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Home My WebLink AboutCOLLEGE PARK BLK 2 LT 12Coil Pork Block Lot 12 #006-242-02 :~ ::~ :' ~ ..PERMIT and .... CERTIFICATE OF APPROPRIATION LAS 191-C ~l/e ~tnte mf Jkla~ku, pursuant to AS 46.15, the Alaska Water Use Act, ~s amended and the regulations promulgated thereunder grants to ':'i':':::' :" "the ~ight to the use of 500 ~mestic use. ....~,..-: ,~, .'"., ........ ..~ . :~.: from the public waters of the State a. The location of the water source to which ~. granted appertains is a drilled ?~!1~~ 76 ~.e~ deep, with±n Lot 12, Block 2, Co]_lcge ""i?:'~:i; ..'Subdivision, said lot ~oda¢~ within ~SW~ Section 23, To, ship ' 13 North";::Ra~: '{;'i~:.q ,,¢;,. -.. :..... '..'.. ~..: '0 . and the water right shall be appurtenant to that certain tract of real property described as follows: Lot 12, Block 2, College Park Subdivision, said lot located within NW¼SW¼ Section 23, Township 13 North, Range 3 West, Seward Meridian. Priority of appropriation began December 7, 1982 . The water right is subject to the provisions of AS 46.15.140-160 and applicable regulations which deal with abandonment, forfeiture, and reversion of appropriations, preferred use, and transfer and change of appropriations. i Ille tate of Alaaka, '~)ivision of:~fmxxt, Land and Water Manageme~. pursuant to AS 46.15, as amended, issues this Certificate of Appropriation on this ,~ 7~r.¢~ day of ~,J~/~4.¢ A.D. Land and Water Management State of Alaska before me, the undersi · .. y me to be the Director or his ment of Natural authorized representative of theD~visi0n of g~ .s~.~', Land and Water · ~ .;?~:,;,..~, '~ ,~ . · · %-::...';,.~*;." ' ', .;' 7 ;;-*:~ Resources, and acknowledged tb'me that he.~ecuted 'the: f0rSgoing )ehalf of said -'~ -;, ,,' ~ ~;~%~ '::.C?~ State, freely and voluntarily and for the us8 and purposes therein set forth. ~n ectimnnu Oerenf, l([~'¢'e'hereu;io set my hand and affixed my offical year in this Certificate' irst, s v(a¢;~;~,~ , "' . :-,~., .. :'" .... NOTARY ~U~ ~n and for the~tate of Alask~ My Commission Expires: ~~': 'l l PURSUANT to AS 46.15.160 and applicable regulations the certificate holder shall notify the Alaska Divi- sion of ~ Land and Water Management upon CHANGE OF ADDRESS or TRANSFER OF ANY REAL PROPERTY related thereto. LAS 191-C 10-190 Rev. 6/79 BESSE, EPPS & POTTS 2220 EAST 88 AVENUE ANCHORAGE, AK 99507 (907) 349-6451 W~ ~LT~ Subdivision: Lot: Block: C oz.,_o..c~ g" /D.,~ ~ Client's Name: Address: Tester: Initial Reading on Meter: GALLONS GAr.r~Ns TIME GPM A VOLUME TC~AL VDIAIME Production Rate: .~_~GPM 24-Hour Capacity "--' Gallons Municipality of AnchOrage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 .parcel I.D. 006~242-02 1. GENERAL INFORMATION Current Property owner(s) Mailing address Lending agency Mailing addre~ Real Estate Agent Mailing address CER'I:'IFICATE OF HEALTH AUTHORITY APPROVAL:' ..--'.,':, '= ·~ FOR A SINGLE FAMILY DWELLING ...... ':'; '"'.." :, Co .replete legal description Location (site address or directions) 5811 RADCUFF DRIVE * ANCHORAGE, AK 99504 SELKRAGG'S . Day Phone - .' 5811 RADCUFF DRIVE * 'ANCHORAGE~ ...AK Expiration D~ie!'" ~;~:~ ;" ~'~z~ '"';(~) -~ ' ' ,... ..... . .... - ..., , .....~-.;., ¥; .... COLLEGE PARK SUBDMSIONj ,.LOT ~2, BLOCK 2 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage · Community Class Well Public Water System JOHN BLAINE w/ PRUDEI~iN.'~ J. W. :'- ' ' ' '~ :",~.q P,n.~t3'" : .... ~-~,," .--. :'-, -.-.~ Day phone. ~,..-------- ........ . ..... ,.,, .... !.: .,. TYPE OF WASTEWAIER DISPOSAL: Individual Holding tank ~ Community On-site E~]~ ; Public SeWer" The Municipality of Anchorage Development Services Department (DSD) Issues Certificates'or; 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. Cedificates 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 sewed by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. J Note: Alaska Water and Wastewater Consultants, inc. shall be pald $ t,o~. at, or pnor I to closing for the engineering services provided. · ' ' 4, 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 AuE'K)dty Approval Guidelines forthis application, shows that the on-site water supply and/or wa'st~watei' disposal system is(are) safe, funciional and adequate for the number of bedrooms and type of structure in(~cated herein. I further verffy that based on the - information obtained from the Municipality of Anch. orage files and from my invesfigatlon and inspecqon,'the. on-site water supply and/or wastewater disposal system is(are) in compliance wfth alt applicable Municipal and State codes, ordinances, and regulations in effect at ~e time of installation. Name of Firm'" ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. -' Phone '337'L6179 Address - 6901 DEBAER ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Prir;iec~ I~ame JEFFREY A. GARNESS, P.E. Date Engineer'sComm~nts:' -. .... ' "' ~;. '.'--'. ........ . . '.:- ' -' In conducting this evaluation, AKWWC, Inc. atternpted to provide a thorough, conscientious engin~edng analysis of the systern in accordan~e with ADEC and MOA .... i" DSD Guidelines & Regulation& The roporfed results described the pedormance of the . system under the conditidn~ encountered at the b'me of the test, and separation.. distances rneasumd to readily identifiable features. The operational life of all wells and · septic systerns.'depend on the local soils condition, groundwate~levals that may fluctuate during the year, and the water usage of the family bei~j served by the system. These conditions are outside the control of the evaluator of the system. ~a#sfacto~y test results d~ndt gba~antee future peffonwance of the system, nor do they gu~rentee that '. · ~ there ar~ no hiddehdefects o~encreachrnents. AKWWC, In'c. can therefore no, provide ..... · a~ ~va.~ . hty ~ fuf~'e ~stirnale of how long the system will conUnue to meet the ~ _-' · :. '... ~ operational requirements Of the ADEC or MOA DSD. The ~onteet of this report is for ' the-~dle i~t Of. th~- bv~n~r listed above. An~ ~lian~ ~pon'or us& ~f this re~r~ by ~ny . other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE I~. ^pproved ~or ~ bodrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: .~ HAA Checklist Se'ptic .System Advisory Well Flow Advisory (Rev. 12/01) Manitenance Agreements Supplemental Engineer's Reort Other · Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety 0NIslon On-Site Water & Wastewater Program 4700 South Bmgaw SL P.O. Box 196650 Anchorage, AK g9519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal DesmlptJon: COLLEGE, PARK SUBDIV~,SiON; LOT 12t BLOCK,,.2,,. Parcel ID:,,. 006,-.242--02 WELL DATA we~l type eR~VA~ Date completed lg5g Total.depth ,, 76 lt. If A, B, or C provide PWSID~ Sanitary seal (Y/N) ,.YES. Cased to 70 ,,. lt. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Arsenic:. N/A, mgJL. Well Log (Y/N) ...... NO Wires properly protectecl (Y/N) . YES Casing height (above ground) , 12+ in. AT INSPECTION .... 4/2g/03 ..... ...... 28 ........ fL 4.66 g,p.m. Nitrate 0.10 mg~L. Other bacteria 0 .colonies/100 mi. Date of sample: 4//29,/03 Collected by:. AKWWC, :;INC- B. SEPTIClHOLOING TANK DATA PUBLIC SEWER i, ..... , i L Fo:nd:fl~ep:sion over ~nk ~) D m~lng .... Pumper ............ C. ABSORPTION FIELD DATA PUBLIC S~ER T~I dep~ .... [ Eft. abso;Uon ama ~~ D~sslon over field Date of adequa~ te~ , , ~~(~sd~) ~ r. For b~r~ Ruld dep~ in abs~~~~a~d ;~g~ ' New dep~ In. ~ps~ ~me: m. Final fluid dep~ , in. ~so~on rote >= g.p.d. ~~a~ent (pest 12 mo.) ~ & ~e) , . . If yes, give date . , LIFT STATION Date installed Size in gallons M~ "Pump on' level at in. "Pump~ High water alarm level at in. Cycles tested. Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N//A On adjacent lots 100'+ Absoq~flon field on lot Public sewer main 50'+ On adjacent lots 100'+ Public sewer manhole/cleanout 50'+ Sewer/septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Property line, Absorption field Water main Water service Ii uace water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water service line Building foundation. Water main Surface water ay, parking/vehicle storage Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I ca.fy 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 Pd~ted~ame Date ~ //-,/~ JEFFREY A, GARNESS Fee $ 3'/5. -'- Date of Payment ~" ~'0,~ R ipt.umber g (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number 05/07/03 14:32 FAZ 19077623189 JACK WHITE 1~02 ASBUILT ~ & ,~SSOClA~ES LA]~ $1~V~[; 69~,-0829 I HEREBY CERTIFY .THAT I HAVE SURVEYED TH'E SCALE, INOICA~. IT IS THE RES~SIBILI~ OF THE ~ ~ D~MINE THE ~I~EN~ OF ANY WHI~ ~ NOT ~R ~ T~ RE~ VISION P~T. UND~ NO CIRCU~TANC~ S~ ~Y DATA H~N BE US~ mR CONS~ION ~ ~CE LIN~ OR ~R E~LISHING ~D- DRA~ ARY LINES. SGS Eof.# Client Name Project Name/# Client Sample ID Matrix 'Sample Rcmarks: 1032326001 AK Water & Wastewater Consultants Inc. ColleRe Park LI2 B2 College Park LI2 B2 Drinking Water All Dates/Times are Alaska Standard Time Printed Date/Time 05/01/2003 14:10 Collated Daterfime 04/29/2003 12:00 Received Date/Time 04/2912003 15:17 Allowable Prep Analysis Parameter Results PQL Units Method Limi~ Date Date init Waters Department Nitrate-N Microbiolog~ Laboratozy Total Colifo~ 0. I00U 0.100 mg/L EPA 300.0 (<=10). 04/30/03 0 col/100mL SMI$ 9222B ('<=1) 04/29/03 JS lq. AP MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE- OF INSPECTION FOR HEALTH AUTHORITY APPROVAL (DF ON-SITE SEWER AND WATER FACILITY 264-4720 A pplic at ion D ate GENERAL INFORMATION Legal Description (include tot, block, subdivision, section, township, range) Loc~hon (ad~r~ss or d~rections) .............. ~:,'~M_ ~%~z~ p.~,. (b) Apphcant Name -%~2. P¢_t;~-~ Telephone: Home Business Applicant Address (c) Applicant is (check one): I:ending Institution [] ' Owner/builder I~ ' Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to tile following address: TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms ~' Other WATER SUPPLY Individual Well ~ Community [] Public D Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 SEWAGE DISPOSAL Onsite [] Public ~ Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department o~ Environmental attesting to the legality and status. ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FiLE SEARCH, DA I'A AND INFORMATION 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 shows that the on-site water supply and/or wastewater dis posal 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 flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system ~s in compliance with all Municipal and State codes, ordinances, and regulations in effect/on the date of this XCCs'C~t~T,_.'~ n sta ] ] a t 'ion Name of Firm __~~-'~~5 ' /~;)- Address %?-.~ ~,c ~ ~'~ ~ ~ ~ ~ ~'-~ Date ~/~ ~', ~' Telephone DHEP APPROV~~' Approved for ,.~_~1~/.~_ .~._ bedrooms by , . . Terms of Conditional Approval Date CAUTION The Muncipahty of Anchorage Department of Health and Env,ronmental Protection (DHEP) issues Health Approval cerbhcates base~ ~ upon tile representations g~ven m paragraph 5 above by an independent The as to homes A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOAj NNqI{~I~iIH AUTHORITY APPROVAL (HAA) ~~=~'p~..,~.HECKLIST-FEBRUARY 1984 · ~ 26~4720 Leg~ Description: ~ wWel Class fication ~/A~Z.~ f,~z"'/ If A, 13, C, D.E.C. Approved (Y/N) ell Log Presenl (Y/~N)~ Total Depth ~* Cased ~~, Stat c Water Level --. _ Casing Height Above Ground [ Electrical W ring in Conduit (Y/~( Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ~ Water Sample Collected by ~ ; Date Water Sample Test Results ~/~~ ~ ~ ...... Comments ~~ ~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date Installed StandpiPes (Y/N) Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Size No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped , for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(1 '~/84) Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Su pply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that U~;;hegked, v~rified or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Sgned ~.,,~'~..~U),~Ja% Date ~-~/~,~. Company a~.,~--~. ~7'.~ ' ~'~ MOA No. Receipt No. ~)9' ~ ~"~ Date of Payment Amount: $ ~-lc~ Page 2 of 2 72-026 (11/84) BESSE, E' S & POTTS September 5, 1985 Dept. of Health and Environmental Protection 825 "L" Street, Suite 400 Anchorage, AK Attn: John Lynn Re: Lot 12, Block 2 College Park Subdivision Dear Mr. Lynn, As requested, we have verified the existance of casing for the water well located on the above referenced lot. The casing is approximtely 6" below ground with a 1" diameter galvanized pipe protruding about 3' above ground. Sewer service is provided by Anchorage Water and Wastewater Utility. Please call if you have any questions. Sincerely, ~:nginee'r "Providin,q a quafitV l~ersonalized service to those building Alaska's future"