HomeMy WebLinkAboutCOLONIAL PARK BLK 1 LT 1BColonial Park
Lot 1B
Block 1
#050-302-22
PAGE 1 of 2
M -W DRILLING, Inc.
P.O. Boz 110378 • 10930 Old Seward Highway
(907) 349.8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner WA LACE BOSSERMAN Use of Well DOMESTIC
Location (address of: Township, Range, Section, if known; or distance main road
LOT 1B BLOCK 1, COLONIAL PARK: 19945 3rd STREET
EAGLE RIVER, ALASKA
Size of casing--EL—Depth of Hole 371 Leet Cased to 371.20 feet
Static water level 340 tt, 0)P66. , }(below) land surface. Finish of well (check one) open end ( x ) ;
Screen ( ); Perforated .( .. )..
_ � 4
Describe screen or perforatio
Well pumping test of 5 gallons pet QMk (minute) for--l---hours with 100% tt
of drawdown from static level. "I "
r+
Date of completion 21 AU GUS! 1.1996•!'
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
,_0__TO '!M;TNG STICK UP
8 TO
34
34 TO78
78 ' TO
85
85 TO
87
87 TO
172
172 TO
176
—17SLT0-1Z2_
17g To_Zilfi_
__2llfi_TO_215_
915 TO 9'tR
_2.'18—TO 94?
__2A2_TOy4G
246 TO 260
GRAVELLY
AiiLT: COBBLEY
PZRAVEL:`DAMP., CLAYEY
fiflAYiteROWN:'ISILTY..� '=- � _
SAND: LOOSE'' `
` SEP 251996
_
..__._.-_.• =Municipality of Anchoraoe
CLAY: SILTY, GRAVEL STREAKS Ge'
1 —CUSTOMER
2of 2
M -W DRILLING, Inc.
P.O. Box 110378. 10336 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner wAi i Arc ROSSERMAN Use of Well
Location (address of: Township, Range, Section, if known; or distance main road
Size of casing Tlepth of Hole Beet Cased to Beet
Static water level tt (Shovel)below) land surface. Finish of well (check one) open end
Screen Perforated
Describe screen or perfor on
Well pumping test at gallons pei (hour) (minute) forhours
with et.
of drawdown from Static "I.
Date of completion
WELL LOG
Depth in feet from
ground surface Give -details of formations penetrated, size of material, color and hardness
__2_60TO__i_10 fGRAVEL: SILTY. SANDY, COBBLEY
310 TO 345 SB
345 _T0355._ GRAVEL
CLAY GREY RECEIVED
35R TO inat
167 TO --- 30—
__a6_1__T0__3Z1__
_TQ_
TO
TO
W -L
Munictoaliry of AnCh0rAQe
'0- Dept. Health & Human Services
I M;F
1 —CUSTOMER
PAGE 1 OF
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 (UPGRADE) PERMIT
PERMIT NUMBER:SW960236 DATE ISSUED: 8/07/96
DESIGN ENGINEER: EXPIRATION DATE: 8/07/97
OWNER NAME:BOSSERMAN WALLACE B &
OWNER ADDRESS:19945 THIRD ST
EAGLE RIVER, AK. 99577
PARCEL ID:05030222
LEGAL DESCRIPTION:
COLONIAL PARK BLK 1 LT 1B
LOT SIZE: 15236 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION 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 (18AAC72) 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 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
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:
SUBMIT WELL
COMPLETION;
THE NEW WE
RECEIVED B
ISSUED BY:
LOG WITHIN 30 DAYS OF WELL
AND SUBMIT ASBUILT SHOWING
DATE • V_I Y"
DATE • 65h21T_(
0
rn
C6
M
2
0
O
0
0
0
111=20'
(P86-200)
COLONIAL PARK SUBD.
LOT 1 B, BLOCK 1
15,236 S.F.
S 89056'00"E 111.2
/
10' T. & E. ESM f.
LOT 1B
ACA" Oo ic•p
/ WELL
Yl�LL �N 7tAtA.'
/ "T
/
IER�
•
2a• x 6.3'
1 B.W. CMII _,.
d
N
1
24.9'
2.1• x 5.2 EXISTING
F.P. CMM BUILDING
FENCE (APX)
-BU I
A.C. DRIVE
S 89056'00"E 111.34'
3RD STREET
"FINAL STRUCTURE AS -BUILT"
GASTALDI LAND SURVEYING
Jeff A. Gostoldl, R.L.S.
