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HomeMy WebLinkAboutHOPP LT 6Hopp Lot 6 #014-091-23 /_/~/~ ~ ~ ~ ~ N/S '// 2 VELL LOG Ft. belo, hlcknes, q ~ELL DEPTH; (completed) Surface Elevation Oa~mpletI~  ~ ~Auger ~Jetted ~red ~Other: ~ ' ~ 8 FINISH OF ~ STATIC ~ATER LEVEL: ~ 'ft. ~a~ve ~ow land surface  ft. after hrs. pumping ~ D.p.m. ~,n App .... d Pit ~s Adapter ~A~ve Grade ~2' GROUTING:" ' ~ell Grouted: ~Yes ~ ~ * Ik PUHP: (If available) HP SANITARY: Feet Oire~tion Type Type: ~rslble ~ Other: This ~11 was dDtlled underD~jurlsd~lon and t~ls report Is true to the best o~ my knowledge and belief: Registe~Bus~ness Nam~ /. Contract License Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and 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 ParcetI.D. 0 t ¥ - ~ 9 / - %' ~ GENERAL INFORMATION Complete legal description La/- Location (site address or directions) Current Property owner(s) Mailing address Expiration Date: Lending agency Mailing address Real Estate Agent Mailing Address Roast 7' Pat /~¢¢_r~ Dayphone ¢ ~s, ~4 6~f ~o~ ~y~ Day phone Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: ~ Day phone 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).lssues Certificates of Health Authority Approval (HAA) based onty 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 welt and may be reissued with new water sample results. (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. 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 Anchorage 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 Address Engineer's Printed Name Phone '3' '-/~ - / .7 5-5- DSD SI/GNATURE V' Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisow Well Flow Advisory (Rev 01102) X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Da~e '~ii~St...; Stat c..i~ater; evel. . ' ~ .... .- .~ ~ ......:. :: .. .. : ' .:::...,....~.. , ·, . :Da{e:'o~.p~i~ing.:. '"' :..:..Pu'mpe~. - ..:.; .... ': :...:.-.,.,... ,:,:. :::": ,:/': :'.:':' . ~i~.i~3.~.~iF~D.~DATA~)..~/~/~.A..:.~/c;.~:~:~..:~.~`:~.:~:~.:A~.~ :" '." .::::': L~:.:'"' ". :...:; ':,,. :'- D'~a:in~tie~::"'"~ ,~'.:'..: · ' Soii'-rati.ng (g~PJ'd::~::'~:~/~Br~)::: ;':...":.: "- 'S~em :tYpe.':'.. ': ' keng~k,.~:~;:.:.,::- ff. ':'.~h. .......... ~:' ;' ' · ~av'~i~:~i~w::.~ik~ ':'T~i~d~th...."" ,."-:~. Eft: .absorpti~n~.~e~ ::,..': ',::~ :' Mb~ito~}~u~:..:'. '~: "..D.pp.~es~.n.o~er field. ,. , ....... .;;:,,T .,....,;..:. ~...,. . . :...... . · . .Date O~'~de~u~Py te~ :' Resul~'.(pas~Fail) ~ For . bedrooms Fl~id;~p~k:in:a~O~tien field be~m,t~ ~., :.i~.:...:.' ".Wa~.added:. ' · '~l::: ~ew.depth;~ in. .... ~Elapsed"~i~e: min. Einal:~aid dept~ c:,';..~' .jrt.; Abso~tien.rate >= g.p.d . Ah~.mj~.enati~n:kea{ment (past 12.~0:~ (~/N'&:.~e): ... If yes;.g~e.date wel, pr.oductton 9 '~ g;Pim; ':::'.~"...:.:';¥.~.:i%~ii: ,:.-: '- ~' - . '. ...... - TM ' ,WATER SAMP, I~E'.'RESUETS: "' ' "" COlifo~i~. ii:i'!::ii~:i::.:i: .cblo~ieS/lOG.mlv" :....Ni~t~: ~:.~]~:'"' mg;~~': - :'.':: ~h~.b:a~e~a., '.,. ~ colonies/l'0o..ml.. ' ' '~,. :"..'L' :;:.:'~:..;"¥'.:~," .L . ' ' .... · '' "~':'".~i~ 'Z~:t&~o~- ' ':' · "' '. : ', .,,. .... -: .~:~.: ~,.~ :,~ ...~ ........... . . :. ~': ~.. .; ~an~p~B{t~al;} :. -. Da~e i~stal~d ':' . .". ':";f":~ ;"C', -,....?':'.' "' .:. '. . "- · :Numbe f paam.n{S " "' ' ~.: ~.'.:};..?,~'L' ". - D:.'.. LIFT!'ST~ATION tX/. ,4. Date installed "Pump on" level at in. Datum. Size' in .gallOns ~Pump':0f¢'. level at.' Cycles tested Manho!e/Access (Y/N) · "High'water. alarm level at Meets. alarm & circuit requ rements? 'SEPARATION'DISTANCES SEPARATION DISTANCES .FROM WELL ON LOT TO: Septic tanldlift station on lot AbsorPtion fie,!d on lot Public sewer.rr{ain Sewe?/septic service line .... 0~ adja~'t'"i0ts .... ~: on adJadent lots A), ~,. Public 'sewer manhole/cleanout "-' · ".".':" ' .' · ', - - 'ri' Holding tank /',/.' ~. SEPA~,ATION DISTANCES FROM SEPI~IC/HOLDING TANK :~0NiLoT TO: N'. ,~. (~ At ~.~t~'~2- Absorption field Surface water Building foundation Water main Property line Water service line Wells on adj'acent.10ts SEPARATION DISTANCE FR(~M ~i~sOF~PTION FIELD ON LOT TO: ');~'; ;4. (__ A~'zc'b~'4z Property line Water. Service 'line Curtain 'd'~:ai'n F. COMMENTS Building. foundation Water main Surface water Driveway, pa~king/vehicle storage Wells on adjace~:lets ENGINEER, S CERTIFICATION I certify that I have'.determined through field inspections and review, of Municipal.rec<~rds' that .the: above systems are in conformance With MOA HAA guidelines in effect on, this. date. Engineer'S Printed Name Date ~"'~'c~c(r~, ~ ~ ~'~'~ HAA Fee $'"'"' Dat~ Of Payment Receipt Nu'~'ber (Rev. 1.2/0.1) .......... ;..Waive; Feb'$ ' ' ' 'J D~te.,of Payment - .'- ReCeipt.Number ztK CT &E Environmei ~ Labor, atqry Division r,~'/. Drinking Water Analysis Report utu O tTorm Uactena R~D INSTRUC~ONS ON REVERE SlOE B~ORE COLLE~NG SAMPLE MUST BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM PRIVATE WATER SYSTEM :~ Send Results ~V~t ~' Sy~te~l N~me/C0~pany Name P~cr~e Number ~viad{~ Address Send Invoice C~{a~t Name '-~ Fax Send Results : q Send Invoice SAMPLE DATE: SAMPLE TYPE: [:~ Treated Water i -: Untreated Water · Routine 200 W. Potter Drive Anchorage, AK 99518-1605 Tel' (qn7} 5~;9_9'~a'~ TO BE COMPLIED BY ~B~61-5301 ~at~is sh~ ~is Water SAMPLE ~ ~: ~afls~ Un~s~ ~le over 30 hours old. Re~l~ may ~ bnml~ble, Sample t~ long in ~n~t, Sam~e ~ould ~t ~ over 48 hm old ~r analysis ~ i~i~ mliab~ ms~. Ple~e send a new sa~le Via s~cial delive~ mail. Analytical Method: '~ Membrane Filter Lab Ref No, Result' Analyst Sent to AOEC: ANC FBK JUN Date: Time: Client notified of unsatisfactory results: Repeat Sample (refer to lab no. T~me; LJ Fax "Special Purpose Location Collected from: Time Collected ~_. Colte~.-led: by (initial): ~ ; 'Z. :&-O P~ '~t Date: ..... BACTERIOLOGICAL WATER ANAYSlS RECORD I~MO-MUG Result: Total Coliform Membrane Filter: Olrect Count Verification: LTB Fecal Coliform Confirmation; Final Membrane Filter Results: Reported By: Comments: E, Coil O' Colonles/100ml I'NTC · Too Nu~'~rou$ m C~n{ BGB COLIFORM 01~ · C~ner Sactefla Colifom~ltOOml ~ ~Lm~-~ Member of the 8G$ Group (Soci*t~ G~n~rale de Surveillance) CT&E ReL# 1028382001 Client Name Flattop T¢cbafical Sty. Project Name/# Hood S/D L6 Client Sample ID Hopp S/D L6 Matrix Drinking Water PWSID 0 Sample Remarks: All Dates/Times are Alaska Standard Time Printed Date/Time 12/16/2002 15:51 Collected DatelTime 12/12/2002 11:00 Received Date/Time 12/12/2002 12:10 Technical Director Stephen~C~de Released By (~~ Parameter Results PQL Units Method Allowable Prep Analysis Limits Date Date Init Waters Department Nitrate-N 2.11 0.200 mg/L EPA 300.0 (<=10) 12/12/02 JS Microbiology Laboratory Total Coliform TNTC OB col/100mL SM18 9222B (<=1) 12/12/02 JS BLM LOT 23 < BLM LOT 26 LOT 5 (._ 7'/~/_.c COPT) EXIS~]M6 HOUSE ZZ LOT 6 ® TRACT A I 24.2 - EXISTING ~ BUILDING SHED 24.2  89'59'30" E 70.00' LOT 13 NOTE: SNOW AND ICE MAY CONCEAL MINOR SURFACE FEATURES, ~',[;~;~~ EXFLU~ON NOTES: It Is t~e o~ne¢~' rsrcon~billLy to ~elerrnlne LEOEN0: SET FN0 LAND & CONSTRUCTION SURVEYORS-PLANNERS-ENGINEERS 44.0 Wr~ST BENSON BLVD. ~ 103 (f~x) 551-O626 ANCHORAGE, ~ASKA 99~ (907) 562-5291 LOT 6, HOPP SUBDIVISION MUN ICIPALIT~Y.4~F-ANCHORAG E DEPT. ©:  DEPARTMENT OF H~ & ENV RONMENTAL PROTECTI~viRONME~TAL H:~OT~CTION  825 L Street - Anchorage, Alaska 99501 ( ENVIRONMENTAL ENGINEERING DIVISION JUN l Telephone 264-4720 Dg l /gh REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~ kA~TYE~ ~,~ DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be processed, Please allow ten (10) days for processing. 1. PR~RTY ?~NER PHONE MAI LING ADDRESS ~ PROPERTY RESIDENT (If different from above) ~ PHONE PHONE 2. BU~ MAILING ADDRESS 3. LENDING INSTITUTION I PHONE MAILING ADDRESS 4. REALTOR/AGENT I PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6, TYPE OF RESIDENCE [~SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] . ~]:wo [] Five E~ Three [] Six [] Other 7. WATER SU~PPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM uDIVI DUAL/ON-SITE** BLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled priOr to that date, give well depth (attach log if available.) ~TA **If individual/on-site, give installation date .. If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 7:2-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY. DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1, TYPE OF REsIDENcE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER r-] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2, WATER 'SUPPLY PERMIT NUMBER r-] INDIVIDUAL DEPTH OF WELL r"] COMMUNITY DATE DRILLED I--] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area ISewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [:~APPROV ED FOR ~'~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 3/78)