HomeMy WebLinkAboutMCMAHON #1 BLK 3 LT 25 Municipality of Anchorage Page J of 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: -~'~¢--/ ~ Lb~'7(~¢~ PIDNumbor: Ol'~-- 3(.¢[-- Name: ,Z~ [-~ ~ e- Wastewater System: [] New [] Upgrade Address: '~, O ,, '~ oy,. t O t c~ ,P-O ABSORPTION FIELD Phone: JNo. of Be~!.~ooms: [] Deep Trench [] Shallow Trench [] Bed [] Mound [] Other LEGAL DESCRIPTION so, Rating: Total Depth from original grade: GPD/Sq. Ft. Lot:~-~,~'~ Block:'~ ~ ~ ~z/~Subdivisi°n'~'-~\ 9spth to pipe bottom from original grade: Ft. Gravel depth beneath pipe Ft, Township: I Range: Section: Fill added above original grade: Gravel length: Ft. Ft. WELL: [] New [] Upgrade Graveldepth: Numberoflines: Distance betweee lines: Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft, Ft. SQ. Ft. Driller: Date Drilled: StaticWater Level:Ft. Installer: ~ ~~'~J Date installed:o//,/f/_~/~ ~.~ / J Yield: GPM I Pump Set at: Ft. Cas,e~ ,s,,ht Abovs ~ro. Ud:Ft. TAN K SEPARATION DISTANCES I ~i~Septic [] Holding [] S.T.E.P. To Septic Absorption Lift Holding )ublic/Private Manufacturer: Capacity in gallons: Prom Tank Field Station Tank S .... Lines ~n~NC~f Well Io~ It7 Material: ~ ~ Number of Compartments: Surface Water /~f//,/~ LIFT STATION Lot Size in gallons: Manufacturer: Line ~0 ~ Foundation q I, "Pump on" level at: I "Pump off" level at: High water alarm at: CurtainDrain ~ Pump Maka & Model Electrical Inspections per~ormed by: Remarks: BENCH MARK " Assumed Elevation: ~¢ ~'' I ~ f~, ENGINEER'S SEAL Inspections performed by: ~ ~ Dates: 1st ¢~ lq ~ ?~0 ........ ;~.:'~:'.' Department of Health and Human Services approval ":'", ' ' · 72-013 (1/91) MOA 25 $ 7"' / 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:SW910376 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:ALASKA HOUSING FINANCE CORP OWNER ADDRESS:P.O. BOX 101020 ANCHORAGE, ALASKA 99510 DATE ISSUED:12/17/91 EXPIRATION DATE:12/17/92 PARCEL ID:01736105 LEGAL DESCRIPTION: MCMAHON #1 BLK 3 LT 25 LOT SIZE: 22050 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: 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 (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~ ISSUED BY -..~Z~ , / DATE: /'~-I l~/q ( Tom Fink, Mayor unicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 December 18, 1991 Ted Moore, P. E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 25 Block 3 Mc Mahon Subdivision #1 Waiver Request #WR910058, PID ~017-361-05, SW910376 Dear Mr. Moore: Your request for waiver Of the required 10 foot Separation between a septic system, and a lot line has been approved. waived distance is 9 feet.from the north property line. The This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer. On-site Services Concur: ~ On-site Services ljw#7 THEODORE F. MOORE, P.E. PH: (907) 345-1355 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 ~P/~>~,~&~ ~ , ~k~:~:~ ~ ~.,:~, ~*~', .... , '," .,.. ~ ........... ~<~,~;~ ~, C1VIL & ENVH~ONMENTAL I~NGINEI~RING · ENERGY CONSERVATION & ANALYS~ D~ember 10, 1991 MUNICIPALITY OF ANCHO~GE ENVIRONMENTAL S~RViCE8 DtVJSION D~C 1 0 iBBI 14530 ECHO ST. ANCHORAGE, ALASKA 99516 Dear Sirs: RECEIVED The purpose of this letter is to provide the required design narrative in support of our application replace the septic tank serving the residence on Lot 25, Block 3, McMahon S/D #1, located at 3901 Doroshin Avenue. A site plan, specifications and a soil log are enclosed for your review. 