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Home My WebLink AboutKING (PLAT 67-87) BLK 1 LT 2 MUNICIPALITY OF ANCHORAGE f'-'~'._' :-. ' -., ../~;~ ' '-- ,.-", DEPARTMENT OF HEALTH & HUMAN SERVICES_ Division of Environmental Services On-Site Services Section - -. -- '- .... - ...... P.O. Box ~96650 Anchorage, Alaska 99519-6650 :~ ':7 -~ 343-4744 -;~' :'- ' '-- CERTIFICATE OF HEALTH AUTHORITY ' ' APPROVAL FOR A S INGLE FAMILY DWELLING Parcel I.D. # ~ I ~/- ~'~"~ ~"~'~' ~'0~'~" '"< ~- ' ;:" "' :HAA# _1. GENERAL INFORMATION _Complete legal description £ot 2~' -Bloe~- I ~.K~n~ :Su~b::~d~vZ~ion ~ _ -,::_..~,. . . _ .. ~.., - .... ~!.-~,..f;¥ ...... ; ::-":;'~2:;;A.~ NUMBER O~ ........ ...... -~'--: -~. ~-.,~-- <... ..... '~:~ '~,~ - ~'¢- ;':: ~:-."- r%- '~'~, ....... ~-, ' ?' . -i~: ': ':'-. ..... indNidual Well :.L~:;-':{~-;~;:..;; '-" ,,:~- '- ..,' ~, ';'¢.'*.;.'";-; · '. - Public water z.:.;, - - :-<?_~;;;? * :'~-- * .... -'. .... ?-," ........ ;'~:/' :-~'7~' --_; .:.: NOTE: ~f communi~ well system, provide .wri~en confirmation from , :'-;.; ...................... · .-.:- :... ,.... ... · _ - . ..... m to thelegah~.andstatusofsystem ..... - ~':-4.' '- ~PE OF WASTEWATER DISPOSAL: ?::~':-<,- _. ..... -?.¢¢; ....... ..,?<.,., .............. Holding tank_,,....:-: .... _-...,~,:. :.._ a~esting to the legality and status of system. "- 72-O¢.5(Rev. 1/91) Front MOA~21 5. STATEMENT OF .......... - *-. --~ As ce~ified by my seal affixed hereto and as of the validation date shown below, veri~ that my investigation of ~is Health Authori~ Approval application shows ~hat the on-site water supply" and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and ~pe of structure indicated herein. I fu ~her veri~ that based on the information obtained from the Municipali~ of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system ~s in compliance with all Municipal and State codes, ordinances, an~ r~ulations in effect on the date of this inspection.. Name of Firm ~ ~. ~ ~N~ Phone ~ ~- 7-/ 17~4 E~le River L~ Ro~ ~ .... '-':, _ . Address Engin~ signature ~7/ '~' ' '''/' 6ate ':"~/~}' ~ ':REQUEST YOU ISSUE A'CONDITIONA[:,HE~LTH AUTHORITY AP~OVAL.:~Y' TO BE r . ~ .. ~ · . ~ .~ : .... . ~..,~.:.~~-~, ~. .- ..... . ~ . ~ . ~ :. ~ ' ~M~ ';~ ~ - . . . . .., . · .. · . , ._..- . . . . .; ,- g,..,~.~.;~~,~.,,.~ -:- . . · . ............... [~ - . ~ ~ ..... .... : ..... . -: ..... .. ?-: ..... .~.=..-. : ..... ~... '.... :,..~.,.:.~ .~-. c~.88oi...:_...:,'.:~.:.:.~ .~;~.-:'-.-..~ 6. DHHS SIGNATURE-:. : . "_:: ' ",. ~:'~,:~!~[[~h~[~:'. ?';::~' ~:'~: :~: _':.' .::-::'.~= ':,~;:~ ?'-A~ ?;':- ,- ;~ ' '?~ Di~pprov~.' :~:7[:.?:~ ~?~:~'?.:~ .~; ..~-'; g-~;.i:~*;~. ;~;?~;?::'~ ?Y~:~-:~..::: ;~::,.::::;:.:~;~ ¢;:~' ;.~ ::~.~'~'~:<~-~-::;-~:' ~:~;-~': :~:::~' .' ~ ~-~ :~ Condtbonal approval:for .~: .....~ · ..... -::bedrooms, 'w~th...the-followmg "..:.':?':~?,:-'-X~a~fg~i cag'~'~~.:'' ~'~'"" ' "-': ....... '~-' ' "' :-':'""" :~" ...... ':? ''":''::''~ "' '''~ ": :~":"'":'?" ~:...::.,.--?:...._..C-.-.~..,..,:.,..~.,-~,._:,.....;::~-:..: :.. . :.::.:--, .. ,~,,..:..-.::, ~.., :.,~. . -.:- ?-: . ::.:-:. .....-.-..,.~,..,.:.-::.:?:~; .... c0~JQ~t:~i~SP~ctio'ns or analyze'da~a 'before a certificate.is issued. The Municipality 'of'Anchorage is not responsible for errors or omissions in the professional engineer's work. - . ' ...' ~ ... :.'~.: ' :, . .~; ' '-"'"" '"' ':_' _ , .