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Home My WebLink AboutMILE HI BLK 5 LT 1AMile-Hi Lot 1 A Block 5 #050-201-19 · 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: ~V,,/'~:5,o4.oo PID Number: ~ ~-¢~lld Name: ~/~i/L. ~ ~L~.~'t~ AIb~"~,~/-~ Wastewater System: ~New B Upgrade Phone: ' I ..... / / ~o.~Bedroom~: ~ Deep Trench ~hallow Trench O Bed ~ Mound 0 Other ~ Total Depth from original grade: LEGALDESCRIPTION_ s°H Rating: .~ GPD/Sq F, Township: ~ Range:~ S ~ n: Pill added ~bove original grade: Gravel tength: WELL: ~New C Upgrade Gravel width: Number of lines: D~stanc~ w~n I n~ C~assification (Private, A.B,C): Total Depth: Cased TO: Total absorption area: Pipe mCeriat: Casing He~ght Above Ground: SEPARATION DISTANCES ~i~ ~ ~o~ui.g ~T.E.~. Surface Water >/~' >/~/ >/~o' / ~/~ LIFT STATION Lot Size in gallons: c ur "Pump on" level al: "u~p off" I~el at: High water alarm Curtain ~ ~ Assumed Elevation: Michael E. Anderson Department of Hea.i{~nd Hun~ Services approval ~; ' ' " 7?-OI3(Rev 9/91) MOA 25 Municipality of Anchorage Page 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: ~y¢ ~O~O, PID Number: of__ ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 October 14, 1993 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Attention: Onsite Services Engineer Subject: Lot lA, Block 5, Mile Hi Subdivision Well Abandonment Dear Onsite Services engineer: The existing well on the subject lot was abandoned to allow placement of a new septic system. The well casing was cut off 4' below the ground surface. The casing was then filled with sand and the top 10' filled with concrete. A 3/8" steel plate was welded atop the casing and concrete placed around the perimeter of the casing to 6" above the welded cap. The abandoned well was then backfilled to existing ground level. All work was accomplished in accordance with A.D.E.C. regulations. Sincerely, Michael E. Anderson, P.E. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930400 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:ALBERTSON BRIAN J & NATALIE L OWNER ADDRESS:21849 WILLSON WAY EAGLE RIVER, ALASKA 99577 DATE ISSUED: 9/28/93 EXPIRATION DATE: 9/28/94 PARCEL ID:05020119 LEGAL DESCRIPTION: MILE HI BLK 5 LT IA LOT SIZE: 95484 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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: ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 September 21, 1993 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot IA, Block 5, Mile High Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: The owner of the subject property intends to upgrade the septic system prior to selling his property. Topography of the lot is characterized by extremely steep slopes and shallow bedrock. The drainfield, however, will be placed on the most level portion of the lot. A lift station will be required. An existing well on the property will be plugged and abandoned in accordance with Municipal regulations. A joint site visit was held with Mr. Robbie Robinson to discuss the proposed system and to study the problems associated with placing the system on this lot. The resulting design is based on the information obtained during that visit. If the system is constructed in accordance with the attached design the following statements can be made: The system, if constructed as designed, will have no adverse impact on the wells currently in use or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, will drainage patterns in the area. Sincerely, impact on Michael E. Anderson, P.E. SHEET NO. OF ~,Se! E. And~ 4381 - E SHE~TNO. CHECKED BY CATE ..... SCALE Lot lA, Block 5, Mile High Subdivision DESIGN FACTORS: SYSTEM REQUIREMENTS: Two Bedroom Home Percolation Rate: 37 Min./Inch Application Rate: .45 GPD/SF Shallow Trench System 1000 Gallon Septic Tank 2.5' Gravel Below Pipe (2 Bdrms. X 150 GPD) / .45 GPD/SF = 666.7 SF 666.7 SF / 5 Ft. X .64 (Red. Factor) = 86 LF of Trench Therefore: Construct One Shallow Trench 86 LF with 2.5' of Gravel Beneath Distribution Pipe. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMEO FOR: ~ · E~A. O~SOR,PT,ON: I.-' I^. 13 14 15 18 19 20 COMMENTS SITE PLAN Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT ~ pO. DEPTH? E Depth to Water After~ Monitoring? Date: -- Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~'7 (minutes/inch) PERC HOLE DIAMETER TEST I~UN BETWEEN ~" FT AND '~ FT ' I ERFORMED .: . , ¢¢ ' ..THATT ,ST STWAS.ERFORMEO,N ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4185) (ENGINEER'S SEAL) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST WAS GROUND WATER FI ENCOUNTERED? S 11 L ~1, IF YES, AT WHAT ~ 0 t,/~' II DEPTH? p 12 E 13 - Monitoring? Date: ~ ?~ Gross Net Depth to Net Reading Date Time Time Water Drop 14- 15 16 19 20 PERCOLATION RATE //o (minutes/i.ch) PERC HOLE DIAMETER TEST,RUN B,ETWEEN ~' FT AND ~ FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) , ~-12-f,:'~, ii:-~2 A:q ;Ai'~H~FA.'.;E T.-~iK ~: "ELEIi:Q I'7% 907 277 $715;# I I 2~0.00 ~20 OSI 10 HHF- 7 sta~e 200.00 100.00 o~o 0.oo 40 OSI 05 HH - 2 sta§e* 10.00 15,00 20.00 25.00 30.00 35.00 NET DISCHARGE, GPM 40.OO 45.00 5O,00 PAGE 1 OF 1 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 (UPGRADE) PERMIT PERMIT NUMBER:SW930345 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:ALBERTSON BRIAN J & NATALIE L OWNER ADDRESS:PO BOX 771514 EAGLE RIVER, AK 99577 DATE ISSUED: 9/03/93 EXPIRATION DATE: 9/03/94 PARCEL ID:05020119 LEGAL DESCRIPTION: MILE HI BLK 5 LT iA LOT SIZE: 95484 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 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: THE NEW WELL MUST BE LOCATED 100 FEET OR MORE FROM THE EXISTING SEPTIC TANK AND LEACHFIELD. THE EXISTING WELL MUST BE PROPERLY ABANDONED. 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. ci.anchorage.ak.us (907) 343-4744 CERTiFiCATE OF HEALTH AUTHORiTY:APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D..050-201-19 1. G~NERAL,INFORMATION iComplete legal description or directions) Location(slte,.a,ddress 21849 Wilson Way Current Propertyowner(s). David Douglas Mailing address 21849 Wilson Way, Expiration Date: Lot IA, Block 5, Mile-Hi Subdivision Dayphone 786-3473 River, AK 99577 Lending agency Mailing address Day phone e Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: ~-~-*~/~ ~ NUMBER OF BEDROOMS: 2 I ~/¢/~o 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 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 private or Class C well and may be reissued with new water sample results less than 30 days old. 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. 72-025 (Rev. 01/00)' 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 Health Authority Approval Guidel!nes for the Health Authority Approval application show 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 flies 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, and regulations in effect at the time of installation. $ & $ ENGINEERING Name of Firm 17034 F.~le River Loop Reed No. 204. Phone Address F..,Igle River, Alaska 99577 Engineer's Printed Name P, oberl: C._.~. Cowan Date 6. DHHS SIGNATURE ~ 'Approved for ~ bedrooms. Disapproved. Conditional approval for ~ bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Sept!c System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: ~- ..C'"- ~) o Original Certificate Date: Reissue Date: 72-025 (Rev. 01/00)' Municipality of Anchorage O~ Department of Health and Human Servl~Sl:: C E I V E Division of Environmental Services ' · '"' On-Site Sendces Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 NOV ~ I Z000 www.ci.anchorage.ak.us (907) 343-4744 HEALTH AUTHORITY APPROVAL CHE~AL LegalDescription: /..ct IA; If A. B. or C provide PWSID # Sanitary seal Cased to I~ / ft Casing height (above ground) FROM WELL LOG I,q/~ ~'z;' P~(-./../~Jd--~- AT INSPECTION Parcel I.D.: ~'-~ ~ -- II ~' Well log Wires properly protected ~ in. A. WELL DATA Well typer~ Iv A Date completed ~_~?J Total depth / ~) ft / / :7-?' . ~-~.C g.p.m Static water level ~ ' ft Well production I . g.p. m WATER SAMPLE RESULTS: Coliform O colonies/100 mi Date of sample: h/~ ~//o o Nitrate ~), ?~' 3 mg/I Other bacteria Collected by: $ & $ ENGINEEIUNG colonies/100 mi 17034 E~j?e River L~p Road Ne, 204 B. SEPTIC/HOLDING TANK DATA E~;}* River, A~Gka ~S~ Tank Type/Material ~ i/~C Oate ins~ll~ ,o/~ ~ Tank s~z~ gal Num~r of Comp~me~ ~ ;Cleano~-~ FOUndation cleano~ V~ Depression over ~k ~ O High ~ter al,m ~ c. ABSOR ON eELO DATA, Daeinstall~ JO/~3 ~ilmting (g.p.d.~or~)~e~S~tem~ ~/g~ Len~ ~? ff Wi~ ~ ff Gravel~l~pi~ ~-~fl To~I depth ~ , Effete ~o~on ~aa~2 Uon,ofing ~be ~ Depression over field ~ Date of ad.ua~ test ~ ~ Resu~ ~.,) P~ For ~ ~.oms~ Fluid dep~ in a~o~on field ~fore t~t ~. in Water add~ ~ ~ g~. New dep~ /~ in. El~s~ ~me: ~ / rain Final fluid dep~ /~ in ~so~tion rate >= ~ g.p.d. ~y rejuve~flon treatment (past 12 mo.) (Y~ & ~) ~ ~~ If yes. g~e date ~ 72.02S (Rev, 0t/00)' D. LIFT STATION Date installed /0/~',~ 'Pump on" level at (~7 in Datum "~1° OF"/'~J'~ E. SEPARATION DISTANCES Sl=e in gai~ons / "Pump oft" level at Cycles tested in Manhole/Access ~ High water alarm level at (~ in Meets alarm & circuit requirements ~._.~____ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot I ~ ~ Absorption field on lot /0~) ~ Public sewer main /',,!/,~ Sewer/septic service line ~. ~' ''+- On. adjacent lots On adjacent lots I00 ~+ Public sewer manhole/cleanout Holding tank ~/6 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line Water service line /~) Wells on adjacent lots Building foundation Water main /~//,~ Drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /~::) ~ Building foundation /4~ ~ Water main Water Service line /~) /4- Surface water /42~) t,~- Curtain drain /'{/z~f&_ ~,~f,/~ Wells on adjacent lots Absorption field Surface water Driveway, parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICA'nO, I certify that I have determined through field inspections and renew of Municl., .cerds t.at =ye s,tams are in conform_,a]_ce with MOA HAA al~l~ines in effec~on tt~ date. Engineer, Printed Name ~ HAA Fee $ ~ Data o~ Payment Waiver Fee $ . -.., Date of Payment Receipt Number .... ~' 72-02~ (Rev. 0~,~o)' , .. kUN ...... L,.. OF M E M 0 R A N D U 1.! WATER WELL ADV?-SGRY HEALTH AUTHORITY APPROVAL NO. O~O~-ql During a recent Health Authority Apprcva! Ch-site inspection and tes~ cf the potable water supply we!! cn Lot I R . Block ~ ~--of /~;~- ~1' Subdivision, zhe well's productivity was determined to be ~,~ gallons per minute. The minimum well productivity required by this Department (~!C !5.55) for a ~ bedroom residence is ~.~ gallons ' per minute. Althougk the subject we!! currently exceeds this minimum requirement, al! parties concerned are advisad that ~he production capacity of the well may fiuctuace. Restriction of ncn-critica! water uses such as washing cars and watering lawns and gardens may be required. This ~adviscry must be attacked to al! copies cf the subject Hezitk Authority Apprcva!. NOU--~-~ l!::Y3 S~$ ENG?I,P_E~[NG c~ 694 lP1! .......... ~ot~u~ T-92! P,0]/05 ,d~_. CT&E Environmental Servlc~a inc. CT&£ R*~ 10073320O2 Client Sample ID LIA B5 Mile Hi ~,~n-~ ~'ink~ng Wa~r Ordered I'WS[D 0 Ptint~.d Date/Time 11/27/2000 14:53 Collided D~'~'l'in~ 11/'22/2000 9~05 Rieeived I:)~VTim~ 11/22/2000 12:!0 TKludrg Dire~or · ~phen C. vae . . O.?