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HomeMy WebLinkAboutMCMAHON BLK 1 LT 12 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Nares DISTANCES /.--/',4J~ (~L ,/45"~,~'/~ ~ SEPTIC ABSORPTION WELL Addre~ ~/ he ~ ¢~ TANK FIELB I TANKS ~ SEPTIC ~ HOLmN~ TYPE OF SYSTE~ - ~TR~NC. ~ aE~ ~ W,~A~N ~ OTHER o.gin~ g~d~ ~ ~ ~ FT T *, ~ Gravel length ~ Gravel width ~ ~ T°tal abs°rpti°n area ~ ~ i 8~FT -- FI Installer Date installed 4' WELLS & ~ ~ ~PRIVATE ~ OTHER(Identifv) · ~'~f~ ~ Installer Date Installed: ,~ ~ REMARKS: ~l ~e~ ~~' ~= Inspections PeHormeO by~ I ~~ ~~ ~e~il~ that Ihi~ ins~e~ian wa~ ~e~orm~ ae~nrdinfl to all Municipal and Stale guidelines in effect on this da~: /~ "~ 72-013 (3/85) 995 i6 l}ay I;,:'hor'l(,~: l:::'ar' c::e ]. I d: () L(::~ L Leg a ]. ~ Sub d :i. v i Sect :i. on: ;;~8 Tc, wnsh:Lp ~ :!.?.N Range; 3W Lot.~Size 3[:Z45C~ Max Bc~)d r. ooms: 'ih :i. s Per. mi t [ :L "['o'L a ]. Cap ac i t.y ',', 4 !ii~iEF:'i.i[; TP, F.!K: M:i.n:i. mum Lo't.a]. ~ep'!:.:Lc ~'..,:'_.',.r'~l.:: c:apac:.:.'Ly~ :i.,,1Z50 cal].on?5~ Eac:h sep'l.:i.c: i,: ~:. , .~ .... have aL least 2. c:ompa~tr~en'Ls. D~FrLh 'Lo t. op <::),~ septic L~znl<(s) .C 4,,0 ~:., .... p (.? qL,'. ;i. r' eS :i. nsu 1 at. i (::in oV,:.):.H~ 'Lan k (:~!i) ,, I NS"i'AI...!.. PER' ENGINEIii~RS ATTACHIED DESI GI',t. NOT II::'Y DHHS PF,'.IOR TO lEACH 1NSi:~ILZC:T'i:CiN. 'THIS I::'EFi:MI'f' EXF:'I!::i:I~:S 12/::S:l./Siii!, A NEW I::;'IERM!]' W):LL. BE NEEDED iF' SYST'I:ZM IS NIH' INST'AI...I....ED ON (::)IR BIi!.'".F'ORI~.:: THAT DA]"E TH]:S SYSTEM IS F:'OFi: 11'"IE: EX IS 1'lNG 4 BEDFi:C)CtM S ZNGL. E F'AMZt:L..Y DNELI...:!:NG i CEF~'i" I I:::Y TFh'.Yr' [ i,, '.[ am i'am:i.].:i, ar w:i.t.h 'Lb,?: reqL~iPemen'L~.s for or'r...sit~e sewers arid wel].s as set ior'th by the Municipal:i.'Ly of Anchorage (flO~) and t.l"~e St. at.~ of Alaska,, 2, :i: will :i. ns'Lall 'l:.he syst. em :i.n accordance with all MOA c:odes ar'id Pegulat:[or/s, ar'id in {::ompliarice:~ with the des:i, gn cr':i.'L~mia of t..hi~ permit, .:,,, I wi. lL adl"'~{ere 'Lc) ali M[)A and Sta'Le of Alaska r'equ:i.r'ement~ for t. he se'L bac!< disi.ances ~ rom .ar'iy exi.~t.J.n~ well., wa~tewater' d:i.~l:~OSa], sy~'t, em or" -put:ii. it: sewepage sys'Leta on 'l:..l"lis or'. ar'ly ad.iac:ent cH" nearby ].c,t, 4,, i unch.:-,rs'Land 'i..lla-I:. 'Lhis !]er'mi'L is raj. id for. a max:i, mum of 1 l:)edr'ooms,, al. sci Lu'"mier-~tarid t.J']~t'l:, 't.,hi~ capac;i, ty of the tc)ta], i~iys'lL(alfl :i,~, .[[ J::iG:~di'~l::lCims ar'id - .. .... '" / :::l I. ~.I~ i [.:,:'L:I ~ ; , ~ ~:)~ I ....... :'::' ~'~ Bvx DATE ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite ANCHORAGE, ALASKA 99503 (907) 561-5040 CHECKED BY. DATE SCALE ......... .ii!i_ .............. ............ ........... ........ ............. ........ ...... ..... ....... .......... .......... ............. ........... ; .............. ; ............ ~ ........... ~ ~ .............. ~ .......... ~'' '"'[-i ............. ? .............. ; .............. ; .............. ; .............. ; ............. ~ ............ !' .............. ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO.. ~ OF CHECKED BY DATE 7, ?o,,,,¥o l-,o,, 0 O. o. o 0 ~L C. REID, CE - 2251 V. Rondo:', NO. z05.14 LOT SURVEY CERTIFICATION' I tlEREBy CERTIFY TIIAT I IIAVE SUtIVEYF[') TIlE PROPERTY SIIOWN ANC) OESCRIBE~) HEREON AND TIIAT THE IMPROVEMENTS SITUATED TIIEREON AHE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXIST Prepared by: GERALD V. RANDALL. JR. Rvq. Land Surveyor 2820 C STRE~T..SU~TE 3 Phone: 279.7414 ANCt4ORAGE. ALASKA 09503 IT IS TIlE CONTRACrOR'S RESPONSIBiLiTY TOCIIECK TOPOF FOUNDAIlON IN Itl:LA· TION TO FINISlt GRADE AND BUILDING SET BACKS IN RELATION TO LOT LINES ANo EASEmEnTS. . LEGEND · * 518 REIIA.q HECC.,.,FFiEO o 5/8 REBAR SET ri 2'~,2" HLJft & fAC,: O EXISTING .¢1 E%'A[iOtiS DATLJM ASSuME~ SCALE: PERFORMED FOR: ~"~(~ ~ LEGAL DESCRIPTION: ,~'~ :~,~NGINEER'S SEAL) DEPARTMENT OF HEALTH & HUMAN SERVICE~ 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST~ ~ ~,.~ Township, Range, Section: 4 5 6 7 8 9 10- 11 12 13 14 15 16 17 18 19- 20- SLOPE I IIIII I IIIII WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E SITE PLAN Depth to Water After ~,_.~ Atonitoring? ' ~Y Date: Reading Date Gross Net Depth to Net Time Time Water Drop '~OMMENTS 5OIL ~'-'~b PERFORMED BY: ~f"~'~ ~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/8§) PERCOLATION RATE ~/, ~"~' (minutes/inch) PERC HOLE DIAMETER TESTR.N.ETWEEN ?,~' PTA~D ~' PT , ALASKA EnUIROnmEnTAL CONTROL S RUIC S, In(:. SPECIFICATIONS FOR A TRENCH-TYPE WASTEWATER DISPOSAL SYSTEM LEGAL DESCRIPTION: LOT 12, BLOCK 1, McMAHON SUBDIVISION 1.0 GENERAL 1.1 The drawings, sheets 1 'through~, shall be a part of -this specification. 1.2 All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Health & Human Services (DHHS), the conditions of the permit, and all applicable rules and regulations currently in effect. 1.3 Ail elevations and depths are advisory, and are to be verified or modified in the field by the engineer or inspecting agency. 1.4 It is the responsibility of the owner or installer to adhere to approved designs for installation, maintain tile specified separation distances, and have the appropriate inspections. 1.5 If the installation is not inspected by an AECS engineer, AECS will not be responsible for the installed system. An engineer at AECS should be consulted prior to construction to determine the number of inspections that will be required and to explain what these inspections will involve. 2.0 SEPTIC TANK 2.1 If there is an existing septic tank, it may be used if it meets the capacity requirement for the residence and tile approval of the MOA. 2.2 The septic tank shall be a UPC-Approved two-compartment tank, constructed of 12-gauge steel with bitumastic coating and set level on undisturbed soil. If the tank is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 inch burial type polystyrene rigid board insulation. 2.3 The septic tank and trench shall be a minimum of 100 feet from any private well or body of water, 150 feet from Class C wells, and 200 feet from Class A or B wells, unless otherwise specified. Less than the required separation distance must have prior approval or waiver by ADEC or MOA. 2.4 The septic tank shall be a minimum of 5 feet from the hoase foundation, and a minimum of 5 feet from the absorption area. 2~5 Piping shall be fitted with a mechanical watertight calder coupling on tile outlet and inlet of the septic tank. Piping shall be 4-inch solid PVC ASTM D3034 or cast iron, sloped a minimum of 1/4 inch per lineal foot. If the piping is buried at a depth of 4 feet or less, it must be insulated wi'th an overlying layer of 2 inch burial type 1412 W6gt 33[~) &V~DU~ · &[lChO[~aq¢, &[&$ka 99503 · (907) 279-5553 3.0 polystyrene rigid board insulation. 2.6 Cleanouts shall be installed as designated and capped with air-tight rain caps (Jim caps or equivalent), and extended a mlnimmn of 1 foot above ground level. 