HomeMy WebLinkAboutALDERWOOD BLK 1 LT 12
F'ERMIT NO.
[:,EPARTHENT HEALTH F~ND EN',/IRONMENTBL. ;.:OTECT ION
825 "L'" STREET., RNC:HORFIGE., F~K. 9950:1
264-4720
I.-.IEL_L. F"E ~:: f"l I -I"
( 820628 )
APPL I CANT
LOC:FIT' I ON
LEGFIL
ROBERT VRUGHN
SBND LAKE
LT. i2 BLKi RLDERWOOD S/D
SRA B',q t684 [:, FINCH
LOT SIZE
t5L~00 SE~UARE FEET
HINIHUM DISTFtNCE BETWEEN R WELL FIND RN~r' ON-SITE SEWF~t3E DISPOSAL S'¢ST'EM IS
±00 FEET FOR A PRIVFITE WELL OR t50 TO 200 FEET' FROM Ft PUBLIC WELL [:,EPENDING
UPON ]'HE T'¢PE OF PUBLIC WELL.
MINIMUM DISTFtNE:E FROM Ft PRIVATE WELL 'l'O Fi PRI',/FITE SEWER LINE IS 25 FEET FiN[:,
TO A C:OP1MUNIT¥ SEWER LINE IS 75 FEET.
WELL LOGS FiRE REQUIRED FiND MUST BE RETURNED TO THE DEPARTMENT H I'f'HIN
OF THE WELL COMPLETION.
OTHER REQUIREMENfS ['lR~r' FiPPL'¢. L=;PECIFICFIT~ONS FiNE:, CONSTRUCTION DIRGRFIMS 8RE
F¢,/RILRBI. E TO INSURE PROPER INSTBLLRTION
F'EF-:I',I I T' E>-::P I RI~;ZS [:,EF':EZf. IBEF: T=.'-'-i..
I CERTIFY THRT
1.: I Rid F8HILIRR b~ITH THE REQUIREMENTS FOR ON-SITE SEWERS FiN[:, WELLS FiS SET
FORTH B'~ THE MUNICIF'RLITY OF RNCHORRGE.
2: ~ WILl.. INSTBLL THE SYSTEM IN RCCORD8NCE 14ITH THE CODES.
FIF'F'L ICANT ROBERT ?/~IGHN
'v'4. 0
Static Water Level ~ feet
WELL LOG,
Gallons Per Minute
Draw Down feet
Tota~ ~eet of ~-~t= !3 0
Type Material Drilled~
0 feet (~ to
Hefty Drilling
S.R.A. Box 1553 H
A nchorage,Alaska
99507
/'~UN1CIPALITY OF ANCHORAGE
RECEIVED
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)
Location (address Or directions)
(b) Prop'erty bwner ~ ~t~ ~~ ~ C Telephone' (home)
Mailing Address
Business
(c) Lending Institution Telephone
Mailing Address
(d) Real Estate Company and Agent
Ad d tess
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-Family ~ Number of bedrooms
3. WATER SUPPLY
Individual Wellj~' Community [] Public []
Note: If community well system, must have written confirmation from the State Department of EnvironmentaJ
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site [] Public,J~ Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty 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 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 end 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 ?~_z¢--~' ~' ,* __~-.~- Telephone
Address /~'~D ~~4~ ~"~~ ~ ~q~'~-
Date ~~ ~
6. DHHS APPROVAL
Approved for ~ bedrooms by
Approved ~:~.._~ ' Disapproved
Terms of Conditional Approval
Conditional
Date
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
{~-j~f~ON~"~T/~'l~:~C~:~ority Approval (HAA)
~,~- ' .".' , CHECK~LtST,~FEBRUARY 1984
¢ F P ~_ 5 ~9~ 343-4744
RECEIVED
LegalDescription: ~ /Z,
A. WELL DATA R '~ ~:' ~ ~ ~''' ~'
Well Classification ~/~ If A, B, C, D.E.C. Approved (Y/N)
WellLogPresent(Y/N)~,~ Date Completed ~--/Z-~ Yield ~,~ ~J/'~
Total Depth/~ ~ ~ Cased to /~ / Depth of Grouting ~/~
~ /
Static Water Level ,7 ~ Pump Set At ~
Casing Height Above Ground ~ ~ ~/ ~
Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) ~ Depression Around Wellhead (Y/N) ~
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ~ ; On Adjoining Lots ~/~ '~
