HomeMy WebLinkAboutHIDDEN ACRES LT 5
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This As-built shall not be used for
~ny pJrpose othe~ than financing
r~qui~]~n~s. Under no circumstances
shouIG ~:,~y data i~oreon be used for
constrtmtion or for establishing
~-c./~'/":~' boundary or fence lines.
AS-BUILT NO CORNERS SET THIS DATE
EASEMENTS OF
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON.
I hereby certify that I have performed a Moriagee's
spectJon of the £O]]O'~'g described property: ~ O-Q5 ....
Anchorage Recording Precinct. Alaska, and that the improve-
ments situated thereon are %vithin the property lines and do
not overlap or encroach on the property lying adjacent there-
to, that no improvements on property lying adjacent thereto
encroach on the premises in question and that ii]ere are no
roadways, transmission lines or other visible easements on
said property except as indicated hereon.
Dated at Anchorage, Alaska
FRED WALATKA & ASSOCIATES
Engineers and Surveyors
po U C H~'6-650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TONY KNOWL&S
MA YOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Permit 9: 840009
January 31, 1985
TO: Permit Applicant
SUBJECT: Lot 5 Hidden Acres Subdivision
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1984.
Permits are issued on a calendar year basis by authozity
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent
to this Department for documentation of the installation
and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as-built inspection report
and the yellow copy must be sent to this office for review
and approval, and for documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Keith E. Bandt, SupeYvisor
Environmental Engineering Program
KEB/ljw
enc: Copy of Permit
SWP/057
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LOT SIZE:
LOT LOCFITION:
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: THE I'tLINIF:IF'FILiT"r' OF FtN'"F-F.'FIGF' '::HOFI::' FIND THE S, TFiTE OF FIL.F!SI':::FL
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FIND IN 'ZF$'tF'L. IFtI",E:E I.,.!ZTH THE L':'E:E';~EiN E:RiTE:F:IFi Ol.: THIS "-"~ ....
I HILL. FiB'HE:RE TO F~I.J._ I'IOFf FIND :~E, TFITE: 31:::' FILFt2;I.:::FI F. rE(;!UtREEHEF,ITF:; F'OR THE L:E'T E:FIC:I':.':
E:'ISTFtN(::E::!5 F'F,':OI.'I l.::lN"r'E?::~:E,T.i:NG FIE[..[ .... .['IF.'.'STE'I'JFtTE'c' I':,I'::;POE;FtI_ ..:,'~:,tE:tl Ol'q: PI tE~LIF:
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,~.I-,..~F. PlaE E;"r'STEH- 'THI:E; .....
MUNICIPALITY OF ANCHORAGE
DEPARTMENT
OF
HEALTH
&
HUMAN
SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
1. GENERAL INFORMATION
Complete legal descriptio.n
' CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Location (site address or directions)
Property owner
Mailing address.
Lending agency
Mailing address
Address
Day ph'one
Day phone
Day phone ~'1-
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: ~
NOTE:
TYPE OF WATER SUPPLY:
Individual well ~/'
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4, 'TYPE OF W.~TEWATER DISPOSAL:
Individual on-site
Holding tank
C_o~rJmuQ[ty_o~--siJe-_
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality ahd status of system,
NOTE:
72-025 (Rev. 1/91) Front V[OA#21
5. STATEMENT OF INSPECTION BY ENGINEER
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 application shows that the on-site water supply
and/or wastewa~er 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.
Phone
Name of Firm /,~"-~'~¢~t
Address ~
Engineer's signature
Date
DHHS SIGNATURE
^pproved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only.upon.the representations_given in..paragraph5 above byan 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 engineeCs work.
72-025 (Rev. 1/91) Back MOA~I
KbLblVI:U
Municipality of Anchorage FEB 05 1999
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division MUNICIPALITY OF ANCHO
825 L Street, Room 502 · Anchorage, Alaska 99501 · (gr~v~°~Jl~4~ARwcEs DIVISION
Health Authority Approval Checklist
Legal Description: L,-/- ~ RL,',,~'~/.¢.~ ,~b/-.~ Parcel I.D.: O/~. -- ~.,c/~_.. _ / "7
A. WELL DATA
Well type
Log present (Y/N) y
Total depth
Sanitary seal (Y/N) 7
Date completed
Cased to ~_,.~, I
If A, B, or C, attach ADEC letter. ADEC water system number
Casing height (above ground)
Wires p~operly protected (Y/N)
AT INSPECTION
FROM WELL LOG
Date of test ID- ~ ' ~ ~ ~.- ~-~- ~q
Static water level ,~ 0 7~'
Well production c~, _~ g.p.m. ~
WATER SAMPLE RESULTS:
Coliform ¢ Nitrate l'~,J..~ Other bacteria
Date of sample: ~/Z.,/¢ ~ Collected by:
B. SEPTIC/HOLDING TA~.A
Date installed %size Number of Compartments Cleanouts (Y/N)__
Foundation cleanout (Y/N) '~Depression (Y/N) High water alarm (Y/N)
Date of Pumping Pumpe'~
C. ABSORPTION FIELD DATA
Date installed ~ Soil ratin~p.d./fF or ft2/bdrm) System type
Length __ _Width. ____ Gra~ickness below pipe _ __ Total depth
Effective absorption area__ __ Monitoring 'rub'~resent (Y/N)__ Depression over field (Y/N)
of d,uao, test ,,..,s _ _
Fluid depth in absorption field before test (in.); Imm~.%l~ after. , gal. water added (in.):_
Fluid depth (ins) Minutes later: Abs;r%iate :_ g.p.d.
peroxide treatment (past 12 months) (Y/N) If yes, ~ date
g.p.m.
72-026 (Rev. 3/96)*
bedrooms
LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"~P. ODni't .ue~e. at*
"Pump off" level at*
F.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line .
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM ~IC/HOLDING TANK ON LOT TO:
Foundation __ _ Prop~ line .... Absorption field
Water main/service line __ __Sudace %er/drainage .... Wells on adjacent lots
SEPARATION DISTANCE FROMAB~0RP~ION'~ELD ON LOTTO:
Property line Building foundatior~ Water main/service line
Surface water
Curtain drain
ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area
Wells on adjacent lots
I certify that I have determined thru field inspections and review of Municipal records that the above systems are
in conformance with MOA HAA guidelines in effect on this date.
Signature / _
Engineer's Name t ~ [/¢/" '~ "1 ~-~ u ¢' ~¢-.I ~ ~'~
Date /~l~'/~J ~
HAA Fee $.
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
¢_,_._ ~¢-_ ?¢
Waiver Fee $
Date of Payment
Receipt Number
Environmental
Services
CT&E Ref.# 986058020
Client Name Tobben Spurkla~d P.E.
Project Namely n/a
Client Sample ID Lot 5 Hidden Acrc~
Matrix Drinking Water
Ordered By
PWSm
Sample Rem~l<s:
Client POg
Printed Date/Time 02/04/99 14:05
Collected Date/Time 02/02/99 13:00
Received Date/Time 02/02/99 13:40
Technical Director: Stephen C. Ede
patan~er Results P~L UniTs
DaTe O~te Init
Sicra[e-N 0.~00 u 0,100 mg/k IrA 300.0 10 ma~ 0Z/0~/99 02/0~/99 SCL
ZTK CT&E Environmental Services inc.
LaboralorV Division F~~~~lJJlla~'/ll/'~'lagll~'/lla
Anchorage, AK 99518-1605
DriVing Water ~a[ysis Repo~ for Tota~ Cotifo~ Bacteria ~ w
~AD fi~TRUCTIONX ON ~V~g SIDE 8EFO~ COLLECTING SAMPLE Tek {9071 562-2343
~ax_ {~7) $61-$301
TO B~ COMPLE~D BY L~O~TOKY
' BE COMPLETEI:) BY WATEE SUPPLLEg.
PUBLIC WATER SYSTEM I.D,
pRiVATE WATER SYSTEM
~94~'~ ~U.,~
Month D~y Y~lr
Analysis shows thi~ Water SAMPLE to ~:
Sansfactory
c3 Unsatisfactory
tn S~ple ov~ 30 hou~ ot~ r~ul~ may
~ unreti~tc
nO~ ~ ov~ 48 hcu~ old ~ cxmmauon
~o indi~ rcliabl~ ~sui~, pl~e send
Angly~ ~n __ -
' Num~ of cotoni~ 1 ~ ~,
~b ~[ N~ R~ult' Analyst
SAMPLE TYPE:
{2 Tr~at~! Water
El Routine
cl Rel~at Sam pl~ (for ~utin* s~mpl~ ~ Unt~t~ Water D~:
with lab rtl- fl~~) Client aotifl~ of u~facto~
~ S~iat EuXine ~mt Coll~t~
~A~LE LOCATION Collgg~ By
Ph~ S~ wire Fax~
BACTERIOLOGICAL WATER ANALYSIS RECORD
::2-7 '-- ',~ .....
DTI000656