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HomeMy WebLinkAboutT15N R1W SEC 19 LT 36T15N, R1W, 5¢ction 19 Lot 36 #051-241-30 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, At( 99519-6650 www.ci,anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ('~.5 l-'~c~ c¢ /- ~-~) HAA# /,/Cz_oil.(' [',,;~ L~ Expiration Date: GENERAL INFORMATION Completelegaldescription Lot 36, T15N, R1W, Section 19 Location (site address or directions) 19342 Klondike Drive Current Property owner(s) Madeline Boyd Mailing address Dayphone 694-9125 Kathy/Greatla~5 Lending agency Mailing address Day phone Real Estate Agent Greatland/Kathv Geraci Day phone 694-9125 Mailing Address ~//Z ~ Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:' NUMBER OF BEDROOMS: 2 I //~/~' o TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates cf Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independen: professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipalit) of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72 025 fRev 01 001' 5. 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 based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address S & $ ENGINEERING 17034 ~.~gl.~ ~.,,,~ I a~!~ ~e.~rI Nm 504 Eagle River, Alaska 99577 Phone ~;. ~1 ~/ - ~ ci 7 ci Date ///7/~.,.,. ,,¢.,~., ,,,~:..._, ,.. z,,, · ,%... .... ,~ ,-, __ bedrooms, with the following stipulations. Engineer's Printed Name Robert C. Co~an DHHS SIGNATURE Approved for ~ bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Original Certificate Date: Reissue Date: 72.025 tRey 01 0Ol' Municipality of Anchorage Department of Health and Human Servicebx E C E ! V E Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 NOV 0 ? 2000 www. oi.anchorage.ak.us (907) 343-4744 MUNICIPALITY OFANCHORAGE ENVIRONMENTAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: ~ 7- 5(~ ]' ~l-l ~ h,J ) ~'~1 t,~)' ~/l q ParcelI.D.: __ A. WELL DATA Well type ~'~,,~/Y'/~ 7-~-- Date completed (//W Total depth ~//V/~- ft If A, B, or C provide PWSID # __ Sanitary seal Cased to ,~) / ft FROM WELL LOG Date of test Static water level ~\~ Well production / g.p.m WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Date installed//~-~ Tank size Cleanouts ~'(.~ Foundation cleanout Date of pumping . /©/~7~ C. ABSORPTION FIELD DATA Well Log .Al c~ Wires properly protected Casing height (above ground) / '(/- in. AT INSPECTION g.p.m Nitrate ('~. ~ Collected by: mg/I Other bacteria ~ colonies/100 mi & S F.'NGINEERING ;~034 ~J~gle River Loop Road No, 2_0~ Ee~l~e ~iver~ Alaska 99577 /~/~ gal Number of Compartments ,~4~ Depression over tank Pumper Date installed /¢ ~'~ Soil rating (g.p.d./ft2 or ft2/bdrm) /7~ ~ System type ~-,~v'c:/-,~ Length ('¢// ' ft Width -.~ / ft Gravel below pipe ~:/ / ft ..~ / // Total depth .o/~/~ ft Effective absorption area ~fF Monitoring tube ~------~ Depression over field~ Dateofadequacytest//_~,¢~ Results~) ~ For ~-bedroo~.s~,, Fluid depth in absorption field before test ~ in Water added/~-~"~ gal, New depth in. Elapsed Time: //~--' min Final fluid depth ~-/~/~ in Absorption rate >= :~.h g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ,/v/~-Xv'c~ /~v'/_,'z~/v' If yes, give date __ 72-026(Rev. 01/00)* LIFT STATION Date installed . Siz. c-~allons "Pump on" level at ~--i~"Pump ~ff" level at __ Datum .~J \ Cycles tested in E. SEPARATION DISTANCES Manhole/Access High water alarm level at in Meets alarm & circuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septictank/lift station on lot /,¢~ ~ On adjacent lots Absorption field on lot ,/07~ /¢ On adjacent lots Public sewer main /t/J.,~ Public sewer manhole/cleanout Sewer/septic service line ,~ ¢- / ¢- Holding tank SEPARATION DISTANCES FROM SEPTIC/I-I~b~I~I6 TANK ON LOTTO: Building foundation ~- ~- Property line ~- '¢ Absorption field Water main /~//J,~ Water service line /? §- Surface water Drainage ~)/ /7 Wells on adjacent lots // SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /"0 '~/- Building foundation /~¢) /.w- Water main OU;~//,~_ Water Service line /~ /'/~ Surface water /0~ ~¢'- Driveway, parking/vehicle storage Curtain drain ./?¢W~ ~/.n4//t/ Wells on adjacent lots ./¢7~ ~ /~ ¢- F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name ,,'/~)~ ,~./t T C. Date /! HAA Fee $ _~"'~!~), Date of Payment //--~ Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 01/00)* 10-19-00 09:00 F ROhI-CTE ENVIRON~NTAL 5615301 T-E80 P. 04/0§ F-G92 ~tk 'CT&E Environ mental Se tv ices Inc. Laboratory Division 111~~ffil~l~4mr~-~'j~,~-~'~'~'~'~'ar~'~'~'~'~'~ 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria,.~:^"°bnr"~°' READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Fax: 1fl07) 661-B301 MUST BE COMPLETED BY WATER SUPPLIER ' TO BE COMPLETED BY LABORATORY 13 PUBLIC WATER SYSTEM i.D, # 13 PRIVATE WATER SYSTEM F3 Send Results 13 Send lnvolce 17034 Eagle River Laap Road No.~I~ Fl Send Results F1 Send Invoice SAMPLE DATE: Month SAMPLE TYPE: Routine Repeat Sample (for routine sample with lab reL no. _ 13 Special Purpose SAMPLE LOCATION L ~'1 [Z. cvtq~ttr..e_ ~1 006-4O Day Year 0i Treated Water Untreated Water Time Collected Collected By SsiS shows this Water SAMPLE to all,factory [] be; Unsatisfactory Sample over 30 hours old, results may be unreliable Sample too long in transit; sample should not be over~l~aoars old al examination to indicate reliable results, please send new sample via special delivery mail. .a,..eee,.ed Time Received - t AnalyticaIMethod: ~Membrane Filter D MMO-MUG Number of colmties/100 mi, Lab Ref. NO. Result* Anhlyst Sent to A.D.E.C. Anch Fbks Jun [] Faxefl Date: Time: Client notified of unsatisthctory results: Phoned Spoke with Dale: . Time: Faxed Comments: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coliform E~ Coil Membrane Filter: Direct Count ~'~,~) __ Colonies/10O mi Verifieatlom LTB BGB COLIFIRM Fecal Coliform Confirmation Final Membrane Filler R.g~F~ ~_,~ Coliform/100 mi ~.~ MemberoftheSOSGraupiSoel&tdG6naraledeSutveiflanael ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, [LLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA 10-1§-00 08:§§ FRO~-CTE ENVIRON~NTA~ ,~t~, C T&E Environnlental Services Inc. 56]5301 T-680 P.02/O§ F~G92 1006408001 S & S Engineering N/A L36 Klondike St, Drinking Water Client PO# CT&E Ref,# printed Date/Time 10/18/2000 12:18 Client Name Collected Date/Time 10/12/2000 15:30 Project Name/# Received Date/Time 10/13/2000 9:30 Client Sample ID C. Ede Technical Dlrectqr · Stephen.. Matrix ~ ~ Ordered By Released PW~ID 0 Sample Remarks: Allowable P~ep Analyst5 Parame~;er Results PQL Urtit~ Method Limi~ Date Date Init Water~ Department Nitrate-N 0.500 U 0.500 mg/t EPA 300.0 10 max 10/13/00 SCL Microbiology Laboratory Tota| Coliform col/100mL SM18 9222B 10/13/00 JDT ~_~MUNICIPALITY OF ANCHORAGe. He; hh and Environmental Prot¢ ~ion Fourth Floor West .~ 825 L Street Anchorage, Alaska 99501 264-4720 SEPTIC TANK: DISIANCE--I~~---' / NUMBE~I OF FP, OM Wi LL ~ MANUFACIURER '~'~ MAFERIAL ............... COMPARTMENTS )---' -- INS!DI LENGIt,I ....... INSIDE WIDTH ........ LIQUID DEPTH LIQUID CAPACITY/g~-~5 GALLONS. TILE DRAIN FIELD: TOTAL LENGTH NEAREST L.OF LINE ................. OF LINE _ ~ of Lines ...... DISTANCE BETWEEN LINES ..... TRENCH WIDTH-.~- IN. TOTAL EFFECTIVE /'.,~S~C);(F11ON AREA ~ SQ. ~ f. LENGTH OF EACH LINE DEPTII OF FILTER ; ',3FPI',I: lOP ()t JILL 10 [INISII GRAI)E MATERIAL BENEAIH TILE _~' ~. ABOVE TILE--- SEEPAGE DIAMETER OR WIDTH EENGTH ,, DEPTH Log Crib Rings Crib Size: DIAMETER .... DEPTH._.__ DISTANCE FROM: WELL_ _. TOTAL EFFECTIgE NEAREST LOT LINE_ __ ABSORPTION AREA (WALL AREA) SQ. FT. }11 Lass: Depth: ~11 Distance To: Lot Line Ldg: Sewer Line: [pe Materials: of Bedrooms: ]staller: ~marks: DATE January 4, 1978 Paul E. Payeur Box 200 Klondike Street Chugiak, Alaska 99567 Subject: Lot 36 Section 19 T15N R1W Permit #77826 A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, Health and Environmental Protection Sewer and Water Section F' L-J~i'. M ]. 't LCIC:AT 1 ON PFIIJL E I-H*rELIN. E:U. ~:i~ k:L..ON£:,.~I'4:E ::,1 C:HU(3IFIkl L3T .:,I~.,E, 'L'2P_OC~O ~;I~-:!i_tFIRE FEE-I Eld 1:,. ,: ............. .,r:, ', '-,-:1.70 = 2!: _,IJIL h.'ldTJ:.J"~13 ':'-,~-~ Hi, I:N .... i l-tE LENGIH DIMENSION ']HE I::,PAI-'IH tip FI iRENCH OR. F'II' ZL5 "iHb. t;,]2.:;i'RNCE BEi'I4EEN i'HE SURFRCE UF THE GROUND RND IHE ~CI[1EiM OF 'IHE EXCRVBI1ON ,::IN FEE]'). i'HERE lb NO SEI [41[.)i'H FOR I'RENCHE5. IHbL UNR',/EL DEPTH i2; THE MINIMUP1 DEPIH OF 8RRVEL BET[4EEN 'file OU:I'FRLL F'~PE NND tHE BOIIOM OF ]FIE EXCR',/R]]:ON (IN FEET). td PHCKRt_-iE PLI:tNF MPI'T' DE I NS1FILLED FIT THE PERM iT'I'EE'"S OPTION SUBJECT T'O I'HE I-uLLt]F41NG CONDi'~tONS: i. E):t'HER t4 CLRS$ ]: OR I1 NSF FIPPROVE[:' PLRN] MR"r' BE IN..CJTI:~LLEC'; 2. Ft CONiiNUOUS MRIN'FENFtNCE RGREEMENT iS RE6)UIRE[:'. iF' R HRIN'I'ENRNCE MGREEFIENf' IS NO'I KEPT CURRENI' "r'OU FtBSORP'IION :S'¢S-I'E:M F~N[:',-'"OR '¥'OU MR"r' BE SUE,'JEC'F 1'O PROSECUf'iON. ,", ,~: ...... ,. . 1HI,_, E:HC:I'::]- 1 LL ~ ;",IG CIF" FIN'¢ --,'r _. t Ef I !-4'[ 'i HL)LIT F' Z NFIL ]: NE;F'EC:"I~ i ON I::IN[:' FIF'F'R. Ok"RL B"P E,E bI..IE,.JE_.] T{) I--~,_..,E_.I_II L:,EF'IflI'4:I f'IENT ~.,,I ~ LL '" .... ' ' "" ':' ' - LN ,_,1 IE :~E!..IH.~E b,[_,FL_,HL _,'r_, EH "" f'i 1 N i f,IL.IP't i):[ L'~;'i FtNCE E,E. 1 £iEEI'4 FI PJELL. Pli"t[:~ FIN"r~ ' · -~: "- '" ' ' '"' ':" "" '::" ~-~ ":' : ' :1.~:10 P'EEi F' t4' FI FN..L~,HIE 1.4ELL ltI~' ;?~4~4 FEET f-.h FI F'LIE:LIC I' triER 14tE[::g..iif~'.EMENI'L4 MFI'?' FIPF'L"r'. '~F'E".:iF]'2FIT[ INS; PIND '.]CINS"I'N'. 'z'i'I3N I)IFtl3RFII"I~; FIRE FI',,,'t-tJ. LHE~LE-i'0 IN_,Ltl4..E F'R"PE'I4' II'.4S;THI_LFIT.[CIN. _ =,E~4ER_, FIND ~JELL- SET t:URiH b?'r' iHE MLINtC:IF'FILZ'I"r' CIF FINC:HORFtGE. 14:E:%~(I)ENC:P-J:~RE;P'IOE)EL~E[:' '1-O ):NC:LU[:'E MORE IHFIN ~ BEi)RCIOi'"I%. 0 OEtE GEO, ECHNICAL Et DEVEL,~PMENT Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 CO. Russell Oyster Ear/Ellis 694-2774 SOZL LOG 6ee-2~80 Soils ~ Foundations Land Development Performed for: Name: ~/)~/-. ~:-. ~-~0~ Tel. No. Hatltng Address:~ ~/~'~'*- ~ ~/~/~/~' Legal Description: Depth (feet) S011 Characteristics 2 ; 5 6 7 8 9 10 11__ 12, 13 15 Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No ~ If yes, what depth~ Drain Field~