To Nearest Edge of Absorption Field on Lot ~ ; On Adjoining Lots ~/
To Nearest Public Sewer Line ~ To Nearest Public Sewer Cleanout/Manhole [ ~ +
To Nearest Sewer Service Line on Lot ~ / ~
Water Sample Collected by ~~ ; Date ~ ~- ~ -- ~ ~
Water Sample Test Results ~c~.'~ ~,~,.' ~,,~ n,~,~
Comments
B. SEPTIC/HOLDING TANK DATA
D~!.~d Size No. of Compartments
Standpipes (~/'"N~----._ Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N)
Depression over Tank~._ Date Last Pumped _~__
Pum Con tact o~~ ~;for ~
H°lding,~nkPing/Maint~nanceH~g'~Water Alarm (Y/N)~~,. Tempora~ Holding Tank Permit (Y/N) _
SEPA'RAT~ISTAN~ FROM SEPTIC/HOL~NK:
To Wate r,S'~'~ We~, ,~:;, '~' To B~ndation ~
To P~e~.~n~,., .~ . To Disposal Fi~
TO ~~hd,s~r'Major Drainage Course
Commen~S' ' · ~ ~'
72-026 (Rev. 7/88) Front Page I of 2
C. ABSOI~PTION FIELD DATA
Soils Ra~ing,in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test '- ......
SEPARATION DISTANCE FROM ABSORPTION"FtF~LD:
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
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
"~'"%operty Line
To Existing or Abandoned System on
' On Adjoining Lots~
To Cutback (if pYes.~nt)
Date I nst~'afl~d
Size in Gallons''''
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
inspection.
Signed
COmpany
.Date
MOA No.
Receipt No. ~2
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
e~i;rPt~e,~late of this
ur_
. _
ALASKA E UIROI'ImelqT^L CONTROL SERUICE$, I C.
I~nqin~¢ri~q 6 ~nui~onm~nlel $~u~li~s
09/08/89
NARSTON REAL ESTATE
2804 NORTHERN LIGHTS BLVD
ANCHORAGE AK 99517
ATTN KEITH NADING
SELLER-SAME
90191
LEGAL:LOT 12 BLOCK I ALDERW00D
FLOW TEST ON WELL
WELL FLOW DATE-09/08/89
A FLOW TEST WAS PERFORMED ON THE WELL. 1057 GALLONS OF WATER WAS
PUMPED AT A RATE OF 4.4 GPM OVER A DURATION OF 4 HOURS.
THE DRAWDOWN WAS 4.4 ' WITH A RECOVERY TIME OF 10 MINUTES
AND THE STATIC WATER LEVEL WAS 55 FEET.
THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME.
1412 ~v'65~ 331~b &V6nU6 · &ncho~aq6, &lzskz 99503 · (907) 279-5553
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
FEDERAL TAX ID # 92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order ~ 16538 Date Report Printed: SEP 12 89 @ 17:20
Client Sample ID:LOT 12 BLK 1 ALDERWOOD OB~SIDE TAP
PWSID :UA
Collected StP 8 89 ~ 15:00 h~s
Received SEP 8 89 ~ 16:00 h~e
Preserved with :AS REQUIRED
Client Name : A E C S
Client Acct : AKECSRP
P.O.~ NONE RECEIVED
Req t
Ordered By : -
Analysis Completed :SEP ii 89 Send Reports to:
Laboratory Supervisor, :S~EPHEN C. EDE 1)A E C S
Special SAMPLE COLLECTED BY S. REID.
Instruct:
Chemlab Ref f: 7427 Lab Smpl ID: 1 ~atrix: WATER
Allowable
Parameter Tested Result/Units Method Limits
NITRATE-N ND(O.IO) mg/1 EPA 353.2 I0
Sample
Remarks:
1 Tests Performed ' See Special Instructions Above UA=Unavailable
ND- None Detected "See Sample Reroarks Above
NA- Not Analyzed LT=Less Than, 6T-Greater Than
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. .~
TELEPHONE (907) 562-2343 5633 B Street
; Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
[] PUBLIC WATER SYSTEM I.D., I I I I I
~ PRIVATE WATER SYSTEM
Name Phone No.
