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HomeMy WebLinkAboutBENITO BLK 3 LT 5'D Benito Block 3 Lot 5 #050-272-19 Municipality of Anchorage -� Development Services Department ' Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O S' O - ? *7;L - f 9 HAA # 0-F) nog Expiration Date: I O� - 30 - 06 1. GENERAL INFORMATION Complete legal description Lot 5: Block 3: Benito Subdivision Location (site address or directions) 17230 Bearnav Cir. Anchnrar Current Propertyowner(s)Estate of Keith Landers Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone Tim Rittal / Remax Day phone 244-4472 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: 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 andlor 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 sample results. (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. Individual On-site ❑ ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer 1p 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 andlor 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 sample results. (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 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 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 S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name. g0i(3f•R?- C. Coi.✓.4,-_- Date `i 4c /os - OF a 0 5. DSD SIGNATURE 9fQ` 80 1Z Approved for _ bedrooms. Disapproved. �1t `�Te. �5.(�•'' Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory _� ON-SITE WATER AND WASTEV IArr., PROGRAM F0 0 V��iii Maintenance Agreements Supplemental Engineer's Report Other By: _ / GV , Original Certificate Date: (Rev DIM2) 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.ak.us (907) 343-7904 HEALTrH' AUTHORITY APPROVAL CHECKLIST 7 Legal Description: L&T- 13Locx- f3e»r m S/p Parcel ID: O 10 - 1D 1 % 9 A. WELL DATA Well type ��Vg1rt If A, B, or C provide PWSID # _ sv� 4 Well4Jf j 5 9* Date completedy�1 T3 Sanitary seal�!! 1) —yr -:5 Wires properly protected &R) `1 Total depth =ft. Cased to DLft. Casing height (above ground) f Lin. FROM WELL LOG AT INSPECTION Dat# of test .. q 0 S Static water level r Well production P.M. �^ s g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./I. Other bacteria O colonies/100 ml. Arsenic: mg./I. Dale of sample: zi9IoS Collected by: g a S rules rA r�rru(� B. SEPTICIHOLDING TANK DATA f ut,L tL St-u)C2 Tank Type/Material Date installed Tank size gal. Number of Compartments _ Cleanouts (YIN) Foundation cleanout (YIN) _ Depression over tank (YIN) _ High water alarm ) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed S60);ting (g.p.d.M2 or ft2/bdr System type Length ft. Width ft. Gravel below pipe ft. Total depth _ ft. Eff. absorption a ft2 Monitoring tube _ Depression over field Date of adequacy test Results (Pass/Fail) For _ bedrooms Fluid depth in absor field before test _ in. Water added_ gal. New depth_ in. Elapsed Ti _min. Final fluid depth _ in. Absorption rate >= g.p.d. An luvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed _ `Pump on' level at Datum _ Size in gallons Manhole/Access / in. `Pump off" level High water alarm level at E. SEPARATION DISTANCES Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: f OE t,I L S r—uaFtz- Septic tank/lift station on lot *-)t4 On adjacent lots -to Absorption field on lot kilk' On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line 16 1-t2^ x Holding tank iJ tC SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 'Put3Ltc- gL4cat uL Building foundation Water main Property line Surface water Wells o ots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT T0: '{ vi3L t L Property line Building foundation Water Service line Surfac r� Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS �SJt- SEw4tA 4- L14-1L-tNITMLLCO IN /q73 iG�a«DCnrutIt1n�, G. ENGINEER'S CERTIFICATION I 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 I`�BE.4T �, r�8t✓A� "RaarxtQCOWAN a � CE -"Of Date `I kib9�_ 11 HAA Fee $ 4 30. •. Date of Payment of /,- -7 / e s' Receipt Number 01 q f 8,0 (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number lit Truc,TlzAlos Jul 20 05 04s51p Jim Sullivan 907-688-2543 P.1 July 20, 2005 S&S Engumeering R.E. 17230 Bear Paw circle ARCTIC PUMP & WELL INC. Jim Sullivan PO Box 770197 Eagle River, AK 99577 (907) 688-1510 On 7-20-05 We Performed A well survey at this property 88 static 89 pump set 97 deep 8'6" pittless 40+ casing We also installed A MOA Well seal Please feel free to contact me with any further questions. Sincerely, S Ivan 09-21-05;08:37 : SCS Re" Client Namo ProleetName/N Client Samplem Matrbc Sample Rcmorks: 1055903001 S & S Engineering Lot S, Block 3, Benito SID Lot 5, Block 3, Benito SID Drinking Water ;907 561 $301 R 2/ 4 All Datesrrimet are Alaeka Standard Time Printed Datemme 09/19/2005 8.15 Collected Datentme 09/09/200514:10 R"cfvedDstdrlme 09/09/2005 14:35 Technical Director Stephen C. Ede Mierobiology Laboratory Total Coliform 0 coV100tttL SM209222B 09/09105 TU Allowable Ptcp Analysis hmtnwor Results POL Units Method Container ID Limits Date Date loft MIMWN 1.81 0.100 mg/L EPA 353.2 8 (ca10) 09109/0S PLW Mierobiology Laboratory Total Coliform 0 coV100tttL SM209222B 09/09105 TU 'PCG:➢ rwf,tD ILROiI UA��IAlI++rARq'A°w"" x...'' I.f4. i7jV L //:'• NwIT ewR mAAa u PWwr s1nAa I N =SO.0 G� 9/.34,• I• p tc - •,� F,, �,, r'��.rifrG os I � --- 7i 7 ti IV) ' v 0 I SURVEY CERTIFICATION��rrraaaa Prepared by PLOT PLAN ��•e ..11144 Robert E. Johns, Jr. & Assoc. " rjwe `' ""'r"r "'"' "� •�s Professional Land Surveyors ... 842 E. 12 AVE. AP {S ? , ^ ANCHORAGE, ALASKA 99501 9 _.' / Snlo: Roc. Lot S.F. Rae. Plot F90 No. t'.�•.�J N — r FOUNJATON AS -BUILT / /" / •' �"' •'%: �' 30 C.L.. L A.A.I c a+.N a_ rr+r.�uM eM r M, ••• •• IA CTI* S,IIYoy.C: :'raRn CKock" 0 ....... .........1:. .......... ......8-30—Q:! Y• Y• .. A0 ROBERT.�E. U(Mlli JR. � � I:EJ ww .rNriM..Nw,�,LrYlrlr. I A : r/ o w B-30-05 '!I'd: N110052 w.0.5 -2G6 I A Lora Uro.n: FINAL STRUCTURE AS -BUILT •� 41 21 +dot ♦� "o"o ••'•............... •.✓' y�wq Legm U..Cr'rytl.m: O A •" "" "`" r o" GLK 3 I T tiM r�,wN w�.M+rd'. t��; r°/eesicnd �•' . 5 N . w. aaaartr►� BENITO ❑ LOT SURVEY SURVEY TYPE SYMBOLS11FIXIMAiIOK AR-9ULT ........... ❑ MAI. [1RIx:1 AS-euLT o SET RFBAR 4�° DRAINAGE AsrFIALT ❑ PLOT PLAN ... AS -BUILT ... LOT SURW1 ... Tq OCRAPHY O FOJND RFBAR t....q.�y wOOD FENCE /�CONCRETE N vrR PrTRr,19ATO.! AS-w%L, . Ne !�M, T 165LN ASSUMED ELEV.y-%_-y CRAI. PFENCEJjJfj DECK PLOT PLANS &LOT SURVEYS ;TOTE; IT IS THE RESPONSIBILITY OF THE BUILDER OR OWTIER, FRIOR TO OTILY TIIOSE IMPROVEMENTS ADOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRACE RELATIVE: SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO OE'ERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WI41CH DO NOT APPEAR ON THE RECOROFO SUBDIVIS-ON PLAT. ALL D,STANCE.S ARF RErn"D UN,S c UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USEn FCR CCNSTRIICTION OR rOR ESTARI ISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONS'SILITY FOR THE INITIAL TRANSACTlrN TX.t'F AND ASSUMES FINANCIAL LIALI!ITY O`RY FOR TIE :OST OF THE SURVEY. LISTED CISTANCES PREVAIL OVER SCAUKO. FEPEOJUCTICI: MAY CAUSE ERRORS III SCALE