'We are also requesting a lot line waiver allowing the soil absorption trench to be within 9 feet of the property Iine. According to records on file in your office, the original 3 bedroom wastewater disposal system was installed in September of 1974 and consists of a 1000 gallon concrete septic tank followed by a 26' diameter seepage pit with concrete rings. At some later date the system was upgraded by the addition of a soil absorption trench configured as shown on the site plan. During our adequacy test of the system on September 27, we added 2000 gallons of water from a tank truck to presoak the system, then added another 895 gallons of water from the well. This amount of water filled the seepage pit to a maximum depth of 39" and the monitor tube in the trench addition to a depth of 15". Once the flow of water was stopped the fluid levels receded at an adequate rate for a tlu'ee bedroom residence. Per my discussion with Dan Roth at your office, I understand that a three bedroom system with an undocumented upgrade can be approved without further as-builts if it is demonstrated that the system is 'functionally adequate, and does not encroach within 4 feet of groundwater. The soils test performed at the time the original system was installed was dug to 13.5' We measured the depth of the seepage pit to be 11' and the monitor tube in the upgrade trench extended to 9' below ground level. We therefore dug a new test.hole on November 20 to a total depth of 16' at the location shown on the site plan. No groundwater was encountered. If our adequacy test of the system and groundwater assessment is acceptable to your office, we are requesting a permit to replace the septic tank. At the time of om' adequacy test we noted that the septic tank was not completely full, so we dug down alongside the tank and discovered that the seam at the midpoint of the tank where the two halves are joined together was not watertight. Since this cannot be readily repaired, we are requesting a permit to abandon this tank and replace it with a new 1000 gallon tank as shown. Since one cleanout of the upgrade trench is only 9 feet from the north property line, we are also requesting a lot line waiver allowing it to remain as is. Due to the relatively large lot size in this subdivision and the significant setback of existing septic facilities, granting.of this waiver will not have any impact on the ability of the owners of Lot 16 to future upgrades of their system when needed. please give me a call if you have any questions on this submittal. Sincerely, Ted Moore, P.E. e~' L.o T' 8 V LoT' Flattop Technical Services :::~:: 14530 Echo Street Anchorage, Alaska 99516 L2~', r3L~c3, McI"IAHON _~ I-F ~ PI-AN NoT'~: TP~L~ t.~ lVor AI~I. Flattop Technical Services 14530 Echo Street, Anchorage, AK 99516 Phone (907) 345-1355 Lot 25, Block 3, McMahon S/D 3901 Doroshin Avenue Septic Tank Replacement Specifications 1.0 General: 1.1 The scope of the project includes abandonment of the existing 1000 gallon concrete septic tank and installation of a new 1000 gallon septic tank. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and State requiremems. 1.3 All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.4 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 2.0 Septic Tank: 2.1 The existing septic tank is to be abandoned by pumping, removing the top and burying the crashed pieces on site. 2.2 The new septic tank shall be Municipally approved with a minimum of two compat hi-~ents, and shall be set level on undisturbed soil. Each compartment shall be equipped with a wate~light manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shah have a minimum slope of 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shah be installed within 5 feet downstream of the septic tank. 3.0 Inspections: 3.1 Two engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the septic tank has been set level and the piping connected, but prior to backfill. 3.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. ,Flattop Technical Serv~,ce~ 14530 Echo Street A. nchorac~e, A]as/~a 9951~ Municipality of Anchorage ' DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMEDFOR: A~FC c/~ ~)~ery! ?oA~Zcr-(¢~t~-I ~.e, LEGAL DESCRIP PlCI~'C~/"/O,P1 --~/O 4¢'.,.~ Township, Range, Section: ,~'~'cJ'~.c~,~ SLOPE SITE PLAN 4 5 6 7 8 g 10 ~/~L S~y 1//)WAS GROUND WATER ~li ~ ENCOUNTERED? L IF YES, AT WHAT O 12 DEPTH? p E 13' C~,¢'Y, ~'~y' Depth t0 Water Alter /'/'~ P~'Y' 14 16 17 18 19 20~ Reac~ing Date Gross Net Depth to Net · Time Time Water Drop PERCOLATION RAIE __ (minutes/inch) PERC HOLE DIAMETER TEST RUNBEIWEEN __ FTAND FT ACOORDANOE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: (// ~ / ¢/ 72-008 (Rev. 4/85) GRE ' :R ANCHORAGE AREA BO ' GH Department of Environmental Quality 3330 C Street Anchorage, Alaska gg503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ,~//~'/-//-,/ff~/A] ~,¢~¢/C~/~/[9/~g:,g MAILING ADDRESS /.~, 4~',5~_:~'/ LOCATION ~:~'~/~//L~2 LEGAL DESCRIPTION SEPTIC TANK: DISTANCE ~'/~,'~ ~' NUMBER OF FROM WELL I/O" MANUFACTURER ~'~/~/~/¢~Z~ MATERIAL ~ COMPARTMENTS INSIDE LENGTH. INSIDE WIDTH ~ LIQUID DEPTH ~ LIQUID CAPACITY //~'~) GALLONS, SEEPAGE Pit: NUMBER OF PITS //. DIAMETER ~ /OR WIDTH ~ LENGTH-- DEPTH //' / LINING MATERIAL (~"~z~.z? ~'~RIB SIZE: DIAMETER ¢/,3~'DEPTH BUILDING FOUNDATION~ NEAREST LOT LINE ~//-J. TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE /~-~-~ CONSTRUCTION ~~ DEPTH ~'.~/.~. DISTANCE FROM: BUILDING NEAREST NEAREST //~/'f' SEPTIC .d/~/~-~, )/ SEEPAGE FOUNDATION /~ F/ LOT LINE ~ SEWER LINE TANK //~/ , SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: 3'/¢/~-"/z/' ~//~', PIPE MATERIAL: LOT SLOPE: ,~/~/_M REMARKS: ~//~ ~////~ ~,z*~' Form No. ~=Q~031 DIAGRAM OF SYSTEM DATE ~-~,-~'~ ,~/~'?~' APPROVED G.A.A.B. SEWAGE GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 PERMIT NO. DISPOSAL SYSTEM m APPLICATION AND PERMIT NAME OF APPLICANT /~/~/~"/~/~/ ~--~/L/~"'~7~/~D~/~L~ MAILING aDDRESS INSTALLATION lOCaTION ~ ~/~ INSTaLLaTION OF: SEPTIC TANK SEEPAGE PIT TYPE AND S~ZE OF FACILITYTO BE SERVED ~ ~ ~~ FINANCED THROUGH sol~ TEST ~ESU~TS /~--~/ , DRAIN FIELD OTHER NOte: THIS PERMIT 15 NOT VALID WITHOUT SOIL TEs'lr FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT Of ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE ~/~ (~4.- TYPE SEEPAGE AREa SiZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT , DRAIN FIELD SEPTIC TaNK TO SEEPAGE PIT Wall SEPTIC TANK , SEEPAGE PIT . TO NEAREST LOT LINE. DRAIN FIELD i~ WATER MaIN TO SEPTIC TANK ~:~ DRAIN FIELD SEPTIC TANK. /~/~ '/ . SEEPAGE PIT TO RIVER LAKE STREAM. , DRAIN FIELD /~ '/ SEEPAGE PIT / ~ / aLSO CONSIDER area WELLS. , SEEPAGE Pit CaST IRON INTO AND OUT OF SEPTIC TaNK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH Diameter CAST IRON SIPHON PIPES ON SEPTIC TaNK AND SEEPAGE PIT FITTED WITH airtight REMOVABLE caPS. GRAVEl. BACKFILl. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT IAM FaMILIar WITH THE REQUIREMENTS OF GRE/~jT~/~ORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THat THE aBOVE Date ¢ aPPL,OA.T'B SiGNAT, - GREATER ANCHORAG£ AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Case # Performed For Mountain Enterprises Dated Performed September Legal Description: Lot 25 Block 3 Subdivision McMahonSubdivision This Form Reports Soils Log xx Percolation Test__ - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics l'- Roots and organics PT 2-- Silty sand, light yellow residual soil SM 3-- Sandy silt to silty sand 4-- light brown, low moisture ~;-- ) Interbedded layers of sandy gravels ~7--/i__~/ to well-to-poorly graded sands GW-SW-SP light-to-dark gray,low moisture content Random cobbies tfa - Glaciofluvial ice content deposit ~ ~ l"~.f' -- 12-- 13-- Was Ground Water Encountered? No ~ If Yes, At What Depth? t I Reading Date Gross Time Net Time Depth to H20 Net DropI Percolation Rate Minute Proposed Installation: Seepage Pit xx Drain Field Depth of Inlet Depth to Bottom of Pit or Trench' 1'3.