HomeMy WebLinkAboutSPERSTAD #2 BLK 5 LT 1
MUNICIPALITY C~F 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
Parcel I.D.
UNICIPAI. ITY OF ANCHORAGE
II~)NMENTAL SERVICES DIVISION
8EP 11 1997
RECEIVED
HAA # ~/~fl'--) ~'t'Ut ,~(~r)
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: v
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wa.stewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
Legal Description:
A, WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
Municipality of Anchorage _ MUNICIPALITY OF ANCHOP,~rI~
DEPARTMENT OF HEALTH & HUMAN SERVIC~CC~ONMENrALSEP, VICES ~[~1)
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 34~rd~'4~4'i 1997
Health Authority Approval Checklist R E C E i V E D
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed I ,~ 7o/7 /
eased to /'~2) Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
Y
FROM WELL LOG
g.p.m, b. ~)
g.p.m.
WATER SAMPLE RESULTS:
Coliform ~ ~
Date of sample: ~o / ~/ ?
B. SEPTIO/HOLDING TANK DATA
Date installed Tank size
Nitrate
N ~'~ Other bacteria '"~ ~b
Collected by', ~ -~
Number of Compartments __ Cleanouts (Y/N).__
Foundation cleanout (Y/N)
Depression (Y/N)
High water alarm (Y/N)
Date of Pumping
C. ABSORPTION FIELD DATA
Date installed
Length Width
Effective absorption area
Date of adequacy test
Fluid depth in absorption field before test (in.);
Pumper
Soil rating (g.p.d./fF or ft2/bdrm)
Gravel thickness below pipe
Monitoring Tube present (Y/N)__
Results (Pass/Fail)
Immediately after
Fluid depth
(ins) Minutes later:
System type
bedrooms
Total depth
Depression over field (Y/N) __
For
gal. water added (in.):
Absorption rate = .g.p.d.
Peroxide treatment (past 12 months) (Y/N)
If yes, give date
72-026 (Rev. 3/96)*
Page: 1 Document Name: ENTERPRISE SERVER
PARCEI4":018~072-05-000,98:CARD: 01 OF 01
STATUS: RENUMBERED TO/FROM: -
.................................................................
~FEJES CHRISTOPHER J &' ?SPERSTAD #2
MELINDAC ,' iBLK 5 LT 1
RESIDENTIAL SINGLE FAMILY
- - 1
PO BOX 112117 0
ANCHORAGE AK 99511 2117 SITE 12890 OLD SEWARD HWY
LOT SIZE: 30,000 ---DATE CHANGED ....... DEED CHANGED ....
ZONE ' RO OWNER ' 09/23/97 BOOK' 3124 PAGE: 0486
TAX DIST: 003 ADDRESS: 09/23/97 DATE ' 09/16/97
GRID HRA # ' PLAT ' 000000
NOTES ' PLAT P-453-B
.................................. ASSESSMENT HISTORY ..........................
---LAND--
FINAL VALUE 1995:
FINAL VALUE 1996:
FINAL VALUE 1997:
EXEMPT VALUE 1997:
--BUILDING .... TOTAL---
75,000 74,300 149,300
75,000 74,100 149,100
75,000 78,000 153,000
0 0 0
--EXEMPTION---
..... TYPE
STATE EXEMPT 1997:
FINAL VALUE 1997:
150,000
-COMM COUNCIL-
3,000 OLD SEWARD-OCEA
Date: 9/24/97 Time: 10:56:32 AM
.~1~, CT&E Environmental Services Inc.
CT&E Re#.# 975424001
Client Name Tobben Spurkland P.E.
Project Nmne/# N/A
Client Smnple ID T.W. Spcrstad 5/1
Matrix Drinking Water
Ordered By
PWSID
Sample Remarks:
Client PO#
Printed Date/Time 09/14/97 17:50
Collected Date/Ti~ne 09/10/97 17:30
Received Date/Time 09/11/97 10:20
Technical Director: Stephen C. Ede
Parameter Results PQL Units Method
Allowable Prep Analysis
Limits Date Date Init
Nitrate-N 0.100 U 0.100 mg/L 8M18 4500-NO3F 10 max 09/12/97 JBL
Total Coliform 96 08, NO COLI SH18 9222S 09/11/97 TM~
RECEIVED
ZtK CT &E Environmental Se rvices Inc.
S EP ~,5
Laboratory Division
Mut~icip~ality of Anchorage
D~P4, H~ailh ~, Human Serv ces
Drinking Water Analysis Report for Total Coliform Bacteria 2oo w.
Anchorage, AK 99518-1605
READ INSTRUCTIONS ON REFER, YE SIDE BEFORE COLLECTING SAMPLE Tel: (907) 562-2343
MUST BE COMPLETED BY WATER SUPPLIER
PUBLIC WATER SYSTEM I.D, #. ~
PRIVATE WATER SYSTEM
0 $~ndRzgult~ 0 SeadInvolce
r~ Scnd R~ult~ ri Send lnvoice
SAMPLE DATE:
Montk-
SAMPLE TYPE:
Routine
Repeat Sample (for routiae ~amp~
with lab ref. no. )
D Special Purpose
SAMPLK LOCATION ~ '~' · i
Day' Year
Treated Water
Untmami Water
Comments:
Fax: (907) 561-5301
TO BE COMPLETED BY LABOR~TORY
Analysis shows this Water SAMPLE to be:
~ Satisfactory
Unsafisfacto~
Sample over 30 hours old, results may
be unreliable
Sample too Ions in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new ~ample via specia~dqlivery mail.
Data Received '-'///~
Time Received [ (~---~
AnalysL~ Bepn
AnalyttcaIMethod: ~ Membrane Filter
MIviO-MUG
* Numberofcolonies/100 mi.
- tfluit'
97. 5543
Fbk~
Time:
Time Collected
Colleffe~ By
Phosm~
· /o;/o VT_~_
BACYERIOLOGICAL WATER ANALYSIS RECORD
~ Ca~i
Analyst
Ju~ []
Fax~d
MMO-MUG Re~ull~ Tetal Coliform
Membrane Filter. OIrm Count
Verification: LTR
Fecal Co Iform ConflrmaUo!
Final Membrnne Filter Relults
Reported B te
Client notified of unnatisfactory results:
SlMIm witk
Timed
Colonifl/100 mi
COLIFIRM~
Fnxed
Califor.._m/100 mi
T~ ~ r~ h~
Member of the SGS Group iSociitll GOne'ale de Surveillance)