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Home My WebLink AboutCLYDE M DICKSON BLK 1 LT 6Clyde AR. Dixon Block Lot 6 #007-055-06 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 ww',v.ci.anchorage.a k. us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 007.05506 HAA # .~./'~ Expiration Date: 1. GENERAL INFORMATION Complete legal description ~, Lot 6, Block 1, Clyde M. OIxon subdivision ' Location (site address or directions) , 3324 Old Muldoon Road Current Property owner(s) Mailing address Lending agency Mailing address AmoldVachss Day phone 337-1879 3324 Old Muldoon Road Anchora.qe~ AK 99504 Day phone Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Three{3) Day phone 3. 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 Development Services Department (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 Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a singte family on-site 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 pdvate or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a pedod of 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 the professional 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 verify 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 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 is(are) in compliance with all applicable Municipal and State codes, erdinances, and regulations in effect at the time of installation. Name of Firm Anderson En.qlneerin.q Address P.O. Box 240773 Anchora.qe, AK 99524 Engineer's Printed Name Michael E. Anderson~ P.E. 5. DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for Phone 522-7773 Date 2/14/02 bedrooms, with the follo~ng stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastawater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorege.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot $. Block 1. Clyde M. Dixon Subdivision ~NELL DATA Parcel ID: 007-055.~ Well type Pri~t9 Date completed Total depth IfA, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to tt$ fL FROM WELL LOG Well LOg (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) t2 AT INSPECTION iN. Date of test Static water level Well production WATER SAMPLE RESULTS: g.p.m. 7~,~ fL 4,2 g.p.m. Coliform 0 colonieS100 mi. Date of sample: 2~/2002 B. SEPTIC/HOLDING TANK DATA Nitrate ._~._ mg/1. Collected by: T. Klmbrough Other bacteria 0 colonies/100 mi. Tank Type/Material Tank size __ gal. . Number of Compartments Foundation cleanout (Y/N) Depression over tank (Y/N) Date of pumping ' · Pumper ABSORP.'FION FIELD DATA Date installed Soil rating (g.p.d./fi= Or ft2/bdrm) Length fL W,:lth ft. Total depth fL Eft. absorption area fi= Monitodn9 tuba Date of adequacy test Results (Pass/Fail) Fluid depth in absorption field before test in. Water added Elapsed Time: __ min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (YIN & type) Date installed Cleanouts (Y/N) High water alarm (Y/N) System type Gravel below pipe Depression over field in. __ gal. Absorption rate >= If yes, give date For bedrooms New depth in. gp.d. D. LIFT STATION Date installed Size in gallons · Pump on' level at in. 'Pump off' level at in. Datum Cycles tested Manhole/Access (Y/N} High water alarm level at Meets alarm & cimuit requirements? in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot N/A Public sewer main Sewer Iseptic service line On adiacent lots Nl^ ' On adjacent lots N/A Public sewer manhole/cleanout >1~1' Holding tank N/A SEPARATION DISTANCES FROM sEPTic/HOLDING TANK ON LOT TO: Building foundation, Prope~'y line Water main Water service line Wells on adjacent lots. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line. Building foundation Water Service line Surface water Curtain drain Wells on adjacent lots F. COMMENTS G, ENGINEER'S CERTIFICATION I certify that I have determined through ~eld inspections and review of Municipal records that the above systems are in conformance w~th MOA HAA guidelines in effect on this date. Engineer's Pdnted Name Michael E. Anderson. P.E. Data Date of Payment R~ipt Numar (~. 1~) AbsorptiOn field Sun'ace water Water main Driveway, pa~ing/eehicte storage Date of Payment Receipt Number Waiver Fee $ VE-TECH Engineering Technical Services Fascimile: 907-357-6305 Telephone: 907-357-6304 PO 873141. Wasifla, AK 99687 Date: February 8.2002 Project#: M0205 Legal: Lot 6. Block 1. Clyde M Dixon Subd. Inspector: T.L. Kimbrough Well Depth: Probed to 119 Feet # Bdrms. NA Static Level: 785 Feet · Single-Family Type of Svsfern Tested: I-t Multi-Family Type of Test Performed: r-i Commercial Test: Well Flow Only Septic Adequacy Only Both ..... · .......... Well ST~ MT#1 MT#2 Flow Cum. Static Liquid Liquid MT# 1 Liquid MT#2 Meter Comments Time Rate Volume Volume Level Level Level Delta Level Delta Reading (gpm) (gals} (gals} (fi) (in) (in) (in) (in) (in) 9:32 78.5 NA NA NA 9841, Start :42 40 40 40 84.5 9882 :52 4.2 42 82 84 9924 10:02 4.2 42 124 86 9966 :12 4.1 41 165 86 10007 12:32 4.4 610 778 88.5 10617 13:3; 3.9 233 1008 86 10850 End 4.2 Average Gals/Min Well Flow 13:321I I I 86 IStartRecovery '3:421I I I79 IEnd "ecevery ~DEC Code Compliance: Does septic tank need pumping? I-I Yes I-1 No · NA Is well wire in conduit? · Yes [] No [] NA Is wells sanitary cap installed? · Yes [] No [] NA Elevation of well casing above ground level: 1 Ft. ff Public Wafer Supply: PVVS ID # Is this system curmnUy in compliance? Test Results: ~ Passed Reviewed By: ~ ~ I-t Yes [] Failed [] No · NA Date: Test results are indicative of conditions at time of testing. Ve-Tech nor Michael E. Anderson make any representation to the future life of the systems nor any of the mechanical components of the systems. 82/23/2000 87:42 5073336686 DOT ~ ~ PROJ PAGE: 86/86 CT&E Envlmnmental Services Inc. · I.M~to~V Div'mkm ;-- -- J 200 W. Po~r )flaking Water Analysis Report for Total Coliform Bacteria Am~m,~g~, AK 99SI~,1~0! , ~ IN$~ltUCTION$ ON tF. FTq. ltSK .'~IDE ItE'.FO~E COIoLEC~INC X,4MPL~; Tel: (907) Fax: I90':~ Musx BE CO.~P~t~D SY w^~-~ su,uE~ a fc.uc w^tr.sYs~.~ t.... I I I ilia ,~ nuv^v, WATE~ svsu~ SAMPLE DATE: SAMPL~ TYPE: ~ Rnmln¢ I::1 l~nat Sampk {f~ r~fl~ with J~ rtl. nL. ) Ycar 0 Untreated WMer ThJJ Coile~ed 1 o:/~ TO BE COMPLETED BY LABORATOR. y AnMysis shows this Water SAMliLE to be: n~ Satisfact~ ~k ov~30 ~n o1~ ~ul~ ~y ~ ~li~;e · Dat. R~ntved ' _ Anoly~ Mffhod: ~!~ Meml~nne ,,n MMO.MUG · Numberofcolonies/100 .nd. I~ult' 1 OE O?ISB I-d51 Analyst Tim.:. ClOut n,~ffled ofgnsn'.bfnctocy I~ulu: BAC'fERIOLOCICAL WATER A.,lqALYSIS RECORD BOB ..... ~ COUFIRM MMO-MUG RJ*~II: T,mi Coilten~ M~nlabrln¢ lqltt~. ~ Ceq! verificau, n: LTB F~ctl C, lffe~m Couflrma~ Final Membmae_F1)t~r Ruu~ ~ ColJronn/lO~ mi