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Home My WebLink AboutGRUMMAN PARK LT 2(orl Pa 'Kd r 4% osl io CONTROL SERVIC~ INC. S,EET ,O. ~__l OF ~ '" 1200 West 33rd Avenue Suite B ,~/~/3~ DATE ANCHORAGE, ALASKA 99503 CALCULATED BY Phone 561-5040 CHECKED BY SCALE /; YD DATE L~galt Gr,_,mm~n P~rk ~Subd, Lot ? Static 'Water at' t~7 ft.- - :7'~ '~' ~--<')" '~. ' ' D4d not ~reform 'flog test. -.- "' : , ' ' ;' : ' ~.~w MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE Information Application Date Legal Description (i~cl.ude lot, block, Location (address or directions) Applicants Name ~. Ce Applicants Address subdivision, section, township, range) ::" ' Telephone - Home ~ Business U Buyer ~ ; Other } { (explain); - -- (d) Lending Institution ~ (~\~.~ ~[~ O,,~.,. Telephone Address ~ ~O ~ %v~e~ (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: ' '2. Type of Residence Single-Family.~. Number of Bedrooms Multi-Family~ Other (describe) 3. Water Supply Individual Well ~ Community ~ Public ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status° Sewage Disposal ~ll%/~i~_ Onsite ~. Public*~J~-hL~ 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. t/ [Page 1 of 2] En~t-eerin~ Firm Providin$ Inspecttons~ Tests? File Search~ Data and Information )J!:'-'~'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 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 Manicipa!lty of Anchorage files and from my ~/.d'~nvestigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- i'/:-' ':'~ie~s iR effect o~ the date of this inspec~lOno Approved for bedrooms Approved ~ Disapproved - - Co~i~iou~ CAUTION THE M~dNICIPALITY OF ANCHORAGE DEPARTMENT OF I~E~LTIt AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES ~r~.ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON T~M. REPRESENT~ -ATIONS GIVEN LN PARAG~H 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTER.ED IN THE STATE OF ALASKA° 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 DEEP DO NOT CONDUCT .INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED° THE Mb-NICIPALITf OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK° RR4/eJ/D18 [Page 2 of 2] (DHEP SEAL).. 7-19-84 DEPT. OF HEALTH & -- ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 RECEIVED WELL DATA Well Classification Well Log Present (Y/~. Total Depth ~ ~tS~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~ Separation Distances from Well: If A. B, C, D.E.C. Approved (Y/N) Date Completed /,,c-"/'u'~-'~/'-'¢'''-/~- -->~-. Yield Cased to ¢~ '(~ Depth of Grouting /?/'~' ~ ,~'-- / 4~ PU m p Set At (4-//"~,¢'-~'~¢ Sanitary Seal on Casing~//;N) Depression Around WelJhead (Y/N) To Septic/Holding Tank on Lot /~"¢ ; On Adjoining Lots ,.,c- / ¢O / To Nearest Edge of Absorption Field on Lot d,'¢' ; On Adjoining Lots 7~-/ To Nearest Public Sewer Line ~) / ~ To Nearest Public Sewer Cleanout/Manhole ~ ~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~~ ' ; Date Water sample Test Results ~ ~ ~~ ' D~te Inst~lled Size Mo. of Oomp~mems Standpipes (Y/N) Air-tight Caps (Y/N) F~~a~ Depression over Tank (Y/N) ______ ~¢~~d~/ _ Pumping/Maintenance Contract on File (Y/N) ~ D ¢~1~ _ ;fo'~ r Holding Tank High-Water Alarm (Y/N)` ~ ~.~¢m~a~Holding Tank Permit (Y/N)_ . ~;%~S~2~11ff°m S°~ti~°~ ~[lTo Bu,ld,n~ Foun~ahon ~ p y ' ~ o 'sposa[ RoM 1o Water ~ai~ ki~ ~ ~ ~ To Stream, ~onO, kako, or Major Drainaoe / ~5 ' ' - ' ' ' ,~ ' ' ; ..... 72-026(11/841 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design .... Date Installed Length of Field Width of Field Depth of Field"".--'"~ ~" LravelB hickn Square Feet of Absorption Area n,, ~ ~nu~'Present (Y/N) Depression over Field (Y/N) .~ ~.?D~te~ffLast Adequacy Test Results of Last Adequacy Test I_ ii( C~/~'~7~/~ Separation Distance from Absor/Cttion ~1~.-'/ I I To Water-Supply Well ~/~/-~'~ ~ /I To Property Line_ To Building Foundation .. To Existing or Abandoned System on Lot j ; On Adjoining Lots To Water Main/Servic~lL/~'~ne To Cutbank (if present) To Stream/Pond/~ke/or Major Drainage Course To Driveway/Parking Area, or Vehicle Storage Area Coytsj' D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/.~N)...< Dimensions hoLe/Access (Y/N) Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I I'~r~e checked, ve. rified, or conformed to all MOA and.HAA guidelines in effect on the date of this inspection. Signed ///'¢L'~ 2"~ - ,-----' "~.z- - z~Y'-~-~ D ate Date of Payment Page 2 of 2 72-026 (11/84) ~[,~/ MUNICIPALITY OF ~NCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF ~I~ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) (h) (¢) Legal Description (include^lot, block~L subdivision, section, township, range) Location (address or directions) App!ieants Name~ Telep~hone - Home Business Applicants Address Applicant is (cheek one) Lending Institution ~ ; OWnar/builder~; Buyer~-~ ; Other[~[ (explain); .~?c~:~.