HomeMy WebLinkAboutMURRAY BLK D LT 5Murray
Block b
Lot 5
#014-042-07
Municipality of Anchorage
Development Services Department
Building Safety Division.
On-Site Water & Wastewater Prog~m ·
4700 Sou~h Bragaw SL
P.O: B6x 196650 Anchorage AK 99519-6650
·.. ..... www.d.anchomge.ak.us- . . . · .
(907) 3437904 '. ...
CERTIFICATE OF HEALTH . ,UTHORI'TY APPROVAL
FOR ,b, SINGLE FAHILY DWELI ING · ·
Parcel I.D.- O14-042-07
1. GENERAL INFORMATION
Complete legal description MURRAY SUBDIVISION; LOT 5, BLOCK D,
Location (site addres? or directions)
6647 ROSEWOOD STREET * ANCHORA(~Ef.AK 99518
Current Property 'owner(s)
Mailing ad(~ress
Lending agency.':. -
Mailing address
HEE SUH Dayphone ' 522'7499
4850 SNOW CIRCLE * ANCHORAOE~ AK 99508
Daypho~e
Real Estate Agent
Mailing address
Dayphone ·
Unless o~herw/se requested, HAA wi#be held by DSD for p/ckup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL=
Ind!vtdual On-slta
Individual Holding tank
The Munlclpality of Anchorage Development Services Depadment (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil
engineer registered In the State of AJaska. Cortificates of Health Authority Approval are required for the transfer
of tit~e (except between spouses) for proper'des served by a slngle family on-sita wastewater disposal and/or
water supply system. DSD also Issues HAAs upon request to homeowners. Certificates 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 sample results less than 30 days old. (Certificates may be reissued for a period cf
up to one year with valid water samples.) Certificates 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 Ihe
professional engineer's woric
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
invesfigation, based on procedures outlined in the Heal~h Authod~y Appre~l Guidelines for this application,
shows that the on-site water supp~' and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedroorns and ~e of sffucture indicated herein. I further ved~ that based on the
information obtained from the Munidpali~y of Anchorage files and from my investigation and inspect]on, the
on-site water supp¥ and/or wastewater disposal system Is(are) In compliance wfth all applicable Municipal
and State codes, ordinances, and regula~ons In effect at the time of Installation.
Name of Firm ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. Phone
Address 6901 DE~AER ROAD. SUITE 2B * ANCHORAGE. AK 99504
Engineers Printed Name JEFFREY A. GAENESS. P.E.
Date
337-6179
Englneefs Comments:
In conducting this evaluation, AVtIWC, Inc. attempted to provfde a thorough,
conscientious engineering analysis of the s~stam In accordance wfth ADEC and MOA
DSD Guidelines & Regutations. The repo~t~l results described the peffon~anee of the
system undor the conditions encountered at the time of the test, and sepa~'ation
distances measurad to readi~/ Identifiable features. The operational life of all I~lls and
septic systems depend on the Iocal s~ils condition, groundwater levels that may
£ucfuate duffng the year, and the w-star usage of the farn~ being served by the systarn.
These conditions are outs/de the conffol of the evaluator of the system. Satisfactory test
results do not guarantee fulure parformance of the system, nar do they guarantee that
there are no hidden def~ts or encroachments. AWWC, Inc. can therefore not provfde
any ~arranty or future estimate of how long the system ~II continue to meet the
eperational requirements of the ADEC or MOA DSD. The content of this repert Is for
the sole benefit of the owner listed abo~. Any reliance ulx~ er use of this repe[t by any
other parson or party Is not authorZzed, nor will lt confer any le~al dght whatsoever.
5. DSD SIGNATURE
/,~ Approved for r~ bedrooms.
Disapproved.
Conditional approval for ~
.
.,.~.: ON'SITE
~ : WASTEWATER
bedrooms, wi~ ~e fllowlng s~pula~ons: ~. : PROG~U
.. ...... ..
