Loading...
HomeMy WebLinkAboutT12N R4W SEC 10 LT 40 S50'T12N, R4W, Section 10 Lot 40 $ 50' #011-213-30 ParcelI.D.# MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 198650 Anchorage, Alaska 99519~650 (907) 3434744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING .CO I, 011-215--~-J5-- HAA# /~/~C7_.('~' ~ 1, GENERAL INFORMATION Complete legal description T12N, R4W. SEC 10: LOT 40 S 50ft Location (site address or directions) 884o GLORALEE ST. ANCHORAGE. AK 99502 Property owner Mailing address Lending agency Mailing address DIANNE DUVALL c./o PRUDENTIAL VISTA 4241 "B" STREET ANCHORAGE. AK 9950,3 Day phone (9o7) 727-1o51 Day phone Agent INGRID KIDD w./ PRUDENTIAL VISTA Day phone (907) 727-1051 Address 4241 "B" STREET ANCHORAGE. AK 99505 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5 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 wdtten confirmation from State ADEC lng to the legality and status of system. 72-025 (Rev. 1/91 ) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $800.00 at, or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As cedified 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 compliance with all Municipal ar'Jcl State codes, ordinances, and regulations in effect on the date of this inspection. ~ Name of Firm ALASKA WAT~ VC~;TE~A;FERI ,/~/ I CONSULTANTS, INC. Phone (907)337-6179 Engineer's Signature LA..._ ',~U __ -/,, In conducting this evaluation, AWWC, Inc. ¢¢e~nP,~ ~ ,o provide a thorough, conscientious engIneering anaiyais of thE, system in accordance with ADEC and MO~DHHSI Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of fhe test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local coils condition, ground water 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 avaluator 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 for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. 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 authorized, nor will it confer any legal right whatsoever. 6, DHHS SIGNATURE P"" 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 Cedificates 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. 72-025 (Rev. 1191) Back MOA ¢Y21 Computer Version OCT 0 3 2000 Municipality of Anchorage DEPARTMENT Of HEALTH & HUMAN S~l'~.,~,y 0F ANCHORAC,~J~I~, Environmental Services DivisiOn ENVIRONMENTAL sERV(CES 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 - i~"~.~ Health Authority Approval Checklist Legal Description: T12N, R4W, SEC 10; LOT 40 S 50ft Parcel I.D.: 011-213-55 A. WELL DATA Well Type PRIVATE Log present (Y/N) NO Date completed Total depth 51 '+ Cased to 40'+ Sanitary seal (Y/N) IfA, B, or C, attach ADEC letter. ADEC water system number PRIOR TO 2/6/79 Casing height (above ground) 25" YES Wires propedy protected (Y/N). YES FROM WELL LOG AT INSPECTION Date of test - 9/22/2000 Static water level - 48' Well production - g.p.m. 4.4 g.p.m. WATER SAMPLE RESULTS: O. 5 liy~/L- Other bacteria O Coliform Nitrate Date of sample: 9/25/2000 Collected by: A.W.W.C., INC. B. SEPTIC/HOLDING TANK DATA Date installed Tank size mper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p d/ft2 or ft2/bdrm) ~/N). High water alarm (Y/N) System type Length Width_ Gravel thickness below pipe ~'1~ept~ Effective absorption area Monitoring Tube~sion over field (Y/N) Date of adequacy test ~/Fail)__ For Bedrooms Fluid depth in abso~n.); I ~m ..ediatel~ after, gal. water added (in.): Fluid depth /(~ later: Absorption rate = ~ent (past 12 months) (Y/N) If yes, give date 724)26 (Rev. 3/96)* Computer Version D. LIFT STATION ~ Date installed Size Manhole/Access (Y/N) ~at* "Pump off' level at* .*Datum E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main 50'+ Sewer/septic service line 25'+ (N/A: PRE 1982) On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Lift station 50'+ N/^ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Property line A.~.~~ Water main/service line Surfac~ w~r~-'""~ Wells on adjacent lots M ABSORPTION FIELD ON LOT TO: Property line Surface water Building foundation ~ Driveway, parking/vehicle storage area F. ENGINEER'S CERTIFIC I certify that I hay. e~; of Municipal re~'ords /A with MOA HA~ guld~ Signature Engineer's Name Date ?eld Inspections and review ,systems are in conformance on this date. JEFFREY A. GARNESS Wells on adjacent lots / HAA Fees ~O~' O~) Date of Payment ? O/.~ ./~ © Receipt Number ~-~ (_% O7~/ 72-026 (Rev, 3/96)* Computer Vemlon Waiver Fee $ Date of Payment Receipt Number 10-02-00 10:31 FROM-CTE ENVIRONMENTAL 5615301 T-888 P.O2/O3 F-578 CT&E Environmental Services Inc. Laboratory Division ~.w-~e,j~-j~'JJJfJ, a-.e,~'~J,~ Laboratory Analysis Report CT&E Reft# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 1005772001 AK Water & Wastewater Consultants T12N,R4WSecl0,Lot 40-S 50fi T12N,R4WSecl0,Lot 40-S 50ft Drinking Water Clienl PO# Printed Date/Time 10/02/2000 17:50 Collected Date/Time 09/25/2000 19:45 Received Date/Time 09/26/2000 8:50 Technical Director Stephen C. Ede Released ~ ~ Sample Remarks: Allowable Prep Analysis Parameter Resaila PQL Units Method Limils Date Date Init Waters Department Niirate~N 0.500 U 0.500 mg/t EPA 300.0 10 max 09/26/00 SCL Microbiolo~y Labora~or~r Total Coliform col/100mL SM18 9222B 09/26/00 JDT 20OW. Potter Drive, Anchorage, AK 99519-1005 --Tel: (907) 562-2343 Fax: {907) 561-5301 3180 Peger Road, Fairbanks, AK 99709-5471 -- Tel: (907) 474-9656 Fax: (907) 474-9689 10-0~-00 18:31 FROM-CTE ENVIRONMENTAL 5615301 T-888 P.03/03 F-5T8 CT&E Environmental Services Inc, Laboratory Division ~~r~.er~r~,.e-ll.e,l~:e,~,~r~e 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria A.o,o,e.u. Tel: (907) 562-2343 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING, S.~MPLE Fax: t907} 561-5301 MUST BE COMPLE'rI~D BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY- PUBLIC WATER SYSTEM I.D. # PRIVATE WATER sYSTEM ~ SendRes#lo Send Invoice City ~ SendResu~l f~ Sendlnvotet Month Day SAMPLE TYPE: ~I~ Routine [] Repeat Sample (for routine sample with lab ref. no. ) [] Special Purpose SAMPLE LOCATION Tr~-~J 'g4~c. lo b~/4o-S soft Year [] Treated Water ~ Untreated Water shows this Water SAMPLE to he: tis factory Unsatisfactory [] Sample ever 30 hours old, results may bc unreliable [] Sample too long in transit sample should not be'over~hoars old at examination to indicate reliable results. Please send Analytical Method: ~/Membrane Filter [] MMO-MUO *. ~umh~r nf enlnnies/1 O0 mi. Result* Analyst 100577 ~x~d Date: Time: Client notified of unsatisfactory results: Phoned SpoRe with Date: . Time: . Time Collected Collected By Foxed BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coliform E. Colt Membrane Filter: Direst Count ., Colonlesll00 mi Verification: LTB BGB COLIFIRM. Comments: Reported B~~-''°ate ~~ Member of the S~ Group (Soci~t~ G'~narale da Surveillance) CN~RONM~NTAL FACILITIES IN ALASgA, CALIFORNIA. FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA Coliform/J00 mi