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HomeMy WebLinkAboutMCMAHON #2 BLK 9 LT 15 Municipality of Anchorage Page I of DEPARTMENT OF'HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ...q'cu ~ ¢3,.~ '7 ~- PID Number: 0/7 -.~5' 2_ - Name: ~ ~'1~ h Wastewater System: u New ~ Upgrade Address: ~/ ~.~ ~., ~ ~ ~/~ ABSORPTION FIELD Phone: ~ ~ ~ - I ~ ~ ~ No. of ~drooms: ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTI ON Soil Rating: Total Depth from original grade: ], ~ GPD/Sq. Ft. /~" Lot: Block: Subdiv~ion: Depth to pipe bosom from original grade: Gravel depth beneath pipe Township: Range: Section: Fill added above original grade: Gravel length: ~ Ft. ~ Ft. WELL: E~;¢ D New ~ Upgrade Gravelwidth: Number of lines: Distance between lines: Classification (Private, A,B,C): ~ Total Depth: Cased To: Total absorption area: Pipe material: F_~f Driller: Date Drilled: Static Water Level: installer: Date installed: Yield:GPM Pump Set at: Ft. Casing Height Above Ground:Ft. TAN K SEPARATION DISTANCES ~ s.p~ic u Ho~di.; a S.T...~. TO Septic Absorption Li~ Holding Public/Private Manufacturer: ~ Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ~ C ~O ~ ¢ T~ ~ / ~ Material: Number of Co~adments: Sudace Wa~., > ~' >~0¢' - -- - LIFT STATION Lot , Size in gallons: Manuf¢cturer: Line ~-~ ~' - - Foundation ~ ~ ~ ~, - - "Pump on" level at; "Pump off" level at: High water alarm at: Cudain Pump Mak~ & Model ~ Electrical Inspections pedormed by: Drain ..... I Remarks: ~¢,¢,n¢1%¢~c ~ ~ ¢~pe¢l~ BENCH MARK ~n~o~ ~, ~ I~ ~//0~ ~ LocationandDescription: ~e~h Om~ ~ ~ tn~/ ~ ~,~A q,t ] Assumed Elevation: Department of Health and Human Se~ices approval :' '?, :',, .¢".~ Reviewed and approved by: Date: /¢-~- ~::"'-, ~'""; ',.. . 72-013 (Rev. 9/91} MOA 25 .'; :' '~, PERMIT NO: SW980372 PID NO: 017-362-22 EXISTING TRENCH (~ T.H. #1 NEW 50' LONG SOIL ABS. TRENCH W. 8.5' SEWER GVL. BELOW PIPE NEW 1500 GALLON SEPTIC TANK "BULL RUN" DIVERTER VALVE TBM -- R 100' HOUSE SWING TIES: FROM: COR. "A" COR. "B" TO: S.T.C.O."D" 25' 45' S.T.C.O."E" 35' 51.5' DBL. C.O."F" 38' 53.5' VALVE "G" 39.5' 54.5' TR. M.T. 'T' 89' 90' TR. C.O. "J" 90.5' 91' LOT 15, BLK. 9. McMAHON S/D #2 SEPTIC SYSTEM UPGRADE AS-BUILT INSPECTION REPORT FLATTOP TECHNICAL SERVICES SCALE: 1" = 30' 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 SEPTEMBER, 1998 PERMIT NO: SW980372 PAGE 3 OF 3 PID NO: 017-362-22 NAL GROUND ELEVATION 100.0 4" RIGID 1500 GALLON SEPTIC TANK INV. 93.9' INV. 94.2' BOTTOM TRENCH ELEVATION 85.1' J LOT 15, BLK. 9. McMAHON S/D #2 SEPTIC SYSTEM UPGRADE AS.BUILT PROFILE FLATTOP TECHNICAL SERVICES 14530 ECHO STREET ANCHORAGE, ALASKA 99516 NOT TO SCALE DRAWN BY TFM SEPTEMBER, 1998 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 18, 1998 Expiration Date: Sep 18, 1999 Permit Number: SW980372 Legal Description: MCMAHON #2 BLK 9 LT 15 Design Engineer: 0019 Flattop Technical Services Owner Name: KEN WEIST Owner Address: 3601 AKULA DR ANCHORAGE , AK 99516-2861 Parcel ID: 017-362-22 Site Address: 003601 AKULA DR Lot Size: 35432 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage 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 ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: '~"~'~. ~ Date: THEODORE F. MOORE, P.E. PH: (907) 345-1355 Op T CHNiCAL SER CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS 14530 ECHO ST. ANCHORAGE, ALASKA 99516 September 14, 1998 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 15, Block 9, McMahon S/D #2, located at 3601 Akula Drive. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole # 2. As can be seen from the soil log, the native material between 10 and 21 feet below ground level is a clean medium sand with a measured perc rate of 1 minutes per inch. Using the soil application rate of 1.2 gpd/sq, fi. specified in the wastewater ordinance, this 4-bedroom residence requires a total absorption area of (4 x 150)/1.2 = 500 square feet. The proposed 50 foot long trench design with an effective gravel depth of 5 feet has a total absorption area of 500 square feet. The topography of the lot in the area of the proposed construction slopes down towards the south at approximately 10% The proposed project will have no significant impact on present or future 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. ",,,, ', I ,,,,,,,', /,,/" ''"3..."~''....'.....~'" o SEPTIC ' /' ' ' AREA ', / ,'CONSTRUCT NEW 50' LONG' ''-. ', ' ,' SOIL ABSORPTION TRENCH '' / W. 5.0' GRAVEL BELOW PIPE . '-. / T.H ' ' ' 0#2 ,JST. DIV. VALV~E''. '' LOT 16 ,' ,' EXISTING ,,/' TRE~ ,' ABANDON ,' EXISTING 1250 GAL: ' T.H. SEPTIC TANK .-/' #10 DBL. CmO. INSTALL NEW 1250 GALLON SEPTIC TANK LOT 5 SEPTIC AREA o LOT 15, BLOCK 9, McMAHON S/D/t2 SEPTIC SYSTEM UPGRADE SITE PLAN FLATTOP TECH/qlCAL SERVICES 1 INCH = 50 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 SEPTEMBER, 1998 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. INSTALL DBL. C.O. ~ CONSTRUCT 50' LONG INSTALL \ INSTALL SOIL ABSORPTION TR. ~ ~ "A" "BULL RUN" \ 1250 GALLON~ W. 5.5'TOTALGRAVEL ~ 1 DIV'VALVE ~ ~ SEPTICTANK/ I ~ n~. TO ORIGINAL % SOIL ABS. TR. PLAN VIEW SCALE: 1" = 10' - 0" MONITOR TUBE ,lOUT BACKFILL 12" GINALGROUND -- :ILTER FABRIC :-810 PERF PIPE "- 2 1/2" SEWER GRAVEL BOTTOM OF EXCAVATIOh SECTION "A - A" SCALE: 1" = 5' - 0" LOT 15, BLOCK 9, McMAHON S/D #2 SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATTOP TECHNICAL SERVICES 14530 ECHO STREET ANCHORAGE, AK, 99516 SCALE: AS SHOWN DRAWN BY: TFM SEPTEMBER, 1998 Flattop Technical Services 14530 Echo Street, Anchorage, AK 99516 Phone (907) 345-1355 Lot 15, Block 9, McMahon S/D #2 3601 Akula Drive Wastewater disposal system upgrade Specifications 1.0 General: 1.1 The scope of the project consists of abandoning an existing 1250 gallon steel septic tank and installing a new 1250 gallon septic tank which discharges into a 50 foot long soil absorption trench with a total of 5.5 feet of sewer gravel. A diverter valve shall also be installed allowing future reconnection to the original soil absorption trench. 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 to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 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 1250 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 installed within 1 - 4 feet of the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. A "BulIRun" diverter valve shall be installed downstream of the double cleanout to allow future reconnection to the original soil absorption trench. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 50 foot long trench to a depth of 15 feet below ground level in the vicinity of test hole #2. 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 5.5 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 5.0 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. Note: Additional gravel may be placed in the trench and the distribution pipe laid at a shallower depth, if desired either for safe(y of the installer or to maximize the available infiltrative surface. 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. A minimum of 2 feet of soil cover is to be placed over the filter fabric. 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 conforms 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 insulation or filter fabric, and (5) 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 inspection 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. TEST HOLE LEGAL DESCRIPTION: DATE PERFORMED: PERFORMED FOR: DEPTH (feet) 18.75 -- COMMENTS: FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST Lot 15, Block 9, McMahon S/D, 2nd Addition September 4, 1998 Ken Weist Pt. SM Reddish sandyloam ML Light gray gravelly silt SP/SM Slightly silty, gravelly sand Dark gray, lenses of SP SLOPE , LOT 15 ,'BLOCK 9 T.H. XISTING TRENCH SM Silty gravelly sand ~ Dense T.H. Depth to Groundwater Date No groundwater 9/4/98 Monitor tube dry 9/11/98 89 o, SP/SM Slightly silty sand Dark gray Clock Net Time Pemometer Net Drop Date Reading Time (minutes) Reading (inches) 9/4 12" Presoak 27 1/2 Add water & start 12:20:30 23 7/8 #1 12:32 11.5 20 3/4 3 1/8 Add water 12:32:30 23 3/8 #2 12:47:30 15 20 3/8 3 SM Silty, gravelly sand Light gray B.H. PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER 6" TEST RUN BETWEEN 10.5 F-rAND 11.0 FT Soil lenses are inconsistent. Material encountered in perc test hole was much siltier than in main test hole. PERFORMED BY FLAq-FOPTECHNICAL SERVICES. I ~'*.~.'~ ~ CERTIFYTHATTHIS TESTWAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ITEST HOLE LEGAL DESCRIPTION: DATE PERFORMED: PERFORMED FOR: DEPTH (feet) 21 COMMENTS: Pt. FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST Lot 151 Block 9, McMahon S/D, 2nd Addition September 4, 1998 Ken Weist Lens of GP/GM SM/ML Gray gravelly silty sand Pocket of wet SP surrounded by ML GP Coarse sandy gravel SLOPE SITE PLAN , LOT 15 ,'BLOCK 9 T.H. XISTING 26, FRENCH SM/ML Sandy silt ~ ,b% 89 Depth to Groundwater Date No groundwater 9/4/98 Monitor tube dry 9/11/98 SP Clean medium sand Clock Net Time Pemometer Net Drop Date Reading Time (minutes) Reading (inches) 9/4 12" Presoak 27 1/2 Start 1:12:35 23 3/8 #1 1:14:35 2 21 2 3/8 Add water 1:15 23 1/2 #2 1:17 2 21 3/16 2 5/16 Add water 1:17:35 23 3/8 #3 1:19:35 2 21 3/16 2 3/14 Add water 1:20:05 23 5/8 #4 1:22:05 2 21 3/8 2 1/4 PERCOLATION RATE 1 (minutes/inch) PERC HOLE DIAMETER 7" B.H. TESTRUN BETWEEN 10.5 FTANB 11.0 FT Recommend trench witheffective absorption area between 10' & 15' B.G.L. PERFORMED BY FLA'Fi-OP TECHNICAL SERVICES. I ~'-~-~,~ ~ CERTIFY THAT THiS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ ,//~/ / ~C~ GREA.,:R ANCHORAGE AREA BORL._ GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME J~----'(~ ~'"~"¢"'r/'o¢~' MAILINGADDRESS ~"'Jl~ ~ AD'1''!'