HomeMy WebLinkAboutSEA TURN BLK 1 LT 9See Turn
Block I
Lo1- 9
#017-121-46
MUNIC,,IPALITY t)F ANC;I~OP, AGI2
DFPARTMENT [)F 14EAI.TH & I.-N\/II~OlX!F/IEN i'/\!, P[~OTI.~CTION
EI\IVI RON!V]EITrAI, ENGINEEFitNG
825 I. Street - Anehorafle, Alaska 99501 'l'~!e!~hont~ 264-4'?20
ON-SITE SEWAGE DISPOSAl., SYSTEM AND/OI:*, !~JF, t. L INSPI.;C'i-ION RI::POFIT
LEGAL DESCRIPTION
LOCATION
[Dwellh~(j
Dwelling
Foundation
Deptl~
Crib depth
Driller
Total lengt~,o~ lines/
Material
Material beneath tile ~_. /
NC), OF BEDROOMS
PERMIT NO.
Liquid depth
PERMIT NO.
Liquid capaci'ty in gallons
PERMIT NO.
Total effective absorption a, rea
PERMIT NO.
Fatal affoctivo absorption al'e8
Building fotmdation Nearest lot line
Distance to lot line [PERMIT NO.
Septic tank A~sorption a~ea(s)
, ....... .%2 Inside length
Top of tile to finish grade i~ _ / ///
~ DIS'r~NCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING ,/ ~- ,~
INSTALLER
REMARKS
APPROVED ~.-. / '~
·
72-013 (Rev, 3/78)
DATE LEGAL
DEPARTHENT C'
GEORGE R I}ILLES
.I F...UN L. I F....LE
L'z'¢ E:t SEA TUF.'.N
HF FLI_.RNI
LOORT I ON
L E =F'IL
HEALTH AND EN',,,'IF.'.ONHENTFIL
STREET., HNL, HORH ~E.,
264-472. O
4. tg1 GRRF:'E PL FIPT
F" IE F..: I'"1 ]] 'T
LFO" S I ZE 4]<560 'SI]fiJI:IRE FEET
T'¢F'E OF :SOIL FIB'.SCRF'TION S'¢STEM IS: TF. EN..H
flH,..,IHUH NUHBER OF BEDF.'Or)M'S = 3: SOIL RATING ,:'~F.~ FT,.,'BF.'..'.,= '"P;
"['FIE RED]:!UIRE[:, _,I~.E OF THE =,t. IL REi'~]A[;'F'TION _-,~.=,TEfl IS:
[) E F' ]' t4 = '"-a I_ E 1'-,I ~3 T H =: -:" ":"
_ _-. .... 1:3 R IR %-" [E !_ [:. E F" "F t-~ ==: 5
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TREHCH OR DRAINF"IEL. D.
THE DEPTH OF A TRENCH OR PIT IS THE [:,ISTANCE BETWEEN THE ~SURPAOE OF THE
GROUND FIND THE BOTTOM OF THE E~..',CAVATION (IN FEET).
THERE I'"'; NO SET 14IDTH FOR TRENCHES.
THE GRAVEL [:,EPTH IS THE MINIMUM DEPTH OF GRFIVEL BETWEEN THE OUTFALL PIPE
AND THE 80TTOM OF' THE ENCAVATION ':lin FEET).
RbZI;!bl ]] F:E[:. SEPT I C::
RE_FUN_,IE, ILIT'¢ T.] INF'OF. ff'I THIS [)EF'F~RTMENT [:,IJRINt3 THE
F'EF::MIT I.-IFFLI..NNT HAS THE ' "--'- ':'
I. NSTF-~LLI=ITION I[~=FEE. TIUN.., OF FtN'T' HELLS FIDJRCENT TC) THI:5 FF. EF. ERTT RNC., 'f'HE
NUHBEF: OF RESIE:,ENE:ES THAT THE WELL WILL z, ER,,,E.
l" ~.,.~ C~ ,:' :? ':, Z ~-~-- F- E L- T Z L--~ 1'4 S R F.". E F: E ~':-, tJ :[ F-: E [::,
E, HL. KFILLINB 0F AN'T' =,t_,TEfl HITHOUT FINAL INSPECTION AND APF'ROVRL 8'¢ THIS
r:,EF'ARTMENT WILL BE =,LBJEL. T T0 F'F.:0SECLIT[AN.
