The URL can be used to link to this page

Home My WebLink AboutCREEKSIDE PARK #3 LT 40A MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# 006-101-29 HAA# AH890472 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Lot 40 Creekside Park Subdivision ~3 Location(addressordirections) 7440 Old Harbor Road, Anchorage, Alaska (b) Property owner Jerry Pfouts Mailing Address 37133 4th Avenue (c) Lending Institution Mailing Address SW, Federal Way, Telephone:(home) Business Washinqton 98023 Telephone (d) Real Estate Company and Agent Century 21 New Horizons Address 2213 East Tudor Road, Anchorage, Alaska 99503 Telephone 563- 6233 (e) Mail the HAA to the following address: (or check here El, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Number of bedrooms £our (4) Single-Family ~ 3. WATER SUPPLY Individual Well ~x Community [] Public [] Note: If communitY well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and' status. 4. SEWAGE DISPOSAL On-site [] 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. 72-025 (Rev. 7/88) 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 validatio,n 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. NameofFirm Corwin & Associates Telephone 511-1311 Address 1000 East~Dimond Boulevard, Anchorage, Alaska 99515 Date 11 - 21 - 8 9 Engineer's Seal 6. DHHS APPROVAL AF~r~Kxxxxx bedrooms by ~ A~a~xxxxxxxx Disapproved XXXXXXX Terms of Conditional Approval Failure to supply water samples as Authority Approval dated 12-13-89. ~"""~'""~-' Date May 3. 1990 Conditional required on Conditional Health CC: Bruce J. Corwin, P.E. Corwin & Associates PO Box230608, Anchorage, Alaska 99523-0608 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) L~'-r- 4-0 ~.?.FEi(~! ~)F PA?lq ~ Location (address or directions) (b) Property owner--.~~ / Mai,ng Address ~¢ (c) Lending Institution Mailing Address )~ / (d) Real Estate Company and Agent Address ~'~ lA A .kl c . H ,, Telephone ' (home) Telephone 'ILl/i4t- AK Business ~J,/,/~ Telephone (e) Mail the HAA to the following address: (or check here~.if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Familyx 3. WATER SUPPLY Number of bedrooms Individual Well~:]' Community [] Public []' Note: If community .well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality' and status. 4. SEWAGE DISPOSAL ~ On-site [] Publicx 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. .~ ~,.,..;c:-.~,..~ A-,,.,.,o 5:,.~ 6,...,~7. ¼,4.s ¢c~bu~cC--b 72-025 (Rev. 7/88) 5"~1'~'k'~ t~-~' ~="~d'/t~;~'"~ (~' ~'"'~ '~"/~ Page/C/dc/'1 of 2'2"~' P"~ 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 Address J ('~ (.")0 Date / / //?.1/17~ / / Telephone' 6. DHHS APPROVAL / Approved Disappr?ed Conditional T~.~rms of Conditional Approva~('~-'*'''c**'~"~:~' ~'- ~" The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerifica,ted 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. 72-025 (Rev. 7~88) Back Page 2 of 2 We,.C assificafion Well Log Present (Y/N) ~r~_ Date Oompleted (-'(-/'~ ~ · Total Depth ! Static Water Level I Z,-,O ~ ~-.~,,~ Pump.SetAt Casing Height Above Ground ~I. CJP, ALITY (~F ANCHORAGE (MOA) ,'~ Health Authority Approval (HAA) ~n' o~ ^N~~.L~ST:- FEBRUARY 1984 ~.t,NT~ON,Mr:NiAL S~V~C~S D~V~,~,~ 343-4744 Legal Description: ~ Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line '{"/',/~' / To Nearest Sewer Service Line on Lot Water Sample Collected by .~ F?~l~_~ If A, B, C, D.E.C. Approved (Y/N) Yield Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) /%/ ;On Adjoining Lots [, OC)-'{" ; On Adjoining Lots //0 o ~ To Nearest Public Sewer CleanoutJManhole ~V /~ri.~-_~. ; Date Water Sample Test Results 5 ~-7-~ Comments'y~ {~ ~ ~ ' B. SEPTI~,~DING TANK DATA Date Installed'~ Size_ No. of Compartments Standpipes (Y/N) "-,. Air-tight Caps (Y/N)__ Foundation Cleanout (Y/N) Depression over Tank (Y'~ __~ Date Last Pumped _ Pumping/Maintenance Contac (Y/N) ,... ~ / .,, ;for Holding Tank High-water Alarm (y/N~,,~ · //\~"-///_TemFary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/~NG TANK: To Water-Supply Well ",, To Building Foundation To Property Line '~)q~sposal Field To Water Main/Service Line' To Stream, Pond, Lake or Major Drainage Course Comments ~'~-'c~ /~C/~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA ils Rating in Absorption Strata nstalled Width Square Feet ~bsortion Area Depression over (Y/N) Results of Last Adeq~ Test SEPARATION DISTANC To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage To Driveway, Parking Area, or Vehicle Storag Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test :ROM ABSORPTION FIELD: ~ To Property Line To Existing or Abandoned System on Adjoining Lots To Cutback (if present) D. LIFT STATION DaSd ,,Sipump On,, LevZe in Gall one. el a~ High Water Alarm Level at'~..~ ~' Tested for Meets MOA Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Comments '"""'"'-. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, o/rflonformed toall MOA and HAA guidelines in effect on the date of this inspection. .~ / ~' // ----- .... ......w., Signed Company ~O~[~ ~~O~'I~;~C. Receipt No. ~ )~ ~ ~ ~ ~ / ~ Receipt No. Date of Payment //- ~//' ~.? Waiver Fee: $ Amount: $ ~ ~.~) Date of Payment 72~26 (Rev. 7/88) Back Page 2 of 2 & associates,inc. Consulting Engineer~ 1000 E. Dimond Blvd. · Suite 205° Anchorage, Alaska 99515 · (907) 522-1311 December 14, 1989 Ms. Susan Oswalt Department of Health and Human Services Municipality of Anchorage 825 "L" Street Anchorage, Alaska 99501 SUBJECT: CRIB INSPECTION, 8440 OLD HARBOR ROAD LOT 40, CREEKSIDE PARK #3 Dear Ms. Oswalt: This letter is to inform you the crib sYstem for the above address has been crushed and backfilled following the installation of the new sewer service connect. The work was accomplished by Kincaid and Sons as part of the new construction. Please call if you have nay questions. Very truly yours, CORWIN & ASSOCIATES, INC. Robert Kni~ Vice President CHEMICAL & GEOLOGICAL LABORA2 RIES OF ALASKA, INC. / ~'~'~ ........ '~"'~, 5S33 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907)562-2343 ~'"'-L;a'o~^~,;,~:~"~ FEDERAL TAX ID # 92-0040440 ANALYSIS ltEPORT BY SA~L! for #ozk O~der ! 18299 Date Report Printed: NOV 18 89 ! 13:30 Client Sable ID:L40 CREE[SIDE t3 PWSID :UA Collected NOV 16 89 I 16:00 l~s. Eeceived NOV 16 89 I 16:15 Preserved with :AS Client Name : COItWI# & ASSO~ Client icct : COR#IJ~ P.O,S NOHE ~KCEIVED Roq S Ordered By : J.~ESS Analysis Completed :NOV 17 89 Send ~eports to: Laboratory Supo~vt~or~_LSTEPHEN C. EDE 1)CO~MIN & ASSOC Special Instruct: Chemlab Ref t: 8556 Lab Smpl ID: 1 Natzix: WATKB Allowable Parameter Teated Result Un, ts Method Limts NITRATE-N 0.65 rig/1 EPA 353.2 10 Sable ~OUTIHE SAJ(PL! ~emazks: SAMPLE COLLECTKD BY I Tests ?ezfozMd * See Special Instzuctions Above UA-Unavailable ND- None Detected *' See :hnp~e ~e~qrkf kboYe NA- Not Analyzed LT-Less Than. GT-Greatez Than Drinking Water Analysis Report for Total Coliform Bacteria CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D.# /~ PRIVATE WATE[~ SYSTEM Name M ailin~ldress City SAMPLE DATE: I I I I I I Phone No, State Day Year Zip Code SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no, [] Special Purpose [] Treated Water D Untreated Water SAMPLE NO. LOCATION ~ ILo-r- ,40 2 ] C,r~e r..s,~ 31 4 I S I TO BE COMPLETED BY LABORATORY shows this Water SAMPLE to be: factory tisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received /~--/4 -oc ~ Time Received ~/~,/_~' Analytical Method: Membrane Filter * No. of colonies/100 mi. Time Collected Lab Ref. No. Result* Analyst Collected I I-1-1 I I I r-FI BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTB BGB Reported ~ _'~'"~-~ Time: TNTC = Too Numberous To Count OB = Other Bacteria Collform/100ml Collform/100ml a.m. p.m. PART ONE OF Tl~O REMAINDER TO FOLLO¥/ ~ E o / o Io I I x ~ ~ / ~, 'Z~ I I ~ >~ ~ / ~1 .I I -- ~ c / - I~1 1 ~EX~ / I I ~t: .... ~ o~ ,1 ~ ~ ~ o~ 0 Z Hu ~ ~ ~/~.1 [ [~ Il J/Il · ~ O~ ~ -- m 0 m I~ ~ z 0 ~ ~z ~ 0 - SUBDIVISION: ~','/xdu_~'~A.~,~.,z?~)~-- '~':,~j i'E~LO':'K: i _C;'~" INDICATE NORTH STREET SEWEf'I SERVICE t_~NE SKcT,.,H LOCATION OF CONTROL MANHOLES/£:I..EANOUTS SIZE MAIN: .... TYPE MAIN ..... CONN:~C'[ D[TF;'i-i-] AT MAIN CONNECT LOCATION: ..~_~..'___ 1,0e.~ ~__o~. '~O~.~""' '~]c. . COMMENTS: _J'{_u~ _._~._~__ .~'o~:> . ¢,u'_~"__., . DATE: