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Home My WebLink AboutEAGLE RIVER HEIGHTS BLK 2 LT 42 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Sen/ices On-Site Sen/ices Section P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~'"~,.~-V'~- ;~q-.~ -'~'~ HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Day phone 694-~904 ,, ,, Lending agency Mailing address Day phone Agent Ma~y Co~ SELLERS REAL ESTATE SERVZCES Day phone 578-1000 Address fO7 EC~.~ NoUght, in L~.ql,~t,6 Blvd.~ An~hora,~, Ak 99505 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 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 Public sewer NOTE: X~ If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 5. STATEMENT OF INSPECTION BY ENGINEER Name of Firm Address 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. -'=R;NG ..... ,~;~;le River Loop Road No...2_O~. Engineer's signature DHHS SIGNATURE .~)~' Approved ,or"~/~ ...~a~ bedrooms. Disapproved. Conditional approval for 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 courtes? 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. ; Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ~rcel I.D. 0~0-- A. WELL DATA Well type ~ If A, B, or C. attach ADEC letter. ADEC water system number Log present (Y~ ~ Date completed /,.J,~J I/--/Jo ~-,/~ Driller Total depth Ot~,'V-,~ c, ,~ I,[ Cased to Sanitary seal ~N) '~ Date of test Static water level Well flow Pump level FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line ~1~' t- Casing height Wires properly protected (~N) AT INSPECTION g.p.m. ~5,C) '" g.p.m.,~ · ' ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: ,/ Coliform ~ ~:) c"~'/tc~"'~-- Nitrate Date of sample: ~*" /'~ ° .~....~ ~,~'/', Collected by: B. SEPTIC/HOLDING TANK DATA Other bacteria $ & S ENGINEERING 17034 Eagle Rlve~ Loop Road No, 204 Eagle River, Alaska 99577 Date Installed Tank size Compartments · Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) ~ High water alarm (Y/N) ~.....~~ Date of pumping ~ ' SEPARATION DISTANCES FROt~SEP~IC/HOLDING TANK TO: Well(s) onlot / Onadjacentlots Foundation ' Abso'rption field ' Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size In gallons vent (Y/N) "Pump on" level at Manufacturer · Manhole/Access (Y/N) ~ ~;ff" level at Date install6d ~ L~ngth ~' --' Width Total absorption area Depression Over field (Y/N), Results (pass/fail) Soil rating D. ABSORPTION FIELD DATA Surface water System type Peroxide treatments(past 12 months) (Y/N) / r If yes, give date SEPARATION DIST.A. NCE FROM AB TO: .~' . Wellonlot ..'/-' . _,.'"On adjacent lots - .-.--Pr6pertyline To building foundat;o.n.~,/ To existing or aband6ned system on lot On adjacen.~,-- Cutbank Water main/service line Surfac~ter Driveway, parking/¥ehicle storage area --,~,,., .o.,w.~,.n d:':i: '." ,.!., I ,-. · ..... E. EN b~INEEA'S' ~ERTJFICAT'OI~i I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec~ttl~:f~ ~,~,,nspection. Signature ........ ,~,,t~ .1~ ~* .~~~ EngineePs Na~='°N pao~ ~ool J~Hu ei~.a ~OZ[ ....... . ........ .t." Waiver Fee: $ Date of Paymen, '~ f? /~~ Date ~/-- F/ / -- of Payment Receipt Number Receipt Number Gravel thickness ' ' Total depth Cleanouts present (Y/N) ~ Date of adequacy/J~/ for ~ bedrooms High water alarm level Meets MOA elect~ica~.~s.(YTJ~,) ~--~--: - ~ '~..'~.,r~,~ .,~,~,.,'''~ . - ',,~. .,., ..~ SEPAR~N:'OISTANCE FROM LIFT STATION TO: We orr~n lot ' ' ' On adjacent lots Cycles tested .! ?034 E~g~e Rlvtr LOOp ~o~d ROBERT A.