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Home My WebLink AboutMCMAHON #2 BLK 9 LT 10 · 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: 5'W~o~5'7 PID Number: O1'7 Name: ~,.~t.C~A~L~L. ~ ~A ~y Wastewater System: ~ New ~Upgrade ~ot ~ ~. ~s~u ABSORPTION FIELD Phone: ~H~ ~1 IN°'°fBedr°°ms:~ ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other LEGAL DESCRIPTION so, Rating: J. ~ GPD/Sq. Ft. Total Depth l~-fr°m~°riginal' grade: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: / Range: ~ ~ Section: Fill added~.~above original{ ~ grede:. Ft. Gravel length: ~ ~ Ft. I WELL:exts~,~u Q New ~ Upgrade Gravelwidth: Numberoflines: 01stance between lines: Classification (Private, A,B,C): Total Depth: eased To: ~ ~otal absorption area: Pipe material: A~ Driller: Date Drille~ ~tic Water Level: Installer: Date installed: Yield: ~et at: Casing Height Above Ground: TAN K ~ GPM ] Ft. Ft. SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P. TO Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallona: From Tank Field Station Tank Sewer Lines ~O~A~ ~A~ Well- [O~ [[~t ~ ~ ~ Material: ~ Numberof Compartments: Surface w.t.~ too~ ~ ~ ~ ~ LIFT STATION Lot ~ , ~ ~ ~ Size in gallons: Manufacturer: Line Foundation ~O' ~, ~ ~ ~ ?Pump on" level a~t: I High water alarm at: CurtainDrain ~ ~ ~O~ ~C~ ~1 Electrical Inspections pedormed by: Remarks: BENCH MARK Location and Description: I Assumed Elewtion: ~34 Eagle River Loop RoaG, No, 20~ . Inspections performed :,.~.~ ........................... Department of Health~ Hum~ervices approval : -,. ¢¢..~ ......... Reviewed and approved b Date: / / 72-013 (Rev. 9/91) MOA 25 Permit No. SW950557 Page 2 of 2 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 10, BLOCK 9, ivlcMAHON S/D #2 01756217 Legal Description: PID No.: ST1 $T2 /-99. I' 99.5' / ./FINAL G: ~ADE 1250 GAl , S.T, 91 · 87.0'-~ · 81.5' WATER FOUqD 10-15-95 A B ~-,EXISIING TRENCH GA~L FCO 28' 12' BANBONED COMF ETELY ST1 37' 23' ~b:EW TRENCH ST2 59' 52' . C01 40' 54' ~' SEPTIC T~ C03 63 26 ~ ~- C04 55' 64' MT2 55' 63' ~// / Z EXISTING 1250 GAL SEPTIC TANK / ~DONED COMI L~ELY 72-013 A 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 PERMIT NUMBER:SW950357 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:KELLY MICHAEL T & DANA I OWNER ADDRESS:3901 LEYDEN RD ANCHORAGE, AK 99516 PARCEL ID:01736217 PAGE 1 OF (UPGRADE) PERMIT DATE ISSUED:10/24/95 EXPIRATION DATE:10/24/96 LEGAL DESCRIPTION: MCMAHON #2 BLK 9 LOT SIZE: 31096 (SQ. NUMBER OF BEDROOMS: LT 10 FT.) 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 (iSAAC80) . 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: ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. October 17, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENS[O NS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECT[ONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 10, Block 9, McMahon S/D $2 Request you issue a permit to upgrade the septic system serving the four bedroom house on the referenced property. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole and after seven day ground water monitoring, water was found at eighteen feet. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk EnClosure 17034 NORTH EAGLE RIVER LOOP ' SUITE 204 · EAGLE RIVER, ALASKA 99577 z 0 0 .E~ 3OVBOdD NVqd 311S ,0~ = ,,L Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST /,,1 u< e.. LEGAL DESCRIPTION:j-O'T ]0 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER N O . ENCOUNTERED? SLOPE SITE PLAN ~ S L IF YES, AT WHAT '~ O DEPTH;' '- p Depth to Water Alt r,~/,"- ' FI' ~enitormg? ( Dale: Gross Net Depth to Net Reading Date Time Time Water Drop /o l~/,~ F ~ : o~t ,~ ~, '/~ " - (: ~ o / ,~ , ,¥' g '1.," ~/~ " ~ : ~7 ? ~1~" 't~" PERCOLATION RATE ~' (minutes/inch) PERC HOLE DIAMETER IO I1 TEST RUN BETWEEN __ FT AND FT COMMENTS '17034 Eagle River L~p R~d No. 2~ ~ '" ' /0 . .. ACCO~DANCG W~H~STAT~ND ~PAL GUIDELINES IN EFFECT ON THiS DATE. DATE: ~agle KIVGr~ AlaSK~ 72~08 (Rev. 4/~) IN Hc.. ch and Environmental Prote ion Fourth Floor West 825 L Street ~ Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: DISTANCE / FROM WELL ~00 INSIDE LENGTH MAf'4UFACTURER~. · MATERIAL · COMPARTMENTS INSIDE WlD1-H. LIQUID DEPTH LIQUID CAPACITY /¢'~"--'~GALLON$. TILE DRAIN FIELD: DISTANCE FROM WELL /~'')/, FOUNDATION /V ~ ~ of Lines J DISTANCE BETWEEN LINES X, soRP, iON AREA DEPTlt: TOP OF TILE TO FINISH GRADE NEAREST LOT LINE /~) /5' TOTAL LENGTH .OF LINE TRENCH WIDTH3~ IN. FT, LENGTH OF EACH LINE ~Q /5- ~ 7f"2~[ ! FI DEPTH OF FILTER t ~ MATERIAL BENEATH TILE_~ ~ ABOVE TILE TOTAL EFFECTIVE SEEPAGE PIT: Log Crib Rings BUILDING FOUNDATION__ DI/~-METER __ OR WIDTH ,, LENGTH DEPTH Crib Size: DIAMETER___DEPTH DISTANCE FROM: TOTAL EFFECTIVE NEAREST LOT LINE__ WELL ABSORPTION AREA (WALL AREA) SO. FT. Well class:,..T'~ ~ Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: % of Bedrooms: Installer: ~J~ -~' Remarks: /,..s-o';¢ i O AT E'.~/..~O6;/A P P R O V EO TANKS STRUCTURAL STEEL · ELD1NG 2921 INTERNATIONAL AIRPORT ROAD TELEPHONE 274-3645 ANCHORAGE, ALASKA 99502 To lVhom It May Concern: On September 12, 1977, Newton-Excavating~did purchase from us 1 ea 1250 gallon septic tank, our Inv# 8051-. Newton Excavating did not purchase any other size septic tank during this period Of time. Manager ~,~'UNICIPALITY OF ANCHORAGE?'~ Hea .... ~ and Environmental Prote on Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ONLSITE SEWAGE DISPOSAL SYSTEM NAME,~~~ MAILING ADDRESS ~0'%0 ~ ~-/'[~0'~ ~ LOCAT I O N~'"~ ~ SEPTIC TANK: DISTANCE FROM INSIDE LENGTH_ MANUFACTURER,~ INSIDE WIDIH MATE RIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY/<:~¢) GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL ~. of Lines ABSORPTION AREA ~'~ ~/' TOTAL LENGTH FOUNDATION "~"~ NEAREST LOT LINE OF LINE ~'(' DISTANCE BETWEEN LINES --- TRENCPI WIDTH ~'~. IN, TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LINE DEPTt4 OF FILTER t DEPTIt: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE_~/'' .1~. ABOVE TILE .IN. SEEPAGE PIT: Lo9 Crib Rings BUILDING FOUNDATION__ DIAMETER OR WIDTH ., LENGTH ., DEPTH Crib Size :; DIAMETER___DEPTH .... DISTANCE FROM: TOTAL EFFECTIVE NEAREST LOT LINE__ WELL ABSORPTION AREA (WALL AREA) ,SQ, FT. Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: ~ ~ of Bedrooms: ~ Installer:~3~L~ Remarks: DATE_-~.--/~:~'-"')'"'~ APPROVED ti-lb_ I..b:Nt_.iiH I..)il'q~::N'.::;lt3t'.,l :L5 li.tE LENUiH ,:.J.N FEEl) Ul:: I'HE II-,::~.i:Nti;N [.iii--.." L)I--.'.PttNPJ. ELL). Ihit::. i.;,[:-_i-.'ti-fl tJl. k:l Ii~::b.I'qCPI I.)N." I'-'1'l lb, INb: t.).LL-.,t'FINUE b:bti.,.Jt::JE3.,t iHb. '.:::,tjI-,~.FP`tL:b: UP- 'INE LiNLJt._iP4L) ,*:IN[) iP'II:'. Bt._ll iUf'i DP` IFIE E,*.'::t.;Ifl',,,'Ht].EIN (11"4 FEE].:,. ll.iL-zl<k: 1:::, NLJ k, El i-,.iJ.L) IH P`IjN.' iHI::: t.-ih::htk,'l::.L.: L)bl--'lid I.D., iHt:i: P'iINiP1Uf'i E:,b. PiH UP` UP.:H',,,'EL E:IE'iI.,.iEEN IHE OtJiI-:ffL.L IflNE) IH?:. t-JUt i(JJ"i i. JF iklb E.;:.:',L:P:I',,,'HilUN (J.N FEEl). Id P`'ML:I.::.t-IUb I.-'LPIi'.4 I i"iW'¢ b:[:. 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FiENi5 h'lf':l¥' Hl-'l.-:'L.i.r', .':,PEUiI;-iE.:P`tilONS MMMtL.M'.PJL,,~, i L) ]]N'.':~[JRE PP).Uhi:.R INSI I.ILE,.I:.~ / iliON. J. U~,P..'t LP`'Y II"~P`Ii :ri.: i IflM FHi"I].L.LHI.4: [4,1. tH IHE P.!I::I~:!LJ.[REi"iENIb, PUP..' ON-'.bI t E '.:,E:.!.4EN.'::.-.; i~NE.', ,b.iE:i.,_L'.5 Plb h UR J H E:"r' I HE f'iUN :i: EL: [ I.:'HL. ! I '~' DF F'INCHORi~I.3E. ;L".: I H.[L.i._ ii'.,I~::,tI::!L.L 'INk:. 5"r'b,-i'EM 1i",1 FtCC[)NL)FtNL:L" I.,.lJ. tN iE'i'.PJ .;: .[ iJf'~L)f:h~:%IHJ",!l..) [NFl: triP_ UN-E:;iiE Sb::i[,.!!:R S'¢E,J[:]"l i"119¢ iV. EL..!UJ. RE k-iNi..P:IR(:iEi"lb-'Ni 1i- ]HE P.:I::b, IL:'t":I".-IE;E:. 1:::, i~:I:::f'iLIL)I:}':LE[) J{] lJ",Ii.::i_.U[.)E: I'"I(:JP.:E. i'HMN .:.:: MP'i::'L i L:Hi",i'i E:iEii,g.: ...I i '.::,::;U[:J..:' ~;'.'¢ ........................ L:H'"I'I E ............... ',,,'....::. ~::1 .tenter Health and Env~ronmen' otect~on ' Anchorage, Alaska 99507 form reporto :'T-~b~]~-~- .... ~ .... Y .... Percolatio, test .... DepLh Feet N 3 11-_ .... 5 . 12- '5'1o/o0 W~s ~ter encountered? ,h/~. If yes, aL what depUJ? Gross Time Net Time Uepth .to Water r{et Urop E(,}- 040 (6/74) Readingl)aLe ..... '- ........................... '" = ...................................................... ]]];:~iZ'Li]TZ;.Z ' ........... 7 ----'=- --:( .................................. Porcol~L1on ~te InJ IluLe, ,Proposed ins Lnllo~}~-T -'~h~ge Plt DenOn Fie Id ..................... "; '. IJul)Lh of, Inlet . DepLT~"~'-b:r-")i L or Lrencn Parcel I.D. # 1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 ' Anchorage, Alaska 99519-6650 ; '- ...... 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (si.teaddress or directions) 3~01 Leyden Road Anchorage, AK Pr, opertY owner Mailing address 3901 Leyden Road Lending agency Mailing address Agent ' Michael & Dana Kelly Anchoraqe, Day phone AK 99516 Day phone Day phone 345-8561 Address " ~ Unless otherwise requested, HAA will be held for pickup -:~.~,':',,~-,,;."'~:'-' '-:;; ~.:.¢-~-,~:~;.i.'. '.'??/~!~}~;.~i~'...~_ :.~' ':. ·-. NUMBER ~r =~.-~r~ra~..:·~,.'-~;-' '--~ ::,.::,~.:.,,;.: · ..-.: : : -~-..-- Community well ' ., i .......... Public water ' . - ' ..... ~*" '- ['':~ "": ~ ' NOTE: If community well system, provide written confirmation from Sta~ ADE~ att, est- ing to the legality and status of system. .% ..... ,.. ?i,/. ,' .,/,,'. .' ;. 4. TYP~ OF W~$TEWATER ~I$~O$AL: ,' .-~-~. · · ~ IndNidual on-site xxx Community on-site ~ . . ~:- ..... ,: .:: :- I~tt ~'~ ':" '-: "~¢': ....... ~":':-;.': '_'? :'27. '~ . ' ' ." NOTE: If community wastewater system, provide written confirmation from'State ADEC attesting to the le~lity 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 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 70.~q, "agie P. iver Loop Road Eagle River, Alaska 99577 Phone Date /l /~/~ .,c-- DHHS SIGNATURE ~ ..Approved for bedrooms. Conditional approval for bedrooms, with the following stipulations: - ~.k\ '' -.. ~-.I Additional.Comments By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of hemes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Ray. 1/91) Back MOA#21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Health Authority Approval Checklist Legal Description: A. WlgLL DATA Welltype "-~o.~v'~'r~r IfA, B, orC, attach ADEC letter. ADEC water system number - '- Log present (-'~q) ~/~'~ Date completed ~O - I - '7 -7 Total depth Sanitary, seal FROM WELL LOG AT INSPECTION Date of test Static water level Well production r~ I ~-- g.p.m. '3'. ~ g.p.m. WATER SAMPLE RESULTS: Coliform -~ Nitrate Date of sample: /[/~/ B. SEPTIC/HOLDING TANK DATA Date installed tl-%~q ~' Tank size Other bacteria Collected by: /~. ~o t,o a m Number of Compartments ~ Cleanouts High water alarm (Y~ Foundation cleanout ~TN) ¥~'<o Depression (Y~ ldo Date.of Pumping ~/^ ~v_ Pumper '-~ C. ABSORPTION FIELD DATA Oatej~sthl'led I ~."S 2o[~' Soil.rati~r fi2/bdrm) I. 2 System type ~,~=a, -r~-~ }~ Length /o-7' Width ~'~- ' Gravel thickness below pipe ~t ~ Total depth ~aS. ,~ ' Effective absorption area ~d3& ~ Monitoring Tube present(~N) Y~'$ Depression over field (Y~) V-/o Date of adequacy test ~/,~ ~a~,o . ~ ~y~ Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.): ~ Inunediately after "-~al. water added (in.): Fhfid depth ~ (ins.) Minutes later: Peroxide treatmeut (past 12 months) (Y/N) Absorption rate = If yes, give date g.p.d. D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* C..yx. tea-tesra[ Size in gallons "Pump off' level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~olding tank on lot ID Absorption field on lot Public sewer main '"7t::5 Sewer/septic service line ; On adjacent lots ; On adjacent 10ts ~oo .-~ Public sewer manhole/cleanout mo -+ Lift station SEPARATION DISTANCES FROM~OLDING TANK ON LOT TO: Building foundation ~o' Property line %,.~1 Absorption field Water mai~ffservice line Io ~-- Surface water/drainage to,:, ~4-- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 2~ Water main/service line Surface water Curtain drain Driveway, parking/vehicle storage area Wells on adjacent lots Property line F. ENGINEER S CERTIFICATION I certiJ, i~ that 1 have determined thrufield inspections and review of Municipal reco,'ds ,~:~ ~ms are in co,;)br,,ance with MOA ;~A gu~lines in effkct on this &re. / ~ / ~ o// Signature ~ ~' ~~ ........................................................................................................... .~i~-~b~-~X~-~:>~ .... HAAFee $ ~DO ' ~N Waiver Fee $ '~ - Dute of may~nent //'- 7- ~-~ Date of Payment Receipt Number /~ff & ~.~) Receiptmumber Rev. 8/95 eSS: haa.wk.doc MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL REALTH DEPARTMENT OF t{EALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE : / 1. General Information Application Date _~/~2~/~~ (a) Legal Description (include lot, block, subdivision, section, township, range) (b) (c) Location (address or directions) Tel_~hone - Home Business Applicant is (check one) Lending Institution ~-~[ ; (k~ner/builder~;' Buyer ~ ; Other ~ (explain); Telephone Address (f) Telephone Mail the tiaa to the following address: Type of Residence