HomeMy WebLinkAboutSHANE LEE ESTATES BLK 1 LT 7(�L
PLL
* C), q - (-Os
E
A x
I � O
cF
W
W
W
6sa
a
GL F
F
H
EA
E-4
ui
�
CJi
V1
b
O
O
� E
`
a
%I
r
®®
O
Q
A
Vl
Q
Q
Q+I
G7
E
A x
I � O
W
W
W
6sa
a
GL F
F
H
EA
E-4
b
O
O
� E
`
a
r
as
Mci
A
VI
~ E
co
i
E
A x
I � O
W
W
W
6sa
�
GL F
F
H
EA
E-4
O
O
O
O
r;
co
•Pi
Ci
ci
'C-
(rQJ
w:
fc{1
rn
€a
a
-1:
11!
r4 .
r3
w
Ri
ID
fV
F
EA1
H
E4
Gi
Ni
v;
x
O
H
F
i
i
Pk
r"
%
ittl
E
A x
I � O
i1a �
6sa
�
GL F
E
E
A x
I � O
. ���""F— I �� Co� ���������
`
DEPARTMENT uF HEALTH AND ENVIRONMENTHL .'ROTECTI8N
825 'L' STREET/ ANCHORAGE/ HK. 9950-1-
27.9--2511
9501279~2511
L4 EE L_ L__ F�'G��w` 1-1 1��
PERMIT NO. ( 7718] )
APPLICANT EDWIN RINNER 8310 WELLSLEY CT ]44~41]1
[QCHTI8N
^ L8T SIZE 8000 SQUARE FEET
LEGHL L7 B1 SHANE LEE ESTATES
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSAL.. SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL_
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DAYS
OF THE WELL COMPLETION.
SPECIFICHTIONS HND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
�C� 1-1 1������
I CERTIFY THAT �
1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE" SEWERS AND WELLS HS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2� I WILL INSTHLL THE SYSTEM IN HCCQRDHNCE WITH THE CODES�
SIGNED:~_�����—__~~~___�����~~--__~~—~
�
APPLICANT
EDWIN RINNER
�
ISSUED BY ��,���=�=���_~~�_~DHTE.��~L����—_�^�__
�~~--�~�~T— � |
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 014-061-63 HAA# !7 /, 0 off
1. GENERAL INFORMATION
Expiration Date: /.2.-/7-03
Complete legal description SHANE LEE ESTATES SUBDIVISION; LOT 7. BLOCK 1.
Location (site address or directions) 6670 TIFFANY TERRACE • ANCHORAGE. AK 99507
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
DONNIE do GUDRUN PRESLEY Day phone
c/o JIM CRAWFORD w/ CENTURY 21
Day phone
JIM CRAWFORD w/ CENTURY 21 . Day phone
2739 "Co STREET ' ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
N
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
562-5592
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
❑
Individual Holding tank
❑
Community On-site
❑
Public Sewer
0
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 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 samples. (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.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior
to closing for the engineering services provided.
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 on 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 riles 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 of installation.
Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSO Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identnable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AKW WC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benerit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
S. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
337-6179
Date 51 10103
Conditional approval for bedrooms, with the filowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
YiOF
WATER AND M'
. \\n.,\" r 1 n\ L -i 1. .
PROGRAM
S
T
JJJJJJ/�O�E���l
JJJJrr�tS �No,
By: Original Certificate Date: C% — 17-03
(Rev. 11/01)
Municipality of Anchorage
Development Services Department
Building Safety Oivislon
On -SRO Water 8 Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage. AK 9951 M50
www.cLanchorage.ak.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: SHANE LEE ESTATES S/D; LOT 7. BLOCK 1. Parcel ID: 014-061-63
A. WELL DATA
Well type PRIVATE If A, B. or C provide PWSID# N/A
Date completed 1/20Z1978 Sanitary seal (Y/N) YES
Total depth 58 ft. Cased to 58 ft.
FROM WELL LOG
Date of test 8�--
Static water level 31 ft.
Well production 3 g.p.m.
WATER SAMPLE RESULTS:
Well Log (YM) NO
Wires properly protected (YM) YES
Casing height (above ground) 12+ in.
AT INSPECTION
f 22,(2003
31 ft,
3.0+ g.p.m.
Coliform 0 colonies/100 ml. Nitrate 0.173 mg./L. Other bacteria 0 colonies/100 ml.
Arsenic: N/A mg./L. Date of sample: 8/22J2003 Collected by: AKWWC` INC.
B. SEPTIC/HOLDING TANK DATA PUBLIC SEWER
Tank Type/Material Date installed
Tank size,, _gal. Number of Compartments
Foun=zPng
out (Y/N) essiori over tank (Y/N) _. _ High water alarm (Y/N)
❑ate Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft'or ftibdrm), System type
Length ft. Width ft. Gravel bel o ft.
Total depth ft. Eff. absorption area ft= Monitoring to Depression over field
Date of adequacy test Resul 11) For bedrooms
Fluid depth in absorption field befo _ in. Water added _.__.gal. New depth _in.
