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Home My WebLink AboutDAWN VILLAGE BLK 2 LT 5Dawn Village Block 2 Lot 5 #014-061-43 i'_>= n 1 F+• ;ti J N ^J J '+ rr v rr 4ttn !N m Z_ C m v D m v 70 M owf�' M '• o �1 MMM �O�jIO�jj OI rA •0•��- Ii �1 - 0 � 0 C". At 00��1 � .m M 0O1 N M � o M K°s � � Ootz wIVo � „ o H � H �1 i17. O • t3 -V :b C7 m Cb M } t cl Ij H H H H H H H H H �7 N ►7 � O O O O O O O O O O O O i I In 111 0 Oa. T }W : } In O I lu rlPIJ t 1 rIb rr CD rn C'j III rr •iO+' ci h+ pt N g n 1 F+• ;ti J N ^J J '+ rr v rr 4ttn !N m Z_ C m v D m v 70 M owf�' M '• o �1 MMM �O�jIO�jj OI rA •0•��- Ii �1 - 0 � 0 C". At 00��1 � .m n 1 F+• ;ti J N ^J J '+ rr v rr 4ttn !N i Wal W m Z_ C m v D m v 70 M owf�' M '• o �1 MMM �O�jIO�jj OI CD Ii •0•��- Ii �1 - 0 � 0 C". At 00��1 � r+d •i M 0O1 N M � o M K°s � � Ootz wIVo � „ o H � H �1 i17. O • } t i i Wal W m Z_ C m v D m v 70 v r P M _r Z �. v o N r r s r O Z O • 10/09/2012 21:38 9072430742 AWPS, ih1C. ".rt::+�lo� ,rr.' :.e.r,ri�;•x: �epartm�atY `,�Ua+ art% :;'`.',._ 'jr.l•:'ri.'h' iii �.�. Mark SeyiGh . r' Mayor _ PU4 Installation Lag Well Drilling Permit Number: SW'__ I Date of Issue: Parcel Identification Number:_ PAGE 01/01 0►y- oel- y3 Legal Description [:)p W /V V 14 1- G' Property Owner Name & Address: ,qabdxA —AAsGki 4; -77,1 Ale - Pump Installation Date:— Rump Intake Depth Below Top of WellCasing: %,3� feet Pump NNIanufacturre.,r''s Name: AyAt -0f311-7 Model: Pump Pump Size //A hp Pitless Adapter Burial Depth: jp feet Pitless Adapter Manuf'acturer's Anine:. H1t�P✓ P�dtesa .�.�iapn: �nst:eiier. MIA f 'We?3 13i51n�� ted UPC a , Oul- ietloa'.' `.les 14µ '.y �aoty. POW -- Comments: i AAA Pumn Installer Nene: Attention: The pump installer shall provide a puk p installation log to the DSD within 30 days of pump instal.iation. , T ; t• i�il_I p,l I �C- 11=• H t- I T'r' CIF=' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2515 E. TUDOR RD., ANCHORAGE, AK. 99507 276-2221 4•lELI_ F'E�t�1 I T PERMIT NO. t 77016 ) APPLICANT PFTFF'<;l-)N rrfNtiTRUCTION SRA BOA, 1718X 3,14-8638 LOCATION TESHCAR ST LEGAL L5 B2 DAWN VILLAGE LOT SIZE 10000 SQUARE FEET M I t•J I t•1UM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC I -JELL. WELL .LOGS ARE REQUIRED At -AD MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F=^Ei*~`1'•y T T tilF=iL I C. FkDF,�* Cl"[=- VEFiF�: F=FROM I �:E; UE I CERTIFY THAT 1: I At•1 FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I I•JILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNED:-- -- ` - -- -� .- - ------------------- APPLICANT PET RS, t- CONSTRUCTION ISSUED BY__ - .-___--__ ___________DATE__ //- J p MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES �1 Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 62A/ '43 HAA#' 1. GENERAL INFORMATION Complete legal description Lot 5; Btock 2; Daren V.i Ptaae. SubdLvia.ion Location (site address or directions) 6721 TeahZan Property owner AHFC 029537 Day phone Mailing address Lending agency Mailing address Day phone Agent Ranh Uaaalrontnhy 71 Nem Hon.i_zon.t Day phone _562-6233 Address 2213 Ea6t Tudors Road, Anchorage, AK 99507 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XXX 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 XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Aev. 1191) Front MOAe21 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 furtherverify 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. Name of Firm J EERI G Phone Address 17034 Eagle River Loop Road No. 204 T Engineer's signature Date 6. DHHS SIGNATURE Approved for Disapproved. —� bedrooms. 3Pic � TV�t 4ES _ �f Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 42-/Z 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 orderto 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. 