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Home My WebLink AboutGRANDVIEW HEIGHTS BLK 4 LT 10H h e ig ts' IMP #009-153-07 Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.d.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. _ 009 V)t HAA# ftMK LZ 1. GENERAL INFORMATION Expiration Date: —3L:1 s�o $' Complete legal description GRANDVIEW HEIGHTS SUBDIVISION LOT 10 BLOCK 4 Location (site address or directions) 725 WEST 46TH AVENUE ANCHORAGE AK 99503 Current Property owner(s). CINDY LEACH Day phone _(907) 744-0544 Mailing address 725 WEST 46TH AVENUE ANCHORAGE AK 99503 Lending agency Day phone Mailing address Real Estate Agent MARTY MARGESON Day phone (907) 278-9275 Mailing address 1401 WEST 13TH AVENUE ANCHORAGE, AK 99501'«�' Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 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. 4. STATEMENT OF INSPECTION BY ENGINEER As cerifed 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 files 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 GARNESS ENGINEERING GROUP, Ltd. 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, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD 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 identifiable 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. GEG, Ltd. 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 benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authodzed, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE ✓ Approved for 3_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following Phone 337-6179 Date 2' "/°`f f%m _ercG ZE-Z: WATERANU : WASTEWATER PROGRAM ; Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: 14407 0 UV (Rev. 12101) Municipality of Anchorage ' Development Services Department Building Safety Division < Onsite Water & Wastewater Program 4700 South Bragew St. P.O. Box 196650 Anchorage, AK 995196650 1 p www.ci.anchorage.ak.us a (907) 343-7904 { HEALTH AUTHORITY APPROVAL CHECKLIST y s Legal Description: GRANDVIEW HEIGHTS S/D: LOT 10 BLOCK 4 Parcel ID: 0 09 — / 6- 3 07 A. WELL DATA ; Well type MATE If A, S, or C provide PWSID# N/A Well Log (Y/N) NO Date completed ` 1975 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 144+ g, Cased to 40+ft. Casing height (above ground) 19 in. c FROM WELL LOG AT INSPECTION Date of test _ 12/6/2004 $ Static water level ft. 48' ft. a Well production 9-13-m-5.24 g.p.m. i 3 WATER SAMPLE RESULTS: A Coliform --r& colonles/100 ml. Nitrate QJQmg./L. Other bacteria colonies/100 mi. Arsenic: erg./L. Date of sample: 12/6/200 Collected by: GEG, LID. B. EEit OLDING TANK DATA PUBLIC SEWER Tank Type/Material Date Installed Tank size gal. Number of Compa Cleanouts (Y/N) Foundation cleanout (Y/N) _ Depression over tank (YIN) _ Hig s rm (Y/N) Date of pumping Pumper C. RPTION FIELD DATA Date installs Soil rating .p.d. r ft�/bdrm)_ System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption are ft° Monitoring tube Depression over field Date of adequacy test Results (Pass For—bedrooms Fluid depth in absorption field before test _ in. Water added _ New depth _in. Elapsed Time: — min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date 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 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 50'+ Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER -- Building foundation Water main Property line Wellsots— SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water service line F. COMMENTS G. ENGINEER'S CERTIFICATION Building foundation Wells on adjacent lots 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date Surface water Driveway, parking/vehicle storage .A " 0-- c kv i &,�- -�- /-75 AU -A Waiver Fee $ _ Date of Payment I i 10 q Date of Payment Receipt Number 7 Receipt Number (Rev. 12/01) 12/06/2004 11:54 9072432081 FRED WALATKA & AS50 � PAGE 01 t4-1 i C4FDog Ruri IT d : Well under deck. Deck !� '.'^. r NbC: ppdw 1 .LGE, a� I Rete, 12-4-o4dW 8N; H uyveye a Ccr,Sef OF At %%I i hereby certify that T have su�pyed the following � described WN Proper !� SC4LE /'-- 3t7 of *:"49 ew �T" � � Arrehorag� ReOording i'recinet, Alaska and that the " i nProvements. situated thereon are wittr� the Dropertq rrd *'ele:4a lines and do not overlap or encroach on; the Proper! NO. 32555 IMC adJacent thereto, that no improvements on pro -t1 .,� "". �. ,,,, Q..S ertq lying adiacent thereto encroach on the premises in aF.....«••T.l. tlncshon and that there are no roadways, transmission �hESS1oRAL4 last iindicasi tedahenon. easements on said property excep{ wa� �a►Oh Dated�at.�toohorage; Alaskka�f ' this—z=— d `>_`i 7.Q 7 FRED WALAT1t:A & ASSdj L' 5 _ .. Engineen and Surveyors