- PHONE ::Z~-~I(~c., .,,, LOCATION J~i L U l~ LEGAL DESCRIPTION LIT SEPTIC TANK: DISTANCE i FROM WELL I \ ~ MANUFACTURER ~__~2_.~- MATERIAL INSIDE LENGTH ~/"" INSIDE WIDTH_ ~ LIQUID DEPTH ~"~k"~ a ~, NUMBER OF COMPARTMENTS ./" LIQUID CAPACITYJDt:~OGALLONS. 'flL[ C D, AI N DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA TOTAL LENGTH ! FOUNDATION NEAREST LOT LINE ~ ~ OF LINES °~':~ DISTANCE BETWEEN LINES //A TRENCHWIDTH.~I~''~'N. TOTAL/~FFECTIVE ~ OO SQ. FT. LENGTH OF EACH LINE . ---- __5~ ~ DEPTH OF FILTER ' ¢~'~N ~ DEPTH: TOP OF TILE TO FINISH GRADE ~ MATERIAL BENEATH TILE . ABOVE TILE IN. WELL: BUILDING ~.~ NEAREST FOUNDATION~. LOT LINE /9 CESSPOOL .,~,,~OTH E R SOU RCES APPROVED ~ DISAPPROVED CONSTRUCTION ~"~2_.~ DEPTH_ / '/ ~ SEPTIC ~;)1 SEEPAGE NEAREST~t II SEWER LINE . ' ,~ TANK , SYSTEM REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH, I.~ PIPE MATERIAL: 'Er~&~' DIAGRAM OF SYSTEM DATE I~//'~"J/'''~ APPROVED ~12/"f~ (.~) ~ I '~ I G.A.A.B. Form LQ-032 We] Date complete ........................ : ......................................... Depth of well . / ' Distance to water...~.. ....... :. ............................................................................. Distance to water-while pumping ..... ~.~.. / .at rate of .... :..:...~.~..~..i .......................... gallons, per hour. ' ' '" Formation I from DELTA D'R]LLING COMPANY SBA E~OX'-394 B ANCHORAGE. ALASKA. 99507 F~F'F'L I CRNT LOCRT I ON LEGRL ED HEF.'ZZ] '24d. 8 ERST 20TH R',,,'E T~IGR ST Lt5 E[La MF:MRHON SUE:D RDDN ~f-2 LOT "32."OE~E~ SL:;,I.. RRE FEET T'¢F'E OF Sr~IL ' "-'FIF. E'TION S"r'STEM Iq' TF. EN_.H I'"IR::'::IMUM NUMBER OF' E::EE,F-'3:MS = 4. ..... '=,E, FT,.'"E:F'. ) = t.25 SOIL RRTINb ...... THE REQUIF.:ED .:,I,.:-E OF THE SOll. RE:SOF.'PTIEt'.I TFIE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OF.: DR. FItNFIE:L[:'. THE DEPTH OF' R TRENCH OR PIT IS THE [:,ISTRNCE BETWEEN THE :'SUF..:FRCE OF' THE GROUND RND THE BOTTOM OF THE EXCRVRTION ,.'.IN FEE]"). THERE IS NO SET WI[:,TH FOR TRENCHES. THE GRRVEL DEPTH IS THE I'qlNIMUM DEPTH OF GRRVEL. BETWEEN THE OLJ]"FRIJ_ PIPE RN[:, THE BOTTOM OF THE EXCRVFITION (IN FEET). 'T l---t C~ .:"..=_-'-:" .":, ][ ~'-.~ 2-5 F" f:-."Z C: T ][ C, ~-.t :5 R F-: El F..: E ~.7-". b~ ][ ~;-': E: [:, ' ' '- " E','T' E:AL-:KFZLLING OF AN'-r' S"r'STEM I.qITHFIUT FINAL INSF'EC:TION RND RFFF._ ,AL. THIS DEPRRTMENT WILL BE SUE;...TECT TFI PF.:OSEE:UTION. =,EWH.~E DI_,F..L, HL _-.,'rz, TEft IS:; MINIMUM DISTANCE BETWEEN R WEL. L AN[:' RN'T' ON-SITE '- ....... :-'-':" "-'"- -' :tE~e~ FEET FOR R PRIVATE WELt_ OR '-'--":~ ,-_~.:~L" FEET FOF.: IR F'I_IE:L. IC WELL.. WELL LOGS RRE REQUIRED RND MUST BE RETIJRNE[:' TO THE [:,EF'RRTMEI",IT I.,.IITHII",I 3:E'i OF THE WELL COMF'LETION. SF'E-IFI'RTIONS RND Cf'JNSTRUZTIEN [:,IRGR. RMS RF.'.E R"RILF~E:LE TO INSIJRE 'PROPER I NS TRLL. FIT I ON. I CERTIF'-r' THRT ±: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEI.4ERS RND WELLS RS SET FORTH 8'¢ THE MUNIE:IPRLIT'¢ OF RNCHORRGE. 2: I WILL INSTRLL. THE S'.r'STEM IN RCCORDRNCE 1.4ITH THE CODES. 3:: I UNDERSTFIND TI-IRT THE ON-SITE SEWER S',,-'STEM MR'¢ REQUIRE ENLRRGEMENT IF TFIE R. ESIDENCE IS REMODELED TO INCLI..IDE MORE 'I"HRN 4 BEDROOMS. ' Depa~.rtment of Health mid Environmenta)_~rotection -- :~5-}Vy-F~--T-'ade r Eoad ~ 'Anchorage, Alaska 99507 . S()II,S I,O(; I)I':I{()I,ATION TI;ST Performed for' ...... ~_4:..!_4_~].te-..:~.~Lc:~j ........................................... Date Performed This 4'erin reports: Soils log_.~__. Percolation test Feet 10 11 - 12- 13- 14- Was ground water encountered? MO If yes, a~ whaL depth? ' Gross.' .................... ~ .... Readinq- Date T,,ime . . Net Time .... uePth to ~nter Percolation rate Net i)cop 7'-_ TiiLi'L2.ii'.'ZL"L ................................................................ Iii nute. 'Proposed insLalla't-~]fi-"~ab-e~-ge Pit . . ..... L)rain Field Eq-.o4o (6174.) . MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Pr~3'perty Owner ~c)/¢.~g~':7/' ~"~/f~/~d,~ Telephone:Home Mailing Address (c) Business Lending Institution ~ /t~'/~ ' /¢'~:~ E,(E~/7"" ~.x//~/¢'~ Telephone Mailing Address ~ E,~/_.-~/7'"' ¢/,,x/~,~/' ~Z. (d) Real Estate Company.and Agent Address ~3'b.~-~ ,x,//~,,~/-~/~/ z-/-"~. (e) Telephone Mail the HAA to the followina address: or: Check here [], if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family~ Number of Bedrooms WATER SUPPLY 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. SEWAGE DISPOSAL Onsitek~ 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 72-025 fRev 8/861 Front 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 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 ,~'-~ Te,!ephone Address /Z~ b,.) .~,,3~/¢~¢- Date 3 D HHS APPROVAL ~/~ '//~~-/~/'D Approved for ~bedrooms by ate Approved ~"~"..__.__.. Disapproved Conditional Terms of Conditional Approval CAUTION 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 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. Page 2 of 2 72-025 (Rev 8/86} Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON:SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal DesgriPtion (include lot, block, subdivision, section, township, range) / ¢ Eo~;atfon (address or ~li'rections) t' .~&o/ z,4 ':.' (b)~ 'P[oper~, owner P./~] Telephone: Home Business (c) ,L~iiding InstitutiOn /4 ;' /¢/'-~'~-~ ~--,~- (4~/¢~>7'Telephone ~ilingAdd~;;;,'":''~ /-~E2¢ ~/~¢:~,,'~/-~-7'~/_.~'/'¢/'/0//~ ~,~'/'~ (d) (e) Real Estate Company and Agent ,'~/~¢~/ Address .~/~(~)/--7/ _ ?/~//¢,?'2 .~_,/'~/) /¢/L,/S ~/~ Telephone ~ Mail the HAA to the followina address: or: Check here ~hold for pick up. List contact person and d~ phone qumber below. TYPE OF RESIDENCE Single-Family"[~ /_7/ Number of Bedrooms WATER SUPPLY Well~ Community [] Public [] Individual Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite'~ · Public [] Community [] Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 Front 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 flies 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 ,/'~_-~d 5 Telephone Address /'z~c'¢) c-J ~'~¢"~ .;¢~/?~7,~ ,~ ,,,~/~/¢-~; /:CF<'. Date 6. DHHS APPROVAL . . /' Approved for Z~~bedrooms by d'~//~,~~ Date /'ff~t'ff".,../ 5~'.. J/O',COL. er) 'Apt,,o~-- ~ ' ' Conditional ~ Terms of Conditional Approval ~ ~ /~//~J]~l~ ~ / ~ /~/'~ ~,~,.