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Home My WebLink AboutANGELA HEIGHTS LT 9 ( erlifie Drilliug DRILLING CO~P~¥ BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE694-2588 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE-Started ~' hC~/7'(~ PERMIT NUMBER 7~d¢t(~ Ended DEPTH OF WELL /qL STATIC LEVEL OF WATER FT. DRAW DOWN FT. / ? GALS. PER HR / ~) OO KIND OF CASING {.~ KIND OF FORMATION: From0 Ft. to 0~) Ft. From& Ft. to k Ft. to c~)F') Ft. From 0 Ft. From ~O Ft. to '~,~"Ft. From ~?-9' Ft. to -q~ Ft. From -~-'~' Ft. to 1/~' Ft. From_//.~(- Ft. to / ~ O Ft. From/.~O Ft. to //'~ o~ Ft. From Ft. From__ Ft. From__Ft. From __Ft. From__Ft. From__Ft. From Ft. From Ft. From Ft. to__Ft to Ft to__Ft. to Ft., to__Ft. to__Ft. to Ft. to Ft. to__Ft From__ Ft. to Ft. From Ft. to ..... Ft. From__Ft. to.__ Ft. From Ft. to.__ Ft. From__Ft. to FL From__Ft. to Ft. From__Ft. to Ft. b4'~/~rom~ 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 MISCL. INFORMATION: DRILLER'S NAME .... : : PERMIT NO. MIJ~-4 I C: I PALIT'T' OF A~-4C:HORt~GE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 E. TUDOR RD., ANCHORAGE, AK. 9950? 276-222t L4ELL F'ERf'I IT 76296 ) APPLICANT LOCATION LEGAL DAVE DEANS C~'L00~ ~T L9 RNGELA HGTS SUBD BO× 88 E. R. LOT SIZE 694-9387 1~.4'39 SQIJRRE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM i00 FEET FOR A PRIVATE NELL OR 200 FEET FOR A PUBLIC NELL. NELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE NELL COMPLETION. SPECIFICA"rlONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERr"I I 'f ',.,'RLI E:, FOR OI'-.IE '-r'ERR FRCII'-I 1' SSUE I CERTIFY THAT i' I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SE]" FORTH B~' THE MUNICIPALITY' OF ANC:HORRGE. '~' I WILL INSTALL THE SYSTEM IN 8CC:ORDANCE WITH THE CODES. SIGNED: ISSUED APPLICANT DAVE DEANS MUNICIPALITY OF ANCHORAGE DEPARTMENT. OF HEALZH & 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 050-283-45 NAA# GENERAL INFORMATION Complete legal description Lot 9; Angela Heights Subdivision Location (site address or directions) 10221 Chickaloon Eagle River, AK Property owner .,Mailing address Lending agency Mailing address 'Apryl Webster 152 Dune Dry'ye. Day phone (406) 799-3459 Great Falls, Montana 59404 Day phone Agent Cindy Wilson/ Jack White Co. Address Day phone 694-5500 Unless otherwise requeSted, HAA will be held for pickup. NUMBER OF BEDROOMS: 5 TYPE OF WATER SUPPLY: Individual well XXX 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: 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 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 Name of Firm ]~'~ EagJe I~iver LOOp Road No. 204 Address Eagle River, Alaska 99577 Engineer's signature ~/~/Z_/~. ,F'-~---~ Phone Date DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 ENVIRONMEI~AL &EI~VICES DIVISION AUG Municipality of Anchorage DEPARTMENT OF HEALTH &.'HUMAN SERVICES R E ( Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: ZaT" A. WELL DATA Parcel I.D.': Well type oS-O - 2 Log present~l) Y'-~'~' Total depth Sanitary seal Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~ Date of sample: Nitrate /~ ~5- Other bacteria Collected by: Date completed Cased to ,~/~2 "~' FROM WELL LOG / /o /0 2 (~ g.p.m. -~- ~ -)- g.p.m. Casing height (above ground) Wires