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HomeMy WebLinkAboutHARRINGTON LT 74-A1 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~.c~'~-~De~sc~pti°n (includeTy''~'l°t' blo%~sec~on,~ -- township,f/,.,~/~/range) Location (address or directions) (c) Applicant'iS (ch'eck on~): Lending Institution []; Owner/builder, J~; Buyer [] ;'Other [] (explain); (d) Lending Institutio Address _ (e) Real Estate Company and Agent Address Te~p~o~Te p o e : (f) ~HAA to the following address: TYPE OF RESIDENCE Single:Family~ Multi-Family [] Number of Bedrooms Y Oth~r WATER SUPPLY . Individual Well,J~ Community [] Public [] i :' : 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 (11/84) ENGINEERING FIRM PROVlD~t~I~G INSPECTIONS, TESTS, FILE SEARCH, ~'A~TA AND INFORMATION , As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Healtt~ 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. $ & S ENGINEEEING Name of Firm SRB 196X Address ~GLE R~IVER, AK ~JS~ Date Telephone it': DHEP APPROVAL Approved for ~ Approved ~ bed roo ms bye. ~-~'~-'~- ~Date Disapprovea 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 D~lEP'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 beforre 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) " -* ~<~ ~ HEALTH AUTHORITY APPROVAL (HAA) ~ .~' CHECKLIST- FEBRUARY 1984 ~ ~ ~x- ~ ~ 264-4720 ~ ~ WELL DATA Well Classification Well Log Present (Y/~) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit ~N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments -~' ~ If A, B, C, D.E.C. Approve, d (Y/N) '~)/~ Date Completed /~b, ,z~ ~" ~ ~)~Lo'/"~ YieJd Depth of Grouting Pump Set At L./.~--, Sanitary Seal on Casing Depression Around Wellhead (Y~j) Cased to ~) /8" ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes t~N) Depression over Tank (Y~, Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well .-~ To Property Line -~O~ -/- To Water Main/Service Line Course / '~0 Size /Z-5-~ No. of Compartments (~',/4_ Air-tight Caps t~N) Foundation Cleanout (Y/[~ Date Last Pumped /L~//'~ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation ~.O ~ 4- To Disposal Field ~O ' 4- To ~__] Pond, Lake, or Major Drainage Comments -7Y% ~'. ~. W. Page 1 of 2 72-026(11/84) ~ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed / ~' Width of Field /~-~ Square Feel: of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line /L~ + To~Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field /~ ' Depth of Field ~' / Gravel Bed Thickness ~'~ '~ Standpipes Present ~/N) Date of Last Adequacy Test To Property Line -%(D~4- To Existing or Abandoned System on ; On Adjoining Lots ~4~/~ To Cutbank (if present) A.'/Z Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request** I certify tha~I l~t,,~ i~L~-~ r conformed to__?all MOA/_and NAA guidelines in effect on the date of this inspection. Signed ~p~ ~ 'i Oz~ Date ¢/2.- ~/,c~ Company I~:aII~...'~L~OA No. Re(~eipt No. ~--¢ (-~ ~-~ / ~--) ~-~ / % Date of Payment ~/"~-_~ ~'- ('~ ~ Amount: $'~ _~ O'--O ~~) Page 2 of 2 72-026 (11/84) MUNICIPALITY OF. ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTME~Ff OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information ApplicatiOt% Date ~/~'~ / / (a) Leg~ D~c~p~on (i_qnClude lo~t, block~.k_?~.subdtvision~_section, township, range) (b) Applicants Name .... leph~one- ome Business Applicants Address' (c) Applicant is (check one) Lending Institution (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: Type of Residence Single-Family.' Number of Bedrooms Multi-Family Other (describe) 3o Water SupplM' 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. 4. Sewage Disposal 0nsite ~ 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] 0 Engineerin~ Firm Providih~ 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 regula- tions in effect on the date of this inspection. Name of Firm' .... Telephone 6~--' ~/~'7/ Address , ~¢..~t~ ~lV~:r-~: A! ~,. ~..~' ~ .w, ~ ~ .~ / .~ /'~/v /~ ~ ~;~¢i>'~ ) ~.,y~ ', /I ,. a / Approved ~ Disapproved Condition~ / Te~s of/Conditional Approval CAUTION THE 1CJNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7 -19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AIrfHORITY APPROVAL (HA_A) CHECKLIST - FEBRUARY 1984 ae Be WELL ll~TA Well Classification Well Log P~esent (Y.~ Total Depth ~ / Cased to static Water Level ~ / Casing Height i~J~ove Grcund /8 ~ Electrical'~Wiring in Conduit ~Y~N) Separation Distances from Well: To Septic~ Tank on Lot 9~ / If A, B, o~ Cr D.E.Co Approved(Y/N) Depth of Grouting Sanitary Seal on Casing Depression Around Wellhead Date Completed Pump Set At ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /Z~) ~ ; On Adjoining Lots To Nearest Public Sewe~ Line /J /~ To Nearest Public Sewer Cleancut/Manhole /~/_ ~ To Nearest Sewe~ Service Line on Lot Wate~ Sample Collected By ~)~f ~/~f~'//~ .; Date 7//~/~/' Water Sample Test Results ~ ~-~/~ ~'/~/~ ~W~/ S = CZ O IN Date Installed / ~ ~ 9 Size stand, ins ir-tig t Ca s Holdin~ Ta~ High-Wate~ Ala~ (Y~) ~ ~a~ Holdir~ Tank Pe~t (Y~) ~p~ation Distance .~ ~ptic~olding TaDR: To Water-Supply ~11~ ~O ' To ~ildi~g Fou~dati~ To ~o~rty Li~ ~ /.~~ To Dis~sal Field To ~ter Mai~Se~vi~ Li~ Conm~nts ~ ~",/9~,/,/(,J~ NO. of C~a~tm~nts (~//~ ~ ... T~ Pondt Lake, em Major Drainage [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils l~ating in Absorption Strata ~.~/r.~. Type of System Design Date Installed /~& ~ ~ngth of Field /~ / Width of Field /~ ( ~p~ of Field ~ Gravel ~d Thick.ss ~ S~e Feet of ~sorption ~ea ~.~O ~ Stan~i~s ~esent ~)~ ~p~ession ove~ Field (~' ~te of ~st A~a~ Test Results of ~st ~a~ ~st ~A~/~'/~LT~ogf~/ Separation Distan~ f~ ~sorption Field: / To Buildin~oundation L~D / ~ To Existing or, ~ndo~d System To Wate~ Main/~vi~ Line ~/ To ~t~(if pre~nt) T~~6nd~ke/~ Majo~ ~aina~ C~se ~30 / To ~iveway, Pa~ki~ ~ea, o~ Vehicle St~a~ ~ea ~ /~' Co,~ts D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Con~nts Din~nsions Manholg/Access (Y/N) _~~Off" Level at . ~ Vent (Y/N) Pu~p~ ~u~ing Adequacy Test. Meets MOA ** Check Permitted Bedroc~ Rating A~ainst HAA Request I certify tha~t~I/ha~ checked, verified, o= conformed to all MOA HAA Guidelines in effect [Pa~ 2 of 2] - ~~-- 2-15-84 ~ INSPECT)ON APPOINTMENTS ~J.~.L~J~J~.~ .. TIME TI IVI~ TIME / O~ ,~] ¢ DATE / / DATE DATE ~~ ~ INSPECTOR -' I NSP I NSPECTQ~/ ~ICIPALI~ OF ANCHORAGE ~UNICIPALITY OF A~CHORAGE , DEPT. OF H~ALTH & DEPARTMENT OF H~ALTH & ENVIRONMENTAL PROTECTI~viRONMENTAL P~OTECTION  825 L Street - Anchorage, Alaska ~9501 SAU TAT O D V S OU 6 1981 Telephone 264-4720 .o. o. )IRECTIO~S: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER ~ PHONE MAILING ADDRESS ~ ~,~.. ~N~ 0~ PROPERTY RESIDENT (If different from above) PHONE PHONE 2, BUYER MAI LING ADDRESS 3. LENDING INSTITUTION [ PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADD~ESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF ~ESIDE~CE ~ One '~ Four ~ SINGLE FAMILY ~ Two ~ Five '~ MULTIPLE FAMILY ~ Three ~ Six Other 7. WATER SUPPLY '~1~ INDIVIDUAL~ ~ COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. Awell Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg 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 NUMBER OF BEDROOMS I. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE [--IPUBLIC UTI LITY Connection Verified []Septic Tank or []Holding Tank Size: !.)__.~-O-- If Tank is homemade give dimensions: [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTALABSORPTIONAREA MATERIAL C /~,~j. 4. DISTANCES WEI_L TO: [] OTHER Absorption Area to nearest Lot Line Septic/Holding Tank Absorption Area Sewer Line INearest Lot Line 5. COMMENTS I~"'~APP ROVE D FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BYe? 72-010 (Rev. 6/79) DAVID A, SLENKAMP RO6ERT A. SHAFER MECHANICAL ENGINEER CIVIL ENGINEER 694-9055 694-2979 June 1, 1981 Sherry Harrington P.O. Box 563A Chugiak, Alaska 99567 Dear Mrs. Harrington, Reference: Lot 74A: Section 9: T15N: R1W: starner Road: Peters Creek A sewage system adequacy test was performed on the system located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity of 1250 gallons. The seepage pit was charged with approximately 800 gallons of water and after a 24 hour period all of the water which had been added had percolated out of the crib. It can be concluded from this test that the septic tank and seepage pit are currently functioning adequately for the four bedroom duplex located