 99501 8 19*
Attn: Susan Oswalt
Ro: Lot 1, Block 7, Paradise Valley R ECE I VE D
This is a request for a waiver of distance from the absorption bed to the road
ditch.
In October 1984 when the system was installed the ditch to the south of the lot
was not a flowing stream. It was a road ditch that handled the normal drainage
from Austria and one block of Romania. The bed is 71 feet from the ditch and
located at 6 feet of elevation above the ditch. The soil under the bed are
poorly graded gravels to a depth of 9.5 feet below the system. At this point
there is fractured bedrock. The system is 6 feet above the bedrock. The system
is nearly one bedroom larger then needed since the soils rating was rated up
from 125 to 150 as an extra safety factor. This will spread the waste stream
over a larger area which would greatly reduce the possibility of untreated water
reaching the ditch.
Assuming a normal parabolic flow, this would enlarge the soil filter area to 920
square feet at 2 feet under the bed.
At a realistic loading of 50 gpcpd and 4 persons in a 3 bedroom house the
loading would be 0.2 gpd per square foot. At the full design loading of 450 gpd
the loading would be 0.49 gpd per sq.ft.
Because of the sandy -gravel the filtering capacity would be very good. The water
in the ditch should not be affected by the system. It is not expected to create
a health hazard. There is a homeowners group who are working on resolving the
drainage problems in Paradise Valley. At any rate this homeowner should not be
penalized for something beyond his control.
A waiver to a distance of 71 feet to the "stream" is requested until the issue
of drainage in Paradise Valley is resolved.
If the waiver is denied, please outline options which he may follow to obtain
approval.
Thank you.
Sincerely,
Leroy C. eid Jr., Ph ; PE
President/
1200 West 33rd Auenue. Suite B • Anchorage, Alaska 99503 • (907) 5615040
ALASKA ENVIRONMENTAL
CONTROL SERVIC^, INC.
1200 West 33rd Ave&- Suite B
ANCHORAGE, ALASKA 99503
(907) 561.5040
JOS "T / Piloee 7 Plo l)1l ✓/ wl/
SHEET NO. Ql , OF
CALCULATED By /� • DATE • 2� ��
CHECKED BY DATE
_.._ /:30
ALASKA ENVIRONMENTAL
CONTROL SERVI , INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561.5040
Jo. Loi ae.^Cct 7 /�ifl�sa' ✓lnurj�
SHEET NO. / l OF
CALCULATED BY �' ^' CN DATE
CHECKED BY / DATE
/�s
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
1. GENERAL INFORMATION /
(a) Le�aa Description (include lot, block, sub/ vvision. section, tgwnship, range)
l4i3n/�/i.1/ �1 1_45114.i .fi�/.tom /ri`'%///V
or
(b) Applicant Name k^'1'eleph ne: Home R siness �� �fL
Applicant Address vv
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder,l"\Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution _L_LJL
Address
(e) Real Estate Company and Agent
Address
Telephone
(1) I
'�—b J —
r i a� Telephone' Ca
2. TYPE OF RESIgENCE
Single-Famil Multi Family❑ Other
Number of Bedrooms_77
,�r/1111 t1\
3. WATER SUPPLXj
Individual Wetl Community ❑ Public ❑
Note: 11 community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
t
Onsita Public E3Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
i Page 1 of 2 72-0nnve4)
i
n
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
A
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 aCequale
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information ot!ared
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. /'
—Telephone-21���y
Name o1
Address
Date o
/rl
aw
DHEP APPROVAL '
Approved for T� �� bedrooms by 0-.t_X 0' Date
Approved Disapproved Conditional
Terms of Conditional Approval
Ilii i \ "'',
CAUTION
`L
...............•...
cy C. IL -id. Jr. •�'
No.2251.E •=� ;.;
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 cr
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineers work.
Page 2 of 2
F 72-0251111114)
round • hou.oa builderr, kmic.
118 June 1985 /
• a� was fi salt
� w
Municipality of Anchorage oGid(AA_1V1
Department of Public Works
3500 E. Tudor Road
,Pnchorage, Alaska 99507
Dear Sir: lorLf
i
As per the June 17 meeting with DEC concerning various drainage
problems within the Paradise Valley Subdivision the following
system is proposed to be installed to divert the existing drainage
off Lot 4, Block 9.
1. The existing 18" culvert running under Romania Drive
' between Lot 20, Block B and Lot 4, Block 9 will be
abandoned. (Culvert.will be dug out and roadway filled
with gravel.)
