The URL can be used to link to this page

Home My WebLink AboutSEA TURN BLK 2 LT 12Turn Block 2: Lot [Z #017-121-36 S6 ill 10 20 04:51, Ancho;-Eige`Well & Fluinip Ser 072,1130742 P.5 Legal Description Property Owner Name &..-kddress: Pr" c�, ILkrn Z L 12— Pump Installailon Date: 7 L PumpD Iritakt eprb 31clovv'Topof Well Casing: Pump -MauafiActurers Name. Punip Model: Pump Size �9,1 hp Pidess Adapter lRurial Depth; (3 feet Piffess, Adzpter Manu betu rer's Name- PitlessAdapter IDstaller: /1. Wvtl Disinfected Upon Ckmmplction? Vcs L! No Nltthod of Disirifection: C'Offlments: Pwamp lasio.1ler Name: Attention: Thenump ftistall!er shall provide a purn-o irjstallazior, log to the DSDyvilhin :3f) days of purrp instnllaiici, --;C(D Dtrore Pond 0. ;OX 190615,0 INN .,',fork Segh;P Arc r c. ? e, M,' � 9 5 7 mayor ni Pump Installation Log Well Drilling Permit Num ber: Si ,V--- Date of Issue: Parx-0 1d(.mtifkafion Number.,- 0/7- 10 1 - 31i Legal Description Property Owner Name &..-kddress: Pr" c�, ILkrn Z L 12— Pump Installailon Date: 7 L PumpD Iritakt eprb 31clovv'Topof Well Casing: Pump -MauafiActurers Name. Punip Model: Pump Size �9,1 hp Pidess Adapter lRurial Depth; (3 feet Piffess, Adzpter Manu betu rer's Name- PitlessAdapter IDstaller: /1. Wvtl Disinfected Upon Ckmmplction? Vcs L! No Nltthod of Disirifection: C'Offlments: Pwamp lasio.1ler Name: Attention: Thenump ftistall!er shall provide a purn-o irjstallazior, log to the DSDyvilhin :3f) days of purrp instnllaiici, Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 19~50 Anchorage, AK 99519-6650 www. ci.a nchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D., 017-121-36 1. GENERAL INFORMATION Expiration Date: .~'/~'~/~?.~' Complete legal description Lot 12 Block 2 Sea Turn S/D Location (site address or directions)~' 6058 Azaiea Drive1Anchora,qe, AK 99516 Current Property owner(s) Richard Huff Day phone 907-345-5859 Mailing address Lending agency .6058 Azalea Dr. Anchorage, AK 99516 Mailing address Day phone Inspection Company Mailing Address U.S. Inspect Attn: Evens Duclair Day phone ,703-293-1529 3650 Concorde Pkwy~ Ste~ #100, Chantill¥~ VA 20t51-1129 Unless othe~se requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 4 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 ara required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. 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 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. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validat_iofi date shown below. I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for this Health Authority Approval application shows 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 fu~her 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. Name of Firm Pannone En.q. Svc. Phone 272-8218 Address P.O. Box 102954~ Anch~ AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date ~'/~l Engineers Comments: ,~. conducting a~ adequacy tc~ I ataA'~pt ~o l~-o~dg a thorough, cn~inccri=~ ~n~lysis o£thc ~ ht accordance with MOA DSD Guidclincs & P-,c'b-ml~ons. Thc rclxn~l r~dL~ dcscrik thc ix:rformaac~ o f thc system unda- thc cond/hons encoun~ at ~c ~ o f ....... ~ o.. thc tc~, and SelXWahon dis~nc~ measured to rcad/ly ~dcnt/fiable f~atu~. The opcra~onal ff£¢ of all .... wells and scpbc ~ depend on the local soil coaditmn, ground ~atct leve~ ~t ~ fl~ duxlng the yem', and the water usage o f Ihe family b~ sexved by the systeaa. 'l'hesc conditio~ ~ hidden dct'cct~ or eac~oachmcnts. PES c~n thc~cforc not l~vidc an7 warrant7 for futm-c l~'fl'ormancc ADEC or MOA DSD. Thc contmt of this rcTx)rt is for the sole 10caetit oftb. e owner listed above. Aay reliance upon or usc of this report by any othcr pc~-.