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HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 2 LT 45 -agl River Heights Block Lot 45 050-282-12 Ir'l I;'l'l'fT i',lf'l I'-Ii.ll'.l ] I--: ) I-~"l'Zll_ ~ T~., iTir:'- F:,CF'AIT'TI"IFCtJT ?'~%IEFII.Tt-I FIND EN'v'IRONH~IqT£tL 276-222t IdEI_ I_ F'ERI-'I ."[ T ( 7F;,O",'~-, ', P. 0 OOX 935 E.R. LOT $IZF 694-2J. 59 i0742 SQ.RRE FEET llli'illllhl I')]STtghlCC BETIJfTFi',I n IJEI.I. Ri,,Ii-) f'li, jy ON-SITE SEI,IRGE DTSPOSRL SYSTEM IS 1RA f'i:l?I f~'~R R PPIMATE I.IIZI_I. AP.. 2f'tR FEET FOR R PUBLIC I,IELL I.IF;I I I.AO% Ar::vE ,reE~:)Ul'F'FIT~ f'li"Jr~ I'IlIST DE RETURNED TO THE DEPRRTHENT I, IITHTN 20 DRYS .'-;l"~:CfF~r:Klflrh%',t; FIND CDN'~TF..tUCTION DIRGRRMS RRE RVR~L.I-IDI..E TO INSURE PROPER t ;4s;'fRI I KIT f R,~J .t.t..t]FY 'lllfll :1: ][ I91.1 rl,llll.:fflR I.IITIt TI4,'" K'E~T;I. IIK:EI,1F'-i',IT$ FOR ON-SITE SEHERS FIND WELLS A_~ SET n'd:;fTII R',' TtlF' i',ltlh!'IC:TPDI ITy OF Ri'.,!CHCIRI'IC, E ;:' '[ l.]ft_l fr,f';ll=lLI. 'TI r" c,,c . ¥.:,TEM III ¢ICCORDFIi'iCE 14[Ttt TFIE CODES. ( erlffie Drilliug fiog DRILLING COMPANY Boxg7, EAGLE RIVER, ALASKA99577 · TELEPHONE694-2588 OWNER OF LAND ~/~,"~/f~ ~ DEPTII OF WELL ADDRESS LEGAL DESCRIPTION / DATE- S,~,~d /Z~/~ STATIC LEVEL OF WATER FT. _! E.d~a /~/_~ s-~ GALS. PER IIR / ~ C~ / / KIND OF CAS,N~ ~ ~ o o KIND OF FORMATION: From ~ F~.,o From ~[ Ft. to From ~ Ft. to From ~-/4 FI. to From Ft. to Ft. From FI. to F~. From__.Ft. to FI, From Ft. to Ft. From__.Ft. to Ft, From FI. lo From Ft. to From Ft. to Ft. From Ft. to FtC: From Ft. to__Ft. From Ft. to Ft. / Ft. Ft, From From From From From , Ft. to Ft. to.__ Ft. to___ FI. to.__ · Ft. to ·/" Ft. to ~' From~ Ft. t~o ' From Ft. to___ From Ft. to From ~ Ft. to From Ft. to From.__Ft. to From .__Ft. to From Ft. to From ~ Ft. to From Ft. to Ft, Et*¸ Ft. Ft. Ft. · Ft. t Ft.. F(. · FI. Ft. Ft. Ft Ft. Ft. FL DRILLER'S NAME MUNICIPALITY OF ANCHORAGE PkJWj4 �.t� Development Services Department a.= Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Parcel I.D. 050 282 12 1 Certificate of On -Site Systems Approva Expiration Date: q— 2,5-- zo GENERAL INFORMATION Complete legal description EAGLE RIVER HEIGHTS BLOCK 2 LOT 45 Location (site address) 18032 BARANOFF Current property owner(s) DEAN Mailing address Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well E Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer 0 Waiver request for: NONE Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 9,45 / 3 3 Date of Payment /ae2o Receipt Number 02�I D COSA # OSC-ZO 1279 Waiver Fee $ Date of Payment Receipt Number Waiver # 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, 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 C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 6/20/2020 �N OF A/, 49 TH 6. DSD SIGNATURE •• •••• •�•••• �10 System #1 Approved for3__ bedrooms �� CHARLES G * *L *I�1 0 System #2 Approved for bedrooms ��1�F��s. CE -13854 Disapproved l�l 4PROFEW' QP • �``� r pp ll -� Conditional approval for bedrooms, with the following stipulations: VVNI CM /11Yu Original Certificate Date: Cv r Z S� ©z0 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: EAGLE RIVER HEIGHTS BLOCK 2 LOT 45 Parcel ID: 050 282 12 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA FOR Well log is filed with Onsite (or attached) 40'e t 1976 Date drilled Total depth 102 ft Cased to 102 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) +12 in. Date of flow test for COSA 6/9/20 Static water level at beginning of test 58 ft. Comments OVER 600 GALLONS PUMPED. B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: PROPERTY IS ON PUBLIC SEWER COSA Checklist yellow sheet Well production at time of test +5.9 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑ N ON Coliform bacteria is Negative Nitrate 6.26 mg/L ❑ Nitrate less than MRL (ND) Arsenic ** ug/L ❑ Arsenic less than MRL (ND) Collected by C.Balzarini Date of Sample 6/820 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: PROPERTY IS ON PUBLIC SEWER Adequacy test date Results O Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑✓ Yes if No Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ❑✓ Yes if No ❑7 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft ✓❑ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ft ft ft ft ft ❑ Yes if No ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No. Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS ** Well has historically low arsenic levels per previous approvals in 2004 and 2013 Research shows that neighboring properties have similarly low arsenic concentrations Request that COSA be issued with pending arsenic results. Results will be submitted once available. 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. 6/24120 COSA Checklist yellow sheet OF A4,4 49 TH '• ... .......... CHARLES G BALZARINI� CE -13854 PROFESVO ft ft ft ft MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT �� 907-343-7904 On -Site water and Wastewater Section `` Fax: 343-7997 www.muni.org/onsite Nitrate advisory Certificate of On -Site Systems Approval # OSCOSC201279 Subdivision: Eagle River Heights, Block: 2, Lot: 45 A water sample revealed a nitrate concentration of 6.26 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. C- •$ Ma�l�ng Adtir�s P O BoX 196650`* Anchorage; AlaskO9519 6650 www muni org I From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. '01'N } Al, 0 �� �� x � � #� �Mail�ng Address �fY` O Box 19650 * Anchorage,�AlasFCa 99519 6650 � wwin� muni org�� . � =�� 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 Parcel I.D.# C~'c CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 45, Block 2, Eagle River Heights S/D Location (site address or directions) 18032 l~aronoff Avenu9 Property owner Mailing address Lending agency Mailing address Agent Address Connie Sumrall Day phone 696-2970 Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 3 NOTE: Individual well xxx Community well Public water 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 xxx Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system, Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.'O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. 050-282-12 1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: .Complete legal description EAGLE Location (site address or directions) Current Property owner(s) EUGENE Mailing address R~R HEIGHTS; BLOCK 2, LOT 45 18052 BARANOF STREET * EAGLE RIVER, AK. 99577 & NANCY MARATrA Day phone 696-4804. 18032 BARANOFF STREET * EAGLE RIVER, AK. 99577 Lending agency Mailing address Real Estate Agent Mailing address Day phone BROOKE &: STILTNER w/ REMAX Day phone 694-4804. 