2. A new 24" culvert with thaw pipe will be installed at the
Intersection of Austria Drive and Romania Drive.
3. Existing drainage ditch on Northside of Romania Drive
to be extended approximately ADOLF to existing 30"•
culvert at intersection of Romania and Goldenview Drive.
a. Ditch to be a mininum of 24" deep with 2:1 side
slope and a 18-24" road shoulder.
b. Culvert to have a mininum of 24" fill over top of
I culvert.
roposal Respectfully Submitted,
I+ROBERT L. TAMBURELLI
;Enclosure
IRLT:da
2/.rn w b..re—......1 1, onriG 2AC 201C
6
^ LL E
2G,538 29,803 L 11 r:ti ;O• 21,871 ^ 18,134 6 1
ue
4
GY� ° \• 25,380
liq• \ �- •�` '� / ti • .O ` / ✓✓✓✓ t p^ 1.
rn•u•J• I c 1ko
.. 1414 1 n
,7 3
.. • 1•fa�\ �V1 ^ J
�1 n 0 \ 17,147 • i
j • l . . �, : 19.265
I, r I % i .^1 \••
6
12,992 \ •``. b-0
`• i; 19,918 ! '� '• ,�• 1 �• �$o `�i
19
• j .y , t/ w ;S ^ 19,683 ! IPj♦ / ' 114,498 •+
i J' '` , �'`is •° .7 '• '3 ' • °O\�i q + 17,4491
• ` 1 �,a
•/ '•lf z4a>6 q d•
35
..,1 21,237
• ° : •.. 241Fr .Q
• g r .� • f e
a11,'1, .I • ''Z efI\all'ee•• .-J• n. �a1 �eaa 5 •q 4
�W ne.f� •-1 ,•�,y'eo .'• .11 �T 23,823 f♦q
e 34 + 6
[5,372 r �• ti * • �a • 24,031
so
/ i a
27, 813 / e ` �. / ' 23,432 .
i32
��,.° ¢ • 29.036to
a •
1
•` 31 `
33 589
• .•� � ..,,0 ,�J} `• •• \\
% ♦ °.
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+ 30
37.421 �\
ir
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�Fai1
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• P YM {
c
.�t'j'�aif•.��'j(+c�i �.�`Y+. w f•.. r..I .t1', 'i �'ty��,
• 1
.. r. n
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 S
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
Applicant Name CV-LP41' S ChY1-41bhl9elephone: Home 'V4-828(0 Business - Z72 -'W11
Applicant Address P-10. &ole 66.16 Arr`ror� _ Alrst� 99�oz
Applicant is (check one): Lending Institution ❑ ; Owner/builder(; Buyer ❑ ;Other ❑ (explain); -
Lending Institution
Address
Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
Telephone
0
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑ Other
Number of Bedrooms 3
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
Onsitek Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have wri!ten confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11$41
r1
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 &ilzrdtwe/�/ CrW76-10kt elephone —561-5040
Addre
Date
Cone�,�/ons/ e
C0t7c ,U;1- f0 peopn� yl, Owl tsl1rjnG a7� 44.1C-11
x
A
VC.R"Jr.
No. 2731-E ,r.
6. HEP APPROVAL
rcvod-tor N bedrooms by - Date
Approved Disapproved Conditional X
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 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 (11/84)
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIR0M ENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
(a) Legal Description
Location (address or directions)
Application Date ,1"5 I&S
subdivision _section, township, range)
Applicants Nam a7s/-P.2f<i
(b) A
pp e��e,P t �,��' � Telephone - Home_.
Applicants Address
(c) Applicant is (check one) Lending Institution ; Owner/builder
Buyer ; Other E:::l (explain);
(d) Lending Institution Litt :4 -ed q « k A �ks A q Telephone 7 F& 63Z) -q
7
Address If o 6 - 3 (o %"- A L/ -e- 4 &c c, k e rei -< A /G cl 9sb 3
(e) Real Estate Co. 6 Agent
Address
Telephone
(f) Mail the HAA to thefollowing address:
Gl�q/les 14 C ILr:S l /kms
O 9 L
nc-e r e�5 c- 14 /4sk•7
2. Type of Residence
Single -Family M Multi -Family Other
Number of Bedrooms
3. Water Supply
Individual Well Community 1= Public
of k. "A
to
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 Q Community Holding Tank Q
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 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 regula-
tions in effect on the date of this inspection.
