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HomeMy WebLinkAboutMCMAHON BLK 1 LT 18 Municipality of Anchorage Pac. 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: o~ [ ~:~¢:~"f~ RID Number: ~ ~ ~ o~ ~ ~ ~ff~ ~~ / ~, ~ ABSORPTION FIELD No. of Bedrooms: ~eepTrench ~ Shallow Trench ~ Bed ~ Mound ~ Other Phone: ~ ~ ~ Lo~~ ~ BIock:~ ~ ~Subdiv[si°n:~~ Depth to pipe bottom from origina~de: Ft. Gravel depth beneath pipe ~ Ft. Township: Range: ~ Section: Fill added above original grede: Gravel length: WELL: D New ~ Upgrade Graveldepth: ~ Ft. ~ C~O~(~A,B,C):_ Total Depth: Ft. Cased To: Ft, Total absorption area:~ ~ SQ. Ft, ~Pipe material:~ Driller:~~ j~ Date Drilled: Static Water Level:Ft. ~lns~r~ ~, Date~Stalle~:~_ GPM Ft. Ft. SEPARATION DISTANCES ~septic ~ Holding ~ S.T.E,P. ~ ~ Capacity in gallo s: From Tank Field Station Tank Sewer Lines , Well ~ ~ ~ ~ ~ ~: Ma~~ Number of Compartments: Surface LIFT STATION Lot ~ Size in gallon~ Foundation ~l ~ ~ ~ ~ ~ "Pump on" level ~,: "Pump off" level at~ Cu~ainDrain ~ ~ ~ ~ ~ ~ ~ Pump~aks&Model Electdcal,nspectionspe~ormedby: Remarks: B~NCH MARK Location and Description:  Assumed Elevation:~ ENGINEER'S SEAL Inspections performed by: 170~ Eagle R~er L~P Read Ne'~S: lst~-tS~l Eagle River, Alaska~5~ 2nd A-t~-~I // ~~ Department of Hea~and Human Services approval .¢~,; ,., .%., Ho. ]4,7.E Reviewed and approved by: Date:¢ -2~- ~/ ~ ~ ...... ' 72-013 (1/91) MOA25 Permit No. ~/,::~'~ Page ~- of. 2-- Municipality of Anchorage 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 LegalDescription: [~'==q' k~5. ~. / ["/~C-['-'l/~,!~L-z:~r~ ~ ~ PIDNo.: I 72-013 A (2/91) MOA 25 PERFORMED FOR: LEGAL DESCRIPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: Township, Range, Section: SLOPE SITE PLAN 1 8 9 10 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT O 12 DEPTH? p E Dopth Io Water After 13 - Monitoring? Date: Reading Date Gross Net Depth to Net Time Time Water Drop 14- 15 16 17 19 2O PERCOLATION RATE '~ ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN T AND __ FT :, . · COMMENTS J / ' PERFORMED D~D]c ~:.,.~.-, Al~n 99~77 ~// /~ -~ ~- CERTIFY THAT~HIS T~T WAS PERFORMED IN ACOORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI~CT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ~ ~ / / ' 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 WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910058 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:WARNER JAY L & OWNER ADDRESS:3931 MCMAHON AVE ANCHORAGE, ALASKA 99516 DATE ISSUED: 4/16/91 EXPIRATION DATE: 4/16/92 PARCEL ID:01704134 LEGAL DESCRIPTION: MCMAHON BLK 1 LT 18 LOT SIZE: 32450 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE: L/_ /5 --9/ April 10, 1991 ROBERTSHAFER, P.E. ROGERSHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER LNSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 18; Block I; M~Mahon Subdivision; PER~IT REQUEST NARRATIVE: Request you issue a permit to upgrade the septic system serving the referenced property. The existing system which was constructed approximately 1968 is now in a state of failure with very lithe absorption capacity. The proposed upgrade consists of a 1250 gallon system tank with a deep t~ench absorption area. The property slopes gently to the north. Due to the large lot sizes in the area the we~ and septic densities are low. We can see no advise affects on the development of n~ighborin~ properties due to the installation of the proposed upgrade. If you require add~onal information for your review, please contact 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE PERFORMED FOR: LEGAL DESCRIPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 5 6 7 8 9 10 11 12 13 14 15- 16- 17 18 19 2O DATE PERFOI Township, Range, Section: SITE PLAN SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Deplh to Water AltQr . Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEE~ FTAND 2 FT COMMENTS / / PERFORMED BY: i 7034 :a~J,~ Riv~;' L~op J~oad N~, ~ /~ CERTIFY THAT TN~g TEST WAS Eaqle River, Alaska 9~7~ . //j j -- .~ f ~ PERFORMED IN ACCORDANCEWITH ~LL STATE AND MUNICIPAL GUIOELINES~F~CT ON THIS DATE, DATE: :/'J /~/ 72-008 (Rev--4/~ 5) / 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 Parcel I.D. Cf CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) '~5/ J~c/~/~- /Z~¢_! ~)~ Property owner Mailing address Lending agency Mailing address Agent I~ ~- ¢k ¢~ Ad dress ~'"~-~ CF'q~ Day phone '3?'5 / Day phone Day phone NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Unless otherwise requested, HAA will be held for pickup. NOTE: Public water If community well system, provide written confirmation from State AD£C attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer 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 disposat 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. Address 150.'~ ~'/"_.~ rJ ~v~- ~ EngineeFs signature ~~~=~ Date DHHS SIGNATURE (~  Approved for // Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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. 72K)25 (Rev. 1/91 ) Back MOA ¢Y21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /--I~)/', ~// //~(~//,//~/~c-~ ~'/~ Parcel I.D. A. Well Data Log present (Y/N) Total depth Sanitary seal (Y/N) Y If A, B, or C, attach ADEC letter. ADEC water system number Date completed (.,)~khzr~Jn.. Driller Cased to ~n~-~c,~n. Casing height // Wires properly protected (Y/N) 7 FROM WELL LOG AT INSPECTION - - /gl ' g.p.m, g.p.m. Date of test Static water level Well flow Pump level1 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 Date of sample: Nitrate Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~'///~ ¢/¢/! Tank size 12~-O ~',~ I. Cleanouts (Y/N) Y Foundation cleanout (Y/N) High water alarm (Y/N) Compartments Depression (Y/N) Alarm tested (Y/N)/~/Z~ Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Sudace water/drainage On adjacent lots Absorption field Foundation ~./' Water main/service line /~/o-~_. 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed //~ Size in gallons ~' Vent(Y/N) ~ High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) -- "Pump off" Level at .Cycles tested -- SEPARATION DISTANCE FROM LiFT STATION TO: Well on lot J On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed Length (~ / Total absorption area Date of adequacy test Width Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) O, ~) .System type ~)~P '7'-/~E, VC'// Gravelthickness ~ / Totaldepth /O / Cleanout present (Y/N) Y Depression over field (Y/N) ,AJ Results (pass/fail) PA~ S for /-~ Bedrooms ,~// ~/ Aftertest ~ ~/ ~"~ll~' 4~J~ If yes, give date '~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /',~ To building foundation On adjacent lots ./-- Surface water Curtain drain On adjacent lots "]'//~0/ Properly line '~z ~) / To existing or abandoned system on lot Cutbank /~/o~n~ Water main/service line Driveway, parking/vehicle storage area 11o/ E, ENGINEER'S CERTIFICATION Signature Engineer's Name Date "~/ I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ t..~O¢ Date of Payment Receipt Number Waiver Fee $ ~//~' "'~C'~ Date of Payment ¢ 7 C ~'9'-?/y-~ Receipt Number 07/11/94 12:50 CTgE ENUIRONMENTPL LAB SERVICES -~ 90?2582419 NO. 518 Q02 LABORATORY ANALYSIS REPORT Client N/~mo POLAR CoNsULT WORK. Order 79995 Printed Date 07106194 ~ 18:29 hrs. O~red By ~ Coll~t~t~ 06130194 ~ 16:30 ~. Proj~ct~ ~cav~te ~GOI~4 ~ 16:40 ~s. Nitrat~N 4.4 rng/L EPA 353.2t~00.0 10 07/01t~4 cMA * ~ 81~ ee, ial Ing~tlona Above '' See Sampl~ P,~:ma~ks Above U; Und~tg~efl, Reportedvalueis thepia~ticoi qual/tificaion limlt. D = ,$~cond~ dil~ion, UA ~ Unavaiigble NA ~ l~t Analysed 5633 B Street, Anchorage, AK 99518-t600 ~ Tel: (907} ~62-2343 Fax: (907) 561.5301 ENVItRONMi~NYAL I=ACIt. ITIE$ IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, uTAH, WEST VIRGINIA 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1, GENERAL INFORMATION Complete legal description Lot ~ Block I; Mc Mahon Subdivision; Location (site address or directions) 3931 Mc Mahon Property owner Mailing address Lending agency Mailing address Warner Day phone 345-3229 3931McMahon, Anchorage, Alaska Day phone Agen~ill Minus e CENTRY 21/PACIFIC NORTH Day phone Address 1120 Huffman Road, Anchorage, Alaska 99515 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 ~ 345-1444 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. 4. 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 s~uewwoo leUOpJppv :suo!jelndp, s 8U!MOIIOJ eq~ q~!M 'suuooJpeq 'sLuooJpeq ~oj leAo~dde feuo!~!puoo 'peAo~ddes!G ~o~ peAo~ddv ~ ~I:In.L~fNDI$ SHHCI '9 ,g Municipality of Anchorage ~i~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Parcel I.D. ~::~ t. ~ "~¢~3//~-~, If A, B, or C, attach ADEC letter. Date completed OW' ~.'"- \':A,{::::~,'~ Driller Cased to ~''c:~[ ~ Casing height Wires properly protected (~N) V Well type Log present (Y~i~ t-~ Total depth I<~~:~t ~ Sanitary seal (E~Jq) Y FROM WELL LOG g.p.m. ADEC water system number ©F--- ; On adjacent lots Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: t Septic/h~ank on lot I Absorption field on lot Public sewer main Public sewer service line AT INSPECTION ~ ~ g.p.rr~ PO ~; ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ ~/'~ ~) Nitrate Date of sample: ~,'- ! / --~ Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~- Cleanouts~/N) High water alarm (Y/N) . Date of pumping Tank size /'~' ~''"L~ Compartments Fo ;n~on clean out ~,'~/N)y Depression (Y/~ Alarm tested (Y/N) ------ To property line_ Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I ~'~ On adjacent lots ~, C::<~ I ''~ Foundation I Absorption field "~-~c::> Water main/service line 72-0~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE Size in gallons Vent (Y/N) "Pump on" level~ High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump, off" level at Cycles tes---~-~ Surface water D. ABSORPTION FIELD DATA Date installed ,¢~._ \ o~ ,.- ~ ~ Length (~:~'~'~* Width Total absorption area "q ~---~' Depression over field (Y(~. Results (pass/fail)/N/~-~/' Peroxide treatment (past 12 months) (Y/~C~j~'. Soil rating Gravel thickness ¢::~, ~ /Pr' System type '-~~{~ Total depth Cleanouts present.N) Date of adequacy test ~ ~ for ~ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \ '2~! On adjacent lots \ ~ IR- Property line To building foundation ~'¢~ ( To existing or abandoned system on lot On adjacent lots '~c>l J¢ Cutbank /k/'t~/'~ Water main/service line Surface water / f-~ [''~- 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 inspection. Signature Engineer's Name ./ Date of Payment - ~ ./ _~'%,~ Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 8 STREET ANCHORAGE. ALASKA 99518 TELEPHONE (907) 562-2343 Date Repo~t Printed: APB 22 9[ ~ 11:$6 PAX: (907) 561-5301 Client Sample ID=LIS gl MCMA~ON S/D · Collected IPR Analy. le Completed :APR 12 91 Released ~y : PRELIMlttAR¥ Client Name Client Acct ~PO t ;R. SNARER Send Reports to: PO I NONE EEC~IVED Chemlab R~i t: 91140t Lab Smpl ID: I Matrix: ~A~R Allo~able Pazametez ?eeted Result Unl%e Method Limits Soaple RO~IN~ SANPLE COLL~C~ED BI: RAI. ~emark,: Tests Performed ' See Special Instructions Above ~A.Un~vallable None Detected "See Sample Remarks Above