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Home My WebLink AboutSEACLIFF BLK 1 LT 21c cliff Block Lot 21 #011-221-22 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 (9O7) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I,D. 011-221-22 i, GENERAL INFORMATION Expiration Date: Completelegaldescription SEACLIFF S/D; LOT 21, BLOCK 1; Location (site address or direciions} 5142 SHORE CREST DR. Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address NICK GOODMAN 124 BF_.AUFOR(; CE. ANCH. AK. 99515 Dayphone 243-9965 Day phone NANCY BERG-POLLOCK w/JACK WHffE Dayphone 3201 'C' ST. SUffE 200, ANCH. AK. 99503 762-5813 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 "A" Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site E~ 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 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 o! Anchorage Is not responslble for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewaler Consultants, Inc. shall be paid $ to closing for the enginee#ng services provided. 4, STATEMENT OF INSPECTION BY ENGINEER al orpdor ] As certified by my sea/affixed hereto and as of the va/idafion date shown below, I verify that my investigation, based on procedures outlined in the Hea!th Authority Appreval Guidelines for this app/icafion, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedreoms and type of struclure ind/cated hcrein. I further vedfy that based on the information obtained from the Municipality of Anchorage fi/es 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 instal/afion. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. CARNESS. P.E, Date 337-6179 Engineer's Comments: In conducting this evaluation, AKV~'WC, Inc. attempted to provide a thorough, conscien/ious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regu/afions. The reporfed results described the performance cf the system under ~ha conditions encountered at ~he time of the test. and separa'Jon distances measured to readily identifiable features. The operatlonal life of alt we/is and septic systems depend on ~he local soils condition, groundwater levels that may £uctuate during the year, end the water usage of the family being served by the system. These conditions are outside the control of the eva/uator of the system. Satisfactory test results do not guarantee future performance of ~he system, nor do they ~uarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long tho system will continue to meet the operational requirements of the ADEC or MOA DSD. The content cf th~a re~ort is for the sole benefit of the owner listed above. Any refiance upon or use of this re,~ort by any other person or par~y Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE · ~ Approved for ,~ bedrooms. Disapproved. Conditionalapproval for __ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing stipulations: ,,~ ,- . ,.~% ..-' ~amJenance Agreements Supplemental Engineers Reo~ Other Original Certificate Date: Legal Description: A. WELL DATA Municipality of Anchorage . o Development Services Department '; 8ulkllng Safety Division On, Ire Water & Wastewater Program 4700 South Bragaw St, v P.O, Box 196650 Anchoraga. AK 99519-6650 (907) ~,3-/~04 Well typeC. LASS 'A' Date completed Tctat depth Date of test Static water level Well pnxluction WATER HEALTH AUTHORITY APPROVAL CHECKLIST SEACUFF S/Dj LOT 21. BLOCK 1; IfA, B, otc provide PWSIDft210485 Sanltaly seal (Y/N) Cased to ff. FROM WELL LOG g.p.m. Pan=el ID: 011-221-22 Well Log (Y/N) Wires pmpedy I ATINSPEC~ON colonies/100 mi. Nitrate mgJL. Other bacteria , mg./L. Data of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material CONCRETE Tank size 1250 gal. Numper of Compartments Foundation deanout (Y/N) NO Date of pumping 9/26/02 C. ABSORPTION FIELD DATA Date installed 1965 Soil rating (~or It~xlrm) UNK Length 8 It, Width 8 It. g.p.m. ¸in. colonies/10o mi. Date installed 1965 I Cleanouts (Y/N) YES Depression over tank (Y/N) NO High water ~darm (y/N) N/A Pumper ISSACS Totaldepth,l.l+/.-ff. Eff. absorption ama 192 fi= Monitoring tube YES Date of atlequacy test 10/1/02 Results (Pass/Fall) PASS Fluid depth in absoq:~on fleld baf0re test .~3 in. Wateraddede1036gal. Elapsed Time: 275 min. Final fluid depth 53 in. Absorption rata >- 450 Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes. give date *LAST 149 GALLONS CAUSED RISE OF 4 INCHES. CtBACK[D-UP INTO SEPTIC TANK O THIS POINT, System type SEEPAOE PIT Grovel below pipe 6 ft. Depreesion over field NO For 3 bedrooms New depth *'57in. g.p.d. D. LIFT STATION Date installed Size in gallons Mallhole/Ace.~e _~ (Y/N) 'Pump on' level at in. 'Pump off' I~ gt in. High water alarm level at Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main. ~ ~ce line Meets alarm & circuit requimments'~ On adjacent Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: *ST IS UNDER DRIVEWAY Building foundation 5'+ Water main 10'+ Property line 5'+ ~ Absorption field 5'+ Water service line UNKNOWN SurPace water 100'+ Wells on adjacent lots *'173' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5'+ / Building foundatinn 10'+ ld Water service line · UNI(NOWN Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots *'185' Water main 10'+ Driveway, parldng/vehlcle storage F. COMMENTS ** TO CLASS 'A' WEJ.L (lg87 ADEC WANER) G. ENGINEER'S CERTIRCATION I certify that I have deten~ined through field inspections end revfew of Municipal records that the above systems are in confoffnence with MOA HAA guidelines in effec~ on this date. Engineer's Printe~ Na Date JF...I'FI<EY A. GARNESS Date of Payment (Rev. 12~o~) Waiver Fee S Date of Payment Receipt Number 09/27/02 FRI 10:18 FAX ! O0? ?82 3180 J~ck Whi~e Es~ac~ , . .. ASBUILT IDATE: .. IInY: Isc. A Iwo~Jc ORDer: PREPAP,.~D BY: · DOWLINO & ASSOCIATES KO. BOX 110029 ANCHORAOE, AK~$II.0029 REVISIONS EASEM ~ O~ RECORD. O'II'IER "ri lAN THO~E SHOWN ON THE'REC{~.D~O FL,AT. ARE NOT SHOWN IKON riPE REBAR COIU4EK FOUND HUO ANDTACK IFIELD BOOK: NO.: DATE 8Y ALASI WATER & WASTEWATER CONSULTANTS,. INC. November 19, 2002 Municipality of Anchorage Development Service Deparlment Building Safety Division On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref. SeacliffS/D Lot 21, Block I; 5142 Shore Crest Dr. To Whom It May Concern: Based on the location of the ~vater key box, and where the water line enters the house, it is assumed that the water line runs a path around the trees located on the west side of the front yard. See attached drawing/~hat shows the assumed location of the water line. If you have any~¢ti~ns,[ please call us at 33%6179. Pre,de 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 09/2?/02 10:10 FAT I 907 762 3169 J~ack 1;hl~e Esta~ l~002 ,.o~* ~.l ,~.oc~( I ANCHOR.AOE RECORDINO DISTRICT · 4,, ~,,"% ~., * o'"' ' ',,' * · _~-.~'...'- A'"'*.:'~ · ~'; .-.. ..... ...........~ ..... ' .....::;? EA.'~ EMENTS OF RECORD. OTItI~ R TI THOSE SHOWN ON TI Ir"R£Cr )RD~D PLAT. ARE NOTSHOWN HERr. ON. (~) BR. AS$ CAP MONUMENT IP. ON riPE (PLAT NO,: ) 0~ REBAR CORNr. R FOUND ri HUO AND TACK DATE: BY: SCALE:. j WORK ORDER: ' Z.. I PREPARED BY: DOWLINO & ASSOCIATES P.O. BOX 110029 ^NCHORAGE, AK 99~11-0029 R~VISIO~S JFIELD BOOK: GRID NO.: DATE BY