MINIMLIH DISTANCE BETHEEN A WELL AND ANY ON-'SITE SEWAGE DISPOSAL SYSTEM IS
:LOF~ FEET FOR R PRI',,,'RTE WELL OR ~50 TO 200 F:EET FROH A PUBLIC WELl_ DEPENDING
UPON THE T'¢PE OF PUBL. IC WELL
MINIMUM DISTANCE FROH R F'RI'v'R'f'E HELL TO FI PRIVATE SEHER LINE IS 25 FEET AND
]"0 R COI"IMUNIT'¢ SEWER LINE IS 75 FEET.
I.,.tELL LOGS taRE F:'.EL.]UIRED AND HUST E:E RETURNED TO THE [:,EF'RRTMENT WITHIN
OF THE WELL COMPLETION.
OTHER REQUIF:EMENTS MA'¢ I:IF'PL¥. SPECIFICATIONS AND CONSTF.'.UCTION DIAGRAHS ARE'"
AVAILABLE TO INSURE PROPER INSTALLATION.
F" E F.:." P1 I T E ,---. F ]: F: IF_ S [:, E t]: E ~"1 B E: ~: _:,. 1., -.t '~.. C'. [:-i
I CERTIF't' THAT
1: I AM FRMIL. IRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH B'¢ THE MUNICIPRLIT~¢ OF F, INCHORAGE.
;:?.: I WILL INSTALL THE S'.r'STEM IN FIE:CORDANCE WITN THE CODES.
7.': I LIN[:,ERSTFIND THAT THE ON-SITE SEHER S'¢STEH MFI't' REL.]UIRE ENLFtRGEMENT IF THE
RESI[:,ENCE IS REMO[:,ELE[:, TO INCLUDE MORE THAN Z.': BEDROOMS.
S I G N E [:,: ........................................................
HPF L I ..PINT ]EE F.' 3E R [:, I LLES
ISSUED [, T ...................................... [:,FITE ',,,'4.
[:,EF'RRTMENT OF HEALTH AN[:, EN',,,'IE:ONMENTFIL PE'OTECTION
':'":"~ "L ~TREET., FINCHORRGE, AK. 995
../. 264-4728
1--I E L L R !'-.1 [:, C~ 1'4 -- '_---..I T E
PERM I
~" "- IS '
T"r'F'E OF SOIL FIBSOE'.PTIEIN -,'rz, TEH
MFtXTMLIrd NUHBER. Of EEDRCOMS
:.-_-;EL-JER F'ERI"I T T
LOT SIZE f~SG(] S'3..!LII-DRE FEET
]'HE REQUIRED SIZE OF THE SOIL .F~BSORF'TION S'Y'STEI"I IS:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFIINFIELD.
THE DEPTH OF FI TRENCH OR PIT IS THE DISTANCE 8ETI. dEEH THE SURFP]CE OF THE
GROUHD FIND THE BOTTOM OF THE EXC:FIVRTION (IN FEET]).
THERE IS HO SET HIDTH FOR TRENCHES.
THE GRR',/EL DEPTH IS THE MINIHLIM DEPTH OF GRI'.SVEL BETHEEH THE OUTFRLL PIPE
FIND THE BOTTOM OF THE E,NC:RVRTION (IN FEET).
R E,_--':~-. bi I RE[:-, 5EF'T
PERMIT FIPPLICFINT HAS THE RESPONSIBILIT'¢ Ti_] INFOF.:M THIS DEPFIRTMENT DURING THE
INSTALLATION INSPECTIONS OF FIN'¢ HELLS 8DJRCENT TO THIS PROPERTV RNC, THE
NIJi'dBER OF RESIDENCES THFIT THE HELL HILL SERVE.
Tl..~Cl ( 2 ) I I"-I$PEE:-T I 01'4--~, RF-:E F-:EI~LI IRE[:,
BACKFILLING OF RN"P S'¢STEH HITHOUT FINFIL INSPECTION AND RPPR]VFIL E',Y' THIS
DEPARTMENT HILL BE SUBJECT TO F'F.'.OSEOUTIOI"I.
