HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 2 LT 25
~UN1C1PAU'TY OF ANCHORAGE
... :;. ~.'~o,:. ; D~PL OF HEALTH &
.., ENVtRO~NYN-
RECEIVED
LOG OF DRILLING by.A ,5' 'L DP, ILLING COMPANY
STA,TIC LKV~'L OF W~TER ~'T .....................
/~UNICIPALli'y OF AI'~CI-Ig2,A~,-
£NVI~ONM, EN~'AL S£~,V t ..... ~NIClPALI~ OF ANCHO~A~E
"~ uw~flE~LTH A~HORI~ APPROVAL (HAA)
CHECKLIST- FEBRUARY 19~ ·
' R E C E I V E D Legal Description: ~--~ ~
WELL DATA
Well Classification
Well Log Present'N)
Total Depth / C:~"?_ t Cased to / c::,, .~
Static Water Level ~' 4' ! I ~"
Casing Height Above Ground
Electrical Wiring in Conduit~N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
F. If A, B, C, D.E.C. Approved (Y/N) ikJ/~,~
Date Completed /c~, - ~ - ~*? Yield"~ / ,. f-'% /~.D/~f ~
Depth of Grouting -------
Pump Set At
Sanitary Seal on Casing
Depression Around Wellhead (Y~
; on Adjoining Lots
To Nearest Edge of Absorption Field on Lot ~; On Adjoining Lots
To Nearest Public Sewer Line ~ ~ I To Nearest Public ~wer
CleanouUManhole ~ ~ ~ ~ To Nearest ~wer ~ice Line on
Water Sample Collected by ,~ ~ ~ ~~ ; Date
Water Sample Test Results ~ ~y ~ ~' ~
Comments ~ I~L ~ ~~ ~--~-~
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (WN)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Size No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
Comments '~"~
.To Building Foundation .-~t :~ :.-~,, :.'.,, ·
To Dispo I I '
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata -~ "~
Date Installed
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
Lot
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (WN)
Date of Last Adequacy Test
To Property Line
' To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present) .
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area. or Vehicle Storage Area
Comments .--~, '-¥-
D. LIFT STATION ' · .., ' '
· · Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (WN)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy ;rest. Meets MOA
°° Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, or conformed 1o all MOA and HAA guidelines in effect on the date of this inspection.
Signed $ & $ ENGINEERING Date
17034 Eagle Rive~' Loop Road No. 204
Company r~gle2lver~_~?7 MOA NO. ~,"~-- - c:,¢::,.~
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
2. GO~. c.)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my sea affixed hereto and as of the va ~dat~on date shown below, I venfy that my nvesbgat~on of th~s 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 MunicipaIity 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 $ & $ ~'~GINEERING Telephone ~:~ ~.1 -- 2_...'~ ~/"~
Address · 17034 I=~,,.,I. ~.~... ~ ~ ~
Date Eagle River, Ala~,l(a 99577
DHHS APPROVAL
Approved tor 7"~{~-,-.,, .~'.~) bedrooms by
Approved ~ Disapproved
Terms of Conditional Approval
Conditional
CAUTION
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
engineers work.
Page 2 of 2 ?2-o~s m~, e~ sack
I MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
GENERAL'INFORMATION {MUST BE COMPLETED PRIOR TO SUBM'ITTAL)
(al Legal Description (include lot, block, subdivision, section, towr~ship, range)
Location (address or directions)
l~qq~ ~rmnnf
lb) Property Owner ~4_rr_13_ Telephone: Home
Mailing Address
lc) Lending Institution " ' Telephone
Mailing Address
Business
(d) Real Estate Company and Agent A~r'{ n~-,~ ~-nkPr,~- ~{," .r~rrllrl
Address ~ztt3 ~_ q~h: ~.(h~ ~n~ ~n~hm~g~: ~l~k~ qq~t
Telephone ~R~-3R3~
(el Mail the HAA to the followino address: oc Check here~ if hold for pick up.
List contact person and day phone number below.
o~er~ by Eric
S & S ENGINEE}ING
17034 Eagle Rive~ Leep Rea~ Ne,
.... E,,t~lc River, Alaska
TYPE OF RESIDENCE
Single-Family F~
Number of Bedrooms
WATER SUPPLY
Individual Well~ Community1-1 Public n
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL *~
Onsite n Public I'~ Comn3unity~; Holding Tank I"1
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 72-0,5 r~,v s'~t r.om
CHEMIC/IL & GEOLOGICAL L/IBOR/ITORIES OF.4LtlSK/I, INC.
TELEPHONE (907) 562-2343 5633 B Street
· , o Anchorage, Alaska 99518
Drinking Water Analyms Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
E] PUBLIC WATER SYSTEM I.D.#
~-"'"PRIVATE WATER SYSTEM
Name
Mailing Address
Phone NO.
S & $ ENGINEERING
l?n~zt.E=Cl? ~ Ive~-_L _-~_;~R oed Nort204
Eagle River, Alaska 99577.
State
Mo. Day Year
Zip Code
SAMPLE TYPE:
Fi Routine
Fi Check Sample (for routine sample
with lab ref. no.
Fi Special Purpose
) FI Treated Water
Fi Untreated Water
SAMPLE
NO. LOCATION
I
51 ' I
Time Collected
Collected By
/t~'o ~ I/
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
[~ Satisfactory
[] 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*
I~-~1 I-~
I IFI~
I IF-F1
I II-F1
I Im
Analyst
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS Membrane Filter:. Direct Count
Collformll00ml
BEFORE
COLLECTING SAMPLE
TNTC = Too Numberous To Count
OB = Other Bacteria ~
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 ~ FEDERAL TAX ID ~ 92-~0440
Client ~0t : {{0~E IU~C'I) Req I:
Clleet 8~ol 1O: [25, B2 ~AG~ RIVI~ B~
Sample Rec'd ,' FEB 2 88
Ordered By
~end
Reports To: $ & $ ~NGI{(EI~ING
1~34 IAGI~ RIVI~ LO0? RI)., 121)4
~GIZ IHVElt, {k[. 99577
York Order I{o. : 5013
Client Account : SHSIiNGP
l)ate Report Printed: F{~B 4 88 9 12:31
I~eleased By : 2
Reports A~dress 12
Special
Instruct:
(he, lab Re! I: 9002 I~b Smpl II): I Matrix: Yater
Aliovable
Parameter Tested Result/Units ~thod Limits
NII!~I~-N 1.2 mo~tl EPA 353.2 10
Sample SAmPLe. COLLECTED 2/2/88, 1340 BRS. I{(XrI'INZ SAI~L{~
R~rks: ANALYSIS CUP, PLL~F.I): 2-4-B8
I Tests Performed
NI~ {{one I)etected
I~= {(et Analyzed
m 8em .~eclal Instructions iWve
){ ~ee ~l~lel~emarksN)ove
LT=Less 'fhan, Cl'--Greater l'nan
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date ..~'-~ ~'.,"/-~' ~-
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 25 Block 2 Eagle River Heights Tlhn, R2W Sec.
Location (address or directions)
17936 Baranof Ave Eagle River
(b) Applicant Name~Uck Green Telephone: Home 694-2095
(c)
12
~/A
Business
Applicant Address 1"/936 Baronof Ave, Eagle River AK, 99577
Applicant is (check one): Lending Institution []; Owner/builde~; Buyer []; Other [] (explain);
(d) Lendinglnstitution USA Credit Union
Address PQuch 6613 Anchorage AK, 99~02
(e) Real Estate Company and Agent N/A
Telephone
Address
Telephone
Mail the HAA to the following address:
Pickup
TYPE OF RESIDENCE
Single-Family~ Multi-Family []
Number of Bedrooms 3
(f)
Other
WATER SUPPLY
Individual Well[}[ Community[] Public[]
Note: If community well system, must have written confirmation from the State Department of Environmenta~ Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL . .
Onsite[] Public'~ Community[] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental CortsewatJon
attesting to the legality and status.
Page I of 2
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 this 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 disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection. ~'v~'l 'ch
Name of Firm TeIephone
Address F-.~(;I.E RIVER ENGINEERING
Date ~'/~. £/£ ~' EAGL~ RIVER, AK 6~577
6~4-5155
Engineer's Seal
DHEP APPROVAL -' ' '
Approved for
?ballrooms by ~-~ ~ ~o-~ Date
Approved ~ ' i ed Con I
Terms of Condi~onal Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based ~olely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy 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 work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HA.&)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: /-*~' ?' ~ ~'*
MUNICIPALITY OF ANCHORAGT.
