HomeMy WebLinkAboutEAGLE CREST #2 BLK J LT 3BEagle Crest #2
Block J
Lot 3B
#050-293-95
Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW930483 PID Number: 05029395
Name:
Wastewater System: 4 Ne p grade
Helen Wright
Address: e/O ygoo Pda.Aat�G� 4f/A•+
3r
ABSORPTION FIELD
L L
Phone:
37G- e5eo
No. of Bedrooms:
3
Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Othe
LEGAL DESCRIPTION
soil Nting:
Total Depth from original grade:
GPD7S Ft
Lot: Block: Subdivision:
Depth to p. a bottom from ongmat grade:
Gravel depth beneath pipe
3 A 11 e4 s ''Z
Ft
Ft
Township:
Range:
1
Section:
Fill added sb a original grade:
Gravel length:
LA -7
7
Ft
Ft
WELL: y New ❑Upgrade
Gravel width:
Number of lines:lance
betinen Imes:
Ft
Ft
Classification (Private. A.B.C):
Total Depth:
Cased To:
Total absorption area.
Pipe material:
/2_1 S1A
Ft,
116,1 x! Ft
SO FI
I
Duller:
Date Drilled:
Slabc Water Level:
Installer:
Date Install
a [.✓4' ti W "J/
//4 3
13 Ft.
yield:Pump
Set al: Casing neibi Above Ground.
(/
TANK
GPM
= /5 Ft. t Ft.
SEPARATION
DISTANCES
❑Septic ❑Hold ❑S.T.E.P.
To
S.Pbc
Absmphon
L01Molding
uboaPrnaie
Manufacturer:
apacity In gallons:
From
Tank
Frld
Subon
Unit
Sewer Linea
Material:
N Der of Compartments:
Well
4
f.
Surfac e
LI STAT\ N
Water
Wate
Lot
Size in gallons:
Manufac rer:
Line
=
"Pump on" level at:
"Pump off' level al:
h water alarm at:
Foundation—
t� t
Curtain
Pump Make B Model
Electrical Inspections performed by:
Drain
rJ 14
Remarks:/,,i
v
BENCH MARK
Location nd Description:
IA,rt -re G a r>
2 It. G
Assumed Elevation:
�OG.! OV eC- b.I LL
ENGINEER'S SEAL
OF•AkAIX gsp�p
�a�9��0
w47�- s.a r--��� � 3�3 r �9y
oa lf��•
Inspections performed by: Dates: 1st
• •»•»
:
2nd
....».;...
W B
Howard C. Hohn+
boas'•, 14o.3063 w
Department of Health and Human Services approval
-E ;
SM 13
�! I��-
O a9F R•OFESSI�'P.-�a
Q
Reviewed and approved by: -AON'rt 1.04 Date:
Uoa��vo„�
72.013 (Rev. 9191) MOA 25
CITATION
STRZ.FT
EXISTING EDGE OF ASPHALT
APPROX. LOCATION
SAANTARY SEKER LINE
S S
SET 15 X JO'
.......... .... ... ... . REGAR
-A
(6
CONCRETE
FOUNDA TION
589'57' 1 7"W
R
75.74 RE"O"ERED /5
Rcaw
OT JB
9,370 S.F.
EXISRNG SPOT
ELEV. (np)
S
too,
WELL PROTECTION
...RADIUS (TYT,)
NOTE!
STRUCTURES SHOWN
WERE VISIBLE AT THE
TIME OF THE SURVEY.
OTHER IMPROVEMENTS
MAY BE COVE -RED BY
SNOW.
OF 44
Howard . Hohm
NO 06U
S89*58'00"E
LOT 7
V .... EXIST. om
........
a
*4
RECOVERED Al
MON.
NOTE.-
THIS LOT SERVED LOT 8 A
BY CITY SEWER
Sll"df PLAN
NOTE: SCALE. SlIT f vp I
ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE.
LVI: 3.9 BLOCK: I AnNnm wmonmWmmm
Eft CLE CREST SUBD.
,eN,O .4,0,0.
PERMIT NO. SW930483
'sY"7-!,'F7 PLA
eAfZrVlCZ.-4LlT.V OF AVCZZolUC_
.j
ZI2vmAACUJlrTRlX C0Rp0,q4Tj0,v0P'%
4900 PALMER-WASPLLA NW.. SUITE 3 WAS11A. AK 9%54
(907) 375-00W FAX (907) 376-9939
GATE:
DATE JW. NWOM. IDESIC" or.
�6L 93-09-08 93,02.31
CHtc,
SCALE: DRAY 700T EO.
04ECX
=30' EPF
'
20.5
EXIST.
1. . . 1 .
WOOD
5.4' DRAKE
FRAME I
ENCROACHAiENT
HOUSE
0 ..................
EXIST. WELL
WELL
.....
0 ................................€.
.. . ............................
3.3
ea
10' UTILITY EASEMENT
RECOVERED 14
76. 14
RfaAR
NOTE!
STRUCTURES SHOWN
WERE VISIBLE AT THE
TIME OF THE SURVEY.
OTHER IMPROVEMENTS
MAY BE COVE -RED BY
SNOW.
OF 44
Howard . Hohm
NO 06U
S89*58'00"E
LOT 7
V .... EXIST. om
........
a
*4
RECOVERED Al
MON.
NOTE.-
THIS LOT SERVED LOT 8 A
BY CITY SEWER
Sll"df PLAN
NOTE: SCALE. SlIT f vp I
ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE.
LVI: 3.9 BLOCK: I AnNnm wmonmWmmm
Eft CLE CREST SUBD.
,eN,O .4,0,0.
PERMIT NO. SW930483
'sY"7-!,'F7 PLA
eAfZrVlCZ.-4LlT.V OF AVCZZolUC_
.j
ZI2vmAACUJlrTRlX C0Rp0,q4Tj0,v0P'%
4900 PALMER-WASPLLA NW.. SUITE 3 WAS11A. AK 9%54
(907) 375-00W FAX (907) 376-9939
GATE:
DATE JW. NWOM. IDESIC" or.
�6L 93-09-08 93,02.31
CHtc,
SCALE: DRAY 700T EO.
04ECX
=30' EPF
CITA7701 -
APPROX. LOGTION
SANITARY SEWER UNE
LOT 3A
a
EXIST. WELL
10' UTILITY EASEMENT
EXISTING EDGE OF ASPHALT
SET 15 X JO'
REBAR
J
Ltj
EXIST. I:
WOOD
No SE :.
NOTE.
THIS LOT SERVED
BY CITY SEWER
S89'57'17°W
M
EESPOT
ELEV. V, ( (f (p)
5
100'
WELL PROTECTION
'RADIUS (TYP)
I LOT OB
\4
i
M
EESPOT
ELEV. V, ( (f (p)
5
100'
WELL PROTECTION
'RADIUS (TYP)
I LOT OB
10,37 S. F.
N O C/o
'.
]LI
a CONCRETE
FOUNDATION 'm
N
205 T9.a
O •
Z
5.4' DRIVE
ENCROACHMENT
WELL
EXIST. WELL
76.14
589 58,oO�E RECOVERE6 Al
MON.
LOT 7
�) LOT 8 A
NOTE.T
STRUCTURES SHOWN
WERE VISIBLE AT THE
TIME OF THE SURVEY.
OTHER IMPROVEMENTS
MAY BE COVERED BY
SNOW.
NOTE:
ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE.
EXCLUSION NOTE:
IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTANCE OF ANY EASEMENTS,
COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
UNDER 140 CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE LINES.
AS—BUILT CERTIFICATE:
I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY:
LOT 3B. BLOCK ✓, E.ACLE CREST SUBD. 2ND ADD.
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. 3B
,,.. Al LOT: BLOCK: J ®!"�a n
A/ ��. s �® s
EACLE CREST SUBD.
„ %m JA 2ND ADD.
r SECTION 7 TOWNSHIP 14 N RANGE 1 W
Eric P. Fuglestad �0 PUT N9. 83-137 EWARD MERIDIAN
dj
F�+,MNo.72ta—s_Ap„ ANCHORAGE RECORDING DISTRICT
GRID NW54
4900 PRAM-WA.SIL A HWf.., SUM J WA56U, AR 99654
(907) 575-5500 FAX (907) 376-96x9
'ASE JOB NDDBER:F.B. RDNBER
93-09.08 9302.31
CAlE: DRAWN: CHECKEDh
1"=30' EPF jDIA
AS -BUILT
Z
DOC Co. Obi
SIULLIVAN WATER WELLS
P.O. BOX 070212,6HUGIAK. ALASKA19501 • TELEPHONE 638 2151
N ER or LAND mem OF %%LLL
!. -.ADDRESS
LEGAL DESCRIPTION
. . 6
V Ended En UALS� Ff It Ilit
1/4
KIND 01 CASING__6n���
kRMtT NUMBER
�t:ICINU OF FORMATION:
From�Ft.to�%APE ^A
Ft. I OAD-51 IF 1. 1 _&tf T -4115T.
ft.loF.,
Ft. to_Ln_FI.__4.:4
—Irt. From Ft*
Ft. to
Ft.
�Ft.
to
Fl_
From•_
Fl- 10 --fl.
--------------
rMol
Ft.
From
1. to
—Ft.
From
F1. In--ft-
From___Fl.
io—.-Fl
---------------
FFom.Fl.
Ft.
From
1' 1pram
_f t. to-
FI.
INFORMATION:
rlum
Ft. to
Fl.
From
fl. to --Ft
--------------
rMol
Ft.
From
1. to
—Ft.
From
F1. In--ft-
From___Fl.
io—.-Fl
---------------
FFom.Fl.
From
FI. to --Ft
DRILLERSNAME AgAft
rk 6
PAGE 1 OF 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 -L- STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW930483 DATE ISSUED:11/17/93
DESIGN ENGINEER:DUMMY COMPANY EXPIRATION DATE:11/17/94
OWNER NAME:WRIGHT HELEN
OWNER ADDRESS:P 0 BOX 770905 RD
EAGLE RIVER AK 99577
PARCEL ID:05029395
LEGAL DESCRIPTION: EAGLE CREST H2 BLK J LT 3B
LOT SIZE: 10370 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT:
THIS PERMIT IS FOR THE CONTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL 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 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
1. OBSERVE SEPARATION DISTANCES:
2. SUBMIT WELL LOG WITHIN THIRTY
25' TO SERVICE LINE
75' TO SEWER MAIN
100' TO MANHOLE
DAYS OF COMPLETION OF WELL.
PAGE 2 OF 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
R LOT WIY%B CONNECT TO�IC SE ... ST.
RECEIVED BY ,ATE:
ISSUED BY: "`^ �^ ^ "` DATE:
' CITATION
S89.57'1 7"W
EXISTING EDGE OF ASPHALT
STRE�'T
-�:::.-::..
��oti�
102.7
APPROX. LOCATION
...........
Q ....................................
�.
' Ex SScor
SWRARY SEWER UNE
....................
(TP) ..
(T
EL..
`pq0 s.
.
...............................
SET 15
9 SB _
Y'.
75.74 RECOVERED 15
Io!�
R£R4R
REB.4R
I
W \
...I ..................
'100,
J
}..........I
..`;. L
...
..WELL PROTECTION
(^
a .....
RADIUS (TYP) .,
...:...
LOT 3B
L
I
10,37 S. F.
In
.....
t
\LOT
3A
n.5
Ot
17.5
J
^%
p PROPOSED
p
^
/
U)
FRAME HOD p
FF — 103.0 h
Q
_
/
EXIST.
E ST I-
DRNE
ENCROACH.
40.0
t
FRAME f
...............
