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Home My WebLink AboutT12N R4W SEC 11 N2NW4SW4NW4NW4 PARCEL 16Parcel I.D. 1. 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 0/2.-2,~Z--~3-0C~o-~"7 HAA# ~-~\ ~\~(~' ~'1 GENERAL INFORMATION Completelegaldescription Tt~_t.3 ) i~-+WI ~_~_,-' t~._~ J ~ Location (site address or directions) --? ~ i_,~- ...~_~.r~...L L.~--- (2~o.o..D Property owner Mailing address Day phone Lending agency Mailing address Day phone Agent ~.~ ~"r'u,,~ ~--- Address Day phone 2~_,~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well Y' 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. 72-025 (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 files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in com~iance with all Municipal and State codes, ordinances, and regulations in effect on the date of,t~is inspection. .Alask-~ t6amr & l/ . · Westewater Name of Firm ~17 Address / / Engineers signature DHHS SIGNATURE /~.. Approved for 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 DHHS 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. Legal Description: A. WELL DATA Municipality of Anchorage aNV~ttON~a~N, li~-w¢'t DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825%" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4743. Health Authority Approval Checklist ~ ~ Well type e~I:P-~V~ If A, B. or C attach ADEC letter. ADEC water system number ~J [~* Log present (Y/N) b,I D Date completed Total depth ~ fi;~, ~ Cased to 4~ ' .... Sanitary ~eal (y/N) Date of test Static water level FROM WELL LOG Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION g.p.m. ~" 4~ ~f~'/"/ ~ ~ ~ Otherbacteda Collected by: Well production Nitrate WATER SAMPLE RESULTS: Coliform Date of sample: Tank size NtLmber of Compartments __ Foundation cleanout (Y/N) __ Depression (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Date installed Soil rating (g.p' System type Length Width ~ Effective absorption area /~. Monitoring Tube [ Date of adequacy test / Results (Pass/Fail) Fluid depth field before test (in.); h __(ins.) Minutes later: ~/'-Peroxide treatment (past 12 months) (Y,rN) For · Total depth. bedrooms Immediately after gal. water added Absorption rate = If yes give date .g.p.d. Manhole/Access (Y/N) ~¢mu, p'~"~~~Pm~' level at* _ es tested: E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holdiog tank O11 lot Absorption field Public sewer main ; On adjacent lots Public sewer manhole/cleanout Sewer/sqa-i~scrviceline >' Z,.~:~t ~ .~vou,,lc4 Lift station ~I~B,~i~,~ ~,~CES FROM S~?/ff/I.~?;ING TANK ON L;2?~:on fiel~~ SEPARA rlON DISTAN~ ~~ ~tt:~//~/;/;~ Driveway, parkin~vehicle storag~ ~ m~ Vm ~ Wells on adjacent lots Property line F. ENGINEER'S CERTIFICATION itl conJbrmance)~(~HJA/~;le/~ne; in effect on this date. Eagineer'sName /--~W A. ~5 ...................................................................................................... HAA Fee $ J~ ~ ~ Waiver Fee $ DateofPayment ~/~//~ Date ofmaymen, Receipt Number /t~? 3~ ~ Receipt Number Rev. 8/95 OSS: haa.wk.doc DEI'T. O[F' ENVIRONMENTAL CONSERVATION January 27, ]984 437 £ Street Suite 200 Anchorage AK 99501 Mr, Alfred Sunqutst Anchorage Water & Waste~ater Uttttty 3000Arctic Boulevard Anchorage, Alaska 99603 Deer #r. Sunqutst: 'Subject: AIIHU Earlos L.I.Do 144 Se~er Construction (8421-DA-220) We have reviewed the plans and specifications for the subject project. The prlvate well to ae~er 11nas and manhole horizontal separation distances are watved as follows: T, odds Half Acre: watve well to manhole horizontal separation to 27 ft. watve ~ell to se~er horizontal separation to 25 ft. Lot It Bleck 1: Strawberry Patch Subdivision waive well' to se~er horizontal separation to 60 ft. watve ~el1 to clean-out horizontal separation to 55 ft. · Pail~el 16, Sec. 11~ T--12N R4#t S.H.: waive well to se~er separation to 55 ft. The-proJ~,Ct ts herel~ approved for construction for the 1time wtth whtch t!~t~i;l)ki~l~nt ts concerned. Thts letter coflstttutea the permtt requtred !W A.S~ 46'~03'.720(&) for approval of smverege systema. -]t~ld ~e ~re~d that ftnal approval wtll necessitate the submission ~r ~ ' · "~ti~..~_~' Ai~'tXl!.!~' PlOneo. Th. ts wtll Corlsequently mandate that a profo$- -.'/~ 'i~ , ~l~lIMIl~:C?.