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Home My WebLink AboutPURINGTON LT 8 Parcel I.D. # 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 ECEIVEu APR 1 ~ 1999 ENVIRONMENTAL SERVICES DIVISION 1. GENERAL INFORMATION Complete legal description Location (site address or directions) /~ r-uc.H o P._A CE-~ ~< Property owner Mailing address Lending agency Day phone Day phone Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community welt NOTE: Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer communit~ wastewater system, provide written confirmation from State ADF_~ attestin~ to the legality ~d status of system. 72-025 (Rev. 1/91) Front MOA#21 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 verifythat 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 I¢~-I ~c~t t~ ~-~J c,-~ ~ ~e-*¢_~ ~ ¢_,, Phone Address P. O, ~oX ~_~ H ~'~ I ~ /~ cl+of4,zt ~-E-~ A-~ Engineer's signature bedrooms. DHHS SIGNATURE ~ Approved for ~'~LL.~(:Z) Disapproved. Conditional approval for Date 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 DHHS do not conduct inspections or.analyze.data before-a cert ficate is issued. ~'he Municipality of Anchorage is not responsible for errors or omissions in the professiona! engineer's work. 72-025 ~Re~.1/91] Back MOA#21 Legal Description: L, A. WELL DATA Well type ~ t/ATE' Log present (Y~) Total depth ~<~ew ~,J Sanitary seal (~)'N) KI:L.I: I V KU APR 1 q 1999 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVI,~.~Abrf¥ Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist ~CI~.t~C,-TC~o .S/_b Parcel I.D.: If A, B, or C, a~ach ADEC le~er. ADEC water system number ~/~ Date completed Cased to "~HO Casing height (above ground) I ,~ '/ Wires properly protected ~YN) "/~- ,~ AT INSPECTION P_~' g.p.m. ~ ° C) g.p.m. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS:. Coliform .~ ¢° ~em~/~/oo ~£ Nitrate / Date of sample: ~I'PP--tL- J~ Iqq~ B. SEPTIC/HOLDING TANK DATA ~ LA ~L-I C_~ ~at~-~-~ ~._Tank size Number of Compartments Foundation cleanout (Y/N) C. ABSORPTION FIELD DATA Collected by: d- H~'&I S ~'~.1C~ G- I 0 ...._.~ _._High water alarm (Y/N) Pumper ~ Soil rating (g.p.d./ft~ or fF/bdrm) System type Length ~W~;~_, Gravel thickness below pipe ~.~-'~'~ ept~~hN Effective absorption area __~~Tube pres~ ~"Depression over field (Y/)~_ ~l:ti; ;'e;,c~e iq:::Ystoel~;,~: ,ie~ ,mrs' Results (P~l,~ed~~added (inl):~I'edlO~ms FlUid depth ,..-(in~)s Minutes later:. Absorption rate = ~. g.p,d, ~past 12 months)(Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION I~'J/~ ~lled Size in gallons Manhole/~ ~ ~el at* ~High wateralarm level at __ / 'Datum % ~ E, SEPARATION'DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot k,J//~ On adjacent lots Absorption field on lot ~ )/~ On adjacent lots Public sewer main o~ O ~. i o Public sewer manhole/cleanout Sewei/septic service Fine "7 '2_.,~' / Lift station SEPARATION DISTANCES FR~3M SEPTIC/HOLDING TANK ON LOTTO: ~//~ Foundation --Prn e~0_~._~y_ line ~ Water main/serv' '~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: , ~J/A , ~ ~ Building foundation Water main/service.~~~ Surface water storage area Curtain drai~EL_.- Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records in conformance with MOA H~ guidelines in effect on this date. Signature .~ ~ HAA Fee $ Date of Payment Receipt Number ('~ ("~,'-~ "7 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number z~_~Z~ CT&E Environmental Services Inc. CT&E Ref,# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID Sample Remarks: 991359001 Riggio Engineering L8 Purington S/D-4137 Brantley Lot 8 Purington S/D Drinking Water 0 Client PO# Printed Date/Time 04/09/99 08:57 Collected Date/Time 04/01/99 19:15 Received Date/Time 04/02/99 13:40 Technical Director: Stephen C. Ede Released By.