Mailing Address
City State
Mo. Day Year
SAMPLE TYPE:
~L Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
SAMPLE
NO. LOCATION
Zip Code
[] Treated Water
I~ Untreated Water
Time Collected
~~Collected\
TO BE COMPLETED BY LABORATORY
A~saSiS shows this Water SAMPLE to be:
tisfactory
[] unsatisfactory
[] 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
Time Received
Analytical Method:
Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No.
7427
Result*
I
I
I
Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter. Direct Count v
Verification: LTB BGB__
Final Membrane Filter Results 90____.-
Time:
Coliform/100ml
/~ C:Y?'5 a.m.
TNTC -- Too Numberous To Count
OB = Other Bacteria
Colllorm/10Oml
PART ! OF Z R~MAINDER TO FOLLOW
MUNICIPALITY OF ANCHORAGE
DMSION OF ENVIRONMEN~kL HEALTH
DEPARTMENT OF HEALI~ AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AITIIqORITY APPROVAL CERTIFICATE
1. General Information Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range).
Location (address or directions)
(c)Applicant is (c~ o~) ~nding Institution ~; ~r~il~r ~;
Burr ~ ; ~er ~ (e~lain);
(e) ~al Estate ~. & ~nt , .
-
2. ~ of ~si~
Single-Famil .y~.
Multi-Family
Other (describe)
Number of Bedrooms . ~
3. ~ater Supply
Individual Well ~-~ Community ~--] Public ~
Note: If c~,~,,~nity ~11 system, must have written confirmation from the State
Depa=tment of Environmental Conservation attesting to the legality and status.
Is the ~11 adequate fo~ the r.Aanber of bectrcons specified in this FAA (Y/N)
4. Sewage Disposal
0nsite ~-~ Public ~ C~,',,~nity ~ Holding Ta~k ~
Is the wastewater disposal system adequate for the ~mmber of bedrocras
[Page 1 of 2]
2-15-84
5. Engineering Firm Providing Inspections, Tests, Data and Information
I certify that I have checked, verified, c~ conformed to all MOA HAA Guidelines in
effect on the date of this inspection.
~=~~ Date ~/~/~
Add~ess
S i~ned by
Date
6. DHEi~ Approval
Approved for
Approved ~
( ENGINEER SEAL)
Disapproved ~-~ Conditional
Terms of Conditional App£oval
The Municipality of Anchorage Depa~twent of Health and Envirornental Protection dces
not guarantee the continued satisfactory performance of the water supply and/ct the
wastewate~ disposal system. This approval indicates that, as of tb~ validation date
show11 abo~, based on the data and information furnished by an engineer registered in
the State of AlasKa, the water supply and wastewater disposal system is safe and func-
tiop~l for the m/~ber of bedrcoms and type of structure indicated.
(DHEP SEAL)
7. Mail the HAA to the following address:
~m2/dS/s
[Page 2 of 2]
2-15-84
ae
MUNICIPALITY OF ANCHORAGE (MOA)
CHECKLIST - FEBRUARY 1984 v oO~ a
Lot 12 Block 1 Alderwood ~
If A, B, c~ C, D.E.C. Approved(Y/N)
8: ~: ~ %- Yield
Depth of G~outing N/~ '
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
Well Classification
Well Log P~esent (Y/N) ~/~/Z.~ Date C~leted
Total Depth / % O Cased to / ~ O
Static Water Level ~ ~ Pump Set At
Casing He ight Above Ground ~ ~ ~!
Electrical Wiring in Conduit (Y/N)
Separation Distances f~cm Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Se~r Line ! ~O! ~-
Cleancut/Manhole | ~ ~ To Nearest Se~r Service Line on Lot
Water Sample Collected By 7~, ~' ; Date ~) Z. Zg- ~ ~
Water Sample Test Results ~ ~ ~-~ $ ~% T~; ~- ~
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
B. SEPTIC/HOLDING TANK DATA
Date Installed Size No. of Compartments
Standpipes (Y/N) Air-tight Caps (Y/N) Foundation Cleanout (Y/N)
Depression ove= Tank (Y/N) Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ; for
Holding Tank High-Water Alarm (Y/N) TemporaTM Holding Tank Permit (Y/N)
separation Distances frcm Septic/Holding Tank:
To Water-SupplyWell
To Property Line
To Water Main/service Line
Course
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, c~ Major Drainage
Con~ents
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption A~ea
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distanee frc~ Absorption Field:
To Water-Supply Well To P~operty Line
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Building Foundation To Existing or Abandoned System
Lot ; On Adjoining Lots
To Water Main/Service Line To Cutbank(if p~esent)
To Stream/Pond/Lake/c= Major Drainage Course
To Driveway, Parking Area, c~ Vehicle Storage Area
Con~ents
De
LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Dime ns ions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
Meets MOA
C~nts
** Check Permitted Bedrcon Rating Against HAA Request
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed ~~, ~~
Company ! , ~
Date
MOA No.
