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Home My WebLink AboutSPRUCE ACRES LT 11OI 4- Z 0 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Appiication Date o/o8/8 . (a) Legal Description (iqclude lot, block, subdivision, section, township, range) Lot 11 Spruce Acres Location8339 (addresSspruce 9S~ ~directions) Applicants Name Vra~zolav Draha Telepbone Home349-12~siness (b) (c) (d) Applicants Address_ Applicant is (check one) Lending Institution Buyer ~-~ ; Other ~ (explain); Lending Institution Address 8339 Soruce S'b. Anchorage, Alaska 99507 [-----[ ; Owner/builder~; Telephone (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: Call Tony BarCer for pickup.(266-1559 Vi, a~Js]_av ]~aha 8339 Spruce St. Anchorage~ Alas--~ 2. T~e of Residence Single-Family~ Xulti-Family~ Other (describe) Number of Bedrooms Two (2) 3. Water Suppl_Z Individual Well X~l Community .~. Public ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, 4. Sewage Dis o~ 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] 5. Engineering Firm Providing Inspections~ Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date showa 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 regula- tions in effect on the date of this inspection° Name of Firm Barter and Associates Telephone 563-7164 Address 5331 Tudor Top Circle Anchorage, Alaska 9950~ Approved for ,~ bedrooms B~j~I~f.I~/~.~ Date Approved ~ 'Disapproved /~'--'-~ '- ~n~it io[l~=- Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTME~f OF I~ALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASRAo THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES ~ID THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP 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 NORK. Sm ) RR4/ej/DI8 [Page 2 of 2] 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (NOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: MUNiCIPAUTY OF ANCHOP, AG~ DSPT. OF HEALTH & 5NVJP, ONMENTAL PROTECTIO~ OCT ! i987. private Date Completed ? If A, B, or C, D.E.C. Approved(Y/N) Y ? Yield 6 gpm Depth of Grouting ? Pump Set At ? Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) N Well Classification Well Log P~esent (Y/N) N Total Depth 104 f~. Cased to Static Water Level ~ ~ Casing HeightAbove Ground 6 in. Electrical Wiring in Conduit (Y/N) Y Separation Distances f~omWell: To Septic/Holding Tank on Lot ; On Adjoining Lots n/A To Nearest Edge of Absorption Field on Lot N/A ; On Adjoining Lots N/A To Nearest Public Sewer Line ~ ~ /~+~-'%~To Nearest Public Sewer Cleancut/Manhole ~ c~r~od ~ ~ ~ ~+, TO Nearest Sewe~ Service Line on Lot ~ ~ Wate~ Sample Collected By T. Bar~er ; Date 10/07/84 Water Sample Test Results .._¢~4,af~a~r~ Commsnts ** A call ~o AYA, IU to confirm sewer connect revealed no records or as-builds although ~hey did confirm a dye ~est. SEPTIC/HOLDIN~ TANK DATA Date Installed'X~ Standpipes (Y/N) Depression ove~ ~ank Pumping/Maintenant ~tract Holding Tank Hi~.-~at~m Separation Dista~ [oe~ To Wate~-S~ ~11~ :~22er Main ~ne-- Corm~ents ,artments ,n Cleanout (Y/N) ank Permit (Y/N) Major Drainage Receipt ~ Date Paid: Amount: [Page 1 of 2] 2-15-84 C. ABSORPTION ELD DATA Soils Rating Date Installed Width of Field ;orption St~_ata Square Feet of Absorption Depression over Field (Y/N) Results of last Test Separation DR To To Buildi~ Lot To Water To To Driveway, Counts Type of Length of Depth of Grave Design Thickness Present (Y/N) of Last Adequacy Test T~Proper ty Line To ~sting or Abandoned System cn ; On Adjoining Lots To Cutba~prese nt) Major Drainage Course .ng Area, o~ Vehicle Storage Area D. LIFT STATION Date Installed Dimnsions Size in Gallons ~. Manhole.s (Y/N) "Pump On" Level at \ ~"Pum~Off"~ Level at. High Water Ala~nn Le~{el ~t ~ ~>~ Vent (Y/N) ** Check Permitt Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA ~icl=~].iDes. in effect on the date of this inspection. [Pa~ 2 of 2] 2-15-84 CHEMICAL & TO BE COMPLETED WATER SYSTEM: SAMPLE DATE: ~ Mo. ~_ Routine D Check Sample (for routine with lab mf. no.__ D Special Purpo. SAMPLE NO. LOCAI'ION . 1 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE , INC. icteria - ' · - SUPPLIER '(*) See h;on r ' 'r ~*Treated I BY LABORATORY ; s shows this ~/Vater SAMPLE~o be: )le too 10rig in transit;sample should e over 30 hours old at examination to able results. Please send new )le via special delivery mail Received. Method: Filter Ref. No. Reault* Analyet~v Mem~ne ~ltec Direct Count ' ~ ~: Collfo~/l~ml TNTC= Too Numerous To Count TM ' ": .... ' ..... ~""-' '~ ' - · ApPLF~iNT FILLS OUT UPPER HA' ~ONLY Buyer Address Zip Code Realty Co. & A~nt Address Zip Code ~ Family ,~ Water Supply ~ual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available)· ~ Public Utility /~ ~ ~'~ ~/~, , Sewer Disposal ,::', ~ ~ In~idual Year Individual Installed: ~ ~hen Connected to Public Utility: / ~ ~ ~ ~diC Utility c 7 NOTE: THE INSPECT]ON FEE MUST ACCOMPANY EAGH RE~ST BEFORE ~OCESSIN~CAN BE INITIAT~D. Time Time Time Time ~ Date Date Date Date Inspirer Inspirer Inspirer Insp~tor Field Notes: ~UNICIPALI~ OF ANCHORAGE RECEIVED (~P~ROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED 12-023 {3182) .' ~HEMICAL & GEt,LOGICAL LABORATORIES Oz.' ALASKA, INC.~ TO BE CO MPLETED BY WATER SUPPLIER WATER SYSTEM: - LO, NO. Phone No Mailing Address City Mo, Day SAMPLE TYPE: i~ Routine 'D Check Sample (for routine sample with lab ref. no; [] Special Purpose State ~[p Code Year [] Treated Water [3 Untreated Water SAMPLE NO. 2 3 4 5 Time Collected Collected By I ':;/ ~'?'' TO BE COMPLETED BY LABORATORY Aha vs s snows this Water SAMPLE to be: F;~i"Satisfactory [] Unsatisfactory [] Samole too long n transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received / ' '~ ~; Time Received Analytical Method: [] Fermentation Tube ~]"Membrane Filter Lab Ref. No. Result* Anal,yst I.'''.' .~'i F-l-q~ "¢:~':'? i-[-I ~ [-'[-I READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collect e~t Source NO. 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours