HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 3 LT 4A#0 0,�a v,4
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 l.D. # n - ��\ - $ y HAA # O pn9 rog9.
1. GENERAL INFORMATION
Complete legal description H A 13Lo ca 3 ISAGLC 1?1V4-0- NrJ
Location (site'address or directions) 10 '�:L 19 C 144, � o 04 ROCK -TL
C/3RiV" /tr
Property owner TI) h £ f Srv1 I T N Day phone G q y - E; S -Y -z
Mailing address L0""111 9 e-uA)N o e 120 c, j< S% q9,r77
Lending agency N 6A - AN✓t�rL OA "44Y '7_0/,pP'A Day phone a S 7 -3y 6
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: q
3. TYPE OF WATER SUPPLY:
Individual well
Community well
X
Public water
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
ommunity-onsite .
Public sewer
NOTE:, If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system:
72.M(P..1/91) Front MOAn1 .
5. 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 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
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 in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm S & S ENGINEERING Phone `' Y ' a -g 7 9
a9 a rver oop Road No. 264
Address Eagle River, Alaska 99S77
Engineer's signature Date—) '1 `I
;C OF
CE-8801AV
6. DHHS SIGNATURE �+ t!` ' `` •• .. ..
t
Li� t
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Date
CAUTION
The Municipality of Arichorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates on y upona ie`presentations given–TrFpa-ragraph-5above-by-an"Independent
professionalengin4e registered in the State of Alaska. The DHHS does this as acourtesytopurchasers ofhomes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work,
crass m... uvir •.a Mon m
RECEIVED
.Municipality of Anchorage JAN 29 19
s
DEPARTMENT OF HEALTH &HUMAN SERVICES PAUW OF A
Environmental Services Division SE�,�
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907p�
Health Authority Approval Checklist
Legal Description:
(pJA &o6-,,3 EA/wi-94L Iy! Parcel I.D.:
A. WELL DATA
well typeNJ UAI-6- If A, B, or C, attach ADEC letter. ADEC water system number
Log present (9/N) Date completed IS,411-9 3
Total depth b Cased to _ �J�f Casing height (above ground)
Sanitary seat ON) # S Wires property protected &N)y 4, 5
FROM WELL LOG
Date of test g'3
Static water level /3ti .
Well production /,' 9 -
p.m -
WATER SAMPLE RESULTS:
AT INSPECTION
g.p.m.
-tr RE S TR, G 40 13% 0"nI I�MB�" L-
Calrorm n Nitrate O . q L Other bacteria
Data of sample: Collected by: G t g I (' s
S. SEPTICIHOLDINGTANK DATA
Foundation cleanout (YM)
Date of Pumping
C. ABSORPTION FIELD DATA
Length
Effective absorption area
0
v !3 "1 C 5 1, W4, 2 17034 Eagle River Loop Road No. 204
! Eagle River, Alaska 99577
size Number of Compartments Cleanouts (Y/N)
Depression (YM)
_ Pumper
P/f+
(YM)
Soil rating (g.p.dJW or fts/bdrm) System type
Gravel thickness below pipe Total depth
present (Y/N)_ Depression over field (Y/N)
Data of adequacy test Results(Pass/Fail) For bedrooms
Fluid depth in absorption field before test (in.); Immediately after_ alwater added (in.):
Fluid depth (ins) Minutes later: Absorption rete =
Peradde treatment (past 12 months) (YM)
72-020 (Rev. 3/913)'
If yes, give date
D. LIFT STATION 11/14
Date installed l
Size in gallons
Manhole/Access
at' (Y "Pump on" level at' "Pump oft" level at.High water alarm lem
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot *A On adjacent lots NIA
Absorption field on Id ��14 On adjacent lots tNAA
Public sewer main 7S / r Public sewer manhole/cleanout
/f
Sewer /septic service line � Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Property line Absorption Hold
Water maintservice line Surface
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Building foundation
Surface water
Curtain drain
F. ENGINEER'S CERTIFICATION
on adjacent lots
Water main/service line
Wells on adjacent lots
I carllly that I have determined thru field ins
in conf0nnanae with M inspections and review o! Municipal
_ / �/ yuidel/ s in effect on this date,
Signature �E// !�I r
Engineers Name RM f -f T
Date l a R
HAA Fee S Waiver Fee $
Date of Payment o/ — 1 I— p 9
Date of Payment
Receipt Number O 4Q%O u5
:.�-- P Recei t Number
�'—r r -r—
72-026 (Rev. 3/g6)•
storage area
y j •
ROBERT C. COWAN W�
�c CE -8801
are
I I- I .i•I II4. 11, •, J 111 111111
J11T1-F-99 TUI: 15:45 SPECIAL FD RI -.CURT!
JM'N-07-1777 AJ -W- v - . . _
CT&E Environmental Services Inc.
Laboratory Division
AJ&
Z00 NY. Potter Dt1Y6
Anchore9e,AK99518
Td: (907) 662.2343
Fix: (907) 561-..5301
CUentPDN: n1a
ChemLsb Rel. 0: 99.0400 meeting Printed Daterrim619
e: 112915:00
Client Name: SSS Engines" Co11.,ted Datorrime: 1128199 0930
Project"am#: N* ELL ReceivedDaterTime: 112819911:25
Client Sample 10:. L4A S3 ER His Technical D;rector. Stephen Ede
Matrix:
prinidng Water
Re!essed By:
PWSID nla
Samote Remark*:
Atlowebfe Prop
Total Coliform (MF)
Nitrate
Ttf i�L UNtS IYIGVVv
0 i� coV100 m; SM92225
().96 01 mg/L EPA 300 10.0
1!
MOOS
Date Intl
1ner99 tuo
/1213199 SOL
02/01/1999 09:22 9076941211 S AND S ENGINEERING
Jwv-m1777 1� � �tf V t ae eo t r•'�.•wecwe —. j. ^ r
ME Cnvirenmentel SarServices
Inc. ►�����iay�ioriifat
LaborstoN Division
PAGE 02
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PUBUC \PATER SYSTF"t 1.0.0
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9ACrZMOLOGICAL WATER ANALYSIS RECORD
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Municipality of Anchorage
Department of Health and Human Services
625 "L" Street
Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650
Mayor http://Www.cl.anChorage.ak.us
February 8, 1999
Note to file
Re: Eagle River Heights Lot 4A, Block 3
There is a private well on this lot. No permit was ever issued, however the well has
been documented through a well log and a surveyed site plan
This information is sufficient to approve this well, despite the lack of a permit.
Donna Mears, EIT
Civil Engineer I
V,. C Macv)
by
DOC Co. Eoa
SULLIVAN WATER WELLS
P.O. BOX 272, CHUG IAK, ALASKA 99567 • TELEPHONE 6882759
OWNER OF LAND i4r/ 'g Y Fo N3•v,=S7S DEPTH OF WELL °
ADDRESS
jc;(r •� G O C41nla 42 24S"CY STATIC LEVEL OF WATER FT. !"z
LEGAL DESCRIPTIO 4 Q iict f r�
DATE • Started f �% ? Ended
PERMIT NUMBER
KIND OF FORMATION:
From
Ft. to
Ft.
From
Ft. to _) t' Ft.
Ft.
From
Ft. to Ft.
l ie Aum L
From Ft. to1. 7 Ft.
r
Ft
From
FL to
From
t.
Ft. to Ft.—
Ft. to
From
From
7 Ft. to r' ? Ft.
r�L
Ft. to
From
5 Ft. to ! U f Ft.
C
Ft. to
From
Ft. to Ft.
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—_From
Ft. to
Ft.
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r04^ja t,,'Q -of� G
From/41
Ft. to!T$�Ft
From
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From
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From ! ' Ft. to I E' ! Ft.
Cy C. !1 A✓r'G 5
Ft.
From
Ft. to Ft.
Ft. to
From Ft.
From Ft. to Ft
From Ft.
From Ft.
MISCL. INFORMATION:
DRAW DOWN FT.
GALS. PER HR 72 `
KIND OF CASING e, Z
From
Ft. to
Ft.
From
Ft. to
Ft.
i From
Ft. to
Ft.
From
Ft. to
Ft
From
FL to
Ft
From
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From '
Ft. to
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From
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From
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t From
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From
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—'Ft.
From
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DRILLER'S NAME
Time
Time Tim Time
r*Ar i
Date
Date Date Date p n
InspeIcto-r�. n InsPector
Inspector Inspector 1_J._J il 1 1
Field Notes: l C MUNICIPALITY OF ANCHORAGE
a �. •S t OF t!!11TI I G it r CCt�l.t t9s W ENVIRO J, -Ni AL FROiL..iAN
t t, tiU �Awtou & yA ��rpd�RECEIVED.
( )
'CONDITIONS OF APPROVAL
APPROVED BEDROOMS
()DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE+g..3
BY: l.n' YZS
Soils Rating Date Sewer InstalledI Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size
APPLIC^NT FILLS OUT UPPER HALT-•vNLY
Property Vnr
m rry Foosnes
_ -
zro code
Malting Address
.
BOyB1 James
E. Smith
Zip Code
Address
Lending Institution
Colonial Mortgage
Zip Code
Address
Phone
MaInce
Realty Co. d Agent
Jack White Co. Clair Ramsey
Zip Code
Address
Legal Description
Lot 4A, Blk 3, Eagle River Hts.
Street Location
Type of Residence
!
R Single FamilyMultiple Family
No. of Bedrooma_3_❑
Other
Water Supply
ATTACH WELL LOG. A well log Is required for al
0 Individual
\ For wails drilled prior to that date, give well depth (attach log It available).
Q Community
(�
O Public Utility
Sewer Disposal
A Year Individual Installed:
O Individual
When Connected to Publ,C (lllllty:
lrillity
(%✓`'
DPublic
Holding Tank
PI -E INSPECTION FEE MUS ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time Tim Time
r*Ar i
Date
Date Date Date p n
InspeIcto-r�. n InsPector
Inspector Inspector 1_J._J il 1 1
Field Notes: l C MUNICIPALITY OF ANCHORAGE
a �. •S t OF t!!11TI I G it r CCt�l.t t9s W ENVIRO J, -Ni AL FROiL..iAN
t t, tiU �Awtou & yA ��rpd�RECEIVED.
( )
'CONDITIONS OF APPROVAL
APPROVED BEDROOMS
()DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE+g..3
BY: l.n' YZS
Soils Rating Date Sewer InstalledI Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size
I
November 16, 1983
Harry FOO:inUs
Locarno
Anchorage, AK 99503
Subject: Lot 4A, olock 3, Eagle !river HCi(3hts
for the
theividual followin�wer itemsdhaveebeenceonpcannot
leted
• A well 109 submitted to this ottice for our tiles and
reviow.
° flIt the well was drilled this year, a permit "lust be
obtained from this office.
Please notify this Department for a reinspection when the
noted discrepancies have
boon
callcorrecteis d.
It thereaare any
further questions, please
Sincerely,
Cory Willis, R.S.
Acting Sewer 6 ;later
Program :tanager
Cw32/ej/E1
^/ w � � y
A s o se`s L`C S�
ti Lf - A .
ANCHOI AGE WATER & WASTEWAI cR UTILIT
Tony Knowles
Mayor
August 19, 1983
3000 Arctic Boulevard
Anchorage, Alaska 99503
(907)
Owned by the Municipality
of Anchorage
Harry Foosnes
3960 Locarno Drive
Anchorage, At: 99504
Dear Mr. Foosnes: 061-1)
This is to confirm that [flock 3, North 1/2 of Lot 40of Eagle
River Heights is connected to municipal Sewer.
Sincerely,
LCIS NICKELL
Customer Service Representative
Anchorage water & wastewater Utilitv
POST IN A CONStACUOUS PLACE
LAND USE No.l
PERMIT
BUILDING SAFETY DIVISION
MUNICIPALITY OF ANCHORAGE
3500 EAST TUDOR ROAD PHONE 2762512
i
GRID
NO
ZONING
AREA
NO. DISTRICT'.
f. L'
1. PROPERTY OWNER
DATEI_
ISSUED � �'�
-L..FHONE
2. MAILING ADDRESS r
3. BUILDING CONTRACTOR.
LEGAL DESCRIPTION . �..A
4. OF PROPERTY O BLOCK - SUBDIVISON
5. STREET ADDRESS r. ,
6. DESCRIPTION OF WORK: _LNEW_—ALTERATION__ADDITION_OTHER—
r i
7. USE OF NEW STRUCTURE
A. Residential:. `1 SingleTamily_Two-FamilY_M 61 ti - Family
_Accessory Building
B. Commercial: _Retail-Nholesale_Of fice-Professional
—Combination _Other
C. Industrial: .—Manufacturing _Storage_ -Processing
D. Other
I hereby affirm that the above information and that submitted in application
for this permit is true and correct to the best of my knowledge. I understand that
this permit is issued on the basis of that information and is subject to compliance
with all pertinent codes and ordinances of the Municipality of Anchorage.
X SIGNATURE OF A�PLICA NT
THIS PERMIT EXPIRES 180 DAYS FROM
DATE OF ISSUE UNLESS CONSTRUCTION,
AS DEF INED IN THE ZONING ORDINANCE,
HAS BEGUN.
IZED OFFCIAL
;AUTHOR
FORM 84 012 (6/761
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