HomeMy WebLinkAboutHERITAGE HEIGHTS #1 LT 27AHeritog
Heights
Lot 27A
#015-36!-46
--i~-~-~'- ~255 E. Fireweed Lane, Suite 102. Anchorage, AK 99503. (907)277-2021
~1,~ ~ ~'~' J1800 E. Parks Hwy., Suite D-100 Wasilla, AK 99654 · (907) 376-3005
/
GILFILIAN ENGINEERING INC.
Professional Environmental Consultant~
Main
January 29, 1993
Mr. Kent Hartzberg
P.O. Box 202444
Anchorage, Alaska 99520
GEI Project No. 93007
Dear Mr. Hartzberg:
Mat-Su Office:
Engin~r Ev~uation of On-Site Water ~d Sewer Systems
~t 27A, Hefi~ge Heights Subdivision
93~ Spruce ~o~ Circle, Anchorage,
255 E. Fireweed Lane, Suite 102, Anchorage, Alaska 99503
(907) 277-2021 · FAX (907) 274-8683
1800 E. Parks Highway, Suite D-100, Wasilla, Alaska 99654
(907) 376-3005;o FAX (907) 373-5686
In response to your verbal request made on January 12, 1993, Gilfflian Engineering, Inc. (GE1)
has completed a preliminary evaluation of the operation of the on-site water and sewer systems
that serve the above referenced property. This letter provides a report on the results of an
adequacy test. conducted on the septic tank/soil absorption system, a well flow test, and water
quality tests done as a part of this site evaluation.
Subsequent to receiving your request for our services, we obtained records pertaining to the
property's on-site water and sewer systems that were available at the Municipality of
Anchorage's (MOA) Department of Health and Human Services. In addition to those records,
we received a copy of the certified letter dated December 29, 1992, sent to Lennart and Louise
Augustsson from Mr. John Smith, P.E., Program Manager of MOA's On-Site Services Division.
Mr. Smith's letter served as a Notice of Violation (NOV) to the Augustssons regarding the
illegal use of the property's on-site well and sewage disposal systems.
In reference to Mr. Smith's letter, it is our understanding the purpose of this report is to address
the NOV's February 1, 1993 requirement of retaining the services of a registered Professional
Engineer to the evaluate the condition of the existing on-site sewer and water systems.
93007-A.REG
Mr. Kent Hartzberg Lot 27A, Heritage Heights Subdivision, Anchorage, AK
DESCRIFrlON OF FIELD INVESTIGATION
On January 15 and 19, 1993, representatives from GEI visited the subject property and obtained
information on the type and use of the on-site water and sewer systems. During the initial site
visit, Mr. Steve Rebillard, an Environmental Geologist with GE1, had the opportunity to meet
with you. According to verbal information provided by you, the septic tank consists of a 1,500-
gallon two-compartment septic tank, and the soil absorption system consists of a seepage trench
of unknown size. At that time, Mr. Rebillard took measurements on the site topographic
features with tie-ins to the existing pipe improvements.' Attached to this letter is a copy of a Site
Plan drawing that was based on Mr. Rebillard's measurements superimposed on an as-built
survey of the property made by another firm.
On January 19, 1993, Mr. Robert S. Gilffiian, a Field Technician with GEI, conducted an
adequacy test on the septic tank/soil absorption system and a well flow test on the water well
pumping system. Also, representative water samples were collected from the Water supply
system and sent to Mat-Su Test Lab, Inc. for total coliform bacteria and nitrate analyses.
The septic system adequacy test involved the discharge of clear water from the dwelling's water
system into a sewer line cleanout that drained into the septic tank. The flow rate was
determined by recording the measurements on a metering device attached to the 3/4-inch
diameter garden hose used to discharge water into the sewer line cleanout. The flow rate was
measured at 15-minute intervals throughout the test period. The liquid levels in the septic tank
were monitored via two 4-inch diameter tank pump out pipes as water flowed through the tank
into the seepage trench. There were no monitor pipes available in the soil absorption system
to observe the changes in the liquid level in the seepage trench.