Name of
Address
Da
6. DHEP Approval
Approved for t bedrooms
•
(ENGINEER SEAL)
Approved Disapproved
,/_ Telephoned%/—Swo
0 Ai, 41t0
ar .•• .,,S,IP..
P. uiu• y.•..w• •ewn'• [7
d•• ' /Le v C •Raid, Jr.
♦� �J' '•, io. 2251 1 .' ;• � � ;'
— �,F_GDate 7
tional ✓
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIROMIL'NTAL 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 DUEP DOES THIS AS A COURTESY TO PUP,CHASERS 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 RESPO%SIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
a
MUNICIPALITY OF ANCHORAGE
• . �� Irl DEPT. OF HEALTH &
�. ENVIRONMENTAL PROTECTION
MUNICIPALITY OF ANCIDRAGE (MCIA)
HEALTH AUTOCIRITY APPRCKML ( HAA) APR 10 1985
CHECKLIST - FEBRUARY 1984
RECEIVED
j A. WUL D1M% Legal Description:
Well Classification If A, B, cc Cr D.E.C. Approved(Y/N) IIIA
Well Log Present Y@1) Date Completed /o/3ot-y Yield ,s
Total Depth ao8 ' Cased to a; Depth of GroutingNonJs'_
Static Water Level q4'- Ptmlp Set At d&t1Ld., g & /vs
Casing Height Above Ground // Sanitary Seal on Casing N)
Electrical Wiring in Conduit (YA Depression Around Wellhead (Y,O
Separation Distances from Well:
To Septic/Holding Tank on Lot :D3 � s On Adjoining Lots i�
To Nearest Edge of Absorption Field on Lot Lj.�( �s On Adjoining Lots..4
To Nearest Public Sewer Line A)tA- To Nearest Public Sewer
Cleancut,/Manhole 01A- To Nearest Sewer Service Lins'on Lot AJ/A-
Water Sample Collected By s Date 71i'l�rS``
Water Sample Test Results
I
B. SEPTIC/HDLDIM TANK DATA
Date Installed VOIA4 Size I.26'40 No. of Cotpartments Z
Standpipes MIN) Air -tight Caps ft _ Foundation Cleanout _
Depression over Tank (Y Date Last Pumped
PumpinWVAintenance Contract on File (YIN) JJ/,+- s for 7)
Holding Tank High -Water Alarm (Y/N) ASIA Temporary Holding Tank Permit (Y/N)AJIA
Separation Distances from Septic/Holding Tank:
To Water -Supply Wall IO.' To Building Foundation ,21r B.5,
To Property Line 77 '-f To Disposal Field S
To Water Main/Service Line Nlk To Stream, Fond, Lake, or Major Drainage
Cot so /DO!
Ccmwnts
(Page 1 of 21
ti✓
Receipt #
Date Paid:y-�v-4--
Amount:
2-15-84
T
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata &-0 Type of System Design BE,4
Date installed of Field 3(c"
Width of Field Depth of Field 3's"
Gravel Bed Thickness /to
Square Feet of Absorption Area G844d Standpipes Present Y i)
Depression over Field (16) Date of Last Adequacy Test �A
Results of Last Adequacy Test N/A-
Separation Distance from Absorption Fields
To Water -Supply Well /. z To Property Line 77/
To Building Foundation To Existing or Abandoned System on
Lot 'ylk t On Adjoining Lots 4.)6(- _
To Water Main/Service Line AJ IA- To Cutbank(if present).aS-14
To Stream/Por44Ake/cr Major Drainage Carse /p 0 '
To Driveway, Parking Area, or Vehicle Storage Area 94
Comments
D. LIFT STATION
Date Installed )V14- Dimensions 'VIA -
Size in Gallons tk Manhole/Access (Y/N) WA
"Pump On" Level at A'Iate "Pump Off" Level at A
High Water Alarm Level at NIA- Vent (YM) JOIA
Tested for N1A- Pumping Cycles doming Adequacy Test. Meets MDA
Electrical
Ccmments
** Check Permitted Bedroom Rating Against HAA Request *;
I certify that I have checked, verified, or conformed to all Mao RAA Guidelines in effect
on the date of this inspection. I _
Signed
KBI/d5
J1 ��iTII
00, /
l
(Page 2 of 21
Z
by C. Raid, Jr. • N
W. 22-51-E
CJJ
2-15-84