~-,'. :,.: ,'. -: ::. · -: · Department of Health and Human Se~i¢~s (DHHS) issues Health y iupon the representations given in pamg~raph· 5 above by an independent istered in the State of Alaska. The DH HS does this as a courtesy to purchasers Of homes ~titutions in order t0 ~atis~ certain federal and state requirements. Employees of DHHS do not 72-025 (Rev. 1/91) Back MOA #~1 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~..~c,'C '7~ ~L ~, \/-i~ Parcel I.D. Oth~ ~ P-ri - ~- 6., If A, B, or C, attach ADEC letter. ADEC water system number Date completed L~V-~ Driller A. Well Data Well type Log present (Y/~ Total depth Sanitary seal (Y/N) Cased to V3Y--- Casing height Wires properly protected ~N) FROM WELL LOG Date of test Static water level ~ Well flow jJ g.p.m. Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot 'Public sewer main Sewer service line AT INSPECTION · On adjacent lots ; On adjacent lots . Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: '~ -~ ?--'~, ~.5~ B. SEPTIC/HOLDING TANK DATA Date installed '"' ' '" Tank size Nitrate ~. ~ ~ Other bacteria (~' ~ 3->o--WS- Collected by: ~% Compartments Cleanouts (Y/N) High water alarm (Y/N) Date of pumping '~? ~ DISTANCE~ING TANK TO: SEPARATION Well(s) on lot ..--~- '" On adjacent lots To Absorption field Sudace water/drainage Foundation cleanout (Y/N) .D~ TM Alar~ ~ Pumper Foundation Water main/service line 72026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at Manufacturer High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DI~FT STATION TO: ~ On adjacent lots Manhole/Access (Y/N) "Pu~_..Rgp~ at Surface water D. ABSORPTION FIELD DATA Date installed Length Soil rating (GPD/Ft2) Gravel thickness System type Width Total depth /' Cleanout present (Y/N) Depression ove~ Results (pass/fail) for ~ Bedrooms Water level in absorption field before test A~..~te~ Peroxide treatment (past 12 months) (Y/N) ./~yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD Well on lot On a~ Property line To building foundation / To existing or abandoned system on lot On adjacent lots ~ Cutbank Water main/service line SurfaCe wate~.p..-/ Driveway, parking/vehicle storage area C~,~alh drain Total absorption area Date of adequacy test E. ENGINEER'S CERTIFICATION I certify that/have checked, verified, or conformed to all MOA and HAA guidelines in effect o~nt~ of this inspection. Signature -, Date H~Fee$ ~. ~ W~iverFee$ D~te ol P~yme~ ~ Date ol Psyme~ ~eoeipJ Numar ~ ~ ~ ~ ~ ~eoeipt Number 72-026 (3/93)' Back GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 9950'7 '279-8686 REQUEST FOR AP?ROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR ~ /4.,..~ _ ' 4..: '/.~.~/ Phone ......... . . ~-~}/-.--.~, ,,:'~:~~ / , Nu~be~ o~ Bedrooms: 6. We1] Data: ~~ A, Type' ,-~/0 ~.~ B. C. Construction ~11 D. 7. Sewage Dlsoosal .System: A. Installed Installer C. Septic Tank: 1, Size 2. Manufacturer D. Seepage Pit: 1. Size 2. Material Disposal Field: Total Length of Lines Distances: A. ~ell Septic Tank .,. , Nearest Lot Line Foundation to Septic Tank Absorption Area to Nearest Lot Line , Absorption Area , Sewer Lines , Other Contamination . ' ~ Absorption Area Page t'5o 9.!] Comments Aonroved Disapproved Date Approval Valid for One Year From Date Signed Greater Anchorage Area Borough, Department of ~nvironmenta] Quality DIAGRAM OF SYSTE~ t certify that the information contained in this request for approval to be a true arid accurate representat~.on of the subject sewer and water facilities located st: August 1~, lg73 First