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Home My WebLink AboutT13N R3W SEC 13 LT 3 OF GAAB TR97/AKA BLM L107 (TR 97 BEING SW4SE4SW4NW4) 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. # (~"~"~l~, - (~'{D '2h- ~ ~ HAA # ~.~ 1. GENERAL INFORMATION Complete legal description L~'-T'.~ ~ 'T~-&C-T- /¢':7/ ~CT/¢~' /9/ -Y/~/,-'~ Fb..~ ~ Location (site address or directions) Property owner Mailing address Lending agency Day phone Mailing address Address ~ £ ~A ~ ~ '-~L-~-"'~ Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ 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. 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~)25 (Rev. 1/91) Front MOA#21 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 further verify that based on the information obtained from the Municipality of Anchorage flies 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. Name of Firm~'~¢'~)~¢c~ ~- ~¢J~.. S~J(- Phone Address ~,~ ,k~;~or,, 1 ~{~_o~'-~ ~,~fl Ol~L A F- Engineer's signature_ Date S G.^TU.E Approved for '~-~ '?-g~ Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS 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 6 E I V E DEPARTMENT OF HEALTH & HUMAN SERVICES ' Environmental Services Division ·1 1998 825 L Street, Room 502 · Anchorage Alaska 99501 (907) 3,+o-,+74,+ : Municipality Of Anchorage ·. . Dept Health & Human Services Health Author ty Approval ChecKds~ Legal Description: /-,~;j t--"p_ I~ ':7- / -.~c- t~ -T'~,-~t]~,,;~ ~ Parcel I.D.: A. WELL DATA Well type '~c2 Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) /~/ ~ Wires properly protected (Y/N). ~ Date completed Cased to z.¢o-~- ' FROM WELL LOG AT INSPECTION Date of test ~/! q (' ~ Static water level ! ~ ! Well production g.p.m. -~' ~ f' g.p.m. WATER SAMPLE RESULTS: Coliform ~ C~ ~ Nitrate Date of sample: ,~//,~/?~ [ :~,/2~,[~'~ ¢~.IC~.P F-t~-~_ Other bacteria " ' Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Tank size ~ments Cleanouts (Y/N).__ Foundation cleanout (Y/N) ~ ._.---~e~e/s/~,on (Y/N) High water alarm (Y/N) D te~plng Pumper C. ABSORPTION FIELD DATA Soil rating (g.p.d./ft~ or ft=/bdrm) System type Gravel thickness below pipe Total depth ~ent (Y/N) Depression over field (Y/N) Effective absorption area Date of adequacy test ReSult{ (Pass/Fa~TF'--.. For bedrooms Fluid depth in absorption field before test (in.); Immediate. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = ~ Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pum~m~l~ High water alarm leveJ.a *t~-~,'-~ *Datu.r;n .~Cyel s6rC~e sted "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ,,4//~ A~O~(J Absorption field on lot ,.&2/¢. Public sewer main //d::~ ~ Sewer/septic service line ~."T' '~ 5- ~ On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line Absorptio.~~ Water main/service line Surface water/drainage ~n adjacent lots SEPARATION DISTANCE FROM A_~.S, ~T TO: ~.ai~ Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections in conformance with MOA HAA guidelines in effect on this date. Signature. ~ ------ Engineer's Name Date '~ are HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Steven R. Pannone, P.E. Consulting Engineer P.O. Box 142025 Anchorage, Alaska 99514 (907) 272-8218 WATER SUPPLY SYSTEM ADEOUACY TEST Legal: Owner: Residence: Lot 3 Tract 107, Sec 13, Township 13 N, Range 3 W Ms. 520 Patsy Road Anchorage, AK 99504 Date of Test: 3/14/98 Well Flow Only Test Procedure: A well log was not found. From information provided, the well was drilled in approximately 1947 and is cased to greater than 40 feet. The well cap did not meet the sanitary seal requirement of the MOA, and the wires were not properly protected. The well cap was upgraded to meet Municipal requirements. The static water level in the casing was discovered to be approximately 17 feet below the top of the casing. During the test we pumped a total of 777 gallons of water from the well at the rate ofT.0 gallons per minute (GPM), which caused the water level in the casing to be drawn down to 27 feet, but no further. Based on our test data, we determined that the total yield of the well is in excess of 7.0 GPM, which exceeds the Municipal criteria for approval of a single family residence. This well also meets the FHA lending criteria that a well be able to supply a minimum of 720 gallons over a four-hour period. Water samples collected on March 15, 1998 are being analyzed by CTE Environmental Test Lab at this writing and will be forwarded as the results become available. TESTS RESULTS: This well production meets the code requirements of the Municipality of Anchorage. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system. The reported results describe 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 depend on the local soil condition, ground water levels tbat my 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee tbat there are no hidden defects or encroachments. We can therefore not give any estimate of how long the system will continue to meet the operational requirements of the Municipality and State. MP~R-26-2998~ &5:25 CT&E ESI ANCHORAGE 90?56iS30& P.¢2/02 ~ili~k. ~T&E Envh'onmenl~l Se~ic.~ CT&E P~f,# 981232001 Client Name Pannon~ Bni Project Name/# L3 TRI0'/~13 Client Sample ID Kitten Sink Matrix Drinking Wa~er Ordered PW$1D ~'ample Re~11~rks: Ciicat Printed Date/Time 03/26/98 08:15 Collected D~te/Tlme 03/18/98 14:00 Receiwd Data'Time 0!1/l!1198 11:30 Technical INfector: Stephen C, Ede 0.100 mg/L E.A 30o.o max OS/gO/Pr eMV TOTAL P. 02 CT&E Environmental Services lnc, )rinking Water Analysis Report for Total Colif'om~ ~'~'"' .~,J,,,.,~,. ~-~u.;~o~ &4O INSTR~'CTIO~3 0,~ RE~E~ SlOE ~EFORE COL~K~Z~V~ ~,}IPL~ Telt 1~7} ~61-1343 Fax: {~7) 561.5301 AaMyat L