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HomeMy WebLinkAboutMCCABE LT 8 Municipality of Anchorage IN On-Site Water and Wastewater Section • (907) 343-7904 Page 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231231 PID Number: 018-231-26 Dwelling: W Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade Name Amy McFarlane ABSORPTION FIELD Trench Q Wide Trench El Bed El Mound Site Address 13201 13201 McCabe Circle ❑ Other Phone (907) 250-1426 Number of Bedrooms Three (3) Soil Rating 0.8 Total depth from original grade 7.0 / 7.0* GPD/sF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.0/4.0 Ft. Gravel depth beneath pipe 3.0 / 3.0 Ft. Subdivision Block Lot McCabe 8 Fill added above original grade 1.0/-0.2 Ft. Gravel length 33.0 / 33.0 Township Range Section Ft. Gravel width 5.0/5.0 © Ft. Beds: Number of Lines n/a Distance between lines n/a Ft. SEPARATION DISTANCES To Septic Tank Absorption Field Lift Station Holding Sewer Total absorption area Number of trenches 2 Dist. between trenches From Tank Line 569 Ft2 >6 Ft. Well >100' >1100' N/A N/A >25 TANK 91 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1,000 Gal. Surface Water > 100' >100' N/A N/A Material Plastic Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation >10, >10' N/A N/A TATION Manufacture Capacity, Remarks *Trenches listed west / east Gal. Insulation placed over tank Alarm location Elec stalled by Installer PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield B. Schiller Drainfield D3034 CO/MTD3034 Inspector A+ Home Services BENCH MARK (Assumed elevation) 100 ft Inspection ection 151 9/28/23 2n 9/29/23 Location and description Back door threshold 3`" 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp ,d of qt ll Conditional Approval: Date : • • :q�Q�O$ flaw�P'��, e*.•49TH . .....1. . '• Septic System % Benjam'n; chiller ¢� ��� • • �`44�® Date Approved Date /6 2� CE 12592 �t Yoh ,ll` PROFESSlON4� Note: this approval do not include well permit requirements. k", v v.nvu v� / / // // // / / (2) 33' LONG x 5' WIDE x 3' EFFECTIVE DEPTH ABSORPTION TRENCHES CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT DV - FLOW DIVERTER VALVE FS - FLOW SPLITTER MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND 2CO PERMIT # OSP231231 PID # 018-231-26 A B 1"=40' 3-BDRM HOME DV 10 ' U T I L I T Y E A S E M E N T McCABE SUBDIVISION, LOT 8 FEET 0 40 80Benjamin Schiller CE 12592 R E GISTEREDPROFES S I O N A L E N G INEER Mc C A B E C I R C L E E A S T 11/13/23 PLAN AS-BUILT SHED SHED LEYDEN ROAD TH#1 CO2 FCO NEW 1,000 GALLON SEPTIC TANK EXISTING TRENCH TO REMAIN IN SERVICE FS CO4 CO3 CO1 MT2 MT4 MT1 MT3 100' WELL RADIUS FROM NEIGHBORING LOT APPROXIMATE MAPPED DRAINAGE (NO LONGER EXISTS PER SITE VISIT) CO6 CO5 MT5 A B FCO 48.3 MH 43.6 SV 42.5 2CO 42.2 DV 42.2 FS 81.9 CO1 87.9 4.7 29.7 34.2 36.2 37.6 73.4 72.3 MT1 85.969.8 CO2 110.179.4 MT2 110.280.3 CO3 92.084.9 MT3 90.983.0 CO4 111.188.0 MT4 112.790.2 CO5 55.945.8 CO6 80.551.1 MT5 54.844.3 BM PROFILE AS-BUILT (NO SCALE) 93.2 88.9 93.8 97.8 FC O MH SV 1000 GAL SEPTIC TANK 95.8 FINISH GRADE 33' DRAINFIELD ROCK MT 1 TH # 1 NO GROUNDWATER 7/12/23 87.8 90.8 CO 1 CO 2 81.8 87.8 90.8 94.8 ORIGINAL GRADE MT 2 2C O 93.0 Benjamin Schiller CE 12592 R E GISTEREDPROFES S I O N A L E N GINEER 11/13/23 PERMIT # OSP231231 PID # 018-231-26 McCABE SUBDIVISION, LOT 8 WEST TRENCH 94.6 FINISH GRADE 33' DRAINFIELD ROCK MT 3 TH # 1 NO GROUNDWATER 7/12/23 87.8 90.8 CO 3 CO 4 81.8 87.8 90.8 94.8 ORIGINAL GRADE MT 4 EAST TRENCH INSULATION v v L EYDEN ROAD ( NOT DE VEL OPED ) N 89 59'55" E280. 00 N 89 59' 55" E 312.24 OF Atq�4p o THESURVEYDATA AND MEASUREMENTSHEREONAREPREPARED FOR THE OWNER OFRECORD AS OF THEDATEOF THIS SURVEY. ANY USEOF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS .49 TH oO WRITTEN PERMISSION IS PRO V/DED. �� V "_� THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOId ANY CONFLICTS BETNEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS 9f'. SHANE A. HOLT .' OO NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES- LS ' EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHONN J -6914 c 4p HEREON ( UNLESS INDICATED) NOTE= FENCELINES THAT MAY APPEAR ON THIS DRAGIING ARE NOT TO BE USED TO DETERMNE r0fessiona��o� PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS - ANY PAVING SHONN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOGI AND/OR ICE. M S O M O O O O AS-BUILTSURVEY 1" =30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT8McCABESUB. (PLAT 79-129) A NCHORA GE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLEIMPROVEMENIS SITUATED THEREON ARE WITHIN THE PROPERTYLINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DA TED ATANCHORAGEA LASKA THIS 4 TH DAYOF OCTOBER , 2023 15626 227-40 234-46 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223.8615 375@GCI.NET MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231231 Effective Date: Work Type: Septic Upgrade Expiration Date: Tax Code Number: 01823126000 Site Legal Address: MCCABE LT 8 G:2936 Site Mailing Address: 13201 Mc Cabe CIR E, Anchorage Owner: MCFARLANE REVOCABLE TRUSTS Lot Size in Sq Ft: Design Engineer: FORGE ENGINEERING Total Bedrooms: This permit is for the construction of: "S Sr: rl llepartment 8/25/2023 8/24/2024 4111E Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: • Prior to construction, the missing standpipe at the end of the existing field is to be located and repaired. iReceived,By: 1:57 U J -Fo _r Date: Issued By: Date: 3 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 018-231-26 Property owner(s) Amy McFarlane Day phone (907) 250-1426 Mailing address 13201 McCabe Circle, Anchorage, AK 99516 Site address 13201 McCabe Circle, Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) McCabe Subdivision, Lot 8 Legal description (Township, Range & Section) Lot Size 41,118 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X Septic Tank 1ZUpgrade ❑X (w/wo AD U) Holding Tank ElRenewal ElDuplex (D) El Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 991- Waiver Fees: Date of Payment: Receipt Number: Permit No. 0�) I-' 271 Permit App__- : - Date of Payment: Receipt Number: Waiver No. August 18, 2023 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: McCabe Subdivision, Lot 8 - 13201 McCabe Circle Septic system design & Tank replacement Dear On-Site Services Engineer: The owner of the above lot has a trench that has