$HAFER Eagle River, Alesk& 9951! CIVIL ENGINEER~.~79 L~TION OF WELL ~egll Delcdpt~n):* ~ WELLOEPTH~ ~~ FT. CAS~NG: ~t + ' ~. SCREEN: ~ STATIC WATER LEVEL (Top of Casing): '~1 t CLOCK ELAPSED TIME SINCE DEPTHTO DRAWDOWNI TIME PUMPINO STARTED/ WATER, FT. RECOVERY RAT~OPM REMARK8 STO~eED, MI.. 1~{2hOurs) 1 ~ ~ h~rs) Subsequent Var]atlons Can Oca~r. CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING ANALT$I$ [EPOE! IT SABLE fo~ ~Nl[otdet! 34216 Dote Eepott P~inted: VAT IS 91 ! 1S:O6 FAX: (907) 561-5301 Client Sample ID:L42 ~2. RAGL! RIVER I~I$. PW~ID :UA Collected MA! 14 91 ql 11:30 h~e. Received ~ 14 91 I 14:00 ~a. Client Rase :$ Client Acct leq ! Cheul&b SeE I: 911996 Lob Smpl I0: $ Matzix: MATER illovoble POZ&Mtez Tested Result Units Method [AMis NITRATE-H 2.7 ~/1 Z~A 255.2 10 3ample ROUTII~ ~A)iPLE COLLECTED BI: RAY I Tests Pezfozmed * See Speciul Instzuctiorm Above UA-Unavailable Iff)- None ~etected *' See Sanple Renatks Above RA- Not Analyzed ' LT-Less 'Than. GT-C:eotot'Than ,CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street i Anchorage, Alaska 99518 Dri'nklng Water Analysis Report for Total Colif,orm Bacteria TO BE COMPLETED BY WATER SUPPLIER · .,;; .- ,.. - . PUBLIC WATER SYSTEM I.D.# PRIVATE WATER SYSTEM Zip Code Mailing Address City ': Stath Mo. Day Year SAMPLE TYPE: ~ Routine [3 Check Sample (for routine sample with lab rel. no. · ' [3 Special Purpose ,, . .,. :: SAMPLE ,' ,~ NO. LOCATION I ) [] Treated Water [] Untreated Water · Time Collected Collected By I ~v.~^ F-~ I I I I TO ~E COMPLETED BY LABORATORY ¥ Analysis shows this Water SAMPLE to be: atisfactor~ ' ' Unsatlsf~6t~.,' ' ' ': -:~' :' ':: '" [] 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 ~'-/IL~~ TIn~e1 Received ' IqO0 * ' Analytical Method: Membrane Filter ' No. of col0nlesll00 mL .Lab Ret. No. Result* . Analyst 91.19% I I ['-D READ INSTRUCTIONS I ' BEFORE -, COLLECTING SAMPLE TNTC ='Too Numerous To Count - OB = Oth'er Bacteria ~, BACTERIOLOGICAL .WATER ANALYSIS RECORI;) ':: : c,_ Membrane FIItec Direct Count ~ ~ Coliform/100 mi VerlflceUon: LTB ' I . DGB - _ Final Membrane Filter Res~lte-.---.. t ....... Colltorm/100 mi . i. i t,.~%~ ,.m. ~ .. -'. ,':pART, O EOF'TWO: REMAI ER TO'FOLLOW Filo No.; 4-1 Mr. Edward Lsr~el l~.O, Rox 11~ Eagle River, Alaska 99S77 Aeeo~ln~ to th~ Anc~or~e Code at' Ordinances 'Sewage Disposal Practices'. Cl~apter 1O. A~lale ll.4S. SeetJon 16.4S.0S0: · If we do not hear f~*o~ ~ within seven (?) days, we will ~ssum~ thit our ~s ~ ~M. We, ~, r~ y~ ~ ~Y ~ You must ~pply fro. · ee~n~lo~ pe~dt ~ ~e ~mit ~r f~ M~ ~~. ~ ~ ~ ~. Iry~ have . ~ ~e ~e, ph~ ~ ~ h~t~e ~ ~t~ the ~t 2~8~. e~ ~S~ or ~ De,timer of He~ ~d En~m~d RECEIPT FOR CERTIFIED MAIL~O¢ (plus postage) PS Form NO INSURANCC COVERACE PROVIDED-- ApT. l~?l 3800 NOT FOR INTERNATIONAL MAIL No.: 4-1 Box ~ River° Alaska Dear It has ~ brought to our ati~lon fhat public s~wor Is avallablo to Block Il. Lot 4~, l~agle River P. oiwhte Subdivision. J,e~ordin~ to O~t~r An~borofe Am Bo~'ourh O~din-,,~. Chapter 1~. Artl~ le.4~, Seotio~ 16,4S,0S0: PSeptic tank-oeepafe system oew~.~e diopoeol f~etllties shell not availoble wit_M~ seventy (70) feet of the nearest lot line or seld pr~nl~es ,, ,*. If we do not bear fi'om you within o~ven (7) dsys, We will assume thlt our z~ ~re m)rr~t, We, tbet*efoFe, request you con~ any and fdl s~'Uet-d~eo 10~ (m the subject property to publl~ Mwer du~inf the lO?S eonstru~ti(m s~tsm3. You must ~pply for a connection p~-'mit from the ~Jt ~ for t~ G~or ~h~-~ Ar~ ~, ~ E~t Tud~ ~. Ify~ ~ve ~ ~ ~e~ng ~ ~ve, ple~ ~ n~ h~tete to ~t~ ~ ~it ~r ~ sT~eeee, e~ 2SO, or t~ D~a~t of En~~ ~ ~ 274-~61, oxt~ot~ 141. RECEIPT FOR CERTIFIED MAILbOx' (plus postage) STREET AND NO. P.O., STATE AND ZIP CODE OPTIONAL SERVICES FOR ADDITIONAL FEES RETURN b~ I .