HomeMy WebLinkAboutMCMAHON #2 BLK 8 LT 7
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
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: $[4/~)~ OO~'~ PIDNumber:
Name;
~v'¢lf-~n /.,, ~ ~¢~ c~ Wastewater System: B New. ~ Upgrade
Address:
~1~0 ~c~er D~.~ Anc~ ~¢1~ ABSORPTION FIELD
Phone: 3 ~-- ~ Z ~ ~ No. of Bedrooms:
~ ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other
LE GAL D ES CR I PTI O N so, Rating~ Total Depth from original grade;
Lot: _ 7 Block; ~ Subdivision:~ ~ ~¢~ ~ Depth Io pipe~o~bollom~from original grade: Ft. Gravel depth~,~beneath pipe Fl.
Town'hip: I Range: ISection: Fill added above original grade: I Gravel length: ~O
~ Ft. Ft.
Number of lines: Dislance be[wee~ lines:
WELL: ~X~ST D New D Upgrade Gravelwidth: ~ Ft. i ~ Ft.
Classification (Privatej A.B,C): Tolal Dffpth: Cased To: Total absorption area: Pipe material: ~
Driller; Date Drilled: SlalicWater Level: Inslaller: Date installed:
Yield: Pump Set at; Casing Height Above Ground:
~.~ ~. ~. TANK
SEPARATION DISTANCES · Septic ~ Holding ~ S.T.E,P.
To Septic .Absorp on Lilt Holding )ublic/Private Mannfact~rer: Capacity in gallons;
Material:
Well j~$l J30~ -- -- IIO' ~1 Number of ~mparlments:
Surface
Wate~ >Wo' >~oo' - - - LIFT STATION
LineL°t ~l{ j~l . -- . Size in gallons: [ Manufacturer;
I
Foundation ~ ~ t ~ ~ , , . -- "Pump off' level at: ~ "Pump off" level ah High water alarm at:
Curtain Pump Make & Model ~ Electrical Inspections performed by:
I
Remarks: Cp~ ~ ~nx~llt~ ~er ~K BENCH MARK
Inspections perform'ed ~' ' 14530 Echo Street Dates: 1st ~/t 19~ ~/.~.,~?
Department of Health~d Hu vioe~ approval ~ .~,~o~
PERMIT NO: SW950056
PID NO: 01736148
SWING TIES
FROM: A' B C
TO
C.O. D 25 36
C.C. E 3O 42
C.C. F 33 47
C.O. G 4O 2O
M.T. H 42 43 ,
C,O I 56 69
PLAN VIEW
SCALE: 1" = 30' - 0"
KUTCHER DRIVE
WELL
PAGE 2 OF 2
""" ~ HOUSE
TBM
NEW 1000 GAL.
THEODORE F. /.AOORE
CE - 3589
,o% SEPTIC TANK
NEW 50 LONG SOIL B ~ /
ABSORPTION TRENCH / ~ ~
" BOT,
~ T.H, #1
79.6
(DRY)
ORIGINAL GROUND ELEV 98.9'
BO'I-rOM TRENI
PROFILE VIEW
NOT TO SCALE
INV.
94.1'
1000 GAL~
SEPTIC J ~__INV.
I 94.3'
LOT 7, BLK. 8, McMAHON S/D #2
SEPTIC SYSTEM UPGRADE
AS-BUILT INSPECTION REPORT
FLATTOP TECHNICAL SERVICES SCALE: AS-SHOWN
14530 ECHO STREET DRAWN BY TFM
ANCHORAGE, ALASKA 99516 MAY 4, 1995
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HO-MAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NLYMBER:SW950056
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:LAWRENCE WELTON L
OWNER ADDRESS:4140 KUTCHER DR
ANCHORAGE, AK 99516
DATE ISSUED: 4/25/95
EXPIRATION DATE: 4/25/96
PARCEL ID:01736148
LEGAL DESCRIPTION:
MCMAHON ~2 BLK 8 LT
LOT SIZE: 26762 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MI/NICIPAL 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:
A BULL RUN VALVE OR EQUIVILANT SHOULD BE INSTALLED DOWNFLOW
OF THE NEW SEPTIC TANK SUCH THAT THE OLD TRENCH CAN BE
ISOLATED FOR POSSIBLE FUTURE USE.
