HomeMy WebLinkAboutT13N R4W SEC 25 N2N2NE4SE4 PTN (6)Z5
~"' MUNICIPALITY OF ANCHORAGE
· DIVISION OF ENVIROb~4ENTAL HEALTH
DEPARTMENT OF HEALTR AND ENVIRONMENTAL PROTECTION
.~PLIC~ION FOR ItF_~TH AU~HORITY APPROVAL GERTIFICATE
1. C~aneral Information
Application Date December 7, 1984.
(a) Legal Description (include lot, block, subdivision, section, township, range)
..A portion of N% of N~ of NE~ of SE¼f Section 25, Township 13 North,
Range 4 West, Seward meridian.
Location (address or directions)
1008 Wilshire Ave. (Between Arctic BlVdo & Spenard)
(b) Applicants Name~Barbara Trantina Telephone - Home ~g Business
Applicants Address 1008 Wilshire Ave.
(c) Applicant is (check one) Lending Institution ~ ; 0wner/builder~ ;
Buyer?--~ ; Other~ (explain);
(d) Lending Institution Frontier Ak. State Credit UnionTslephone 563-3766
Address ~OO E~de Anchoraqe, AK
(e) Real Estate Co. & Agent
Address --
Telephone --
(f) Mail the HAA to the following address:
FroDt~¢r Ak. State Credit Union
3500 Eide
_ Anchoraqe~ Alaska
2. Type of Residence
Single-Family~
Multi-Fam~ly~
Other _(describe)
Number of Bedrooms 3
Individual Well
Community
Public~
Note: If community wall system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewase Disposal
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.
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5. Engineering Firm Providin~ Inspections, Tests~ Pile Search~ Data and Information
Am 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 w~stewater 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'wsstewater disposal
system is in compliance with all Mmnicipal and State codes, ordinances, and regula-
tions in effect on th~ date of this inspection.
Name of Firm QUADRA Enqineerinq, Inc.
Telephone 276-3770
Approved ~ Disapproved
Te~s of Condf~iou~ Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 FEDER~kL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICAT~ IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/eJ/D18
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At
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Well Classification Private
Well Log P~esent (Y~
· , ~,
I.,4U¢4%CipALh OF ANCHORAGE
DEPT. OF HEALTH &
Eb!VJ~ONMENTAL p~G~ECTJON
JAt' 'J. 6 1985
RECEIVED
Legal Description: A portion of N% of
of NE~ of SE¼~ Section 25, Township 13
North, Range 4 West, Seward Meridian.
If A, B, c~C, D.E.C. Approved(Y/N)
Date C~,~leted ~ Yield ·
Total Depth 73 feet Cased to -- Depth of~G~outing --
Static Wate~ Level -- Pump Set ~t --
Casing Height Above Ground 2'4 ih~hes (6~". Dia. ) Sanitary Seal on Casing (y/N) Yes
Electrical Wi~in~ in COnduit (Y/N) Yes . . Depression A~cund Wellhead (Y/N) No
Separation Distanc~' f~cm Well:
To Septic/~oldin~ Tank on Lot -- ; On Adjoining Lots --
To Near~st Ed~e of Absorption Field on Lot -- ; On Adjoining Lots --
To Nearest Public Sewer Line ~5~- . To Nearest Public Sewe~
- House C/O
Cleanout/Manhole l~(D'~ To Nearest Sewer Service Line on Lot 30'
Wate~ Sample Collected By "Bo McFadd. en ;~ Date December 5, 1984 ~
Wate~ Sample Test Hesults By Chemical & ~-eoloqical Lab, Anchoraqe
C~nts Flow. tes~ ~;ielded ~66 .9al/min total or 0.22 gal/min per bedroom.
Tested Jan. 3, 1985.
2:45p.m.
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N)
Depression ove~ Tank (Y/N)
NOT APPLICABLE
Size
Ai~-tight Caps (Y/N)
Date Last Pumped
No. of Ccmpa~tn~nts
Foundation Cleanout (Y/N)
Pumping/Maintenance Contract on File (Y/N) ; fo~
Holding Tank High-Wate~ Alarm (Y/N) Tempo~a~ Holding Tank Pe~,~it (Y/N)
Separation Distances f~om Septic/Holding Tank:
To Water-Supply Well To Building Foundation
To Property Line To Disposal Field
To Water Main/Service Line To St~e~, Pond, Lake, c~ Majo~ Drainage
Course
Counts
: Receipt
??~'~ Amoun t:
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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
NOT APPLICABLE ~
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes P~esent (Y/N)
Date of Last Adequacy Test
Separation Distance frcm Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To P~operty Line
To Existing or Abandoned System cn
; On Adjoining Lots
To Cutbank(if present)
To Stream/Pond/Lake/c~ Major D~ainage Course
To D~iveway, Parkin~ Area, o~ Vehicle Stc~age Area
CoaguLants
De
LIFT STATION
NOT APPLICABLE
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Levei at
Tested for
Electrical Codes(Y/N)
Dimensions
Manhole/Access (Y/N)
"Pum~ Off" Level at
Vent (~Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
Counts
** Check Permitted Bedroom Rating Against HAA Request
! certify that I have checked, verified, oF confor~d to all MOA HAA C~lidelines in effect
on the date of this inspection. / ~
Signed ~~ ~ ~~ Date/~/~ ~
Company ~Y/~ ~6t~/~L~A/~ MOA No. ~W'~-/g~
KB1/d5/s
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