72-025 (Rev. 1.91) Bxk MOA 421 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOTS QLOGK Z DAW1J UILLA6E Parcel I.D. A. WELL DATA Well type PRII/AII If A, B, or C, attach ADEC letter. ADEC water system number 60 Log present QN) YE -S Date completed L��2Z/ y Z Driller PEOP JERs,EYDR1LUu6 c0. Total depth V Cased to 40+ Casing height 3611 Sanitary seal &N) YES Wires properly protected DN) YCS Z FROM WELL LOG AT INSPECTION00 o Date of test IZ �y I Z LU 37 13� c Static water level Q uwi M Well flow Z� g.p.m. �0.3 g.p.m.Q LUN V. Pump level UVKNOW/1 Ur(II(AWN z UJ p LU SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot NJA ; On adjacent lots Absorption field on lot N%p ; On adjacent lots 100f 4 Public sewer main �� Public sewer manhole/cleanout Sewer service line i Petroleum tank NONE KX10Lbt) + IN ACC60WCE w R66ULATUuSQT/M6 of /NSrALL4r/0N. WATER SAMPLE RESULTS: Coliform 0/100141 Nitrate 0.10 "A Other bacteria 0�/vom/ Date of sample: /Z /Za I giZ Collected by: S` S 6)U&1NEE21AxP B. SEPTIC/HOLDING TANK DATA = M001JICI PAL SEW&Z Cleanouts (Y/N) High water alarm (Y/N) Date of pumping SEPARATION DISTANCES FROM Well(s) on lot :To property line ure ater/drainage 72-026 (Rev. 7191) Front Tank size n cleanout (Y/N) Compartments . Depressio —Ala<tested(Y/TANK adjacent lots Foundation Absorption field. Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION — MU1J/G(f0AL SEWCYZ Date Insta Manufacturer _ Size In gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at " PlAn High water alarm levet Meets MOA electrical codes (Y/N level at SEPARATIO ANCE FROM LIFT STATION TO: I on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA — MUMC(PAL SEcJEr2 Dat stalled Soil rating System type — Length ' Width Gravel thickness Total depth l ! Total absorption area Cleanouts present (Y/N) Depression over field (Y/N), Date of adequac Results (pass/fail) for Peroxide treatment (past 12 months) (Y/N) If yes, give date _ SEPARATION DISTANCE FROM ABSORP FIELD TO: Well on lot n adjacent lots erty line_ To building foundation.. To existing or abandoned system o On adjacent lots Cutbank ' = Watermain/service line Surface w r Driveway, parking/vehicle storage area _ ain drain E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on th 4 -,41 S & S ENGINEERING 0` .v 17034 Eagle River Loop RoedNo.204tQ .•'••�M Eaglo River Alaska 99577 bedrooms of this inspection. Signature '% * to Engineer's Name •�••��•�•� Date ' r 1 Z �5, ROGER J. CHAFER u�r� 0215 J �6 s� ••• ,•' V �✓ �e%tA 1PRO ESSON O HAA Fee $ / Waiver Fee: $ Date of Payment Z Z Date of Payment Receipt Number Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 6633 A STREE1 ANCHORAGE, ALASKA 9951,e TELEPHONE (307) 582.2343 FAX: (907) 661-6301 AMALISIS AISULTS for INPOICI 1 61509 iCheslat Raf.1 92.6775 Sample 4 1 Wilt: Mitt, Client Semple ID : LS 12 UWX PILLAGE Client Pau :S G S I1(ClNI111I1G P"11) : U1 Client Acct :SNSINGP Collected r 12/10/92 l 07:49 his, 1POt r pW :NONE RICEIYID Received : 12/10/92 1 14:0i hra. 19g4 Ptessrved with Ordered 1y +R. SNAPIR Analysis Completed r 12/11/9:. Sorel Repotts to: Laboratory Sapetviset : TIPNIN C. IDE 1)S Q S INCINIIAINC Released 17 :2) •........a..u.u...................... ......... .u....u.u.u.................... ................. .............. ............o... patemotst ltesulto Unite N9thod Allovcble Limits ........................ ............................................... w............................................................. NITAATI•N ND(0.10) rq/1 IPA 353.2/300.0 1C Sample IOU7111 SSNPLL COLLECIIO DI! 9COIT S. flematks: ......................................................................................................... 