PH: (907) 345.1355 Ap~ 21, 1995 ~CHORAGE, ~KA 99516
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application for a
permit to upgrade the wastewater disposal facilities on Lot 7, Block 8, McMahon S/D #c2, located at 4140
Kutoher Drive. The original soft absorption trench failed to pass a recent adequacy test. Soils logs, perc
test results, sieve analysis results, a site plan, design drawings and specifications are enclosed.
The proposed system will be constructed in the vicinity of test holes #1 and # 2. As can be seen from
the soil logs, the native material between 11.25 and 16.5 feet below ground level is a coarse gravelly sand
with a measured perc rate of less than 1 minute per inch. The enclosed sieve results performed on a
sample of the material removed from the actual perc test hole show it to be predominantly sand; therefore
no additional sand filter should be needed. Using the soil application rate of 1.2 gpd/sq, ft. specified in
the wastewater ordinance, this 3 bedroom residence requires a total absorption area of (3 x 150)/1.2 = 375
square feet. The proposed 47 foot long trench design with 4 feet of sewer gravel beneath the horizontal
distribution pipe has a total absorption area of 376 square feet.
The only suitable soil stratum encountered during the soil exploration work begins at 11.25 feet below
ground level. By digging himself a lower platform, the backhoe operator was able to extend the depth of
test hole #1 to 19.3 feet below ground level, which is approximately 3 feet deeper than the machine can
normally dig. This test hole penetrates 4 feet below the bottom of the proposed trench, and no sign of '
bedrock or impermeable material was encountered. The enclosed well log for this property shows similar
material extending to 22 feet below ground level. Given this data, coupled with the fact that it is not
practical to dig a deeper test hole, we are requesting that you waive your cun'ent policy of requiring that the
test hole be dug to 6 feet below the bottom of the proposed system.
The test holes were excavated in the midst of breakup after a particularly heavy snowfall year. Some
minor water seeps were encountered in the vicinity of a shallow restricting stratum, however they did not
represent groundwater. Not unexpectedly, a couple of inches of water was observed in the bottom of
each monitor tube seven days after the test holes were dug. We believe that this water is attributable to
surface meltwater washing silty material down through the recently excavated soil into the bottom of the
perforated pipe, and do not feel that it should be classified as groundwater for design purposes.
The topography of the lot is basically level, with a barely perceptible slope towards the southwest.
The proposed project will have no significant impact on present or futm'e water supply and wastewater
disposal systems serving adjacent properties, nor will it have any significant impact on reserved space-
surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on
this submittal.
Sincerely,
Ted Moore, P.E.
WELL
KUTCHER DRIVE
\
\\ HOUSE
/
/--
/
/
/
/
\
\
. ~
I WELL
) ~ ,I
/ /
/
/
/
% /
\/
NEW 47° LONG
SOIL ABS. TRENCH
WITH 4' SEWER GVL,
T.H.//2
/
/
/
/
SEPTIC
SYSTEM
1%
/
/
/
/
/
/
/
/
/
/
EXISTING
T.H.#1
I
EXISTING
- - -SEPTIC TANK
WELL
SEPTIC
SYSTEM
HOUSE ,.,,!
LOT 7, BLK. 8, McMAHON S/D #2
WELL AND SEPTIC SYSTEM
SITE PLAN
FLATTOP TECHNICAL SER¥[CES 1 INCH = 50 FEET
14530 ECHO STR'FF.T DRAWN BY TFM
ANCHORAGE, ALASKA 99516 APRIL, 1995
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIMATE.
NEW 47' LONG SOIL ABS, TRENCH
~"---WITH 4' GRAVEL BELOW DIST. PIPE
PLAN VIEW
SCALE: 1" = 10' - 0"
-MONITOR TUBE
CLEANOUT
~D BACKFILL 12"
iIFIED BACKFILL
4" DIA 5-810
PERF PIPE
1/2" -2 1/2"
GRAVEL
BOTTOM TRENCH
15'-3" DEEP
SECTION "A - A"
SCALE: 1" = 5'- 0"
LOT 7, BLK 8, McMAHON S/D #2
SEPTIC SYSTEM UPGRADE
PLAN AND CROSS-SECTION
FLATTOP TECHNICAL SERVICES SCALE: AS SHOWN
14530 ECHO STREET DRAWN BY: TFM
ANCHORAGE, AK, 99516 APRIL, 1995
Flattop Technical Serv~es
14530 Echo Street, Anchorage, AK99516
Phone (907) 345-1355
Lot 7, Block 8, McMahon S/D g2
4140 Kutcher Drive
Wastewater disposal system upgrade
Specifications
1.0 General:
1.1 The scope of the project consists of abandoning an existing septic tank and installing a new 1000
gallon septic tank followed by 47 lineal feet of soil absorption trench containing a total of 4.5 feet of sewer
gravel.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform with Municipal and State
requirements. All separation distances shall be in confoi-lnance with Municipal requirements, unless
specifically waived.
!.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any
buried utilities.
1.4 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after
the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction.
2.0 Septic Tank: .~
2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removing the top
and backfilling with soil.
2.2 The new 1000 gallon, 2 compartment septic tank shall be Municipally approved and shall be set
level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4"
cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type,
rigid insulation.
2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The
waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste
line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A
cleanout shall be located within 5 feet of the building foundation, and a double cleanout shall be installed
within 5 feet downstream of the septic tank.
3.0 Soil absorption system:
3.1 The soil absorption system shall be constructed by excavating a 47 foot long trench to a depth of
15.25 feet below the original ground elevation in the vicinity of test hole #2. The location shall be
approximately as shown on the site plan. Particular care shall be taken to avoid damaging large trees in
this area which provide visual screening for the house.
3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to
allow proper infiltration.
3.3 A total of 4.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with
the perforated distribution pipes laid level such that the pipe inverts are no less than 4.0 feet above the
bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing
the g200 sieve.
3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on
the design drawings. The portion of the monitor tube extending through the sewer gravel shall be
perforated.
3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel before backfill
with unclassified material.
3.6 The top surface of the cover material shall be raised a minimum of 12 inches higher than the
surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1.
3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the
site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed
to promote rapid revegetation of all areas disturbed by the construction.
4.0 Inspections:
4.1 A minimum of 4 engineering inspections will be required during the course of the project: (1)
initial stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the native material has been excavated to expose the'~
infiltrative surface to ensure that it is level and at the right elevation, and confonns with the soil test
information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected
up to the septic tank, but prior to placement of filter fabric, and (4) after rough backfill and grading is
complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to
backfill. This in.spection may be incorporated with any of the above inspections.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
rTEST HOLE
FLATFOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: LOT 7, BLOCK 8, McMAHON S/D g2
DATE PERFORMED: APRIL 12, 1995
PERFORMED FOR: WELTON LAWRENCE
DEPTH
(feet) __
Pt
SM Reddish sandy loam
GP Coarse, rounded sandy gravel
minor seeps due to rapid snow melt
ML Gray silt
SM Gray, very silty sand
Indistinct transition
ML Gray sandy silt
Some smearing of sidewalls
1
SM Silty sand
12
SP Coarse gravelly sand
14-
Black
8P/SM Somewhat silty sand
Fine, gray, soft
B.H. 19.3'
SLOPE
Depth to Groundwater Date
No groundwater 4/12
2.5" water in M.T 4/19
(See comment below)
SITE PLAN
Clock Net Time Percometer Net Drop
Date Reading Time (minutes) Reading (inches)
4/12 3 ~allon oresoak 10:50 20
Parc hole dry 10:51 1
Add 5 gallons water 10:55 28 1/2
10:56 1 21 1/2 7
10:57 1 20 1 1/2
10:58 I 18 I/4 1 3/4
Perc hole dry 10:59 1 17 I/2 3/4
PERCOLATION RATE <<1 (minutes/inch) PERC HOLE DIAMETER 7.
TEST RUN BETWEEN 11.5 FTAND 12.0 FT
PERFORMED BY FLA'VrOP TECHNICAL SERVICES. I ~...~ ~
COMMENTS: Minor seeps observed at bottom of shallow gravel stratum~ attributable to test hole being dug during breakup, when a heavy snow
cover was rapidly melting into shallow underlying soils. The minor amount of water which collected in the M.T. does not represent groundwater.
CERTIFY THAT THIS TEST WAS PERFORMED IN
ITEST HOLE
LE~3AL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
DEPTH
(feet)
1
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
LOT 7, BLOCK 8, McMAHON S/D #2
APRH., 12, 1995
WELTON LAWI~NCE
Pt
sM Reddish sandy loam
GP Brown/black sandy 8zavel
Rounded stones
ML Gray silt
SM Gray silty sand
Dry, does not smear
Cleaner than comp. sffatum in T.H. gl
SLOPE
SP Coarse ~rave]ly sand
S/miinr to T.H. gl
Depth to Groundwater Date
No groundwater 4/12/95
3" water in M.T. 4/19/95
(see comment on T.H. gl)
Clock Net Time Percometer Net Drop
Date Reading Time (minutes) Reading (inches)
See Perc test of SP stratum conduc ;d in T.H. gl
PERCOLATION RATE <<l (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 11,5 FTAND ].2.0 FT
COMMENTS: Test hole dug to establish continuity of materials encountered in T.H. gl. Due to space limitations, it was not possible to excavate,
this test hole as deep as Test Hole #1; thus separation from groundwater is based on T.H. gl. See comment on log for T.H. #1 re groundwater.
PERFORMED
BY
FLATTOP
TECHNICAL
SERVICES.
I.__~_~/~0~,,~,(_ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THiS DATE. DATE:
LABORATORY TEST REPORT
R&M CONSULTANTS, IND. 9101 VANGUARD DR. ANCHORAGE~ ALASKA 99507 PH 907-522-1707
CLIENT/PROJECT: FlatTop Technical Services / McMahon SlD
TEST ON: Field Sample
SOURCE: Lot 7, Block 8
SAMPLED FROM: Test Hole #1
LOCATION: Perc. Test Hole
SUBMITTED BY: client
DATE SAMPLED: unk
DEPTH: 12' B.G.L
R&M PROJECT: 451072
LAB NO.: 5026
FIELD NO.: 1
DATE REPORTED: 4/21/95
DATE RECEIVED: 4/12/95
GRAIN SIZE DISTRIBUTION CLASSIFICATION COMPACTION
sIEVE % PASS SPEC. UNIFIED AASHO FAA
5" % + 10 OPTIMUM MOISTURE:
4" % + 3 MAX. WET DENSITY:
3" % GRAVEL 35 MAX. DRY DENSITY:
2" % SAND 61 CORR. MAX. DRY DENSITY:
1 1/2" 100 % SILT 4 % FRACTURE:
1" 91 % CLAY METHOD:
3/4" -- 84 FSV NATURAL DENSITY:
1/2" 79 LL NATURAL MOISTURE:
3/8" 75 PL WEIGHT LOOSE:
#4 65 Pi WEIGHT RODDED:
#8 CLASS *'SW
#10 47
//16 GRAIN SIZE DISTRIBUTION CHART
#20 23 j ........................................
#30 ~o ..... ,, ,,,, j j
//40 13 ~ ~o I',II I - ~.,II I ,,
III
" J"l', J ......
#50 z 7o'~"I' ,,,,J J Ill
#60 g ~ 5o""I IIIIII : ,, ,, ......