The on-site water supply well consists of a 6-inch diameter steel casing that was located in a well
pit. The well is equipped with a submersible well pump that pumps water tO the single family
dwelling. The well pump flow rate was measured during the septic system adequacy test. The
GILFILIAN ENGINEERING, INC. -2- 93007-A.REG
Mr. Kent Hartzberg Lot 27A, Heritage Heights Subdivision, Anchorage, AK
flow rate averaged 6.3 gallons per minute (gpm) that ranged from 6.0 to 7.0 gpm. The total
amount of flow used for the well flow test and adequacy test was approximately 618 gallons,
which is equivalent to the daily flow typically used for the design of an on-site septic tank
system to serve a 4 bedroom dwelling.
DISCUSSION OF FIF. I.D AND LABORATORY TEST RESULTS
Based on the adequacy test field measurements, the septic tank system was found to be in
satisfactory condition. The soil absorption system (seepage trench) adequately handled the
minimum flow for a 4 bedroom dwelling. The effluent level in the septic tank rose 1-inch at
the start of the test and remained at that level throughout the test period. There were no effluent
back-up problems observed 'in the sewer line nor in the septic tank.
The average well pump flow rate was 6.3 gpm. This rate of sustained flow exceeds the MOA's
minimum flow requirements for a 4-bedroom dwelling.
A copy of the water quality test results from Mat-Su Test Lab is also enclosed with this report.
The nitrate concentration in the well water was below the detection limits of the test (less than
0.2 mg/1). The total coliform bacteria concentration was found to be zero (0) colonies per 100
milliliters. These laboratory test results indicate the quality of the well water comply with the
minimum MOA drinking water quality requirements for a single family dwelling.
CONCLUSIONS AND RECOMMENDATIONS
As noted above, the existing on-site septic tank/soil absorption system and water supply well
system appeared to be operating properly at the time of our site investigation. It is our
understanding per the aforementioned NOV issued by Mr. John Smith, P.E., the well and septic
tank system currently used on the subject property were installed and operated without the
proper permits. Also, there is a question regarding the use of the garage for an office; thereby,
GILFILIAN ENGINEERING, INC. -3- 93007-A.REG
Mr. Kent Hartzberg Lot 27A, Heritage He!ghts Subdivision, Anchorage, AK
resulting in the well being classified as a Class C Public Water Supply Well (defmed by the
Alaska Department of Environmental Conservation (ADEC) under 18 AAC 80, Drinking Water
Regulations).
Although there remains the issue of non-compliance with the MOA and ADEC regulations
concerning the construction and operation of the private/public on-site water supply and sewer
systems, it is our professional opinion that the current operating conditions of these systems does
not pose an immediate threat to public health and the environment. Given the time frame
provided in the NOV for bringing these on-site systems into compliance with MOA/ADEC
regulations, we recommend the following approach be used to resolve the non-compliance issues:
During the month of February 1993, the use of your property for residential and/or
business purposes should be evaluated to determine if the current and future use will
comply with applicable land use / zoning regulations. Dependent on that determination,
appropriate steps as outlined below can be made to upgrade and/or replace the existing
on-site water and sewer systems.
During the month of May 1993, a deep test hole should be excavated in the proposed
location of a replacement soil absorption system that will serve the building
improvements on the property. The test hole must be logged by an engineering firm and
will provide information for the design of the replacement soil absorption system.
o
Prior to June 15, 1993, an engineering plan for the proposed on-site improvements and
a MOA sewer/water application be submitted to the MOA On-Site Services Division for
review and approval. The purpose of the submittal is to obtain the necessary permits to
allow the construction of the proposed improvements.
After spring breakup, the well pit must be properly abandoned. Either the existing well
casing be extended to a height of a minimum of 12-inches above the surrounding ground
GILFILIAN ENGINEERING, INC. -Z~- 93007~A.REG
Mr, Kent Hartzberg Lot 27A, Heritage Heights Subdivision, Anchorage, AK
surface or the well be properly abandoned and replaced with a new well drilled at a
location that meets the appropriate minimum separation distances from sources of
contamination. Also, if the well is determined to be classified as a Public Class C water
supply source, then plans must be submitted to ADEC for approval to construct and
operate the well.
Upon your concurrence, we will submit a copy of this report to Mr..~mith, P.E., of the
MOA On-Site Services Division for his review. Gilfflian Engineering, Inc. is available for
further consultation on this project and would be pleased to provide you wiih additional services
as needed.
If you have any questions regarding our findings and recommendations, please do not hesitate
to contact me at 277-2021.
Sincerely,
GILFILIAN ENGINEERING, INC.
Robert E. Gilfilian, P.E.
President
Enclosures:
Site Plan Drawing
Nitrate Analysis from Mat-Su Test Lab, Inc.
Total Coliform Bacteria Analysis from Mat-Su Test Lab, Inc.
GILFILIAN ENGINEERING, INC. -5- 93007-A.REG
~ LOT 27A
~ o
~ .GE
o REEN USE
o
o -
S89 53'24"E 330.28' (PLAT)
SCALE IN FEET
LEGEND 0 50
A 6" DIA. STEEL CASED WELL
0 4" DIA. SEWER CLEAN-OUT PIPE 25 100
· 4" DIA. SEPTIC TANK PUMP-OUT PIPE
SITE PLAN - LOT 27A, HERITAGE HEIGHTS SUBD., 9300 SPRUCE KNOLl
SCALE AS SHOWN
GILFILIAN ENGINEERING, INC.
DATE: 1-26-93
Mat-Su Office: 1800 E. Parks Highway. Suite D-100. Wasilla, Alaska 99654
Anchorage Office: 255 E. Fireweed Ln., Suite 102, Anchorage. Alaska 99503 PROJECT $ 193007
CODE: 193007.GCD
,4AT-SU TEST
Soils - Concrete - Water
Field and Laboratory Testing Services
5751 Mayflower C°uf~ Wasll!a, Alas~ go~o54 - 7880
Phone (907) 376-3005 Fax (~07) 373-5686
CLIENT: Gilfilian Eng neerin.q, InC.
ADDRESS: 255 E. Fireweed, #102
Anchorage, AK 99503
PHONE# 277-2021
ACCOUNT #: 001
TEST(s): Nitrate
DATE: 1/25/93
COST OF TEST(s):
TAX:
TOTAL:
PAYMENT: CHECK #
REFERENCE NO:
$22.00
0.44
$22.44
CASH
393O1O
LEGAL/PROJECT NAME: Lot 27A, Heritage Heights, Anchorage GEl #93007
PRIVATE: / PUBLIC (LIST STATE ID NO.):.
DATE RECEIVED: 1/20/93 TIME RECEIVED: 1600
DATE SAMPLED: 1/19/93 TIME SAMPLED: 1235 SAMPLED BY GEI/BSG
Analysis Performed:
Level Detected NICL
Nitrate 0.0 mg/I 10 mg/I
mg/I = milligrams per liter
ND = none detected
MCL = maximum contaminant level
NOTE: This analysis was performed by: Mat-Su Test Lab, Inc.
If you have any questions concerning the above results, please call me at 376-3005.
Cheryl Ful~V~a~-er L~I~ Manager Date
OHVNO(]
LL
L,$
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmere Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. munLorg/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O'~5- ~G{- ~)
GENERAL INFORMATION.
Complete legal descriptiOn
LOcation (site address) ..
Current ProPerty owner(s)
, Mailing a~dreSg.
Lending agency
COSA# ~oC- \\\~
Expiration Date:
'~4 Jr~o~ ~;~ Day phone
t
Day phone
Mailing address
Real Estate Agent
' Mailing AddreSs .~,
Unless othenVis~, requested, COSA will be held by DSD for pickup.
NUMBER OF'BEDRQOMS: ~
Day phone
3.. 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 Depadment (DSD) issues Cedificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site System's 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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. (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, I verify that my. investigation,
based on procedures outlined in the Certificate of On-Site Systems 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 o.f 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 ZJTq,~"xLI~D
Address ~:).3 '~,
Engineer's Printed Name LAg,5 ,.-~otlPJ,<.L,qNb
Approved for H
Disapproved..,
bedrooms.
Phone
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well .Flow Advisory
Nitrate Advisory X/.
By:
(Rev 11/o5)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
~)~ Original Certificate Date: //O - J'~ -/[
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650 '
. www. muni.org/onsite
(907) 343~7904"
CERTIFICATE.OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: ~-~.tTAG~,. ~.I~-I. ITS'I~{ LoT ~A "'"'"Parcel ID: OI5- ~1- ~{o
A. '.WELL DATA
We, type
Date completed
Total depth ~ Cl~) ft.
IfA, B, or c provide PWSID # -'
Sanitary seal (Y/N) Y
Cased to. '7~'/~) ft.~
Well'L~0g (Y/N) Jr'
wires p~0~efly protected (Y/N) '7'
Casing height (above ground) iT.+ in.
FROM WELL LOG
Date of test U~I K~ow~
Static water level ~t~<,~n ff. '"
Well production ~(v~D~3 g.p.m.
WATER SAMPLE RESULTS: ~ W¢~, 0.~,~,,
Coliform /V'6;~ colonies/100 mL Nitrate
Arsenic: JV0 ug/L date of sample:
B. SEPTIC/HOLDING TANK DATA.
Tank Type/Material ~ ~'I~.~. F../,~ e ~
!
Tank size ' JS00 :gal Number of Compartments
Foundation cleanOut (y/N} ~ '~/ Depression over tank (Y/N) ._
AT INSPECTION
g.p.m.
co,ectod by:
!
!
Date installed loll
Cleanouts (Y/N)
High water alarm (Y/N) '
Date of pumping Pumper
C. ABSORPTION FIELD DATA
'Date';~stalled {°l'lJcl5~ SOil rating ~~ or~/bdrm) 0,~,
Length ",.5'~ ft. Width '~. ft.
Total depth. ~ . ft. Eft. absorption area {l:O~ft2 Monitoring tube .
Date of adequacy test ~101'~ Results(Pass/Fail).
Fluid depth in absorption field before test S.~ in.
Elapsed Time: l~0 min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
System type D~O
Gravel below pipe.
¥ Depression over field iV'
Water added......~ gal.
in. Absorption rate >=
fto
For Z~ bedrooms
New depth. ~0[ in:
folio g.p.d.
If yes, give date ~
:E.
LIFT STATION
Date installed ,/,'"Size in gallons ,,~anhole/A~s (Y/N) ,~
"Pump on"~ "Pump off' level at J High Water alarm level at J in.
Datum · Cycles tested ,,//~ ' Meets alarm & clients? '
sEpARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
!
Septic tank/lift station on. lot IOO 4. ~ ! ~
Absorption field on lot JOe ~4-
.Public sewer main '~/,,4 ·
Sewer'/septic service line ?..5 ~-
Animal containment areas =jO 14-
I
Oh'.adjacent lots I00
On adjacent lots I GE) i.~
Public sewer manhole/cleanout
Holding tank /V/~
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation J~ 14' ~, '~' ~Property line ,,~ I
Water main A//A Water service line
i
IO
-I-
Wells on adjacent lots ~OOl'{' .... ·
Absorption field
Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'l'l- Building foundation {0 ~
'
Water Service line lO + Surface water I(~14' .
Curtain drain ~l'l' ~N,D~ Wells on adjacent lots 10014
Water main /~/'/A~
Driveway. parking/vehide storage , ~-~ t~.
COMMENTS ; "~ '
G. ENGINEER'S CERTIFICATION
review of Municipal records that the above Systems are in
conformance with MOA COSA guidelines in effect.on this date.
Engineer's Printed Name L
Date ~/ZO/~ I ..... -- -"
COSA Fee $,. ~(~
Date of Payment
Receipt Number
Waiver Fee $
('"_~ Date of Payment
Receipt Number
(Rev. 4/10)
Municipality of Anchorage
Community. Development Department
Development Services Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # 111362
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
27A of Heritage Heights #1 subdivision. This inspection revealed a nitrate
concentration of 6.64 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
SGS Ref.# 1114084001
Client Name Spurkland Engineering Printed Date/Time 08/31/2011 16:48
Project Name/# Heritage Heights L27A Collected Date/Time 08/25/2011 4:00
Client Sample ID Heritage Heights L27A Received Date/Time 08/25/2011 16:35
Matrix Drinking Water Technical Director Stel~hen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic
ND 5.00 ug/L EP200.8 A (<10'~ 08/30/11 08/31/11 NRB
SGS Reft# 1113936001
Client Name Spurldand Engineering Printed Date/Time 08/25/2011 11:30
Project Name/# Heritage Heights L27A Collected Date/Time 08/18/2011 17:00
Client Sample lD Heritage Heights L27A Received Date/Time 08/19/2011 13:35
Matrix Drinking Water Technical Director Stephen C. Ede
Saml~le Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Waters Department
Total Nitrate/Nitrite-N
6.64 0.100 mg/L SM204500NO3-F B (<10) 08/24/11 AYC
Microbiology Laboratory
E. Coli
Total Coliform
Negative 1 100mL SM20 9223B A 08/19/11 DLC
Negative 1 100mL SM20 92231] A 08/19/11 DLC
LOT 27A HAS 100,563.0 Sq. FT.
25A
26A
S89'56'21 "E25.00
14,0.2
ESTM
WOODEN FENCE
0.7' WIDE RETAINING
160.3
CONCRETE PAD
EXISTIN(2
WALKWAy
GRAVEL DRI~
SECOND FLOOR
DECK
BRICK
1.0' WIDE
N89'54.'10"W330.20
GRAPHIC SCALE;
Inch = 50 Feet
t~OR:
John Lopez
£anMark
Engineering & Surveying, Inc.
9330 Vanguard Drive, Suite 203
Anchorage, Alaska 99507
(90?) 562-6050
Date
9/10/04
Grid
2438
Drawn by
CEF/DLM
25 12.5 0 12,5 25 50
Scale
1" : 50'
I00
AS- BUILT
2400819
Field Book
208
I hereby certify that the property described hereon has been surveyed
by me, or at my direction, and that the improvements situated thereon
are within the property lines and do not overlap or encroach on the
property lying adjacent thereto unless otherwise shown. That no
improvements on the property lying adjacent thereto encroach on the
premises in question and that there are no roadways, transmission
lines or other ,easements on said property except as shown.
It is the responsibility of the owner or builder, prior to construction,
to verify proposed building grade relative to finish grade and utility
connections and to determine the existence of any easements, covenants,
or restrictions which do not appear on the recorded subdivision plat.
Listed distances prevail over scaling.
Reproduction may cause distortion.
Legal Description
Lot 27A I
Block
HERITAGE HEIGHTS
SUBDIVISION
ADD. #1
A^row Pump & Well Service, LLC
P.O~ Et0× 110496
Anchorage, AK 99511
Office: (907) 346-9355 · Fax (907) 333-8976
Eagle River: (907)622-9~5
No, 9129
CUSTOMER
--~. ............ : 7: ....... :,7:: .....
dOB SITE
F-_&,?.._.._¢. .... ~:._:-_>: ,/U_._.. -~
_.:.4::::. ~: ...... :.-¢.2D'.'7-7__
b
m .~Ua~y ..... D~R~iON ........ P.,~ ,O.E,,, AMOUNT
EABOR HOURS RATE AMOUNT TOTAL MATERIAL
TOTAL ~BOR
WORK ORDERED 8Y~ DATE COMR
LA80~
ThankYou
SIGNATURE
(1 Hereby Acknowledge the Sal.isfactory Compietion of the Above Described Work arid agree that if above work is not paid for in 90 days I Agree to
Pump & Well Service, L,L,C. the right to remove unl:~ici for equipment and charge for labor already performed & labor to remove unpaid for equipmer¢,)
TERMS: ACCOUNTS PAYABLE AT 10TH OF MO~ FOLLOWING, PURCHASE.
SERVICE CHARGE AT la. ATE OF 1~5% PER MONTH WILL BE,CHARGED O1~! OYERDUE ACCOUNTS.
MuniciPality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and WaStewate~ Program
4700 South Bragaw St.
P.O. Box 196650 Anchoragel AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWEELING
Parcel I.D.
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
HAA # Oq
Expiration Date:
Current Property owner(s) C~ ,-/-Jx
Mailing~address f'. O. ~o,x
Lending agency No~.
Day phone
A-~cAo,'?'G /~'-,x
Day phone
=
Mailing address
Real Estate Agent
Mailing Address
~jZol '["" £/:~ /~na4o",~'¢' ~ AL~
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
3. 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) 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 (exc&pt 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. (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, 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 vedfy that based on the information obtained from the
Municipality of Anchorage flies 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
DSD SIGNATURE
~ Approved for Z.~ . bedrooms.
Disapproved.
Conditional approval for
.#
bedrooms, with the following stipulations:,,,,,,,,.
Additional Comments
.
Note: ~he well for this proper~ meets e~s~g State a~d
present. It is suggested that periodic testing be performed to insure the wells continUed suitability.
Current nitrate concentration is 5.42 mg/l. EPA maximum concentration is 10.0 mg/l. More
information on nitrates is available from the On-Site Services Program, at 343'7904.
Attachments:
HAA CheCklist
Septic System Advisory
Well Flow AdviSory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
(Rev, 01/02)
- EIFT*$TA'ilrO'N~'/V, ,f,
Date installed
Pure ~ on" level al in.
Datum
Size in gallons
"Pumc off" level at 'n.
Cycles testea
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
E. S E P AR'A T ro~'DI ~'I"',~[~CES ..............................................................
SEPARATION DISTANCES
Septic tankTlift 'station 05 lot
Absorption field on lot
Public sewer main
Sewer/septic service line
I o ~' On adjacent lots ;::> t~',::,'
I ! <¢' ' _ ..... On adjacent lots ':>
/V. /f. Public sewer manhole/cleanout
· ~ 'z~-' Holding tank
Building foundation ¢~-'
Water main ~. ~.
Wells on adjacent lots ~ ~oo·
S E PARATiON-D FSTANdE'~-~~FO~o~ ...................................
Property line ~ ~ ' . ,~ Building foundation ~ ~' ' Water main
Water Service line
Cur(ain drair
F'~ COMMENTS
Property line 7 z' Absorption field 'fo '
Water service line ';> ¢,¢' Surface water '~ /~,o'
Driveway, parking/vehicle storage
Surface water ~. loc,,
Wells on adjacem 10ts '> ~c,o,
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are ¢n
conformance with MOA HAA guidelines in effect on this date
Engineer'sP?inte8 Iqarrie i-~¢o,:~'o ~ ~
HAA Fee $ ~/~' °---~'-~
Date of Payment /~ ! -~ f ¢'t'
Receipt Number
(Rev. 12/01
Waiver Fee $
Date of Payment
Receipt Number
CE - 358
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
Parcel I.D.
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING ~ e. t'5~u ~
ors- - 36'/- qo"
GENERAL INFORMA¥1ON
Complete legal description Lo t
Location (site address or directions)
HAA#. 0 ~0 3- ~t5
Expiration Date: ~_~ _ /t '7- 0 ~
Current Property'owner(s)
Mailing address
Lend!rig agency
Mailing address
Real Estate Agent
Mailing Address
Day phone '~zz-~',5~T
Day phone ~-~.'-,~83',.~
.j
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class__
Public Water System
Well
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. 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. Cedificates 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. (Cedificates 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.
^tote ' Per cop), o?
'4. STATEMENT OF INSPECTION BY ENGINEER
As cedified 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,
andregulationsineffectatthetimeofinstallation../v.,./, r,,.,.,,/b' .~," ~/~/ col;,,G,,-,,.-. ~e,~ eco~/ ~,~ .e,~,~. ~,~ l-'J"',,,~ ~ ~.,. ,,~,~<.. ,.,-.~./,.,.-
Name of Firm. i="la/-,/off '-/'~cA,~ ,' r~./' _Cern,-; e~.../ Phone .3' '~..c'- ,.3'.~--..~-
Address / qZ".~O ~'d-~ J",/-./ ~ -~~'4; /~
Engineer's Printed Name '"7"~¢~...~0,--~ ~-, /--z~.,o,.-~ Date
DSD SIGNATURE
Approved for /7L' bedrooms.
Disapproved.
Conditional approval for
bed~'ooms, with the following stipul
Additional Comments
Note: The well for this property meets existing State and Municipal Codes. There are nitrates
present. It is suggested that periodic testing be performed to insure the wells continued suitability.
Current nitrate concentration is 5.42 mg/l. EPA maximum concentration is 10.0 mg/l. More
information on nitrates is available from the On-Site Services Program, at 343-7904.
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
By:
Original Certificate Date:
(Rev. 01/02)
~Drinking Water Analysis Rep.'ei't for Total Coliform Bacteria
~EAD INST~UCTION~ ~N EEVE'RSE SIDE BEFORE'~OLLEC?ING SAMPLE
MUST BE COMPLETED BY W .ATER SUPPI~IJ=R '
[~] PUBLIC WAiER $¥$TEf,1 ID=
J[] PRIVATE WATER SY.ETF. M
Send Invoice
' ,4,~ 64o,-,~. ~,. ..
SAMPLE COLLECTION: · '
Time: [ : I 0 W~ AM PM
T~nsp~ed ':
to ~b sy: ~'Same as ~lle~or Other:
, BE COMPLieD BY ~BO~TORY
200 W. PO.TTER DRIVE
ANCHORAGE, ALASKA 99518
Tel: 907-562.2343
Fax: 907-561.5301
~ Ref No.
10411
SAMPLE .TYPE:
[~ Routine
I-1 Repoht Sample
(refer to lab
'FI Special Purpose
[] Treated Water
[] Untreated Water
Sample Receiving:
Date:
Time:
Temp::
Delivery Method:
Received By:
C0mmen~s:
Phone #:
Fax #;
[] RU~H SAMPLE
Bactefioloqlcal Water Analysis Record: [Sent to ADEC:,
· ; MMO-MUG (P/A) RESULTS: I ANC FBK JUN
I Sent to Client:.
MEM~E FILT~ RESULTS: IPhoned ~ Fax~
' .~lr~t Count:, O Colo~esll~ml
~ Mombr~he Fiiter V~ca~on: ISoo~e~ ...........
~ MMO-MUG (PLA) ,,,~,~ [LT8;. --
[BOB: _ ~ Satisfactow
,~c~... { EC. "~ Unsatisfacto~
Analytical Me,od:
Form # FY/- 0053 10/24!03
JACK
Record~n~ D~: 301 -,,%~chorage
11/7/2003 11:03,,U',~ Pa3es:l ~! i
T-O?6
P
J
I
QUIT CLAIM DEED
T%~E GF~OK ' LOt,~SE AUoU~ON, A
~v~ ~ ~t c~s ~ ~ ~. A ~ ?~ON
~D~ ~T t~O ~ ~CO~ OF ~ ~O~OE
~ Oct~c~ 31.2003
~'L-otrm £ A UOUS'I~s~t~ .
Municipality o.f 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
Parcel I.D. O tS"- 3~! - ¥~'
1. GENERAL INFORMATION
Complete legal description L o ~' '~, 7/f~ ~_,~, .J~v~.~
Location (site address or directions) ~5' I ¥o /J-~, L o H-
"*' CurrentPropertyowner(s), Fczn/-
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup~
NUMBER OF BEDROOMS: ~
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class.
Public Water System
[]
, We, []
Expiration Date: -- / - 0
Dayphone ~.~.
Day phone
Day phone
~PE OF WASTEWATER
IndMdual On-site
IndMdual Holding tank
~mmuni~ On-site '
Public ~wer
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 propedies 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. (Cedificates may be reissued for a period of up to one year with valid water samples.)
Certificates 'are valid for one year for propedies 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, 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.
NameofFirm FI,~,/~ ~-~cA~*~¢~/' ~"'~"~¢<,,* Phone
Address
Engineer's Printed Name -'/"& .,o ~_..fo/'~ F=. Iwc,o/~, Date
5. DSD SIGNATURE
/..// Approved for L~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments Note: The well for this property meets existing State and Municipal
Codes. There are nitrates present. It is suggested that periodic testing be per-
formed to insure the wells continued suitability. Current nitrate concentration
is 5.42 mK/1. EPA maximum concentration is 10.0 mg/1. More information on nitrates
is available from the On-Site Services Program, at 343-7904.
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
(Rev. 01~2)
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
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. d. anchorage.ak, us
(907) 343-7904
Legal Description:
A. WELL DATA
Well type. ~'~'/'
Date completed
Total depthS, 91 ft.
HEALTH AUTHORITY APPROVAL CHECKLIST
L~,/' 'E,-,',7 /].., ~¢~',~-~v~¢' Ht~v~b Z/.D~I ParoellD:
IfA, B, or C provide PWSID #
Sanitary seal (Y/N) ~
Cased to;>'/,~ ft.
FROM WELL LOG
Ce
ft.
g.p.m.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform {Q colonies/lO0 mi.
Arsenic: ?.A. rog.fl.
SEPTIC/HOLDING TANK DATA
Tank Type/Material ~ ¢.r,{-~ c_.
Nitrate ,,5'."/~. rog./1.
Date of sample: II/6'/'o2'
/ £/'et/
Well Log (Y/N). &/
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
I 71'o2
¥, ¥ '/' g.p.m.
Y
I~' in.
Other bacteda O colonies/100 mi.
Collected by: . ~'/~/-.~/o '7'ecg 3"oc
Date installed
Cleanodts (Y/N).
High water alarm (Y/N)
Tank size IK'OE/ gal. Number of Compartments
Foundatior! cleanout (y/N) 'r' Depression ever tank (Y/N)
Date of pumping I I / II / o.3 Pumper ~j-~ ct
ABSORPTION FIELD DATA
Date installed It)/16'/9~' Soil rating (g.p.d./~ or ft=/bdrm) t~.6'~_~ System type
fL W~dth 'E ft.
Eft. abscrption area/ot~'~ ftz Monitcdng tube__
II ['7/~.3 Results (Pass/Fad)
· in. Water addedl ?..7~ gal.
Gravel be!ow pipe ?
Y' Depression over field __
Length.
Total depth ~- lt.
Date of adequacy test
Fluid depth in abscrpticn field before test
E;s~sed Time 137 min. Final fluid decth ,5"~,~ in.
An'./rejuvenation ffeatment (past 12 mo.) (Y/N & tyl:e)
Absc~ticn rate >=
For ~ bedrccms
New depthb~, ?- in.
6'o~' g.p.d.
if'/es. ?ye date
D. LIFT STATION /~.
Date installed
'Pump on" level at in.
Datum
E. SEPARATION DISTANCES
Fe
Size in gallons
'Pump off" level at
Cycles tested
in.
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & drcuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
$
Septic tank/liE station on lot I (2 ~
Absorption field on lot I I O'''°
Public ~sewer main fJ. ,4.
Sewer/septic service line ';> ~_C, Holding tank PJ, ~.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
o
Water main k/. A.
Wells on adjacent lots
On adjacent lots ~ too ~
On adjacentlots '>' I~,~ '
Public sewer manhole/cleanout
Property line 7'?_
Water service line
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
' Surface water '~'
i Wells on adjacen't lots
Absorption field
Surface water
Water main /4. ,~.
Property line ~
Water Service line
Curtain drain
COMMENTS
ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review &Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name -'7-)~
Date P,[o~'~t~r t~
in.
Driveway, parkingNehicJe storage ~' ,.5TM '
Waiver Fee $
Date of Payment
Receipt Number
~C,S Eel.#
~llent Name
Project Name/#
Client Sample ID
.~latrix
1037236001
Flattop Te¢lmical Sty.
Lot 27A, lleritage ]Its
Drinldng Wat~
PWSID 0
~anple R~ma~s:
All Dates/Times are Alaska Standard Time
Printed Date/Time 11/12/2003 7:13
Collected Date/Time . 11/06/2003 14:1 $ '
Received Date/Time 11/06/2003 15:15
Ni~ate-N
$.42
Allowable pn, p Analysis
Total Coliform 0
0,100 mg/L EPA 300.0 B ('<-10) 11106/03 JJB
col/100ml. $M18 9222B
A (<-1) 1 !/0~/03 DKC
! I
I
I
· Lc, c,
EASEMENTS C,.C R(COC~D, OTHER THAN
THOSE ,~;~O:','N ON THE R'~CORD~.D
PLAT, ARE NOT ~HOWN HEREON.
· ®jp
.I.