4T26 Well 88th Ave.
Anchorage, Alaska 99502
PHCME 248-4454
GRID I DATE
1
F. 8. JOB NO.
96-01 1 CPSiB1
1 hereby certify that I hove surveyed file
properly deplcled above 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 not
appear on the recorded subdivision plat.
Under no clrcurm lances should ony data
hereon be used for aonstruellon or for
establishing boundary or fence lines.
ANCHORAGE RECORDING DISTRICT. ALASKA
NOTE: NO CORNERS SET THIS DATE.
..
Jr _
#A.jhc4 E. A. l.a
50'
(NTS)
®e+ssa0e•
A
OF.
y' 49111 ' 9
M..••••h• ems••: •�.
'Very A. Gostaldl : e m
i 1 Q
LS -6091 �4 4
'• 4
,eJesslonol �° 0
�4aeus**
WI
J
(P86-206)
COLONIAL PARK SUBD. t�r^F"
LOT 1 B, BLOCK 1
15,236 S.F.
S 69056'00"E 111.25'
10' T. & E. ESMT.
________----- __T— ____—
/ IL
LOT 1B
Y/ ff
WELL
I/
O i /
rJ1 I / •
C.P.
r /
iY
2.0'X 8.5'
O.W. CAW
r
N
UI 24.9' °
z I 2 1 X 5.2 EXISTING
BUILDING
F.P. cnNr
111=L0'
FENCE (APX)
iGRAVEL
C; DRIVE
N 6
1.71 X 9.11
Tr
l
--S-89056'00"E "111.34'
3RD STREET
"FlNAL STRUCTURE AS—BUILT'
CASTALDI LAND SURVEYING
Jeff A. Castaldl. R.L.S.
4726 West 88th Ave.
Anchorage, Alaska 90702
PHONE 248-7474
GRIDI DATE
NW 55 1
F.D. JOB NO.
96-01 1 CPSIBI
1 hereby certify that I have surveyed the
property depicted above and that no
encroachments exist except as Indicated.
It It the responslblllty of the owner to
determine the existence of any easements,
covenants or re-strictions which do not
appear on the recorded subdivision plat.
Under no circumstances should any data
hereon be used for construction or for
es lablishing boundary or fence lines.
ANCHORAGE RECORDING DISTRICT, ALASKA
NOTE: NO CORNERS SET THIS DATE.
O
Cg
m
M
LO
e
O
O
M7
50'
(NTS)
*01►aaoli+
®*"`:P� OFA, qL s .`
® Co 49 H* 7
Jeffery A. Gasloldl S c N
p O
•. LS -6091 ,: �° AV
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9/17la�)�
• Municipality of Anchora z AUG 17 21116
On -Site Water and Wastewater Program
(907)343-7904
aL` ���
Certificate of On -Site Systems Approval
Parcel I.D. 050-302-22 Expiration Date: 11.2q
1. GENERAL INFORMATION
Complete legal description Colonial Park. Block 1 Lot 1 B.
Location (site address) 19945 Third Street.
Current Property owner(s) Terry R. Huff
Day phone
Mailing address 19945 Third Street.
Eagle River, AK. 99577.
Real Estate Agent
Day phone
2. TYPE OF DWELLING:
IE Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well 0
Individual ❑
Individual Water Storage ❑
Holding Tank ❑
Community Class Well ❑
Community ❑
Public Water System ❑
Public Sewer lX
WaiverNariance request
Received by: Date: 3L2
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ I Waiver Fee $
Date of Payment Date of Payment
Receipt Number ozo(e Receipt Number
COSA# 05C-1 �e Waiver#
5. STATEME;;N'S�T OF INSPECTION BY ENGINEER
As certified by my se'tii affixed-fi§d, 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe 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 soil
condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
Disapproved
Conditional approval for
Date 8/11/2016
bedrooms, with the following stipulations:
By: Original Certificate Date:
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 erors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbluesheelr'- c
System
#1
Approved for
bedrooms
System
#2
Approved for
bedrooms
Disapproved
Conditional approval for
Date 8/11/2016
bedrooms, with the following stipulations:
By: Original Certificate Date:
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 erors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbluesheelr'- c
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: Colonial Park. Block 1 Lot 1 B. Parcel ID: 050=302-22 .
A. WELL DATA _
Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y
Date completed 8/21/1996 Sanitary seal .(Y/N) Y - Wires properly protected (Y/N) Y
Total depth 371 ft. Cased to 371'2 ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 8/21/190& 8/9/2016
Static water level 340 ft. 324 ft
Well production 5 g.p.m. 3.4 g.p.m.
WATER SAMPLE RESULTS[
Coliform /t/P colonies/100 mL Nitrate ��., mg/L
Arsenic ug/L Date of sample o 4 %)LetG Collected b.,
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Date installed
Tank size gal. Number of Compartments Cleanouts (Y/N)
Foundation cleanout (Y/N) — Depression over tank (YIN) High water alarm (Y/N)
Date of pumping " Pumper
C. ABSORPTION FIELD DATA
Date installed _ Soil rating (g.p.d./ftp or fe/bdrm) System type
Length ft. Width_ ft. Gravel below pipe ft.
Total depth ft t" %Eff absorption area flz Momtodittube � Depression over field
Date of adegtaCy tetsf ' Results (Pass/Fail) T— For bedrooms
is ..
Fluid depth in absorption field before -test in. Water added gal. New depth in.
E)apsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN '& type) If yes, give date
D. LIFT STATION
Date installed" Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. 'Pump off" level at in. High water alarm level at in.
Datum Cycles tested- - Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT*O:
Septic tank/lift station on lot N/A On adjacent lots 100+
Absorption field on lot N/A On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer /septic service line 25+ Holding tank 100+ "
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line Absorption field
r
Water main - Water service line Surface water
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO: Y `'
Properly line Building foundation Water main
Water Service line Surface water Driveway, parking/vehicle storage - -
Curtain drain Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify That l have determined thtough field inspections and
review of Municipal records that the above systems are in >>'
conformance with MOA COSA guidelines in effect on this date. ..... - ......
'
En ineers Printed Name Steven Pannone
9 }eVen X Gino ie -
Date
8/11/201Q $�` CE 8149
COSA canary sheet _2-6-16.doc "-
1 21=20"
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liNOTE.
No CORNERS SET Tlil$ DATE.°
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Municipality of Anchorage
Development Services Department :=
Building Safety Division <'
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650 /
www.muni.org/onsite •% "'��� ---1
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-30A -,Z P, COSA# IM135
Expiration Date: A - 1 % - Q
1. GENERAL INFORMATION
Complete legal description CCLCA11A L _Pfh21L L11g K 1
Location (site address) I I g 4 S 'Ttf'I IZ'D S7.
Current Propertyowner(s) S -IT -VE 6OWMIlHJ Day phone -(44)4- aogS
.1'115—M -
Mailing address ,f Cie) 4,5 -FI f 1 Fti7 ST. 1-Aftc-E r_IUtW-_ -FIL S ALI-
- --Lending agency Day phone—
-- .-- ---
Mailing address
Real Estate Agent
Mailing Address
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 [�
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
D_1�
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 _'gla River Engineering Services Phone 69q --51S
0,72 1 vrVV
Address =�--1� a11,n. Ale oor77
Engineer's Printed Name C+i-r-IS-roertc-- e— tA)ciot> Date 510810-4-
S. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:-- -
mnacnmems:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date:
(Rw. 11105)
Municipality of Anchorage ,,• d°,
• �" Development Services Department
Building Safety Division `
On -Site Water & 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 CHECKLIST
Legal Description: 601,0 )ZAI, PARK LoT Z G 9to" Parcel ID: 055'0-302-�Z
A. WELL DATA
Well type je&n),47 ; If A, B, or C provide PWSID # _
Date completed 4 1Zlh6 Sanitary seal &'N)YtZ5
Total depth 3J ft. Cased to =ft.
FROM WELL LOG
Date of test I[?, I j9 6
Static water level 3yo ft.
Well production 5 �r #I , g.p.m.
WATER SAMPLE RESULTS:
Coliform 'e--colonies/100 mL Nitrate 0. 7 mg/L
Arsenic: jD ug/L date of sample: Ax/Dlr-
Alur-ti!FTW CC
B. SEPTIC/HOLDING TANK DATA
an'
T' 'Material
Tank
Foundation cle
Date of pumping _
Well Log & YES
Wires properly protected 01N) Yt S
Casing height (above ground) ?_in.
AT INSPECTION
y/ZZ/off
3 2Z ft.
�. g.p.m.
Other bacteria colonies/100 mL
Collected by: G 41rW5 &4LZ41R!A/Z
Date installed
gal. Number of Compartments _ Cleanouts (Y/N)
(Y/N) _ Depression over tank (YIN) _ High water alarm
C. ABSORPTION FIELD DATA
Date installed
Length ft.
Total depth _ ft.
Date of adequacy test_
Fluid depth in absorption
Elapsed Time:_ min
Any rejuvenatio eatmei
Pumper
Soil rating y� ./ftp or ft2/bdrm)
Width 4, l ft.
Eft. absorption
(Pass/Fall)
517
System type
Gravel below pipe ft.
tube Depression over field_
r
test _ in. Water added_
Final fluid depth _ in. Absorption
(past 12 mo.) (Y/N & type)
If yes,
For _ bedrooms
New depth_ in.
...
D. LIFT STATION
Date installed Size in gallons
'Pump on" level at _ in. "Pump o Level at
Datum lU-vcles tested
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot At,+
Absorption field on lot Ill
r
Public sewer main f /GKJ
Sewer /septic service line 3 r
Animal containment areas 1 SD if
Manhole/Access
water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots +100 r
On adjacent lots t (
r
Public sewer manhole/cleanout /32
Holding tank -f &V
Manure/animal excrete storage areas 1 Sy r
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line Absorption
Water main Water service line
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORP
dN.
Property line foundation _
Water Service line Surface water
Cu rain Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
LOT TO
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this dale.
Engineer's Printed Name Gff2y+G?oPMfIR Q. ww%
Date SIo '0109
COSA Fee $
Date of Payment ��17
Receipt Number q4a3�
(Rev. 11/05)
a
Water main
Driveway, parkingivehicle storage_
"
i
Waiver Fee $
Date of Payment
Receipt Number
SCS Rear
1071583001
Client Name
Eagle River Engineering
Project Name/M
Colonial Park LI O
Client Sample ID
Colonial Park Lot I B, Block I
histdx
Drinking Water
PWSID
0
All Dates/Times are Alaska Standard Time
Printed Date/Time
04/30/2007 9:02
Collected Date/f[me
04/17/2007 14:45
Received Date/Time
04/18/2007 11:45
Technical Director
Stephen C. Ede
Sample Remarks:
Allowable
Prep Analysis
Parameter
Results
POL Units McUwd Container ID
Limits
Date Date
Init
Metals by ICP/MS
Arsenic
ND
5.00 ug/L EP200.8 C
(<10)
04/20107 0428107
TK
Waters Department
Total Nitraic/Nitrite-N
0.973
0.100 mg/L SM204500NO3-F D
(<10)
0423/07
1DS
Microbiology Laboratory
Total Coliform
0
col/IOOmL SM209222B A
( 1)
04/18/07
DLC
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES li
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage. Alaska 995195650
(907)343.4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
Parcel I.D.# 050-302-77 HAA# 14A0000`1r1
5
1. GENERAL INFORMATION
Complete legal description CQ:0...., -SRV supe ,.sION. LOT 1( BLOCK 1
Location (site address or directions) 19945 3rd STREET
EAGLE RIVER. ALASKA
Property owner nONA' D AND SARAH eIKFN Day phone _(907) 696-7746
Mailing address 19945 3rd STgEET cert c RIVER -ALASKA
Lending agency Day phone
Mailing address
Agent F STI TNER / REMAX OF EAOI F RIVER Day phone (907) 694-4200
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well xx
Community well
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 on-site
Public sewer xx
NOTE: If community wastewater system, provide written confirmation from State ADEC
Ing to the legality and status of system.
