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Home My WebLink AboutALDER PARK LT 4 i MUNICIPALITY OF ANCHORAGE ( ' · DEPARTMENT OF HEALTH & HUMAN SERVICES 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 GENERAL INFORMATION ~ :. ~ · ?. ,. Complete!egal description L-CT zl-' IKLD~.i2; '~,~. SU D. Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup... NUMBER OF BEDROOMS: -~'~ TYPE OF WATER SUPPLY: Individual well Community well ..... ; NOTE: Public water ...... 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 NOTE: If community Wastewater SYstem, p~:ovide Written b°nfirmatio/Y ffbrn sta}e ADEC attesting to the legality abd status of'system. .'.'7:~7; ,. :. :, 72-025(Rev. 1/91) Front MOA#21 STATEMENT OF INSI:~..TION BY ENGINEER -' As certified by ~y~Seal affixed heret° and as of the validation date shown below,_ I verify that my investigation of thl~ Health At~thority Approval application shows that the'On'~ite 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 ~-~J. '~'¢,,~: ~'TT (-.ON~Ol~k)~ Phor~e Engineer's signat ..... ~. '/' / ._ ,' Date -..~'~L.~. ' Approved for bedrooms. - - DisaPPrOVed. ' ..... ~ Conditional approval for ~h~ ..... :'bedro0m~, with the following stipulations: By:/' _ 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 req uir~ments. Em ployees of DHHS do not conduct inspections or aha yze ,.data be!ore a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work .... ; 72-O2.5(Rev. 1/91) Back MOA#21 ,?.,:'?;:'.' ,::~.,::.:. .-,- Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT ~ ~LI~J~ 'l:~ ~{J~). A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) I~ _~__.~:~ Parcel I.D. Oit-[~t-~_~ If A, B, o~attach ADEC letter. ADEC water system number Date completed '!~~- ~'-/0 Driller .~ ~'+-- · Cased to ~'-~C3(3 ~. Casing height ~ Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ! 20 [¢'~ · Absorption field on lot I ~-(o ~'~. Public sewer main ~O ~ Sewer service line k30~ g.p.m. ~o ,' On adjacent lots ;On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA ~0~= .S~{%-~:IV~ ~Y, lO0~.O ~'Ol~, ~ ~%~ ~ ~O C~ ~. Date installed ~ I~V0 Tank size I OOO ~. ~~Compartments ~ Cleanouts (Y/N) ~ Foundation cleanout (Y/N) ~ ~ Depression (Y/N) ~ High water alarm (Y/N) ~/~ Alarm tested (Y/N) ~/~ Date of pumping ~'LLne.. lO 3 [~o)~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~) k) ~- On adjacent lots ~0 To property line ~_.0 ~ Absorption field Surface water/drainage J~ ~) ~ 6 Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION ~/,~, . Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pun~ko-~~ at High water alarm level J ~ tested Meets MOA electrical codes(Y/N)///`' SEPARATION DIST~.ANCE~ROM LIFT STATION TO: ~ On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed -~-F~. ~'-/~ Length I(o ¢::+- Width Total absorption area ~ l~ 4 ~. Soil rating lC:tO .-,~/~3~.v~A_ System type ST::Ep,t~f: io[1.- ~ ~', Totaldepth lb Ct . Depression over field (Y/N) Results (pass/fail) Gravel thickness Cleanouts present (Y/N) ~.-%, Date of adequacy test for -TJ~t;I,~: ~' bedrooms Peroxide treatment (past 12 months) (Y/N) ~'~ If yes, g. ive date SEPARATION DISTANCE FROM ABSORPTION FIELD TO;' - Well on lot ~b h3'"E On adjacent lots 17..~ ~-FLO~E) Property line To building foundation ! ~;~j.~.- · To existing or abandoned system on lot Onadjacentlots ~'(~ ~ Cutbank Ix~(~l~'~' Water main/service line Surface water ~ 0 I~F__. Curtain drain ~/~. Driveway, parking/vehicle storage area,. -'/O ~". E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ ~0~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPROVAL OF ON.SITE RESIDENTIAL WATER AND SEWER SYSTEMS PROPERTY DESCRIPTION ~t, S~ecX & ~ubdlvlllon Or ~ SU~ Lot 4, Block i (5001 W.SA~h Avenue) Alder Pa=k Subdivision Class "C" PWSID no.217453 [~tlleale luued lot Aggllo&tlO~ N=: '-'- '"i 9421-DW-164-162 This approval does not constitute a guarantee of any kind, explicit or Implied, as to the performance of the water supply and wastewater disposal systems. WATER SUPPLY A recent water sample was tested and found to meet Dep, artment of Environmental Conservatlon drink- lng water standards for total coliform bacterla.=nd n~trate. Name i~t~. Environmental lo,.. Enqineer, I 6/24/9~ WASTEWATER DISPOSAL The domestic ~,,~ter system was: Inspected by the De"~:~,r,[ment of Environmental Conservation an_~[,~und to be In compliance with [] applicable requlremsnts~AC 72; ~ Inspected ~r w~~ that ~e system complies with applicable re- ~ qulrementS of 18 AAC 72; ~ Installed ~~~e~omDIles wlt~ applloable requirements tested by ~les that th~~a~ce of the system is satlsfacto~ ~ and t~;~~;&-~'~PIres with the minimum separatl~ces specified in 18 AAC 72. This I of ,,, bedrooms. '~8,04~, {Rev. e/list DISTR;SUT1ON: wHiTE--BANK/LENDING INSTITUTION: CANARY--APPLtCANT; PINK--DEPARTMENT DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE[ 800 E. DIMOND BLVD., 'SUITE 3-470 ANCHORAGE, ALASKA 99515 June 27,1994 WALTER J,.HICKEL, GOVERNOR (907) 349-7755 Mr. Roger Greif 5001 W. 84th Anchorage, AK 99502 SUBJECT: Lot 4, Block 1 (5001 W. 84th Avenue), Aider Park Subdivision Anchorage, Alaska; ADEC Project No. 942'~.DW-164-162 Dear Mr, Graft: This letter is in response to the information received in this office June 22, 1994, concerning a letter of compliance regarding the above public water system, The Department has completed its review of the submitted information which Included recent · .water sample analyses for.,total coliform bacteria and inorganics for nitrate. Since this drinking weter system hes been previously approved by the Department, and because it serves less than 13 bedrooms, the water system is a Class "C" Public Water System, Verification that the water Supply has been recently tested will be required to maintain compliance with State Drinking Water Regulations, Results from the recent water samples submitted were satisfactory for both total coliform becteria (6/8/94) and inorganics for nitrate (10/28/93), and satisfy this concern. Therefore, for the concerns of this Department, this system is in compliance with State of Alaska Drinking Water Regulations (18 A/kC 80). Attached is an "Approval of On.Site Residential Water and Sewer Systems" certificate verifying this system's status as an approved water system that is in compllance with 18 AAC 80. Thank you for your cooperation with this Department, if there are any questions regarding the above please do not hesitate to call. brand fax transmittal memo 7671 Sincerely, Michael Lu, E.I.T, Environmentat Engineer ML/cf Attachments I~01¢~ REMIT T~: BILMNC3 NUMBER; STATE 01; AI.AS~ YE/~ ~RO~l. kEG DIS? SU~ PLAN REVIEW NC). ~ DE~ OF E~RONME~A~ CONgE~ATION DEC CONT~ ~P~D OR PRI~ED): u JUN~U, ~ ~1-17~ , PHON~ MAKE C~ECK PAYABLE TO: STA~ OF AL~ ,.. ~9 - 7795. ' ~pll~nt name. Mdress and phone number: IMPORTANT ~ -- .... ~0~ ~ ~_~& &V'~ 1. P~ease ~e~ invoice number on your ~. ~mlt ~ ~ ~ ~la fo~m with ~ur pa~en~ FEE REGS. 8U~ DESCRIPTION / FEE ~81g Fee ~ount ~ount ~or REFERENCE ~TEG, plan mvlew -' 72.212 DOMESTIC WASTEWATER P~N REVIEW' (~)(i) WA ~aed on Peak ~=Ign ROw Of ~ gpd (a) (4) ~ ~,~1-~,~ gpd $7~ (a)(e) ~ ~,~1.