HomeMy WebLinkAboutALYESKA NORTH #3 Block 5 Lot 11 MU.,C,.^L,TY Or ^.CHOR^GE DEPARTMI'I~IT OF HEALTH AND ENVIRONMENTAL PhUTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL/6~j~"7_ (~.?~) ~ OF ON-SITE SEWER AND WATER FACILITY 264-4720 / / Application Date ~/~/~? ,- / GENERAL INFORMATION subdivision, section, township, range) . . // (a) Legal Description (include lot, block, Location (address or directions) Business (b) Applicant Name ~¢~.~/~'~-,¢U,~ Telephone: Home (c) Applicant is (check one): Lending Institution [] ' Owner/builder []; Buyer [] ' Other/~ (explain); "-- (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family~.~ [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well~(' 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 Public/~r~ Community [] Holding Tank [] Onsite 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 PROVIDI, INSPECTIONS, TESTS, FILE SEARCH, D ~ 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 inspectio, n. Name of Firm ~,',~' -~ ,~4"~ ,~'"'~ / ~ ~t"/~"~ Telephone ~'~ ~J / Address '~,~'~f-'O ~'~_ ,~-~.~,'~'" /, /'~C-X. .,,'~v~..~_~"C~ -~, o DHEP APPROVAL pproved,or * CCPbe room, Approved ~ Disapproved Conditional Terms of Conditional Approval Date Engineer's Seal 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) MUI~J~AU~ OF ANC~ ~VffiONMENTAL SERVICES DIVISION FEB ! ? 987 RECEIVED WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal DescriDtion: r,j Well Classification ~'~ ,' L'"~.~ If A, B, C, D.E.C. Approved (Y/N) ' Well Log Present (Y/N) 11~-.~ Date Completed I O..///g/ Yield ':~' - ! / ~ . ¢l~ ' I,. Total Depth '~.,o~:~ Cased to 7--~ Depth of GrOuting ~ Static Water Level ,/(/~v-- '~.~.~,'~¢.e._ Pump Set At ' /~/,~,'/r",~'o Casing Height Above Ground ~'"~ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) . ~ ~ Depross~on Around Wellhead (Y/N) .~::~ Separation Distances from Well: To Septic/Holding Tank on Lot //~t~/'O/l~-~:: ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /~__D~/-~; On Adjoining Lots ,~ To Nearest Public Sewer Line -'~'~ ~ ~'~'"¢ To Nearest Public Sewer .~... I ~la~-.~-- ~ ~.,~ / Cleanout/Manhole -~', ,,~"~"~'o Nearest Sewer Service Line on Lot Water Sample Collected by ~/~ ~~ ;Date Water Sample Test Results '~'~.~?~. ~ .'~~ Comments ~J.~ ~o ,~[ou..,-.,~~,~ ~ ;~.;,/~/,~:,~7' ,~,~J SEPTIC/HOLDING TANK DATA Date Installed '~,~. , Size No. of Corn partments Standpipes (Y/N) ~. Air-tight Caps (Y/N) ~~~ Foundation Cleanout (Y/N) Depression over Tank (Y/N)~ Date Last Pumped __~ Pumping/Maintenance Contract'~F_i~le (Y/N) ___--; for ~__ Holding Tank High-Water Alarm (y/~..._~_____. Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holdin~k: To Water-Supply Well '~ . To Building Foundation To Property Line '~.~.~ To Disposal Field ___ To Water Main/Service Line '~ . To Stream, Pond, Lake, or Major Drainage Course -'~ , Comments '~ Page 1 of 2 72-026(11/84) Co ABSORPTION FIELD DA'~ Soils Rating in Absorptio StrafeX Date Installed Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Square Feet of Absorption Area Depresmon over Field (Y/N) "~ Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: ~ . To Water-Supply Well 'X~ To Property Line To Building Foundation . . ~ To Existing or Abandoned System on Lot __ __; On A'~ining Lots To Water Main/Service Line ____ __ 'l~,Cutbank (if present) To Stream/Pond/Lake/or Major Drainage COurse ',~ To Driveway, Parking Area, or Vehicle Storage Area Comments . D. LIFT STATION Date Installed '~ Dimensions Size ~n Gallons ~ Manhole/Access (Y/N) . "Pump On" Level at ~ "Pump Off" Level at . High Water Alarm Level at ~ Vent (Y/N) _ Tested for %,% Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h ave~che~c, Jra~;~v~ifie~d~ or conformed to all MOA and HA~A guidelines in effect onthe date of this inspection. Signe/,~'~/~-,-~-~-.--.--Date _ ~ Company~~ ~'A/~. MOANo. Receipt No. ~ o //'- O~tr-.) / ,.~ Date of Payment (:~-///7-- ~,~ 7 Amount: $ //'0 f_..) ~ Page 2 of 2 72-026 (11/84) 440 W. Benson Blvd. Stdte 206 PE.-NII SUIA Anchorage, Alaska 99S08 (907) BOl-S107 February 13, 1987 2001 Realty 13~5 West 9th Anchorage, Ak 99501 Attn: Bob Campbell ~: 11/5 North Addition Alyeska #3 NHN Toas Drive Health Authority Well Approval. Dear ~/~. Campbell At your request I have preformed and inspection of the well on the above referenced property and preformed the necessary well flow test to acquire the health authority review by the municipality. The well was tested for a 3 bedroom home and was found to deliver the ~50 gallons per day requirement at a rate of 5 gpm with ~_nimal draw down. The water sample taken the same day was tested and found to be satisfactory with no coilform present. The water pressure tank appears to be functioning adequately provide a continuous pressure of 30-~5 psi during the testing period. Application is in progress for the waiver of the well to sewer line separation distance and health authority approval. Sincerely Wayne Henderson P.E. WH:pes Suite 200 99501 Arctic EngXneers ~nc. tSOO a. 3otb Avenue / A~y~s~t Subd~vXs~on ~a~ad upon new geoLo~i~l and sews~ consC~uct~o~ info~tion ~lch n~ ~y potential le~Se diverted away fr~ the subject well ~he ~rtmnt here~'' 37 it ~d ~e wll to sewe~ M~ole ~ratZ~ fr~ 100 it co 54 it ~~ K~t t~e wll cas~ Xs Srounted Ko bed rock aa recoun~d ~ you~ letter Of Feb~y 2~, 1984, Slnt;erely' -1~ ~_ Eric kaon luvlrom~eucal *~nglneer 27~-Z533 437 E. Stree~ Sul~e 200 Anchorage, AK 995~1 April 17, 198~ To ~hom ft "-,~ay Goaceru: Well Waiver Lot 11, Block 5, Unit 3, North Addition, Alyeska Subdivision Thls ofllce Aaa recezved eviaence that cae ~all on ti~e sub3ect property- aaa been propegly ~rouced to comply rich the velvet granted l~rcb © I BLOCK I II I0 4 8 7 8 9 12 13 8 ? 6 5 4 BLOCK 6 /P_5.00' EZCLUSl0N NOTE: It b Ins e~ re'~.onslblllty t~ determine the exlstmm~"., of any e~sements, ~ovenants, or restrlc~ons whibh do not appear on the recorded ~ulxllvlsion plat. Under no circumstances should any dar8 hereon be used for constmcUon or f01' establishing boundary of fence lines. SURVEY CERTIFICATION: I hereby certify that I have .urveyed the property shown and d; ~1 ~ ~ ,crlbed hereon end thet the lmprovements sltuated thereon ere wlthln the property llnesendnencroechmentsexllt other than noted. PLEASE NOTE: It Is the contract LEGEND: SET FOUND ! w.o..: 87,....L.. ~.~ ENGINEERS · PLANNERS · SURVEYORS -or'. respon,lbtllty to check- top 5/B' REBAR O O - of foundation In relation to HUB & TACK [~ ~ IDRN. e¥:~ 440 WEST BENSON BLVD. finllh grade end building let- MONUMENT ~ (~ ~ _.#~v, . ANCHORAGE, ALASKA99503 562-5291 beck. In relation to lot line. AL.CAP . and easements. P K N A I L X IRON PIPE (~) omo: LEGAL DESCRIPTION: ~]- ELEVS. - DATUM APPLIC ~IT FILLS OUT UPPER HAL ONLY · .,t ~t~. i :;~>~..~ ,~..~t't:'__ Phone / ,;Malling~',ddress !":"" ~' ' /'~''iX' ~ :"/'//~'/~'~'r~;" L' ~ ZipCode / / ~.j/ ~)['.. ~' ~.~ Buyer ,- ;~' : .., -.- ~ ' Phone Lending institution /Z /,,. :,~ ~//:~, (. .:::~.; :' /~' ~:', ..... '~q~ "":~/'?: Address :~ ~ ~D~ ~ Zip Code Phone Realty Co. & Agent Address Zip Code Type of Resi~nce '~. 81nole Family Multlpl~ [amlly ~o. of 8odroo~ ~ Other ~:', ~ Water Supply ~'lndividual A~ACH WELL LOG. A wal log is required for all wellS drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). : Public Utility sewer ~o,~, ~ / ~ ~ ~3 ,., ,,, ~ ~ Individual Year Individual Installed: ~ ~ (~ ~HoldingPUblic UtilitYTank~~ , / ~ ~ / 0.~.7~ When Connected to Public Utility: NOTE~HE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Date Date Date~. ~ ~ ~ Date Inspector Inspector In~ [nspec~r Field Notes: . < ( )DISAPPROVED Soils Rating Date ~wer Installed Well To ~sorption Area Well Log Received Well to Tank Septic T~k Size 72-023 (31~) Decembe'c 29~ 1~ '~' ,Joan I~ourne/Karen L. P.O. ~ox 34148 Anchorage r AK 99501 Subject: Lot 11 Block 5 Unit 3 ~:~o Addition to Alyeska Subd. Approval for the individual se~,~er and water facilities cannot be granted until the follow.zing items have been co~'pleted: A well log sub~]itted to this office for our files and rev iew. Water %~as observed at the ~Tp:ound-casing area, We %,.;ill to kno%,; the source o~ this A survey from a registered surveyor will also be needed to ascertain the ].ocation of the community se~,;er line and your The ~;ater £acilities were not turned on at the time of tn_ scheduled inspection. Please call this office for another appo in tment. Please notify this de~')artment for a reinspection when the note(] ~]iscrepancies have been corrected, if there are any further questions~ please call this office at 264-4720. Sincerely, cc: Alaska Conti~enial Jim Roberts Associate ~nvironmental Specialist CHEMICAL & GE ~OGIC.4L LABORATORIES ( .4L~ISK.4, INC.~  TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER - 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria ~ TO BE COMPLETED BY WATER SYSTEM: Water/System Name Mailing Address ......... _~ .. ~ .,~,. City Mo. Day TO BE COMPLETED BY LABORATORY I.D. NO. Analysis shows this Water SAMPLE to be: f[~atisfactory - [] Unsatisfactory Zip Code SAMPLE TYPE: [DxRoutine ~ 'l~,heck Sample (for routine with lab ref. [] Special Purpose Year ater [] Sample too long in transit; sample should not be over 48 hours old ,at examination to in~licate reliable results. /lease send - ',new ~mple: ...... * .....~ ..... '? i' !/' Date Received 2 .~ ' Time Received ./".~ [*J'"L~ Analytical Method: Fermentation Tube Membrane Filter SAMPLE NO. LOCATION 1 2 3 4 , ,i%,, Lab Ref. NO, I c(~lonies/100 Result* Analyst Rev. 1978 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Data Collecte(t Source No. Date Recalved ] Iml R~;I~ I.~.,-. ~.,u. ~v. ~mPtlve ~0ml ~0ml [~1, [0mi l~l ~,Oml 0.~ml 24 H~ri 48 HOUri Conflr~to~ 24 H~rs 4~ Houri EMB Broth 24 houri: Multiple Tuba Report: Membrane FIItart Direct Count Verification: L.TB Final Membrane Filter ReSults ~ t'~ Broth 48 hours: lOml Tubes Positive/Total 10mi Pot'tlonl Collform/lO0ml BGB ' ....