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Home My WebLink AboutTURPIN #1 BLK 1 LT 10 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 Parcel I.D. 1. GENERAL INFORMATION Complete legal description Lot 10; Block I; Turpin Subdivision #I Location (site address or directions) 6412 Markstrom Property owner Mailing address A. B. Combs Day phone 6412 Marstrom, Anchorage, Ak. Lending agency Mailing address Agent K~vin Taylor VISTA BETTER HOMES & GARDENS 5uuu C S~e~c #1ul Address Anchorage, Alaska 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: $ ~t TYPE OF WATER SUPPLY: NOTE: Day phone Day phone 562-6464 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 WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer XX If communify wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 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 flies 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. Name of Firm $ & $ ENGINEERING Address ~ 7034 Eagle River Loop Road ~agJe I~iver, Alaska Engineer's signature Phone Date DHHS SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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. MuniqiPality of Anchorage Department ~)f Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT /0; J.~(.IC '1 /--[qPJ~l~""~/D ~ Parcel I.D. A. WELL DATA Well type ~,~.b~__ Log present (Y/~) Total depth Sanitary seal If A, B, or C, attach ADEC letter. ADEC water system number Date completed (-~ - - Driller Cased to ~0 '~- Casing height Wires properly protected ~/N) y~E> FROM WELL LOG Date of test (~ ~ f44¢~, Static water level // Well flow Pump level g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot ~-'1// Public sewer main .~ ~0 r .~- Sewer service line TER SAMPLE RESULTS: Coliform ~ ~'/~9 Date of sample: ~[''t~ ¢~!~ K DATA Cleanouts (Y/N) High water alarm (Y/N) Date of pumping SEPARATION DISTANCES FRO~NG TANK TO: ; On adjacent lots ; On adjacent lots /~//,/~ PUblic sewer manhole/cleanout ~ Petroleum tank Other bacteria /~'~ Collected by: ~ ~ %-~ F___./,oO~r~e~.~r4~- Tsnk size Oomp~rtment8 ~(Y/N) ~/N) Well(s) on lot Surlace water/drainage 72-026 (Rev. 7/91) Front On adjacent lots Absorption field Foundation Water main/service line CONTINUED ON BACK PAGE · LIFT STATION ~ Meets MOA electrical codes (Y/N) ~ ~ D.~RPTION FIELD DATA Date Length Curtain drain E. ENGINEER'S CERTIFICATION Soil rating Gravel thickness bedrooms System type Total depth Total absorption area ~ Cleanouts present (Y/N) % , · over field (Y/N) -'~"Ba~ adequacy test De.~ression Results (pass/fail) for Peroxide treatment (past 12 months) (Y/N) If da'"'"'"~"-~te yes, give SEPA-R-A-T~ON DISTANCE FROM ABSORPTION FIELD TO: ~/,~ '~Ct6L./¢- %~Fv'E/~. Well on lot ~ On adjacent lots Property line To building foundation~"----._ To existing or abandoned system on lot On adjacent lots C~ Water main/service line Surface water ~ Driveway, I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. $ & S ENGINEERING 17034 Eagle River Loop Road NO, 204 Signature [%¢~ I~;,.'~-,,-,,..,-.,,"'--' ..... ....,."'". Engineer's Name r~,,~ x,, Date HAA Fee $ / 70 Date of Payment ~-'~¢/'-~'" Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE ! 51700 Chemlab Ref.t 92.0884 Sample t I ~atzlx: MATgR Client Sample ID PWSID Collected Received Preserved with DRINKING WATER LIO BI TURPIN S/D tl Client Name ;3 ~ S ENGINEERING UA Client Acct :SNSENGP MAR 5 92 ~ h~s. BPO$ : MAR 6 92 @ 12:00 lms, Noq$ : AS REQUIRED Ordered By :R. S~EER POt :NONE RECEIVED Analysis Completed : MAR 9 92 Send Reports to: Laboratory Supervisor : STEPHEN C. EDE i)S & S ENGINEERING Paramotor Results Units Method Allowable Limits NITRATE-N ND(O.IO) mR/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: J.W. Remarks: i Yests Performed ' See Special Instsuction~ Above UA-Unavailable ND= None Dotected "See Sample Remarks Above NA= Nat Analyzed LT=Less Than, GToGraater Than ~"~ SGS Member of the SGS Group (Soci~t~ G(~n~rale de Surveillance) INSPECTION APPOINTMENTS ' I NSPECT~ ENVIRONMENTAL SANITATION DIVISION AUG 2 r? 1981 Telephone 264-4720 5, LEGAL DESCRIPTION STREET LOCATION 6. TYPEOF RESIDE C NUMBER OF BEDROOMS ~ One ~ Four ~' ~ TWo ~ Five SINGLE FAMILY ~ MULTIPLE FAMILY ~ Three ~ Six [] Other 7. WATER SUPPLY iNDIVIDUAL* COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** F~ PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) / ~/~-~ f~ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE'MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY ' ' 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED I~] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER I~]INDIVIDUAL/ON -SITE DATE INSTALLED L~PUBLIC UTILITY Connection Verified INSTALLER [~]Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL '4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS E~APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~ ~ATE BY July 229 1969 Mr. Charles O. Whittaka~ civilian Hf!itary Referral office PoO. BOX 179 Anchorage~ Ak. 99501 SUBJECT: qate~ Supply Se~vtng ~lock 1, Lot 10, TuPpin Subdivision~ Home of Mr. James Wapren Dear Mr, Whittakem: This lettor is to confirm the fact that th~ water supply serving the subgect location i~ app~oved by this office. Mz,. FosteP~ ownep of the propemty~ has coDnected to Cen- tral Atazka Utilities wate~ supply. The main tru~k sewer line will ,bm installed at the rear of ~h~. subject p~oDerty within sixty (60) (lays. Sfncercly. DAVID R. Lo DUNCAH~ Hedi~al Dirscter Davl~. iia~n~ss~ F,. Sanii:ariau Dtl:rn 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, September 1, 1981 A.B. Combs 6412 Markstrom Drive Anchorage, Alaska 99504 Subject: Lot 10 Block 1 Turpin Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: The water analysis'report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. A well log needs to be submitted to this office for our files and review. A permit for the installation of the well needs to be obtained from this office. The well permit fee is $15.00. If there are at 264-4720. any further questions, please call this office Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: First National Bank of Anchorage Post Office Box 4-2090 995D9