HomeMy WebLinkAboutMCMAHON #2 BLK 9 LT 14
Municipality of Anchorage Page / 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:
/~.~5 Wastewater System: D New ~pgrade
Address:
~. ~/ ~ Deep Trench ~ Shallow Trench ~ed ~ Mound ~ Other
Total Depth from original grade:
LEGAL DESCRIPTION Soil Rating; ~,
Lot: ~ Bloc~ Subdivision:~/~ ~ ~ Depth to pipe boEom~from~original grade: Ft. Gravel depth beneath~, pipe~/' Ft.
Township: J Range: ~ Section: Fill added above original grade: Gravel length:
I
I
WELL: D New D Upgrade Graveldepth: /~ Ft. ~ ~' S Ft.
Classification (Private, A,B,C): Total Depth: ~ Total absorption area: Pipe material:
Ft. Ft.
SEPARATION DISTANCES ~.ptic ~ Ho~ng ~ S.T.~.P.
TO Septic Abso~tion Lift Holding ~;5=~Private Manufacturer: Capacity in gallons:
Fro~ Tank Field Station Tank Sewer Lines
Material: Number of Compadments:
SudaCewater N/~ 2 LIFT STATION
Line ~/P / p/p I P/D / Size in gallons: Manufacturer:
Foundation .~/ ~/~1 ~j~ 'Pump on" levet at: ~ High water alarm at:
Cu~ain ~/~ / Pump Make & M~ectrical Inspections pe~ormed by:
Drain
Remarks: BENCH MARK
Location and Description:
Assumed filovation:
Inspections pedormed by:
Department of He uman s app~ '~;~?,., ...'~%--
Reviewed and approved b~~~~
72-O13 (1/91) MOA 25
Permit No, ~//J ~z.j 0~/~,7 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: .545-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: MCMAHON .2 LOT 14 BLK 9
PIP No.: ~)/'7- ~/,ZCz'~/'
SCALE
1" -60'
A~..× LE]T 14
'-'ELL
EX[ST. TRENCH & TANK
ADANDONED [N PLACE
TO CODE
00- SWING TIES
T 13
NO SURFACE WATER +100'
NO KNOWN CURTAIN DRAINS
A-C = 90.6
B-C = lg4.6
A-D = 39.9
B-D = 168.0
A-E = 159,7
B-E = 69.6
ELEVATIE]Ng
(NaT TO SCALE)
ORIGINAL
GROUND
LEVEL AT~
HT2
0
83.7
8-11-95
ENGINEER'S SEAL
~f..' 49TH~ ".~(
~n~X. LOUIS A. BUTERA
~0-%"'. ~[-~3~ .."~
~;.... ..."¢~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW940437
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:ACKLES ROBERT C & PATRICIA J
OWNER ADDRESS:3645 AKULA DR
ANCHORAGE, AK 99516
DATE ISSUED: 11/28/94
EXPIKATION DATE: 11/28/95
PARCEL ID:01736221
LEGAL DESCRIPTION: MCMAHON #2 BLK 9 LT 14
LOT SIZE: 32800 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
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 ANCHOKAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS)
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.
DATE:
DATE:
Louis Butera, P.E.
Registered Civil Engineer
November 2, 1994
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re:
McMahon//2 Lot 14, Block 9
Narrative & Septic Upgrade Permit Application
Dear Mr. Cross:
The proposed septic upgrade will have very limited impact on adjacent properties for the following
reasons:
1.
2.
3.
The surrounding lots are large, allowing sufficient room for septic sites.
Immediate neighboring septic systems are all +30' distance.
Reserve space is not required, however it appears to be adequate, due to absorption
capacity.
4. Drainage will not be affected and is not a major consideration in our design.
5. New system is located over the test hole, however a two foot sand filter layer will
be installed under the bed.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\C :\WPWlN60\WPDO CS\ 1994\94~06SA.NAR
P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907} 694-5195 · Fax (907) 694-3297
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: McMahon//2 Lot 14, Block 9
to
1. The septic plan is for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
1. Existing septic tank to be pumped, excavated and abandoned in place to code.
2. A new, MOA approved 1,250 gallon septic tank shall be installed as shown on the
site plan. Grade appears to allow a gravity installation, however a lift station as
described below may be required.
BED
1.
2.
3.
4.
5.
6.
7.
8.
The bed is to follow the natural land contour to maintain uniform total depth of the
bed bottom.
The bottom of the bed excavation shall be level, plus or minus 1.5".
The total depth of the gravel bed excavation is not to exceed 3'. A 2' sand ~ter
layer shall be placed under the bed using a MOA approved sand filter material.
Filter sand is to be from Quality Sand & Gravel or engineer pre-approved
equivalent.
The bed gravel is to be covered with typar fabric material.
Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the leachf'leld.
The area over the bed is to be finish graded to prevent ponding of surface water
runoff.
The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
C:\WPWINt0\WPDOCS\1994\944168A.SPC PAOE I OF 2
TOTAL EXCAVATION DEPTH = 3' grovel, 5' sand
GRAVF. I. DEPTH = 6" under pipe, 2" over pipe
BED LENGTH -- 57' BED WIDTH -- 15'
SOIL RATING = 0.7 (filter sand) GPD/ft2
SEPTIC TANK SIZE = 1,250 gallons BEDROOM CAPACITY = 4
RECOMMENDED ELEVATIONS:
BENCHMARK = Bottom edge of siding near north comer of house =
EXISTING FOUNDATION CLEANOUT = ±95.04
NEW BF~D, BOTTOM OF SAND = 91.1
NEW BED, BOTTOM OF GRAVFJ- = 93.1
PIPE INVERT AT BF~D = 93.6
MINIMUM SEWER LINE SLOPE = 1%
100.00 assumed
NOTE:
We recommend excavation to verify elevation of the foundation cleanout. If the
system does not allow gravity feed, a 1,500 gallon Orenco/Anchorage Tank lift
station is to be installed.
Twenty-four (24) hours notice required for all inspections.
C:\WPWiN60\WPDOCS\ 1994~,944)68A.SPC PAGE 2 OF 2
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK 99577
(907) 694-5195
SHEL~T NO. OF
SCALE
!Four Bedroom Single Family Dweilliig ............. . ! .......... i ........... i ............ i ........... i ...............
..... (4BR) (.150. gtxI/BR) = 600 glxl .................. ! .................................
'Percolation rote = 0.9 ~iitesiinCli '"< "i'.Omififi~.dlinch '"": .................... i ~ .
Use a 2' sand filter layer
Use application rote for bed of 0.7 gpd/ft2 . :
· (600 gpd) + (0:7 gpd/ft2) =' 857 ft
857 + 15' wide = 57' long
................ Bed dimensionsl ...................................................................................................... : ...................................
Length ............. ='57
Width ..... 15~ ..............
Total depth of sand.layer = 5' (below.grgun~I surface)
Total depth of gravel layer = 3' (below ground surface)
Sand laye~ thictmess =
............. Grovel under pipe ........ =
\C:\WPWIN60~WPDOCS\ 1994\gd-0~gA.CAL
BOTTOM DF' REAR HOUSE SI])ING
ELEVATIONS ~ ~oo,oo
(NDT TD SCALE)
--I
m
°z ORIGINAL T
GROUND 0
~ lOL04 LEVEL 96,1
]6 LF ~ 17.~ , SEEPAGE AT 89,1
4' PVC _*~ ~ IIJL _ ,,, .! ...... ,,,/
9s,o,~ I ,~4.6 'ST LF .:-~ 'BTM P~PE 93.6
4' PVC '~ ~
94,8/ ~ 17. N "BTM GRAVEL 93.1
",BTM DF' SAND 91,1
SEPTIC PROFILE
LEGAL: MCMAHON #2 LOT t4, BLK g
OWNER: ACKLES
CONTRACTOR: N/A ~ .~gTH ~/~ .. ~9.
P.O. Bo~ 773~94
(907) 694-5195 FAX: (907) 694-3297
· SEPTIC m F1 T
~ / ~,.~ <-.%.~" - ~ ,e. L B T 6
~ - TEST HOLE
* - ~ONITOR TUBE
o - SE~ER CL~NOUT
NO SURFACE ~ATER +100' ~ - WELL
~SE~ENT
NO KNOWN CURTAIN DRAINS EXISTING TRENCH
LEGAL: ~CMAHON ~2 LOT l&, BLK 9 ~L~..