0...... I ......... a........... 1 Tute Performed . $99 Special Instructicno Above UA•Uravailable NO• Ilia$ Detected " See Semple Rematka Above N1• Nat Anelyzed LT -List Then, OT•Ctestet UAn QN SGS M►•m5er c1 the SGS Group (SocI614 09'+dralo de Sdrvellince) �� rrn nnnnnnnon nnnnnnnon nn nnnnnnnnonOOot1O00QOOst1:11 bl Z_I-2661 MUNICIPALITY OF ANCHORAGE • �- Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY -FOR SINGLE FAMILY DWELLING Parcel I.D. # HAA # !� ngry'1IAA 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 5; Stock' 2; Dawn V.cttage Subdiv.izion Location (address or directions) 6721 Tech&&, Anehonage (b) Property owner - Telephone: (home) Business Mailing Address (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent CENTURY 21/NEW HORIZONS ATTN: Stephanie P"zek Telephone 562-6233 (e) Mail the HAA to the following address: (or check hereX2, if hold for pick up.) List contact person and day phone number below: 5 & 5 ENGINEERING 17034 Eagle River Looe RenA No e()4 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family ®C 3. WATER SUPPLY Number of bedrooms 3— Individual Well ®.Y Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ❑ Publics Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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. Name of Firm Telephone fee— 2971 Address 17034 Eagle River Loop Road No. 204 Eagle Date 6. DHHS APPROVAL Approved for -3 bedrooms by Approved Disapproved Terms of Conditional Approval Conditional • r_ 's Seal • gobert A Shcfx • ' a� Pb. 1457-2 • v r. f AC 0 FES Date l , � CAUTION . . The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 72-025 (Rev. 77881 Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) p`� ��` • Health Authority Approval (HAA) PPS CHECKLIST - FEBRUARY 1984 __ 343-4744 ��p �J� V Legal Description: Loi" A-17; IN 41n� A. WELL DATA Well Classification iA)! i /e rA Ak (�u If A, B. C, D.E.C. Approved (Y/N) rJ1,4_ Well Log Present (Y/N) _ 14 Date Completed 4-2 ZYield 9 !j 02,id Total Depth 3�Cased to Depth of Grouting —" ( 7 - ZO- 5,0 Static Water. Level 3 Pump Set At L) (� Casing Height Above Ground f Sanitary Seal on Casing (Y/N) u Electrical Wiring in Conduit (Y/N) !4 Depression Around Wellhead (Y/N) AJ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 11 ; On Adjoining Lots / 00 f To Nearest Edge of Absorption Field on Lot N f W ;On Adjoining Lots .. ` 00 / To Nearest Public Sewer Line * SD To Nearest Public Sewer Cleanout/Manhole S -t- To To Nearest Sewer Service Line on Lot Z b Water Sample Collected by - '-*D `f- :D t 4 e--e--tri A ; Date 7 - 1 - `1 V Water Sample Test Results ►� "� c o d u - ►aG1 e� i r�1 �- !y �'� I e S Comments 'r -1••N 4CG0rd 4N)Q? (.y�th /`EGu1W 11c)NS (tAc, Of 1Nsm/14 N, AA L) tJ*(C- A S e wey. B. SEPTIC/HOLDING TANK DATA Date Installed Size - No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/NDate Last Pumped Pumping/Maintenance Contact on�FI-e Y/� ; for Holding Tank High -Water Alarm ( /N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/H DING TANK: To Water Supply Well To Building Foundation To Property Line'Disposal Field To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments _Ah O N 1C-;Io,A S e LJ e r 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area Statndpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTI FIELD: To Water -Supply Well To Property Line To Building FoundationTo Existing or Abandoned System on Lot ; On Adj • ing Lots To Water Main/Service Line To utback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments AL L�(iPA eweir D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) _ Comments Z Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request' I certify that I have checked, verified, or conformed to all MOA,and HAA guidelines in effect on the date of this inspection. Signed ,��-•..