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Home My WebLink AboutMCMAHON #1 BLK 7 LT 1 Municipality of Anchorage Page / of DEFA.q~ MENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519~6650 · Telephone: 343-4744 On-Site Wastewater [~isposal System and/or Well Inspection Report Permit Number: Name: Address: Phone: of Bedrooms: LEGAL DESCRIPTION Lot: Block: I "7 Subdivision: Township: Range: [] New [] Upgrade : Classification A.B.C): Total Depth: i.3riller: e Drilled: PIe Numbe[: (~l."'~ - '~z~ \- \~ Wastewater System: ~ New [] Upgrade ABSORPTION FIELD' ' Deep Trench Soil Rating: 2 Shallow Trench E] Bed RI Mound [] Other I Total Oepth from original grade: GPD/Sq. Ft. ~ / grade: Gravel depth beneath pipe Fill added above original grade: Gravel length: ~.,~ z/, Ft. Gravel width' lber of lines: Distance betwes~ lines: Ft. ~ ion area: Pipe material: ~;~' '7 ~ SQ. ~t. :Water Level: Installer: Ft. Yield: From Well Surface Water Lot Line Foundation Curtain Drain Se/at: I Height Above Ground: Ft. iN DISTANCES Remarks: TANK ~i~Septic E] Holding [] S.T.E.P. Material: LIFT STATIC Size in gallons: "Pump on" level at: Capacity in gallons: Number of Compartments: ) (: High water alarm at; Electrical Inspections performed by: BENCH MARK tion and Description: Inspections performed by: 'J~2A-I~ I~:'A,"r~cH- Dates: lst_.~~ Department of Health.and' Hu,man Services approvm Reviewed and approved by: ~~//~' -'~'"'~ Date: 72-013 (Rev. 9/91) MOA 25 Assumed Elevation: ENGINEER'S SEAL · ,~, cD ~*,,~,,,~ Permit No. Municipality of Anchorage 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 Legal Description: Z.~ 7- / , ~:~.x3¢/(' 7/ ~¢/'~/P,-/q~3~J .~//D PID No.: 72-O13 A (2/91) MOA 25 ENGINEER'S SEAL , ~Vl~ ~ A ,~,~' Permit No. Page ~ of 47/-- Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal Syst,em and/or Well Inspection Report Legal Description: L.///~ ~z /~'¢'c,/~/4<2/~' ,~'/O PID No' 72~13 A (2/91) MOA 25 A ENGINEER'S SEAl. :~ ~ ~AVID P. AU,~AAN J Page Municipality of Anchorage 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 Legal Description: I Ne-u-; "-' I~'~ I I o ........ : ...................... r'"'"~ ...... r Z./.. # ?ye II Monitcr.-ng Tube ......................Septic Tank 72-013 A (2/91) MOA 25 19075225845 P.01 'T.~ DAT~. June~ ~1..t9~5'.' " ' - ' ." '-"~ · ~h~k yOU. 'Gb'O~ge~. ~eas~re:.do~'n'g bu'sines~ ~th~b~! . '..'.... '.~.'. ?"~14 " '-- -:-' '~"L,' ..... :. ' ..~ 8t - 90' Very..'sil.ty-water.'hea~l~K mate~al in a 'fine~,ssnd & gravel un'~l':'~ No mob or demob cost e.r..se~.up;,.c, eSt..Cost CZ drilling:..$~,OO pe~..fO~t x'.~ ~_' 90 feet: $2,160',O0, ' Oost'~-D'f..the 'muni approved well cap &seai '..~8~0...'.~. ':' MEMO RECEIVED Municipality ot Anchorage Dept, Health & Human Services Date: To: From: Subject: Monday, September 18, 1995 Dan Roth David Ausman Lot 1, Block 7, McMahon SD Please f'md attached the revised as-built for the subject property. I corrected the item listed with exception to the flow splitter as:Per our discussions. I also adjusted the elevation measurements so that they all us~ the top of the well cap as control. I appreciate your patients on this one. Please give me a call if there are any other changes that need to be made. Thanks MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950115 DESIGN ENGINEER:POLARCONSULT ALASKA, INC. OWNER NAME:SEIBERT RAIJA K OWNER ADDRESS:12851 KILLEY ST ANCHORAGE, ALASKA 99516 DATE ISSUED: 6/14/95 EXPIRATION DATE: 6/14/96 PARCEL ID:01736117 LEGAL DESCRIPTION: MCMAHON #1 BLK 7 LT LOT SIZE: 27488 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL 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: THE ENGINEER SHALL USE A ZABEL Z200 FLOW DIVIDER OR EQUIVALENT TO SPLIT THE FLOW OF EFFLUENT FROM THE SEPTIC TANK TO THE TWO ~ABSORPTION TRENCHES. RECEIVED BY: /~_~_~ ~_d//t~/~~ DATE: DATE: Zabel Z200Flow Divider° Zabel Z200 D Flow Director BRAND NEW FOR 94 - The Zabel Flow Divider replaces old fashioned distribution boxes and pipe manifolds and The Zabet Flow Director replaces expensive, old fashioned Y-valves. They are also more effective and easier to install. All Zabel products are manufactured from high quality injection molded PVC and carry Zabel's Lifetime Warranty if parts fail due to manufacturer's defect in material or workmanship. The warranty does not include replacement parts not sold by Zabel and does not include labor for removal or reinstallation. 1. The Flow Divide distributes effluent leaving the septic tank by means of a patented central weir design that insures the flow is evenly divided even if the Flow Divider is not perfectly level. 2. The inlet pipe of the Flow Divider is constructed so that effluent will flow from it and down into the effluent into two equal portions. 3. Distributes flow better than D-boxes and mani- folds that are subject to frost heave or ground settling. 4. Testing shows that even with a level discrepancy of 1/8" or more between the right and left port, the division of the flow was almost 50/50. A standard D-box or manifold distorts the flow under these same conditions. 1. The Flow Director is a Flow Divider with a pat- ented sleeve valve installed to distribute the efflu- ent flow to a primary field of your choice and allows the secondary field to rest until needed. 2. The Flow Divider automatically back flows from the primary to the secondary field and does not depend on the homeowner to change the sleeve valve in the Flow Director. A standard Y-valve is dependent on the homeowner to change the flow direction at the proper time. Unfortunately, this usually does not happen and a problem develops such as an effluent break out resulting in ground water contamination. 3. At the time the septic tank is normally serviced, the septic tank service company can redirect the flow allowing the primary field the opportunity to rest. · Manufactured from injection molded PVC. * Always insures an even flow. · Doesn't create solids build up. · Will not clog. · Lifetime Warranty. Laboratory Test Results using 1000 ml samples @ 3 gpm Level Right Port Left Port 1/16" Tilt Right Port Left Port 1/8" Tilt Right Port Left Port Average Distribution 50.03% 49.97% 50.2% 49.8% 51.3% 48.7% Questions concerning Z200 Flow, Divider · Zabel Z2OO-D Flow Director please call 1-800-221-5742 or Fax (502) 267-8801 for further information. Z200-01-11/94 ,' o 06-12-1995 05:09PM FROM TO 3454?86 P.02 polamonsult .alaska, .inc. 'ENGINEERS · $ORVEYOR8 · ENERGY CONE;ULTANTS i RE~CEI!VED· :' ! .JU'N 1 ~ 199§ ' ': : D? 'He~l}h'& Hdma~ ~ervices' . '.. 1 '1.' , ! ..". : ~"';~;~,4 ~':~'. :r~ ~.b_~ '~ '--' '" ' .:: 't '.' '../,: ., ! I' .:. · ::. :'.i"':'~::- ~ ~':.~ :'..;.'.:....! --graF.": '.-:' I ; · ' . ;.',:. ..;,:.'..-' :"-. :'_.-..~.CO:NSD'7.,T ;'..:"'.----.' ....... · : : ' ': '.'-' '.' ~'-'. ......~" - '.-'_-...'; : ;".'~'.~. - :' ' '-':::. ' '-.,.": I - ' .- ' : · :.:~ ' ~ ' ·" ! " - ::" · ..... '. ':}.'. ' · , , ::..'. ::,.-.: . .. · ! .. . ... , :-.... . .J - : .. :.~ . ! j '. ...'.. : · 1-,503'WEST33RD AVENUE ~.SIJJTE 310.:, ANcHoRAGE;. KA:ggS03; .' :. ': -!: .:': Ji . . .-' .' P~ONE'(907'J2~8'2420~TELEFAX(907}i258'2419 · ' '! ', . ! ~ : : i j" ;. ' : : : . TOTAL P. 02 polarconsult alaska, inc. ENGINEERS * SURVEYORS * ENERGY CONSULTANTS May30, 1995 DHHS, Envkonmental Serv~es, On-siteServices P.O. Box 196650 Anchorage, Alaska 99519 Attn.: Permit Review Officer Re: Design and Construction Approval for On-site Sewer System at Lot 1, Block 7, McMahon S/D. Dear Sir, Please accept the following design for review and permitting. The proposed system does not affect the current use of the adjacent properties and will have minimum future impact. If you have any questions, please give me a call. Sincerely, Matthew Korshin POLARCONSULT Attachments: On-site Sewer/Well Permit Application Site Plan, Sheet 1 of 8 - System Design Calculations and Specifications, Section, Sheet 2 of 8 Section & Profile Views, Sheet 3 of 8 Percolation Test, Sheet 4 of 8 Percolation Test, Sheet 5 of 8 Percolation Test, Sheet 6 of 8 Percolation Test, Sheet 7 of 8 Percolation Test, Sheet 8 of 8 $320 Check for Permit Fee 1503 WEST 33RD AVENUE * SUITE 310 * ANCHORAGE, ALASKA 99503 PHONE (907) 258-2420 · TELEFAX (907) 258-2419 · p~larconsult alaska, inc. 1503 West 33rd Avenue · Suite 310 ANCHORAGE, ALASKA 99503 (9G7) 258.2420 Fax (907) 258-2419 SHEET NO I CALCULATED BY //~/~ CHECKED BY SCALE / I/: /"/~ t oFF DATE DATE Z--o"F ~o,,~ :. i~ .............................. 2~;~: i .......... i : ' ; i ...... ~ .............. ~ ~ ~ ; : .......... ..... .......... ........ ....... ...... ~=n~ M~icipa~...of.~=ho~e...desi~ r=q~..... ~al=co~.ioff~. nO._w~W,., expr~s.., o~...~plie~, o~.peffo~=~ .or .- lo~=vi~ ofth6~ . sys~e~ ~d is noi responsible for ~a~=s ~socjated~ wi~: i~ p=ffO~c= or lo~vj~. ~is d=si~ h~ bee~ ~ed on . ..... b~ .b~jL, .If ~.~g cons~cfion~=, so~ == ~nd ia b=. l=~i.favo~l=..~.~=d ~om th=so~I=s~, .th=.system may sreq~ke r~i~ orinot be able to be cons~c~d at all. ~e~loc~ons of~e soils t=s~,imonito~ wells; ~ leachfi=l~ =e approx~ale ~d have be~ verified by ~ rogistered l~d s~yor prior tO site ¢~hning ~"d system, cons~cdon._~Ol~rconsuit.will.nOt bo..r~Ponsiblo.~fo~.- d~ages associated with e~om relat~g to the location ~s~ptions. '~ ' *~1 ~o. ; .p arconsult alaska, inc. T ~ SHEET NO. OF · ' 1503 West 33rd Avenue · Suite 310 ~*/~/~_,~ '' ANCHORAGE, ALASKA 99503 CALCULATEDSY /~ DATE (907) 258'2420 Fax (907) 258-2419 CHECKED BY SCALE DATE cment. MUniciPality ofiAnehorage design reituir~ments. ~olarConSult.ioffers. n6..warranty,...eXPress..or .ira ,lied,. of. performance or longevity o~'th* system and iR not responsible for damages aSsociated witl~ its Performance Or longevity. This design has been Uased on he.built, if.~uring cOnstructiOn the..soils are. found..io be lessi fav0rabl~, than asSUmed from these}testS, th* system.may ;reqUire redesign ornot be able to be ConstrUcted at all. The locations of the soils tests, monitorhg Wellsi anti leaChfields are approXimate and have been .... b~ ~erified by a.registe?ed !and sUrVeyor pti°rt° site. planning and.s]stem coristmctiorL palarconsult will n0t. be rasPonsible for.. damages associated With errors relating to ibc location a~sumptions : :. ; : .p~larconsult alaska, inc. · 1503 West 33rd Avenue · Suite 3].0 ANCHORAGE, ALASKA' 99503 (907) 258.2420 Fax (907) 258.2419 CHECKED BY. DATE SCALE / ~'~/ ..... ~:'~:' ..... ....... ~ · , i :,,,~- ~~'"'""-i ................................ : .......... .......... ' ' ~'"'"F'i'"' ...... ! '" .:. .... ,]~......... }.......I..