Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
EAGLE RIVER HEIGHTS BLK 2 LT 46A
RECEIVED · * icipalitYof Anchorage A?,.JNICJPALr~, OF ANCHo~:~,~.,~ DEPT. OF HF,~ALTH C 1.1A¥ 4 _RECEIVED POUCH 6-650 ANCHORAGE, ALASKA 99502 (907) 279-2511 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (825 "L" Street) ~ ~ ~ / · April 29, 1977 %76104 Melvin Jacobs Box 619 Eagle River, Alaska 99577 Subject: Permit Expiration Dear Mr. Jacobs: A permit issued by this department for well and 'or onisite sewer installation on Lot 46A Block.2 ~glo ~{,7~r Np~ghe~ ~2 Subdivision has expired since the issue date exceeds one (1) year. In the event you still plan to install the well and/or on- site sewer system, a new permit is required. The original soil test may be used to obtain a current permit..' If the well'has been drilled, .a well log should be sent to this department to document the installation date. If you have any quetions rggarding the above matter, please do not hesitate to contact this office immediately at 279- 2511, extension 224 or 225. Sincerely, . Les N. Buch~ Sanitarian LNB.ljh DEPARTMENT OF HEALTH AND RO 2510 E. T~OR RD., ~CHORAGE, AK. 99507 276-2~t WELL PERMIT PERMIT NO. ( 76104 ) APPLICANT [1ELVIN JRC08~, BOX 6i9 - E.R. LOCATION CARIBOU ST LEGAL L46R B2 EAGLE RIVER HGTS #2\ ~, ~ LOT SIZE ' i10~8 SQUARE FEET MINIMUM DISTANCE ~EN R WELL AND i00 FEET F~ fl PRIVATE WELL ~ 200 ~ F~ R P~LIC W~L. WELL L~S ~ REQUIRED AND MUST ~ ~NE~TO T~ ~PRRT~NT WI~IN 38 DRYS 0F THE WELL C~PL~ION. SPECIFICRTIONS AND C~TR~TI~ DIRGR~ R~ILRBLE T0 INSURE PROPER INSTRLLRTI~. . PERHIT VALID 'FOR ~NE~YERR FROM ISSUE I CERTIF~ THAT REQ~~ ON-SITE SE~R~ RN~ WELLS R~ SET I RM FRMILI~ WITH T~ 2: I WILL INSTALL THE SYSTEM I~ ACCORDANCE WITH THE CODE~. I~SUED 'BY&--~--~2RTE~ MUNICIPALITY OF ANCHORAGE { 7 7_ Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section - ' Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-281-46 1. GENERAL INFORMATION Expiration Date: olu_�' I , 2 0 oC G ' Complete legal description EAGLE RIVER HEIGHTS BLK 2 LT 46A Location (site address) 10108 Caribou St Current property owner(s) WHITE CON N I E S & SHAD Day phone 623-344-7344 Mailing address Real estate agent Janan 2. TYPE OF DWELLING: rx-1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4.: TYPE'OF WATER SUPPLY: Holding Tank Private Well El Water Storage ❑ Community Well ❑ Public Water System ❑ Waiver request for: Day phone 6233 u<'3 V V 7� 4 ti W7,7 �� n w C << 01681,9 TYPE OF WASTEWATER DISPOSAL: Private Septic ❑ Holding Tank ❑ Community ❑ Public Sewer El Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ eau Date of Payment g1027_/a0 /)1.0 Receipt Number � OMW U COSA # 5C a d 116'd Waiver Fee $ Date of Payment Receipt Number Waiver # COVID-19 25% DISCOUNT APPLIED 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. 1 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng 6. DSD SIGNATURE System #1 Approved for bedrooms �z System #2 Approved for bedroomsir Disapproved Conditional approval for bedrooms, with the following stipulat onsY`' Y. �.WATER Air® WAS-fv-�'IAI ER C L", �Lgv i R By: I ri P utk Original Certificate Date: J� 7 �C� b 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 X Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: EAGLE RIVER HEIGHTS BLK 2 LT 46A If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA FE -1 Well log is filed with Onsite (or attached) Date drilled 6/29/76 Total depth 96 ft Cased to 93 ft 01 Sanitary seal is functioning correctly ❑E Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/24/20 ¢¢ Static water level at beginning of test 69A ft. Comments 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: COSA Checklist yellow sheet Parcel ID: 050-281-46 Structure served by this system Well production at time of test 6+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes 0 Nc X