HomeMy WebLinkAboutEKLUND #1 BLK 4 LT 11
/~ ' '~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME IP H ON-'~
LEGAL DESCRIPTION
Wel, . I~b.rptio~eb Dwe~~.~ PERMIT NO.
~ ~ < z M~n,~t,,,~ ..~~ M~ No. o~,~tm~t~
~ ~ bi~ depth
Liq. capacity in gallons Inside length Width
I0~ D ~F HOMEMAD~ ~
~ ~ DISTANCE TO: Well ,~ Dwellinq PERMIT N~,
~ ~ ~ Manufacturer : Material Liquid capacity in gallons
~ DISTANCE TO: ~]~O /~ ~ 7~
Tre~h~idth
Total le,]gth ef liees- ~n lines
~ ~ Z No. of lines Length of e~ne~- Dista
~m ~ ~ . ~ ~ ~-- ~nches Total effective absost~a
~ ~ ~ Top of tile to finish grade/~ . ,viaterial beneath tile G mc..e' ~
Length Widt~ Depth /~ PERMIT~/NO.
~ -Total effective ab
~ Type of crib ~diameter Crib depth ~
~ Well
~ .~E TO: ~ ~u ndation Neares~
. ss . . Depth Driller , Distance to lot line PERMIT NO.~/~
~ ~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO: ~ / OO -~ t
OTHER
PIPE MATERIALS
~ ~ , DATE LEGAL
72-013 (R~.3/78)
PER.'II ¥ NO.
-FFLIL. HN I
F'T [LN
LEGFIL.
[:,EF'RFTMENT OF HEFILTH RN[:, EN',,,'IRONMENTRL.. ~:r't"ECTION ,
' 825 "L~"STREET., ~RNC::H~?:RGE., FtK. 2~9' L ~¢~ ~ /-
........... --~- ~
· - ,,- ... . _ _ c]':M.-;;'~ 09¢ ¢
FIL I..P~z,..N [:,E:FI RUSTI HOM PO 8"'~q 594 ER .......
MILE 10 E. R.
L1t B4 EKLLIND ~1 LOT SIZE 43:500 SQUFIRE FEET
TYPE OF 'S.',OIL RBSOF.:F'TION _'¢zTEH IS: TF..EN_.H
MR,:.:,Irl..H FIJMBER OF BEDROOMS = 2-":
¢' ] 205
.:,L I L F.:RT I NG ( St;! FT/BF.'. ::, =
THE REQUIRED SIZE OF 'THE '=;rtlL HE, z, uRFTI_N .=,t_,TEM IS:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF 'THE TRENCH OR DRRINFIELD.
'T]qE DEP'T'H OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFFtCE OF' THE
GROUN[:, FIN[) THE BOTTOM OF THE E,',:;CR'v'FITiON (IN FEET).
THERE IS NO SET WI[:,TH FOR TRENCHES.
THE GRR',/EL DEPTH IS THE MINIMLtM DEPTH OF GRR',/EL BETWEEN TNE OUTF'"RLI... PIPE
RND THE BOTTOM (]iF." THE: EXCR',/FITION (IN FEET).
FE.,..MIT FIPPLICFINT HRS THE F..E=,FLNz, IE, ILITt TO INFORM ]"HIS [.',EPFIRTMENT DURING THE
le.. .,-,] .,.. ~ ~
INSTAL. LFITION IN'=;F'ECTIONS OF FINY WEL_.:, FID..IFICENT TO ]"HIS FRLPERF'r FINE:' THE
N IHE, E'.F. OF F.:ESI[:,ENCES THRT THE WELL WILL SERVE.
MINIMUM DISTFINCE BETWEEN R WELL FIND RNY ON-SITE SENFIGE DISPOSFIL SYSTEM IS
100 F:'EET FOR R PRIVRTE WELL OR t50 TO 200 FEET FROM FI PUBLIC WELL DEPENDING
UPON THE TYPE OF PL.IBLIC WELL.
MINIMUM DISTRNCE FROM R PRIVFITE I.,.IELL 'TO R PRI'v'FITE SEWER LINE IS 25 FEET FIND
]"0 FI COMMUNITY SEWEF.'. LINE IS 75 FEET.
WELL LOGS FIRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 3:0 DFIYS
OF' '}"HE WELL COMPLETION.
OTHER REQUIREMENTS MFIY FIPPLY. SPECIFICFITIONS FIND CONSTRUCTION DIFIGF.'.FIMS RRE
FIVFIILFIBL. E TO INSURE PROPER INSTFILLRTION.
I CERTIFY THFIT
±: I FIM FFIMILIFIR WITH THE REQUIREMENTS FOR ON-SITE ?.,EWERS RND WELLS RS SET
FORTH E;Y THE MIJNICIPRLITY OF FINCHORFIGE.
2: I WIL. L INSTRL. L THE SYSTEM IN RCCORDFINCE WITH THE CODES.
3:: I UNDERSTFIND THFIT TNE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IP THE
RESIDENCE IS ?.EMODELE~, TO INCLUDE MORE THRN 3: BEDROOMS.
/7/t--
..... . ................. : ........
RPF'LICRNT ~L L. RRSON DBR RLtSTI HOMES r1 .
,:.,:. .., ,, .,- " v4. e
~ 0 & E ENG,,~IEERING & DEVELO~ MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
594-2774 or 688-2280
Russell Oyster
694-2774 SOIL LOG
Performed for: Name: //~ /~ L~,~.~'J
Mailing Address:{~<~)- ~ ~ ~/. e~ ~V~t ~/~ ~*~r7
Depth (feet)
Soil Characteristics
9__
10__
Earl Ellis
688-2280
Tel. No, ~9~- 2~7
PLOT PLAN
11__
12__
13__
14__
15__
16__
Ground Water Encountered: Yes
PERC, TEST
-_ ~~/~
what dopth
Proposed Installation: Seepage Pit Drain Field.
Comments: ~0~ J~"~-~t,~' ~'~:~9 ~"' /--~J
Pe,ormed by: ~'; ~~'~,
by
DOC Co. d0a
SULLIVAN WATER WELLS-
P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELI::PHONE 688-2759
OWNER OF LAND
ADDRESS ~2 c~;
LEGAL DESCRI~ION
DATE - Sta.ed ~;/):/f [ Ended
PERMIT NUMBER
DEPTH OF WELL /0 0
STATIC LEVEL OF WATER FT.
DRAW DOWN FT. 7 0 '
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From (~ Ft. to ~ Ft. ~t.,C-~ ~.~.~,~, ~a'~.~
From ~J~ Ft. to ~ Ft. ~&~ ~ 6~
From ;?~ Ft. to ~O Ft. ~ ~C ~
From Ft. to Ft. ~ C ~ ~
From c'f7 Ft. to [Ol ,Ft. 7~~ ~~ ~
Fromm. Ft. to Ft. ~ ~ ~
From Ft. to ___Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft,
From Ft. to Ft.
From Ft. t~ Ft,
From Ft. to___. Ft.
From Ft. to Ft.
From Ft. to Ft
From Ft. to Ft.
From Ft. to Ft._
From___Ft. to Ft._
From Ft. to Ft,
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From__Ft. to Ft.
From Ft. to Ft.
From Ft. to ,Ft
From__Ft. to Ft..
From Ft. to , Ft.
From Ft. to Ft.
From__.Ft. to .Ft
From__Ft. to Ft.
From Ft. to__Ft.
From Ft. to Ft.
,cd'
MISCL. INFORMATION:
DRILLER'S NAME
4?9
•
• 13,
• �.-'-e Municipality of Anchorage (
On-Site Water and Wastewater Program Mil i
(907) 343-7904 S a e
Certificate of On-Site Systems Approval
Parcel I.D. 05054107 49- <Expiration Date: / r /0
1. GENERAL INFORMATION
Complete legal description EKLUND #1 BLOCK 4 LOT 11
Location (site address) 4458 KOGRU
Current Property owner(s) MIKE ROBICHEAU Day phone
Mailing address
Real Estate Agent Day phone
6189 0
5 17
2. TYPE OF DWELLING:
111 Single Family (w/wo ADU)
❑ Duplex o- MAY 18 2018 3
❑ Multiple Dwellings (Single Family and/or Duplex) ..6.. ti
w
c.