failed, so we are submitting this permit application for the construction of a new septic system. The attached site plan identifies the location of the home and well, as well as the proposed septic location. The ground surface on the lot slopes very mildly and is essentially flat, except that there is a short dropoff from the lawn to the undeveloped/uncleared portion of the lot to the east. There are no slopes greater than 25% (with a height of more than 6’) anywhere on the lot. Drainage arrows are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. We performed a perk test on this lot but had to stop after three 30-minute intervals. Although the change in water levels was not within 1/16” for the final two intervals, we ran out of time in the day to continue. The perk rate slowed from 6.0 min/in for the initial measurement to 7.1 min/in and then to 8.0 min/in. We investigated the soils logs from the surrounding lots and found consistent soils with generally better results than this: Knik Heights Block 1 Lot 18 <1 min/in Knik Heights Block 1 Lot 19 3.75 min/in McCabe Lot 1 Rated 85 SF/BR McCabe Lot 6 Rated 85-150 SF/BR McCabe Lot 7 Rated 100 SF/BR We request that the noted perk rate and application rate of 0.8 GPD/SF be accepted for this design. Wells on this and adjacent lots are shown. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The new system will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic tank. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231231, Deb Wockenfuss, 08/25/23 There will be at least 6’ between trenches, and 13’ from the existing trench. Please refer to the attached test hole log, plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE // // // // // (2) 33' LONG x 5' WIDE x 3' EFFECTIVE DEPTH ABSORPTION TRENCHES MAINTAIN 13' SEPARATION FROM EXISTING TRENCH AND CONFIRM 100' FROM ADJACENT WELL CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT DV - FLOW DIVERTER VALVE FS - FLOW SPLITTER MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND 2CO 1"=40' 3-BDRM HOME DV 1 0 ' U T I L I T Y E A S E M E N T McCABE SUBDIVISION, LOT 8 FEET 0 40 80Benjamin Schiller CE 12592REGISTEREDPROFESSIONA L E N GINEER Mc C A B E C I R C L E E A S T 450 7/24/23 SEPTIC PLAN SHED SHED 450 450 450 445 445 440 LEYDEN ROAD TH#1 CO FCO NEW 1,000 GALLON SEPTIC TANK DECOMMISSION EXISTING SEPTIC TANK PER UPC EXISTING TRENCH TO REMAIN IN SERVICE FS CO COCO MT MT MT MT ≥13' 100' WELL RADIUS FROM NEIGHBORING LOT 445 REPAIR OR REPLACE MISSING CLEANOUT APPROXIMATE MAPPED DRAINAGE (NO LONGER EXISTS PER SITE VISIT) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231231, Deb Wockenfuss, 08/25/23 MCCABE SUBDIVISION, LOT 8 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 5' 4' 3' DESIGN FACTORS:SYSTEM REQUIREMENTS: 450 GPD PEAK FLOW PERK RATE: 8 MIN/IN APPLICATION RATE: 0.8 GPD/SF 5' WIDE TRENCH SYSTEM 1,000-GAL SEPTIC TANK BOTTOM OF TRENCH: 7' BELOW GRADE FLOW LINE ELEVATION: 4' BELOW GRADE 450 GPD / 0.8 GPD/SF / 5' WIDE * 0.58 RED FACTOR [ 3' DEEP] = 65.6 LF TRENCH REQUIRED (66 LF SPECIFIED) GEOTEXTILE FABRIC 7/24/23 PROVIDE ADDITIONAL MIN 6" FILL TO ACCOUNT FOR SETTLEMENT Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231231, Deb Wockenfuss, 08/25/23 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 DEPTH (feet) TEST HOLE 1 DATE READING START TIME NET TIME (minutes) DEPTH to WATER NET DROP PERCOLATION RATE: (MIN/INCH) (inches)(inches) DATE OF MONITORING WAS WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING IF YES @ WHAT DEPTH? 