72-025 (Rev.1191) Front MOA 021 Computer Verslon
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. l further verify that based on the Information obtained from the Municipality of
Anchorage files and from my Investigation and Inspectigqqn, the on-site water supply and/or wastewater
disposal system is in compliance with all Municipal arlgState codes; ordinances, and regulations in effect
on the date of this Inspection. -A / I
Name of Firm
Phone (907) 337-6179
Engineer's Signature t(�Y ice- Date 3 81 00
ALASKA WATER & WASTEWATER
CONSULTANTS, INC: SHALL BE
PAID $800.00 --AT, OR
PRIOR TO, CLOSING FOR THE
ENGINEERING SERVICES PROVIDED.
6. DHHS SIGNATURE.
Approved for bedrooms
By:
Disapproved
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Date 3—/5__ 00
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 omisslons in the professional engineer's work.
72-025 0W. 1191) Back MOA A21 Canputer Vembn
KKEIVED
Municipality of Anchorage MAR 14 2000
DEPARTMENT OF HEALTH & HUMAN SERVIC %civmurr of
Environmental Services Division , .^_,'MEWAI SM
825 _V Street, Rm 602 Anchorage, Alaska 99501 (907) 343.4744
Health Authority Approval Checklist
LegalDescription: COLONIAL PARK S/D• LOT 1t. BLOCK 1 Patoell.D.: 050-302-22
A. WELL DATA
Weti Type PRNATE K A, B, or C, attach ADEC letter. ADEC water system number N/A
Log present (YIN) YES Date completed 8/21/%6
Total depth 371' Cased to 371' Casing height (above ground) 2'+
Sanitary seal (YIN) YES Wires properly p (YM) YES
FROM WELL LOG
Date of test 8/21/96
Static water level 340'
Well production 5 9 -pm.
WATER SAMPLE RESULTS:
AT INSPECTION
3/31/2000
329'
4.7 9—
P.M-con
form
0 Neste 0.77 ma/L Other bacteria 0
Date of sample: 3/3/2000 Collected by: A.W.W.C., INC.
B. SEPTICIHOLDING TANK DATA
Date installed Tank size Number of Com ts� gearnouts (YIN)
Foundation cleanout (YIN) , 'De w— (Y/N) High water alarm (Y/N)
Date of Pum Pumper
C. ABSORPTION FIELD DATA
Date Installed Sell rating (g.p.dAt2 or f12/bdrrm) System
Length yykfih Gravel thlclaness below pipe
Effective absorption area Monitoring Tube
Date of adequacy test
Fluid depth In
Depression over field (YIN)
For Bedrooms
teat (In.r Immediately atter gal. water added (In.):
(Ins) Minutes later. Absorption rate
Perondde treatment (past 12 months) (YIN) If yes, give date
n-025la«.3WCOMAKvw"
D. UFT STATION
Date ki tarred size
Manhole/Access
High water alarm
E. SEPARATION DISTANCES
level at' 'Pump ofr level ar
*Datum.
SEPARATION DISTANCES FROM WELL ON LOT TO:
SOPOd oldklg tank on lot N/A On adjacent krty N/A
AbScMtlon field on k1t — N/A On adjacent kits - N/A
Public sewer main 100'+ Public sewer mantlola/deanout 100'+
Sewer/septic service one 25'+ Lift station N/A
SEPARATION DISTANCES FROM SEPTIVHOLDING TANK ON LOT TO:
Properly ane Abso"m
Water maWservice One Surface
SEPARATION DISTANCES FROM ABSORPTION
Property One
Surface water.
adjacent kits
Water malrVservice One
Driveway, parldng/vehlde storage area
F. ENGINEER'S CERTIFI TIO
orMd at t de Id 8rspectlons end review
YAM MO l n frl d te M oantbmrence
Signature
Engineers Name JEFFREY A. GARNESS
Date �/3 oa
HAA Fees e3 OD, 6V
Data of Payment // OT
Receipt Number 1!5-4 Z er
n,= Mit- Mr tbmpacx vW&'W
Wells on adjacent kits
Waiver Fee
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES AEML
Division of Environmental Services
On-Site Services Section LILILZIO
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 05030222
HAA # �-\ qN9 1, nLI �1
1. GENERAL INFORMATION
Complete legal description Lot 1B, Block 1, Colonial Park S/D
Location (site address or directions)
19945 3rd Street, Eagle River
Property Owner Wallace B. Bosserman Day phone 696-8201/242 8200
Mailing address 19945 3rd Street, Eagle River, Ak 99577
Lending agency City mortgage Day phone 696 0701
Mailing address 11901 Business Park Blvd. Eagle River, Ak 99577
Agent Suzanne Cool, Vista Real Estate Day phone 689-6464
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3 \q
3. TYPE OF WATER SUPPLY:
Individual well X
Community well
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 on-site
Public sewer X
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72a25(n...1A1) Fm t MOA.21
S. STATEMENT OF INSPECTION BY ENGINEER ,
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm 4y0MfPAJ C.1GAA C-7_W4Aft, Phone SL3-7is57
