HomeMy WebLinkAboutEAGLE RIVER MID HEIGHTS BLK 4A LT 2AEagle River
Mid Heights
Block 4A
Lot 2A
#050-271-53
® Municipality ®f Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 050-271-53
1. GENERAL INFORMATION:
Expiration Date: _1 ^ 30 -2 O
Complete legal description EAGLE RIVER MID HEIGHTS; BLOCK 4A LOT 2A
Location (site address) 10029 BAFFIN STREET, EAGLE RIVER, AK 99577
Current Property owner(s) OLIVIA SEBASTIAN
Mailing address
Day phone C/O OF AGENT
10029 BAFFIN STREET, EAGLE RIVER, AK 99577
Real Estate Agent RUTH BARNDT
2. TYPE OF DWELLING:
M Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone 227-8040
3. NUMBER OF BEDROOMS:
5
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
Waiver/Variance request for:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $-2, O COUI ►.�'
Date of Payment to -22W` 2- d
Receipt Number a 3 13 s' C�
COSA # 0�2U 1603 _
Date:
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: Gayness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date:
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/parry that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
System #1 Approved for rJ bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
By
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bedrooms, with the following stipulations:
Original Certificate Date:_[ 0' ` 3 o zy Z
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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.doc
Legal Description: EAGLE RIVER MID HEIGHTS; BLOCK 4A, LOT 2A Parcel ID: 050-271-53
If more than 1 septic system on tot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1971(?)
Total depth ft
Cased to UNK ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 10
116
f2o
Static water level at beginning of test 120 ft.
Comments *124'+ PER GEG INSPECTION REPORT. PER 1
B. TANK DATA 1AWWU SEWER
••---�----•—
Ag75,*�, yearsTane/mateMeasured operaid level in septic tank
Standpipes/fi u per record drawing
Structure served by this system
Well production at time of test 3.2+/- gpm
Water storage tank volume NONE gallons
Well disinfected for coliform test? ❑ Yes ❑ No
1'Coliform bacteria is Negative
Nitrate mg/L ZrNitrate less than MRL (ND)
Arsenic ug/L tlArsenic less than MRL (ND)
Collected by GEG, LTD.
Date of Sample 10/16/20
INPSECTION REPORT WELL IS 147' DEEP
C. LIFT STATION
❑ Required maintena
years
Lift station material
Comments:
D. ABSORPTION FIELD DATJAWWU SEWERA------•
stem tested (date installed)
❑ ALL stan present per record drawing
Total measured depth r rade ft (max)
Measured depth to pipe invert from e ft (min)
❑ N/A – pressurized field
F-71 Monitor tubes go to bottom of effective. If not, sta
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for er than 30 days prior to
date of test)
qr ' roduced gallons
nts/Deficiencies:
COSA Checklist yellow sheet
Adequacy test date
Results ❑ Pass For edrooms
>Fluiddepthprior to in
gal
in
Elapsed time min
Fin id depth in
Absorption ra gpd
Any rejuvenation treatm ast 12 months)
If yes, enter date
PON
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'
❑ Yes
if No
Community Sewer Manhole/Cleanout > 100'
Surface Water >_1.000-'. if No ft
r7 Yes
if No
ft
❑ Yes
if No
.50+ ft
Neighboring Tank > 100' ❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No
ft
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' Yes
if No
ft
Neighboring Absorption Fields > 100'
If septic tank is under driveway commen
*
Animal Containment > 50' Yes
if No
ft
❑ Yes
if No
ft
..50+
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' F-1Yesif
No
ft
[] Yes
if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Buil in - tions > 10'
❑ Yes
if No
ft
Surface Water >_1.000-'. if No ft
Property Line > 5'
❑. ss
if No
ft
Wells o Lots:
Absorption Field > 5'
❑ Yes
if No
Private Wells > 100' ❑ Yes if No ft
Water Main > 10'
es
if No
ft
Community _ 00, []] Y.e,s_ if No ft
W ice Line > 10'
❑ Yes
if No
ft
If septic tank is under driveway commen
From Absorption Field on Lot to: (Please enter distances if less than required)
Bui din ation > 10'
❑ Yes
if No
ft
If absorption field is underment below
Property Line > 10 ""
❑. ss
if No
ft
Wells o }, n Lots:
Water Main > 10'
❑ Yes
if No
Private Wells > 100' ❑ Yes if No ft
Water Service Line > 10'
es
if No
ft
Commu s > 200' ❑ Yes if No ft
S ater > 100'
❑ Yes
if No
ft
F. ENGINEER'S COMMENTS
*THIS PROPERTY AND ALL ADJACENT PROPERTIES ARE SERVED BY AWWU SEWER.
**MET SEPEARATION DISTANCE AT TIME OF INSTALLATION OF AWWU SEWER MAIN.
WELL AND SEWER CONNECT ARE PRE -1 983 'UNKNOWN.
G. ENGINEER'S CERTIFICATION
l 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.
COSA Checklist yellow sheet
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AS-13UILT
I hereby certify, that I .have surveyed' the following descrbpd
property:
Anchorage Recording Preeinet, Alaska, and that the improve-
ments situated thereon are within the property lines and do not
overlap or encroach -on the property lying adjacent thereto, that
no improvements on= lyingadjacent thereto encroach
on the premrses in question and tat there are no roadways,
transmission Imes or other visible easements on said property
except as indicatW hereon.
Dated st Eag Rivtr, Alaska
this. 19
HOStRT C. JOHNSON Ap
SCALE: Registered Land Surveyor No.LS
11"' •• 3 d Box 77-0456,. s4c
River, Alaa-99577
Phone (90'a') 6 ;5 3
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AS-13UILT
I hereby certify, that I .have surveyed' the following descrbpd
property:
Anchorage Recording Preeinet, Alaska, and that the improve-
ments situated thereon are within the property lines and do not
overlap or encroach -on the property lying adjacent thereto, that
no improvements on= lyingadjacent thereto encroach
on the premrses in question and tat there are no roadways,
transmission Imes or other visible easements on said property
except as indicatW hereon.
Dated st Eag Rivtr, Alaska
this. 19
HOStRT C. JOHNSON Ap
SCALE: Registered Land Surveyor No.LS
11"' •• 3 d Box 77-0456,. s4c
River, Alaa-99577
Phone (90'a') 6 ;5 3
GR=ATER ANCHORAGE AREA BOROtIrH
HEALTH DEPARTMENT N? 432
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
609 4 - 2,7 7
NAME ' " r `j -'� �1%� (� %� ADDRESS MAILING �fn/� �`y�Yl/ls� [� PHONE
LOCATION � �' � �'1 i f �%y *� � / /41'/` EGAL DESCRIPTION °`Of z C�`/i �i � ��' /Ci Jt M�
SEPTIC TANK: �'�n�' ;''fade— ei I' lo✓ed
NUMBER OF
DISTANCE FROM WL � %t'G7dIzed)ATERIAL �!'Y1C✓ � //���/� COMPARTMENTSID
,
LIQUID CAPACITY ��y0 GALLONS. INSIDE LENGTH C�'< Jr < INSIDE WIDTH �7` < DLI EOPTH <
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS � OUTSIDE DIAMETER OR WIDTH17
, LENGTH_, DEPTH 5
LINING MATERIAL �' � � . DISTANCE FROM WEL ,/a r0 11� DING FOUNDATION IV
---------------------
NEAREST LOT LINE ZU TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)GJ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
------- FOUNDATION
NUMBER OF LIMES
DISTA CE BETWEEN LINES
ABSOTION AREA
SQ. FT. LENGTH OF EACH
TOTAL LENGTH
NEAREST LOT.. LINE OF LINES
TRENCH WIDTH IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL: j'6s C Y T o DISTANCE FROM WATER
TYPE DEPTH , BUILDI NDATION. SAMPLE , NEAREST
LOT LINE EWERSINE ,TANI_rJ�Iyeat/pvS STEM foo/rte SPOOL OURCES_
,P4�vr
DISTANCES:
ij�
DIAGRAM OF SYSTEM
DATE ✓�L % Z L� "� APPROVED
H ALT UTHORITY
GAAB-34D-z _ _GREATEF- ANCHORAGE AREA '- OROUGH Case No. _r64
HEALTH DEPARTMENT Z' 7 G
327 Eagle St. Anchorage, Alaska 99501 279-2511 jfj
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
S 1, ,r.'I-, MAILING ADDRESS �� " `�`>>' PHONE NO.
NAME OF APPLICANT � ����1'lr' ` � '�-
RESIDENCE ADDRESS r. :"i > '.(' LOCATION OF INSTALLATION
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK SEEPAGE PIT ` , DRAIN FIELD ;; KER_
TO SERVE THE FOLLOWING FACILITY 3 %3 (` L) C}_ /l- l /�rg1C__
FINANCED THROUGH
PERCOLATION TEST RESULTS'
TO BE INSTALLED BY '� f
ANTICIPATED DATE OF COMPLETION r AL 1 tC �
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS iV PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
SEPTIC TANK SIZE�TYPE �� 1(.t' SEEPAGE AREA e1TYPE Lill
/'�0Of' DIAGRAM OF SYSTEM
DISTANCES:
�Ca
�_k'
6C
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I.�i■■■■■■■�®�"i�■■■■■■��■
LLJ
■11■■��J"■■■■■■I■■■ri1■■■■iii■
ALTH AUTHORITY
\ OR
LI Er4SED DESIGNER
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
� I i
DATE �% 1 t. APPLICANTS SIGNATURE _�uti� �J JILLL
■Ili
I.�i■■■■■■■�®�"i�■■■■■■��■
■11■■��J"■■■■■■I■■■ri1■■■■iii■
■NEEMM!!I■■■I■■ill■!,FAME
!
■����■■■■��■■■�■■■ue::■Elio
■11■■111■■i�s'��I■'{®■■■■■■■��■
■11■■■■�■■■Ill■■■■■■■■■��■
■11■■■■■■■■ISI■■■■■■■■■��■
-------------------
\ OR
LI Er4SED DESIGNER
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
� I i
DATE �% 1 t. APPLICANTS SIGNATURE _�uti� �J JILLL
� REATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
.. 327 EAGLE STREET
ANCHORAGE, ALASKA 99501
rx
CASE N
Performed For Charles Barr Date Performed 8/10/70
Legal Description: rot 2 Block A. SulAivision Eagle River"lid Heights
This Form Reports a: Sos s Log xx 'Percolation Test
Depth
Feet Soil Characteristics
brown silty sandy gravel
2 (GM)
4�
gravelly sand w/cobbles (S
6
gray gravelly sand (SW)
10
gravelly sand w/cobbles (SP)
12.�,..t
r
t
sem,
Was Ground Water Encountered? no 0
If Yes, ,lt ba at epth
Location Sketch
Readir. :[e
Gross :ime Net Time Depth To H2O Net Drop
i
Frop-,sedSeepage Pit Drain Field
Depth Of Inlet Depth To Bottom Of Pit Or Trench
COMMENTS:
Test Performed By: R. E. Carlisle These recommendations are computed
from visual observation and based
Data Certified By: National Testing Services n the ,nified classification system.
Date:
ILI
Parcel I.D. 050-271-53
3f "Li
Municipality of Anchorage °
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
�
Expiration Date: 2 (' ' �— 1 J
Complete legal description Eagle River Mid Heights, Bock 4A, Lot 2A
Location (site address) 10029 Baffin Street Eagle River, AK 99577
Current Property owner(s) Ralph and Beckie Oliva Day phone 694-3833
Mailing address 10029 Baffin Street Eagle River, AK 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Five
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
❑
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Pi�hij� Inlater Cvctom
❑
Public Sewer
ISI
Waiver/Variance request for: Distance:
Received by: z�Lt ue.) Date: 7/$//3
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $
Date of Payment
Receipt Number b`o�b1 G
COSA#
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 Anderson Engineering
Address P.O. Box 240773 Anchora
AK 99524
Phone 522-7773
Engineer's Printed Name Michael E. Anderson, P.E. Date 6/29/2013
6. DSD SIGNATURE +°®'°'
..... E a.....,
1 /System #1 Approved for bedrooms a MicHGi :fi+,)&L)ERSON <4
M
System #2 Approved for bedrooms J�•,e CE -4381
7-/—
Disapproved 1o9Fp
►pROFESS' °0S, ®•
� 4flN ®®
Conditional approval for bedrooms, with the following stipulattiiols®®®®�®
Original Certificate Date: :7 - ,-- / 3
The 664nidpzKy of'AySH6rage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based onl)
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
Septic System Advisory
Well Flow Advisory
COSA blue sheet ! . , c
Nitrate Advisory
Arsenic Advisory
Other
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 Mid Heights, Block 4A, Lot 2A Parcel ID: 050-271-53
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (Y/N) N
Date completed 1971 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y
Total depth UN ft. Cased to >40 ft. Casing height (above ground) >12 in.
FROM WELL LOG AT INSPECTION
Date of test 6/18/13
Static water level
Well production
WATER SAMPLE RESULTS:
ft.
Coliform 0 colonies/100 mL Nitrate '48 mg/L
Arsenic N/D ug/L Date of sample: 6/14/13
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size gal. Number of Compartments
Foundation cleanout (YIN) Depression over tank (YIN)
Date of pumping Pumper
121.9 ft.
2.6
g.p.m.
Collected by: Anderson Eng.
AVWVU Sewer
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.pA./ftZ or ftZ/bdrm)
Length ft. Width
Date installed
Cleanouts(Y/N)
High water alarm (Y/N)
System type
ft. Gravel below pipe ft.
Total depth ft. Eff. absorption area ftZ 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
Date installed
"Pump on" level at
Datum
Size in gallons _
in. "Pump off' level at
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot NIA
Absorption field on lot N/A
Public sewer main
>50'**
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
Manhole/Access (Y/N)
in. High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots N/A
On adjacent lots N/A
Public sewer manhole/cleanout
>50'**
Holding tank N/A
Manure/animal excrete storage areas >1 00'
Absorption fie
Surface water
Water main
Driveway, parking/vehicle storage
F. COMMENTS
**Separation Distance Met Code at Time of Sewer Main Construction.
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 COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 6/29/2013
COSA brown sheet_1 D-1 P12.doc
*;
49TH
.y......... , < .:. �.....
A,
-MICHAEL E. ANDERSON - 4:
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1111'aO®®SS 'QIS
Lot 3A
FENCE
Lot 1 A
Lot 9A
PLOT PLAN AS BUILT X SCALE 1" = 40' GRID NW 52 Project No. 13-112
Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
(907) 522-6476 Phone
Registered Land Surveyors (907) 522-4625 Fax
kenOlongsurvey.com / jonathanOlangsurvey.com O�`�•OF A�9S�0
1 hereby certify that I have surveyed the following described property: P 49THt..LA*N
�0�
LOT 2A, BLOCK 4—A, EAGLE RIVER MID—HEIGHTS SUBD. (Plat No. 84-414) 49TH
Anchorage Recording District, Alaska, and that the improvements situated thereon are * ......*
within the roe Imes and do not encroach onto the roe D
property rh' property rty adjacent thereto, that D
no improvements on the property lying adjacent thereto encroach on the surveyed ? t y^ .
premises and that there are no roadways, transmission lines or other visible KENNETH,
easements on said property except as indicated hereon. i+ '• ,�
Dated this the 24k1 Day of TuL.-,a , 'Loll . at Anchorage, Alaska 4p••4—.520%.-'-5w�
a
It is the responsibility of the owner to determine the existence of any easements,OQ�fFSSloW-
covenants, or restrictions which do not appear on the recorded subdivision plat. DDODOo�
S 89'58'00"E 191.33'
re
W
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n
Lot 2A
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23,912 s.f.
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24.2'
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2.0' x 20.4'
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00
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2 STORY RESIDENCE
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81;
0
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Z
WELL
3.2' 2.0' x
m
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12.2' 9W
m
DECK
12.3' 11
8.2'
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32.4'
ELECTRIC a TELECOM
UTILITY EASE)
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a
6
ROOF OVERHANG
FENCE
Lot 1 A
Lot 9A
PLOT PLAN AS BUILT X SCALE 1" = 40' GRID NW 52 Project No. 13-112
Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
(907) 522-6476 Phone
Registered Land Surveyors (907) 522-4625 Fax
kenOlongsurvey.com / jonathanOlangsurvey.com O�`�•OF A�9S�0
1 hereby certify that I have surveyed the following described property: P 49THt..LA*N
�0�
LOT 2A, BLOCK 4—A, EAGLE RIVER MID—HEIGHTS SUBD. (Plat No. 84-414) 49TH
Anchorage Recording District, Alaska, and that the improvements situated thereon are * ......*
within the roe Imes and do not encroach onto the roe D
property rh' property rty adjacent thereto, that D
no improvements on the property lying adjacent thereto encroach on the surveyed ? t y^ .
premises and that there are no roadways, transmission lines or other visible KENNETH,
easements on said property except as indicated hereon. i+ '• ,�
Dated this the 24k1 Day of TuL.-,a , 'Loll . at Anchorage, Alaska 4p••4—.520%.-'-5w�
a
It is the responsibility of the owner to determine the existence of any easements,OQ�fFSSloW-
covenants, or restrictions which do not appear on the recorded subdivision plat. DDODOo�
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services 44
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 I.D. # 050-271-53
HAA # HA980162
1. GENERAL INFORMATION
Complete legal description r.nt- 4A Block 4A, Fagle River Mid Heights SID
Location (site address or directions) 10029 Baffin Street, Eaqle River, Ak 99577
Property owner
Steve4 Karen Morrisette
Day phone 696-1493
Mailing address _- 10029 Baffin Street, Eagle River, AK 99577
Lending agency Remax Eagle River Day phone 244-6742
Mailing ad
Agent
Address
Brook
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
Day phone 244-6762
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 _ xxx
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5.
6.
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.
S & S ENGINEERING �p
Name of Firm 17024 Eagle River 1 nap Read Ne 204 Phone 6 CI y -,?,9 7 /
Eagle River, Alaska 99577
Address _ [
Engineer's signature
DHHS SIGNATURE
Approved for f VE bedrooms.
Disapproved.
Conditional approval for
Additional Comments
NUTla
Date -7 /1 'd c n
CE OF
3ERi C. COWAN t f�Q
CE -8801 � ���A
•..M� '� X. PFdFFSa1Ot
bedrooms, with the following stipulations:
Date 7- If - -7 9
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 courtesyto purchasers of homes
and their lendi ng institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1191) Back MOA #21
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services it
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 I.D. # O e !'� HAA # 45 Qr\CC 0 1LOa
1. GENERAL INFORMATION
Complete legal description Fag1a River Mid height-,- rot 2, 'R1nnk 4A
Location (site address or directions) 10029 Baf fin St., Eagle River, AK 99577
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Steve & Karen Morrisette Day phone
10029 Baffin St., Eagle River, AK 99577
Remax Eagle River
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
Day phone
696-1493
244-6742
Day phone 244-6742
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
XXX
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev 1/91) Front MOA#21
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 S & 5 ENGINEERING Phone 6_' ci'y - orf 7
17034 Eagle River Loop Road No. 204
Address Di,Ala<ka 99577
Engineer's signature
6. DHHS SIGNATURE
Z Approved for 7_141fEE bedrooms.
Disapproved.
Conditional approval for
Additional Comments
By:
Date 6 /3 3 IQ 5'
ti OF
....• ..,.. ...:.ter..-�..:..,
• ROBERT C. COWAN !
%
CE - 8801
It
01
bedrooms, with the following stipulations:
Date G -2q-q3_
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21
RECEIVED
Municipality of Anchorage 'U''
4 19
DEPARTMENT OF HEALTH & HUMAN SERVICES MUNICIPALITY OFA
Environmental Services Division ENVIRONMENTAL SERV N
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: �Rf�L 'R"JF'e- MOD N. -i . MT5 Parcel I.D.: U S' 0
A. WELL DATA Le Ati $ux"K +P.
Well type Pti i vAT£ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y N o Date completed I cl f
Total depth 14fi fc mo )
P U Fur: Cased to } Casing height (above ground)
Sanitary sealY/ ) �j E S Wires properly protected ON) t EC
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform t�
FROM WELL LOG
Nitrate 0,2 `U
n+
AT INSPECTION
17-4
41.0 + g.p.m.
Other bacteria 0
Date of sample: Collected by: S41 � of"6.1NffV + )
B. SEPTICIROLDING TANK DATA Pv Y1L. I C S 4,; w4j e
Date installed
Foundation cleanout (Y/N)
Date of Pumoino
C. ABSORPTION
Date installed
Length Width
Effective absorption area
Date of adequacy test
size , ) Number of Compartments
Pumper
Cleanouts (Y/N)
High water alarm (Y/N)
Soil rating (g.p.d./ft2 or ft2/bdrm) System type
Gravel thickness below pipe Total depth
Monitoring Tu resent (Y/N) Depression over field (Y/N)
Results (Pass/Fail)
For bedrooms
Fluid depth in absorption field before test (in.); Immediately afte
Fluid depth (ins) Minutes later: Absorption rate = _
Peroxide treatment (past 12 months) (YM) If yes, give date
72-026 (Rev. 3/96)`
water added (in.):
D. LIFT STATION /J
Date installed Size in gallons
Manhole/Access (Y/N) "Pum " level at*
High water alarm level at* *Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
"Pump off" level at*
Septic/holding tank on lot 01A On adjacent lots
Absorption field on lot N On adjacent lots A
Public sewer main �o t Public sewer manhole/cleanout 5.0 F �
i
Sewer /septic service line 12- 4 -
Lift station
ON DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation
Water main/service line Surface water/drainage
ON DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line —Building foundation
Surface water
Curtain drain
F. ENGINEER'S CERTIFICATION
�c SCJ. 1ST. R-E-OV)az0 AT TiH L Of:
Absorption field
�Ha-e 'acent lots
_ Water main/service line
ng/vehicle storage area
Wells on adjacent lots
1 certify that I have determined thru field inspections and review of Municipal records t 1Fe 9116 s are
in conformance ith M A HAA guidelines in effect on this date. y'� �/''".—. •�'•..�S,f.
Signature 1✓V 9th }
.«�
Engineer's Name �O it 2 : �- ........f •,,,,
p ROBERT G COYJAN f 4
Date %a 3 l 9 i 4'; y CE - 8801
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # 0'0 -171-S3 HAA # ,/-/W 6'��Z613
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 2A7 Mock 4A. Eag& Riven Midheiaht4
Location (address or directions)
10029 Bai jin
(b) Property owner Pe1212eIS Telephone: (home) Business
Mailing Address P.U. Box 336, Eaqee R,LveA, AL 99577
... - .:'.::.» .;:..yXy.'fSIF_bUrly \T-.•N-�n.-�, f�9� .. ti' � , res�..v'.�:::9c::��:Y:;wF:�6.i1 ..i ,. r.:.Ziav:K�i-tM.>&Y- W .:�._a.r.:T}-�-..,.
(c) Lending Institution Telephone
Mailing Address
(d) Real Estate Company and Agent Gheat.Pand RonDty- Kathq Poppe_
Address P_0_ Rnv 433, FagPe 12juP&,A�„ 99377
Telephone 624-9 J 2�
(e) Mail the HAA to the following address:,(or check here�V_jf hold for pick up.)
List contact person and day phone number below:
5 & 5 ENGINEERING
17034 Eayle River Lapp Rang No ')04
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single-FamilygX Number of bedrooms 4
3. WATER SUPPLY
Individual Well 2< Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ❑ Public qX Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION .
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firr% Telephone
Address 17034 Eagle River Loop Road No. 204
Eagle Mver,
Alaska 99577
Date
The pxopenty owne_n wishes .the HAA .iAsued on
June 5, 1989 to be ammended box a bout bedroom
xe/s.idence, a3 ahown on page 1 ob -th.id bonm.
Ab can be seen bnom the pn.eviou.6ty .6ubm.itted a
checUheet, the pnopenty meets the nequitemen s �� .•••'• •�;�;�
bon a bout bedhoom %esidence., �►�a�.'` ••�•,'i o
0 ...........r .
• lbbod A. Shwim
J, ••� No. 1457 fi ? j
+.•� ••• ••,.N�zbOf
yr, w•,•»�..•� A&
6. DHHS APPROVAL
Approved for bedrooms by Date �/P�,��"
Approved Disapproved Conditional
Terms of Conditional Approval ,f
1V4rtQ ,' EF��'�T� � z Ca7d o �It•.rl�� � : Uuil�i�evi skriC S �!6 t9i?
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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
oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # i��n'�� I '"� — HAA # k� 1�`� 1� ^1
1. GENERAL INFORMATION (Must be completed prior to submittal) p A Q yl
(a) Legal Description (include lot, blo k,subdivisions ctiol, township, ange), I 1- �i SSS p ` A-DC-
I
Location (address or directions)
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address
Telephone: (home) Business
Telephone
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here ;�,# hold for pick up.)
List contact person and day phone number below:
5 & 5 ENGINEERING
17034 Eagle River Loop_ Read ire '1C4
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single -Family. Number of bedrooms
3. WATER SUPPLY
Individual Well Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ❑ Public Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm 5 ENGnNEFRtNG Telephone
17034 Eagle Riv*r Looe Road No. 204
Address , e r Al2ska99577
Date
No. 1c574
a
til. `U!'", :` = '..0 •'!.�
6. DHHS APPROVAL—
Approve d for bedrooms gate
Approved ___ Disapproved y1 . Conditional
Terms of Zonditional Approval ZZLAL _
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
, 10LINICIPALITY OF ANCHORAGE (MOA)
�t Health Authority Approval (HAA)
��2P��p� CHECKLIST - FEBRUARY 1984
w�'0�9 343-4744
e0v219
O Legal Description: �
,O,
��
A. WELL DATA
Well Classification c) \J1 cpj'^� If A, B, C, D.E.C. Approved (Y/N) T
Well Log Present (Y/� � Date Completed ^" 4�I'I 1` Yield Z 6 P?rl A- v�
Total Depth IFIL Cased to 11c� 4 Depth of Grouting
Static Water Level �2�j-r / Pump Set AtyIL.
Casing Height Above Ground 2 '( Sanitary Seal on CasingQ)55N) V 1)
Electrical Wiring in Conduit$/N) `1 Depression Around Wellhead (Ydo rA
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ra /� ; On Adjoining Lots /A
To Nearest Edge of Absorption Field on Lot A ; On Adjoining Lots J
To Nearest Public Sewer Line `Jb �; To Nearest P blic Sewer Clean out/M nhole
r
To Nearest Sewer Service Line on,Lot ?moi
Water Sample Collected by /�-�G lr�E�L-ir�G ; DateZSR 8
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N)
Depression over Tank (Y
Size No. of Compartments
Air -tight Caps (Y/N)
Pumping/Maintenance Contact on File (Y.
Holding Tank High -Water Alarm (Y/N)
Foundation Cleanout (Y/N)
Date Last Pumped
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments
;for
Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
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
Statndpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Aban-doned System on
On Adjoining Lots
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments 1" 1 o rJN ['t ee�= ,
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
— "Pump Off' Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test.
"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
inspection.
J
Signed 5 &6 ENGINEERING
Company 17034 Eagle River Loaf ice;.., 3. . 204
Eagle River, AIRSKU
Date
MOA No.
Receipt No. :� // 0 3 `
Date of Payment ! ,
Amount: $ y ey
Receipt No. —
Waiver Fee: $ —
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
$�tert � 1h�pE•
NO +45741 01
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Received December 26, 1973
Time of Inspection Morning
Date of Inspection 127/73
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
VA
1. Approval Requested By: CMTIFVls RFAITV
Address: Phone:
2. Prooertv Owner: rharlpz Rarr Phone: 694-2767
3. Legal Description: Lot 2, Block 4A Eagle River Mid Heights
4. Location: Baring Street
5. Tvpe of Facility to he Inspected:^ Single Family Dwelling
Number of Bedrooms: Three (3)
6. Well Data:
A. Tvne Drilled
C. Construction Standard
7. Sewage Disoosal Svstem:
B. Depth 147'
D. Bacterial Analysis Satisfactory
A. Installed 9. Installer Self
C. Septic Tank: 1. Size 1000 qd1%• Manufacturer Sp.lf-mads
D. Seepage Pit: 1. Size 17'X13' 2. Material Concrptp Rlnrkc
E. Disposal Field: Total. Length of Lines
8. Distances:
A. Well To: Septic Tank 70Absorption Area 95� , Sewer Lines
Nearest Lot Line Other Contamination
3. Foundation to Sentic Tank Absorption Area
C. Absorption Area to Nearest Lot Line
aeq.le�t for Approval of Inoividual Sewer & Water Facilities
Pale Two
9. Comments:
s
rinnrove /C•IAC Disapproved Date � ? T
Approval Valid for One Year From Date Signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
1 certiry that the information contained in this request for approval to be a true
and accurate representation of the suhiect sewer and water facilities located at:
Signed
Date
March 31, 1970
Mr. Charles S. Barr
Box $41
Eaafle River, Alaska 99577
Dear 'sir. Barr:
SU ZLCT: Water and Sewer Systems
to Serve Six (6) Bedroom Duplex on
Lot 2, dock 4A, eagle River Mid
Heights Subdivision
The1.
Greater Anchorage Area Borough }health Department has checked
our files regarding individual water and sewer systems in the
area of the subject property. The following was found:
Water - An approved well can be located on the subject lot and
will provide adequate supplies of potable rater. The
well depth will most likely be from. 90 -loo feet doep.
Sewer - An adequate otic tank -seepage pit system can be located
on the subject lot. A permit for the installation has
been obtained. A soil test must be subMitted to this
office yet to determine the size of the seepage pit.
Sincerely,
CI.Irr-O2D F. ,TUiKINS0 R.S.
Administrative Director
BY
Rolf P. .tr C a , P.S.
Environmental Health Supervisor
RRS:rn