16600 CENTERFIELED DRIVE * EAGLE RIVER, AK. 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3.. 'TYPE. OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well I Individual O~-site D Individual Water Storage D Individual Holding tank [~] · Community Class Well ['-] Community On-site r-] Public Water System [-I Public Sewer I I The Munlcipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska.. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 samples. (Cedificates 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. , : :,{ i A h° age , qici lity o ~. · ,,: Mu pa f nc r ,~:,Develo'pment SerVices Department i .: i.~ ' 'Build ng Safety Dvson · ~ ',~ .On-Site Water & Wastewater Program . .~ ' '."4700 South Bragaw St.r ~ '~ Box AK 99519 '-6650 .~P.O~ '196650 Anchorage, '. !.~.~ , · ,:~/ww.ci.anchOrage.ak.us = [ ~ (907) 343-7904 ' ~ :!' !,:!. ~ · ~ ..., ~ .~:~,, ... HEALTH_ .~.UYHORITY.,,. . . APPROVAE. . CHEC.,KLLISTi; 'Lega Description: EAGEE:RIVER HE!GHT.S 'SUBDIVISION; 'BLOOK 2, LOT 14 ar ID: 050-282-12 ~ ,, ; .',;:1 ,,~, , '; '(,. !i : , ! .:,.: ~', : ;' ' ' ~e,, y~ PR~A~ . r : I ~ ~ '', B, ; P~:°videPWsID#'i:N/A'::':' : .W;~, ogilYlN)'i .YES [?,!.e ~:~pletOd 10/25/1'~76 !: San;J~a~y s~ai (Y/N) YES' :j! , 'r :::~ : wires prd~e;l~ 'P~{ected iY/N) ' YES T.o!al dePth.. 102. fi. i. :~, '.. :,. ' C,ased to'. 40+. fi.. ;-i; ' :, Oasing height (abbve ground 12+ .in. ~' ]' r,! · ~ ;, ; '~ , ',' , " ' '; · i! I' ;~ :' -; 'FROUWEL-,LLO.G': .... ' :;i.;' '4: AT INSPECTION ~ ~:!, .i',~' ';': ~,, ,!:h, ':t:i ,: , ~....'::,,: ,-., ,,~,;'i:,l': ,i,i!! r~Da' ortest , ~, 10/25/7s.I,~, .' "!, '; ;',i,,: 2/23/200,~! "~i i , '' , :iStahc water level : , ~' 60 fi. i:? .,... . ~ fi.' .!,Well.,,: I' '.!p: '' :i~ducti°n '';:"' '" 36~i; !' [~ '"' ,'?' ' "'g.p.m.'., . :,~: ;;i.. . ;!:; 'i: ";. !; ;. ,:4.7: !t;'. : g.p.m. WATER SAMPLE RESULTS' ", ., .~,i, ;; ': ; 'i . .,i, '; ":! !r ,,: !:; ~;,; ;'i .. Ii!! ' ..:;.;:: .~ !'J"',.tl.i... : ;I !: ~... ;;~' . :~': ';.i !". ' .i. ' . ' ': '.{ .?ii :" ,, . :.I i l. tj.. . ' J' " ':4 ' .~ :' i. ~..' ! . ' co!,,form ,,' ~ colonies/100 mi. i!:~Ni!rate ~mg./E. :! ." : Other: b'~ teria;: "~,:; cOlonieS/100 mi ', . '' ~ ;~ u I'~.'~ I ~' ~ I;' , '~ , " ; ' .' .i , ; · ' . ,~ ',:, " ~ ' t ~ . . . - ' ,',, , . ,~ , . Ars, emc.?}!N/A mg./L. :; .. '" ! l:'Date of sample:2/23/2004 ':iCol ected by"!L;: ' .;'GEG~ ~ Ltd. SE ~" ..... '' B. PTIClH. OLDING TANK DATA : . ,PUBL C SEWER.,., . .. ~.: ~. , ~ ' ~ ~' · Tank Type/Material ....... i{ -.~ ! :.. ' i , ,,:.. r3~f~ in~fmllpH .~J, ' .... ' ~ ' i ' ' ' '~' ' "~ ' '' "~ : ' ' '::~? "' ' Tanks~ze- gal. I ,~.~. NumberofCompartments ,'. .~ i I'i , - 't II , ii ,': ! , , ~'::i1' ! ',~lt ' ' ' : L : ,~.'.' ~"' i ;' 'il Foundati01n cleanout (Y/N),:' ~ ~.. (Y/N) r:. '.'.~ :" Hig i 'm (YIN,) '~ ! '" ' ' ' '~" '::;' :'" ' "% · ~1 i"'i! .... I ........ - , ~ . ........ ~ ~:: Pumper , ~ =; ~ ' 'I 'i; '. ; . r !~.', '.', ;''['~:'t'::'i'l ' ' ' '"; '~ C. ABSOR.PrTION FIELD DATA ; ... '!',PUBLIC-SEWER ' '""" ,-,..,;. ,,: :, ', ;II .ti ", "~ ./ ',,i, , , ;,~ ' h I ,,,.~,;. ir,, !; , ' , I '~ ': ! !' ' ' .,,, ,i,. Soil__;aiing(...'dm'or~ '" "" ' '" "" .... '" . ' Datemstalled.. .... . ~ , __... . ,~ ',System Length ii~ '~' :' fi. i~:..,!;:;~,Width~':',, -;; :;i.: :;:'flj,i~i .