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EAGLE RIVER HEIGHTS BLK 2 LT 46F
Engle River Heights Block 2 Lot 46F #050-281-58 — +... ...�..—«...vu.►-....�..--wTn... �.w.w.«-w'N--- nrvw•-%AP�r .� , W4%3.f�'l.w.'w. ..;..i•1�iry7t••�y�«.. by the Co. aea SULLIVAN WATER WELLS P.O. BOX 07027$ CHUGIAX.ALASKA 99587 • TELEPHONE 808.2759 ` OWNER OF LAND r'.r{^2 1 y /K Al -r F2 DEI'TH OF WELL ADDRESS 177.3e C' ilk A 1 C QL STATIC LEVEL OFWATER FT. 7� LEGAL DESCRIPTION < i LG ;Z 9,67--S DATE • Started Ended PERNITNUMBER 111511trYlR'4 KIND OF FORMATION: DRAW DOWN FT. GALS. PER HR �n A KIND OF CASING From Ft. toFt. C�Sr 1G `� + r L From Ft. to Ft. From t Ft. to � Ft. From Ft. to Ft. From4Ft. to � Ft._pG+= C� �`I' From Ft. to Ft. FromIF' 1Ft. to doG Ft. From4rFt. to Sy FL From_Ft. tom FL a -f/< i i ',4" 4 =t_LFrom Ft. to Ft 7-1 61"r S/L r From Ft. to Ft 4,g,04? -j From Ft. to Ft. From Ft. to COs Ft. From % O coFt. toil0k Ft. -C." i Y Cl/F y ? 14' .0-L From From Ft. to Ft. Ft. to Ft. + SA..JO 44 k J1 L s From Ft. [o Ft Gy l' I E2 From Ft. to Ft. From Ft. to FL From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From .. Ft. to w Ft. From Ft. to RECEIVED . From Ft. to Ft. From Ft. to--- t�uft. g 1895 From Ft. to Ft. From F[. [o Ft. From From Ft. t 4vtvnie[p'�ih Ft� opt. HealTt8 Human Services From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft M1SCL. INFORMATION: PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW940082 DATE ISSUED: 4/20/94 DESIGN ENGINEER:DAVID R. DAYTON, P.E. EXPIRATION DATE: 4/20/95 OWNER NAME:SMOOT DANIEL & BEVERLY J OWNER ADDRESS:10007 WILDWOOD ST EAGLE RIVER, ALASKA 99577 PARCEL ID:05028158 LEGAL DESCRIPTION: EAGLE RIVER HEIGHTS BLK 2 LT 46F LOT SIZE: 11442 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (16AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED B ISSUED BY: DATE l DATE:4 `20 10 Q V/r-- LL_ 4+rTE It is the�slbdily of the owner or PLOT PLAN builder; prior to construction, to verity proposed building grade relative to finish 'L'ot 461= Block2 grade and utility connections and to r determine the existence of any easements, Subdivision - covenants , or restrictions which do not AJe+oe��e Recording District, Alaska oppear. on the. recorded subdivision plat. PREPARED BY: PREPARED FORS DAVID R. DAYTON R.L.S 202/0 DONALAR~' ... • 1713 9 G4414.r.� r 4:ro�'n t-" f CHUGIAK; ALASKA 99567 1= • a �� r R�vaR �4� ' `19577 _ BY DATE r'rqq� W.O. NO. DWG. NO:; FIELO:BOOK NO. CHECKED BYz SCALE:�_ PLAT FILING NO SECTION, TOWNSHIP,B._RANGE GRID •DIED i 30' - 6's-ISca - Se�lZ,r14•N,22W NWIS3 �,VV A.0 WKJ C • w!S I Ga•M •f .iT ..I .. I — /BA Is • •i ESp�C•yf.1'bT a+•• SE - `ir a � v4 •• Jr Q htioua0• ' 1 Q I 4Gi/ V•• ST rw Mir II ,r 'Mu Eccc ' s' • ecEG I Tp.a.u+.+.+a E4•rr• 1 33'Al"X59 4L: J�311 Or At IL Q V/r-- LL_ 4+rTE It is the�slbdily of the owner or PLOT PLAN builder; prior to construction, to verity proposed building grade relative to finish 'L'ot 461= Block2 grade and utility connections and to r determine the existence of any easements, Subdivision - covenants , or restrictions which do not AJe+oe��e Recording District, Alaska oppear. on the. recorded subdivision plat. PREPARED BY: PREPARED FORS DAVID R. DAYTON R.L.S 202/0 DONALAR~' ... • 1713 9 G4414.r.� r 4:ro�'n t-" f CHUGIAK; ALASKA 99567 1= • a �� r R�vaR �4� ' `19577 _ BY DATE r'rqq� W.O. NO. DWG. NO:; FIELO:BOOK NO. CHECKED BYz SCALE:�_ PLAT FILING NO SECTION, TOWNSHIP,B._RANGE GRID •DIED i 30' - 6's-ISca - Se�lZ,r14•N,22W NWIS3 MUNICIPALITY OF ANCHORAGE o �i Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-281-58 1. GENERAL INFORMATION Expiration Date: Z _ 20 —�O21 Complete legal description EAGLE RIVER HEIGHTS BLOCK 2, LOT 46F Location (site address) 10007 WILDWOOD STREET, EAGLE RIVER, AK 99577 Current property owner(s) MICHAEL & CHARLIEANN BEAVER Day phone Mailing address Real estate agent 10007 WILDWOOD STREET. EAGLE RIVER. AK 99577 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Z Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer Z Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the.engineer. COSA Fee $ 2. [ O cown Date of Payment ! 