2.7 If a lift station is required it shall be a combination lift station septic tank per Anchorage Tank and Welding, Inc. design. Specifications are attached. ABSORPTION AREA 3.1 The gravel for the trench shall be 0.5 to 2.5 inch, screened rock with less than 84 passing #200 sieve residual. All substitutes must have prior DHHS approval. 3.2 The bottom and sides of the excavation shall be raked with the backhoe blade to insure that it has not been compacted during excavation. The bottom elevation shall be level. 3.8 Monitor standpipe(s) shall be placed as shown in the drawings, and shall be 4 inch rigid PVC ASTM D$034, or cast iron. The section shown with holes may be 0.5 inch holes drilled on 6-inch centers on opposing sides of the pipe, or a regular section of perforated sewer pipe clamped to a solid section with either a no hub coupling or a solvent joint. A rubber rain cap (Jim cap or equivalent) shall be installed over the top of the pipe. 3.4 The distribution pipe shall be perforated 4 inch rigid PVC with a minimum crush strength of 1500 lbs and shall meet the approval of DHHS for use as drainfield pipe. All distribution pipes shall be laid level. 8.5 Trenches may be paralleled, but must have a minimum separation distance between the trenches of 10 feet or 2 times the gravel depth (whichever is greater). 75 feet is the maximum allowed linear length of any trench. 8.6 If the final grade over the 'trench is less than 4 feet above gravel, insulation is required, using burial type polystyrene rigid board insulation. There shall be 1 inch of insulation for every foot of soil less than the required 4 feet of cover, but there must be at least 24 inches of soil cover even though insulation is used. The solid pipe extending from the septic tank to the drainfield shall also have 4 feet of cover or an equivalent layer of insulation to prevent freezing of the line. 3.7 If insulation is not necessary, the gravel shall be covered with a layer of nonwoven 6eotextile fabric (such as Mirafai, Fibretex 200 grade, Poly Filter X or equivalent). 4.0 INSPECTIONS 4.1 A minimum of two inspections are required for the installation of the trench. The first inspection will be of tile open excavation to assure that -the system is installed in the proper soil strata, correct depth and meet minimum specified design parameters. 4,2 The second inspection will be after placement of -the gravel, monitor standpipe and distribution pipe to verify proper installation and position prior to backfill. 4.3 The inspection of the septic tank installation can be incorporated with any one of the above listed inspections. 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 NAME PHONE - [] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION NO. OF BEDROO~.~ ~.~:~Z Manufacturer . A~ ~ Liq.)ap~t~lons iF HOMEMADE: Inside length~ Width~ Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ Well Foundation Nearest lot line PERMIT NO ~ZZ ~ No. of lineso ~,~ L~ngth of ea~i~ To~l len~h o~i~ Trench wi~ho inches Distance between lines ~ ~ ~ Top of tile to finish grade Material beneath tile ~ fective absorption area Length Width Depth PERMIT , m~-~ ~ Ty~ ~ Crib tire abso tie ~ ~in~oundation ~ Nearest lot line ~ /DISTANCE TO: Well , ~ ~~ Depth Driller Distance ,o lot line PERMIT "O.~o O~ ~ ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 'REMARKS O 72-013 er. 3/78) 3 4- §- 6- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 ~76-:Z221' SOILS LOG - PERCOLATION TEST SLOPE ' 9 ISOILS LOG [] PERCOLATION TEST DATE PERFORMED: .... SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop 14 15 16 17 18 19 2O PERCOLATION RATE (minutes/inch) 72-00~ (7/76} PERIII T 1'.8. RF'F'L I CRNT L OF':FIT 1 ON LEGRL MEF.:LE BEETER E. uN:,TF, UL.T I L12 E:i MCMRHON L12 E:t I'ICMh]HOI'.,I :,F.H i~4EI LOT SIZE ""-"~' r.':: '-, · ....--..4..I :,6. UHF..E FEET TYF'E IqF SOIL RBSCIRPTION '-'"- ', - :,'r:,TEH IS: TRENCH ~ · : s MFIXIMUM NUI{,E[ OF BEDE. U_M_, = 2: ':;F~IL RATING (SQ FT¢.BR)= 275 THE REQUIRED _,I~.E OF THE :,UIL RBz, LF. FTI_N SYSTEM IS: [:.~EF" TI4 = ~2 L E~4[3TFI= ~S2 F®,_~ r~. n .- .... eL-- [:"EPTH = c. THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRRINFIELD. ]"FIE DEPTH OF R TRENCFI OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF TFIE EXCR',/RTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRR',/EL DEPTH IS THE MINIMUM DEPTH OF GRRYEL BETWEEN THE OUTFRLL PIPE FIND THE BOTTOM OF THE EXCRYRTION (IN FEET). ~."Eg!L~ I E:E[:. SEPT ][ C: TF~lq]-::' S T ZE= :l. OE'---3 ,"~RLLC, h~S PERMIT RF'F'LtCRNT HRS THE REc. FON=,_BILIT~r TO INFORM THIS DEPRRTMENT DUF..INL~ THE '-- ' ' -- 'II , ~ I INSTALLATION IN_,PECTIUN= OF ANY WELLS AD~TBCENT TO THIS PR_PERTz 8ND THE N_IMBEF.' I)F RESI[:,ENCES THRT THE WELL WILL SER'¢E. T[4C~ ( 2 ) I tqSF'EC:T I C~hh-'-; RRE REg.~L~ I BRCKFILLING OF RNY 3r.-TEH WITHOUT FINRL INSPECTION RND RPF'F.:OYRL BY THIS [:,EF'RRTMEN]" WILL BE SLIB..TECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS · 00 FEET FOR R PRIVRTE WELL OR &50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITFIIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY RPF'LY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. F"E F::I--1 'r 'T E::-=:F' I F."ES [:.EC:E~'tBEF-: 2::1_. t%=,-.'5:,--2-, I CERTIFY THRT ±: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND klELLS RS SET FORTH BY THE MUNICIPRLIT9 OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE HITH THE CODES. ]:: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS. L Ca_~) F I ON Y4. 0 [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 216-2224 SOILS LOG -- PERCOLATION TEST PERCOLATION TEST SLOPE SITE PLAN PERFORMED FOR: 1 2 3 ~----~ 4 5 7 8 9- 'Iii ' 10- 11 12 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED7 IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop / f¢/~/~ ~-',f~ ~ /'7" o PERCOLATION RATE ~--0 : ~ 7(m~-i n u t~l~es/inc h ) / ?80 72-008 (7/76) SIX INCH WATER U/ELL DRILLED AND CASED CBT TO THE DEPTH OF .... ~..~~ .... ~ DRILLED AT THE: RATE OF -~4~0;' PEr FOOT. PrOPErTY OWNER ___~;~i i,~c.~.:_ _~.~¢..~ LOCATION OF WELL SITE~_~ ~~ ~~ ~ DRILLER _ ..; ..... ~ r: ~,~~~:.i~;J~ ~ WELL LOG: COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING 'WORKS FOR THE SUM OF THANK YOU VErY MUCH. BERNIE CLAUS OF RAMPART DRILLING SERVICE CHARGEOF ~% PER MONTH WILLCBE ASSESSED ON DEPARTMENT OF HEAl-TH &'-HUMAN SERVICES Division of Environmental Services ..... - ,.. · ~'.On-Site Ser~ cessection .-;.~.L~,~- ,., P.O; Box 196650'.' Anc~(~rage~Alaska'' 995i9-6650 · .,,: -:/?ii,~r. · . ?.: .::~ _:3'~744.;~;':,'-: !:':,-~,..-~',': '-,.,. :' ' ,' .'. '- " .- . : ' · ~..'~._.".~! .. -.-' . ;~' ! ' , .' : - ::" - .'- APPROVAE FOR A SINGLE FAM LY DWELL NG ' ' ~- ,: _:.'.:~..,.',- . . - -. ,. . '.;:. :; ~:.': ':?:;;. :.._.:1; .-.GENERAL INFORMATION . '. :;- :: ~,'{,;~.:~:~.~.';p~. · : ' '" ,- ~ompmm ~eg p - Location (site address o r·directions 3 6 51 '~M~Mahon · Aoenu¢ i~:.-: .. Property owner -ii~'i,'i:'~:i;:f [' Mailing address -i!~i~i ?? ': ::'.'i' '." :':'Le~ding agenCy ':.':?.i:':-!:: ': ? 'Mailid~ address "'" Address Mike Cook Day phone · '" ': '"~ Day phone (h) 345-7740:.. (w). 564~4809.- .,~ hone Individual well Unless otherwise requested, HAA Will be-~e~d for pickup. NUMBER OF BEDROOMS: .4- v/'~ .... - ::?'~ !}¢~ :'/"'. :~"'~ NOTE: '. If community Well. system;! ~rOWde .'written '~° n~irmati°n from State ADEC attest-. ing to t'he legality and status"bf!s~y~tem.~' :-:.,. !": '-~. ' 4. TYPE OF WASTEWATER DISPOSAL: : Holding tank ..... ~- '-:- '.'. ' ' ~i:!i:':i?i:i'(:' '-i'NOTE: If community.waste~vater System~'p'rofdde Written~cOnfirmation from State ADEC .:- .:5:?ii~i~'i:- ' attesting"tO'the legalitY'.and Stairs':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 verifl/that investigation of this Health Authority Approval 'application. shows that the on-site water supply an~/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 c n 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 corn pliance with all Munic!pa and State codes, ordinances, and regulations in effect on the' date of this inspection, Name of Firm $ A _~ ~_NG!NEE~!__u~_. · /'/'~ 17034 Eagle River L~ ~d N~ 2~// Address Eag~ ~;vu,, A~.~.~ t '/~ Engineers signature .// ~ DHHS SIGNATURE ~ Approved for / Disapprove. d. Conditional approval for bedrooms. Phone C'~'~'' Date bedrooms, with the following stipulations: Additional Comments Note: The Well, for this property meets exis'tin9 State and Municipal Codes. There are nitrates present. It is suggested ~hat a 'periodic t'eSting..be performed to insure ,the' .wells continj~d suitabil~. Ni~rate.~concentration is 9.72 mg/1; EP, A mn~r'~m~m/~ ~+ ~ ~4~ l'n' ~' ~/'i ' ' ......... one .... r ~id~ ............ ..-- By: / ~ The Municipality of Anchorage Department 0fHealth 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.. 72K)25 (Rev. 1/gl) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT I Z /~C~' I f~¢/l/~/fi-~ ~'//.) Parcel I.D. A, Well Data Wall type Log present(~N) Y/~ Total depth Sanitary seal,N) Date of test Static water level Well flow Pump level1 If A. B. or C. attach ADEC letter. ADEC water system number /"-Jf~/~ Date completed ~//~/~20 Driller Cased to F/--1b ~ Casing height Wires properly protected~l) ~-~'~ FROM WELL LOG g.p.m. AT INSPECTION ~uNIcIpALI'IY OF ANCHOI~t: ~.t~ViRoHMENTAL SE?,V[CES DIVISION :~,,, 0 8 1994 g.p.m. RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/he~Jtank on lot //_')(~) ~ Absorption field on lot / O ~- f Public sewer main ?~' ( Jr- Sewer service line ~' /"~ ; On adjacent lots / O0 ; On adjacent lots /O 0 Public sewer manhole/cleanout /~) O/7~ Petroleum tank //.J~.~.J/,, WATER SAMPLE RESULTS: ~ Coliform O/'/00/~D~- Nitrate Date of sample: Z/(0 / ~ ~. r~ ~. /'///~////~_ Other bacteria Collected by: ~"~---c~' E/'-'/~/'/,-,~f~-//~-/'M~ B. SEPTIC/HOL-GIN6-TANK DATA Date installed ~/[g / ~ Cleanouts~) Ye High water alarm (Y~) Date of pumping I Tank size /~-..~ ~'~'Ji/-- Compartments Foundation cleanou~/~l) c~'~-_.? Depression ('~(~'") Alarm tested (Y/N) /c///~ SEPARATION DISTANCES FROM SEPTIC~ANK TO: Well(s) on lot /(,~') (,~L- On adjacent lots ./~.,~-~ (7~'~ To property line /O ff'- Absorption field Sudace wateddrainage /(")CoG/-- CONTINUED ON BACK PAGE Foundation '~- !/ Water main/service line C. LIFT STATION J~O p~ (~"~'~ Size in gallons Vent(Y/N) "Pump on" level at 2s 2'~ump off" Level at High water alarm level ~1 t Meets MOA electrical codes (Y/N) SEPARATION DIS~ FROM LI~ STATION TO: ~~ On adjacent lots Sudace water D. ABSORPTION FIELD DATA ~(G/~/ Date installed ~/,[/~ I/Z/~/~ Soil rating (GPD/F¢) ~?~/Z¢3 ~ system type Length ~/~,~' Width ~'/~< Gravelthickness ~ /~ Totaldepth ~/~ Z ~ present'N) ~ Total absorption area/~Z~/ ¢ ~ Cleanout ~ Depression over field (Y~ ~ Z/ ~ ' '~ ~ ' ~ /~ Bedrooms Date of adequacy test / ~ / ~ ~ Resul~s~/fail) __ r~ _ _ __for Water level in absorption field before test ~W ~ u After test ~/¢ Peroxide treatment (past 12 months) (WN) ~G ~¢~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot //© To buildingfoundation On adjacent lots Surface water // Curtain drain On adjacent lots ~/c_~ c~ ¢ ~¢- Property line To existing or abandoned system on lot Cutbank /t. Jo¢.-¢~/~¢-~ (~jE'/,~'7'-Water main/service line Driveway, parking/vehicle storage area /(-~ E. ENGINEER'S CERTIFICATION Engineer's Name~ 7034 Eagle~ead Eagle River, Alaska/g~577 / ........ ~ ' Date H~ Fee $ ~OO o~ Waiver Fee $ Date of Payment '~'~'¢ Receipt Number Date of Payment Receipt Number 72-026 (3/93)* Back CT&E Ref.~ Commercial Testing & Engineering Co. Environmental Laboratory Services REPORT of ANALYSIS 5633 B Street : 94.0664-3 Anchorage, AK 99518-1600 Client Sample ID :L12 Bi MCMANON S/D Matrix :WATER Client Name :S & S ENGINEERING Ordered By :R. SHAFER Project Name : Project~ : PWSID :UA Tel: (907) 562-2343 Fax: (907) 561-5301 WORK Order :75779 Printed Date :02/15/94 @ 10:48 hrs. Collected Date :02/10/94 @ 17:20 hrs. Received Date :02/11/94 @ 11:45 hrs. Technical Released By Sample Remarks: ROUTINE SAMPLE COLLECTED BY: S.S. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-.-N 9.72 mg/L EPA 353.2/300.0 l0 02/14 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 Member of the SOS Group (Soci~t(~ G~n~rale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner /-'/~/~. Mailing Address (c) Lending Institution Telephone: (home) Telephone Business Mailing Address (d) Real Estate Company and Agent Address (e) Telephone Mail the HAA to the following address: (or check here~,if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE ,/' Single-Family~)!~' Number of bedrooms 3. WATER SUPPLY Individual Well~, Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site~i!~, 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. 72-02S (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORIV~ATION As certified by my seal affixed hereto and as of the validation date shown below, I ve~'ify that my inw;stigation 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 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 ,,~"~' Telephone Address /¢/Z~- /~ ..~'~ ,/~"~/ 6. DHHS APPROVAL Approved for /7/ Approved ~ bedrooms by Disapproved Terms of Conditional Approval Conditional Date 'f-'¥l i L'I ~ The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated 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. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ZdT A. WELL DATA Well Classification Well Log Presenting'N) Total Depth ~'~/" Cased to Static Water Level Date Completed Depth of Grouting Pump Set At x.)/~' Sanitary Seal on Casing(~N) DepressiOn Around Wellhead (Y~) If A, B, C, D.EiC. Approved (Y/N) Yield (~ ..i~.~- ~)¥¥ Casing Height Above Ground Electrical Wiring in ConduitCN) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ; On Adjoining LOts ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ! To Nearest Sewer Service Line on Lot Water Sample Collected by ~4~--¢$ /C- Water Sample Test Results /~/~-- 7~ ~ Comments ~ ~/~'-¢/z.- '' ;Date //-¢'~"~ / B. SEPTIC/HOLDING TANK DATA Date Installed ~'-/~-'oc'~ Size Standpipes~) Depression over Tank (Y~) /~?''~''O'/ No. of Compartments Air-tight Caps~)N) Pumping/Maintenance Contact on File (Y/N) Holding Tank'~l'i~h;~Nater Alarm (Y/N) SEPARA'T ON D'ISTAI~6,ES FROM SEPTIC/HOLDING TANK: To,Water-Supply~Welh- . ,~ ~ /~ ~ To Building Foundation To ProPerty Line ' t./'O ~ To Disposal Field TO'W~ter.Mmn/Service Lithe ~ /~ To Strea.~n, Pbn'd, Lake;CrC ~a;jor Drainage Course Comments.,~:,... -, ,'., ~,,:. Foundation Cleanout~N) Date Last Pumped /..,//,/~ ;for .x.,)/~"- Temporary Holding Tank Permit (Y/N) .iJ/,~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y~) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: Type of System Design Length of Field ! Depth of Field Gravel Bed Thickness ~, t Statndpipes Present(~N) Date of Last Adequacy Test To Water-Supply Well To Building Foundation Lot ,~'/~ To Water Main/Service Line ! To Property Line /~d To Existing or Abandoned System on To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ; On Adjoining Lots /~'/'~ To Cutback (if present) Comments D. LIFT STATION Size in Gallons ~ ~ )//~- Manhole/Access (Y/N) "Pump On" Level at -._._ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) ~ Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, vej'ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date /,Z. -,2-¢- ~"~' MOA No. Receipt NO. 6,.),~ ~¢¢,/~/./,~2/,/~ Z/' Date of Payment ,//'?//~, ;/~///~ Amount: $ /.7¢¢) ~'~ '-- 12-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order $ 10376 Date Report Printed: NOV lO 88 @ 17:08 Client Sample ID:L12, B1, MCNAHON O/G TAP PWSID :UA Collected NOV 9 88 @ 11:55 hxs. Received NOV 9 $8 @ 15:00 h~s. Preserved with :4 DEG. C Client Name : AECS Client Acct: AKECSRP P,O.$ NONE REC'D Req ~ Analysis Completed :NOV 9 88 Send Reports to: Laboratozy Superyi/or, :STEPHEN C. EDE / 1)AECS Released By : ~ ~-'- ~ 2) Special Instruct: Chemlab Re£ $: 3393 Lab Smpl ID: 3 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 3.2 mE/1 EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: 1 Tests Performed ' See Special Instructions Above UA=Unavailable ND= None Detected "See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than '~ i D~.TE RECEIVED INSPFCTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR 0 \ \ DI=P[. C)F H:~ALIH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL P~OTECTION  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99§01 Telephone 264-4720 RE_C, E!~.ED REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIREDTIONS: Complete all parts on page ~. Incomplete requests will not be pro~essed. Please allow ten (10) days ~or processing. 1. PROPERTY OWNER PHONE MAi LiNG ADDRESS~.//- PROPERTY RESIDENT (If different from above) PHONE PHONE 2. BUYER ~D~ ~ ~t S~~ -- 3. '~ENDINGINSTITUTION ~ * ] PHONE MAILING ADDRESS 4, REALTOR/AGENT PHONE MAI LING ADDRESS 5. LEGAL DESCRIPTION Low N'[ -//- i STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One ~ Four [] Other~ ~_SINGLE [] Two [] Five FAMILY [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well log is required for all wells drilled ' since June 1975. For wells drilled prior to that date, give well depth (attach log 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) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2, WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3, SEWAGE DISPOSAL SYSTEM E~]INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified E~]Septic Tank or [] Holding Tank Size: [ ~....~-z~ If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCE8 WELL TO: Absorption Area to nearest Lot Line NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] OTHER [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED NSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line 5. COMMENTS [][~'/'APPROVED FOR ' ~/--~ BEDROOMS [~]~"CON DITION'AL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE I BY ,~ 72-010 (Rev. 6/79)