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HomeMy WebLinkAboutMCMAHON #2 BLK 8 LT 5 Municipality of Anchorage Page I 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 Name: ~ ~ Wastewater System: ~ New ~Upgrade A~ss: ABSORPTION FIELD Phone: ~. ¢~ ~No. of Bed~oms: ~DeepTrench ~ Shallow Trench ~Bed ~Uound QOther Total Depth from original grade: LEGAL DESCRIPTION s°" Rating: O, ~ GPD/Sq. Ft. ' Subdiv~ion: Dap h o pipe bottom from original grade: Gravel depth beneath pipe Township: ~ Range: ~ ~ Section: ~ Fill added aboveo,~original_ grade:[.~ Ft. Gravel length: ~ J Ft. I WELL: ~ts~ New ~ Upgra~ Gravelwidth: Number of [ines: Distance between lines: Classification (Private, A,B,C): To~l ~ Cased To: Total absorption area: Pipe material: ~ ¢~ 0-~ Driller: ~ ~ D~te Drilled:~ump Set at: Static Water Level:Ft. Installer:~ ~* Date installed: ~ /]/ Yield: Casing Height Above Ground: TAN K ~ GPM I Ft. Ft. SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P. TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ~ N~ ~ ~ ~ ~ ~ ~ ~O ~ Material: Number of Compa~ments: Surface ' ~ LIFT STATION Water Ioo]~ )oo · ~ ~ LineL°t ~0~ ~t ~ ~ ~ Size in gallons: Manufacturer:~ at: High water CuAainDraiR ~ -- ~ o~ ~ ~b ~o~ ~ p~el Electrical Inspections pedormed by: Remarks: BENCH MARK Location and Description: Assumed Elevation: Inspecti0nsperf0rmedby~AssNs;;;===:~:c Datos:~st ~/~/~ 17034 ;~gme River Loop Road, No. 204 2nd ~/'/~* ~ ~ ~ ROBERT. C. COWAN uepar~men; o; Heal--Human Services approval ,,./.~.~- ......... .. Reviewed and approved by:/~ Date: ~-/~-~g 72-013 (Rev. 9/91 ) MOA 25 Permit No. 2 2 $w960197 Page of 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 LOT 5, BLOCK 8, McMAHON S/D //2 017-361-46 Legal Description: PID No.: FCO 2' 23, - ST1 21 ' 51.5' - ~" -- ST2 28.5' .59' - DBL2 31' 42' _ WELL FD 32' 42.5' - C01 - 1.52' 166' MT1 - 128.5' 163' C02 - 85.5' 116' ~) FLOW /ALVE (FD)  * ~EXIST 'RENCH *"~ ~'''~' A~ANDONED AS SU ;H THAT IT ~Y BE USEB IN 'HE FUTURE. COiMTcB+86.8'/ sc~ ~~" = 40, ,STB C02 t 8~7~ ~ GRADE~ ~ ~Y / C02 = 84.0 ~.~¢/;,;~---~ ..... i~ % ROBERT C. COWAN 70.0' B.O.H. 72-013 A (Rev. 9/91 ) MOA 25 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 NUMBER:SW960197 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:KEN EVANS OWNER ADDRESS:12601 ELMORE RD. ANCHORAGE, AK. 99516 PARCEL ID:01736146 PAGE 1 OF 1 PERMIT DATE ISSUED: 7/16/96 EXPIRATION DATE: 7/16/97 LEGAL DESCRIPTION: MCMAHON #2 BLK 8 LT LOT SIZE: 37961 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 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 (iSAACS0) . 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:f !v~. ~ f/~t[~~ ISSUED BY: _. -. DATE: DATE: ROBERT C. COWAN, RE. ROBERT A, SHAFER, RE. June 28~ 1996 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD OESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 5, Block 8, McMahon Subdivision ~2 Request you issue a permit to upgrade the septic system serving the existing four bedroom house on the referenced property. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered and atfer seven day ground water monitoring, the monitoring tube was found to be dry. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. The proposed 1250 gallon septic tank is to be placed outside the well protective radius. Attached is a site plan which depicts the location of the proposed tank. If you require additional information, please contact us. Sincerely, ' o~ert C. Cowan, P.E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP ' SUITE 204" EAGLE RIVER, ALASKA 99577 1"=50' F- O .