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Home My WebLink AboutWALTER G PIPPEL ADDITION BLK 6 LT 10Waiter G. P*IPP el Addn Block 6 Lot 10 #050-123-10 FHA F~fo2973 ~'J FEDERAL HOUSING ADMINISTRATION ~ ''/ Form Approved Rev. Jul~ P,~ Budget Bureau No. 63-R296.8 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA : INSURING OFFICE MORTGAGEE SERIAL NO. ~ MORTGAGOR OR SPONSOR SUBDIVISION AME PROPERTY ADDRESS Co~on~do Ro~d BLO~K NO. LOT NO. ~ TOTAL NUMBER: BASEMt~NT [~Yes [] No ] New installation : WATER SUPPLY BY: r [] Public system [] Community system SEWAGE DISPOSAL BY: [] Public system [] Community system additional bedrooms? ,~ (if Yes, how many.) Yes No '~., SYSTEM DES~G.hm FOR i: U Individual NO. 0y BD.~,~$. GARB~*0E DISP0$AL'/ D PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT tEALTH DEPARTMENT iNSPECTOR'S SKETCH It is the opinion of the [] State [] County [] Local Department of Health that this individual water-supply system ~is [] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the [] State [] County ~] Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: U Can be expected to function satisfactorily, and [] Cannot be expected to function satisfactorily is not likely to create an insanitary condition DATE SIGNATURE A~suat 8s 1968 B. hvlme, o TITLE NOTE: The health authority should complete the appropriate opinion statement above and affix date, signature and title in the spaces pr0vlddd. ' Use of the above grid for Health Department Inspector's sketch as well as use of the back of this form is at the option of the health authority. PART Ill.--FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that'the Individual water-supply system be considered [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM ] CHIEF ARCHITECT ] DEPUTY FOR CHIEF ARCHITECT FHA Form 2573 R~v. July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENI' consists of [] Septic tank, [] Cesspool. Septic Tank~ Distance from well,__ Total liquid capacity,. Inside length,_ Distance from: Wv'ell Inside diameter, feet. Material, Number of compartments gallons. Capacity inlet compartment, .gallons. feet. Liquid depth, feet. Inside width,~ feet. feet; foundation, feet; nearest lot line at [] front, [] side, [] tear,. feet. Depth,. feet. Liquid capacity, gallons. Lining material grCONDAR¥ TR[ATMINT consists of [] Tile disposal field. [] Seepage pits. Other Tile Disposal Field: Distance from: Well, Total length of tile lines, Trench width, Length of each line, Type of filter material: [] Gravel. feet; foundation, feet; nearest lot line at [] front, [] side, [] rear,.__ feet. Number of lines, Distance between lines, inches. Total effective absorption area in bottom of trenches, feet. Depth, top of tile to finish grade, [] Broken stone. Other Depth of filter material beneath tile,~ inches. Seepage Pits: Number of pits Outside diameter, .feet. Depth, Distance from: Well, feet; building foundation,. Inspection made byl [] State. [] County. [] Local Health Authority. Inspected by- Date of inspection , 19 feet. .feet. .square feet. .inches. Depth of filter material over tile, .feet. Lining material feet; nearest lot line at [] front, [] side, [] rear, (TITLE) inches. feet. REPORT OF INSPECTION~INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main, feet. Size of main, inches. Individual wells [] are [] are not customary- in neighborhood. Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighborhood [] are [] are not being developed with both individual water-supply and sewage-disposal systems. Lot size' feet wide, feet deep. Dwelling set back from front property line,, feet. Individual water supply from: [] Drilled well. [] Driven well. [] Dug well. [] Bored well. Distance of well from: Building foundation, cast iron sewer,_ feet; tile sewer,_ seepage pit,. feet; cesspool, Well construction: Diameter, inches. Total depth, .feet. Type of casing, Approximate depth to pumping level of water in well,_ feet. Approximate yield, Sealed watertight to depth of feet. Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill. Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes, [] No. Pump: [] Shallow well. [] Deep well. Length of drop pipe, feet. Pump capacity, Located in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground. [] Pump pit. Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Yes. [] No. Type of storage: [] Pressure. [] Gravity. Capacity, .gallons. Has bacteriological examination of water been made? [] Yes. [] No. If answer is "yes," give date Quality of water [] is [] is not satisfactory for human consmnption. Installation [] does [] does not comply with approved exhibits, if any. Inspection made by: [] State. [] County. [] Local Health Authority. Inspected by Date of inspection 19 feet; nearest lot line at [] front, [] side, [] rear,~ feet; septic tank,. .feet; disposal field, .feet; other sources of possible pollution, feet. Depth of casing, _gallons per minute. _gallons per minute. feet; 19 (TITLE) INDIVIDUAL SEWAGE AND WATER FACILITIES I~' /~'/~ L~ J~ (Fill out in T~iplicate) /,~-) ~ ~/~z~ ' ~- / ~- ~f ) ~' , ~ ~,~ 5. Wate~ Analyszs: // ~/ _ , .. ~d~, , g ~' d. Distance fpo-w~l to closest existlng op pmoposed: '~' 1. Sewer llne ~. Septic ~nk (~ . ~. 3. Seepage Ar~a.,,,,,~* 4. Cesspool' 5. PPopePty Line houses, bamn~ d~alnage ditch~ etc. Sewage disposal system. / b. Septic tank capacity in gallons, c. Name of septic tank manufactum~,~ Othem soupces of possible contamination, i.e.~ creeks, lakes, 1. If "home made" show diagram on reverse side of this fo~m. Disposal field op seepage pit size and type ,./~~ _. ,. ,, p~operty line /0 to house foundation 1. Distance to h ~. Percolatlo~. Test '~esults . .. .~.. f. Percolation Test performed by ~ Use the reverse .side of this form to show diagram. Diagram should include ~he roi_].owing information: p~operty lines~.well location, house location, ~,lft~c tank location, disposal area location~ location of percolation test, ~ d~reetion of ground slope. 9, The 1-~-f~.~nt~on On tkis form is true and correct to the best of my knowledge. signature of Applicant "' Date Si~'n'ed T__O~ BE FILLED OUT BY HEALTH DEPARTMENT PERSON~NEL ~'The above described sanitary facilities are hereby approved, subject to. the _ro.l!owzng on~mffons: Conditions :_., -~m~._~_. The above described sanitary facilities are disapproved for the following -Approval is valid for one year following the date of approval. CPJ:cw [,~-'RTMENT OF HEALTH AND WF~'- '~E ~--, DIVISION OF' PUBLIC HEALTH BACTERIOLOGICAL WATER ANALYSIS OTHER CITY SAMPLE COLLECTED BY j, r · . DATE COLLECTED TI~E COLLECTED Sample Collecled From J~'Xitchen Tap [] J~throom Ta~ ~ Basement Tap [~ Other [Iisi1 When? Lab. No. OFFICE Records in Ibis office indicale Ibis WATER SUPPLY to be of: Analysis shows Ibls Water SAMPLE to be: J~]~/ SaEsfaclory [] Oueslionable Unsatisfactory. [] Il an "Unsolislaclory" or "Questionable" stalus is indicated above you should tahe immediaie adion as recommended below. Noilly consumers water is polluted. Roll or chemically Irea~ this waler as outlined in the enclosed leaJlel "Drink R Pure." 2. Increase chlorination sufficiently to meet recommended residual standards. Determine source of confaminaRon aha take acllon necessary 1o maJnlaJn a sale wafer supply alal limes 3. Check chlorlnaRnn and other mechanical equlpmenl. ~ake certain if is funcRonmg properly. · 4. [f aher'c'~eecklng equipment a dislnlectlng residual [s not obtoined, please S. This is a surlace water source aAd sublecf to oollullon by man and an}mals. An approved water supply source should be develoaed. . 6. Improve your [~ spring ~] duE well [] driven well J~] drilled well [] cislern. 7. Relocale your well to a safe Iocallon ;n relaUonship to your sewage dlsposal system. [] see enclosure 8. Sample ,Ioo long in transit: sample should not be over 48 hours old al examination fo indicale reliable resu[h, alease send new sample. I- Boflle Rroken in lransii, please send new samp~e- 9. Conlacl your nearest [] Local Health Deparlmenl or [] Alaska Division of Public Health. sanilalion off[ce for bullelins, consullation and SANITARIAN'S REMARKS Signature READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD 48 hours . EMB AGAR tadose Broth, 24 hrs. 48 hrs. Groin's stain Colilorm Densily Most probable ~o. per 100cc.) pm Re.or*ed hy This analysis indicates Coliform Orgamsms to be: /~ '~Absenl ') Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Q'S0 - /Z3 -/0 COSA # Q Lb2lQG Expiration Date: - O 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address S T/THY Day phone jrrle- 0357 /Cfi 39 0- o rp't —J, 2orma Day phone Z rAOr l 6,Gc- %% nn Day phone 24/y - Q 3S7 Unless otherwise requested, COSA will be held by DSD for pickup. (ift2 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ Individual Water Storage Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer 52 The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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. (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 seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems 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 regulations in effect at the time of installation. Name of Address Phone 6?V— iQacP Engineer's Printed Name ST6t/6 Eti1 C Date O, A�-qae .l.JT11. ea T •* 5. DSD SIGNATURE�CPE 625E�g Ff J�••.••• PE 6455 •• :>� 1/ Approved for bedrooms. �t9fo••'• •• A�``�� Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory NCZ0Ie)Ell kyj ,'-li,,,'••NTSE • �"i � n 11111 Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date:/— 0 a (Rev 11ros) Municipality of Anchorage • "` Development Services Department \ Building Safety Division �- On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYS T EMS APPROVAL CHECKLIST Legal Description: /we se L/,0 Parcel ID: Q SO —/r3 yy A. WELL DATA Well type f If A, B, or C provide PWSID # Date completed >'Q« Total depth --Uft. FROM WELL LOG 61JA /V/, ft. AfI4 g.p.m. Date of test Static water levet Well production Sanitary seal (YIN) Cased to —7-3ft. Well Log (YIN) /t1i Wires properly protected (YIN) Casing height (above ground) n. AT INSPECTION -ky 3Z ft. r g.p.m. WATER SAMPLE RESULTS: Coliform ! colonies/100 mL Nitrate � mg/L Other bacteria U' colonies/100 mL Arsenic: A ug/L date of sample:&Qj� Collected by B. SEPTIC/HOLDING TANK DATA Pu f3L/ C SEN — it wwU Tank Type/Material Tank size gal. Number of Compartments Foundati cleanout (YIN) _ Depression over tank Dat f pumping C. ABSORPTION FIELD DATA Date installed Length 1t/ Total depth _ ft Date of ade;uatest Fluid depth orpti Pumper rating (g.p.d./112 or ft2lbdrm) Width ft Date installed Cleanouts (YIN) High water Eff. absorption area _ft2 fionitoring tube field before test _ Elapsed me: _ min. Final fluid Any r ' venation treatment (past 12 mo.) 0 System type _ Gravel below pipe / Water added_ gal. In. Absorption re >= & type) ft. er field bedrooms New depth_ in. If yes, give date ... D. LIFT STATION Date installed "Pump on' I I at —in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off' le I at _ in. Cycles t ted SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (Y/ High water al level at Meets at m 8 circuit requirements? T11 Septic tank/lift station on lot /,.( ,# On adjacent lots N/n0:/1 e. fs.