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HomeMy WebLinkAboutPARKER LT 11Parker Lot 11 #008-031-22 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 w~w.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ~')(~" (r)~, I - ~ HAA# 1. GENE~LINFORMATION ~pimtion Date: C~omplete legaldescription PARKER SUBDMSION; LOT 11 Location (site address or directions) 4243 PARKER PL * ANCHORGAGE, AK Current Property owner(s) · Mailing address Lending agency Mailing address Real Estate Agent Mailing address JASON MOLL 4243 PARKER P~ * ANCHORGAGE~ AK Day phone 562-1644 Day phone. KEN CURRY w/ COLDWELl. BANKER FORTUNE Day phone 2525 'C" STREET * ANCHOEAGE, AK 99503 884-1090 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 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. DaD 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 Wastewater Consultants, Inc. shall be paid $.~,E~.~at, or prior 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 data 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 structuro 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 ALASKA WATER & WASTEWATER CONSULTANTS. INC. Address 6901 DEBARR ROAD. SUITE 2B ° ANCHORACE. AK 99504 Engineer's Printed Name JEFFREY A. OARNESS. P.E. Phone 357-6179 Date Engineer's Comments: In conducting this evaluation, AW%4,'C, 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 perfon, nance 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 sen/ed by the system. These conditions are outside the control of the evaluator of the system. Satisfactoq, test results do not guarantee future perfon'nance of the system, nor do they guarantee that there are no hidden defects or encreachments. A W3/VC, Inc. can therefore not previde 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 parly is not authorized, nor will it confer any legal right whatsoever. 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: -- ...?rS?._'' O -SlTE W TE ND : ~ = WASTEWATER: Manitenance Agreements ~J~m ~~ Supplemental Engineefs Reod Other /.//' / Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wasfewafer Program 4700 South Bragaw St. P.O. Box 196650 Anci~rage, AK 99519-6650 www.ci.ancharage.ak.us (go7) 343-7g0~ HEALTH ,UTHORITY ,b, PPROVAL CHECKLIST Legal Description: PARKER SUBDIVISION. LOT 11 Parcel ID: 008-031-22 A. WELL DATA Well type pervA~'£ If A, B, or C provide PWSID# N/A Data completed PEr' 1985 SanitanJ seal (Y/N) yIrS Totaldedth 40'+ ft. Casedto 40'+ ft. Well Log (Y/N) NO Wires properly protected (Y/N) YES Casing height (above ground) 12 + in. Date of test FROM WELL LOG UNKNOWN AT INSPECTION 5/ /2002 Static water level Well production ft. 51 ft. g.p.m. 5.4+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: .0043 mg./L. Nitrate 0.304 mg./L. Other bacteria 0 colonies/100 mi. Date of sample: 5/31/2002 Collected by: AWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date inst~Jled-----'''''~'~ size gal. Number ~ts (Y/N) Tank Foundation ~rassion over tank (Y/N) High water alarm (Y/N) D_...~plng Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ffZor ft~/bdrm) System type Length ft. Width ~ .fl. G~ ~ Total depth .ft. Eft. absorption area ft ~ Depression over field Date of adequacy test /,,,_,.,___~,,_,-Resal~-'~Pass/Fail) For bedrooms ~ld befora test in. Water added gal. New depth in. -"Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (pest 12 mo.) (YiN & type) If yes, give date D. UFT STATION Date installed Size in gallons ~ "Pump on" level at in. '~?.~4~ High water alarm level at in. ~ ~ Cycles tasted Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lotN/A Absorption field on lot N/A Public sewer main 50' + Sewer/septic se~ice line. 25'+ On adjacent lots 100'+ On adjacent lots 100' + Public sewer manhole/deanout Holding lank 75' + 50'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line Building foundation Water main Sulface water PUBLIC SEWER ABSORPTION FIELD ON LOT TO: SEPARATION DISTANCE FROM ~ main Property line Building foundation Water service line ~ Driveway, parking/vehicJe storage __ Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municfpal records that the above systems am in conformance with MOA HAA guidelines in effect on this date. Engineer's Print~:l N~me Date ~o/~/0 Z, ! JEFFREY A. GARNESS .,,,Fees Date of Payment Receipt Number (~. 1~01) Waiver Fee $ Date of Payment Receipt Number '02 05/28 TU~ 16:33 FA/ 907 .. FORTU~ PROP. ~002 /,z,.T, o'0 _. ~ ~) /~ ond.lhQt th~ JmproYomenh ~ltu~tod IherlO~a~l i CONTRACTING ENGINEERS ~ ASSOC. J Phon~ 270-~77~ ~ ~J"~;| IAIFH b. JOK~A c MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ## OOH — HAA #3 Complete legal description Z -C' f /) Pa �e� -f/-D Location (site address or directions) y 2 '� 3 Pam P P/--, c Property owner _ Pcc trt c t— T&4- eA t, Day phone 21�5 7 - / 3 / / Mailing address 14C 3Z, 20X crr,l�cc A4-,- 9H6s y Lending agency /4 fat 01/; Da hone YP Mailing address Agent Cllarl p� ri/ /'�ude� �« / U,r rs. Day phone Address 1/-2y/ 'P" S�. f�^c%,��c��, ,-L-- p9S65L Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 2 2-7 —7 2 7 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 v NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Front MOA #21 STATEMENT OF INSPE�.:.'€ ICI SY 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 an type o struc ure (n (cate ere(n. 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 �_ (� r T;- c» <G 5 Cj Phone J Address G �_ ��� s �. �"c!����7cjP 4 z—, 6 - Engineer's signature � t� � Date _ /`'a,z a A o iU. 4'V y-- E'UUC:GC+C+G PGdai S+©fJ CGG if+a t-f.t 4 u . ACG�ml4onrac �a ::� Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments c bedrooms, with the following stipulations: Date... 72-025 (Rev. 1/91) Back MOA k21 Municipality of Anchorage MAY 15 2000/ DEPARTMENT OF HEALTH & HUMAN SERVICUNICIPAUTY OF Awc�10 Environmental Services Division INAENTALSER" „CF-`' -- 825 -L -Street, -Room -502 Anchorage, -Alaska -99501-•-(90-7-)-343-4744 Health Authority Approval Checklist Legal Description: Lo S 14 Parcel I.D.: G c� A. WELL DATA Well type FV I- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) N Date completed t3e 1�� 196 2 Total depth > `(a Cased to Casing height (above ground) Sanitary seal (Y/N) Y Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level AT INSPECTION eg / C16 1S 1 7 it IT - 72 -026 r Well production g.p.m. 8. 2 t g.p.m. WATER SAMPLE RESULTS: Coliform O co ( //OO 1n ✓Q Nitrate < 0.S m /-e Other bacteria none reno��o( Date of sample: S Collected by: f�(a f -) TNc4 h en B. SEPTIC/HOLDING TANK DATA ]V. A, 4 w Gv u Se eu e� Date installed Foundation cleanout (Y/N) _ Date of Pumping C. ABSORPTION FIELD DATA Date installed Length Width Effective absorption area Date of adequacy test Tank size Number of Compartments Cleanouts (Y/N) Depression (YIN) Pumper N. A. A- 5,-&6­eF/? Soil rating (g.p.d./W or ft2/bdrm) High water alarm (Y/N) Gravel thickness below pipe System type Total depth Monitoring Tube present (Y/N) Depression over field (Y/N) Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): - Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)" D. LIFT STATION N /4 • Date installed Manhole/Access (Y/N) _ High water alarm level at* Cycles tested E. SEPARATION DISTANCES "Pump on" level at* "Pump off" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot _ Public sewer main N. A. N • A, On adjacent lots to • A-. On adjacent lots A�. ,�k (� Public sewer manhole/cleanout ! GS Sewer /septic service line 7 ? s ' Lift station N• 4- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: V-4. Foundation Property line Absorption field Water main/service line Surface water/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: N- A Property line - Surface water Curtain drain F. ENGINEER'S CERTIFICATION Building foundation Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots I certify that / have determined thru field inspections and review of Municipal records that. the above -systems are in conformance with MOA HAA guidelines in effect on this date.0 Signature / \ � 4 f.'x'lC Ci V UL'h0 J bL°9Q4"'P 6:Ci FC. . r Engineer's Name -% e6 �o ��y`� G '� •i^ IC CCcz� LO4hi4,C§P!"R,OGC QCCG CGP. 1S ZOO uk, 35,3 ° Date HAA Fee $ 3 c --,O -,— -� Waiver Fee $ _ Date of Payment _4 5 —//-, Date of Payment Receipt Number 11P 7 446 % ✓ Z-[� Receipt Number I/ 72-026 (Rev. 3/96)* Buyer Address Zip Code Phone AOd~,ss . Zip Code ~ )2- ~-~ / ' Phone Realty Co. & A~nt Address Zip Code Street Locati~' ~ ~ // ~ "' Type of Resi~nce ~ Single Family ~ Multiple Family No, of Bedroo~ ~ ~ Other Wster Supply Individual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June ~975.  drilled to that date, give Well depth (attach Icg if available). For wells prior Community ~ Public Utility Sewer Disposal ~ IndiVidual Year Individual Installed:  Public When Connected to Public Utility: Utility Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time q Date Date Date Date Inspector Inspector Inspector Inspector (~) APPROVED BEDflOOM8 *CONDITIONS OF APPflOVAL ( ) DISAPPROVED ( ) O0~DITIONAL A~PflOVAL'~ Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received Well to Tank Septic T~k Size 72-023 (3182)