Single-Family~ Number of Bedrooms Other (describe) Bo Water Suppl_~y 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. e Sewage Disposal Onsite ~ Public ~ Community ~ Holding Tank ~ No~a' Ifl community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 0 Engineering Firm Providing Inspections, Tests, File Search, Data and Information 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 Municipality of Anchorage files and from my investigation and inspection, the on-site '~mter 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° Name of Firm Date__ ~pg~c DHEP Approval Approved for/~d/~2~.bedrooms Approved~,7_ D±sapproved Terms of Conditional Approval Telephone CAUTION THE i~dNICIPALITY OF ANCHOraGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH ALrfHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PAP~G~PH 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 LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- b~NTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ~CHORAGE IS NOT p~SPONSIBLE FOR ERRORS OR OMISSIONS IN TH~ PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/DI8 [Page 2 of 2] 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAAi CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION A?P, 2 4 985 Legal Description: ~~,~0 Well Classification Well Log P~esent ~/~) Date Completed Total Depth ~ / Cased to /~ / ..Static Water Level.- .. ~0'~ Pump Set At Casing Height Above Ground ~. ~o~ Electrical Wiring in con~dui-t~Y~) Separation Distances f~c~ Well: To Septic/}{olding Tank on Lot /~ ~ If A, B, c~ C, D.E.C. Approved(Y/N) / D,~/~7- Yield Depth of G~outing ~//~- , Sanit~ ~al on ~sing ~ ~ession ~nd ~l~ead ; On Adjoining Lots t/a0 To Nearest Edge of Absorption Field on Lot /OO ~- ; On Adjoining Lots To Nearest Public Sewer Line ~ ~ To Nearest Public Sewer Cleanout/Manhole /V~ To Nearest Se~r Service Line o~ Lot Water sample Collected BY ~ ;Date ~/Z~/¢~ ~- '- Water Sample Test Resul~ts ~ ~6f%~C~-O~ ~ _ i .~. H. SEPTIC/HOLDING TANK DATA 1/ Date Installed 3/~0/~ Size /2~-O No. of Compartments Stan~i~s.~) Ai~-ti~t ~ps ~) FoUn~tion Cleanout~) ~ession o~ Ta~ (~ ~te ~st P~d P~ing~inte~n~ ~n~a~ ~ File (Y~) ~'~ Holding Ta~ High-Wate~ ~a~ (Y~) ~~ Holdi~ Ta~ ~t (Y~) ~-. / ~p~ation Distance ~ ~Ptic~olding Ta~: To Water-Supply ~11 ' /~ '~ To ~ilding F~ndati~ To ~o~ty Li~ ~0/~' To Dis~sal Field To ~ter ~i~vi~ Li~ ~'~ To S~e~, ~nd, ~e, ~ ~jor ~aina~ Co~ ~/~0~ [Page 1 of 2] Receipt ~ Date Paid: Amount: 2-15-84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed ~/-~ ~/:~ ' Width of Field ~ r Square Feet of Absu£-gtion ~A~ea Depression Over Field Results of Last Adequacy Test /~--~ ZE~ Type of System Design Length of Field -'.~ Depth of Field /O! '-'/~/ Gravel Bed Thickness ~/9~ Standpipes P~esen~) Date of Last Adequacy Test - Separation Distance from A~sc~ption Field: To Water-Supply Wall To Building Foundation Lot ~/]~" TO Water Main/Service Line / ~ D ~ ~-- To P=operty Line .~ ~a) ~ ~ To Existing or' Abandoned System on ; On A~joining Lots '~-~D/~ · ~-~/ ~ To Cutbank(if present) To St~eam/Pond/Lake/or Major D=ainage Course ? I~D/ ~ To D~iveway, Parking Area, or Vehicle Storage Area ~z '~- LIFT STATION Date Installed __~ Di~re.~sions ~ Size in Gallons ' 7~Z~ M~~~ Tested for //~.'~...Pu~ping Cycles ~in~ Adequacy Test. Meets MOA Electrical CodesJ ** Check Permitted Bedrccm Rating Against HAA Request I certify that I have checked, verified, c~ confo=m-ed to all MOA HAA Guidelir~s in effect Ccmpan .~.~ MOA No. ~Z~O~-q · ~G~ERS % -~ ~ 2-15-84 ALASKA i LIIROISm iSTAL COFITI OL IF1C. 4/24/85 MICHAEL T KELLY P O BOX 110226 ANCHORAGE AK 99511 SELLER-MICHAEL T KELLY MICHAEL T KELLY P O BOX 110226 ANCHORAGE AK 99511 50156 LEGAL:MCMAHON #2 SUBDIVISION BLOCK 9 LOT 10 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-4/22/85 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 608 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 614 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 12/8/84 · FLOW TEST ON WELL WELL FLOW DATE-4/22/85 A FLOW TEST WAS PERFORMED ON THE WELL. 614 GALLONS OF WATER WAS PUMPED AT A RATE OF 4.6 GPM OVER A DURATION OF 2 HOURS. THE DRAWDOWN WAS 8.7 ' WITH A RECOVERY TIME OF 20 MINUTES AND THE STATIC WATER LEVEL WAS 90 FEET. THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME. MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED 1200 LUesl 33rd Aucnu¢. Suile ~ o Ancbrd% Aldska 99503 ~, (907) 561-5040 ~,=~ x ?-~MUIeICIPALITY OF ANCHORAGE~ ~ , ~DEPARTMEN 'OF HEALTH AND ENVIRONMENT, ~PROTECTION ~ ~ ' - 822 L Street, Anchoraa~. Alaska 99501 264-4720. Date Received: March 14, 1978 #1: Time 10:30 a.m. #2: Time ~3: Date 3-15-78 Wednesday Date Insp Pratt Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES o Lending Institution Request: Spokane Mortgage Company Mailing Address: 3201 C Street, Suite 250 Phone: 277-0543 Property Owner:' Gene R. Janigo Mailing Address: Post Office Box 4-1805 99509 Phone: 243-0292 Legal Description: Lot 10 Block 9 Mc Mahon Subdivision #2 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Four Number of Bedrooms: Well System: Individual well (x) Community/Public System ( ) Permit # ~C~ Depth of Well 150' Well Log on File ( ) ~/ Construction Bacterial Analysis 6. Sewage Disposal System: On-site System (x) Public Utility ( Permit # Installed 19~7 Installer Septic Tank Size ,_~~~ ~(~Manufacturer ~ Absorption Area ~ Soils Rate /~-0 Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot ~line Absorption Area to Nearest Lot Line Page Tw~ Department of Health and Environmental Protection Request-for ApProval of Individual Sewer and Water Facilities Legal Description: Lot 10 Block 9 Mc Mahon Subdivision #2 Comments: Affadavit Attached:f_~ ~~ Approved: ~ Date: Disapproved: Date: Letter Attached: ( ) Department Worksheet: = ~< i' ' MUNICIPALITY OF ANCHORAGE /--~.~ i Department of Health and Environmental Protection ~~/ 825 L Street, Anchorage, Alaska 9'9501 ~e~uest for Approval of Individual Sewer and Water Facilities Mailing Address: ~. Name of Buyer: Mailing Address: 2~ o Phone: Lending Institution: Mailing Address: Phone: Realtor/Agent: Mailing Address: Legal Description: A~ Street Location: ~y~q~ Single Family Residence: Phone: Number of Bedrooms: Multiple Family Residence: ( Number of Bedrooms: 7. Water Supply:~_ *Individual Well ~ If Individual Well, well depth ~.~/ If Community System, name of system 8. Sewage Disposal System: *~n-site System If On-site System, date of installation: Public/Community System ( ) ('~ Public System ( ) *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