HomeMy WebLinkAboutEAGLE RIVER MID HEIGHTS BLK 4B LT 15Eagle River Mid
Heights
Lot
Block 4B
#050-271-25
M-W DRILLING, Inc.
P. O. Box 4-1728 · ~811 Dawson
,' A C 907-279-1741 ~
ANCHORAGE, ALASKA 99509
We~l Owner
DRILLING LOG
=Use of Well Dom
Size of casing ~
Static water level 75
Location (address of: Township, Range, Section)ff known; or distance main road
Ll~,, B!k~. !.'id Heirht~ Su~divi~ion
Ea£1e River~ Ak.
~.,~¢~,- ,~*k,~ I~'~f ~l~'~f-~' ~lo~ 't~f ,~-~ e_~v,;~j, ~I'-I~-.L.~
Depth of Hole 1 aO feet Cased to 1 .~:~ feet
ft. (aboiii~) (below) land surface. Finish of well (check one)
Screen ( ); Perforate~--(-' :~' ). ~ /
Describe screen or perforation Hone
Well pumping test a! 1~, gallons per (1~6'{~¥) (minute) for 1 hours with
of drawdown from static level.
open end (
x );
Date of completion
Depth in feet from
ground surface
1 Oct lC72
W,:L, tOG
Give detai~ of formations penetrated, size of materim,
ft.
.TO 1
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S~]ty Gr~v*]
Cobkle Gravel
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'."iny'ne E. '~ertber~/
2 -- State
/l../E'uz-- (.;AY /
S ~ $ ENGINEERING
i12:O34 Eagle River Loop Road
~a~l~ Ri~ar~ Alaska
FL ELEV.: 450.85
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COSA Checklist
Legal Description: EAGLE RIVER MID HEIGHTS BLK 413 LT 15 Parcel ID: 05027125000
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA
❑■ Well log is filed with Onsite (or attached)
Date drilled 10/72 Total depth 140 ft
Cased to 139 ft
❑■ Sanitary seal is functioning correctly
❑■ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA 4/23/24
Static water level at beginning of test 114 ft
Comments * MOA approved Pit -Well
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed)
❑ ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑ Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Well production at time of test 5+ gpm
Water storage tank volume0 gallons
Well disinfected for coliform test? ❑ Yes ❑■ No
❑■ Coliform bacteria is Negative
Nitrate 2.47 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑■ Arsenic less than MRL (ND)
Collected by NRim Eng.
Date 4/23/24
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date _
Results ❑ Pass
Fluid depth prior to test
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
in
Absorption rate gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings)
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:* Property served by Public Sewer
COSA Checklist June 2022
in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
❑Yes if No na ft ❑Yes if No 40+ ft
Neighboring Tank > 100' ■❑ Yes if No ft Private Sewer/Septic Line > 25' ❑■ Yes if No ft
Absorption Field on Lot > 100' ❑ Yes if No na ft Holding Tank > 100' ❑■ Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50'■❑ Yes if No ft
Q Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑ Yes if No *40+ ft ■❑ Yes if No
N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No na ft Surface Water > 100' [—]Yes if No na
Tank to Property Line > 5'
Field to Property Line > 10'
Water Main > 10'
Water Service Line > 10'
F. ENGINEER'S COMMENTS
* Waiver in file
ft
III
❑ Yes if No na ft Wells on Adjacent Lots:
❑ Yes if No na ft Private Wells > 100' ❑ Yes if No na ft
❑ Yes if No na ft Community Wells > 200 ❑ Yes if No na ft
❑ Yes if No na ft If tank or field is under driveway comment below
G. CERTIFICATION & STATENIENT 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firth NorthRim Engineering Phunc 694-7028
Engineer's Printed Name Steve Eng Date 5/9/24
COSA Checklist—June 2022
OF
A"Arc
�/
r .49TH.
j4r l Steve Eng
A, CE -6256
5/8/2
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0~0 - ~ '~/- -~Z-
1. GENERAL INFORMATION
Complete legal description L,o t
HAA# OOO
Expiration Date:
15~ Block 4B~ Eagle River Mid Heights S/D
Location (site address or directions) 10210 Baffin Street
Current Property owner(s) John Murdock Day phone
10210 Baffin Street, Eagle River, AK 99577
Mailing address
694-2386
Lending agency
Mailing address
Day phone
Real Estate Agent
Day phone
Mailing Address /~,jZ/~,,z.¢._-
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: ,
?/,~/~
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
~ Individual On-site []
[] Individual Holding Tank []
[] Community On-site ,'~
[] Public Sewer ~
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for the transfer of title (except between spouses) on properties served by a single family omsite
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
Certificates of Health Authority 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 less than 30 days old. 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.
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 Health Authority Approval Guidelines for the Health Authority Approval
application show 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 applicable Municil~asnkdl~¢.~ ordinances, and regulations in effect at the time of installation.
17034 Eagle River Loop Roaa Ne, 20~
Name of Firm Eagle River, Alaska 99577 Phone
Address
Engineer's Printed Name Robe,-t: C. Cowan
DHHS SIGNATURE
F.-'/ Approved for /~ bedrooms.
Disapproved.
Conditional approval for
~,..',~¢~,
'~',. ca- 88o~ /?.~
~ % ,',c~' ~
bedrooms, with the following stipulations.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date: / .¢., ~ ::Z. (.¢ - ~ O
Original Certificate Date:
Reissue Date:
72025 ,Rev 01 00V
Legal Description:
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-4744
RECEIVi
SEP 8 1 2000
MUNICIPALITY OF ANCHORAGE
HEALTH AuTHoRITY APPROVAL CH ECKLISFTNVIRONMENTAL SERVICES DIVISION
A. WELL DATA
Well type f/~! t.',¢-/'~t If A, B, or C provide PWSID # __
Date completed /O/~-~-- Sanitary seal
Total depth /z¢-0 it Cased to ¢¢O ft
FROM WELL LOG
Date of test --JO////
Static water level '~- ft
Well production . J ~'- g.p.m
WATER SAMPLE RESULTS:
Coliform o colonies/100 mi
Date of sample: F~//~/
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Date installed Tank size
Cleanouts Foundation cleanout
·
Date of pumpin~
Nitrate 2,.6y
Collected by:
Well Log ¢~'
Wires properly protected
~¢~ in.
Casing height (above ground)
AT INSPECTION
/
ft
gal
mg/I
Other bacteria o colonies/lO0 mi
5 & S ENGINEERING
17034 Eagle River Loop Road No. 204
Depre~ tank
Kumper
Nu...mb'er of Compartments __
C. ABSORPTION FIELD DATA
Date installed ' ~ Soil r~p.d./ft2 or ft2/bdrm)
Length ft W~../' ft Gravel below pipe
Totaldepth _.ft .~ti~eabsorpti?ar~a__fl2 Monitoring tube
Date of adequacy~.te~t _ __ _ Results (Pass/Fail) _ __
Fluid d~on field before_tTst. _.~. __ in Water added
Ela.~8"Time: rain Final fluid depth in
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
High water alarm
System type
ft
__ Depression over field
For bedrooms
__ gal. New depth
Absorption rate >= __
If yes, give date __
in.
g.p.d.
72 026 (Rev. 01/00)*
LIFT STATION
Date installed /"//~'/Size in gallons
"Pump on" lev..~.t~ in "Pump off" level at
.r"
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot _ A/--
Public sewer main ~d~'
Sewer/septic service line
in
Manhole/Access
High water alarm level at in
Meets alarm & circuit requirements
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Building foundation Property line Absorptio..Q..fierd
Water main Water service line ~-S-df~e water
Drainage Wells on adjacent Iot~
SEPARATION DISTANCE FROM ABSO~D ON LOT TO:
Property line Bui. C~foundation Water main
Water Service line ~-"'~urface water Driveway, parking/vehicle storage
Curtain drain ~ Wells on adjacent lots __
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name
Date
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 01/00)*
,~tr~ CT&E Environmental Services Inc.
1005641002
S & S Engineering
N/A
L15, B4B, ER Mid Hts
Drinking Water
CT&E Ref.# Client POg
Client Name Printed Date/rime 09/21/2000 18:33
Project Name/# Collected Date/Time 09/19/2000 11:55
Client Sample ID Received Dategrime 09/19/2000 16:24
Matrix Technical Direetor, Stephen C. Ede
Ordered By d~ ~
PWSID 0 Release
Sample Remarks:
Allowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date Init
Waters Department
Nih-ate-N 2.64 0.500 mg/L EPA 300.0 10 max 09/19/00 SCL
Microbiology Laboratory
Total Coliform
0 col/100mL SMI8 9222B 09/19/00 KAP
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
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner --.~o,+~J -~, ~,'r~
Mailing address
Day phone
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well
Public water
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
NOTE:
Public sewer ~ TM
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-O25 (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
Address
Engineer's signature'
DHHS SIGNATURE
/~/ Approved for ~
__ Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date 4
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.
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~'/-,~' ~--g ~:~ Parcel I.D.
A. WELL DATA
Well type tl~'i
If A, B, or C, attach ADEC letter.
Log present (Y/N) /
Total depth / z'/'d~
Sanitary seal (Y/N)
Date completed ~)P--.4'~ / -/~7,''2-- Driller
Cased to /3 ~ Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow I
Pump level
ADEC water system number
Absorption field on lot
Public sewer main
Sewer service line
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ,~/,,.~ -
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: ~/~,~//~
; On adjacent lots '~/~
; On adjacent lots
Public sewer manhole/cleanout-'h~ ~"-~
Petroleum tank
~. ~-"~ Otherxl~cteria
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
Tank size Compartments
Foundation cleanout (Y/N) Depression (Y/N)
Alarm tested (Y/N)
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~'//~
To property line
Surface water/drainage
On adjacent lots
Absorption field
Foundation
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
/
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
Date installed
Length
Total absorption area
Width
Depression over field (Y/N)
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Surface water
Soil rating
Gravel thickness
Cleanouts present (Y/N)
Date of adequacy test
Results (pass/fail) for
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot On adjacent lots
If yes, give date
Property line
bedrooms
To building foundation
On adjacent lots
Surface water
Curtain drain
E; ENGINEER'S CERTIFICATION
To existing or abandoned system on lot
Cutbank Water main/service line
Driveway, parking/vehicle storage area
System type
Total depth
HAA Fee $ / -~ , c,~ Waiver Fee: $
Date of Payment ~'~- ..~C3 -- ~ Date of Payment
Receipt Number ~--~/~"~::~ .(~ / ~'- ? ~ Receipt Number
72-026 (Rev. 3/91) Back MOA 21
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
D. R. DAYTON, P.E., R.L.S.
~"~~~ Chugiak, Alaska 99567
20210 Donalar St.
(907) ~~
696-2417
March 25, 1993
WELL FLOW TEST
Legal Description: Lot 15, Blk 4B, Eagle River Mid Heights Subd.
Date of Test: March 25, 1993
Depth of Well: 140 ft.
Casing Depth: 139 ft.
Static Water Level: 120 ft.
Test:
The well was pumped through an outside hose bib, while metering
volume and measuring drawdown.
The well produced a total of 612 gallons in 90 minutes. The maximum
pumping rate was 6.9 gallons per minute which produced a maximum draw-
down of 0.8 ft.
Results:
The well is currently producing adequately for a 3 bedroom home.
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
Cli~n~ Name DAVID DAYTON ?.E Collected :03;23/93
Ordez~d ~y :D iI DAYTON ~eceived :03/23/93
~ro}ec~; Name WORK Ordez :64297
F~SiD :UA Technical Director :STE~NE~. EDE
Sample ROL~;IN~ Slg~bi COLLECTED BY: DR D TAG ~ARKED COLLECTED AT 2!30
Remarks: WE RECEIVED $AMPLZ ~T IlOO ~S
QC Allowable Extract lr:~lys~
?a~a~eter Results Quai. Units ~ethod Lindt~ D.te D~te Inlt
NITRATE-N 3.35 mg/1 EPA 353.2/300.6 10 03/26/93 LLH
See SFec~s] In~tructaorm Above UA - Unavailable
Undetected, Reported value ~ tb~ practical quantification l!mJt L? - Le~s Than
%econdary dilution GT - ~[~ater Than
~ ~1~I~ ~e~r o, 1~ SGS Grou~ ISoc,~ G~,ra,~ ~. Su~e,,,~.ce~
·
MIJNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONM]!NTAL HEALTH
DEPARTMENT OF HF-~TH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR REA~TH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application DateZO--?-~/
(a) Legals.../~'~Descripti°n~~tt~(include~:~M~ ~. g._t~"l°t' block,~:S~ bdivision,~ t ~'"~ .~"~ ~-s¢c~l'°n' township, range)
LocationXaddress or directions)
(b) Applicants Nam~ff04 g ~ ~f,~Ooc~4', Telephone Homk ~- Z~>~
- Business
Applicants Address ~S ~5~ /=~'/~.4 ~' 7- /~=~f~'
(c) Applicant is (check one) Lending Institution ~-~ ; 0wner/~.~.;
Buyer ~ ; Other ~-~ (explain);
(d) Lending Institution
Address H"~
(e) Real Estate .Co. & Agent
Address
, ~ ~,~ ~'lv< Telephone
Telephone
(f) ~ the HAA to the following address:
Type of Residence
S ingle-Family~ Multi-Family ~
Number of Bedrooms ~
Water Supply
Other (describe)
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.
Sewage Disposal
0nsite ~-~ Public~ Community ~-~ Holding Ta~k ~-~
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]
5. Engineering Firm Providin~ Inspections~ Tests~ File Search~ Data and Information
DHEP Approval
Approved for ~ bedrooms
Approved ~, Disapproved
Te~s of Conditional Approval
As certified by my seal affixed hereto and as of the validation date shown below,
verify that my investigation of this Health Authority Approval shows that the on-sit~
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 my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with 8.11 Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
SRB lg~}( , Telephone
Name of Firm i ~-'-',~-L~
PM. 694-2~70
Address ............ _~_~ ~,~ ~.
Date ,../N
...... .
(ENGINEER SEAL)
ConditiO~ ~
CAUTION
THE HUNICIPALITY OF ~NCHORAGE DEPARTMENT OF HEALTH A~ND EN~fIRON~iENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AIN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. TI~ DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES ~ND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDER3~L ~ND STATE REQUIRE-
MENTS. EMPLOYEES OF D~EP DO NOT CONDUCT INSPECTIONS OR ;~ALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/Di8
[~age 2 of 2]
7-19-84
ae
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUIMORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
~uNICI?ALITY OF A~-,~cHOP~G~
DEPT. OF HF_/',LTH &
~,N,,/t R O h~ MrL. x!T/,.L p~O'fECT[ON
Well Classificat~ y/~- ~
Total Depth ~/~'c~ Cased to
Static Water Level y~ !
Casing Height Above Ground /8 /t
Electzical Wiring in Conduit (~
Separation Distances f~c~ Well:
To Septic/Holding Tank c~ Lot /~//~k
Sanitary Seal on Casin~/{~)
Depression A~ound Wellhead (~
; On Adjoining Lots
To Nearest Edge of Absoz~ptio.n,.Fiel.d on/Lot. /~/~--. .; On Adjoining Lots /~////~
To Nearest Public ~S~?~r Lin~ ~U To Nearest Public Sewer
Cleanout/Manhole~ ~C /~, ~o Nearest Sewe~ Service Line on Lot
Wate~am~le Test Results ~ ~-/ 3~/r/~ C/70 /~ ~/
B. SEPTIC/HOLDING TANK DATA
Date Installed Size No. of Cc~,~a~tments
Standpipes (Y/N) Air-tight Caps (Y/N) Foundation Cleanout (Y/N)
Depression over Tank (Y/N) Date Last P~pe~
Pumping/Maintenanc~ Contract o~File (Y~
}tolding Tarlk High-Water Alarm (Y/N) -- Te~ora~61ding Tank Permit (Y/N)
Separation Distanoes f~cm Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, c~ Major D~ainage
Co~ents
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD E~TA
Soils Rating in Absorption Strata
Date Installed
Width cf Field
Square Feet of Absorption Area
DePression over Field (Y/N)
Results of Last Adequacy Test
of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
Separation Distance f~c~ Absc~ption Field:
To~ater-SupplyW~ll
To Building Foundation
Lot
To Water Main/Service Line
To Property Line
TO Existing or Abandoned System cn
; On Adjoining Lots
To Cutbank(if present)
TO Stream/Pond/Lake/or Major Drainage Course
To D~iveway, Parking Area, c~ Vehicle Storage Area
C ~me n t s
LIFT STATION
Date Instailed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
~ime ns ions
Vent (Y/N)
Pumping Cycles du~ing Adequaof Test.
Meets MDA
Electrical Codes(Y/N)
Comments
** Check Permitted Bedroc~RatingAgainst HAAl~mquest **
I certify that I have checked, verified, or conforn~d to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed
Company
Date
MOA No.
KB1/d5/s
[Page 2 of 2]
2-15-84
MEMORANDUM(Briet Com--- -iications)
-TO:
FROM:
SUBJ.:
State r4 Alaska
Name Dept./ D iv./Sect. Me" Stop
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Pe e,(,.- K,> 6,�
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No(K �4(-C LOCIP-e C-Gwrf�-UC-fC4 go-VCrck I Ca'AC-6'&tC--f(C)-%
--/. �-e ctA X -t 5 4A e j CA-� OAjLd -*1 e -c, v- -e LA) r- I( n 1 *S
SC.C:�- f rd Iti ot�
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C((A V I %A, S V 4 C-+ �G A 0
02-001 C(l 2/80)
ANCHOR. dE WATER & WASTEWA ._R UTILITY
Tony Knowles
Mayor
3000 Arctic Boulevard
Anchorage, Alaska 99503
(907)
October 10, 1984
Bruce Erickson
Environmental Engineer j~ECEtVED
Alaska Department of Environmental Conservation
437 "E" Street, Suite 200
Anchorage, Alaska 99501
RE: REQUEST FOR WAIVER WELL RADIUS ENCHROACHMENT
EAGLE RIVER MID HEIGHTS SUBDIVISION, LOT 15, BLOCK 4B
Dear Mr. Erickson:
The Municipality of Anchorage Water & Wastewater Utility is
requesting a waiver for a conflict of an existing private well
and an existing Municipal sewer main.
The owner of said lot is closing on a house refinancing and
the lending institution will not close without a waiver from
ADEC.
As per the attached plan, AWWU installed the sewer line as a
Lateral Improvement District called Eagle Heights L.I.D. 50-8.
The design took in account of the existing wells and called for
mechanical joint pipe with concrete encasement for protection of
wells.
The plans were designed in 1978 with construction in 1979.
There is not any record on file of a waiver from ADEC. The only
ADEC correspondence is a grant for the L.I.D. prdject.
Your immediate attention is requested. If you have any
additional questions, please call me at 786-9723.
Sincerely,
Planning Tech IV
Anchorage Water & Wastewater Utility
RWB:dw:DllO
Attachment
cc: Louis J. Bonito
.Skip Edinger
Jack Murdock
ANCHOR,,GE WATER & WASTEWA I UTILITY
Tony Knowles
Mayor
October 10, 1984
3000 Arctic Boulevard
Anchorage, Alaska 99503
(907)
Owned by the Municipality
of Anchorage
John R. Murdock
45 Baffin Street
Eagle River, AK
99577
RE: ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION WAIVER
LOT 15, BLOCK 48, EAGLE RIVER MID HEIGHTS SUBDIVISION
To Whom It May Concern:
The Municipality of Anchorage Water & Wastewater Utility
(AWWU) designed and installed sewer mains in Eagle River Mid
Heights Subdivision under a Lateral Improvement District, Number
L.I.D. 50-8. This project was 50% funded through a grant from
the Alaska Department of Environmental Conservation (A.D.E.C.).
At the time of design, A.D.E.C. reviewed and approved the plans
as part of a requirement of elegibility for A.D.E.C. grants. The
plans were designed to encase the sanitary sewer to protect the
well on Lot 15, Block 4B.
A.W.W.U. contacted Bruce Erickson, Environmental Engineer of
A.D.E.C. and Mr. Erickson said the approved plans, along with the
grant funding, is the waiver for the well enchroachment. Mr.
Erickson also indicated this letteF from A.W.W.U. will meet the
requirements for waiver from A.DfE.C.
Attached is a copy of the October 20, 1978 letter from
A.D.E.C. indicating that the sewer meets A.D.E.C. requirements.
If any additional information is required, please feel free
to call me at 562-6305.
Sincerely,
Anchorage Water & Wastewater Utility
RWB:dw:E2
Attachment
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location:
Eagle River Area
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received February 17, 1977
Time of Inspectionl~.~p. FT~
Date of Inspection ~t~-~7 /~r/
REQUEST FOR APPROVAL OF '"'/~c~%~/
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv.
First National Bank of Anchorage, Southcenter
Post Office Box 4-2090 99509
Donald Nims
Box 75 Baffin Street
Phone: 274-1521
Phone: 276-4312 (h)
694-9082 (w)
Lot 15 Block 4B Eagle River Mid-Heights
NHN Baffin Street
5. Type of facility to be inspected
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
Single Family No. of bedrooms 2
B. Depth
D. Bacterial Analysis
B. Installer
2. Manufacturer
2. Material
1. Size
1. Absorption Area
Total length of lines
, Absorption area
, Other contamination
, Absorption area
B. Foundation to septic tank
C. Absorption area to nearest lot line
, Sewer Lines ,
EQ-034 (1/74) Page 1 of two pages
MUNICIPALITY OF ANCHORAGE ~MUNICIPAUTY OF ANCHORAGE
DEPT. OF H:-ALTH &
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTII~tViRONM~NTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA FHA
2. Property Owner: Donald N±ms
Mailing Address: Box 75 Baffin Street
3. Name of Buyer:. John R. and Anita L. Murdoch
FEE 1 ? 1977
Mailing Address:
4. Name of Lending Institution:
Mailing Address: ?,0.
5. Name of Realtor or Agent:
CONV xxxx__
276-4312 (husband)
Day Phone: 694-9082 (wife)
344-5335 (husband)
3007 Arctic Blvd #82 Day Phone: 277-6303~wife)
First National Bank of Anchorage South Center Branch
Box 4-2090 (99509) Phone: 274-1521
none
Mailing Address: Phone:,
6. Legal Description: Lot 15 Block 4B Eagle River Mid-Heights
Location:.
NHN Baffin Street
Well & Septic
No. Bdrms. 2
ri ndividual ~
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply. Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
Individual (on-site).
72-003(3/76)
Pa_ge 2 of two pages - Re it for Approval of Individual ~ ~r & Water Facilities
L~gal'-Description Lot 15 Block 4B Eaqle River Mid-Heiqhts
Comments
Approved
~ ~ ~ sapproved Date
~roval Valid for one year from date signed
Greater Anchofa(e Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
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)