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Home My WebLink AboutMCMAHON BLK 1 LT 19McMahon lock I Lot 19 017-041 -33 Permit Number: OSP101122 Tax Code Number: 01704133000 Work Type: Septic Permit Effective Dates: July 23, 2010 On-Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade to July23, 2011 Design Engineer: ANDERSON CONSTRUCTION & ENG'G Subdivision: MCMAHON Site LegalAddress: MCMAHON BLK 1 LT 19 G:2835 Owner/Address: ONORATO R E LIVING TRUST 50% & CLOVER JOAN M LIVING TRUST 50% ONORATO R 3961 MCMAHON AVE ANCHORAGE AK 995162823 Site Mailing Address: 3961 MC MAHON AVE, Anchorage Lot Size in Sq Ft: 32450 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: _ Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www.muni.org/onsite (907) 343-7904 Parcel I.D. ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Property owner(s) Mailing address Site address Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Lot Size '~ :~ ~'%;--D Sq. Ft. Day phone Zip Code Zip Code Number of Bedrooms ~ ~ oo~ THIS APPLICATION IS FOR ([~ all that apply): Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage THIS APPLICATION IS AN: Initial [] Upgrade Renewal [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number: Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 July 15, 2010 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: McMahon S/D Blk 1, Lot 19 To Whom it may concern: This is a request for a new 4 bedroom replacement septic system. The current 1250 gallon tank is failing and needs to be replaced. Two new test holes were excavated along the west property line because the owner would like to upgrade to a 4 bedrooms system. Both test holes consisted of 20 feet of poorly graded loose silty sand. No water was observed after the 7 day monitoring period and the perc rates were 2 minutes per inch. The existing system could not be located even with the asbuilt drawing, The vegetation (or lack of) seems to show it being as shown on the site plan. The lot has a gentle slope of about 4 to 6 percent which runs around the west shed then heads to the north at the lower slope. The new primary trench is not parallel to the slope as required by code but due to the existing layout and lot lines, my proposed layout works best given the conditions. The south end of the trench will be deeper then the north end but we have the elevation from the test hole depth (-20 feet) and the soils are consist throughout the area. None of the neighboring lots will be impacted by this new installation, due to the large lot size and good soils. If you have any question please call me at 727-8864. Michael ~/.~derson, P.E. ~-MOUND OVER DESIGN CRITERIA: (TH~I) (TH~2) ~. f -,,~'~//-(~RADE 4 BDRM X 150 -- 600 GPD ORe ORe SOILS -- 600/1.2 -- 500 GPD -1.o m -1.o R FABRIC 500 GA/12 -- 42' 2o ~ ~4"e PIPE ~-SEWER ROCK (1) TRENCH sP sP 8.0' DEEP 6.0' EFFECTIVE -s.o 42' LONG -20.0_ -20.0 SEPTIC FIELD SECTION - H)JFFMAN ROAD-X~ ~ ~ I / / \ \ I / I ~ LOT 7 LOT 8 I ~ b0T 9 ~ LOT 10 I · ~ I I I \ \/ / \ / \ \ / :~. // / I \ \ / ~ / / \ I · I t ,, /'~"'"~'-,, \~ /! / \ / LOT 17 LOT..~IS....~.,...,z LOT 19 EXISTING WELL / / / PRoPOSE~ ~N,E~--~ .~'O~.~~ ~- EX~STI,~ WE,, ~ ,, ,',~ ~~. 7~.-- ..... .z/. lOO' ,~,us. 'n,p ;I ', / \ ~1 II I ./ ! -- \ / \ / \ / Septic Design Prepared for RICK ONORATO ~_~.W....~. ............. .~ McMAHON SUBDIVISION, BLOCK 1, LOT 19 -'Ancnorage, Alaska ANCHORAG£, ALASKA gg515 10' EASEMENT /// ~ SECONDARY TRENCH ~..__-", ..'--"PROPER'IY UNE--~ .,.--'-I~--"~---,. NG~ · ~ / [ SYSTEM, APPROX ) ~,,. ,,, EXlSTINO SEPTIC CLEN~. OUTS-- ... ii ~ !! IL~ I ~ --~ WILL BE CRUSHED .~--/-"-~," / --"~//~ ~A.D REMOVED ~ II / \ V .~k' ........ ~ '/ / / :.:- -..? t/ / '. "::: '. : . GRADE ASSUMED 1.~00' // /fl.2" INSULATION LAST 10~ TYP:'..- -. ~ ~ '":.~. · .. ' \ // SEWE WE ,,8~.0 BOTTOM OF TEST HOLE ..-- 42' .- N.T.~ - M cXxM A H 0 N AVE N U E - Septic Design Prepared for McMAHON SUBDIVISION, BLOCK 1, kO'l' 1~ ~' ~.-" Anchorage. Alaska Michoel N. Anderson, P.E. DAT~: 7/23/20~0 [~'-.. ~o.~E~ ..":~g 4661 NATRONA AVE. DRAWN: DJR ANCHORAGE, ALASKA 99516 ~45-~ / eAX: 545-1~91 SCA'e: ~":~0' Performed For: Legal Description: 5- 6- 7- 8- 9- 20- COMMENTS Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.ci.anchora,qe.ak.us (907) 343-7904 Soils Log - Percolation Test Slope OF A~ ?~ ~ ~,,~..' A, .'~ ~, , ,-,... '.? ~ ~ ~ICHAEI N. ANDERSON ~ ~ ' ~". CE- 9469 ."~ 1~... ...'~' Date Pedormed: ~~ Township, Range, Se~ion: Site Plan WAS GROUNDWATER ENGOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? P Date: Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETVVEEN '~.'~" FT AND ~'t(/,~;''' FT PERFORMED BY: /MT! ~'~.C-,~ C i[~0,4 I CERTIFY THAT THIS TEST )A/AS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: Performed For: Legal Description: 2- 3- 4- 5- 7- 8- 9- 10- 12- 13- 15- 16- 17- 18- 19- 20- COMMENTS Municipality of Anchorage Development Se~lces Depa~ment Building Safety Division On-Site Water and Wastewater Program El 4700 more Road P.O. Box 196650 Anchorage, AK 99507 ~.ci.anchora~e.ak.us (90z) 343-z904 Soils Log-Percolation Test ~ ~/ ~( ~ Township, Range, ?.__.~ Slope Site Plan WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? L O Depth to Water After ,! p Monitoring? 7~ J~ ~ E Date: Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN /1~ FT AND '~ FT PERFORMED BY: /~ A C~, I CERTIFY THAT THIS TEST/~VAS// PERFORMED IN ACCORDANCE WITH ALL STATE AND MONICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: y [,~7,/~¢:) "~' 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 E~'JW~E NAME PHONE MAILING ADDRESS LEGAL DESCRIPTION LOCATION . ~ /~ f NO. OF BEDROOMS 2 ~ DISTANCE TO: ~1 ,,~ /~ Absorption are~ Dwelling~ PERMIT NO. ~ ~ Manufacturer Material.~ / No. of compartments Liq. capacity in gallons Inside length Width Liquid depth /2~O IF HOME--DE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in gallons Nearest lot line ~ PERMIT NO. ~ DISTANCE TO: We]l~F /~, Foundation ~Fll~' ~ No. oflines ~ ~ ' ~¢ , w~ inche~ Distancebetweenlines~/~, _ Length of each line. Total length of lines . Trench ~ ~ ~ Top of tile to finish grade t / Material beneath tile Total effective absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class¢-~ r i~i Depth Driller Distance to lot line PERMIT NO. ~ I Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER ~ ~'~ ~'~, ~ PIPE MATERIALS SOIL TEST RATING /~b ~7 ~m , " I NSTAELER , ~. ~ rJ ~ ~ R EMAR KS ~ =( / ~ 4~ APPROV ED 1// DATE LEGAL 72-0t¢3 , t-tLir-,i l' C: T . ~",11 DEPRRTMENT O, HERLTH RND ENVIRONMENTRL F~-,C, TECTION .