properly protecte(~/N) AT INSPECTION Date installed ~~ Cleanouts (Y/N) Foundation cleanout (Y/N) High water alarm (Y/N) ~mper~~ Date ihstal-'i]'e~'~ ::' ~, ~- ~-- ?; Soil rating (g.p.d./~ or fF/bdrm) System~type ~ Length"',''~'m' M~ Gravel thickness below pipe ~th Effective absorption area ~ube pr~ession over field (Y/N) Date of adequacy test ~~ For bedrooms Fluid depth in absorption field be~ t~t~.); ...... Immedia~4~r__ gal. water added (in.):__ Fple~i~xiddeeP~t 12 'mo nth s) (y/N) ......., if Yes, give dth ~''' Abs°rpti°n rate ;te-"""~g'p'd' 2-026 (Rev. 3/96)* ~ If A, B, or C, attach ADEC letter. ADEC water sYstem number Date installed ~ _ ~ize in gal~ Manhole/Access (Y/N) __ ~~ "Pump off" level at* ~'. SEPARATION DISTANCES Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT ,TO: '~ J"It ' ~-' On adjacent lots ////. /'~'. On adjacent lots /f-'/.,"~ - Public sewer manhole/cleanout /~?O/-/- Lift station ./~//. A, DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ,/'//, .Foundation '"'--,,._ Property line .... Absorption field___ Water main/service line'"'"'"'"---~ Surface water/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ~ON LOT TO: ~~"- Property line Building foundation ~ ~ain/service line Surface water ~-~ ENGINEER'S CERTIFICATION -~-"'~riveway. torage area Wells on adjacent lots ~~ I certify that I have determined thru field inspections and review of Municipal Signature - ~/.,~-~/ (..,-. ~ Engineer,s Name ~t~0 z~:,,,t.~ C. ~ ~,,,,/..~/ Date ~"/~'1 / ~(. HAA Fee $. ~ Date of Payment Receipt Number 72-026 (Rev. 3/96)* records~stems 'are Waiver Fee $ Date of Payment Receipt Number 08×20x9~ 09:1~ CT&E ESI ANCHORAGE ~ 907~9~1~11 NO.?9~ Q08 CT&E Environmental Services Inc. Laboratory Dlvi.ion m~e~',~'~',~aram-~'~'~a.,a.amr~,~,~,ar, e,~,~,~e~e,~~~~~ 200 W. Potter Drive Anchorage, AK 99518-1605 Tel: (907) 562-2343 Fax: (907) 561-5301 CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID Sample Remarks: 963795001 $ & S ~agin¢¢d~g Lot 9, Aagela Heights Subd. Lot 9, Angela Hcigh~ $ubd. Drinking Water 0 Client POg Frinted Date/Time 08/19/96 16:05 Collected Date/Time 08/13/96 18:10 Received Date/Time 08/15/96 11:30 Technical Director ALterabLe Prep Analysis Parameter ResuLts POL Units Hethed Limits Date Date init ~itrate-u ~ 1.95 O.ZO0 mg/L EPA 353,Z 08/16/96 NJtrJte-N 0.100U 0.100 mg/L EPA 353.Z 08/15/96 ESC Total coliform 0 0 cot/1OOmL $H18 9Z~gB 08/15/96 TAV Member of the 8G8 Group (80ci6t& Generals de $urveillenee) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA. ILLINOIS, MARYLAND, MICHIGAN. MISSOURI. NEW JERSEYr OHIO, WEST VIRGINIA 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 050-283-45 HAA# HA930630 1. GENERAL INFORMATION Complete legal description Lot 9 Angela Heights Subdivision Location (site address or directions) 10221 Chickaioon Eagle River Property owner Dennis Crepeau Mailing address Lending agency Mailing address Agent Nancy Stahly % Address PO Box 671923 10221 Chickaloon Eagle Day phone 696-1094 River, Alaska 99577 688-4939 Day phone Aurora Properties Dayphone Chuqiak, Alaska 99567 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water Five (5) SSSSS 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: SSSSS 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 & S Engineering Phone 694-2979 Address 17034 Eagle River ~oop Road, Suite 204, Eagle River Engineer's signature Date 99577 DHHS ZZZ SIGNATURE Approved for Five (5) Disappi'oved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments ',~ ---- Date October 20, 1993 By: / 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 H L.I ~( 13 R H. F' F!: I] F:'E F:: i- I E S T E L I'.l o. 