Elapsed Time: in. Final fluid depth _ in. Absorption rate >= g.p.d.
e uvenation treatment (past 12 mo.) (YM & type) If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A
Absorption field on lot N/A
Public sewer main 75'+
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/deanout 100'+
Holding tank N/A
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: PUBLIC SEWER
Building foundation Property line Absorption field —
Water main
Water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water service line
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Building foundation Water
Surface
Wells on adjacent lots
water
parkinglvehide storage
f 1 certify that I have determined through field inspections and * 4
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
f
f e
Engineer's Printed N me JEFFREY A. GARNESS �Q •• f
Date 0703 �a p
G:
HAA Fee $—J I S — q
Date of Payment i�- 1 ' 2 ' 03
Receipt Number __ 41 (,PQ%
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
9- 3-03;10:55AM;
SGS Ref.Of
1035410001
Client Name
AK Water & Wastewater Consultants Inc.
Project NameNf
Shane Lee Estates, Blk 1 Lot 7
Client Sample ID
Shane Lee Est.
Matrix
Drinking Water
Sample Remarks:
9222B -Non-coliform growth detected on Blank; sample results are not affected.
;907 5615301
All Dates/Times are Alaska Standard Time
Printed Date/time 09/03/2003 8:28
Collected DatelTime 08/22/2003 14:50
Received Date/time 0MV2003 15:10
Technical DireMo�r!. Step a C. Ede
Released B,y�� 4 oe j
a 2/ 3
Allowable Prep Analysis
Parameter Qualifiers Results PQL Units Method Container ID Limits Date Date Inst
Metals by ICP/MS
Lead 1.49 0.200 ug/L EP200.8 C (<-15) 0827/03 08/31/03 WAW
Waters Department
Nitrate -N 0.173 0.100
Nitrite -N 0.136 0.100
Microbiology Laboratory
Total Coliform 0
mg/L EPA 300.0 B 0822/03 JJB
mg/L EPA300.0 B (<-j) 0822/03 JJB
coV100mL SM189222B A (<=1) 0822/03 JS
61,
Sep 03 03 12:21p Jim Crawford
Sep 02 C3 02:SSa
A Fg6GERT/F/CAT/O1'V
OF AN AS-E3UIZ-7 SURV16 y
FERFORME� ,B7• J.R. Sf�/GLE�Q
A522- S.
LOT 8
9075625598
20 �j PAVEC
• OR' WAY � o
\J m I wec� $ EaVST.� CCC.••vvv
O syea '° sreE�r. N w
I'°= l" /37./2' X04 w
0
CwcOp e�K'E* .nPPROXIMATES ' '3/ Y � ''
P¢oPGRTy u^vE.CnY A=rc-)
CUT 6
U1
Z1
D
D
DATE
Loi 7 , Slack
, 5noneg Lam. Esfb A=,s
Anchorage Recording District, Alaska
OT -SURVEY CERTIFICATION
I hereby ewaly that laevo eurroyed the property eoowe we d.eotl►eo
hereon. and that the hnpro+aaente oltualN thereon aro Wilms oleo proper
arty life and ds nal werlop ero*etoaah We adiaaet property uta that
no lowenewuera on adlepne property owlep w w4roodh so the WwWoo4
U "lion and Mol Men ws as roadway@. suety 11nse, or MMr risible
eo@n.eate on Veld property *asset as Indleated "row.
;F 9F A(
..—l. 6ullon
W191
V V
EaeetYnls of neer& slow tban Ma* Mown an
the plot of N@wd ars Mt *he -I heron unless
othwelse /toted.
LEGEND
0 Bross or Aluminum copped monument recovered
O Iron pipe and/or rebor recovered.
0 2 x 2 hub 6 tack recovered
• We"xWoobar sst this survey
Scale /ii_ y.l•
.J.J
Dote n /�I Q
7— �J —, J�
Prepared by: ReyeWdLW5N pyor
(901/279-b200 519W 40th Ari Anch rape Alamo 9950/
Ref. 203
F B. No. �� /^,�
Property of. g n
cr
F C L�
w u
;� g
; SS as
pa . .
`4'q
In N
m F
O
y
Ui
,20 p
y
CL °
u
it•
lON
I)
FVp
t7
B
M
N
T
G
z
Lo z
%
J
` 1�]
C�
}
I ,
����v .L4
Biel L
�^
+
"""'�
a
_x � ; t s : �, /J/�� ,^(�jT[/ `� � �,d R s l—w.
�`•_ . x 's',^�' +
�
• � Nf E' 1 j� `F {�1l �
/a..3
A,g,
�.'\
µmo 5 t�
'�jx4b'g
eFe
! tw.
642
r
o /
A -i :T T,
r it
e a �, S� , .yam. y' � � t
i
78 _
j -lot .c
/�" 9.7� R • 1 g� ' �w
47
Iy
p ya c � -� � ry �'
1 �Bt3ll�/
ti° •�
•,tm
�.psloeo _-'
seL19t4loot
o� g 1�? `� ��
�' V
11
w
✓r
rj
w
•
C-Zztzr. b'
a
—
- ----Bigg
ama.e
.1
$ 'a • ` i
19 v
tu
Q 8
g am en ' 1s I
3
•e®Li1 a 9Y8n�$s������&fix•
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
Parcel I.D. # C) (In I `In 3�1 HAA # I�{�G1
1. GENERAL INFORMATION
Complete legal description v
Location (site address or directions) bb 7(3 i ll x^44 T�'^�
Property owner CqttXy_ZN; Lu Ir k4� lc2 Day phone yi- ea i 5Y
Mailing address *� �
Lending agency c,�-+� �f ' "`"�`��`-W Day phone
Mailing address /J
Agent �)�kp Day phone 2.'5-70/57
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: 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, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev.1/91) Front MOAN21
5.
6.
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 of this Health Authority Approval application 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 furtherverify 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. -7/q, I
Name of Firm I m�% e.,,l ".r14-LaV_4 �_ Phone r L i3
Address o_ws i�/(� �'� !YU l'� Iq
Engineer's signature
DHHS SIGNATURE
XApproved for �/�.�2 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
bedrooms, with the following stipulations:
By:
Date 7- /z - 9
�t
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
f Pprovai certticates based oNy upon tFhe 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.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: �m-LL_ P> Y, Parcel I.D.1—
L-
A. Well Data
Well type �—If A, B, or C, attach ADEC letter. ADEC water system number.
Log present present (Y/N) Date completed 1170Z 4 Driller -u
_�7 ;-tr
Total depth 5 6 Cased to � � Casing height 7
Sanitary seal (Y/N) Wires properly protected (Y/N) f
FROM WELL LOG AT INSPECTION
Date of test
Static water level
m
Well flow g.p.m. �, 3 g.p.m.
Pump levell �c° 7 tTl w
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot N�/� ; On adjacent lots
Absorption field on lot / ; On adjacent lots
Public sewer main 01 Public sewer manhole/cleanout I zy
Sewer service line Petroleum tank N
WATER SAMPLE RESULTS:
Coliform Nitrate ® Other bacteria Ile
Date of sample: to 3�e /R3 Collected by: 1, a,o
B. SEPTIC/HOLDING TANK DATA
Date installed
ank size
Compartments
Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N)
High water alarm (Y/N) Alarm tested (Y/N)
Date of pumping Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot On adjacent lots Foundation
Tv PrvPertY line /�bsorPtion fiield
Surface water/drainage
Water main/service line
CONTINUED ON BACK PAGE
72-026 (3/93)' Front
C. LIFT STATION
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at "Pump off" Level at
High water alarm level Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA I,-/
%
+�
/A—
Date installed Soil rating (GPD/Ft2) System type
Length Width Gravel thickness Total depth
Total absorption area Cleanout present (Y/N) Depression over field (Y/N)
Date of adequacy test Results (pass/fail) for Bedrooms
Water level in absorption field before test After test
Peroxide treatment (past 12 months) (Y/N) If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot On adjacent lots Property line
To building foundation To existing or abandoned system on lot
On adjacent lots Cutbank Water main/service line
Surface water Driveway, parking/vehicle storage area
Curtain drain
E. ENGINEER'S CERTIFICATION
1 certify that l have checked, verified, or conformed to all MOA and HAA guidelines in eq)o�Ff onThWcYclte-Q( this inspection.
Signature
Engineer's Na l �PV fV��a � L=
Date
t;• ->'-
HAA Fee $ 70 ° �� Waiver Fee $
Date of Payment Date of Payment
Receipt Number 2r5 Receipt Number
72-026 (3/93)' Back
.09/93 12:02 CT&E ENVIRONMENTAL LAB SERVICES - 2793916
FOMMERCIAL TESTING & ENGINEERING CO.
VIRONMENTAL LABORATORY SERVICES
°'"`:' I 'A( it I a REPORT of ANALYSIS
Chemlab Ret.#w :93.3137-1
Client Sample 7.0 :L7 B1 SHANE LEE:
Matrix :WATER
Client Name :TOBBEN SPURI(LAND, P.E.
Ordered By :TOEIBE.'N SPURKLANB
Project Name
P.roieck#F
PWSID :UA
NO.605 003
5633 8 STREET
ANCHORAGE, AK 99518
TEL: (907) 562-2343
FAX: (907) 561.5301
WORK Order :67B07
Report Completed :07/07/93
collected :06/30/93 @ 13:15 hrs.
Received :07/01/93 @ 08:15 hr5<
Technical Director.:STEPFIEN ME
Released By
Sample Remarks: ROUTINE SAMPLE CML,ECTED BY: TOBSEN, f
QC Allowable Ext, Anal
Parameter Results Qual Units Method Limits Date rite Init
Nitrate -N 0.13 Mg/E' EPA 353.7/300.0 10 07/07 LLH
See Special Instructions Above - -------M^UA-=-Unavailable
*
94sa Sample Pemarks Abesv*n� NA - Not Analyzed
V T, UnuclC 191 RMEM V012 18 Ut P16CUCK WAIIT iMrKIM llkt, GT iwe55 Thal?
D = Secondary dilution. OT Greater Than
VONS S M®mbar of the SGS Group (Sooi6W 06n6rale de Surveillanca)
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSkY, SOUTH CAROLINA