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Home My WebLink AboutEAGLE RIVER HEIGHTS BLK 3 LT 11 S100'Loj,u I�ucnhdS E16LJE 3 " u 6c). Q-,-) I - oLI MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES a Division of Environmental Services ' !)'On -Site Services Section " P.O. Box 196650 Anchorage,'Alaska 99519 6650 '343-4744 CERTIFICATEOF, HEALTH AUTHORITY, ' .APPROVAL FOR A SINGLE FAMILY.? WELLING ParcelLD.q 050-271-04 HAAq 4.1�aLl�1i�. ' ' 1. GENERAL INFORMATION Complete legal description Eagle River Heights Lot 11 less the north 65', Block 3 Location (site address or directions) 10132 Cbain of'RockEcStreet, Eagle River, AK ' ;Property owner ' HUD Day phone 271-4342. Mailing address eoe n Rin Ayn --_ R_x N 64Anrhnrage au 99513 Lending agency N/A Day phone Mailing address _.. ., ... .. .,.....«. Agent' _ AG�� nmkA, GiSanAvJ33Aim�r ....Day phone 961-1111 ,• - Address 640.W. 36th.Ave., Suite 1. Anchorage, ^AK 99503-5807 ` Unle ssotherwise requested, HAA will be held for pickup:: ; 2.' 'NUMBER OF BEDROOMS: 2 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 Community, =: X on=site ..• Putilic'sewer ... r system, provide written confirmation from State ADEC NOTE: If community' wastewate attesting to the legality and status of. system. n-m(Ra. 1N1) Front MOAF21 W 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 Iurtherverifythat based on the information obtained from the Municipality of Anchorage tiles and from my invest!9ation 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 Eagle River Engineering Services Phone 694-5195 Address P.O. Box 771294 Ea le River AK 99577, Engineer's signature Date 04/01/94 ...._...'_. ._. _ _. ... ...... ...... OF azo , A A%j •. �•�....a ,. ....ii• r Louie A. EulCra Oa % cEsra 6. DHHS SIGNATUREAL•r.SStoaP�4� "Approved for ' bedrooms. Disapproved:......._ Conditional approval for" bedrooms, with the following stipulations: Additional Comments By: 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 engineer's work. • 72-025M..1/91) 8Kk POA m . Municipality of Anchorage Ak Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Cnhec f1vSK -NTS Parcel I.D. 44 — LoT /1 Gess 0-1 /Yeanr b5' A. Well Data Bcorx3 Well type G If A, B, or C, attach ADEC letter. ADEC water system number 9f71--DW-0'7L175 (Y/N) Date completed Driller Total dep Sanitary seat (Y Date of test Static water level Well flow Pump levell Cased to Casing height FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot properly protected (Y/N) AT INSPECTION m n .c n o m 0 z On Public sewer main Public sewer mar Sewer service line Petroleum tank WATER SAMPLE RESULTS: lots Coliform Nitrate Other Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date alled Cleanouts (Y/N) High water alarm (Y/N) Date of pumping 101a64, Sew Tank size Compartments_ dation cleanout (Y/N) Depression (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING T Well(s) on lot On adjacent lots tested (YM) To property line Absorption field Water Surface water/drainage CONTINUED ON BACK PAGE 72-026 r rsal• F=t STATION Date in3tal Size in gall Vent (Y/N) High water alarm level Meets MOA electrical codes (YM) on'level SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer (Y/N) 'Pump off" Level at tested D. ABSORPTION FIELD DATA �i�6/.G scwcr Co....e_ - Length Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ftz) System type Gravel thickness Total depth present (YM) Depression over field (Y/N) (pass/fail) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots To building foundation for Bedrooms yes, give date To existing or abandoned system On adjacent lots Cutbank Water main/service Surface water Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION line I cerfify that I have checked, verified, Or conformed to all MOA and HAA guidefines in effeporl tir�dRj�Ql this inspection. �c ` F 11 Ar' � CrnT�t Signature �.....:5.,� -� r ....•.... .• ,..c Engineer's Name Date dP2/c / /99y �jC%sr:• HAA Fee $ ' Date of Payment Receipt Number, 72026 (=)' Back N Waiver Fee $ Date of Payment Receipt Number STATE OF ALASKA I n, DEPARTMENT OF ENVIRONMENTAL CONSERVATION • . iti •. APPROVAL OF ONSITE RESIDENTIAL WATER AND SEWER SYSTEMS vita new•`• PROPERTY DESCRIPTION Lot.I elpcl`aSLpolw•6lrr orJJ.5.6TZ, Block 3 ' lEagle RiverHeightsSubdivisoin Class "C" Public Water System. pa,lfllcala IssuW for Apollcallm No: This approval does not constitute a guarantee of any kind, explicit or Implied, as to the performance of the water supply and wastewater disposal systems. WATER SUPPLY . A recent water sample was tested and found to meet Department of Environmental Conservation drink - Ing water standards for total coliform bacteria. and nitrate Hama / "',Environmental 0ale jam, � loci Engineer Mar. 21,194 T WASTEWATER DISPOSAL The domestic wastewater system was: / ❑ Inspected\DDepartment of Environmental Conse [ion and found to be In compliance with applicablef 18 AAC 72; ❑ Inspectedal Engineer who�Rifles thai the system complies with applicable re- quirement / ❑ Installed by a Certified Instal w certifies that the system complies with applicable requirements of 18 AAC 72; or ❑ tested by a Profession ngineer w certifies that the performance of the system is satisfactory and that the syste omplies with th minimum separation distances specified In 18 AAC 72. This approv valid fora ❑ single family multi -family unit with a total of bedrooms. Tllla I Dale . 19 0404 (Rev. West DISTRIBUTION: WHITE—BANKILENDINO INSTITUTION: CANARY—APPLICANT; PINK—DEPARTMENT roll MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENCIRONHENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block , subdivi Tion, section, township, range) (address or 6fl4 24?a X74 •oec•f-- (b) Applicants Name Na fs Telephone - Home Business Applicants Address (30z SO et4611', er- eCce! %j =I %fK 94Pi� (c) Applicant is (check one) Lending Institution Owner/buf3•her�; Buyer = ; Other [=I (explain); (d) Lending Institution W1QZLAA11 1'tG-mP'2z- l. - Address V�OQ (e) Real Estate Co. S Agent Address Telephone (f) Mail the HAA to the following address: ! r 2. Type of Residence Single -Family Multi -Family Other (describe) Number of Bedrooms n re- _ 3. Water Supply / Individual Well Community Public � C(05,> C Z VtSr`dQwc OA/ Note: If community well system, must have written confirmation from the Stat Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite r—_1 Public CiEr Community 1= 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 21 r-% 5. Engineering Firm ProvidinS 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 regula- tions in effect on the date of this inspection - Name of Telephone WS ?273 Address y�� ONItl33N1ON3 8 c�� •:•� '�.'�' Date i c s• 40' OPSOEBOX-2RaI�NO �... AAiMORAG� 7A 3 W-09 (ENGINEER SEAL) �• • _•••R.1,h D. Euch /••�A �'!/! Pf n�•. CE -5333 +Q 6. DEEP ADproval Zl�yPrcft��so Approved for cue bedrooms By�ate / Cy$ Approved Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF MUTE AND ENVIROMIENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 HOSES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- WENTS. E.`MOYEES OF DUEP 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. (DHEP SEAL) RR4/ej/D18P' 0 f a [Page 2 of 21 ';Lt Glc o��`G+YYII 7- ta-'4�- �0"�4' ! I 7-19-84 MUNICPALITY O` p1 Cr^EACZ MUNICIPALITY OF ANCHDRAM (MOA) C�ws�usC�: _ OPI HEAL:rH AU11ioRITY APPPDVAL (HAA J A J J 2 5 11985 C}ECCMIST - FE'BRUARY 1984 '7'1I l D Legal Description: d A. FELL DATA --J-21 It L3 k 3 Well Classification G If A, B. or C, D.E.C. Approve (Y/N) f_ Well Log Present (y/N) IU Date Completed 1%5-11 Yield S WPI Total Depth Cased to / SO Depth of c�cutinG /U Irl" static Water Level Pump Set At Casing Height Above Ground /,3„rn. Sanitary Seal on Casing (YIN) Electrical Wiring in Conduit (Y/N) Z Depression Around Wellhead (Y/N) N Separation Distances from Wall: To Septic/Holding Tank on Lot / 20 ; on Adjoining Lots JV /!t �2 m 0 To Nearest Edge of Absorption Field