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Home My WebLink AboutFREEMAN LT 3R;;e6mart suw% P,m it (D t(o zwoor Ceve(apment Services 0epartment (wilding Safety Division --�� On -Site Wc+e'r 4 Wastawal er rroorar 4740 8ragaw Street P.O so 196,50 Anchorage, AIL?9519-6650 :lark 2egich mayor 09W TLIlILOI'Oi On51T? X907) ?43-7904 Pump Installation Log cell Drilling Permit &umber: SW_ Date of Issue: _ arcel Identific2ti0n Number:_ =IlVloL*- Property Owner Name & Address: �4ve ump Instn1latdon Date: Z—;;P— ump Intake Depth Below Top of Well Casing: 17 feet nmp. Manufacturer's Name: Ike �aG�Ke� l ump Model: % l 2 " j nmp Size hp itiess Adapter Burial Depth: I I feet itless Adapter Manufacturer's Name: itiess A-daPterinstall6r! .i_li D sinfec?ed'Jpoa Tple�� L-= 'Iechud �fisinec�on: laY :ommemts: lump Installer Name: Aw-P 5 �. antion: The pump installer shall provide a pump installation lag to the DSD %itivn 30 days of pump installation_ R� 7 7 .�Cerfifie'd.WeW V For ..........Robert -Combe.. Location...... ........ . ... ................. Date coppleted ..... ........... ............ ........•.. ........ Depth....... of well ........ =.-Feett.-�-: ..... . .. ........... 11 ....................... I ............. Size of casing..... *.-6Inch... ...... ........ * ...... ................. ........ tij Distance to.water. ... -0. Distance to water while p,�,nping..� .... .. r of ...... 6.0.0 .......... ..........gallons, per ljour. alc Description of,,FdnrA#bn,—,,, from to Yellow clay and -rook". —'o 1A Sand Yellow Clair Gray cla 35L— Hard pan - H eaying�!,an ra Water, a and t�c-<. if, 210 212 AjtEALTN a the above thbotrue DFPT. C* Of 00twINTAL. PRO Driller2 C'V YON ED MMERVILLE WELL DRILLING Star Rt. A,: Box, 1773 Ancharago,.Alaske ie OF ANCHOR We advise you to attach this certificate to yoiAuMj&.LTTY A f< GDEPT. OF HEALTH & 'ENVIRONMENTAL PRCTECTI I Jq1;j '011 .4 -;l �nI 4� 0 It r''i • 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 Application Date S/2of&S 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lo -r 3 FREE 4`1AN SU0 Location (address or directions) *2 to Mona five � Anchorcp!ye 99 -CIC (b) Applicant Name fioberf�var61_Telephone�I:Home YY' 4S7 Business Applicant Address Vol hzervo cgve• Amsho,lge,A'liafAe '??$-4 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder m ;Buyer ❑ ;Other ❑ (explain); (d) Lending Institution ,Aj 2C< Z' //�f1� "czcz/s Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Family19 Multi -Family❑ Other Number of Bedrooms 9 K1•`J3 ��;i-'iRd1;7 Individual Well 59 Community ❑ * Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite K Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 ' 72-025 (11,84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 hereinl 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 of Firm Flet %ChstCn( ,Serrrcy Telephone -Vis' ars- Address S R Box 7360-Y 1VS� 30 er.Av SA AAclorov� Ak 99S/S Date S/ZO /8,S See no/w on clrtckli - rrya44y, Separahm ofi.rlaoCesi a /eh4r of *u claAe r7ards!f pit well. ' THEODORE F. MOORE �• ,�•.� CE -3589 • • VQ,� O I r�C �•••.....