The URL can be used to link to this page

Home My WebLink AboutEAGLE RIVER HEIGHTS BLK 3 LT 10AEagle River Heights Block 3 Lot I OA #050-271-41 Municipality of Anchorage 11'�ApGE SL Development Services Department r Building Safety Division = On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-271-41 COSA# 08C /a Expiration Date: / o - /3-/ 1. GENERAL INFORMATION Complete legal description Eagle River Hts Block 3 Lot 10A Location (site address) 10112 Chain Of Rock, Eagle River, AK 99577 Current Property owner(s) Diaz Missy Day phone 373-4037 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Dawn Burton Day phone 373-4037 The Zimmerman Team Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site ❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 Certificate of On -Site Systems 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 NorthRim Engineerings Phone 694-7028 Address PO Box 770724 Eagle River Engineer's Printed Name Steve Eng Date 7/6/2012 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 inland 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 subject to these various and dynamic characteristics and are outside the control of 1 evaluator of the well and septic system. 5. DSD SIGNATURE VSIApproved for - bedrooms. Disapproved. Conditional approval for Attachments COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory bedrooms, with the following WASTEWATER Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date:" (Rev. 1110 Municipality of Anchorage s<, e> • '� Development Services Department Building Safety Division On -Site Water & Wastewater Program a "" 4700 Bragaw Street P.O. Boz 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Eagle River Hts Block 3 Lot 10A Parcel ID: 050-271-41 A. WELL DATA- Public Water Well type P If A, B, or C provide PWSID # Well Log (YIN) N Date completed 1964 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 140 ft. Cased to 140 ft. Casing height (above ground) 36 in. FROM WELL LOG AT INSPECTION Date of test 6j , . 6f3 91 1 Static water level na _ ft, , 126 ft c, - Well production Ila g.p.m. 8+ g.p.m. WATER SAMPLE RESUL'f S: Coliform Pass colonies/100mL Nitrate 2.28 mg/L Arsenic: 0.274 ugll Date of sample: '5131/12' Collected by: nr ' B. SEPTICIHOLDING TANK DATA Tank Type/Material — Date installed -- Tank size - gal Number of Compartments = 'Cleanouts (Y/N)-_ Foundation cleanout (Y/P#) - Depression over tank (YIN) High'wafer alarm (YIN) — Date'of pumping- ------ - Pumper ----• - C. ABSORPTION FIELD DATA- Public Sewer Date installed Scil rating (g.p.d./ftz or ft2/bdrm) -_ System type = Length = ft. Width —ft. Gravel below pipe =ft. Total depth - ft. Eff. absorption area — fl? Monitoring tube __ Depression over field — — Date of adequacy test ------ Results (Pass/Fail) — For - bedrooms Fluid depth in absorption field before test =_ in. Water added -- gal, New depth _in Elapsed Time;_ min. Final ftujd depth in. Absorption rate,,>,,;`. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date -- D. LIFT STATION Date installed na Size in gallons ha Manhole/Access (YIN) na Pump on" level at na in. ."Pump off'ievel at na in. High :water alarm level at na in. Datum na Cycles tested na z Meets alarm & circuit requirements? na E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot na Absorption field on lot na Public sewer main 75'+ Sewer/septic service line 25'+ On adjacent lots 100'+ On adjacent lots 1001+ Public sewer manhole/cleanout 100'+ Holding tank na Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation — Property line = Absorption field Water main Water service line — Surface water = Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Building foundation Water main Water Service line — Surface water — Driveway, parking/vehicle storage = Curtain drain Wells on adjacent lots F. COMMENTS _.A _ G E GINEER'S CERTIFICATION ®y�•� �4ti714 I certify that I have determined through field inspections and review of Municipal records char the above systems are rn - .. conformance with MOA COSA guidelines in effect on this date. kt Stevan W. Eng Engineer's Printed Name Steve Eng!