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HomeMy WebLinkAboutTURPIN #1 BLK 4 LT 3Turpin Block 4 Lot 3 #006-095-15 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.cLanchora ge.ak.us (907) 343-7904 CERTIFICATE OF HEALTH .AUTHORITY APPROVAL FOR .b. SINGLE FAHILY DWELLING Parcel I.D. 006-095-15 t. GENERAL INFORMATION Expiration Date: · 0 I 00 tO G -I~/'Ol Completelegaldescdption TURPIN t~l, LOT 3, BLOCK 4 Location (site address or directions) 620 LILAS PLACE Current Property owner(s) LLOYD REESE Dayphone 337-0355 · Mailing address P.O. BOX 141454 ANCHORAGE~ ALASKA 99514 Lending agency Day phone Mailing address Real Estate Agent Mailing address RENEE B1ANCO Day phone 261-7650 DYNAMIC PROPERTIES 3111 'C' $iREEI' ANCHORAOE, ALASKA 99503 Unless otherwise requested, HAA will be held by DSD for plckup. 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 B 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 AJaska. 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 propedies 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 vaIid 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. STATEMENT OF INSPECTION BY ENGINEER *:. As cerfified by my seal affixed hereto and as of the velidation date shown below, I verffy that my Investigation, based on p~ures outlined In the Health Authori~y /~oproval Guidelines for this application, shows that the on-site water supp~' and/or wastewater disposal system Is(are) safe, functional and ad~luate for the numbar of badrooms and lype of stracfure lndicated herein. I further verffy that based on the information obtained from the Munidpaliiy of Anchorage files and from rny Investiga~on and inspection, the on-site water supp~ and/or wastawater disposal system is(are) in c~mpliance with all applicable Municipal end State codes, ordinances, and regulations In effect at the b'me of installation. .. Name of Firm ALASKA. WATER &: WASTEWATER CONSULTANTS, INC. Phone 33776179 Address 6901 D~BARR ROAD, SUITE 2B * ANCHORAGE, AK 99504: '-'"*..' '. -i E~gine~'s'i=Hnt~J'~l m~) JEFFREY ;'~' (;ARNEss i::: a ':";* , *P.E,'...i ."' .... '. Date , ':' ..: .. ,. :.:..,Englnee(s Co~mehts: .. ,. consdenffous eegtneedeg ana~fs of the system In a.ccordence with ADEC and MOA DSD Guidelines & Regula§ons. The reperted msul~s descn?m~d the performance of the system under tho conditions encountered at the time of the test, and separation ~ distances mcasumd to madib/ Identifiable features. The operational life of ail wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate du#ng the year, and the water usage of the family being setl~d by the system. ' Thesecondittonsareoutsldethecontrelofthee~/aluaterofthesystem. Satisfacterytest . results do not guarantee future performance of tho system, nor do they guarantee that there are no hidden defects or enc~'~achmente. AWWC, Inc. can therefore not provfde any watrenb/ or f[rture estimate of how long the system will continue to mos! the operational requirements of the ADEC or MOA DSD. The content of this report Is f~r the sole benefit of the owner listed above. Any reliance upon or use of this repert by any other peraon or party Is not authorized, nor will It confer any legal right whatsoeyer. '5. DSD SIGNATURE · ~ Approved for ~ bedrooms. Disapproved. conditional approval. Attachments: HAA Checldist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Odglnal Certi~cate Date: '~ - ~//../Z _ 0 / '. Municipality of Anchorage Development Services Department Building Safety Olvtalon On-Site Water & Waatewater Program 4700 ~outh Oragaw St, P.O. B(~ 196650 Anchorage, AK gg519-6650 www.ci.ancttorage.ak.ua Legal Oesc~ptlon: A. WELL DATA Well type ~'mVA~ HEALTH AUTHORITY APPROVAL CHECKLIST Parcel ID: TURPIN ~I, LOT 3, BLOCK 4 Il' A~ B, or ¢ provide FqN~ID~ N/A Data completed PRE 1974* Sanltmyseal(Y/N) Y,E~, Totaldepth >51 ~ Cssl!Klto 40'+ [ FROM WELL LOG Date of test N/A N/A ff. N/A g.p.m. wetl Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 46' lt. 6.8 g.p.m. Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Data of sample: 3-5-01 Nitrate 0.5 mgJL. Other bacteria Collected by: AWWC, INC. 006-095-15 NO YES 12 in. 0 colonies/100 mi. C. ABSORPTION FIELD DATA Data installed. Soil rating (g.p.d./ft~r ~/bdrm) System type ~ Length fl. Width ft, G~ ft. Total depth ft. Eft. absorption ama ft~~ Depression over field. Date of adequacy test ~ass/Fall) __ For bedrooms Fluid depth in absorpaon field be~3m-l:l~t In. Water added gal. New depth in. Elapsed-~+~.~~''~'~. Final fluid depth in. Absorption rate >= g.p.d. ...N~y~e~uvenation treatment {past 12 mo.) (Y/N & type) if yes, give data B. SEPTIC/HOLDING TANK DATA PUBLIC SEWER Tank Tybe/Matarlal Date instalJjld.~/ Tank size gal. Number of Com~arl~?~J3~,~---'"'-'"'~-eanouts {Y/N) Foundation clean--ion over tank (Y/N) High water alarm (Y/N). D.~t~*l~3/fl~ Pumper D. UFT STATION Date installed. . Size in gsflons M~ _ 'Pump on' level at in.'Pump off' n. High water alarm level at in. Datu___~m Cycles tested Meets alarm & drcuti requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Sep~c tank/lift station on lotN/A Absorption field on lot N/A Public sewer main '30'+ Sewer/septic service line * 10'+ *SEE NOTES BY TED MOORE,I P.E. ON 1990 HAA. I On adjacent Iota N//A On adjacent lots N//A Public sewer manhole/cteanout Holding tank N/A '65'+ SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK ON LOT TO: Building foundaUon Property line ~ Water main ~ Surface water. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation.~ ~~ Driveway, pa~ng/vehlcte storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and mvtew of Municipal records that the above systems am in conformance with MOA HA4 guidelines in effect on this date. Engineer's Printed Narpe Date JEFFREY A. GARNESS HAA Fee $ ,-~(~)- Data of Payment Rece pt Number. (Rev, 12a30) Waiver Fee $ Date of Payment Receipt Number. 03-09-01 16:18 FI~M-CTE ENVII~NTAL ~ CTI£ Envlr~lmental 5e~k:e~ In~. $615301 T-418 P.gZ/O~ F-OGT Client ~amph ID MltrL~ Ordeal 1011145001 AK Wa~cr &: Wu~wam- Comuhnts Inc. ~t3 B~4 Chat Cdbff~d Te~hsleeJ Director 03/09/2001 14:52 03/05/2001 14~$ 03/06/2001 12:15 0500 U 0500 m~L EPA 300.0 10max 03/o~01 Tolg Coliform 0 coYl00mL SMI8~'x22B 03/06/01 SKW MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ~-/o,v~-- ~.¢~'.4¢_ Telephone: (home) Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent ~_7 ~. -Gt3y Address Telephone (e) Mail the HAA to the following address: (or check here [~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms 3. WATER SUPPLY Individual Well ~ Community [] Public ~IJNICIPM~.iTY OF ANCHoRAc.~ DEPT. OF HEALTH -- £NViRoNMENTA[ PROTECTION RECEIVED Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [] Public [~ Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 IRev. 7/es) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown bel ow, I verify that my investigati on of th is Health Authority Approval 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 further 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 Municipal and State codes, ordinances, and regulations in effect on the date of this inspect[on. Name of Firm ~'1 ~¢-/~,¢¢ 7-~6/~'~! _~'¢-,/'~c -~ Telephone Address I Date :;Engineer s Seal 6. DHHS APPROVAL Approved for "~ Approved [-"'"'~D i s a p p rov e d Terms of Conditional Approval bedrooms e Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. MUNICIPALITY OF ANCHORAGE (MOA) Health Authorily Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: /-"~ WELL DATA Well Classification Well Log Present (Y/N) Total Depth~ qb" Cased to ~' /'lC' Depth of Grouting Sta:tic Water Level 'Y ~/' Casing Height Above Ground I 'f' Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot H..4. ( C,/-.y ~'~.cc,¢¢-) To Nearest Edge of Absorptio~ Field on Lot ~/--'~. ~¢'~.,.,'c~/'~ If A, B, C, D.E.C. Approved (Y/N) Date Completed _/of'e 19 7' ~ Yield ~' ..¢.. ?.5'~.-,. Pump Set At ~' Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line¢: ~O ' To Nearest Public Sewer To Nearest Sewer"Service Line On Lot ~ to' Water Sample Collected by . Date Water Sample Test Results ~~¢~- ~¢4 ~z~¢c~6{~ 8EPTIO/HOLOIN~ TANK DATA D~te ln~talled size No. o~ Oompartm~nt~ Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) MUNICIPALITY OF ANCHOP, AGE DEPT. OF HEALTH & ENVIRONMENTAL PROT[CTION To Buiiding Foundation To Disposal Field i~L~,.,L i V LI./ Standpipes (Y/N) Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line To Stream. Pond. Lake or Major Drainage Course Comments {,,,/¢~7-x~'¢~ Co,,~,~ ~c /'~o.n jo 72-026 (ROY. 7/88) Fronl Page I of 2 C. ABSORPTION FIELD DATA N,/~, Soils Rating in Absorption Strata Date Installed WiSth oflField Square Feet of Absortion Area D~pression over Field (Y/N) Res,u,l!s of L, ast Adequacy Test SEPARATION DIS'~'ANcE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot . . ... To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Coume To Driveway, Parking Area, Rr Vel~icle Storage Area Comments.. (./¢¢i~,~'¢,~' ~op,~c ~o.* /~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line To E>~isting or Abandoned System on -. ; On Adjoining Lots ' To Cutback (if present) Dm LIFT STATION N. ,~, Date I'nstalled Size in Gallons "Pump On" Level at High Water Alarm Level at' 'Tested :[Or Meets MOA Ei~iricar Code's (Y/N) ' Comments Dimensions ._ Manhole/Access (Y/N) "Pu'mp off" Level'at' Vent (Y/N) ' 7 ......................... 'Pumping Cycles during Adequacy Test. **Check Permitted B6droom Rating Against HAA Request** I certify that I haveichecked, verified, or conformed to all MOA and inspection, Signed..~~ Date 0ec MOA No. ,ffect on the date of this Engineer's Seal Receipt No, Date of Payment Amount: $ __ /2-026 (Rev, 7/88) Beck Receipt No. Waiver Fee: $ Date of Payment. Page 2 of 2 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel i.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lo/ Location (address or directions) (b) Property owner Mailing Address Telephone: (home) _ Business (c) Lending Institution ~'/"/'~'~ Mailing Address (d) Real Estate Company and Agent /~,~- Telephone Address Telephone (e) Mail the HAA to the following address: (or check here F"Xl, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms 3' 3. WATER SUPPLY Individual Well ~ Community [] Public [] .Note: If community well system, must have written confirmation from the State Department Of Environmental Conservation attesting to th legality and StatuE. ' ' ' : 4. SEWAGE DISPOSAL On-site [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th~s Health Authority Approval 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 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm i~(¢zC'-'tt~t~ 7-~c/1~[¢c4f ~'¢ru't'c~,~ Telephone Address Iflf$'30 E¢~o (~/./ tZlr~ c/4of'~¢~., .,4P'c Date D~c / ~ 6. DHHS APPROVAL Approved for .'