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HomeMy WebLinkAboutNADINE LT 20A1 NADINE PARK 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent A1 P~ Nadinc Krin~le¢ pioneer Home 923 W. Lot 20-AI; Nadi~e/Subdivision; 7880 ~dine Str6~ Day phone Ith Avenue, Anchorage, Ah. 99501 Day phone Day phone 52~-2350 Address / Unless otherwise requested, HAA witbe held for pickup. NUMBER OF BEDROOMS: /2 TYPE OF WATER SUPPLY: / Individual well / _ XX _ Community well / Public water / NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and Status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA~21 By: 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 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 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 ............ .. ~o2 ;~.{:.4 i,.:~ :~o4 ne Address -',~ ~ Engineer's signature Date Conditional Health A~hority Approval requiring/~e owner to enter into a Sewer Main Extension Agreement/ w~h AWWU and connecting to Public Water and Public Sewer by 15 July 1991. DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 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 E)HHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~025 (Rev. 1/91) Back MOA #21  Municipality of Anchorage ,./~"~ Department of Health & Human Service,~ HEALTH AUTHORITY APPROVAL CHECKI. IS'~v,~'~,~ Legal Description: ~E) -/'~ -~ A~,~d/~J~ _~.,&,N,. Parcel I.D. /~,D~ A. WELL DATA Well type ~.~/If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) 1 Date completed_ .~"~-~ -~ Driller Total depth / C2 / / Cased to ~ O / ¢' Casing height ( Sanitary seal (Y/N) f~ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test ~.272v- (oz¢ /-¢- ~--~ff Static water level ~O -~ ~ Well flow _ (g'~)O ~ ¢ ~ g.p.~- ~. ~ Pump level ~ ~ ~ ' g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ 0 Absorption field on lot (nO "{' Public sewer main Public sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout _ Petroleum tank I0o '"t' /oo lOC "/- WATER SAMPLE RESULTS: Coliform .~ ~q '~' % ,-J, ~ c."/'(2 r c/ Nitrate Date of sample: /--/' ~ ,~- -- Collected by: Tank size ~ Od? Foundation cleanout (Y/N) Other bacteria Compartments L.) Depression (Y/N) /k.) Alarm tested (Y/N) B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping 4 - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: -t Well(s) on lot ~ ~ On adjacent lots /~0 To pr,operty line I ~ '~' Absorption field L) ('~' Surface water/drainage / CO r~ Foundation Water main/service line_ 72-026 (Rev, 3/91} Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gall.gr~~'' -~\ Ve.[;~"/N) ~, %¢) ,~%mp'~n" level at High water 'alar~rr~6~ Meets MOA'e~l~¥rical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION'NT~ Well on lot On adjacent lots '""N D. ABSORPTION FIELD DATA Date installed "-' I ~ (¢ 4 Length (,2 ~. Width Total absorption area L~ Depression over field (Y/N) Results (pass/fail) ¢ ~ ~, Peroxide treatment (past 12 months) Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water Soil rating g-) ('~ System type ~,_) Gravel thickness L/~ Total depth Cleanouts present (Y/N) Date of adequacy test /-~ -- for .2, ~ ~_.0~ ¢' O0 A/~ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I~ 0 To building foundation On adjacent lots Surface water Curtain drain Onadjacentlots / ¢)(~ ~ Propertyline .~L To existing or abandoned system on lot Cutb,ank ~'-0 P Water main/service line E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ~7o34 ~,gle River Loop Roa~ No. 204 d'.;r~'~}~ ' ;?)'~ k .¢¢~' HAA Fee $ /,~¢ C._~-- Date of Payment /-/~/¢ - ~'/ Receipt Number =.~2~:~ // 72-026 (Rev. 3/91) aack MOA 21 Waiver Fee: $ Date of Payment Receipt Number April 11, 1991 ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL ~NSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Stre~ P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 20-AI; Nadine Subdivision; Request you issue a condition~ He~ Au~ho~ty Approval on the referenced property. According to the property owner the septic tank and seepage pit on the referenced property were instated in 1964. We observed the septic tank being pumped on April I, 1991. The capacity is approximately 900 gallons° On April 5, 1991 the septic tank was nearly full. During a well flow test the tank was filled. Another 600 gallo~ of water w~ added to the system w~hout adverse .effect. Municipal water is now available to the property. The buy~rs intend to extend Municipal s~r to the property and connect the residence to both Municipal water and sewer this coming summer. However, they wish to purchase the property a~ this t~e. Hence, the request for a conditiona~ Health Authority Approval. If you have any questions, or require additional information for yo~ review, please conta~ us. Sincerely, ROBERT A. SHAFER, P.E. RJS/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 EAST 296.76 201.6':t: 10' UTILITY EASEMEI~T L' WOOD EAN-TO SEPTIC VENT -X 3o.u- o /~. ,¥ 7,/ o' lO'x~O' ~ ~ ANCHOR EASEMENT EAST 296.80 ~,S BUILT 5Y!N SCALE 1' = 50' 33' PARCEL CONTAINS :97,896 ~ SQ. FT. EASEMENTS OF RECORD, 0~ ~AN ~OS[ SHO~ ON RECORDED P~T No. 67-155 , ARE NOT SHO~ HEREON. I hereby certify that I have performed a Mortgogee's inspection of the following described property : LOT 20-A1 NADINE SUBDIVISION Anchoroge Recording District, Aleska, end thor the im- provements situated thereon ore within the property line end do not overlop or encroach on the property lying odjocent thereto, thor no improvements on prop- erty lying odjacent thereto encrooch on the premises in question and that there are no roadwoy~, trans- mission iinee or other visible eosements on s(]id prop- erty except os indice+.ed hereon. Doted et Anchoroge, Aiasko this lOth .._doy of SEPTEMBER , ~9 90. LOUNSBURY & ASSOCIATES, INC. Surveyors, Engineere, ~ Plsnners 723 W. 6th Ave. ANCHORAGE, ALASKA 272-5451 GRID~ 2234- FIELD BOOK No, 90-1086 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA99518 TELEPHONE (907)562-2343 ANALYSIS REPORT BY SABLE fez WORKorder! 32967 Date Report Printed: APR 3 91 8 17:27 FAX: (907) 561-5301 Client Sample ID:L20-AI NADINE PWSID :UA Collected APR 2 91 ~ 13:50 h~e. Received APR 2 9i ~ i6:40 ks. Preserved with :AS REQUIRED Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO { PO N NONE RECEIVED O~dered By :R. S?b~EER Analysis Completed :APR 3 91 Send Reports to: Laboratory Super~lso_f=_~. T?NEN C. EDE 1)S & S ENGINEERING Chemlab Ref t: 911199 Lab Smpl ID: 1 Matrix: NATER Allowable Parameter Tested Result Units Method Limits NITRATE-N ND(O.iO) mg/1 EPA 353.2 10 Sample SABLE COLLECTED BY: RJS. Remarks: I Tests Performed · See Soecial Instructions Above UA-Unavailable ND- None Detected "See Sample Remarks Above NA= Not Analyzed LT-Loss Than, GT-Greater Than ~!~;;;'."*"~ Drinking Water Analysis Report for Total Coliform B~totoda '~ TO BE COMPLETED BY WATER SUPPLIER TO DE COMPLETED BY LABORATORY SAMPLE TYPE: ILZ¢.- Routine L3 Check Sample (for routine eample with lab reft no [-J Special Purpose Treated Water Untreated Water SAMPLE NO, LOCATION 4 I. J Time Coll~cted sie show.n this Water SAMPLE to be: tls factory E] Unsatisfactory [_..] ,Sample too long I~ transit; sample should not be nwr 30 hours old alexamln~tion to indicate reliable re~ulta, Please ~end new s~mple via specl¢l delivery mail, 0 ,0 ........... . Time Received ~.¢¢¢ -~ Analyllcal Method; Membrane Filter No, of colonies/100 Lab Ref. 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