HomeMy WebLinkAboutEAGLE CREST #2 BLK J LT 2BEagl
Crest
Block
Lot 2B
#050-295-97
APR 16 '93 11:47 I~:/t~ OF £AGL£ RIVR,
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, AL/~KA
OWNER OF LAND
ADDRES~
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IIUSCL. IN~OPJ, iATION:
MUlti I C I I,;i¢:~L I I'Y I_]i=
DEPARTMENT ~' HEALTH AND ENVIRONMENTAL .(OTECTION
825 L STREET,264-4720 ANCHORAGE, AK 99501
ON--SITE WELL PERMIT
PERMIT NO:
DATE ISSUED:
860555
09/08/86
APPLICANT:
ADDRESS:
CONTACT F'HONE:
BILL SULLIVAN
P.O. BOX 670272
CHUGIAK, AK 99567
688-2759
LEGAL DESCRIP:
LOT SIZE:
SUBDIVISION: EAGLE CREST 2NDADD. LOT: 2B
SECTION: 7 TOWNSHIP: lqN RANGE:
10540 (SQ.FT. OR ACRES)
BLOCK:
certify that:
1. I am familiar with the requirements for
2.
5.
on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
I will adhere to all MOA and State of Alaska requirements Cot the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
SIGNED DATE:
APPLICANT: B~% ~LLI VAN ,
ISSUED BY ~-~/¢-~'7' '~-'~ DATE,
Municipality of Anchorage
Development Services DeDartment
Building Safety Division
On-Site Water and Waslewaler Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 995t9-6650
www,ct.anchorage.ak.us
(907) 343-7g04
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
1. ..GENERAL INFORMATION
Expiration Date: "~ -
· ~Aailing addres?." .~E=
Len(~i~g'~(~, Day phone
It,la[ling address
Real Estate Agent
Mailing Address
Day phone
NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class~ Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-sile
Individual Holding tank
Community On-site
Public Sewer
The Municipality o~' Anchorage Developmenl Services Department (DSD) Issues Certificates of Health Authorily
Approval (HAA) based only upon the representations given In paragraph 5 by an independent professional civil
engineer reglslered in the Slate o1' Alaska. Certificales o[ Health Authority Approval are required [or the lransfer of
lille (except belween spouses) for properties served by a single family on-sile wastewaler disposal and/or water
m~pply system. DSD also Issues HAAs upon request 1o homeowners. Cedificates of Health Authority Approval are
valid for 90 days from the date of issue [or properlies served by a private or Class C we!l and may be reissued wilh
~]ew water sample results less lhan 30 days old. (Ced[fica[es may be reissued for a period of up lo one year with
valid water samples.) Certificates are valid for one year for propedies 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 pro[essional
engineer's work.
4. STATEMENT oF INSPECTION BY ENGinEER
As certified by my seal affixed hereto and as cJ the valldatton da{e shown below, I verity Ihat my tnvesllgalion,
based on procedures outlined In the Health Authod['/Approval Guidelines for this applicalion, shows that the
on-site waler supply and/or wastewater disposal system Is(are) safe, funclional and adequate for the number of
bedrooms and type of structure Indicated herein. I Jurther verify Iha~ based on the Information obtained from Ihe
Municipality of Anchorage files and from my Investigafion end Inspection, Ihe on-site water supply end/or
waslewaler dtsposal system Is(are) In compliance With all applicable Municipal end Slate codes, ordinances,
· and regulations In effect at Ihe time oflnstallafion.
Name of Firm ,~'~ ~ ~-'~/(.//,v/~A-,~-J.-.,/~--
Engineer's Pnnted Name
5. DSD SIGNATURE
. ~ Approved for 3
Disapproved.
Conditional approval [or
bedrooms.
Phone
bedrooms, with Ihe following stipulations:
Additional Comments
Altachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Cedificale Date: ~ - ..Q. ~ - C3:2__
Municipality of Anchorage
Development Services Department
Building Safety Division ~,~°
On-Site Water & Wastowater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650 ~1~.~
www.ci.anchorage.ak.us _
(goT) 4 .',,go4 -
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDesoription:/_~PT '~-~ : ~14._,~': ~-~7'" ParcellO: 0~'-0,
, /
A. WELL DATA
Well type '~/~-~ V~,,~'~
Oate completed ~/~'~, Sanitary seal (Y/N) Y
Total depth I (~ ~, ft. Cased to 4~'~.
FROM WELL LOG AT INSPECTION
Static water level t '~ '~ ' ft. I ~-~'-.-"~'
Wall production
Well Log {Y/N) Y~_
W~es properly protected (Y/N) '7"
Casing height (above ground) { ?-.-'lt- In.
fi*
g.p.m.
WATER SAMPLE RESULTS:
Coliform (~ colonies/100 mi.
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank siZe gal.
Nitrate ~, I{~ rng./1. Other bacteria .~.~_ colonies/1 O0 mi.
Collected by: ~fl ~ 4~/~--~//'~''''-'~- /'"~'~'-
. Foundation cieanout (Y/N)
(Y/N)
Date installed
Cleanouts (y/N)
High water alarm (Y/N)
Date of pumping.
C. ABSORPTION FIELD DATA
Date installed
Length
Total depth ft.
Date of adequac
Fluid
~efore test
(g.p.dJft~ or ~/bdrm)
W~th ft.
ft2 Monitoring tube
Results (Pass/Fail)
in. Water added
System type
Gravel below pipe
Depression over field
gal.
ft*
For bedrooms
New depth in.
Elapsed
Final fluid depth in.
(past 12 mo.) (Y/N & typ~)
Absorption rate >=
If yes, give date
g.p.d.
D. LIFT STATION
Date insteJled /'J,/~ Size in gallons
'pump on" #)vel at .._.~ln. 'Pump off" level at
Manhote/Access (Y/N)
in. High water alarm level at in.
Meets alamt & C~lt requirements?
Fo
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tenldlift station on lot
Absorption field on lit
,/~//~ On adjacont lots
/'"///~ On adjacent lots
Public sewer main /~:~'/'/- Public sewer manhole/cleanout /{~Q /~-
Sewer/septic service line. ~ ~" ~ ~ H¢flding tank .......
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ~)(. I ,'~ ~.~ C.- ~ C--..f._~
Building foundation / Properly line / Absorption field
Water main / Water sewice line/ Surface water /
Wells on adjacent ii/ . /
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Water Sewice line Surface water / Driveway, parking/vehicle storage
Curtain drain Wells on adjacent lots/
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
confo~nance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name ,~6~ r- ~'.
Date .¥/& ~-/0 "z.
Date of Payment
Receipt
Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
APR-19-02 03:58PM FROM-CT&E ENVIRON~NTAL SRV
.~t~_- CT&E Environmental Servic~a Inc.
9075615~01 T-516 P.02/02 F-6~6
CT&E Ref. #:
Client Name:
Project Name:
Client Sample ID:
Matrix:
1022048001
S & S Engineering
Eagle Crest # 2
Lot 29 Block J
Dnnking Water
PWSID n/a
-Sample Remarks:
Parameter
Nitrate
Results
3.16
POL Units~
0.2 mg/L
Total Coliform (MF)
cell1 O0 mi
'Client PO#:
Pdnted Date/Time: 04/19/02 15'45
Collected Date/Time: 04118/02 13:55
Received Daterrlme: 04118/02 17:35
Technical Director:
Allowable Prep Analysis
Method Limits Date Date Init --
EPA300 100 O4/19/02 JDT
SM92~2.B 04119/02 KAP
I I,~11
IU
I .']1
ll. llf~l.
I HEREBY CERTIFY .THAT I HAVE SURVEYED THE SCAL~;
FOLLOWIN(; DESCRIBED PROPERTY, /,,~-,.,.-,~-t:~
~ NO ~MENTS ~IST ~C~ ~ ~, ~;7., ~ .~' ~.-
~ ~ D~RMINE THE ~ISTEN~ OF ANY
W~ ~ ~ ~E~ ~ ~ R~ ~1- ": ~X .................... ~...,,~ ~.,{ ~ '
VISI~ P~T. U~ NO CIRCUMSTANCES S~ F~ f~-.. t5-~{8 ...'~e
~Y DATA H~ BE U9~ ~R ~NS~U~ION
~ FEtE LIN~, OR ~R E~LISHINO ~ND- D~WN
ARY LINES.
ASBUILT-NO CORNERS SET THIS DATE.
