The URL can be used to link to this page

Home My WebLink AboutEAGLE RIVER MID HEIGHTS BLK 4B LT 20agle I ive Mid-Height lock 4 Lot 20 050- 271 -30 ~AR--25--99 THU 1~01 AM KN~.E~I~EERI~ 90? 696 8111 P. 02 by SULLIVAN WELLS P,O. BOX 670272, CHUGIAK, ALASKA 99~67 · TELEPHONE ~88-2759 OWNER OF LAND BORE HOLE DATA DEPTH ADDRESS LEGAL DESCRIPTION 23a~._ 4 ~' PERmiT NU BE Date o, ,ssue_ T_- '/ · .,. '. ' ~.'~'-"~'. '. ~ ..... ~"6~:~ '"" 'y~ iNDENTIFICATION ~OMB~ - ' Meth'bd of Drilling:" - ., ~r r°ta~ ~ cable t~l Depth of we,: t'6~; ', ".., Casing Type $'r'_~? ~__Wall Thickness . ~,~'~ inches Diameter ~,~ l~ inches, depth_ //-,~ feet Uner Type: _ Casing Slickup Above Ground: ~ feet Static Water Level (from ground level): it ,,~ b __ feet Pumping level: . ._feet after_ hrs. pumping gpm Recover Rate: _.. IO~. gpm Method of Testing: /~ 1 ~) Well Intake Opening Type: ~;~'End ¢1 Open Hole ~ Screened; Start feet Stopped feet [~ .pefforatioQs Start__ ; feet. Stopped, ,= , feet Grout Type:~. ~T~MI T~ _~oiume Depth: from_ (~ feet, to '" feet Pump intake Depth: feet Pump Size__. _bp Brand Name Well Disinfected Upon Completion? ~ No Method of Disinfection; RECE,w,=r', i v Li.,/ - APR 1 1999 MUnicipality of Anchorage Dept. Health & Human of Anchorage: Department of Health & Human'Services and/or Department of Environmental Conservation, MatSu Bor6ugh: Oepartment of Environmental Conservation. PM KENNETH ~ LAN~ L.ol 20 19,7~ s,f. Lot \ MAR--25--99 01 1 158.27' EAGLERIVERROAD P.O1 PLOT PLAN ASBUILT ~- SCALE ~' ' 3o' GRID NW 5Z Projeof No. e8-~ ~4 K....,hn i .,~,,~ 1731 George Bell Clrele, Anchorage, Alaska 99515 ~,,.,~.E, v* ~w~ (Q~7~ ......... XZK--R4.6 ~ Phofle Registered Land Su~eyor {907) 345-4625 Fax I hem~ e~fy ~t I h~e ~ ~e f~bwl~ ~d~ pm~ ~ b h G~Ii~ of ~ ow~r b d~e~lne h ~l~nce of any PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUlVL~N SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHOI~AGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PER/EIT PERMIT NUMBER:SW980098 DESIGN ENGINEER:DUMMY COMP~qlN-Y 0WNERNAME:NOP, MAN EDWARD M & RUTH A OWNER ADDRESS:10012 BAFFIN ST EAGLE RIVER, ALASKA 99577 DATE ISSUED: 5/07/98 EXPIRATION DATE: 5/07/99 PARCEL ID:05027130 LEGAL DESCRIPTION: EAGLE RIVER MID HEIGHTS BLK 4B LT 20 LOT SIZE: 19785 (SQ. FT.) NT3MBER 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 AN-D THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18D2kC72) AND DRINKING WATER REGULATIONS (18AACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOT/RS 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 SDi~IE DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ISSUED BY: ~ lOP .............................. Post-It" brand fax transmittal memo 7671 [# of pages '°~ ~ ~,~.~ ~ ~ c~.~./~./t. ~./9~ ,..,. ,Vayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 March 3, 1995 Edward M. & Ruth A. Norman 10012 Baffin Street Eagle River, AK 99577 Subject: Lot 20, Block 4B, Eagle River Mid Heights Pemdt #SW940037, Parcel ID ~)50-271-30 Dear Edward M. & Ruth A. Norman: The subject permit, issued February 24, 1994 by this office for a single family well and/or on-site wastewater system, has expired as of February 24, 1995. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If the on-site wastewater system has been completed and a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of conslxuction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well pemdt. If you have any questions, please call this office at 343-4744. erely, //~ Jpmes Cross, P.E. Program Manager On-Site Services JC/kb cc: Robert C. Cowan, P.E. PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW940037 DESIGN ENGINEER:ACUMETRIX CORPORATION OWNER NAME:NORMAN EDWARD M & RUTH A OWNER ADDRESS:10012 BAFFIN ST EAGLE RIVER, ALASKA 99577 DATE ISSUED: 2/24/94 EXPIRATION DATE: 2/24/95 PARCEL ID:05027130 LEGAL DESCRIPTION: EAGLE RIVER MID HEIGHTS BLK 4B LT 20 LOT SIZE: 19785 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (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 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE: ~ - 2~ - ~'~ \ / LOT 79 / '~ I PR ~ : 44.5 ~ , / ~,~ ~~. 