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
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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:
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•" "" "`" 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