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Home My WebLink AboutWOODLAND PARK LTS 14F & 15F 0 �5/ 20 3 2.,,': 22S 903le, 5-011, 02, ALF-11WE MUNICIPALITY_Qf ANCHORAGE DEVELOPWNT SERWES DEPARTMENT W7-343-7904 On-Slt,e tater and Waitewater Section w, Fax: 343-7997 Well Decommissionina Lo Subdivision Wocd!Emd Park Block LCt 14 15,#e 34b ) tvAA?f IJ P, T R Section Lot 010 - 011 - III Nwm David Harper Aarovy Fump & weii servic;e, t.*_cW_ DEC l(w;lof dw i;rnmb iss,-rr,,,2; AUIC 15.55.060LIt a. L1 t,, L' Loc!'Oc') Use I°e soacci !Wow t;},movide a ar,�,,.rvirq of ire prnp�r`,y sli�whlg W,� folw—fing iternz. * North arrow Decommii;gk,,rzi� vmil )caflon !, N. L.C.Clatior, 0� rVI Mar a, file pl(,{,qrey Tlvo�*Parptp, vying-tle diehincqs I'v we! shov6n or- ifie drawing ,te, The swhg-i c dl,kIznce�� shat lbo mumured from either parm5nevt mructvires o., tr,,s propeq m I Meter •rld MUNICIPAEITY 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.# ~(~\0~;~- %Z) 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual wel 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 If community wastewater system, provide written confirmation from State ADEC attestin9 to the legality and status of system. 72-O25 (Rev. 1/91) Front MOA#21 5. STATEIVIENT 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 verifythat 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. ' Nameof Firm '1 o ~),~-~ '¢ ~'-- [¢,- ~,-~'-~ ';~ ~-. Phone ~"7 ~l '~,~ /G Address I H Z-O Engineer's signature "~ ~~ DHHS SIGNATURE · '// Approved for -'~,~c:~- Disapproved. Conditional approval for bedrooms. 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,~laska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to estisfy certain federa! 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 /.~._~3~\ DEPARTMENT OF HEALTH & HUMAN SERVICES DEC 0 Environmental Services Division 825 L Street, ROom 502. Anchorage, Alaska 99501. (907) 3~1~ Health Authority Approval Checklist Lega[Description: ~'~pc~/'~44~ ~.~,~c,~z, ~--'~ Parcell.D.: A. WELL DATA Well type ~, Log present (Y/N) Total depth !~ ~ Sanitary seal (Y/N) Date of test Static water level Well production N If A, B, or C, attach ADEC letter. ADEC water system number ~'~//~- Date completed Cased to I(o ~ Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION '-/'7 FROM WELL LOG g.p.m. g,p,m, WATER SAMPLE RESULTS: Coliform ~X~ .__ Date of sample: t B. SEPTIC/HOLDING TANK DATA Date installed Nitrate Tank size N, ~ Other bacteria Collected by: ~ ~ Number of Compartments __ Cleanouts (WN)__ Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N). Date of Pumping C. ABSORPTION FIELD DATA Date installed Pumper Soil rating (g.p.d./fF or ft~/bdrm) System type Length Width Effective absorption area Date of adequacy test Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later:. Gravel thickness below pipe Monitoring Tube present (Y/N) Results (Pass/Fail). Immediately after Absorption rate = Total depth Depression over field (Y/N) __ For gal. water added (in.): g.p.d. bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line Manhole/Access (Y/N) High water alarm level at* *Datum Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons "Pump on" level at* "Pump off" level at* On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Property line Water main/service line Surface wateddrainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTQ: Property line Building foundation Surface water Curtain drain ENGINEER'S CERTIFICATION Absorption field Wells on adjacent lots Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots I certify that I have determined thru field inspections and review of Municipal records:th,at thb aSt~t/~ ~y~,tems are in conformance with MOA HAA guidelines in effect on this date. ~:. -' Signature . Engineer's Name ~ ¢~ ~,~- ~'1 ~;::::~ ',J ~' '~ ~',,_ v~ Date l, /97 HAA Fee $ Dateof Payment Receipt Number 5 ,~/L/7 