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Home My WebLink AboutALDERWOOD BLK 1 LT 17 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.# ~\~-~Z~\~:~-;~. ~) HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 17; Block I; Ald~rwood Subdivision;. Location (address or directions) 6334 Air Guard Road (b) Property owner Chris Ride_out Telephone ' (home)248-311 5 Mailing Address 6334 Air Guard Road, Anchoraqe, Alaska 99502 (c) Lending Institution G.M.A.C. Terry C0rbi~f:: .._ Telephone Business Mailing Address (d) Real Estate Company and Agent Address 3000 A Str&&t FORTUNE PROPERTIES. INC. ATTN: Geri S~ite #101 Anchorage. Ak. 99503 Crowle y Telephone 562-7653 (e) Mail the HAA to the following address: (or check here)(~, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 t~n..i~ Ri,v~ Lm,~.~_ R~_~_d ~. ~ Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family J~ Number of bedrooms 3. WATER SUPPLY 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 [] Public F~X 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 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 $ & S ENGINEERING Telephone 17034 Eagle River I. opp i~oad No. 204 Address Eagle River, Ataska. Date Z-z-- c=Lo 6. DHHS APPROVAL Approved for --~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional 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 ^. w.,, R E C E IV E D We, aassiJication ./4 Well Log Present (Y/N) N/ Date Completed Total Depth tJ~ Static Water Level MUNICIPALITY OF ANCHORAGE (MOA) Heal[,,l~.~/~9~i~y Approval (HAA) hqCtPALI-I ~[~x~a , _. ,_.~.~~BRUARY 19114 ~ON~L ~ 3~3-4744 ~'~,./ 2 ~ ~9~0 Legal Description: ~ Cased to ~--~O 'f Depth of Grouting ~ ' Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) If A, B, C, D.E.C. Approved (Y/N) ~'~/~ ~.. '7 _~"- Yield ~. ~-- Casing Height Above Ground I ~:~ "~r Electrical Wiring in Conduit (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 Water Samp. le Test Results Comment?¢' t3_J~lJ -t-O B. SEPTIC/HOLDING TANK DATA Date Installed Si~_ _ No. of Compartments Standpipes (Y/N) A~ght Caps (Y/N) ~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) '~ Date Last Pumped _ Pumping/Maintenance Contact on File (Y/% ~ ; for Holding Tank High-Water Alarm (Y/N) ir~ ~ -,~ (/--~mporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEF~'~O/HOLDrN~TANK: To Water-Supply Well _-- ~;~uilding Foundation To Property Line__ ' . To D~osal Field To Water Main/Service Line ~ To Stream, Pond, Lake or Major Drainage Course Comments ~)U b It r_. ~ ~U~ C V" 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Abs~,~.ption Strata Type of System Design Date Installed ~ Length of Field __ __ Width of Field ~ Depth of Field __ __ Gravel Bed Thickness __ __ Square Feet of Absortion Area ~. Statndpipes Present (Y/N) Depression over Field (Y/N) '~ Date of Last Adequacy Test Results of Last Adequacy Test . ~. SEPARATION DISTANCE FROI~SORP~I~ F~ELD: To Water-Supply Well ~ To Property Line __ To Building Foundation "~ To Existing or Abandoned System on Lot ~__--; On A(~j~ng Lots To Water Main/Service L'me _______ 'i~utback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments P,~ h/l'~ ~-~ cO C ~ D. LIFT STATION Date Installed 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 S & S ENGINEERING 17034 Eagle Kw~ L~ ,~v=~ Nu ..... Company =..d,~ River, Alaska ~9577~ Date MOA No. Receipt No. Date of Payment Amount: $ Receipt No. Waiver Fee: $ Date of Payment ..~,4~bT(~lq~"~l~lit~d~e_C of this ~_ ~~ngi~s~S~l 72-026 (Rev. 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAIOLE £or Work Order % 21762 Date Report Printed: ){AY 21 90 @ 09:38 Client Sample ID:L17, Bi: ALDERWOOD S/D PWSID :UA Collected MAY 16 90 @ 12:20 Received ){AY 16 90 @ 13:05 h~s. Pzeserved with :AS REQUIRED Client Name : S ~ S ENGR Client Acct : SNSENGP P.O.% NONE RECEIVED Req % Ordered By : R. SHAFER Analysis Completed :[{AY 16 90 Send Reporte to: Laboratory Super~i{o{ :STEPHEN C. EDE L)S ~ S ENGR Released By :~~--~ d,~f-~- 2) Special Instruct: Chemlab Ref #: 901380 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N ND(O.iO) mu/1 EPA 353.2 10 Sample SAMPLE COLLECTED BY RDJ. ROUTINE SAMPLE. Remarks: 1 Tests Performed ' See Special Instructions Above UA-Unavailable ND- None Detected "See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT-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 [] ~=~,o ~T~ S~ST~M,.D.