~! Grab, bi fi.. ~t1' ~1 ' ..... ';~ ' ' , ;" ': ' : ' ,ii; '! Total depth ' fl.. ! Eft. absorpti~n ~rea . ~ fl~ ~1of.i ; ~I ~:. ,:~ over, field !: :'I '~ ' ' ' Ji:' :, ,f:,i'l i'!~'.:: ~',- 'ii' ~,:-'~ '' ' ;'!,: :rt'i' ~i ;!; ' ' , ' . Dar? of adequacy test ~ , ,;. ::.:..:'- ~, Results, r.,'/l I ,; . !i.. Fc~r bedrooms .... , ,.'.,.~ . ..: .... . .... ;,,:;::.;: i' FI,Uid depth in absorption'field ' ' in. in. ' . :Water added.. ~i~r ' '!~al.: .·'-'. '::i! '~ .N~w dePth Ela ~dTime: : oth '. in ;! i:"l.i: Ab,~,-,,~i,-,J:,-~;.~'~.- ~. l~enafi r treatment (past 12 mo.) (YIN & type) I .....~ .........: ,, ~lf yes, o ye date g.p.d. 02-27-04 04:26Pg FROU-CT&E ESI, SGS ENV SERVICES 9075615301 T-539 P.02/03 F-726 SGS Re£# Client Name Project Name/# Client Sample ID Matrix 1040884001 AK Water & Wastewatcr Consultants Inc. Ea~;Ic River Hts B2, Lot 45 Eagle River Hts B2, Lot 45 Drinking Water Sample Remarks: All Dates/Times are Alaska Standard Time Printed Date/Time 02/27/2004 13:41 Collected Date/Time 02/23/2004 9:55 Received Date/Time 02/23/2004 11:45 Technical Director ~/,.~ Stepherj C. Ede Allowable Prep Analysis Paramc~' Results PQL Units Method Container ID Limits Date Date 1'nit ~aters Department 'N~trate-N 3.56 0.100 mg/L EPA 300.0 B (<=10) 02/23/04 JJB Microbiology Laboratory Total Coliform 0 col/100mL SMI8 9222B A (<=1) o2r23/o4 DKC BROOKE N I3°02~CID"E B2.513~ PAGE 01/01 o 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 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. S & $ ENGINEERING Name of Firm 171334 Ea~le River Loop Road No. 2e~ Phone G Eagle River, Alasl(a ~9577 Address / Engineer's signature "'-~('~ ~ z//~;"'- Date lC / DHHS SIGNATURE 'v' Approved for __ Disapproved. __ Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Sen/ices (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 eh'ors or omissions in the professional engineer's work. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES ,~c~P^~,,~ Environmental Services Division "mh~I~NTAL 825 L Street, Room S02 · Anchorage, Alaska ggs01 · (g07) 343-4744 Legal Descfiptim: A. WELL DATA Well type Log present~)/N) Total depth Health Authority Approval Checklist Rtv~.? H(~-~ T.~ ParcelI.D.: If A, B, or C, attach ADEC letter. ADEC water system number Date completed I o / ;1 .~ ,/*~ (, Cased to ~/0 -/- Casing height (above ground) Wires propmty protected 4~1) YE ~ Date of test Static water level Well production WATER SAMPLE RESULTS: FROM WELL LOG ~0 3O AT INSPECTION /o g.p.m. ,,t". & g.p.m. Coliform o Nitrate 3. o 7 Offmr bacteria o Date of sample: I o / t ~. / ~/~' Collected by:. S & S ENGINEERING 17034 Eagle Rlwr Leep Romd Ne, 204 B. SEPTlC/HOLDINGTANKDATA p u ~ ~, ~_ ~ ~ ~ ~ ,% Eagle Rl'mr, Ala~m ~)5~7 Date installed Tank size Number of Compartments CI~(Y/N) · Foundati~o~n. cteanout (Y/N) Depression (Y/N) High ~ (Y/N) C. AB ,~SORPTION FIELD DATA System type Length ~ Width _,'6'ravel thicimess below pipe Total depth Effective absorption area ' ,,,~Monitmtng Tube present (Y/N) Depression over field (Y/N) Date of adequacy test J Results (Pass/Fall) For Fluid depth ~eld bofom test (in.); Immad~ataly after gal. water added (in.): Absoq:~ion rate = g.p.d. 72-o26 (Rev. UFT STATION Date installed Manh~e/Accese (Y/N) High water alarm level at* Size