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HomeMy WebLinkAboutHOMECREST LT 7 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (i.nclude lot, block, subdivision, section, township, range) Locatio~:(~dress or direcdoo~)i~ (b) Prqpe.yOwner /o>/ 7~~ Telephone:Home Business (c) Lending' institution · - ~~ Telephone Mailing"Address '" (d) Real Estate, ComPa~n¢ and Agent Address Telephone ~, (e) Mail the HAA to the followino address: or; Check here r-i, 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"J~. Community[ri Public [] 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 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 disposat 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 J~"~/~'5~d ~ Address /;7-¢'0 ¢c) .,~'~ /~/~<, .5/~,IT'ZV ~ /~/"(~. ,//y</ ~,~'~j '~ Date Approved for /~¢-~'/(~.')bedrooms by . Approved ~ Disapproved Conditional Terms of Conditional Approval 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. 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. Page 2 of 2 72-025 IRev 8/86) Back Y-",~ MUNICIPALITY OF ANCHORAGE DEPARTMENT'OF HEALTH AND ENVIRONMENTAL PRf, j'rECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~-- I',-~'"'/,~ 7 / / GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~ ~¢~ Telephone: Home ~ Business *..,ic nt*ddre.s PECK FE. (c) Applicant is (check OHO): Lon~ino Institution ~; Owaor/buildor~; Buyor ~; Othor ~ (oxplain); (d) AddressLending Institution ~~~lephone ~~ ~ (e) Real Estate Company and Agent ~ Address Telephone ~ (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-FamilyJ~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY 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 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. 72-025 (1 ~/84) Page 1 of 2 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 b ~'~"~...~ Address /,~-~) ~') Telephone DHEP APPROVAL ~' Approved for ~ bedrooms by _ . - Date AP~ 'E~c-a~-r- ~-. .... Conditional /~ Terms of Conditional Approval ~"~'.-r..-.?~z..~, //-¢z.~,.¢~ ~ 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) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALrrY OF ANGHOI~C_~HECKLiST . FEBRUARY 1984 DEPT. OF HEALTH & 264-4720 WELL DATA Well Classification Well Log Present ~)N) Tota Depth I (~ / Static Water Level ENVIRONMENTAL PROTECTION ;FEB 6 I987 RECEIVED Date Completed ~ ~'C,. Description' /~' ~ __}~2, 7 H~44E CK~'~/~ If A, B, C, D.E.G. Approved (Y/N) Yield Cased to 10~ ! 4/2, :. 7' Casing Height Above Ground la ~ '~ Electrical Wiring in Conduit ( ~_~ '"~ ?~ &~//~,'~_~_ Separation Distances from Well: To Septic/Holding Tank on Lot ~/~'/'^ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot J~J'//"~ ; On Adjoining Lots To Nearest Public Sewer Line / (~-~[¢~ I.?I-~To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments '.~ Depth of Grouting Pump Set At t~/V'~/[/'~(,¢]/~f Sanitary Seal on Casing ~)N) Depression Around Wellhead (Y~ ,/~'~_) ~' 71~ To Nearest Sewer Service Line on Lot OEFF ;Date B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N), Holding Tank High-Water Alarm (Y/l, Separation Distances from Septic/H To Water-Supply Well To Property Line To Water Main/ServiCe Line Course Size No. of Compartments Foundation Date Last Pumpe for Holding Tank Permit (Y/N) . To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed Length of Field Width of Field L Depth of Field Gravel Bed Thickness Square Feet of Absorption Area . Standpipes Pr.,e~nt (Y/N) Depression over Field (Y/N) . /.