DEPT. OF HEALTH &
ENVIRONMENTAL PROT£CTION
WELL DATA
Well Classification d~>/"/~'~'' ~ If A, B, C, D.E.C. Approved (Y/N)
WeIILog Present (Y/N) Y Date Completed O~ ~ /)'~.3. Yield
Total Depth /o .3. ~ Cased to /,~ ,3. · Depth of Grouting
Static Water Level ¢$ / Pump Set At
Casing Height Above Ground -.~ ~" Sanitary Seal on Casing (Y/N}
.,~ Depression Around Wellhead (Y/N)
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot /'/-'/'""~-
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by ~'-*',:rx.-,'~'¢ ,-*
Water Sample Test Results .-~"~ ~'-,
; On Adjoining Lots
'"'1~ ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot ~ b"'~"
; Date
SEPTIC/HOLDING TANK DATA ,~,.//,~
Date Installed '~.,~"~
Standpipes (Y/N)
Depression over Tank {Y/N)
Pumping/Maintenance Contract on File {Y/N)
Holding Tank High-Water Alarm {Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Size __ No. of Compartments
Air-tight Caps (Y/N) Foundation Cleanout (Y/N)
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation.
To Disposal Field
To Stream, Pond. Lake, or Maior Drainage
Comments
Page I of 2
72.026(11~84)
Soils Rating in Absorption Strata
Date Installed
Width of Field
Type of System Design
Length of Field
Depth 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
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
Date Installed
Size in Gallons
~Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Perr~itted 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 this inspection.
Signe(~ Date '~'~ ~./.~ ,~-
Company
Receipt No.
Date of Payment ~; - ~L IO - ~.~.~
Amount: S ~'~ ~'"~'
Page 2 of 2
EAGLE RIV"%
ENGINEERING SER~,¢ES INC.
P. O. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
Jo. J"*/"P*~- ,*~Y,.x--.~ ~-.~rze ,~o/,.~, ~.
SHEET NO.
CHECKED BY DATE
EAGLE RIVER ENGINEERING SERVICES
Lou Bulera P.E.
P.O. Box 773294
Eagle River. Alaska 99577
Telephone (907) 694-5195
Mr. Steve Morris
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Anchorage, Alaska 99502-0650
Ref:Lot 25, Block 2, Eagle Rver Heights
Dear Mr. Morris;
August 26,1985
RE.¢EI.V ED
On behalf of my client, Buck Green, I am submitting the
information necessary for you to make a decision on approval
of a request for waivier of separation distance. This waiver
is for a well serving a Single Family on the above referenced
lot.
The waiver requested is horizontal well to community sewer
line and manhole separation distances of 26' and 40' respectively.
The waiver to the community sewer line was previously consid-
ered during the D.E.C. plan review of the MOA, AWWU Caribou L.I.D.
50-4. The Single family well is located on the enclosed plan
and profile drawing for this sewer project. The situation of
this well existing too close to a public sewer line must have
been addressed before the constuctton of the lateral. A check
of records at the State D.E.C. is not possible because they do
not have records dating hack to 1972. It is obvious from the
plan that the matter of well protection was considered as water
tight Joints were incorporated in constuction of the lateral.
I believe that this well has a prior wavier to operate at the
current distance and that the municipality should uphold this
waiver approval. L:
If there are any questions or concerns please call me at
my office 694-5195.
Sincerely,
Leu Butera P.E.
nchora e
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TONY KNOWLES.
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
September 5, 1985
Lou Butera, P.E.
Eagle River Engineering Services
Post Office Box 773294
Eagle River, Alaska 99577
Subject: Waiver Request WR85-021: Lot 25 Block 2 Eagle River Heights S/D
Dear Mr. Butera:
This Department concurs with your assertion that the well on the subject
lot has been previously granted a waiver to the required separation
distances between the well and the sewer lateral. Although no direct
evidence of a waiver exists, notes on the as-built of the sewer line
indicate that a waiver had been previously approved. Please consider
this a waiver of the separation distances required between the existing
well and the sewer manhole and line on Lot 25 Block 2 Eagle River Heights
Subdivision.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
SSM/lJw
- . . ...'~ ': s?.J : " .j~..
- ' ,' ' .~ · AS-BUiLT ' ' ·
I hereby cerUfy, that ! have ~urveye~l ~the '~ollo~4ng
Anchorage ~ec~d~ng"~cmc~ Alaska. ~d :that the
improvements situated thereon ~e within the p~ty
lines and do not overlap, or en~oach.on the proper~
lyln~ adja~nt thereto, t~at
arty ly~n= adjacent th~eto en~oach on the p~mises in
~ue~Hon and that there are no roadways 'trens~ssion
hnes or other vis ble easemen~ on said p~pe~y except
as ~dl~ted hereon. : ,- - .....
Dated at'Ea61e ~v~, ~h'
-.-Reg~ter~ ~nd Su~eyor No. ~80-LS
. 1 = ~ ( Box 4~. Ea~le ~ver, ~aska ·
. - .... Phone ~94-2~43 .....