~ (d) Lending Institution Telephone Address (e) (f) Mail the HAA ~:o the following address: I ~r,.k / .Type of Residence Singte-Family~ Number of Bedrooms Multi-Family~ Other (describe) 3. Wa~er Supply Note: If community well system, must have ~-ritten confirmation from the State Department of Environmental Conservation atte~sttng ~o the legality and status° 4. ~ewa~e 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] 5. En$ineering Firm Providing Inspections, Tests~ File Search~ Data and Informatlo~/~ As certified by my seal affixed hereto and as of the validation date sh°wn below, verify that my investigation of- this Health Authority Approval shows that the 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 Mamicipali~y of Anchorage files and frou~ z~y investigation and inspection, the om-site water supply and/or wastewa~er disposal system is in compliance with all Municipal and State codes, ordinances, and regula-~ ~fous in effect on the date of this inspec~iono Approved for ~ bedrooms BJ/X Y~' 7.~~~ Approved Disapprov.d, Co~i~ion~ ~ CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ~TH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE RF~?RESENT- ATIONS GIVEN IN PARAGRA~ 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTEP=~ED IN THE STATE OF ALASKA° THE DHEP DOES THIS AS A COURTESY TO PL~RCHASEKS OF HOM~ES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE= MENTSo EMPLOYEES OF E~EP 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. (DHEP SEAL) [Page 2 of 2] 7-19-84 Be Mm~CmP~ITY OF ~C~G~. (MOA) HmmT~ an~o~ ~PROV~ (mi CHECKLIST - FEBRUARY 1984 Legal Description: WELL DATA Well ~ ~e~nt (Y~ ~te ~leted ~~ Yiel~-~~ Total ~ p~.~'~'~ ~ d Static Water. ~1 Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (y~ Separation Distances f~c~ Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot -TO Nearest Public Sewer Line Sanita_~y Seal on Casing Depression A~ound Wellhead ~/N)~ ; On Adjoining Lots ; On Adjoining Lots /~/~ To Nearest Public Sewer Cleancut/Manhole /D~ Q ~ ~ To Nearest Sewer Service Line on Lot~/.f~/~ Water Sample Collected By ~/~ ; Date Wate~ ~Sa~le Test ~s~lts .% S~C/HO~a ~ m~ ' ' Date Installed 4J//~ Size ~3/j_ No. of C~,~a~tments Standpipes (Y/N) ~U//t Air-tight Caps (Y/N) nY/~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) rU//:~. Date' Last Pumped ';,'d/~ Pumping/Maintenance Contract on File (Y/N)~tY//~-; for Holding Tank High-Water Alarm (Y/N) /%//~- Temporary HoldiP~ Tank Pe~£¢Ht (Y/N) Separation Distances f~om Septic/Holding Tank: To Water-Sapply Well A3/~ To Buildi,.~ Foundation To Property Line To Water Main/Service Line Course To Disposal Field ~3//? To Stream, Pond, Lake, c~ Major Drainage Receipt Amount: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD [ATA Soils Rating in Absorption Strata ~J/~ Ty~e of System Design Date .Installed A3//~ Length of Field Width of Field ~J[/t Depth of Field ~)f..~. Gravel Bed Thickness Square Feet of Absorption A~ea A)//r Standpipes P~esent (Y/N) Depression over Field (Y/N) pD//~ Date of Last Adequacy Test Results of Last Adequacy Test ~3/~ Separation Distance from Absorption Field: To Water-Supply Well ,t)//~c To P~operty Line AJ/f~ To Building Foundation A3/~ To Existing or' Abandoned System cn Lot AD/~L ; O~ Adjoining Lots /ti fA To Water Main/Service Line ~J/~/~ To Cutbank(if p~esent) To Stream/Pond/Lake/c~ Majo= D~ainage Course To D~iveway, Pa~king A~ea, c~ Vehicle Storage A~ea 4J/7~ . D. LIFT STATION Date Installed Size in Gallons "Pm~-~} On" ~1 at High ~te~ ~ ~1 at Tested fo~ Ele~ical Co~s (Y~) Dimensions /u/~ nhole/access (,Y/N) "Pump ~f" ~vel at ~/% Vent ~Y~ ) ~ing Cycles ~ing Adeq~ ~st. Meets MOA Ccaments Check Permitted Bedroom Rating Against HA_A Request I certify that I have checked, verified, o~ confor~ed to all MOA HAA .~, ilues in ef~fect on the/pdate of this inspection. . .,., '""'" '""°" Signed Date . '~/~5' [Page 2 of 2] ',,~;~_~. -- 2-15-84 ALASKA I rrdlI OFIITII FITAL COFITIROL IFIL ~§Jn¢~rJn§ 8 ~ir~m¢~l~l $luJics February 5, 1985 Department of Health and Environmental Protection 825 L. St. Anchorage, Ak 99501 Attention: R. Robinson Subject: Lot 2 Grumman Park The well, on the subject property, is located under the house. The well has a sanitary seal, but the wiring is not conduit. A well flow test was not performed at 'thins time. The well appears to fulfill separation requirements from the public sewer, with the possible exception of the service line to the residence itself. A clean-cut wAs'ndt observed outside the residence. ~ The residence is not currently occupied, and the intention is to connect to public water as soon as feasible. The water was sampled and found to be satisfactory. This office recommends tat the requirements o~f /~ell flow test and conduit~.~on wiring ~be forgone, with the provlsiod that the health ~uthority is 'conditional upon prompt connection with public water and proper abandonment of the well.. If this office can be of further assistance, please contact us at: 561-5040. Sincerely, L.D. Montgomery _Approved by: