HomeMy WebLinkAboutSUNSET HILLS WEST BLK 4 LT 1Sunset Hills
West
Block 4
Lot 1
#018-203-34
j����
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
Street, Anchorage, Alaska 99503 274-4561
Date Received April 14, 1976
Time of Inspection
9:30 a.m.
Date of Inspection 4-1.9-76 - Monday
REQUEST FOR APPROVAL OF Les
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv.
1. Approval requested by: First National Bank of Anchorage
7. Sewage Disposal System: On-site system
A.
Mailing Address: Post Office Box 720,
99510
Phone:
2.
Property Owner: Johp & Ida Asplund
1. Size
_ Phone: 344-5372
D.
Mailing Address: 4005 Spenard Road
1. Absorption Area
.2. Material �'urc2
3.
Legal Description: Lot 1 Block 4 Sunset
Hills
West Subdivision
4.
Location: Hancock off of Jarvi
5.
Type of facility to be inspected Single
Family
No. of bedrooms _ 3
6.
Well Data: Individual - serving
one
A. Type
B. Depth
C. Construction (f�I�], ,� ��.�
D. Bacteria] Analysis
7. Sewage Disposal System: On-site system
A.
Installed _
1966 B.
Installer WJJZ&_�
C.
Septic Tank:
1. Size
2. Manufacturer
D.
Seepage Pit:
1. Absorption Area
.2. Material �'urc2
E. Disposal Field: Total "length of lines
8. Distances:
i
A. Well to: Septic tank _ Absorption area 7 _ , Sewer Lines
Nearest lot line � O /-7' Other contamination _ doal r-
B. Foundation to septic tank Absorption area
C. Absorption area to nearest lot line
EQ -034 (1/74) Page 1 of two pages
ge 2 of two pages - Ret st for Approval of Individual er & Water Facilities
Legal Description Lot 1 Block 4 Sunset Hills West Subdivision
Comments
Approvedi.►x� Di spproved Date
Appr v 1 Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
E -To 19 v Ab&A(41E IMA Alm omD
WA TE R)
X
Asp -Ul CO3 ra
.SulvsET 9i4ts WEST TRH G iN
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
EQ -034 (1/74)
CIS
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276.2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO—VA_--_FHA_-
2. Property
MUNICIPALITY OF ANC11ORASC
nEPT. OF HEALTII S
FNVIRONnaFNTAL FF,O[FCnON
OR 1y7G
\.1-, cr,I . M.
_CONV_L
Mailing Address: S.& M4 IL P_ /? d -Day Phone: —1 V , 3 7 2_-
3. Name of Buyer: -1 ✓( %J K,2r�L. !! ----
Mailing Address: D a S� 12� —_ Day Phone: �_7g
4. Name of Lending Institution: _f= /axe 3AA�_
Mailing Address: Phone:
5. Name of Realtor or Agent:
Mailing
6. Legal Description:
Phone:
Location:_��-4e.P.eo %vim-- —
7. Type of Facility to be Inspected: No. Bdrms. _!;9! —
8. Water Supply
Type of Supply: Public Utility ---Individual..
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
72-003(3/76)
Type of System:
Public Utility Individual (on-site)
If Individual, date of installation
1 t�J1��1-1�1
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 995196650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 018.203-34 HAA#
Expiration Date: _3 " P, % — 0 6
1. GENERAL INFORMATION
Complete legal description Lot 1. Block 4. Sunset Hills West Subdivision
Location (site address or directions) 14134 Hancock Drive
Current Property owner(s) Patricia Kennedy Day phone 242.3137
Mailing address
Lending agency
Mailing address
14134 Hancock Lane Anchorage, AK 99515
Day phone
Real Estate Agent Jody Moses Day phone 243-3137
Mailing Address 3801 Centerooint Drive, Suite 200 Anch AK 99503
Unless otherwise requested, HAA will bo held by DSD for pickup.
2. NUMBER OF BEDROOMS: Three 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system Is(are) 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(are) in compliance with all applicable Municipal and State codes, ordinances,
and regula0ons In effect at the Gme of Installation.
Name of Firm Anderson Engineering Phone 522.7773
Address P.O. Box 240773 Anchorage AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 12/21/2005
KIaucL c u+nauai
b. DSD SIGNATURE
t� Approved for _ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By, Original Certificate Date: —2_ %
(R.. fwo)
Municipality of Anchorage
Development Services Department
Building Safety DhAsion
On -Site Water 6 Wastewater Program
4700 South Bragaw SL
P.O. Box 198850 Anchorage, AK 99519-6850
www.d.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 1. Block 4. Sunset Ifllls West Subdivision
Parcel ID:_91M3-34
A. WELL DATA
Well type E611I2 If A, 8, or C provide PWSID 0 _
Well Log (Y/N) N
Date completed _ Sanitary seal (Y/N) Y
Wires property protected (Y/N) Y
Total depth do ft. Cased to _),t_fL
Cesing height (above ground) _24 in.