HOUSE
1001+ TO
0'I
I
S.S. AWN
/
EXIST WELL
---
1
I
PROPOSED I
o
WELL 11
/
of :
h:
PROPOSED 1
EXIST. WELL
0
DR4/N4GE (iYP)
y'
S.S. MAIN:
10' UTILITY EASEMENT
RECOYERRO�
ro.
76.14
589.58.00.,E
RECOVERED Al'
MONS
Q —
LOT 7
TOP MON.
1 ASS. EL. =
100
NOTA
j CONT. INT.
= 1, LOT 8 A
THIS LOT SERVED
BY CITY
SEWER
SITE PLA1�T
NOTE:
SCALE: 1' — 30'
MIT T OF T
.4&.�C*���»»`��� ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE.
`�a•••. 't•• LOT: BLOCK:
3251 t/
»f49th »�!♦ SUBDMSION: CORPORATIO00 n N
y!/ EA CLI' CREST SUBIJ. 1900 PAWER-WASILLA HWY.. SUITE 3 NA4LLA• AK 99654
2ND A.D.D. (907) 376_0800 FAX (907) 776-9629
AkEric P. Fugtestad�= APPD; DATE:,roe NUMBER: DESIGN Or.
~No.7z18—s�,r e��� 93-09.08 EPF
••• agOf `..»....."��`'�� T:IL'LL PL'RMIT SCALE. PRAWN. CHECKED:
•,�olk,klklk ����• (MC-"CIPAL/TY OF ANCHO/¢40--) �" =30� epf J•) fA
Municipality of Anchorage O
• -� Development Services Department
,a�apgs} e
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.enchorage.ok.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING QJ -9 -155ve,
Parcel l.D. 050-293-95 HAA# 11.4 0 a.0 a I
. Expiration Date: 1 1
1. GENERACINFORMATION
Compiet'legaldescriplion Lot 3B• Block J• Eagle e Crest -Tnd Addition
Location (site address or directions) 18718 Citation Rd. Eagle River
Current Propertyowner(s) Robert Minor Dayphone 365-8612
Mailing address same
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
Day phone
Day phone
.71W Z. 4'e", 411 110 i
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
❑
Individual Water Storage
❑
Individual Holding lank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
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 professional civil
engineer registered in the Slate 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 sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid foe 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
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 or structure Indicated herein. I furtlier 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 elf applicable Municipal and Slate codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm S & S Engineering Phone 694-2979
Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577
Engineer's Printed Name Robert C. Cowan Date q/X7/0 :?-
RO
5. DSD SIGNATURE Jlr�i` ¢ERT C. COWANCE-6801
Approved for 3 bedrooms. +•'�' �` � ' =
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
. -1
Additional Comments \� ••ON-61It••
N/ATFR AND ' m
WASTEWATER :
PROGRAM
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory //
By: .�I�k/• G&/
mr. 12M)
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: Ll �-
9-20-02; 6:00PM;
JAELS CUE Environmental Services Inc.
CT&E Ref.0
1026167004
Client Name
S & S Engineering
ProlectName/0
N/A
Client Sample ID
Lot 3B, Block7,!Eagle Crest N2
Matrix
Drinking Water
Ordered By
PWSID
0
Sample Remarks:
;907 Sat S30t r S/ 5
All Dates/Times are Alaska Standard Time
Printed Date?ime 09/20/2002 16:04
Collected DowTime 09/18/2002 13:55
Received Date/Time 09/18/2002 15:10
Ttchstical D S pen C. Ede
Relent
Pmmet- Results PQL Units Method
Waters Department
Nitrate -N 1.47 0200 ag/L EPA300.0
Microbiology Laboratory
Total Coliform 0 col/100ml. SM18 9222B
- PRELIMINARY -
Allowable : Prep Analysis
Limits Date Date Init
(«10) 09/19/02 IDT
(<-1) 09/18/02 KAP
—\ Municipality of Anchorage
• �- Development Services bepiliment
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, Ak 99519-6650
www.ci.anchorage.ok.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 0d"0—a D3 — HAA# 44%�Ov2//
Expiration Date: - 3 - 0.2-
1.
.Z1. GENERAL INFORMATION
Complete legal descriptiort = Lot 3B, Block J, Eagle Crest - al.4 e Addition
Location (site address ordirections) _
Current Propertyowner(s) 'Robert
Mailing address .
Lending agency
Mailing address
Real Estate Agent
Mailing Address
18718 Citation Rd. — Eagle River, Ak.99577
Minor
Day phone
365-8612
18718 Citation Rd. -Eagle River, Ak. 99577
Unless otherwise requested, HAA wN be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
ED
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site 1_j
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 professional civil
engineer registered In the Slate 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 sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certifidates 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
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 syslent 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 Stale codes, ordinances,
and regulations in effect at the time of Installation.
NameofFirm S & S Engineering Phone 694-2979
Address 17034 Eagle River Loop Rd. - Eagle River, Ak. 99577
Engineer's Printed Name Robert C. Cowan Date r/d//0z
6
5. DSD SIGNATUREr ROBERT C. COWAN is
CE -8801
Approved for bedrooms. 1+t>�,
Disapproved. t L',i,-_yt�•^
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
C)N-SITE
WATER AND • m�
WASTEWATER
PROGRAM
Maintenance Agreements
Supplemental Engineer's Report
Other
By: - • �G� ��`'L' Original Certificate Date: S' 2 - C -21
(n, +um
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.enchorage.ek.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: JV3Bt >gLOG le– `J'' Parol ID: O f oi–
A. WELL DATA
Well type P114 ✓4Lk
Date completed 1i I a13
Total depth 162 ft.
If A, B, or C provide PWSID # = Well Log (yrN)
Yef
Sanitary seal (Y/N) Wires property protected (YIN)
r t
Cased W -�ft. Casing height (above ground) _Ia_Lin.
FROM WELL LOG
Date of test 11/013
Static water level 13S -
Well
3iWell production /0 9—
p.m-WATER SAMPLE RESULTS:
Coliform eolonieslloo ml.
Date of sample: n Z
S. SEPTIC/HOLDING TANK DATA
Tank Type/Materlal
AT INSPECTION
13 G ft.
7� S g.p.m.
Nitrate ) •'" m9A.S EOther NCINtOtRING�� O colonies/100 ml.
Collected by: 17034 Eaela River Leen Read No. 404
Eagb Rlvw. Alaska "377
,#WtV LI P46 L' / L
Date installed
Tank me gal. Number of Comperb is Cleanouts (Y/N).
t Foundation cleanout (Y/N) Depression w nk IN)_ High water alarm
Date of pumping
C. ABSORPTION FIELD DATA
Date installed
Length ft.
rating (g.p.dN or ft2/bdrm) —
Width
type
ft. Gr;4el below pipe ft.
Total depth _ ft. / Eft. absorption area ft' Monitoring tube
Date of adequacy jdst Results (PasslFall)
Fluid depth In sorption field before test _ in. Water
Elapsed Ti e: — min. Final fluid depth — kr.
Any rejuvenation treatment (past 12 mo.) (YM S type)
Depression over field
For _ bedrooms
gal. New depth— in.
rate >= g.p.d.
If yes, give date
D. LIFT STATION
Date installed
"Pump on' level at
Datum
Size in gallons
in. `Pump off" level at _ in.
E. SEPARATION DISTANCES
Cycles tested
Manhole/Access (YIN)
High water alarm levet at
Meets alarm 6 drcult requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO
Septic tankAift station on lot -f! r- On adjacent lots
Absorption field on lot At AQ- On adjacent lots N I3
Public sewer main X00 f 1L Public sewer manholeldeanout e76) f.L
Sewer /service line 7,5 + Holding tank n1 A
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: PtJ 3L/ L
Building foundation
! Water main
Wells on adjacent lots
4 SEPARATION DISTANCE
i
Property line
4
Water Service line
Curtain drain
F. COMMENTS
G. ENGINEER'S CERTIFICATION
line _ Absorption
service fine Surface water
ABSORPTION FIELD ON LOT TO:
Building foundation Water
Surface water
Wells on adjacent lots
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 le g J &A T C. cot-'.4,,
Date S / a 1 /0 -.�—
HAA Fee $ 3 7 S- , Waiver Fee $ _
Date of Payment � /a r to 'a- Date of Payment
Receipt Number o a- 00 9 0 Receipt Number
(Rev. 12/00)
parking/vehide storage
i 10D M@ oowu,
40;: \ CE -8801
ku
i:, ..........