~..' A '. '~
o~ER: ~CKLES ~..~~".
CO,TRaCTOR: ,/~ ,,
JoB ~ 9~-oe81 DATE: ~/~6/9~1 SCALE ~ = ~0' ~::.~._~ ...... ...~.~
(907) 694-5195 FAX: (907) 694-3297
Municipalily of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGINEER'S SEAL)
PERFORMED FOR: '~-"~"'~-~ DATE PERFORMED:
LEGAL DESCRIPTION: I-~'H/~I'~{"'I~ L~lfl [~C~l, Township, Range, Section;
SLOPE SITE PLAN
6
.7
8
9
10
11
12
13
14-
15.
.16-
17
18
19
2O
COMMENTS
~P. ~AP--GP... c~8,ND, Dtz.'¢' "'"/ .SEE_ps,
~Y
WAS GROUND WATER
ENCOUNTERED?
S
L
DEPTH?IF YES, AT WHAT 7 "5 ~EP,..~ po
E
Depth lo Water After
Monitoring? -I ~' / Dale: / / -
=,[E. 'SJTIE PL~I' -
Gross Net Depth to Net
Reading Date Time Time Water Drop
~-i/ Io.z4..~lH Z/'.,N A.,,,v~- ?,, ¢ .~10 ~
I l, H~'o;H~ .~.o HIN IO~'~ ~ '~'
~ ,, I~OH :~ " Io?/~''
PERCOLATION RATE 0 .C:~ (m~nutes/inch) PERC HOLE DIAMETER ~:~11
TEST RUN BETWEEN ~ FT AND q FT
I NST&IJp 1,1,5'"~ PgC, H~GL~TT'E.D~ TO ~ I%'
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE:
72~008 (Rev. 4/85)
GREA.,.R ANCHORAGE AREA BOR . ,;CH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
MAILING ADDRESS ~)- ~J~ ~' ~-~ ~-- ~- O --u~' PHONE
LEGAL DESCRIPTION L ~ --~ c~
SEPTIC TANK:
DI STANCE I ~
FROM WELL_ ~fOO MANUFACTURER_
INSIDE LENGTH / INSIDE WIDTH
MATERIAL
LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID C A PACt TY I')"S~C~GA LLON S.
DISTANCE FROM WELL ~OOJ~' FOUNDATION
/ NEAREST LOT LINE ~ ~ I TOTALOF LINES LENGTH~ '~ I
~[ /~ TRENCH WIDTH~' IN. TOTAL EFFECTIVE
I
SQ. FT. LENGTH OF EACH LINE
~ I DEPTH OF FILTER
MATERIAL BENEATH TILE ~; i~ IN. ABOVE TILE ~O IN.
NUMBER OF LINES I DISTANCE BETWEEN LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
Typ~ I~ '~ \~--) CONSTRUCTION
DEPTH DISTANCE FROM:
BUILDING NEAREST ¢ NEAREST I ~_..%_, SEPTIC
FOUNDATION q~'~ , LOT LINE '10, SEWER LINE Lt') TANK
CESSPOOL ~, OTHER SOURCES ~
APPROVED DISAPPROVED REMARKS
SEEPAGE
/()O,~gYSTEM ( 42 CD ~'
DISTANCES: / .-"~-
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE: ~.
REMARKS: .(-._0t,\
DIAGRAM OF SYSTEM
DATE 1~,1 ~qI'F~ APPROVED
r~G.A.A.B.
Form EQ-032
F'EF::M I T biO.
[:'EF'RRTMENT 17~ HEFILTH FtND EN',,,'IR]NMENTRL. P~OTECT
825 '"L STREET., RNC:HORRGE.,
2'79-25:Lt.
( 77127 ) '~~
FtF'F'L I CRNT
LOCRT I ON
LEGFIL
HERZOCj 24:t8 ERST 2F~I"H R',,,'E
gr..:,
TRIGFI ST
L14 89 MC:MFtHON SI_IBD AD[:,bl ~: LOT SIZE
;2:77-3::1.66
35C1C~l~:l SE!UFIRE FEET
-"-' '' - IS
T'¢I='E OF SOIL HB=,J[BTILIN S'¢STEM : TRENCH
MRXIMUM NI. JMBER OF E:EDROGMS = 4
:50IL f;.:RTING ,'S:' FT,-."BR)= ~ ........
THE REQUIRED SIZE .OF ]'HE SOIL RBSOF.:F'TION S'T'STEM IS:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET::, OF' 'f'HE TRE:NCH OR DRRINF'IEI._D.
'THE DEPTH OF Ft TRENCH OR PIT IS THE DISTFINCE BETWEEN ]"HE: '.:~;LIRFRCE OF THE
GROUN[:, FIND THE BOTTOM OF THE EXCRVRTION <IN FEE']").
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRFt',/EL [:,EPTH IS THE MINIMUM DEPTH OF GRFt',,,'EL E:ETWEEN THE OU"f'FRLL. PIPE
FIN[:, THE BOTTOM OF THE EXCFI',/RTION (IN FEET).
F-: E ,'::., L.~ }[ F-: E] [:,, S E F" T ][ C: ]- R ~'-,~ ~-:-': :5 :t ;:.~ E = :l_ ;i: 5 (E~ "..]J R b. L... C~ f.-.~ :.:=3
'-'"- , NITHOLIT F'INRL. INSPECTION RND HFFF.. ,HL "FFIZS
BRCI<F I EL I NG OF RN"r' --, 'r --.,TEl I ' ' ' -" ',,' -B'¥'
E:'EF'RRTMENT WILL BE S. E TECT l'G F'F.'.OSECUTION.
MIblIMUM DISTRNCE BETWEEN 8 WELl._ RND FIN'.r' ON-SITE SEWRGE DISPOSRL S'¢S]"EM IS
iCaO FEET FOR R PRI"/RTE WELL OR 200 FEET FOR FI PUBL. IC WELL
WELL LOGS FIRE REQUIRED FIND MUST BE RETURNED TO THE DEF'FIRTMEbtT WITHIN 3:0 [:'FI'¥'S
OF THE WELL COMPL. ETtON.
SPECIFICFITIONS FIN[:, CONSTRUCTION DIFIGRRMS FIRE FI',,,'FII[..FIBL.E TO INSURE PROPER
I NSTRLLFIT I ON.
I CERTIFY THRT
.1: I FIM FFIMILIFIR WITH THE REQUIREMENTS FOR ON-SITE 'u-]EI.4ERS FIN[:, WEL..L.S RS SE]'
FORTH B'¢ THE MUNICIPFILIT'¢ OF FINCNORRGE.
2: I WILL INSTFII.L THE S'¢S]"EM IN FICCORDFINCE WITH THE CODES.
]:: I UNDERS]"RN[:, THRT THE ON-SITE SEWER S'¢STEM I"lFI'.r' RE6!UIRE ENLRRCiEMENT IF THE
RESI[:,ENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS.
,, . .'...- . Depe--~tment, of Health and Environmento:~Protection
,. 2510 E, Tu~P,~
Anchorage, Alaska 99507
S()iI,S [,O(; I'E.[IO [,ATI()N
Leual Uescrip~'i'b]~] -o: ..................................... ',)ate Perfon,~ed .... ~--I 77:__:-_'. ......
This .form ~epovts: Soils lo9 ~ Percolation ~est
Del) th
Was ground water encountered? .~.,__ .........
:If w,s, ar] wnaL depth? ------.
Reading Date
Gross Time Net Time Depth to Water Net i;rop
IZO-'
LEGEND:
~ Breaa C~p-Mo~u~ent
~ Iron Pipe
· Steel Pin
m Survey Hub ~
I hereby Dewily ~at.a~urvey of Lpt
.Subdivision was made on ~ ~ ' 17 and
that the improvements situat~ thereon are within the pro~y lin~
and do not overlap or encroa~ on the prope~y lying ~ja~nt thereto,
that no improvements on property lying adjacent thereto encroad~ on
~he premi~ in que~ioh and that there are no roadways, transmimion
lin~S 0r other .visible easements on ~id pro~y ~cept as indi~t~
hereon.
CONSTRUCTI'NG ENGINEERS
SRA BOX ~, Anchorage, AlaSka 99507
.~-0817 ~4-7960
UPDATED AS-BUlL
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
Parcel I.D. # ~\"~-
GENERAL INFORMATION
Complete legal description
MQMahon #2
Lot 14, Block 9
Location (site address or directions)
3645 Aklua Drive, Anchorage
Property owner
Mailing address
Patricia Ackles
3645 Akula Drive, Anchorage, AK
Day phone
99516
345-5901
Lending agency
Mailing address
Agent
Address
Vista Mort§age/A.Scott
Day phone
4241 B Street, Suite 304, ~nchoraqe, 7~ 99503
Vnr~tln~ Pr.np~vt~./T.Taylnr Day phone
°5~ ~ Strcct, ~ ...... ~ 99503
562-6444
265-9103
Unless otherwise requested, HAA will be held for pickup..
NUMBER OF BEDROOMS: 4
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.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (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 Eagle River Engineering Services
Address P.O. Box 773294, Eagle River, AK
Engineer's signature .~-'t.~ _~-~ -~---
Phone
99577
694-5195
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
.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 homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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 (Re, 91) Back MOA #21
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL ~RVICE$ DIVISION
Municipality of Anchorage SEP 1 1 1995~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division ~ECEIVE
825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-47
Health Authority Approval Checklist
LegalDescription: ~']~/l/],~//OA/ ~/-~ ~TT/q ~l.~ ~ ParcelI.D.:
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N) y~-~
Date of test
Static water level
Well production
OiT_ 3 zZ,, -2--1
If A, B, or C, attach ADEC letter. ADEC water system number
Casing height (above ground)
Wires properly protected (Y/N)
Date completed
Cased to ~. 6~ E /
FROM WELL LOG
~/x
AT INSPECTION
g.p.m. 7, z9 g.p.m.
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: o910d9o
, /
B. SEPTIC~GTANK DATA
Date installed 0~/0~/9~'~ank size /~ ~
/1/% 3 5~'"/'lq ~,/L-- Other bacteria
Collected by: ~'/e_ E ~
Foundation cleanout (Y/N) Y~ Depression (Y/N) NO High water alarm (Y/N)
Date of Pumping [~:~/g9 '?/~7~_a P u mp er
Number of Compartments ~ Cleanouts (Y/N). ~
C. ABSORPTION FIELD DATA
Date installed tQ~//Y~/~5~ Soilrating (g.p.d./fi2~'v-fC/bd~) 0'~ Systemtype
Length 5,~ I 0' 5!
Width /~ / Gravel thickness below pipe Total depth
Effective absorptiou area . ~5~ CMonitoring Tube present(YfN) )/~'~ Depression over field (Y/N)
Date of adequacy test/%//~'~/~_.,c Q/d) Results (Pass/Fail) P/qXZ For ~ bedrooms_~
Fluid depth in absorption field before test (in.); ~ Immediately after --gal. water added (iu.):
Fhfid depth ~ (ins.) Minutes later: '~-'- Absorption rate = ----- g.p.d.
Peroxide treatment (past 12 months) (Y/N)
~-' If yes, give date
D. LIFT STATION ,/',///rd'-
mo
Date installed Size in gallons ..__..~-~-~
Manhole/Access (Y/N) "Pump oil" love '.~a--*-~''~'~/"Pump off' level at*
High water alarm level tit* ~ *Damn
Cycles ~
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/6,tditrg tank on lot / / ~
Absorption field oil lot
Public sewer nmin
dgower/septic service line
/03
?