KB1/d5/s
[Page 2 of 2]
2-15-84
HEMICAL& GEOLOGICAL LABORATORIES OF ALASKA, INC~ '~
TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER " ~
5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name
I.D. NO.
Mailing Address
City State
Mo. D~y Year
Zip Code
SAMPLE TYPE:
]~V~Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
~ Untreated Water
SAMPLE
NO.
1
2
3
4
5
LOCATION
l
Time Collected
Collected By
Ts
TO BE COMPLETED BY LABORATORY
X~/pel~sis shows this Water SAMPLE to be:
Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 48 hours old at examination to
indicate reliable results. Please send new
sample via special delivery mail.
Date Received ,~-- ~. ~--t~ ~/
Time Received
Analytical Method:
I-1 Fermentation Tube
Membrane Filter
Lab Ref. No. Result* Analyst
*No of colonies/100 mi or No of Po$$ve port*ohs
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
0&]220 lb}
Rev. 5978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date C o~lect e~ SourCe
Time Recelve¢l p.m. Lab. NO.
P~eSu m pt lye 10mi 10mi 10mi 10mi ]0mi 1.0mi 0.1mi
24 Hours
41 Houri
~_~nflr m, ltory
24 Houri
48 H o,u fl
EMB Broth 24 hours:
Multiple Tube Report:
l,#mbran, I Fliter: Direct Co~nt
Verification: LTB
ReOo~ted BY '-- '--" ' " ~ ---
Broth 48 houll:
1omi Tubes posJtlv~rrotal 10mi Portlonl
Coliform/! 0Omi
BGB
-'_~-t-- ~-~c.,o.,o~,
Date
APPLI¢- NT FILLS OUT UPPER HA! ' ONLY
Phone
Lending Institution ~ . .... - r Phone
Realty Co. & Agent Phone
Address
Legal Description .L.0'T ~ ~ ~--~~1 ~ ZipCode
Type of Residence
'~ Single Family
Multiple Family No. of Bedrooms
[] Other
Water Supply
~_ Individual ~,...~ ATTACH WELL LOG. A wetl log is required for all wells drilled since June 1975.
[] Community ~'~[2, ~ ~ For wells drilled prior to that date, give well depth (attach log if available).
[] Public Utility
Sewer Disposal
[] Individual Year Individual Installed:
.~ Public Utility When Connected to Public Utility:
Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time Time Time .
Date Date Date Date
Inspector Inspector Inspect(~) . Inspector
MUNICIPALITY OF m
~'~T C~ i~L , ~, '.
o RECEIVED
(~) APPROVED BEDROOMS
*CONDITIONS
OF
APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (3182)
CHEMICAL & Gl.
LOGICAL LABORATORIES , ' ALASKA, INC.
TELEPHONE (907)-279-4014
274-3364
ANCHORAGE INDUSTRIAL CENTER
5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name
Mailing Address
I.D. NO.
Phone No.
City State
MO. Day Year
SAMPLE TYPE:
[3 Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
SAMPLE
NO. LOCATION
I
I
Zip Code
[] Treated Water
[] Untreated Water
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
'[:~].,~atisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample·
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
~Membrane Filter
Lab Ref. No. Result* Analyst
I FI--]
*No. of colonies/100 mi. or No of Positive port~ons
READ INSTRUCTIONS
BEFORE
COLLECTING SAM PLE
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collecte~ Source
Data Received Time Recelvlcl b.m. Lab. No.
Presumptive 10mi 10mi 10mi 10mi 10mi 1.0mi 0.1mi
24 Hours
48 Hours
Confirmatory
24 Hours
48 Hours
EMB Broth 24 hours: Broth 48 hou~:
Multiple Tube Rabort: 10mi Tubes PoMtlve/'rotel 1Omi Po~tlon~
Membrane Filter: Direct Count Collform/[OOml
Verification: LTB BGB
Final Membrane Filter Results ,~ Collform/lOOml
R~or ted By Data
': Timer a.m.
I)omo