Coliform bacteria is Negative Nitrate>`� © mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by NRim Eng Date of Sample 4/24/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑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 Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ✓Q Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25'E] Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ✓❑ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ✓❑ Yes if No ft ✓❑ Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft ❑✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: ❑ Yes Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft 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 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."` S a ;4 -O , rY4av COSA Checklist yellow sheet u ft ft MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Nitrate Advisory Certificate of On‐Site Systems Approval # OSC201164 Subdivision: Eagle River Heights, Block: 2, Lot: 46A A water sample revealed a nitrate concentration of 9.4 milligrams per liter (mg/L). 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. Since nitrates are known to slowly increase, we recommend you monitor the water quality. 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. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Nitrate Fact Sheet 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 medi a 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. Lot 15 Lot 46B z Lot 46C i I Lot 16 33.00' 'ria'F 1 "{t Ori' I 8.1' z 12.1' SHED WELL Lot 46A 10,886 s.f. WOODEN FENCE 11E:i i 1 STORY RESIDENCE 131.95' Lot 46J N M M M PLOT PLAN AS BUILT —2L SCALE 1" 330' GRID SW 53 Project No. 20-174/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, i n C . (907) 522-6476 Phone 0000ppOO (907) 522-4625 Fax o p F q ��4 Professional Land Surveyors ken*langsurvey.com o .. ... q 0 jonothan*langsurvey.com �4P •,s �O I hereby certify that I have surveyed the following described properly: Lot 46A, Block 2, EAGLE RIVER HEIGHTS SUBDIVISION (Plat No. P-588) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated this the ��Day of at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH*f LS 5202.."' gJOG 44Onz0�:ESSIONA1- 00 AECC963 Page 2 of 5 :. ' 'MUNICIPALI OF ANCHORAGE ' Department of Health & Human Services..~ ' · . DIVISION OF ENVIRONMENTAL SERVICES: , - ~ · .... . ~ :.~:343-4744. : -.: ~;,..~;. . :"*;,.~ ...... CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ...... ,,: ~ '?; ..... ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING' '.:.. :-,.: ' ' :/ Parcel I.D. # (~)~) - ~(~ ~ - t-\b3 HAA# ~~°t ~ ~:3~, " 1. GENERAL INFORMATION (Must be comple, ted prior to submittal) ...... ~ (a) Legal Description (include lot, block, subdivision, section, township, range) ...... Lot 46A; Block 2; Eagle River ~{eights Subdivision Location (address or directions) 10108 Caribou Street, Eagle River, Alaska (b) Property owner BUD ~032072 Mailing Address Telephone: (home) Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent ASSOCIATED BROKERS/Sandy · Address 640 West 36th Avenue, Anchorage, Alaska 99503 Telephone 563-3333 ............. ' (e) Mail the HAA to the following address: (or check here [~, If hold for pick up.) . ,..' - -': ' List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, Suite 204 Ea~le River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family r~ Number of bedrooms 3. WATER SUPPLY Individual Well~ Community I-I Public Note: If commun ty well system, must have written confirmation from the State Department of Environmental Con{ervatior~ attesting to th legality and stat~i$ ' 4. SEWAGE DISPOSAL . ..,~ . · , :* -.:~. - .... : ..... ;.*. ~ On-siter=l . Public~] CommunityCI ' Holding Tank D ~.":£' . *- .' · '*-.; ~: ~:; ~:* '" Note: If community well .system, must have written confirmation from th.e` S!ate Departme. n~ .o~f.E..n_v?o..nmental Conservation attesting to the legality and status. .