,,,,
#80 ~ 4o,,,,', ,,,,"'"II 'II"' I:',III ,,,,,: I[1,
//100 6
',"!!!;
#200 4.3 lO'~"I,,,, """ ,",, · """ '""'
.02MM o ,,,,, ~,,
~oo ~o ~ o.~ o.o~ 0.005
.005MM
.002MM GRAIN SIZE (mm) ·
)][], JJJJJ J ,J, JJ J ["[[~
TOTAL WT. TESTED 1439 GMS.
COARSE SPEC FINE SPEC
ORGANIC CONTENT %:
L.A. ABRASION LOSS:
REMARKS: * Estimated Dlassification
DELETERIOUS MAT.
MINUS #200 MESH
SOFT FRAGMENTS
COAT & LIG. OR L.T.WT.PT.
CLAY LUMPS
STICKS & ROOTS
FRIABLE PARTICLES
THIN-ELONGATED
ORGANIC COLOR
FINENESS MODULUS
SULFATE GOUNDNEGS
DEGRADATION VALUE
ASSORPTION
SPG.-BULK
SPG,-BULK S,S.D,
SPG.-APPARENT
Tested By: CLP Checked By: DKJ
· ~ 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
NAME PHONE
I'~ NEW
UPGRADE
LEGAL DESCRIPTION
LOCATION
Well j
g~ DISTANCE TO: J
~- ~ Manufacturer
~ N Liq. capacity in gallons ............
I i
~--~ Manufacturer
[Z J DISTANCE TO: Wel,~/~ ,
~ J~ INo. of iin*s ~ I Length of e~ line
J~l / I
~ ~ width
~ ~ J Type. of crib
_
DISTANCE TO: Well
~ JCl~s Depth
Absorption area. Dwelling
Width
NO. OF BEDROOMS
PERMIT NO,
N~ of compartments
Inside length Liquid depth
Dwelling PERMIT NO.
Liquid capacity in gallons
Material
Foundati.on Nearest lot line
Total le~ of lines mrencJ;t~::~ ~-~w[dth
PERMIT NO.
Distance between lines
inches
Material bene~.~h tipO inches Total effecti~.~4;~Etion area
Depth PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
Driller Distance to lot line PERMIT NO,
Sewer line Septic tank Absorption area(s)
OTHER
PiPE MATERIALS
SOIL TEST RATING
,NSTALLER~ ~ ~"~ ~j ~X~
REMARKS
APPROVED
DATE LEGAL
72-013 (Rev. 3/78)
[:,EI:::'RRTMENT OF HEFiLTH ,9~i'-,I[) Ei'-,i',,,' !' RO;-".~MEBiTRL F'i:;?.OTECT i ON
82U "L." !;TREET., RNCHOi?.FR3E., R.K.
2E;4-.4'720
'-.'.' ',:"80',;!f~8~: )
hli:::lY:: i FIIjM .......... _
,L! b!:;. f"IF P~'f',[4"]-i'T:: :=
THE
!~.,..-~.:-,.., J.R.,._[._ ~_ ,::.~. (3F' THE SO Z L F1Eff_-';ORF'T l ON S?STEM Z S:
THE LENGTH DiMENSiON IS THE: LENGTH (IN FEET) OF THE TRENCIq OR
THE DEPTH OF f::i TRENCI4 OR PZ'i~ ZS THE Dt%TRNCE BET'NEEN THE SURF'ROE OF 'I"H'~!;
GROUND RNi:::, ]"HE BOTTO!"I OF THE EXCF!VRTZON ,::ZN F'EET).
THE:RE IS NO SET !.4li}'FH FOR TRENCi'-IE:':5.
THE GRRVEi._. [:,EPTH l:!~; ]'HE MINIMUM DEPTH (]F GRFf,,,"-EL BETI4EEN THE OU'T'Fi:~I....!.. PIP':'E
i:~N[;, THE BOTT'OM OF THE E',:.,iCF~?,,,'FiTtON (IN FEET).