3. NUMBER OF BEDROOMS: 3 �� 01 6 8 i,`'��
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual E
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: NONE
Distance:
Received b . �� ....- .: Date: ( 5' (5
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 5ot1.c) Waiver Fee $
Date of Payment 5/21111 Date of Payment
Receipt Number O251l 'C) Receipt Number
COSA# OSC t 12J' 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 C&M ENGINEERING Phone 854-5558
Address 30840 PRUDHOE BAY AVE
Engineer's Printed Name CHARLES BALZARINI Date 5/12/18
OF AL4k‘tt
6. DSD SIGNATURE * 49T
, H '% %�- ���
•
K System #1 Approved for .3 bedrooms -'
•
System #2 Approved for bedrooms �+ ck-
� HARLES G BALZARI 5
Disapproved #$F C 1 6 • o
Conditional approval for bedrooms, with the following s?l .N48,4FESSIO�A
**- -t-e/CAA, 12-6 C*0try4C (1-V-e41-,
A-,0-17_et, (7,0d%a S` ( S �r� k(C. Cc Z—O Pavr e(9L()
vC
• •
ryG
. ••• ONSITE
WATER AND r''
a WAS I EWATER o•
T PROGRAM �c
C'�n\11f y—
By: v'-^� Original Certificate Date: Cc,
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 X Nitrat- • •Ti • • .
Septic System Advisory senics4ry"
Well Flow Advisory Other .
COSA blue sheet 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: EKLUND#1 BLOCK 4 LOT 11 Parcel ID:05054107
A. WELL DATA
Well type private If A, B, or C provide PWSID# n/a Well Log (Y/N) yes
Date completed 6/3/81 Sanitary seal (Y/N) yes Wires properly protected (Y/N)ves
Total depth 101 ft. Cased to 101 ft. Casing height(above ground) 20 in.
FROM WELL LOG AT INSPECTION
Date of test 06/81 9/26/17
Static water level flowing ft. unk* ft.
Well production 8 g.p.m. +2.0 g.p.m.
WATER SAMPLE RESULTS:
Coliform neg colonies/100 mL Nitrate 0.347 mg/L
Arsenic nd ug/L Date of sample: 5/7/18 Collected by: charles balzarini
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 06/81 0
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) ves
Foundation cleanout(Y/N) yes Depression over tank (Y/N) no High water alarm (Y/N) no
Date of pumping 08/22/17 PumperJRs
C. ABSORPTION FIELD DATA
Date installed 06/81 Soil rating (g-p-d-/ftor ft2/bdrm) 205 System type TRCA
Length 54 ft. Width 4 ft. Gravel below pipe 6 ft.
Total depth 10 ft. Eff. absorption area 648 ft2 Monitoring tube yes Depression over field no
Date of adequacy test 9/26/17 Results (Pass/Fail)pass For 3 bedrooms
Fluid depth in absorption field before test 64 in. Water added 450 gal. New depth 68 in.
Elapsed Time: 1440 min. Final fluid depth 64 in. Absorption rate >= 450 g.p.d.
Any rejuvenation trgatment(past 12 mo.) (Y/N &type) none known If yes, give date na
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 TO:
Septic tank/lift station on lot +100 On adjacent lots +100
Absorption field on lot +100 On adjacent lots +100
Public sewer main +100 Public sewer manhole/cleanout +100
Sewer/septic service line +25 Holding tank +75
Animal containment areas +100 Manure/animal excrete storage areas +100
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation +10 Property line +5 Absorption field +5
Water main +10 Water service line +10 Surface water +100
Wells on adjacent lots+100
ABSORPTION FIELD ON LOT TO:
Property line +10 Building foundation +10 Water main +10
Water Service line+10 Surface water +100 Driveway, parking/vehicle storage +10
Curtain drain +50 Wells on adjacent lots +100
F. COMMENTS
Artesian well, plug prevented determination of static water level.