1 �21 D'� b Receipt Number. a 1 � 0 COSA # 05C ZO ( 6 Z 5 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 11/10/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWrS 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms i g�P01= Aj49 \111 TM • '. Curtis Huffman s�F,_' C11 20/202 �r� PROFESSO bedrooms, with the following stipulations: OF At�(((,,SPI-SITE c WATER AND WAST':v PR G[; ' AM Original Certificate Date: l �"� © -2.0 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: EAGLE RIVER HEIGHTS BLOCK 2 LOT 46F Parcel ID: 050-281-58 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 4/1994 Total depth 112 ft Cased to 112 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 11/9/2020 Static water level at beginning of test 67 ft. Well production at time of test 5.4+ gpm Comments B. TANK DATA - NA Age of tank(s) _ years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA - NA Which system tested (date installed) ❑ ALL standpipes present per record drawing - Total measured -depth fromgrade-_ft (max) Measured depth to pipe invert from grade _ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 8.10 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) FWES Collected by <= "`=._ Date of Sample C. LIFT STATION 11/9/2020 ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth -in Elapsed time min ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date FRES Comments/Deficiencies: E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No NA ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No o� m Septic/Holding Tank on Lot to: (Please enter distances if less than required) ®-s ® _ ® N Building i-�undations > 10' ®Yes if No ft Surface Water > 100' ®Yes if No _ Property Line�> 5 ®Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Water Main > 10' if No ft Community Wells > 200' Yes if No Water Service Line > 10' Yes if om ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances Uess�than required) Building Foundation > 10' ® Yes if No ft If aqorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Well-'' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review Q`. of Municipal records that the above systems are in conformance;101QJ�.' with MOA COSA guidelines in effect on this date. • !� • • • .•! ...... ........... • • Curtis Huffman ��� ��c/•, CE 128991 .•\���� :80p OFESSION�4'�r ft ft ft ft ft ft ft ft Yes if No ft Private Wells > 100' ®Yes if No From Absorption Field on Lot to: (Please enter distances Uess�than required) Building Foundation > 10' ® Yes if No ft If aqorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Well-'' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review Q`. of Municipal records that the above systems are in conformance;101QJ�.' with MOA COSA guidelines in effect on this date. • !� • • • .•! ...... ........... • • Curtis Huffman ��� ��c/•, CE 128991 .•\���� :80p OFESSION�4'�r ft ft ft ft ft ft ft ft IN, itrate Advisory Certificate of On -Site Systems Approval # OSC201625 Subdivision: Eagle River Heights Block 2 Lot 46F A water sample revealed a nitrate concentration of 8.1 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing AddressP O Box 196650 *Anchorage, A►aska 99519 6650 *wiivw muni org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Maibng Address P 'O Box 196650 *Anchorage, Alaska 99519 6650 * www muni org • '� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-281-58 1. GENERAL INFORMATION Complete legal description EAGLE RIVER HEIGHTS 32. L46F Expiration Date: 7A� Location (site address) 10007 WILDWOOD ST., EAGLE RIVER AK 99577 Current Property owner(s) DENNIS & STEPHANIE SPENCER Day phone Mailing address Real Estate Agent 10007 WILDWOOD ST., EAGLE RIVER AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class_ Well ❑ Community ❑ Public Water System ❑ Public Sewer WaiverNariance request for: Distance: Received by .'l s ) r:' ,° Date COSA to be released to the engineer, unless other}dse f4quested by the engineer. COSA Fee $ '-A,U/ ,� Z � Date of Payment olgha Receipt Number ot157q J COSA# O's C13//40 Waiver Fee $ Date of Payment Receipt Number Waiver # 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, 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 4/12/13 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 well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a ., system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen 4.1 A encroachments, deficiencies or discrepancies exist. ' r 6. DSD SIGNATURE System #1 Approved for 3 bedrooms. System #2 Approved for bedrooms. Ilk Disapproved. Conditional approval for bedrooms, with the following stipyl(:IFA M Original Certificate Date: y a 6 Z/_,� The Wnicipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory V Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet -10-10-12 doe If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: EAGLE RIVER HEIGHTS B2, L46F Parcel ID: 050.281-58 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # _ Date completed 411994 Sanitary seal (Y/N) Y Total depth 112 ft. Cased to 40+ ft. FROM WELL LOG Date of test 411994 Static water level 72 ft. Well production 15 9.p -m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 5.76 mg/L Arsenic: ND ug/L Date of sample: 4/112013 B. SEPTIC/HOLDING TANK DATA — PUBLIC SEWER Tank Type/Material Tank size _ gal. Number of Compartments Foundation cleanout (Y/N) Depression over tank (Y/N) Date of pumping Pumper Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 41112013 ft. Collected by: ARCTERRA Date installed Cleanouts (Y/N) High water alarm (Y/N) C. ABSORPTION FIELD DATA — PUBLIC SEWER Date installed _ Soil rating (g.p.d./ft2 or ft2/bdrm) _ System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 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 fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION —PUBLIC SEWER Date installed "Pump on" level at _ in Datum Size in gallons "Pump off"level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot NA Absorption field on lot NA Public sewer main 75'+ Sewer /septic service line 254 Animal containment areas 504 SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Water main Property line _ Water service line Wells on adjacent lots ABSORPTION FIELD ON LOT TO: PUBLIC SEWER Property line_ Water Service line Curtain drain F. COMMENTS G. ENGINEER'S CERTIFICATION Building foundation Surface water Wells on adjacent lots Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots NA On adjacent lots NA Public sewer manhole/cleanout 100'+ Holding tank NA Manure/animal excrete storage areas 100'+ Absorption Surface water Water main Driveway, parking/vehicle storage 1 certify that t have determined through field inspections and review of determined through field inspections and review of Municipal records that inspections and review of Municipal records that the above systems are in Municipal records that the above systems are in conformance with MOA above systems are in conformance with MOA COSA guidelines in effect on conformance with MOR COSA guidelines in effect on this date. COSA guidelines in effect on this date. on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 0411212013 COSA brown sheet 10-10-12.doc in. Municipality of Anchorage Community Development Department oz Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # OSC131140 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 46F of Eagle River Heights subdivision. This inspection revealed a nitrate concentration of 5.76 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage , Development Services Department —_ Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ` CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-281-58 HAA # 0 S O t? 6 Expiration Date: 02 - O �o 1. GENERAL INFORMATION Complete legal description Lot 46F Block 2 Eagle River xeiptire jn Location (site address or directions) 10007 Wildwood St - Eagle River, Ak. 99577 Current Property owner(s) Walter Bevens Day phone 694-1906 Mailing � adP-r.�"fri4907 Wildwand St Fng1P Rivrr, ev 89577 t, Lending agericy ' Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. Day phone /0t/}7/aS 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 ID The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 Health Authority 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 S & S Engineering Address 17034 Eagle River Lp.Rd.- Eagle River, Engineer's Printed Name Robert C. Cowan Phone 694-2979 �Ak. 99577 Date /D I -XS 16'r- OF /it 1kit 5. DSD SIGNATURER08EE-8801 RT - CoWAN C Approved for 3 bedrooms. a Disapproved. ^kJtt:' Conditional approval for bedrooms, with the following stipulations: Additional Comments Note: The well for this property meets existing State and Municipal Codes. Therp j1re nitrates present. It Is suggested that periodic testing be performed to Insure the wells continued suitability. Current nitrate concentration is 6.07 mg/1. EPA maximum concentration is 10.0 mg/l. More Information on nitrates is available from the On -Site Services Program, at 343-7904. Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: ��� Original Certificate Date:_ _.(R.r 01101) Municipality of Anchorage • Development Services Department �fa Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: � qPF j� liu nnTc-944TS Parcel ID: Dr-�O -a?,>r'5S A. WELLD Well type lt/#rr- If A. B, or C provide PWSID # = Well LogONq \Ipe-S Date completed y Sanitary seal&) Wires properly protected (:N t r12 f Total depth 1 I Z ft. Cased to 4D+ft. Casing height (above ground) in. FROMELL LOG AT INSPECTION Date of testLl q4 fo 1 Static water level � 2 f ft. 6q ft. �-/ Y-Lln.rfe AY Well production �S g.p.m. 702 + g.p.m. P ""P J(. PL-Vr+4,..-6 WATER SAMPLE RESULTS: Coliform O colonies1100 ml. Nitrate 6.0'� mg./l.// Other bacteria O colonies/100 ml. 1 t Arsenic: — mg./l. Date of sample: 10 o S Collected by: 5 9- S (K.YTEJK)Q 7 U B. SEPTIC/HOLDING TANK DATA 8 L (L Gi Ifo�yL Tank Type/Material J Date installed Tank size gal. Number of Compartments _ C efYll Foundation cleanout (Y/N) _ De r n c (Y/N) _ High water alarm (Y/N) Date of Pumper C. ABSORPTION FIELD DATA "?O$LI` S ez- Date Installed Soil rating (g.p.d.W or f?mrm) _ System type Length ft. Width ft.�Gaw pipeTotal depth _ ft. Eff. absorption area ft� Monitor'ession over field Date of adequacy test Resul ss/Fail) For _ bedrooms Fluid depth in absorption field befor _ In. Water added_ gal. New depth_ in. Elapsed Time: Final fluid depth _ in. Absorption rate >= g.p.d. Any ' enation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION �V$LtLL4_1j?5J7 Date installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons Access (Y/N) at _ in. High water alarm level at in. Cycles tested Meets alarm & circuit requiremenls7 SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tank/lift station on lot A]R On adjacent lots 200 f Absorption field on lot A3A On adjacent lots 2A0r + r Public sewer main i5 Public sewer manhole/cleanout (enr+ Sewer /septic service line A5 + Holding tank IU A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ( 0gLIL ZY6�15-4z- Building foundation Property line Absorption f Water mainne Surface water Wells o ots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i3L t C - Property line Building foundation Water main _ Water Service line Surface water y, parkingivehicle storage Curtain drain Wells on adjacent lots F. COMMENTS OF '$L A:•t G. ENGINEER'S CERTIFICATION . c)+`J I certify that I have determined through field inspections and �- •• -' '. review of Municipal records that the above systems are in .. .........., �. . conformance with MOA HAA guidelines in effect on this date. ' T, i aoeErtr c cower Q j Engineer's Printed Name ROB£.er Caw,},.