Natio;~al P. O. Sox 720 ^nchora§~, Alaska 99510 Water and se~er facilities servinq Lot 2, Block 1, King Subdtvtsio)) Dear Sir: ~Jpon your request, .this department inspected the sub.ject facilities o,~ August 9, 1973 and noted the following: i~ a ))it approximately 19' south of · Li~e casting musL be raised to 18' above t = grou~d a~)d the pit fille~ with semi-impervious soil. The punlp a~)d pressure tank must be relocated elsewhere. i'he on-site SeWage disposal system ~ee~inglY consists of ~ septic ta))k and seepage pit but they are located too close to Lhe well. Public sewer ts available to the properly an~ the ~welling must be connected to it. This aepart~eent will give temporar~ approval on the subject fu)~ds needed for the above facilities >,.nding the escrow of improvements, ihese improvements must be made by September 20, 19)3. AFiy questions re~aedtng the above, please contact me at 274-4561 · Sincerely, T. Rumfe!:., R.S., Sanitarian TR/V,o £nclosures cc: Crawford Rydwell FHA F~'m 2.573 ~ U. S, DEPARTMENT OF HOUSING AND URDAN DEVELOPMENT ~='/~' Form Approved FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63.R0296 HEALTH AUTHORITY APPROVAL '~ INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAl. NO. Anchorage First Nat'l. Bnk. of Anch. MORTGAGOR OR SPONSOR W i f~PROPERTY ADDRESS Buyer: Linnell, Jas. M. (277-1561)wks~ Seller: Rydwell, Crawford (344-0310) J 2930 E. 84th Avenue -Anch. SUBDIVISION NAME BLOCK NO. 1 King Subdivision TOTAL NUMBER: 1 2 1 WATER SUPPLY BY: [] Public system BASEMENT r-'] New installation UYes U.No r-]Community system Ak. LOT NO. Can attic or other area be made into addll~lonal bedrooms? (if Yes, how rnany~.) r-] Yes J~ No ['~] Individual BDRM$. GAR~SAGE DISrOSAL [] Individual [] Yes [] No SEWAGE DISPOSAL BY: [~] Public system O Community system PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT ~IEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the N State [--1 County [] Local Department of Health that this individual water-supply system [] is [] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the r-] State ~] County rem with proper maintenance: ]Can be expected to function satisfactorily, and is not likely to create an insanitary condition --]Local Department of Health that this individual sewage-disposal sys- --']Cannot be expected to function satisfactorily )ATE JSIGNATURE ] TITLE ~ I NOTE: The health authority should complete the appropriate opinion statement above and affix date, signature and title in the spaces provided. Uso of the above grid 'for Health Department Inspector's sketch as well os use of the back of this form Is at the option of the health authority. PART Ill.--FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the Individual water-supply system be considered [] Acceptable [~1 Not Acceptable Sewage disposal be considered ['-] Acceptable [] Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA form 257~ Rev. July 19S8 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septic tank. [] Cesspool. Septic Tank: Distance from well,__.feet. Material Total liquid capacity, Inside length, feet. Inside width, Colspooh Distance from: Well, feet; foundation, Inside diameter, feet. Depth, Number of compartments gallons. Capacity inlet compartment, Ibet. Liquid depth, feet. feet; nearest lot line at [] front, [] side, [] tear, feet. Liquid capacity, gallons. Lining material SECONDARY TREATMENT cnnsists of [] Tile disposal field. [] Seepage