:
in.
6-16-02; 3:26PM;
CT6E Environmental Services Inc. '
Cr&E Ref.#
1022415002
Client Name
S & S Engineering
PrcgeetNamd#
NA
Client Sample ID
Lot 3B Block J Eagle Crest 7! 2-
Matrta
Drinking Water
OrderedBy _ ........
...... _. _.. _.... _...----..__._. __......... ........
PWSID
0
Sample Remarks:
;907 661 6301 • 3/ 7
All Dates/Times are Alaska Standard Time
Printed Daterrime 65/09/2002 10:05
Cottected Datelrime 05/0612002 16:00
Received Datelrime 05/07/2002 14:05
Technical Director Stephen C. Ede
Releasid j;7 U4.0V6
Allowable Prep Analysis
para-eter Remit; PQL Units Method Units . Date Date !nit
/caters Department .
Nitrate -N 136 0.200 mg/L EPA 300.0 (<10) 05/07/02 JDT
Microbiology Laboratory
Total Coliform 0 col/100mL SM189222D (<1) 05/07/02 KAP
R
a
T'I
t r MUNICIPALITY OF ANCHORAGE
4 DEPARTMENT OF,HEALTH & HUMAN!
f v,r
7 � Diwsion of Environmental Services
S ,Il,'"4 .Yl t?i i•iZ it' rfi�' ,ODr Site SeNICeS SBCtIOfly , M ,tlMn
i
13.0Boz 196850 Anchorage Alaska •99519-8850
CERTIFICATE OF HEALTH,AUTHORITYr+'
APPROVAUFOR A SINGLE FAMILYiDWELLINGr
�.
r "r t
�. Parcel i D'ri
¢r` v'; 1' ` GENERAL INFORMATION '°
c, Lor 3F3.$�ocie
� ;Complete legal descrlphon,
Locatig�ll psi address ofl�dlrectiona). f
����(�{�f'�0� {'r S��r- ` 4 IGJL.l ✓P/C. r 't �l'
! \ . i ,wnu.iMe�Moee ,vne<d %•,•�jr ,",,; r '"I -', ,•,.
Prop')erty owner.: t��c �, .t/i✓ ic,.�/ Day phone 37G SSD
..
f Mallih�iaddl " &� /�Atinr/L LyASjt .� hLz 3d !.✓asrcca g�1L5r{"
Q t f9
II Lending agBncyr '+�"A Day.phone
_' I yip t ^.lam• �'' : .^lir t.•.i'� ..1 rit
'•Mailing address-
,
Agent ' ' Day. phone
Address t
Unless otherwise ireHAA will be held for pickup
2. NUMBER OF BEDROOMS:;_ _... !
4
4 t v
3 TYPE OF WATER SUPPLY. -
G Individual well '
Coinmunity,well `
rPublic water, t?,
--NOTE .If community well system,;, provide wntten.conhrmahon from State ADEC attest
Ing to the legality and status of system
I ' 4 - 'TYPE OF WASTEWATER DISPOSAL Y
t
Individual on site
` Holding tank
`
IL
Community.on site) '
Public sewer , ; £ j cl : r• f n k L
y ! a r.,
'NOTE +`If community wastewatersystem provide written confirmation from State ADEC
attestting to the legality, and status of.system. ;
� nms (R.. ,A,{ rim, MOA m
r � ,
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 • , i
-` Investigation of this Health Authority Approvafapplicationshows 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.