15828:::: ~~ ~~t ~ N 89'58'25" W . s.s._~.,.~ ~ ZONED R- lA FRONT = RO' ~ ~ S/DZ = ~' ~ITE ?LAN REAR = 10' ~: SHT ~ OF ~ ~ NOTE: ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE. ~ % ~ ~ ~ACUMETRIX CORPO~TIO~ ' MID--HEIGHTS SUB. 4900 PALM/R-WASILLA HWY., SUI~ 3 WASILLA, AK 99654 .~~~~ ~ (907) 376-8800 FAX (907)376-Be29 .~ ~ ~ DA~: J~ NUMBER: DESIGN ~eo ~-' ~ ~ DRA~: CHECKED: ~%~,:;,,.,: (MUNICI:ALITY OF ANCHO~ 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 (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D: 050-271-30 1. GENERAL INFORMATION Complete legal description Expiration Date: Eagle River Mid-Heights S/D, Block 4B, Lot 20 10012 Baffin Street, Eagle River, Alaska Location (site address) Current Property owner(s) Mailing address John Bonaventura Day phone 694-2967 10012 Baffin Street, Eagle River, Alaska, 99577 Lending agency Mailing address Day phone Real Estate Agent Mailing Address Audrey Mason Day phone 11525 Old Glenn Hwy, Eagle River, Alaska 99577 622-3344 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 [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site 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 Douglas T. Kenley, P.E. Phone (907) 746-1073 Address 9806 NoKhstar Cimle, Palmer, Alaska 99645 Engineer's Printed Name Douglas T. Kenley Date la. I~'./e DSD SIGNATURE ~/'J Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipu Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X By: (Rev. 11105) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ~_~~Original Certificate Date: Municipality of Anchorage 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: Eagle River Mid-Heights S/D, Block 4B, Lot 20 Parcel ID: 050-271-30 A. WELL DATA Well type Pdvate If A, B, or C provide PWSID #~ Date comPleted 05~23/98 Sanitary seal (Y/N) Y Total depth 166 ft. Cased to 166 ft. FROM WELL LOG Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION Y 16 in. Date of test 05/23~98 120 ff. 12 g.p.m. 10/14/10 Static water level Well production WATER SAMPLE RESULTS: 120.1 ff. 5.1 g.p.m. Coliform Negative colonies/100 mL Arsenic: ND mg/I B. SEPTIC/HOLDING TANK DATA Nitrate ND mg/L Date of sample: lO/O5/lO Other bacteria colonies/100 mL Collected by: F. Kenley Tank Type/Material Tank size gal. Number of Compartments ~ouni:l~tion. clean, ut (Y/N) Depression over tank (Y/N) D~te of,primping Pumper Date installed Cleanouts (Y/N) High wate~ C. 'ABSORPTION FIELDDATA .Date installed Soil rating (g.p.d./ft2 or em type Length .ft.' Width f ft. Gravel below pipe Total depth ft. Eft. ab~ ~ Monitoring tube Date of adequacy test f~Results (Pass/Fail) Fluid depth, in abso~iO~eld before test in. Water added ..EIa~: min. Final fluid depth in. ~y' rrejuvenation treatment (past 12 mo.) (Y/N & type) Depression over field For bedrooms gal. New depth Absorption rate >= If yes, give date in. g.p.d. LIFT STATION Date. installed "Pump on" level at __ in. Dctum Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main 75+ ft. Sewer/septic service line 25+ ft. Animal containment areas 50+ ft. Size in gallons Manhole/Access (Y/N) "Pump off" level at ' 'wa er alarm level at Meets alarm & circuit requirements? On adjacent lots lOO+ ft. On adjacent lots lOO+ ft. Public sewer manhole/cleanout lOO+ ft. Holding tank N/A Manure/animal excrete storage areas lOO+ ft. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line ~ Absorption field Water main Water service line Surface water on adjacent lots ~ Wells SEPARATION DISTANCE FROM ABSORPTION FIE~ TO: Property line ~tion~ Water main Wate~ Surface water Driveway, parking/vehicle storage ~n drain Wells on adjacent lots F. COMMENTS: G. ENGINEER'S CERTIFICATION I ce~ify that I have datelined though field inspections and ~view of Municipal ~co~s that the above systems am in .... - · conformance w, th MOA COSA gu,defines ,n effect on th,s date. Engineer's Printed Name Douglas T. Kenley Date COSA Fee $ ~ ~ Waiver Fee $ Date of Payment / ~ ~ Date of Payment Receipt Number ~ ~ ~ ~ ~ Receipt Number (Rev. 11/05) SGS Ref.