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number Page: 1 Document Name: ENTERPRISE SERVER PARCEL: 010-091-35-000-18 CARD: 01 OF 01 RESIDENTIAL SINGLE FAMILY STATUS: RENUMBERED TQ/FROM: - - - 1 CHRISTENSON CLYDE L & SHEILA J WOODLAND PARK LT 15F & 14F LOT SIZE: 14,000 ZONE : R1 TAX DIST: 003 GRID : 1628 NOTES 3401 WOODLAND PK DR 0 ANCHORAGE AK 99517 2112 SITE 3401 WOODLAND PARK DR ---DATE CHANGED ....... DEED CHANGED .... OWNER : / / BOOK: 0000 PAGE: 0000 ADDRESS: / / DATE: 00/00/00 HRA # : 000000 PLAT: 000000 ................................. -ASSESSMENT HISTORY .......................... ---LAND-- FINAL VALUE 1995: FINAL VALUE 1996: FINAL VALUE 1997: EXEMPT VALUE 1997: --BUILDING .... TOTAL--- 36,900 57,400 94,300 34,600 67,700 102,300 34,600 68,400 103,000 0 0 0 --EXEMPTION--- ..... TYPE ..... STATE EXEMPT 1997: FINAL VALUE 1997: 0 -COMM COUNCIL- 103,000 TURNAGAIN Date: 12115/97 Time: 08:26:18 AM _ D~3-1X-1997 L.T,~:E E:-~I NNCHOR~)GE }rinking Water Analysis Report for Total Colitbrm Bacteria ~F~4D INSTI~UCTIONS ON REVERSE SIDE BEFOP..~ COLLEC'IT[NG SAMPLE .MUST BE COMP.L~..TED BY WATER SUPPLIIill PuBLiC WATER SYSTEM l,O, # ~ pl~¥.aTli WATEII SYSTEM ~ TO BE COMPLF..TED BY LABORATOI~Y A~la~ysis show~ ~s Water $A~L~ to a Sample ov~ 30 hcu~ old, r~ul~ may qap ¢ t~ l~g in ~i~ s~ple ~hould ~ot ~ ov~ 4~ ho~ old ~ ¢x~ nafiofl to in~e mli~l¢ ~, Ptea~ send - ~F' ~ F' 02''~.~' CT&E Ref.# Client Name Project Name/# Client Sample iD Matrix Iobben Sp~Idand P.E. 3401 Woodl~md Park Dr. Potablc-3401 Woodland Park Dr Drinking, Water Client PO# Printed DatezTime 12/[ 1/97 !4:45 CollectedDate/Tlme 12/08'97 15:00 Received Date/Time 12/0~/97 15:20 Technical Director: Stephen C. Ede Nitra~e-N 0,!00 U 0,I00 ma/L ~PA ~00.0 l0 m~x ~2/09/97 RMV 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 FAMILY DWELLING GENERAL INFORMATION Complete legal description _ Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone_ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ ~ 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site / Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEO 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 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. Phone ~"?~-&~ / ~' Name of Firm Address Engineer's signature DHHS SIGNATURE ~. Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 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 certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~25 (Rev. 1/91) B~ck MOA 1¢21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed I(~ ~'~ Driller Cased to 1 (¢P -~ Casing height A. WELL DATA Well type "~ Log present (Y/N) Totaldepth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level / FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Wires properly protected (Y/N) Public sewer main Sewer service line g.p.m. AT INSPECTION /0 g.p.m..~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of. pumping Nitrate -~ Other bacteria Collected by: NONE- Tank size Foundation cleanout (Y/N) ~ Alarm tested (Y/N) Pump,er Compartments Depression (Y/N).. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots To property line Absorption field _ Foundation Water main/service line Surface water/drainage CONTINUED ON BACK PAGE 72-026 (Rev. 7/91 ) Front C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at . Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed Length Width On adjacent lots NoN - Soil rating Gravel thickness Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Surface water System type Total depth Cleanouts present (Y/N) Date of adequacy test for SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain If yes, give date bedrooms On adjacent lots Property line To existing or abandoned system on lot Cutbank Water main/service line Driveway, pa~'king/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name HAAFee$ /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 I'tESULTS for IN¥OICE $ 59239 Chemlab Re£.