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HomeMy WebLinkAboutSNOW VALLEY LT 23Cops-o'Dz-s/- 00 LoT 23'c _`%C ,mac l c MUNICIPALITY OF ANCHORAGE V V �i Cc�T l Off) V -"I. DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE ff'' 1. General information Application Date `t (a) Iega� Description (include lot, block, su ivitsion,isecticn,ntaanshiR, range) ion (address or directions) (b) Applicants Name Applicants Addr (c) Applic` �rt 's (check one) Lending Institution Owner/builder Buyer r �7T ; Other f:::j (explain); (d) Lending Institution N, a A Telephone �� -C Address All � , �..��T • V(� /1 ` f l�' (e) Real Estate Co. & Agent (3` 116;,47 Address ( rl� Telephone 2. Type of Pesidence Single -Family Multi -Family Other (describe) Number of Bedrooms 3. Plater Supply Individual Well Community Public Note: If ccrmurity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. < Is the well adequate for the number of bedrecros-specified in this HAA (Y,N) 4. Sewage Disposal Onsite Public Community Holding Tank Is the wastewater disposal system adequate fcr the rimber of bedrorms 5. Engineering Firm Providing Inspections, Tests, Luta and Information I certify that I have checked, verified, or conformed to all VIOA HAA C-AA-blines it effect on the date of this inspection. Signed" Date Nacre of Firm fir. J Tele or Address Signed by iC/fir f?/� -%� J`o ��= G ,� C?, Date ♦000000000006 0.0 �1 1000 ( ENGINEER SEAL) g��iQOQ®00 '+.^��-a o0� 0 �: '• Wph s. Jokcta , EE -1995 6.DHEP Approval Approved for, 3 tedrooms Approved Disapproved Terms of Conditional. .orfroval nmi ' Lnate 7L�. ConditzonaJ- The Municipality of Anchorage Departmnt of Health and Environmental Protection do not guarantee the continued satisfactory performance of the water supply and/or LJ wastewater disposal system. This approval indicates that, as of the validation dl� sham above, based cn the data and information furnished try an ergirR-e:r registerei the State of Alaska, the water supply and wastewater disposal system is safe and 3 ticnal for the riimber of bedrecros and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s (Page 2 of. 21 2-15-8a F c MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION( MAR 2'-1 rr)n RECEIVED Well Classification If A, B, Cr, C. D.E.C. Approved(Y/N) Y Well Log Present (Y/N) Date Completed Oc `F l 3 f I c 7 3 Yield 1006 P1lr) Total Depth 10 7 r Cased to 10-2-, Depth of Grouting — Static Water Level Pump Set At Sc`-eeh D`Z/ Casing -Height Above Ground / Z�f Sanitary Seal on Casing (Y/N) lectrical Wiring in Condui7t Depression Around Wellhead (Y/N)A( Separation Distances from Y��s W'AOn Adjoining Lots To Septic/Holding Tank on Lot tA.4- ; N, A. u t6 To Nearest Edge of Absorption Field on Lot Or. Adjoining Lots O •k , To Nearest Public Sewer Line a, ----TO Nearest Public Sewer r t Cleancut/Manhole 7-7-0 To Nearest Sewer Service Line on Lot I60 I' G u� Water Sample Collected By A4 4K� 'rowe_��, % Date 3 _ z3 s� Water Sample Test Results �yG Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size No. of Ccmpartments Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contract on. ile (Y/N) ; for Holding Tank High -Water Ala( Temporary Holding Tank Permit (Y/N) Separation Distances from Sep o rg Tank: To Water -Supply X11 — To Building Foundation. To Property Line TO Disposal Field To Water Main/Service Line Course Comments (Page 1 of 21 To Stream, Pond, Lake, or Major Drainage s 2®i5®84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area p, Standpipes Present (Y/N) Depression over Field (Y/N) �DatA of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorptio Fiel To Water -Supply Wbll o Property Line To Building Foundation To Existing or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Con mnts D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Comments nsions e/Access (Y/N) Off" Level at Vent (Y/N) I�Iring Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAS �i[�s in effect on the date of this inspection. AV Signed Date Z *'49 • p4 rw C`onpany ����� �ovcs�,7 MOA No. % .... . r .....0 4 .... •.. ...;... KB1/d5/s Ralph B. Jok.la R1 CE -1995 47 a � (Page 2' of 21 2-15-84 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: 