: On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATiON DISTANCES FROM SEPTIC/IIOLDII'4G TANK ON LOT TO:
Building foundation 7 ! Property line 'd-~/ Absorption field
Water~mairdservice line J~O / Surface water/drainage -~L/l)OJ Wells on adjacent lots
Fo
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation ~- o<' ! Wate~ _-m~i,qservice line
Surface water 7L/~)(,') Driveway, parking/vehicle storage area
Wells on adjacent lots ~/) 0
Curtain drain /'Y0,&'~' '
ENGINEER'S CERTIFICATION
Property line
! certify that ! have determined thrufield nspecttons and rewew of3dun ctpal req~'i~.S
in conformance with MOA H~ guidelines in effect on this date
Signature ~~
Engineer s Name ~ C S ~Uf~ ~
"b
Date
....................................................................................................... ~.~¢~rr~.~z
HAA Fee $ ~ ~ / ~ Waiver Fee $
Date of Payment ~/;//S ~ Date of Payment
Receipt Number ~2 ~ q ~S [/ .) Receipt Number
Rev. 8/95 OSS: haa.wk.doc
09/10/~6 li:~l CTSE ESI ANCHORAGE ~ ~07 694 ~297 N0,072 Q07
CT&E Environmental Services Inc,
Laboratory Division -
C~ Sa~lv 1.D M~on ~ 14/9
~trlx DriJ~ ~VaWT
Ordered By
200 W. Potter Ori¥~
Tel', (907) 5B2-234[t
Fax: (907) 561-5301
ClleJ~t PO//
Pt, hated Date/5~hne 09/~0t96 09:14
Collo~tefl Date/Time 09/05t96 13:50
Received Date/Time 091051~6 14:! 5
Ttdmical Dissector: Stepl~n C. Kale
Sample Remml~:
~itr'fta-H 0.10~U 0.1~0 mg/L EPA 555,Z 0g/06/~6 ESL
Total colifom 0 O coL/1OOmt- stalg 92228 09/05/9& TAV
ENVIRONMENTAL FAE~LITIEg IN At_A~KA, CALIFORI~[A. FLORIDA, ILLINOt.Ai MAIWI.AND, MICHIGAN, MtSgOURI. NEW JERff~Y, OHIO, WEST VIRGINIA
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF H~ALTH AND ENVIRONmeNTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1o General Information Application Date /~-~//~ /~ / /,J"~
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicants Name~.~ ~ z~J. fzh:
Applicants Address ~-~ /~f~'~/~
(c) Applicant is (check one) Lending Institution
Buyer~ ; Other~ (explain);
Te~e'p~one ~- ~ome
Business
(f)
Mail the HAA to the following address:
~Residence
Single~Family~
Number of Bedrooms
~ndividnal Well~
Multi~Family~
Other (describe)
¢o tty[ eublic
Mote: If community well system, must have wx'itten confirmation from the State
Department of Environmental Conservation attesting to ~he legality and status.
4. Sewage Dis osal
Onsite ~ Public ~ Community ~ Holding Tank ~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
go~ 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, !
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 ~ype of structure indicated herein.- I further verify that,
based on the information obtained from the }~nicipality of Anchorage files and from my
investigation and inspection, the ou~site water supply-and/or wastewater disposal
system is ~n compliance with all M~nicipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection. /L?~z~,~./ ~/ ~{~-~~.~./~z~/~
Name of Firm ./~./~w.~ ? ' ~- ~.c~/~/~ ~ Telephone ~Z- Y~/~'
Disapproved--
Address_ /'~'? ~
ate
DEEP A~
Approved for~/,/._~.~.bedrooms
Approved ~.~_.
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ~CHORAGE DEPARTMENT OF NEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESEnt-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERF~
IN THE STATE OF ALA?SKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
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 I~N THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/eJ/D18
[Page 2 of 2]
7-19-84
February 10~ i984
Donald and Rac~ael Sullivan
llg6 Ke~%oxer
bellingham, Washington 98226
~_ock 9, ~.~cf. iahon .~ubdivision
· ~uo3~ct. Lot t~,
Approval for the individual sewer and water ~acilities cannot
be grante.~ until the following iteras have beer] completed:
t The septic tank pu~'~ped with a receipt submitted to this
de?artment.
0 An adequacy test needs to be performeO os the existing
l~aching area. This test will deter~nine if the system i?~
adequate according to National Standards. A listing o~
private firms performing the test is enclosed. This report
needs to be submitted to this office for our review.
o Ex)os~[ . .~ the. well for our inspection to determine_ proper
construction, atso to insure minimum distance re(luirements
are met between] the well and sewer system.
Locate and expose the cleanout to the seepat~e Dit and/or
leaching area for our inspection. This is to insure the
~[~inin]um distance require~ents are met between the well and
sewer system.
Please notify this ~)epartment for a reinspection when the
noted discrepancies have been corrected. I~ there are any
further questions~ please call this off, ice at 264-~i720.
Sincerely,
Jim Roberts
Associate Environmental Specialist
gl~37/ej/i~l
Enclosure
CC:
~o~}ert and Patricia Ackles
3645 Akula
Anci]orage, AK 99507
Realty Cente. r
8404 Hartzell Noad
Anchorage, AK 99507
~F~JST ~ P~SSDCIATES
ENGINEERS - PLANNERS - SURVEYORS
1610 DIMOND DRIVE
ANCHORAGE, ALASKA 99507
=PTIC SYSTEM
ADEQUACY REPORT
LEGAL DESCRIPTION
OR SEC-I'ION ~ T__ N ,
~ SUBDIVISION
R W 5. M. ALASKA
PERF, OR MED FOR:
TYPE OF SYSTEM '
NUMBER OF BEDROOMS
SEPTIC TANK WAS PUMPED [] YES
~ SEPTIC TANK - SIZE
[] CRIB OR SEEPAGE PIT
I~"~ LEACH FIELD
[] NO
GALLONS
~1: Time
Date
Insp
>~MUNICIPALITY OF ANCHORAGE---~
DEPARTME~ 'OF HEALTH AND ENVIRONMEN~ ~ PROTECTION
825 'L Street, Anchorage, Alaska 99501
279-2511, ext. 224 or 225
Date Received: July 8~ 1977
3:30 p.m. #2: Time #3: Time
7-8-77 Friday
Date Date
Willis
Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Alaska Statebank
Mailing Address: 310 East Northern Lights Blvd. Phone:
2. Property Owner: Ed Herzog Phone:
Mailing Address: 2418 East 20th Avenue
3. Legal Description: Lot 14 Block 9 Mc Mahon Subdivision
4'.
e
279-7637
277-3166
e
Single Family Residence: (x)
Multiple Family Residence: ( )
Number of Bedrooms: three
Number of Bedrooms:
Well System:
Permit #
Construction
Individual Well (x) Community/Public System ( )
Depth of Well Well Log on File ( )
Bacterial Analysis
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site System (x~ Public Utility ( )
Installed Installer
Manufacturer
Soils Rate Material
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorption Area
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 14 Block 9 Mc Mahon Subdivision
CoK~ent s:
Affadavit Attached: ( ) Letter Attached: ( )
Disapproved:
Date:
Department Worksheet:
· .- F-% MUNICIPALITY OF ANCHORAG[~'' ~7'i::'c:;.%;-.. c.:
· ~ Department of Health and Environmental P.~o~'~:t~i~n
//.~.' ' ' 825 L Street, ~c~orage, Alaska -9-9%~.~h·
~%~)) . ' 279-2511, ext. 224, 225 ,,,, o
>~~quest for Approval of Individual Sewer and Water Facilities
1. Property Owner: ~ ,~.~.'~
Mailing Address: 2~[% ~ .~1~- Phone:
Name of Buyer:
Mailing Address:
Phone:
e
Lending Institution: _~~ ~[~?~
Phone:
Mailing Address:
Legal Description:
Street Location:
Phone:
Single Family Residence:
Multiple Family Residence:
Water Supply: *Individual Well
If Individual Well, well depth
Number of Bedrooms: .~
Number of Bedrooms:
(~ Public/Community System
If Community System, name of system
8. Sewage Disposal System: On-site System ('~ Public System ( )
Zf On-site System, date of installation:
( )
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77
APPLle'-'NT FILLS OUT UPPER HAl"-: ONLY
- ~, ,- Phone
I~rpperty~wner ~_~ (~ y\(> ~ ~) '~ .r-
Phon~
Lan~ing Institution 5,~
Phone
Legal Description / U l ~ ~ / ·
Street Locatim
5¢¢:
Ty~ of Resi~nce
Single Family
'~ Multiple Family No. of Bedroo~
~ Other
Water Supply
lndividual A~AOH WELL LOG. A w~l log is required for all wells drilled since dune 1975.
~ Oommunit~ For wells drilled prior Io that date, give well depth (attach Io~ if available}.
~ Public Utility
Sewer Disposal
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
~ ~ ~ ///~
~'ime / ~ Time 0 Time
Dale Date Date Date
Inspector Inspector Inspeotor lnspeotor
Field Notes:
( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
Date ~wer Installed Well To Absorption Area , ~ Well Log Received
Soils Rating
/' '~ ~ -- / ~'- ~ 7 Well to Tank /~ Septic T~k Size
72.023 {3/82)