- . Page I of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS,. F!.LE SEARCH, DATA AND INFORMATION s cert f ed 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 wastewate.r,disposal system is safe. functional and adequate for the number of bedrooms and type of structure indicated herein. I further verity 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'complla6ce with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of FirmS & S ENGINEERING Telephone _~ ~'~z~--F- ~,~ 17034 Eagle River L~x~p Roed No. 204 Address Eaale River, Alaska 99577 ' Date · .. ...... :'. ........ ~ .,y ~, Approved for ~ bedrooms by " to 2 _'27- ...... · · -',t.,,, ' .... ' .' ' ' Approved ~ '~/' Disapproved ' ~onditional T?m~ o[,Gonditional, ~roval ' Note:' The well for this property meets existing State and '~" ~' Munlci~l Codes._ .There are nitrates, present;~.It is · "., gugg~ted that periodic testing be performed to '"";7, insur~ the wells continued suitability. Nitrate . ~ '"'concentration is 8 mg/1. EPA maxim~ concentration is ............... : 10.0 rog/1.. .................................... - ........ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph $ above by an independent'professional engineerl.. registered in the State of Alaska. The DHHS does this as a courtes~,itb purchasers'of h6mes and their lending' Institution.s inorder to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections ~nr analyze dat.a befo~:e a certificat~ is is~6id. The M unicipality of Anchorage is not respo'n'sible for errors or omissiohs the professional engineer's work. ........ ~ ... ~ - - ~-o~ (,~,. z,~) ~ Page 2 of 2 A. WELL DATA Well Classificat~ Well Log Present {~N) ~. Date Completed Total Depth C[L~' Cased to ~'~ Depth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit ~N) MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line .~. To Nearest Sewer Service Line on Lot Legal Description: ~-.-~'~ If A, B, C, D.E.C. Approved {Y/N) ~'~/~' ~,-' ~ o'7 U Yield Pump Set At Sanitary Seal on Casing (~)N) '~/ Depression Around Wellhead (Y,~ I~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA ~ Size No. of Compartments' ' Standpipes (YTN)'-~ Air-tight Caps (Y/N) ~ Foundation Clea_e_e_e_e_e_e_e_~~. Depression over Tank (Y/N)~'~'''~. ' . Date La ped ~ · Pumping/Maintenance Contact on ~X--~'. ; o ~ Holding Tank High-Water Alarm (Y~.._ / ' '-~-.~ry Holding Tank Permit (Y/N) __ SEPARATION DISTANC..~.~SEPTIC/HOLDIN~ TANK: ~ To Water-Supply~.~ To Building Foundati'o~._ , ToDisposaIFiel ' """--....... To Water Main/Service Line ~ To Stream, Pond, L~ke Or Major Drainage Course Page I of 2 C. ABSORPTION FIELD DATA ., Soils Rating in Absorption Strata Type of System Desig~ Date Installed Length of Field Width of Field Depth of Field - ' ..'-' ' Results of L~st AdequaCy Tes~ Gravel Bed Thickness - ~.St Ad..e, qua. cy Test SEPARA I S~ANCE FROM : To Water~Supl~l~ Well / ~ To Property Line TO Building F°undati°n ;/"//i , ~ To' Existing or Abandoned System on Lot , ~ ; On Adjoining Lo-"'~' To Water Main/Seal'ne · ' To Cutback~ . To Stream, ~ Lake, or Major Drainage Course '"',... To D~y, Parking Area, or Vehicle Storage Area Comments ' , , · D. LIFT STATION Date Installed ~ ' z~ , -- -. "' · Dimensions"~ Size in Gallons-' · ' ' '" ' ' ' "* ;- ' Manhole/AcCess (Y/N) High Water Alarm Leve~'6Tat-~-- ~ ~/Vent (Y/N) ' ~ Tested for /--'~'---.- ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Code_.s.(.W'R) ~ Comments .~ ~ '*Check Permitted Bedroom Rating Against HAA Re(~uest** ', , I certify that I have checked, ~erified, or conforme~ to' all MOA'and 'I~tAA guidelines in effect orl ttte.-.date of this inspection. . . , ~ .. . , ' Eagle River, Alaska 99577 Date ~/~ ~ ~,.