8.0 7/5 1 2 3 GM (SILTY SANDY GRAVEL) Professional Engineers Stamp: NO McCABE LOT 8 07/05/2023 018-231-26 Amy McFarlane 3:01 3 0 16 1' OB 30 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER TECHNICIAN: M. Jakubisin 8 0 16 - NONE 7/12/23 COMMENTS: SITE PLAN 5 016 USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED 7/24/23 GM (CLAYISH) 3 0 16 7 4 16 4 4 16 3 0 16 6 12 16 3 12 16 30 30 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231231, Deb Wockenfuss, 08/25/23 e MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION , ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ NO. o .oo,8 Manufacturer ~ ' Materi~ Liq. capacity in gallons Inside length Width Liqu~ ~ , ~{urer M~ Liquid capacity in gallons Well Foundation~o, ~earestl~t~ , DISTANCE TO: Le ~OOo, ch +l'n ,en¢~s Trenc~i~h ' ' "°'°flines& S~ ¢ J~ Total inches Total eff~ption area Top of tile to fin,sh grade~, ~ ~,--' J_ ~ Material beneath tilo~ ~ inches Length Width ~ Depth ~' PERMIT NO." Type of crib CHh diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER /00 ~ ~ ~ 0''~ 72-013 (Rev. 3~78) F EId"l~l NO. I..":,EPRF.:TMENT OF HERL. TFI RND ENV:[R. ONMENTRL PROTECTIOI'.,I 825 '%~'" STREET, FINCHORRGE, RK. 995Oi 264-4720 }.-dl EEL. It .... f=~ ~'dl E::, G) Ih,fl ...... '.S; :E -tF IEE ,:.' 790516 ::, F I" L ]. _. - l'.t] GENE J'Ftl'.,I LOcFcr' ]: ON HCCF:IBE I ....... :~h L LO M ..L .HE, E :~S,-."[:, LO'T' .:, .[ ZE "I"'¢PE OF E;E'[I... RE'=;r"~F.'E:TICff.,I ....... :,'r:,TEl'l I':',. TRENCFt i'"tF:t::.,;]:f'IL.If'I I'.41..II','IE:EF.~ DF BEE:,RCIOM~E; = .7:.,: :,_Il_ RFITING ,::E;Q F F.'E,R..= ' "'=" ' :' ' I :'5: "f'FIE REQU I RED :."'.'; Z ZEE OF THE E:;O Z L HE,_,URF ] f Ul',l 5'¢E;TEFI ::L 00 'T'FIE LENGTH DZMENSION IE; THE LENGTH <ZN FEET) OF THE TRENCH OR DRFll'I'.~FIELD. THE DEPTH OF FI TF:ENCH OR PI'T IS THE [:,tE;]"FINCE E;ETNEEN THE: E;URFFICE OF THE GROUND RND THE BOT]"OH OF THE EY,',CRVRTION ,:.':IN FEET::,. 'THERE IE; NO SET N];E:,TH FOR TRENCHES. THE GF..:R'v'EL PEP'TH IE; THE FIII'.~MLIH DEF'TH OF GRR~,,,'EL BETI.dEEI'.4 "FHE OUTFRLi.. F'IF'E ¢~N[::, THE BOTTOH OF THE EXCRVRT ]:. ON ,::IN FEE"I"). PEF.:HIT FIF:'PL.:EE:FINT HR}; 'T'HE REE;POI'.~E;1E,.f. LII~ T3 ZNFORI"I Tt..IZE; [.EFhF.Ti'IEH[ [:,URZI'.4G THE :I'NC]"FII i FITION Zi'.,I:'::";PECT]:ONS OF' RI",I'¢ NEL. L'_E; F'IE:,J'RCEI",FF TO TH:}5; r~,:.r"~r., 'r FII",ID THE I'.4JHE:F.'R CF RESI[,FTI'.4CE~.-; THFIT THE 14ELL NILL 'Z, EF..:VE. t"Ili'.,t]:MUH DIE;TFll'.,IC:E BE"f'NEEI'.4 R NEL. L RND Rl'.,l'.r' ON-'Z, ZTE E;E:NRGE B, :E :SF:'O:i;;RL :5'¢STEFI 1.00 FEET FOR Fl F""'RIVF1TE I.'.tELL.; OR ::LE~Z TO 200 i:':'EET FROM R F'UBL?,; ':: HELL [:,EF'EI",IDING UPON 7'HE T'.r'F'E OF F'JE:t 'I;E: NE::L.L. I,-IELL LOG:E; RRE F.'.EQLIZRED RND i"ILI?E;T E"~E RIE"['URNED "f'O THE DEPFIRTI'qEI",IT NITHIN 30 OF' THE NELL COHPLETIO[',I. OTHER REL::¢.JZREFtENT:~; MR"r' RPPL"r'. ~,PECIFZCFtTION$ FIND CONSTRUCT;ION L'."ZRGRFIMS FIVRZLRBL. E 1"0 .