~ 0.~00 mS/L ~PA 3O0.0 10 max 11/22/00 SCL Coliform O col/l OomL SMI S 922ZB 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description HAA# Location (site address or directions) Property owner Mailing address Lending agency t~'//~,-~.,/~ ,/t//~-' ~-- ~/~/~,t., Day phone Day phone Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community,wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72*025 (Rev. 1/91) Front MOA #21 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 inves_ti~gation 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 of Firm ,/~ b ~--Tz. 5o~o --,,,,,,,,,,,,,,,,~ o /~c~'l~l~J~, Phone Address ~ O. /~0 Engineer's signature Date qqS- DHHS SIGNATURE i/'" Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: By: Additional Comments Note: The weZZ for this propert_v meets ex±st±n? State and Municipal Codes. There are nitrates present. It is ~,~o~ ~h~ ~ ~ ........................................ ~;~nued suit~ity. N~r~te ;~ce[tration is 5.44 mg/1. EPA --,. 7, - - * v r / t 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 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 errors or omissions in the professional engineer's work. 724325 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~,/"~/ ////-;/-c'///½ ~/~,~- Parcel I.D. A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) / Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~'/~Z.-/¢'.~ Driller Cased to /?.--/& / Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION ID 2: / g.p.m, g.p.m. ~ ~ /~F' ~ ~ ~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform r~ Date of sample: Nitrate Collected by: Other bacteria B. SEPTICEd~L=~IN~ TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping /~///~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /~?-"/ On adjacent lots ~> '~ / To property line ~ ~Q/ Absorption field /~/ Surface water/drainage Tank size /7---5~-~ ~. Foundation cleanout (Y/N) /~ Alarm tested (Y/N) Pumper /~///~'~' Compartments 2--- Depression (Y/N) Y Foundation ~- ?'Z.-- / Water main/service line ~7~'/ 72-026 (3/93)* Front CONTINUED ON BACK PAGE Date installed Size in gallons Vent (Y/N) C. LIFT STATION/-~---/-~/¢- 7'-.//-/%//~'' /~.~z~ "Pump on" level at High water alarm level f Meets MOA electrical codes (Y/N) Man u fact u re r~/-~c~,-~y ~/7'~x~,~ Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot /0~-~/ On adjacent lots Surface water .'~ /~'~ ~ D, ABSORPTION FIELD DATA Date installed Length ~'~7 Width Total absorption area ~7~'~ Date of adequacy test /~//~--'"- Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) . ~ Gravel thickness Cleanout present (Y/N) /Y' Results (pass/fail) ~ System type ,¢~/.~' Z~'~'~/.~.~ Total depth ~--~' Depression over field (Y/N) for / Bedrooms After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: / Well on lot //D ' On adjacent lots ~ ~,~ Property line To building foundation ~ ~ ~ To existing or abandoned system on lot On adjacent lots ) ~-~ / Cutbank ~ ~ / Water main/service line Surface water ~ /~o / Driveway, parking/vehicle storage area ~' Curtain drain /'/'/,~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this. !nspect/on. HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number 4 t .COMMERCIALTESTING & ENGINEERING CO. VIRONMENTAL LABORATORY SERVICES ........ 8 REPORT of ANALYSIS Chemlab Ref.