# 1105380001 Client Name Douglas Kenley P.E. Printed Date/Time 10/14/2010 12:29 Project Name/# E.R. Mid Hts S/D, B4,L2~ Collected Date/Time 10/05/20 l0 I7:37 Client Sample ID Outside Hose Bib Received Date/Time 10/06/2010 9:10 Matrix Drinkin~ Water Technical Director Stephen C. Ede Sam¢le Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/07/10 10/13/10 NRB Waters Department Total N itrate/N itrite-N ND 0.100 mg/l. SM20 4500NO3-F B (<10) 10/08/10 AY(' Microbiology Laboratory E. Coli Tolal Colilbrm Ne,e, ative I 100mL SM20 9223B A 10/06/10 I)I.C Ne~zativc I 100mi. SM20 9223B A 10/06/10 I)LC 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 GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Day phone Day phone Mailin. g address Agent Address Day phone e Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 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: × If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-~25 (Rev. 1/91) Front MOA lit21 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 was~ewater 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 Address Engineer's signat~~ Phone ~'o 7- ~'& -~/// Date DHH$ SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date "¢ -2 - ~ 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 DH HS 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 d° 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. R CEIVEu Municipality of Anchorage MAR 2 6 1999 DEPARTMENT OF HEALTH & HUMAN SERVL~iPALiTY Ol: AN(:tdU~A Environmental Services Division ENVIRONMENTAL SERVICES DIVI3~/_~_~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: _F~dx ,~,~- /~,-~ /,/~. ~'/~ /'/~/. Z-/-2/2 Parcel I.D.: A. WELL DATA Well type ~l~v',~, ~ Log present (Y/N) Total depth /~ / Sanitary seal (Y/N) y Date of test Static water level Well production /~' WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ ~'/,~ Cased to /~ / Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG i~ ~) ~ AT INSPECTION g.p.m. / g.p.m. Nitrate ~). ~'~' Other bacteria Collected by: Date installed Foundation cleanout (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Tank size Number of Compartments Depre~ High water alarm (Y/N) Pumper Date installed Soil rating (g.p.d./ft~ or fta/bdrm) System type Length Width Gravel thickness below pipe ~ Effective absorption area Monitoring Tube ~on over field (y/N) _ Date of adequacy test Results~--a~FFail) For absorpt~ Immediately after gal. water added (in.): Fluid depth in Fluid depth / (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (y/N) If yes, give date .bedrooms 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested Size in gallons ~ "Pump on" level at* __._---~p off"level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on iot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line Absorption field Water main/service line .Surface water/drainage Wells on SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT .'..T.Q~''~ Property line Building fou~~ Water main/service line Surface water ~ ~ Driveway, parking/vehicle storage area Curtain drain Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspec#ons and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature ~ Engineer's Name ~_~,~,-~F, ",~x rec~th~ ~"t~ystems are HAA Fee $ ~- ' Date of Payment Receipt Number Waiver Fee $, Date of Payment Receipt Number 72-026 (Rev. 3/96)* ' MAR-Z4-OO 00:08 FROM'CTE ENVIRONMENTAL ,~ CT&E Environmental Semices Inc 5615g0i T-56g P.OZ/O5 F-10g CT&E Ref.$ 990979001 Client Name KND Eugiuccrin§ Project Name/$ N/A Ctiem Sample ID E.R. Mid H~ Baffm 10012 Matrix Drinking Water Ordered By PWSID 0 S~mple Remarks: Client POt/ ~ Date/Time 03/23/99 11:46 Co]lee~ed Date/Time 03/16/99 13:00 Received Dale/Time 03/16/99 14:45 Technical Director: ~ephen C. Ede Parameter ResuLts PQL units AttowaDle Prep Anatysis Totat coliform ~ateru Departme~nt AnaLy~es Nicrate-N 6 OB/lDO eL, NO COLI 0.665 0.$00 ma/L SH18 EPA 300.0 03/16/99