~I",ISLIRE PROF'ER tl",!%TRLLRTION. I CERTIF~¢ THFFT ::L: I RFI FRFIILIFtR I.,.II"FI--I THE RE6!UIREMENTS FOR ON..-.$ITE SEHER2':; FIND NELLS FIE; F'ORTH 8'¢ THE I"IUNICIF'RLIT"r' OF RNE.':HORFIGE. 2: I 14:[L.L. INSTRLL. THE S'¢L'--.,TEi¥{ It'4 RCCORDRNCE NITH THE COB'ES;. :ii:: :[ UNE:'EF~2:.;]"FtND THRT THE ON-E;ZTE .SEI.4ER r:-:,"r'STE"i"I MR'¢ REL.'::!UIF.:E ENLFiF. fCiEFIENT IF THE RESIDENCE IS REHODELEE:' TO INC:LUDE I"IORE THFI!'4 ..7..': BEDROOMS. ]: '.:.';:SIJE[:, B"r'. ................... ::... ............. [)15] E -.._ .......................... J ',,'? MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2224 SOILS LOG - PERCOLATION TEST ,~ SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: 1 2 3 4 5- 7 8 9 10 11 12 13 14 15 16 17, 18- 19- 20- WASGROUND WATER ENCOUNTERED? 72-008 (7/76) SLOPE SITE PLAN IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) SIX INCH WATEr WELL DRILLED AND CASED OUT TO THE DePTh DrILLeD at THE Rate' OF ~1.9.00 PEr FOOT. : ProPErtY OWNER ~L~, LOCATION OF.WELL SITE · $9---135~ ~ aha 135--197' Co,~4 o~ 34,t.2X~,: $3914. O0 ~, lOed, L $¢oj,: $21.00 ALL LabOr AND MATERIAL FOR COMPLETION OF SAID DRILLING. CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ~3935o O0 DATE THANK YOU VERY MUCH. bErNLe CLAUS OF RAMPART DRILLING WORKS ~.:'.~ oc.~. 77~Lh, 7979 SERVICE CHARGEOF IYa% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. , · DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TflV1E DATE DATE - · DATE INSPECTOR INSPECTOR ~ INSPECTOR A MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT, OF H2ALTH &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTII[~t~I~'IRONMENTAL 825 L Street - Anchorage, Alaska 99501 /~) ENVIRONMENTALTelephoneSANITATION264.4720 DIVISION ~'0 ~. 1980 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND $ DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing. PROPERTY RESIDENT (If different from above) PHONE 2. BUYER MAI LING ADDRE88 3, LENDING INSTITUTION I PHONE I MAILING ADDRESS 4. REALTOR/AGENT I PHONE I MAILING ADDRESS STREET LOCATION 6. TYPE OF RESIDENCE ~'~SI NG LE FAMILY [] MULTIPLE FAMILY N~MgER ~E~SEDROOMS [] One [] Four [] Two [] Five ~ Three [] Six [] Other 7. WATER SUPPLY [~'~INDIVI DUAL~ [] COMMUNITY [] PUBLIC UTILITY ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM [~ INDIVI DUAL/ON-SITE*~ [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 [Rev. 6/79) ~J~ ~-O GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, Location (address or directions) .. 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 264-472O Application Date ~_~ towns--'~Fp, range) (b) . Applicant Name ~//~/;* z~&)d. Telephone: Home .~¢5"- .~5/~/? Business "Applicant Address /,¢Z¢,.):~ /L/~.//,,,~.-- ~,.,~,. Z.-7~'~. 