°%r�`CE-eeot ,f`:�j Date /0 (xs-/O i ,t�htJM" HAA Fee $ 113 0 4 /7I' ( oe.. r& Waiver Fee $ Date of Payment 10 / a (. /o s— Date of Payment Receipt Number o-7 S 9 3 3 Receipt Number (Rev. 12/01) 10-24-05;10:37 ; —S&%— SGS ReU 1056614001 Client Name S dt S Engineering Project Name M Lot 46F Blk 2 ER Heights Cunt Sample ID Lot 46F Blk 2 ER Heights 114atrh Drinking Water Sample Remarks: :907 661 6301 # 2/ 4 All DatetRimef are Alaska Standard Time Printed Date/Time 102112005 14:10 Collected Date/time 10/122005 14:26 Received Date/time 10/122005 162S Technical Director Stephen C. Ede Alloy abk Prep Analyr4 Pane P wtu PQL Units Method Container ID Limits Due Dam Tait Niaere-N Kicrobioloay laboratory 6.07 0.100 mg/L EPA 3532 B (a10) 10/12/05 AIS Total Coliform 0 eol/100mL SM209222B A (a°I) 10/12/0S T1F Municipality of Anchorage Development Services Department C =- j Building Safety Division .. On -Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6 www.ci.anchorage.ak.us 3 3-7904 k.us (� (907)343-7904 U�} CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-281-58 1. GENERAL INFORMATION HAA# N40,) -61g7 Expiration Date: % — a ;Z. -,C Complete legal description EAGLE RIVER HEIGHTS SUBDIVISION: LOT 46F, BLOCK 2. Community Class Well ❑ Public Water System Location (site address or directions) 10007 WILDWOOD STREET ' EAGLE RIVER, AK 99577 Current Property owner(s) LARRY TREVOR Day phone 694-1906 Mailing address 10007 WILOWOOD STREET • EAGLE RIVER, _AK 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 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 iA The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 samples. (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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid 3 8"75 at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixedhereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance withal/ applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn ALASKA WATER do WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SURE 28 * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC. Inc. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local so11s condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AMC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal tight whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Phone 337-6179 Date C z Conditional approval for bedrooms, with the filowing stipulations: Attachments: HAA Checklist t/ Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other _ ON-SITE WASTEWATER BY:! // l tJ /0'_ Original Certificate Date: 14 - .2- �2_ - 0 2 (Rev. 7291) Municipality of Anchorage • Development Services Department Building safety Division OnSbe Water ti Wastewater Program 4700 South Bragaw SL P.O. Box 198650 Anchorage, AK 9951943650 www.d.anchorage.ek.us (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: EAGLE RIVER HEIGHTS S/D: LOT 46F. BLOCK 2. Parcel 10: 050-281-58 A. WELL DATA Weil type PRIVATE If A, B, or C provide PWSID# N/A Date completed UNKNOWN Sanitary seal (Y/N) YES Total depth 70'+ ft. Cased to 40'+ ft. FROM WELL LOG Data of test LINK Static water level UNK ft. Well production LINK g.p.m. Well Log (Y/N) NO Wires property protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 4/11/2002 68 ft. 8.5+ g.p.m. WATER � RESULTS: Coliform colonies/100 ml. Nitrate �' 9 4mg•/L• Other bacteria _C4_ ies/100 ml. Arsenic: N/A mgJL. Date of sample: 4/11/2002 Collected by: AWWC. INC. B. SEPTICIHOLDING TANK DATA Tank Type/Material PUBLIC SEWER Date installed _ Tank size gal. Number of Compartments _ Foundation cleanout (YIN) _ D_e�Sssie rank (YM) High water alarm (Y/N) Date n_ Pumper C. ABSORPTION FIELD DATA PUBLIC SEWER Date installed Soil rating (g.p.d./ft'or ft'Ibdrm)_ System type Length ft. Width ft. Gravel bolo Ips ft. Total depth ft. Eff. absorption area_ ft' Monitoring to Depression over field Date of adequacy