~uct baste 1Mpectton of thts project $o as to be able ,' : ~ 't~b]~ ~ff oh"lie betlt plans. Arrangement for thts Inspection ~ork t6 Envlromnental Engineer · ANCHORAGE WATEI~ ~; WASTEWATER 3000 Arctic Boulevard Anchorage, Alaska 99503 (907) ~te Pro~ect ~ngtneer 0£ Environmental Conservation 437 "E" Street (Second ~loor) Anchorage, Alaska 99501 Re~ Earles L.X.D. 144 Dear Nr. Reid, Anohorage Water S Wastewater Utility seeks A.D.E.C. approval ko ~o~t'runtw meintainw and operate portions of Earlee L.X.D. 144~ Sewer oloaer to drinking wate~ sources than established ~rm~,on distances specified in State Waetewater Disposal lt~g~l~iOnU~ la request of a regulation waiver, and in' eu~e~..rd~oeWith T~tle 18 of the Alaska Administrative Code, C~e~"?2,(ISAA~ 72.021.a), Anchorage Water and Weetewater lUkits the following information for your review and ~nsid&~ition. o£ garlee b.l.D. 144 lies within the 100' private drinking water sources (#ells) at These looation8 are illustrated on the drawing sheet 3 of 3 (attachment A) end Half Aore- approximate distance between the private wellaad pro_~eed sewer line is 25 feetl distance to p~posod alanhole S 2 is 27 feet. 2) StrlWborrYPetch Subdivision; Block 1, Lot I - diet~floebotween the private water well end proposod ll~e is SS feet~ distance to cleanout in 50 feet. 16, Sec. 11, ~I2N R4~ a.M. - apprmximete distends! the private wa~er well and pro~sed sMr li~ t~ ~ Within the subject well radius waiver areas, all sewer pipe will be 8-inch ductile iron pipe, ~lass 50, with a wall thickness of 0,27 and a working pressure of 350 PSI plus a surge allowance of 100 PSI. As this sewer line is a gravity system, the working pressure will be 0.0 PSI, making it ideal for construction within well radii. On a gravity system there is more static pressure on the outside of the pipe than on the inside, thus giving more concern to infiltration than exfiltratlon. Ductile iron pipe has a life expectancy greater than other conduit materials because of its structural strength and resistance to abuse, abrasive elements, and oorrosion. Nanholee and cleanouta constructed within the protective well radii are of special construction. The sewer line within the manholes is mechanically sealed and gaeketed to prevent leakage of eny~$ewaga into the manhole, subsequently preventing any leakage of sewage out of the special manholes. ~e Huniolp~l D~p&rttaent of Health and Environmental Protection wes able to. provide t~O Well ~ogs; each in the vicinity of the waiver~q~sst lites, The Niohaelis Well ~ indicates a depth of 302 feet. ~rles. Su~/vis/on~ ~t 2 shes a depth of 308 ~t. ~Vell ~$ reveal ex~ensive layers o~ d~ olay, .ba~p~u.~clOF~ ~oiOy gF~vel mixes~ providing an lm~mable l~r ~t~nthe 8~er pl~ and the source aquifer of these w!18.' ('eH at~chMnt B) ~hia o01tp!etls our ~equeet for a waiver. Should you require any · dditt~l /nforsation, or have any questions concerning the '. ~e' iafomti~ please contact the undersigned, An~hoceqe Mater 0 Maot~ater Utility at yo~r convenience. PeEe Waotswater Utility 0 0 CT&E Environmental Services Inc. Laboratory Division ~~~z~zT~7~-,~z~7~, Laboratory Analysis Report CT&E Ref.# Client Sample ID Matrix PWSID 0 962014.962014001 Hose Bibb Drinking Water Collected Date 05/23/96 Technical Director: Stephen C. Ede Sample Remarks: Nitrate-N Total Coliform Results QC PQL Qua[ Units Method Allowable Prep Analysis Init Limits Date Date 0.100 U 0 0.100 mg/L EPA 353.2 0 col/100mL SM18 9222B (DW) 05/29/96 EMB 05/23/96 TAV U - Undetected LT - Less than GT - Greater than D - Secondary Dilution J - Below the calibration range 200 W. Potter Drive, Anchorage, AK 995184605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 3180 Peger Road, Fairbanks, AK 99709-5471 -- Tel: (907) 474-8656 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA Dale installed SEPARATION DISTANCES SEPARATION DISTANCES FROM WELl. ON UOT I'O: Septic/holding tank. on lot bi Absorption field on lot Manhole/Access (Y/N) .~....j}m:nTr'On lcveTa!~._~ q~ump ofF' level at* High~~~' Datum . L. ' ~tested : On ad acent lots ~ ~ oD : On adjacent Iols ~ I 0 0 PuNic sower nmnhole/cleanout ~~ ~~DI~ANCES~ FROM SEPTIC/IfOLDING TANK ON LOTTO: ~ Buildin~mmda~ Propm tv line Absorption fi~d~ Water main/sm~ice line S~ff~e-~?'/d'a ge _~son adjacent lots SEPARA~ON DISTANCE FROM ABSORP~O~tgi?I~gN. LOT TO: Building foundation ~ Water m;mosmxdcc line ~ .... Surface Water ~ 3' e,-,,'* ..... t-my/vehicle storag~~ C~nin Wells on adjaccnl [o~s Property hllg LNGINEER S CERTIFICATION ! cert~9 that [ have determined thrufie[c~hi37Jection.~' and reviews, CE-7953 ,~J tIAA Fee $ Date of Payment Receipt Number Waiver Fee $ Rev. 8/95 OSS: haa.wk.doc ~ TO CENTER DF WELL = 7 FEET ~ TD CENTER DF WELL : 31,8 FEET B ~0 CENTER OF NH = 7%3 FEET C TO CENTER 0F MH = 51.6 FEET F WELL TD CENTER DF MANHOLE = 98,2 FEET (APPRDX,) W£LL' TO EDOE DF MANHDLE = 98 FEET (~PPRDX,) MANHDLE