-.~._, "L" STREET, HNCHURRUE, RI<. D_g501 . 2~4-4,.-" 20 ' L,JELIt F'ERMIT NO. ( 808228 ) HPPLIF:~NT GLENN GOLqDMQN i24~ FRIENDLY '~2 99504 A ~ ~7~8-0712~ LOCWFION LEGRL LOT ~9 BLOCI< % MC MQHON S?D .. LOT SIZE z2000 SQURRE FEET TYPE OF SOIL MB_,ORFTIuN SYSTEM IS: TRENCH MRXIMUM NUMBER OF BEDROOMS = 3 SOIL RRTING (SQ FT/BR>= THE REQUIRED SIZE OF THE SOIL RBSORPTIOF~YSTEM IS: [:,EPTH= 7 O -l-1 LEi%I~.]TH= 58 C-i R Fi'..-' E L DEPTH=-..- --'-" THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF B TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCBVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFHLL PIPE RND THE BOTTOM OF THE EXCRVHTION (IN FEET). F-:EQIJ I F-'E[:, SEPT I ~----- TRNF-: S I ZE= :L£i00 6RLLOr4S PERMIT RPPLICFINT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTQLL8TION INSPECTIONS OF I~NY WELLS 8DJ8CENT TO THIS PROPERTY 8ND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. THE, (2) I ~4$PECTIO~4---¢ ARE REm2LIIRED BBCKFILLING OF ANY SYSTEM WITHOUT FINRL INSPECTION AND RPPROVRL BY THIS DEPRRTMENT WILL 8E SUBJECT TO PROSECUTION. MINIMUM DISTBNCE BETWEEN 8 WELL BND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS t00 FEET FOR B PRIVBTE WELL OR 150 TO 200 FEET FROM ~ PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTQNCE:FROM ~ PRIVQTE WELL TO 8 PRIVBTE SEWER LINE IS 25 FEET 8ND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED 8ND MUST BE RETURNED TO THE DEPORTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY 8PPLY. SPECIFICRTIONS 8ND CONSTRUCTION DI~GRQMS 8RE RMBILRBLE TO INSURE PROPER INST8LLQTION. PEEl-1 I T E::-', P I RES DFCErIBER --~:~-.. :1.~80 I CERTIFY THRT t: IRM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPRLITY OF 8NCHORQGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. }: I. UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT I~ THE RE_,IDEN~E IS REMODELED TO INCLUDE MORE THQN 3 BEDROOMS. · ~ SIGNED: ...... 8PPLICRNT GLENN GOODMRN ' ISSUED BY ...... DflTE~-~Z-~-- .... V4. 0 .~, -~ 825 "L STREET, ANCHORAGE, AK. ' 264-4?20 i-.-IELL . Al-iD 01'-.I z ~ ITE SEPal--iR F'~ERMIT NO. ( ) LOCAT I ON f-lLIf'-~ I ']- I F"'RL I T'-r' OF RI'-~C:HE~Ri:~GE DEPARTMENT F'-%HERLTH AND ENVIRONMENTAL '-'-"'_]TECTION TYPE OF SOIL RBSORBTION SYSTEM IS: MAXIMUM NUMBER OF BEDROOMS PEAr,1 I l' LOT SIZE ~-4-~--~-QLIARE FEET SOIL RATING (SQ FT?BR)= /OO THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [)EPT: .'= /[ LENGTH= ~--0 GRAVEL r_:,EPTH= ---I° THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF 8 TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE BND THE BOTTOM OF THE EXCAVATION (IN FEET). REI21J I RED SEF'T I C 'FR~4~{ S I ZE= /O 0 ~ ~3RLLI]~S PERMIT APPLICANT HGS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TWC~ ( 2 ) I i'-,ISPECT I ~]f4S I-'IRE REQLI I RE[:.-' BACKFILLING OF ANY SYSTEM WITHOLIT FINAL INSPECTION AN[> APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN ~ WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR B PRIVATE WELB OR 150 TO 200 FEET FROM R PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN gO DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MR9 APPLY. SPECIFICATIONS RND CONSTRUCTION DIAGRAMS ARE AVGILABLE TO INSURE PROPER INSTALLATION. PERI~I I T E:~:P I RES DECEMBER Z-'-l.. 1~q 80 I CERTIFY THAT 1: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. ONSTRUCTION TEST LAB "One Test is worth a Thousand Opinions" 2204 Cleveland Anchorage, Alaska 99503 277-0231 erfomned for RCJ ENTERPRISES egal Description: Lot 19 'Block 1 his Forth reports: SOILS TEST VISUAL - yes Date Performed Subdivision McMahon PERCOLATION TEST 6/23/80 Depth Feet soil Characteristics BROWN CLAY SILTY GRAVELLY SAND 8 SANDY GRAVEL [0~ SILTY SAND BOTTOM OF HOLE as Ground Water Encountered NO 'f YES, What depth? ! eading Date Gross TJ~e Net TLme Depth to H20 Net Drainage ercolation Rate Minute Proposed Installation: SEEPAGE PIT DRAIN FIELD XXXX Depth of Inlet Depth to Bottom of Pit or Trench O~4ENTS: - -R&ting for GW-GP zone from 8-11 feet: 100 sq. ft./bedroOm. By: James R. ~stad, L_6/ 3/80 7 P.E. est Performed by LB Data Certified Date C.ONSTR JCTION TEST LAB :~RFORMED FOR, GLENN GOODMAN £GAL DESCRIPTION: Lot 19 Block 'HIS FORM REPORTS: x~Visuol Soils Examination 1800 iN. 48TH AVE. STE. 'C' ANCHORAGE, ALASKA 99505 248-1333 DATE PERFORMED: 7/14/80 Subdivision McMahon Percolation Test ~EPTH SOIL EET DESCRIPTION -14' 4" TOP SOIL 2.5t Tan silty gravelly sand, \ dry f Clean grey fine dry sand - SP-150 SF/BR BOTTOM OF HOLE AS GROJJNO WATER ENCOUNTERED NO YES, WHAT DEPTH 5GEND -- Parc zone S - Sample taken -- Frozen zone -- Water table NOTES GENERAL SITE SLOPE £ADING DATE GROSS TIME NET TIME DEPTH TO H20 NET DRAINAGE ~RCOLATIO~ ~OPOSED }MMENT~ :ST PERFI DRAINAGE REQUIREMENTS'._ 2.5' - 14~ - ].50 SF/BR PIT X~3'[DRAIN FIELD [3 OTHER DATA CERTIFIED BY: James R._g~n~sta. d .. ]P. E. DATE: 7/14/80 :;CON. STRL 'CTION TEST LAB ' PERFORMED FOR: LEGAL DESCRIPTION: THIS FORM REPORTS: GLENN GOODMAN Lot 19 Block' xMVisual Soils Examination 1800 ~48TH AVE. STE. 'C' ANCHORAGE, ALASKA 99503 248-13~53 DATE PERFORMED: Subdivision McMahon O Percolation Test 7/14/8o DEPTH SOIL FEET DESCRIPTION NOTES 4" TOP SOIL 2,~5' Tan silty gravelly sand, \ dry / Clean grey fine dry sand - SP-150 SF/BR 14' BOTTOM OF HOLE WAS GRO, UND WATER ENCOUNTERED NO IF YES,' WHAT DEPTH LEGEND ® -- Perc zone ®S- Sample token · -- Frozen zone GENERAL SITE SLOPE ·- Water table :{EADING DATE GROSS TIME NET TIME DEPTH TO H2_O NET DRAINAGE DRAINAGE REQUIREMENTS: 2,.5' - 14~ - X]~I~iDRAIN FIELD 0 OTHER 15o S~/BR DATA CERTIFIED BY:James R. Ringstad; P.E. DATE: 7/14/80 WATER WELL LOG /~UNICIPALtTY OF ANCHORAGE DEPT. OF HZALTH & I~h~VIRONMENTAL F~,OTECTION FOSS DRILLING ..SSOC.~ATED AUG 7 1980 909 CHUGACH DR. #37 ANCHORAGE, ALASKA 99503 RECi:IV[D WELL OWNER Glenn Goodman USE OF WELL Domestic WELL LOCATION Lot 19~ Block 1 McMahon Subdivision SIZE OF CASING 6" STATIC WATER LEVEL REMARKS DEPTH OF HOLE 203 183 FT. G. P. M. FT. CASED TO 203 FT. 8 WITH 18 FT. OF DRAWDOWN. DATE COMPLETED 8/6/80 PUMP TO BE SET AT 202' 0 to 35 Alluvium: grey color, medium hardness 35 to95 Till: grey color and hard 95 to 100 Alluvium: brown and soft 100 to115 Alluvium: grey color, medium hardness 115 to135 135 to 201 Till: grey and hard Alluvium: grey and medium hardness 201 to 203 to to to to to to to to to to to to Sand and Gravel: grey~ with water MUNICIPALITY OF ANCHORAGE Department of Health & Hu!~an Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # /_-)/' 7-- ~-)/-//-- .~'._~' HAA # ~1 ?h(~ - (~'%~'-i ~ \ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 19; Block l; McMahon Location (address or directions) 3961 McMahon (b) Property owner ~ubbard James Mailing Address 3961 McMahon (c) Lending Institution Telephone: (home) Business Telephone Mailing AddreSs (d) Real Estate Company and Agent Kru~vne & Wendt / Marie Harris Address 3gAA P~nal~ .qP~-~t S~l~t~ 250 Anchorage, Alaska Telephone 279-1561 (e) Mail the HAA to the following address: (or check here E~if hold for pick up.) List contact person and day phone number below: $ & S ENGINEERING 17034 Eagle Ri,~er Loop Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3 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 E~ 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. (Rev. 7/88) Page I of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by mysealaffixed hereto and as of the validation date shown below, l 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 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 ['egulations in effect on the date of this inspection. Name of Firm Telephone ~ .4~.~' ,-~.~ ~ Address Date S & S ENGINEERING Eagla River~ Alaska 99577 6. DHHS APPROVAL Approved for -~ bedrooms by_ Approved __~--~ Disapproved Terms of Conditional Approval Conditional Date 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 k~J~q~C~P ~~l. _ ¢ ~<x/Ic~S O~V~O~ ~¢,:N~ICIPALITY OF ANCHORAGE (MOA) (,~,~ .... ~ H~Authority Approval (HAA) ~/~][3~ ~ iC~'~KLIST- FEBRUARY 1984 ~ 343-4744 ' Legal Description: A. WELL DATA Well Classification /~/'~/(./~/.~ If A, B, C, D.E;C. Approved (Y/N) ./ Well Log Present ~ ~ Date Completed ~-~ -~d2 Yield ~' 27/g'~ Total Depth~0 ~ Cased to ~z:::2.~ DePth of Grouting ~ ¢'~ Static Water Level //~3 Casing Height Above Ground //~' / / Electrical Wiring in Conduit(~N) y SEPARATION DISTANCES FROM WELL: To Septic/,~,Idlng -Tank on Lot //4:~O Pump Set At ' 20~, Sanitary Seal on CasinON) y Depression Around Wellhead (Y~) ,4_2 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /~J'7/3 To Nearest Public Sewer cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ~. ,~ _~-~. ~! ¢~;t¢::;~tf'-~ : Date Water Sample Test Results ~¢:>~, ~...~/ Comments To Water-Supply Well //¢:~/..O To Propert.y Line ' /~2 ~-~- To Water Main/Service Line ~ ~ To Stream, Pond, Lake or Major Drainage Course SEPTIC/~ TANK DATA Date Installed ~/~0 Size //~-O No. of Compartments Stand pipes((Y)N) y Air-tight Caps') Depression over Tank (Y/(~/ Pump rig/Ma ntenance Contact on File (Y~N) Holding Tank High-Water Alarm (Y/N) /~ / ~ SEPARATION DISTANCES FROM SEPTIC/~ TANK: To Building Foundation Foundation Cleanout (~ ~ Date Last pumped /0 - ~/~ ~"~ ~/ /'~" ;for '--"- Temporary Holding Tank Permit (Y/N)/~J'//~ To Disposal Field Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata _,/"~ Date Installed ~-~/ ~ ~ ~¢2 Width of Field Type of System Design Length of Field Depth of Field ,..,~vel Bed Thickness Square Feet of Absortion//~Area L~-,~C'~/k.] Statndpipes Present(~N) ,/ Depression over Field (Yk./ Date of Last Adequacy Test Results of Last Adequacy Test ;_~',/g 'q',/..r',~,,,,-¢--~ ?,-,.~,~ ~, -~/"- ',..~ ~/r~ ,.f' / / SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well f¢2o r/_ To Property Line To Building Foundation Z. g2 ~"~ To Existing or Abandoned System on Lot /~' ~ *"~ ; On Adjoining Lots ,.~'-':~ To Water Main/Service Line ~.¢"-D t.W~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~ /,¢¢. ~7 //L]J' I~-_,~-0 To Cutback (if present) /~r¢ ,,..~ ~' D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions yanhole/Access (Y/N) "Pump Off" Level at // /~ Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ,,-,-'~'~'~'~ oF A~ Signed Company Date MOA No. 5 &-$ 17034 EaRle River Loop Road No, 204 Eagle River, Alaska 99577 /o ./z. ? Receipt No. Date of Payment Amount: $ 72-028 (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 BT SA}~LE fo~ Work O~der ~ 9990 Date Repozt P~inted: OCT 25 88 @ 09:45 Client Sample ID:L19, Bi ),JCMAHON PWSID :UA Collected OCT 21 88 ~ 16:05 h~s. Received OCT 21 88 ~ 16:30 h~s. Pzese~ved with :4 DEG. C Client Name : S R S ENGINEERING Client Acct: SNSENGP P.O.~ NONE REC'D Req ~ 0zdered By : Analysis Completed :OCT 24 88 Send Repo[ts to: Laboratory Super~i§oz,:STEPNEN C>_EDE 1)S & S ENGINEERING Releasea Ey: ~ ~.~ Special Instruct: Chemlab Ref ~: 3143 Lab Smpl ID: 1 Matrix: WATER Allowable Parametez Tested Result/Unite Method Limits NITRATE-N 1.1 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE Remanks: 3AMPLE COLLECTED BY R3S. i Tests Pez£o~med * See Special Instructions Above UA:Unavailable ND: None Detected "See Sample ~ema~ks Above NA= Not Analyzed nT=ness Than, GT=Gzeatez Than ,. INSPECTION APPOINTMENTS ~J D~,TE RECEIVED ~IME'~ TIME ~ ~¢ /-'"' TIME \,,.,, / INSPECTOR I NSPECTO INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF Iq;:ALT[I & O 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ?;,O'[ECTION' ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW&FF~J~I-~It~IL;F-6D DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. 1, PROPERTY OWNER PHONE MAILING ~,DDR ESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE ~ MAILING ADDRESS MAIl-'lNG ADDRESS ~ ' . 4. RE.~LTOR/AGE~.~ ~)~'~[¥l~l~)f--~vf~ _ . PHONE 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four ~ SINGLE FAMILY [] Two [] Five I [] MULTIPLE FAMILY ~ Three [] Six 7. WATER SUPPLY [] Other '~ INDIVIDUAL* * ATTACH WELL LOG. Awell log is required for all wells drilled [] COMMUNITY since June i975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM '~]- INDIVIDUAL/ON-SITE** I~x~) YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY 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 NUMBER OF BEDROOMS ,.- [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER~- 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line B, COMMENTS [Z~.~APPROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~.~ DATE BY 72-010 (Rev. 6/79)