HomeMy WebLinkAboutUS SURVEY 3042 LT 95B T10N R2E SEC 19U S Survey
3042
Lot 95B
#075-093-38
Municipality o.f Anchorage
Development Services Department ·
· Building Safety Dlvtslon .
On-SiteWater&WastewaterPr°gr~m "· ~'" .'
4700 South Bragaw SL -.' ....
P.O. Box 196650 Anchorage, AK 99519-6650 ·
www.d.anchorage.ak.us ' - . :
(907) 343-7904"
CERTIFICATE OF' HEALTH AUTHORITY APPROVAL
'FoR A SINGLE FAMILY DWELLING '
Parcel I.D 075-093-38
1. GENERAL INFORMATION
Explration Date:
Complete legal description U.S. SURVEY 3042 LOT 95 B
Location (site address or directions) Ho'rr-NTOTr MINE RD.
Current Property owner(s) JtU JOHNSON
Mailing address 3940 ARTIC BLVD. SUITE 103 99505
Le~ding agency
Mailing address
Real Estate Agent
Mailing address
Dayphone
562'2424
Day phone
Day phone
Unless otherwise requested, HAA will be held by DSD for plckup.
2. NUMBER OF BEDROOMS: 2
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 Authoflty
Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil
engineer registered In the State of Aflaska. Certificates of Health Authority Approval are required for the lmnsfer
of fitie (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 pdvate 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.
4 STATEMENT OF INSPECTION BY ENGINEER
As cerb'fied by my seal affixed hereto and as' of the ~atidation date shown below, I verify that my
Ir~estigation, base~ on proced~?~S outlined Ih the Health Authod~y Approval Guidelines fo? this application, '
sh°ws that the on-site Water Supp~, and/or ~,,astewater disposal system la(are) safe, funct~onal and adequate '
for the number of bedroOms and type of sttucture lndicated hereln. I further verify that based on the
information obtained from the Municipality of Anchorage files and. from my Investigation and Inspocfion, the
on-site water supply and/or wastewater disposal system Is(are) In compliance wfth all al~plicabie Munlcl~a!
and State codes, ordinances, and regulations in effect at the Eme of Installation.
Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone ,357-6179
Address 690~1 I~EBARR ROAD, SUiTE 2B * ANCHORAGE. AK 99504.
Englneer's Printed Name JEFFREY A. CARNESS, P.E.
Engineer's Comments:
In conducting lhis evaluation, AWWC, Inc. attempted to provide a thoron£h,
conscientious engineering ana~ts of the system In accon~ance with ADEC and MOA
DSD Guldeilnea & R~gulations. The reperted results desortb~d the i~edon'nanse of the
system under the conditions encountered at the time of the tos~ and sol~aration
dis~anses measured to madly, Identiflabis featores. The operational life of ail wells and
septic ~Tstems depend on the Iocal soils condition, groundwater levels that may
fluctuate dudng the ~ and the water usage of the faml~/ being eetved by the m/stere.
These conditions are outside the cont/~l of the eyaluator of the system. Sailsfacto~'y test
results do not guarantea future perf~tnance of the system, nor do they guarantee that
there are no hidden defects or encreachments. AWW~, Inc. can therefore not Frovide
any warranly ur future estimate of how lcng the system will continue to meet the
opera~onal requirements of the ADEC or MOA DSD. The content of thls repett ls for
the sole benefit of the ov~or listed above. Any reliance upon or use of Ibis rel~tt by any
other posen or parly Is not autho#zed, nor v,#l It confer any I~Jal right wha
5. DSD SIGNATURE
I.,/' Approved for ~ . bedrooms.
Date
Disapproved.
Conditional approval for __
bedrooms, with the fllowthg stipulaUons:
ON-SITE
Attachments: HAA Checklist
Septic System Advisory
Well Flow Advisory
Original Certificate Date: /..j, - ,,,3, (o - O I
Manitenance Agreements
Supplemental Engineer's Reort
Other
Municipality of Anchorage
Development Services Department
Bu;a'lng Safety Olvlakm
On. Site warm' & Wastawater P~
4700 South Bmgaw St.
P.O. Box 196650 Anclxxage, AK 99519-6650
A. WELL DATA
Well type emvA'~
Date completed
Total del:~ 74'+ ft.
HEALTH AUTHORITY APPROVAL CHECKLIST
u.s. SURVEY 5042 LOT 95 B Parcel ID:
UNK
IfA, B, orC provide PWSID~ N/A
40+ 'lt.
Casad te
FROM WELL LOG
Date of te~t UNK
Static water level UNK ,fL
Well production UNK g.p.m.
WATER SAMPLE RE~ULT~:
Collfmm 0 colonies/100 nd. Nilzate Q mgJL.
Date of sample: 4/29/01 Collected by:.
e. 8EPTiC/HOLOING TANK OATA PUBLIC
Well Log (Y~)
Wh'es propedy protected (Y~).
Ca,~ng height (above ground)
AT INSPECTION
4-29-01
67 It.
g.p.m,
6.3
AWWC, INC.
SEWER
075-095-38
NO
12+ in.
colonies/lO0 nd.
Tank Type/Material Date Installed
Tank ~ze gal. Number of Com~
C. ABSORPTION FIELD DATA
Date Inste~ed. Soil rating (g.p.clJlttor ~/bdnn) System type
Leng~ fL W]d~ fL Grav~~ fL
Tot~ depth lt. Eft. al:~otpUon ama It~ M~..~..~-'"'"'~ ~presslon overfleld
Fluid dept~ in absorption ~ In, Wateradded gal. Newdep~ in.
D. UFT STATION
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Se~c tank/lift stain on lot N/A
Absorp~on field on lot N/A
Publlc sewer main
,Sewer Isepflo aewtce II~ '25'+
*PER AWWU RECORDS
On a~acemb= 100'+
On a~acentb= 100'+
PubUo~ewermanhol~deanout
I..k:ddl~mnk N/A
· 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ~
Building foundation Property line ~.------/~3soq~on field,
Water main ~ne, St~face water
SEPARATION DISTANCE FROM ABSORPTION FIELD ~
Prope~y une ~ Water maln.~
Water senace line ~..--~"~'Surrace water Driveway, pang/vehicle storage
~ Wel~ on adjacent lots.
F. COMMENT~
G. ENGINEER'S CERTIFICATION
I cerSfy that I have determined I~rough field InspecUons and
review of Municipal mconfs that the above systems em In
conformance v/4h MOA I.IAA guidelines in effect on this date.
EnglneeCa Prtnt~ Name
Date ~
JEFFREY A. C, ARNESS
HAA Fees
Waiver Fee $
Date of Payment
Receipt Number
(R~v. 12~o)
Date of Payment
Receipt Number
~'~L~07*
/
~-~ .......
~I~ WATER & WAgTEWATER ~ ,
.............. ...... CONSULTANTS, INC. 1" = 40' ......... /'lF~' ~ ..... '
JIM JOHNSON 562-2424 1 OF 1
~ .~.,~.: ~"..~. ~0 '%...5~~
U.S. SURVEY ~042; LOT 95B.
SITE P~N '~