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Home My WebLink AboutTIMBERLUX #3 BLK J LT 7Timberlux Block Lot 7 #018-271-75 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: ~ - '~- O :22.. 1. GENERAL'[NFORMATION Looat on (s;te-address' or d~rect~ons) Mailihgaddress ..";.: ,' Lending agency Day phone Day phone Mailing address Real Estate Agent Day phone Mailing Address Un/ess ~therwi~e requested. HAA will be held by DSD far pickup. 2. NUMBER OF BEDROOMS: + 3. TYPE OFWATER 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/Maska. 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. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C we!l and may be reissued with new water sample results less than 30 days aid. (Certificates may be reissued for a period 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 [or errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As ce~fied 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 redly that based on the information obtained from the Municipal[b/ of Anchorage files end 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 .) ~/'7'7~ ~ -~ ~ ~ ~f""~ ~Jf'~ ~"~<~""'" Phone Address ~,~-,~'I 0 .c~,,./'~'"'/C-2b-~---/-'//~3'/74'~' D .""~/:~'(~--~. Engineer's Printed Name J,c~./~ ~.. '~'~'~F'~/Jo/'~--, Date DSD SIGNATURE t/// Approved for L~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw 8L P.O. Box 196650 Anchorage, AK 09519-6650 wwv. ci.anchorage.ak, us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST · A. WELL DATA we, type' P~'~' ' gate completed4~¢'?(" IfA, B, or C provide PWSID # Sanitary seal (Y/N) ~' fL FROM WELL LOG Static water level ~-- ~ · fL Well production ~ g.p.m. Well Log (Y/N) VVlres properly protected (Y/N). Casing height (above ground) AT INSPECTION ~ g.p.m. in. Gravel below pipe . ~' ft. ~ Det0ression over field ~l~J/. For ~' bedrooms New depth~.~, in. .~' ~ g.p.d. WATER SAMPLE RESULTS: Coliform ~) coloniesYl00 mi. Nitrate ~J{. Other bacteria (~ colonies/100 mi. i : Arsenic: mgJI. Date of eample:x~-I,CJ"' ~collected ~: . l, B,. SEPTIC/HOLDING TANK DATA . '~: ,.. !~ Tank Ty, pe/Mateda! ~_.~Z~~ Date installed C?_.""_._JJ ~ ~1,.- . ,'~ - . ~.. ~lam, lg~fi ,olf~=l~ano~~ Depmssionovertank(y/N) {V High water alarm (y/N) ~V ' fL Width ~ fL Total depth J I fL Eft. absorption area~J~ 1~ Monitoring tube , Date of adequacy test ~......~::~.,~7~.~.~ Results (Pass/Fail) Fluid depth in absorption field before test '~ ~ in. Water added ~/ct_~gal. Elapsed Time: ~'t'l~,~.~'~ Final fluid depth ~ in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N &'t~pe) I~) .~'~ af./.~'~ If yes, give date D. LIFT STATION Date installed ~ S~ ~'~'-~hole/Access (Y/N) in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot ./,Z~p/' Public sewer main On adjacent On adjacent lots Public sewer manhole/cleanout Holding tank /~/'4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation '~ ~ '~ Property line ~ / Absorption field Water main /~ c~r~ ~'~, Water service line '7 0 Wells on adjacent lots .-~ / (~ SEPARATION DIST~ FROM ~SORP~ON FIELD ON LOT TO: Pm~ line ~ ~ r Wa~rSe~line [ ~1 Curtain drain Surtacewater /~O~C ~ ~er~9~~ Building foundation ~' ~:) Water main ~ Sun'ace water/d~f/C- Or~.ay, pa~ng/v.~e ~rag~ .5 .~ Wells on adjacent ~ts ''~ )'~! F. COMMENTS Date of Payment Receipt Number (R~v. 12/01) Waiver Fee $ Date of Payment Receipt Number ..... 20OW. i1~ O~ BE PUBLIC WATER sYSTEM shem this W~er SAMPLE to be: SAMPLE DATE: Moatla Day SAMPLE TYgE: C2 Roudne ~ Repent SMaple (fw routiOe tsm~ ~ wl~h lab I~. ue. , · ) Tre~d Wins' Uau, m~ Warn' By ada fbka · Jun SACTE.IUOLO~ICAL WATEit ANALYSIS RECORD BGB · CoMbS/tOO sd · COLIFIRM - _ ColifMu/lOl ad ._,Ir flaal M~~'r~e Film' ~ _ Regeflod By ~ Dtw ~C.~a. T1me~ CT&E Ref.# Client Name Project Name~ Client Sample ID Matrix Ordered By PWSID 1020871001 James Sizemore & Associates Lot 7, BI J Timberlux ~ ~ Lot 7, BI J Timberlux .~-,.~ Drinking Water 0 Client PO# Prtnted Datefflme 02/19/2002 i1:33 Collected DatefHme 02/15/2002 13:35 Recetved DateJTIme 02/15/2002 14:05 Technical Director Stephen C. Ede Released By/'J~ ~ Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Waters Department Nitrate-N 0.308 0.200 mg/L EPA 300.0 (<10) 02/15/02 JDT Microbiology Laboratory Total Coliform 0 col/100mL SMI8 9222B (<1) 02/15/02 SBII -5- ~/ gV' $7,° II"F AS-BUILT NO CORNERS SET THIS DATE ~ASEMENTS OF RECORD, OTHER THAN 'HOSE SHOWN ON THE RECORDED · I.AT ARE NOT SHOWN HEREON. p~jl. I hereby certily that I have performed a Mortgagee's inspection of the following described property: {--'¢'~ ~ ¢..L.o.4/.: ;~' ~- Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the properly lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on Ihe premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this / ~ '~ day of, yVfl V.E/',I SF'.~,..~_~ 20 O I FRED WALATKA & ASSOCIATES (907) 248-1666 Engineers and Surveyo.rs