HomeMy WebLinkAboutMCMAHON #1 BLK 6 LT 4
Municipality of Anchorage Page
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: ;~c~J ~1 ~ 00~',~ PID Number: 017-~oi
Name~4~ ~t~'~m~ ~~ ~HIT~-~oVp Wastewater System: D New ~ Upgrade
Address: I'C" ABSORPTION FIELD
Phone: No. of B~rooms:
~ ~ , ~ ~ Deepmrench ~ Shallow Trench ~ Bed ~ Mound D Other
Total Depth from original grade:
LEGAL DESCRIPTION So,,~,n, 1. ~ ~S~.~. ~*
Lot: ~ Block: ~ Subdiv~ion:~ ~ ~ ~ ~ Depth to pipe boflom~from original grads: Ft. Gravel depth beneath~. ~p~pe Ft.
Township: 1 Range: I Section: Fill added above original~rade:~, ~.~' Ft. Gravel length:~o, ~ ~ ~Z ~ ~'l~Ft.
WELL: E~i~ ~GNew D Upgrade Gravel width: ~1 Number of lines: Distance baleen lines:
Ft. ~ IOl~ Ft.
Classification (Private, A,B,C): Total Depth: ~ Total absorption area: Pipe material:
Driller: ~ ~e Drilled: Static Water Level:Ft. Installer: ~ ~ ~*~t~ Date installs
Y~PM IPumpSet at: Ft. O~*.,,*,M*~.~ou.*~. TANK
SEPARATION DISTANCES ~septic ~ Holding D S.T.E.P.
To Septic Absorption Lift Holding =ubl[c/Private Manufacturer: Capacityin gallons:
From Tank Field Station Tank 8ewer Lines ~ R¢~ ~t~ I Z~
Wel~ JO2~ JoTt~ ~ ~ 2S1~ Materish ~¢¢~ Number°fC°mpadments:
Sudace
Water IOO1+ )oo~h ~ ~ LIFT STATION
LOt
Line ~ I~ I0 1 ~ ~
Foundation ~t~ ~ ~ ~ ~ "Pump on" level
High
water
alarm
at:
Cu~ainDrain ~ ~ ~¢o~ ~ ~e[ I Electricallnspections pedormed~
v Location and Description:
~E, ~~0 ~7~~/~ IAssumed ElevatiOn:
Two
Inspections peflormed by: _ ~ __ Dates: 1 ~ [~,,,.
?320 East Cheste~ Hts. C~]e · -;/z~/~ ~t;~', N0. ~0~
Department of He~aEa~~"~ices approval ''t~;,,., ~;~.,,,.~
Reviewed and approved by:__~C~~ Date:
72-013 (Rev. 9/91) MOA 25
'PERMIT' NUMBER: PARCEL ID:
sw~oo~ AS-BUILT DRAWING
/ / \
/ / \
/ /
A B /
~T1 42.0 24.5 N~ ~ff~ / : ::
ST2 48.5 55.0 ~EL~/ : :' ~ I
~BL1 49.5 34.5 :
DBL2 50.0 35.0 L f I
=0i 68.5 81.5
~c°~~TM
~~ ~ TRENCH CONNE~
ELO~
..... ~__ TO BU~ RUN VALVE SPLI~R (ES)
F~GGEO ~ A I
NOTE: THE ~T P~PER~ UNE W~
REGI~RED ~D SU~OR. ~E SEP~ON DIST~CE
B~ THE ~ PROP~W UNE AND THE N~LY
INST~D TR~CH~ tS GR~T~ T~N 10'.
/ ~ /
"~"~ ~: WASTEWATER ,
A~S~ WA~.R &
LEG~ D~CRIP~ON:
YPE OF WORK:
AS-BUILT OF SEPTIC SYSTEM UPGRADE
PR~ED FOR..STEVEN GILBERTSON C/O JACK WHITE 762-5865
ATTN: SHARI BOYD
J.L.M. 1 = 40' 2 OF 3 I '~<~
..~,.'...E~: AS BUILT DRAWING
SW980036 ' O17-361-26
\ / or COVER
ORIGINAL GRADE ~ \ /
= 9,L41~ 21,1 ~ ~ ~l; ~ORIGIN~ G~DE
f = 92.57
91.2
~ ~ r~ ~r
PROFILE VIEW
PREP~EO BY:
A~S~ WA~R &
McMAHON SUBDIVISION ,1. LOT 6. BLOCK 4. ~.;~
PREPare mR:STEVEN GILBERTSON C/0 JACK WHITE PHONE NUMBER:
ATTN: SHARI BOYD 762-5863 ~. '.. C.E. .,"~
m~:6'1/8/98 amWN ~: SC~: PAGE:
J.L.M. 1 = 40' 3 OF 5
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)
PAGE 1 OF ~'l%~b. Pf~X
PERMIT °~ ~{~k
PERMIT NUMBER:SW980036
DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES
OWNER NAME:GILBERTSON STEVEN L & CAROL A
OWNER ADDRESS:3900 DOROSHIN DR
DATE ISSUED: 3/20/98
EXPIRATION DATE:.3/20/99
PARCEL ID:01736126
LEGAL DESCRIPTION:
MCMAHON #1 BLK 6 LT
LOT SIZE: 30672 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS {18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY: ~~/~--
DATE:
DATE:
7320 East ChesterlHeights Cir¢le~ Anchorage,- ~laska 99504
Phone (907) 33%6179~-~ F~x ~9'0.7) 338~2z16.
Consulting Engineers
March 9, 1998
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref.' Septic System Upgrade for Lot 4, Bk 6, McMahon S/D #1
qO0 Oo sm
To whom it may concern:
1. GENERAL: The existing 4 bedroom home is served by a private septic system and well.
The existing trench is surcharged and must be upgraded prior to the sale of the house. One tesf
hole was excavated to the east of the existing septic system. The soils are summarized as follows:
2. SOIL CONDITIONS: The test hole was excavated to a depth of 15 feet. Below the
organics the soil was primarily a silty sandy soil with some gravel to a depth of 10.5 feet, where
the soils changed to an impermeable siR. No groundwater was encountered. Two percolation
tests were performed, one at 10.5 to 11.0 fi. which perked greater than 120 minutes/inch, and the
other at 4.0 to 4.5 feet which perked at 2.5 minutes/inch. The intent is to place the bottom of the
drainfleld at a maximum depth of 4.5 feet ( 6 feet above the impermeable ML strata).
3. DRAINFIELD: We are proposing to install two 5 foot wide trenches that are 45 feet long,
4.5 feet deep and each have an effective depth of 24 inches. This corresponds to an absorption
area of 643 ft2, or an application rate of 0.93 gpd/ft2 (assuming 600 gpd total flow). This gives a
conservative application rate since the allowable absorption rate is 1.2 gpd/ft2.
4. SURFACE WATER: There are no surface waters within 100 feet of the proposed upgrade.
5. TOPOGRAPHY: The ground to the north of the proposed upgrade slopes moderately
downhill from the driveway (approximately 15%). The ground to the south of the proposed
upgrade slopes moderately downhill from the south property line (approximately 20%). The
trenches are proposed to be installed between the slopes in the lowest portion (within the swale)
on approximately a 5% slope. There are no slopes greater than 25% within 50 feet downhill of
the proposed trenches.
6. SANITARY SEAL ON WELL: The well cap cover on the well does not meet current
Municipal HAA guidelines and must be replaced with a new sanitary seal. As part of this project
the contractor will be required to install a new sanitary seal.
If you have any questions, please call me a 337-6179, or 244-9612.
Sincerely,
James P. Williams, P.E.
Civil Engineer
~-EXISTI
LOT 3, DLK 6
McMAHDN S/D #1
DOROSNIN
LOT 4
13
WELL~
///-EXISTING
LGT 5
TANK & TRENC
EXISTING WELL-~
LOT 12
NDTEj THIS IS NOT A SURVEY. THE LOCATION OF ALL WELLS, SEPTIC SYSTEMS,
AND STRUCTURES IS APPROXIMATE, THE CONTRACTOR SHALL VERIFY THE SEPARATION
DISTANCE FROM THE SEPTIC SYSTEM UPGRADE TD ALL WELLS DN ADJACENT LDTS,
SEPTIC UPGRADE~
2ED FOR:
PREPARED 3Y'
DATE: 3/9/98
McMAH[]N ~fl, LOT 4, BK 6
STEVE GIL3ERTSON
ALASKA ~/ATER & ~/ASTE~/ATER
]]RA~/N: ~/ILLIANS
1" = 100'
P. Williams;
".. CE-g§08 ..°
'L[tT 3
HOUSE
LOT 4
TIE INTO EXISTING FCD W/4' DIA
33034 PVC PIPE
SLOPE LINE 1/4' PER FOOT
LOT 5
PRO ]SED 1250 GALLON SEPTIC
INSTALL DOUBLE CLEAN-OUTS PRIOR TO BULL RUN
BULL RUN
EXISTING TRENCH REMAIN FOR FUTURE USE--
TIED INTO _L RUN VALVE AS SHOWN
~---TH
t/D
(TYP.) (TYP,>
~' '-- EXISTING TANK TO BE ABANDONED
"~-~ REMOVE LIDS AND FILL WITH EARTH
IPROFESSIDNAL LAND SURVEYOR PRIUR TO CONSTRUCTION, J
---PROPOSED TRENCHES, 2 EACH, 5' WIDE, 45' LDNG,
4,5' MAX, DEPTH WITH 2,5' DF DRAINRDCK,
(MAINTAIN A MIN. SEPARATIDN BISTANCE OF 10'
3ETWEEN TRENCHES>,
LOT 13
LOT 12 L
SEPTIC
PREPARED FOR: STEVE
PREPARED 3Y~ ALASKA
DATE: 3~9/98 DRAWN~
UPGRADE, McMAHDN ~1, LOT 4, BK6
GILBERTSUN
WATER & WASTEWATER
WILLIAMS SCALE~ 1' = 30'
James P. Williams,,'
'.. CE-g60B ..'
Municipality of Anchorage ~ ~ 4 91'
DEPARTMENT OF HEALTH & HUMAN SERVICES~-~°'
825 "L" Street, Anchorage. Alaska 99502-0650 ~p~.t~? ¥~. ;,
so,.s.oa --,E.co.^T,o. T£s; '~.~Z;. ~M!
q~..I
LEGAL DESCRIPTION: ~~¢ &~¢ ~Township, Range, Section:
SLOPE
WAS GROUND WATER r~/r,x
IV"
ENCOUNTERED?
· S
IF YES, AT WHAT
DEPTH? p
E
Dep~m Wa,er
Monilorino? '"' '/ Dale:
1
2
3
4
5
6-
7
8
'9
10
11
12
13
SITE PLAN
~"J~.~ ~)-~[~ Reading Date Gross Net Depth ~F Net
Time Time Water Drop
/~ - ~" --
l~ta~ ~ ~" ~"
4,0.-~,~' ~ ~o j ~'.ss l~a~ g~,, ~" / ~" ~"
14
16
17
18
20
PERCOLATION RATE ~J~ (minutes/inch) PERC HOLE DIAMETER ~'/¢
TEST RUN BETWEEN q FT AND ~'~ FT
COMMENTS /~ IOWO/~ ~0,' ~?'~. ~ YS~' ~'% ~.s~ ,a.~ ~ ~
~=~. ~ ~sI / ~,// ~. ~/,.// ~'~,~ ~ ~,~ .~ ~ ~.
/ ~ ~
~/~1~
72-008 (Rev. 4/~)
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
PHONE
NAME
MAI LING ADDRESS
¢-H//5
[~f~EW
[] UPGRADE
LEGAL DESCRIPTION
NO. OF BEDROOMS
PERMIT NO.
Well ~. Jr'- Absorption area Dwelling
DISTANCE TO: /O 0
Manufacturer
Inside length Width
Liq. capacity in gallons
No. of ~.~partments
Liquid depth
IF HOMEMADE:
Well Dwelling PERMIT NO.
DISTANCE TO:
urer Material Liquid capacity in gallons
Well t/~) ~' t* ~ Foundation Nearest lot line PERI~J.T J~O.
DISTANCE TO: Total I~g~.~f/lines Trench ~"-~/ ~ O('~ (~ ~'
Length of each line Distance between lines
No. of lines [ w,.~)~, inches
Total effective absorption area
inches
Top of tile to finish grade
Material beneath tike
Depth
Length Width
Type of crib Crib diameter Crib depth Tota] effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line
DISTANCE TO: Building foundation Sewer line Septic tank
PERMIT NO,
PERMIT NO.
Absorpt on area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING / ¢~ ~"~
INSTALLER
R EMAR KS
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
[.',Eif:~RR'i"J"IE:::i'.~'i'' OF' HEFiL"f'H f:IND ENVZ R(3NMENTFiL.. PROTECT i ON
6',;25 '"I..." STREET., RNC,L.:OFd:'~6iE.,
PER,~'IZT NO. ',:: 7'80~-::~8::L )
glPF'!. ]' "::F!?.,iT
L O C ,el T i 0 N
lED H .E R.7..']] E'i
[:,OROE;H t N ;;: ::
L4 E~6 f'i] i-'!Rl'-. :: ?'I ::5,.'"C'
'-:' :t i <:' F'
LOT
THE L. Ei",IGTH D!MEZNSION !S THE LENGTH ,::tN FEET) OF ]"H~Z 't-RENCI'-J OR DI:.~:RiNFZELD.
]"HE] DEPTH OF R TRENCH OR PIT ):.¥7 THE ,DISTFtHCE BETk!EEN THE SURFFi,':::E: OF" THE
GROUND Rt"4[:' THE BOTTOM OF THE E::'.';Cffv'RTZON < !N FEET).
THERE IS NO SET 14.iDTH. FOR ~f'RENCHEE,.
THE GRFtVEL DEPTH l% THE M)JI"4Ii'"IUM DEPTH OF GRFi',/EL BET!.qEEi"'4 THE OLri"FF!LL
RBiD THE BOT]~Oi"I OF THE EXE:ff,/RTZON (IN FEET).
I.::'!.'Ei::::J"ilT jr~.:'Fq 'r-RMT F:,':-':, il .... 1' ....... F,_ ,t_,.,E;'~.._'f'V TO ': ..... f-.
ZN'-'::;T6!LLFI'F.~;ON );NSPFZCTZOi~'4:F:, OF FIN'?' !.4ELL'.:: iqDJ'i::iL::EJ"4T Till TI"I~:; F:'ROF'ERTV r'i?',!£:' THE
..... c ...... EIF r r.:'N '"E'::; ]'HF '- ' '"'
, b -!:_,l-:.k RES i' ..... TI.4FFF . _ t. 4:.~ - .~,.: ~.L SERVE.
ERE,¥Fii...L. iNGOt:= ,-,-~ , - ...................... r",¥
,~.I'.,r b"r'L-,IEM !4!TI~t]IjT F!NRI_ i.N:~i::'E(2TiON RN[:, !dPPt~:LA,,'HL ,-':,. THIS
[:,EF'RRT!',!ENI
.,, . LL. c~b.'"- '.r:.";LiE~.:i', E:CT_ TO.
MINIMUM DZSTRNCE BET!4EEN F:i [,iELL. RND RN'.¢ ON-SZTE SE!.4FiGE D!SF'OSRL S'.?STEM !:5
:i.~!E~ FEET FOR R F'iR~VRTE t.4EL.L..~ OR
;].50 'f'O 2E~¢ FEET FROM R F'LiBI._!C kiELL [:,EF'ENDZNG UPON THE T"r'PE OF PUE:LZC !.4EL.! ....
!4ELL LOGS RRE RE~;!UIRED RND ?lUST BE RETURNE:D TO THE DEPRRTMENT !,.II'f'Hliq 2:E~ DF:;'¢S
OF THE !4ELL. COb!PL.ETZON.
OTI4ER RE~;)UIREMENTS MR"¢ RPPL."r'. SF'EC~FIE:IqTZON% RND CONSTRUCTION DZFiGRRM::~; RRE
R%¥::i!L. RBLE '¥O ZNSURE PROPER ZNSTRi_LRTZ ON.
I CERT ]: F"? THF;,'T
&: I Ri"! F"J:::iHIL!!::iR l-4:J:]]"! Ti-IE REQUIF.':EHENTS FOR ON-.':':;!TE S.EI4ERS RND k-".l:::Lt..::5 R:i'i; SET
FORTH B"? THE .MUNICIPF:-',LI]"'¢ OF PtNCHORRGiE.
;2: i W:i'LL. I?,ISTRLi... THE ?-/STEM '_r.N RE:CORDRNCE 14iT!q THE CODE:i::;.
;~:: I UNDERSTRh!D THRT THE ON-SZTE SE~,iER SYSTEM MFW t:;?.I::(41jIt~:!E ENL.FIRGEMENT ):F "FHE
RE:':i;ii)EI'..ICE IS REi"!ODELED 'f'O !?!CI...UI2, E MORE 'i'HRN 4 BEDROOMS.
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15-
16-
17-
18-
19-
20-
COMMENTS
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-222~
SOILS LOG- PERCOLATION TEST
~S01LS LOG
[] PERCOLATION
TEST
SLOPE
1'7
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross ' Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND ~ FT
PERFORMED BY:
72-008 (7/76)
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF
DRILLED AT THE RATE OF ~78,00 PER FOOT.
PROPERTY OWNER [J'~'~.., ~ I{¢~p¢ 277- 3166
201 ~e.t.,
I,OCATION OF WELL SITE .C~o f BZ~., .~_ St~; /~'¢/¢~¢~'~"z
iWELL .LOG: :; :,
48---99' Ca.b. bd.e.o ar.d .Loo.~e. o/t~e.L. 8ora. e. t~a,t.e~ .bemb;~ raa,t.e;d.~ o..~ 100 ~e.e.4, 8h.o~X.m~
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 ~--~/~'
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Day phone
Day phone
Agent ~.~/x~. {.~,rh~ (?J~-g- ~--~ ~'P~ /.~'q'~/~' ~Y'/~Day phone
Address
=
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
lng to the legality and status of system.
If community well system, provide written confirmation from'State ADEC attest-
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev. 1/91) Front MOA#21
5. STATEMENT OF ;-NSPEiDTION 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 thi inspection.
Alaska Wastew f
Name of Firm 73~I1: Ctt~Nter ~ ~le~
Address ~a~Ala~ ~5~ ~
DHHS SIGNATURE
Approved for
bedrooms.
Phone
Date
Disapproved.
~4, Conditional approval for ~'L)~'~ bedrooms, with the following stipulations:
Money shall be put in escrow to complete a new wastewater disposal system
in accordance wl~h ~BS ~er~lt #S~980036. ~he ~boYe wo=~ shall be completed
by April 15 1998, Money in escrow shall not be released until this office
has g~von ~n~l ~pprmm],
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 DH HS 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..O25(Re~.1/'91) Back MOA#21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Legal Description:
Health Authority Approval Checklist
A. WELL DATA
Well type
Log present
Total depth
Sanitary seal
If A, B, or C, attach ADEC letter. ADEC water system number
Date of test
Static water level
Well production
Date completed
Cased t° ~O I
FROM WELL LOG
g.p.m.
Casing height (above ground)
Wires properly protected (~/N)
AT INSPECTION
g.p.m.
WATER SAMPLE RESULTS:
Coliform ¢
Date of sample: ~_~ ~:) _C~ ~
Nitrate
~, ~cj ~4(~//j~ Other bacteria (:~
Collected by: '~-~ ¢, ~'~-
B. SEPTIC/HOLDING TANK DATA
Date installed
Foundation cleanout CN)
Date of Pumping
Tank size I Z~'O Number of Compartments ~ Cleanouts
Depression (WN) ~o High water alarm (Y,~
Pumper ~ S~~~0 ~ ~
Soil rating ~ or fF/bdrm)
Gravel thickness below pipe
C. ABSORPTION FIELD DATA
Date installed
Length ~' ~-/ Width
Effective absorption area
Date of adequacy test
Fluid depth in absorption field before test (in.);
Fluid depth )~//¥ (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
System type ~/?/)~ ~/~-/'Jd
Total depth cj, / _+-
Monitoring Tube present (Y/N) '¢, Dffpression over field (Y/N) __
Results(Pass/Fail) /~J'/~--~5~-~ ~=or h~~L
Immediately after__~-gal, water added (in.):
Absorption rate = /~//~ g.p.d.
If yes, give date ~/~
bedrooms
72-026 (Rev. 3~96)
D. LIFT STATION --t
p off" level at*
High water alarm level at' _~ *Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
I CO On adjacent lots
/
~ CO f- On adjacent lots
/g]~- Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation --~ ~'/- Property line ~.~ r.f_
Absorption field
Water main/service line /0~'# Surface water/drainage ]0o
· Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line /~) ~ Building foundation /0 ~L Water main/service line
Surface water /OC~ '¢
Curtain drain /~/'~- /~oc~,rJ ,
Driveway, parking/vehicle storage area
Wells on adjacent lots /00
ENGINEER'S CERTIFICATION
I cedify that I ha~et~be~ ,Id inspections and revie
,w of Municipal record~lb~'t~d~ iJ~re
in conforman wi ines in effect on this date.
S, n tu, ......
Engineer's Name
HAA Fee $ ~
DateofPayment '~/~ l'~
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MAR-10-lgg8 13:13
CT~E ESI AHCHORAGE
~T&E Environmental 8or. ices Inc.
9075~15301 P.0~03
CT&E Ref,#
CJieut Name
Project Narne/~
Client Sample ID
Matrix
Ordered By
PW8~
9810140O1
AK Water & Wastewater Services
McMahon 8//3 No. I L4, B6
McMahon S/D No, 1 L,4, Bg
Drinking Water
Sample Remarks:
Client FOg
Printed Date/Time 03/10/98 09:3'/
Collected Date/Time 03!06/95 12:45
l~ecelved Da{:~/Time 03/06/98 13:55
Tee~cal Director: Step~n C. Efle
Total
0
0,!00 mg/L
MethoP
~PA ~00.0
Prep AnoL¥~ia
10 max 03/07/98
Al[atckat Water;er & Wa t;eWaltl;er
7320 East Chester Heights Circle ~ Anchorage - Alaska 9~$U~I~VlRONMEf~TAt SEfl¥1CE8 DI¥1SION
(907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
MAR 20 1998
March 20, 1998
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Conditional Health Certificate for Lot 4, Bk 6, McMahon #1 S/D.
To whom it may concern:
The existing 4 bedroom house is served by a private well and septic system. The trench system
was inspected and deemed to be operating in a surcharged condition. Alaska Water &
Wastewater was retained to design the upgrade. The design was submitted to DHHS and a
permit was issued on 3/20/98 (today). Unfortunately there is not adequate time left to complete
the installation and obtain M.O.A approval and comply with the closing date established in the
sales contract. Consequently, we are requesting issuance of a conditional HAA so that the sale of
the house can proceed. The existing system is functioning, in that it is not backing up into the
house, nor overflowing onto the ground.. Based upon my observations, there are no
environmental or health concerns associated with granting the conditional HAA. The intent is to
install the new septic system prior to May 15th, 1998.
If you have any questions, please contact me at 337-6179, or 244-9612.
assistance.
Sincerely, /~
Jeffr~ I~ · M.S.
Princi d ~ O-.q'
Thank you for your
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
017-361 -26 HAA#
1. GENERAL INFORBiATION
Complete legal description Lot 4; Block 6; McMahon
- RELEASE OF CONDITIONAL
Subdivision #1
Location(siteaddressordirections) 3900 Doroshin
Anchorage, AK
Property owner
Mailing address
Lending agency
Mailing address
Agent Shari
Address
Steve Gilbertson
3900 Doroshin
Day phone
Anchorage, AK 99516
Day phone
Boyd/ Jakc White Real Estate Dayphone 762-5863
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
xxx
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 ver!fy 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 :this inspection.
Name of Firm A'ltaska Water &
z~ nchora~e~ ¢~'lasEi~, ~9 '
Address ~ ,¢}~, /
Engineer's signature r~ :/~//}~"--
/ / //
le Phone
SIGklATLIRE
Approved for
bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Note: The wel]. for this property meets existing State and Municipal Codes.
--T~a-r-e~r~--n:£.~-t~s-9-r~os~n.t. I-t--i~--s~s4;e~d tt~per~,~ ~t~ng he
performed to insure the wells continued suitability. Current nitrate
~~'~~ ~/i~--E-PA n~i conce~tr~ion is l~mg/l.
More information on nitrates is available from the On-site Services Program,
Additional Comments
By: ¢' _] .
The Municipality of Anchorage Departrnent 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. 1/91) 13ack MOA ¢¢21
Legal DescriPtion:
Municipality of Anchorage R E C E IV
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division JUN 2 2 39
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Municipality of Anchorage
Dept. Health & Human Services
Health Authority Approval Checklist
A. WELL DATA
Well type ¢) Pn}x/A'TF-
Log present (~TN) ~E'~
I
Total depth ~o t
Sanitary seal (~N) ~/~:5
Date completed
Cased to ~c~ ~
If A, B, or C, attach ADEC letter. ADEC water system number /'~
Casing height (above ground)
Wires properly protected (~/N)
Date of test
Static water level
FROM WELL LOG AT INSPECTION
Well production
WATER SAMPLE RESULTS:
Coliform ~z~
Date of sample: -~/~/?-~
B. SEPTIC/HOLDING TANK DATA
Date installed 3,/~/w ~, Tank size
Nitrate ~" ~ q . r~/t.. Other bacteria
Collected by:
Alaska Water & Wastewatet
7320 East Chester Hts. Circle
Anchorage, Alaska 99504
Number of Compartments
Foundation cleanout (~1)
Date of Pumping /~J 15 ~
C. ABSORPTION FIELD DATA
Date installed · ;
Length ~ o'(1'~ ~'e¢'~i Widthr
Effemive ~so~aon area
Depression (Y/I~ ~Jo
Pumper
Soil rating ~ or-~t~m) I. 2..
High water alarm
Date of adequacy test
System type
Total depth
Gravel thickness below pipe
Monitoring Tube present (~N) '~e.s Depression over field (Y~I~ /~J ~
ResUlts (Pass/Fail) For Lfl¢ bedrooms
Fluid depth in absorption field before test (in.); "'-" Immediately after ~ gal. water added (in.):
Fluid depth ~ (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
Absorption rate = q.p.d.
If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed Size in gallons
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation '2_ :~ i ~ Property line ~'
Water main/service line Io I+ Surface water/drainage IOo~+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line I c>
Surface water Io o{ -f-
Curtain drain I~ o~e
Building foundation
Absorption field
Wells on adjacent lots I°c) i+
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots I oo~
ENGINEER'S CERTIFICATION
I certify that I havtdetermine~ru field inFp~ctions and review of Municipal records that t~h~..~t~s~tems:are
in confo~an~ith MOA ~ g~li~e~ i~effect on this date.
Engineer'~me ~ff~ / ~/~f
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
· .Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
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 allow ten (10) days for processing.
1. PROPERTY OW~R~~ PHONE
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS
3. LENDING INSTITUTION J PHONE
I
MAILING ADDRESS
4. REALTOR/AGENT J PHONE
MAILING ADDRESS
STR RET LOCATI ON
6. TYPE OF RESIDENCE
~SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OFBEDROOMS
[] One ~ Four
[] Two [] Five
[] Three [] Six
[] Other
7. WATER SUPPLY
~ INDIVI DUAL* * ATTACH WELL LOG. A well log is requ'ired for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTILITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~IN DIVI DUAL/ON-SITE** **If individual/on-site, give installation date ~
If system is over two (2) years old an adeqL~oy test is required
[] PUBLIC UTI LITY by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED.
72-O10(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DA"rE DATE DATE
I NSPECTO R 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
[] I NDI VI DUAL/ON -SITE DATE INSTALLED
[~l PU BL. IC UTILITY ~¢-.-~ ~ ~).
Connection Verified INSTALLER
[]Septic Tank or []Holding Tank
Size: !.,3.~"~ If Tank is homemade
SOILS
RATING
give dimensions; ~.
TYPE OF TANK MANUFA.~R.E~R. A
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line t Nearest Lot Line
WELL TO:
~bsorption Area to nearest Lot Line
5. COMMENTS
I~"'~APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED //~
DATE BY (Title)~_,
LEGAL DESCRIPTION
72-010 (Rev. 3/78)