Parcel I.D. #
. ~ 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
~UNICIPALI1~ OF ANCHORAGe
CERTIFICATE OF HEALTH AUTHORITY ENVIRO 'NM~NTAL S~VICI-'S DIVISION
APPROVAL FOR A SINGLE FAMILY DWELLING
050 293 97 ~o~ ','
HAA# ~'~ ~'~-.~ ,~
ECEIVED
IAY 2 8 1998
1. GENERALINFORMATION
Complete legal description Lot 2Bt Block J: ~ale Crest
Location (site address or directions)
Property owner
Mailing address
18646 Citation
Eagle River, AK
P~h P~q~on Day phone 6q~-o~o4
'18646 Citation Eagle River, AK 99577
Lending agency city Mortoaqe/ Jeannie Mee
Mailing address
Day phone 696-0701
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:;
Individual well
Community well
Public water
NOTE:
XXX
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OFWASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer xxx
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and es 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.
$ & $ ENGINEERING
Name of Firm
;~'G~-~ ~.~ R;,,~, L.,~v ~'. ..... ~., ..~ Phone G ¢~ ~/~ .~. 9 '7 ~'
Address Eagle River, Alaska 99577
Engineer's signature .. '?~./~.' ~
Date
DHHS SIGNATURE
~ Approved for . t"'"-'~ C)
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 errom or omissions in the professional engineer's work.
IaAY 2 8 998
Municipality of Anchorage .._.^.._. ~
- 1~' OF ANM'~w,~
DEPARTMENT OF HEALTH & HUMAN SE~_~ .......... ,,.,~I~T~
Environmental Sewlces DMsion ~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Legal Description:
Health Authority Approval Checklist
ooo
A. WELL DATA
Well type
Log present(~)
Total depth
If A, B, or C, attach ADEC letter. ADEC water, syetem number
Date completed
Cased to I ~' ~'
Casing height (above ground)
Wires pmper~ protected ~)
Date of test
Static water level
Well production
FROM WELL LOG
g.p.m.
AT INSPECTION
z.+
I 'l
~. 2.. g.p.m.
WATER SAMPLE RESULTS:
Cctffomt (~ Nitrate
Date of sample:
Collected by:
B. ~O TANK, DATA
Date instal~ Number of Compartments ~ Cleanoute (Y/N)__
F~~.. ~. _____~__ High water alarm (Y/N)
Date of Pu~pi~g' ' :"' ' "' Pumper
C. ABSO~I:~10N FIELD DATA-':'
~.....
Length~ ~"~'dtYr~ Gravel thickness below pipe Total depth
Effective absorpfion area Mo~M'~ad.~Tupe present (Y/N)
Depression
over
field
(Y/N)
Date of adequacy test Results (P~~ _ For
Fluid depth in absorption field before test (in.); Immedtate~ gal. water added (in.):
Fluid depth (ins) Minutes later:. Absorption rote =~-.~ g.p.d.
Peroxide treatment (past 12 months) (Y/N) If yes, give date ~
72-02e (Rev. 3/96)* ~
bedrooms
D. UFT~
Date installed ' -"'-,,.~ Size in gallons
Manhole/Access (Y/N) ~
High water alarm level at* *Datum ~
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELLON LOT TO:
Septic/holding tank on lot
Absorpfion field on lot
Public sewer main ..~
"Pump off" level at*
I cerSfy that I have determined thru field inspections and mvfew of Municipal record~~.rns are
HAA Fee $ '~'~-~ ' '"'"
Date of Payment ~
RecaiptNumber~9~'7,9..'~/~.~74~'C
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
Water main/service line .SuSa .se water/drainage
SEPARATI~ORPTION FIELD ON LOTTO: "
Property line ,; ~ BulFd~aa~.~~ Water main/sewice line
F. ENGINEER'S CERTIFICATION
~ '~' Litt stat,Ion '~
DING TANK ON LOTTO:
Absorption field,
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
I'1RY-04-1~ ~:41 CT&E ESI ~ c34~756t$3~1 P.02/~4
Client ~
C'I'&E Ref.# 981902001 l~lnted D~te/'Flzn¢ 05/01/98 14:18
Client Name $ & S Engineer's CoUected Datdq'ime 04/28/98 0'/:10
ProJec~ Name/# H/A Received DalerX'sme 04/28/98 08:30
Client Sample ID LeI 2B BK CJ EaSie Crest #2 Techolcal Director: ~cphen C. Ede
Matt~c DriVing Water ~
Ordered By 0 Released By
s:
AItO~abt e prep AnaLysis
Limits Dete 0ate init
0 cot/100mt, s#'~8 ~Z]tt 0~1~8/98
Toter CotlforJ~ ?.TJ 0.100 mS/I, EPA :500.0 10 ama 0~/Z8/98 G~--P