MINIMUM DISTANCE BETWEEN FI HELL FIND RI'dV ON-SITE SEHRGE DISPOSAL SYSTEM IS
100 FEET FOR F~ PRIVATE HELL OF.'. 150 TO 280 FEET FROM R PUE:LIC HELL DEPENC, ING
UPON THE TYPE OF PUBLIC: HELL
MINIMUM C, ISTFINCE F'RCH"I Fi PRIVFITE HELL TO FI PRI',/RTE SEHER LINE IS 25 FEET AND
TO R COMMUNIT'¢ SEHER LIHE fS 75 FEET.
[dELL LOGS ARE REQUIRED AND HUST 8E RETIJRNED TO THE C, EPFIRTMEHT HITHIN ]'.':0 DRVS
OF THE HELL COMF'LETION.
OTHER REQUIREHENTS MR"r' RPF'LV. SF'EC:IFICRTIONS AND CONSTRUCTION DIRGRRMS RRE
RVR~LRBLE TO INSURE PROPER INSTRLLFITION.
PEAr,1 I T E.':--::P I F-:E5 DE,]EhlE:ER 2-':- :;L.. 1:~80
I CERTIF'Y' THAT
1: I RM FAMILIAR HITH THE REQLIIREr,IENTS FOR ON-SITE SEHERS AND [dELLS RS SET
FOE'.TH B'Y' THE r,IUNICIPRLIT'¢ OF 8NCHORFIGE
2: I HILL INSTALL THE S'¢STEM IH ACCORDANCE HITH THE CODES.
3: I UN[:,ERSTRND THAT THE ON-SITE 5EHER S'¢STEM MR'¢ REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMO[:,ELED TO INCU_,DE MIl, RE THAN ~ BEDROOMS.~ , ¢ ~. / -
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6~650, Anchorage, Alaska 99502 276-222'[
SOILS LOG- PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
2O
COMMENTS
DATE PERFORMED:
[] PERCOLATION
TEST
SLOPE SITE PLAN
.... I-7- ?'
[ -r f] ' +, t-i--1-Y' ~ .... k '1
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND
72-008 (7~76)
DATE:
,SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF ~__
DRILLED
PROPVRTY OWNER I/b?.o ¢:co¢cr,~c ~3.~ 279-4355 ~,-~/~ ~
LOCATION OF WELL SITE
VFELL LOG:
0 ......23" O]evt c. Lm) vsZ,U~. 7.5,°4
Co~Z o.fi 9~d.J~b~9~: ;'~2777.00
Co4~- off ge_J~ $cc?.L.: b'21o O0
MUNICIPALITY OF ANCHORAO[~
DEPT. OF HEALTH &
' ffNVIRONMENTAL PROI'ECTIOI~
RECEIVED
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING,
/RITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF
'(HANK YOU VERY MUCH.
:$,273o o O0
BERNIE CLAUS OF RAMPART DRILLING WORKS
g. ERVICE CHARGEOF 1~% PER MONTH L BE AgSESSED ON P~T DOE ACCOUNTS.
Municipality of Anchorage
Development Services Department
- Building Safety Division ·
, On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. BOX 196650 Anchorage, AK 99519-6650
. w,~v.ci.anchorage.ak, us
- (g07) 343-7904
Parcel I.D..
1.
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE'FAMILY DWELLING "
or7 -'1~! - fid' : "'"
GENERAL INFORMATIOH
Complete legal de~cfipti0n L,,/' 9/
Lccat[o~ (site addres{ ~'~: ~irections)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
'~ unless otherwise requested, HAA will be held by OSD for pickup. .~,~'
2. NUMBER OF BEDROOMS:
3. TYPE OFWATERSUPPLY: ·
Individual Well []
.'Individual Water Storage []
Community Class Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HA, A) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authc~ty Approval are required for the transfer of
[tle (except be~,een spouses) for properties served by a single-family on-silo wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or e public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the profess:oriel engineer's work.