~,~ gpd ~1,~ {a) F) WG More ~sn 7~,~ gpd $1,~ (s)(8) WH ~dlfl3flen~ <~%: ~ perce~t of fee In (~)(I) to ~) Modifications ~% m ~%: equivalent %age of fee In (a)(1) to ~ Modlfl~tlona >~%: 1~% of fee In (~)(1) to ~) (a)(9) ~ For aewer replaoement, or ex~enelon of <~ fi, > 1,~ ~. $1,~ ~ ~.lot ~tnm with bank loan ~lfl~tlon $2~ (~) ~ Fee redu~lon of 10% If almultaneoue eubml~ of 18 ~C ~ plmnm ~AID: -- O~H or No~e: ~ent due u~an To~! Amount of Fee $ -- CHECK · m~lot of To legally ~n~ruct, Inatsll, motile, ar operate ~y pa~ Of a dameetlO wa~teweter f&¢ll~ In Naeka, ownem/operatora are r~ulrad to pay a plan review fee pursuant m AS 44.~.025. PIoa~ check the Information on ~1~ form for a~ur~ snd remi~t~e ~rre~ plan review fee to t~e aaare~ above, with a ~py of this form. Signature of DEC oon~: ~~ ~ there ue ~ny questions regsrdIng this form, plea~ ~nt~m your Io~l ~EO offi~. ~t,: ~/~ ~ ..... WHITE - APPUCANT, YELLOW - REMITTANCE COPY, PINK - FISCAL, GOLD - FILE COPY I~ ~rlnlKt an recycled MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL ~ALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date subdivision, section, township, range) (a) Legal Description (include lot, block, Location (address or directions) (b) Applicants Name ~,c_~AfLO ~t%~ ~ Telephone - Rome Business Applicants Address_ (c) Applicant is (check one) Lending Institution ~-~ ;~~builder ~ ; Buyer ~-~ ; Other ~--~ (explain); (d) Lending Institution ~A/~~- Telephone (e) Real Estate Co. & Agent Address I 0(") Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single-Family~ ~-~ Other (describe) Number of Bedrooms 3. Water Suppl~ 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] 5. En~ineerin~ Firm Providin~ 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 M~ntcipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all M~nicipal and State codes, ordinances, and regula- tions in effect ou the date of this inspection. Approved for bedro~s ~ /h. [~ Date Terms of Conditional Approval C, ADTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ~ALTH 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- MENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT R~$PONSIBLE FOR ERRORS OR OMISSIONS IN T~E PROFESSIONAL ENCINEER~S WORK. (DHEP SEAL) RA4/ej/D18 [Page 2 of 2] 7-19-84 ae MUNICIPALITY OF kNCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classificstion Well Log P~esent (Y/N) Total Depth ~OO Static Water Level Cased to 80~ If A, B, cz' (~)D.E.C. Approved(Y/N) Date Cc~f~p le ted Pump Set At ~F/t/~t~/~ ~Z~. Yield Jilt ~ o~-_'-' Depth of Grouting /%///1 ~\ Sanitary Seal on Casing (.Y/N)~ Depression Around Well/~ead (Y/N)/k/ To Nearest Public Sewer Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~ ~ ,--" To Nearest Edge of Absorption Field on Lot To Nearest Public Sewe~ Line Cleanout/Manhole ,.~] .lIN To Nearest Sewer Service Line on Lot ~ ~ ~ Water Sample Collected By (x) ~ PA ; Date L4 -~3-~'~::~'-'"'"~- Water Sample Test Results ?'.'.~. A '( (%_~AC76~~( ~ B. SEPTIC/HOLDING TANK DATA Date Installed QF~ ~ctpO Size Standpipes (Y/N) ~/ Air-tight Caps (Y.~) ~pression o~ Ta~ (Y~) ~ ~te ~st P,~d P~ing~intenan~ Ccn~a~ ~ File (Y~)~/~; for Holding Ta~ High-Wate~ ~a~ (Y~)~/~ Te~ra~y Holding Tank ~t Sep~ation Distance ~ ~ptic~olding Ta~: To Water-Supply ~11 ~ 0 ' To ~ilding F~ndati~ To ~o~rty Li~ ~ ~ ~ To Die,sa! Field To ~ter Mai~vi~ Lir~ ~ 60' No. of Compartments ~-- Foundation Cleanout (Y/N) ~ ~ To Stream, Pond, Imke, cr Major Drainage Course Con~ents [Page 1 of 2] 2-]5-84 C. ABSORPTION FIELD DATA Soils Rating in Date Installeq Width of Field Type of System Design~ Length of Field APg~ Depth of Field [ ~) ' S~e Feet of ~sorption ~ea ~PP~X, ~ ~O~ Stan~i~s ~e~nt (Y~) ~p~ession o~r Field (Y~) ~ . ~te of ~st A~a~ Test ~- ~sults of ~st ~a~ ~st Sep~ation Distan~ fr~ ~sorpt~o~ Field: To ~ter-Supply ~11 QJ~') b%~% To ~o~rty Li~ To Building F~n~tion [~' To Existing or ~ndo~d System Lot ~./~ ; ~ A~joining ~ts ~ xe To ~ter Main/~vi~ Line ~ IOO/ ~ To ~t~(if pre~nt) ~/~ To Stre~ond~ke/~ ~jor ~aina~ ~ ~/~ To ~iveway, Parki~ ~ea, ~ Vehicle St~a~ ~ea %0 ~ Con, rents O~ 7-11- g~; Qn~,~3~ Date Installed Size in Gallons "Pump On" Leal at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets ~.