HomeMy WebLinkAboutMCMAHON #1 BLK 6 LT 2McMahon
Block 6
Lot 2
#017-361-24
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
PHONE [~-N E'.".' -
NO. OF BEDROOMS
~<~= Manufacturer G ~e~ Mater~w~l No, of~artmonts
~ Liq.~a~ci~n~llons I IF HOMEMADE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ ~ Manufacturer Material Liquid capacity in gallons
~, DIS TANOETO: Well~p [ O~I Foundation , Nearest
=~ ! inches Total effective ~;orp~on area
~ Top of tile to finish gradeF~ Materialbeneat t' ~ inches (~ ~'~'~
ken,th ~idth Depth P~BMIT ~0.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ . Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
SOIL TEST RATING
iNSTALLER
REMARKS
DATE LEGAL
72-013 (Rev.
RETURN TO: Division of Geological and O' 'lslcal Surveys (DGGS~ f ~ STATE OF A~S~
3001 Porcupine Drive (Tele~ .et 277-6615) DEPARTMENT OF NATURAL RESOURCES
An¢~rage, Alaska ~9501
WATER WELL RECORD
Or,lli.g Co.pa.y N,~ . r,ll,<D~ U 0tilling P~rmlt No.
A.O.L. No.
OCATION OF WELL 1 Please complete either la, lb, or lc. n'~'~ .....
la. Borough Subdivision Lot Rlock lb. Fraction Section No. Township Range Meridian
1c. Distance end Direction from Road Intersections 3. OWNER OF WELL:
Address:
2. WELL LOG Feet SurfaceBel~ 4- WELL DEPTH: (completed) Surface Elevation ComplDa~e ore,ion
~ / ~ Irrlg,,Jon ~ Rechatge ~ Co~rciaI
~Test Well ~ Other:
7. CASING: ~ Thr~ded ~Welded
in. to ft. Oepth
8. FINISH OF WELL:
Type: ~'~ O[a~ter:
Set bergen ft. and
~[ STATIC WATER LEVEL: ~
~A~ve ~eelow land surface
Type of Measure~nt:
D~PT. OF I4~ALTH ~ 10. PUMPING LEVEL below land surface
~ ft. after ~ hrs. pumping g.p.m.
RECEJ v ,,. GEOUT/N': Weit Gro,,ed; ~Yes
13. PUMP: (If available) HP
Length of Drop Pipe ~ ft. ca,city ~ g,p.m
Type: ~ Sub~rslbie ~ Reciprocat ing
~ Jet ~ Other:
14. REMARKS:
tS. WATER WELL CONTRACTOR'S CERTIFICATION:
This well was drilled under my jurisdiction and this report is true to :he best of my knowledge and belief:
Coov Distribution: WHITE - State DGGS, PINK - Dri)ler, CANARY - Customer
· ' [.',EPRRTMENT ¢"-"HEALTH FIND ENVIRONMENTAL r-'OTECTION
~ ...... "L STREET.. ANCHORAGE, AK.
, - 264-4720
PERM'1' NO. ,' 8802:70 )
RF'PL I CAN]"
LOCRT I ON
LEGAL
BEETER _.ON:.,T
DOROSH I N
LOT 2 BLK 6 MCMRHAN '_-SUB
SAR 1546-E
LOT SIZE
.4~-~-,0..,o
]: ¢:',..':',.."10 SQJRF.:E FEET
T"?F'E OF SOIL RBSORPTtAN SYSTEM IS; TRENCH
MAXIMUM NLIME:ER OF BEDROOMS = 4
SOIL RATING '::SQ FT,.'BR..'- 1--'-_
THE REQUIRE[:, SIZE ~lF THE SOIL FIBSORF'TION S'.',"STEM IS:
E:. E F'-E H =~.D3 , E r-,.3 T H =~ 4 2 G ~: R %. E L E:" E F' T H = e;I ,/,,
THE 'LENGTH DIMENSION iS THE LENGTH (IN FEET) OF THE
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE 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 EXCR',,,'RTION (IN FEET).
" "-'"
SEPT I u--: TR~-~:-".' '--] I ZE= 1--- 5~--~' ~3RLLON$
- F" '- 'FI '- ' T"r'
PERMIT HFFLI_.HNT HAS THE RE=,F_N=-,IE, ILI TO INFERM THIS DEPARTMENT [:,LIRING THE
INSTFtLLFIT!AN IN'-'~PECTIONc, AF AN"," WELLS ADJACENT TO TFIIS FRDFEF. T~ AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
BACKFILLING OF FINY ~',T:.,TEM WITHOLIT FINAL INSPECTION FIND APPROVAL BY THIS
DEPARTMENT WILL BE '"';',UBJECT TO F'ROSE-'UTIEN.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
±00 FEET FOR ~ PRIVATE NELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE:tS 25 FEET AND
TO FI COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'ERr.1 I T E:=---;F-" I F.;ES [:.EC:Ef4E:ER -----::1.. i'9:-
! CERTIFY THAT
~: I RM FRMILIFIR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
' I]11 '
~:: I UNDERSTAND THAT THE ON-SITE 5EWER SYSTEM MR'¢ RE,,_IRE ENLARGEMENT IF THE
SIGNE[:': ~
RPF'L I CFINT E:EETER CONST.