on this property. However, the system cannot be guaranteed against subsequent failures. If we may be of further assistance, please do not hesitate to call. S~ly, cc: Cy Barker Realty Rainier~.Mortgage:Company Municipality of Anchorage Department of Health and Environmental ProteCtion SRB 196X EAGLE RIVER, ALASKA FROM: MEMORANDUM AT: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received (-~©l Time of Inspection~ Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval'requested by: ~v~C~C~-~L~z~ Mailing Address: L~k~q<~ ~, ~t~F~ ~ ~}~ Phone: 2. Property Owner: ~m, ~r>~ ~,~ Phone: Mailing Address: ~ ~, ~ ~e~ , O~~ 3. Legal Description: m)~n e~ ~,~ ~ ~c~ - 4. Location: ~ 4~,,~-~ ~ ~ ~P~ 5. Type of facility to be inspected ~.,].~.,~O)~.~ .._~ , No. of bedrooms 6. Well Data: A. Type [~j,,~ B. Depth ~ t C. Construction Sewage Disposal System: A. Installed ~/~L( C. Septic Tank: 1. D. Seepage Pit: 1. D. Bacterial Analysis B. Installer Size /~__ ~-~P 2. Manufacturer Absorption Area /0~//o ¥~ 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank ~0~ Absorption area , Sewer Lines __ Nearest lot line ~ , Other contamination / B. Foundation to septic tank ~ b , Absorption area C. Absorption area to nearest lot line LQ-034 (1/74) Page 1 of two pages GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: 2. Property Owner: Mailing Address: CMRO VA × FHA E. Roy Sta~ner Box 306 Chucach, AK 99567Day Phone CONV 3. Name of Buyer: Martin Matyear Mailing Address: 611 Mumford Day Phone274-5641 4. Name of Lending Institution: The.~Lomas & Nettleton Co. 4449 Business Park Blvd. Mailing Address: Anchoraqe, AK. 99503 Phone 274-7661 5. Name of Realtor or Agent: ned uric Mailing Address: 507 ~ ~NQuthern Liqhts Phone 274-4505 Call R.E. Agent for Inspection 6. Legal Description: Location: T15ATRiW Sec 9 Lot 23 (See 7. Type of Facility to be inspected: Duplex 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 If Individual, date of installation Individual (on-site) 1964 X EQ-037 (1/74) 'Page'2 of two pages - Re ~st for Approval of Individual Legal Description (~/'/ (~ll ,~ ~.~L, mer~ q ,er & Water Facilities Comments Approved Disapproved Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and ~ccurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED ~ ~0-~ ..... .~~z~m~m~2~/ Date J ~.-~-"'7~ EQ-034 (1/74) / Se Approval~ request~d~by: ii~-Lo~as:~'-' N'ettl e.~on ~C~m'pa~ny ' . .'. ".'..-':.t. i]" Mailing'Address'"" 4449, Busicefis_ --~'~ark' Boulevard Phone: 274-7661 Pro erty Owner-' E, ~y Starner Phone: ~a~l~n~ ~ddress: Box 306, Chu~ak, glaska 99567 4. Location: 5. Type of facility to be inspected 6. Well Data: A. Type Indi'~idual Dupl ex No. of bedrooms Four B. Depth 52' M&W Drilling . .-. C. Construction D. Bacterial Analysis ~ ' A.' Installed ' ,.1964 -. .... ----~B. Installer'' Owner ..... ;~': 'C.'Septic Tank: '.'ll- Size 1,25'0 "'-''-.2~Manufacturer ' Steel'}F~b - ';~ii~i-i D."','Se'~ge"Pit?~?:':l?~'.~Absorpt~on'A~e~''r'l 0~1 Ox.9.~::':-~","2~.'::~.Hater~al Log - crib .-','-:': :'~::5';:. E.?:D!~po?al:,:.?~d[~-.:.~,al..:;:!ength.o.~. lines ' ' : , :....~ .... '. 8. DIstaQc6s. '.. ;.,.~;-..-,:. '.'--: ':. _.~-;.:.' . · ... - A. Well to: ' Septic tank''80' , Absorption area ., Se~er L~nes Nearest lot':line 25"...'--'-,.,Other contamination B. Foundation ~o-septic ~ank'-';. 20] ~. ]., Absorption area C. Absorption area to nearest, lot line 100~ "':~"":;'-~'~" ' -' ' ,,--- "'' ' "'~".~':"i- : Page 1 of two pages ..' -,~ , ' i:-'TUT15._~xR1W Section ~..I~¢~al DescrY. priori . - Comments '.~ '.' ' ~'C ..... .,. ....... ,~., ......... :,' :?~:"' '""""'":""Lq' ~o~,,.,. .... .-- :.. · -..-.:.... .? :..,..... :,;CC..:.i::;., p p ~.o. ~ ed ~ ~2~, .}~ .Disapproved: .... . . -.:.Date :::.,..~;:.:::-:':::C:';:::::v ::"v.,:':'??:C:~:'Approval.~Val~d for one year from date s~gned -: · . :~}~<~-}~?~{.?:~?}~[:~?;~Greater~Anchorage?Ar~a' Borough,. Dep~rtment of Environmenta!. QualitY certify that the information contained in this Eequest for approval to be a true and 'accurate representation of the subject sewer and water facilities and these facilities · are operating satisfactorily.- S'IGNED~ Date . ] ' .:~,_ ::.. ~ . ::, . :. .;.. . .... i / / ! / Y[9OOOI£Q