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Home My WebLink AboutTURPIN #1 BLK 1 LT 15Turpin #1 Block 1 Lot 15 #006-094-21 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 C, Parcel I.D. 096-094-21 HAA# t / (�_�? � 7!;� 1. GENERAL INFORMATION Expiration Date: _Z - / 47� — 0 Complete legal description TURPIN SUBDIVISION #1 • LOT 15 BLOCK 1 Location (site address or directions) 6310 MARKSTORM STREET * ANCHORAGE AK 99504 Current Property owner(s) Mailing address Lending agency Mailing address DEBORAH RIVERA Day phone c/o ASSIST A SALE Day phone Real Estate Agent c/o MARK LITTLE w/ ASSIST A' SALE Day phone Mailing address 8001 PIONEER DRIVE ANCHORAGE * AK 99504 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 338-2482 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. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l 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. 1 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 26 * ANCHORAGE, AK 99504 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. 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 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 condition, 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. 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 person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 337-6179 Date t t /C e Zc.,L Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist 1/ Septic System Advisory Well Flow Advisory By: (Rsv. 12/01) il(i((((((/�(� �JY OFA v VIV-JI I t WATER ANO WASTEWATER DD rnr�o A K J�'c - .... • �c Manitenance Agreements 'iiNTFEN ' Supplemental Engineer's Reort iJll J)1 ? ) Other Original Certificate Date: i 1 J i tl jMunicipality of Anchorage an • ''� Development Services Department Building Safety Division ` On -Site Water & Wastewater Program P T. 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: TURPIN #1 LOT 15, BLOCK 1 Parcel ID: 006-094-21 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N A Date completed 1974 Sanitary seal (YIN) YES Total depth 54+ ft. Cased to 40+ ft. FROM WELL LOG Date of test UNKNOWN Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Well Log (YIN) NO Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 7/1/2002 52' ft. 5.7+ g.p.m. Coliform 0 colonies/100 ml. Nitrate 2.68 mg./Other �z4 bacteria 0 colonies/100 ml. Arsenic: N/A mg./L. Date of io 94 same Collected by: AKwwC, INC. B. SEPTIC/HOLDING TANK DATA PUBLIC SEWER Tank Type/Material Tank size gal. Foundation cleanout (Y/N) �a pumping C. ABSORPTION FIELD DATA Date installed Length ft. Number of Compartments HBe sion over tank (YIN) Pumper Soil rating .p.d./ rft1bdrm)_ Width ft. Total depth ft. Eff. absorption area ft2 Date of adequacy test Resul Fluid depth in absorption field bef In. Elapsed Time: in. Final fluid depth treatment (past 12 mo.) (YIN & type) Date installed (Y/N) High water alarm (YIN) System type Gravel be be ft. Depression over field For bedrooms Water added —gal. New depth _in. in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements?, E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field on lot N/A Public sewer main 50'+ Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 50'+ Holding tank 75'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Water maineFservldc fine Surface water aNell n adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water service line Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION l 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. Engineers PrintedJName JEFFREY A. GARNE55 Date t! )006 . HAA Fee $ 3'15 • °O Date of Payment Receipt Number zg 0 J3 (Rev. 12101) Driveway, parking/vehicle storage Waiver Fee $ Date of Payment Receipt Number su11� SlslA$—m ............. A. ar ess: F-7953di NOV. 8.2002 111ud:20y1 1:37PM INTEGRITY 10:10 9072767804 1ST PROPERTIESDI ROBERT E JOHNS JR NO.758 P.2 PAGE 02/03 vam�l A■0I / / •�,i�a %{ S regOM S% "'0 m0A`Y x Amar AU■.s .C„ V' �_ c..4Aas.n III unH AGY■i Q N89"X0' i0f,0 7A00' . CA 'y `� Jc1C7STlNBHO✓,Sf �' l 2•/6 See , N , % N �0 O y� O /0' N APDX4 'lip w 797,00 - UNDER NO ORCUUMANCES SO= AN A THE SURVETDR TARES RESrONSOU% FM 7NE W IJSCEO W MCES PREVAIL Lar ap� SURVEY TYPE T)NAATM A ILILT FW1 SlINIGIME AS-eR.T NOT N,Ytl ... IS�My... IAT 91f,LN.. I IdS>AWIIY QLDT PUNS It LOT SURVM T IS THE RESPONSIBLL7TY OF TME BUILDER OR C 'ONS7RVClIO1I, TO VOUrr PROPOM BLDLDIN6 IO API)SHED GRADE AND UTILITY CONNECTIONS u DIB OOSTENCE OF ANY EASI:SL41T9, COVENANTS "CH Do NOT APPEAR ON THE RECOImm SL SURVEY CERTIRWION _T PLAN Irf a 49C aR 9t UNOA71CN AS-9p.T K-- AL S==K Ag-OIA.T 6_aFn.V. LT AND ASMW FINANCIAL UAWff OW VCR ENE COST OF ENE SURVEY. 'RODUC IM MAY CAUSE ERRORS N SCAM SYMBOLS ■ SET'RFRAR ■r= ZF DRADI,ICE "-''`-.-.f AMHALT o Mm mAR 4-0-4 90CD FDIC£ 07NORM ® ASAMED ELVL -,r= MU, FEgEE ® HOOD DECK KIP ONLT TN09E IAIPRONLAIENTS AWO%C TAIOUNO AND VIMBLE NAIL BE 9NOMN. rEN= WW" SOMC CLEA IOUES MEWALK% DRIVFWAYS. VOL. ARE 10TM W 7NF1R APPROAON® ON, ONLY. SNOW .MAY PACE SH W 111PIIONE71miT� mm AND LOC HOW ALJ. DIISTANCSW ARE RECORD UN =VASE NOTE Prepare y Robert E. Johns, :lr. & Assoc. Professional LaETdI Surveyors ANCHWAM ty�A M M SLOIt 1 n = 30, Ian. IAA pft��pfdtO Nn DWA 9rMytll waerHOVE 7DL�i'O 13ER a, 2o02 'N39 LOT 15, $LOCK Y, T "I.N SM FIRST ADDITION TO ORIGINAL 't00SITE MUNICIPALITYANCHORAGE • '� DEPARTMENT OFFHEALTH & HUMAN SERVICES Division of Environmental Services it On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY Property owner' Mailing address Lending agency``— Mailing address /Z I W Man'f Ba/ Day phone 26 2 -1 � 6 7 Ccrw� so h,.,, AK M69 phone 277-D700_ 79 Agent 46V ealvwr ton {Fo%rll�� ge,%Ify Dayphone Address IID/ 'e' 7('' AVe., A-"c6rc/�Q.l AK %95!U Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: r �' 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: 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 _ - - 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 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 P_014rcrini tim # Phone �5p — 2y2 ) 5o 3 w. 3 �' � -4 310 Address Engineer's signature Date g y/ /jp 3 6. DHHS SIGNATURE l�/Approved for bedrooms. a Disapproved. Conditional approval for Additional Comments F*" W .......... ...... ® MW V. AUSMAM 0 CE - 1393 w m •• ._; A! bedrooms, with the following stipulations: 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 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. 7M25(Ray.1/91) Back MOAN21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 46 Legal Description: ("(r )14 # /1 0• 111, LC/ 45 Parcel I.D. 0060q Y2110000 0RIA44g97-A/_1 Well type nVA& If A, B, or C, attach ADEC letter. ADEC water system number NIZ4 Log present (Y/N) Al Date completed .s/51114 Driller /4y_";"::, Dr/%/yg Total depth 93/ Cased to ()nk40)'n Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG (%n kn awfl v4kneww uoknvwn g.p.m. i%nkn ywn AT INSPECTION 3- 52 f - no recc-d o� c,y WP ,o SERVICES DIVut ISION SEPARATION DISTANCES FROM �tWELL TO: AUG ] ] 1993 Septic/holding tank on lot IVIA ; On adjacent lots &A n ` Absorption field on lot N�/ 1 ; On adjacent lots N14 LLiti VED i �I Public sewer main 70 Public sewer manhole/cleanout X&M an PnV4 i Public sewer service line 65Petroleum tank X114 WATER SAMPLE RESULTS:> RE+F57 — <Iogp Coliform �� Nitrate 2. 9 m, / G Other bacteria // O1'• Date of sample: 8/2 /9 3 Collected by: ,% /04V ^�f4M B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping PU3G/C SEWEg —Tank size Foundation cleanout (Y/N) Compartments — Depression (Y/N) Alarm tested (Y/N) _- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot— On adjacent lots - To property line — Absorption field - Surface water/drainage — Foundation - Water main/service line - 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons — Vent(Y/N) High High water alarm level "Pump on" level at -- Meets MOA electrical codes (Y/N) — Manufacturer - Manhole/Access (Y/N) "Pump off" level at — Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot — On adjacent lots — D. ABSORPTION FIELD DATA Date installed -- Length Length Total absorption area Width — Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) - Soil rating — Surface water = System type -- Gravel Gravel thickness Total depth — Cleanouts present(Y/N) — Date of adequacy test — for — SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots To building foundation - On adjacent lots — Cutbank Surface water Curtain drain E. ENGINEER'S CERTIFICATION If yes, give date — Property line— To ine- To existing or abandoned system on lot = Water main/service line Driveway, parking/vehicle storage area -- bedrooms I f certify that ! have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. /v s� '+��•®fie A4�°�'` • ��Signature �cdle AS rheM Engineer's Name p _ Date D 1/D% 9 3 S ......p...e a � v. ausawM . CE.tyg3 4� HAA Fee $ —T (2 Date of Payment��q 3 Receipt Number LAS 72-026 (Rev. 3/91) Back MOA 21 ec�70 Waiver Fee: $ — Date of Payment Receipt Number MUNICIPALITY0 10 OF ANCHORAGE s) a`n �s' r= ni DEPARTMENT OF ENVIRONMENTAL QUALITY Al r -J bON 3330 "C Street, Anchorage, Alaska 99503 — 274-4561 SEP 2 1976 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and NJATER FACILITIES R E c F. I VF D 1. Type of Inspection: CMRO VA _ FHA CONV Y 2, Property Owner: BAR EP, Grady S. and Marie T. Mailing Address: 6310 Markstrom Anchorage Ak. Day Phone 333-3725 752-4953 3. Name of Buyer: _ ?`Zone Mailing Address: Day Phone 4. Name of Lending Institution: The First National Bank of Anchorage Mailing Address: _ P. 0. Box 720 Anchorage AI--. Phone 279-4481 x572 G. Name of Realtor or Agent: done Mailing Address: Phone 6. Legal Description: Lot 15, Blk 1 Turpin SIT) Add. #1 Anchorage Location: 6310 Markstrom Anchorage Ak. 99504 7. Type of Facility to be inspected: Single Family Pesidence No. Bdrms. d S. Water Supply Type of Supply: Public Utility Individual Well If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation EO -037 (1174) 8/27/76 M. A. Dodge