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Home My WebLink AboutNEWLAND BLK B LT 4A MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL H ~:;~-~.~ / 2'-1/4::~ OF ON-SITE SEWER AND WATER FACILITY 264-4?44 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) (b) Location (address or directions) Propedy Owner ~0~) GO~OO~ Telephone: Home Mailing Address ~1~ ~ '~0~ Business ~7~-i~ 01~g~) (C) Lending Institution {_~0¢d~¢¢ ~,, ~"T'T'(.,~-,~ Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here ~d~ if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Familyt_~' Number of Bedrooms WATER SUPPLY Well/~" Community [] Public [] Individual Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public'S' Community [] Holding Tank [] Note: If corn munity 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 fRev 8/86) Front EN(~INEERING 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 syste~ in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of th s inspection?F Name of Firm ~2'~' ~2.._~Z0.. ~-~¢~_ ¢..'~ ,Pc-~2_~~ Telephone Address ~ ~-' ~P{ A~ ) ~C~{0~ ~ ~--o ,,~.l Z::, l )'"'l c, .'~,,~ 4.. DHHS APPROVAL Approved for "/'~'~' ~-~bedrooms by -~~ ~2. '~~ Approved Disapproved Conditional Terms of Conditional Approval ~ '~'~-~'~ ~ CAUTION 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 profes§ional 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. Page 2 of 2 72-025 fRev 8/86) Back MUNiCiPALiTY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVIS~I~NICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 MAR 1 7 1987 264-4744 RECEIVED Legal Description: WELL DATA Well Classification 'F'F'.I~,'AT~Z If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~0 Date Completed OI~V-~0~,0(~ Yield Total Depth ~J0UJI~ Cased to ~j~.~0b0~ Depth of Grouting Static Water Level ~I',JI~J0t,0~ Pump Set At ~_~1 Sanitary Seal on Casing (Y/N) '~'~'~ k~'~'')~ Depression Around Wellhead (Y/N) Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/H0iding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ¢¢ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by C~-F:::;? ~--~- ¢~' ; Date Water Sample Test Results .~AWl~¢A¢-q'O5'-~( (~ ~H60 SEPTIC/HOLDING TANK DATA Size No. of Compa~ments Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Course Comments Page I of 2 72-026 fRev 8/86¥ Fronl ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Di LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that/\have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed"'~ ~ (,-~ J~"?~ %~ {)~ Date ,~/{ ~ / ~ 7 ReceiptNo. ~OO / - ~O~ ~ Date of Payment ~- /~ ~ Amount: $ ~ ~ ~ Page 2 of 2 72 026 fRev 8/861 8~ck JML '; LABORATORIES, I NC, LABORATORY 1,0. ¢ ,~(,.,~,C) 7127 OLD SEWARD HIGHWAY ~NCHORAGE, ALASKA 99518 1907) 344-8551 BACTERIOLOGICAL WATER ANALYSIS TO BE COMPLETED BY WATER SUPPLIER ~IIH D/~.~ ~"3(.~ [] PUBLIC [] INDIVIDUAL ). NO. (PUBLIC SYSTEMS) C. TRCI.E CI_Agg I I I I ) -J A B C Residential IE OF SYSTEM TELEPHONE NUHBFR ;TEM ADDRESS FY .; ~, [, STATE ~ ZIP CODE ;ATION WHERE SAMPLE WAS COLLECTED · L/ .... ." -:.