1¢~.,,/~,~,, ,,,~./. (c) Applicant is (check one): Le~ding Institution []; Owner/builder']~¢; Buyer []; Other [] (explain); (d) Lending Institution /V/It Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ii~ Multi-Family [] Number of Bedrooms -~ Other WATER SUPPLY Individual Well~' Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite/~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDI['INSPECTIONS, TESTS, FILE SEARCH, D, ~, AND INFORMATION As cedified 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 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 Municipal and State codes, ordinances, and regulations in effect on the date of this inspection./7~C,'~'~---~ ~. _~/~ Name of Firm ~ Telephone Address /~ ~ ~]-- ~ ~/~ ~ ~/~, ~ ~J Date ~ ~ ~ /~t~' /~ Approved for '/~_! (~'~_2bedrooms by Approved ~/~ Disapproved Conditional Terms of Conditional Approval 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 engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MO~) HEAL-THAUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ,~7" ~' DEPT. OF HEALTH &' ENVIRONMENTAL 'PROTECTION R ,:CEIVED Well Log Pre. sent&N) Total Depth ~..o~ / Cased to Static Water'Level (..~) Casing Height Above Ground Electrical Wiring m ConduitS/N) Separahon Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by /~' Water Sample Test Results If A. B. C, D.E.C. Approved (Y/N) "~//~ Date Com~pleted ./0-17-79 Yield ,~O(,, Depth of Grouting Pump Set At / ~' Sanitary Seal on Casing(~) Depression Around Wellhead (Y~ / / ~/~.O ; On Adjoining Lots --,/~,~¢-2 · ; On Adjoining Lots /~" To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date 5~/4- Comments(~ Z,~ /rc~r~J 7-~7" & B. SEPTIC/HOLDING TANK DATA Date Installed Stand pipes Y~N) Depresmon over Tank (Y.~ Pumping/Maintenance Contract on File IY/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding. Tank: To Water-Su pply Well To Property Line .~0 / ~" To Water Main/Service Line Course .?~o Size /~-'~0 c~ No. of Compartments Air-tight Caps,)N) Foundation Cleanoul~N) Date Last Pumped ~"-/~'-°~' ,'¢./~ :for /t,?~ Temporary Holding Tank Permit (Y/N) To Building Foundation ~'~/ To Disposal Field /(3 To Stream, Pond, Lake, or Major Drainage Comments Page'tcef 2 ~:~¢'- 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~-~-?? Width of Field Square Feet of Absorption Area Depression over Field (YN~ Results of Last Adequacy Test Type of System Design "7 Length of Field yX---" '-~ Depth of Field // Gravel Bed Thickness ~' '~' Standpipes Present{~) Date of Last Adequacy Test Separation Distance from Absorption Field: /, To water-Supply Well /~FO To Property Line To Building Foundation ~'~ / To Existing or Abandoned System on Lot /-,J/~4- ; On Adjoining Lots ~"o / ,./'- To Water Main/Service Line /O/,.f- To Cutbank (if present) '/-,~,/,~ To Stream/Pond/Lake/or Major Drainage Course /~:~ / ~ To Driveway. Parking Area. or Vehicle Storage Area Comments LIFT STATION ~ D~'~_ / /~//~ Dimensions Size in Gallons ~ Manhole/Access (Y/N) "pump On" Level at ~ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) . TE~ fair- ~Y--~-N~ ~ during Adequacy Test. Meets MOA e 'c Codes( / ) ~ Comments ~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hav~e)he,,c~ed,~'~erified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '~----'-'~'/)'~//"~- Date ~ -,Z-3 ',~ Company /~"~ MOA NO. ~-~ Receipt No. ~ O~ I ~ Date of Payment ~ ~-~ Amount: $ ~,~ ~:~'<::~ Page 2 of 2 72-026 (11/84) JOB ALASKA ENVIRONMENTAL CONTROL SERVIC~, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO CHECKED BY OF , DATE ' i \