$ 92.5510 Sample ~ I Matrix: WATER Client Sample ID PWSID Collected Received 14/15 F WOODLAND Client Name :TOBBEN SPURKLAND, UA Client Acct OCT 6 92 ~ 13:00 hzs. BPO{ : PO} :NONE RECEIVED OCI 6 92 ~ 14:01 h~s. geq{ : AS REQUIRED Ozde~ed By Analysis Completed : OCT 7 92 Labo~atoxy Supe~'~l~PHEN C. EDE 1)TOBBEN 3PURRLARD, P.E. 2) Pazameter Results Units Method Allowable Llmtts NITRAYE-N ND(O.IO) r~/1 gPA 353.2/300.0 lO Sample ROUTINE SA~iPLE COLLECTED BY: STUART. Remarks: i Test~ Performed ' See Special Instructions Above UA=Unavailable ~D= None Detected "See Sample Remarks Above RA- Rot Anal)zed LT-Les~ Than, CT-G~eater Than ~ S~'~S Member of the SGS Group (Soci(~t~ Gdn0rale de Surveillance) CO,U, UER, AL rEStING ,t _NGINE R NG co. mv CHEf'ICAL & GEOLOGICAL ~BORATORY TELEPHONE (907) 562-2343 5633 B Street ~ Anchorage, Alaska 99518. Drinking Wa~er Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ~IVATE WATER SYSTEM SAMPLE DATE: ~ ~ Mo. Day SAMPLE TYPE: ~-4~_Routlne [] Check Sample (for routine sample with lab ref. no. [] Special Purpose Year [] Treated Water ~--Untrsated Water SAMPLE No. LOCATION 41 ~L 'rime Collected Collect,ed By READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Reported By TNTC = Too Numerous To Count TO BE"COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: /~ Satisfactory [] Unsatislactory [] Sampiettco long in transit; sample should not be {~ver 30 hours old at examination to indiCate reliable results. Please ser. q:l now sample via special delivery mail. Date Received Tim..a~lvad t qO I Analytical Method: Membrane Filter * No. of cblonies/lO0 mi. Lab Ref. No. Result* I I a~st BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LSB Fecal Coliform Confirmation Final Membrane Filter Results BGB Coliform/lO0 mi Data coliform/t00 mi OB : Other Bacteria ~ ~0,~ ~~ Member of the SGS Group (Seci~t~ G~n~rale de Surveillance) HEALTH AUTHORJTYAPPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM 10-26-72 PART L--TO i~E COMPLETED BY ~:HA INSURING OFFICE Anchorage MO~TO*OES j SE~IAt NO. First National Bank of Anchorage J Case f)194-631 MORTGAGOR O~ SPONSOR Buyer: HART, Ernest Do 279-5411 work Seller: BOLTON~ Roger W. 344-9257 Home SU~IVISION NAME Woodland Park Sub. TOTAL NUM~,EI~ 1 X3 1 j~ Public system j 3401 Woodland Dr. 005-3 [~]Public system 8aSEMENT j ~ New installation .aal.o~ ~o~,t ~ ~mm.nity system ~ Individual J ~ Yes D No PART IL--TO BE COMPI. ETED BY HEALTH HEALTH DEPARTMENT INSPECTOR'S SKETCH i J~LOCK NO. l LOT NO. , F I Lots 1z 115 , __ ___:s 1~.~ ~ is [] is not .¢atisfactory 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: -']Can be'expected to function sitisfactorily, and [] Cannot be expected to function satisfactorily is not likety to create an insanitary condition ~ATE . , J S,ONA'r ..Uae../ . , ir/ --'~ J TJTLE GREATER ANCHORAGB AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alask~ 99507 279-8686 Time of Inspection /~ Date of Inspection REQUEST FOR APPROVAL· OF INDIVIDUAl, SD~ER & WATER FACILITIES FOR . Address: Phone Type of Factl~ty.~o be Inspected:~ Number Of Bedrooms: 6.. Well Data: A. Type /~~ B. 'Depth .~ '/,yJ/ , , C. Construction.~~ D. Bacterial AnalMsis~/l~, 1~-~1-7~ .,, A. Installed 8. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Size 2. Material B. Disposal Field: Total Length of Lines ., 8. Distances: A. Well To: Septic Tank __, Absorption Area ,,, Sewer Lines [~'+- ; Nearest Lot Line /0~- , Other Contamination B. Foundation to Septic Tank '---- "} Absorption Area ,, C. Absorption Area to Nearest Lot LiDe ~' Request for Approval of Indfvldue] Sewer & Water Faof]ittes page Two Appr~l Valid for One Year From Date S~gned Greater Anchorage Area Borough, Department of ~nvironmenta] Quality DIAGRAM OF SYSTE. M I cerfiffy that the information contained in this request for approval to be a true and accurate representation of the subject sewer and weter faci!it~es located at: Signed Date