Attachments: HAA Checldist
Septic System Advisory
Weft Flow Advisory
Manitenanca Agreements
Supplemental Engineer's Reort
Other
Original Certificate Date: ~ , ~ .- C) !
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wasteweter Program
4700 South Bmgaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.enchorage.ak.us
(907) 343-70O4
Legal Description:
A. WELL DATA
Well type PerVAT[
HEALTH AUTHORITY APPROVAL CHECKLIST
MURRAY S/D; LOT 5, BLOCK D, PsrcellD: 014-042-07
I~/ELL P£RM~T I$$U£D 2//19761 I*"PER ARROW PUMP &: WELL SERVICE.I
IfA, B. or C provide PWSID# N/A
Data completed'~PPRox 1976 Sanitary seal (Y/N) YES
Totaldepth **40+ lt. Casedto *,40+ ft.
Date of test
Static watar level
Well production
WATER SAMPLE RESULTS:
Coliform g coloniesil00 mi.
Data of sample: 5/1/01
B. SEPTIC/HOLDING TANK DATA
FROM WELL LOG
UNK
UNK ft.
UNK g.p.m.
Nib-ata q.~ mgJL.
Collected by:
Weti Log (Y/N) NO
Wires properly protected (Y/N). YES
Casing height (above ground) 18+ in.
AT INSPECTION
5/1/Ol
34 lt.
*'6.5+ g.p.m.
**FLOW RESTRICTED
BY PLUMBING
Other bactaHa g colonies/100 mi.
AWWC. INC.
PUBLIC SEWER
Tank Type/Matarlal Data installed
Tank size gal. Number of compa~
Fc.7~nk (Y/N) ~ watar alarm ~/N)
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d.fft~or ~/bdrm) Systam type
Leng~ .ft. Width ft.
Total depth ft. Eft. absorp,on ama fl' Mon~ Depmssi_on over fi. eld.
Data of ed.uacy test ~8i,) .... !.or . ..bed=ms
Ruiddepthinebsorpfl~ in. .Wataradded_. ga!. New depth in.
Elapsed Time: . Final fluid depth in. Absorption rata >= g.p.d.
~treatment (past 12 mo.) (Y/N & type) If yes. give date
D. LIFT STATION
Date installed Size in gaflons
"Pump on' level at in. "Pump off' n. High water alarm level at __ in.
Da..~.~m Cycles tested Meets alarm & dmult requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lilt station on lot
Absorpfion field on lot
Public sewer main 75'+
Sewer/septic cendce line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
SEPARATION OISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: P U B LI C
Building foundafion Property line Absorption field
Water main ~
SEPARATION DISTANCE FROM ABSORPTION FIFtl3 ON LOT TO:
Pmberty line Building foundation Water main
Well8 on adjacent lots
F. COMMENTS
100'+
SEWER
G. ENGINEER'S CERTIFICATION
I cerUfy that I have determined through field inepacfione end
retaew of Municipal records that the above systems ere in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Pdnte~ N~me
Data
JEFFREY Am GARNESS
HAAFee$ $4::~D. ~
Data of .eymont
Receipt Number
(Rev.
Waiver Fee $
Data of Payment
Receipt Number
I m m
LOT 4
150.00
BUIU~
L01 $
LOT 5
LOT 18
LOT 17
[LECE~O: SET
440 ',~S!
N'iO.1OP-,A~E. ,~,~,¢A 99503 562-D291 (fox~f,61-66~
AS--BUILT OF':
LOT 5, BLOCK D,
MURRAY SUBDIVISION
APR-26-O1THU 13:48 AI~U F~ NO. 9075825427 P, 02
elOqUO~l IoJluo~l 1.o u~sooo'3
~Y-25-01 09:45 FI~t~- T-O8Z P.02/03 F-519
CT&E
Environmental Services Ir~c.
