HomeMy WebLinkAboutMCMAHON #1 BLK 3 LT 31
.~IUNICIPALITY 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
NAME PHONE
LEGAL DESCRIPTION (~__¢
Well
. I DISTANCE TO: .~-
~-~ I Manu f~ctu~'er .....
Liq. caB~¢ity in gallons
~ DISTANCE TO: IWell
~ -- ~ Manufacturer
~=1 DISTANCE TO: IWe'¢/OO
~ I No. of~i.~s _ I L..gth of e~oh ~ine
~ ' ' 'h
~ Top of tde to hms grade ~
~ Length Width
~ ~ I Type of crib Crib diameter
~m DISTANCE TO:
Well
~ IGlass Depth
~ DISTANCE TO Building foundation
OTHER
PIPE MATERIALS
SOIL TEST RATING
REMARKS
Absorption area
· I0~
Inside length
Dwelling
Foundation
Total length of lines
Material ben~t~
Depth
Crib depth
Building foundation
Driller
Sewer line
Dwelling
IWidth '
PERMIT NO.
Liquid depth
PERMIT NO.
Liquid capacity in gallons
E~]UPGRADE
Material
Nearest lot line
Tre,c.~ ~dth
PERMIT NO. 2 ~ ~ O~.~ '
Distance between lines
inches
inches
Total effective absorption area
PERMIT NO. ¢
Total effective absorption area
Nearest lot line
Distance to lot line PERMIT NO.
Sept c tank Absorpt on area(s)
APPROVED
DATE
LEGAL
72-013 (Rev. 3/78)
F'E!;F,i:i',! i T N 3.
!IH ,J. .... ¢~ !'.4Ui"IBER OF EE[':,F,;'r':OhIZ .... .l~.
"fl-ii:' L. Ei'.~IEiTH DIMr. Zi'--4S;{ON ~":; THE i I::'i'-~GTH ,:;'[l"i ~-~',",f., ElF THE l""'i"i'~' J JJ J]]~ ~]:
...... , ri,.:. Di%7.'FtNCE BE IHmEI'~ THEi: ;,u':.,
THiE f)EF:'TH !::It:::' lq 'f'i:;~'.ENE:H (3F-':: F'!T 'rq ?, :: ........... ' ..... t:,~-,- THE
(.:;F;l(]i!jl.][:, !::iND THE BOTTE-:.h! OF THiE EX"; i:~:".¢i::Fi'';.; IZl['.,l ( i ~'~ i::'.['Z[{"[' ).
THE~'F' .......... T c-, NO SET. I.,.I I t]:,TH FnR
""1 .q:/'.'"- (]i[(ff':!':::'!.~:]L,..: .... =.r'":"~' ', h I:F.'; T:'HE i'1¢.~,.:_:'*-~'°'~": ':,'...,: f-':'EPTH OF ......................... 'IR'tsI':,,'E'I [:',P'l'i' ']trl:'~:'; THE;
FIND THIE E:OTTOM OF "-~""" F.:'2. _~ ./:' FEET::.
t.~:: ..,..,f .!fl,::~.ll, , 1.,.,I (
F'E!:;::i'"i i T FIF'FI_.. I Z l::lh!'.' [-iH~, THE
;[ NSTF!!...LFiT .T. i3N INSPECT ! El.NS OF RNh..' i,;.'E ...... ':~_ RE:,.~RC:E!'-Ci" TO TH ;f S i::'F,: '.- F'ERT'.¢ R~.,!!;:, 'f'Hi:E
fqi. J!'iE:E;F~: OF ...... ;)F"::-"f"EN'"'F'g.~ .. ~ .,.. ......... THRT
MiNI!"i,t.It"i DISTRI'.~CE BET!-4EEN Fi' I4ELI._ RND RN".? ON-SiTE
d3;3~3 F'EET FOR i:! F'RIVRTE ~,4EL.!...*
;L!ff. iI3 TO ;29!3 FEET FROi'q R PijBL.'(C I.,.iEL.!~ [)EF'E?.]DZNG UF'ON THE T'¢F'E O!:::' PUE~i....IC !4EL.I..
HELL. LO(~S FiRE REg!L.!ZRED lIND IdljST BE RIETURNED TO "i'!4E DEF'R,~;?.TMENT !4Z'F!4,:(N :ii:*b D,'.":i?';~;
OF THE P]ELL COHPL. ET ZOI'.4.
O'THER RE(;:!Lt:t;t~:EP1EN'TS PiFI'¢ RPF'L?. SF'ECIF!CRTiONS RND C:O!'.,I%TRLICT ]: ON D!REiRFiM:F;
R',,,'Fi I !..F:i!:5'LE{ 'TO I NSL.tRE PFi:Eff:'ER i NL'-',TF!L.i._F!T t ON.
! 'C:F_':?.T ! F'h; TH, FIT
:L: t Fi.U FFit'"t]:i..,,!RF.: 14]:TH THE REg!U):REHEi"',!TS .r.:OF: ON-SiTiE SEI.qEi:;~'.::.:; f,':i~'4D !-'I!Ei..,[_.S i:;:iS SET
F(3i~'.'I,FH E:"..r' THE': [qI.jN l E: l PPtL :I: T"r' OF' RNC:HORF~(3E:.
2: I i4ZLJ.... ZNS'f'F~LL 1"iaE S?S'i~'E.h! ZN i:~E:C:C6;:D.RNCE I,.i!TH THE CODES.
:21:: i LIlI"4'DERSTF!ND "f'i-~,FIT "['IaE ON.--SI"i"E SEklER S'¢S'f'EM MR'?' REZ.%JiR[E EI'-4L.Ri:~:~ZEi'dig'NT IF THE
F.:ESZ!::,E:NCE !S I;:EhiODEL. ED TO :(NCLUDE f:'iORE THRN 4
/
PERFORMED FOR:
LEGAL DESCRIPTION:
~,.~.~L~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-222~
SOILS LOG- PERCOLATION TEST
DATE PERFORMED:
[~SOILS LOG
[] PERCOLATION
TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
/
SLOPE
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND ~ FT
72 008 (7/76)
SIX iNCH wATER'WELL DRILLED AND cASED: OUT TO ¢'~E DEPTH 0~" ~8 ~ ' ;.'):~? ?:. '~' ~;
COsT:INCLUDES ALL ~BOR AND MATERIAL FOR COMPL~ION OF"SAID DsILLING. '.
WRITE CHECN PAYABLE TO RAMPART DrlLNING WORKS FOr THE:SUM OF
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 lot, block, subdivision, section, township, range)
Location (address or directions)
3~q~
(b) Property owner
Mailing Address
(c) Lending Institution
Telephone: (home)
Telephone
Business. '~ ~'¥¥ -O,5'O/
Mailing Address
(d) Real Estate Company and Agent
Address
LZoYb
Telephone
(e) Mail the HAA to the following address: (or check here~, if hold for pick up.)
List contact person and day phone number below:
FLATTOP TEC~ :~ v'C ~'
TYPE OF RESIDENCE
Single-Family [] Number of bedrooms
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.
SEWAGE DISPOSAL
On-site'l~ 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.
72-025 (Rev. 7/88) Page I of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND 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 inspection.
NameofFirm [:L,,~TTOP T£C~ ~1/C5 Telephone '~ G/5-- I~o-----------------~--5--
Address ) ~'.5-,_~0 ~-CI-jO <~T, /~C,/--J. ~/~' ~/~ ,.~'/~
Date ~oc/e~ ~..<~- 7.,
DHHS APPROVAL
Approved for
Approved //~
bedrooms by
Disapproved
Terms of Conditional Approval
Seal
ate
Conditional
"f;T'l I P]i
The MunicipalityofAnchorageDepartmentof 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
_~.~'~ . 5t.~ MUNICIPALITY OF ANCHORAGE (MOA)
,,,x..xx.Cx~.~x-.,~'' (,~r,'~ Health Authority Approval (HAA)
~"' o~' _~-'~I;¥/ CHECKLIST - FEBRUARY 1984
I Description: L.
WELL DATA
Well Classification
Date Completed' S'/7~'
Well Log Present (Y/N) ~'/ES
Total Depth c~ ' Cased to
Static Water Level -~-f~ ~
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ~'5 I ~ TO
TO Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results ~-J-c~¢/oc',,y -
Comments 0 ~r';n..~ ¢..X.a~'ll
If A, B, C, D.E.C. Approved (Y/N)
Yield ~'7./~ GPI~.
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
C,¢). ;OnAdjoiningLots 11~4 -.re,
I O'7 ' To C.c. ; On Adjoining Lots 'z/oo '
'7/Oo /
To Nearest Public Sewer Cleanout/Manhole
~ 130~
Sb'C¢ ; Date ~//14//¢0
Air-tight Caps (Y/N) ~/~-<~ Foundation Cleanout (Y/N)
~O Date Last Pumped
SEPTIC/HOLDING TANK DATA
Date Installed ~/7~ Size J2,~O No. of Compartments 2
Standpipes (Y/N) '~,E<~
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N) N ,A · ; for I~.,~ ·
Holding Tank High-Water Alarm (Y/N) ¢4./~. Temporary Holding Tank Permit (Y/N) F(./~'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Building Foundation
To Disposal Field /0 /
'2/oo
To Water-Supply Well 1:5 I F~'ot~ L".~.
To Property Line ~ 2
To Water Main/Service Line ~ .~'O
To Stream, Pond, Lake or Major Drainage Course
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~/75
Width of Field 36"
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
~20 lq/
Type of System Design
Length of Field '5~-,2 /
Depth of Field I J~
Gravel Bed Thickness ,~ /
Statndpipes Present (Y/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
ToWater-SupplyWell JO7' t:/¢0~4 ¢,0.
To Building Foundation 25 ' /':~¢4 C.0.
