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Home My WebLink AboutDAWN VILLAGE BLK 2 LT 7Customer's Order No. Address SOLD I¥ ALL claims Ind returned goods MUST t)e accompanied by tills Rec'd by PERr4I T NO. I'-llJl'-,I T C ] 'AL I:T¥ OF FIl'-41'-:l _IF,'F-II3E DEPARTMENT uF HEALTH AND EN'¢IRONHENTRL PROTECTION 2516 E. TUDOR RD., ANCHORAGE, AK. 99507 276-222i I-4ibl F'FRI-'I T T ?70i8 > APPLICANT LOCATION LEGAL PETEP~0f-t nA~.J~TPllOTION ~ESHCAR ST L? B2 DA[4N VILLAGE SAR BOX iT±AX LOT SIZE ~44-86~8 10000 SQUARE FEET NINII'IUI'I DISTANCE BETHEEN R ~4ELL AND AN'¢ ON-SITE SEHAGE DISPOSAL SYSTEI.1 IS 10~ FEET FOR R PRIVATE HELL OR 2061 FEET FOR R PUBLIC ~,~ELL. HELL LOGS ARE REQUIRED AND IdUST BE RETURNED TO THE DEPRRTI'IENT HITHIN ~8 DR'T'S OF THE HELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIRGRRI4S ARE AVAILABLE T0 INSURE PROPER I NSTRLLRT I ON. F'EF-:i'-I I T ',.-'R L I b FCIR ONE '-'r'ER R FF-:CII~'I I $$1JE I CERTIFS' THAT ±: I Ah1 FAI'IILIRR ~4ITH THE REQUIREMENTS FOR ON-SITE SEHERS AND HELLS ms SET FORTH EW THE f.IUNICIPRLITM OF ANCHORAGE. 2: I HILL INSTALL THE S~'STEI.1 IN ACCORDANCE HITH THE CODES. APPLICANT PETE?Ti :O;'ISTRUCTION S 89°57'20"E ~35~1T IC,,~,"O $0 F1 32986 I0 9 UTILITY EASEMENT lO'UTILITY EASEM PT lAST ~ 5 IO, Z'90 S~ rT. s¢o3 't--' 9,491 SOFT e~ 89e 17'17'[ ~ 8 7 I0.~$ SQ irt ') 6 7.?~ SOFT. 5 24 "[ 8°994 8.~5 ~ 32976 - '~ ROAD ,~ ~t L) '/ - ' . 125 · 5/8"x30" Rebar w/ Alum cop 5~t flush w/print Prop3r t;gn 5/8"x 3d' Reb~ USK Man 3"x~" Alum Cop SURVEYOR'S CERTIF I, EC-__~RL D K(~RYNTA plat of senfatJon of lands actually shown correctly and that all monuments and lot car MUNICIPALITY OF ANCHORAGE D,v,s,o. OF E.V, RO.ME.TALroR .EALTH SE.V,CES 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot. block, subdivision, section, township, range) Location (address or directions) (b) Property Owner Mailing Address Telephone: Home ,7~g'-jl/~.~' Business (c) Lending Institution Telephone Mailing Address ' (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here .[~if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family"~ Number of Bedrooms WATER SUPPLY Individual Well~ Community [] Public F1 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE 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 72.025 (Rev 8,'86) Front 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 h~rein. 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 .~'4. ! -5"o ¢o Address d Date ¢-~ DHHS APPROVAL Approved for .~/~' (~r~ bedrooms by Approved /~ Disapproved Terms o[ Conditional Approval Conditional Date CAUTION 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. Emplo~,ees 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. Page 2 of 2 72.025 rRev &'86t Back MUNICIPALITY OF ANCHORAGE (MO~.,I HEALTH AUTHORITY APPROVAL (HAA) 'CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~.o7""/ A. WELL DATA Well Classification Well Log Present (Y~'~. Total Deptt~ 9! ~" Static Water Level t~) Casing Height Above Ground Electrical Wiring in Conduit{~N) Separation Distances from Well: To Septic/Holding Tank on Lot , ~'~,~1//~/'~' If A, B, C, D.E.C. Approved (Y/N) Date Completed ~'~E /¢~5" Yield Cased to ~ Depth of Grouting ~'~, ~' · Pump Set At ~ ~' · -~ Sanitary Seal on Casing(~N) Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot To Nearest Public SeWer Line{~) ~"~' *' Cleanout/Manhole {~ ~'~ ' Water Sample Collected by ,~'~' Water Sample Test Results Comments ~/~'~,4. ~ ,~J/,,4 ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sawer Service Line on Lot (~ /0 ·.~' /~)/~'~/ ; Date .~r'-X,,O B. SEPTIC/HOLDING TANK DATA ' Size No. of Compartments Air-tight Caps (Y/N) Foundation Cleanout (Y/N) ~ ~ Date Last Pumped ~ ~ ) _ ~ ~; for ____ Temporary Holding Tank Permit (Y/N) To Water-Supply Well .__. ~ Foundation __ __ To Property L'me ___.___ To Disposa'l"~.,..~~ __ To Water Main/Service Line To S Pond, Lake, or Major Drainage Course ~ Comments Page I o! 2 72-026111/84) ABSORPTION FIELD DATA _~ Rating in Absorption Strata Type of System Design Date"t~ed ~ ~ Length of Field Width of Fi61~,~ Depth of Field ___ Gravel Bed Thickness Square Feet of Absorption")~,. ~ Standpipes Present (Y/N) Depression over Field (Y/N) '""-,_ Date of Last Adequacy Test . Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ~ To Existing or Abandoned System on Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ; On Adjoinin~ Lo'"~'~t To Cutbank (i pro~~ D. LIFT STATION ~ Dimensions Size in Gallons ~lanhole/Access (Y/N) "Pump Off" Level at "Pump On" Level at High Water Alarm Level at '~~ont (Y/N) Tested for . . Pum~g Adequacy Test. Meets MOA Electrical Codes (Y/N) Co m m ents ' . '* Check Permitted Bedroom Rating Against HAA Request ** I certify that ~ch~e~e~j ~/{~?ified, or conformed to all MOA and HAA guidelines in effect on the dateof thisinspection. Signed ~. ~4../$ ... Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026(11/84) '~ ¢HEMICAL & GEOLOGICAL LABORATORIES OF AL4SKA, INC. = ~,.Lj~.~'o~.'/.'~"~,~ FEDERAL TAX ID # 92-0040440 Client Sample ID:LT. 12, DA%~I VILLAGE FWSID :~l Collected PAT 20 89 @ 16:00 h~s. Client ~ : IECS Client lcct : [KZCSRP P.O.! NO~ REC'D O:dered BI : A. ~EN A~lysie Coaplete~ :PAY 23 8B S.r~ Reports to: La~oratory Supe~vleo~ :SIEPHL~DDE 1)AECS Eeleased By : ~'~'*~' ~-'' ~X...-~ 2) ipeclal l~txuct: Chemlab Ref ~: 1116 Lab Smpl ID: I P~trlx: Wstel Allowable Pa~amete~ Tested Result/Unite ~ethod Limits NIIEIIE-N ~(0.10) ~g/1 EPA 353.2 10 Sample RO~INZ SABLE. Rem:ks: SA~LE COLLECtZD $I A. ~IEN. 1 lests Pe~£o:med · See Special Iratructlons Ahoye Ul-Unavallable h~- ~one Detected "See Sample Red,ks Above NA- Not Analyzed LT-Leee than. Ct-G:eate: than .., DATE' RECEIVED o. .... INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECT INSPECTOR J MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all pa~s on page 1. I~omplete r~u~ will not ~ pr~d. ~ease allow ten (10) days for pr~slng. 1. PROPERTYOWNER ~ PHONE MAI gl NG ADD.SS PROPERTY RESIDENT (If different from above) PHONE 2.BUYER PHONE MAILING ADDRESS MAILING ADDRESS ( j 4. REALTOR/AGENT ] PHONE MAILING ADDRESS LEGAL DESCRIPTION 6. TYPE OF RESIDENCE NUMSER OF~BEDROOMS [~] One [] Four r~¢. SINGLE FAMILY [] Two i '[] Five , [] MULTIPLE FAMILY ~ Three [] Six r-i Other 7. WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** ~ YEAR ON-SITE SYSTEM WAS INSTALLED. .J~ PUBLIC UTILITY 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 I--I SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [~3 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 [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTI LITY 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. DISTANCESwELLTO: Se""c'"°ld'ngTanklAbs°rp'i°nAr" ISewer"ne IN"r"'L° Line Absorption Area to nearest Lot Line 5. COMMENTS I~'""APPROVED FOR ..~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) / [] DISAPPROVED .~~ DATE BY '72-010 (Rev. 6/79) MUNICIPALITY OF ANCHORAGE ~ ~ DEPARTMENT8250Fi. HEALTHstrlot - ,4,11¢hor4ge, & ENVIRONMENTAI.Ai~k, ~501PROTECTION ~ ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEINER FACILITIES DIRECTIONS: Comptete all part~ on page 1. IIt~omplite reque~ will not be pr~ Please allow ten (10) day; for ptone~ing. 1. PROPERTYOWNER I PHONE PROPERTY RESIOENT (if dif~ront from abow) PHONE z. BUYER PHONE MAILING ADDRESS 5. ~NO'N=I"ST'TUT'ON ~ P,ONE MAILING ADDRES~ 4. REALTOR/AQENT [ PHONE 5. LEGAL DESCRIPTION L7 STREET LOCATION TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY J~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY 8. SEWAGE OISPOSAL SYSTEM [] INDIVIDUAL/ON'SITE** ~ PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] Other [] Two [] Five ~"" Three [] Six ATTACH WELL LOG. A well log is required for ell wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. '12-0i 0(3/78) ..... ' THIS SIDE FOR OFFICIAL USE ONL DATE R ECEIV~'D ' INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE /NUMBER OF BEDROOMS [~SINGLE FAMILY i-'1 ONE lY_] THREE I'--I 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 NDI VI DUAL/ON -SITE DATE INSTALLED I---I 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 Absorption Area to nearest Lot Line 5. COMME.TS - [] CONDITIONAL APPROVAL (letter must accompany certificatel [] DISAPPROVED LEGAL DESCRIPTION ' 72-010 (Rev. 3/78)