'Si 0 7 - i:., :i:!; :.;_:-- 1 3 1 ) [I c t.. i ::.~i:, 'ii 5 1 4; 5 4 F:' . 0 2 TOTAl. 975 i1o~1 [.¢m~t~(J [;osi New ............... $ ~ .1:2 ,.0 ~Q .... COST API'ROACH COMMEN']'f;: / ~,,,e'~',"' ~'~ qsC~ ] O00l :$ .... '~ th~ egttm~'ted effec~,{vo age of tho Improvement, -- ........ h-.-'-';., ..... due ~o thc ~:-.:':~,l.?p '~,7(d~,v~,~.!a~dv;,/~.¢c.) :%..__ ~k~-~ ~]oorp]~. with ~ ~,',,~'.~ ~,,t:~,~,~ .,~o i~.,~ ,,~.,-~,~ ...,~f~ ,¢~,~ -- the n , t ~ .... .__~IN~I~T[D VILU[ ~ ~tT A~H~A~ .... : 2 ~M'~e~gired ~' F~eddJe M~ and [~,~1 0 Mae) ' ,::"! Ag~r~',~ / , . / ,.. , ......... ~ .... s t i/7 Fl~g jr4 ~Z~ ~[5.~i~g~...~~- ~ ....... ?':.~.~ ............. ~":"'~ .... ',/ '" , , ~ v~e 'r ~ 1/2 Mite ' ....... ; ' , '.':~'~';~',,'--,' :~'. ' ' ' : : ..... ' ~ ~ ~ ~ ':'~"' :', ~',' :': :7" 'i~ .~. . . '~_]~"' ..... .:~ ~ . . ~ :: ¢ ~ ,~.~.~.,.~ .......... ~ ...... ~ ..... .:. , ~,,',~ ~ z~. oo : . ,~3~,oOg...., ............. ~.. . ....~,~ ........... .. S~ ~ .... 'J .~ ........................... ~ . ............ . ..... ,,~....'"". ' , ............ , ,. ~- , ~ ,,,.:, $ ~ 3~.,~ ~. ~.L,.~ ........... ,,. ~ .,. ..................... . .... I j .......................... ,,~ . ".~ ~le~ o, [In~rch:~ ' .'..'~' .~'.~:::::~'.:.'~ ~.? ".:/..F'.~' ~A ~A ~ , - ...................... : ...... , ........ ......... ............... ~i D,~"OS¢"/iirt~ ' 9-93 ~/'93 1793 5,93_.~3. _', ~ ....................... ~ b~:~l,on Avenge S J m.[J ~t: Similar ........................... ,. ..' ........... ' ' ' I ~,~,~.. ,1 !.,A}3L~.~_. D.~g L7/~.m..]. .; ~, ~c,g,L~z~`~ ~._T. , ~ m,ig:~ ~,u ~,~' __. _~;J~v.~ .... ~t! s ~,~, ................ ~is/~..~m ....... ~ .......... .i)''i. ~ ~..!._0 0~_ ...... GIIW..~.B. ...... (;"ih ........... b~ Dk, ~lFnc Typical. 2'1 -1 , O!lu~}! ...... J ...... O.U) ....... ¥.. Dec1,, Fnc O t~..~ J~ ~_ ....... I--' I,Q~ _.Sq Ft.] .... '3,60Q I .:i'!'!i ol "'".:.:?To'~r11(,l~t~ orl 'S~{~S CO~; ;Sfi$orl: S L:i }, e I J ,'5._ .ill J- .-: ...... . .... - ........... · . - ., ::'~ J rm~A, HUD ~/or VA /:': ' r 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL INFORMATION Complete legal description Lot 9'i ~'A~g;~z Location (site address or directions) Property owner Mailing address Lending agency Mailing address 10221 Chiekaloon Ea_qle River, AK Dennis Crepeau 10221 Chickaloon Eagle River, Day phone AK 99577 696-1094 Day phone Agent Nancy Stahly/AURORA PROPERTIES Address P.O. Box 671923 Chu.~iak~ AK 99567 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: Day phone 688-4939 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system., 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank community on-site Public ~Jewer 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 slUeLUU~O0 leuo!l!PPV :suo!lelnd!ls §U!MOIIOt eql ql!M 'SLUOOJpeq 'SLUOOJpeq le^oJdde leUO!l!puoo 'peAoJddes!O Jot. pe^oJdd~.