•• F. 6. DHEP APPROVAL C oAM, T 10A)14 � /n '� Appreued for B bedrooms by &4_C -� Datet— Approved Disapproved Conditional X Terms of Conditional Approval ` ' "-� Q ` Z'e— L,_4 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 above 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 engineers work. Page 2 of 2 72-025(11/54) MUNICIPALITY OF ANCHORAG: DEPT. OF HEALTH 8, ENYIRONME,VTAL PRCTICT10tJ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) 1 M5 CHECKLIST - FEBRUARY 1984 J 284-4720 � Zi ' RT Legal Description: �"a* .3 /� A. WELL DATA Well Classification PmWeth If A, B, C, D.E.C. Approved (Y/N) Ad - Well Log Present (Y/N) r Date Completed Yield > y O•I wL Total Depth 212 Cased to PID (% Depth of Grouting ALA - Static Water Level _61' Ipmr well low) Pump Set At U4h Casing Height Above Ground�if e,vell Sanitary Seal on Casing (Y/N) r Electrical Wiring in Conduit (Y/N) "19 Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot'* On Adjoining Lots loo To Nearest Edge of Absorption Field on Lot I00'P ; On Adjoining Lots «� To Nearest Public Sewer Line fid. To Nearest Public Sewer Cleanout/Manhole M -A. To Nearest Sewer Service Line on Lot Water Sample Collected by ' Tft! ; Date Slid lar Water Sample Test Results—5g&_,ftCBw Comments* « ctHQC4ltyc % fGr f'LsOsitldi�I ~Ymare' Ayot A s# a+tU at Ame . AF COTS B. SEPTIC/HOLDING TANK DATA Per sgpqc- Date Installed AIM ! Size No. of Compartments Standpipes (Y/N) r Air -tight Caps (Y/N) r Foundation Cleanout (Y/N) Al Depression over Tank (Y/N) N Date Last Pumped _V1,10Aft Pumping/Maintenance Contract on File (Y/N) A44- ; for __ N.A. Holding Tank High -Water Alarm (Y/N) _"• Temporary Holding Tank Permit (Y/N) �• Separation Distances from Septic/Holding Tank: o To Water -Supply Well 9s. * To Building Foundation - To Property Line To Disposal Field Z S To Water Main/Service Line #14 • To Stream, Pond, Lake, or Major Drainage Course It>tCi' Comments Wedf ib seem C -Ce ae rho'a .neo•e.itr.•tt�tf Sb' of we of ecKrif t:Aee Page 1 of 2 72-026(11,84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata an k Type of System Design Qea! dMIJVJ;62�ro"Wer) Date Installed 19 i0 1 Length of Field Knk x 3 Aati/144 144r = .So'e A Width of Field u N k 2 Y Depth of Field Un r � y 5,,;� tibl tv.p. uAk Gravel Bed Thickness Un k Square Feet of Absor rea Standpipes Present (Y/N) N Depression over Field (Y/N) Date of Last Adequacy Test ryas Results of Last Adequacy Test Separation Distance from Absorption Field To Water -Supply Well ( 00 + To Property Line 14.0 To Building Foundation I r To Existing or Abandoned System on Lot N. A ; On Adjoining Lots 7 30 r To Water Main/Service Line 1%4. To Cutbank (if present) _Nen A To Stream/Pond/Lake/or Major Drainage Course 7 (00' To Driveway, Parking Area, or Vehicle Storage Area r Comment��lrs wa►at't of t44 C)es:eh could Or F.vnof on 000P hlw are6ewAov. Ti nriiMtwl 1eo.ii 440 4irirr 140:1./ L6W I I! 4c" for 4 3 besfrw^ haws w.h.X a D. LIFT STATION3 BPR M NF "0"102 Date Installed tr t Size in Gallons IA i "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments WOLL Mehta r /oeraa 1 1 1 I I F p CAR 4 i_.1�� IteroRrao �f!*nc TAMIL aF Manhole/Access (Y/N) "Pump Off" Level at •• Check Permitted Bedroom Rating Against HAA Request •• Vent(Y/N) PftN i/ILID MN Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 7 17 n Date S120/6Y Company tbftFrech Sat Ar MOA No. a_S!9 •2 Receipt No. _3 1:�C&4t y Date of Payment 5 cAI- OF A4�h Amount: $ �) S"� �,`Q•� •'Engin ef's. ,49TH • ......................i 01 Page 2 of 2 `THEODORE I, F. MOORE �� •._ 72-026111,841 - 3589 "qy - .. 1 1 I a...0lsf rQ�yr _ 4 ' CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.' >.� ` TELEPHONE (907) 562.2543 ANCHORAGE INDUSTRIAL CENTER 5633 B Street•. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I I I I I (•) See h on back I.D. NO. \a"C tip `Vie a1 Se -C. r Water System Noma Phone No. Mailing Address - p --_- A nv- ` fl la�kc� 1�1SIly pry Sure 2p Cods SAMPLE DATE: O S Mo. Day Yaw SAMPLE TYPE: EJ Routine ❑ Check Sample (for routine sample. with lab ref, no. y ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE NO. LOCATION I . I Lo't 3 Frtewio� 2 3 4 5 MUNICIPALIOF ANC Hoer. DEPT. 9EAD tPIJSTRUCTIONS ENVIRONMENTAL PRCTECTION I V 2 ; og FORE RECEIVED COLLECTING SAMPLE Time Collected Collected By et'IOPM rFM TO BE COMPLETED BY LABQRATORY Analysis shows this Water SAMPLE to be: El Satisfactory ❑ Unsatisfactory ❑ Sample too long In transit; sample should not be over 30 hours old at examination to Indicate reliable results. Please send new sample via specialdelivery mail. Date Received Time Received l SD O Analytical Method: ❑ Fermentation Tube ❑ Membrane Filter Lab Ref. No. Result' Analyst l I m I I m I I m I I m .ffo a eaar✓ 100 m o. 6-o a Mruw oo.rom 06-+220 NI BACTERIOLOGICAL WATER ANALYSIS RECORD M.. 15113 Membrane Filter. Direct Count Colllorm/loom) Verification: LTB 8GB Final Membrane Filter Results ' ' Colllormllooml Reported ByDate?- Time: a.m. P.M. TNTC = Too Numerous To Count * - MUNICIPALITY OF ANCHORAG2 P �/ `' .,,j�,,/ i -r , "' r ' q -E',,�:• DEPT. OF HEALTH R FNVIRONMENTALPRCTECTIO,I ,;FLAOP TE TTCHNICAL SERV,,ICES: �,.,....._ � � RECEIVED CIVIL& ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 May 20, 1985 Ms. Susan Oswald Water and Wastewater Program Mgr. M.O.A. Dept. of Health and Env. Protection Pouch 6-650 Anchorage, Alaska 99502 Dear Ms. Oswald: By means of this letter I am requesting that you grant a variance from the 1984 Health Authority Approval Guidelines pertaining to acceptance of existing pit wells. This request applies to Lot 3 of Freeman Sub., which is located at 2101 Mona Ave. in the Hillside area of Anchorage. There are several factors which I feel justify the granting of this variance. The homeowner, Mr. Robert Combs, has lived on this lot since the well was drilled in 1970, and a high quality of construction is evident. He needs to obtain Health Authority Approval for refinancing, not for re—sale. The one acre lot straddles an east—west running ridge with significant relief on three sides, and the pit well is located near the west end of the top of this ridge, so contamination from area—wide flooding is not possible. The pit itself is covered with a sturdy greenhouse with a trap door in it's floor, so it is well protected from the elements. The pit has an inside diameter of 64 inches, and is constructed of blocks laid up with mortar. The top course of blocks extends above ground level, and the poured concrete floor is 12 feet below the top. The 6 inch well casing extends 5 inches above the floor and is sealed with a standard well seal. The wiring leading to the well casing is not contained in conduit, but this requirement should not apply here, since the pit itself serves a protective function. The concrete floor has one hole in it for the pipe leading to the house. The pressure tank is located at the bottom of the pit. While the walls are naturally damp as a result of condensation on their cool surface, there is no evidence of present or past water ponding in the pit. Construction of a daylight drain, while possible given the topography, would be an expensive undertaking which could adversely affect the integrity of the pit. n N In summary, I found this to be a well constructed and well maintained pit well. There appears to be little potential for adverse effects on the public health, and consequently I recommend granting a waiver for this pit's continued existence, in it's present configuration. Please call me if you have any questions. Sincerely, Ted Moore :49L"* ^n •.�9 �* i�••.9 LHu.......�i.,ki* .THEODORE F, MOORE (.�'. CE -3589 •'��i MUNICIPALITY OF ANCHORAGZ DEPT. OF HEALTH R ENVIRONMENTAL PRCTECTIO71 RECEIVED