~~ SM9222B - Bacteria sample invalidated due to laborato~T error. Resample requested. Parameter ResuLts POL Units Hethod ALlowable Prep Analysis Limits Date Date Init Nitrate-N 0.693 0.500 mg/L EPA 300.0 10 max 04/03/99 04/03/99 SCL 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (add[ess or directions) (b) Applicant Name 7~/c,/ Applicant Address (c) Applicant is (check one):' Lending Institution ~; Owner/builder~; Buyer ~; Other ~ (explain); (d) Lending Institution ~~ ?"' ~~, Telephone -,~-~ '-3''-'~¢''''7-~ Address (e) Real Estate Company and Agent Address Telephone TYPE OF RESIDENCE Single-Family ~t ~ulti-Family Number of Bedrooms Other WATER SUPPLY Individual Well)~ Community [] Public [] Note: If community w~ll system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4, SEWAGE DISPOSAL Onsite [] Public,,'l~ Community [] Holding Tank [] Note: If community well system, must have written confirmation from the Stats Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-o~5 (u/84) ENGINEERING FIRM PROVIDING m~SPECTIONS, TESTS, FILE SEARCH, DATA ~ND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, ~ 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 inlormation 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 /~,¢,;4, ~d ~/} /~ ~/2~ ~ ~,, Approved for ~,~-'~ bedrooms by ~ //~-t -~---'~k.,~,%--~.J~,, ate LJ~'~//~6/~ ::~rrn~V:;conditi~o al A pprova~iSapproved '~ 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. Tile 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-o25 (11/84) WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MO~I MUNIciPALiTY OF ~L~A, DT~2~.UTHORiTY APPROVAL (HAA) DEPT. OF HEALTH ~-NVIRONMENTAL pRo~.?CI-JECKLIS'F- FEBRUARY 1984 · =~lON 264-4720 ivlAY o R E C E i V E D Legal Description: "~'~/~'///'"'~'~'~' If A, B, C, ~,E.C. Approved (y/N) Well Log Present (YO Date Completed ~,,¢/~/d/'v'2'uf dpzz¢ /¢?'?.~- ,Yield Total Depth ~w/~''¢~'°/ Cased to~/~') ¢0/'/' Depth of Grouting Static Water Level ~ -~ / Pump Set At Casing Height Above Ground Electrical Wiring in Conduit '(~N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot Sanitary Seal on CasingdN) Depression Around Wellhead (Y~'~ ; On Adjoining Lots 4//,/) ; On Adjoining Lots To Nearest Public Sewer Line ;¢¢'~ ! To Nearest Public Sewer Cleanout/Manhole /~'rr/ / To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~ SEPTIC/HOLDING TANK DATA Date I~ns % ~ze No. of Compartments Standpipes (Y/N~,.,~ /¢_~/~tight Caps (Y/N)__ Foundation Cleanout (Y/N) Depression over Tank Pumping/Maintenance Contract o~N) .... ; for __- Holding Tank High-Water Alarm (Y/N) ~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: '~,,u,4;,~ bon' To Water-Supply Well __ _ _. '~ -''~'~'~,F°unda ----- To Property Line ____ To Disposa~~ To W(~t;urrsMeai n/Service Line To ~d, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA ~ing in Absorption Strata .J Date Instal~e ~ ~////..f Width of Field_. Results of Last Adequacy Test Separation Distance from Absorption Field: ~ ~op To Water-Supply Well erty Line To BuildingLot Foundation ; On Adjoinin Tg"..,..~ TOLots~,.,,.,,.,~ Existing or Abandoned System on To Water Main/Service Line To Cutbank (if pres~ To Stream/Pond/Lake/or Major Drainage Course To Driveway. Parking Area. or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test LIFT STATION ~. Dimensions Size in Gallons '~-.,~%~_ Manhole/Access (Y/N) "Pump On" Level at -~'~.....~.~ "Pump Off" Level at High Water Alarm Level at ~'~--~.