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Home My WebLink AboutT13N R3W SEC 22 LT 19T13N, R3W, Section 22 Lot 19 #006-313-08 Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 A~chorage, AJaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 006-313-08 1. GENERALINFORMA~ON Completelegaldescdp~on T13N. R3W. SEC ?2: LOT 19. SOUTH PORTION OF THE ~ 1/2 Location (site address or directions) ~243 CANDY PL4CE ANCHORAGE AK 99508 Property owner Mailing address Lending agency Mailing address DAVF' BATEMAN P.O. BOX 212086 ANCHORAGE AK. Day phone 99521 Day phone (~07~ 333-1691 Agent OLGA PTAK w/ PRUDENTIAL JACK WHITE Dayphone (907~ 762-3189 Address 3201 'c' STRFE'r ANCHORAGe. AK 99503 Un/ess otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well xxx 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: Individual on-site Holding Tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC lng to the legality and status of system. 72425 (Rev. 1191) Front MOA #21 Computer Vemicn Note: Alaska Water. and Wastewater Consultants, Inc.. shall be paid $800.00 at, I or prior to, closing ~or the engineering sengces prov~decL I 5. STATEMENT OFINSPECTION 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 sb'ucture indicated herein. I further vedfy that based on the information obtained from the Municipality of Anchorage files and from my Investigation and Inspe~on. the on-site water supply and/or wastewater disposal system Is In compliance with all Municip, al,,~nd State codes, ordinances, and regulations in effect on the date of this Inspection. ,,' Engineer's Signature [",--- ~'~f[/~ (~ ~ Date I In conducting this evaluation, AWWC, Inc/a~e~ted to~z~de a thorough, conscientious engineelfng ana~sis of the system in accordance ~th ADEC and MOA DHId~ Guidelines & Regulations. The reported results described the pedorrnance of the system under the conditions encountered at the time of the test, and separation distances measured to readi~, identifiable features. The operational life of all wells and sepb'c systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the fami~' being sen'ed by the system. These conditions are outside the control of theevaluatorofthesystsm. Satisfactorytestresullsdonotguaranteefuturebedormance of the system, nor do they guarantee that there sro no hidden defects or encroachments. ' system will continue to meet the operational requirements of the ADEC or MOA DHHS. The co ,e ,e, th,s,eport,s,er the se,e bene,,,o, the er,,s,ed,be . reliance upon er use of this report by any other person er party is not authorized, ~-, ....._..~,~....:.. o.~ nor will it confer any legal right whatsoever. 6. DHHS SIGNATURE [,""'" Approved for ~ Disapproved Conditional approval for bedrooms bedrooms, with the following stipulations: Additional Comments. The Munic!patity of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upcn the representations given in paragraph 5 above by an Independent professional engineer registered in the State of Alaska. The DHHS dces this as a courtesy to purchasers of hcmes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspecticns or analyze data before a certificate is issued. The Municipality of Anchcrage is not responsible for errors or omissions in the professional engineer's work. 72.025 (Rev. 1/91 ) Bac.~ MCA #~21 Computer Ve~sicn RECEIVED Municipality of Anchorage /s~ DEPARTMENT OF HEALTH & HUMAN SERVICES · Envlronmentel so~ces OMslon NOV 1 ? ~'00 825 "L 8trsaL Rm 502 Anchorage. Alaska 99501 (907) 3434744 Health Authority Approval Checklis~ ~ owtS~ Legal DasCfll~On: A. WELL DATA T13Nt R,.~tt SEC 22; LOT 19 SOUTH PORTION OF THE FAST 1/2 Parcel I.D.: 006-313-08 Well Type PI~NATI[ If A. B, or C, attach ADEC letter. ADEC water wstem number Logprsaent(Y/N) N Date completed HOUri[ BUILT IN 1955 Total depth +7'+ Cased to 4-0'+ Casing height (above ground) Sanlta~/seal (Y/N) Y~$ 'Wires properly protected (Y/N), YES Date of test FROM WELL LOG AT INSPECTION 10/26/2000 Static water level - gc~' Well production - g.p.m. 4.6 c~m~ ~j., N~te o. ~-,~, -._ O Date of sample: 10/26/2000 ~ Collected ~ ~.lOther bactehe A.W.W.C. INC. B. SEPTIC~OLDING TANK DATA Date Installed Tank,tm ~ ~Cl_ ~eanouts (Y/N) Foundation cleanout (Y/N) ~lon ~ High water alerm (Y/N) C. AB$ORrrI'ION FIELD DATA Date Installed Soil rating (g.p.d~2 or fl2/t)drm) System type J Length Width. Gravel INcl~esa below pipe ~ Effective atmofl~On ama Monitoring Tupe p~~~len over field (Y/N) FI:: dd:[p~ In a~.); ,ll'4~ed=Abs011~l:::te= gal. water added (In.,: ~nt (past 12 monlhe) (Y/N) If yes, gtve date ~-02S (Rev. a,'~7' Oxreum' vemm D. UFT STATION , Manhote/A- -'c~-~s (Y/N) level -t* ,"Pump off" level et' *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO.' Septic/holding tank on lot Absorption tleld on lot Public ~wer main N/A 50'+ On adjacent lots, 100'+ On adjacent lots 100'+ Pubftc sewer manhole/cteanout §0'+ Sewerlce~o sendce line 25'+ Uft ~tetion N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Properly ftne -- Water real.se ~ urfa~ wa~r/dmlnage SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: ,Wefts on adjacent lots Properly ftne Buftding foundation Surface water ------"-~D~, ~ng/vehlcle storage ama ?~qa~''-''-'-~'~ Wefts on adjacent lots al Municipal recks thag I Fee ' O0. oate of Paymen Receipt Number Walwr Fee $. Date of Payment Receipt Number ~IUNICIPALITY 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 3 -0 (~ HAA# ~ GENERAL INFORMATION Complete legal description Lot 19; Sec 22; ~?13N; R3W Location (site address or directions) , ¢~'~"~ .-~/-, · ~.~.,, ~-rPrope~y owner '~ :~en Cose ?' '~:..~}hgg addrg~~ '"dyo .... Jack White Real Estate .... Lending agency .... % .-.'~ .. . . ~. -. Mailing addres~ · ~' '%.Agent 9arty Cassaday / Jack White Real Ad~h:(~Ss' : 2243 Candy Place Anchoraqe, AK Day phone 320] "C" St. Day phone 348-0585 AnchoragP, AK 9950, Estate Day phone 762-3168 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: -' Individual well xx× ;~' 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: Individual on-site 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. ?2-025(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 bed rooms 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 & $ ENGINEERING NameofFirm ........................ ,, ,~,~ Phone (~/-'/ Address Eagle River, Alaska 99577 Engineers signature '""//~)~/~- //~-'~----- Date · ~ Approved for (~'-~- ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: (~~/}~Q,/~ t/5/' (/(_J{~ Date Tt~e 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 ahd 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 ANCHORAG,~ ENVIRONMENTAL SERVICES DIVISION FEB 2 lO g7 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SER~$i~ Environmental Services Division--C ~,-!. Ii V E D 825 L Street, Room 502 · Anchorage, Alaska gg50J · (907) 343-4744 Health Authority Approval Checklist Legal Desoription:L~-I) 7-::~? ~); ~'~('~ ;~- / 7Z.3/c/j ~ $~, Parcel I.D.: COG '- ¢81 3 - O g A. WELL DATA Well type Log present (Y/~_) /v O Total depth Sanitary seal (~N) Date of test Static water level Well production If A, B, or C, attach ADEC letter. ADEC Water system number Date completed f Cased to Casing height (above ground) Wires properly protected ~N) FROM WELL LOG AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform O Date of sample: ~ / ;L ~ / ~ '7 B. SEPTIC/HOLDINGTANK DATA Nitrate O , / '7 7 Other bacteria O Collected by: S & S ENGINEERING :7034 -"au:~ R;vur L°op ~oad e4o. 204 Eagle River, Alaaka 99577 Date installed Tank size Number of Compartments Cleanouts (Y/N) ~ Foundation cleanou!~,(Y/N) Depression (Y/N) High water a~..~.Y~ DateofP, u~i~g' ,;:';':' :~.-?i~'~ Pumper__~ ~ ~ · L ',.,:" '. C. ABSO.,R~ION FIELD DATA~ :~ . · Date~.~irf~i~lii~d.~. ,'.. ....... Soilrating (g.