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Home My WebLink AboutWALTER G PIPPEL ADDITION BLK 9 LT 6 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050-123-25 HAA # ~°\l~ i ~--~ GENERAL INFORMATION Complet~legal description Lot 6, Block 9, Walter G~ Pipoel , . Location (site address or directions) 17137 Park Place Eagle River, AK Property owner ~ruce H. ~ttson 10~18 Steeple Drive Mailing address Day phone Eagle River, AK 99577 694-2031 Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Three (3) TYPE OF WATER SUPPLY: Individual well Community well .XXX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 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 ?egulations in effect on the date of this inspection. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchoraqef AK 99524 Engineer's signature ~.& ~'~4-~e~-""~ :: Da;te 4/2/99 DjHH$ SIGNATURE /., .~ A. pproved for ['kt ~-~'~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date 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 engiheer registered in the State of Alaska. The DH HS 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA · Health Authority Approval Checklist Lot 6, Block 9, Walter G. Pippel Parcel i.D.: 050-123-25 - House is served by Municipal Water System Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date completed Cased to FROM WELL LOG g.p.m. Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Date of test Static water level Well produrction g.p.m. WATER SAMPLE RESULTS:. Coliform Nitrate Other bacteria Date Of. sample: Collected by: B. SEPTIC/HOLDING TANK DATA i977 Date installed. Foundation cleanout (Y/N) Date of Pumping 3/24/99 C. ABSORPTION FIELD DATA ' Date installed 1977 Tank size Y 1,000 Number of Compartments .--O~e Cleanouts (Y/N) Depression (Y/N) N High water alarm (Y/N) N Pumper JR's Pumping Service Length .unkno~ Width Unknown Gravel thickness below pipe Effective absorption area 324 S~ Monitoring Tube present (Y/N) Y Date of adequacy test 3/20/99 Results (Pass/Fail) Pass 0 Fluid depth in absorption field before test (in.);. Fluid depth (ins) Minutes ater: 24 ~'s. Peroxide treatment (past 12 months) (Y/N) N Y Soil rating (g.p.d./~orft2/bdrm) Unknown Systemtype Seepaqe Pit 5 '(App. ) Total depth 9 ' Depression over field (Y/N) N For Three bedrooms Immediately affer463 gal. water added (in.):. 22.5" Absorption rate = If yes, give date 450 q.p.d. 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES None on Lot F. Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line "Pump off" level at* Mu~ici~l Water System On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation GT 5' Property line GT 5' Absorption field GT $' Water main/service line GT 25' Surface water/drainage GT [00' Wells on adjacentlots GT 100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation GT 10' GT 10' Water main/service line Driveway, parking/vehicle storage area 2 ' Wells on adjacent lots G,T, 100 ' Property line GT 10' Surface water GT 100' Curtain drain None on ENGINEER'S CERTIFICATION I certify that I in conformance with MOA HAA guidelines in effect on this date. Signature '~/~ Engineer's Name Michael E. Anderson, P.E. Date 4/2/99 HAA Fee $ ~ ~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* April 2, 1999 RECEIVED APR 2 1999 Municipality ot AnCh~oraqe Oept. Health & Human uervmes Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 6, Block 9, Walter G. Pippel Subdivision No. 1 Private We" ~'3044YDear Onsite Services Engineer: The three bedroom home on Lot 6, Block 9, Walter G. Pippel Subdivision No. 1 is currently served by the Municipal water system. The private well on the lot was recently decommissioned in accordance with Municipal Ordinance AO No. 96-98(8) by Barr Enterprises of Eagle River. The casing of the well was cut off at a point nearly 3 feet below the ground surface. The casing was then filled with concrete for the full depth. A .25 inch thick steel plate was then welded to the top of the casing. The area was then backfilled to original grade. Pictures of the abandoned well are attached for your use. Sincerely, Michael E. Anderson, P.E. Attachments APPLIC,', ~T FILLS OUT UPPER HAL[,, ,~)NLY Address ; Zip Code Street Locati. Type of Resi~nce ~ngle Family Water Supply ~ A~ACH WELL LOG. A wall log is required for alkwells drilled since June 1975. ~ndividual ~ ~ ~ ~ For wells drilled prior to that date, give well depth (~ttach log if available). ~ Community ~ Public Ufilily Sewer Disposal ~lndividual ~_.Year Ind~idual=lnstal~ed: Time Time Time Time Inspector Insp~ctor Inspector Inspector // MUNICIPALITY OF ANCHO~ DATE 72 023 (3182) EXCAVATION ROBERT A. SHAFER WORK August 23, 1983 CIVIL ENGINEER 694-2979 Ron waisanen P.O. Box 771316 Eagle River, Alaska 99577 Dear Mr. waisanen, R~ference: Lot 6; B~ock 9; walter G. Pipple subdivision A sewer system adequacy test was performed on the sytem-located on the referenced property as you requested. The septic tank -.,was, pumped and verified to have a cabacity of 1000 gallons. The seepage pit was charged with 1500 gallons of fresh water and after a period of 24 hours approximately ll00 gallons had percolated out of the crib. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property i~ currently functioning adequately. However, the system cannot be guaranteed against subsequent failure. zf ,y be of further service, '. ~ER, P.E. please do not hesitate to call. cc: Municipality of Anchorage Department of Health and Environmental Protection SRB lgBX EAGLE RIVER. ALASKA DATE.: 19 CITY ~jl, ~ .... N0. 