� i, Company S & 5 ENGINEERING17034 Eagle River LOOP KOado 2e Date • ••••' '�e:1s Date Ea le River, Alaska 99577 Q %/ �* o `� � "�* al =: Cr �!o bfl 3 --`'' ti ' 0.MOA No. Receipt No. a s o7 7 r.2 Receipt No. Date of Payment — C% Waiver Fee: $ — Amount: $ l % �" U Date of Payment 72-026 (Rev. 7/68) Back Page 2 of 2 �.IM01./yQ, CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. a 5633 B STREET • ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562-2343 ''aa FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT SI SAME for Work Order 1 2S743 Date Report Printed: JUI. 27 90 ! 09:36 Client Sample ID:LS 82 DAWN VILLAGE FHSID :UA Collected JLL 20 90 ! 15:00 hrs. Received JUL 20 90 ! 17:30 his. Preserved with :AS REQUIRED Analysis Completed :JUL 20 90 Laboratory Sups:viscr :STEPHEN C. ED! Released Ey : 14, Yr�<�— / �j i G Special Instruct: Chemlab Ref 1: 902573 Lab Smpl ID: 3 wittiz: WATER Parameter Tested Result Units --------------------------------------------------------------------- HITEATE-11 ND(0.10) mg/l Sample ROUTINE SA.YPLE. SAYDLE COLLECTED EI R.S.JR. Remarks: Client Name S & S ENGINEERIH, Client Acct SHSENGF P.0.1 HONE RECEIVED Req t Ordered Ey : P.. SHAFER Send Reports to: 1)3 & S ENGINEERING 2) Allowable Method Limits -------------------------------- EPA 353.2 SO ............................................................................................. 1 Teets Performed See Special Instructions Above UA -Unavailable 1 HD- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Tian a � J \� .. . _.. MUNICIPALITY OF ANCHORAG DEPARTMEn OF HEALTH AND ENVIRONMENT _ _. PROTECTION i; y!I 825 L Street, Anchorage, Alaska 279-2511, ext. 224 or 225 99501 #1: Time 2:30 P.m. #2: Time Date 5-4-77 Tues Date Date Received: May 4, 1977 #3: Time Date Insp Pratt Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska Mutual Savings Bank Mailing Address: Post Office Box 1120 2. Property Owner: Mailing Address: 99510 Phone: 274-3561 Pederson Construction, Inc. Star Route A Box 1718X 99507 Phone: 344-8638 3. Legal Description: Lot 5 Block 2 Dawn Village Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) 5. Number of Bedrooms: 2 Number of Bedrooms: Well System: Individual Well (Z) Community/Public System ( ) Permit # 77016 Depth of Well 971 Well Log on File ( ) Construction Bacterial Analysis G. Sewage Disposal System: On-site System ( ) Permit # Installed Septic Tank Size Absorption Area Public Utility (yj Installer Manufacturer Soils Rate 7. Distances: Well to Septic Tank to Sewer Line to Nearest Lot Line Nearest Lot line Material to Absorption Area Absorption Area • l�U�lC1PALITi or. 1.NCF10 MUNICIPALITY OF ANCHORAGE DZIPT. �' I:'`'Y'' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECtibRo .. ' 1 r"�"'_CTICN 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 Y7 10 - REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES RECEIVED 1. Type of Inspection: CMRO VA FHA CONV� 2. n Property Owner: 9,-)N, 'j C Oh -0 P cc<_p %1 4/1 _r_, . Mailing Address: 21 LK ay Phone: yF!54L/— fee? drx'�' 9VL57 7 3. Name of Buyer: Mailing Address: Day Phone: 4. Name of Lending Institution: Mailing Address:X• Phone: eZZ62-O ,QCGfZic c 4javn o�� 5. Name of Realtor or Agent: 00 Mailing Address: Phone: 6. Legal Description: Location: e;7 7. Type of Facility to be Inspected: li" No. Bdrms. 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation 72003(3/76) i n � Page Two _r Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 5 Block"2 Dawn Village Subdivision Comments: Affadavit Attached: ;(;) Letter Attached: ( ) Approved: 2 C Date: Disapproved: Date: Department Worksheet: