HomeMy WebLinkAboutEAGLE CREST #1 TR B LT 43Eagle Crest #!
Tract B
Lot 43
#0§0-291-06
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
PERM? NUMBER~ t D,te of
TAX INDENTIFICATiON NUMBER "~-~,~-Q--"-,~.,L.-...~
le Well located at approved Permit location? ~ ~ No
Method of DrilJing: ~,.3~l~ry ~ cable tool
Depth of We/l:__,~ I
Diameter__ ~//~
InChes, depth "~/'i ~ feet
Uner Type: ,.~.
Casing SUckup Above Ground: _.~ feet
Stallc Water Level (from ground level): ~ feet
Pumping level:_ feet after_ ~r~. pumping _ _gpm
Recover Rate:__ ..~ qpm
I ethod of Testlng:__ /
Well Intake Opening 'l~pe: J"l Open End D Open Hole
~ Screened; Sta~ feet Stopped. feet
I~:M"~ora flons Ste~
Grou
Depth: from_ feel to, ~
Pump Intake Depth: __
Pump Size. hp Brand Name
We]! Disinfected Upon Completion? ~ [~ No.
Method of Dlalnfectlon:
Comments:
;"7
Ddller'a Name ~
ATTENTION: It la the responsibillly of Ihs properly Owner to ~bmit a copy of the ~ log to the proper aufl~od Mu
of AnChorage: Departmen! of Health & Human Services and/~ De ry. nicl ' '
Department of Environmen~l Con ' pertment of Environmental Con · o pal~
servebon, serVa0on. M,~tSu BOrougn:
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WATER SUPPLY PERMIT
Initial
Date Issued: May 23, 2000
Expiration Date: May 23, 2001
Permit Number: SW000121
Legal Description: EAGLE CREST#1 TR BLT 43
Design Engineer: 0000 None Required
Owner Name: Llnda Frank
Owner Address: 10900 Con'ie Way
Eagle River, AK 99577-
Parcel ID: 050-291-06
Site Address: 018939 EAGLE RIVER RD
Lot Size: 15180 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
IT IS Tt[E RESPONSIBILITY;OF TH~ OWNER OR BOTTDER I
PRIOR TO COHSTRUCTION TO VERIFY PROPOSED BUILDING
ECTIONS. AND TO D~'~'~E THE EXIS'II~CE OF ANY
EASEMENTS, COVENANTS OR RES~fRICTIONS WHIC~{ DO NCr~
APPEAR ON T~E RECORDED SUBDIVISION PLAT.
NOTE:Rr.k'VATIONS ARE ASSUMED DATUM.
PROPOSED CONSTRUCTION PLAN
..... SE~/L~D & ASS0ClAI~..~ ~ SU~'yiN~ 694-0829'
I HEREBY CERTIFY .THAT I HAVE SURVEYED THE ~E' . ,
FOLLOWING DESCRIBED PROPERTY, /~-~ ~.
~~ DATEr
.
~N~ ~ D~ER~INE THE ~ISTENCE OF ANY ~EID~
E~EMENTZ, COVENANTS, OR RESTEI~IONS . ~/ ......
WHICH DO NOT ~PEAR ON THE EE~D~ ~BDI-
VISION P~T. UND~ NO CIRCUMSTANCES S~ F~ ·
~Y DATA H~EON 8~ US~ FOR CONS~U~ION
ARY ~INES.
Parcel I.D. 050-291-06
Ll
a
Gk @u
Municipality of Anchorage
On -Site Water and Wastewater Program .�
(907)343-7904
Certificate of On -Site Systems Approval
Expiration Date: 7- 16 " / 3
1. GENERAL INFORMATION
Complete legal description EAgle Crest #1, Tr -B, Lot 43
Location (site address) 18939 Eagle River Rd
Current Property owner(s) Stewart & Sheila Mee Day phone
Mailing address 18939 Eagle River Rd
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
❑
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
WaiverNariance request for:.
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee Waiver Fee $
Date of Payment Date of Payment
Receipt Number 03Cn(0G Receipt Number
COSA# MC--1311a."j 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 Pannone Engineering Services LLC
Address P.O. Box 100217, Anchorage Alk. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SI ATURE
System #1 Approved for bedrooms
System #2 Approved for _ bedrooms
Disapproved
Phone (907)272-8218
Date / :1�55 q0 F__
Conditional approval for bedrooms, with the following stipulations:
By: �Certificate Date: 6e.