~ or pal7 is not authofizcd nor win it confer any 6. ' DSD SIGNATURE ~APproved for Z// bedrooms. Disapproved. Conditional approval for __ bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X .... :70,,;%_ ~.~'~ -' ON-SITE ~ '. WA,~TEWITER : : :. .,' '- Maintenance A~reements Supplemental Engineer's Repor~ Other Original Certificate Date: Reissue Date: D. LIFT STATION Date installed 'Pump on' level at Datum Size in gallons In'Pump off level at Cycles tested Manhole/Access ~ in ' High water alan"n level at in Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot t6( Public sewer main ~,~- Sewer/septic service line On adjacent lots 100+ ' · On adjacent lots 100+ Public sewer manhole/cleanout Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main ;~5* Property line 50+ Water service line At~orplion field 11' Sudace water 100+ Drainage 10~N' Wells on adjacent lots 1~0+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10" Water Service line - 25+ Building foundation Sudace water 100+ Water main ~r~+ Driveway, parking/vehicle storage ~- Curtain drain 100+ Wells on adjacent lots 100+ F. COMMENTS , *System AI;q;)e{~m to be aoon)x. 75-80% used. **From Records G. ENGINEER'S CERTIFICATION I certify that l have detennined through Ifeld inspections and review of Municipal records tha~ the above systems ere in conformance with MOA HAA guidelines in effect on this date.' Engineer's Printed Name Steven R. Pannone. P.E. Date -lzll · .~q~. ..... , '...._ ~e. ~ ~91.." ,t Wa~er F~ S D~e of Payment R~i~ Numar Municipality of Anchorage Development Services Department · Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. cl.anchorage.ak, us (907) HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type _.P Date completed 811611984 Total depth ¶59 ft Lot 12 Block 2 Sea Turn Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi Date of sample: 5/2012002 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Anchoraqe Tank Steel Date installed 8114/1985 Tank size 1250 Cleanouts Y Foundation cleanout Y Parcel I.D.: 017-121-36 If A, B, or C provide PWSID # Well Log _Y Sanitanj seal Y . Wire~ propedy protected _Y Cased to 159 fl Casing height (above ground) 1~"+ in. · FROM WELL LOG AT INSPECTION - 8/1511~84 6/2012002 .: 73 It 63 It 12 g.p.m 4,5 g.p.m Nitrate .~..D mg/l Collected by: Other becteria~ colonies/lO0 mi Laura Pannope gal Number of Compedments 2 Delxeseion over tank N High water alarm N/A Dateof pumping 6/2012002~ Pumper Northland , C. ABSORPTION FIELD DATA Dale installed 5114/1~[)85 Soil rating (g.p.d./ft2 or It2/lxlrm) 287sf/bd System type TrenCh Length 13' & 60' It Width 2.5 fl '- Gravel below pipe 8 fl Total depth 11.45 fl Effective absorption area 1168 ft2 Monitoring tube Y DepreSSion o~er fietd N Date of adequacy test 6/2012002 Results (Pass/Fail) P~ss ' For_4 bedrooms Fluid depth in absorption field before lest 27.5/64 In Wa[er added§00 gal. New depth32.6/71.S in. Elapsed Time: 1440 min Final fluid depth.~.g~;~tci'n- ~A''~ Ab~oqXion rate >= 500* gp.d. Any rejuvenation treatment (pas~ 12 mo.) (Y/N & type) N If yes, give date (Rw. 1 I/~Y-23-0! 1Z:3TPV FI~E EflVll~l~l,~flTkt. S~ 90TSG153~I T.-656 P.0Z/03 F-475 Sampte All Dal~rTIm. are Alum Standard Time ~nt~ Dat~tme 05~002 13:47 CeU.~d Date~me 05~0~002 14:~0 R~ved Dnt~l~ 05~0~2 15:30 Allowable P~q) ,A~.tys~a N~to-N 0.223 0.200 mg/L EPA 300.0 (<10) 0~/20/02 JDT M~.c:ab~.oLog7 Libor*& C o c'J' To~d Col~/'or:3 0 ¢oVI00n~ 5M18 ~z22B (<11 0~/2.R/02 KAP ,C..,&.-o- ~ENT~ OF RE~:)~. ~ 'I~AH '.'AS-a. UU.T ' ~o 'c.o~F-.s s~ 't'.ts D^~