test Results ail) For bedrooms Fluid depth in absorption field be _ in. Water added _9a1. New depth _in. Elapsed Time: Final fluid depth _ in. Absorption rate >= g.p.d. enation treatment (past 12 mo.) (Y/N 8 type) if yes, give date D. LIFT STATION Date installed 'Pump on' level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot N/A Absorption field o I t N/A I Public sewer main 75 ,+ Sewer /septic service line 25'+ On adjacent lots 200'+ On adjacent lots 200'+ Public sewer manhole/cleanout t 00'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Water main Properly line Absorptlon field Water service lin ice water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: PUBLIC SEWER Property line Building foundation Water main Water service line Surface water nveway, parkinglvehicle storage Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Nme JEFFREY A. GARNESS Date f(I J07 HAA Fee $ 3,7,-5 , o0 Date of Payment .7e— /9 Receipt Number Q /1? 5 % (Rsv. 12/01) Waiver Fee E Date of Payment Receipt Number ee•S9'C � • f 3, 13 A I N N W� it n • 4 o „ 0•�^ IZ h 1 C .s • srccaVo.+c Q FAFc • I vi canr"'r Al ��/•9S in m /2 SSCYJbV L/A/6- -T ' i3 . F.rC(�f Ri✓SR Ad. ASSUILT-NO CORNERS SET THIS DATE. . sue d ASsmum LAPID %•LYING 694-ow HEREBY CERTIFY THAT 1 HAVE SURVEYED THE FOLLOWING DESCRIBEO PROPERTY, Z-07' dL4. Z,EAGLE RirF.QHf/G.YTS 6veYJ: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE Of ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOF APPEAR iR THE RECUM SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATE LNESN BE US EffESTABLISN BOION nRY LINES. $CALE' •ya��r'•'jw� i per: • •.••h.,�•� i=7Jn�-•f'J+.� s..... v a H % a R x M M :W f,%. LS -69116.:;S nRe•co'^" DATE, /�y0 95 GRID. NW :5'3 FBI DRAWNi W. SG. 20/l0'd 20BBv69 01W -W I1N301 S38 10:4S 2002-0T-Mdi 4-17-02; 3:57PM; CUE Environmental Services Inc. CT&E Ref.# 1021880001 Client Name AK Water & Wastewater Consultants Inc. Project Name/# Eagle River Heights SID ClientSampielD Lot46FDlock2 Matrix Drinking Water Ordered By PWSID 0 Sample Remarks ;907 581 5301 All DatesMmes are Alaska Standard Time Printed Date/Time 04/17/2002 10:16 Collected Date/time 04/11/1002 13:38 Received Date/time 04/12/2002 15:00 Technical Director Stephen. Released By Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init !Patera Department Nitrate -N 4.97 0200 mg/L EPA300.0 (<10) 04/12/02 3DT Microbiology Laboratory Total Coliform 0 col/100mL SM18922213 (<1) 04/12/02 KAP 9 LL MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Ad R LL Division of Environmental Services sm 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.# Ono -ZSR' HAA# Np,q�c353 1. GENERAL INFORMATION Completelegaldescription '-` 46r; nlnnk 7, rg%glp River Heights Location (site address or directions) 10007 Wildwood Street Eagle River, AK Property owner Gary & Lisa Dallas -Koziol Day phone Mailing address 10007 Wildwood Street Eagle River, AK 99577 Lending agency Day phone Mailing address Agent Markaye Simpson/ Prudential Vista Day phone Address _ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XX 689-6504 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 on-site Public sewer XX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 77-MOR".1NO From 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 Alaska water & Wastewater Culisaltn"ts, lee. —Phone— Address hone 337-10%79 Address 7820 East Chester Hts. Circle Engineers signature Anchorage, Alaska 99504 Date /O ALASKA WATER & WASTEWATER CONSULTANTS, INC. IS TO BE PAID4LBM-OD AT CLOSING FOR ENGINEERING SERVICES PERFORMED. 6. DHH6 SIGNATURE _X Approved for _ 3 bedrooms. M Disapproved. Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. performed to insure the wells continued suitability. Current nitrate concentration is 6.15 mg maximum concentration is 1U.0 mg/l. More information on nitrates is available from the On-site Services Program, DHHS, 343-4744. Additional Comments Date 10 -14 - 98 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. 