Name ofFiri: cO 4.+E7n; Ph6ne-376=60,ao
Address, Z71ciOO
j
� -¢s� c.�'�ta3• L:J,�'!c't L7�
I
Engineer's_signatureM - n •1'Date ' "
rI 'I
OF
vOV
� y 10 �pROFESSI 1
6 DHHS.;SIGNATURE..
APprovedlfor r 3 bedrooms
�tDisapproved.
rConditional, approval ?for " 'c bedrooms with�the following stipulations
n Additional Comments
By. .�oH�J; $TSI iT14 r' ,I
° � � ` ,Date " 3 4- .• ' 'I
f
CAUTION
...
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
fy
engineer registered in the State of Alasm. The DHHS does this as a courtesy to purchasers of homes
and their lendinginstitutionsinordertosatisfycertainfederal and state requirements.EmployeesofDHHS donot
' -
conduct Inspections or analyze data before'a certrficate'is issued.'The Municipallty.of Anchorage'IS not
responsible for errors or omissions ig the e professional engineers work."'
i.
Municipality of Anchorage
AQQ
Department of He' alth'and+Huinan Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Zr SPS !3-g- J Parcel I.D. 0,5e770 Se 7
�d f�L� CmLsi �'2
A. Well Data
Well type 1Rrvn:1g7- If A, B, or C, attach ADEC letter. ADEC water system number
Log present (YM) Date completed / / /93 Driller &"fyl,., W)cc Gtlaru
Total depth /L 2 Cased to /G / z -f Casing height /2 '+-
Sanitary seal (YM) Y Wires properly protected (YM)
Nfo w&Lr_
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
/5t
T /55
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot N44 ; On adjacent lots
Absorption field on lot 14 14 ; On adjacent lots rJ 4A
Public sewer main 11-2 r Public sewer manhole/cleanout /e 0 a'
Sewer service line "7y + Petroleum tank N 4,4
WATER SAMPLE RESULTS:
ColiformS�f-4a2oK,y Nitrate T S4 -11S 1,461,ps5eOtherbacteria
Date of sample:a /�f y Collected by:
B. SEPTIGHOLDING TANK DATA
Da�Installed _ '
Cleanouts(Y/
High water alarm (YM)
Date, of pumping
SEPARATION DISTANCES FROM
Well(s) on lot
To property line
Tank size C
idation cleanout (YM)
Alarm teste
per
PTIC/H! ING K TO:
adjacent lots F
,ption field Water
line
72-026(393)•FMM CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size
Vent
•Pump on' level at
IUM,
'Pump off' Level at
High water alar level Cycles tested
Meets MOA ele
SEPARATION
Well on lot_
(Y/N)
D. ABSORPTION FIELD DATA
Date installed
LIFT STATION TO:
adjacent lots
rating (GPD/Ft)
LengthWidth
Total absorption area Cleanout
Date of adequacy test Re:
Water level in absorption field before test
Peroxide treatment (past 12 months)
SEPARATION DISTANCE FROM
Well on lot
To building foundation
On adjacent lots
water
system type
_Total depth _
(Y/N) Depression over field (Y/N)
FIELD TO:
adjacent lots
for Bedrooms
_After test
If yes, give date _
\ Property line
To existing or abandoned
Surface water. Driveway, parldng/vehicle storage area
Curtain drain
E. ENGINEER'S CERTIFICATION
1 cerVfy that I have checked, verified, or conformed to all MOA and HAA guidelines in
Signature
Engineers Name W C
Date eqC1
HAA Fee $ 3 Z' c Waiver Fee $
''
Date of Payment `7`//' 7 _2 Date of Payment
Receipt Number AT? 71 (-3436 Receipt Number
/11
72-026 (3193)• Back
is inspection.
44(
N.. •��y _N�N.j}. A �1
No.3063-E
Commercial Testing & Engineering Co.