~d~dr~,__ __Sy~m~pe Effecti~:~5~Yption area" ~nt ~/N) D~ms~ ~er field (WE) Date of adeq;'~Cy test "' / Results (Pass/Fail) Far bedrooms Fluid depth in abs~fore test (in.); ~~ment (past 12 men''~ (ins) Mint~ts~(~/atN~r: 72-026 (Rev. 3/96)* Immediately after gal. water added (in.): Absorption rate = g;p.d. if yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level at~a~ _~-~"~"Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /~ JR On adjacent lots /0 '~ -/- Absorption field on lot ,~ //4- On adjacent lots / 4) 0 ' -/- Public sewer main '7 ,.¢ 'Y~ Public sewer manhole/olc~meut-~ /d O -/- Sewer/septic service line '~ ,~¢ ''/- Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Property line Water main/service line. Surface water/drainage ..¢--"'~ells on adjacent lots SEPARATION DISTANCE FROM AB~EE Ob~N LOT TO: Property line ...4~dilding foundation Water main/service line Surface wa~...._....--~'''''''''''''~ Driveway, parking/vehicle storage area Cur~tairC~ain Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records ~ems are Signatur ;~ J' ? ~,9~ Engineers Name ~( ~ . ~/~/~7 ~ ~ ~ ~OBER~ 6, COWAN HAA Fee $ Date of Payment 72-026 (Rev, 3/§6)* Waiver Fee $ Date of Payment Receipt Number AND S ENGINEERING ~.3~06/'t997,1~'88 51:;1 9~769412~i ; i ~ S AND :S ENOTNEERING ~1' wi '~1NSPECTION APPOINTMENTS TIM'~ TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTO~-~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OE ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTil & 825 L Street ~ Anchorage, Alaska 99501 ENVIRONMENTAL pi~OTECTION ENVIRONMENTAL SANITATION DIVISION OCT 1_ 9 198] Telephone 264-4720 REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEg ~r-A(~VE~ D DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing, PROPERTY RESIDENT (If different fr~bove) ~ PHONE 2. BUYER PHONE MAILING ADDRESS 3, LENDING INSTITUTION ~ PHONE 6, TYPE OF RESIDENCE [] One [] Four [] Other__ []~"~-SI N G L E FAMILY [] Two [] Five [] MULTIPLE FAMILY []~hree [] Six 7. WATER SUPPLY I~]-"~ DIVI DUAL* * ATTACH WELL LOG. A well log is required for ail wells drilled [] COMMUNITY since June 197~,, For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM i f [] INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. [~-"~PU BLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev, 6/79) THIS SIDE FOR OFFICIAL USE ONLY · 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS E~] 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 [] I N D IVI DUAL/ON -SITE DATE INSTALLED [~PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [~/'~PP ROVE D FOR .-~ BEDROOMS ~ CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~]~j DATE BY 72-010 (Rev, 6/79) January ll, 1971 Veterans Administration P.O. Box 1399 ~achorago, Ah~ka 99501 SUbJeCT: Sewer mid Water Syste~ for T12N, R3~, Sec. 9, Lot Owned by Jerry t~. Cooley: VA Dear $ir~: This Detmrt~a~ent was recently asked to make an inspection for the Civilian ~litary Referral 0f£ice on the subject residence. At the time tills 0apartment gave approval to this residence for the Veterans Administration on October 14, 1969, ig was a single family dwelling. ~ecause of the addition of the rental unit, the status of tile ~ell has changed from individual to se~i=public. Scoff-public protective radii are not mainZained, however, as there is a seepage area within 120~ of the well and a septic tank within ~0' of the well. The-sewer s~stem is also not functioning properly m~d overfl~ing onto the surface of the groined at times. For these reasons we can ~o longer extend our approval. Should funds be e~crowed to cover ~he cost of bringing the sewer system m~d water supply into complim~ce, and if the sewer system is maintained free from overflow in the interim, temporary approval ~uld bo grm~tod by this Department ~til such time as weather conditions m~o improvements legible. Sincerely John R. Lee, R,S. Sanitarim~ cc: Jerry ~. Cooley