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Home My WebLink AboutCAMPBELL HEIGHTS BLK 4 LT 20A Static Water Level feet Ken Pool Lot 20.iBlk.4 Campbell Heights Subd. Gallons Per Minute 30 Draw Down feet Total Feet of Uasin~ ?& Ty~e Mater~a! Drilled o feet tO J~7 C~mv.l w/water tO 65 ¢lnv.erav~l %O 74 Cravo! w/water .to Hefty Drilling S.B.A. Box 1553 H Anchorage ,Alaska 99507 ~0 DEPT. OF HEALTH & EN~RONMENTAL PROTECTIOhl FEB l 9 ~:' RECEIVED MUN I C I PAL I TV. OF ! ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~PERMIT NO: 'DATE ISSUED: RPPLICRNT: ADDRESS: i. CONTACT PHONE: 825 L STREET, ON--~ I TE B40~5~ o, 05/47/84 SOLAR INVESTMENTS 20i E. !56TH AVE ANCHORAGE, AK ~50~ 562-0484 ANCHORAGE, AK 99501 264-4720 SUBDIVISION: CAMPBELL HTS. SECTION: 4 TOWNSHIP: LOT SIZE: 8400 i(SQ. FT. OR ACRES) I cERTIFY THAT: I LOT: 208 BLOCK: 4 RANGE: 3W LEGAL DESCRIP: .2. SEWERAGE SYSTEM APPLICANT: ISSUED BY I AM FAHILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. I MILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS, AND IN COMPLIANCEIWITH THE DESIGN CRITERIA OF THIS PERMIT. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL~ WASTEWATER DISPOSAL SYSTEM OR PUBLIC ON THIS OR ANY ADJACENT OR NEARBY.LOT. .~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage,343.47~ Alaska 99519-6650 CERTIFICATE OF HEALTH AUTHOR,~ APPROVAL FOR A SINGLE FAMILY DWELLING 0~-~--~ GENERAL INFORMATION Complete legal description . Parcel I.D. # 1. Location (site address or directions) 3751 E. 67th Avenue ,.-~. j ~ .~'. I Anchorage, AK ..Pro. petty owner, Robert & Elberta Boughton ~';' ~, !': ~ ="Mailing add~;ess ' .3,751 E. 67t:h Avenue J~nchorage, Day phone 563-3842 AK 99507 Day phone 563-3033 ~ !, .... ~laska %...~Lending agency . . Home Mortgage '- · Mmling address{ Agent I" Day phone Address e Unless otherwise requested, HAA will be held for pickup. 3 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Inldividual well Xxx Community well Pulblic water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to ~he legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: nd wdual on-s~te Holding tank % -' Community on-site I xxx Public sewer NOTE: If community wastewater system, provide.written confirmation from State ADEC attesting to the legality and status of system. 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 applic~, tion 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. $ & $ ENGINEERING Name of Firm :7c~.~' =~;~ =;,~, L,,,,~ Rv~d No. 2~ Phone ~ q ¥ - 3- c/7 c/ Address Eagle River, Alaska 99577 Engineer's signature Date -7/~//~/7 DHHS SIGNATURE Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipelity of AnChorage Department of Health and Hurna~ 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. Th~ DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employe~s 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 A ~ Municipality of Anchorage aw,..~...,~,~ ....... s~fm~,~t .~ DEPARTMENT OF HEALTH & HUMAN SERVICES ~~ '[ Environmental Services Division JUl 0 9 ]~J~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744' Health Authority Approval Checklist RECEi VED A. WE~ DATA L~ pmse~ ~) T~I de~h ~ ~RO~ WELLLOG Dam ~ m~ ParcelI.D.: 01¥ '-0~- - ~'~' If A, B, or C, attach ADEC letter. ADEC water system number Date comp~etsd ~ /, ~- / ~' ¥ Cased to '/~ Casing height (above ground) Nitrate Wires pmperiy pmtscted (~/N) AT INSPECTION '7/3/e7 g.p.m, g.p.m. Static water level i Well production WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~ Tank size Foundation cleanout (Y/N) Pumper Collected by: Soil rating Other bacteria ENGINEERING l~ e~t., m,,~._ *_.~_ ~ ~e_-~ .H:. 2__~. River, ~15~ 4)9577 Number of Compartments __ Date of Pu ' ' ; -, C. ABS ,OkPTION FIELD DATA ~. Date instldled /', ~ ......... [ :. Len~tlh "; Width. , Depression (Y/N) Hlgl test (in.); Gravel ~ pipe I Tuba presem (Y/N) Immediately after System type Total depth Depression over field (Y/N) __ For gal. water added (in.): .bedrooms (Rev. 3/96)* '(ins) Minutes late~. Lrmst 12 months) (Y/N) Abamptton rote = If yea, give date g.p.d. D. UFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank Absorption field on lot Public sewer main Sewer/septic sewice line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line Absorption field Water main/service line .Surface water/drainage : _ W~ SEPARATION DISTANCE FROM ABSORPTION FI~ Properly line _ ~ Wate~ m~n/cewice #ne Surface water ~ Driveway, parfdngNehicle storage area Cu ' n~-d~''~ Wells on adjacent lots F. ENGINEER'S CERTIRCATION HAA Fee .$. Date of Payment Receipt Number ~ I certify that I have determined thru field inspections and rm4ew of Municipal records ~tems are Engineer s Name Date ~ Date of Payment __.~_..~ ~" Receipt Number 72-026 (Rev. 3/96)' CT&E Environmental Services Inc. CT&E ReL# Client Name Project Name/// Client Sample ID Matrix Ordered By PWSID Sample Remarks: 973107001 S & S Efigineefing N/A I Lot 20A Blk 4 Campbell His Drinking Water 0 Client PO# Printed Date/Time 06/20/97 16:16 Collected Date/Time 06/17/97 14:00 Received Date/Time 06/17/97 14:15 Technical Director: Stephen C. Ede Released By~ ~ Nitrate-N Total Coliform Results 0.56~ o Units 0.100 mg/L col/lOOmL Attouable Prep Analysis ~ethod Limits Date Date Init $M18 ~500-NO3F 10 max 06118197 JBL S~18 92228 06/17197 RAM Rick Mystrom. Mayor Mtmicipali of AnchOrage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.a nchorage.ak.us August 8, 1997 Robert C. Cowan, P. E. S & S Enginee,nng 17034 Eagle River Loop Road Suite 204 [ Eagle River, Alaska 99577 Subject: ~¥aiver Request for Lot 20A Block 4 Campbell Heights Subdivision I Yaiver Request # WR97003S, PID//014-072-8:3, HA970275 Dear Mr. Cowan: Your request for waiver of the required 100 foot horizontal separation from a private well to the public sewer manhole and the honzontal separation of a private well to the private sewer line of 25 feet has been approved. The approved horizontal separations are as follo~vs: the ap'proved waived separation ora private well to the public sewer manhole of 83 feet, and a private well to the private sewer line of 10 feet. This wa,vet approva applies to the existing well and public sewer manhole and private sewer line only Any future upgrade will require a separation distances be met or another approval from th~s department. th If there are any~ furt er questions or concerns regarding these waivers, please call our office at 343-4744. Daniel J. Roth I Civil Engineer On-Site Serv c~s Program Boughton Property MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR970038 I PID# 014-072-83 HA# HA970275 Permit # Date Received:i July 9, 1997 Legal Description: Lot 20A BLock 4 Campbell Heights Engineer: Robert C. Cowan, P.E., S & S En~ineertn~ 17034 Ea~le River Loop Road, Ea~le Rtver~ Alaska 99577 Applicant: Roblert & Elberta Bou~hton Waiver Requested: Private well and the public sewer manhole of 83 feet; private ~well and private ~sewer line of l0 feet. Criteria: i. Points: 2. Special Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Conditions: 3. Other: Waiver is Granted: X Waiver is NOT Granted: List Condmt~ons or Reasons for above: ~FF ~ Date: 8-7-77 By: P4 / Name of Reviewer Rec #: 02796/0805 Amount: $ 920.00 Date Paid: July 9, 1997 (~) o + { ~ PDHv rs 2.3' 2.¢ 2.3 ~LTEST ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. July 8, 1997 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Stree~ P.O. Box 196650 Anchorage, iAlaska 99519-6650 REFERENCE: Lot 20A, Block 4, Campbell Heights Subdivision Request you issue a Health Authority Approval on the referenced property and grant a waiver for the horizontal separation distance between the private well and the public sewer manhole at 83'; and the private well and the private sewer line at 10'. The mitiga~g factors involved which support the issuance of the waivers are as follows: 1. The topography in the area, as shown on the site plan, is relatively flat with a slight slope towaid the South. This would tend to direct any released effluent fi.om the well. 3. Nitrate sample taken fi.om the well located on the referenced property indicated .564 mg/l. 4. fi/ells serving other properties throughout the neighborhood have been placed at similar distance fi.om the public sewer line. With no well water related health problems reported, tiaa, t we are aware of; this would appear to be an acceptable practice for the area. Attatched ~re surrounding well logs. We, therefore recommend a waiver for the separation distance between the well and the public sew& manhole, and a waiver between the well and the private sewer line. If we may be of further service please contact us. Sincerely, i Robert C. Cowan, P.E. MuNICIPAU"~ Of ANCHORAGE ~.t,,IV I p.O NMT-tqT Al- SERVICES DIVISION JUL 09 1997 RECEIVED 17034 NORTH EAGLE RIVER LOOP * SUR'E 204 * EAGLE RIVER, ALASKA 99577 LEGAL DRAWN LOT 18 / \ / ~ I I / 67 AVE. × __ _// .~-- S--S--S'~S--S-- / LOT 20A, BLOCK 4, CAMPBELL HEIGHTS S/D CKO. R.C.C. DATg_8_97 SliT. 1 OF 2 LOT 2B LOT 2A STRUCTURES. [AS£MENTS. OR ENCROACHMENTS SHOWN ON THIS SiTE pLM¢ AR[ ~tS SHOWN ON AN AS-BUILT SURVEY DRAWN BY:I I MARSHALL D. POE 1 IT IS THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION AND PROPERTY UNES PRIOR TO CONSTRUCTION. \ \ LOT 19 \ PUBLIC / / LOT 20A ~i LOT 20B I / / \.PUBLIC SEWER MANHOLES-'/ I/ / _1~ MAIN ,- / / LOT 3%2 LOT 2 LOT IA / / / / ROG£RT C. COWAN C/-8801 BLOCK 3 CLIENT STRUCTURES, EASEMENTS, OR ENCROACHMENTS ~ ~ AN AS-BUILT SURVEY DRAWN BY: ~ ~ ~ UARSHALL D. POE IT IS THE RESPONSIBILITY OF THE CONTRACTOR DISTANCES, AND PROPERTY LINES PRIOR TO CONSTRUCTION. 10' WAIVER REQUESTED j m ~ TO PRIVATE SEWER LINE~ ~ ~ J ~ ' ~ ~ / ~u~uc s~ ~o~ CLIENT {~ MUNICIPALITY OF ANCHORAGE (~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFI ;ATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-472O Application Date /O 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, sec. tion. township, range) ';. Location (~ddress or cJ~re~'ti0ns) ' ' (b) AppliCant Name /'['l ,~' · :',z>c~ f Telephone: Home . (c) Business App~i'ca~t is (~hec~ o~e): Lending Institution D: Owner/builder ~; Buyer D; Other ~ (explain); (d) Lending Institution Address Telephone (f) (e) :~a~r~iate Company and Agent Telephone J Mail the HM to the IoIlow ng address: TYPE OF RESIDENCE Single-Family/J~ Multi-Fa nily I'1 Other Number of Bedrooms! ._ WATER SUPPLY Individual Well ~. Corn unity I-1 Public ri Note: Il community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality ancJ status. SEWAGE DISPOSAL ~.~ ' Onsite ri Publi~ Community J~ Holding Tank [] Note: If community well sy[tem must have written confirmation lrom the State Department of Environmental Conservation attesting to the lega ty and status. Page 1 of 2 ENGINEERING FIRM PROVIDli.. INSPECTIONS, TESTS, FILE SEARCH, D~'. AS ~ertified by my seal affix}ed hereto and as of~he validation date shown below. I verify that my investigation of this Health Authority Approval shows t~at the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedroom~s and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of ~nchorage files and from my investigation and inspection, the on-site water supply and/or wastewater d sposa system s n comp ~ance w~th all Mun c pa and State codes, ordnances, and regulations in effect on the date of this inspection. I Name of Firm K"~ E'C ~' Telephone Address I ,Z-O 0 ,~J .~ ,~ ~'d /{',*,c l, .~ ~C. Date /(:~-~/- ~ Approved for ~ bedrooms by Approved ~,'/' i Disapprove(J/ J con~t~°Unal Terms of Conditional Approval Date /~///'~ "~"/~-' 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 th~ State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to sa{isfy 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 v~ork. Page 2 of 2 · 72-025 (11/84) WELL DATA Well Classification Well Log Present Total Depth "~ Static Water Level MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANO~-:CP. AC,~ DEPT. OF HEALTH ENVIROi%'.~[NT/.L FF.:CTECT;C: ~, ,' w, ~ If A. B, C, D.E.C. Approved (Y/N) Date Completed ~ - !z--~ M Yield Cased to -~ ~ Depth of Grouting Casing Height Above Ground Electrical Wiring in Ci)nduit~/l~l) Separation Distances from Well: To Septic/Holding Tank on Lot I · To Nearest Edge of Absorption Field on Lot -~' To Nearest Public SeLer Line "=~(~ '+ CleanouVUanhole Water Sample Collected by Water Sample Test Resu ts Pump Set At ~ Sanitary Se~l on Casin~N) Depression Around Wellhead (Y~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Comments ; Date SEPTIC/HOLDING TANK DATA Air-tight Caps (Y/N) Foundation Cleanout (Y/ Date Last Pumped Depression over Tar Pumpin e (Y/N) Holding Tank High-V~ater Alarm (Y/N) Separation Distances'lfrom Septic/Holding Tank: To Water-Supply Wel~ To Property Line To Water Main/Servi( Course Corn Page I of 2 72-026{ t i,'84) uilding Foundation Field Tank Permit (Y/N) Pond, Lake, or Major Drainage ABSORPTION FIELD DATA in Absorption Strata Date 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 Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (WN) __ Date of Last Adequacy Test To Water Main/Se~ice Line To Stream/Pond/Lake~nage Course To Driveway.~139~A~ rea. or Vehicle Storage Area ; On Adjoining To Cutbank , Line __ To Existing or Abandoned System on ~ Dimensions / Size in Gal.,.ons ~ Ma~ole/~ "Pump On Level at ~ .........~OIf" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for ~ es during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request I certify~J3a~e chec2d, verified, or conformed to all MOA and HAA~guidelines in effect on the date of this inspection. Signed "~/'~'"Z'~'.'~?7/-~'~';/~--/,/ ' Date _ /~ ' ~ ~ Company ~-~ MOA No. Receipt No. ~~ Date of Payment ~b'~-~ Amount: $ ~ ~0~ Page 2 of 2 ALASKA e UIRO ITI T^L CONTROL :. Depart~ nt or Health and Envlrbnmenta2 Protection 825 L Street Anchorage, alaska attn: Kelth Bandt ., September Legal: Lot 20A Block 4 Campbell Heights Dear Kelth: A well tlo~ test was performed at .September 1P84.".Over 500 gallons GPM. /;he above p~operty on ~lere pumped at a rate Thls Is an adequate flow and rate for the 3-bedroom the property. house Approved: 51ncereZy, . ~(lronmenta! Scientist