Th nicl ge Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represents "ons 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 engineers work.
ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
COSA blue sheet f - L. c
X Nitrate Advisory.,
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSAChecklist # #.Lof 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: Eagle Crest #1, Tr -B, Lot 43 Parcel ID: 050-291-06
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (YIN) Y
Date completed 5/23/2000 Sanitary ( ) seal Y/N Y Wiresproperly protected (Y/N) Y
_
Total depth 401 ft. Cased to 401 ft Casing height (above ground) 18 in.
FROM WELL LOG AT INSPECTION
Date of test 5/23/2000 4/1/13
Static water level 152 ft. 151
Well production 3 g.p.m.
WATER SAMPLE RESULTS:
Coliform :- —0—colonies/1 00 mL Nitrate �' 0 qmg/L
Arsenic A-4) ug/L Date of sample: 7-1 Ji lr
B. SEPTIC/HOLDING TANK DATA
k TypelMaterial
Tank siz gal. Number of Compartments
Foundation cleano Y/N) _ Depression over tank (Y/N)
Date of pumping Pumper
C. ABSORPTION FIELD DATA
3
ft.
9 -13 -m -
Collected by: Qy'S
Date installed
Cleanouts(Y/N)_
High water alarm
Date installed Soil rating (g.p.d./ft2 o b System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorpti rea ft2 Monitoring a Depression over field
Date of adequacy test Results (Pass/Fail) For _ bedrooms
Fluid depth in abs on field before test in. Water added gal. w depth in.
Elapsed ' e: min. Final fluid depth in. Absorption rate >= g,p.d,
rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
"Pump on" level at
_ Seize in gallons
in. "Pump off'T
Cycles tested.
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot N/A
Absorption field on lot N/A
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 100+
S 4?JIC/HOLDING TANK ON LOT TO:
Building fou
Water main
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO:
Property line B
Property line _
Water service line
Water Service lin Surface water
in drain Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Manhole/Access (YIN)
wa er alarm level at in.
Meets alarm & circuit
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
I certify that 1 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 Steven R. Pannone
Date / 20q0 ?-
-
COSA brown sheet 10-10-12.doc
Absorption fie]
Surface water
Driveway,
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 'L' Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanchorage.ak.us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY 'APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D... 050:291-06
1. GENERAL INFORMATION :' : . ..
Complete,legal description '~ .E.agle Crest Trac~... B, Lot 43
Location (site address o!'.dire~:ti0ns) :':~. :-
Current Property owhe. r(s) ;, Linda Frank -'
Mailing address
Lending agency
Mailing address
HAA#"OOO //- ~2
Expiration Date:
Day phone 694-8585
' '11421 Old Glenn Hwy. #102, Eagle River, AK 99577 "'
.... Day phone '
Real Estate Agent Day phone
Mailing'Address
Unless othen/cise requested, HAlt will be held by DHHS for pickup. HAA picked up by:
.2. NUMBER OF. BEDROOMS:
3. TYPE OF WATER SUPPLY:
· Individual Well ' []
· I~dividua!....Water Storage []
· CommiJnity Clas~ ~'~ell []
'P~blic Water System []
TYPE OF WASTEWATER DISPOSAL: ...
Individual Holding tank '- [] .'
Community.On-site ~· []
Public Sewer · [~
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health
Authority Approval (HAA) based only upon the representations given In paragraph 5 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) on properties served by a single family on-site wastewater disposal and/or water
supply system· DHHS also Issues HAAs upon request to home owners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a pdvate Or Class C well and may be reissued with
new water sample results less than 30 days old. Certiticates ara valid [or 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.
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 Health Authority Approval Guidelines for 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 ~pe 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 applicable Municipal and State
codes, ordinances,"an"d'.regulations in effect at the time.of installation. - : ":, -
Name of Firm .KNn Fn~lneer,ng ' '"" ' " Phone
Engifieer's Printe~l Nar~'e'-l(ehneth M n,,ff,,~ . '" Daie' '"
' - . _-?,.~_.........._~.~, I
..... ' · · -: ;' '.; ' ' , ' F'X.~'.."-, ' ,'A ".."~,4" Il ' ~ ......
' "" "~" '; ' ' ' ' ', ~ ' ' ' · · ' ~¢9... . ~;~" ".'l~'l ENGINEER'S
· 6. DHHS SIGNATURE
· J~ Appro~;ed for '"'::
· bedrooms.
