HomeMy WebLinkAboutLot 03 CD: bt '-'q ~ <Ct m: '0 0 0 0 o O): t/'i ,.-I ! ':*' C 0 · x.,.,.~ ° ~¢~ ~ MUNICIPALITY OF ANCHORAGE ~"~'~,~ x,~¢'; ~-"- ~,%~ /'.,"J.J.J.J.J.J.J.~,,,~'N Department of Health & Human Services ~..~.~ ,.<.,~x©~F ~,,,%"3 <..,,~,~: ~4~.f:~..)DIVISION OF ENVIRONMENTAL SERVICES ~r~.~--~ M... ~' ON-SITE SEWER AND WATER FACILITY .~ D / Parcel I,D.# /~ ,'"'-- ~"'..~ z~ HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, to. wnship, range) Lot 3, '"Block 1~ Ra~vmond Ted~ow Location (address or directions) 11224 C~]e.qt~a]~ Eagl~ R~v~t:- (b) Property owner Altec ~f57601 Mailing Address _52o ~.. 34hh: (c) Lending Institution Mailin'g Address Telephone: (home) Ap~hc~r~g~ A1 ~1~ Business .~G1 -19(")0 Telephone (d) Real Estate Company and Agent JAe/~ax- r~ee Walker Address __~660n Cente~field D~, ~201; ~ag!e R. iver~ Alaska Telephone 694-4200 (e) Mail the HAA to the following address: (or check here~, if hold for pick up.) List contact person and day phone number below: 99577 S & S ENGINEERING 17034 Eagle River Leop Read Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family'] Number of bedrooms 3 WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site [] Public t~ 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 th'is 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 disposar system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. ENGINEERING 17034 Eagle River Loop Road No. 204 ~_~91e River, Alaska 99577 Name of Firm Address Date Telephone 6. DHHS APPROVAL App roved fo r "~/-~:~.)bed room s by Approved /~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph5 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 DHHSdo not conduct inspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageis not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 ,o,<~ MUNICIPALITY OF ANCHORAGE (MOA) ,~ ~-/~.~ Health Authority Approval (HAA) ~ ~ ~ 343 4744 ~:,~'> .O~ ...~' ~ Legal Description: ~ A, WELL DATA Well Classification~ ~ ~1~~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present CN) ~Date Completed ~ ¢ ~ ¢ ~ Yield I Total Depth~ Casedto ~ Depth of Grouting ~ ' Static Water Level ~ Pump Set At ~ Sanitary Seal on Casing Casing Height Above Ground Electrical Wiring in Conduit4C~N) y SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line~""~ '~' ,./ Depression Around Wellhead (Y,~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test ~esults B. SEPTIC/HOLDING TANK DATA ¢,~ t,~ Date Installed Size No, of Compartments Standpipes~.,~ Air-tight Caps (Y/N) Foundation Cleanout (Y/N) ____ ,u ,ed ____ Pumping/Maintenance Contact-- ____; for Holding Tank High-Water Alarm (Y/ )~~ank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Building Foundation To Property Line To Disposal Field To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Width of ' Id Feet of Square ~Area Depression over Field (Y/N)'"'"-~~ Date of Last Adequacy Test Results of Last Adequacy Test ~_ SEPARATION DISTANCE FROM ABSORPTION~ To Water-Supply Well To Property~_.~ To Building Foundation To Ex~ystem 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 Stor_age Area Comments D. LIFT STATION Da et~nstalled ,S, ize 'Pump On" Leve~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request*' I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of inspection. Signed Company Date MOA No. & & S ENGINEERING 17034 Eagle River Loop koad NO. 204 Receipt No. Waiver Fee: $ Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Date of Payment Page 2 of 2 ROBERT A. SHAFER April 25, 1989 CIVIL ENGINEER 694-2979 HEALTH AUTIIORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESJGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WA rER DISPOSAL SYSTEM DESIGN Mr. Steve Eng State of A~aska DEPARTMENT OF ENVIRONMENTAL CONSERVATION 3601C Street Anchorage, Alaska 99503 REFERENCE: Waiver horizontal separation between wells and and sewer main; Lots 4A, 4C and 4D; Block I; Raymond Tedrow Subdivision; Eagle River, Alaska (8621-WA-077) Dear Mr. Eng, In your letter dated October 22, 1985 (copy attached) you issued a conditional waiver for the horizontal separation between two wells and a sewer main being