~I I I I ]~PRIVATE WATER SYSTEM Name Mailing Address Phone No. ENGINEERING ~0~4 Eagie River Leep Re4~ ~ ~ River, Alaska ~_ 57'~r~ City State Mo. Day Year SAMPLE TYPE: /Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose SAMPLE NO. LOCATION I 31 4 I 5 I Zip Code [] Treated Water [] Untreated Water Time Collected ~C°llected B~ TO BE COMPLETED BY LABORATORY alysis shows this Water SAMPLE to be: Satisfactory [] 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 ~----'o-I ~ -F'{t0 Time Received IB~_F-h Analytical Method: Membrane Filter * No. of colonies/lO0 mi. Lab Ref. No. Result* Ana~y?~t READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LTB BGB Final Membrane Fil~~ Reported Time: Collform/lOOml Collform/lOOml p.m. TNTC = Too Numberous To Count OB = Other Bacteria PART ONE OF TWO REMAINDER TO FOLLOW MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SI'rE SEWER AND WATER FACILITY 264-4720 Application Date ~,~ '!'~'~"~:~ GENERAL INFORMATION Legal Description (include lot, block, subdivision, section, township, range) Iz T'/7 / ' '75 Location (address or directions) (b) Applicant Name t~¢~'E~'I'~ Applicant Address (c) Applicant is (check one): Lending Institution ~; Owner/builder~; Buyer ~ ' Other ~ (explain); (e) Real Estate Company and Agent (f) Address Telephone Mail the HAA to the followJng address: TYPE OF RESIDENCE Single-Family.~ Multi-Family I-'1 Number of Bedrooms ~ Other WATER SUPPLY Individual Well~l~ Community [] Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [] 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 (11/84) Page 1 of 2 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. -...5~ Name of Firm '/~'~"~- Telephone Date -f~'~-t/" "f;'~' Approved for ~'-~4.~'>~J~ bedrooms Approved Disapproved Conditional Terms of Conditional Approval 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. The 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 72-025 (11/84) WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF AN~IG~"1 AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & CHECKLIST- FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264-4720 M/~Y' ] ~ '~ Legal Description: ,/.~'7"/7 RECEIVED If A, B, C, D.E.C. Approved (Y/N) Date Completed /~,,~" /~'"7~," Yield "'~- Depth of Grouting /.,/,,4 Pump Set At ,xJ/,,~ Sanitary Seal on Casing(~) Depression Around Wellhead (Y~:~) /<///,'~ · On Adjoining Lots "<'/,~,/~) ,'<,/~/~ · On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date /% Well Log Present (Y~Jl Total Depth Cased t(~ Static Water Level ~ -~'-~' / Casing Height Above Ground ,/° ~' 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~/'~--,~ ~/'~" Cleanout/Manhole 6) "/-~" Water Sample Collected by ,'/'~'~"~')' Water Sample Test Results SEPTIC/HOLDING TANK DATA Da~ Size No. of Compartments Standpipes (Y/N)"~,,,~ Air-tight Caps (Y/N) __ _ __ Foundation Cleanout (Y/N) Depression over Tank (Y/~ Date Last Pumped Pu~Ce Contract on'"F,~I,~(,Y.,~/N) .... ;for Holding Tank High-W.ater A_larr~ (,Y,/,N),' ~ Temporary Holding Tank Permit (Y/N) Se~ptic/Holding Tank: ~~ply Well __ :~. F:undation To W:t;:r:ai n/Service Line To :~~nd, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) Co ABSORPTION FIELD DATA S~ in Absorption Strata Type of System Design Date Install~,,,~____ Length of Field ____ Width of Field ~ Depth of Field Gravel Bed Thickness Square Feet of Absorption Area'"~ Standpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test . Results of Last Adequacy Test Separat~m Absorption Field: To Water-Supply Well ~,~Property Line __ To Boflcling Foundation ...... ~ To Existing or Abandoned System on Lot ~ On Adjo'ming Lots"~,,xx ~~ne__ To Cutbank (if pre'S'~ ~omments LIFT STATION :i':~//4~ Dimensions ~ Manhole/Access (Y/N) "Pump On" Level at ~ "Pump Off" Level at High Water Alarm Level at Tested for ~s during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have.ehecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'('/ /&'~'~' Date -~-"-/¢'~ Company /'~-~/'~ MOA No. No. Date of Payment Amount: $ &% Page 2 of 2 72-026 (11/84) ,,,LIIROFImI F1TAL COFITROL $1 kolCl $, (~nqin~¢rinq $ I~nuJronmcniol Studies G /~¥t EORG~'BRIARD 6334 AIRGUARD ROAD ANCHORAGE ALASKA 99515 5115186 GEORGE BRIARD 6334 AIRGUARD ROAD ANCHORAGE ALASKA 99515 60189 LEGAL:ALDERWOOD SUB. BLOCK 1 LOT 17 FLOW TEST ON WELL WELL FLOW DATE-515186 A FLOW TEST WAS PEP, FORMED ON THE WELL. 462 GALLONS OF WATER WAS PUMPED AT A RATE OF 9.2 GPM OVER A DURATION OF 1 HOURS. THE DRAWDOWN WAS 5.8 ' WITH A RECOVERY TIME OF 5 MINUTES ANT) THE STATIC WATER LEVEL WAS 57.5 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. 1200 LUcst 33rd ~ucnue. $uii¢ [~ · ~nchorc~q¢, ~l~ska 99503 .[907) 561-5040 MAY 3 7 1982 May 26, 1982 [] JAY ~ IIA~¥O#D, ~OVER#OR 437 E. Street SECOND FLOOR ANCHORAGE, ALASKA 99501 (907) 274-2533 P.O. BOX 515 KODIAK. ALASKA 99615 (907) 486-3350 P.O. BOX 1207 SOLDOTNA, ALASKA 99669 (9O7) 262-5210 P.O. BOX 1709 VALDEZ, ALASKA 99686 (907) 835-4698 P.O. BOX 1064 WASILLA, ALASKA 99687 {907) 376-5038 Steven D. Shrader, P.E. Alaska Development Consultants, Inc. 6100 "A" Street, Suite 2 Anchorage, Alaska 99501 SUBJECT: Sanitary Sewer Improvements for Alderwood S/D Addition #4 (8221-DA-070) Dear Sirs: We have reviewed the plans and specifications for the subject project. The project is hereby approved for construction for the items with which this Department is concerned. The 75 foot well to sewer requirement is waived to 40 feet. This letter constitutes the permit required by A.S. 46.03.720(a) for approval of sewerage systems. Environmental Engineer BEE/sw 18-.09 LH ACHEMICAL & 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 t~ PRIVATE WATER SYSTEM Name Phone Mailing Address City SAMPLE DATE: State Mo. Day Year Zip Code SAMPLE TYPE: "~ Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose Treated Water Untreated Water SAMPLE NO. LOCATION 3 I 4 I S I Time Collected Collected TO BE COMPLETED BY LABORATORY Date Received Time Received Analytical Method: Analysis shows this Water SAMPLE to be: 'Satisfactory [] 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. Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* 7/t- I I-~ Analy,? BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter:. Direct Count Coilformll00ml BEFORE COLLECTING SAMPLE Verification: LTB Final Membrane Filter Re~~ _ ~/~ Reported By BGB Date Time: Coilformll00ml 1~6 ~.r~. p.m. TNTC = Too Numberous To Count OB = Other Bacteria ALASKA ENVIRONMENTAL CONTROL SERVI(~-', INC. 1200 West 33rd Aven~,., Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 JOB ~ SHEET NO. C,,,C'.,'ATED S¥ /' CHECKED BY SCALE OF DATE DATE _ ~,,,~.~.,. ,: ......... .. - .... _.~-:,:"--'-"' L .... ,', ,_,:~-=__, ~._, .... ._, ._ ,_ : , , , , ... ['!:?.~'[ :, . .~:. IIi / I .-,-..-.-- , I.I, /..- . I r' O . ~ ~TAI, I. iYIHT~.~- '*~(TTf~) .. ~ ~ GUARD ~ ROAD : -. :~,f ~ ~ - 6 ~~'~:' ' ......... A'~ -- - ~ % N / ." "I ~'~""'~' ~ r~,~. I r.;.~,.~{& % X. ;. ~::,....~;~1 :;.:;, -. . ~ ~ '~ :~.::~;~:'~,:~. z ~ ~ ~ ~ ~CHOR~OE ~NTERNAT~ONA~ ~ o~x,~ .' :;~247~;;!..,;': : , , AIRPORT TRACT X I ~ ~'~ x ~ z-._:-;~'::.~: ALDERWOOD SUBDIVISION · GRF-ATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Received -7/, / Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF I~IVIDUAL SEWSR & WA~R FACILIIISS FOR Number of ~3odrooms: '~ell Data:~ ' Ye A. Type B. C. Construction D. Sewage Disoosal System: ~~Q~- , Depth .... , , Bacteria] Analysis A. Installed B. Installer C. Septic Tank: 1, Size 2. Manufacturer D. Seepage Pit: 1. Size 2. Material Disposal Field: Total Length of Lines 8. Distances: A. Well To: Septic Tank , Absorption Area , Sewer Lines , Nearest Lot Line , Other Contamination Foundation to Septic Tank Absorption Area C. Absorption Area to Nearest Lot Line · ~ueft for Approval of ~agc-Two Comments: ]ivtdual Sewer & Water Facilit Approva~lid for e Year From Da%e Signed J- ~ Greater Anchorage Area Borough, Department of Environmental Quality D,Au~AM OF o. STEN~. ~ cert.~fv that the information contained in this request for appreval to be a true and accurate representation of the subject' sewer and water facl!ittes located at: Signed Date