~)~;: ,:?:.,~ _LECTED BY: ~S~IGNATURE ), DE OF SAMPLE . tECK ONLY ONE TH]~COLUMN)' ]' DRINKING WATER · x ~/CHECK TREATMENT FOR LAB usE ONLY [] RESUBMIT SAMPLE Sample rejected because: CHECK ONE OR MORE [] Sample too lohg in transit. Sample should not be over 30 hours. ] RAW SOURCE WATER -I NEW CONSTRUCTION OR REPAIRS ] OTHER(Specify) []]CHLORINATED [-]FILTERED E]UNTREATEg OR OTHER THIS SAMPLE A CHECK SAMPLE TO A PREVIOUS NON-CONFORHING SAMPLE? [] YES ~'NO PREVIOUS COLLECTION DATE ALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORM) ND REPORT TO:(PRINT FUI~L NAME,ADDRESS AND ZIP CODE TY STATE ZIP [] Sample received too late in week [] Not in proper container [] Leaked out [] Insufficient information provided. Please read instructions on form. [] Other (Specify) ANA~AL METHOD: ~MEHBRANE FILTER ~ FERMEUTATION TUBE Date & Time Started Date & Time Completed LABORATORY RESULTS [] Other Bacteria [] Test unsuitable because: [] Confluent Growth [] TNTC SATISFACTORY Z U~SATISFACTORY [] BACTERIOLOGICAL WATER ANALYSIS RECORD FOR LAB USE ONLY TOTAL COLIFORMS FECAL COLIFORMS OTHER Hemhrane Filter: Direct Count Verification: LIB Final Membrane Filter Results Reported By BGB Date Time Coliform/1DOml Coliform/lOOml READ SAMPLE COLLECTION INSTRUJCTIONS ON BACK OF FORM ~o~da to vevi~ ~ th~ ~etu~e (s) is ~ i~ not ~1~ and ~'u~ 30, tB76. [~t 4~ Blockb':'~ ~-,cwlumt ~-' " ~ Subdivision Uear ~,irs. Dickersoh: (~tober 7~ 197o. l~te ~esults were received on October 1970 mm arc satisfacto~')'. Since re)b', A~Ja:4i~J strative i)irecto'r Envirom~ntal [iealti, Supervisor August 8~ 1969 The attached letter was sent to the following people: Mr. Vaughn Pointer Mro Jack Laub 62~ Wo 86th Ct. 606 W. 86th Ct. AnchoPage, Ak. 99502 Anchorage, Ako 99502 Mr. Ton HeaZh 618 W. 68th Ct. AnchOrage~ Ak. 99502 Mr. Charles Laraux 621 W. 68th Ct. Anchorage, Ak. 99502 Mro John Heafer 605 W. 86th Ct. Anchorage, Ak.. 99502 Mr. Earl J. Johannes Anchorage, Ak. ~ Mr. Thomas Bittner ~/ 8626 Vernon Street~ Anchorage, Ak. 99502 ~r. Lee Grant v 8636 Vernon Street Anchorage, Ak. 99502 August 8~ 1969 Mr. Vaughn Pointer 62q We 86th Ct. Anchorage~ Ako 99502 SUBJECT: Public Water Supply On Lot q~ Block B, Newland Subdivision Dsar Mr. Pointer: The Greater Anchorage Area Borough Health Department recently conducted a survey of the subject water supply and fo%md the following: lo The cesspools on Lots 3 and 4, Block B, are much too close to the well. State law requires that septic tanks be at least 80' from the well and seepaKe pits be at least 1~0' from the well. 2,, A recent check by a well driller showed that the well is supplying barely enough water to serve two houses and as you know there are now thirtsen (13) residences on the wello Due to the conditions in paragraph #1, we request that a joint sewer system be installed to serve the two subject lots and that it be located the prescribed distar~ce from the well. Should this not be done, then this Departmeut has no recourse other 'than to require the owner of the well to tull off all supplies other 'than to hi~ o~n h~ne. The second problem of water s%~ply and quantity could be solved by further development of the existing well or drilling a new wello This letter serves as notice that the subject sewer systems now located on ~ots 3 and ~, Block B~ ~ewland Subdivision, are to be moved o~; or before Septer~ber 15~ 1969. Permits must be obtained from this office prior to relocation of any sewerage system° Stncerely~ DAVID Re Lo DUNCAN, {4. Do Medical Director BY: ~ Sanitarian RRS: rn