- S~o~'~w~m -I~ d d~t e-d~ll[~id .......... '~5~' P POSTMARK OR DATE PS Fo~ Apr. 1971 3800 INSURANCE COVERAGE PROVtDED*-.- NOT FOR INTERNATIONAL MAIL e ~'~le River Area fl.. o 10:30 a.m. 12-1-76 Wednesday Pratt GRATER ANCHORAGE AREA BOROUGH Department of Enviro~ental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received November 30r 1976, Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR VoA· Security Pacific Mortgage 319 West ~th Avenue Frances A. Israel Phone: ~ Phone: 333-5102 $~Q1 East 6th Avenuet Space 64 Lot 42 Block 2 Eagle River Heights Chandalar Street Approval'requested by: Mailing Address: Property Owner: Mailing Address: Legal Description: Location: Type of facility to be inspected Single Family No. of bedrooms Well Data: A. Type ~ndividual B. Depth C. Construction D. Bacterial Analysis Sewage Disposal System: Public Utility A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank , Absorption area , Sewer Lines Nearest lot line , Other contamination, B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages L DEPARTMENT OF HEALTH AND ENVIRONMENTAL 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 ~' 2. Property Owner: Mailing Address: Mailing Address: Name of Realtor or Agent: FHA~CONV Day Phone: 3. Name of Buyer: ~)~k~ .~_.~ Mailing Address: ~ /~E ~~ ~ DayPhone: 4. Name of Lending Institution: Mailing Address: Phone: ~ ?~_-~'~ _s 6. LegalDescription: ~/~- ~.~ ~/4 ,-~ ~/',~.~/~ X~7.J~.~- .~..~-- Location: C~'~ ~,~'~ -~*---, 7. Type of Facility to be Inspected:. 8. Water Supply Type of Supply: o 'No. Bdrms. Public Utility Individual ,~' If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation. Individual (on-site) ~a%e. 2 of two pages - R(~t for Approval of Individual x"--%r & Water Facilities Legal Description Lot 42 Block 2 Eagl~ River Heights Approval ,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGPAM OF SYSTEM I 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) Rev. 1973 DATE AL~'EPAflTMENT OF HEALTH AND SOCIAL S'~S DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL WATER AHALYSIS Lab No. OFFICE INDIVIDUAL [] SEMI-PU6LIC f-I CHLORINE RESIDUAL PPM REPORT RESULTS TO ADDRESS CITY ADDRESS OF SOURCE ZIP CODE COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAM, PLE COLLECTED BY DATE COLLECTED ' TIME COLLECTED [] Othe~ (L;st) r'lUnder House READ INSTRUCTIONS ON REVERSE SIDE BEFORE Analysis shows this Water SAMPLE to be: [] ~af;s~actory SANITARIAN'S REMARKS COLLECTING SAMPLE Lac)•se Broth lOcc 10cc 1Otc 1Otc 10¢c 1.0cc 1.0cc 66.1~o (b) BACTERIOLOGICAL WATER ANALYSIS RECORD TEST User Propert% Address: Subdivdsian: OYt T~SF: [] Po,~itive Ne.~af/ve - . (., .-.., f~?' x 4ODI1"IONiIL Office; '! F/eld: ~dminl$teted By.. ' ~,-..~-... PW-062 (7-74) 1975 Am::hora~a, Alaaka 99504 S~ett ~ot 42 ~1o~: 2 Eagle ~/we~ Heights Dear l.~a. Xsraelt in a ~ore ~m ~p~t c~ give a~goval on t2m wall, f~a m~t ~ ~a to fill in t~ pat wl~ 27G-2221, ~xt~on 285. ~ort C. Pratt, It.c-. , ~anitaxian January 4, 1978 Clarence Lamay Post Office Box 93S Eagle River, Alaska 99577 Subject= Lot 43 Block 2 Eagle River Heights Subdivision Permit #~7519 A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, tlealth and Environmental Protection Sewer and Water Section