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Home My WebLink AboutBELLA VISTA #1 LT 11BLot 11B #013-051-69 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. 013-051-.~ ~? 1. GENERAL INFORMATION Expiration Date: Completelegaldescdption ['B~'tlA V~STA SUBDMSION ~1; LOT 11B (VACANT LOT)' Location (site address or directions) 7708 LUMBIS AVENUE * ANCHORAGE, AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agen! Mailing address ED ABERLE Day phone Day phone BUD BOWUNG w/ JACK WHITE Dayphone ;'' 762-3134. 3201 'C" STREET * ANCHORAGE. AK 9950,3 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 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. Note: Alaska Water and Wactewater Consultants, Inc. shall be paid $1,050 at, or pdor 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 vedf~ that investigation, based on procedures outiin'ed in the Health Authority Approval Guidelines for lhis 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 sttucture indicated herein. I further vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/er 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. Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504- Engineer's Printed Name JEFFREY A. CARNESS, P.E. Englneer's Comments: In conducb'ng 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 b'me 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 levela that may fluctuate dutfng the year, and the water usage of the family being served by the system. These conditions are outside the control of the evafuator cf the system. Satisfactory test results do not guarantee future performance of the system, nor de they guarantee that there ara no hidden defects or encroachments. AWWC, Inc. can therafora not provide any wamanty 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 tfght whatsoever. Phone 337-6179 Date I/l~/-/-- 5. DSD SIGNATURE I/'"/' Approved for bedrooms. Disapproved. Conditional approval for __ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing stipulations- [~., ..,, n~, ,,.~.;~-. · ...-,-,.~ ~. ~' ':C2' '. "'~.- ~. .c~ ~.~- ON-SITE · .~i WATFF, A;qD '..r,:. ~ : WASTEWATER : ~ ; PROGRAM Manitenance Agreements Supplemental Engineer's Reort Other .y: //.. zzz (Rev. 12~1) . Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. 8ox 196650 Anchorage, AK 99519-6650 (~37) 343-?9O4 Legal Description: A. WELL DATA Well type ~IVATE Date complete~ UNK Total depth 60+ It. HEALTH AUTHORITY APPROVAL CHECKLIST BEt. LA VISTA SUBDMSION ~1i LOT 11B Parcel ID: If A, B. or C provide PWSID~ N/A Sanitary seal (Y/N) YES Cased to 40+ ft. FROM WI~LL LOG UNKNOWN Date of test Static water level UNKOWN Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Arsenic: 0.0164mgJL. B. SEPTIC/HOLDING TANK DATA UNKNOWN g.p.m. o13-o51 Nitrate 0.20 mgJL. Date of sample: 1/11/2002 PUBLIC SEWER Well Log (Y/N) Wires pmbedy protected (Y/N) Casing height (above ground) AT INSPECTION /11/2oO2 39 .It. 3.7 g.p.m. Other bacteda Collected by: Date installed NO YES 12+ in. 0 colonies/100 mi. AWWCt INC. Tank Type/Material Tank size gal. Number of Compartme~ (Y/N) F~/ -"' ' ' ' tank(Y/N) High water alarm (Y/N) C: ABSORPTION FIELD DATA · ' Oate'i~'talled Soil rating (~or It~/bdrm) ~~System type / ~n~ '" fl. ~ .fl. G~ fl. m~l de~ ff. Eft. a~on ama fl~ ~ ~pm~ ~ fi. eld _ Dam of adequa~ ,, ~ ~~a,~ . ~r . .~ Ruid dep, in ab~~ '~~ __ ga~. N~ d~ M. D. UFT STATION Date installed SIze in gallons "Pump on" level at in. "Pump off' n. 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 100'+ Sewer/septic sen;ice line 25'+ On adjacent iota 100'+ On adjacent lots 100'+ Public sewer manhole/deanout Holding tank N,/A 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Property line__ Aboo ~ ~ Water sen. ice line, Sudace water. Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation. Water main ~ Water sewice line Sudase~hicle storage Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspec~ons and rewew of Municipal records that the above systems are in conformance with MOA HAA guidelines in effecf on this date. Engineer's Printed Name JEFFREY A, GARNESS HAAFee$ "~"7 ~-. eo Date of Payment I //'7/o Z Receipt Number ~"[/'4/~ (Rev. 12J01 ) Waiver Fee $ Date of Payment Receipt Number JAN-15-O2 1Z:28P~ FROiA-CT&E ENVIROFI~ENTAL SRV .~TK CT&E Envlron..ental Se.ices Inc. 90T5515361 T-$2! P.OZ/03 F-815 CT&E Ref.~ Client Name Project Name~ Client Sample ID Matrix Ordcred By PWSID 1020226001 AK Water & Wastewater Consultants Inc. Bella Visla #1. Lot I lB Bella Vista gl. Lot I lB Drinking Watee Sam~te Remarks: CUent PO# Printed Date/Time 01115/2002 10:56 Collected Date/Time 01111/2002 11:05 Received Date/Time 01111/2002 13:05 Metala Department Arsenic Results 0.01~4 PQL Units Method 0.00200 mg/L EPA 200.9 Allowablc Plep Analysis Limits Date Datc Init (<0.05) 01/14/02 JMP Nitratc-N 0.200 U 0.200 mg/L EPA 300.0 (<10) 0l/I 1/02 JDT ~ierobioZogy l~aborato~, Total Coliform col/lOOmL 5MI8 9222B (<1) 0Ill 1/02 YAP