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Home My WebLink AboutWINCHESTER HEIGHTS SOUTH #1 LT 2 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 Parcel I.D. # CERTIFICATE OF HEALTH;AUTHORITY APPROVAL FOR A SINGLE F/~MILY DWELLING 1. GENERAL INFORMATION Complete legal description [Jot 2; Winchester Heights South ~]. Location (site address or directions) 4034 E. 84th Avenue Anchorage, AK Property owner Mailing address Lending agency Mailing address. Wa(/ne & Pebble Johnson 1264'5 Iris Way Day phone Eaqle River, AK 99577 Day phone 694 -7889 Agent Sally Horri£on/ VISTA REAL ESTATE Day phone 689-6~96 Address 16635 CentsrfJ. eid Drive Eaq!e River, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 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 If community was,ewe,er system, provide written confirmation from State ADEC attesting to the legality and status of system. Legal Description: of AnchorageR E C E IV E Municipality DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ,JUN 825 L Street, Room 502 · Anchorage, Alaska 99501 · (90..7~18¢,~),¢¢,:¢of Anchorage uept. Health & Human services Health Authority Approval Checklist Parcel I.D.: Oil'/- ~V~_.~ ~ A. WELL DATA Well type /%t Log present (Y,f~) f,, o Total depth If A, B, or C. attach ADEC letter. ADEC watei system number -- Date completed u //¢ f Cased to q o w Casing height (above ground) Sanitary seal (~'N) 'Y ~/.-) Date of test Static water level Well production FROM WELL LOG Wires properly protected (~N) AT iNSPECTION U /t( .g,p.m. (~. / g.p.m. WATER SAMPLE RESULTS: Coliform O Date of sample: 5" / / 6 / ¢/ ,(, Nitrate O, I Other bacteria Collected by: $ & S ENGINEERING 17034 Eagle River Loop Read No. 204 Eagle River, Alaska 99577 B. SEPTIC/HOLDINGTANKDATA ~,//~ ~,,au&c~c_ ~,~,/~ Date installed Tank size Number of Compartments ~ Foundation cleanout (Y/N) Depression (Y/N) __ High wa~(Y/N) __ __ Date of Pumping'' IPumper __/ C. ABSORPTI°N FIELD DATA i ~ Date installed : ' Soil rating (~ fF/bdrm) __ __ System type __ __ Lengt~ " Width,." ",? ,.GCavel thickness below pipe _ Total depth EffectiVe absorption. area .,., ,'i ~:'/,~oring Tube present (Y/N)__ Depression ever field (Y/N) __ Date of adequacy tesi ~ Results (Pass/Fail) __ For___ __ bedrooms Fluid depth in abso~ld before test (in.); Immediately after gal. water added (in.): Fluid dept~~__ (ins) Minutes later: Absorption rate = .g.p.d. P.,9~.dxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* 05×51×9G CT&E ESI ANCHORAGE CT&E Environmental Services Inc. Laboratory Division Laboratory Analysis Report CT&E ReL# 961784.961784002 Client Sample ID L2 WINCIqI~STlgR blOTS SODTH~ ~atrlx Dri~t~ Water PWS~ 0 s~ ~esu[ts QC POL 0.100 U Collected Date 0.5/I 6/96 TedmlcaJ Director: Stephen C. 0.100 mg/'"~pA 35~.~ .......... 200 W. Potter Drive, Anchorage, Al{ 99618.1605 _ Teh (907) 562-2343 Fax: (907} 501-5301 3180 Pager Road, Fairbanks, AK 98709-5471 -- Tel: (907) 474-8856 Fox: (907) 474-9685 ENVIRONMENTAL FACILITII~S IN ALASKA, CALIFORNIA, FLORIDA. ILLINOIS, MARY~ANO, MICHIGAN. MISSOURI Nrw ~c~,~,'~,~' .. ~ ' CT&E ESI ANCHORAGE CT&E Envlronmenta[ Servmes Inc. Laboratory Division Drinking Water Analysis Report for Total Coliform Bacteria 2oo ~,. ~o,t~, ~:,~., INSTRUCT[ON~O:Yt~F£I~E$IDEBI~FOR~COLLECThYGSAM]°LE Tel: {907) 567,:V~,~: MUST BE COMPLgTI~D sY'wATI-3K SUPPLIER ""~ PUBLIC WATER SYSTEM I.D, PRIVATE WATER Se.w/Invoke 0 Sendlnvolc~ Month Day Year SAMPLe TYPE; Routine U Treated Water Repeat Sample (for routine sample ~ Untreated Water with lab ref. n0.~ . ) Special Purpose Time Collected SAMPLE LOCATION Collected By TO BE COMPLETED BY Analysis shows this Water S,,,dvl P L . ~ Satisfacto~ O On~at]s facto~ Sample over 30 hours o~d, ~cs.~ :~, be unreliable to [ndlc~te reliab}e renlkS. Analytical tdethod: O * Number of colonies/lO0 mt. ' Lab RtL No, Result~' : BACTERIOLOGICAL WATER ANALYSIS RECORD DIMO-MUG Result: Total Colh'orm blembrane Fiiter~ Direct Count · Verili¢ofion: LYB . Fecel Col{for.el Confirmation Reported By E. Coli O Col0nics/100 mi BOB .... ¢OblPIRM r.vrc D. LIFT STATION Date installed ' Size in gallons Manhole/Access (Y/N) High water alarm level at* ~ *Datum Cyclo~ Io~~~ "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot On adjacent lots ~/,4 On adjacent lots ~v //4 Public sewer main '7 5' ' -H Public sewer manhole/cleanout Sewer/septic service line c~- /¢- Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line . Absorption~j¢~ Water main/service line Surface water/drainage ~ Wells on adjacent lots SEPARATIQN DISTANCE FROM ABS~T TO: Property line .;,8'0ilding foundation Water main/service line Surface water Driveway, pa[king/vehicle storage area C~n Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records tt i~"¢d~'~stems are in conformance with MOA H.4A guidelines in effect on this date. //'2 /// ~ ~ ~.~." ,~"..,~,~-'~ Sgnature /~ c . ~ Date "AA Fee $ ~;00 ~'- Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Date of Payment Receipt Number 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 regulations in effect on the date of this inspection. S & S ENGINEERING Name of Firm . ]~;~, I=agle River Loop Road No. 204 Eagle River, Alaska 99577 Address Engineer's signature Phone DHHS SIGNATURE Approved for 3 Disapproved. Conditional approval for bedrooms. bedrooms with the following stipulations: Additional Comments /¢~]/Id P,..'/q?f'R i,~ ,~p,¢/L,CBz E 7'¢ T'/Y/..¢ 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 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 cerHficate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.