FROM WELL LOO
AT INSPECTION
Date of test
14A105
Static water level R
792 It.
Well production g.p.m.
p,o g.p.m.
WATER SAMPLE RESULTS:
Coliform —Q_colonkWlOO ml. Nitrate _ML mg.A.
Other bacteria _-L colonies/100 mi.
Date of sample: _12MMS Collected by: _ LH
B. SEPTICIHOLDING TANK DATA
Tank TypelMaterial
Date installed
Tank size gal. Number of Compartments _
Cleanouts (Y/N)
Foundation cleanout (Y/N) _ Depression over tank (Y/N)
_ High water alarm (Y/N)
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soti rating (g.p.d.Ats or fta/bdnn) _
System type
Length fL Width
it Caravel below pipe tL
Total depth _ It. Eff. absorption area ftp Monitortng tube _ Depression over field
Date of adequacy test Results (Pass/Faiq
For _ bedrooms
Fluid depth In absorption field before test _ in. Water added_ gal. New depth_ in.
Elapsed Time: _ min. Final fluid depth _ In.
Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
If yea, give date
D. UFT STATION
Date installed
'Pump on' level at _ in.
Datum
Size In gallons
'Pump air level at _ in.
Cycles tested
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm 6 dreull requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankMft station on lot WA On adjacent lots x W
Absorption field on lot WA On adjacent lots�> W
Public sewer main 49 Public sewer manhole/cleanout Aff
Sewer /septic service line >25' Holding tank WA
SEPARATION DISTANCES FROM SEP71CIHOLDING TANK ON LOT TO:
Building foundation Property One _ Absorption field
Water main Water service line Surface water
Wens on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property One Building foundation Water main
Water Service One Surface water Driveway, parkinglvehide storage
I
Curtain drain Wells on adjacent lots
F. COMMENTS
y�P�E pF y
O. ENGINEER'S CERTIFICATION • '
i
I certify that I have determined through field aispecllons and 49th o
review of Munhdpal records that the above systems are lo
conformance with MOA HAA guidelines in effect on this date.
moan, c wmorsa
Engineer's Printed Name Michael E Anderson. RE � CE -M
Date 12121=5 14hA��' l
HAA Fee $ qro
Date of Payment / Z L 2 —D S
Receipt Number SiAi:7ZA='P :.
Waiver Fee $
Date of Payment
Receipt Number
12-19,05;16:02 ; ;907 561 5301 # 2/
SCS Ref.0
1058043001
CllentName
Andcrxon Engineering
PrOccl Namcl#
L1 B4 Sunset Hills West
Cllent5ample ID
LI B4 Sunset Hills West
Metrix
Drinking Water
PWSID 0
Sample R.emotks:
Ali D+tcxITimci art Alaska Standard Time
Printed DaltMme 12/1512005 13:49
Collected Datc/flma 12/07/2005 11:45
ReceivedDate/Time 12/05/2005 11:57
Technical Director Stephen C. Ede
Punmetet
Rnolts 1,04 Units Mcthod
Allewublo
Container Limits
Prep
Dow
Awlysie
ID
Data Ink
Nlirnto-N
0.126 0.100 mg/L EPA 353.2
B (<-10)
12/08/03 1C
Microbiology Laboratory
Total Collrorm 0 col/l00mL SM20 92220 A (ti11 12/08/05 TLF
12-18-05:16:02 ; ;907 661 5301 # 3/
SGS/CT&E ENVIRONMENTAL SERVICES
Drinking Water Analysis Report forTotal'Collform Bacteria
RM INSTRUCTIONS ON REVERS! atoll atPORa CMUCTWO S"pLL
MUST BE COMPLETED BY WATIiR SUPpL1t1R
❑ PUSUC VVATSR SYSTEM IM
❑PRIVATS WATER SYSTEM
❑ Sano RaWN O a"trnalm
❑ Srd Results
2D0 W. POTTER DRIVE'
ANCHORAGE• ALASKA B951
Tel: 907-582-2343'
Fax 907.781.5301
lab Ref Nq
1058043
NUNN
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SAMPLE COLLECTION:
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SAMPLE TYPE
❑ Routine
TO BE COMPLETED BY LABORATORY
SamoleR_eoeTn`-
Temp:
Delivery Method:
Received By.
CommedR
Repeat Semple
❑ Troatod Water
0 Untreated Water
(rotor to lab no. t
Speclal Purpose
0AIMPIeDW30homold: ❑ RUSH SAMPLE
Reatdb may M wnllaWe'
❑ 4s Hour weber Phone #:
mots lmtlorr
Fax SELL
...........................................................................................................................................
NAGIArloleeleal Wator Analvsla Record•
Anatysb
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Am"6;al Methoo:
Membrane Filter
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