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Home My WebLink AboutEAGLE RIVER HEIGHTS BLK 2 LT 19Eagle River Heights Block 2 Lot 19 #050-281-42 A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588 OWNER OF LAND ADDRESS ~ ~: LEGAL DESCRI~ION ~ATE-SIa~ed ,/- DEPTH OF WE~L STATIC LEVEL OF WATER FT. DRAW DOWN FT. aT~ GALS. PER HR KIND OF FORMATION: From t'.~ Ft. to From ~} Ft. to From .7 Ft. to From ~75" Ft. to From ~? / Ft. to ~ Ft. From ':'! !' Ft. to /0,~ Ft. From __Ft. to Ft. From Ft. to___Ft. From.__Ft to Ft,_ From__.Ft. to Ft. From Ft. to Ft. From Ft. lo Ft. From Ft. to Ft.__ From Ft. to Ft From __ Ft. to Ft.. From __ Ft. to From Ft. to Ft. Ft 0¢~'C' ~,d'ed"''''~ From Ft. ,~,~/-~oO ~' - ~ ~'~ ~ From Ft._ ~Z~/~ From From Ft. O From From From From From From From From From From From Ft. to Ft. Ft. to Ft._ Ft. to___Ft. .Fi. to FI, Ft. to FI .Fi. to Ft. FI. to Ft. Fi. to Ft. FI. to Ft. Ft. to Ft. Ft. to__.Ft Ft. to__.Ft Ft. to Ft. Fi. to Ft._ Ft. to- Ft. Fi. to Ft. Fi. to Ft~ MISCL INFORMATION: DRILLER'S NAME PERMIT NO. APPLICANT LOCATION LEOAL CLARENCE E. LRMAY EAGLE RIVER L19 B~ EAGLE RIVER'HTS .'1UN I C ! PAL I T¥ OF RNCH~-,RRG£ DEPARTMENT OF HEALTH AND ENVIRONMENTRL PROTECTION 825 'L' STREET., RNCHORAGE, RK. 99501 264-4720 t~IELL PERI'II T ( 781062 ) BO){ 935 EAGLE RIVER LOT SIZE MINIMUM DISTRNCE BETWEEN R WELL RND ANY ON-SITE SEWROE DISPOSAL SYSTEM IS t88 FEET FOR R PRIVATE WELLJ OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TVPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 38 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICRTIONS AND CONSTRUCTION DIRGRAMS ARE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PERMIT EXPIRE~ DECEMBER ~l~ 694 3175 45888 SQUARE FEET I CERTIFY THAT 1: I AN FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS FORTH BY THE MUNICIPALITV OF RNCHORAOE. 2: I WILL INSTALL THE SYSTEM IN RCCORDANCE WITH THE CODES. APPLICA.T CL.R~.OE E. LA.AY iSSUED _~._ ..... _u~_j~~ .... DATE___~: ........ V3. 2 ~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME iNSPECTOR ,NSPECTC~ ~ ~/ ~'/ NSPECTO~ MUNICIPALITY OF ANCHORAGE DEPT. OF H~ALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~RO~ENT~ 825 L Strut - Anchora~. Ala~a ~1 E.WeOaME.T LSa. TAT OaD WS O" JAil ;3 98L RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL'WATER AND SEWER FACILITIES )1RECTIONS: Complete all parts on page 1. Incomplete ~u~ will not ~ pr~. ~ease allow ten (1 O) days for pr~slng. 1. PROPERTY OWNER ~ PHONE PROPERTY RESIDENT (If different from abo~) PHONE PHONE MAILING ADDRESS LEGAL DESCRIPTION iTREET LOCATION 6. TYPEOF RESIDENCE NUMSER OF~BEDROOMS [] One [] Four ~ SINGLE FAMILY [] Two r-I Five I-'1 MULTIPLE FAMILY ~:~ Three [] Six [] Other 7. WATER SUPPLY ~i~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For Wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISMAL SYSTEM [] INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ~ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY I-'1 INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM I-'lIN DIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified r-'lSepticTank or []HoldingTank Size: If Tank is homemade ive dimensions: NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING TYPEOFTANK MANUFACTURER MATERIAL Septic/Holding Tank TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area ISewer Line. [] OTHER INearest Lot Line 5. COMMENTS DATE [] [~;~--- DISAPPROVED APPROVED FOR BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) 72-010 (Rev. 6/79) MUNICIPALITY OF ANCHORAGE - .-.- -- NMENTAL PROTj~[C'tPAU~( OF ANCHORAGE ~.~.~ ..... ~PT. F ..ALTH & ENVIRONMENTAL ENGINEERING DIVISlOfl TMeph~ ~7~ MAILING ADDRESS 3. LENDING ~INSTITUTION MAILING ~. ~LTOR/AGENT MAILING ADDRE~ PHONE PHONE PHONE PHONE E. ~.EGAL DESCRIIrrlON ,G 7' TREET LOCATION E. TYI~E OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One ~'~'~ur [] Two r-i Five [] Three [] Six [] Other 7. WATER SUI~'LY [~"~DIVIDUAL' I-1 COMMUNITY [] PUBLIC UTILITY & SEWAGE OISK)S~L SYSTEM [] INDIVIDUAL/ON-SITE** ~,'/PUBLIC UTI LITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled pr, ig~t~Q~that date, give well depth (attach log if available.) If system Is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72431o(3/78) - - THIS SIDE FOR OFFICIAL USE ONLY ; DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR~ INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS I--'1 SINGLE FAMILY I'-I ONE "r-I THREE [] FIVE [] OTHER [] MULTIPLE FAMILY Y--I TWO [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL. [] COMMUNITY DATE DRILLED I--I PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER F"IINDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER I'-ISepticTank or [~]HoldlngTank Size: If Tank is homemade so;t.s RATING · give dimensions: . TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Absorption Area to neeres! Lot Line 5. COMMENTS [~ APPROVED FOR ~ BEDROOMS [--I CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE By (TitIel LEGAL DESCRIPTION 72-010 IRev, 3/78) P.O. BOX 4-1276 ANCHORAGE, AL~*SKA 99509 464g BUSINESS PARK BLVD. Ddnk|n8 Water Analysis Re~ort for Total Coliform Bac~erla TELEPHONE {907) 279-4014 TO BE COMPLETED BY WATER SUPPLIEI~ ' PUBLIC WATERSYSTEM: III I II1= P~ldic WetM Syit~ N~ ~ ~ ~ - y Zip Code Mo. Day SAMPLE TYPE: Year [] Routine [] Check Sample (for routine sample with lab ref. no. .) [] Treated Water ~ ~ ,,¢,j~ [3 Untreated Water peclal Purpose SAMPLE Time Collected NO. LOCATION Collected. By 2 I I TO BE COMPLETED BY LABORATORY LABORATORY: NAME ADDRESS CITY Date Received Time Received d?~ Analytical Method: [] Fermentation Tube .~Membrane Filter Lab Ref. No. Result* Analyst I I-F1 I READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310 (3.78) 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. ]978 '61.c) L Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program $ A F E z r 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 050-281-42 COSA# 0`JG1a)gD6N Expiration Date: — `' ..2 1. GENERAL INFORMATION Complete legal description Eagle River Hts Block 2 Lot 19 Location (site address) 10208 Caribou Street, Eagle River, AK 99577 Current Property owner(s) Koger, Dianne Day phone 696-0640 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address AK USA Mortgage Day phone Katherine M. Day phone 244-3574 AK USA Mortgage Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3.__TYPE OF_WATER _SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ Individual Holding Tank ❑ Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems 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. (Certificates may be reissued for a period of up to one year with valid water samples.) 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. 4. 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 Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724 Eagle River Engineer's Printed Name Steve Eng Date 9/8/2012 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all wel'Land septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system.OF A4 ta.'C.ii 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Attachments COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory bedrooms, with the following Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other stoven W. Eng By: Original Certificate Date: (Rev. 11105 Municipality of Anchorage Rs • '� Development Services Department .} Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Eagle River Hts Block 2 Lot 19 Parcel ID: 050-281-42 A. WELL DATA- Public Water Well type P If A, B, or C provide PWSID # _ Well Log (Y/N) N Date completed 1/1/79 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 102 ft. Cased to 102 ft. FROM WELL LOG Date of test 1/1/79 Static water level 65 ft. Well production - 12 g.p.m. WATER SAMPLE RESULTS: Coliform Pass colonies/100mL Nitrate 2.86 mg/L Casing height (above ground) 24 in. AT INSPECTION 9/7112 66.5 ft. Arsenic: 0.274 ug/I Date of sample: 8/30/12 Collected by: nr B. SEPTIC/HOLDING TANK DATA Tank Type/Material-------- Date installed — Tank size = gal. Number of Compartments= Cleanouts (Y/N) —Foundation cleanout (Y/N) --Depression over tank (Y/N) High water alarm (Y/N) =Date of pumping Pumper ------- C. ABSORPTION FIELD DATA- Public Sewer Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) = System type Length = ft. Width —ft. Gravel below pipe — ft. Total depth = ft. Eff. absorption area _ft2 Monitoring tube _ Depression over field = Date of adequacy test ------ Results (Pass/Fail) For = bedrooms Fluid depth in absorption field before test in. Water added= gal. New depth — in. Elapsed Time: _ min. Final fluid depth — in. Absorption rate > Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date -_ D. LIFT STATION Date installed na Size in gallons na Manhole/Access (Y/N) na "Pump on" level at na in. "Pump off' level at na in. High water alarm level at na in. Datum na Cycles tested na Meets alarm & circuit requirements? na E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot na Absorption field on lot na Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank na Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation -- Property line— Absorption field --- Water main — Wells on adjacent lots = Water service line — Surface water --- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line = Water Service line — Curtain drain --- F. COMMENTS Building foundation = Surface water -- Wells on adjacent lots = 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 COSA guidelines in effect on this date. Engineer's Printed Name Steve Eng Date WWO12 Water main — Driveway, parkingivehicle storage COSA Fee $490.00 1 Waiver Fee $ _ Date of Payment j 11Date of Payment Receipt Number N 5'�L1 G Receipt Number, (Rev. 11/05) osctaigaA 049 Steven W Ung PE 6256 AS -BUILT sC i'`t ql I hereby -certify that I have surveyed the following QL--'I- 4- O0. t Z. described property- L o'7/ 1 � { 7 , {a! ®c. -if; 2'-, - Se-��-a7'� r 3� Anchorage Recording Precinct Alaska, and that the:... improvements situated thereon are within-. the .property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements an prop- erty lying adjacent thereto encroach on the premises in - question and that there are no roadways transmission lines or other visible easements on said property except as indicated hereon. - - Dated at Eagle River, Alaska thin !�� day of J f-tl�2. lgi ROBERT JOMfSON`= " SCALE: Registered and Surveyor No.' 6NLS I"= 2 '�p Box 456, Eagle River, Alaska Phone 694-2543 - - - 14.� N- AS -BUILT sC i'`t ql I hereby -certify that I have surveyed the following QL--'I- 4- O0. t Z. described property- L o'7/ 1 � { 7 , {a! ®c. -if; 2'-, - Se-��-a7'� r 3� Anchorage Recording Precinct Alaska, and that the:... improvements situated thereon are within-. the .property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements an prop- erty lying adjacent thereto encroach on the premises in - question and that there are no roadways transmission lines or other visible easements on said property except as indicated hereon. - - Dated at Eagle River, Alaska thin !�� day of J f-tl�2. lgi ROBERT JOMfSON`= " SCALE: Registered and Surveyor No.' 6NLS I"= 2 '�p Box 456, Eagle River, Alaska Phone 694-2543 - - - SGS SGS Re£# 1127678001 Client Name NOrthRu Engineering Project Name/# /02QB CG/'i�aJ Client Sample ID ER5 Matrix Drinking Water Printed Date/Time 09/06/2012 15:17 Collected Date/Time 08/30/2012 09:00 Received DateMme 08/30/2012 12:05 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method ComatnerlD Limits Date Date Init Metals by ICP/MS Arsenic Waters Department Total Nitrate/Nitrite-N Microbioloav Laboratory E. Coli Total Coliform Page 3 of 6 0.274 5.00 2.86 0.100 Negative Negative ug/L EP200.8 C (<10) 08/31/12 08/31/12 NRB mg/L SM214500NO3-FB (<10) 100mL SM219223B A IOOmL SM219223B A 09/05/12 CMA 08/30/12 SDP 08/30/12 SDP