In gallons E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: SeptlcJholdlng tank on lot ~/ ! '~ Absorption field on lot A' / ,A Public sewer main -4. On adJacem lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line Absorption field j Water main/service line Suffans water/drainage /~-6~djacent lots SEPARATION DISTANCE FROM ABSORPTION R~=~OT TO: :u dmPeZ lin jr ~° un datl: ~-~y, p ~~;Zg~L~ce line ...... Cu~ Wells on adjacent lots HAA Fee $ RecelptNumber ,ZT/'~ ~-'~ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Paymem Receipt Number ,~s~'~__. CT&E Environmental S.rvtce~ Inc. CT&E Rei'.# 9859~ 1002 CUt~t ['4am e S ProJect N~e~ Clie~ ~mple ~ ~ 45 B 2 ~glc River Hgts Mat~ Dt~g water ~ By ~S~ 0 Sampc l~m~'ks: Client Printed I~te/Time 10/15/98 15;15 Collected D~teFTlme 10/12/98 14.45 Received DnteFllme 10113/98 12:05 Technlcnl Director: Stepbeu C. Ede itlo~able Prt.~ ~,',atyifs I;teate-# 3.~? 0. t00 ~g[L E~ 300.0 Municipality Of Anchorage Development Services Del adment Building Safety Division On-Site Wa~er and Waslewaler Program 4700 South BragaW St. P.O. Box tg6650 Anchorage. Al( 995tg-6650 ww, w.cLanchorage.ak. Us (g07) 34:L?~04 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-282-12 1. GENERAL INFORMAT. ION ega de;'eri t .ot 45; 'LbEation (site ~ddress:or'd. irections) Current Property owndr(s)" '..Mailing address ..' Lendir~{Ta~ency Expiration Date: t'/'~O /oZ.-- Block 2; ~.agle River tle'ights Subdivision 18032 Barono££ Ave. Chad & ^my Rot,trial Dayphone 604-3986 Day phone Mailing address Real Estate Agent Sharon Mtnsch Mailing Address 16600 Centerfteld 'D'r. Sl;e Unless otherwise requesled, I tAA will be held by DSD for pickup. Day phone 694-4200 201 Eagle River, AK 99577 2. NUMBER OF BEDROOMS: ,3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well 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 Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an independent prolessional civil engineer registered tn the State of Alaska. Certificates of Health Aulhority Approval are required [or Ihe transfer of title (except between spouses) for propedies served by a single family on-site waslewaler disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for propedies served by a privale or Class C well and may be reissued with new water sample results less than 30 days old. (Cedificales may be reissued for a period of up lo one year with valid water samples.) Certific'~les are valid t'or one year for properties served by Crass 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 cedified by my seal affixed hereto and as o~' the validation da{e shown below, I verity that my Investigation, based on procedures outlined In the Health Authorily Approval Guldellnes for this application, shows Ihat Ihe on-site water supply and/or wastewater disposal sy~lem Is(are) safe, functional and adequate for the number of bedrooms and lype of stmclure Indicated herein. I fudber Verity Iha{ based on the Informalion oblained from the MunicipalRy of Anchorege files and from my Invesflgafion and Inspeclion, the on-site water supply and/or wastewater disposal system is(are) In compliance Wilh all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. NameofFirm S & S Engineering, Address 17034 N. Eagle River Loop Ste. Engineer's Printed Name Robert C. Cowan DSD SIGpNATURE J/'"' Approved for Disapproved. Conditional approval for Phone 694-2979 204 Eagle River, AK 99577 Dale ~/,~. ~ ~ ~-- bedrooms, with the following sllpulations: Additional Comments Attachments: HAA Checklist Septic Sys{em Advisory . Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Cedil~ca[e Date: Municipality of Anchorage Development Services Department Building Safety Division On-Sita Water & Wastewatar Program 4700 Sou~ Bragaw St. P.O. Box lg6650 Anchorage, AK 99519-6650 www,ci.anct~orage.ak.us (~07) 343-?~34 ,O HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well ~e ~g~ I v~-T'~ If A, B, or C provide PWSID # Date completad/~_/_Z.5'/~-~, Sanitary saal (Y/N)/ Total depth/D ~-- ff. Cased !~ FROM WELL LOG Date of ! O / Static water level ~' O ff. Well production ~:~O g.p.m, Well Log (Y,~l) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 4. ~"' g.p.m. in. WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi. Nitrate ]- 16 mg./t Arsenic: n,a./L Date of sample: Ottter bacteria ~ . colonies/100 mi. SEPT]C/HOLDING TANK DATA Tank Ty .l~l, eM/daP- -- . ~ ~ ~ ins~ll~ F~on ~eano~ ~)". ;' ' / De--ion ~ ~nk ff~) H~h ~r a~ ~ ~ng~ '-.--,. "~/ , ~d~ ~ G~l~pi~ ff. / To~l depffi ff. Eft. abso~flon ama ~ Mon~g ~ ~ ~p~n ~er ~ld Da~ of adequacy ~ R~u~ (Pa~ail) [ For Flu~ dep~ in ab~ field ~m test in. ~r add~ gal N~ dep~ in. E~ps~ Ti~: m n. Fi~l fluM de~ ~. ~mfion m~ >= g.p.d. ~ rejuvenation ~ ~nt (~st 12 ~.) ~IN & ~) ~ If y~, g~e date D. UFT STATION Date Installed-- 'Pump on' level at/ in. / Datum E. SEPARATION DISTANCES Size in gallons 'Pump off' level at__ Cycles tested Manhole/Access (WN) in. High water alarm level at in. Meets alarm & ctn::uff requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift stafio'n on lot '~/ Absorption field on lot Public sewer main On adjacent lots ~v//~- On adjacent tote ,M/,,9 Sewer Is~se~ice line Holding lank ~// SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Propertyline ,,,"" Absorpfion field ,,,,.-, Water main ' Water/~:e line Surface water / Wells on adjacent lots SEPARATION DISTANCE F,o/M/)~3soRpTION FIELD ON LOTTO:. liney' ..,ding ,o.nd.,on W. te,' ..,,,, W=rS., ce,.e / F, C;:l~;dEraljs / ,We~s on adjacent lots G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and rm4ew of Municipal ~co~ls that the above systems am conformance with MOA HAA guidelines in effect on Efts date. Engineer's Pdnted Name Date ~ /~'3 / O ''t- HAAFee $ '3 "/~". "'~ Date of Payment ~'/~',-~/'~ ~- Receipt Number o ~. 'f ~ ~ ~ (Rev. 12/0t) Waiver Fee $ Date of Payment Receipt Number · ~UG-T$-0Z I2:37PM FROU-CT&£ ENVIRON~:NTAL SRV ,~T~_.' CT&E Envlronmentel Servlcee Inc. 9075615381 T-855 P.02/09 F-285 CT&E Ret.# 1025208001 Client Name S & S Engineeting I'roJett Name/# NA Client Sample ID Eagle l~ve~ lite L45,132 Matrix Drinking Wat~ Ordered By I'W~ID 0 Sample Remarks: All Dates/Times are Ala~.a Standard Time Printed Date/Time 08116/2002 8:49 Coil.ted Date/Time 08113/2002 17:00 Received Date/Time 08113/2002 17:40 Technleal Director Stephen C. Ede Watera Department. Nittate-N 3.16 PQL Uoi~ M~xl AHow,~ble Pr~ Analyai! Limits Dale Dale 0.200 mg/L EPA300.0 (<=10) 08/14/02 lnlt JDT Total eolllOOmL SMI8 9222B (<=11 O8/13/O2 0 0 ~J 0 0 0 0 BARAN DFF AVENUE t~ Bc:J°Sc:J'O0~lr I '~ I .~5~ I%1 eg°59°OD'~A~ 131.95'