Address PQ 90)f Z4-AA'7 7-r �14-,.,t c4,i c A &ttf 1441- 99 ti -Z 1/
Engineer's signature M'Lr',eLtLDate 9 Z
6. 'DHHHS SIGNATURE
�j
2 Approved for bedrooms.
M
Disapproved.
Conditional approval for
Additional Comments
t'411 VI 0
i`I1 N JI4. 341 1
n�
a
bedrooms, with the following stipulations:
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 purchasersof 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.
72023 m.. ,N,, 8C ,.0..21
Municipality of Anchorage
e DEPARTMENT OF HEALTH & HUMAN SERVICffE- CEI V E D
Environmental Services Division
825"L" Street, Room 502 a Anchorage, Alaska 995019 (907) 343-4744
SEP 251996
Municipality of Anchorage
Health Authority Approval Checklist Dept. Health & Human Services
Legal Description: Lot 18 Block 1, Colonial Parcel 1D05030222
ar
A. WELL DATA
Wellt,pe Private
Log present (YIN) '
Total depth 3 71.0'
Sanitary seal (Y/N) _
Date of lest
Static water level
Yes
If A, B. or C, attach ADEC lever. ADEC water system number
Date completed 21 August 96
Cased to 371.01 Casing height (about ground) 22 --
Wires
2"Wires properly protected (YM) Y e s
FROM WELL LOG
21 August 96
340'
Well production 5GPM 9 -
p.m -
WATER SAMPLE RESULTS:
Coliform 0
Date of sample:
9/16/96
B. SEPTIC/tIOLDING TANK DATA
AT INSPECTION
9/14/96
5,2GPIA
Nitrate .239 Other bacteria
Collected by: Stuart Gilbert
C
g.p.m.
Date installed Tank size Number of Compartmems Cleanouts (YIN)
Foundation cleamut (Y/M Depression (Y" High water alarm (Y/1)
Date of Pumping Pumper
C. ABSORPTION FIELD DATA
Date installed
Length Width
Effective absorption area
Soil rating (g.p.&W or felixinn) System type
Gravel thickness below pipe Total depth
Monitoring Tube present(Y/N)_ Depression over field (Y/N)
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test (inJ Immediately after_ gai. water added (in.):
Fluid depth (ins.) Minutes later: Absorption rate = a.p.d.
Peroxide treatment (past 12 months) (Y" If yes, give date
D. LIFT STATION
Date installed
Manhole/Access (YIN)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at'
"Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot : On adjacent lots
" Pmnp ofi' level ar'
Absorption field on lot . On 4acem lots
Public sewer main CT 100 Public sewer manholetcleanout
Sewer /septic service line
38'
Lift stauon
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line Absorption field
132'
Water main/servioe line Surface water/drainage Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water
Curtain drain
F. ENGINEER'S CERTIFICATION
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots
Property line
/ certijv that / have determined thru field inspections and review of Uunicipal recordt-ohl the trbave systems are
inconjormnncewith X10A H.11
:.
Signal ureAr
Engineer's Name AC,Nsw1.- C AryOdCT1.([tn)
Date 9 Z4 9b W,Au: - t:
HAA Fee $ 3�•
Daze of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee S
Date of Payment
Receipt Number
w L,� 14S 9ul(,7-
(P86-206)
COLONIAL PARK SUBD.
LOT 1 By BLOCK 1
9z o' 15,236 S.F.