] ,."h:. RE:E;PONS):E'.-ii..);-F"r' TO ]ixiF("lPhi "i"l-l'fc-; L. mF H . ,tlr.:.l, t !',I !l:i;"l'l'-,~li:i, 'I Pi~:;
! ?'?STFIL. t...t::IT I ON L' t'.I'.~;F'E ]':T ]' Z HS OF RN"r' !.4ELL:~.]; !:!D..]'RCENT T '~ TH ! 2!; PR E F'E[';:T'v' Fli",![:' THE
· '-, ..... r- F,£'2 .' "' ~E'] "1"~ '"-I I ' ' SERVE.
BFiC,k]::'!i.J._.];?',I(]i FP' ........ FIN? S?STL:]"! h.II'THr]IFF r~:"~"~] ..... L. .,.r,,=4"c.L.?'~"-'"'"' .......... ! I,_r4~ FIND
..-E'.r 4...r~. n."~T WILL. . . ~,'"'"-'::. ...... '::i. IF:.TEF:T 7"] F'RO:~;ECL!TZON,
~'ItI"4!HUH DIS"i"RNCE BETNEEN F:i.' WELL RND RI'q"? ON-'SiTE SEf.4RGE DiSF"OSi::IL. S"¢STEM
±E~E~ FiEE]' FOR R PRIVRTE 14ELL.~
J..~iO TO ;.~:('.16~I F.F..'EET F'ROF! .I::i PUBLIC i.'.IELL. DEPEND '...( i",!G UPON THE T?PE OF ,r":'LIBLIC NELl ....
!4Ei..I_ i.~OG'L:; RRE REQUIRED RNC--' MUST E:E RETLiRNED 'FO THE DEP,qF..:TMENT !,.ilTHtN
OF T'HE i4.ELL COMPLETION.
OTHER I:;.':EGtJlF.':EMENTS !'"!R? FiPF'L'.¢. SF'ECIF:ICFi]"IOi'.~% RND CONSTr.,;:UCTZOI'.~ D!RGRF:iI"IS
ff,?FI!!..RBLE TO IN:i:;URE PROPER iNSTRLL.RTI
i CERT!F'h.' THF!T
i: i FiM FRMIL. iRR NiTH THE REQUiREMEf.~;TS FOR ON-.:~;!"r'E SEi.,.iERS RN[:, !,.!EL.L:5 h~:; SET
FORTH E~'.¢ TI-IE MUN!CIF'RLI"i'? OF' RNCI~iORFIGE.
2; :( !,.IZLL :[NS]"i::ILL THE S?STEM IN RCCORDFiNCE WiTH THE COl)E:::;.
/2i:; ); UNDERSTRND THRT THE ON-SiTE SEIqE:R S'.¢STEM MFiY REQUZRE ENL. RRGEMENT IF THE
RES!DENCE iS REMODEL.ED "i"O INCLLiC, E MORE THi:aN ]:~: BEDROOMS.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch ~.650, Anchorage, Alaska 99502 276-222'~
SOILS LOG- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
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COMMENTS
60 /~/z ~ ~ D^,E PE.EORMED=
SLOPE
SOILS LOG
[] PERCOLATION
TEST
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
FT AND
(minutes/inch)
~ FT
72-008 (7/76)
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF
DRILLED AT THE RATE OF $~8.00 PEr FOOT.
ProPErTY OWNEr //~° ~ /~ey~.o~ £77-$16¢
LOCATION OF WELL SITE Z~. ? B~A. y Sa~:
DRILLER /~ e./Z/'~ C_~ Of~ ~.O. YFt.,t~2Yb:~. ~~ bio Y~P~O o
188
WELL LOG:
109-765'
$300.00
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PaYabLE TO raMpart DrILLINg WORKS For ThE SUM OF $36~O/-/-. 00
THANK YOU VERY MUCH.
B~E CLAUS O~F RAf~A~ DRILLING WORKS
SERVICE CHARGE O f IV~% PER MONTH WILL BE ASSESSED .ON ~CC( UNTS.
PARTMENTOFHEALTH & HUMAN SERVICES_ '- ":- : -'
' Division of Environmental. Services -. .
P.O, Box 196650 Anchorage, Alaska 99519-6650
- CERTIFICATE OF HEALTHAUTHORITY .....
APPROVAL FORA SINGLE FAMILY DWELLING
Parcel
HAA~
1, GENERAL INFORMATION
"Location (site address ordirecti0nsi
:':-" i'-' ..... 'l~r~pe~:Ownel~: ',:.'i~-'[~r°~- ' '~;-f:;~'-~..~'~-~--~"t-;'."+~ --' ' Day phone
~. TYPE OFWATER ~UPPLY: ' ' ': .....
Individual well ~ · ' - .
.. -.- -._':', NOTE: If commum~ well system, provide wri~en confirmation fro~ ~tate ADE~ attest~ ~ ~? :~'~
....... '~'-NOTE: If communi~ wastewater system, PrOVide walden confirmation from State ADEC ' ..........
a~esting to the legali~ 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 verify that my
investigation-of ihis 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 ts in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspeption.
NameofFirm' .';~/o/~ 7-ec/~;~.f .~'~"~'~'¢~' Phone
Address 1¥3-3~ ~-/~o ~'~, /}./~¢hor~ '/4/.~
.. · . ~ ~ ~ , -
.... '" -~"-: .......... : ............... ~ ..... '"' .... lr~, T~ - '" ~ ............... "'
' .'' ' ' .-:' ': " "
. . '-. ' : ..:.'.... ..'-- ~ '-~...-: .-.. ~ ~,~ ~*e*e~ _~..' :. - :. - . .F .'- '.- ":.-' ~::-'..'.~ . ~ '~.' ·
. .. . -:.. -.~. ~L~~ · . . . ._- .... .._.--:. = .
' ' - -6 DHH$ SlGNATURE.:..~-- '.. ' "'v "'" "'" ' : "-: ~""', ':
." :. _". '. t ~ - .... ' -- L,: ' F~;~;~'~:~ ~ ;F TM -..:.'... - L,- · '"~ '~L' '" -' ':~' ~-~ -;~L- .. 2:;!%~ '.--'_~
: . ~.-: -_--_--_.;-.,.-' "-'~ - t:_Oonditiohal:apProvar for -- '-. : .... ;;: bedrooms,, with .the.followmg4:~pulat~ons::~..~.:~¢~:
ij and their lending institutions in °rder.:~° s~tisfy certein federal end state reqU rements. EmploYeesof DHHS do not
::~nd~Ct~ inspections or en~qYze: .da~ before a certificate: Js issued~ 'The MuniciPalitY .of AnChorage s not
responsible for errors or omissions in the professionel engineer's work.
72-025 (Ba~,1/91) Back MOA~I
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescription: ~..o'1' ~ l~/~.'c~ I"'[c1'1~/lo~ #~ ParcelI.D. d) lT~~''t'~/8
A. Well Data
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
/8#'
FROM WELL LOG
5"/~¥ / 7~'
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed 5'/?- ¥/' 7 ~' Driller I~
Casedto I~&" ?~rJc~ Io:7 ' Casing height
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES' FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main /~/, ,~..
Sewer service line I
Wires properly protected (Y/N)
AT INSPECTION
.g.p.m.
.g.p.m.,~
; On adjacent lots ~ ~c,o '
; On adjacent lots ~ ! ~o '
Public sewer manhole/cleanout
Petroleum tank N¢,/)~
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
o
Collected by:
Other bacteria
F I ~ t' N i~ -1"~' cl~
B. SEPTIC/HOLDING TANK DATA
Date installed ~ / ~ / ?5-
Cleanouts (Y/N) ¥
High water alarm (Y/N)
Date of pumping /~/- ,4,
Tank size ! 000t?ol Compartments
Foundation cleanout (Y/N) Y' Depression (Y/N)
,4. Alarm tested (Y/N) /V. ~.
h/~ ~J~ Pumper /q' ~.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I '~
To property line '~ ~'
Sudace water/drainage
On adjacent lots ~ Ioo~ Foundation ~ ~-'
Absorption field 3~' Water main/service line ~2 '
72-026 (3/93)° Front CONTINUED ON BACK PAGE
C. LIFT STATION N, A,
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Sur/ace water
D, ABSORPTION FIELD DATA
Date installed 5' / ~ / ?¢- Soil rating (GPD/FF) I,
Length 5'o' Width 3 ' Gravel thickness
Total absorption area ~O r'a' Cleanout present (Y/N)
Date of adequacy test N. A, ( N 4 ~,~ Results (pass/fail)
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
After test
If yes, give date
System type
Total depth
Depression over field (Y/N)
for ~
N
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 1 3
To building foundation
On adjacent lots '~
Surface water >
Curtain drain ~on~
On adjacent lots I J ,5' ' Property line
To existing or abandoned system on lot
Cutbank ~o,~ er Water main/service line
Driveway, parking/vehicle storage area
E, ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in e~[e~i~i~R'~c, date of this
EngineeCs Name
Date
HAA Fee $
Date of Payment
Receipt Number ,--~ ~ ~' "~
72-026 (3/93)° Back
inspection.
Waiver Fee $
Date of Payment
Receipt Number
05×03×9S 13:11 COMMERCIAL TESTING ~ 90734513SS N0.374 Q02
CT&E Ref,#
CT&E Environmental Services Inc.
Laboratory Division ........
95.1633-1
-~rlx ~AT=R Laboratory Analysis Report
client Sa~le ID L7 ~LK6 MCMAHoN 8/D #2
Client Name FLATTOP TECHNICAL SRV
Ordered By TED MOOEE
Project Name
Pro]ect~
PWSID UA
Sample Remarks: SAMPLE COLLECTED By: T. F. MOOR~.
WORK Order
P~inted Date
Collected Date
Received Date
1~290
0~/03/95 · 11~]9
0~/01/95 · 09:00
0~/01/9~ ~ 09:40 hr~,
Te=}u%ical Director STEPHEN c, EDE
QC Allowable Ext. Anal
~arame=er Results Q~al Units Method Limit~
Nitra~e-N
6.20 mg/L EPA 3~3.2
UA ~ ~availabl~
see Sable Remarks ~o~e ~A - Not Analyzed
Un~etected~ R~por=ed valise l~ the pra=tica~ ~u~%tification limi=. ~T = ~= Than
2~ W. Potter Drive, Anchorage, AK 99618-t608 -- Tel: {~7) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN A~S~. CALIFORNIA FLORIDA
DEPARTMENT OF HEALTH & ENVIRONMENTA O ON
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
PI RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OW?~ER PHONE
MAILING ADDRESS ~
PROP~(.~f different from above) PHONE
2. BUYER PHONE
MAI LING ADDRESS
3. LENDING INSTITUTION I PHONE
MAILING ADDRESS
4. REALTOR/AGENT I PHONE
MAI LING ADDR ESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. T~PI~ OF RESIDENCE
t~SING LE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One [] Four
[] / Two [] Five
[~ Three [] Six
[] Other
7. WATER SUP~EY ~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~'"~IN DIVI DUAL/ON-SITE**
[] PUBLIC UTI LITY
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE NIUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONL
DATE RECEIVED
~ NSPECTION APPOI NTM ENTS
TIME ; TiME ' TIME
DATE DATE DATE
DIRECTIONS:
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
~//SING LE FAMILY E~] ONE [~//'TH R ES [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
E~ INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified -~OG RECEIVED
3. SEWA*E D,SPOSAL SYSTEM "~'~ ~ ?~00~~ ~
~NDIVIDUAL/ON -SITE ~ATE INSTALLED
~PUBLIC UTILITY ¢ ~7 ~
Connection Verified INSTALLER
Size:. If Tank is homemade SOILS RATING
give dimensions: /~ ~
TYPE OF T~NK MANUFACTURER
4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
1
WELL TO:
Absorption Area to nearest Lot Line
~ CO~DITIO~Ak A~BOVAk (letter must accompaay certificate)
~ DISAPPROVED
DATE BY (Title)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)