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Home My WebLink AboutMCMAHON #2 BLK 8 LT 10 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 [] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION No, of compQ~ents DISTANCE TO: ~STANCE TO: Manufacturer DISTANCE TO: / I ~-~> Top of tile ,o finish grade ~ Length Width Type of crib Crib diameter Well DISTANCE TO: lClass Depth DISTANCE TO Building foundation Dwelling /~_~ I wd~ Liquid depth Inside length Dwelling PERMIT NO, Liquid capacity in gallons Material Founda:~(~n N s Total length_of lines Trench w~dth Material beneath tile ~ f -/ inches PERMIT NO. Distance between lines Depth Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO, Sewer line Septic tank Absorpt on area(s} Total effective absorption area /.:.o z. PERMIT NO. OTHER PIPE MATERIALS .-fo SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78} PERMIT NO. F L I .~l--ff',lT ED LOCRTION MCMAHON LEGRL L:tO B8 MCMFIHON DEF'RRTMENT OF HERLTH AN[) EN IF.._NI1ENTML PROTECTION .... ".~ '"L" STREET., HNCHO'RHUE., AK. ggPiA'I ( '78E~540 ) 24:~8 E. ~E~FH LOT SIZE 3:Z..':O,qU-3 SQUARE FEET '~ '"" ', IS: TYPE OF SOIL RBSORBTION _~'.=,TE. fl TRENCH MRF';IMUM NUMBER OF BEDROOMS = 4 SOIL RATING (:SC...! FT,.-"BR)= 15C~ =,.,-_,rEM IS: THE REQUIRED SIZE OF THE SOIL RBSORPTION '-"~" ' DEli'Ifil== :.t;Fz LEN,STH= ,~1- :~: C..iF" R %," 5] b. THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF 'rHE TRENCH OR DRRINFIELD. THE DEPTH.OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURF'RCE OF 'THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE: MINIMUM DEPTH OF GRAVEL_ BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM ]'HIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL. WILL SERVE. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT 1'0 PROSECUTION. MINIMUM DISTANCE BETWEEN R NELL. AND ANY ON-SITE SEWAGE D!SPOSRL SYSTEM IS ~00 FEET FOR R PRIVATE NELB OR ~50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPGN THE TYPE OF PUBLIC WELL WELL. LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS OF' THE WELL COMPLETION. OTHER REQUIREMENTS MAY RF'PLY. SF'ECIFICA'rlONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THRT 1: I RM FAMILIAR WITH THE REQUIREMEN'rS FOR ON-SITE SEWERS AND WELLS RS SET FORTH 8Y THE MUNICIPALITY OF ANCHORAGE. 2; I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODEL. ED TO INCLUDE MORE THAN 4 BEDROOMS. =,IGNEE: :__~ ........ RFPLICRNT ED HLI2~G ,/ ¥~c't ~r~ BY- __.c,'n~ ..................... -" ~:' PERFORMED FOR: LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6--650, Anchorage, Alaska 99502 276-2221' SOILS LOG -- PERCOLATION TEST DATE PERFORMED: ~Z/SOI LS LOG PERCOLATION TEST (FEET) 1 2 3 ®- t3- ~3 14 17 18 ~0 COMMENTS SLOPE I WASGROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTR? SITE PLAN S E Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND __ FT 72 008 (7/76) ~ .... ' ::C."i?.-' ' ' %??:4%'. ' .. ~..~..~ ~.¢¢¢~*¢::'- . .:_ ~: s,:',. ... · ~' 4 , - · . '";' ' ' . ',~fi2Z(?-' :'--2:Z~'~.' .. -~5:Y~:b';,* ~ ~7&:'~yfi?~.-,~' . .: - ..z-'c - ".' SIX INCH WATER WELL DRILLED AND CASED OUT TO THE D~PTH OF ~.~1 To~A~ .... ~':. .... ~ COST INCLUDES ALL LABOR AND MATERIAL' FOR COMPL~ION OF SAID DRILLING. ' .... WRITE CHECK PAYABLE TO RAMPART BRIkL1NG WORKS FOR THE SUM OF..¢.._,_¢2oE~. BERNIE CLAUS OF RAMPART 'DRILLING WORKS MONTH WILL BE-A~E~ED O~S%~E ACC ~TS. SERVICE CHARGE O -. ' . RO~?L FOR AS NGLE FAMILY DWELLING --;'...:. ;:.~:7~;-,:.,.-::. :.:~. Parcel I.D. ~ _~ , ~ ,::.,...: ~:,., HAA ~ ~- . ............. ,~,, ........ ~. -... 1.. GENERAL INFORMATION ........................ -.:,. .............. . .............. . ~ :, .... ,.,.....-~,~ ,~ ............... - ........... .,.. ~-~:.~. ~ : .-_ ...... ~ ............................. . ~ . -.. ........ -,~¢%~,~.~.': .:: ,. ..... bcation'(site add~b'~:b~ire~tions) -' 404~, L~e.~ ~o~ .::,':-, ":. ,'~ , y D~~ ..... Day. phone , 5. STATEMENT OF INSPECTION BY ENGINEER ' ' :.-~' .._"?' i' As certified by my seal affixed hereto and as of the validation date shown below, I verif investigation of this Health Authority Approval application shows that the on-site water supply ~:. and/or wastewater disposal system'i~'~.fe, functional and' adequate'for the number of bedrooms :---"~?'~: and type of structure indicated herein'~ I further veritythat based on the information obtained from '-?:7 the Municipality of Anch0rage fi!es and from my investigation and inspection, the on-site water -'- supply and/or wastewater disposal Sy$,tem is in compliance with all Municipal and State codes, ..- ordinances, and regulations in'effect onthe date of this inspection. :' ' ¢ ~ ' . 17034 ~gle River L~p Road No, 2~ _ . .~ :~..,, .- Address Eaale River. Alaska 995~ / '': ~ - ' . , . , . -1 Enginee¢ssignature '~~-'~ ". "Date · '~"~ :, . :.,: ,.:....;;,~;.: -:.. ,- : :;' _ . .. ~ · ' .... '.. ~ '' ..,- _ , ": : ' '"- '" :':"-:- ' "- - "' ' ~':':'"'~ h' - ;:-" L'.:'.:L::'.~:.:- . . . . ., : ..... .. .... ,.,. :. .,. ., ,.~- . · ,.,~ · .., ,,. ;.,~,:. . ,...._ , · . . . . ,~ ~ ~ .- ..,, ~ ~-.... ........ ...~..~ " .... '"' ' 'Apr -- ...... . -~: .................. .:.. ...... , .,~ ......... , :.-,**:, ~ '"'?~ -. p eyed for ...... bedrooms ............... ~-., ~ ................................................. .......................... ~ ..... Cond~bonal_approval, for,: .... bedrooms .,w~th,the following ~ ' '--':'.': :~ '¥7~:~--:' ' .... :, ':-. :,' ....'"' ': 3-" :-- ' :';': ,:-'" ~'O'"' .. '.'-, -.' ." ~. ' ." ~ .,.,"/.' ,~.v..-',:~* ...... -': '-:' '",".,<~,~'¢~;.'. : ~, ,&,~ ~ .L Add~ cna Comments · '. .......... : ..... . .... ,' ~'% . ,, .- ). -~/.~',.' .. . ~ .... ,, - , . -. .... ~. ,:. , . The Mu:~i~Jl~'i~':~ ~n~h°rageDepartr~'nt ~f H~alth and Human sexists: iDHHsi i~:'~ith ~Uth0r'i~;',:.'~ ~;;: ~' ApPrOVal ~difiC&t~: ba~ OnlY.UpOn'the rePreSentatiOns'given 'in paragraPh 5 profe~io~ai~-gi~(~ist~ i6~the s~te of Alaska. The D HHS does this as a cob ~es~ t° pU ¢~'~ of h~m~?,?:/; ~-~ and their ~8~'8i,g. id~tit~a.9~S.~8 order tO~t!$~'.~ain federal and State requirements~ Empioy~'8~'OHHS condUct i6sPecti0ns~ 6rF~n'al~e data :before':~ ;'ce~ificate is'JsS~ed~The MuniciPali~ Of Legal Description: Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502. Anchorage, Alaska 99501. (907) 343-4~ C E iV E DEB 4 1995 Health Authority Approval Checklist Municipality ot Anch_oraqe Dept. Health & Human ~erwces £~.~c ~" tn~/~t4o~ ¢,)o#2-Parceli.D.: 0t7 -3~(/ --t-/ A. WELL DATA Well type Log present (6~lqq) Yg 5 Total depth ] If A, B, or C, attach ADEC letter. ADEC water system number Date completed 7/'> / 7 ~ ! Cased to I ~' ! Casing height (above ground) Sanitary seal (~qq) y~ 5 Wires properly protected (~9/N) Date of test FROM WELL LOG ~1~/~ ~ Static water level Well production WATER SAMPLE RESULTS: AT INSPECTION It Coliform 0 Nitrate Date of sample: . I~ / 7 / ~.5'- TAN DATA ' Date installed ~ / ~l // ? ~' Tank size ~ ~L ~ ~p, '7 ,l'~ Other bacteria 0 Collected by: $ & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Number of Compartments ,~ Cleanouts Y(~N). ~g .3' Foundation cleanout (~f/N) "/~-- $ Depression (Y~) Date of Pumping I I//O[q~- Pumper C. ABSORPTION FIELD DATA * /~/7~ Date installed (o Length ~' .5 Width Effective absorption area ~G 0 Date of adequacy iest It [ tV/~' Soil rating (g.p.d./ft2 o~ 3 (- Gravel thickness below pipe System type '-rd~,~ c ,¥ Total depth l ~ Monitoring Tube present((~fN)Y~ S Depression over field (Y~) /'~ 0 Results (Pass/Fail) ~o~/, $ j For /'/ bedrooms Fluid depth in absorption field before test (in.); __ Fhfid depth '7 (ins.) Minutes later: Immediately afterG~-o gal. water added (in.): Absorption rate = ~o 0 3 g.p.d. Peroxide treatment (past 12 months) (Y/N) D. LII~ STATION Date installed Size in gallons ~ Manhole/Access (Y/N) "Pum~ "Pump ofF' level at* High water alarm level at* ~ *Datum Cy~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: S~t~lc~olding tank on lot Absorption field on lot Public sewer tnain Sewer/septic se~ice line : On adjacent lots : On adjacent lots Public sewer manbole/cleanout Lift station "~ SEPARATION DISTANCES FROM~'-~-~?dHOLDING TANK ON LOT TO: Building foundation ~ -p Property. line ~ -4- Water maim'service line 30 e '~ Surface water/drainage /00 Absorption field Wells on adjacent lots 5--/_/_ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain t~ o~, ,L F. ENGINEER'S CERTIFICATION Water main/service line 30 Driveway. parking/vehicle storage area £ Wells on adjacent lots /0o j Property line 1 certiJ:v that I have deterntined thrufield inspections and review of Municipal records thc.~t,~l~vl~s, tems are in conformance with ~O~J H~uidelin~s in effect on this clare. / // 1~ / S~gnature' Date t /t 6 q ) HAA Fee $ J o u ~ Wawer Fee $ -<-::'a'~ Date of Payment Date of Payment Receipt Number I q ~/ (' ~ t 0 3 ) Receipt Nunlber Rev. 8/95 OSS: haa.wk.doc CT&E Environmental Services Inc. Laboratory Division Laboratory Analysis Report WATER LI0 BLK8 MCMAHON S/D #2 ~derad By R- COWAN Prln~ed Dace ~:;<~jeet ~ama Collected 19521 1~/09/95 ® 16:00 Technical Director STEPHEN C. EDE Remarks: SAMPLE COLLECTED BY: BOB C. QC Allowable i~,~,rame t e r Re£:~l~$ Oual Unite Method bit~%lt~ Date Dabs Init , ~ra~-N 0.75 m~/L EPA ~S~.2 10. 11/0S/95 ~ee SDecial Instruc~ions Above UA ~ Unavailable ' Seu Sa~nple Remarks Above NA - Not Analyzed i~ Undetected, Reported value is ~he pra~ical q%~anbification limit. LT ~ Le~ Than ':i;, ~e~o~ld~ry ~l~tlon. GT - G~e&ter Than 200 W. Potter Drive, Anchorage. AK 99618-1606 -- Tel: {907) 562-2343 Fa~: (907) 661 :~i~VIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA. FLORIDA. ILLINOIS. MARYLAND, MICHIGAN. MISSOURI. NEW JERSEY, OHIO. WEST VIRGINIA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 025 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PHONE 1. PROPERTY OWNER " r~ PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION [ PHONE I MAILING ADDRESS 4. REALTOR/AGENT [ PHONE I MAILING ADDRESS STREET LOCATION 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four ~' Two [] Five ~ Three [] Six [] Other 7. WATER SUPPLY {~ INDIVIDUAL* *ATTACH WELL LOG. Awell Icg is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM [~" INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy'test is required [] puBLIc UTI LITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY · DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE I NSPECTO R INSPECTOR INSPECTOR DIRECTIONS: 1, TYPE oF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Cohnection Verified. LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ~ "'"'~ F Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: l~,.~-~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFAC~,I~E.R.. TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS ~ 'APPROVED FOR ~,~ BEDROOMS F-I CONDITIONAL APPROVAL {letter must accompany certificate) [~] DISAPPROVED DATE BY (Title} LEGAL DESCRIPTION 72-010 (Rev, 3/78)