~ Approved ~ bedrooms by ~-~~' ~Date /~ -~-/~ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~25 (Rev. 7/88)Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ~..~J. A. WELL DATA Well Classification Well Log Present (Y/N) N Date Completed Total Depth~ 'he ' Cased to · "/'¢ ° Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) I? 7~ Yield · ~ "/'5",,~/~,, Static Water Level U q' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: Pump Set At ~' Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) N To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line~ To Nearest Sewer Service Line On Lot ~' ¢, ~,, ~'~'c~¢,") ; On Adjoining Lots N, ~. Ikl,/~, ; On Adjoining Lots I~t, A.. To Nearest Public Sewer Cleanout/Manhole 3'5" Water Sample Collected by ~'?'~{'/'~/~ ~'¢cb _('o,¢ ;Date WaterSampleTestResults ~~ - ~o~ ~c~ l~ B. SEPTIC/HOLDING TANK DA~,~, Date Installed Size No. of Compartments Standpipes (Y/N) Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments To Buiiding Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments (./'¢¢~ ~,,~ r~ E'o~/~'c/"~ /~ AcC/~-,c~..( Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ To Cutback (if present) D. LIFT STATION N, ,~-, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical'Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level'at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and H~,A.~b~li~i'~l~e~ffect inspection, Signed __~~ Company I=(~/ Date Dec Receipt No. Date of Payment /~ -~) - ~ 0 Waiver Fee:$ Amount: $ / ~¢ [)C~ Date of Payment 72-028 (Rev. 7/88) Back Page 2 of 2 the date of this Engineer's Seal FLATTOP TECHNICAL SERVICES 14530 Echo St., Anchorage, AK Ph, (907) 345-1355 Legal 'Description:. Street'Address: 620 ADEQUACY TEST DATA SHEET 99516 Client Name:. /-LoYD Test Date:. Initial Conditions: Float #1 in set Float #2 in' set-- Float #3 .in set-- Float #4 in set Water added' through: TeSted By: " b,t,o, " pipe w, " fluid " b,t,o, "pipe w, " fluid " b.t.o,. " pipe w, ".fluid " b,t.o, " pipe w, " fluid '"'~CTION TiME H20 METE[ NET, GAL WEL'L FLUID LEVEL TAKEN ' LEVEL CT~T II',~o _ ~75& ----Q ............... 91 11:2o ,. ~g 816 60 ~ ~-. ~o tiff 27? ~23 ~8 3 :/o ffq~oy. 7Yf esured ..... y~ ~ s,v~ ~e~ ~/~ Adequate for ..~ Bdrms Unit Absorption Capacity = Average Absorption Rate Surge Capacity Adequate for Bdrms %, CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907)562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAI~LZ for ?fork Order ~ 30464 Date Report Printed; DEC 3 90 @ 10:30 Client Sample ID:L3 E4 TURPIII ~1; GARAGE uTILITY ?~VSID :UA Collected NOV 29 90 ~ 11:30 lye. R~eeived NOV 29 90 ~ 1~:20 hrs, Preser¥~d with :AS REQUIRED Client {lame ' ~LATTOP TECHNICAL SRV Client Acer : FLAIYO? P.O.U !IORE RECEIVED Req ~ O~dored By TED ~OORE Analysis Co]npletod :NOV 30 90 Send Reports co IJFLATTOP TECHNICAL SRV Labor~tozy ~upez¥1~o% :~TEPREN C. EDE Chsmlab Ref ~: 905031 Lab S;npl ID: I ~atrl×: WATER Allowable ?arametex Tooted gemlIt Unit8 }~ethod Limit~ NiTRATE-I~ ND[O,IO~ )~g/1 EPA ~53.2 lO Sample ROUTIRE SAIdPLE, Remarks: SAI~LE COLLECTED BY CHRIS. 1 ~ests Poz£ozmed See Special Instructions Abovo UA-Unavailable RD~ [tone Detected *' See Sample Remarks Above NA= Not Ana3.¥zed LT=Le~s Than, G~:G~e~te~ Than hi 50 ST*O+OO~O.T"I 7' STA 7+69.61 MH TP-$ SEE 3O x' +~ 'bi