•e✓' Absorption field on lot 0 On adjacent lots �r/� P"6�c re ler i J/ Public sewer main �Q / 11,1147) Public sewer manhole/cleanout SQ [ y��J Sewer /septic service line 2 S Holding tank Animal containment areas 04 �1, Manure/animal excrete storage areas /OO �'t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: f uaLIc- .f15�)E2- Building'/, uilding foundat' n Prope71inic,, Absorption f rd Water main Water tine Su rfac water Wells o djacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r(J61-10. -St59,-)65A ProperXdraiin Water line Curtail F. COMMENTS G. ENGINEER'S CERTIFICATION Building foundati _ Surface wat Wells o adjacent lots I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name /a7(, Date COSA Fee $ !:k 3 O Date of Payment R 5? ' ( R Receipt Number 1,q _7V (Rev. 11/05) Water main Driveway arking/vehicle storage Waiver Fee $ Date of Payment Receipt Number �•.;�p it ............. Stsvrn w. Enq .' w � '.� ff k56 �l•j 1�� FOrESStC;�..� �G.fDif/.,dt70_ �,CJ ASBUILT Sa4ARD &ASSOCIATES LAND SURVEYING 69 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: FOLLOWING DESCRIBED PROPERTY: _ /TrZoe DATE.- 0 A(� AND THAT NO F.NCROACHMENTSIEXIST EXCEPT AS ,�ip INDICATED. IT IS THE RESPONS131LITY OF THE OWNER TO DETERMINE TH- EXISTENCE OF ANY r - = � GRID r...:.......... ..:... EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD f * Duel. Mvk SLS -591eward a ANY DATA HEREON BE USED FOR CONUTRUCTION z� �� < r .� OFFENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN] x.,.'41 taatwSu Test Lab of Alaska �r vMile 3.2 Palmor-Wasilta Hwy.Midtown Cornmunity Business ParkP.O. Box 7749Paln�er, Alaska 9964 5Phone: 74S -300S Fax: 746-3010 Drinking Water Analysis Report Total Coliform Bacteria Client: rr.p py'!I , � PWSID#(if ap cable): re_, p / S7 7 Phone _ 7 U�,>! Fax #: Paid: This Section to be completed by Sampler Legal Description of Property. - r, Ply e. LIo Sample Site Location: OJ -L& Delivered to Lab By: /Vis, fi(% X,4- Lz�, (I.E.: Mchen sink, bathroom sink• outsioe hose bib) Time Sampled:6 l(1G Date Sampled: 7/15- 16t Sampled by: J C Sample Type: Routine:] Treated:[] Untreated p, Repeat Sample #: This Section to Be Completed by Lab Analysis Results: Satisfactory []Unsatisfactory ❑Sample too long in transit (greater than 30 hrs.) 'Request resarnle. Copy Sent to State: Yes : No ChiomogeniclFtuorogenic Method Results: !!''yy�•� Tota! Coliform Present (P)/Absent (A) Lab I.D. #. 7t _/�'r' E. Coli Present (P)/Absent (A) Date Received: Time Received: Received by: Date Test Begun: Z&S- Time Test Begun: /5S5 Analyst: � Date Completed: 6 Time Completed. 1-55e, Analyst: Refer to Back Side for Instructions MatmSu Test Lab of Alaska EMIS'rNY Water Quality Testing M Mile 3.2 Palmer-Wasilla Hwy. P.O. Box 2749 Midtown Community Business Park Palmer, Ak. 99645 Phone: (907) 745-3005 Email: mat-sutestlab(rDrooershsa.eom Fax: (907) 745-3010 Client: North Rim Engineering Date Arrived: 7/15/08 PO Box 770724 Report Date: 7/15/08 Sample Date: 7/15/08 Attn.: Sample Time: 0900 Client ID: Lot 10 Block 6 Pippel Collected By: PWSID M Source: M.S.T.L.#: M80477 Sample Matrix: Comments: JrL�Method Parameter Units Results MDL Date Analyzed Time Analyzed MCL TNT 835 Nitrate-N mg/L i I 0.47 0.23 7/15/08 1220 10.0 i i I i I Legend: MRL - Method Report Level MCL = Max. Contaminate Level B - Present In Method Blank E - Estimated Value H - Above MCL D - Lost to Dilution SCS ReEN 1083550014 Client Name Mat Su Test Lab, LLC Project Name/p Water Samples Client Sample ID M80477 No Rim Eng. Pipple 6/10 Matrix Drinking Water MSID 0 Sample Remarks: All Dates/rimes art Alaska Standard Time Printed Date/time 08/07/2008 16:23 Collected Date/time 07/152008 9:00 Received Date/time 07/182008 15:00 Technical Director Stephen C. Fde Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 A (<10) 07/25/08 07/31/08 NRB