~q ('00] SITE PLAN DESIGN 100' WELL RADIUS z ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS HEALTH AUTHORITY ~PROVALS SEWER&WATER MNN EXTENSIONS SEWER&WATER iNSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSIYE WASTEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS (907) 694-2979 FAX (907) 694-1211 ~EFERENCE: Lot 5, Block 8, McMahon Subdivision #2 June 28, 1996 }ENERAL= The scope of this project includes the installation of a 1250 gallon septic tank and a leachfeild trench to serve the 4 bedroom residence located on the referenced property. The existing trench is to be abandoned as such that they may be used in the future. The existing 1250 septic tank is to be excavated,. pumped, crushed, and abandoned completely. e Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. e The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. ~EPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. e The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA99577 Page Two Lot 5, Block 8, McMahon Subdivision ~2 June 28, 1996 De e Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3e A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. e Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 5, Block 8, McMahon Subdivision ~2 June 28, 1996 De Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2o The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 0 Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 0 Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Be A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 5, Block 8, McMahon Subdivision ~2 June 28, 1996 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. e The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 5, Block 8, McMahon Subdivision #2 June 28, 1996 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ROBERt C, COWAN .~',~'~ ,~ ~: ec nSO1 PERFORMED FOR:'/[~ f~ ~4~ -~ DATE PERFORMED: ~'7O~o'r~' LEGAL DESCRIPTION:~~7~ ~ ~ ~ J~J~'¢ ~ownship, Range, Section: 5 6 7 8 9 10 11 13 14 15 16 ~ 17 :~.., 20- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE SITE PLAN I Deplhto Water Alter 'f~t~-y Monitoring? Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '-~ FT AND ~' FT COMMENTS PERFORMED BY' $ & S ENGINEERING · CERTIFY THAT THIS TEST WAS PERFORMED IN · fT~-4~op Ro.d .o. 2O4 ~"" ' "' 7 / ~/rd C~ ACCOROANCE WlTl'~Lj~S~"e,~f~pa~/~J~l,~F GUIDELINES IN EFFECT ON THIS OATE. DATE: 72-008 (Rev. 4185) ~--,MUNICIPALITY OF ANCHORAGE3~, " Hea _h and Environmental Prote ]_on ' Fourth Floor West 825 L Street Anchorage, Alaska 99501 26~-4720 INSPECI'ION REPORT ON~:~llr: i)ISPO2AI, NAME._ /~-~~ M/",ILING ADDRESS --.~-~-~----~--~-~-O~-'~ Pi'iON5 SEPTIC TANK:: DIS]AIWCEj t~ ~ ..,,~.~//~1 ~ NUMBER OF INSIDE LENGTH INSIDE WIDTH__ LIQUID DEPTH ........... LIQUID CAPACI-I'Y~ GALLONs. TILE DRAIN FIELD: ~ .- . I ¢ / . TOTAL LENGTH / ~ of Lines .... /..__ O,STANCE [3[:TWEEN L,N~S _~ .... TmCNC,~ wuwrH~,N. TOTAL EFFECTIVE ; ABSOnP'IION AREA ~ SQ. FT. LENGIIt OF EAClt I.INE ~ * DEPTI] Of- FILTER DEPili: ~QP OF TILE 10 t tNIStt GRADE fi' MA-FERIAI_ BENEA1H T1LE__~___IN. ABOVE TILE 7 IN, SEEPAGE PIT: Log Crib DI/:xMETER ..... OR WIDTH ..... ~_~ ..