~ gI:ln.LYN~IS '9 I:J3=INI~DN=1 Aa NOI10:IdSNI dO 1N=IiN;llV'.LS 'g Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: .Parcel I.D. A. Well Data Well type Log present ~.~N) Total depth \ ~ \' Sanitary seal ~/N) ~',J~.T-~r~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed (.~ - \ ~ - '7 ~, Driller ~ Cased to \ z~\~ ~ Casing height ,,~ Wires properly protected ~/N) FROM WELL LOG AT INSPECTION Date of test Static water level \ o Well flow · Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot ~' Public sewer main Sewer service line Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (~ Nitrate Date of sample: ~,c:> .. ~ ~ B. SEPTIC/HOLDING TANK DATA Collected by: Other bacteria ~ 5 & 5 ~GI~F..Ei{tNG ~7~33--~ [;~!-~ ~!,~r Loop Road No. 2~14 Date installed Tank size Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) ~ High water alarm (Y/N) ____~ (Y/N) Date of pumping ~ Pumper SEPARATION DISTANCES FRO~NG TANK TO: Well(s) on lot ~ On adjacent lots Foundation Absorption field Water main/service line Surface water/drainage 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANC. E-F-RC~M LIFT STATION TO: W~ On adjacent lots Manhole/Access (Y/N) "Pump o~ ~~~''~' Surface water D. ABSORPTION FIELD DATA Date installed Soil rating (GPD/FF) System type Length Width Total absorption area Date of adequacy test Water level in absorption field before test Gravel thickness Cleanout present (Y/N) Results (pass/fail) Total depth De op~~ Bedrooms .,.~r test Peroxide treatment (past 12 months) (Y/N) /If yes,, give date SEPARATION DISTANCE FROM ABSORPTION F~ TO: Well on lot /~ lots Property line To building foundation To existing or abandoned system on lot On adjacent lots / Cutbank Water main/service line S~u~' Driveway, parking/vehicle storage area GCirtain drain E. ENGINEER'S CERTIFICATION dAA s inspection. I certify that I have checked, verified, or conformed to all MOA a guidelines in effect on the date of thi S gnature 17034 ~,,1~ - , . Eagle River/- Alaska- 99577- e ........ ~-- / ~:¥' ':~ <;'...~:~:" '~:~:~:~:~.:~:~:~:~:~:~:~'~F:.~ ~ ':. '-~ :, ;~ .]:.:. engineers ~ame / / Date /~~/~ H~ Fee $ Waiver Fee $ Date of Paym~ent j~ [ l~ [ ~{ ~ Date of Payment Receipt Number ~ ~ ~ ~9 ~ ~ ~.~/~ ~oco,pt ~um~ar 72-026 (3/93)* Back 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 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 9; Angela H~iqhts Location (address or directions) lO221 (b) Property owner Mailing Address Kodak R~ocatio~ · .Telephone'(home) Business (c) Lending Institution Alaska U.~S..A.~ Cr.~.di£ U~'.~n Telephone (d) Real Estate Company and Agent JACK WHITE COMPS, NV~KATHY 0LMSTEAD Address 10928 Eaql~ River Road. Eagle River Alaska 99577 Telephone 694-5500 (e) Mail the HAA to the following address: (or check here'~ if hold for pick up.) List contact person and day phone number below: . S & S ENGINEERING ~70~4 Eagle Ri~er Loop Road N0.2(~.~, " Eagle River, Alaska 9957~' 2. TYPE OF RESIDENCE Number of bedrooms Single-Family J~ 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 thins 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 Address Date S & S EN~IN~.ERiNG 17034 Eagle Rt,~er Leop Road No. 204 Eagle River, Alaska ~$,'"7 Telephone 6. DHHS APPROVAL Approved for/~'~'~'~/) bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional Date 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 Well Classification MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: - IQ SEP- 8 Well Log Present~}'N) "/ Date Completed Total Depth ~'~-~' Cased to If A, B, C, D.E.G. Approved (Y/N) ~.