INSPECTION'B~ EI~I~R - ':
STATEMENT OF ' ' ' ': ' '
/~s'c~fi~l by my seal affixed hereto and as'0f th'e~alida~6n, da!~ shown bel~: I ve~ ~at my invesSga{~o~,- .
b~s~d'~h'pm~dures 0u~in~d In ~e He~l~ ~ A~?~I G~d~li~es fo~s'appli~n shows ~at ~e'on- '.
sRe ~ate[ supply an~or.~ste~ter dlsposal..s~[~,j~(a(~) ~fe,,~n~fiona] and adequate for the number
b~dro0~s and ~e of s~ indicted h'~m~. I,fu~r'ved~ ~t based 6R ~e inf~mati0~ obt~i~ from the '.
M~ici~ali~ 'of ~mg~ files ~'nd fr6m~ .i~v~sfi~6~ a~d ~ln'~6lioh.-~e O~site '~ter'sup~l~ and/or ."
~{te~ter dispo~'al S~stem'i~(ar~) In'~mpli~n~'~'~ll'~li~?e Municipal and s~te ~des, o~d~nanc~[
ahd ~gulat]o'ns in'~ffect at ~ time 0f i~s~ll~on. ·" · ' .': ::. ;" -.. ~ ' .-'
FI~~ ~l~f~ ~A.~A~/~,~'~: .... Phone
E6g[ne~['s PdnDd ~Pm.~ :~° ~ ~-~o 0 ~
DSD SIGNATURE
l~'~-.Approved for
Dis~pproved~ '
Conditio-nal ,ppro¥~I for
· Additional Comments
b'e'dr~o;ms,'with the follo~g stipulatiohs:
. ..:%%
...~-~::': ON-SITE '"::~
WATE~ AND rn:
~. ': WASTEWATER ~
: ,, .:. .
·
Attachments: HAA checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
' Supplemental Engineer's Report.
Other
Original Certificate Date:
(R~. 01/02)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St,
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
1. GENERAL INFORMATION
Complete legal description /_~,/- 9.,
Location (site address or directions)
Expiration Date: '7- -~- O '~_
Curr~nt Property owner(s)
Mailing address
Lending agency
I '/~c, / 'Z ~ ~o,~ ~"~ ~,'~ I¢; ,~
H~- G ~ ,-~ Day phone.
Day phone
5"Z Z - 3'
Mailing address
Real Estate Agent
b~o~z F'.~. ~.~, Day phone
Mailing Address
Un/ess otherwise requested, HAA will be held by DSD for pickup.
2. NUMBEROF BEDROOMS: ..~
o
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
[]
[]
[]
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. 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,
based en procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) 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 flies and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time cf installation.
NameofFirm ~'~[/~? 'T',c,4~;¢ c~/ _.~ ¢ rv;¢~'~" Phone
Address
Engineer's Pdnted Name "~ ~,c.,,~.~o~ F.
DSD SIGNATURE
.ENGINEER
rovee lot ~ ueuruu . ,
App . _ · · ' .
Conditional approval for . bedrooms, with the following
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Odginal Certificate Date: q - "~ - O~-~-~
{Rev. 12~0)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewatar Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(S07) 343-7~04
HEALTH AUTHORITY APPROVAL CHECKLIST
.ac WELL DATA
Parcel ID: ¢:)t ? - I Z/- 5f~)"'
Well type /~,xf
Data completed ~9 1 7 / ~'~
Total depth /~.3 fl.
If A, B, a. C provide PWSID # . .
Sanitary seal (Y/N) Y
Casodto I~L3~ .ff.
W.el! Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) I '~ in.
FROM WELL LOG AT INSPECTION
Dateoftest .; ?/7 / ~ O ~J f/ ~ Z. / ~ ~ .
Static water level 7 '~ ft. ~ ¢:? ft.
Well production 15- 1" g.p.m. '7,) 't' g.p.m.
WATER SAMPLE RESULTS:
Coliform ~ colonies/100 mi.
Data of sample: ;~ ~/P.Z/OZ..
Nltrata~o,'~ .mg.A. Other bacteria (~) colonies/100ml.
Coilectedby: ~ i~ l'~,p '"/3,c~.e ; e~ f .Cc,er
Bo
SEPTIC/HOLDING TANK DATA
Tank Type/Material -~-; . ~ Sef, fi~l/.~e/ Date installed
Tank size ~ gal. Number of Compartments ~
Foundation Cleanout (y/N) ~' Depression ova' tank (Y/N) iV
Data of pumping 3/Z7(p~- Pumper ~ ~' ~
High watar alarm (YIN)
C. ABSORPTION FIELD DATA
Date installed ~
Length ~ ft. Width ~' ft.
Total de~h ,~, 7 ff. Eft. a~fion ~a ffe~ ~ M~g tube __
Date of ad~ua~ ~st 3 / Z Z/0 ~ ~ (P~I), ~
Fluid dep~ in abso~fion field bede ~st 31 ~. Wa~r add~ ~ ~1.
Elaps~ Time: 71 min. Fin~ flu~ d~3[ ~ in.
~yrejuvena~on~a~nt(past12mo.)~&~) N~ ~
Soil rating (g.p.d)ft~ ar ~/bclm~) I't,,e' ~'~,~,Systam type
Gravel below pipe
Y Depression over field
Absorption rata >=
For ~ bedrooms
New depth
g.p.d.
If yes, give date A/, ,~,
D. UFT STATION
Date installed Size in gallons
'Pump on" level at in. 'Pump off' level at
Datum Cyctas tested
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & cimuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
'Sel~tic tank/tiff station on lot I I ~"
Absorption field on lot ·
Public sewer main ~. ,~. ' "
On adjacent lots · '2 /oQ ,
On adjacent lots
Public sewer rnanhole/ctaanout
SeWer/septic service line ~, Z.~" Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main ~,/,/~.. ' '
Wells on adjacent lots ·
SEPARATION DISTAI~CE FROM ABSORPTION FIELD ON LOTTO:
Propen'y line
Water service line
Absorption field
Surface water
Property line t
Water Service line
Curtain drain '
COMMENTS
Building foundation :~ 0'+
Sudace water "> I~'
Wefls on adJacent lots ~, too'
Water main p./~.
G. ENGINEER'~ CERTIFICATION
I certify that I have determined through 8e/d inspections and
review of Municipal records that the above systems are in
conformance ~ MOA HAA guidelines in effect on this date.
Engineer's Printed Name 'T/l~C~r~- ~ PI¢=~.,~
Date ,3'/~ '7 ! ~00'~.. '"
Driveway, perking/vehicle sim'age · ~-.&~~
HAA Fee $ .,~
Date of Payment
Receipt Number
(Rev. 12/00) ,
.Waiver Fee $
Data of Payment
Receipt Number
20' ELECTRIC £^SEMENI!
LOT 8
LOT 9
EXISTING DUll DiNG
..<, LO)' 7
~R-26-0Z 03:10PM FRi~-CTiE Efi¥1R~I~iTAL
_._CT&E EnvironmenMI S~rvices Inc.
~0~5515101
T-233 P.0Z/03 F-tI8
CT&E RH'./~ 1021497001
Clips! ~mm~ Flat:op Te¢~nica! StY.
i'ro]e~t Name~ Sea Turn S/D
Client Sampl~ ID [.ot ~; Block 1
Matrix D rlz~,iug Water
Ordert'd By
PWSiD 0
Samptc Ib:rr~k.~
Client PO~ Pre-Paid Coils/NO3
Pdnted DaterTlme 03/26/2002 10:40
Colk~ed Date/Time 03/"22,~002 13'.30
RetHved Dnte~'Tlme 03/22/2002 14:00
T~'b. kzl Dlre~jg-..... S~epb~'q'j Ede
Reltued By~~ t
Uait~ Me,od
Dote l~te Init
Hatos:e Department:
Nitraic-N
0.200 U 0.200 mgR. ~I'A 300.0 (<10) 03/22/O2
I~Lcrob:tology L~bormt:ory
'l'o~l Coliform 0
co~lOOmL $M18 9222B
(<11
03/22/02 YAP
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
L 9 B 1 Seaturn S/D T12N R3W Sec 35
2/12/85
Location(addressordirections)
14800 Zircon~Circle
(b) Applicant Name __Beth Allard Telephone: Home Business 345-7165
Applicant Address 14800 Zircon Circle Anchorage, AK 99516
(c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); i{E
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
Beth Allard 345-7165
TYPE OF RESIDENCE
Single-Family;t[~ Multi-Family []
Number of Bedrooms 3
Other
WATER SUPPLY
Individual Well]l~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite:~f- Public [-I 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 I of 2 7~-025 m/84)
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 AEGS, Inc. Telephone 561-5040
Address .J.2g)~_W_~3r.J~S_t~r_eet B A~ch~t&g~gK 995~3
Date __2J_I2.L85
Engineer's Seal
This Department has received written conf~rmation (AECS, Inc.) of the conditional
of February 21, 1985 has been met. Therefore, this property now meets with MOA
requirements.
Approved for Three (3~_ bedrooms .-L.-c~-~-c. . ..... Date
Approved .,.,/~.A Disapproved Conditional _
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered 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 requirements. Employees of DHEP 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 (11/84)
HUql,JiP~tLITY OF ANCHOP~iG~
· ~[vloLOJ OF E~IRO~AL ~LTlt
FOR HE~TH A~tlORiTY APPROVAl, CBRT~ICATE
Application Date
g~SaL Description (include lot~ block, snbdivision, section, township, range)
t,ocn~ion (addreps or directions)
(b) Applicaa{:s Nam~ .A. . ~<c_~ TelephO. nm~_ -- Hom~ Business
(C> Applicant is (chec~Qne) Lending Institution ~ ~ O~er/bnilder ~ ;
(d) Lending Institution Telephone
Address
(e) Real Estate Co~ & AgenC
Address
(f)
Telephone
Mai]. the ~kA to the following address:
T~_~ of Residence
Single-Family[~.~
~umber o~ Bedrooms
Multi=Famil y [~
Other (describe)
3o Water Sup~;]!
Note: If communi,~y well system, must have written cor~firmation from the Stage
Department of Enviromnental Conse~ation attesting to the legality and status°
4o S e~wa_~g~e .~ D_i ,~ p~o s~a.~l
. ~ Public i~l Comm=ity ~ Holding Tank ~
0nsite ~g~
Note: If community well system, must have written co~irmation from the State
~:~.~ Department of Enviro~nental Conservation attest:Lng to the legality and status.
[Page 1 of 2]
5o En ineering Firm Pr_ovidin~~ls Tests File Search'~D~t~a a~nd
As certified by my seal affixed hereto and as of the validation date s~ below~
verify that my investigation of this Health Authority Approval sho~ tI~t the
water supply and/or ~stewa~er disposal system is safe, f~ction~ and adequate
the number of bedrooms and type of struct:ure indicated herein.. I further verify
based on the infomuation ob~ain~ from the Municipality of Anchorage files and
inw~stigation ~d inspection~ ~he on-si~e ~ter ~upply and/or ~stewater disposal
system is in compliance with ~1 [~niaipal and Stage codes, ordinances~ a~ regula.-
tious in effect: on the date of ~hts inspection.
Approved _. Disapproved ~ Coudikional
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPAR'f}iENT OF HEALTH AND ENVIRONMENTbJ. PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAl, CERTIFICATES BASED SOLELY UPON T~ REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIOiqAL ENGINEER REGISTERED
IN %7tE STATE OF ~J~ASKA. THE DHEP DOES THIS AS A COURTESY TO I)UP~CHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND ST. ATE REQUIRE~
MENTSo .~PLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFOR.F, A
CERTIFICATE IS ISSUED. THE MIINICIPALITY OF ANCHORAGE IS NOT RESPONSIBI~E FOR ERRORS
OR OMISSIONS IN TIlE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEzkL )
RR4/ej/D18
[Page 2 of 2]
7 -19-84
A. W~.r.r. DATA
Well Classification
Well Log l:~'e~ont~l)
Total Depth ] ~/~ /
Static Water Level
Cased to
Casing Height Above GrOUnd /, '~ /
Electnzical Wiring in ConduitS/N)
Separation Distances f~om Well:
To Septic/Holding Tank on Lot /0 ~/~-
To Near~st Edge of Absorption Field on Lot
To Nearest Public Se~ Line