~. Date of La~"dedequacy ;est' Results of Last Adequacy Test ~eparation Distance from Absorpti°n ~ie~d: // o Water-Supply Well f To Property Line To Building Foundation To Water Main/Service Line Stream/PondiLak~~ Drainage Course To To Driveway, ~ Area, or Vehicle Storage Area To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Dimensions ~ Size in Gallons . /,~ Manhole/~~"""~/N) A / ///--7t ~ Off" Level at "Pump On" Level at ¢ v /~ High Water Alarm Level at j.,-~"~ Vent (Y/N) Tested for ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical C~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify t hat~av~/~)h~e~ed,,~riJ~d, or ~nformed to all M~A and~AA guidelines in effect on the date of this inspection. Signed ~ --/~~Date ~/~ 7 Company Y~--7~C, MOANo. ~(-~ ~ Receipt No. ~O/ 0 ~0 '~ Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) -,.'%'.. .jif- ALASKA ENVIRONMENTAL CONTROL SERVICe, INC. 1200 West 33rd AvenUe, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 ~o. L 7 /32 7 /-/O/V)£ C/~F____.5 7' SHEET NO. / OF CHECKED BY SCALE [ ~ 50' DATE ALASKA EI dlRO lmeI1TAL COI1TROL SERuEeS, InC. TOM BOWEN 853] PECK AVENUE ANCHORAGE ALASKA 99504 SELLER- TOM BOWEN 853] PECK AVENUE ANCHORAGE ALASKA 99504 02/06/87 70015 LEGAL:HOMECREST SUBDIVISION LOT 7 BLOCK 27 FLOW TEST ON WELL W r EL~., FLOW DATE-02/05/87 A FLOW TEST WAS PERFORMED ON THE WELL. 465 GALLONS OF WATER WAS PUMPED AT A RATE OF 5.16 GPM OVER A DURATION OF !.6 HOURS, THE DRAWDOWN WAS ]2,1 ' WITH A RECOVERY TIME OF 10 MINUTES AND THE STATIC WATER LEVEL WAS 42.7 FEET, THE WEI,L IS ADEQUATE FOR THIS 3 BEDROOM HOME. 1200 LUcsl 33rd Auenu¢. Suite [~*, Anchoraae. Alaska 99503 .[907] 561-5040 dML LABORATC IES, INC, 7127 OLD SEWARD HIGH~AY ANCHORAGE, ALASKA 99518 (907) 344-8551 LA ORV I.D. BACTERIOLOGICAL WATER ANALYSIS I I I I NAME OF SYSTEI SYSTEM ADDRESS TO BE COHPLETED BY WATER SUPPLIER DATE COLLECTED TIME 'COLLECTED I TYPE OF SYSTEM /?;~p:J EJ PUB~NDI¥IDUAL CTRCLE CLASS I I ) A B C ~esidenti~l ~ CITY STATE ZIP CODE LOCATION WHERE SAMPLE WAS COLLECTED TYPE OF SAMPLE ~ ~ ! (CHECK ONLY ONE THIS COLUMN) DRINKING WATER ~/CHECK TREATMENT ~ RAW SOURCE WATER [] NEW CONSTRUCTION OR REPAIRS ri OTHER(Specify) •CHLORINATED ~-~FILTERED ~TREATED OR OTHER IS THIS SAMPLE A CHECK SAMPLE TO A PREVIOUS NON-CONFORMING SAMPLE? DYES ~.0 PREVIOUS COLLECTION DATE ANALYSIS R~QU~STED (IF OTHER THAN TOTAL COLIFORM) SEND REPORT TO:(PRINT FULL NAME,ADDRESS AND ZIP CODE ADDRESS FOR LAB USE ONLY [] RESUBMIT SAMPLE Sample rejected because: CHECK ONE OR MORE ri Sample too long in transit. Sample should not be over 30 hours. D Sample received too late in week (")Not in proper container •Leaked out F-) Insufficient information provided. Please read instructions on form. []Other (Specify) RECEIVED FROM~ ~AiTO_j~ UCCc. RECEIVED BY DATE ~-'~-..-~? TIME ANaL METHOD: ~qMEMBRANE FILTER •FERMENTATION TUBE Date & Time Started Date & Time Coml LABORATORY RESULTS [-) Other Bacteria [] Test unsuitable because: [] Confluent Growth [] TNTC SATISFACTORY ~/U#SATISFACTORY [] BACTERIOLOGICAL WATER ANALYSIS RECORD FOR LAB USE ONLY ~T~OTAL COLI FORIqS FECAL COLIFORMS E] OTHER Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Results Reported By READ SANPLE COLLECTION INSTi~TIONS ON BACK OF FORM BGB Date Time ~Coliform/lOOml Coliform/lOOml Certified Well Date completed. '4~e"/-"ff-'- .~ . / .~....~.../....i!i! ................................ Depth of well ................. ........... ].~..0....~ ....... '. .......................................................... '~S~e of ~i~ ..................... :.::~...=fi. '5 ~:~:..0..~ .................................................. Distance m ~r: ............. :.. ~.,~. [ ............ ~ ......... [ ............ ' ..................................... D~s~n~'tO Water while pumping : ':. ~ O0 ENVIRONMENTAL . -OL ........................................ ~tl~ns~r hour~ We advise you to attach this certificate to your' deed. John'g Read ~, SPENARD, ALASKA [)EF'FIRTMENT OH HERL].'H RN[:, ENVIRONMEN]"RL F'R. OTEC].'ZC, N 825 '" L "' STREET., RNCI..-tORF:IGE., f::fK. S~S~50± 264-4720 PERMIT NO. ( 8&OD87: ) RPF'LICRN].' THOMFIS E. BOWEN L. OCR"F I ON PECK STREET LEGRL L 7 B 27 HOMECREST PO BOX 'I..,'[.00 LOT SIZE 688-]:424 SQURRE FEET MINIMUM DIS"FRNCE E:ETNEEN R P.tELL RND RN'¢ ON-SITE SEI.4RGE I}I. SPOSRL S¥S"FEM IS ::L00 FEE]" FOR I'=I PRiVF!.TE 1.4ELL OR :258 TO 200 FEET FROM R PUBLIC WELL DEPENI:)ING UPON THE T'-r'PE OF F'UBLIC P.fELL MINIMUM DISTRNCE FROM Ft PRIVFI]"E NELL TO R PRIVFITE SEI4ER LINE IS 25 FEET RND TO la C:OMMUNIT'¢ .'SEI,.IER LINE IS 75 FEET. P.IELL LOGS-'.'; FIRE REt]:.!UIRED RN[:, MUST BE RETURNED TO ]''HE f}EPRRTMENT WITHIN OF THE !-,.!ELL COMPLETION. OTHER REC~UIREMENTS MFt'¢ RPPL'-r'. SPECIFICFITIONS RN[:, C:ONSTRUCTION DIFIGRRMS I=IRE RVRILRBLE TO INSURE PROPER INSTFILLRTION. F" EZ F~: 1'1 Z T' [':.E ::'4 F" Z R E ~:-5; trz:¢ E C: E: ~',1 E: E I1-;..': ].:2':. ::L _,, :1 .?.4. ,',F_.~ :_1_ I CERTIF'¢ THRT 2.: ! BM FRMILIF~R I.,.IITH THE RE6!UIREMENTS FOR ON-SITE SEI.,.iERS RND WELL.:"]; RS SET FORTH B'¢ TNE MUNICIPRLIT¥ OF RNCNORRGE. 2: I P.IILL. INSTFtLL THE S'¢STEM IN FICCORDFfNCE I.,.fITH THE CODES. S I GNED: ............................................................................ FIPPL I CFtN].' THOMFIS E. EK)t.4E!'..I ,,-~UNICIPALITY OF ANCHORAGE Department 'Health and EnvironmentaI~otection 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * WELL __-'.~ _]'~ ........ ':.._.l '.__'.: PERMIT Applicant: "/"//'7/0/~ ~)~,/~.~ Mailing Address: ~ /7/0/) Location: ~:~ ~d~ ~-- Phone Number: Legal Description. ~ e: Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: __ Holding Tank Maximum Number of Bedrooms: ....... Soil Rating(sq.ft/br) ' · ' The Required Size of the Soil Absorption System Is:' DEPTH LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation[in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation[in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by th'is department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, t 9 8 1 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. SigneR.: IssUed by:~ Applicant ~ // ~/ ' Date: ---- SWP/024(1/81) Depa~n~ O~ Beat~h a~d ~v~ro~ntat D~TH ........... LENGTN :'~' length dt~nsio~ depth of a hr~ach or pit is ~h~ disLanc~ betwee~ the s~rEac~ oE ~h~ ground~ t~ ~t.