~OA E le ctr ical Codes ( Y/N ) Con~T~ nts ** ** Check Permitted Bedroom Rating A~ainst HAA R~quest I certify that I have checked, verified, or conformed to all MOA HAA C~_~ _~ _%~i~n effect on the date of this inspectio~o~. , . __./ ~,/ / KB1/d5/s [Page 2 of 2] 2-15-84 ANCttORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR 274-2533 Mr'. Ted Hawley Arctic Eng!~neers 1506 West 36th Avenue Anchorage, Alaska 99503 May 13, 1985 bIUNICIPAL~Ty OF ANCHO DEPT. OF HE .... ' .... ~ ~'~OTECTioH 3 19,85 RECEIVED SUBJECT: Class "C" Well, Alder- Park Subdivision, Lots 1-7, Anchorage 852FA-187 Dear Sir': The Department has reviewed She Engineer. As-built plans for. the subj~,ect project. Final approval i,,~= hereby given for- the water system. The Certificate to Operate is~attached for ~he water system. Any future expansion of the subject project will require additional approval from this office. The separation distances fall under, the old semi-public water system regulations. ' Sincerely, SWE/dd ENCLOSURE: Steve l~ng, P. E~ EnvironmentalE~gineer HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Inorganic, Organic, and Radiochemical Contaminants TO BE COMPLETED BY PUBLIC WATER SUPPLIER PUBLIC WATER SYSTEM: I.D. NO. Arctic Engineers, Inc. Public Water System Name 1506 W 36th Avenue Address Anchoraqe, A1 as ka 99503 City State Zip Code Note: Check box to left of contaminants listed below for the analyses desired. SAMPLE DESCRIPTION' Collected By TN Alder Park Subdivision Sample Location Source Type [] Surface Water Sample Date ~-~ Mo. ){~ Routine Sample [] Special Purpose Sample ~ Ground Water Day Year ~ Untreated Water [] Treated Water TO BE COMPLETED BY CERTIFIED LABORATORY CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. Laboralory Name 5633 "B" STREET Address ANCHORAGE, ALASKA 99502 City State Zip Code Sample NOl 8316 Laboratory Analysis No. ETY Station No. 4-23-85 Received by Date INORGANICS Limit [] Arsenic (0.05) [] Barium (1.) [3 Cadmium (0.010) [] Chromium (0.05) [] Fluoride (2,4) [] Lead (0.05) [] Mercury (0.002) [] Nitrate Nitrogen (10.) [] Selenium (0.01) [] Silver (0.05) [] Turbidity (1 NTU) < < < < < < < ND Indicates Not Detected 5-2-R5 Mg/I 0. C26 0.05 0.002 0.03 0.13' 0.01 0.10 0.01 0.01 0 ?0 Date Analysis Completed ORGANICS Limit [] Endrin (0.0002) [] Lindane (0.004) [] Methoxychlor (0.1) [] Toxaph.ene (0.005) [] 2, 4-D (0.1) [] 2,4,5 - TP Silvex (0.01) RADIOACTIVITY Limit [] Gross Alpha (15) [] Radium 226 & 228 (5) [] Gross Beta (50) [] Strontium - 90 (8) [] Tritium (20,000) Signature of Laboratory Supervisor Mg/I pCi/I 5-2-85 Date reported CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. Drinking Water Analysis Heport for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I I I I I I I<'' see h °n b'ck I.D. NO. Water System Name I r~D,d ~. . 7 o/ ~ Mailing Addr®ss SAMPLE DATE: I~1~/i Phone No. State Zip Code SAMPLE TYPE: _~Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose ) [] Treated Water [] Untreated Water SAMPLE NO. I I I I LOCATION ,I Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ~Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received /.~,'r~ Time Received Analytical Method: Fermentation Tube ]'~Membrane Filter Lab Ref. No. Result* Analyst ~/~; ~ ~ / I I ICI I r-~ I ~ o~-'~ 220 Co) R~Bv. 198~ BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTB Final Membrane Filter ResUlts ~} TNTC = Too Numerous To Count Collformll00ml BGB__