Disal~p'~:~ved. : ."" ' ·
Conditional approval for bedrooms, with the following stipulations:
Additional Com'ments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original CertifiCate Date:
Reissue Date;
Municipality of Anchorage
Department of Health and Human Ser~C
E I V E
Division of Environmental Services
On-Site Services Section 825 'L' Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650 SEP 1 8 2000
www.ci.anchorage.ak.us
(907) 343-4744
MUNICIPALITY OF AN¢~0RAGE
HEALTH AUTHORITY APPROVAL CH E~I)~~AL S~CES DMSION
Legal Description: Eagle Crest Tract B, Lot 43
Parcel I.D.: 050-291-66
A. WELL DATA
Well type private
Date completed 6/2012000
Total depth 401 ft
IfA. B. or C provide PWSID
Sanitary seal
Cased to 401
FROM WELL LOG
Well Leg ¥
Wires properly protected X
Casing height (above ground) 24 in.
AT INSPECTION
Date of test ~ · 6/2012000
Static water level 152 It
Well production 3 g.p.m
,J g.p.m
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi Nitrate 1.04 mg/I Other bacteria
Date of sample: 8/2912000 Collected by: KND Engineering
7 coloniesll00 ml
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material NA ~
Date installed Tank size gal Number of Comp
Cleanouts Foundation cleanout Depression over tank ,.,,,'"High water alarm
Date of pumping Pumper J
C. ABSORPTION FIELD DATA J .
Date Installed. Soil rating (g.p.d.lit~ or f?,,A~) System type NA
Length ft Width f It Gravel below pipe .It
Total depth ft Effectiv a .fi2 Monito~ng tube __ Depression over field
Date of adequacy test f Results (Pass/Fail) For bedrooms
Fluid depth In ab,,,~x~n field before test in Water added gal. New depth
El~e'. ~ rain Fina. I fluid depth in Absorption rate >=
Afiy rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
in.
g.p.d.
(Rev. 11/99)
LIFT
STATION
Date installed Size in gallons ....Mentl'b're/Access
'PumP~3~' le~. in High water alarm level at in
Cycles tested Meets alarm & circuit requirements?
Dat~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N,~
Absorption field on lot ~A
Public sewer main ?~'+
On adjacent lots
On adjacentlots tnn'+
Public sewer manhole/cleanout tan'+
Sewer/septic service line
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Building foundation Property line Absorption field ~
Water main ' Water sen/ice line Su~.ev~
Drainage _ . Wells on adjacent lots ~
SEPARATION DISTANCE FROM ABBOT
TO:
Property line ~"Goll~ing foundation Water main
7Z SUw(;:CoenWaatd~arcent IOtS Driveway. parkingNehicJe storage
F. COMMENTS
Prlvete well with ,nllhlic. sewer
'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 HAA guidelines in effect on this date.
Engineer's Printed Name ICenneth M 13ufft,~
Date
!
HAA Fee $ ~, 4::,~
Date of Payment ~ '/~;~' ~
Receipt Number (-,.'~ ( ~"~"'~ ~-'~ ~:>"~ ~"~
(Rev. 11/99)
Waiver Fee $
Date of Payment
Receipt Number
CT&I' Environmcnlal $, :es Inc.
CT&E ReLw 1005026001
Clieu~ Name I,~N'D Eugmecrmg
Clieul Sample ID I st Add Eagle Crest Lot 43. BB
Matrix D~m~ng Wat¢~
Ordtr~ By
PWSID 0
Oieut pO~
Printed Dalt~fime 08/31/2000 11:54
Collected DatrdTime 0g/29F2000
R~eived Date/'l'in'~e 08,29/2000 11:15
Tt~hnical Director Stephen C. £dc
Sample Remarks*
EP300 Nia'aTe: LCS was ouT,id.* acceptaacc criteria (86.8%). All o~er QC met criteria, Ma~ ~e recovezed at 92.1% ~d 85.3%.
S~le value n~y be b~a~ low.
A~Owablc ~p ~alys~s
P~am~ R~ PQL Um~ M~ L~ Da~c ~ lint
Niuatc-N I 04 0.$00 mgdL EPA 300 0 I 0 Trax 0gt29,'00 SCL
Nicrobiolo~ Laboracor~
Total Cohform
7 OB, No Coh
col/l O~nL SMI8 9322B