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area '2 ~- /
Comments
I
To Property Line ~ /I
To Existing or Abandoned System on
/
; On Adjoining Lots ~ 7..5'
To Cutback (if present) N '/~ '
O. LIFT STATION ~,1 o klE
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
__ Manhole/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 alt MOA and HAA gui~[i(L.e,s,d~ effect on the date of this
inspection .....
Company F/~fi~ ~c4 ~/c~{ ~C'~
~ .... ~ ...................... ~ngmeer s Seal
Date II / 7/¢~
MOA No. ~ -~1~
ReceiptNo. ~ ~ ~ g}
Receipt No.
Date of Payment / ) - ~ ~ 5 Waiver Fee: $
Amount:$ /7~ ¢ 3 Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343
FEDERAL TAX I.D. #92-0040440
ANAL~$ZS ~E?OgT BX S~PLg io~ Work O~der ~ 27257
DeLe ~*port Printed: SEP I~ 90 ~ 17:42
PWSiO :UA
Collected S~P
R*q ~;
JmaiysJs Col~p].eted :B~P 1~ 90 Send teport~ to:
Laboratory dupervisox :STBPHEI{ C. ODE 1)FLATTOP .... I'"
fieleased ~v : ) 2)
Inst}:uet:
Chemlab Ref ~: 903659 Lab Sl'~pl iD: 1 Matrix:
Allowable
Parai.etor Tested Result Onit~ Method Limits
..... a a mO/1 EPA 353.2
llm,;arks: SM~PLE COLLgCTED B~
}~one Detected *' So~ Saiapla ~emm:ks Above
Notanalyzed ET=Less Than, GT-Greater Than
APPLI =', IT FILLS OUT UPPER HAL' iONLY
Phone
?rope~ty ~wner %~..~, ,~/~.,/~L.//,.~ ~..j~..,~
Mailing Ad~e~ ~/~ ~ff)~/~./
Address Zip Code
Lending Institution ~O~ &~ ~/~ ~ ¢ ZO~'~ Phone
Address Zip Code
Realty Co. & Agent Phone
Address Zip Code
Street Looati~ '~(~ V~ '~0 ~n-rM
Type of Residence
Single Family )
Multiple Family No. of Bedrooms
~ Other
Water Supply
Individual ~ A~ACH WELL LOG. A w~J log is required for all wells drilled since June 1975.
Community ~ ~' For wells drilled prior to that date, give well depth (attach log if available),
~ Public Utility
Sewer Disposal
lndividual Year Individual Installed:
Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED,
Time
Time Time Time
Date Date Date
Inspector
Field Notes:
Inspector
Inspector
Date
I n s p~.;t,o r
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROT[CTION
FEB g
* CON DIT[ONS OF APPROVAL RFCF. iVED
Soils Rating
72-023 (3182)
Date Sewer Installed
Well To Absorption Area
Well to Tank
Well Log Received(~'~ ~..~/..~.~_
Septic Tank Size
ALASKA EIIUIROIlmEI1TAL. COI1TgOL SERuIC $, IrlC.
I~nqineerinq 6 I~nuironmen{ol $1udies
FEB 20 1984
DENNIS ZILAVY
3645 DOROSHIN
ANCHORAGE AK 99516
SELLER - DENNIS ZILAVY BUYER - SAME
SUBDIVISION - MCMAHON BLOCK - 3 LOT - 31
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A DEEP TRENCH WITH AN AREA OF 520 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 913 GALLONS.
BASED UPON THE TEST DATA T.HE SYSTEM IS ACCEPTABLE FOR A
4 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON FEB 18 1984 .
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR
THIS 4 BEDROOM HOUSE.
~ _ ~ / ~ ~':~
· ~ ~ Ler~y C Reid, Jr .* ~L'~
1200 LU~st 33rd Aucnu¢. Suile J~ o Anchora§¢. Aiaska 99503-(907) 561-5040
MUNICIPALITY OF ANCHORAGE "
'~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please a~low ten (10) days for processing.
PHONE
1.
PROPER¢. , ~ ~
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS
3. LENDING INSTITUTION I PHONE
I
MAILING ADDRESS
4. REALTOR/AGENT I PHONE
I
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION I
6. TYPE OF R~DENCE
~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOM~¢~
[] One L~~ Four
[] Two [] Five
[] Three [] Six
[] Other
7. WAT~ivi DUAL*
[] 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
E~I N DI VI DUAL/OI~-SITE**
[] PUBLIC UTILITY
**If individual/on-site give installation date ~ ui.~rred~
If system is over tw~ (2) years old an ade~acy tet ' q '
by this Department.
NOTE: THE INSPECTION FEE MUST ACcOiVIPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78}
THIS SIDE FOR OFFICIAL USE ONLY /
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL 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
TOTAL ABSORPTION AREA MATER,AL
4, DISTANCES Septic/Holding Tank Absorption Area ISewer Line 1 Nearest Lot Line
1
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
~APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Title)
LEGAL DESCRIPTION
72-010 (Rev, 3/78)
