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Home My WebLink AboutT12N R3W SEC 22 LT 9 N2S2Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL 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. 015-141-44 1. GENERAL INFORMATION Complete legal description Expiration Date: T12N~ RSW~ SECTION 22; LOT 9~ S2~ N2~ S2 Location (site address or directions) 10850 OUR ROAD * ANCHORAGE~ AK 99516 Current Propertyowner(s) WAYNE & KARREN UNCOLN Day phone 770-2775 Mailing address 420 IDAHO STREET * ANCHORAGEt AK 99504 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~r~ Individual Holding tank Community On-site ~] 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. Note:Alaska Water and Wastewater Consultants, Inc. shall be paid $ (~. ¢~- at, or pdor 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 vedfy that my investigation, based on procedures outlined in the Health Authodty Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate forthe number of bedrooms and type of structure indicated herein. I further vedfy 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 ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUffE 2B * ANCHORAGE, AK 99504- Engineer's Printed Name JEFFREY A. CARNESS, P.E. Date 337-6179 Engineer's Comments: In conducing this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results desc~bed 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 se~,ed 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. AWWC, 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 benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authoMzed, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for ~ Disapproved. Conditional approval for 0.";o?'-. · ' ''.. bedrooms, with the fllowing stipulati~'~- .- WATER AND : rn = : WASTEWATER · - PROGP~,~ I : 0^%. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Dlvisicn On-Site Water & Wastewafer Program 4700 South Bragew St. P.O. Sox 196650 Anchorage, AK 99519-6650 www.ci.anchomge.ak.us (9O7) 343-7904 Legal Desc~ipfion: A. WELL DATA Welt type plaVATg Date completed Total depttt HEALTH ~,UTHORITY /~PPROVAL CHECKLIST T12N~ R3W, SEC. 22; LOT 9~ S2~ N2~ S2 Parcel ID:. 015-141-44 If A, B, or C provide PVVSID# N/'A Sanitary seal (Y/N} Cased to 294 ft. FROM WELL LOG 293 .ft. 5/'1978 295 ft. Date of test Static water level Welt pnxtuction WATER SAMPLE RESULTS: Coliform _.~ colonies/100 mi. Arsenic: mgJL. e. SEPTIC/HOLDING TANK DATA 8.5 g.p.m. Welt Log (Y/N), Wires property protected (Y/N) Casing height (above ground) AT iNSPECTION 5/17/2002 270 ft. 5.2 g.p.m. 24+ in. NltmteO'eSt'~/ngJL. Other bacte~ (:~ colonies/lO0 mi. o.te of.rap,.: Co,.=., ,<. Tank Type/Material Tank size 2000 gal. Number of Compartments 2 Foundation cle. anout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 5/15/'2002 Pumper. C. ABSORPTION FIELD DATA 1Date installed 1/lggl Date installed 1/' 1 g91 Cleanouts (Y/N) YES High water alarm (Y/N) YES A+ SERVICES Soil rating {~r fl~x:lrm) 125 system type BED Length 38 ff. Width 25 ft. Gravel below pipe 0.5 ft. Total depth ._~ft. Eft. absorption ama gs0 ff~ Monitoring tube YES Date of adequacy test 5/'17/2002 Results (Pass/Fail) PASS Fluid depth in absorption field before test 0 in. Water added 797 gal. Elapsed Time: 0 min. Final fluid depth O in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN Depression over field. NO For 5 bedrooms New depth 0 in. 750+ g.p.d. If yea, give date - D. LIFT STATION Date installed 1/1991 'Pump on' level at 39 in. Datum N/A E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: SV.e in gallons 2000 'Pump off" level at 39 in, Cymes tested 3 Septic tank/lilt station on lot. 100'+ At~:=ptlen field on lot 100'+ Public sewer main N,/A Sewer Isepfic service line 25'+ Manholel.~__ _,~'ess (Y/N) YES High water alarm level at. 45 .in. Meets alarm & circuit requirements?. YES On edjacem lots 100'+ On edjacem lots 100'+ Public sewer manholeJcieenout Holding lank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS Absorption field Surface water G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal mconfs that the above systems are in conformance with MOA HAA guidelines in effect on this date, 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ Date "7 _/Io/0,2- dI:.I. FKEY A. 0ARNESS HAA Fee S .~ Date of Payment Recel~ Numtmr (Re~. 12/01) Waiver Fee $ Date of Payment Receipt Number JUL-IO-OZ 04:13~ FROU--CT&E ENVII~ONI, ENTAL $1W ZtK CT&E Environmental Service, Inc. 9075615301 T-T35 P.02/03 F-74Z All Dat~t~Tlmes ara Alaska Standard Time CT&E Ref.# 1024055001 Olent Name AKWater & Wastegatter C°nsultante loc' pdnted Dntefflme 07/10/2002 14:25 Project Name/# TI 2N R.3W Sec 22 Lt 9. N2 N2.52 Collt~ed Date/Time 07/08/2002 S:2 I Recdved Date/Time 07/0~2002 9:00 C'llent Sample ID 10550 O~ Rd ?,ehmtcnl Director Stephtn~.de PWSID 0 v .... ' ~ -- Sample gcmark~ P.~ alL~ PQL Uni~ MeO,~d Limiu I;~te D~e Inli. g_. Ni~te-N 0.858 0.200 ml~. EPA 300.0 (<10% 07/08~02 ]DT Microb:Lology L-borat:ory Total Cotifonn 0 coVlOOmL SMI8 9222B (<1} 07/08/02 SBt[