~,,, ...... DEPTt4 Rings Crib Size: DIAMETEFt ........ DEPTI.I ........ OISTAfqCE FROM: WELL TOT,Z~,L EFFECTIVE BUll DIF~G FOUNDATION NEAREST t OT LINE ABSORPTION AREA (WALl. AR~.A) ................ oQ, FT. ~ell ~ ilass: Depth: ~ell Distance To: Lot Line ~-ldg: Sewer Line: ~ipe Materials: ~/_~{-P~L~_ . of Bedrooms: ~ installer:~~~, ~emarks: i _ iE G R L, I':::U T C H iL::F;: L. 5 i::: 8 i"!!3h'iRHON ¢' 'i'HE i....Ei'.a3'rt--~ D :( htEN~.:, ~ ON ):% T'HE LENGTH ,;: ~; N FEET ::, OF THE TF;:ENE:H OR Di;;:R ;!: NF' ]: EL.D. THE DEPTH OF R T'RENCH (:)i~: F:']]T ]:S THE: DZ[t~;TFINE:E E:E:q"HEEN THE SI..JI:~:FRCE OF THE Gi;;:OLJBID A?.4i:::, THE E:OTT'OH OF' 'THE EXCRVAT]:Ohl ,:: ZN F'EET). "ii.4Ei(:E ):5 NO SET i4ZE:,TH FO[;~: 'TRENCFtES. THE G~RR¥%I... DEEF'"i"H ;!:E; T'HE i¥iZNZJ'it..ihi DEP"FH QF G~:RVEi.... BETHEE:N THE FiND THE BOT'i'Oi"i Oi:: THE EXCFtVF:iTZON (]:i",J FEET). R i;,R(:.:k:t!iGl:f; F:'LRNT !"'iW.? E:E :i:f4rE;'TFt!_!..E[:) R"F THE PEK:I',iZ"i'TEE"~E; OP'T'I(:ii'.4 :~:.:,LiB,:[EC:'i" TO 'T'HE ::L. E):'FF.IiEF, i: B CL...¢:E-SS :( OiR ):]. NSF RPPROVED I::I COi'.4T.):i'qi. JCjLi% f,IF-I:i:i'4-i"ENRi'.~CE P, GREEHENT Z'.5 F,'E:6!UZI:i?.E[.':,. ZF:' FI h/FIZN'T'[~:NRNE:E: !aGREEi','iENT ]'% NOT i..'.'.'E:PT' C':LiRREi'.iT t::iBS(EIRI:;;'T]:Of.4 S'~.'S"l"Ef"'i RhiD,-.'"OR ;T'O[..I E',F:i(31.::]F' ]: LL .T.. has (::iF i::'!N¥ ~.~;'¢!L:;TEi'"I H :[ THOUT i:' :[ NFiI... :I: i'.,Lc Pt:/CT ]: E i"! Rf-,E:, RF'PF.'.OVP, L. Et'.¢ "f'H :[ % E:,EF:'Fif;.:'f'i"'iE:hiT H :i: L.I... E:E :}-];L!E:..]'EC'T "t*Q PROSEE:L.iT ]: ON. i"'i:!:i'-,i:!:i'"ii..JhI DZEi;q"F.i?.~.CE E;E:THEEN !::i HEL..L. RND FIN'-? Ot'4,---::~;Z'FE :.2;iE:HFt6E FEE']" FOR R PR]iVFi"!'E NELJ... OR ;~:i;~fi(i:.i FEET FOR R F:"iJBL~[C t4EL. i .... L.OGS FIRE: REg!Lili:;?.[.-':i:':, FINE:, F'iU.'.:_;'i' i¢.~i:?: F.-::E'i"UF;:iqFE[;:, TO 'THE E)E:F'Ri:RTPIENT HELL.. COi'iF'L.~:T .i: RE(;:!i.J Li: REf"iENTS i"IR'¢ RPPI.._¥. SPEC ): J::' L( E:RT ij Oi',iti.:.; laN[}, CCiF,IISTRLJC'[' .1.' Oi"4 E.', ]: REiFi:F:iI"!:.:.:.'; FIRE j...I::IE~[...iE 'i'O ]: NSURiE i::'ROF:'EF.: ]: N$"FI::H...L. RT :i: :j..: Lr Ri"1 FRi',I.(LiRR HJ:'Ti4 THE REi:;!U]:REi',IEN'T'f~; FOR ?Oi;~:'i'H BY THE kiUN:[C:[P[a!..Z'¥¥ OF RNE:HORR6iE. ;;;~: ): HZi...L. :(NSTRL_L. THE ~;'¢STEi',t ):N RCCORDRi'.4E:E Hi'TH THE CODES. :~:: Z UNDER:E;TR~-4D THRT ']"HCJ~: ON--%Z*i"E 5EHER ¢~;'¢:E;TEI'¢i hiW'r' !RE~;!U :i: RE ENL.F~RGE:t'dENT :[F THE l)e.'~rtment of Health and Environmen~--~Protec/ion 2516 E. Tudor Road Anchm'ag'e, Alaska 99507 276-2221 N()ILS hi)il I'EI~()I,A'i'I()N TENT Performed for q~-P ~-(~. 0~,~ :)ate Pcrf'ormcd l'h~s form re~or-ts'--~-~']b}. 9_b~ ..... ~ Percolation-tE~ 5 - 6- 7 - 8 - 9 - Depth 3 - 10- 11 - 12 - 13 - 14 - LOT4- 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.# Oi'7 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING -- 3~ I - H(~ HAA# 1. GENERAL INFORMATION Complete legal description Lot 5; Block 8; ~'~,ahon #2 oubd~.v~s~on Location (site address or directions) 4050 ,~cher Property owner ? ..Mailing addreSs ' 'l~ending agency Mailing address Agent K2,~z Evan~ 1'2601 E.b:.7ore Road Day phone Day phone ~45-5927 Clair Ramse~f/ Jack ~g~:e. Co. Day phone 762-3116 Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank ': COmmunity on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~25 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature S & S ENGINEERING