~' C0 MME N T S: Lower soils unit will contribute primarily to percolation.' Accordingly we would recommend using, 155 sq/ft ~er bedroom. Test Performed BY HowardJ,.Gr~y ALASKA MINERA'L ~&'MATE'R'IA'LS LAB Date Certified BY: Date: 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # (-'~'-~ 1. GENERAL INFORMATION Completelegaldescription /.oT' 25 : ~L I~ 3 I~c ~A H o~ ~1 Location (site address or directions) Property owner A. H, F. ~ , Mailing address ,520 E,, ~q.~ Day phone ~G/- Lending agency Mailing address Day phone Agent C~-g~Vz- Pofl~.gt~, (2E~T. 21 Address 112o E0 HvF-Ft~Ar4 ~b,. Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: -~ TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: 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 5. 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 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 Add ress J ~ .5' ;~ O Engineer's signature F~.ATToP T~ckJ ~WC:£ Phone .~~ ~ "~?'¢.¢,,-~v.__ Date DHHS SIGNATURE _ ~'~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: .-~©~4 M ..~'~ d~- Date 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 th is 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. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: i... ~/ ~ ~ t"(cl"~A~o/~ ~ I Parcel I.D. A. WELL DATA Well type ~'¢'~ [,'cz/-& Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number N, Ac, I~ Date completed ~ ~'/¥ Driller J Cased to ~ ,' ~/,~-' Casing height ~ ?-- ' '¢ Wires properly protected (Y/N) Date of test .... Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION ~ $,0 SEPARATION .DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ~ ~_8-' WATER SAMPLE RESULTS: Coliform ~ co( Date of sample: B, SEPTIC/HOLDING TANK DATA Date installed I / Cleanouts (Y/N) High water alarm (Y/N) Date of pumping ; On adjacent lots c.o. ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Nitrate ~- ~ ~J/--~- Other bacteria t.8. / E.o/~ I Collected by: Tank size ICaO O ~'~( Compartments Foundation cleanout (Y/N) ~' Depression (Y/N) N IW,~, Alarm tested (Y/N) N, .. =.. hi, A, Pumper __ Ne SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Foundation ~ I Watermain/serviceline ~' ~-&-' Well(s) on lot I~/'~ T0 property line ~ .3'0 ' Surface water/drainage On adjacent lots Absorption field 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LiFT STATION TO: Well on lot On adjacent lots · Surface water D. ABSORPTION FIELD DATA Date installed ~ / 7~ Length ¢..~' D¢~ -W. iCCn Total absorption area fll'~)¢'m~ Depression over field (Y/N) N Results (pass/fail) ~¢' -¢J Peroxide treatment (past 12 months) (Y/N) Soil rating System type Gravel thickness ~' ' Total depth Cleanouts present (Y/N) Date of adequacy test for If yes, give date N,~. bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot I~;o' To building foundation On adjacent lots ~ Surface water 1~' too Curtain drain On adjacent lots "~" f°'°¢ Property line To existing or abandoned system on Cutbank N, 4. Water main/service line Driveway, parking/vehicle storage area 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 ~ / HAA Fee $ / "~7(") C~ ~ Date of Payment /C;~-/'%~/~ ~'( ) Receipt Number · _.