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HomeMy WebLinkAboutRIDGE VIEW LT 29Ridgeview Lot 2:9 #014-111-03 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. o HAA # Expiration Date: GENERAL INFORMATION complete legal description ~.~ ¢ 2~ Location (site address, or directions) Current Property owner(s) ~ ~ ~ Mailing address I ~ ~-t 'L /~ Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held NUMBER OF BEDROOMS: DaY phone Day phone Day phone TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class__ Public Water System TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] Welt [] 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 5 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 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 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. Name of Firm Cf, c ~ ¢ e//'A( ,/~-1~1 ¢, ¢ Engineer's Printed Name DSD SIGNATURE )~ Approved for 3 Disapproved. Conditional approval for Phone bedrooms. bedrooms, with the following stipulations: By: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: / ~/~/("-).? (Re,,', 12/00) field 'in. 'g:.:p.d. 'Dat~:installed "Pump on" level at in. ·Datum SEPARATION .'DISTANCES cycles te~ted. ~ ..... '" '" "' Meets alarm & 'Circuit'requirements? SEPARATION DISTANCES FROM WELl ON.LOT TO: ' S~l~ti~;'-~4n~liff':s{ati'bn'ori"ibt .Absorption field On lot ~ ~ .... :Public' sev~er.main "'": :z~"0/' ;/" --- ' :' 'Sewer'/s~tic ~'i~i~ i[n~' "~'O'~r:~¢~ .... .... · .S I-~'PA RA'¢i0 N 'g 1'STatIC ES F R0t;,;i':~S E p'~lO/U eL D'I. ,N Gi,-¢~.~.~;;:O N ..LOT: ;FO: . .. , Bt~ild~ng'.foundation Property ne. ~'... . Al:/So~p~ion field Water main ~'.Water .~¢-~vicc I;. ~' - Surface.water WPIl$ oh.dQlacent.'lots - in; SEPARATION.:DI'STANOE FROM:ABSORPTION F.I.EED -ON: L©;T TO: Property line Building [oundation Wa'tbF.':Serviceline ' ~wat;;:' ' "' ;:"1:' ......... ~ Welts'en.'a(~JaiC~r~'t.,Iots .' .. - · Water main' DriveWay·,, patkin'gtveiiicl~: S~o rag e F; COMMEN.rrs G. E'NGIN EER'Si CERTiFICA~rioN 't,certffy ~hat; I: i~bvb~.d~t~rr~in'e'd: ~h~u~h field in~C~i~'s:'~n~t ".,:" ..... ,' ": ' ~'e.view 'of Municipal recoYd$ tha¢ ~he .above systems are co~ifo~'rnance with 'MOA HAAguidelines .in effect on. this.dat~:i · Engineer's..Printe. d.Name ~'l ~.~x, z~,A:~ ~'P/..'~-¢ ¢<¢ d. rl ~ ~', ' ..- Date · . 57'; o o 51!:~'!:~;t:e:.oflpa.yr~ent:. //~(/,~./¢' ,~' . Receipt, Number (Rev. 1'2/00) .......... ,,., . Date ~f:PC~yment ',: -:..,.~ ~.~;' !2:~g FRCSYCT&E ENVI RON!,~£NTAL SRV ~I~ C T&E Environme~t~, Se rvices inc. T-gl5 P.'S2/02 F-4[,3 Cticnt Name Ciieut Sample ID Matrix [ U2798600i M;,ke N. Andmson, P E. Kidgeview L29 Ridgeview L29 Driakmg Water PWSiD 0 All Dateg;Times are Alaska Stan0ard Time Printed Date~Time 1 [/25/2002 12:14 Collected BateFrime 1',/22/2002 t0:00 Receh'efl Date/T~me 1[/22/2002 10:30 Waters D~&r tment 0.4~9 POL L'nirs Method 0.200 :ng/L EPA 300.0 Limmt Date Dare 11/22/02 lfic z'obioioglr La~orator~- Tat~;I Col/form coi/100mL 8Mi8 922213 (<=1} 1 Ii22702 SKW aarX r mrn n o 0 0 j f z m x== o p n In x m —i m Ii 0 MV6I.CX SfNIE P1PK r z. mLOEn wrw Mlus + Q m z _ _ -- CIIVWM VT X PON sy� m,d O a Otl wtsotl �'M�'. Q S.0 LANE fll CMtiv CC ti c> I O 'o F4 a IENst 1'4 $ WNC Lw V SL �S y / x a'• 1MN M NEWT a. (10 G-) I v I W ::: D _ — 01) 1 l sEwNRo b wa M E. $EWNN :Mn D D I N = I z ;U a O I 0 v „ O MV6I.CX SfNIE P1PK r z. mLOEn wrw Mlus + m z _ _ -- CIIVWM VT X PON MV6I.CX SfNIE P1PK r z. m z _ _ -- o � sy� m,d O a Otl wtsotl �'M�'. Q CMtiv CC I O 'o F4 a 1'4 $ WNC Lw V SL g� M1 n FORT MCX DEM WUTMY KE ATIM 0 -0 0 �§? D Z D Z ti Z C m 0 m PROJECT: WELL DRAINAGE LINE LOTS 29 AND 30 RIDGEVIEW SUBDIVISION 1142 East 71st Avenue Anchorage, Alaska NORTHERN LIGHTS ENGINEERING 2825 GLACIER AVENUE ANCHORAGE, ALASKA 338.4826 D R A F T E C H C.A.D. DRAFTING SERVICES 1510 Columbine Street, Anchorage, Alaska 99508 m z _ _ -- O / x / M (10 G-) I v W 1 D 01) 1 l M 1 D D I N = I z ;U I O I 0 v „ O co M M 1 cNo // mm - Z M 1 / In Z7Z C M m�0 J \ // D m \ r onim c� M O Z D / O = / -0 \ // I / � v \ // o m // PORTABLE BUILDING vC I 0 -0 0 �§? D Z D Z ti Z C m 0 m PROJECT: WELL DRAINAGE LINE LOTS 29 AND 30 RIDGEVIEW SUBDIVISION 1142 East 71st Avenue Anchorage, Alaska NORTHERN LIGHTS ENGINEERING 2825 GLACIER AVENUE ANCHORAGE, ALASKA 338.4826 D R A F T E C H C.A.D. DRAFTING SERVICES 1510 Columbine Street, Anchorage, Alaska 99508 C D M O N N x _ m O N" 00y n 1 A D IM D D C z O Z r p r rn W D D v N I r O 5/8" 6" O i o m o PROJECT: g o m D J WELL DRAINAGE LINE ^ F g LOTS 29 AND 30 _ RIDGEVIEW SUBDIVISION m 1142 East 71st Avenue Anchorage, Alaska 1 A W N 7 Z O 1 A D IM D D C z O Z r p r rn W D D v N A N M 0D O m O O r rn r ti Z z O W m m x N > ti n m Z r— r Z m rn O Z rn CO A O z m m O m m O (n r In O N m Z z n rN*l z� D C � m � � O r Z m D 2 r co m fn m n V) O S M z ➢ Z y G) O D Z r ' r NORTHERN LIGHTS ENGINEERING 2825 GLACIER AVENUE ANCHORAGE, ALASKA 338-4826 D R A F T E C H —C.A.D. DRAFTING SERVICES 1510 Columbine Street, Anchorage, Alaska 99508