HomeMy WebLinkAboutDOWNEY LT 2Downey
Lot 2
#050-294-02
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DEPARTMENT Of /EALTH AND ENVIRONMENTAL P iCTION
825 L STREET, ANCHORAGE, AK 99501
. 264-4720 ~
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PERMIT NO: 850335
DATE ISSUED: 06/20/85
APPLICANT: AUDREY MASON
ADDRESS: P.O. BOX 773875
EAGLE RIVER, AK 99577
CONTACT PHONE: 694-4200
�
LEGAL DESCRIP: SUBDIVIS~ ONo QOWNEY LOT: 2 BLOCK: 0
' SECTION: 7 TOWNSHIP: 14N RANGE: 1W
LOT SIZE: 17000 (GQ.FT. OR ACRES)
I certify that:
1. I am Familiar with the requirements for on-site sewers and wells as set
forth by the Municipality.6f Anchorage (MOA) and the State of Alaska.
2. I wi:ll install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back
` distances from any existing well, wastewater disposal system or public
sewerage nearby lot.
SIGNED DATE.
.- -
APPLICANT: AUDREYnIMA N"
'
ISSUED BY DATE: Clo2 6/c6(5
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SULLIVAN WATER WELLS
P.O. BOX 272, CHUGIAK, ALASKA 99667 • TELEPHONE 688-2769
OWNER OF LAND '' ` s
ADDRESS
LEGAL DESCRIPTION
DATE - Started Ended'
T
PERMIT NUMBER
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DEPTH OF WELL i 6 r— . .3 '`_
STATIC LEVEL OF WATER FT
DRAW DOWN FT
GALS. PER HR `-
KIND OF CASING
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DRILLER'SNAME�
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MISCL. INFORMATION:
DRILLER'SNAME�
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL gY ,aoa 9,2
OF ON-SITE SEWER AND WATER FACILITY
264-4720 4
Application Date ,Tu1V 12, 1988
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lk�wnP Lnt 9 Rl nnk N/A
Location (address or directions)
Eagle RJ3r Road
(b) Applicant Name sn�U pA��O A vleephone: Home 694-9568 Business 694-5195
- - -;--Applicant Address 16600 QPnfnrfiPlrl Thrive Suite 201 EagleRver, AK 99577
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ;.Buyer ❑; Other ❑ (explain);.
(d) Lending Institution N,LA Telephone
Address
(e) , Real Estate Company and Agent Re/MaxAudre-V Mason
Address 11660 Centerfield Drive Suite 201 Eagle River, AK 99577
Telephone 694-4200
(f) Mail the HAA to the following address:
_,._'Pick-up by Engineer
2. TYPE OF RESIDENCE
Single -Family ® Multi -Family ❑ Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well IR Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite ❑ Public ® Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
i
■
r.
� E
3. WATER SUPPLY
Individual Well IR Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite ❑ Public ® Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
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 Eagle River Engineering Services Telephone 694-5195
Address P.O.B. 773294 Eagle River, Alaska 99577
Date 7h
OF .4,/ -%*
"q yC ~ROPESSION," 4w
6. DHEP APPROVAL '
Approved for 3 bedrooms by Date 7_ Z 498
Approved Disapproved Conditional
Terms of Conditional Approval
n
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 engineer's work.
Page 2 of 2
72-025 (11/84)
A�GNpRAG'�
N`G`Qpw'(`f ��60 OF ANCHORAGE (MOki
E ,RONttgOPIrALTH AUTHORITY APPROVAL (HAA)
"ICKLIST - FEBRUARY 1864
Jv� 1 264-4720
�� Legal Description: � ° f"
R T /4e y R 1 w Tee-, -7
A. WELL DATA
Well Classification1g" � ' If A, B, C, D.E.C. Approved (Y/N) mA
Well Log Present (Y/N) Y Date Completed gf& S Yield G• G ��^' TeJfe�[ 7/P�
Total Depth ag. Cased to /66 Depth of Grouting
Static Water Level /y 6 4910✓ hA eatrI^;.f Pump Set At
Casing Height Above Ground 20 Sanitary Seal on Casing (Y/N) Y
Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N
Separation Distances from Well:
To Septic/Holding Tank on Lot W�+ ; On Adjoining Lots w�a
To Nearest Edge of Absorption Field on Lot N4 ; On Adjoining Lots !A
To Nearest Public Sewer Line f'?S To Nearest Public Sewer
Cleanout/Manhole +loo To Nearest Sewer Service Line on Lot
Water Sample Collected by�.5"'�`�'' �( ; Date
Water Sample Test Results C.a l►�i•.�•• = OJ.'�
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed Size No. of Compartments
Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N)
Depression over Tank (Y/N) Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ;for
Holding Tank High -Water Alarm (Y/N) Temporary' Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well To Building Foundation
To Property Line To Disposal Field'
To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course _
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION %
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
On Adjoining Lots
To Cutbank (if present)
Dimensions
Manhole/Access (Y/N)
"Pump Off' Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date
Eagle River Enginbdrlhg_$bMcas�6
Company b, n W 113994 MOA No.
taglb Rivet, AK 99577 )
Receipt No. 694- .2 3 d-
6
Date of Payment
v
Amount: $ % i �) -- �A,� �I� Q, e0 r,
T� €� ° .
�'�® •D 00 DC36G&U9Y®ODS - oB1e®�tl�m
7 09999090°°9°°Oo�°0°°°°°!•9 ca�
Page 2 of 2 j
tc L Louis A. Butera % trams
� ® CE -6736
72-026 (11/84) �4�'� Doo � �� ����
00
�� O® '9000®°®° 1W
�� PROFESSION
Parcel I. D. 050-2902
o£ B�
Municipality of Anchorage
On -Site Water and Wastewater Progr
(907) 343-}�7¢9,
® 23 iFS.5U4.5R.5
Certificate of On-etS stems .Approval
S�_v I i "
1. GENERAL INFORMATION
Complete legal description DOWNEY LOT 2
Location (site address)
Expiration Date:
18721 EAGLE RIVER ROAD EAGLE RIVER AK 99577
Current Property owner(s) JOHN DILLIVAN
Mailing address
Real Estate Agent
BRYANT THORPE
2. TYPE OF DWELLING:
x❑ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
❑
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
P� ihlic Water Rvctarn
_I----
❑
Public Sewer
Ixl
WaiverNarence request for: NONE Distance:__
h
Received
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ rJ%
Date of Payment 1
Receipt Number D 33ni G
COSA# CX264
Date: 1//6//
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 SPURKLAND ENGINEERING
Address 203 W. 15TH AVE.,STE.202A, ANCHORAGE, AK 99501
Engineer's Printed Name LARS SPURKLAND
6. DSD SI NATURE
System #1 Approved for -21 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
Phone 279-3916
Date 9/10114
G�� ��t�r`)i
VI
PUnKLAND,
�� ��.•. 115 0 • lv �/
p oEs
with the following stipulatio`V.1%,1�1Z,_ ,r
By: Original Certificate Date: 8 i
The nicip Iry orage 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 engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet ° ., -
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: DOWNEY LOT 2
A. WELL DATA
Parcel I D: 050-2902
Well type PRIVATE If A, B, or C provide PWSID # Well Log (YIN) Y
Date completed 6/1985 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 166 ft. Cased to >40 ft. Casing height (above ground) 24+ in.
FROM WELL LOG AT INSPECTION
Date of test 6/85 8/29/14
Static water level 144 ft
Well production 10 9—
p.m-WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 2'55 mg/L
Arsenic ND ug/L Date of sample: 8/29114
B. SEPTICIHOLDING TANK DATA
Tank Type/Material
Tank size gal. Number of Compartments
Foundation cleanout (Y/N) _ Depression over tank (YIN)
Date of pumping Pumper
136 ft
5.6
g. p. m.
Collected by: ANSON MOXNESS
Date installed
Cleanouts (Y/N)
High water alarm (YIN)
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./f:2 or ftz/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.) (YIN & type) __ If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
0
Size in gallons
"Pump ofr level at
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main 75'+
Sewer /septic service line 25'+
Animal containment areas 50+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Property line
Water main
Water service line _
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO:
Property line
Building foundation _
Water Service line
Surface water
Curtain drain
Wells on adjacent lots _
F. COMMENTS
in.
Manhole/Access (YIN)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank NA
Manurelanimal excrete storage areas 100+
G. ENGINEER'S CERTIFICATION
t 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 date.
Engineer's Printed Name LARS SPURKLAND
Date 9/10/14
COSA brown sheet_10.10.12.doc
Absorption field
Surface water
Water main
Driveway, parking/vehicle storage
in.
N880 38' 04"W 132.04'
eu. a
n>,ss Nsaaer
N
nxxr suns �"°`
WELL
SHED 42.0'
s�
P, EXISTING
o HOUSE a
1
w'
14.0o
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CD
CD,
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28.0' 20.8'
No
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TRACT M
5
0
o
io
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Cr!
AM
i
100' WELL RADIUS, �P2
F
— — — — — — — — — — — — — —
15' T&E ESMT
N89Q 58'00"W 132.00'
EAGLE RIVER ROAD
a
UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE UNES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LOT SueM:Y SURVEY TYPE
SYMBOLS
FOUNDATIM As -BMT
• SET REBAR DRAINAGE ASPHALT
RNAL siRIIOTIMIB A5-euILT
O FOUND R®AR-
q-�g WOW FENCE CONCRETE
HPLOT PLAN ... AS-IaALT ...LOT SURYiY ... TCPOFR Y
OU II ASSUMED ELEV.�-' METAL FENCE WOW DECK
AS-eucT... B[IM A5 -&XT... No 2
PLOT PLANS & LOT SURVEYS
NOTE:
IT is THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
SHOWN. FENCES. WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS,
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURVEY CERTIFICATION
q''It
Prepared by
Robert E. Johns, Jr. & Assoc.
aD„LA
•.••'••oF
Inrsy va, as lla. y�ery ar,swe
,��.`P�E•........... •♦j
Professional Land Surveyors
na.s e,na .IaarN a a M lot an..%
m
1 ,qq�`
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1700 Brink Drize
ANCHIXtAGE, ALASKA 9950
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scale:
Rae. Lot S.F.
Roc Plot File No.
FOUNDATION AS -BUILT
49th .
y - :. .....�
„ _ ,
1 = 30
.::� ..: ":»'
,� 00
�.«,
Dote Swaeyed: 08/18/14
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aeckaa DA MK
raeme.i . as kT ra s a.
• _
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k
snaeeir ti awnalla. a ss. Assts.
r ` JO JR.
s a':• o
Data Drew: 08/19/14
cic: NW054
w.o. 14-372
FINAL STRUCTURE AS -BUILT
•�gia :•• 4121 —S :• Aejr
•'a
�/
Legal Description:
I, aee.T c AYw. r_ ArrsY Net I
=rrr s ss naK.
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Lot 2
Lao ea
DOWNEY