on Lott in ; Oen Adjoining Lots 'a -F To Nearest Public Sewer Line i0 -F To Nearest Public Sewer Cleanout,/Manhole t To Nearest Sewer Service Line on Lot to D 7CIL Water Sample Collected By ; Date /— /S-f�✓� Water Sample Test Results S inn}2�OwhI `Se�ane�iow B. SEPPIC/HOLDING TANK DATA �j C p /% /1% u Iv i .S e r✓ e-/ Date Installed Iv Size No. cf Carparlaents Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped pumping/Maintenance Contract on File (Y/N) for Holding Tank High-water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Bolding Tank: To water -Supply wall To Building Foundation To Property Lille To Disposal Field To water Main/Service Lina To Stream, Pond, Lake, or Major Drainage Course Ccaments Receipt # Date Paid: Amount: c) S (Page 1 of 21 2-15-84 i C. ABSORPTION FIELD D?iTA _ C. &" �?- Soils Rating in Abscrpticn 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 That Results of Last Adequacy Mast Separation Distance fawn Atiscrpticn Field: To Water -Supply Wall To Property Line To Building Foundation To Existing cr Abandoned System cn IAt f on Adjoining Lots To Water Main/Service Line To Cutbank(if present) To Stream/Pcnd/Lake% Major Drainage Corse To Driveway, Parking Area, or Vehicle Storage Area Camients D. LIFT SIATICN N Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pumg.On" level at "PUIV Off" Leval at High Water Alarm Level at Vent (Y/N) Tested for Bunging Cycles during Adequacy Test. Meets MDA Electrical codes(Y/N) Comments Check Permitted Bedroom Rating Against HAA Request *" I certify that I have checked, verified, cr conformed to all m0A HAAfY in effect on the date of this inspecti 4: ---------- Signed .' V��• Date 2 10 --, f' 1C . itv'' J" Comgnrny MDA No. lZal- 033 ..... • •: BUSH ENGINEERING Z �p� p P. O. BOX 4-2884 KB1/dJ/S NCH �R�•//�F A� K OM RCbC11 D. EJSiI /Y.MG 45-2M VGWY '.•\ (Bp7) 745 2'l73 CE -533 [Page 2 of 21 �Ai k'�os•� 2-15-84 n 1 ii I` i • 1 II DEPT. OF 6NJ'I110\ MENTAL CONSERI,%TION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 January 24, 1985 Bush Engineering P. 0. Box 4-2964 Anchorage, Alaska 99501 (004� BILL SHEFFIELD, GOVERNOR SUBJECT: Waiver Horizontal Separation between Well and Septic Tank, Lot 11, Block 3, Eagle River Heights (8521 -WA -095) 274-2533 Dear Mr. Bush: The waives the horizontal separation subject betweenthcwaiver ewelland septic t tictank touest and 120feet, between the well and community sewer line to 70 feet, and between the 5 well and private sewer line to 60 feet on the subject property for 2 q0 single family residences only. Sincerely, St e ng P.E. 10 District Engineer Idd- G �" el SE/dd et 4 y� C' 3f L I • r CHEMICAL & t:El Y L LABORATORIES OF, ALASKA, INC. TELE HONE (907) 562.2343 - ANCHORAGE INDUSTRIAL CENTER / 5633 B Street Drinking ater Analysis Report for Total.Colifoim Bacteria `' 1 •• TO BE COMPLETED BY WATER SUPPLIER r r P (•) See h on beck% WATER SYSTEM: t D Were System Name Drn RAY A.9AAA Mailing Address Orr SAMPLE DATE: F70 Mo. Yew ,...1s1 r SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. ❑ Special Purpose Zip Gose ❑ Treated Water ❑ Untreated Water SAMPLE NO. LOCATION r L// �� •. ' .. I T leo ` z l £� q to R) it r"- Ff 7-4 I 3 I I 4 I S I I READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Delos (b) ae.. feu Time Collected Collected . By - TO BE COMPLETED BY LABORATORY An ""lysis shows this Water SAMPLE to be: tSatisfactory I ❑ unsatisfactory S Impie too long In transit; sample should not be over 30 hours old at examination to Indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received -� C)-cl AniAlytical Method: • Y ❑ Fermentation Tube KMembrans Filter Lab Ref. No. Result' Analyst sees EN m m CD II ' •ra a sow»✓ Foo wr a MO. of Fero-.. :I .1 BACTERIOLOGICAL WATER ANALYSIS RECORD i , renrr...nnnnmi Membrane Filter. Direct Count Verification: LTB J �"" Final Membrane Filler Results _, J Coilformlt00m1 Reported By t7 —4 Cate Time: a.m. J . 1 p.m. TNTC= Too Numerous To Count ) { � I