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Home My WebLink AboutWENTWORTH BLK 1 LT 8 MTJNICIPALiTY OF ANCHOR-&GE DIVISION OF ENVIRONMENTAL HE~TH DEPA/{TMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 18 July, 1985 (a) Legal Description (include lot, block, subdivision~ section, township, range) Lot 8, Block 1, Wentworth Subdivision, Sec 28, T12N, R3W, S.M. Location (address or directions) 3220 East 40th, Anchorage, AK 99508 (b) Applicants Name Lyl~ M~nrh~nt (c) (d) Telephone - Home3R7_0215Businesspv6-12%q Applicants Addres~.~ 'An~Jox~_a~.e~ 9950q Appliqant is (check one) Lending Institution ~; Owner/buildor~ ; Buyer ~--~ ; Other ~ (explain); ' Lending Institution ' TelophCne~ ~ .~ {-/~/~ Address .~; (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: Lyle Marchant call when ready 2. Type of Residence Single-Family~ for pick-up 337-~2~ or 276-1333 Multi-Family~ Other (describe) Number of Bedrooms _ Three 3. Water Supply- Individual Well~. Community~--~ Public~ ~ Note: If community well system, must have ~zritten confirmation from the State Department of Environmental Conservation attesting to the legality and status° 4. Sewage Disposal 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] Engineering Firm Providing Inspections, Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date sho%m 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 CRW ENCTMERRTMC CROUP Telephone 562-325? Address 3900 .Arctic Blvd. ~?os~_a~nborag~: AM qqsOq Date 18 July, 1.985 DHEP Approval # ~"~" ~,pproved , f bed rooms Approved _~ ' Disapproved Term~ of Conditional Approval itional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENSfIRON~NTAL PROTECTION (DHEP) ISSUES HF~kLTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGPakPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF AI~SKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DREP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPAJ~ITY OF ANCHORAG? IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK° (DNEP SEAL) RR4/eJ/D18 [Page 2 of 2] MUNICIPALIT'/ OF ANCHORAGE D[Pf. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Lot R , R1 n~.lz I ; N~n t-~n~¼ Subdivision - Sec 28, T13N, R3W Well Classification Private Well Log Present (Y/N) No Total Depth 55 ~ Cased to 55 ~ Static Water Level 1 4 ' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: If~A, B, C, D.E.C. Approved (Y/N) Date Completed 1 9 6 3 Yield To Septic/Holding Tank on Lot N / A Depth of Grouting Unknown ~9 Pump Set At . ~ Yes Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) No ; On Adjoining Lots N / A To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line 6 3 ' Cleanout/Manhole 1 1 8 ' Water Sample Collected by B. Looney WateF S~im ple~Test Results Satisfactory Comments N / P, ; On Adjoining Lots N/A TO Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date 6/26/85 72' See attached waiver from DEC for separation distance between a public sanitary sewer line and this private SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) well. No driller's Size No. of Compartments Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments P~ge 1 of 2 72-026(11/84) C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major,Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) LIFT STATION N/A Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments I certify that I h.(g/Cc~57¢ok~d, veri]~ied, or conformed to all Signed //~~"/ Date 18 July, Company Receipt No. Date of Payment Amount: $ ** Check Permitted Bedroom Rating Against HAA Request ** MOA and HAA guidelines in effect on the date of this inspection. Page 2 of 2 72-026 (11/84) 1985 : .... MOA NO. ST-85-253 DEPT. OF ENVIRONMENTAL CONSERVATION BILL SHEFFIELD, GOVERNOR ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 274-2533 CRWEngineering Group 3900 Arctic Boulevard Anchorage, Alaska 99503 July 10, 1985 Horizontal Separation Waiver Between Well and Community Sewer, Lot 8, Block 1, Wentworth Subdivision, Anchorage, Alaska 8521-WA-009 Dear Sir: The Department has reviewed the subjectwaiver request and hereby waives the horizontal separation between the well and ccam~mity sewer to 63 feet on the subject property for a 3 bedroom single family residence only. Sincerely, Steve Eng, P.E. District Engineer SE/dd GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection 1. Approval requested by: Alaska Mutual Savings Bank 4. 5. 6. o December 20, 1976 Mailing Address: Post Office Box 1120 Phone: 274-3561 Property Owner: Mailing Address: Nathiel Goodhue 3220 East 40th Avenue Phone: 274-4679 Legal Description: Lot 8 Block 1 Wentworth Subdivision Location: 3220 East 40th Avenue ~ Type of facility to be inspected Single Family Well Data: A. Type C. Construction Sewage Disposal System: A. Installed C. Septic Tank: 1. D. Seepage Pit: 1. E. Disposal Field: Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area No. of bedrooms 3 Individual B. Depth D. Bacterial Analysis Public Utility~.~ B. Installer Size 2. Manufacturer Absorption Area 2. Material Total length of lines , Absorption area , Other contamination , Absorption area to nearest lot line ., Sewer Lines , EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Req_~st for Approval,~of Individual ~er & Water Facilities Legal Description Lot 8 Block 1 Wentworth Subdivision Comments Approved ~--~- Disapproved Approval iValidfor one year from date signed Date Greater 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 and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) GREATER ANCHORAGE AREA BOROUGH DePartment of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES i. Type of Inspection: CMRO VA 2. Property Owner: Nathiel Goodhue Mailing Address: _3ee~O.E. bOth 3. Name of Buyer: .Susan O. Besse FHA CONV X Day Phone e?4-q679 .. Mailing Address: 2o5~ Campbell Place Day Phone 4. Name of Lending Institution: Alaska Mutual Savings Bard~ Mailing Address: P.o. Box 1120 Phone 5. Name of Realtor or Agent: NONE Mailing Address: Phone Legal Description: Lot 8, Blk. 1 W~ntworth Shhd. Location: 3220 E. 40th Avn. Anchorage, Alaska to be inspected: Single Family No. Bdrms. 3 Type of Facility Water Supply Type of Supply: If Individual, If Individual, Public Utility number of dwellings depth of well X date of installation Sewage Disposal System Type of System: Public Utility If Individual, Individual presently served x Individual (on-site) EQ-037 (1/74)