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Home My WebLink AboutEAGLE RIVER HEIGHTS BLK 3 LT 12A;F YA I -,. WA. A iA mc [me 12 rA-W'6vM 3 N� *wm-o!;C) z71 (ol MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 12A Block 3 Eagle River Heights Subdivision Location (address or directions) 10212 Chain of Rock Road (b) Property Owner Rick Holmes Telephone: Home 694-3415 Business Mailing Address 10212 Chain of Rock Road Eagle River Alaska 99577 (c) Lending Institution Northland Mortgage Telephone 563-5150 Mailing (d) Real Estate Company and Agent Re /Max E R % Pat Angwine Address Telephone 694-4200 (e) Mail the HAA to the followina address: or. Check here Qx if hold for pickup. List contact person and day phone number below. S & S Engineering 17034 Eagle River Loop Road #204 Eagle River Alaska 99577 2. TYPE OF RESIDENCE Single -Family Ekx Number of Bedrooms three(3) 3. WATER SUPPLY Individual Well 1x Community O 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 O Publici2x 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. 72-0761R" 8,861 Pont Page 1 of 2 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 S S S Enaineerinit Telephone Address 17034 Eagle River Loop Road #204 Date This department has received written confirmation from regarding the Conditional Approval of February 27, 1987 been accomplised and an inspection has been completed b property meets with the Municipal standards and is now Engineer's Seal the engineer (S b S Engineering) . The corrections have y the engineer. The subject approved. 6. DHHS APPROVAL i iJ three(3) Date April 29, 1987 Approved for bedrooms by Approved XXXXXXXXXXXX Disapproved Terms of Conditional Approval Conditional CAUTION 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 lendi ng 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 72-025 OR" 666) Back it. HEALTH AUTHORITY APPROVALS SEWERS WATER MAIN EXTENSIONS SEWERS WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELLINSPECTION S FLOW TEST SITE PLANS ROADDESIGN SOILTEST PERCOLATION TEST STRUCTURALS MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSTBTEM DESIGN April 28, 1987 Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 ATTENTION: Dan Bolles REFERENCE: Lot 12A; Block 3; Eagle River Heights Subdivision Dear Dan, ROBERT A. SHAFER CIVIL ENGINEER 691.2979 You issued a conditional Health Authority Approval on February 27, 1987 on the referenced property. The conditions stipulated on this approval required the well casing to be extended, a pitless adapter be installed and a new water line between the well head and the house. It also required an existing pit to be filled. All work required to satisfy these conditions has been completed. Request you isSW.,a final Health Authority Approval at this time. M.�HAFER, P.E. cc: Pat Angevine RE/MAX REALTY MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH b ENVIRONMENTAL PROTECnON 'APR 2 81987 RECEIVED SRS 196X EAGLE RIVER. ALASKA 99577 ( ' MUNICIPALITY OF ANCHORAGE n 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 2 -ZZ -87 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L I Z A. 'b'S F . 2. It-", Location (address or directions) (b) Applicant Name 9ld-9 F°NO Telephone: Home 1,q�(-3yri- Business Applicant Address 10-ZIZ, Gu06AA Cy5= &e -g- c 2. A,,- . 4c --1C nrl (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain); �nP t►t-V►.117 l`&o A'[oy'fo&Telephone 54 �SIS'O (d) Lending Institution _ T Address (e) Real Estate Company and Agent Address Teleph ne (f) -MaeV th AA to the following �following address: �FA 2. TYPE OF RESIDENCE Single-FamilylQ Multi-FamilyO Other Number of Bedrooms 3. WATER SUPPLY Individual Well CK Community[3 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 ❑ Public P.( Community O Holding Tank O Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-02501,84) Page 1 of 2 5. ENGINEERING FIRM PROVIDINU INSPECTIONS, TESTS, FILE SEARCH, DAIA 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 tiles 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. S 8 S ENGINEERING Telephone Name of Firm U034 ft9l. Rim '�.-Kfflr Via. 204 Address Eagle River Alaska 99577 Date \ 13&4u& \JaLL 1 NTG CD/Witi/iNGc3: \N 02/c �o IJ C 1 e 00 ►r.1 �✓c �� C^Iww L- A Mf"IMIiw1 eP /Z' A@"a tiJLouNA Ldvct L)I�I �TA1.� {,�TLdSS !*J A?,Z7/L. �VR-Y VA?bYL 40"i A M��•-SIM YM VA /D� .04 ortK ) D tic Ido+ l c �j C-1 , 1989W spr 71, 6. DHEP APPROVAL 1, Date /� ' ��'t+^ 7 , Zed 7 Approved for 11&bedrooms by . Terms of Conditional Approval a f 24 `ZU' "6:4 co.�� /,i�•u c svr7-z 40el"- At, lav 7-1,9-1 CAUTION 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 engineers work. Page 2 of 2 72-025111184) f 1 MUNICIPALITY OF ANCHORAGE (MOm) MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL SERVICES DIVISION CHECKLIST- FEBRUARY 1984 284-4720 FEB 2 71987 Legal Description: Lo! /ZA RECEIVED CAtr _� K�'3 A. WELL DATA Well Classification 5-F If A, B. C, D.E.C. Approved (Y/N) N/A Well Log Present (Y/I§PDate Completed QPPi2571r II& Yield 7S GGM-+ Total Depth Cased to 410'4 Depth of Grouting Static Water Level ?60 / r Pump Set At Casing Height Above Ground 'V 3'ayaf's'� Sanitary Seal on Casing G)N) Electrical Wiring in Conduit (YQ Depression Around Wellhead Oftq "C> Separation Distances from Well: To Septic/Holding Tank on Lot �Jr34 L Sawa ; On Adjoining lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line S.- To Nearest Public Sewer Cleanout/ManholeS ! To Nearest Sewer Service Line on Lot /B t Water Sample Collected by S v S C clt�r ; Date OZ' 23 £ i Water Sample Test Results - — - Comm�ents/ �'' Sr='= /1A ;-vZM Fv>~ Ln/oru' To o 11��u To �2ltirc. WaLI IP -4 MC>F) MiL! NC_ B. SEPTIC/HOLDING TANK DATA Date Installed 4- Size No. of Compartments S(andpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression Pumping/Maintenance Contract on -M Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/ To Water -Supply To Prope me Main/Service Line Course . Date Last Pumped for Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Comments:JC 1� To I>>iiurL. .�cTw�'4L Juc.v /O /�Ho. 111"t" AwwU Pagel of 2 72-026(11164) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Dae Installed Width o 'aid _ Square Feet of Absorption Ari Depression over Field (Y/N) _ Results of Last Adequacy Test Separation Distance from Absc To Water-SupplyWell To Building Foun on— Lot T ater Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or VehictStorage Area Comments 0A 8,;S i0 .,X..� D. LIFT STATION Type of System Design Length of Field Depth of Field Gravel Bed Thick ytifandpipes Present (Y/N) Date of Last Adequacy Test To Pry Line On Adjoining Lots To Cutbank (if present) or Abandoned System on Dimensions Size in Gallo Manhole/Access (Y/N) Pump On" Level at "Pump Off" at High Water Alarm Level at Vent (Y/N) Tested for n Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments " Check Permitted Bedroom Rating Against HAA Request -- I certify that I have checked, verified, orconformed toall MOA and HAA guidelines in effect on the date of this inspection. SignA& S ENGINEERING 1 • ate�-ZG—�% Comp Rb•r, Ategk assn MOA No. 614AD 3 Receipt No. p P2 .00V t % ^ ��".� 11 Date of Payment c-;2–off % _ t Amount: $ /�� si , 't r„ R Page 2 of 2 72-026 (11,84) CHEMICALlU GEOLOGICAL LABORATORIES I TELE HONE (907) 562.2343 5633 B J+ Anchorage./ Drinking Waker Analysis Report for Total Col TO BE COMPLETED ❑ PUBLIC WATER SYSTEM LD.N ;",PRIVATE WATER SYSTEM Sd'S LNr' Nama17473 7477 Malting Address WATER SUPPLIER Phons No. City�[�� State Ic SAMPLE DATE: LJ L�� T :7 Mo. Day Year Zip Code SAMPLE TYPE: 17J Routine ❑ Check Sample (for routine sample t ❑Treated Water with lab ref. no. ❑ Special Purpose❑ Untreated Water ,l SAMPLE !_/zA LOCATION A / I Time Collected W � @y _ ALASKA; INC- 199518 NC. a99518 m Bacteria ,TO BFB COMPLETED BY LABORATORY AnalyIs shows this Water SAMPLE to be: 1a1 e Satisfactory •. ❑ Unsatisfactory . .1. /. ❑ Sample too long In transit; sample should no'be over 30 hours old at examination to )ndicate reliable results. Please send new sample via special delivery mail. � Date iIieceived Time Received Z'0nr y Analytical Method: Membrane Filter i No. of colonies/100 ml. I Lab Ret. No. Results Analyst ED `i J mm >j l I� BACTERIOLOGICAL.WATERi ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter. Direct count BEFORE I' Verification: LTB iiFinal Membrane Filter sults COLLECTING SAMPLE Reported ay TNTC = Too Numberous To Count OB = Other Bacteria Coll orm/100m1 1` s--�Coilformf100m1 Oato ---O--ql— Time: / S20 a.m. i 5� ,.:3. I I 4 Time Collected W � @y _ ALASKA; INC- 199518 NC. a99518 m Bacteria ,TO BFB COMPLETED BY LABORATORY AnalyIs shows this Water SAMPLE to be: 1a1 e Satisfactory •. ❑ Unsatisfactory . .1. /. ❑ Sample too long In transit; sample should no'be over 30 hours old at examination to )ndicate reliable results. Please send new sample via special delivery mail. � Date iIieceived Time Received Z'0nr y Analytical Method: Membrane Filter i No. of colonies/100 ml. I Lab Ret. No. Results Analyst ED `i J mm >j l I� BACTERIOLOGICAL.WATERi ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter. Direct count BEFORE I' Verification: LTB iiFinal Membrane Filter sults COLLECTING SAMPLE Reported ay TNTC = Too Numberous To Count OB = Other Bacteria Coll orm/100m1 1` s--�Coilformf100m1 Oato ---O--ql— Time: / S20 a.m. i 5