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Home My WebLink AboutTHUNDERBIRD HEIGHTS #1 BLK 6 LT 23Thund rbird Heights Block 6 Lot 23 #051-582-06 �S Municipality of Anchorage Development Services Department Building Safety Division �-� On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.enchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0.6-1-_1562-66 HAA# R R 01 00 BY 1. GENERAL INFORMATION Expiration Date: 3 - /2 - O ,:z Complete legal description THUNDERBIRD HEIGHTS SUBDIVISION #E1; LOT 23, BLOCK 6 Location (site address or directions) 27617 MALLARD COURT CHUGIAK, AK 99567 Current Property owner(s) ROGER NICKLES Day phone 688-3504 Mailing address 27617 MALLARD COURT CHUGIAK, AK 99567 Lending agency Day phone Mailing address Real Estate Agent ROGER MORRIS w/ PRUDENTIAL VISTA Day phone 689-6464 Mailing address 16635 CENTERFIELD DRIVE EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 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 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 well and may be reissued with new water sample results less than 30 days old. (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 for errors or omissions In the professional engineer's work. Note: Alaska Water and Wastewater Consultants, inc. shall be paid $700.00 at, or prior 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 AuthontyApproval 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 tiles 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 213 ' ANCHORAGE, AK 99504 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. Tho operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do theyguarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing 337-6179 Date OFAP�'', ON-SITE WATER AND. fT1:: WASTEWATER PROGRAM Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other (Rev. 1ZW) Original Certificate Date:__ 3 — I %z — O 1 1.-.__...... - - - I I - -", , .-._ ,............... - ................ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.alLus (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description. THUNDERBIRD HEIGHTS S/D IF 1; LOT 23, BLOCK 6, Parcel ID:- 0 5- 8 2 0 G A. WELLDATA PUBLIC WATER 1 1. Well type PUBLIC If A, B, or C provide PWSID# W Date'iompleted Sanita Wires properly protected (Y/N) Cased to —ft. FROM WELL LOG Date of test Static water level We' uction 9 -P.M. I WATER SAMPLE RESULTS: Coliform colonies/100 mi. Wrote Casing height (above ground) in. AT INSPECTION ft. g -p -m - mi. Collected by: B. SEPTIC/HOLDING TANK DATA 1:*INSI140T ON WRMN REPORT. r I I , DE CRAWLSPACE JR S PUMPI�G PUMPED OUT 12W GALLONS Ton : k TypelMaterlal STEEL Date Installed 10/16/78 Tank size *1250 gal. Number of Compartments 2 Cleanouts (YIN) YES ir I Foundation cleanout (Y1N)!-*-y_ES Depression over tank (Y/N) NO High water alarm (Y/N) NIA Dat:81of pumping 2/9/01 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA [*MEASURED IN RELD.1 Dat o Ins t ailed 10/16/78 Soil rating (g.p.d.Wor((!� 125 System type TRENCH Length 33 �!ft. Width 3 —ft. Gravel be low pipe Total depth -2jj,4—ft. Eff. absorption area 396 fe Monitoring tube —YES Depression over field NO Date of adequacy test 1/9/01 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth In absorption field before test —0 In. Water added 744 gal. Now depth34 In. Elapsed177 I Time: min. Finalfluiddepth 29 In. Absorptio n rate >= 450+ g.p.d. Any I �rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN if yes, give date D. LIFT STATION Date installed Size In gallons 'Pump on' level at in. E. SEPARATION DISTANCES High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot Absorption field on lot Public sewer main service line PUBLIC WATER On adjacent Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water, 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 109+ Surface water 100'+ Driveway, parking/vehicle storege 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field Inspections and L: review of Municipal records that the above systems ars in """" ' ' . . """• conformance with MOA HAA guidelines In effect on this date. Engineers Print d Nme JEFFREY A. GARNESS�,.,�•C�-7953 :p Date Z O/ VO4� s ••U.........••.� 4�do DQ�f'�o f ss e1oll 040pOo�� HAA Fee $ c" Waiver Fee $ Date of Payment_ 3 �%'D( Date of Payment Receipt NumberReceipt Number (Rev. IWO)