* tank and leachfield installed in 1981, due for replacement in next 1-5 years.
g;A,✓n 92pc5 E GJCA1E 17‘,l%rAt/ -15ptcrt.04/ ',.�\
(, CN -4kcQ TCA/l;�EvsZ S O,v 6/3r L::vt`4.$A/0)201,gt, ,66XV
A k
4.G. ENGIEER S CERTIFICATION ,,,17
I certify that I have determined through field inspections and `• •`
review of Municipal records that the above systems are in . C-2•
conformance with MOA COSA guidelines in effect on this date. * • '1f 7 ••
Engineer's Printed Name charles balzarini r _-
Date 5/12/18 • • *• • • • • A01
ARLES G B RIN1111
tP 'PROFESS\ON�10.
cosA canary sheet 2-6 15.doc `� AN �
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT a '1 907-343-7904
On-Site Water and Wastewater Section ., Fax: 343-7997
www.muni.org/onsite \
Septic Tank Advisory
Certificate of On-Site Systems Approval # OSC181214
Subdivision: Eklund #1 Block:4, Lot: 11
The septic tank for this property is 37 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
•
. `J .�ZS •Mtt'11,- 2
tlY 4t1 t{
•
•
'f .w
�
i t � .
a• �i 5��� ,
+ti 3 g. . F r r,
arm, � ° ?' i• r.> P�'�%8. .< •� v
Mailing Address: P.0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org
MUNICIPALITY OFANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
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. # 050-541-07
1. GENERAL INFORMATION
Complete legal description
Eklund #1
Lot 11, Block 4
Location (site address or directions)
'~' ~ ' :- -NHN Upper Kogru Avenue, Eagle River
Pro~3e~tQ owner'~ 'scott Shumway & E~abeth Cha~ Day phone 696-4980
Mailing address. P:O. Bn× 770R6~. ~a~]~ ~v~: A~ 99577
L~nding agency No~ .... ~,/~ Pre=set Day phone
Mailing address 16635 Cente~ield ~ive, ~eqle River, ~ 99577. .
~Un'les~ ot~ise requesmd, HAA will be held for pickup ..... ~ ..~,~.~ _
..................... Individualwel · X : -~ .... ~ ~ ~ ~ - '
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legahty and status of system ,.,'~.~ -
TYPE OF WASTEWATER DISPOSAL: ¢' ~
........ ..?~ .............. Individual on-s~te .~....., ~.~ ~ ~.~..
Ho d ne tank ' ~
........... ~ Public sewer ","
NOTE: If community wastewater system, provide wri~en con.~rmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91 ) Front MOA i121
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 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 ~agle River Encj'~_eering se. rvices
Address P.O. Box 773294, Eagle River, AK
Engineer's signature
Phone 694-5195
99577
Date 06/22/95
,,,.~.~.. ' A ''~f~
DHHS SIGNATURE
Approved for'
Disapproved, '"
; .:::. Condition~!, approval for bedrooms, 'with the following stipUlations:
L ' ' ' 'f'-l'lli'ii
; ~. , ~'~ :¢' ;<2: .
'*-..~ ~..The. M6n'ici~3ality,,, of,'~c.horage, .,-- . Department of Health and Human Services (DHH'S) issues Health Authority
', 'Approval Certificate~b,a~ed only upon the representat ons given in paragraph 5 above by an independent
*', '.,, . - ~. .~,'~ ~ .
pro~sa[onal eng~6~er registered m the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and th~(r'J~dingi~sti~utions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct in~P~tions or analyze data· before a certificate is issued. The Municipalit7 of Anchorage is not
responsible for errors or omissions in ~[he professional engineer's work.
72-025 (R~.1/91) Ba~k MOA~21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: FJ~LU/VD ~-~' /
A. Well Data
Parcel I.D.
Well type ~-/I/A~/~ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) I~-~ Date completed 0~//0 ~,/~/ Driller
Total depth Cased to
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
/
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/h:!d!:g tank on lot //~ /
Absorption field on lot //~' ~'
Public sewer main /~///0~
Sewer service line 7~'/~ !
/~ / / Casing height
Wires properly protected (Y/N)
g.p.m.