2 9 3 4 g 7 ~x ALL C~JMS AND RETURNED GOODS MUST BE' TOTAL ACCOMPANIED BY THIS BILL. "~ DAVE RECEIVED , ~, INSPECTION APPOINTMENTS ~TIME TIME TIME DATE DATE DATE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~VIRONMENTAL pEOTECTiON 825 L Street - Anchorage, Alaska 99501 1980 / ENVIRONMENTAL SANITATION DIVISlO. Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts o~] page 1. Incomplete requests will not be processed, Please allow ten {~0) davs for processing. PROPERTY RESIDENT (If different from above} ~ONE 2. ~UY~R PHONE 3. LENDING INSTITUTION PHONE 4 REALTOR/AGENT - ~ ~ ~ PHONE MAI LING ADDR~ ~ ~ / ~..~ ~ ' - X ' STREET LOCATION \'~ ~ One ~ Four SlNGLE FAMILY ~ Two ~ Five ~ MULTIPLE FAMILY ~ Three ~ Six [] Other 7. WATEFER SUPI~ SUPPLY ~'~NDIVIDUAL* ' ATTACH WELL LOG. A well log is required for all weJJs drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~iNDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUF:ST BEFORE PRocEssING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY I. 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 [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~]INDIVIDUAL/ON -SITE CATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [] Sept ic_~al31~-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 fi,~¢,,~, ,~t~)U ' [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) ~ DISAPPROVED 72 010 (Rev. 6/79) #1: Time Date Insp / MUNICIPALITY OF ANCHORAGF' DEPARTMB~OF HEALTH AND ENVIRONMENL~-z- PROTECTION 825 L Street, Anchorao~. Alaska 99501 264-4720 Date Received: Jan,~wy ?~ 1QTR l:3~m. 78 Monday Time i----~ ~%~ DH ~3: Time REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska National Bank of the North ~ailing Address: 3301 C Street, Calais II Phone: 2. Property Owner: John Berg Mailing Address: Phone: 694-9025 3. Legal DesCription: Lot 6 block 9 Pipple Subdivision 4: Single Family Residence: (x) Number of Bedrooms: Three Multiple Family Residence: ( ) Number of Bedrooms: o Well System: Permit ~ Construction Individual well (x) Community/Public System ( Depth of Well Well Log on File Bacterial Analysis ( ) Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # Installed ~qq~ Installe~ Septic Tank Size ~, ~]f]~] ~.o~qc_. Manufacturer ~n~a~ ~ - Absorption Area ~ Soils Rate Material · ~.~. e Distances: Well to Septic Tank to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area Pag~ TWO Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 6 Block 9 Pipple Subdivision Comments: Affadavit Attached: ~~ ApproveS: ~¢%. Date: Disapproved: Date: Letter Attached: ( ) Department Worksheet: RECEIPT FOR CERTIFIED MAIL--30¢ (plus ~ostage) SENT TO POSTMARK OR DATE STREET AND NO. P,O,, STATE AND ZIP CODE CPTIONAL SERVICES FOR ADDITIONAL FEES RETURH , Shows to whom and date delivered ........... lsd RECEIPT ~:" *~ With delivery to addressee only ............ 65¢ ~"2 ' Shows to whom date and where delivered .. 35¢ SERVICES., ~' With delivery to addressee only ............ 85¢ ~IVER I% ADDRESSEE ONLY ...................................................... ~'g SPECIAL D,.LIVERY (extra fee required) .................................... PS Form 3800 NO INSURANCE COVERAGE PROVIDEO-- (See other side) A~r. tE?t HOT FOR IHTERNATIONAL MAIL * OPO:EEl2b~;d~o*?~ / (~MUNICIPALITY OF ANCHORAG~-~--" Department of Health and Environmental Protection 825 L Street, Anchorage, Alaska 99501 ' 264-4720 ' ~quest for Approval of Individual Sewer and Wate~~ iF~Cili~es Property Owner: Mailing Address: Name of Buyer: Mailing Address: Lending Institution: Mailing Address: Realtor/Agent: Mailing Address: 5. Legal Description: Street Location: ~/.~ ~ ~- Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: * Individual Well ~Public/Community System If Individual Well, well depth If Community System, name of system Sewage Disposal System: *~n-site System ~Public System If On-site System, date of installation: ( ) *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy .test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 GREATER ANCHORAGE AR~A BOROUGH Department of Environmental quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Received__~Oct l, 1973 Time of Inspectio% 1]:00 a.m. Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WA~R FACILITIES FOR VA Oct l, ]973 3. 4. 5. Aoprovat Requested By: Smileys Realty . Address: Box 1086 Eagle River Phone: 694-2115 prooertv Owner: Dave Mahler Phone: 272-7757_ Legal Description: Lot 6, Block 9, Walter G Pipple Subdivision Location: Parkway Type of Facility to be Inspected: Number of Bedrooms: Three (3) Well Data: A. Type Drilled C. Construction Standard Sewage Disoosal System: A. Installed ~ 1972 C. Septic Tank: 1. D. Seepage Pit: 1. E. Disposal Field: Distances: A. Single Bamily ~ellinq B. Depth 70', D. Bacterial Analysis Satisfactory . - B. Installer Wallace lO00 2. Manufacturer Wallaee Size 324 sq' 2. Materiel Concrete Total Length of Lines Well To: Septic Tank 61' , Absorption Area ]00' ~, Nearest Lot Line , Other Cor{tamination Foundation to Septic Tenk 7' "~ Absorption Area 30' Absorption Area to Nearest Lot Line 20' , Sewer Linea Page Two Comments: n [/ . Approva] Valid for One Year From Date Signed %rearer Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 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 located at: Signed Date