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MOA)ENVIRONMENTAL PROTECTION
HEALTH
AUTHORITY
APPROVAL
FEB ! '3
CHECKLIST - FEBRUARY 1984
~,egal Description.R E ~J~i ~ E ~,Loc,< r
If A, B, c~ C, D.E.C,. Approved(Y/N)
/y~ / . Depth of Grouting,
Pump SetAt
Sanita=y Seal on Casing C(~/N)
Depression A~ound Wellhead (Y~
; On AdjOining Lots
:/.~! ~ ; On Adjoining Lots
To Nearest Public
'Clean. t/Ms.els ~~ To ~est ~ ~vi~ Li~ on
Wate~ S~le Colle~ed By ~~ ;
Wate~ S~le Test ~sults .~c~ . ~ t ,
~t~ z~t~z~ ~/~/~ sm /~ ~o. o~ ~,~t~
Stan~ims~) ~' ' Ai~-tight Caps.) , Foundation Clean°u~)
P~ng~i~t~na~ ~ ~ ~ (~~ ~ ~o~ ~/~
Holding Ta~ High-Wate~ ~am (Y~) ~~a~ Holding Tank ~t
~p~ation Distends ~ ~ptic~olding Tank:
loF/~
To Water-Supply ~11 ~ ~/ TO ~ildin~ Foundatioq
To ~o~ty Li~ ~ / ~ To Dis~Sal Field. /~ /
To ~ter ~i~/Se~vi~ Li~ ~ ~-/~ To S~e~, ~nd, ~e, ~ ~jor
Co~ ~j 6 0 ~ ~-
[Page 1 of 2]
Receipt
Date Paid:
Amount:
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Abso~10tion Strata
Date .Installed
Width of Field
Square Feet of Absorption A~ea
Depression over Field (Y_~
Results of Last Adequacy Test
/ ~-~.~/ Type of System Design
Length of Field ~ /
~p~ of Field ~ /
Grail ~d Thick,ss ~/
~ of ~st A~a~ ~st
Separation Distance f~c~ A~sc~ption Field:
To Water-Supply Well /~/K- ,,__~"' TO lh~operty Line
TO Building Foundation /~ ~- To Existing or' Abandoned System cn
Lot._ ~ ~- ; On Adjoining Lots
To Wate~ Main/Service Line Wu ~ i~z- To Cutbank( if prese.nt) AY/~4-
To St~eam/Pond/Lake/c~ Majo~ D~ainage Course
To D~iveway, Pa~king Area, c~ Vehicle Stc~age A~ea
D®
LIFT STATION
Date Installed · '
Size inGallons J ' /
i~i~r~Al:~t:tL~- ve ~~A~ '~ s t. Me_ets MOA
Electrical Co ~/~Y~
** Check Permitted Bedroc~ Rating Against HAA ~quest **
I certify that I have checked, verified, o~ conforn~d to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed ~. ~OF4~_~~ ~9~-~$/~J--Date
Co~pany MOA No. ~%'U
KB1/d5/s
[Page 2 of 2]
OF
2-15-84
ALASKA ulBonm nT^U COi'll'ROL S l ullC{ S, I C.
{~n~i.~¢rinq 8 ~vi~onm¢.t~J SluSics
MUNICH',",Ltl¥ O[~ ;~,NCHORAGJ~
DEPT, OF HEALTH &
ENVIRONMENTAl. PROTECTIOI~
Department of Health & Human
Services
825 L. Street
Anchorage, Alaska 99501
7 June 1985
RECEIVED
RE: Seaturn Subdivision Block 1 Lot 9
Compliance with Conditional Health Authority Approval
On June 7, 1985 the well on the above property was inspected. The well
wires were encased in conduit which extended belowground. The well is
now in compliance with all Municipality requirements.
Approved:
~ ~, ,.' ~i?0 c.' ~ %~9~' ,'~
Sincerely,
Cen Turner
uvironmental Scientist
1200 UJcsl 33rd Aucnu¢, Suil¢ B./~nchoroq¢. Al~s[o 99503 .(907) 561-5040
ALASKA B IUIF Olqm F1TAL CO TF OL Sel dlCe$, IFIL
I~n~ir,~r, inq 8 I~,',ui,'o,',m~r, tal St~di~s
2/7/85
BETH ALLARD
C/O 14800 ZIRCON CIRCLE
ANCHORAGE AK 99516
SELLER - PENNY DILLES BUYER -
SUBDIVISION - SEATURN BLOCK - 1 LOT - 9
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 400 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 440 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON 2/12/85 .
