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Home My WebLink AboutWONDER PARK #1 BLK 5 LT 8Wond r Pork Block 5 Lo1- 8 #006-292-23 Municipality of Anchorage Development Services Department Building Safat,! Division On-Site Water and Wastewatar Program 47C0 South Bragaw SL P.O. Box 196650 Anchora[;e, AK 99519-6650 w~wv. ci.anchorage.akus (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1, GENERAL INFORMATION Complete legal description Loc~tion (site address cr dire~ions) Current Property owner(s) Mailing address Lending agency H~# /L/,4~0~5-/ Expiration Date: /0[ Z ~- ]a~. Day phone Day phone Mailing address Real Estate Agent Mailing Address Day phone ~-/3 -7,0- Unless otherwise requested, HAA will be held by DSD for p.~ckup. 2. NUMBER OF BEDROOMS: ~ 3. TYPE OF WATER SUPPLY: · Individual Well 1~' Individual Water Storage [] Community Class __ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer [] [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representaticns given in paragraph 4 by an ~ndependent professional civil engineer registered in the State of Alaska. Certificates of He31th Authcrity A~.prova~ are required for the transfer cf title (except bob, yeah spouses) for properties served by a single-family on-site wastewater dis~'.osal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authcdt7 Approval are valid for 90 days from the date of issue for properties served by a pdvat.~ or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a pedod of up to one year with valid water samples.) Certificates are valid for one year for prol:er~ies sewed by Cl~sz A or B we!Is or a pubEc water sy-.tem. The Municipality of Anchorage is not responsible for errors or omissicns in the prcfessional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 vedfy that based on the information obtained fram the Municipality of Anchorage flies and from my investigation and inspection, the Ch-site water supply and/or wastewater disposal system is(ara) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Address ~'~ '~- c~L4~ Engineer's Pdnted Name DSD SIGNATURE ~ Approved for .-~ bedrooms. Disapproved. Conditional approval for' __ bedrooms, with the following Date stipulations: Additional Comments By: (Rev. 01/02) Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: '~/~'/~ ~ MnniCipnllty of AnchOrage Development Sewices Department Bufldlng ~sty OMslon Or~M Water & Wastawater Program 4700 8outh 8ragaw SL P.O. Box 196650 Anchorage. AK 99519-6650 www.cLanc~orage.ak.us (907) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Ifl~LL DATA Date completed IfA, B. otc provk:le PVV~ID # Parcel ID: ~(,:,- ~¢~'~.~ WellLog (Y/N) Y.-I Wires property protected fi/N) Totaldepl~ft. :' Casedto 12.~, f~ Caslnghelght(abovegmund) I/2- in. FROM WELL LOG AT INSPECTION . Well production g.p.m. /~ g.p.m. WATER SAMPLE RESUL'rS: Coliform ._(2~__colonles/10OmL Nitrate ~ I_') rog J1. Otherbectarta ~.t.,~ colonles/10Oml. Amenlc: ~-mgJt. Data of.mple: ~/_~- Co,ected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material · ~ Date installed Tank size ~ gal. ///,N~mber of Comperlmenta Cleanouta (Y/N) Foundation ctaanout.