Client PO~
CT&E Ref.# 101222600! pttnted Date/Time 05/04/'2001 16:20
Client Nam~ Al~ Water & Wastewatcf Consultents Inc. Collected Date/Time 05/01/2001 0:00
Project Name~ 6647 Roscwood Received Date~'l'ime 05/01/200! 16:40
~lent Sample ID Lot $ Mm'ray S/D T~katcal D4re~or Stephen K'. £de
Matrix D.dnking Wa~ By
Ordered By
PWSID 0
Sample Remarks:
Allowable ~ A~l)-sis
Limits I~te Date Init
Nimate-N 0.$00 U 0.500 mg/L EPA 300.0 10 max
05~1~1 SCL
To~tColi~m~ 0
0 coVI00mL SMI89222B
O5/Ot/OI ~
13,1.~ F' FIf~I'I t'"IE N"I' (
H[i:F~L..TH RN[::, EN',,,':[IRONi"II£N'f'FIL. 3TEC"F:[EIN
11..113, O[~: Fill:::,. , RNCH(Ji~::FI[!i[:_'., f:lh'.'.'
4:t.(:!~(~; 'Tt.IF.',NFI~3F:I]:N E~L.',/I~:, FIFq" hi
L[:ICFI'I' ]; Obi
LOT
13 ]: hi :1:I¥1Uf4 D ]: 2~;"t'FINCE F.R[:)FI HELL "1'O F:IN"r' SIEF:'1' Z C 'f'RNK,.'"PRCKF:IGE PLFINT Ot~', 50 ~ L. FtBSORF'"I'Z ON
:5"r'2~;'FE:I"I ]::E; 2..(~)E~ F'F I::'O1:~'. FI I':;'R:[',/F~TE:H[~:LL RND 2E~E~ FT FOR R F:'UBI...:[C HE:L.L..
HEI..,I... I..J3[]i:~; I'"II. J2Yl E:E RE'I"UE'.hI[~:[)'1'O 'I"H~: [)E:PFIR'f'hlENT b. I Z'f'HZN ;:~:8 E:'R'¢2; OF THE: HEL. L.
E:O I'"IF::' I.,., E'I" ]: O I",t.
I~i;F'EC :1: I:' :t: CI::I']' ]: (:)[',12~ 1:::11",1[::, E:ONS"I'RUE:'F ]: Ol",l [;, :[ RQR¢:Ii"IS RRE [~VFI I LFIBLE TO I I"J2;UF~:E F'ROF'ER
:1: I',IIE;'I" F:I L L I::~ "F 11:0 N.
:[ I:.'.:EI;;~"I" ]: I::;'"¢ 'I"HF:I"I" :1: FIP'I [::'FIFI .'f. L :1: FiR 1.4 ]: TH 'THE REI;!LI Z I;,'EI"IlENT~; FOI~: ON-"5; I l"E 'E;E]-,.tER~; RND HE:LL.':~;
FI'.!~; ~;i;E'II::'ORTH ['i~'¥' THI!E I'"II...IN :[ E: ]. F:'I::I[... :1: T'?' OF RI"4CHO~F:IGE RNI3' [,.1:1: LL. Z N2;'i'FtLL. Z 1'4 FICCORDRNCE
I.,.I :I: 'TH "I"HE CODE.
]?ebruary 2~ 1977
Mr. Jeff Th~ns~n
4106 T%~rnagain Boulevard
Apartment N
Anchorage, Alaska 99503
Subj ¢~ct: Per.~i% Expiration
permit: issued by .~:his department for well and/or
installation on Lot B Block D Murray Su~livision has
~xpired. since th~ issum ~{ate exceeds one (1) year.
In the ew~nt you stall plan to install the ~,~!]. and/or on-site
sewer syste~a, a n~w pe~.Tait is re~quired. ~he soil tes'h original
may be use. fl to obtain a current per;ui%.
the well has been drilled, a well lof3 should be sent to this
¢],~partmen% %o ¢to~ument the insta'ilation ~.teo
jif you have any questions regarding tho above matter~ pl~ase
~to not hesitate to contac% this office im~adia%ely at 279-2511~
extension 22~ or 225.
Sinceroly,
Les No Buohholz~
Sanitarian