- Date of Payment ~ ~ ~ / Waiver Fee- $ Amount:$ / ~ ~-~ ~ Date of Payment 72~ (R~.7~) 8ack Page 2 of 2 FEDERAL TAX I.D, #92-0040440 Client ~enple ID:LOT 461; BLOCK 2; Ii,L! RIVEI HT3. $/D P~ID :UA Collected FIB 18 91 4 IS:Q0 ImF. Received FEI 19 91 4 14:40 Client Acct: Laboratory Supervi,~I?~J C. IDI 1)3 & $ Z~GI~IRI~G Released By =~~ ~ 2) Chemlab Ref l: 910563 Lab Snp1 ID: I Matrix: #ATIR Allowable Faraneter !eite~ Ret~t U~te Method Limes ~ITRA!I-R 8.0 ~/1 I?A 353.2 10 ~mple ROUTI)~ SAMPLE COLLICTID BY: RAT Remarks: I Toffs Performed ' See Special Ir~tructtona Above UA-Unavailable RD- Xone Detected "See ~mple Remexks Above NA- Not inaly~ed LT-Lest Then. GT-~eater Then 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, sectio~, townshi.~nge). Location (address or dire..c~ions). (b) Applicant Name ~~e,ep,,u~ ~ . . . , _ ,~ Applicant Adaress (c) Applicant is (check ne): Lending Institution ~; Owner/b~der ~; Buyer ~; Other~ (explain); ~~ ~ ' ne ~ (d) Lenaing mst tu Address Telephone (f) Mail the HAA to the following address: S-&-S-Engtneerlng ', SRB 196X ~ Eaqfe ~iver, alaska 99577 TYPE OF RESIDENCE Single. Family,,~/ Multi-Family I-I Number of Bedrooms ~ Other WATER SUPPLY Individual Well ~' Community 1'3 Public [] Note: If community w~ll system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [] Pu~)lic/~ Community [] Holding Tank [] Notei Il community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SE,~RCH, As certified by my seal affixed hereto and as of Ihe validation date shown below. I verif Authority Approval shows that the on-site water supply and/or wastewater disposal system is saf~ for the number of bedrooms and type of structure indicated herein. I further verify that based on the Infor~ti~ from the Municipality of Anchorage files and from my investigation and inspection, the on-site water su wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect the date of this inspection. Name of Firm S & $ Engineering Address SRO 196x Date E'n,,!, ~iver. al,~1~ Telephone Approved ' '~, "Disapproved Conditional Terms of Conditional ApprOval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) Issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 abov~ 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 WELL DATA MUNICIPALITY OF ANCHORAGE (MO~i HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Well Classification Well Log Present/~/J~ Total Depth '~z~'~,~ Cased to ~;>~,.~ / Static Water Level /7~, Casing Height Above Ground Electrical Wiring in Conduit (Y~ 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 /~O -~- If A. B, C. D.E.C. Approved (Y/N) Dale Completed ~, -Z~'- rig Yield Depth of Grouting ,~/"~ Pump Set At Sanitary Seal on Casing{~ Depression Around Wellhead / ~ ; On Adjoining Lots /J'/ ~J/~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by .~' '~ ~ ~-",~ F,/,,~'~'~'//~ ,~ ; Date Water Sample Test Results .~'",,"~ -'~"'/ Comments B. 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 Size No. of Compartments Air-tight Caps (Y/N) Foundation Cleanout (Y/N) /]Date Last Pumped ,/A////e/~ Holding ~ fa~rk Per mit (y/N) To Building Foundation To Disposal Field To Stream. Pond. Lake. or Major Drainage Course ~ Comments __ Page I of 2 72-026111/84) 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 To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway. Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions / Ma.nhole/Access (Y/N) "Pump Off" Level at ///~ ~' Vent (Y/N) / /~ Pure n C clesdunn Ad uac Te ~ p g y ' g eq y st Meets MOA Comments ** Check Permitted 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. Signed .S. & S Eng,neeril~ Date ,//.~O /~) ~' Company ---*'~t~...~l=.~.~ MOANo. ~O~ ~ Page 2 of 2 4, '~ ~,.,,,,.~' ..