~,. Vent (Y/N) _ Tested for ¢~;~Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) '~ Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h_j~v/~h ec.c.c~d, veri)fi~d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~"~'"- ('''' //4''//'~'-'-' Date Company ~ MOA No. No. Date of Payment ~,~ ~- Amount: $ ( ¢%' Page 2 of 2 72-026 (11/84) ALASKA ,,dlROFIITleFITAL COFITROL SE!h ICE!S, ~l~§incePin9 $ ~nuiro~mcnlaJ ~ludies LINDA DAVIS 9451KYLIE ClRLCE ANCHORAGE ALASKA 99515 SELLER--SAME 5/21t86 LINDA DAVIS 9451 KYI, IE CIRLCE ANCHORAGE ALASKA 99515 60213 LEGAL:PURINGTON BLOCK 0 LOT 8 FLOW TEST ON WELL WELL FLOW DATE-5/16/86 A FLOW TEST WAS PERFORMED ON TIlE WELL, 357 GALLONS OF WATER WAS PUMPED AT A RATE OF 5.9 GPM OVER A DURATION OF 1 HOURS. THE DRAWDOWN WAS 18,2 ' WITII A RECOVERY TIME OF 30 MINUTES AND THE STATIC WATER LEVEL WAS 30 FEET. TIlE WEI,L IS ADEQUATE FOR THIS 2 BEDROOM HOME. 1200 UJ¢sl 33rd A,)¢nu¢, Sulle B. Anchoraq¢, Alaska 99503.(907) 561-50z10 ALASKA Bi,dlROIqETI FITAL COFITROL SI hulC S, IBC. 20, 1986 Municipality of Anchorage Department of Health aad Human Services 825 L. Street Anchorage, Alaska 99501 Attn: Steve Morris RE: Lot 8, Block 0, Purington Subdivision Dear Steve: The well for the above referenced lot is located in a pit in the ground. Per our previous conversations on tile requirement of pit wells, the homeowner has brought this pit well up to code and I inspected in on May 16, 1986. Tile pit measures 6 feet in length, 4 feet wide and 7 feet deep, from the ground surface. The walls are constructed of concrete blocks with a concrete slab floor. The block wal].s extend.l.5 feet above the ground surface and are lined on the interior with 1 inch styrofoam insulation. Tile well casing extends 1 foot above the ground surface but is still 0.5 feet below 'the top of the b]ock walls. A , sanitary seal is on tile casing and all wires in tile pit are enclosed in conduit. The concrete slab floor has a floor drain which empties int~ a dry well below the floor. An insulated wood structure lid covers the entire pit and is sloped for drainage. A pressure tank is also located in this pit. From my inspection, I feel that this well pit meets all Municipality of Anchorage requirements and does not pose a threat of contamination to 'tile water snpply system. Casing is 1 foot above ground surface. Walls and bottom are impermeable and dry. A floor drain is present and surface drainage is directed away from 'the pit,. If you have any questions, please feel free to contact me at 561-5040. Sincerely, Alan Wien Engineering Technician Approved by: 1200 LUcsl 33r] ~uenue, ~uile ~ o~nch0raqc, ~iosko 99503 ~(907) 551-5000 /~L/~I~/~ Cl~lVlr~,tJl~]lVlFpl ! CONTROL SERVIC"% INC. 1200 West 33rd Aven~ , Suite B ANCHORAGE, ALASKA 99503 (907) 561.5040 SHEET NO OF CALCULATED BY /' '~/'~ / DATE CHECKED BY DATE_ SCALE / ~J4) I APPLIC HT F~LLS OUT UPPER HAL ONLY Phone Property Owner [~.../, ///Ii?;..).) /17. //(../, > ~ .... (~.~ Buyer Address Zip Code Phone Lending Institulion Address Zip Code Realty Co. & Agent 7~/z'4?:z'~ (~(~."i,;/); ,'~}" [.';¢,' ~ /?"/( .~:i' ]:)//"/ /,C',:.'/. Phone Leoa, gesoriptio, /~','/,;/,': /2,'~ :",~"? /',' Street Location '~'//,.) 7 ,/://o,,' / ,//" ,~/. ,.,,,:2lf[-~ .y:-,/ ./:~Z~ Type of Residence .('.:Y ~,- ;' ' /Single Family Multiple Family No. of Bedrooms__ [] Other Water Supply (..~,'lndividual ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. [~"Community For wells drilled prior to that date, give well depth (attach Icg if available). [] Public Utility G~"~' ' ,,~.~.~ Sewer Disposal [] Individual Year Individual Installed: ~ Public Ulility When Connected to Public Utility: '"~,._.~ -- L~ Holding Tank -- NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time gate Date Date Date '-? -- ~ I Inspector Inspector Inspector Inspector 0I~PT, O~ HEAL'IH RECEIVED ( _.~ APPROVED BEDROOMS 'GONDITIONS OF APPROVAL ( ) DmAPPROVED ( ) OONDITIONA~- APP~I~I.O,_VAL' DA ~ Soils Rating Date Sewer installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72.023 (3182) Ju:ty 13, 1993 Ancho;:ai c~ AT,_ 9950l; [; J. nce r o !.¥,