~ Depression over tank (Y/N) High water alarm (Y/N) Date of pumping/// Pum,r C. AB$ORPllOR FIELD DATA Data installed ~ Soil rating ~.p/,~/~. or ~Fedrm) System type Lengt~ It. , .,~ ft. Gravel below pipe ft. Totei dep~ ft. Eft. ~,s/~tion area ft; Monitoring lube Depression over field Date of adequacy test / Results (Pass/Fall) ~ For bedrooms Fluid depth in absorpti/~ffleld before tast in. Water added__ gal. New depth in. EtapeedTime:~z~~nalfl.ui_dd._Tp.~' , in, Absorption rate >= g.p.d. Any rejuvenation treatment (pest 12 mo.) (Y/N & type) If yes, give date Do I IFTSTATION Date i~stelle:l 'Pump on' level at in. Datum E. SEPARATION DISTANCES Size in gallons~'~ 'Pump .~el at in. Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/~ft station on lot ~/~ Absorption field on lot Public sewer main ~ sewer Ise~c service line On adjacent lots On adjacent lots N/// Public sewer manhole/cleanout Holding tank ' SEPARATION DISTANCES FROM 8EPT1C,/HOLDI,~TANK ON LOT TO: eu, .g U.dation . .o. on fie,d Water main . WateTP6dce line Surface water Wells on adjacent lots · SEPAl,. TION OlS"~'ANCE FROM ABSORPTION ~ ON LOT,To: · ' I~mperty line . ' eull~!ng four,on . Water main . CUrlaln.~lralo .Wells/~di~c~nt k~s ' . F. COMM~fr~ G. ENGINEER'S CERTIFICATION I cerUfy that I have determined through field inspectfons end mvfew of Municipal records that the above systems are/n conformance va~h MOA HA4 guidelines in effect on this date. Engineer's Printed Name ~ Oget.1. c:~rv ," ~l~.~.~ Date 7'-/..~--'C) ~ $ Receipt Number ,,~.~ I1~"' (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number J~-72-[~2 C4:037M ~:RO~-CT,tE EIIVII~I~Ik'NTAL SflV ~,d~t~ssn. CT&E Envl~tag .rv~ Inc. ,al OCT561530! T-059 P.OZ/'I~3 F-191 C'T&E ltd.# 102434~001 CUsat Name Tobben Spur~a..xJ Project t',;ara.~ Wonder Park Cliff Sampl~ ID Lot 9 Brock $ MatrLz D~¥~-g O~ered By San~pte Re,~ark~: All Dar e~Timt~ are Alaska Standard TIm~ I'r~t~l Dm~i~ ~,~0~ 14:46 CoUe~ D~ ~/15~0~ 12:30 ~elv~ Dat~l~ 07115,~ 14:30 Tethnlc~] Director 1.00 U Al~o',,"~'le ~ Analysis Limiu D*m D~ ~it 1.00 m~/L EPA 300.0 (<10) 07/19~2 xicrob~olo~' LaboracorF T~I Celiform o c~l/t00mL SMl8 ~222B 0711~2 KAP 07/23/02 TUE 16:43 FAX 2739¢45 .... PRUDE.',ffIAL ~00t .. *' "' &~.BUILT "NO CORNERS SE'rEIS Dill , ~.-',~'~"~'i.',,... I hereby certify ~aI I have performed a Mo ee$ in ection ~ ~. ~ ...~ e~r~ on me ~re~s In question and ~at ~ere are no .~.~ ~ted at ~ora~, P~T ~E N~ SH~ HERE~. ~.~ ~ (~ 24~1~ (;REAT].~R ANCHORAG[~ A.~,A BOROIJC:H !)eoartment; of Env~ro~rr~eng,~'~ Qua!~gy 3500 Tudor Road, Ancho'~rage, Alaska 99507 279-8696 Date Rec:e~ved. ~ ~3 Time of Inspection ~.'dO ~, REQUEST FOR APPROVAL OF INDTVII)UAL SE~IE2 & ¥.~ATER FACILITIES " , . 5. Type of Fac. 11ty to be Inspected: Number of 9edrooms~ 6, Well Data: ,A. Type ..... A. Installad B. Instal]ar C. Septic Tank'. 1, Size 2. Manufacturer D. Seepage Pit: 1. Size 2, l~aterial E. Disposa} Field: Total Length of Lines 8. Distances: A, Well To: Septic Tank , Absorption Area · Sewer Lines Nearest Lot Line , Other Contamination B. Foundation to Septic Tank "~ Absorption Area C. Absorption Area to Nearest Lot Line Approval Vel. id Cot One Year From Daf;e Siqne~ Greater Anchorage Area ?,orouoh, Department of E;~vironmental qua!~.~y I)'IAGi~AM OF SYSTEM I certify that the information contained tn this request for approval to be a true and accurate representation of the subject sewer and water facilities located at: Signed Date