~,;~ /'/r/~' Q ~,5 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT EY SAMPLE for WORKordert 357B8 Date Report Printed: SE? 30 91 @ 16:46 Client Sample ID:L25 E3 MCMAHON Sl PRESSURE TANK HOSE BIB PWSID :UA Collected SKF 27 91 G 08:45 h~s. Received SKF 27 91 G 12:35 Preserved with :AS REQUIRED Client Name Client Acct B?O t :FLATTOP TECHNICAL SRV :ELATTOT PO ~ NONE RECEIVED :TED MOORE/C}BIS Analysis Completed :$EP 27 91 Send Reports to: Laboratory Supexvi8or.:~EPH~N C. EDE I)FLATTOP TECHNICAL SRV Relea. ed Ey : ~~ ~ 2) Chemlab Ref t: 915116 Lab Smpl ID: I Matrix: WATER ~ Allowable Parameter Te~ted Kesult Unite . ~ethod Ltatts NITRATE-N 3.2 mE/1 EPA 353.2 10 Sample RO~TIN~ SAMPLE COLLECTED BY: CBIS. TAG ~RKED COLLECTED DATE AS Remarks: 9/29/91; SAMPLE RECEIVED ON 9/27/91. 1 Tests Performed ' See Special Instructions Above UA-Unavailable liD- None Detected "See Sample Remarks Above NA- Not Analyzed LT-Less Than, gT-Greater Than Member of the SGS Group (Soci6t6 G6n~rale de Surveillance) THEODORE F. MOORE, P.E. PH: (907) 345-1355 CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVA~ON & ANALYSIS 14530 ECHO ST. ,February 10, 1992 ANCHORAGE, ALASKA 99516 John Smith M.O.A. DHHS P.O. Box 196650 Anchorage, AK 99519 Dear Mr. Smith: RECEIVED Municipality ot Anchorage Dept. Health & Human Services Per your request, on February 7 1 conducted an inside inspection of the residence on Lot 25, 'Block 3, McMahon S/D #1, located at 3901 D°r°shin Avenue. Based on my inspection I can assure you that at the present time there are a total of only three bedrooms in the residence. I trust that this information'will allow you to proceed with issuance of the requested HAA certificate. Please give me a call if you have any questions on this. Sincerely, Ted Moore, P.E. cc: AHFC c/o Century 21 - Pacific North 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 GENERAL INFORMATION Complete legal description Location (site address or directions) 3c/ol bo~?os/-/~ A~'E, /~flCfloWA~£ Property owner Mailing address Lending agency Mailing address Agent C Address ALASKA Day phone ,S~l-I?oo Day phone ~ 9~'- IIq~ po~bgE · CE'~7'uRY 11 ¢/~¢. ~0~/¢ Day phone D~5--/¥¥¢ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: 3 Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewafer 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 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. Name of Firm ~ZATTOP 'FE~/-J ~(/¢~ Phone Address 1~5'3o £ct-lo s"r. /~NcH,. ,~t~ clct~/(~ Engineer's signature _¢~-'~--'~ '~, ~ Date 3 qS'- /3.5'5- DHHS SIGNATURE A .. Approved for ~~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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. 72-025 (Rev. 1191) Back MOA ~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. WELL DATA Well type [~I~tv'ATE Log present (Y/N) Total depth :~ Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ l~tTZ¢ Driller ~ 2 Cased to ~ INff Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /O~/f Absorption field on lot 1 ;~o' "r~ C.c. Public sewer main N.A. Public sewer service line ~ 25 ' g.p.m. AT INSPECTION ; On adjacent lots ~-/oo ; On adjacent lots '~ Ioo' Public sewer manhole/cleanout PetroleUm tank WATER SAMPLE RESULTS: Coliform 0 c~, I [¢oo ,,, ¢ Date of sample: Nitrate Collected by: Other bacteria F~-ATTOP "r"~cfl. B. SEPTIC/HOLDING TANK DATA Date installed 11/~3/~ Cleanouts (Y/N) High water alarm (Y/N) N Date of pumping Tank size lotto G/~ ~- Compartments 2. Foundation cleanout (Y/N) ¥' Depression (Y/N) . Alarm tested (Y/N) N,/~, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I OcJ On adjacent lots ~-/oo Foundation ~ To property line '~ 3o Absorption field ~ I$ Water main/service line Surface water/drainage >,/oo t 72-0~6 (Rev. 3/91) Front MOA 21 , CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ff/7~ Length _26~ ~J& ~lST~. Total absorption area ~O ~' 4. --r'~E~¢fl Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) __ Soil rating 15,.