FLOW TEST ON WELL
THE WELL FLOW RATE WAS 1.7 GPM FOR 4 HOURS.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1500 IS ADEQUATE FOR
THIS 3 BEDiR~(~M HOUSE.
1200 LUesl 33rJ Aucnu¢, $uii¢ [~eA,chora§¢, Alaska 99503 ,(907) 561-5040
-'-- D, .'RECEIVED
INSPECTION APPOINTMENTS ."~ .~q ~,
TIME TIME
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. ()F
825 L Street - Anchorage, Alaska 99501 ENVIRONiv'~£i',~J,:,L
ENVIRONMENTAL SANITATION DIVISION ,.~!, j
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER F/~IF~II~I~
DIRECTIONS: Complete all parts oil page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. RP~OPERTYOWNER . I PHONE
PR O~.Y .R~F~SI D EN~ (I f ~ from above} PHONE
2. BUYER PHONE
MAILING ADDRESS
3. ~ ,N~p~T~IT.~l PHONE
· ENDING ,
4. REALTOR/AGENT
MAILING ADDRESS
5. LEGAL DESCRIPTION ,
STREET LOCATION
6. TYPE OF RESIDENCE
SINGLE FAMILY
[] MULTIPLE FAMILY
WAT _E R SUPPLY
~. INDIVIDUAL*
[] ' COMMUNITY
[] PUBLIC UTILITY
NUMBER OF~BEDROOMS
[] One [] Four E~ Other
[] Two [] Five
Three I-'l Six
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date; give well
depth (attach tog if available.)
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE** ~-~
[] PUBLIC UTILITY
yEAR ON-sITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] --Sr~'GLE FAMILY [] ONE [] ~'~'HREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVl DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, S~E]NAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
~]Septic Ta, nk or ~ Holding Tank ~ ~
Size:/~ If Tank is homemade 8OILSRATING
give dimensions: / ~',~,) ~
TYPE OF TANK .~)_~ MANUFACTURER ~..~ ~r~.'~
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line J Nearest LotLine
WELL TO:J .-)
Absorption Area to nearest Lot Line
5. COMMENTS ~:~
~ CO~DITIO~Ak APPBOVAk {letter must ~ompan~ certificate)
DATE
72-010 (Rev. 6/79)
October 8, 1981
George A./Penny Dilles
4131 Grape Place #1
Anchorage, Alaska 99504
Subject: Lot 9 Block ]. Seaturn Subdiviszon
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
~ ~ompleted:
(1) The well log needs 'to be submitted to this off,ice
for our files and review.
(2)
The wires to the well head are in violation of the
Municipality of Anchorage codes and need to be
placed in conduit.
The water facilities were not working in order to
obtain a water sample at-the time of inspection.
Please notify this office for a reinspection when the
noted descrepancies have been corrected. If there are any
further questions, please call this office at 264-4'?20.
Sincerely,
James S. Roberts
Associate Environmental Specialist
JSR/ljw
CC:
First National Bank of Anchorage
% Karl Kaufman
Post Office Box 720 99510
Mark Begich
Mayor
Development? Services Department
~utk';mg~.~:-~'r,--~, ~. z Division
0n-5i¢¢ W~'~r ,& W~stew~ter Progrem
4700 ~regow Street
P.O. Box 196650
Anchorcge, AK 99519-6650
(,907) 343-7904
Well Drilling Permit Number: SW__
Pump Installation Log
Date of Issue:
Parcel Identification Number:
Legal Description
2%_/
Property Owner .Nalpe & Address:
Pump Installation Date: ~:'7/4~
Pump Intake Depth Below Top of Well Casing: //~' feet
Pump Manufacturer's Name: F~'J --]
Pump Size ~fi~ hp
PitlessAdapter BurialDepth:/~ feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion'}~Yes ~ No
Method of Disint~ction:
Comments:
Pump Installer Name:
Anchorage Pump & Well Service
330 East 76th Avenue
Anchorage, Alaska 99518
Phone: 907-243-0740
Fax: 907-243-0742
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.