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Home My WebLink AboutTURPIN BLK 3 LT 14 & 15 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 00~ '- 0 ct ~ - I,s*'" ~IAA# ~/~x/c~/~¢'.~ \( 1. GENERAL INFORMATION Corn plete legal description Lots 14 & 15, Block 3, Turpin S/D~~ Lopat or~ '(Stte. address or directions) 641 East 8th Ave., Anchorage, AK Property owner . - f,~'¥'y .~t-rain Mailing address Day phone ~R-?T1R ..~ending agency ~Mailing address Agent' Mark Soquet/Soquet Realty Day phone Day phone Address 4155 Tudor Centre Dr., Anchorage, AK 99508 229-0045 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ? TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~)25 (Rev. 1/9~) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my sea~ affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the num her 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 S .... & S ENGINEERING Phone 4; '1 ~ - ~.c/ -7 ~' I/u:~4 Eagle River Loop Road No, 204 Address Eagle River, ~,JasJ~a 99,~ ~ Engineer's signature ~/L~/5~ ~ ~"----~'~' Date ~'/'7 /~/'~ DHHS SIGNATURE /J Approved for '7 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. AUG 0 Municipality of Ancherage DEPARTMENT OF HEALTH & HUMAN SE RVICES MUNI¢IPA~.I~¥ OF NVIRONM£NTAL ~ Environmental Se~ices Division ' ~wc~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegalDescription: ,~o~- ~5~ ~- ~ OL~-- 3 T'~,"z,%~--¢l ParcelI.D.: Co r~ _ 0~1~- A, WELL DATA : Welltype t~p'¢vA'r(- IfA, B, orO, attach ADEO letter. ADEOwatersystem:number Log present (Y/~ /~ 0 Date completed ?,~o,,L ~ o ~/~ ~ Total depth /~0~ ~ ~,~, ?Cased to~'°'4' ~ 0 ~ Casing height (above ground) Sanita~ seal ~/N) Y & y Wires properly protected ~/N) FROM WELL LOG AT INSPECTION Date of test Static water level " Well production'; g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: ~ / '// Nitrate ~), I Other bacteria O Collected by: S & S ENGINEERING 17~$,i Eagle River Loop ~oad Ne. 204 B. SEPTIC/HOLDING TANK DATA la,;A~., c- ~',f. ~..~,~ Eagle RIver, Alaska 99577 Date installed Tank size Number of Compartments Foundation cleanout ,,(~.~N) __ Depression (Y/N) High w~l"m (Y/N) __ Date of Pumping'/;~.i~' .'~J~'" ~*~ Pumper C. ABSORP;~ioN ;IELDDATA ';'"'~ '~ ~ , Date in;ailsd .......; ".. i~..i .Soil ratin~r fF/bdrm) __ Effective ~bso~ption area ~ ,...'~M~) Depression over field (Y/N) Date of adequacy test ~ Results, Pass/Fail) Fluid depth in abs~gr~ field before test (in.); Immediately after Fluid__ (ins)Minutes later: Absorption rate = P~roxide treatment (past 12 months) (Y/N) For gal. water added (in.): g.p.d. If yes, give date bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* ~at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main '7 ~ "-/- Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station '../ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line Absorp~ Water main/service line. Surface wateddrainage .,...---'""~'elis on adjacent lots SEPARATION DISTANCE FROM AB~ ON LOT TO: Property line ....--B'dilding foundation Water main/service line Surface water ~ Driveway, parking/vehicle storage area Curt~ Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certi~y that l have determined thru field inspections and rewew of Municipal recor~ IN~ystems are in effect on this date. in conformance witl2'A,~DA~l-It~ATguidelin¢s HAAFee $ ~D, ~ WaiverFee$ Date of Payment ~/~ /~' Date of Payment Receipt Number ~( ~D ~ Beck'pt 72-026 (Rev. 3/96)* CT&E Environmental Services Inc. Laboratory Division 200 w. Potter Drive Anchorage. AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 ChemLab Ref. Cf: Client Name: Project Name: Client Sample ID: Matrix: 98.4142-1 S&S Engineering n/a L14 & 15 B3 Turpin Drinking Water PWSID n/a Client POCf: n/a Printed Date/Time: 8/7~98 09:30 Collected Date/Time: 8/4/98 18:00 Received Date/Time: 8~5/98 14:40 Technical Director:. Stephen Ede Released By~ Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Total Coliform (MF) 0 co1/100 mi SM9222B 8/5/98 TMW Nitrate 0.1U 0.1 mg/L EPA300 10.0 8/6/98 RMV ~ DATE RECEIVED INSPECTION APPOINTMENTS ~-~'~.( -~ TIME TIME TIME ~UNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCHORAGE ( ENVIRONMENTAL SANITATION DIVISION APR 8 1981 Telephone 264-4720 DIRECTIONS: Complete all Carts on page 1. Incomplete requests will not be proce~ed, Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE PROPERTY RESIDENT {If different from above) PHONE PHONE MAI LING ADDR ESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5, LEGAL DESCRIPTION 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MU LTIPLE FAMILY WA ER SUPPLY 7. % INDIVIDUAL* []" COMMUNITY [] PUBLIC UTILITY NUMBER OF~BEDROOMS [] One [] Four [] Other ~,~ Two [] Five Three [] Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8, SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** ~,~ PUBLIC UTILITY .YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL ' DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []'INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: r'YPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDRO0/ S [] CONDITIONAL APPROVAl- (letter mu~]]cco~pan¥ certificate) 72-010 (Rev. 6/79) ~'~ / Department of Environmental Quality 3330 %" Street, Anchorage, Alaska 99503 274-4561 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: 3. Legal Description: 4. Location: Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR ~ ~~~~ Phone: 5. Type of facility to be inspected No. of bedrooms 6. Well Data: A. Type ~~ B. Depth foo C. Construction D. Bacterial Analysis 7. Sewage Disposal System: /,~~ ~ ~- Ao7'~/°~- A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Req~.~st for Approval of Individual S..er & Water Facilities ,Legal Description Comments ~y~/~ ~,~- /: Approved Di sapprov~ Date Approval .Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) 3330 GREATER ANCHORAGE AREA BOROUGH ~/¢~/~ Department of Environmental Quality "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES t. Type of Inspection: CMRO VA '~HA CONV 2. Property Owner: %--~r~y5 Mailing Address: ~L-~--~/-- L 3. Name of Buyer: __~'~'~/~ -. Mailing Address: Da~' P_hone Name of Lending Institution: ~¢::! $'/~ ¢t] _~'_/- ~', 0~:2/~ ~. Mailing Address.~.O'.~D~ ~o -~//~)' Phone~ 7¢ //~q"~/~ ~r~-~ Name of Realtor or Agent: ~ ~--~,(:: /~('~"~/ '~/ Mailing Address: <~//-/ ~'~.~'~jg~, I~eE~.. Phone ~')~/ 7~ Legal Description: Location: )IU- Type of Facility to b~ inspected: Water Supply Type of Supply: If Individual, If Individual, Public Utility Individual number of dwellings presently served depth of well /~ 0 Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation 1974 Glenn Phillips Able Realty, Inc. 814 [~est Fireweed t. ane Anchorage, Alaska 99503 SU.~O[;C~. On--ai~ sewer and water facilities serving Lots 14 & 15, Block 3, Turpin Subdivision Dear Hr. Phillips: At your request the above 'facilities were ~nspecte(I by this Department on August l, 197~,~. At tha~ time, it was found that the water serving the stoject property is via a private ~.;e']l ~hat is underground. In order to comply with the State Code of Ordinances the well casing must be reconstructed so it extends 12" above ground '~ ~ . I..vel or connect to a pui~'l i c ;.~a'ter sys tern, i'? avai 1 able. This Department can give 'its approval wheo a connection to public water or the well upgrade is accc~nplished, Sewage is disposed of via the Borough Sani~;ary Sewer System and is approved. If you have any guestions concerning the above please contact me at 274-4561. Si ncer'el.y~ C~ F. Sellers~ Environmental Control Officer CFS/ko