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Home My WebLink AboutBRENNER LT 3Lot 075- 06 ! -84 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wa. taw~ter Program 4700 South Bmgaw SL P.O. Box 196650 Andx)mge, AK 99519-6650 ¢o7) 343-7m)4 Parcel I.D. 075-061 -84 1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: ,,,~- Complete legal description Location (site address or directions) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BRENNER SUBDIVISION; LOT .3 BRENNER CATHY OLY C/O AGENT STREET GIRDWOOO, ALASKA Day phone 78.3-0009 Day phone DAVE BAUER W/REMAX PROPERTIES Day phone 78,3-2010 HIGHTOWER ROAD. GIRDWOOD, ALASKA 99587 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well · Individual Water Storage [--] Community Class Well [-'l 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 $800. O0 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 Authority Approval Guidelines for this application, shows that the on-site water supply and/or wasteweter disposal system is(am) 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(am) 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 337-6179 Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Pdnted Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: 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. The operational life of all wells and septic systems depend on the local soils cond~'on, 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 they guarantee that there are no hidden defects or encroachments. A WWC, 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 stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other ~-~- .- . -~,.- ~.' ON-SITE '-~:' ~ ~" VV~I D~ ~I~U . '" ~ [ WASTEWATER By: ~..--v'/' L~4'''/, (R~¥, 12/00) Odginal Certificate Date: Municipality of Anchorage Development Services Department O~S~ Water & Wastw~t~r Program 4'J'O0 ~:X~h Bragaw St. HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: BRENNER SUBDIVSION; LOT 5 Parcel ID: 075-061-84 A. WELL DATA Well type PmVA~ If A, B, or C provide PWSlD~ N/A Datecompletad 11/12/85 Sanltaryeeal(Y/N)YE$ Totaldepl~ 114 ft. Casadte 110.2 lt. FROM WELL LOG Date of test ~1/12/65 Static water level 26 ft. Well production 5 g.p.m. wall ~ (Y/N) Wlree pmpedy pmtacted (Y/N) Casing height (above ground) AT INSPECTION 10/25/01 .34 It, 5.9 g.p.m. YES YES 12+ in. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Date of sample: 1 O/25/01 B. SEPTIC/HOLDING TANK DATA Nilrata 0.5 mgJl.. Collected by: Other bacteria AWWCr INC. Date installed Tank Type/Material -- Tank size gal. Number of Co~_., Founda~r tank (Y/N) High water alarm (Y/N) Date Pumper C. ABSORPTION FIELD DATA 0 colonies/100 mi. Date installed Soil rating (g.p.d./~or It=/bdrm) System type ~ ~ Length ~ It. Wldm ft. ~ ft- Date of ad.uacy test ~811) . .._~_._.. ~.or j__Trooms uvenation treatment (past 12 mo.) (Y/N & type) If yes, give data O. UFT STATION Date installed. Size in gallons Manh~_~;~/ 'Pump on" lavel at in. ~ High water alarm level at ,in. ~ ~ Cycles tested. Meets alarm & circuit requirements? E. SEPARATION OISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllllt station on lot N/A Absorption field on lot Public sewer main 75% On adjacent lots N/A On adjacent lots N,/A Public sewer manholeJcleenout * 100' Sewer/septic service line 25'+ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line .~/~~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line. Building foundation, Water main F. COMMENTS *SEE: ATTACHED AWWU A$-I~UILT. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems ere in conformance with MOA HAA guidelines in effect on this data. JEFFREY A. GARNESS Engineer's Pdn)ed/~lame Date h /~/0 1 HAA Fee $ Data of Payment Receipt Number (~. ~) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ,07t~-061'-84 HAA# :¥ :~ ~ ' GENERAL INFORMATION COmplete legal description Lot 3; Brenner Subdivision Location (site address or directions) NHN Brenner Street Girdwood~ Alaska Property owner Mailing address Lending agency Mailing address Agent Address Matt Tenter P.O. Box 1041 Girdwood~. Day phone AK 99587 783-0987 __Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well xx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system, TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. 