The URL can be used to link to this page

Home My WebLink AboutMCMAHON BLK 4 LT 4 Municipality of Anchorage Page / 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: .~,'~' glO~.'72~ PID Number: OI '7-- O~/| -- ~ '7 Name: ~,. ~,'~ "~; ~c~ ~-'~" Wastewater System: []New [~Upgrade Address: t;Z.~ol L~,,-,-~.~,,~c S-(- ABSORPTION FIELD Phone: INo. of B[.~/rooms: /~DeepTrench E] Shallow Trench r~Bed ~lUound [~Other Total Depth from original grade: LEGAL DESCRIPTION SoilRating: . (~ GPD/Sq. Ft. ~;~ Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Towm,.:,I R.n.*: s,~,~ .,,, added above original grade: Gravel length: Number of lines: Distance between lines: WELL: ~ New D Upgrade Grave~ ~;~ ~ Ft. ~ ' ' ~t. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. ~O SO. Ft. ~T~ ~Iq; Driller: Date Drilled: StaticWater Level: Installer: Date installed: .~. Ac~ ~/~/q~ Yield: GPM ~ Pump Set at: Ft. Casing Height Above Ground:Ft. ~ TAN K SEPARATION DISTANCES ~Septic a Holding ~ S.T.E.P. To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank S .... Lines ~ I ~ Material: Number of Compa~ments: Sar*ace LIFT STATION Water ~ ~ ~ ~ Lot Size in gallons: Manufacturer: Line ~O "Pump on" level at: "Pump off" level at: High water alarm at: Foundation ~ CudainDrain ~ ~ Pump Make & Model Electrical Inspections ,Pe~°rmed by: Remarks: BENCH MARK I Assumed Elevation: 1 ~ - ~, n / cENeiNEER'~ SEAL Inspections performed by: ~ Dates: 1st_ q~/,I .~ >,7;_~~,~:: ....................... Department of Hea~ and~uman S~vices approval . % <:, :'- ............ Reviewed and approved by: Date://- 2 / - ~/ , /- 72-013 (1/91) MOA 25 Well CD GDING YS TO HOUSE GAL. SEPTIC MT 2S ~0 75 SCALE; 1~ -- 50 F~, 125 150 I TBBBEN SPURKLAND P.E, 203 W 15TH, AVENUE ANCH, AK, 99501 (987) ~79-29]6 LDT 4 ~LDCK 4 McMAHDN KEN PITCHER 12601 LORRAINE STREET II SEPTIC SYSTEH A,Si~UiLT ]DATE, NDV, 1], SHEET, 2/3 62.5 £ ~ondord Trench: 58,5' LZ7N5 ]0' DEEP 6' DF SEVER RZTCK 4' m/n, Cover Firs~ ho{£ o£ trench /nsulo$ed CD 6olng both woys Mira£1 140 Monlt;om ~ 4' Cover ~ Exist. 6round 6 £eet o£ Septic /?ocr ronk I850 GAL SEPTIC TANK --x~ G~Mr TBBBEN SPURKLAND P.E. 803 W15TH. AVENUE ANCH. AK. 9950] 4 3LDCK 4 HoHAHDIV KEN PITCHER 18601 LORRAINE STREET SEPTIC SYSTEM ASBUILT ])ATE, IV~V, ]l~ 199! SHEET, 3/3 GRID, 2835 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' PAGE 1 OF 1 PERMIT NUMBER:SW910272 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:PITCHER KENNETH W & OWNER ADDRESS:12601 LORRAINE ST ANCHORAGE, AK 99516 PARCEL ID:01704107 DATE ISSUED: 9/06/91 EXPIRATION DATE: 9/06/92 LEGAL DESCRIPTION: MCMAHON BLK 4 LT 4 LOT SIZE: 40218 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD 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: DATE: 1-' ~ ~.~F~ [..J~<]C. ~-~N~ F:~ . ~=K=] ~ 203 ~ 15th. ~venue~ Suite 206 ~NCHDR~SE~ AL~SK~ 'LOT SEPTIC SYSTEH-:DESIGN~ 4 BLOCK 4 HcHah-on KEN PITCHER No Ground Water or Impervious Layer to 16.5 Use Standard Trench Soil Rating. From test August 5~ 1991 4 and 15 rain/in =.8 gal/min Required Area per Bedro(~m: ].50/.8 =187.5 sq..Ft.. Finished Floor Elevation Lowest Floor 100.00 Existing Tank Water Surface 95.5 Ground Sur,~ace at Absorption Field 98 +- 'Testhole Total Depth Less 6 Y ee'l.'.'. [..,ess 5 Ft Cc~ver 16.5 10.5 7.5 Rc:~c:k Depth 7.5 ~t Max U s e 6.0 ,~ t Number c)~ Bedrooms 4 Length o.F Trench 4 x :187.5 / t2 = 62.5 '~t SYSTEI~i COI~iF I GUR~T ! Ol~i STANDARD TRENCH TOTAL LENGTH- 62.5 FT. TOTAL WIDTH 5 FT. TOTAL DEPTH 10 FT. ROCK DEPTH 6 FT. COVER 4 FT. SEPTIC TANK 1250 GAL. ABANDON EXISTING SYSTEM PUMP AND CRUSH.EXISTING TANK PUMP~ CRUSH, AND BACKFILL EXISTING PIT Septic System Design Lot 4 Bloc,L:: 4 McMahon The installation o'~ this septic system will nc~t prevent wells Yrom be installed on the adjacent lots. There are ne developed or natural sur,~ace / sub surface drainage courses (:)n th:i.s or the adjacent lots. The prc]pesed sept:lc system ~ill not change the genera], s].(]pe o~ the area. F'c, nding and/or concentration c:~.~ surYace runo~:.~ will no'I: result ~rom th:i.s installation. Septic System Design Lot 4 Block 4 McMahon LOT 9 LOT 13 LOT 19 K 1 LO? 20 BL OCK LZTT i0 C LOT 3 % Well 0 Testhol~ Well LOT 8 4 LOT 7 J LOT 6 FU££:h/ CREEK RZTAO ~:~:.,~,,~:,.;,.: i:: .' '%, ' - - - I ~,," ."~. "j...::'~ o 5o no ~5o ~oo ~so 30o as~t~ ~mm~ %~ ~,,. ~ ,~ SCALD I = 100 Ft ~mROFESS~O~aTM TDBBEN SPURKLAND P.E, 6751W. DIMDND BLVD. ANCH, AK, 99502-3904 LOT 4 BLOCK 4 MEMAHON KEN PITCHER 12601 LORRAINE STREET SEPTIC SYSTEM DESIGN DATE, AUGUST 36 199l SHEET, Il3 GRZD,£835 tv'ell A~xur~ecl Ele, !!!!]i!!:!:!:i:i:i:iiiiiiiii?i?iii:i:i;'I G,4L, £EPUC TAm 99.9 GN. fl, V, ~Z6 S; TRENCH 98,0 PERC, V. 9LB 100 1,50 £00 SCALE: 1-~ = 100 Ft £$0 300 350 TBBBEN SPURKLAN]} P,E, 203 ~/ 15TH. AVENUE ANCH, AK, 99501 LDT 4 BLDCK 4 McMAHflN KEN PITCHER 1~°601 LDRRAINE STREEF SEPTIC SYSTEM DESIGN DATE, Al)GUST 38 I99I SHEET, 8/3 GRII), 283,.5 Clean LTu~ ~ lvloni~om 62.5 Standard ?rench: 62,5' LONG 10' DEEP 6' ElF SEWER ROCK 4' mm, Cover 1250 9al Septic tank M/raP/ 140 Cleonouts /~ Monitor Feet o£ Septic Rock Ground 4' Min Cover ~over T~nk 1£50 GAL SEPTIC TANK J TBBBEN SPURKLAND P,E, E03 W15TH, AVENUE ANCH, AK. 99501 LEi? 4 ~LOCK 4 klcHAHON KEN PITCHER I260] LORRAINE STREET SEPTIC SYSTEM DESIGN SATE, AUGUST 30 199l SHEET, 3/3 GRID, 2835 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p Depth 1o Water After ?j ~/.~3~//~E Monitoring? D Date: __ SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop ;67, tO Jul'l~-"t~p( I~f~ PERCOLATION RATE /2~ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN ~FTAND ~ FT COMMENTS PERFORMED BY: -~, ~ ' ~ CERTIFY THAT THIS TEST WAS PERFORMED IN 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: I 2 3 4 5- 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S SEAL) Township, Range, Section: ~" I,~.~: ~_.~, ~ ~ ~¢2) SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth to Water After Monitoring? Dale: I N Gross Net Depth to Net Reading Date Time Time Water Drop ur: bo -- q" - PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TESTRUNBETWEEN ~'YZ- FTAND F FT PERFORMED BY: ~'~. ~ I %-~ ,-~o CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WlTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /% '~0.~ ~ ~ ~ { 72-008 (Rev. 4/85) 203 ~lSTh. Rvenue Sd~e 206 A~CHO~AGE~ AL~SK~ ~501 SPECIFICATIONS FOR SEPTIC SYSTEM INSTALLATION LOT 4 BLOCK 4 McMahon S/D SEC 28 T12N RSW 1.0 GENERAL 1.1 Owner is Ken Pitc.:her. 126'01 L.orr'aine Street~ Anchorage~ Alaska 99516. 267-2402 W 345-3309 H 1.2 Engineer is t. he person or er]tity hired by the Owner' to inspect this project. The Engineer must be recognized by the Municipality o¥ Anchorage~ Department o~ Health and Human Services. 1.3 Contractor is the person or ent:i, ty hired by the Owner to install this project. The Contractor must be recognized by the Municipality o~ Anchorage,~ Department o{ Health and Human Serwices. 1.4 The Dra~.in{~s~ sheets 1 through 3~ shall be part: c)-F this speci ,~ication. i(..5 Ali. materials and workmanship shall meet '~he reqLlire- merits ~ the Municipality o~ Anchorage~ Department' o~: Health and Human Services~ the conditions o~ the permit~ and all applicable rules and regulations currently in e.~-~ect. I. ~ 6 A1 ]m excavat i on depths are advisory, and are m~i o be veri¥ied and may be modi.~ied in the ,~ie].d by the Engineer. 1.7 It is the responsibility o¥ the Owner or the Contractor · ho adhere to the approved design,~ to veriYy that the speci- fied separat, ion distances are met~ and that the required inspections are per.Formed. 1.8 'The Contractor c)r" the Owner sha.~.l report to the Engi- neer any observed condition which would put the septic: system in vic~lation o~ State or' Municipal regulations,, 2.0 SEPTIC TANK 2.1 If there is an ex:isting sept:i.c tank.~ :it may be used i~ it meets t. he capacity requirement for the residence. The taF]k shal 1 be inspected by the Engineer, and i ts water tightness and structural integrity shall be veri~ied~ 2~2 A ne~-~ sept. ic tank sha].l be one ~abric. ated by either Anchorage Tank and Welding or by Greet Tank Specifications .For septic; system installation Lot 4 Blt, ok 4 McMal'ion S/D pg~l The septi(: tank shall be a UF'C-at.~proved two-compartmerlt tank, constructed of 12 gauge, or better, steel with bitu mas'tic c:oating. The tank shall be set leveI on undisturbed soil.The tank sha].i be covered wit. h the equivalent o~ ~our' ~eet o~ soil. 2.3 The septic tank sinai], be installed a minimum of five Yeet from the Inouse -~oundation and a minimum o.F f-1. ve feet from the absorption area. 2.4- The septic tank shall be a m:i. nimum of 100 feet fr'on'~ ar]y well serving a single residence; 100 feet .From any body o~ wat:er~ creeks or drainage ditches witln flowing water; 150 feet from Class "C" wells~ and 200 .feet from Class A or Class B wel].s. 2.5 Ali. pipe c:onnections to the tank shall, be mechanical watertight calder couplings. Cleanouts shall be installed as designated and capped with air-tight rain caps. Clean- outs slnall extend a minimum of 12 inches above ¥inal ground elevation. Provisions shall be made for landscaping and .i. mport, ation i~ topsoil. 2.6 Lift station shall be as manufactured by Anchorage Tank and Welding 3.0 ABSORPTION FIELD 3.1 Gravel used in 'l"lne absor'ptior~ field shall be 0.5 t.o 2.5 inch screened roc.'k, with less than 3% pass:lng the No. 200 si eve. .3.2 Sancl~ used ~or level:Lng or for fi].ter'ing~ shall have an e~fective grain size between No. 40 sieve arid No. 18 sieve. LJniformity ccief~:icier'~t slnall be less than 4. Not more than 5% by ¥,~eiglnt shall pass the Ne. 200 sieve. · 3~3 4-inch perforated p:i. pe shall be ASTM F810. For' pres-. sure distribution.~ pipe shall be Schedule 40 PVC ~r ABS. 3~4 Solid 4-...inch pipe shall be Cast Iron or ASTM D3034. ~.5 Monitor standpipes sha].l be installed as slno~,~n. That section o~ the pipe penet, rat. ing the gravel shall be per.Fo- rated, either by drill, lng 0.5" holes on 6.'.-inc:h cent. ers or by .joining a sect:Lor~ of FS10 perforated pile to a solid section of pipe. 3.6 Geotextile shall be Mira~i 140. 3,,7 Insulation slnall be extruded direct burial polystyrene. Dow Chemical Styrofoam HI 40. 3.8 '¥opsoil shall be a mixture o~ 40-60% organic mattet'-~ Specifications for septic system installation Lot 4 Block 4 McMahon S/D pg. 2 20-30% sand and more that 20% silt. All measured by volume. ....'~. ~--", Grass seed shall be Kent. ucky bluegrass. quantities are 4.0 INSTALLATION 4. 1 Locate ali. underground utilities, pr:oper'{.: y 1 ir~es, ~ut~J. re driveways, existing or proposed water wells, water ways, surface and sub sur-face drainage ~acilities, lakes~ pends, and all other ~acilities requiring separation dis- tances ~rom the proposed sep{ic system. I'qoti~:y O~ner or Engineer o~ any observed possible conflict. 4.~ Stake alignment o¥ system v~ith markers shoe.;.tng 'Line protect:i, ve distances ~rom wells and water bodies. 4.3 Establish an elevation benchmark. This BM slnall be · ~ '' "'-'-' ~" stable and permanent. An arbitrary easily ~ d~..r t.~.~-~.aL .[e, elevation (:)~ 100 can be assigned. Use garage .floor slab. 4.4 Install the tank as shown on the drawings. Record tine inlet and ~utlet elevations c]'{ the '~ank. Tank sha].l be pl aced on undi S~L~rbed !']ative ~5[]i i. 4.5 Excavate the absorption ~ield. Bottom o~ excavation slnatl be level and scari-~ied. I~, sidewalls smears, they shall also be scarified. Record elevation o~ beginnJ, ng.~ m:i. ddle and end o~ trench, Record elevation e-~ each COl"ner and center pr4int o~ bed. Construction equipment shall not operate ()n the ~loor o~ the excavation. Any material com- pacted by the operation o~ the construction equipment shall removed and replaced with uncc)mpacted materials. 4,,6 Place the rock t.o tine depth speci.fied,, Do not cc~ntami- ina~]e rc$(.-.k wit. In t]at. ive mat[arials or spoils -Frc)m thE, e;.,'cava- t:i.c)n. Level the rc](:.k sLlrt:ace (..F- 1") before installing the pereorat, ed pipe. 4,,7 Install the dist. ribution pipe. Recor'd the elevation each .j~int.. f::(.~i'" pressure system solvent weld tine joints. 4.8 Cover the dist:ribut:i, on pipe with rocf.::~ and cover tine e;.,'cavation with geotext:i, le be~or"e backfilling and ~lacing insulation~ i~ required. 4.9 Record the ~inished ground ~.~levat:i. on at the be.q~nning, middle and end c)~~ trench. Record the ~inish ground eleva- tion at each corner and at the midpoint o~ tine bed. 4.10 Furnish a copy c.)~~ ali. survey notes to the Engineer. 5.0 INSPECTIONS 5.]. A minimum ef three inspect3, ons ar'e required. The ¢,':irs~t insp(.z~ction will be of the open excavation. At this time tl~e soil cenditions will be observed and compared to the design assumptions. Ground ~ater conditiens or presence o~ bedrock will be verified. The second inspection will be a~ter placement of standpipes~ distril')ution piping~ tank(s) and other nent:s as specified. The third :i. nspec'~ion wi].], be a-[ter completion o~~ the work. Any deficiencies will be noted and the ~ontra~tor noti~:i.e'-,d. SL~c:h de.fic:i, erlcies shall be corrected ~.~it:hin ten days. 5.°.. .,. All electrical work requires either an MOA electrical inspection or cer t:i. f i cat i c,'~ by an licensed electrician. Submit proo.F ~:)~c in93pect, ion or' certzification to the Engineer. Submit catalog data o¢ all mechanical equipment,, 5.4 Notify Engineer at least 24 hours in advance c:)~ begin- nj. Jag ~t]y ~,~c.~rk. Speci.F:i. cat:i, ons for s6.~ptic system installation Lot 4 Block 4 Mclflahon S/D pg. 4 GRr" -C.R ANCHORAGE AREA Bf ....... UGH Department ~3E0n~:irs~rn2;ntal Quality Anchorage, Alaska 99§03 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /~A//~ ~/z/ /~j./~-C~c: .. MAILING ADDRESS LOCATION ~/~/'& ./~/~, LEGAL DESCRIPTION ,~/'/ ~/~' //~C'/~/:/~/ :/E~)/ SEPTIC TANK: DISTANCE / FROM WELL/~ ~-/2~'/~1~6 FACTU RER INSIDE LENGTH. ~ INSIDE WIDTH MATERIAL £/'~" ~'/C. NUMBER OF COMPARTMENTS LIQUID DEPTH ~ _LIQUID CAPACITY /~:~) GALLONS. SEEPAGE PiT: NUMBER OF PITS / DIAMETER -- OR WIDTH LINING MATERIAL ,/~2~/') CRIB SIZE: DIAMETER BUILDING FOUNDATION 2~¢/t NEAREST LOT LINE~2~) Cw ADDITIONAL ABSORPTION LENGTH //,, DEPTH D~EPKT~H~: DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~/--~) '/ SQ. FT. WELL: / Y' CONSTRUCTION BUILDING NEAREST FOUNDATION ~ LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK SYSTEM REMARKS DISTANCES: INSTALLED BY: /¢-.,~.t'2..,¢~. ~,~¢d', PIPE MATERIAL: LOT SLOPE: REMARKS: c~'~,¢',-~ ,,'¢/¢¢,¢'//) Form No. EQ~031 DIAGRAM OF SYSTEM SEWAGE GREATER ANCHORAGE-AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "~:" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456! DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. NAME OF APPLICANT LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SO,L tEST RES"LtS SEEPAGE PIT ~ , DRAIN FIELD TO SE INSTALLED SY PHONE OTHER NOTE: THIS PERMIT I~ NOT VALID WITHOUT SOIL TEST ~ ~../-~,~'~/~u~'~,l ~o,/ 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. SEPT,C TAN~ S,ZE IO~o ~'~I TypE T ~5~T~:,~.[~.~.~,~':m.~SEEPAGE AREA S,ZE TYPE.lO&' O~ ~,.~.x MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~OUNDAT,ON TO SEEPAGE P,T SEPTIC TANK TO SEEPAGE PIT WALL WELLTO SEPT,C TANK /~ SEEPAGE P,T /~ DRAIN FIELD //~ ALSO CONSIDER AREA WELLS. WATER MaIN TO SEPTIC ,TANK DRAIN FIELD SEPTIC TANK, /~-~ . SEEPAGE PIT CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET iNTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIG TANK AND SEEPAGE Pit FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKI=ILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G~ ~,A.A,B- ~ DIAGRAM OF ~YSTEM I CERTI~ THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2S-68 AND THAT.THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. F Leoal ~escri~tion: Lot ~ BlOck ~ Subdivision Percolation Test Renorts Soils Loq ~m~ Soil Characteristics This Korm ~enth Feet / 5 lO Was Ground Water Encountered?~ I~ Yes, At what Denth? l' Readinst Date Gross Time Net Time Depth to H20 Net Dron r Percolation Rate Minute Proposed Installatiln:. _Seenacle~.~. Pit ~ Drain Field Inlet "* Pit Or Trench Deoth of · Denth To Bottom Of Cn~ENTS: [~ Test Performed(By ~ ~~/~ Data Certified 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 GE.ERA' ,. ORM^T,O. Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well 4. TYPE OFWASTEWATER DISPOSAL: Individual on-site- . _ . : ., Holding tank Community on-site Public water NOTE: If community well system, provide written confirmation from State ADEC.attest- lng to the legality and status of system. ' - Public sewer NOTE: If community wastewater system, provide written confirmation from State AD£C · - attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~Y21 S'rATEMENT 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 'n compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm '~/~ ~ Address Engineer's signature Phone 6. DHHS .SIGNATU RE '//' Approved for bedrooms. Disapproved. __ Conditional approval for Date bedrooms, with the following stipulations: Additional Comments 'By:' ~' , :.:i!:_-~ v~'/~ 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 en gineer registered in the State of Alaska. The D H HS dqes 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. 72~325 (Rev. 1/91) Back VlOA ~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: [~t~o,~.~ ~-~ (]L~ z~ Parcel I.D.: A. WELL DATA Well type K Log present (Y/N) ~ Total depth r~ ~,'[~' ~ Sanitary seal (Y/N) Date of test Static water level Well production If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to 7 FROM WELL LOG ve roM '~ ~.,~O ~ '~ _ Casing height (abo g ~ C.-_ ~, :4 Wires properly protected (Y/N)~'~,Y~ ~ %- - AT INSPECTION '/. ~ ~ ! g.p.m. WATER SAMPLE RESULTS: Coliform ~ ~) Date of sample: ~//~/~7 Nitrate ,~.. ¢2..,'7__ ~'~'//.~ Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed cj ~. i ~ - ct / Tank size Foundation cleanout (Y/N) ~%~O Number of Compartments ~ Cleanouts (Y/N) Ye Depression (Y/N) A/o High water alarm (Y/N) Date of Pumping ¢'/~¢/¢'? Pumper C. ABSORPTION FIELD DATA Date installed ~'- II -- 'l ) Length (~ ~, ~ ~ Width. Effective absorption area ~:,5'O ¢',¢ z Date of adequacy test 5' ' Z$ "~ ~- Fluid depth in absorption field before test (in.);. Fluid depth ¢7, ~'~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Soil rating (g.p.d./fF or fF/bdrm) ~ ~ Gravel thickness below pipe Monitoring Tube present (Y/N). ~ Results (Pass/Fail) ~ Immediately after ~)gal. water added (in.): Absorption rate = '~ ~ g.p.d. If yes, give date System type Deep Tr-¢r~ok Total depth ~ - [0 __ Depression over field (Y/N) /~/'o For J'/// bedrooms 72-026 (Rev. 3/96)* '. :i' '' . '.:: :i : ..... LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* *Datum "Pump off" level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot lb cf, Absorption field on lot JO~~ Public sewer main - Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/H(;Q.D,tN6-TANK ON LOT TO: Foundation [ ~ ' Water main/service line Property line Surface water/drainage Absorption field ~ Wells on adjacent lots 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /~ JO' Building foundation I ~ ~ Water main/service line Surface water "- ~'l'l b Driveway, parking/vehicle storage area I (~ ~ Curtain drain -- [0 Wells on adjacent lots /~ · /-' '_..~..~,,.~,., ..~ ~-...~'~ ENGINEER'S CERTIFICATION ,4,",,. ,::i~ I certify that I have determined thru field inspections and review of Municipal recor, d¢(l~¢~,,th~ ab¢/¢ in conformance with MOA HAA guidelines in effect on this date. Signature '~. Engineer's Name HAA Fee $__ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number .;'Ji.i-z-2-1997 18:52 CT;%E ESI ._~,'~ CT&E Environmental Services Inc. AHCHORAGE F'.~2-'02 CT&E Ilef.# Client Name t'roject Name# Client Sample ID Matrix Ordered By ['WSID Smnple Remarks, 972061001 Tobben Sp~ldand P,E, 4/4 McMalton 4/4 McMahon Drinldng Water Client PO// Printed Date/Time 06/02/97 16:25 Collected Date/Time 05/28/97 18:00 Received Date/Time 05/29/97 0D:00 Technical Director: Stephen C, Ede 2.22 0.100 mg/L 1 OB W/O COL[ COL/]OO ML, Method SHl$ 4500-NO3F ~18 9222B ALlowabLe Prep Analysis Limits Date Dere Ini% !0 max U5/29/~7 JRJ ~g~.~ ~ ~"/ uepa'rgn!en~ oT ~nv~'ronmen~a I uMa ! i~y · Date Received Time of Inspection ~'go~,~, Date of Inspection Approval requested by: Ma~ling Address: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & I;'ATER FACILITIES 2. Property Owner: t-~ail ing Address 4. Location: A. Type C. Construction Sewage Disposal System: Phone: J¢~- ~:-~ Phone: ~.~, £Q.034 (1/74') C. Septic Tank: 1. Size /~,.~,~ 2. Manufacturer D. Seepage P~t~ 'l. Abso~p~'io5 A~ea ~m~f~ 2..~aterial E. Disposal' Field: Total length of lines Distances: A. Well to: Septic tank ~:~/ · .. , Absorption area /~'~'~ ', Sewer Lines Bo C. Absorption area to nearest lot line Nearest lot line ~///J , Other contamination Foundation to septic tank ~r- , Absorption area- Page 1 of two pages B. Depth o,,~;~'L '~ ~ ~ D. Bacterial Analysis --// / Page 2 of two pages - Re~st for Approval of Individual ,~'~'~r & Water Facilities Legal Description Comments Approved ~~~__P Disapproved Date / O~/~ Approval 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) GREATER ANCHORAGE AREA BOROUGH-.. Department of Environmental Quality 3330 "C" St., AnChorage, Alaska 99503 274-q561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO 2. Property Owner: ~r'~ /0,~ Mai-ling Address: 3. Name of Buyer: Mailing Address: VA FHA CONV */ 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or.Agent: Mailing Address: Day Phone Day Phone Phone Phone 6. Legal Description: Location: 1~/~ 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility o ~/~/~', NO. Bdrms. Individual ~ If Individual, number of dwellings presently served If Individual, depth of well ~' Sewage Disposal System Type of System: Public Utility Individual If Individual, date of installation '~-~- ~ (on-site) EQ-037 (~/74)