~ ~ /,d¢~ ~ b Yield _~' C:) ~ Depth of Grouting Static Water Level ~ Casing Height Above Ground Electrical Wiring 'in Conduit~N) '~' SEPARATION DISTANCES FROM WELL: Pump Set At Sanitary Seal on Casing ,¢~4) Depression Around Wellhead (Y~j~)~ To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line \ ~ I..~ To Nearest Sewer Service Line on Lot ; On Adjoining Lots */^ t~//~, ;On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed .Size ._ No. of Compartments St~) ._Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tan~'~-~ ~~~ Date Last Pumped _~~ Pump!rig/Maintenance Contac~ -~ ~~; for H~gh-Water Alarm (Y/N) -~...~.~m..porary Holding Tank Permit (Y/N)_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TA~ . To water'Supply Well To ProPertY Line To Disposal Field To Water Main/Service Line' To Stream, Pond, Lake Or Major Drainage Course Comments. C~r--~ ~.-~----'I'-'{~=~ ~ '~O~b,~. ~-~ ~'~'~--%"'~("~ ' 72-026 (Rev, 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Sedating in Absorption Strata Date Ins~d Width of Field~''-.. Square Feet of Absortion Area~"~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD.'~.,....~ .. To Water-Supply Well ____ To Pro~ine To Building Foundation ____ __ '~,~isting or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line To Cutback (if present)'"~--.~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~--~c)r~t'~-~l~"~---~ ~ "~L...4..C-~ ~.~,_~. '"'~-,,,. Size in Gallon-"~"----~ Dimensions Manhole/Access (Y/N) "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments "Pump Off" Level at ~~g~ycles 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 the date of this inspection. Signed Company Date MOA No. $ & S ENGINEERING 17034 Eagle River Loop Road No. 204 Receipt No "2~ C)9~' ~--'~ '- D O~ (~.~ Receipt No. Date of Pa~ment Qli~i - Waiver Fee: $ Amount: $ ~ ~ ~0~ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 ~ CHe~tCA~~ ,~ C~,OI. OatCYm t,4aoa4to~es o~ ~~, ~Nc. ~ 5633 fl STREET ANC'HORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID ~ 92-0040440 ~ILISIS REPORT BI S~LE for Work Order t 8979 Date Report Printed: ~EP 6 88 ~ 16:57 Client Sample ID:L9 ANGELA S/D PW3ID :UA Cllent Nem~ : $ & S ENGINEERING Client lcct: SNSENGP Collected SIP I 88 ~ 11:45 hrs. P.O.S NO)i~ RIC'D Received SIP 2 88 I 14:40 hrs. Req S Preserved with :4 DEG. C Ordered By : R.P. Analysis Completed :SIP 2 88 Send Reports to: Laboratory Supely&sor. :STIPI~_C. ID] 1)B & S E#OII~ERINO Special ........................ Instruct: Chendab Ref I: 2473 Lab Smpl ID: 5 Matrix: Parameter Tested Result/Units lllowable Method Limts 0.79 mg/1 ~ EPA 3S3.2 10 Sample RODTI~ SIMPLE Remarks: SAMPLE COLLECTED BY RP .................................................................. Z .......... ~ ................. Tests Pezform~ ...... · See Special Instructions /boys Unavallabl )ions Detected '" See Sample 'l~emarkm~ )lot Analyzed LT-Less Than, GT-Greater Than APPLIC ,~iT FILLS OUT UPPER HAL ONLY Property Owner //~. ~ d/,//~/~ Phone Buyer Address ~ip Code Lending institution Phone Address Zip Code Realty Co.