The URL can be used to link to this page

Home My WebLink AboutT12N R3W SEC 9 S2NE4NE4NE4SW4 S132' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date /Z GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Address /~ ~ ~ ~ ~'~ 7' ~ ~ ~S ~,~ is (check one): Lending institution ~; Owner/builder~; Buyer ~; Other D (explain); Applicant (d, Lending ,nstitution//~..?'~, Address CE~',~'~-~ (e) Real Estate Compan~and Agent Address Telephone :,. / Telephone (f) Mail the HAA to the following address: S & $ ENGINEERING SE B J96X F. AGLE RIVER, AJ( 99577 TYPE OF RESIDENCE. Single-Famil,yx Multi-Family [] Number of Bedrooms ' Other WATER SUPPLY \ Individual Wel Community ~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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. Page 1 of 2 72-025 nl,8,1) ENGINEERING FIRM PROVtDIh~,i INSPECTIONS, TESTS, FILE SEARCH, DA £A AND INFORMATION As cerlified by my seal affixed hereto and as of tile 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&$J~NGINi=~RING Telephone Date F.,.&GLE RIVER, AK 99577 · ~k~/,'~¢-~,,4,~ ~¢~'~ Pt,~. /o/ 6, DHEP APPROVAL ~ l~io*~Z- Approved ed oom by Approved _ Disapproved Conditional. 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 satisly certain federal and state requirements. Employees of DHE. P 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 o25 (u/84} WELL DATA MUNIcI~'^LiT~ ,~F AIIf~J~II~ALITY OF ANCHORAGE (MO~/ OTECT~CKLIST - FEBRUARY 1984 2 o Legal Description: RECEIVED Well Classification S. ~ If A, R, C, D.E.C. Approved (Y/N) Well Log Present (Y~ Date Completed ~.2, /EL. Yield Total Depth _ L/,/¢--- Cased to ___.f.~-/¢-~ Depth of Grouting _ Static Water Level (,), /¢-.-.- Pump Set At Casing Height Above Ground /,5¢~}E~-¢'~¢-/ &¢ Sanitary Seal on Casing t~N) Electrical Wiring in Conduit (~/N) Depression Around Wellhead ~N) Separation Distances from Well: To Septic/Holding Tank on Lot .~.~ ~&..t ~._ ~-~L~4.~ ~-; 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 ____--'~./,-fi. To Nearest Sewer Service Line on Lot Water Sample Collected by ~ ~ ~ /~ ~ L~-I~*I'~L-'""~'-I~ G ; Date __/~- Water Sample Test Results _ ,~ ~r.-~"~! % Comments -~. 'V../~.~.~ ~_!A%~,~-¢~. ~'¢-~ /~ ~F77="k./_~"~"x~__ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Size .~. _ No. of Compartments Air-tight Caps (Y/N) ..... Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To I:~uilding Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N} Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: 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 ~/o(J~z_~ E_O).C/L/~-~7~.t~ ~"~ To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date installed Size in Gallons , , / "Pump On" Level at f High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection· SignedS &S I~.1I~..1~¢ Date --/ . Compa~R B~,,q~X- MOA No. Receip~6LE RIVER, AK ~95772~/ Date of Payment ~ ~/~ Amount:$ ~ ~ Page 2 of 2 72 026 (11/84) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPEC'T'ION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 H86-1387 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) T12N R3W Section 9 S132' NE¼ NE¼ NE¼ SW¼ Location (address or directions) 8434 Rosslyn (b) PropedyOwner Jan Riley Telephone: Home 349-6926 Business Mailing Address 13224 Elmhurst, Anchorage, Alaska 99515 (c) Lending Institution Alaska Contential Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) MailtheHAAtothefollowinqaddress:or:Checkhere:~,ifholdforpickup. Listcontactpersonanddayphonenumberbelow. S & S Engineerinq 17034 Eagle River Loop Road #204 Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family ~xx Number of Bedrooms three (3) WATER SUPPLY Individual Well~: Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite Ox Public [] Community [] Holding Tank [] Note: If corn mu nity well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/861Fronl 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. [ further verify that based on the information obtained from the Municipality of Anchorage files aed 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 & S Engineering Telephone Address 17034 Eagle River Loop Road, Eagle River Alaska 99577 Date Engineer's Seal This department has received written confirmation from the engine/er regarding the Conditional Approval of December 26, 1986. The corrections have been accomplished and an inspection has been completed by the engineer/ This subject property meets wi'th Municipal standards and is now approved. DHHS APPROVAL Approvedforthree(3) bedrooms Approved XXXXXXXXXXX~isapproved Date June 23, 1987 Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. 'l-he DH HS 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. Page 2 of 2 72-025 IRev 8'86} Back ROBERTA. SHAFER CIVIL ENGINEER 694-2979 June 22, 1987 HEALTH AUI'HORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPOR rs WELL INSPECTION & FLOWTEST SIYE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS Municipality of Anchorage Depart~e~ of Health and Human Services 825 L Street Anchorage, Alaska 99501 REFERENCE: S of Lot 132~ Section 9; T12N; R3W A conditional Health Authority Approval was issued on the referenced property in December, 1986. The conditions of that HAA required the existing well be brought into Municipality of Anchorage compliance. We performed a field inspection on June 19, 1987 at w~ch ~e we performed a yield test verifying that the we~l will produce in excess of 3 gpm. The static water level at the beginning of the test period was 101 feet. Maximum draw down with the existing pump and through the existing plumbing was 110 fe~t. The water line was buried to a depth of 10 feet and a pit, ess adapter installed with the w~l casing extended to 12 inches above the ground l~vel. The work required by the conditional approval has been completed. you issue a final HAA at this time. ~S/ss Request ON SITE WAS'rE WATER OISPOSAL SYSTEM DESIGN SRB 196X EAGLE RIVER, ALASKA 99577