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 of 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 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 inspection. Name of Firm Address Engineer's Signature Alaska Water & ,~.SK~ WATER & ~ - Wastewater Consuitan~ ~ Shall be PAID $ .~O(,~ ~_~ ~ or pdor to, closing for the '~ Enginee~i , :! . :: : .. : ,- ..:, ~ Provk:le~ DHHS SIGNATURE bedrooms. EWATER Phone ;) /,,J C_, UITE 2B Disapproved. Conditional approval for bedrooms, with th-e following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a ¢ourtesy 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. 72-025 (Rev. 1./91) Back MOA t¢21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES APR ;: 1999 Environmental Services Division ,v~u~',ItC~PALIr¥OF ANCHOI 825 L Street, Room 502 · Anchorage, Alaska 99501 · (90,~)~Ei~7A~4~ERWC~S DiV~SION Legal Description: Health Authority Approval Checklist /o'/~ .3 ParcelI.D.: A. WELL DATA Well type ~ £ ' v',~ i-~° If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) 'Y ~¢ ¢¢ __ Date completed ! V/2 /~Y ~ Total depth / / /-/ / Cased to I I O. ~ / Casing height (above ground) Sanitary seal (Y/N) '7 Date of test Static water level Well production Wires properly protected (Y/N)_ "/¢~ FROM WELL LOG AT INSPECTION [~' ~ g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate *'~"~/~ ~L~).~ Other bacteria .~ Collected by: /~.ut.~/(_~,, //¢ C . ' TiC/HOLDINGTANKDATA l ,',: e w ¢ ,- Dat~____ Tank size .... Number of Compartments Cleanouts (Y~-/~ Date of PumpingF°undati°n cl~_ Pum_~e~epression (Y/N)_:_~High water~..,'~ Length __Width ____ Grav~low pipe __ Total depth __ Effective absorption area ____ M~ube present ~ Depression over field (Y/N)_ Date of adequacy test / Results (Pass/Fail) ~~...__bedrooms Fluid depth in absor~fore test (in.); Immediately after__ gal. ~d (in.):__ Fluid dept~,...-,,/~ (ins) MirJutes._ i,ter: Abs~rpti°n late .= - ~ reatment (past 12 mo~.~72_02~ (Rev. 3/~6)* nths) (Y/N) If yes, give date D. LIFT~ Date installed Size in gallons ~ Manhole/Access (Y/N) level at* ~.-~-~-~ump off" level at* High water alarm level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~// 4 Absorption field on lot ,/~/',4 Public sewer main '~ ~ ~' ~ Sewer/septic service line ~ -[)' z-./' On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station l&O ' SEP ION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation '~ Absorption field ~'---~ Property line Water main/service line __S~r/drainage ~t lots__ SEPARATION DISTANCE FROM ~_B!(~Fl~l~~~n __ Property line __ ~.~_~_._~¢Jdic~o~;datio_ ___ --' e~ice line Su,ace wa~r ~ .......... Driveway. parking*ehicle storage~ Cu~ai~ drain Wells on adjacent lots F. ENGINEER'S CERTIFICATION ,~~ ~, oF,. in conforma~e w~h/~O~uid~lines in effect on this date. , Engineer's N~me/ ¢~ ~' ~¢¢~'* ¢ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Lq' 5 -'rl Z 0 ~ ;2: F JUL--25--96 THU 88:55 AM PLACER CONSTRUCT ION 907 [v~-W DRILLING, In¢, P,O. Box 10--~7~ * 10~,00id Seward Highway ANOHORAOE, A~8~ 9~51 ~ Well. Owner._._-._.._R~N L~,YINE DRILLING LOG P.02 U.e of Wel~ Location (address of: Township, Range, Section, if known; or distance main road ..... L9[...3 Breaner Sub. Size of casing 6" Depth of Hole Static water level___2_6 ft. Screen ( ); Perforated ( Describe screen or perforation . None Well pumping test at__5 gallons per of drawdown from ~tatic level, Date of completion__Mo_v_ember. 12: l 110 feet Cased to 110.20 feet (below) land surface. Finish of well (check one) ). open end ( XY~x ); (minute) for._~_ hours with 100% WELL LOG Depth in feet from grotmd surface Give details of formations penetrated, size of material, color and hardness ~2_TO 4 ~ae. k6~ L1 ____~TO . . 7 0rganle ,, ~ 7 TO 16 Gravel: clay/silt 16 TO ..... 24 Gravel: occ. boulder _.___2,..4_TO_.. 60 . Silty_g_ra_vel --~TO~7,L .. Cravelj.. silt 71 TO 75 ~_D_TO LLO__ . 1 I_0_TO 114 ____TO_ .~ ~TO .TO__~ .... E IV'E D JUL 2 5 ]996 Municipality ot Anchora.qe Dept. Health & Human Services I ~CUSTOMER Lo1' #075-06! -84 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 FAHILY'DWELLING Parcel I.D. 075-061-84 1. GENERAL INFORMATION Expiration Date: Completelegaldescription BRENNER SUBDIVISION; LOT 3 Location (site address or directions) BRENNER STREET * GIRDWOOD, ALASKA Current Property owner(s) CARLA WHEELER Day phone 783-0004 Mailing address P.O. BOX 572 * OIRDWOOD, AK 99847 Lending agency Day phone Malling address Real Estate Agent Day phone Mailing address 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 B Individual Holding tank Community On-site ~E] 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. Cedificates 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.) Cedificates ara 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. PAiD Nole: Alaska Water and I/Vastewater ¢onsullants, Inc. shall be paid $ ~ lo closing for the engineering services pro~'ded. STATEMENT OF INSPECTION BY ENGINEER at, or prior I As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 ALASKA WATER & WASTE'WATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. OARNESS, P.E. Date 337-6179 Engineer's Comments: In conducting this evaluation. AKWWC. Inc. attempted to provide a thorough. conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reporled 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. The 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 sen/ed by the system. These conditions ara outside the control of the evaluator of the system. Satisfactory test results do not guarantee futura performance of the system, nor do they guarantee that there ara no hidden defects or encroachments. AKWWC, 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 per~on or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ~ Approved for bedrooms. Disapproved. Conditional approval for __ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing stipulations: &,.-~ ~-,. ...... ,1~_ ~. ON-SITE . ~' ~ : WASTEWATER : Manitenan~ Agreements ~, 0~- -- ~ '~ Supplemental Engineeffs Reoff W2J))IHli)TM Other (Rev, 12~)$) Original Certificate Date: lO z./. Municipality of Anchorage Development Services Department Balding Safety OM~loa On-Site Wate~ & Wastewater I~ogmm P.O. I~x Ig6650 ~ge. AK g951g-6850 www.¢t.anchorage.alcus {;07) 343-~04 oO . Legal Oescllptlon: A. WELl. DATA Well b13e ~WAT¢ HEALTH AUTHORITY APPROVAL CHECKLIST BRENNER SUBDNSION; LOT 3 If A, B. or C provide PW$1D# Date completed 11/12/83 Toteldepth t14 ff. Date of'test Static water level Well ;redu.;fion WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi. Date of ~ample: 10/2/2002 8. 6EPTIC/HOLDING TANK DATA Tank l'~teltel Tank elze gal, F~undallon deanout (Y/N) Date ef p~fc,lrlg C. ABSORPTION FIELD DATA Date Installed Sanlte~y seal (Y/N) YES Caseqt~ 110,2 It, FROM WELL LOG 11/12/83 26 It. 5 g.p.m. Nitrate [ ,OOmgJL. Collected ~ pUBUC SEW[RI Number of Compartments, Oe~o~...lun over tank (Y/N) Pumper Soil rating (g.p.d.~t;br ItYedrm) VVk~th Parcel ID: O'/5-061-84. wen Log Wires propedy protected (Y/N) Casing height (above ground) AT INSPECTION 10/25/01 34. 5.9 g.p.m. YES Y~S 12+ Other bacteria ~, colontes/lO0 mi. AKWWC. INC. Date Installed Cfeanouta (Y/N) High water alarm (Y/N) ft. Gravel be_l~l~;''~- ff. Total depth _ It. Eft, absorption area It' M~ Depression over field Date of adequacy test ~Faii) .,, , . For bedrooms Flu~l depth in absorptl~ in. Water added gal. New depth in. Elapsad~,~...~-f~li~ Final fiuld depth in. Abso~tlon rate >- g.p.d. .~enatlon trealmem (past 12 mo,) (Y/N & type) If yes, give date O. LIFT STATION Date installed Size in gallons Manhole/Act~,=~ (Y/I,I) "Pump on' level at in. 'Pump off' Inv~.l at in. High water alarm level at Datum Cycles tested Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lotN/A Absorption field on lot N/A Public sewer main 75'+ Sewer/septic service line 25'+ On edjace~ lots N/A On adjacent lots N/A Publio sewer manhole/cleanout Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field Water main Water s~.wi¢e Ii,,= Surface water Wells ~n ~'~ja~,,,L ~O~S SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Pmpen'y line Building foundation Water main Water service line Surface watf,r Driveway, perldng/vehicie storage Curtain ~'3iK Wells on adjacent lots F. COMMENTS *SEE: ATFACHE0 AWWU AS-BUILT. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems ere in conformance w/th MOA HAA guidelines in effecf on this date. Engineers Printed, Name Date :0/,/0,2.. JEFFREY A. GARNESS D.te ofIO/ -I R. pt 2."] 1'7 (~ev. 12/oo) Waiver Fee S Date of Payment Receipt Number ~) .J