i/04~ ~'agJe River Loop Road No. 204 Eagle River, Alaska 99577 Phone Date DHHS SIGNATURE /~V Approved for z¢ Disapproved. Conditional approval for bedrooms, bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Sen/ices (DHHSI issues Health Authority Approval Oertific~es based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHH$ does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHH$ 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) 8ack MOA MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICE,~N Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES AU(~ 0 7 19~ Environmental Services Division E i 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343 Health Authority Approval Checklist Legal Description: A. WELL DATA Le'r ~'~ ~-ocy_ e~ t'J~¢l'~14o,~ ~7_ ParCeli. D.: 4317 Well type Log present(t~/~) ~-" ~ : Date completed Total depth I "~ ~; ~ ~ Cased to Sanitary Seal (~N) ~,[~ ~,~rE 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 ~ Well production WATER SAMPLE RESULTS: FROM WELL LOG AT INSPECTION ,,/~/~,~ ¥' g.p.m: g.p.m. Coliform 0 Nitrate Date of sample: Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~/~ /9 ~, Tank size Foundation cleanout ~1) Date of Pumping c. ABsoRPTION FIELD DATA Date)nstalled ~' q G, Length' ' ur-/ Width EffectiCe absorption area .--tSb*:l~ Date of adequacy ~est ~ :r'~ '~. uJ Number of Compartments 7,_ Cleanouts(~N)__ Depression (Y~) I~ ~, High water alarm (Y~} ,',J o Pumper :': Soil rating (g.p.d./fF or fF/bdrm) O. ~ (;??/~System type '~ I i~. ~ ~ Gravel thickness below pipe $ Total depth Monitoring Tube present (~N).V~. Depression over field (Y~]) ~o Results (Pass/Fail) ~e'J For Pr Fluid depth in absorption field before test (in.); ~ Immediately after ~ gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = ~ _g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date bedrooms 72-026 (Rev. 3/96)* LIFT STATION Date installed' Size in gallons _ ..._--~ Manhole/Access (Y/N) .-----~3fff'¢-~" level at* *Datum "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~,{holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots I adjacent lots I o~ 4- On Public sewer manhole/cleanout /4//'~ Lift station ~/A- SEPARATION DISTANCES FROM~HOLDINGTANK ON LOTTO: Foundation I '7 ' Property line 5o ~ +__. Absorption field Water main/service line lo 4 Surface water/drainage I o~, I ~_ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property .line Surface water Curtain drain Building foundation Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records t~'~z~stems are in conformance with MOA HAA guj~elines in effect on this date. .,~.~'~ ~..~..-r.~..L.~ _~ x, ~",,~ ",.,...~,/% Engineer's Name 4~¢~ C. 4~ c: cow . Date ~2~ C[-8801 Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF A C O GE '-. ~--"~' % 'i .', Department of Health & Human Serviced .-,~.;~1-t/{~]~-';~v~b~!~..3 ~.~ :~; ~.DIVISION OF.ENVIRONMENTAL SERVICES :-.,-;~ CERTIF CATE OF INSPECT ON FOR H~LTH AUTHOR ~-APPROVAL ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY· DWELLING ~'~ ~r~.=. Description (include I~t, block, subdivision, section, township, range) ' - Location (address or dire'~tions) · :;:~ Telephone:. - Business Lending Institution Telephone Estate Company and Agent Iress . :Mail the HAA to the following address: (or check hereof hold for,, ~./ .,. , , . ~, . ,~..... .~' ',~' .... :j - ::'. X..%.._ .. - ' ':/~?~-~::~List contact person and day phone number below: : .*..:~ '.-::;:T~. / ' ." '--''.; ~ ' -:- ' .... . _ "-'-' .'.':~%?;,L~. 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'. .._ ~ - NOIIY~OdNI QNY V&YO 'HOUYIS 3qld 'SlS31 'SNOIZOldSNI ~NIQIAOUd ~UId ~NIUggNI~N/'g MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: ~"~ Well Classification Well Log Present (Y/N) Y Date Completed Total Depth I q~ Cased to [~,~ Depth of Grouting Static Water Level ~ ~"$"- ~ Casing Height Above Ground If A, B, C, D.E.C. Approved (Y/N) Y Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~,~"" Yield Pump Set At 1 8~' Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) ~J 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 Comments ~ ; On Adjoining Lots % ~ "/'"*~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ',Date 9 '"J e B. SEPTIC/HOLDING TANK DATA Date Installed [~,~7 Size Standpipes (Y/N) Y Depression over Tank (Y/N) i ~ Z.~'O No. of Compartments Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) /%/ Date Last Pumped ,1~ .~ I*~-~) .~~ Pumping/Maintenance Contact on File (Y/N) ~ ; for Holding Tank High-Water Alarm (Y/N) ~'~t~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field -/,iI SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK: To Water-Supply Well ~ ,~ t 1 To Property Line /t~ ~' To Water Main/Service Line ~ ~1~ ~ To Stream, Pond, Lake or Major Drainage Course Comments 72-028 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ "1 ~/ Width of Field Square Feet of Absortion Area ~, OO Depression over Field (Y/N) Results of Last Adequacy Test pA~; ~-~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation ~'~ · Lot To Water Main/Service Line '~ (0 ~- ' To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ~ ~' ~ Depth of Field /~ Gravel Bed Thickness ~" Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~' "~"~· To Cutback (if present) I~ ~ A 8o" Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N)~._, ¢/¢~-~-- Dimensions Manhole/Access (Y/N) "Pump Off" L_e~vvePa~ Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, o~r,~onformed to all MOA and HAA gu?.~elin,,e,s in effect on the date of this Signed / Company ~ "%'-',':~.'~Z~ ¢;':~;~; %~ Engineer's Seal Receipt No. Waiver Fee: $ Date of Payment //~ -~ - ~ Amount: $ //~ ~) ¢ ~ Date of Payment / O/,:~/~' (_.) 72-026 (Rev. 7/88) Back Page 2 of 2 KE KNIEFEL ENGINEERING 8441 Miles Ct., Anchorage AK. 99504 (907) 337-1121 · Fax (907) 338-1874 Date of Testing: September 15, 1990 Legal Description: Lot 5, Block 8, McMahon Subdivision Street Address: 4050 Kutcher Number of Bedrooms: 4 Well Depth of Well: 240' Static Water Level (start) 155.6' Average Flow Rate: 603 ga]./117 minutes = 5.1 gpm Max water depth = 159.6' Maximum flow rate = 6.4 gpm The we]] had a sanitary sea], the electrical wiring was in a conduit, and there was no depression around the well. The top of the well was two feet above ground level. Results of Water Quality Analysis: Total Coliform -- 0 colonies Nitrate-N -- 0.8 mg/1 (10 mg/] allowable) Results of Septic System Adequacy: Total Gallons into system: 603 gallons Maximum rise = 0.60 feet System absorbed all water within 9 hours Septic Tank C]eanout is only 95 feet from well casing All other septic system components > 100 from well. The system passed both the well flow test and the septic system adequacy testing. The septic tank to we]] distance waiver is being applied for at this time. The we]] and septic system were tested in accordance with MOA po]icy and reiu]ations in force at the time of this test. LOT 5, BLOOK 8, MO MAHON SUBDIVISION TIME WELL METER TOTAL DEPTH DEPTH DEPTH READING GALS. TANK CO (FEET) (GALS) (FEET) (FEET) COMMENTS 12:38 155,6 9820 0 7.5 8.50 12:43 159.1 9846 26 ~' 7,96 12:48 159.2 9873 53 " 7,97 12:53 159,2 9900 80 8,01 13:08 159,3 9979 159 " 8,01 13:13 159,3 10005 185 " 7.98 13:28 159,3 10087 267 " 7.98 13:43 159,3 10165 345 " 7.98 13:58 159,4 10248 428 " 7,75 14:13 159,3 10329 509 " 7.60 START Second faucet turned on at 14:15 to draw down well. Maximum flow rate with both faucets on was 6.4 gpm. The well dropped to 159.6' depth with both faucets full open, The flow through the meter to the drainfield dropped to approximately 4 gpm during this period. The second faucet was closed at 14:27. 14:28 159,3 10388 568 7,48 7.40 Stop Water 14:35 159.2 10423 603 14:40 155.6 7,49 14:50 155.6 7.50 15:00 155,6 7,55 15:15 155,6 7.61 23:05 155,6 8.02 End of Test Tom Fink, Mayor / lunicipality of Anchorafle Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 October 4, 1990 Robert Kniefel Kniefel Engineering 8441 Miles Court ~- Anchorage, Alaska 99504 Subject: Waiyer Request for Lot 5 Block 8 Mc Mahon S/D ~2 Waiver Request 9WR900044~ PID ~017-361-46, HA900414 Dear Mr. Kniefel: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved° The approved separation distance is 90 feet from well to septic tank. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department° Sincerely, Daniel J. Roth Civil Engineer On-site Services Concur: ~hn Smith, P. - grogram Mana .ger On-site Services ljm: ~6 KE KNIEFEL ENGINEERING 8441 Miles Ct., Anchorage AK. 99504 (907) 337-1121 · Fax (907) 338-1874 October 1, 1990 Mr. John Smith, Manager On-Site Services Program Department of Health and Human Services Municipality of Anchorage 825 "L" Street Anchorage, Alaska 99501 RECEIVED SUBJECT: WAIVER FOR TANK TO WELL DISTANCE LOT 5, BLOCK 8, MCMAHON SUBDIVISION, 4050 KUTCHER Dear Mr. Smith: During the course of performing a Health Authority Test on the above lot, it was determined the well to tank distance was less than the required 100' (95' actual). The purpose of this letter is to request a waiver for the slightly shorter than required distance. The septic system was installed in 1977. The note on the system as-built required a 100' setback from the well to the tank. This leads me to believe the well was installed after the original system was approved. A review of the past records shows the last Health Authority Test was performed in March, 1985. At that time the application noted the well was 100' from the septic tank. The area from the tank to well is clear of any blockage and the distance was taped directly between the two items. As noted on the attached water analysis results, the well has no signs of coliform and a low nitrate reading. The top of well is approximately seven feet higher than the ground at the septic tank. The general slope of the lot is such that the well is on the high portion of the lot with the tank located downslope from the house and well. From the information available, it is requested that DHHS grant the waiver for the tank to well distance. This home is closing a sale on October 12th, and we would appreciate having'the waiver and HAA approved before that time. If you have any additional questions or comments, please don't hesitate to contact us. Respectfully Submitted, Kniefel Engineering Robert Kniefel, P.E. QO ~ O~Tn-- 1777 /~ ,47' T'I4E L~ EL L. I~"a~ ' $7-ar~r_-. o2~* 7 = 7.2? .2. RI 2.? aF 2.4 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRON-MENTAL 6EALTH DEPARTMENT OF ~-~ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR ~ALTH AUTHORITY APPROVAL CERTIFICATE General Information Application DaCe 26 /March, 1985 (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 5, Blpck 8 McMahon Subdivision. S~c~ 28 T]?M~ R~W Location (address or directions) 4020 Kutcher Dr.. Anchora~.e. AK (b) Applicants Name Steve Frost Telephone - Homes45-5323 Business 563-030B Applicants Address 4050 Kutcher Dr. (c) Applicant is (check one) Lending Institution Buyer ~. i Other~ (explain); (d) Lending Institution ~ i Owner/builder~.; Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the H~ to the following address: Steve Frost 2o Type of Residence Single-Family~ Number of Bedrooms Multi-Family ~ Other (describe) __Four Water SupplH ., Individual Well ~ Community ~ Public ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. S__ewage Disposal Onsite ~--~ Public ~ Community ~ Holding Tank ~ Note: If community well system, must have ~rritten confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5o Engineering Firm Providing Inspections, Tests~ File Search~ Data and Information 0 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 Mnnicipality 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 regula- tions in effect on the date of this inspection. ;. of Firm CRW ENGINEERING GROUP Telephone Name Address 3900 Arctic Blvd., Suite 203~ Anchorage, AK 9950~'x~~ DHEP App=oval ~/ Approved for /-c:%~'/~ bedrooms By ;-,.~r_ /~L~. 2~L'~ d~ Date .~,/~ Approved ~ Disapproved Condition~- Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF t{EALTH AND ENVIR. ONMEh~AL PROTECTION (DHEP) ISSUES ~ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESEb~- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA° THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDIN~ INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUILRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A® ,,.~-~? iyL~©i'q,','J~['~]' ',L I~'~ j'~;~Z[~O~ · ' 6 I985 ~CIP~I~ OF ~C~GE (M~) CHECKLIST - FEBRUARY 1984 Private Cased to 24" Date Completed '195' Pump Set At Legal Description: Lot 5, Block 8 Mc~mhnn .ql~bdi vi ~inn If A, B, c~ C, D.E.C. Approved(Y/N) N/A 1977 Yield 12 GPM Depth of G~outing Unknown 18g' Sanitary Seal on Casing (Y/N) Yes Yes 'Depression A~ound Wellhead (Y/N)No 100 ' ; On Adjoining Lots 200 ' + Well Classification Well Log P~esent (Y/N) Yes Total Depth 195 ' Static Water Level 176 ' Casing Height Above Ground Elect=icat Wiring in Conduit (Y/N) Separation Distances f~cm Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot 124 To Nearest Public Se~r Line N/A To Nearest Public Sewer Cleancut/Manhole N/A To Nearest Sewe~ Service Line on Lot Water Sample Collected By B. Looney ; ~ate 3/25/85 Water Sample Test Results Acceptable ; On Adjoining Lots 200 ' + N/n Cca~,~ents B. SEPTIC/HOLDING TANK DATA Date Installed 1977 Size 1 ,250 gal. No. of Cc~%3a~tm~nts 2 Standpipes (Y/N) Yes Air-tight Caps (Y/N) Yes Foundation Cleanout (Y/N) Yes Depression over Tank (Y/N) No Date Last Pumped 3/26/85 Pumping/Maintenance Cont=act on File (Y/N)N/A ; for Holding Tank High-Wate~ Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances f~om Septic/Holding Tank: To Water-Supply Well 100 ' To P~operty Line 90' To Water Main/Service Line N/A Course To Building Foundation 15 ' To Disposal Field 24' To Stream, Pond, Lake, c~ Majo~ D~ainage Co~i~,~nts [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 19 ? 7 Width of Field Square Feet of Absorption A~ea Depression over Field (Y/N) No Results of Last Adequacy Test 150 S.F./BedroomType of System Design ?Fench Length of Field 5~' Depth of Field 10 ' Gravel Bed Thickness 6' 650 Standpipes P~esent (Y/N) Yes Date of Last Adequacy Test 3/25/$5 Acceptable Separation Distance from Absorption Field: To Water-Supply Wall 124' To Building Foundation Lot N / A TO Water Main/Service Line To Stream/Pond/Lake/or Major D~ainage Course To D~iveway, Parking A~ea, o~ Vehicle Storage A~ea Cc~mrents To P~operty Line 10 ' To Existing or Abandoned System on ; On Adjoining Lots 80' To Cutbank(if present) 80' N/A D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Din~nsions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pu~ing Cycles du~ing Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conform~=d to all MOA HAA Guidelines in effect on the date of this/inspection. Co, any CRW ENGINEERING GROUP KB1/d5/s Date 3/26/85 MOA No. ST 85-253 [Page 2 of 2] #1: Time Date Insp ~-'~MUNICIPALITY OF ANCHoRAcp~ ~DEPARTMEN, OF HEALTH AND ENVIRONMENT, ~PROTECTION 825 L Street, Anchorage. Alaska 99501 264-4720 Date Received: April 3, 1978 1:30 p.m. #2: Time #3: Time 4-5-78 Wed. Date Date Pratt Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Alaska Statebank Mailing Address: 310 East Northern Lights Blvd. Phone: Property Owner: Ed Herzog Mailing Address: 3. Legal Description: 4: Single Family Residence: (x) Multiple Family Residence: ( ) 5. Well System: Individual well (x) Permit # Construction Phone: 277-3166 Lot 5 Block 8 Mc Mahon Subdivision XNumber of Bedrooms: Three Number of Bedrooms: Community/Public System ( ) Depth of Well 186' Well Log on File Bacterial Analysis Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # Installed 1977 Installer Septic Tank Size /~-~ Manufacturer ~ Absorption Area Soils Rate /~-~ Material Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line ~ag~ Two ~ ~ Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 5 Block 8 Mc Mahon Subdivision Comments: Affadavit Attached:~ Approved: ._~C~ Disapproved Letter Attached: ( ) Date: Department Worksheet: .,.~ i* MUNICIPALITY OF ANCHORAGE ,)°' Department of Health and Environmental Protection / 825 L Street, Anchorage, Alaska 99501 r , 264-4720 ~quest for Approval of Individual Sewer and water Facilities 1. Property owner: 2~ Name of Buyer: Mailing Address: Phone: Lending Institution: Mailing Address: Phone: o Realtor/Agent: Mailing Address: 5. Legal Description: Street Location: Phone: 6. Single Family Residence: (~ Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: o Water Supply:~. *Individual Well (~ Public/Community System If Individual Well, well depth /~ If Community System, name of system 8. Sewage Disposal System: *~n-site System ) Public System ( If On-site System, date of installation: ~'- /~ / *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77