HomeMy WebLinkAboutT12N R4W SEC 2 LT 16 N82.5'TI2N R4W
ction 2
Lot 16 N82.5'
#012-131-29
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.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 012-1.31- ~
1. GENERAL INFORMATION
HAA# /-/A-oP.O 1'70
Expiration Date:
Completelegaldescription T12N, R4W, SECTION 2; LOT 16t N82.5'
Location (site address or directions) 6901 CARLINE PLACE "ANCHORAOE~ AK 99502
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
BI RISINGER Day phone 24.3-5676
6901 CARLINE PLACE * ANCHORAGE~ AK 99502
Day phone
JACK MAcCARTHY w/ PRUDENTIAL VISTA Dayphone
4241 "B" STREET * ANCHORAGE, AK 99505
275-7259
Unlessotherw~e mqueste~ HAA w~behe~byDSD ~rp~kup.
2. NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual Well ~]
Individual Water Storage
Community Class Well E]
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 4 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 samples. (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. shaft be paid $1~2.~.00 at, or pdor
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 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 Anchorege files 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 2B * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
337-6179
Engineer's Comments:
In conducting this evaluation, AWWC. Inc. attempted to provide a thorough,
conscientious engineedng analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results desc#bed the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of att 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 sen/ed 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 they guarantee that
there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system wilt 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 4
bedrooms.
Disapproved.
Conditional approval for
Attachments: HAA Checklist
Septic System Advisory
Well Flow Advisory
!
Municipality of Anchorage
Development Services Department
Buikllng ~afety DNislon
On.Sita Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anctx~age, AK 99519-6650
(9O7) 343-79O4
HEALTH .~UTHORITY .A, ppEovAL C:HECKLIST
Legal Description:
A. WELL DATA
T12Nf R4W, SECTION 2; LOT 16~ N82.5' Parcel lD:
012- ~31-~J~ JZ~
Well t3q:~e PRNAI~
Data completed.
Total depth. ¢5+
Date of tast
Static water level
Well production
19757
If A, B, or C provide PWSID~ N/A
Sanitary seal (Y/N)..YES
Cased to _ 40+ fi.
FROM WELL LOG
..,,. f g,p.m.
WATER SAMPLE RESULTS:
Well Log (Y/N)_ NO
Wires properly protected (Y/N) _ YES
Casing height (above ground) 12+ in.
AT INSPECTION
~._~_~.~/2002
43 ft.
9.8+ g.p.m.
Coliform . 0 colonies/100 mi. Nttrata. 0.2 mg./L. Other bacteria 10
Arsenic:. N//A mg./L. Date of sample: ~ Collected by:.
"' _ D/NOLDING TANK DATA PUBLICSEWER
.Tan~ .'~eria, . Data installed
Tank size ~aal. Number of Compartments Cleanouts (Y/N)
Foundation cleano~ Depression over tank (Y/N) .. High watar alarm (Y/N).
Data of pumping ' '"'"'-,_ Pumper
C. ABSORPTION FIELD DATA
Date installed --. Soil rating (g.p.d./ft~.~rm).. System type
Length. ft. Width "'"~..~ Gravel below pipe ft.
Total depth . ft. Eft. absoq3tion ama. ft~ Monitoring ~--'"b~ Depression over field
Date of adequacy tast. Results (Pass/Fail) ~ For bedrooms
Fluid depth in absoq3tion field before test in. Watar added, gal. ~ depth in.
Elapsed Time: . min. Final fiuid depth in. Absorption rate >= ~ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) . If yes, give data_
colonies/100 mi.
AWWC, INC.
D. LIFT STATION
PUBLIC SEWER
~ Size in gallons Manhole/Access (Y/N)
"Pump on" level at in.~level at in.
Datum Cycles tested Meets alarm & circu ' ts?
E, SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lotN/A
Absoq~tion field on lot N/A
Public sewer main 50'+
Sewer/septic se~/ice line
UNKNOWN
On adiacent lots 100'+
On adjacent lots 100°+
Public sewer manhole/cteanout
Holding tank 75'+
50'+
ISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Property line Absoq~tion field
Wate/~ervice line ~ __ Surface water_
Wells on adjacent lots ~ _
SEPARATION DISTANCE FROM ABSORPTION
Property line ~ Building foundation _~. .
~/;,rtea~nSedrVrai. nCe.line ~' eway, parkin~
F. COMMENTS
G, ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Print.ed N;~Fne
JEFFREY A. GARNESS
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
a ' f * GARAGE
'.' SEC 2. LOT 15
16.3' ,. ~ , · .
I TI2N. R4W. SEC 2, LOT 16 $2 T12N, R4W,
SEC 2. LOT 21
DATE:
K.D.W. ,'".
Al~SI/ak WATER & ~STEBWI'ER ~:~ = , ~:" ~1~ ~ '..~
BI RISINGER (907) 234-5676 1 OF 1 , '..~[~e~ rbss: ~
WAIVER REQUEST, WELL TO SEWER SERVICE LINE
zt~,. CT&E Environmental Services Inc.
CT&E Ref.#
Client Name
Project Name/t/
Client Sample ID
Matrix
Ordered By
PWSID
Remarks:
1022105001
AX. Water & Wastewater Comultants Inc.
TI2N. R4W, Sec 2 LI6 Inside HB
TI2N, R4W, Sec 2 LI6 Inside HB
Drinking Water
All Dates/Times are Alaska Standard Time
Printed Date/Time 04/25/2002 9:25
Collected Date?rime 04/22/2002 15:00
Recelved DatdTime 04/22/2002 16:15
Technical Dlrect~f...=.~ Stepheg~.q.~Etle
Released By ~~
Waters Department
Nitrate-N
R~ults PQL Uni~ Melhod
AllowaMe Prc~ An~tys~s
Limits Date Date Init
0.200 U 0.200 m~ EPA 300.0 (<I0) 04/22/02 JDT
Hicrobiology Laboratory
Total Coliform
10 OB, No Coil'
col/I OOmL SMI8 9222B
04/22/02 KAP
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED pLAT, ARE NOT SHOWN HEREON (UNLESS INDICATED)
NOTE: ANY FENCELINES SHOWN A~E LOCATED APPRO~JMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES
OR LOCATE STRUCTURES.
PAVING MAy BE SHOWN APPROXIMATELY DUE TO SNOW CONDITIONS
Municipality of Anchorage
George P. Wuerch, Mayor
Building Safety Dix4sion
P.O. Box 10C~,50 · 4700 S. Bragaw Street
Anchon~gc, Alaska ~519-~0 * (~7) 3~3-~01
h ttl~://x~v.cl.anchomgc.ak.us
?-,.'
5/29/2002
Jeffrey A. Gamess, PE
Alaska Water & Wastewater Consultants
6901 Debarr Rd. Suite 2B
Anchorage, AK 99504
Subject:
Waiver Request for 16' from well to private sewer service line
Waiver Request #WR020019
Parcel ID #012-131-29
Dear Mr. Gamess:
Your request for a waiver of the required 25 feet horizontal separation from the
sewer service line to private well has been approved. The approved separation distance
is 16.0 feet.
This waiver approval applies to the existing sewer service line to private well separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Water & Wastewater Program
I
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70lt. $0~ O F/dM.
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1'05~ DRILLING
1336 Tngra Street
Anchorage, Alaska 9950!
USE O~ W~*x. /~ ~ ~,
FEET 01~ DRAt/DOt~N,
DATE COMPLETED
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ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
May23,2002
Municipality of Anchorage
Development Service Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Waiver Request for: Lot 16, T12N, R4W, SEC 2 (6901 Carline Place).
To whom it may concern:
The existing 3 bedroom house is currently served by an on-site private well, and city sewer.
During the Health Authority Approval process, the distance between the well and sewer service
line was unknown. Per your request, we have located this line, measured the distance, and
verified its integrity.
To collect the requested data, a camera was sent down the sewer service line on May 20, 2002 by
Denali Sewer, Drain, & Excavating. The cast iron line was found to be in good condition with no
"bellys", fractures, or joint separations. The line is approximately 16 feet from the edge of the
well. Because the service line is made of cast iron, per the 1970 UPC, the separation distance to
the well must be greater than 25'. We formally request that you waive the separation distance to
16 feet.
Since the connection to the city sewer line on August 19, 1975, Mrs. Risinger has had no
problems with this encroachment. Water samples pulled from the well on April 22, 2002
conclude that this encroachment has had no negative effects on the drinking water. We request
that your department waive the separation distance from the well to the septic service line to 16
feet.
I am unaware of any~adverse impacts this waiver will have on adjacent wells or septic systems.
Ifyou have any qu~es/kons, please contact us at 337-6179. Thank you for your assistance.
6901 Debarr Road, Suite lB * Anchorage, ^K 99504
Ph: {907) 32,7-6179 * Fax: {907) 338-3246 * Website: akwwc.¢ora
~' T12N. R4W. SEC 2, LOT I1 ~ SEC 2. LOT 12
I
~ ~ ' a T12N, R4W,
~ T12N, R4W, $[C 2, LOT 20 T12N, R4W,
SEC 2, LOT
5/25/2002 .
.... CONSULTANTS. INC,~ ~n' '
~ DESCRIPTION:
~E OF WORK:
WAIVER REQUEST, WELL TO SEWER SERVICE LINE
GREATER/[NCHORAGE AREA BOROUGH · '.
':" '* :.. '" · 3SOOTUDORROAD ANCHORAGE. ALASKAgg$07
'~1m I~ I~ sE~/~ ~ ~l'~z; '~;-~
CON E TI fiST EET ORES
PROPERTY OWNER ADDRESS . .
;* .~INCH/C.O, REP. '
CONNECTION DATE . '
J ~,) ~.,j.....
CONNECTION INFORMATION.
//' ,;J~ ,.: ? .'
CONNECT TO LAT.
CONNECTION FEE.'
· ' I'
· . DXTE PAID ~ATE P^'O AMOUNT R^'O $7000
CONNECTION FEE PAID
,,~,, ,, ,, ,~. :... ~o..,~..,,.,.c.v.~.,:
I . I CONNECT AGE.~ I AMOUNT
;' . Ha'In Tap
PAYER NAME
i . PAYERADDRESS
COMMENTS
SEWER MAINTENANCE DEPT.
05/23/02 08:41:21 AM
107 ....
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