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HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 3 LT 4B&6u QA-J��tr\ &""L. , +xosU-am-s3 W t ... ♦ � •'. T'F . !*'v_ - '1�� Yy u vmr ww.^^.,+.aaae....'+—w.viry+) .r .vw...�.• n.. d�vey - .T... _—.. .r..,'..r.�.+� Cit-�e SULLIVAN WATERY WELLS_ , . P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 - OWNER OF LAND NVL.cY Yrpo?.va4i n�e,�iL wr.+O-r JcDEPTH OF WELL S'S� t ADDRESS 960 ' O C 044OJJ +D.!! STATIC LEVEL OF WATER FT. r, ,LEGAL DESCRIPTION .' t C 3 _ iC J Y4krJ DRAW DOWN FT. DATE Started L40 fall Ended ' hI YA • GALS. PER HR 4 a PERMIT NUMBER KIND OF CASING 6 O Q KIND OF FORMATION:' From sC—Ft. to 2Ft. e U c ��o �O Fn/ From Ft. to Ft. From Ft. to--a-Ft. - s /< i Cssy ,i ' From Ft. to Ft. From ' Ft. to ' Ft._6"Lir-lYG From Ft. to Ft. ' r FromFt. to-2_7—Ft'. C t A i G.t From Ft. to Ft i From Ft. to Ft. Ise % O r"t From ' Ft. to ' Ft Frome? Ft. to 's9 Ft From , ' Ft. to Ft. From �Ft. toFt. C �t T S G fil.lm G. From Ft. to FL From Ft. to�,� FL From Ft. to FL From43 FL toLFtl lCrE�os:. From Ft. to Ft. Fron✓�_Ft. to—Lr–CF From Ft. to Ft. From Ft. to � Ft. '� ' From Ft. to Ft. From Ft. to Ft. ' „ From Ft. to - Ft. From Ft. to - Ft. From Ft. to—Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From " Ft. to Ft. From - Ft. to Ft. From Ft. to Ft. From Ft. to Ft DRILLER'SNAME ��� 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.# n(QQ-AM-!5zlitz HAA# IN ",I �nat 3I -A ( 1. GENERAL INFORMATION Complete legal description Lot 413; Block 3; Eagle River Heights Subdivision Location (site address or directions) 10207 Chain of Rock, Eagle River, Alaska Property owner. Michael McCormick Day phone 694-701 Mailing address 10207 Chain of Rock, Eagle River, Alaska 99577 Lending agency FIRST NATIONAL BANK OF ANCHORAGE Day phone Mailing address , Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone _ NOTE: it 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 ;OOt NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(R.A/21) Fant MOA 1121 S. 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 furtherverify 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 Phone Address 17034 Eagle River Loop Road No. 204 Eagle River, Alaska _ Engineer's signature Date 57-1 o—g2 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments A bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes 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 engineers work. nozs m«. 1/91) BWk MOA m Municipality Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L e,t 14e, 5LAI'-b EAQ 1_1✓1441U--Parcell.D. D6��";�!Af-S 3 A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number 014 IN - Log present &N) - Logpresent&N) J Date completed Driller Suwrt/4-x-1 Totaldepth )SSI Casedto tss Casingheight fZN} Sanitary seal )N) Wires properly protected (ZN) MUNICIPALITY OF ANCHORAGE FROM WELL LOG AT INSPECTION ENVIRONMENTAL SERVICES DIVISION Date of test )O ->3Z .t, (�'1Z 0AY 1 1 1992 Static water level Well flow 7, D 9•P•m• gRrE C E I V E D Pump level ti V— V4 SEPARATION DISTANCES FROM WELL TO: / Septic/holding tank on lot d ; On adjacent lots Absorption field on lot �/b ; On adjacent lots (+loot} Public sewer main 75 Public sewer manhole/cleanout Sewer service line 'LS 14, Petroleum tank 25 WATER SAMPLE RESULTS: Coliform U (yam &OA0 • Nitrate '52 ^ !I,11 Other bacteria Ai ,r Kdf Lour _ Date of sample: �'C1 ' 517-17— Collected by: F N B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size Foundation cleanout (Y/N) Alarm tested SEPARATION DISTANCES FRO Well(s) on lot C LDING TANK TO: Compartments Depression (YIN) adjacent lots Foundation To pr yline Absorption field Watermain/service line Surface water/drainage PJB►-�� �F..�F», 72.026 (Rev. 7M) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical 1 "Pump on" level at Manufacturer — Manhole/Access (Y/N) ump off" levet at Cycles tested SEPARAT 'STANCE FROM LIFT STATION TO: I on lot On adjacent lots D. ABSORPTION FIELD DATA Date Installed Length Width Total absorption area Depression over field (Y/N) Results (pass/fail) Soil rating _Gravel thickness Cleanouts for Surface water System type otal depth adequacy test bedrooms Peroxide treatment (Past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FRO BSORPTION FIELD TO: 1 , Well on lot On adjacent lots Property line To building fou ion To existing or abandoned system on lot ;Onadjac lotsCutbank Watermain/service line ce water Driveway, parking/vehicle storage area Curtain drain �p 1 Q(�1 CL S F v 1.> r_ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines In effect on the date of this Inspection. 5 8 5 ENGINEERING or 17034 Eagle River Loop Road No, 204 ,e%b .•'~~�^ Signature a y� �., EagleRiver,-Alaska fCQTR Engineer's Name ���•�••,: ��» .� •• '��• P Date O r^ ; ROGE J. HAFER . HAA Fee $ RIO Date of Payment 5 Receipt Number X,2 k-2 72-M (A". 3101) Back MOA 21 Waiver Fee: $ — Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING b ENGINEERING CO. 5633 B STREET ANCHORAGE. ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALISIS 000,1190 for INVOICE t 52758 Chealab Ref.t 92.1486 Sample I 1 Matrix: NATER Client Sample ID : L4B 63 L►CLL RIPER HIS S/D PNSID : DA Collected : APR 9 92 t 12:20 hrs. Received : APR 10 92 t 14:50 hrs. Preserved with : AS REQUIRID Analysis Completed : APR 13 92 Laboratory Supe U r STEPHEN C.CEDE Released By : ' �' ell Client Name :S G S ENGINEERING Client Acet :SNSINGP LPOt : Regt : Ordered Ey :R. SHAPER Send Reports to: I)S 4 S ENGINEERING 2) POI :NONE RECEIVED .................................................................................................................................... Parameter Results Units Method Allowable Limits MIIRITL-N 3.0 sg/l LPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED &I: RAI. Remarks: .................................................................................................................................... 1 Iests Performed ' $ee Spacial Instructions Above Uk-Unavailable ND• Nona Detected " Sae Sample Remarks Above NA. Not Analyzed LT -Less Than. CT•Gtoater Than (.6"S S Member of the SGS Group (Social GAnArale cle Surveillance) MAY— 6-92 FRI 13:11 (^A P'O1 CHEMICAL& G%OL GdCAL LABORAT RY v A D R'ISION OF COdfdfERCIAI. TESTING & ENGINEERING O. Vr F TELEPNON°_ (907) 562.2343 5633 0 Street Anctorraga,Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. 9 112f PRIVATE WATER SYSTEM ka" S i S ENGINEERING Pnw Nu 17034 Eagle River Loop Road No. 404 Cry t',uu 47c;+— SAMPLE DATE: aS L�—'-i ! ?— Mo. Day Year SAMPLE TYPE: q Routine O Check Sample (for routine sample with lab ret, no. 1 O Trealed Water D Special Purpose 0 Untreated Water SAMPLE T.me Collected No. LOCATION Collected By 31 --I 4 -- sl I READ INSTRUCTIONS BEFORE TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: * Satisf aztory C Unsatisfactory ❑ Sample too bng In transit; sample should not be over 30 hours old at examination to indicate retable results. Please send new sample via special delivery mail. Date Rocelved .6/ -7 /V— Time Received — I 1 ArWyllcat Method: Membrane Filler . No. of colonies/100 ml 495474 —li BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter. Direct Count Vorl8catlon: LSF SGB Fecal Coliform Confirmation Colllorml/oo ml COLLECTING SAMPLE final Membrane Filter Result c'Coliformflooml Reported By Date Ste' D '�9j�2 Time: /' i" - a.m. TNTC = Too Numerous To Count p.m. OB = Other Bacteria APPLIC AT FILLS OUT UPPER HAL ONLY Phone Property Owner IIarry Foosness Mailing Address Chain of Rock Zip Code Buyer McCormic, Michael R. Addres6917 Prgsperity AnclirtrageZIP Code QnqAA Lending Institution Phone First Alaska Mortgage &.Escrow, Inc. Address q fZip CoOB ' Phone Realty Co. & Agent Jack White Co. Clair J.'Ramsey - Zip Code' `- Address 3201 C St. Anchorage Legal Description Lot 4B, Bloc_ k 3.'Eagle Rive Heights Subdivision\ Street Locatlon Chaft of Rock Date Type of Residence G Single Family 1 -. c Multiple Family No. of Bedrooms y ❑ Other Water Supply v Individual �� 11 CYrf� `o L( n O lu ATTACH WELL LOG. A well log is repulr4d f a wells drilled aloes June 1975. For wells trilled prior to that date• glve wel(tle�nTattach log If available). Community S9 "C \ O Public Utility DEPT. OF H`r-ALTH & Sewer Disposal ^ l� O Individual ' ry • Year Individual Installed: Public Utility t 1 When Connected to Public Utility: Holding Tank FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. NOTE: THE INSPECTION 7291l (M!) Tlme Tkne Time Time Date Date Date Date —34 Inspector Inspector Inspector Inspector MUNICIPALITY OF ANCHORAGE Field Notes: DEPT. OF H`r-ALTH & t D ENVIRONM-NTAL PROTECTION J U L 2 718W Whild .Sa.m DECEIVED >- ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL /� ,�' - Au'�-", ( 3) DISAPPROVED _ �, n d � 1��, �. J5 I CONDITIONAL APPROVAL' DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 7291l (M!) CHEMICAL & G& AGICAL LABORATORIES ALASKA, INC. TELEPHONE (907) 5622343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street 1 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY w WATER SYSTEM: t I.D. NO. Water System Nems - U Pnorle No. • (r Mailing Address f � y • state ., ... Zip Code 'V city SAMPLE DATE: F1=J Mo. Dal' ,�, Yqr SAMPLE TYPE:0 Routine j O Check Sample (for routine sample,` with lab ref. no. t O .Treated Water O Untreated Water--, O Special Purpose *': „ ` M ed . ] .�f 4 • ( . F 'tel rt SAMPLE V ,� Isr F "Tlma 1 CCCCCoq000����laa NO. LOCATION / I , ,,,,,CollectW - / ey �� A�. .f .I V �l �I•�1 3 Analysis shows this Water SAMPLE to be: �S2 Satisfactory I34Unsatisfactory ❑-Sample too long in transit: sample should .not be over 48 hours old at examination to indicate reliable results. Please send Inew sample. Date Received w Time Received t7 Analytical Method: +t ',,D Fermentation Tube Membrane Filter rt ,J,.aab Ref. No. Result' Analyst 4 SE % a• C1�1 s, •r 4 ♦Z t s<% . Y t ms r_ f� pp- IY VH� TImIIOVIM M1tgOe f .. _ ._ .. • aa•1t" tb) 6ACTERIOLOOKAL WATER ANALYSIS RECORD • • ' • - • • - Me. Itra READ INSTRUCTIONS Y BEFORE COLLECTING SAMPLE Date Collected -Source a.m. EMa Prom a. nemrnr loml Tutee Peslltm+/Total 10ml Portlone Multiple TWIeRporll collform/100rm1 Munbrane rater, Dimt Count Verlfkatlonm LTa Data Final Membrane rat« Results Colllorm/160ml Assorted Date :r M fTime a.m.