'il U I C) see h on back I 11-- '' I.D. NO. nn ' 1►1f1r, t I�-o `P_U �UI 1Ct nW-Dt'o nP_I 5 t- `P- yVatpr System Name-, - Phone No. t -7q3 — a(D I 7D City \/�' L Hyl IIIJJJI 11 city State zip code- SAMPLE DATE: I-l-_-�---L Mo. Day Year SAMPLE TYPE: b-�"Routine ❑ Check Sample (for routine sample with lab ref. ❑Treated Water O Special Purposee t ❑ Untreated Water SAMPLE Time Collected NO. LOCATION �- Collected By 2 vet i e-� 3 1 4 5 I READ INSTRUCTIONS BEFORE TO BE COMPLETED BY LABORATORY eatinsis shows this Water SAMPLE to be: sfactory atisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received �r�3-U q Time Received •r fill Analytical Method: ❑ Fermentation Tube Membrane Filter Lab Ref. No. Result' Analyst --�% ® Wil. I FT -1 FT -1 ET -1 I m .No. of colonies/ 100 ml. or No. of Positive portions. 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1983 Membrane Filter: Direct Count Verification: LTB BGB Coilform1100m1 Final Membrane Filter Result C J C ilforml100m1 Reported By �(% A n A� Date COLLECTING SAMPLE TNTC = Too Numerous To Count Time: a.m. J P.M. UU 0BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) 274-2533 Address: 437 E. Street Suite 200 Anchorage, AK 99501 March 28, 1984 PWS I.D. 210508 To Whom It May Concern: The Snow Valley Water System is approved for those standards in effect when reviewed. It is currently approved as a Class "A" system under State of Alaska code and statute. JFH/msm Sincerely, J es F. Hayden Environmental F eld Officer WAIMS -0q, q Z 8m N0U3e10ad 1V1N04NONIAN3 T H11V3H 40 'ld3a RVrd0HDW d0 Al11VdIOINn" PV OF Tye` -� STATE OF ALASKA _ DEPARTMENT OF ENVIRONMENTAL CONSERVATION r- 2 = CONSTRUCTION AND OPERATION CERTIFICATE for PUBLIC WATER SYSTEMS A. APPROVAL TO CONSTRUCT Plans for the construction or or modificationof�__ �N© ril� t� L L �— a /�� - ]K L'3 I ' ` ct►� 1 Srl�' ' �! c A c public water system located in !^1 WC.)nCA Atte SGS Alaska, submitted in accordance with 18 AAC 80.100 ,— Vk r- f en eo to V- 19 approved. R F TE IZ T- H E r Acr ❑ conditionally approved (see attached conditions). been reviewed and are BY TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. B. APPROVED CHANGE ORDERS Change (contract order no. or descriptive reference) Approved by Date / e i✓e � 0 I i T_P0 )A &Cl W C. It 0 LV It CL re t a%% —L c�:) IM LA VIA tl XIC I',- k 'C- W 7 LY -e-- v- o, I C., & T 71 q3 - C.. APPROVAL TO OPERATE PWS -0, oZ I or o e The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. The construction of the 9� a W VA' 11' y �, �� public water system was completed on od c� 6eY I q �z 3 (date). The system is hereby granted interim approval to operate for 90 days following the completion date BY TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to op te. BY - TITLE 15ATE 18.0407 (Rev. 11/83) DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEER/MUNI-BOROUGH (Complete Section C) 4. GOLDENROD - MUNI -BOROUGH (Complete Section A) CONTRACTING ENGINE 212 E. INTEW State of Alaska Dept. of Environmental Conservation 437 E Street Second Floor Anchorage, Alaska 99501 Dear Mr. Erickson: JG AND TIONAL Al GE, ALASH Re S & ASSOC. RVEYING 'ORT ROAD 99502 March 2, 1984 Engineering Report Snow Valley Subdivison Water System We hereby request a waiver of lesser separation distance from the requirements of Table A of 18 AAC 72.021 and specifically distance from well to community sewer line. Some of the conditions which are pertinent to the situation are: The existing well was drilled October 1973 to serve 8 lots in Snow Valley Subd. The existing Municipal Sewer line was constructed in 1978 or later within 140 feet of the well. (See attached map.) The well log (also attached) shows a layer of clay from 45' depth to 92' depth. Clay is an impervious material and as such would provide a barrier to the water bearing strata. In addition, the existing sewer line is of ductile iron pipe which should minimize the chances of breakage. We believe the above stated conditions will justify the lesser separation distance and not cause any significant potential hazard to the ground water supply. --------------------------- Sincerely, --- -- - Sincerely, Ralph B. Jokela P.E. RBJ/mt a� r