~ :93.5272-1 Client Sample ID :L8A B5 MILE HI SUBD. PRIVATE WELL H20 Matrix :WATER 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :ALBERTSON, BRIAN Ordered By :BRIAN ALBERTSON Project Name : Projects : PWSID :UA Sample Remarks: ROUTINE SAMPLE COLLECTED BY: A. HARALA. WORK Order :71752 Report Completed :10/08/93 Collected :10/05/93 @ 10:20 hrs. Received :10/05/93 @ 12:15 hrs. Technical Director:STEPHEN C. EDE Released By : ~. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 5.44 mg/L EPA 353.2/300.0 10 10/06 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than SGS Member of the SGS Group (Soci~t~ G~n~rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA 'DEPARTMEi 825 MUNICIPALITY OF ANCHORAGE ~A~ OF HEALTtt AND ENVIRONMENi~ ,,PROTECT/ON Street, Anchorage, Alask~ 99501 279-2511, ext. 224 or 225 Date Received: August 5, 1977 #1: Time ~..~ AQJ___ #2: Time #3: Time Date ~2.;~_] ~ ~/~_ Date Date REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska Statebank Mailing Address: 310 East Northern Lights Phone: 279-7637 694-9198 2. Property Owner: Ray Hurst Mailing Address: Box 692 99577 Phone: 3. Legal Description: 4: Single Family Residence: (x) Multiple Family Residence: ( 5. Well System: Individual well Permit # Construction Lot iA Block 5 Mile High Subdivision Number of Bedrooms: _~WO Number of Bedrooms: Con~nunity/Public System ( ) Depth of Well 395' Well Log on File ( ) Bacterial Analysis Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System (xk Public Utility ( ) Installed ~ ~'~ C Installer Manufacturer Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line ~Page Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water ~_acll~.tl_s Legal )Description: Lot iA BloCk 5 Mile High Subdivision Col~unent s: Affadavit Attached: Approved: '. ~.._~_~ Disapproved: ( ) Letter Attached: ( ) Date: Department Worksheet: - '-" MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 9§604 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO. VA FHA CONV × 2. Property Owner: Ray Hurst Mailing Address: Box 6~2, F.a~le Rioter Day Phone: 694-9198 3. Name of Buyer: Henr~ Hunt smart Mailing Address: Box 6~, Uslbelli.. AK pg?R7DayPhone:KR3=2353 4. Nameof Lending Institution: Alaska ~tatebs, nk Mailing Address: 310 F.. Northern T,~ht~ Phone: ~79-7~;37 5. Name of Realtor or Agent: none Mailing Address: Phone: 6. Legal Description: Lot lA, Blk 5, Mile High Location: Upper Canyon Drive & Willson Way 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Public Utility. If individual, number of dwellings presently served If Individual, depth of well 39F' 9. seWage Disposal System Type of System: Public Utility If Individual, date of installation Single Family No. Bdrms. 2 Individual Individual (on-site) _w_ 72-003(3/76) August 12, 1977 Ray Hurst }~ox 692 Eagle River, Alaska 99577 su~ject~ Lot iA Block 5 Mile _~igh Subdivision DEar A recent inspection of your property revealed several descrepancies that will need to be corrected before we san send approval to the lending agency. (2) (3) The well is presently in a pit and must be extended above ground level and the pit must be filled with ~%perviouse so~ls. The sespage pit is approximately fifty(50) feet from the well. in order to meet the St~e minimut~ requirement there mu~t be a 100 foot radius between yourwell and any seepage pit. The ~%nk must be exposed and pumped to verify its existanee and size. Before any construction can begin on the sewer there must be a soils test performed on the property to dete~aine the size of the aeepage area. A permit must also be obtained before construction can begin. If there are any further ~uestions, please contact this office at ~9-2511, extension 224 or 225. Sincerely~ Robert C. Pratt~ Sanitarian RCP/ljh