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: (~(~//~/~ <~
Collected by:
Other bacteria
B. SEPTIC/I:t~NG TANK DATA
Date installed 0~//~/
Cleanouts (Y/N) X/~
High water alarm (Y/N)
Date of pumPing
Tank size /0OD Compartments
Foundation cleanout (Y/N) ~//~ Depression (Y/N)
/L///~ Alarm tested (Y/N)
~[~/J~/~ Pumper ~--~-~Y~
SEPARATION DISTANCES FROM SEPTIC/HOL-I~NG TANK TO:
Well(s) on lot
To property line ~/~)
Surface water/drainage
On adjacent lots
Absorption field
Foundation
Water mah'r/service line
CONT NUED ON BACK PAGE
72-026 (3/93)* Front
C. LIFT STATION
Date installed
Size in gallons
Manufacturer ~
Manho~
Vent (Y/N) "Pump on" level at / "Pump off" Level at
High water alarm level ./.~.~~ Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DIST~IFT STATION TO:
Well~o~/ On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed 0(~/~> / Soil rating (GPD/Ft2) 7~)5
Length ~ L/ ~ ~ / - / Total depth
Width /-/' Gravel thickness
Total absorption area ~'/-/~/¢ Cleanout present (Y/N)
Date of adequacy test ~2~//~/~ Results (pass/fail)
Water level in absorptiOn field before test ,.z/.~ ,,
Peroxide treatment (past 12 months) (Y/N)
Depression over field (Y/N)
for '~
After test ~.~, .~/~
If yes, give date /V/~
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot //
To building foundation
On adjacent lots -/~
Surface water
Curtain drain
On adjacent lots ~J--/~ j Property line, 7/~/~ /
-P/Q ! To existing or abandoned system on lot ../"//~
Cutbank ~-//~ Water ~in/service line ~/~ /
/~J/~ Driveway, parkingh/ehicle storage area ~//-} /
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in effecto~Jb¢ date of this inspection.
,4
·
Signature
Engineer's Name
Date
HAAFee$ 3~;)- ~
Date of Payment ~-~'/~/~/.
.ece,...um er
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Lot 11; Block 4; Eklund Subdivision ~1
Location (address or directions)
2433 Eagle River Road, Eagle River, Alaska
(b)
Property owner Robert and Mary Schwenne Telephone : (home) 694-0610 B6siness
Mailing Address 2433 Eagle River Road, Eagle River, Alaska 99577
(c) Lending Institution National Bank of Alaska
Mailing Address Anchorage, Alaska
(d) Real Estate Company and Agent TARGET REAL5~f,
Address
Telephone
Telephone
INC./Mary Schwenne
P.O. Box 774627, Eagle River, Alaska 99577
694-2388
(e)
Mailthe HAAtothefollowing address:(orcheck here~,ifholdforpick up.)
Listcontactperson and day phone numberbelow:
S & S ENGINeeRING/694-2979
17034 Eagle River Loop Road, Suite 204
Eagle River, Alaska 99577
TYPE OF RESIDENCE
Single-Family [] Number of bedrooms -
WATER SUPPLY
In'dividual Well IK~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
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 legality 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 end 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 Telephone ~ '~/-'~" ~¢7~
Address
Date
17034 Eagle River Loop Road No~ ;2Q4
6. DHHS APPROVAL
Approved for//.~edrooms by/
'Approved ~ Disapproved Conditional
Date
Terms of Conditional Approval
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
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: ~,.~=,-r- ~,\
Well Classification '~,.1
Well Log Present ((~1) ~ Date completed L,,
Total Depth t~o~ Cased to 1o~ Depth of Grouting
Static Water Level ' ct'
Casing Height Above Ground
Electrical Wiring in ConduitS/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by ~ ~
Water Sample Test Results ~-~-~
If A, B, C, D.E.C. Approved (Y/N) .
Yield '~,~' L~>~ ~c
Pump Set At ~'~,~-r-¢~
Sanitary Seal on Casing ~)'N)
Depression Around Wellhead (Y~)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date ~,- ~-~O-C~
Comments
SEPTIC/HOLDING TANK DATA
Date Installed ~¢-~,t Size
Standpipes ~N) ~
Depression over Tank (Y/~
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) /'~1~
~[~ No. of Compartments ~-
Air-tight Caps (~/N) \/ Foundation Cleanout ~N) ~
~ Date Last Pumped ~- -~ -~ ~
t"l I~-~ ;fbr ~
Temporary Holding Tank Permit (Y/N) ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line \O
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments ~2~>e~'> T-~,-[
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 L~-~\
Width of Field
Square Feet of Absortion Area
Depression over Field (Y~
Results of Last Adequacy Test
'?..c>'5' ~/"~[~.__ Type of System Design
Length of Field '~--¢ ' ,,' ~ '"
~ Depth of Field I o' ~ .-
ravel Bed Thickness
Statndpipes Present (ON)
Date of Last Adequacy Test 7.-
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well I [ ~:'~
To Building Foundation ~ ~ ~ ~
,or
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line to '+
To Existing or Abandoned System on
; On Adjoining Lots "~ '~-
tC) ~ '~ To Cutback (if present) ~1 A-
Comments
D. LIFT STATION
Date Installed
Dimensions
Size in Gallons Manhole/Access (Y/N)
"~ "Pump Off" Level at
High Water Alarm Level at~'"'"-'~ Vent.LY_Z~.)-
Tested for ~ Pumping Cycles during Adequacy Test.
Meets MOA Electrical Codes ~Y/~ ~
Comments,.-~ ' ~
**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.
Signed 5 & S £NGINF. E.E~NG
Company E~91, River, Alaska 9957~
Date ~~ ~ [
MOANo, ~ ~ / 0~
f this
Receipt
No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343
FEDERAL TAX I.D. #92-0040440
Client Sample ID:Lll B4 EKLUND #1
?WSID :UA
Collected JAN 30 91 ~ 15:05 hrs.
~ecelved JAN 31 91 @ 15:00 hrs.
~resezved with :AS REQUIRED
Analysis Completed :FEB i 91
Labozatezy Supezvisor :STEPHEN C. EDE
Released By : ~~. ~.~
ANALYSIS REPORT BY SAMPLE for Work Order $ 31714
Date Report Printed: FEB 4 91 { 12:23
Client Name
Client Acct
EPO #
Req #
Ordered By
ENGINEERING
SNSENGP
PO # NONE RECEIVED
Send Reports to:
1)8 & S ENGINEERING
2)
Chemlab Ref #: 910343 Lab Smpl ID: 1 Matrix: WATER
Allowable
Parameter Tested Result Units Method Limits
NITRATE-N 0.32 mg/1 EPA 353.2 10
Sample ROUTINE SAMPLE COLLECTED BY: RAY
Remarks:
I Tests Performed ' See Special Instructions Above UA-Unavailable
ND- None Detected "See Sample Remarks Above
NA- Not Analyzed LT-Less Than, GT-Greater Than
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343
FEDERAL TAX I.D. #92-0040440
Client Sample ID:L11 E4 EKLUND
PWSID :UA
Collected SAN 30 91 ~ 15:05
Received SAN 31 91 ~ 15:00
Presezved with :AS REQUIRED
Analysis Completed :
Laboratory Supervisor :STEPHEN C. EDE
Released By :
ANALYSIS REPORT BY SAMPLE for Work Ozdex# 31714
Date Report Printed: FEB 4 91 ~ 12:23
Client Name
Client Acct
EPO #
Req #
O~dexed By
ENGINEERING
SNSENGP
PO ~ NONE RECEIVED
R. SHARER
Send Reports to:
i)S & S ENGINEERING
2J
Chemlab Ref #: 910343 Lab Smpl ID: 2 Matrix: WATER
Allowable
Parameter Tested Result Urdts Method Limts
TOTAL COLIFORM SEE ATTACHED col/lO0 ml
Sample SAMPLE COLLECTED BY:
Remarks:
1 Tests Performed ' See Special Instructions Above UA=Unavailable
ND- None Detected "See Sample Remarks Above
NA- Not Analyzed LT-Less Than, GT-G~eater Then
CHEMICAL & GEOLOGICAL LABORATORIES OF ,4 LASKA, INC.
TELF~HONE (907) 562-2343 5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliferm Bacteria
TO GE COMPLETED BY WATER SUPPLIER
~<'-PRIVATE WATER SYSTEM
Name Phone No.
$ & S ENGINEERING
A '~'"" ~',,~ie River Lo~p Read No. :204
Mailing ~l~r~¥e River, Alaska ~J'$77 r
City State
SAMPLE DATE:
Mo. Day Year
SAMPLE TYPE:
E~- Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
Zip Code
.) L~ Treated Water
~ Untreated Water
SAMPLE
NO.
~ I
3 l
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Date Received
Time Received
Analytical Method:
Analysis shows this Water SAMPLE to be:
/,~Satisfactory
[] 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.
Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No. Result*
I I-~
Analyst
~',,~,
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
^.D.E.c. ,.%0,.
Membrane Filter: Direct Count ~
Verification: LTB BGB
Final Membrane Filter Results
Reported By__~,~_~'~.,~'~/'/~-' 'Date ....
Time:
TNTC = Too Numberous To Count
OB = Other Bacteria
.Coliformll00 mi
Coliform/100 mi
PART ONE OF TWO
REMAINDER TO FOLLOW
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 11, Block 4 ~ Eklund Subdivision Addn#1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL J~:D"
OF ON-SITE SEWER AND WATER FACILITY
264-4720
December 10,
Location (address or directions)
Eagle River, Alaska
'(b) Applicant Name Max Sween,y Telephone: Home 694-7070 Business 561-2400
Applicant Address 2433 Eagle River rd. Eagle River, Alaska 99577
(c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending tnstitution National Bank of AlaskaTelephone 694-5373
Address P,O, Box 6127 Anchorage, Alaska 99519
(e) Real Estate Company and Agent N/A
Address ~/A
(f)
Telephone I'~/A
Mail the HAA to the following address:
P~r.k~]D by en~nee~
TYPE OF RESIDENCE
Single-Family [] Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY ~
Individual Well [] Community [] Public []
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
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.
72-025 (11/84)
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 Heal{h
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 Telephone
Address E~.8LE R!VER n'" , ..............
Date z - [ ~ -8 & EAGLE RIVER, AK 99577
P, O. BOX ?73294
694-5195
Engineer's Seal
DHEP APPROVAL
ApproVed for ?,"
Approved ~?~.L
Disapproved Conditional
Date
T~erms of ConUitional Approval
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}
MUNICIPALITY OF AN~-, ,JI~(i~JNICIPALITY OF ANCHORAGE (MO~/
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTIO~EALTH AUTHORITY APPROVAL (HAA)
CHECKL,ST- FEBRU^RY 984
'OEO 6 1986 264-4?20
Legal Description: ~./c/~ ,~'~.,~ x¢~/~ ~'/
A. WELL DATA
Well Classification ~;'~'"~'~- If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) "Y' Date Completed ~/- 3 - ~ I Yield
Total Depth /c~ ' 4" Cased to /6 / ' Depth of Grouting
Static Water Level ~' ~¢1~ -~ ~ ~ ~ Pump Set At -~,~
Casing Height Above Ground 17 ~, L~ Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
Depression Around Wellhead (Y/N)
; On Adjoining Lots I~°4
; On Adjoining Lots io~'~
To Nearest Public Sewer Line ~J//~
Cleanout/Manhole
Water Sample Collected by E.,~,~
Water Sample Test Results
Comments
To Nearest Public Sewer
To Nearest Sewer Service~Line on Lot
; Date
B. SEPTIC/HOLDING TANK DATA
Date installed Size
Standpipes (Y/N) ~/'
Depression over Tank (Y/N) /~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) /v,,~
Separation Distances from Septic/Holding Tank:
/o f-
Air-tight Caps (Y/N)
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course ~]oo ×
No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped /z/
· for /v',4-
Temporary Holding Tank Permit (Y/N)
To Building Foundation +/tO/
To Disposal Field ~ /
To Stream Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed g- B /
3'-
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 H A
Type of System Design
Length of Field ,5"c/ /
Depth of Field ,~ /
Gravel Bed Thickness ~' /
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line "~ lo /
To Existing or Abandoned System on
!
; On Adjoining Lots -/-~ o
To Cutbank (if present)
"/Woo
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 /,DA
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify th,at I h~.~.v,e ch~..e.~ked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection,
Signed "~~ Date /
Company .~ j2.. ~.j MOA No.
Receipt No. ~("'~(~ [-- (~) [
Date of Payment
Amount: S
Page 2 of 2
72-026 (11/84)
Eagle River Engineering Services
P. O. Box 773294
Eagle River, AK 99577
694-5195
MUNIClPAUTY OF ANCNOP, A~J
Engirl~Rl~ i~I~iIiEALTH &
ENVIRONMENTAL PROTECTION
RECEIVED
APPLIC ]T FILLS OUT uppER HALf-'ONLY
Pro'perty Owner (~:~ ~-1~ ~/A Phone
~ e zsc nderson
Mailin~Address Plaza 7, 147, ;Eagle River Zip Code 99577 694-5822
Buyer Unknown
Address Zip Code
Lending Institution Phone
Address Unkn °Wlrl- zip code
Rea,fy Co. a A~nt Commonwealth Area, Inc (HelEa Larson) ~o~j% 9555
Address I).O.Box 249, ~Eagle River zip Code 99577
Legal Descript[on Lot. 11, BioCk 41 F. klund Sub(['. S4
Street LocaU~ Upper Kogruj
Type of Residence, .
Single Family
Multiple Family No. of Bedrooms
[] Other
Water Supply
[~ Individual . ~ ATTACH WELL LOG, A w(~l log is required for all wells drilled since June 1975.
[] Community~?/ For wells drilled prior to that date, give well depth (attach log if available),
[] Public Utility
Se~r Disposal
~: Individual Year Individual Installed:
ILT Public Utility When Connected to Public Utility:
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date/ O
Inspector Inspector Inspector Inspector
MUNICIPALITY OF ANCHORAGE
RECEIVED
(~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) BISAP~OVED
( ) CONDITIONAL APPROVAL*
Soils Rating Date ~wer Installed Well To Absorption Area /~ ~ - Well Log Received
Septic T~k Size
72-023 (3182)
October 10, 1983
Queitzsch/Anderson
Plaza 7, 147
Eagle :' ' ~
~ River, Alaska
99577
Sub]ect: Lot 11, Block 4 Eklund Subd. ~4
Approval for the individual sewer and water facilities cannot
be 9rantef~ until the following items have been completed:
~ 1?he septic tank punlped with a receipt submitted to this
department.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call t~is office at 264-4720.
Sincerely,
cw6~/s2/s
Cory Willis
Time MUNICIPALITY OF ANCHORAGE Time
D,~-t e Date Date
Inspector RECEIVED Inspector Inspector
Oommonts Gondltlonal ~pproval
Date 8ewer Installed Permit No. Septic T~nk Size
~ ~ ~ j Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS~O~T LOWER HALF ONLY
Property Owner ~ ~ ~ ~ ~ ~ ~
Address
Lending~nstitution ~ ~ ~ I00~ ~ Phone
Address ~ ,~'x · .
Realty Co. & Agent ~~ ~ ,~ ~
Street Locat'o
Type~ Residence ~ " ~
~Single Family
~ Multiple Family No. of Bedrooms
~ Other
Wa~Supply
~ Individual A~ACH WELL LOG. A well Icg is required for all wells drilled since June
~ Community 1975. For wells drilled prior to that date, give well depth (attach Icg if
g Public Utility available.)
Sew~ Disposal
~lndividual Year Individual Installed:
g Public Utility When Connected to Public Utility:.
~ Holdin~ Tank q ,, ,
June 7, 1982
Alan and Helga Larson
P.O. Box 594
Eagle River, AK 99577
Subject: Lot 21 Block 4 Eklund Subdivision
Approval for the individual sewer and water facil~tle, cannot
be granted until the following item8 have been completed~
~'~' A well log submitted to this office for our files and
review.
/ ,The water analysis report needs to be submitted to this
office from the Chem Lab, 5633 B Street, for our review.
Please notify this Depsrtment for a reinspection when the
noted discrepancies have been corrected_. If there are any
further questions, please call this office at 264-4720.
Sincerely,
Robert C.~ Pratt
Associate Environmental Specialist
RP121/p/EH