& A.nt ~'~7 ~/-'} ~ ff ~ ~ ~ ~ ~ ~fi ~,~/~ Phone Type of Resi~nce ~ Single Family .I ~ 'Multiple Family No, of Bedroo~ : Other Water Supply lndividual A~ACH 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 Sewer Disposal ~ ~ ~ Individual ~ Year Individual Installed: ~ Public Utility ~ ~-. When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date /~ ....~ ,~ F '~ Inspector Inspector Inspector Inspector Field Notes: {~1~... ~ C-~ ~ J~UNICIPALITY OF ANCHORAGE ~ ~ ", , 0 , . "I DEPT. Or-'.t:,.Li~ ENVIRO~'qM:~xl i',-xL PRO i FC,] ION .SEP ': ? I .RECEIVED ( FAPPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) D,SAPPROVED ( ) COND,T~ONAL APPROVAL' DATE /o-/0 - ~ '~ Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72.023 (3/82) CONTACT: ~AGLE RIVER AREA GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Myrna Johnston, Area 694-9555 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: Date Received September 1, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. United Bank of Alaska % Debbie Border 645 G Street Dave Deans Construction Box 249, Eagle River 99577 Phone: 278-9526 Phone: Legal Description: Lot 9 .Angela Heights Subdivision Location: 6th house on right on Chickaloon off of Eagle River Road 5. Type of facility to be inspected Single Family 6. Well Data: A. Type Individual C. Construction 7. Sewage Disposal System: A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: 8. Distances: A.Well to: Septic tank Nearest lot line B.Foundation to septic tank C.Absorption area to nearest lot line No. of bedrooms 4 B. Depth D. Bacterial Analysis Public System B. Installer 1. Size 2. Manufacturer 1. Absorption Area 2. Material Total length of lines 140' , Absorption area , Other contamination , Absorption area , Sewer Lines LQ-034 (1/74) Page 1 of two pages Municipality of Anchorage Environmental Protection 2516 Tudor Road Anchorage, AK 99507 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & ~,AI_R'~r-F FACILITIES MUNfCIPALiF¥ OF ANCHORA~.E DEPT. OF HEALTH & FNVIRONMENIAL PROTECTION SEP 1 1976 RECEIVED Type of inspection' Ci,IRO VA FHA CONV xx: Prope'rty Owner: Flailing Address: Name of Buyer: Hailing Address: Dave Deans Construction %Bok 249 , Eagle River, AK 99577 Day Phone None Rolando and Grace Rivas None Day Phone None- De~bie' ~ame of Lending ·Institution: United Bank of Alaska ATTN: Border 645 G Street Mailin§ Address: Anchorage, AK 99501 Phone 278-952'6 Name of Realtor 'or Agent: .Myrna Johnston , AREA, Inc , Realtors P. O. Box· 249 'Mailing'Address: Eagle River,'A~'99577 Phone '694-9555 Legal Description:' Angela Heights Subdivision, Lot 9 Location: 6th House on ~i~ht on Chickaloon '·Street off Eaqle River Road· [House is vacant - Agent has ~e~) .Type of Fac'ility. to be 'inSpected: sii~gle l~am~ily ..... No ._ .B, df~qs. '.4 Type O'f S~pply': '.. Pub'lic Utility' ind)vidu&l Xx If' Individu~l"}'numBer of dWeili'ng.s, pre'sehtly .served .'1. If Individual, depth'of ~,vell 1~0' Sewage Disposal' System Type .of S~st'em: Public Utility XX- "individual (on-site) ................. If. Individual., date of installation Page 2 of two pages - Ret ~t for Approval of Individual .~ )r & Water Facilities Legal Description Lot 9 Angela Heights Subdivision Comments Approved ~ .~ Disapproved Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)