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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