~ CAUTION 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 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. Page 2 of 2 72-025 (Rev 8/86) Back MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCH~TH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL SERVICES DIViSK~'IECKLIST - FEBRUARY 1984 264-4744 i AR ]988 RECEIVED WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present6~) Date Com~pleted lotal Depth __ __ _ Cased to ~"~ - Depth of Grouting Stat c Water Level Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y~ Separation Distances from Well: Yield Sanitary Seal on Casing N) Depression Around Wellhead (Y6~)~ ? To Septic/Holding Tank on Lot ~/.Z/¢ ; On Adjoining Lots / To Nearest Edge of Absorption Field on Lo,t >'/~¢/~ ; On Adjoining Lots To Nearest Public Sewer Line /J To Nearest Public Sewer Cleanout/Manhole /J//¢' To Nearest Sewer Service Line on Lot Water Sample Collected by /~Z?~.' _~ /?L~ ¢',d/~/ ; Date Water Sample Test Results Z'~/¢¢ % ~ /3/7,~/~?~ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes ~,/N) ,-*'~ Air-tight Caps~N) Depression over Tank (Y/~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) '~/~/~ Separation Distances from Septic/Holding Tank: Size /Z-'~ o No. of Compartments Cleanout~("JN) ~ ~' Foundation Date Last Pumped ~'~,//f ;for ~/;~ Temporary Holding Tank Permit (Y/N) To Water-Supply .Well To Property Line , - TO Water Main/ServiCe'LinE ::" Course " ' Comments / To Building Foundation / To Disposal Field To Stream, Pond, Lake. or Major Drainage Page 1 of 2 72-026 fRev 8/86) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field To Stream/Pond/Lake/or Major Drainage Course Type of System Design Length of Field Depth of Field /'.'~' / / Gravel Bed Thickness Standpipes Present(~/-~) Date of Last Adequacy Test Square Feet of Absorption Area ~-7 Depression over Field (V~.)~ Results of Last Adequacy Test / Separation Distance from Absorption Field:/, To Water-Supply Well ~'/~ To Property Line To Building Foundation -~"~'" '/' To Existing or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line /C:) ,¢' To Cutbank (if present) lmm ¢- To Driveway, ~arking Area, or Vehicle Storage Area Comments )~ D. LIFT STATION Size in Gallons ~ "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ~'~'~'~-~ .~Ve nt (Y/N) Pum~uring Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have.ahecl~d, verif'~ed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~"¢'~'/~C~ ~"-'//~"%~ Date 72 026 fRev 8~86} B~ck CHEMICAL & GEOLOGICAL LAB ~'"'-L;.'O~,~.~.~,E~.,.~ FEDERAL TAX ID # 92-0040440 AMALY$I$ RgPORT BY ~L~ for ~ork Order $ 516~ Date Report ~inted~ FEg 15 88 9 Client Sample ID:LT 15 DL[ 9 NCMAMAHON Collected ~B 11 88 9 16:45 hrs. Received FEB 12 88 9 08:00 hrs. Preserved with :REFRIG Client Name: AEC$ Client Aoct: AKECSRP P.O,# NONE REC'D Req # Ordered By : A. WIEN Analysis Completed :FEB 12 88 Laboratory Supervisor :ST~HEN Released By, ~ C. ~ Send Reports to: I)AEC$ 2) Special Instruct: Chemlab Ref #: 9089 Lab ~mpl IDt 3 Matrix: Water Allovable Parameter Tested Result/Units Method Limits NITRATE-N 3.6 mg/I ~A 353.2 10 Sample ROUTINE SAMPLE Remarks~ COLLECTED BY A. WI~ 1 Tests Performed * See Special Instructions Above ND= None Detected ** See Sample Remarks Above NA= Not Analyzed LT=Less Than, b"T=Oreater Than OA=Onavailable NJUNICIPALITY OF ANCHORAGE ~ ...... MUNICIPALITY OF ANCHORAGE DEPT. OF t.L,d. TH & t DEPARTMENT oF HEALTH & ENVIRONMENTAL PROTECTIr~)~I,r~ONMENTAL P~,OTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE DIRECTIONS: Complete all parts on page 1. Incomplete teques~ Will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWN~ J PHONE MAI LING ADDRESS .... ' ' ' PROPERTY RESIDENT (If different from above} PHONE 2. BUYER ' ' ' I ' ' PHON~ MAILING ADDRESS 3. ~ENDING INSTITUTION . . . MAI~I NG AD[DR ESS 4. RRALTOR/AO~NT ' JE. LEG~ DESCRIPTION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [~'~Four [~'~G L E FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY I~DIvIDUAL* [] COMMUNITY [] PUBLIC UTILITY * 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 E2]/~IVI DUAL/ON-SITE** [] PUBLIC UTILITY **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 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 INSPECTOR 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 [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PURLIC UTILITY Connection Verified. INSTALLER []Septic Tank or [~] Holding Tank Size: lc~-~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank I'A~sorption Area Sewer Line Nearest Lot Line / WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS ~'~PPROVED FOR ~ REDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY ~ LEGAL DESCRIPTION 72-010 (Rev. 3/78) j ~-~MUNICIPALITY OF ANCHORAGE 'DEPARTME '~OF HEALTH AND ENVIRONMEN'-~L PROTECTION 825 'L Street, Anchorage, Alaska 99501 279-2511, ext. 224 or 225 "'~'~ Date Received: July 8, 1977 #1: Time 3:30 p.m. #2: Time #3: Time Date 7-8-77 Friday Date Date Insp Willis Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Instituti©n Request: Alaska Statebank Mailing Address: 310 East Northern Lights Blvd. Phone: 279-7637 2. Property Owner: Ed Herzog Mailing Address: 2418 East 20th Avenue Phone: 277-3166 3. Legal Description: Lot 15 Block 9 Mc Mahon Subdivision 4: Single Family Residence: (x~ Multiple Family Residence: ( ) N~ber of Bedrooms: three Number of Bedrooms: Se 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 15 Block 9 Mc Mahon Subdivision Comments: Affadavit Attached: ( ) Letter Attached: ( ) Disapproved: Date: Department Worksheet: · : ]MUNICIPALITY OF ANCHORAGE ~ ..... ............ ~' Department of Health and Environmental Pro~'~-io~n '[['~1/ 825 L Street, Anchorage, Alaska L~ 279-2511, ext. 224, 225 -'~' ~equest for Approval of Individual Sewer and Water Facilities 1. Property Owner: ~&~ ~h Mailing Address: &q[¢ ~. Phone: Name of Buyer: Mailing Address: Lending Institution: Mailing Address: 4. Realtor/Agent: Mailing Address Phone: Legal Description: Street Location: Se Phone Phone: 6. Single Family Residence: (./) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: *Individual Well ~/) If Individual Well, well depth If Community System, name of system Public/Community System ( ) 8. Sewage Disposal System: On-site System (~ Public System If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled sin~e 6/75. 3/77