��'� ., PE��G'i Date 7/6/2012' s COSA Fee $490.00 // Waiver fee $_ Date of Payment Date - Date of Payment ReceiptNtimbet ` ` "tJ� Sx-�e. _ Receipt Number_ (Rev. 1.t105). tr_ Municipality of Anchorage Development Services Department Building Safety Division '�+ Onsite Water and Wastewater Program " 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. b5D1-`{l COSA#t)(001;-(o Expiration Date: 9 - 16 - 10 61 1. GENERAL INFORMATION Complete legal description F�KL F cF/yE2 11i5014U B&&,' c 3 Loi ILIA Location (site address) Z0//2 C94(4( OI— oCQCK Current Property owners)RG��ri Day phone ��'9— X00% Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone 114d2i4 ff/12±rf C- i d til Day phone 4' 0357 �EAigL6F O F �cF_ t21V5e0_ Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 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 J� The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Onsite Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 seat affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems 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 Address Engineer's Printed Name STEt(E 61r, Phone bE�-702-d-' Date S o OF A qt+ 1 k+N_ /• •. j.49T.ua.u.•U.•ll.i.. • S. DSD SIGNATURE C�� `;r••• S�epE 6256 Approved for 3 bedrooms. 1`Fo .7.. •... P E:;�u'•, Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: _6_ ' /%' 0 �o (P• .71105) :L Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Bragaw, Street P.O. Box 196050 Anchorage, AK 995198850 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Desaiption:F kE i2rUC4 fii_/6 rJ 9LOCk 3 A WELL DATA Weft type1-- If A, B, or C provide PWSID # Date completed JU Sanitary seal (Y/N) Total depth 1 -440 --ft. ; Cased to ZY-O ft. FROM WELL LOG Date of test Static water level Well production ft. WATER SAMPLE RESULTS: Coldorm !7 colonies/100 mL Nitrate 41, M mg1L 49 ir Arsenic: 2f argil Data of sample: 0-110 B. SEPTICfHOLDINGTANK DATA PVBLfC JfFc zoe_ Tank Type/Material Tank size Foundation deo Date of pump Number of Compartments Depression over lank (YIN) Pumper C. ABSORPTION FIELD DATA )P44/ 10- ,Si rj&L Well Log (YM) AI Wires properly protected (Y/N) V Casing height (above ground) 3ti In. AT INSPECTION ylz s/cc /S7 ft. Other bacteria G colonies/100 mL Collected try Wo - Date (YM) High water alarm (Y/N) Date installed Soil rating p.dJfe or fe/bdrm) Length ft. idth ft. Total depth _ ft. Eff. a on area fe Monitoring tube Date of adequacy test Results (Pass/Fail) Fluid depth in absorp ' field before test _ in. Water added_ Elapsed Time: min. Final fluid depth _ in. A(�E Airy rejuve on treatment (past 12 mo.) (Y/N & type) G/ System type Gravel 71 ionover field For _ bedrooms New depth_ in. rate >= g.p.d. If yes, give date D. LIFT STATION Date installed Size in gallons nhole/Access (YM) 'Pump on' level at in. 'Pump off" level at _ in. High water alarm el at in. Datum Cycles tested Meets alarm circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 6VA Absorption field on lot Public sewer main �/D o I& Sewer /septic service line Z S' On adjacent lots On adjacent lots ! e o rt Public sewer manhole/cleanoutrl- Holding tank Animal containment areas N/A Manure/animal excrete storage areas N1,4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Past rL sc.hrx Building foundation Property tine Absorption f Water main Water s ine Suri ter Wells on acent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 106,4eL to I Ear Property line Building founda ' Water main Water Service Surface we Driveway, ng/vehicie storage Curtain d n Wells adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION OF ,;; gsti�1 I certify that I have determined through field inspections and 0, % 91� review of Municipal records that the above systems are in A 4� �� • = !� conformance with MOA COSH guidelines in effect on this date. s•:; 010 Engineer's Printed Name Seven W. Eng W PE 6256 $14 Date 6fio a COSA Fee $ 3o Date of Payment �-- // -0 L Receipt Number O 3 i (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number w r , I UrOC ``rrer� D/—r v� w�X.X h R. 7'r' Cv �,..• r-rtso.�,. AS -BUILT I hereby certify that I have surveyed the .tollowtng described property: -L --Or 10—A LT e ei' 94-0 r 1' �-wTilii :z-+ �'�LI-•f � /� i -K/ i n-4, Anchorage Recording Precinct, Alaska,'and that the • -' 11 improvements situated thereon are within the property �,�.' ,•,� ". t lines and do not overlap or encroach on the property _. ,,,,.. ,; •9- - lying adjacent thereto, that no Improvements on prop- ,: erty lying adjacent thereto encroach on the premises in s•+'' question and that there are no roadways, transmission {�,� Lnes or other visible easements on said property except -Cw{.-`Jt,lf�s�t�-` - as Indicated hereon. '><'"�—t�C.-� iiZZ �r//��)��-'}•.•�c�.�� Dated at Eagle River, Alaska • _.. _ - - this. ;day otlt1�lDe EOBERT C JOHNSON ? f SCALE: r Re-uteml Land Surveyor No. 80 -LS -Z0 Dox 450, Eagle River, Alaska v Phone 891.2543 GROUP North Rim Eng Attn: Mr. Steve Eng 17237 Bear Paw Circle Eagle River, AK 99577 907-694-7028 Far: 907-694-7026 Client Sample ID: Client Project: Location: Sample Matrix: COC #: PWS#: Residual Chlorine: Comments: AX 2375 North Rim Eng Eagle River I I'S B3 L10A Aqueous n011tZ,lt_ItL`J$t3/+1 Analytica International, Inc. 5761 Silverado Way, Unit N Anchorage, AK 99518 Phone: 907-258-2155 Fax: 907-258-6634 Report Date: 5/82006 Receipt Date: 4252006 Sample Date: 4252006 Sample Time: 11:0O:OOAM Collected By: S Flay Definitions: MRL - Method Reporting Limit MCL - Maximum Contaminant Limit B = Present also in Method Blank If - Exceeds Regulatory Limit M - Matrix Interference J = Estimated Value D = Lost to Dilution • • a RL higher than MCL; target not detected Analysis Method Pre Prep Analysis Parameter Result s Units Flags MRL MCL Method Date Date Analyst 4500-NO3E (Aqueous) - Nitrate Test was conducted by: Analytica - Anchorage Nitrate as N 4.18 mg/L 0.50 /0 5/12006 5/12006 AJ Lab#: A0604198 -01B Analysis Method Pre Prep Analysis Parameter Result s Units Flags MRL MCL Method Date Date Analyst 92228 (Aqueous) - Membrane Filtration MF Test was conducted by. Analytica -Anchorage Bacteria, Other ' <MRL CFU/IOOmL 1.0 4252006 4252006 EK Total Coliform <MRL CFU/IOOmL 1.0 J 4252006 4252006 EK Lab#: A0604198 -OIC Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 200.8200.8 (Aqueous) - Family Well Water I Test was conducted by: Analytica - Thornton Arsenic 1.29 ug/L 0.15 JO 200.8 522006 522006 MCG Reported by: Rob Gustafson, Laboratory Project Manager Page 1 of r^� r^ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH b HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES nn0 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 10 OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date January 29, 1988 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 10A; Block 3; Eagle River Heights Location (address or directions) 10112 Chain of Rock (b) Property Owner Ak• U.S.A. F.C.U. Telephone: Home Business 563-4567 Mailing Address 4000 Credit"Union Dr. Anchorage, Alaska (c) Lending Institution Ak• U.S.A. F.C.U. Telephone Mailing Address Attn. Finis Sheldon (d) Real Estate Company and Agent Ridgeview Properties— Jeff Amistoso Address 12212 Old Glenn Hwy. Eagle River, Alaska 99577 Telephone 694-6001 (e) Mail the HAA to the following address: or: Check here, If hold for pick up. List contact person and day phone number below. e IS ENrINFERIMC ordered by Finis Sheldon 17034 Eagle Rirw Lu p Road No, saga Kiver, AleiKa 2. TYPE OF RESIDENCE Single -Family Q Number of Bedrooms 3. WATER SUPPLY Individual Well),} Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DIS S L Onsite 13ublic Community ❑ Holding Tank ❑ Note: If comm well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 nes iRw 81851 From 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 r ' t iAlGetile'ei !`ro Telephone Address 17g3SEagle River Locp Roa4 tj*,"! Date z — S 60 14 w: • a, 6. DHHSAPPROVAL _ Approved for 2A&e4_)_ bedrooms by Date 1 65 5pe Approved k Disapproved Conditional Terms of Conditional Approval timt][•i.l The Municipality of Anchorage Department of Health and Human Services (OHHS) 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 engineer's work. Page 2 of 2 724175 (Rw 8'961 e+cww r` n UNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF AN EAUTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL SERYIC S urV6HECKLIST - FEBRUARY 1984 264-4744 Fe J 12PJ8 RECEIVED A. WELL DATA Legal Description: 1-�/n �} 13Lx_ 3 Well Classification S• If A. B, C. D.EC. Approved (Y/N) N/A Well Log Present (Y p— Date Completed .4122a01% Z9 0V Yield' EI -S' LIPM'f" Total Depth yr/f-'� 14- Cased to L!D/•,- Depth of Grouting Static Water Level /--z:;r Pump Set At •%— Casing Height Above Ground _"� V " Sanitary Seal on Casing (AN) Electrical Wiring in Conduit 6?N) Depression Around Wellhead (YAP Separation Distances from Well: To Septic/Holding Tank on Lot J E ; On Adjoining Lots �cN To Nearest Edge of Absorption Field on Lot fl res- ; On Adjoining Lots e v C To Nearest Public Sewer Line /e�n ' To Nearest Public Sewer Cleanout/Manhole /C)o I-(- To Nearest Sewer Service Line on Lot Water Sample Collected by `f�^� L= �� ry t1�2± NC. ;Date Z — 7- — f3Q Water Sample Test Results 1=02 2SAc7 Xf1T2A�S Comments '& VA!�L-t— Fc raw P'_A-t,_ NLI.4k� Z-3 —i3g r—y _ L-%H2S. B. SEPTIC/HOLDING TANK DATA Date Installed -k -Y--Size Standpipes (Y/N) Depression over Tank (Y/N) No. of Compartments Air -tight Caps (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Water Main/Service Line Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Course , I Comments *::y= > bens- LoN �rr_ru� TV tour- Sr31A)L- . Page 1 of 2 72-026 (Pr 8'861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed Length of Field Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present(Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Property Line To Building Foundation To Existing or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments _=X=>�oI rc Yj 7a t7 Au` S vlel_ D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at n "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments '• Check Permitted Bedroom Rating Against HAA Request •' I certify that T3W6VfiJ%t*dfied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 17094 Eaola River Loop Road Nq)W Z— S -8e Eagle River, Alaska 99577N Company MOA No. 8�' 003 + k '+ a ... ;I-V, raj Receipt No. O O U / �- `t vf.i) . I Date of Payment Amount: $ ZZ G • O U 0dill' is r,.. ................... .. Page 2 of 2 72-026 (Ft" 8'881 Back a n. A.5-6 27/ HEMICAL & GEOLOGICAL LABORATORIES OFALASKA, INC. 5633 6 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 FEDERAL TAX ID M 92-0040440 Client POI : NONE REC'D Req 1: Client Smpl ID: LIDA, B3 EAGLE RIVER NTS Sample Rec'd : FEB 2 88 Ordered By Send Reports To: S L S ENGINEERING R SCHAEFER 17034 EAGLE RIVER LOOP RD., 1204 EAGLE RIVER, Al. 99577 Special Instruct: Chemlab Ref 1: 9002 Lab SWI I0: 3 Parameter Tested NITRATE -N ANALYSIS REPORT BY SAMPLE Matrix: Yater York Order No. : 5013 Client Account : SNSENCP Date Report Printed: FEB 4 88 9 12:33 Released By : 2fi Reports Address 12 Result/Units Method 2.9 MVI EPA 353.2 Sample SAMPLE COLLECTED 2/2/88, 1330 NRS. ROUTINE SAMPLE Remarks: ANALYSIS COMPLETED: 2-4-88 LABORATORY SUPERVISOR: STEPHEN C. EDE :!� G 1 Tests Performed * See Special Instructions Above ND= None Detected if See Sample Remarks We NA= Not Analyzed LT=Less Than, GT=Greater Than AI Iaable Limits 10 r-� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 ,�// Application Date K 3 r 8S 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, Location (address or directions) I - 30 e -J4 A IIJ of i?oGiC 2 0�' -->A-)-->A-)�o? !Ease, Blow& FAr(b) Applicant Name 2L l v' AOLZA-D Telephone: Home Business 65�9 - 7JV Applicant Address P Dr 8oX 77 7441-7 -_ 6LE 'Ri V -1L . An. 9957% (c) Applicant is (check one): Lending Institution ❑ ; OwnerLDaiiAe X- Buyer [3: Other ❑ (explain); (d) Lending InstitutionAl7 05A Telephone Address DC*JA-L.C> SSFP - Po 6t>< k1e)13 /-kn3!_e . . 141 1135bZ (e) Real Estate Company and Agent Address LiTeleleelphhone (f) SAA the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family E3 Other Number of Bedrooms 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ❑ Publico Community ❑ Holding Tank ❑ Note: If community well system. must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 r2-02501,,4) n 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 $tate codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date 6. DHEP APPROVVAAL Approved for 6A )l C e , bedrooms by Approved Terms of Conditional Approval 1=7 Telephone CAUTION 11l/�/mss " The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. PAn. 9 M 9 MUNICIPALITY OF AWHORApE DEPT. OF HEALTH & �? ENVIRONMENTAL PROTEQION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) APR 9 i4c CHECKLIST - FEBRUARY 1984 2644720 L R E C E I V E Legal Description: oT /V A Ot- 3 E.,G L E ✓E/1 FITS , A. WELL DATA Well Classification -5I` ' If A, B, C, D.E.C. Approved (YIN) i1 Well Log Present (Y/6Date Completed AFra&- 11104- Yiel . SHPT•+ - Depth (1� Cased to ,r . /� Total De p �� Depth of Grouting — Static Water Level /41n / Pump Set At N Casing Height Above Ground 30 Sanitary Seal on Casing(OJ) Electrical Wiring in ConduitdVN) Depression Around Wellhead (Yep Separation Distances from Well: To Septic/Holding Tank on Lot � � ; On Adjoining Lots nJ iL! To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots a To Nearest Public Sewer Line /0U "t To Nearest Public Sewer Cleanout/Manhole 10014 To Nearest Sewer Service Line on Lot Water Sample Collected by 5 14 5 6061A-3 fsZ J- 4 ; Date U - y -PS Water Sample Test Results =►I/ov-»9�!�I�d�IL�Yit►7:r.a�sv>•r[ri[a��i�Iti i • s B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (YIN) Size Air -tight Caps (YIN) No. of Compartments Foundation Cleanout (YIN) Depression over Tank (YIN) Date last Pumped Pumping/Maintenance Contract on File (YIN ) —;for Holding Tank High -Water Alarm (YIN) Temporary Holding Tank Permit (YIN) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Building Foundation To Property Line To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments n5C_/G 5r - Page 1 of 2 �c !:3`49 � I 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Type of System Design Length of Field Depth of Field Gravel Bed Thickness — Standpipes Present(Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ;On Adjoining Lots To Cutbank (if present) Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Z 4 Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (YIN) Comments Check Permitted Bedroom Rating Against HAA Request •' Icertify that Ihave checked, verified,orconformed toall MO an HAAguidelinesineffect onthe date ofthis inspection. a-$, E!Emelimigalva Signed as 19ax Date Companyr'"•3LE Rliry,$fJ4�?y7e MOA No. UC23 Receipt No. — Date of Payment Amount: $ — Page 2 of 2 72026 (11,84) b,bwt A. shake too. W7 -E Rd 5. LEGAL DES RIPTtON DATE RECEIVED y .INSPECTION APPOINTMENTS TIME TIME TIME SINGLE FAMILY ❑ One ❑ Four ❑ Other 1� ❑ Two ❑ Five DATE C21l,, Three ❑ Six DATE ^ ( 1 DATE INSPECTOR _. ' ATTACH WELL LOG. A well log is required for all wells drilled INSPECT R INSPECT ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM In ❑ INDIVIDUAL/ON-SITE" MUNK-WAL11Y OF ANCHORAGE PUBLIC UTILITY MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH E NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE&?61C-NMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ' MAR 16 1981 ENVIRONMENTAL SANITATION DIVISION Telephone 2644720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten 110) days for processing. 1. PROPERT 07ER PHONE MAILING ADDRES PROPERTY RES DENT Ilfdifferent from abovSV HONE .17 0 ofi/I 4V �" t 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE z MAILING AD ES 320 t$ n 4. REALTOR/AG NT PHONE MAILING AODr ES$-• ,.,vr� /), O 'r_ /C 5. LEGAL DES RIPTtON 14 STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other 1� ❑ Two ❑ Five ❑ MULTIPLE FAMILY C21l,, Three ❑ Six 7. WATER SUPPLY ,K INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE" YEAR ON-SITE SYSTEM WAS INSTALLED. PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. rnoto (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY - 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY - ❑ PUBLICUTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL - - 4. DISTANCES WELLTO: Sepbc/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS rr t �Y�ypPROVEDFOR�:L_ BEDROOMS CONDITIONAL APPROVAL Iletter mus ccompany certificate) ❑ DISAPPROVED DATE _ BV 72 010 (Rev. 6/79) Municipality of Anchorage r�" 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DE.PARTMCNT OF IIEALTH AND ENVIRONMENTAL PROTECTION March 19, 1981 Steve Kent 8 Judy Rowland Sun Realty Post Office Box 1201 Eagle River, Alaska 99577 Subject: Lot 10A Block 3 Eagle River Heights Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completedi (1) The water analysis report needs to be delivered to this office from the Chem Lab, 5633 B Street, for our review. (2) The depression and pit around the well casing needs to be filled with impervious type soil so that it slopes away from the well casing. This will need to be reinspected by this office. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt; R.S. Associate Specialist RCP/ljw cc: Spokane Mortgage 3201 C Street - Suite 250 99503