pits. Other Tib'Disposal Field: Distance from: Well. Total length of tile lines,. Trench width Length of each line gallons. _.feet; foundation .......... feet~ nearest lot line at [] front. [] side, [] tear, feet. Number of lines, Distance between lines, inches. Total effective absorption area in bottom of trenches, feet. Depth, top of tile to finish grade, Depth of filter material over tile, feet. Lining material feet. square feet. inches. Type of filter material: [] Gravel. [] Broken stone. Other -n~. D_.ept.~ of filter material beneath tile,~ inches. Seepago Pits: Number of pits .... Outside diameter, leer. Depth, Distance from: Well, Inspection made ~y:~ State. Date of inspectio~ ~ inches. feet; building foundation, feet; nearest lot line at [] ~ont, [] side, [] rear, [] Cnunty. [] Local Health Authority. Inspected by ~9 (TITLE) REPORT OF INSPECTION~INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main,__ feet. Size of main, inches. Imlividual wells [] are [] are m~t customary in neighbgrhood. Give mnst recent record of failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighborhood [] are [] are not being developed with both individual water-supply and sewage-disposal systems. Lot size' feet wide,, feet deep. Dwelling set back from front property line,, feet. Individual water supply t¥om: ~_] Drilled well. [] Driven well. [] Dug well. [] Bored well. Diltance of well from: Building fl)undadon cast iron sewer, feet; tile sewer, seepage pit, feet; cesspool, Well construction: feet; nearest h)t line at [] front, [] side, [] rear, feet; septic tank, feet; disposal field, feet; other sources or' possible pollution, iCeet. Diameter, inches. Total depth, feet. Type of casing~ Approximate d.epth to pumping level of water in well,_ feet. Approximate yield, Sealed watertight to depth of feet. Exterior space htound casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill, Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No. Pomp~ [] Shallow well. [] Deep well. Length of drop pipe,, feet. Pump capacity, Ix)cared in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground. [] Pump pit. Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Yes. [] No. Type of storage: [] Pressure. [] Gravity. Capacity, gallons. Has bacteriological examination of water been made? [] Yes. [] No. If answer is "yes," give date Quality of water [] is [] is not satisfactory for human consumption. Installation [] does [] does not comply with approved exhibits, if any. Inspection made by: [] State. [] County. [] L(x'al Health Authority. Inspected by Date of inspection 19 Depth of easing, .gallons per minute. gallons per minute. 19__ (TITLEI feet; feet. GPO 889-088 NUISANCE COMPLAINT FORM Complainant's Name:__ Street Address: ~g Phone No. 3~¥-,~/'2rr~~ Box No. Description of Complaint: ~?~q Name of Person Against Whom Complaint is Made: Owner of Property Where Nuisance Exists: Owner's Address: Phone No. Location of Complaint:_~c~ ~_.~z~ ~/~3~- ~?~ __ Street Address: Person Receiving Complaint: ~ Date: ~f~-~.~ I certify that such statement of facts is true to the best of my be- lief and knowledge. I request that the foregoing matter be investi-, gated and that appropriate action thereafter be taken. I am willing to testify to the facts stated in the foregoing complaint in court if necessary. Complainant REPORT OF ACTION TAKEN Investigator: Date Investigated: Action Taken:~ DATE COMPLAINANT D REGAR lION OF COMPLAINT: