The URL can be used to link to this page

Home My WebLink AboutEAGLE RIVER MID HEIGHTS BLK 4B LT 17 APF:'L.. I CANT ADDRESS: ...... t~,r,:.,t F:'HONE: S I GL. IEI:;:CONST, ].3040 BACK RI]AD ANCHOFW-~,GE, AK 995 15 345'-;~216 GL!BI)tVISION: EAGLE RIVER M]:D.-...HTS, LOT: 17 , OW ..... ~I!::': 14N F.Ah.,G ..... :.W SECTION: :1.:.2 T ~ .~ .~, ~ ~_~::. .'~ '75()0 (SQ. FT. OF;'. ACRES) BL. OCK: 4B I cer'ti£v '~'""'*'~'" ,~'c:~-'Lln by the Mun~c:i. palit'.,,;' oF Anchc~par...)e d'l,.,~-.~,- ar'id the State 2. I w:L 11 :.ns'La].' l the system. :i.n ac:ccH-dancc~ ~J.'~.l"~ al. t MOA (:cx~r~ ~:~,-.,-~,4 , ..... ,,~bu.,.a~" ~ · + :Lc:n:~,~' 3,, ..T ~,-i.,...~.~.~ ~ ad!']~me., t(] all MOA and State ,mr Ai.a!~ka r'equir~eme~r'~t~ for "~-'-,., ~.~ .~:s(e'L ._hack , . ~'~ ............................ ~-&~.-.-..¢.-...~.-t.,- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~') ,~"~ - ,Q "-I \ - ,.~.'"~ NAA# 1. GENERAL INFORMATION Complete legal description Lot 17; Block 4~ Eagle River Mid Heiqhts Location (site address or directions) 10110 Baffin Street Property owner Mailing address Lending agency Mailing address Virginia Ropp 10110 Baffin St. Eagle River, Day phone AK 99577 Day phone 694-8574 Agent Sam Gimelli/ MARSTON PROPERTIES Address 4105 Turnagain ANchorage. AK Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well ×XX Community well Public water NOTE: Day phone 248-1717 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX 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 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 inves_ti_gation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm _S_&_ _S I=NG!NEEE~I~ ,su.~ ~:~g~e~Riv,r L~ Road Ne. ~::::r's signature Eagle Rl~, DHHS SIGNATURE Approved for /--~c~'_L~/ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: -! Additional Comments Date 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-O25(Rev. 1/91) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description.'~o~ \"] ~.-~/-'¥~ ~...-~,~t_~'J ,l~arcel I.D. A, Well Data Well type ~;;)~-~'.J/:,<~ ~.~ If A, B, or C, attach ADEC letter. ADEC water system number Log present~/N) ~, ~/ Date completed ~O~7--L~:.~ Driller ~-~.~ Total depth \ V, ~, Sanitary seal (~N) Date of test Static water level Well flow Pump level1 Cased to 1 L,,\~ Casing height ,./ Wires properly protected ~N) FROM WELL LOG AT INSPECTION \O.O ~,~ -r'. g.p.m. Septic/holding tank on lot Absorption field on lot Public sewer main SEPARATION DISTANCES FROM WELL TO: ..Sewer service line ~ \ ~ WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate B. SEPTIC/HOLDING TANK DATA ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout ~ -t~-,:, Petroleum tank ~ ~" \'~ Collected by: Other bacteria C) $ & $ ENGINEERING 17034 Eagle Ri,v~' Loop Road No. 204 Eagle Ri~er, Alaska ~57'/ Date installed Tank size Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depre~ High water alarm (Y/N) Date of pumping SEPARATION DISTANCES FROM SEP_.~:~DING TANK TO: Well(s) on lot ~adjacent lots Foundation To ~ Absorption field Water main/service line Surface water/drainage 72.026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level S~Coo~ ~Meets MOA electrical FROM LiFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) Surface water D. ABSORPTION FIELD DATA Date installed Length Total absorption area Date of adequacy test Width Soil rating (GPD/FF) Gravel thickness Cleanout present (Y/N) Results (pass/fail) Water level in absorption lield before test Peroxide treatment (past 12 months) (Y/N) · SEPARATION DISTANCE FROM ABSORPTIO~Q.N'q~ELD TO: Well on lot ./On adjacent lots To building foundation On adjacent lots ~ Cutbank E. ENGINEER's CERTIFICATION .System type .~ .Total depth ~ Depre~eld (Y/N) .~for Bedrooms ~lter test If yes, give date Property line To existing or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area ~ J 17034 Eagle River Loop R~ad No. 204 J / Date / ~ Eagle River, Alaska 99S~' .~,//. ~'~//~'~ HM Fee $ / 7 Date of Payment Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back COMMERGIAL TESTING & ENGINEERING CO. ~.NVIRONMENTAL' LABORATORY SERVICES ... ! ~ REPORT Of AN;~L%[SI~ 5~ ~ STREET - aNCHORAGE. AK 99518 TEL: 907) 562-:~343 FAX; (907 561.530t chemlab Ref.~ :93,3365-[ Client Sample ID :L17 B4B E.R, MID - HTS, . Matrix :WATER :68269 :S & S ENGINeeRiNG ~ORK order Report Completed :07/~6/93 :RAY Collected :07/~2/93 Received :07/[3/93 @ [7t00 Technical Direct°r~$T~~E~E client Name @ [4:20 hfs ordered By hfs project Name : Pro~ect~ : P~SID :UA Sample Remarks: ROUTINE SAMPLE-~['~'~CT~D ~Y: R~Y. AllOwable Ext. Anal QC ~imits Date Date Init Parameter ResultE Qual units Method .... 0.26 mg/~ EPA 353.2/300.0 10 07/~5 ~L~ Nitrate-N NA ~ Not Analyzed ** See Sample Remarks Above U = Undetected, Reported value i~ the practical quantification limit, LT = Less Than GT ~ Greater Than D = Secondary dilution. ~ Ii~ll~l~ Member of [he SCS GrOUp (Societe G,~r,le de Su~,eillance) ----- --ENVIRONMENTAL SERVICES tN ALASKA, COLORADO, UTAH, ILLiNOiS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, sOUTH CAROLINA 09:42 CT&E ENUIRONMENTAL LAB SERUICES i;,' NO. 719 COMMERCIAL TESTING & ENGINEERING CO:'AK DIV "~ CHEMICAL & GEOLOGICAL'LABORATORY TELEPHONE (9o7) 562-2343 5633 B Drinking Water ~nalysi$ Report for Total Coliform Bacteria r"l PUBLIC WATER sySl'F.M I.D. ~ PRIVATE WATER SYSTEM TO BE COMPLETED BY WATER SUPPLIER p~ne No. S & S ENGINEERING 17034 Eegle River Lee_o Roa~d Ne:"J~d E~g~e Riv,r, Alad,~ t~.~ ~- ' SAMPLE DATE: [~F'~--~ ~'~""'T--'-'Z~ Mo. g~y SAMPLE TYPE: t~ Routine n Check Sampte (for routine ~ample with lab ref. no. ) [] Special Purina. ea SAMPLE No. LOCATIOH [] Treated Water I~ Untreated Water ,,J Time Co, Feared Collected 8y TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to b~: ,~atlsfactory [] Unsatisfactory Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results, Pleaae send new sample via special delivery mail cate Received '/I,'~ Time Received ....... 1'7C~(") Analyt~al Method: Membrane FIItm' No. of ~tonies~100 mi. Lab Ref. Ne.Reeult* I I FT~ Anelyet READ INSTRUCTIONS ~ BEFORE COLLECTING SAMPLE TNTC OB = Membrane Filter: Direct Count Verification: L,gB F~I Coliform C~nflrmatlon Final Membrane Filter Re~ult~ -- ?oo Num,r~u$ To Count Other Bacteria BACTERIOLOGICAL WA] , ,[ ANALYSIS RECORD BGB Member 0f tl~e SGS G~0~ ISoci~ Collterm/10O mi ~311farflVlO0 mi o,,. 7 PART ONE OF TWO REMAINDER TO FOLLOW TO TOTAL P, 02 · MUNICIPALIT~f OF ANCHORA~E . DIVISION OF ENVIRONMENTAL ~n~.ALTH DEPARTMENT OF ~a~LTH ~ ENVIRONMENT~L PROTECTION APPLICA2ION FOR ~f~ALTH Ab~fHORITY APPROVAL CERTIFICATE 1. Info.=rio. Applic,tion Dat. Location (addr?ss or dire~tions) . ' ~ (b) Applicants Name/~v~ ~C~,-~,/ Telephone - Home Business ! (c) Applicant is (check one) Lending Institution ~--~; Owner/builder ~ ~yer ~; ot~er ~ (~la~n); Address (e) Real Estate Co. & Agent Address Cf) Telephone ~t& HAA to the following address: T~e of Residence Single-Family~ Number of Bedrooms Multi-Family~--~ Other (describe) Water Supp17 Individual Well ~ Community ~--~ Publ,c ~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservatiou~attesting to the legality and status. Sewage Disposal 0nsite ~-~ 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 I of 2] Firm Providing Inspections~ Testst File Searcht Data and Information Certified by my seal affixed hereto and as of the validation date sho~a below, i verify that my investigation of this Health Authority Approval shows that the om-si,.e water supply and/or wastewater disposal system is safe, functional ami adequate for the r.,mber 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 wsstewater disposal system is in compliance with all M~nicipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Address Date DHEP Approval Approved fo~-~ bedrooms Approved /~- Disapproved Terms of Conditional Approval CADTION THE Mb-NICIPALITY OF ANCHORAGE DEPARTMENT OF R~.ALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES ~.ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE RF~PRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGLNEER REGISTEgF, n IN THE STATE OF ALASKA. TH~ DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AL'D T~EIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. ~MPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR AaNALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DaEP RZ4/eJ/D18 [Pase 2 of 2] 7-19-84 ae Well C lass i f icatio~/6]6~ ~ Well Log Presen~?~ Total Depth /~ / ! Cased to Static Water Level ~'~ Casing Height Above Ground 30 Electrical Wiring in ConduitS/N) JNICIPALITY (DF ANC~ DEPT. OF HEALTH & MUNICIPALITY OF ~%NCHORAGE ([~NVIRONMENTAL pEOTEC~IO~ ~T~ ~O~T~ ~PP~Wn (~) MAR ~ g 1985 CHECKLIST - FEBRUARY 1984 Legal Desc r~ip t/-oi If A, B, c~ C, D.E.C. App~ove~) ~ . /D / Depth of G~outing Pump Set At ~ /~ Sanitary Seal on Casi Depression A~ound Wellhead (Y~/ Sepa=ation Distances f~cm Well: ~/~ /~///~ TO Septic/~ Tank cn Lot ; On ~djoining Lots · o Nea ,t of tion Field LOt , On d:oi ing LOts TO Nearest Public Sewer Line ~-- ~ To Nearest Public Sewer Cleancut/Manhole /(~LD ( ~ To Nearest Sewer Service Line on LOt Water Sample Collected By~ ~'~F~f//TW~//~; Water Sample Test Results ~h 7~~'/~ d-~-~/~ ~ B. SEPTIC/HOLDING TANK DATA Date Installed Size No. of Cu~%~a~tm~nts Standpipes (Y/N) Air-tight Caps (Y/N~_ Foundation Cleanout (Y/N) Dep~essiOn Ove= Tank (Y/N)act cn F?l~e~) P~d Pumping/Maintenance Contr ' ~ / Holding Tank High_Wate~ Alarm (y/N) / _~~i~ Tank ~t (Y/N) D' tances f~cm Septic/Holding T~nk: ' Separation ~s To Water-Supply Well To Building Foundation To P~operty Line To Disposal Field To Water Maip~Service Lir~ To S~eam, Pond, Lake, c~ Major Drainage Cotu~se [Page 1 of 2] Receipt ~ Date Paid: Amount: 2-15-84 C. ABSORPTION FIELD DATA De Soils Rating in Absorption Strata Date Installed of Field Square Depression Results of Separation Distance To Water-Supply Well To Building Foundation Lot of Absorption A~ea Field (Y/N) Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present Date of Last Adequacy A~sc~ption Field: To Line ; On To Water Main/Service Line To Stream/Pond/Lake/c~ Major To Driveway, Parking Area, Co~tnte, nts To or Abandoned System Cutbank( if present) LIFT STATION Date Installed Size in "lam~p On" High Ccattt~r~ts at Alarm Level at Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles drying Adequacy Test. ** Check Permitted Bedrocm Rating Against HAA Request I certify that I have checked, verified, or confc~L~ed to all MOA HAA Guidelines in effect on the dg~.~te~ ~. C~gany ............... KB1/d5/s [Page 2 of 2] 2-15-84 HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: water System Name Mailing Address . / Mo. Day Yem' SAMPLE DATE: SAMPLE TYPE: ~outlne [::] Check Sample (for routine sample with lab ref. no. l-I Special Purpose [] Treated Water .~{:~Ontreated Water SAMPLE Time Collected NO. LOCATION Coll.t. 4I I TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: /~Satisfactorv [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. "2.- ,/ '~ ~ _ Date Received ' .- Time Received -~ Analytical Method: [] Fermentation Tube ,_[~ -Membrane Filter Lab R~f. No. Result* Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE Membrane Filter. Direct Count Verification: LTB 8GB Final Membrane Filter Results Reported By '9 ' /'~/ ' i ,/; ~ Dale ./ Time: CollformllOOml CollformllOOml COLLECTING SAMPLE TNTC-- Too Numerous To Count