94.0'
S 89°56'00"E 111.25'
/ FOUND 5/8"
10' T. do E. ESMT. / / REBAR (TYP)
LOT 101
/ly, 1
o / Pt �� 'X
1T / 'o° a' v� 007
ROPOSED
22.9' PBUILDING ``Y of
10
L
u
s Patent
J i
FIN. FLR. VA •�
97.0• (TYP)
i
40.0'
A.C. DRIVE
50'
P) (NTS)
O
O
:A
w
V
L4
S 89°56'00"E 111.34' FOUND 3 1/4"
AP
103.0' I—N /ZoeToo.o' � M NO UMMENT
1 11= 20' t0
3RD STREET n7ore 3o
NOTE: NO OVERHEAD UTILITIES EXIST ON THIS LOT.
PLOT PL -AN
OASTALDI LAND SURVEYING
Jeff A. Gostoldl, R.L.S.
4726 West 881h Ave.
Anchorage, Alaska 88502
PHONE 248-5454
DR IDDATE
NW 55 7/27/95
F. a. JOB NO.
CPSIBI
I hereby certify that I have surveyed
the property depicted above and that
the proposed Improvements and drainage
patterns are as shown hereon. It Is the
responsibility of the owner, prior to
construction, to verify the proposed
building location on lot, building
dimensions grade and utility connections
and to determine the existence of any
easements, covenants, or restrictions
which do not appear on the recorded
subdivision plot.
***UXMIIII4
SIM
M N *i .1...i....
Jeffery A. Gosloldl • : e
•
LS -6091
u%zelac,C 3 °T4',M Vj
O
iv
0
0
0
:O
L
u
s Patent
J i
FIN. FLR. VA •�
97.0• (TYP)
i
40.0'
A.C. DRIVE
50'
P) (NTS)
O
O
:A
w
V
L4
S 89°56'00"E 111.34' FOUND 3 1/4"
AP
103.0' I—N /ZoeToo.o' � M NO UMMENT
1 11= 20' t0
3RD STREET n7ore 3o
NOTE: NO OVERHEAD UTILITIES EXIST ON THIS LOT.
PLOT PL -AN
OASTALDI LAND SURVEYING
Jeff A. Gostoldl, R.L.S.
4726 West 881h Ave.
Anchorage, Alaska 88502
PHONE 248-5454
DR IDDATE
NW 55 7/27/95
F. a. JOB NO.
CPSIBI
I hereby certify that I have surveyed
the property depicted above and that
the proposed Improvements and drainage
patterns are as shown hereon. It Is the
responsibility of the owner, prior to
construction, to verify the proposed
building location on lot, building
dimensions grade and utility connections
and to determine the existence of any
easements, covenants, or restrictions
which do not appear on the recorded
subdivision plot.
***UXMIIII4
SIM
M N *i .1...i....
Jeffery A. Gosloldl • : e
•
LS -6091
u%zelac,C 3 °T4',M Vj
)ATE SCHEDULED -I I TIME
SUBDIVISION COLONIAL PARK
C
k
G
INSPECTOR
BLKILTITRAC/T� BLK 1 LT 1B
f
SIZE MAIN:
CONNECT LOCATION:
MAIN:
DEPT AT MAIN:
AT PROP. LINE: 'J
COMMENTS �.� U���-�� y - �F-:7; -C
INSPECTED BY: Ir%
a.:G
SCF Cx IS 77.1,1G 7' "��iJJO✓EO
�,
,.
:•� _ �
'^.%`i
.,
i. �.. Y.. n � .•
1r , r�
A, • � t .. +
RYA
September 25, 1996
Municipality of Anchorage
Department of Health and Human Services
Onsite Services Section
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Lot 1B, Block 1, Colonial Park Subdivision
Certificate of Health Authority Approval
Dear On Site Services Engineer:
A new well
was recently completed
on the subject lot to provide a higher
production
rate
to the residence on
the lot. A certified as -built showing the
location of
the well and the well log
are provided for your review. A sample
was taken
from
the water system after
the new well was put in service. An
analysis of
the
water revealed very
low nitrate content and no coliform or
other bacteria.
The
old well was abandoned in accordance with the requirements
of the new
well
ordinance.
The casing was cut off 3' below grade and filled
with gravel
to within 10' of
the top of casing. A 10'. concrete cap was then
added flush
with
the top. A
watertight cap was then welded at the top of the
old casing.
The
excavated area was then backfilled to the surface.
Sincerely,
Michael E. Anderson, P.E.