~ ~'/~b~'M System type Gravel thickness (o~ Total depth Il' Cleanouts present (Y/N) Date of adequacy test for -~ bedrooms If yes, give date /~ .A. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: t Well on lot 15o FROr~ C,O. To building foundation LiD On adjacent lots ~> 3o~ Surface water > ldo' Curtain drain Nc~ oaseRvE~ On adjacent lots '~/~o' Property line F~o~ E,O. To existing or abandoned system on lot Cutbank N,A, Water main/service line __ Driveway, parking/vehicle storage area $0 ~ ~) I+1¥£ ~'~v¢~' t.~( 1~/17/9/ E. ENGINEER'S CERTIFICATION I ceriify 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 "T'}/¢¢¢¢O~q¢ F. t~c,e,~¢_. Date _;~/-- 9,, I¢~P- HAA Fee $ -f_ ?O_- Date of Payment Receipt Number 72-026 (Rev. 3/t11) Back MOA .~%,.~%,,, .. · THEODORE F, MOORE Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (9071 562-2343 FAX; (907) 561-5301 AHALYSIS RESULTS for INVOICE t~ 5445.:. Chomlab Ref,~ 92.2556 Sample ~ 1 Matrix: ?lATER Client Sample ID PW$ID Collected Received Pzesarved with L25 E3 I~CMAHON PRESSURE TANK HOSE BiB JUN 4 92 ~ hrs. JUN 4 92 fl iA:50 hrs. AS REQUIRED Client Name :FLATTOP TEC]INICAL SRV Client kect :ELATTOT BPO$: POS :NONE RECEIVED Req$ Ozde~ed By :TED Analysis Completed : JUN 5 92 Send Reports to: Labo%atpry Supezvzeo= :.~STEPNEN C, EDE 1)FLATTOP TEC}INIC~L SRV £ Paramet e~ Results un/ts ~[ethod Allowable [J,m~ t s ........................................................................................................................................................... N!TRATE-N 0.95 mg/1 EPA 353.2 lO Sa-mple ROUTINE SA~LE COLLECTED BY: CHRIS. Remarks: 1. Tests Pezfo~med ~ Sea Special In, true,ions Above UA~Unavallable ND~ None Detected "See Sample Rem~zks Above NA~ Nat Analyzed LT~Leea Than. GT=Gzea~e~ Than Member of the SGS Group (Soci~t~ G~n~rale de Surveillance) ' ', MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRO-rECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) (b) (c) Legal.l~scripti0n (incl.LLde lot, block, subdivision, section, township, range) Location (address or directions) ...%~ / ~'"~,,~,,.,I Applicant Nam~-~~-~ ~-4~//~XcA~ Telephone: Home Business Applican~t Address Applicant is (che~k one): Lending Institution []; Owner/builder [~; Buyer []; Other [] (explain); (d) (e) (f) Lending Institution Address Real Estate Company and Agent Address Telephone Mail the HAA to the followinQ address: , TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms -~ Othe1 WATER SUPPLY Individual Well [[]'" Community [] Pul: Note: If community well system, must have attesting to the legality and status. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Note: If community well system, must have ~[ ~ttu. uu~ ... ~u~,.. ,, ~.,.¢~ 11 ~.11~ ..~%~.~.[~.. ~J~l ~.11 t~.~ attesting to the legality and status. 72-025 (1 Page 1 of 2 ENGINEERING FIRM PROVIDING~ SPECTIONS, TESTS, FILE SEARCH, DATi ND INFORMATION 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 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~on. Name of Firm ./'~-~%., -~--~ ~/' ~/~ Telephone Address ~ ~ ~ ~ /~ ~/ ~ ~//~ ~ DHEP APP~~ 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 Well Classification Well Log Present (Y/N) Total Depth ~"/¢O ' /~"'~ MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOAi- [H'v'IP. ONMENTAL PRO~ECTION, HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 0(~"~; 5 ~985' Legal Description: 4/'/' / Water Sample Collected by Water Sample Test Results Comments ~E'~- If A, B, C, D.E.C. Approved (Y/N) ~d '?~N/V,~u,~,O Yield Cased to ~'~eept~of Grouting Pump Set At -- Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Static Water Level ~o / Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Y Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line C~eanout/Manhole ; On Adjoining Lots Io°'f' ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on ; Date /'~/Z B. SEPTIC/HOLDING TANK DATA Date Installed ) c,:)-Tff, Size Standpipes (Y/N) Y Air-tight Caps (Y/N) Depression over Tank (Y/N) ,4/ Pumping/Maintenance Contract on File (Y/N) Holdin~ Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well / To Property Line / b No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ~ ; for '- Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field /(~ / To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments / Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field /~/,,~ j/)1,4, Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: Type of System Design Length of Field "~.,,~ Depth of Field /// Gravel Bed Thickness (~ / Standpipes Present (Y/N) Date of Last Adequacy Test To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line /c~ 4- To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) -- D. -L, IFT Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at 'Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I havsch~ckec~, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ,-~.q. '¢'J'~'~- Date /~,/'~'~/~ Company ;~,~':~,~, Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) ~lien~ ~: BESSE, EPPS & 2220 EAST 88 AxqLNuE ANCHOI~AGE, AK 99507 (907) 349-6451 WATER lt.~r.r. TEST Subdivision: Lot: Block: Tes tar: Initial Reading cci Meter: Produe. ti on IRa lm: F, ~ GPM 24-Hour Capaci ry. ~ C~al] cnn GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "¢" Street, Anchorage, Alaska 99503 274-4561 Date Received February 2~, Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1977 1. Approval requested by: 4. 5. 6. Mailing Address: Property Owner: Mailing Address: Cony. Alaska Mutual Savings Bank, Teamster's Branch Phone: 274-5722 Phone: 344-0024 Post Office Box 8-9G93 Michael & Gloria Craig Box 4-2514 99509 Legal Description: Lot 25 Block 3 Mc Mahon Subdivision Location: Doroshin Drive Type of facility to be inspected Single Family No. of bedrooms 3 Well Data: ~,~/~ A. Type Individual B. Depth ~O C. Construction ~ $. Bacterial Analysis Sewage Disposal System: A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: On-site system 1974 B. Installer ~ l. Size /~;~:;~:; 2. Manufacturer ~,,~~' 1. Absorption Area ~/~0 2. Material Total length of lines Distances: A. Well to: Septic tank ~'0~ , Absorption area Nearest lot line /0~-~ , Other contamination B. Foundation to septic tank ~1 + , Absorption area C. Absorption area to nearest lot line ,Z¥' /6;0 , Sewer Lines EQ-034 (1/74) Page 1 of two pages MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. Property Owner: /~/I ICi'~/~ Mailing Address: 3. Name of Buyer: VA Mailing Address: 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: FHA. CONV ~ .......~ Day Phone: Day Phone: Phone: Mailing Address: Legal Description: Location: ¢',~/?~o ,~ ~ ~ o ° 72-oo3(3/76) Type of Facility to be Inspected; -~-'~tN4-C~- ~ ~C~ Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: If Individual, date of installation Public Utility .Individual ~N~-~ Individual (on-site) Pa. ge 2 of two pages - Re¥..t for Approval of Individual ~r & Water Facilities ~egal Description Lot 25 Block 3 Mc Mahon Subdivision Comments Approved  Disapproved Date val,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ,034 (1/74)