77M30%.. v91) BKk Mew rr Municipality of Anchorage 0c] 11 1998 DEPARTMENT OF HEALTH & HUMAN SERYJP,g§,,,, Environmental Services Division •..•' 7NMlMAL U*VI ks DIVISoo 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: tat '(pF B/�7- 94"/ 15iire/ is Parcel I.D.: os;O- 2S 1 - 58 A. WELL DATA Well type PR 1-4A'r If A, B, or C, attach ADEC letter. ADEC water system number /'` Log present®/N) %iES Date completed Lf /4`f 1 / Total depth / 2 I Cased to 112 Casing height (above ground) 24 Sanitary seal YES Wires properly protected O/N) yEs FROM WELL LOG AT INSPECTION Date of test 14/14 10 /-/T 8 Static water level –7:2 t -71 Well production 15- g.p.m. y• S f — g -p.m -WATER SAMPLE RESULTS: Coliform Nitrate • is onarA Other bacteria Date of sample: 10/-1/111 Collected by: ALA s.A 1..lrrrelt. + (J ASrp JATes~ .4sutrw tar Inic- B. SEPTICMOLDINGTANK DATA PVLU I e t5 n f -IL Date Tank size Number of Cleanouts (YM) Foundation cleanout (YM) ep High water alarm (Y/N) Date of ng Pumper C. ABSORPTION FIELD DATA Pu6-1 c S E1.JE.1L Date installed Sal rating (g.p.dJW or ft2/bdrm) System type Length Idlh Gravel thickness below pipe Total depth Effective absorption ants kerin Tube present (Y/N)_ Depressi it field (Y/N) Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.): mediately after_ gal. added (in.): Fluid depth (ins) Min er. Absorption rate = o•P• Permdde tree 12 months) (YM) If yes, give date (Rev. 3/913)' D. LIFT STATION ri✓gu L syE� Date installed Manhole/Access (Y/N) High water alarm level ar E. SEPARATION DISTANCES Size In gallons on" level at" 'Datum off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot IJ /A On adjacent lots ),,o'4 - Absorption bo'tAbsorption field on lot rJ AA On adjacent lots 1001 -1 - Public co1tPublic sewer main -75 �+ Public sewer manhoie/deanoul / o o �4- Sewer /septic service line kw Z51+- Lift station 4 1A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Puau c - Foundation Water line SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Surface water Curtain F. ENGINEER'S CERTIFICATION I certtly that I in conformen Signature _ Building foundation Absorption field P✓gi-re- ScLJf-< Water main/service line Wells on adjacent lots inspections and review of Municipal is in effect on !Iris date. Engineer's Name/ V A - �1a i Date 10.1i -t-IL-re d,0 HAA Fee Date of Payment Receipt Number 72-020 (Rev. 3/98)• Waiver Fee $ storage area Date of Payment Receipt Number OCT -12-1990 09:19 ME ESI RNCMORRC£ CiiE iiiwtel Smw Ifni CUE Reu 983668001 Client Name AK Rater d: Wutewa:er Co=W=:e LU-. Project Name//' Lt 46 F Blk 2 Eagle River Htt Cunt Sample m Outride Hose Bib Matrix D inksg Water Ordered By P14SID 0 ►erenrter Routes attrate•A 6.15 NKR• by ICP 907,501531: P.01i02 Client PON -- Printed Daternme 10/12198 0852 Collected D2t81Tlme 10/07/98 13:28 Received Date/time 10/08/98 08:10 Technical Director: Stephen C. Ede Relmeed By Allowable Prep Analysts PD1 Units Methed Limits Date Date tett 0.100 mg/t. EPA 300.0 10 max 10/08/98 10!06/98 O:5 Total Coliform O eat/100v1 THIS 92229 10/08/98 9My ALASKA WATER & WASTEWATER CONSULTANTS, INC. 7320 EAST CHESTER HEIGHTS CIRCLE • ANCHORAGE. ALASKA 99504 • PHONE: 337-6179 FAX. 338-3246 WELL FLOW TEST DATA, LEGAL DESCRIPTION LO� '/(vF 6,r, 2 Ele- -a I STREET ADDRESS CLIENT GAQ-'? K40 VISA DAu.As /IGozlo PHONE NUMBER NUMBER OF BEDROOMS a F.H.A. - FOUR/ FLOW TEST: NO TEST DATE START 1° 719Y TEST DATE END 1O 7 WELL DEPTH (PER WELL LOG): I12I CASING DEPTH (PER WELL LOG): IZ CASING HEIGHT (ABOVE GROUND): Z + �t DEPRESSION AROUND WELL: YES SANITARY SEAL:- YE / NO WIRES IN CONDUIT: (YES / NO WATER SAMPLES TAKEN: V NO IF YES, DATE: / 0 / 7 / Q $ - MEASUREMENTS IN nElD r r TIME METER READING FLOWRATE WATER LEVEL DRAWDOWN (G.P.M.) (BELOW TOP OF CASING) O x5. I l: o 01 3:1 1 (026 ej 7 0 0 8 7 STATIC = 7 •� 5. -2- RQ.aci - 7 3' -Z' - fum v -7I Cccra oa fr WELL PRODUCTION MEASURED O