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Home My WebLink AboutEAGLE RIVER HEIGHTS BLK 3 LT 8Eagle River Heights Block 3 Lot 8 #050-271-01 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 1. GENER~f'' INFORMATION Complete legal descripti(Jn L-o 7' Location (site address or directions) CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE. FAMILY DWELLING ~ L4~A e Current Property owner(s) Mai!i.ng address Lending agency Mailing address Real Estate Agent Mailing Address Un/ess otherwise requested, HAA will be held by DSD for pickup, NUMBER OF BEDROOMS: ,3 Expiration Date: A,c,< ,¢'7' / ~: . ~,. Day phone £~',., ~4~.~-~. ~ ~,, ,~ F~,~4~ cA~,~ uayphone Day phone e 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 (DSM) 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. DSM 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 sample results. (Certificates 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. 4. STATEMENT OF INSPECTION BY ENGINEER w 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 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 fudher 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(ara) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm s & s ENGINEERING Phone I/u~4 P..aCe River Loop Road NO, 204 Address Eaale River, Alaska Engineer's Printed Name ~O~e-cr C, Co,,~,4,v Date DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 01/02) 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 Legal Description: L~T ~' ~;-k: ,.3 ~44:L~. ~tV~t4- ff~.¢C, 4crJ HEALTH AUTHORITY APPROVAL CHECKLIST If A, B, or C provide PWSlD # Sanitary seal ~IN) Y~ J' Cased to ~fo-~ ft. A. WELL DATA Well type i0,~ Date completed Total depth 1 3 f¢4- ft. FROM WELL LOG Well production WATER SAMPLE RESULTS: Date of test Static water level Coliform ,O colonies/100 mi. ,Arse.nic: ~ SEPTIC/HOLDING TANK DATA g.p.m. Nitrate I- q ~ mg./l. Date of sample: . -Number of Compadments Depression over tank (Y/N) Well Log (Y~), /~ 0 Wires properly protected {~/N) Y4~J' Casing height (above ground). 1~4- in. AT INSPECTION 137 ft. (" g.p.m. Other bacteria O colonies/100 mi. by$ & S ENGINEERING Collected ~1 cad ¢~,:(e River, Alaska 99577 Tank Type/Material -- Tank size , gal. Foundati6n clean(~i (~/N) Date installed Cleanouts (Y/N), Date of pumping '" Pumper '~ c. ^¢0"m,oN F,E,D DAT^ " Date installed ~ ~ Soil rating (g.p.d./ft~'3~drm) System type Length "~' ' ~ ft, ' Widt~/~_______.___.~ ft. Gravel below pipe ft. TD°i:: ~::t;equacy ,'~:t ~. ~onarea ~~n~ti:r)ing tube Depressi;;;ver fie~dedrooms Fluid depth in abaton field before test in. Water added gal. New depth in. ;~a;:;n treatment (past ;;nmalofl,;i(dy;~P:;~ in. Absorption r;t;e;,--give date g.p.O. NO. 204 D. LIFT STATION Date installed Size in gallons ~N) "Pump on" level at ~in. ~ High water alarm level at Datum ~ Cycles tested Meets alarm & circuit requirements? in. E.. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot)V Absorption field on lot N Public sewer main ~ 5"' Sewer/septic service line On adjacent lots On adjacent lots Public sewer manholelcleanout Holding tank /eo .4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: )Ou~., .,- 5'~ ,,,~,e. Building foundation Property line Ab~ Water main ~ . Water service line ~ Surface water on adjacent lots _ ~ . Wells SEPARATION DISTANCE FROZEN FIELD ON LOTTO: Property line ./ Building foundation. Water main Water Servi.ce I...~e'/ Surface water Driveway parking/vehicle storage · . Wells on adjacent lots F. 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 HAA guidelines in effect on this date. Engineer's Printed Name /~i~ ~ ~,,,,~ ~, ~ ~'4~ Date 3'" / 3 e/0 3 HAA Fee $ ~ ''7f~- "" '/'- /,?O Date of Payment 5'" / 3%/o .~ Receipt Number O ,3 ~o ~- ~ 0 Waiver Fee $ Date of Payment Receipt Number (Rev. 12/01) ztL CT&E Environmental Services Inc. Laboratory D h,,ision 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria ^,~ho.,,,. Tel: (907) 562-2343 P,.E,4D INSTRUCTIONS ON I{EF'ER,$E SIDE BEFORE COLLECTING SAMPLE Fax: 1907) 561-5301 MUST BE COMPLETED aY WATEI[ SUPPLIER posL[C WATER SYS~M '.D. # iiiiiii PRIVATE WATER SYSTEM ~ SAMPLE DATE: Month SAMPLE TYPE: ,/~ Routine Repeat Sample (for routine so~,qple with lab ref. no. ) {:3 Special Purpose SAM PLE LO~ATION Day Year 13 Treated Water ~1~ Untreated Water Time Collected Collected By TO BE COMPLETED BY LABORATORY alysis shows this Wat~ SAMPLE to be: Satisfactory Unsatisfactory 0 Sample over 30 hours old, results may I~ unn:liablc Sample too_long in transit; sample should not be ovet~{lhours old at examination to indicate tellable results. Please se~d new sample via special delivery mail. ..,......,v. 7 Analysis ae~n Analytical Method: ~.,.Membra~e Filter /13 MMO-MUG ' 1032855 -//5 R..,,. A..,,. acnL m ,~.aJ.t,.,... ~.ch Fbks Jun Daie: Time: Client notified ef umotltfaetoty re~ults: l~houed Spoke with D~te: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Rt~ult: Total Coliform Membrane Iqlttr: Direct Count ~ Verification: LTB BGB Colonifl/lO0 mi COLIFIRM Fecal Coliform Confirmation CorRR3k~ItS: Flna[ Memb?~~lts Coliform/100 mi ReportedBy'~ate ~--~Zq[O~ Time J ~-'~ ,,,., I [] Foxed O~ - Ot~e ae~e ~~ M~mber of the SOS Group (Soci6tl G~n6ral, de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA. CAUFORNIA, FLORIDA, ILLINOIS. MARYLAND. MICHIGAN, MISSOURI, NEW JERSEY. OHIO. WEST VIRGINIA 05-27-0~ 05:03PM FRO~-CT&E ENVIRONMENTAL $~V 9075615301 T~?30 P.02/02 _ SGS__ SGS Client Name Projt~t Client Sample ID Matrix 1032855001 $ & g Engineering LB, B3, Eagle River Hei~.hts LB. B3. Eagle River Heights Drb~ng Water s:ampl- R~marks: All Dates/Times are Alaska Standard Time Printed Date/rime 05/27/2003 16:29 Collected Date/Time 05/22/2003 12:30 Received Date/Time 05/23/2003 14:15 Technical Director Stephen C. Ede Released By ~ Allowable Prep Am~ly$is . Palameter Restdt~ PQL Units Me0md Limits Date Dam Init Waters Department Nitmtc-N 1.49 0.100 mg/L EPA 300.0 (<=10) 05/24/03 JS Microbiology Laboratory Total Coh fnrm 0 col/I00mL SMI8 9222B 05/23/03 KAP MUNICIPALITY OF ANCHORAGE Building Safety Division MEMORANDUM DATE: June 4, 2003 TO: File FROM: Jeff Poet Engineer II, On-Site Water Wastewater Program SUBJ: Eagle River Heights Block 3 Lot 8 There is a well log in this file marked lot 6 block 3. spoke with the well driller bill sullivan and informed me it should in fact be lot 8, block 3. 33 L _ t w BEAUFORT ST. 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