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Home My WebLink AboutABBOTT LOOP MANOR BLK 2 LT 3Abbot Loop Manor Block 2 Lot 3 #014-181-16 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, AK 99519-6650 www.ci.anchorage,ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O Iq - I~ I -- IJc> 1. GENERAL INFORMATION Complete legal description LO-i-- Location (site address or directions) Expiration Date: Current Property owner(s) '~os < ~ L.,.v -./et Day phone Mailing address Lending agency Mailing address Day phone Real Estate Agent ,,'~'l.',,, I.l~'a,,*~'f/ ~.~ //','t.;~ Dayphone. Mailing Address .,'~/r&-~ C,- ,,--~., q Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: t.../ 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 [] [3 The Municipality of Anchorage Department of Health and Human Services (DHH Health Authority Approval (HAA) based only upon the representations given in paragl professional civil engineer registered in the State of Alaska. Certificates of Healt required for the transfer of title (except between spouses) on properties served I: wastewater disposal and/or water supply system, DHHS also issues HAAs upon Certificates of Health Authority Approval are valid for 90 days from the date of issue a private or Class C well and may be reissued with new water sample results less tha,,,..~.~,_~, ,../,.. ~. are valid for one year for properties served 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. 72-025 (Rev. OwO0)' STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto'and as of the validation date shown beIow, 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. Engineer's Printed Name '~, ~? v.'~..' t,~,, .-~' Date Conditional approval for bedrooms, with the following stipblations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Original Certificate Date: / - r~ ~ ' 0 / Reissue Date: 72-025 (Rev. 01/00)' Municipality of Anchorage Department of Health and Human Sen/Ices Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P,O, Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak,us (907) 343.4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA we, type Date completed __ Total depth Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~)/ colonies/lOOml Date of sample: ~/~o Parcel I.D.: ~/¥-181- lb If A, B, or C provide PWSID # t"t/~r Well Log ~ Sanitary seal '"/' Wires properly protected ',/' ft Cased to ./o~ ft Casing height (above ground) /~ in. FROM WELL LOG AT INSPECTION ft S".5 ft g.p.m '7 g.p.m Nitrate ~ I_'~ mg/I Other bacteria~._~'~colonies/100 mi Collected by: /t_ ~"~. B. SEPTIC/HOLDING TANK DATA Tank Type/Material __~ Date installed Tank size gal Number of Compartments Cleanouts Foundation cleanout ~ Depression over tank High water alarm Date of pumping Pumper ABSORPTION FIELD DATA Date installed Soil rating (g.p. or ft2/bdrrn) System type Length ~ .ft Width ~ ft / Gravel below pipe ft Total depth ft Effective absorption ~ea fF Monitoring tube__ Depression over field Date of adequacy test ~ ~/~sults (Pass/Fail) For bedrooms Fluid depth in absorption field before t~t __ in Water added__ gal. New depth in. Elapsed Time: rain ~nal fluid depth in g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Absorption rate >= If yes, give date __ 72-026 (Rev. 01/00)* Size in gallons ,,J __ in "Pumpo~,,l~ at in C y. Fle's tested D. LIFT STATION. Date installed 'Pump on" level at Datum. E. SEPARATION DISTANCES Manhole/Access __ High water alarm level at in Meets alarm & circuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main ! o~ Sewer/septic se~ice line On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank 1Oo -I- SEPARATION DISTANCES FROM SEPTIC/HOLDI,N/G TANK ON LOT TO: Building foundation _ Property I~/~ Absorption field Water main ;' Water,~fvice line __ Surface water Drainage WellF'on adjacent lots SEPARATION DISTANCE FROM AB,SORP/N FIELD ON LOT TO: Property line __ Buildmg/~ndation__ Water main Water Service line Surfa~ water Driveway, parkingNehicle storage Curtain drain W~ on adjacent lots COMMENTS G. ENGINEER'S CERTIFICATION I certily 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 Primed Name ,I ,, ~ ap ~, v- ~ la. ~c Date ~er.', I HAA Fee $ ~ 00. ~ Waiver Fee $ Date of Payment \ I/~/0'~ Date of Payment Receipt Number 0~{) ~3~1~ ~ Receipt Number 72-0~S (Rev. 01/00)' U5 u BV. ® Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904' Certificate of On -Site Systems Approval Parcel I.D. 014-181-16 Expiration Date: / d 2:2 1. GENERAL INFORMATION: Complete legal description ABBOTT LOOP MANOR; BLOCK 2 LOT 3 Location (site address) 7636 Adobe Drive *Anchorage Current Property owner(s) Leslie Fox-Leyva Day phone 360-2566 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: X❑ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $2,SO t /r,G = ky Lj q Date of Payment lg AZ Receipt NumberO I �3r I J3 G COSA# 05c2.11670 Waiver Fee $ Date of Payment Receipt Number Waiver # 14� 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 Certificate of On -Site Systems 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 (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE < System #1 Approved for _�L bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, Date: i I i o) 4 t J'If �cj A. Ccrness,•.. ;o CE -7953 ~ro f es s'w° #AECC884 OF AIV6 \V,3 J� ON-SITE with the folb5AIg *p MEjjibAND �o WAST E=v`'ATER oz PRUvhHly► JJ�/i;4 n' ))))))))))1111 By: eu Original Certificate Date: / 1 S; Z The Municipality of Anchor/eZDevelopment Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist %� Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Leuai �Descripdon: ABBOTT LOOP MANOR; BLOCK 2, LOT 3 H l-nore than I septic system on lot: COSA Ct-lecklist #—of A. WELL DATA OaieddUed 'ee(/) ---- ~43�5+ uxn / //�/JJ /// ' To��(depth � o/» J ow°xwoww Cased to`� ^"~ -- Sanitary sea! iofunctioning correctly ��VVineeare properly protected Casing height(aboveground) 12+ in. oteatforC{]SA 11/2/21 DateofOvv 'tatiowater|eve|atbeginning of�est 41 Oft Commenta°pEF<GEGVVELLFLOVVTEST B, TANK DATA Age oftank(s) ___years Tankb/pe/materia| ____ Measured openehnyfluid level inseptic tank ____ �l Bhandpipe�foundeboncleanout per record dnavving Date ofpumpinq D. ABSORPTION FIELD DATA Nhk��m�sted (date installed) []ALL stsndpipespresent per record drawing Tota|measured depth fromgrade _ft (may, Mfe to he Ove >tive If not,Oil r fieldSystem pres edIT(Required if cant for greater than 30 days prior todate of igal 10 sG ions introduced _gallons I - r.-essurized field depth into effective Code 0 -required soil er over field "'OSA "heddist yellow sheet Parcel ID: 014-181-16 Structure served by this system Well production sdtime oftest 5+ ~pm Water storage bankvolume N/A gallons Well disinfected for coliform teat? Yes No X Coliform bacteria iaNegative Nitrate_____ mA/L EN] Nitrate less then MRL (ND) Arsen/o_____ug/L [11]Arsenic less than MRL (ND) Collected by GEG. LTD Date of Sample 11/2/21 C. LIFT STATION [� �� Required maintenance completed Age oflift station _____years Lift station material Comments: Odequacy test date Results / |Pasa Forbedroomn Fluid depth prior totest —in Water added ____gal New depth ____in Elapsed time min Final fluid depth in Absorption nate gpd Any rejuvenation treatment (past 12months) f� E �E��T|ON0��MCE� (=~' |,�/Z4 ' iV | From Private Well on Lot to: (Please enter distances if less than required or if COMMUnity well) t BepboTanWLi�StationonLo��1OO'hJ6� �ommuniLySe�er&4anho|eX��Ye� ifNo '~'` � ��Y^��N�ighboringT�nk�1OO'��Yes ifNo� Priv�teSo�e�Sep�ioLine�25'[�]YAb�orptionFie|donLnt�1OO'��Yes ifNo��/\� Ho|dingTnnk�1O0'��YNeighboring Absorption Fie|ds � 10O'Anima| Cont�inm�nt�5O'�] Y��\'os ifNo____� y�anure��nima|Exorei��tor�ge�1UCommunityS�vverK8�in�7�'��Yae ifNo� ��yFronnSepdu/Ho|dinglFankonLot to: (Please enter distances ifless than required) BepboTanWLUtShadononLo��10I hJ6��ommuniLySe�er&4anho�X�1OO' ��Ye� if '~'` � ��Yes if � ^� �~ __- N�ighboringT�nk�1OO' ��Yes ifNo� Priv�teSo�e�Sep�ioLine�25'[�]Yea ifNo� Ab�orptionFie|donLnt�1OO' ��Yes ifNo��/\� Ho|dingTnnk�1O0' ��Yes ifNo� Neighboring Absorption Fields � 10O' Animal Containment �1 Yes ifNo� ��\'os if -- y�anure��nima|Exorei��tor�ge�1UD' CommunityS�vverK8�in��7�' F71 Yes Building Foundations > 10f F-1 Yes if No ft Surface Water> 100' ft Propert\y Line > 5' F-1 Yes if No ft Wells on Adjacent Lots: Abso,ption 'Field > 5 F� Yes if No ft Private Wells > 100' ft E] Yes if No ( Wa'er Main > 107 r_1 Yes if No ft COMMUn" ells > 2007 F-1 Yes if No ft Water Service Line > 10' El Yes if No ft A If tic tank is under driveway comment below -44 ifNo� es if less than required) ��Yes ifNoft Building Foundations > 10f F-1 Yes if No ft Surface Water> 100' ft Propert\y Line > 5' F-1 Yes if No ft Wells on Adjacent Lots: Abso,ption 'Field > 5 F� Yes if No ft Private Wells > 100' ft E] Yes if No ( Wa'er Main > 107 r_1 Yes if No ft COMMUn" ells > 2007 F-1 Yes if No ft Water Service Line > 10' El Yes if No ft A If tic tank is under driveway comment below -44 From Absorption Field on Lot to: (Please enter dis es if less than required) Bullcling Foundation > 10' Yes " o ft If absorption field is under driveway comment below Property Line > 101 es if No ft Wells on Adjacent Lots: Yes ifNnft Private Wells >10O' []Yes ifNoft Water Se ' e Line >1O' MYes ifNoft Community Wells >2O0' Yes ifNoft »'rfaueWater >10D' []Yes ifNoft F, EMG|NEER�S COMMENTS G. ENGINEER'S CERTIFICATION /oerth�ythat / have determined through field inspections and review o/Municipal records that the above systems are /nconformance with MOA COSA guidelines in effect on this date, COSA Checklist yellow sheet #AEComw Lot 11 rrX Lot 10 z 11 1--10' UTILITY EASEMENTS �_42. WELL Lot 2 49"E 19,37' 1.0' CANT O Ld 0 1--: M Z UJ 0 co 40 4.0' 'J X cv to 8,0 0 3,2"-< DECK CHAIN—LINK FENCE 04 WEST 113,80' Lot 9( i 10' UTILITY— Lot 4 EASEMENTS FENCE GRAVEL DRIVEWA y 1,0' CANT —1.1'x4.0' tN CANT 11 2,5.4, . Q� (0 0) ��111 NOTE: DRIVEWAY LOCATION APPROXIMATE DUE TO SNOW & ICE COVER. MORTGAGE SURVEY _K_ SCALE 30'— GRID SW 2233 21-728/Rl - Project No, 11500 Daryl Avenue, Anchorage, Alaska 99515-3044 ii Associates, (907) 522-6476 Phone (907) 522-4625 Fox Professional Land Surveyors ken*langsurvey.com J=' OF A ........... jonothon*longsurvey.com I hereby the- following - deiiiiribed- -1 P I ro 11 pe rty: -1--l-11 -- -- -- ---- LOT 3, BLOCK 2. ABBOTT LOOP MANOR SUBDIVISION �PLAT No. P-647AN Anchorage Recording District Alaska, and that this Mo gage Location Survey Is a representatilon of the conditions that were found on the date the survey was performed—. This survey does not constitute a boundary survey and Is subject to any inaccuracies that a subsequent boundary survey may disclose. The Information contained hereon shall not be used to establish any fence, structure, or other Improvements. a —, , at Anchorage, Alaska # d this th __LQL'_ Day of 1 Is the responsibility of the owner to determine the existence of any easements, E__ covenants. or restrictions which do not appear on the recorded subdivision plot.