COMMENTS: Parcel I.D. # 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 050-281-58 HAA# Np1502101 1. GENERAL INFORMATION Complete legal description Eagle River Heights Lot 46F Blk 2 Location (site address or directions) 10007 Wildwood Street, Eagle River Property owner K & K Inc. Day phone 694-9663 Mailing address 1177"i9 rhilkar r•^11,•* —Fagle River Ax 99577 Lending agency N/A Day phone Mailing address Agent 1p/Max of raglP_-River,Aiyi�y mason. Day phone AC14-e7pn Address 11411 Centerfield Drive Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 rn O 3. TYPE OF WATER SUPPLY: t1 rn Individual well X o, «o " Community well rn c Public water gam -g' m confirmation from State AD EC attest- NOTE: If community well system, provide written ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer X NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 77-075)Pw.1/V1) Fm.1 MOAN21 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 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 Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294 Eagle River AK 99577 Engineer's signature� �'' Date 6. `DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for 0 C't 4 roue A. Cutma W / CE -4736 . •'`4'i 14b0� ."' bedrooms, with the following stipulations: Additional Comments Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is 111717, 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 satisty 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. Municipality of Anchorage APAL Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:if *,x E../a Parcel I.D. 050 - x9/-59 NTr A. Well Data Well type p/ci. wse If A, B, or C, attach ADEC letter. ADEC water system number Log present (YM) Y Date completed //f -Y Driller Total depth //.I ' Cased to //.2' Casing height -�•� ^-� Sanitary seal (Y/N) Y Wires properly protected (Y/N) Date of test Static water levet Well flow Pump levelt FROM WELL LOG y�9 y 7.1' NN Mr�vN /S g.p.m. SEPARATION DISTANCES FROM WELL TO: AT INSPECTION M /✓/4 �,.aw we// O 9•f� o C 7 � rt / 0 Septic/holding tank on lot ,/ /4 r'w41.: re~"' : On adjacent lots r/01> Z Absorption field on lot N/A On adjacent lots +/00 / Public sewer main f 7r/ Public sewer manhole/cleanout t/�o Sewer service line yr / Petroleum tank A'1A WATER SAMPLE RESULTS' O�Dy 95 GYy 02/0//95 VeDA919S 01/m/95 47Y3 toF/9 5 /Z 57/5 �9- Coliform - '0'- Nitrate • 59 m& It- Other bacteria 0� l Date of sample: I- r + - r t OI�/195 Collected by: 0�s•�Cc- B. SEPTIC/HOLDING TANK DATA ,,IA P,ei; r.,,," Date Installed Tank size Cleanouts (Y/N) Foundation cie High water alarm (Y/N) Date of pumping SEPARATION DISTAD Well(s) on lot Z (Y/N) Depression (Y/N) tested (Y/N) FROM SEPTIC/HOLDING TANK TO: adjacent lots Foundation To prop line Absorption field Water main/service line Surface water/drainage CONTINUED ON BACK PAGE 72-026 (3x93)' Font C. LIFT STATION Date installed Manufacturer Size In Vent (Y/N) "Pump on' level High water alarm level Meets MOA electrical codes (Y/N) SEPARATION Well on lot D. ABSORPTION FIELD DATA LIFT STATION TO: (YM) 'Pump off" Level at tested On adjacent lots Surface water Date installed Soil rating (GPD/Fl2) Length Width Gravel Total absorption area Cleanout present Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) SEPARATION DISTANCE FRQKABSORPTION FIELD TO: type Total depth Depression over field (Y/N) for Bedrooms test yes, give date Well on lot / On adjacent lots Property line To building On ad)acen To existing or abandoned system on lot Water main/service line Surface water Driveway, parkinpehicle storage area Curtain drain E ENGINEER'S CERTIFICATION I ceNly Drat I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspeclion. OF A� oz% �!'rq 4 • t r*�9Tu Signature Engineer's Name Zp" /r /JN / I[ l�X. lPt_ � � �e F �• IDMS A. co!c!a Date D7o5f95 �I s •. CE -6736 �o HAA Fee $_ 'i ilo Date of Payment Receipt Number Zoti2 72.026 (3W)' Bwk Waiver Fee $ Date of Payment Receipt Number