~ ~ Receipt No. Date of Payment Amount: $ 72-026(11,84) ~ APPLIP'~NT FILLS OUT UPPER HA'"', ONLY Mailing Addre~ Zip & A~nt ' ~C O / P~one Type of Resl~nce ~ N -/ Single Family Sewe~ Disposal Tank NOTE: THE INSPE~ION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date J--/I Inspector Inspecto¢ Inspector Inspector Field Notes: ~ (-'~) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPFROVED ( ) CONDITIONAL APPROVAL' DATE t~ I ~--~ $o115 ~ating Date ~wer Installed Well To Al>8orptio~ Area WMI log R~ceiv~d Well to Tank I Septic Ta~k Size MUNICIPALITY OF ANCHORAGE L., I. ~ F ;: .'.' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ........ ~'"' ~" ': ..... 825 L Strum · Am:hom~, Almk~ 99501 ..... ENVIRONMENTAL ENGINEERING DIVISION Telephone ~7~ ~) ~ ,. ,. ~ ~ / [ REQUEST FOR ~PROVAL OF INDIVIDUAL WATER AND ~EWER FAClLITIE~ 1. PR~RTY TNER MAI LIN/,IG ADDRESS ~OPERTY RESIDENT (If dif~t from ebon) ~ PHONE BUYER MAI LING ADDRESS PHONE · t LENDING INSTITUTION MAILING ADDRESS 4. REALTOR/AGENT MAILING ADDRESS / PHONE LEGAL DESCRIPTION STREET LOCATION ~. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUI~LY INDIVIDUAL· [] COMMUNITY [] PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five [~ Three [] Six [] Other · ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.} SEWAGE DISPO$AL SYSTEM [] INDIVIDUAL/ON-SITE*' ~ PUBLIC UTI LITY *'If individual/on-site, give installation date 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, 72-010(3178) ~ ~- THIS SIDE FOR OFFICIAL USE ONL DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOM~ ~ SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [-I TWO I-'1 FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY ~/ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUSLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~.JUIUU BIVIDUAL/ON DATE INSTALLED LIC UTILITY Connection Verified INSTALLER []Septic Tank or f-'] Holding Tank S{ze: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA ~ MATERIAL 4. DISTANCESwELL TO: Septrc/Rordln; TankIIAt)~°rpti°n AreaJlSewer Line I NeerNt Lot Line 5. COMMENTS¥ '~f./.a ~APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must aee~ml~n¥ certificate} [] DISAPPROVED L [= ~rA L DESC~ fPTION v 72-010 IRev. 3/78) · 0 8- E ENf-'VEERING E~ DEVELOF'-'?NT CO. 694 27?4 Civil Engineering $oits ~t Foundations Box 90. Davis St., Eagle River. Alaska 99577 694*2774 or 3.13 5240 Ead £1h~ 333-5240 Surveying Land Development GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality I0 "C" Street, Anchorage,'Alaska 99503 274-4561 Date Received August 19, Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1976 9:00 a.m. 8-23-76 Monday Buchholz l. Approval'requested by: Mailing Address: B80 2. Property Owner: Mailing Address: 3. Legal Description: 4. Location: 5. Type of facility to be inspected 'Security NatiOnal Bank H Street Phone: 278-!541 Eagle River Home Bui~Jers Phone: 694-9940 Box 619 Anvik Circie,'Ea~le River 99577 Lot 46A Block 2' Ea~e'R~ver Heights Caribou Sfreet, see map on back Single Family No. of bedrooms 3 6. Well Data:~l A. Type B. Depth 94' 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 Nearest lot line , Absorption area , Other contamination , Sewer Lines B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV 4. Name of Lending In~itution: &..,~ ~ ~~ Mailing Address: ~'h ~, ~t ?-~*~ Phone 5. Name of Realtor or Agent: Mailing Address: Phone 6. Legal Description: Location: Type o, ~aci,ty to be inspired: ~ $~L ~~ Type of Supply: If Individual, number of dwellings presently served Public Utility ' ' Individual / Public Utility No. Bdrms. Individual (on-site) /~ If Individual, depth of well Sewage Disposal System Type of System: If Individual, date of installation EQ-037 (1/'/4) .' . Page-2 of two pages - R~-~J for Approval of Individual L~'~/- & Water Facilities Legal Description Lot 46A Block 2 Eaqle River Heights ¢oeanents Approv~~~ Disapproved Date xf:)"~/-/~/t~ App~al ~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 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)