~... ~U ~ ? ............... ~ ............... : .......... ........ ~ ........................ ............. ~ ............. ........... ~ .......... :. .......... I~ ...... . ......... : ..... ~.~: Z ... ::~ ............ [ ..... ~ ......... :~ ........... ~ ..................................... .......................... ,...._ .......... ........... . ..... ~ ~ .... ........ : .... ..... ................. ~ ............ ~ .... ......... ........... .......................... .......... f ............ ~ .................... ........... ~ ............. ~ ..... { 5'"" '~ ........... ............ .............. :~ .......... ......... ...... , .... : : ....... ............ i.:~ . .......................... ~~~ ~? /0 . )~ ~ : : .......... ...... ~ ....... ~ ~ ~ ~ ; ~ ~'"""~ '":C'[?'/~"~' ~ ............. ................... ....... ......... ......... ]/~ ~ ,,~ ~ : ~ze' '~)~;~ ~ ~ Z/~ ......... ~ ................... ....: : .............. .................. ...... ~ ......... ~ ...... : ................ ...... ~ .......... ~ ~A~;': .......... ?...A.......~;%;.&~;.. ......... ~ ........ .... ~ : ........... ....... ~ ..... ~ ............ .... ; ....................... ; ..... ...~.~.f~].~l.~.~=_....~.~.: ..... ~ : ; ......... ...... ~ .... · .... ~ ...... T' ~'"'T'].[:~;'~'~:':~ '~ ~ ...... ~ . ............ ...... ~ ........ ;....~,~:..~:~.,:~..C[...~.::la~ .~ ~:.~ ......... ........ ~ ............ .... ~ ........ ............. ... ~ ~ ~, :~; ~ ~:~:~:? ~..:?~: ....... i~ .- ..... ~ ....... ........ ~ ......... ........ Septic Ta~k ~on~t ~ng Tube ' ..... ~ ...... :: ........ ~ ............. : .......... :. .......... .... ...... ? ........ ..... ....... ~ ~:: :. ~ ...... .................... ~ ..................... :._... , : ........ ................. ............................................. :. ........... ............................... : ~ ....... ............ ......... d~agcs ~sociat~d with c~o~s ~clat~E ~o tb~ loc~do~ ~p~o~. : : : · PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: 5-- "~-- ~:~-'~ LEGAL DESCRIPTION: ,~O7" / · /-~'/../~ )--~/~,c. pC,~,c~K/Township, Range, Section: -~'/~./~/', 6 7 8 9 10 11 12 13 14 15 16 17 ~o - 18 19 2O SLOPE L SITE PLAN WAS GROUND WATER ENCOUNTERED? '/~/O S IF YES, AT WHAT ,/~//~;~ OL DEPTH? p E Depth to Water After MonitorinD? /,/O /'-,' -~' Dal,: ~-~7-95 Gross Net Depth to Net Reading Date Time Time Water Drop / =j-:5-~/~ /2.? ~,,,~ c~ c:~ ~. ,, / :2: o / / / ~/~ / ~//~ PERCOLATION RATE ~)'e'~-'~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND J~ FT COMMENTS '"[-~-5'~ ~IoL~'-/.,Oc/~r-/o,/~/ I~' ./~0~-¢'* ,~-C~J~.AI'"~¢'- 0/~/ O~tG/J P~-i~N Vl~. PERFORMED BY~Z~.V t[::~ ~ [ ~-~t~!~.~ I ~ ~,.- , CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE. DATE: ~'~ ' ~ ~ 72-008 (Rev. 4/85) Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: /'~ ~/~ ~-'~" DATE PERFORMED: LEGAL DESCRIPTION:~-4~'/, ,~_/,~-'~,.- 5 6 8 9 10 11 12 13 14 15 16 17 18 19 2O Township, Range, Section: '7-1,~../-~t ~'~/,./j ~.~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? /~v"'//,~"'~ pO E Depth to Water Alter ~. Monitorino? /~/'Q"~/~ Date: Reading Date Gross Net Depth to Net Time Time Water Drop ~ 1~ I:Z ;lC> /~ /~//~' I~/1~ ~ /~ / ~.'~o I 0 ~ ~o~ I ~1/~ PERCOLATION RATE /~'° ~,~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' FT AND '~Z FT COMMENTS ~ PERFORMED BY: I ~l~,d' I t'~ I_T~t-~w~ I , CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ _4;;~_....~ ~ 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4-- 7 8 9 10 11-- 12 13 14 ~, O, 1~, 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 COMMENTS Township, Range, Section: SLOPE SITE PLAN WASGROUND WATER ENCOUNTERED7 S IF YES, AT WHAT N/A DEPTH? p E Deplh Io Water After c,.~ ,,j ~'/:2~.~' M0nil0ring? t.,,. -, ~ Dale: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE [ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ FT PERFORMED BY: ~°~ r-~)"rl-CUft~ , ,~ '/~[~'-~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: /-'- /I ~'~, //~,/~d',"L ~,/'~ ORe,-. 1 2 3 4 5 6 7 8 9 10- 11 12 13 14 15 16 17 18 19 20 J~.O.H. OATE PERFORMED: Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? /V/A Oeplh t° Water After D~~ .~/~ ~,/~,.~' Monitoring? Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ///' ~ (minutes/inch) PERC HOLE DIAMETER ~ /~' TEST RUN BETWEEN__3 FT AND ~-/ FT COMMENTS A-5~'~'.fh,~. ~.~,('~--~.~/~.. ¢t'3L [] ~e..~) ~'~E4'-C. t~Jl~y ~S'Ui~-~,,Z~ -~ ~CCO'H~I~ ~ ~ PERFORMED BY: P°//° r'(~",(~ ~f / f , '/~/~"~'. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~'/2~/~ ~ 72-008 (Rev. 4/85) ,j PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7-- 8 9 10 11 12 13 15- 16 17 18 19 20 COMMENTS O~,G-. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: '7-/2A/~ /~..~,'V) ..~-~,. SLOPE SITE PLAN WASGROUND WATER NO ENCOUNTERED? A S IF YES, AT WHAT /V'/,/~ DEPTH? p E Depth t° Water Alter~,.-~a ~'/~Z ~b~ Monitoring? ~ '~ Date: 5AA1 ,= Reading Date Gross Net Depth to Net Time Time Water Drop ?~o~K ~/~/~ /~o - - - ,. I I Z:oo 0 Z" - 2.1 z : o ~ ~ 2. ,'/')~ ,, ;~ ,, ~ ~:~8 Z ~" ~" ~" PERCOLATION RATE <~ (minutes/inch) PERC HOLE DIAMETER &// TEST RUN BETWEEN ~ FT AND /O . FT ACOOROANCE W,T. A'L STATE AND MUN,CIPAL ~U,.EL,.ES,N E~"ECT ON ~H'~ O^TE. °ATE: 72-008 (Rev. 4/85) . - ~ MUNICIPALITY OF ANCHORAGE -:~ ":~ '. I~'~J~l ~ DEPARTMENT OF HEALTH & HUMAN SERVICES '-'*:'" ~-* ~" : L~ '-' Division of Environmental Services --- :: "-' ..-~--i'. ;/";.'~" ~ ' ::;.'.-- -' On-Site Services Section P.O. Box 196650 ' Anchorage, Alaska 99519-6650 ~ :-:~ ' .' CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL INFORMATION ...... L Complete legal description Lot I; Block 71 McMahon S~bd~vZ~Zon #1 Location~i~ite address or directions) .... Property owner~''' -_T._T. HO~ES Mailing'address ~ 'P.O. Box 241488 Lending. agency "~-'~ ~:':-Mailing addreSS .... . '~.'- - .: Agent Furrow CrcCk Rd. and K~l~y Rd. An~horaq~' AK Anchorage, AK Day phone 522-5855 - 99524 Day phone Day phone '/~ ":': '- ' .......... : :;.~' .. ._<,~. ...... ~.:,. ,.,,--~,.. ., ;,.?:': ........ ~?:..., ,: ..... . . -., -. .... ..~ .,~ ...... ...... NOTE: .If commuei~ well system, provide wri~en confirmation from State "-: ..... '~ . ~". ing to the tegali~ and status of systemL' ~ E OF W STEWATER DISPOSAL. .,.. .' _ 'NOTE:- -'if CS~bni¢ ¢~eCa'~er=s~S*i~}~?O~i~e'~iRen ~onfirmation ~5~m a.eo.nu" "" - to the ~ " "~',e~a,,,z and status of system .... STATEMENT OF INSPECTION BY ENGINEER ~, .... As certified by my Sea 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 th~ 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 inves.ti_,gation 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. s & s ENGINEERING Name of Firm ~vu=4 ~,gie ~<tver Loop Address :~.a~jla Riv~, Alaska 99~ Engin~ssignature ~~ ~' Phone Date 6. DHHS SIGNATURE ~.~'* ,.- - ,,...~... d,.~"'",,~. ,. ' Approv~ for ~ bedrooms. - ..... . .... Conditional approval for ,,,, .c.,:, ' - . ~.; b~rooms, with '4he 'following stipulations: ..... Additional Comments conduct In~tions or analyze data before a ce~ificate i~ i~ued. The ~unicJpali~ of Anchorage i~ not re~ponsibie for erro~ or omissions in the'profe~ional eng~n~¢~ work. ~ · ' Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description: A. WELL DATA Well type Log present (~Iq) Total depth Sanitary seal (~q) Health Authority Approval Checklist 8k~c~: '7 /~.~,~t/o~ parcell. D.: OI7 ~ ~GI --I '-] Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: IfA, B, or C, attach ADEC letter. ADEC water system number DatecompletedO~¢~o /o /G/q~ Cased to / ~ o / Casing height (above ground) Wires properly protected AT INSPECTION O Nitrate 0. I 6 Other bacteria / 0 /! Y- / °1 ~ Collected by: S & S ENGINEERING FROM WELL LOG B. SEPTIC/HOL-D'It~ TANK DATA Date installed ~ //6//q~- Tanksize I~t ~'O Foundation clean0ut,~/N) ¥ ~ 5 Depression (Yf~ Date of Pumping ~ / $ - ~ ~¢ Pumper ~ 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Number of Compartments ~- Cleanonts ~q) yt~j ~t O High water alarm (Y~) ~ O C. ABSORPTION FIELD DATA Date installed ~/t6 /q3'-' Soilrating~rfl2/bdrm) O~ Length ~l L~ ~9 t~,~.Width ~' Gravel thickness below pipe Effective absorption area Date of adequacy test~/A System type Total depth 7. ~- ' Fluid depth in absorption field before~ Fluid depth ~ later: Pe~eatment (past 12 months) (Y/N) Results (Pass/Fail) For~ bedrooms ~ gal. water added (iii.): Absorption rate = g.p.d. If yes, give date 7 S-O Monitoring Tube present(~Xl)¥~ $ Depression over field (Y/~ ~ O D. LIFT STATION Date installed Manhole/Access (YFN) ~l at~ ~ "Pump off' level at* High water a~ *Datum Cycl~l~ SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/l~9,di:hg tank oil lot / Absorption field oil lot ,/ 0 0 -/' Public sewer main tv Sewer/septic service line ; On adjacent lots : On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/ ......... TANK ON LOT TO: Building foundation c~ Property line ~ q Absorption field '~ 'J-- Water main/service line [ o /- Surface water/drainage /0 0 -P Wells oil adjacent lots / o 0 -/-- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain t~ ~,, 4, Water lnain/service line ! 0 r _/._ r' Driveway, parking/vehicle storage area /O ! Wells on adjacent lots / 0 0 Property. line I q F. ENGINEEWS CERTIFICATION ....... 1 certify that 1 have determined thrufield inspections and rev,ew of Muntctpal records in co~&rmance with MOA ~A~ guidelines in effect on this date. Engineer's Name ~0d~aF (. ~0~4~ HAAFee $ ~' ~* ~ Waiver Fees Date of Payment . Date of Payment Receipt Number /~ ~~ Receipt Number Rev. 8~95 OSS: haa.wk.doc CT&E Ref.~ Matrix Client Sample ID Client Name PWSID CT&E Environmental ServiCes Inc. 95,4586-1 L1 BLK9 MC~ON Laboratory Division -~ ........... Laboratory Analysis Repgft' RUSH 0~de~ 18914 P~inted Date 10/18/95 ~ 09:42 Collected Data 10/15/95 ~ 11:00 Received Da~e 10/16/9~ % 10:30 Taohnioal Director ~T~PHBN C. EDE San~[e Rema~ks~ ~MDL~ COLLeCTeD RY: BOB C. QC Allowable ~x%, Anal Parameter Reeulne Qual Unl:e Method Lim~=e Da~e Date Init N~trate-N 0,16 mg/h ERA 3~3.2 10. 10/16/95 CMR ~ Bee Special Ins~rucul~n~ Above UA - U~avatlabl~ ~ Undetect%d, Reported value ls t~e practical ~nttfication limit, bT ~ ~ Than ~- Secondary d~lutlon. ~T - Grea=er Th~ 200 W. Potter Drive, Anchorage. AK 99518-1605 .,-'-Tel: {907) 562-2343 Fax: (907) 561-5301 ENVIAONMENTAL FACILITIES IN ALASKA, CA[JFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI. NEW JI~I~$EY, OHIO. WtST VIRGIN[^ ~0~ OE&'ON 1IEI~69~.06 ~ ~NIISBI ~ID~B~WOD ~I:0I