Environmental Laboratory Services �riiriiriii�•iiiiiiiiiiiiii�i���,r,�,;rr,��
LABORATORY ANALYSIS REPORT
CTB.ERef.# 94.1394-1
Client Sample ID LSA EAGLECRESTSUB.ADD#2
Matrix WATER
Client Name ACUMETIUX CORPORATION
WORK Order
77084
Ordered By hIARI DETI I
Printed Date
04/04/94 @ 12:14 firs.
ProjeclNamc
COIhxICdDule
03/31/94 @13:40 his.
Project#
ReccivedDate
03/31/94 @14:30 firs.
PWSID UA
Technical Director
STEM IENC.E•DE
Released Dy: r,jt�W11{
Sample Remarks: ROUTINE SAMPLE COLLECTED BY. TERRYN.
Parameter
QC Allowable Ext. Anal
Results Qual Units Method Limits Dale Date Inil
Nilmtc-N 0.74 mg/L EPA353.2/300.0 10 04/01/94 CMR
----------------------- ------
• &x Special Instructions Above IJA=Lhaavailable
•• Sec Sample Remarks Above NA - Not Analyzed '
U=Undclecicd, Reported value is the practical glunlifiation limit. LTr-I.css1han
D=Secondary dilution. OT= Greater 7harl
N
LL
6.633 B Street, Anchorage, AK 99518.1600 --:.Tel: )907) 562.2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA; ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
CITA770N - S89.57� 17"W
EXISTING EDGE OF ASPHALT
APPROX. LOCATION M M IXISDNC SPOT
SANIrARY SEWER UNE
S S - S S
ser As x Jo' ' 75.74 RECOVERREX
............................................. RESAR
100'
'' ^ : ` WELL PROTECTION
"
J RADIUS (TYP)
:"I I I .....:::.::' ................ .
LOT
\-� � � '•10,37 S.F. (r�
N
0 C/o 3 ` •. v
�1 ILOT 3A ^ _ - 17.4 p m. ¢ 15.3 N o
CONCRETE
FOUNDATION 'u
pi'�,o:• O
to
20.5
rI ..............
WOOD
I' S.S' DANE
FRAME •� ENCROACHMENT
HOUSE
Exist. WELL -- J WELL ° t
® a EXIST. WELL}
TO' UnUTY EASEMENT RECOVERED /4 76.14 I +
BAR S89,58E00"E MON. VERE;• Al
LOT 7
NOTE. .) LOT a A
THIS LOT SERVED NOTE!
BY CITY SEWER STRUCTURES SHOWN
WERE VISIBLE AT THE
TIME OF THE SURVEY.
OTHER IMPROVEMENTS
MAY BE COVERED BY
SNOW.
NOTE:
ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE.
EXCLUSION NOTE:
IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTANCE OF ANY EASEMENTS,
COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
UNDER 140 CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE LINES.
AS -BUILT CERTIFICATE:
1 HEREBY CERTIFY THAT I HAVE SURVEYED HE -_FOLLOWING DESCRIBED PROPERTY:
LOT SB BLOCK J EAGLE CRLSZS SUED. 2ND ADD.
AND THAT NO ENCROACHMENTS EXIST EXCEPT, AS: INDICATED.
LOT: 3.8 BLOCK
Ayum ffivoll—
♦i♦ SUBDIVISION: CORPORATION wrlm
♦ EAGLE CREST SUB.D. 4WD PALUM-WASL A HV(. SUM s WASUA. AX 09434
�► 49' - t
2ND ADD. (ECT) 370-OSM FAX (07) JTe-oexa
""• SECnON 7 TOWNSHIP 14 N RANGE 1 W DAM ws UMBaU FA. NuuCEa
...
�• """ , """ a� SEWARD MERHDIAN 93-09.08 9302.31
♦� � Eric P. Fuglestad = PLAT N.. 83-137 OALL. DRAV". CHECKM
„ ,
1♦P��.,�No.7218-s + ANCHORAGE RECORDING DMMICT 1 =30 EPF �bla
♦♦� No
ION������+• GRID NW54 iA S —BUIL 71