installed under Anchorage Water and Wastewater Utility (AWWU) Work Order #9315-2383-0099. The conditions imposed required ~ sewer main joints wit~n the protective radius of these wells be constructed with HField-Lok" gaskets and heat shrink sleeves and that the well casings be ex~u~ined to be sure they were not disturbed during the excavation and installation of the sewer main. At the t~me of installation both AWWU inspector and the undersigned verified the use of 'Field-Lok" gaskets and heat shrink sleeves. A visual inspection of the wells did not reveal any evidence that would indicate the well casings had been disturbed. The excavation was sufficient distance away from the wells and soil conditions were such that the we~s could not have been disturbed. Since these conditions accompanied the waiver reques~ now issue a final waiver. /AS/ss areviously issued, 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 A~CHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUI2]~ 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR 274-2533 October 2:)-, 1985 S & S Engineering SRB 196X Eagle River, Alasl~ 99577 SUBJECT: Waiver Horizontal Separation between Wells and Sewer Main, Lot 4A, 4C & 4D, Block 1, Raymond Tedrow Subdivision, Eagle River, Alaska (8621~WA-077) Dear Sir: The Department has reviewed the subject waiver request and hereby conditionally waives the horizontal separation from well (Lot 3) and sewermain to 28 feet and well (Lot 4) to sewermain to 39 feet on the subject project only. 'This waiver is conditional on the following: 1. After construction, the well casings will be required to be inspected by the ~ngineer to determine if the casing has been disturbed. Any casings that have been disturbed will either require well replace- ment or grouting around casing. 2. Sewer main must be constructed with "Field-Lok" gaskets and heat shrink sleeves (Raychem WPC/87 or TPS) for each joint within the pro-. tective well barrier. If you have any questions, please contact me at our Anchorage/Western District Office. Sincerely, .SE:pkk CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM I.D.# PRIVATE WATER SYSTEM Name Phone No. S & S ENGINEERING ..... ~ I.~ .. _ ad...~ Mailing Ad~f~ River, Alaska ~577' City Stare · Day Year SAMPLE TYPE: Coutine beck Sample (for routine sample with lab ref. no. .) [] Special Purpose SAMPLE NO, LOCATION I Zip Code [] Treated Water [] Untreated Water Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: r~atisfactory [] 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. Date Received' ~'/ Time Received Analytical Method: Membrane Filter * No. of colonies/100 mi, Lab Ref. No, Result* J I Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Results Reported 8~~ Time: BGB Coliform/~00 mi .Col form/100 mi p.m. TNTC = Too Numberous To Count OB = Other Bacteria - APPLI("' NT FILLS OUT UPPER HAl "' ONLY x , ,) Zip Code Mailing Address [ '~-~ ' .,~ ~- ' ~' ; f~' {. , · ~ ,, ~ ~-':' - "' , , Buyer -., /~: Address Zip Code Lending Institution /// ./?../"~,/ /;'/~', / r-'--, .:/, Phone / ' ' ' / / -' ) / Zip Code Realty Co. & Agent Phone Address /"i../:' [ i ~.: ....' . Zip Code _ Legal Description .". ,~ 2' ~,;;~ .,{ ~, i / , :"-:,'./" ';¢ "'¢/2 ".7' ..',.-/"~//'" ,. ,j , .<6 ~',/; --Street Locatio~ /.' ,w¢~ ',~ :" ,~ / ",- ( ,' /r · /. '~ / ~ , Type of Residence ~\Single Family ~ Multiple Family No. of Bedrooms ~ Other Water Supply ~ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. E3 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 REQtJEST BEFORE PROCESSING CAN BE INITIATED. Time Time Tirr~ Time [)ate Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALI'rY OF ANCHORAGE ?EPT. ©F !',:/.till" RECEIVED ~'"',~,P P ROVED BEDROOMS DISAPPROVED CONDITIONAL APPRO.V~L* 'CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received Septic Tank Size CHEMICAL & G~ LOGICAL LABORATORIES ..£ ALASKA, INC. ~ TELEPHONE (907) 562-2343 ANCHORAGE56331NDUSTRIALB Street CENTER Drinking Water Analysis Report for Total Coliform Bacteria ~ TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: " 1.0. NO. Water System Name ' Phone No. Mailing Address City ,,~ State Mo. Day Year Zip Code SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref, no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. 2 I 4 l LOCATION TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Time Received /~; ~ ~r ~ ' ~ Analytical Method: [] Fermentation Tube y'%Membrane Filter Tlrne Collected Lab Ref. No, Collected By ~-)(-/ I Result' Analyst I FFq READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev, 1978 BACTERIOLOGICAL WATER ,~,NALYSI$ RECORD Date Collected Source a.m. e Received Time Received __ p.mo Lib. NO, Presumptive Z0ml 10mi ..10mi 10mi 10mi 1.0mi 0.1mi 24 Houri 48 Hours Confirmatory 24 Houri 48 Houri EMB Broth 24 houri: " Broth 48 hours: Multiple Tube Report: 10mi Tubei Polltlve,rt'otal ZCml Portions Membrane Filter: Direct Count Collform/lOOrnl Verification: LTB BGB Flnel Membrane Filter Relultl · ' Collform/lOOml tile ~.Fu:liJ. vi. diTta]. SOv,,O~' aniJ ,./ate[ :~.tOlJ. l.'llj. O?, Caiinot CASE NUMBER: S-8423 SUBDIVISION OR PROJECT TITLE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Environmental Health Division CASE REVIEW WORKSHEET~- DATE RECEIVED: ' COMMENTS DU/E'~Y: February 20, 1986 March 17, Lot 3A Block i Raymond Tedrow SubdSvSs~o~ - ~h Vacation, ( ) PUBLIC WATER AVAILABLE ( ) PUBLIC SEWER AVAILABLE ( ) COMMUNITY WATER AVAILABLE COMMENTS: 71-014 (Rev. 5/83) Please check or fill in the following: 1. Comprehensive Plan -- Land Use Classification ~. Residential Commercial Parks/Open Space Transportation Related Comprehensive Plan -- Land Use Intensity Dwelling Units p,er Acre ,/'//fl- Special Study ' ~//'/~' Alpine/Slope'Affecteo~ Marginal Land Commercial/Industrial Public Lands/Institutions Environmental Factors (if any): a. Wetland 1. Developable ~. b. Avalanche 2. Conservation c. Floodplain 3. Preservation d. Seismic Zone (Harding/Lawson) D. Please indicate below if any of these events have occurred in the last three years on the property. A~lpine/Slope Affected Industrial Special Study Case Number Case Number Case Number Case Number Enforcement Action For Building/Land Use Permit For Rezoning Subdivision Conditional Use Zoning Variance , ,,,-,,.,,,,' ~. -.:~ , . Legal description for advertising. 30 Cop,es of Plat Reduced Copy of Plat (8V2x 11) Certificate to Plat~l~~ Fee ,Topo Map 3 Copies'~'~ Soils Report 4 Copies Aerial Photo Housing Stock Map Zoning Map / Water: Sewer: Private Walls Private Septic Community Well Community Sys. Public Utility Public Utility 20-019 Back (4/85) VACATION OF RIGHT-OF-WAY OR EASEMENT APPLICATION Municipality of Anchorage DEPARTMENT OF COMMUNITY PLANNING P.O. Box 6650 Anchorage, Alaska 99502-0650 OFFICE USE REC'D aY: ~ VERIFY OWN A. Please fill in the information requested below. Print one letter or number per block. Do not write in the shaded blocks. O. Case Number (IF KNOWN) 1. Vacation Code Abbreviated Description o1 Vact3~ ~n ~1.~1::~130 I-~l ~O~1E 51Ht:b I ~'02T/-/ 27~ ~:'1c EL~-$'-I' ~flL ST. .Existing ~bl~re~,ia!ed I~ga! d~sc.rip!io~ (T12N,~R~i.W. SEC 2 LOT. 4,~ OR SHORT SUB BLK 3 LOT 34). I~l~lvl~loldol If~l¢l~lo~ F~'I~I~I M/Ill I?:/!!1 I t I I;]'11:1:! I ill i I,:1 ! I I I I I 4. Petitioner's Name (Last- First) City ~' ~.~/*~" fJ~'~tate k ¢, ~~ Phone No. ¢¢~ ~ F¢ 0 Bill Me~ 5. Petitioner's Representative Isl{l~ I~¢/~1~- ~1/ Address ~'~' /¢~::;' ~(" PhoneNo. ¢/~;~-~'¢¢F BiJlMe >'~'~_ 6. Petition Area Acreage 7. Proposed Number Co,/?/_+ 10. Grid Number 11. 'Zone 1471/1~1¢1I/4/1~1 I I 8. Existing Number  Lots 9, Traffic Analysis Zone 12. Fees B. I hereby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to vacate it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. i understand that payment of the basic vacation fee is nonrefundable and is to cover the costs associated with processing this application, that it does not assure approval of the vacation. I also understand that additional fees may be assessed if the Municipality's costs to process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may have to be postponed by Planning Staff, Platting I~oar~r_~lanning Commission, Q,' the Assembly due to administrative reasons. Date: Signature ~o$F8,~2 :~ APR 2 1986 'Agents must .p. rovide written proof or authorization.