HomeMy WebLinkAboutBROWNS RESUB LT 37(PLAT P-498) LT 7 T13N R3W SEC 22Browns Resub
(Plat P-498)
Lot 7
#006-324-12
Parcel I.D. #
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
006-524-12"~ NAA # '~ ~
GENERAL INFORMATION
Complete'legal description
Location (site address or directions) 5007 EAST 25th COURT
Property oWner ._JIi~I'FELLENBURC
[
Mailing address 5007 EAST 25th OOURT
Lending agency
Mailin-g address '
Agent
Address
Day phone
Day ~hone
'..,Day phone
537-5568
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 2
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
xxx
NOTE: If community well system, provide written confirmation from State ADEC attest-
.. , lng [o the legality and status of system. ... ,, ,
TYPE OF WASTEWATER DISPOSALi
Individual on-site
Holding tank
Community on-site
Public sewer
XXX
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Re~.1/91) Front MOA#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 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 d~ ~bof this inspection.
Phone (.g 07) .%~7-6179
DHHS SIGNATURE
~ Approved for 2
Disapproved.
Conditional approval for
TE 2B
ANCH(3RA~F AIARKA gQ~n4 .
bedrooms.
bedrooms, with thee 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 paragraph 5 above by an 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 engineer's work.
Municipality of Anchorage SEA 0'
DEPARTMENT OF HEALTH & HUMAN SER,~V~.~/p,~z ~/POp
Environmental Services Division ' v'~°~l~,?V~/,~,~o/:~.
825 L Street, Room 502. Anchorage, Alaska 99501- (907) 34~-~z~'~.~e,~
UlPI$10z~
Health Authority Approval Checklist
Legal Description:
T13N, R3W, SEC 22, LOT 7
Pamel I.D.: 006-524-12
A. WELL DATA
Well type PRIVATE
Log present (Y/N)
Total depth 70'
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
YES Date completed
Cased to 70'
YES
5/25./83
Casing height (above ground)
Wires properly protected (Y/N)
12'%
YFS
FROM WELL LOG
AT INSPECTION
Date of test 5/25/'83
7/3o/99
Static water level 50'
Well Product[on 20
WATER SAMPLE RESULTS:.
34'
g.p.m. 7.4 g.p.m.
Coliform n (R./r~/~q) Nitrate R77 rnn../I (8/?/~9) Other bacteria o
Date of sample: ~/C~ t ~/Z/~:~¢ Collected by: A.W.W.C._: ,NC:
B. SEPTIC/HOLDING TANK DATA e~~ '
Date installed Tank size Number of Compartments CI . _
· Foundation cleanout (Y/N) Depression (Y/N) High water~.~t'TN) __
Date of Pumping Pumper ~~
C. ABSORPTION FIELD DATA '
Date installed ~ __ Soil rating (g.p.~drm) System type __
Length Width ~ow pipe __ Total depth __ .
Effective absorption area _J~rbnitodng Tube present (Y/N). Depression over field (Y/N)
Date of adequacy test J Results (Pass/Fail) For .bedrooms
Fluid depth in~d before test (in.);
FI~ (inS)peroxide treatment (past 12 2i~tu~.~s lat(y/N~ r:
Immediately after gal. water added (in.):
Absorption rate = g.p.d.
If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access [WN) ,,p~ at*
High wa~ *Datum
C~.,les'f'&st e d
Size in
"Pump off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
On adjacent lots
On adjacent lots
Absorption field on lot -
Public sewer main 30'+ Public sewer manhole/cleanout 85'+
Sewer/septic serVice line 25'+ Lift station -
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation : Property line Absorption field
Water main/service line Surface water/drainage _~
SEPARATION DISTANCE FROM ABSORPTION~O:. .....
Property line ~..mai,;_r~_7 line
Surface water ' J ~g/vehicle storage area
Wells on adjacent lots
I certify that I~t~J/trl~n~/,~l~ru f~eld inspections and review .
Signature
Engineer's Name ,U JEFFREY A. GARNESS
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
6oo,
Waiver Fee $
Date of Payment
Receipt Number