~ O~ fha a~cava~ion(in feet}. ~ ~ REQUIRED S~TIC(HO~I~) TANK ~armit applicaak ha~ ~h~ ce~LbttLt~ will ~ sub~t t0 ~o~. · p~Lva%~ well availabl~ ko Lnsur~ prop~ ins%aLlatio~. ~et ~o:~-h by t~ M~Lc~aL[ty o~ A~horage. (~) I will .~p L t~n t swe/o 2 4 (k/~ 1) January 5, 1978 Tom Bowen 8543 Peck Avenue Anchorage, Alaska 99504 Subject: Lot 7 Block 27 Homecrest Subdivision Permit %77837 A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, Health and Environmental Protection Sewer and Water Section F. P L.:[ _.HN I LOCFFI" ]: CII'.,I L. EGFIE 'EOM BOt.,.IE N o.. _'-.._ F'EC:K RVE LOT ," b,L ~::,.' FI3htE"_iI~'EET SUB E:54-'2 F'ECi'::: Frv'E LOT S:[ZE :iB'_:¢';:;'5 E6:~UFIRE: F:EET .:,L ]: L TRENCH l--ID:,_ RE, I 1 Jl',l S'¢S"I'EH :[ S: I"IFI::.::Zi"ILtI"i NI...itqE:EI:~'. CJF' BEI:)ROOPtS :":' '4 E;OTL RF:ITflqEi <E';E;! F I" ,," E: f,:: ::, = .:1.1._ 'tFIE t;:E6!LI)JRE[:, SIZE OF THE SO:IL FIBSOF.'F"T' ]: ON S"r'STEPt.l:' "" '.:, . THE LENEiT'H D]:PtENSIOI'.,I IS 'T'HE LENGTH (iN FEET'> OF "FHE TRENC:H OR I)RFI]:NFIELD. THE DEPTH OF' FI TRENCH OR PZ"I" ]:S THE D:[.STFINE:E BETHEEN THE SURFFICE OF 'THE CiiI~OUN[::, FIN[> THE E,'OT'TOFt OF' THE EXCFI',,,'FITION ,:.'IN FEET:). 'THERE :IS NO SE"[' I.,.III.":,TH FOR TRENCHES. THE GI;,'RVEL I)EP"I"H 1S THE H]:NZPtUH DEPTH OF GRFI',,,'EL BE'T'HEEN THE OUTFFILL PiPE FIND THE: BO'T"T'OP1 OF' I"HE EXE:FI',,,'FIT]:ON ,:::IN FEET::,. ........................... F" Ftt C: K Ftl K3 E:: F" L._ IF:It Ih.~ FI F'FICKFIGE PLFINT' P1R¥ BE ]:NSTFILL. ED ~"t" THE PERH]:TTEE'"S OP"FZON ZUE:.:rEC'T' TO THE F'OLLOW ]: NI3 C:ONI) :[ T :[ ONS: 1. E:[T'HE:R R CLRSS Z OR II NE;F FIPPROVED PL_RNI" t'"IFIY E:E INS'T'RL. LEE:,. 2. R CON'TZNUOUS HRZN1-ENFINC:E FIGREEMENT ZS REE:!LIZ~'.ED. :IF: F~ HFI]:NT'ENRNCE FIGF~'.EEHENT' ZS NOT KEPT CURRENT YOU HFI'.r' BE RE6ILIZREE:, TO ENL. RF~:f3E THE SOIL.. FIBSORPI"~CIN S'¢S'I"EN FtNI).,"OR YOU HR'.r' BE Sl..JBJ'EC"I" TO PROSEC:UI'ZON. E:FIC:I':::F :[ L.L ]: NG I:IF' FIN'?' ':'~;"r'E;TEH W :[ THiZit..I"r F' ]: I'.,IFIL t N': PEF:T :[ Ed'.,l FIND k F F F . , -.IL TH Z S [::,EF'f:IF~:TPtENT t4 ]: LL EIE ..,IJE,..1Eu I TO F'[:CISEC:I..IT :[ Ol'.,I. MiNIMUH DIE;TFINC:E BETWEEN FI WELL FIN[) FINY ON-'SI'f'E SEWFItlE DiSPOSFIL S'T'Si'E:I"I tS :1. El1:3 FE'EI" FEIR FI PRIVATE HELL OR 2E)EI FEET FOR FI PUBLIC WELL. WEL. L. LOGS FIRE REQUIRED FINE." IqUS"I" BE F.:ETURNED 'T'O 'T'HE DEF'RF.':'I'HENT 14iTHIN ::¢:0 DRYS OF THE HELL COi',IPLE'F]:ON. Of'HER FtEL.~UZREHENTS I',11:t'¢ FIPPL"r'. SF'ECiFZCFITZONS FIND CONS'I"fRUCT :[ ON [::'ZFIGRF;IFiS FIRE H',,,'R:[L. FIE:L.E TO INSURE PROPER INE;TFILLFIT:[ON. I CER'T ]: F'~' I"HFtT ±: I FIFI F:FII'dILIFIR WITH THE RE:'QUIREMENI'5; FOR ON-SITE E;EHERS tRN[) HELLS FIE_:.; E;ET F'OP:'.f'H E:'¢ THE t'"IUN:[C:]:F'RLI"F'¢ OF FINC:HOF~'.I:IGE. 2'.: i W:[L.L INSTFtLL THE S"r'S]EM IN RCC:OI~'.DRNCE WITH THE C:OE:'EE;. :Z":: ]: UNDERSTFIN[:' THFIT THE ON--S:[TE 5;EWER S'T'STEM HFI'¢ F:'.EE:!U]:i~'.E ENL. FtRGEPtEN1' ]:F' TFIE P::ESI[:,ENC:E iS REMO[>ELED 'TO :[NCLUE:,E P1ORE THFIN ,$ E:E[:,ROOHS.