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Home My WebLink AboutWENTWORTH BLK 2 LT 2Wentworth Block 2 Lot 2 #008-023-27 � C��v�iapm>_n�� Serviczs Geparrmen� Euilding Safety Jivisian -,'00 3ragaw 51 PSet ?.0 Sax 195,50 99519-6650 AarF a_akh IViavcr muni.arefnn=_ire (arji) 19-.-,go4 Pump Installation Log IT Drillin° Permit L�'Tumber! SW_ Date of Issue: _ .cel Identification Number— "a 07 ..er al Des Name &Address: T Wo0tit . /,�4ubTY . a Dnstsllation Dater/ ;?— np Intake Depth Below Top of Well Casing:�s feet np D/I m facturer's Name: J« l np 14tod4: e. hp ,ess kdapter Burial Depth: Ap feet - -- ess .adapter Manufacturer's `Tame: .ess � dspcer Ins`�ller: np Installer (ame:� dation: The pump mst Uershall provide a pump installatian lag to the D5D within 30 days of pump matadatiom- Municipality of Anchorage °E Development Services Department Building Safety Division s. On -Site Water & Wastewater Program 470South , St. � C P.O. Box 196655 0 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us r (907) 343-7904 kL CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 008-023-27 HAA# -,4�a U 4(:) 1. GENERAL INFORMATION Expiration Date: 111 q P -mg Complete legal description WENTWORTH S/D, LOT 2, BLOCK 2 Location (site address or directions) 3320 E. 41ST AVENUE Current Property owner(s) DARRELL HILL Day phone 561-7553 Mailing address Lending agency Mailing address Real Estate Agent 3320 E. 41ST AVENUE * ANCHORAGE AK 99508 Day phone BARBARA BOWDEN W/PRUDENTIAL VISTA Day phone Mailing address 4241 "B" STREET * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 562-3300 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 Bwells 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, 1 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd, attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 served by the system. These conditions are outside the control of the evaluator of the systema Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. 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 benerit of theowner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. Phone 337-6179 Date_ !Q' DQ' --- 5. DSD SIGNATURE Approved for bedrooms. Disapproved. p k NUTY � kpF�Pr�¢ Conditional approval for bedrooms, with the filowing stipulatio\G . • °' ., 4ijv KK DYgs iERyN • ooh TA? Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other By: -4 , UM, C, Original Certificate Date: (Rev. 17101) municipanty of ACrcnorage Development Services Departr-nent Building Safety Division` ..:::..._ b bout ragawAI'V " ox norouge A"i 951 anchorara ge ak`us" MIS EALfiH AUTHORITY APPROVAL CHECKLIS Iescnp ion: D L"OT 2 B3"1LbC)f1a�cel 008- __ � � OC PfOVide # N A WeII Loa !V/M NO 8 ipawnar �uctr/N�ession over tank (Y/N) High water`alarm (Y/N)� — Pumper EPTIC/HOLD(I,NG,,T",N"kON LOT TO pUBLXC SEWER CERTIFIUAIIVN 7aVO determined through field'inspections icipal records that the above systems are in with MOA HAA guidelines in effect on this date. ... L 2 1 e r A. amess., "JEFF i;ied7, - , , , EY A. GARNESS a E-7953 f o4 - Date of Payment Receipt Number 07-19-04 12:04PM FROM-CT&E ESI, SGS ENV SERVICES SGSRefH 1044021001 Client Name Garness Engineering Group, Ltd. Project Name/H Wentworth, L2, B2 Client Sample 1D Wentworth, L2, B2 Matrix Drinking Water Sample Remarks: Parameter Results PQL Waters Department Nitrate -N 0.100 U 0.100 Microbiology Laboratory Total Coliform 0 9075615301 T-123 P.02/03 F-273 All Dates/Times are Printed Date/Time Collected Date/Time Received Date/Time Technical Director Units mg/L EPA 300.0 col/IOOmL SM20 9222B B (<=1 0 Standard Time 07/15/2004 16:21 07/12/2004 8:25 07/12/2004 8:50 StepheWIC. Ede Prep Analysis [Dere rl.ra it 07/12/04 JJB 07/12/04 DKC 08/09/2004 15:36 9072737380 BARBARA BOWDEN EAST FORTY FIRST AVENUE I„ o 0 PAGE 02 BUILDING ON SKIDS 0.9 4.0 10' UTILITY EASEMENT N 89659`00" E 27 1_ 28 121 OROC.ED ems: BARBARA B O W D E N EXCLUSION NOTES It In the owners' raeponallity to determine the existence of any easements, covenant, or restrictions LEGEND: SET FND with PRUDENTIAL VISTA which do not appear on the recorded subdivision plot. NOTE; Under no circumstances should any data hereon be 5/e•Re w/CAP® a/e' R, O 125° ALMON. O MONUMENT Used for construction Or for establishing property lines. .. FENCE- ----x— x — SURM' CERTIFICATION: LANTEGW has canducted a OVERHANC- physical surest' of this property ae shown on this dn andwIthl that the Iamftplyv"ments WOOD DECKS- am*Irq situated there n the CONCRETE - mento exist Other Ghon noted. and n0 eng000h- ASPHALT - LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS a S — B U I L. T Q Fo LEGAL DESCRIPTION! SEPTIC STANDPIPES- WATER aa0 WEST BENSON BLVD. # 103 WELL - ANCHORAGE, ALASKA 99503 woRX oRDm NuuttER: (907) 562-5291 LOT 2 BLOCK 2e oATc � auLr te, 200! t^.20' 2004 -L -272A GBerDMD „ >, (fax) 561-6626 SUBD 3-5 31.oe4 WENTWORTH MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services 44 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. #�` 023 Z> 1. GENERAL INFORMATION Complete legal description Lot 2; 13tock. 2; wentwo)tth Subdiv.i6i.on Location (site address or directions) 3320 E., 41st Avenue Anchorage, AK Property owner Duane and Carrot Hunttey Day phone 563-6532 Mailing address 3320 E. 41st Avenue Anchorage, AK Lending agency Day phone Mailing address Agent Kathi. Johnsonl JACK WHITE CO Day phone 762-3123 Address 3201 "C" St)teet, Scute 100 Anchorage, AK Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rov.1/91) Front MOAR21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT Z if( -()CK Z Parcel I.D. wEN� w�2�H s v A. Well Data Well type PIZIVKI-tz�— If A, B, or C, attach ADEC letter. ADEC water system number NIl} � Date completed /t<ce Driller U�/< Log present (Y6 Total depth U. ! d 4a ` f Casing height 2` Sanitary seal (Y/) f tt Date of test Static water level Well flow Pump levell Case to FROM WELL LOG Wires properly protected (9N) ` 6' l AT INSPECTION LZ Pu c i alow Toro of ci+SiNGm d 5,G -9 -P.M. w 3Z' r" w SEPARATION DISTANCES FROM WELL TO: ?Y Cir Ict? Septic/holding tank on lot IIIA ; On adjacent lots 1111A Absorption field on lot NIA ; On adjacent lots A11A Public sewer main /s �" Public sewer manhole/cleanout /00 Sewer service line 0S rt Petroleum tank IVUIU&r l;, vQwiu WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA FU6 C-/ L led Cleanouts(Y/N) High water alarm (Y/N) Date of pumping SEPARATION DISTANCES FROM Well(s) on lot To property Ii Su -w ate (3193)' Front Tank size _Collected by: S CwFYL Other bacteria Compartments cleanout (Y/N) Depression tested TANK TO: adjacent lots Foundation field Water main/service line CONTINUED ON BACK PAGE COMMERCIAL TESTING & ENGINEERING CO. k ENVIRONMENTAL LABORATORY SERVICES SINCE 1908 REPORT of ANALYSIS Chemlab Ref.# :93.2658-3 5633 e STREET ANCHORAGE, AK 99518 Client Sample ID :L2 B2 WENTWORTH S/D TEL: (907) 562-2343 Matrix :WATER FAX (907) 561-5301 Client Name :S & S ENGINEERING WORK Order :66959 Ordered By :RAY SHAFER Report Completed :06/14/93 Project Name Collected :06/09/93 @ 13:15 hrs. Project# Received :06/09/93 @ 14:00 hrs. PWSID :UA Technical Director:STEPHENC. EDE By /Released : -/— Sample Remarks: SAMPLE COLLECTED BY: SS. QC Parameter Results Qual Units --------------------------------------------- Nitrate-N 0.10 U mg/L Allowable Ext. Anal Method Limits Date Date Init EPA 353.2/300.0 10 06/10 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than QN3137 Member of the SGS Group (Societe Generale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA