HomeMy WebLinkAboutCHESTER H LLOYD LT 29 E 105'Chester H Ow
Lloyd
Lot 29 E 105'
#012-361-05
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Municipality of Anchorage
Development Services Department 01, di
Building Safety Division ,
On -Site Water and Wastewater Program i
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.enchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 017-161-05 HAA# L5b3ga-
Expiration Date: ' l " 1:7-05
1. GENERAL.INFORMATiON
Complete legal description rhpqtpr H_ I Inyd,l or 29, F 105'
Location (site address or directions) 17111 W Dimond Blvd_, Anrhorage, AK
Current Property owner(s) Rnhhip L_ Mcnnnald Day phone 770-7094
Mailing address
Lending agency
Mailing address
Day phone
Real Estate Agent -. jjQpe Rtiscn - NTRF Dayphone 688-5748
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: _Z
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 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 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.
Address -20441 Ptarmigan .Eagle_Riyer, AK 99577
Engineer's Printed Name_Kenneth M_ Duffua Date__ 8/11/?()n-t;
Engineer's Comments:
This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the
condition of the well and septic applies only to the
conditions as of the day tested. The flow and absorption
rates may change due to subsurface conditions that
may not be observed from the surface, changes In
land use, local soil characteristics, groundwater levels
that may fluctuate during the year and the water usage
of the family being served by the system. The operational
life of all well and septic systems are subject to these
various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system.
Therefore, KND can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can KND guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following
G�Q•.•'� •'••,.O
ON-SITE
WATER AND •;
WASTEWATER
PROGRAM '
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: p 2::r Original Certificate Date: " 1 7 ' 0
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
HEALTH AUTHORITY APPROVAL CHECKLIST
A. WELL DATA
Well type Private If A, B, or C provide PWSID #_
Date completed 1952+/-* Sanitary seal (Y/NI—Y-
Total depth 140+* ft. Cased to 40+ * I.
FROM WELL LOG
Date of test N/A
Static water level N/A ft.
Well production N/A g.p.m
WATER SAMPLE RESULTS:
Well Log (Y/N) N
Wires properly protected (Y/N) Y
Casing height (above ground)_2
AT INSPECTION
6/25/05
' ft.
S" + 9—
p.m-
Coliform ,SJM&tcolonies/100 ml. Nitrate 0.1 ---- mg./I. Other bacteria _0 colonies/100 ml.
Arsenic: 10.8 g.A. Date of sample: 7/13/05 Collected by: KND Engineering.
far..
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Date installed
Tank size gat. Number of Compartments Cleanouts (Y/N)
Foundation cleanout (Y/N)---Depression over tank (Y/N) High water alarm (Y/N)
Date of pumping
C. ABSORPTION FIELD DATA
Date installed Soll'rating (g.p.d./fe or fe/bdrmj_ System type
Length ft. Width
ft. Gravel below pipe ft.
Total depth ft. Eft. absorption area fe Monitoring tube _Depression over field
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before testn. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) if yes, give date .....
D. LIFT STATION - NA
Date installed Size in gallons Manhoie/Acoess (Y/N)
'Pump on" level at in.
E. SEPARATION DISTANCES
`Pump otr level at in.High water alarm level
Cycles tested Moab alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot-NA—
Absorption
otNAAbsorption field on lot NA
Public sewer main 25'+/ -
Sewer /septic service line 25'+
On adjacent lots NA
On adjacent lots NA
Public sewer manhole/cleanout 50'+
Holding tank NA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: NA
Building foundation Property Una Absorption field
Water main Water service line Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: NA
Property line Building foundation Water main
Water Service line Surface water Driveway, parkinghohicie storage
Curtain drain Wells on adjacent lots
F. COMMENTS
in.
Separation distances per date of well. See attached AW WU drawings. Well probed by AAROW - casing
depth/integrity verified.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Munidpa/ records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Kenneth M. Duffus
Date 08/11/05
HAA Fee $430.00
Date of PaymentGkifir
Receipt Number 2 7QS
(Rev.12101) U0 I
Waiver Fee $
Date of Payment
Receipt Number
71
08/01/2005 12:10 FAX
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A, -VI
ASBUILTSEVARD
I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE
SCh'
FOLLOWING DESCRIBED PROPERTY=
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•S�Ex7t7P//zl'o-440�4sTJ�.e2s`r7eer -z9 ,
AND
SLITY
DATER
INDICATED. IT IS THERESTPSONEXISTAS
O�
/i�
OWNER TD DETERMINE THE EXISTENCE OF ANY
GRID=
TRICTIONS
WHICH DO NOT APPEAR ON THE RECOR ORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES .SHOD D
FB:
ANY DATA HEREON BE USED FOR CONSTRUCTION
/diZ -,72-
72OFFENCE
OFFENCELINES, OR FOR ESTABLISHING SCUND-
ARY LINES.
DRAWN:
y f)Ro
U 002/002
SCS Rct#
1054109001
Client name
KND Engineering
Project NameIN
Chester 11. Lloyd Job 05-033
Client Sample ID
Hose Spigot
Matrix
Drinking Water
Sample Remarks:
All Dales/Times are Alaska Standard Time
Printed Date/time
07/15/2005 11:37
Collected Date/rime
07/07/2005 14:00
Received Date/time
07/08/2005 15:49
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Parameter Results PQL Units Medved Container RD Limits Date Date Init
Microbiology Laboratory
Total Coliform 0 coV100mL SN1209222D A (<=1) 07/08/05 TLF
SCS Ret#
1054109002
Client Name
KND Engineering
Project Name/#
Chcster H. Lloyd Job 05-033
Client Sample ID
Kitchcn Faucct
1lfatrix
Drinking Watcr
PWSID 0
Sample Remarks:
All Dates/rimes are Alaska Standard Time
Printed Date/rime 07/152005 11:37
Collected Datelrime 07/072005 14:05
Received Date/time 07/082005 15:49
Technical Director Stephen C. Ede
Microbiology Laboratory
Total Coliform 0 coV100mL SN1209222D A (<=1) 07/08/05 TLF
Allowable
Prep
Analysis
Parameter
Results
PQL
Units
Method
Container ID Limits
Date
Date
Init
Nitmtc•N
0.100 U
0.100
mg/L
EPA 353.2
D (<=10)
07/08/05
PLW
Microbiology Laboratory
Total Coliform 0 coV100mL SN1209222D A (<=1) 07/08/05 TLF
277.i62
O[ORORAt SULLIVAN.
MAYOR
III PAItIMt Ni fit tNttlll•11161 ^r"VIll"
Y..." FWdw UIdaY
April 2U, 11177
tlr. itIchard It. itrItt
State of Alaska
1)cpartmont of RnvIronmon1111 Contiervitt.lon
pouch "0"
Juneau, AK 4981 1
Subject.: ANlHORAli6, I.ioyo t.A'rh.RAI. 1111,Iti1vl.Mh:NT I)1STmar No, RO
Uetcr Mr. Ilrit.t,
A toot or final, slumped plans and a Ii,•t of "(1 docunw.ntic for
Lloyd I.nterul Improvement. Wii1rlct No. No ury Inclucled with
twIll Lt. h1lilt.
rt
this lnttet. Iu
Mu1%le1p1111yIII Anhurnre1970 NtundnrdConrlrnapeciricntions.
111th rerorunce to your I•'el+rwtry 7, I1177 toper concerning this
pruJeal„ your one eoneern w:,:: the lucnllon or Lilo ntlnitary newer
with ronpecl to the privnit• well tocutod on Lilo oust un'• -third tit
Lnl 29 of c•honler 11. Lloyd 3ubdivinlon (Seo Sheet 9 of the plans).
1 bolleve the rinal plans to by In coururmunce wlLh St.uto
R(tgulntlons conct•rning tsanitnry sewer dlstnnc•o from water wolln.
The well In gacntlon 1t: it prlvuto wotl st.rving the onst tine -third
of Lot. 21) lir Chor.tty I1. Lloyd :ubclivinlc,tl, I bol leve tile :tato
Itegulullunn for private W(IIII: nt'e ate fnllowx:
Iti:_Ianr.'.. rr.ml ilel l
0' 111 Ill' Nu :+alitt.-I-v ::ewel• tltlowelt.
10' it, a0' Only center -tight :ianitary newer
III l ow. .
Itoyoud all' No ronlric•IJoll.
Cunvcirfialions ice hart. hod will, Kyle Cherry of your smt h Central
Itrglnnnl orrice lulllento that. wllllt' mnnholm 111'0 nal consstdorod
water tight need moat 1)1. lucutud boyund GO foot from n privnto
wall, claanoutu aro consfd1.rod water t1Fhl need cnn bo located
no clonor then 10 fool from it prlvato w1.11• 1 h1Lv1. inrludc•d
lhu Standard Doliall for it rlcttnout fur your Inapuctlun.
CN•nnoat COL -1 I!, locatvd apprnstmatoly :t:, fool from t.hv e4uh,loct
privnto well. Sinct• tht• 1,11)1. and IN. clt•:utoul. wlthlu Ihr lD foul
to GD tout radius tiro uototl on tho plans na wll?alor Light Uuin'ry
Iron, I Sce no runfltrt with Seelig. It1.lrtilp
;ulut , wl,t
I nm holding this pru,lg.ct fur yam• approval h1.rttt•o Folrez Lo bi(j.
Slnc•rely.
/ --/-
De
lhutugor. Anchurut;1. :iow1.r lit l l l I
1)131/41/c I
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DEPT. OP BNVIRON"UNTAL CONNLDVATION
lytlari-arwr►►
Mr. Dale R. Morrell, P.C.
Manager. Anchorago sewer utility
3070 Arctic roulevard
Anchorage, Alaska 97501
Doer Mr. Morrell,
May 12, 1977
RECEIVED
1.;,1l I fj IJR
Anrllnr09C \Yater and
Sewer utility
Anchorage, Idovd Lateral tmprovcment District No. 00.
The final plana, tgc.cifications and contract documents ware forwarded to
this office by your explanatory letter of April 29, 1977. The results
of our initial r, -view or this proposal were in our loiter to you dated
February 7, 1977. w,, wore concerned about the separation of a wall at
the end of W. ntmolol iw,ulevard from a cleanout, shout 3219. An now
shown, the clearnut will not endanger the wall.
The plans and specifications of thin project are approved try this uepnrtment
for those items of sur concern.
::inceruly yourn,
Richard 11. Britt
Facility Construction
c ttlwration
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Municipality of Anchorage
Development Services Department
Building Safety Division
/ Onsite Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Ken Duffus
Legal description: Chester H. Lloyd Lot 29 E 105
ZD
The attached paperwork has been reviewed and Is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error in design.
❑ Additional soils information needed.
❑ Water monitoring results inadequate. _
❑ Discrepancy in information submitted.
❑ Topographic information missing or inadequate.
® Incomplete; missing Separation distance well to public sewer main does not meet code.
❑ Incomplete; missing
❑ Additional adequacy test information needed.
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing.
❑ Locations of all soils, percolation and water monitoring tests not shown.
❑ Proposed system loo deep for soils information submitted. _
❑
Well log required.
❑ Omission in narrative.
❑ Insufficient fill over tank or field._
❑ Other.
Name of reviewer: Jeff
Date: 8/15/2005
Please supply the necessary information and re -submit your request.
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