ISSI_IED B ................. BHTE .... V4, 0
PERFORMED FOR:
LEGAL DESCRIPTION:
11
12
13
15-
16-
18-
19-
20-
COMMENTS
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-2224
SOILS LOG - PERCOLATION TEST
SOILS LOG
[] PERCOLATION
TEST
;LOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
CERTIFIED BY: ~'/ ATE:
72-008 (7/76)
PERFORMED FOR,Merl Beeter
LEGAL DESCRIPTION: Lot 2
THIS FORM REPORTS:
CONSTF,-JCTION
TEST LAB
Block 6
I~Visuol Soils Examination
180C :W. 48TH AVE. STE. 'C'
ANCHORAGE, ALASKA 9950.'5
248-1333
DATE PERFORMED: August 22, 1980
Subdivision Mc Mahon
D Percolation Test
DEPTH SOl L N OT'E S
FEET DESCRIPTION
6" Topsoil
Brown (Dry) 225
SILTY SANDY GRAVEL SF/BR
4, -GM-
-- Brown (Dry) (/ 125 ' ')
6' SANDY GRAVEL -GP- SF/BR
GRAVELLY SAND (Dry) 150
-SP- SF/BR
9'
12' GRAVEL -GP- (Dry) SF/BR _
250
14' SILTY GRAVELLY SAND (Dry) -SM- SF/BR"
125
-- SF/B~I
20' GRAVELLY SAND -GP- (Dry) _.~; ~ j
BOTTOM OF HOLE
WAS GROUND WATER ENCOUNTERED NO
IF YES, WHAT DEPTH
LEGEND
~ -- Perc zone
®S - Sample taken
il -- Frozen zone
Kinney R,
3656- E
GENERAL SITE SLOPE
~'- Water table
READING DATE GROSS TIME NET 'TIME DEPTH TO H20 NET DRAINAGE
PERCOLATION RATE:
PROPOSED INSTALLATION
COMMENTS:
DRAINAGE REQUIREMENTS: SEE DESCRIPTION
SEEPAGE PIT ~ DRAIN FIELD O OTHER
TEST PERFORMED BY: L.S. DATA CERTIFIED BY: Kinney R. Baxter, P.E.
· DATE: August 22, 1980
MunicipalitY of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Sou~ Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanchorage.ak, us
(~0~)
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D., 017-361-24
1. GENERAL INFORMATION
HAA H.q In-
Expiration Date: I ~.~ -~3,. ~ - ~ /
Com. plete legal description McMAHON SUBDMSION; ~_OT 2, BLOCK 6, '~ I
Location (site address or directions) 3800 DOROSHIN AVENUE * ANCHORAGE, AK 99516
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
KATHERINE HUGHES Dayphone 564-4316
3800 DOROSHIN AVENUE * ANCHORAGEt AK 99516
Dayphone
Dayphone
Un/ess ob~erwfse requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL.'
Individual On-sita
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorege Development Services Department (DSD) Issues Certficetes of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil
engineer registered In the State of Alaska. Certficates of Health Authority Approval are required for the transfer
of title (except between spouses) for propertes served by a single family on-site wastewatar disposal and/or
water supply system. DSD also Issues HAAs upon request to homeowners. Certficates of Health Authority
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of
up to one year with valid water samples.) Certficatas are valid for one year for properties served by Class A or B
wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the
professional engineer's work.
Note:Alaska Water and Wastewater Consultants, Inc. shall be paid $1,1OO. OO at, or pdor I
to closing for the engineering sen/ices provided.
I
4. STATEMENT OF INSPECTION BY ENGINEER
As cerb'fied by my seal affixed hereto and as of the validation date shown below, I vedfy that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated heroin. 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(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
NameofFirm ALASKA WATER &: WASTEWATER CONSULTANTS. INC. Phone
Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504
"Engineer's Printed Name JEFFREY A. CARNESS. P.E.
Date
337-6179
Engineer's Comment~i
In conducting this evaluation, AWWC, Inc. attempted to pfotdde a thorough,
consc/en#ous engineedng analysis of ~e eystem ln accordance with ADEC snd MOA
DSD Guidelines & Regula~on,. ,e mpofled msu,s des~bed ,e peffo~ance of ,e
system under ~e ~ndiEons en~untemd at ~e Eme of ~e tesh and sepa~on
~eptic systems depend on ~e Io~1 soils ~ndi~on, groundwater le~ls ~at may
flu~uatedudng~e~ar, and~ewaterusageof~efam#ybeingse~dby~esystem.
~ese conditions am o~side ~e ~ntml of ~e e~luator of ~e system. Satisfa~o~ test
results do not guamntee ~um pe~o~ance of ~e s~tem, nor do ~ey gua~ntee ~at
~em am no hMden defects or en~achments. A~C, In~ can ~emfom not pmvide
ope~tional requirements of ~e ADEC or MOA DSD. ~e content of ~is mpo~ Is for
· e sole benefit of ~e o~er listed above. Any mfiance upon or use of ~is mpo~ by any
other pe~on or pa~ is not a~odzed, nor will ~ ~nfer any legal dght whatsoever.
DSD SIGNATURE
* [~"" Approved for L~
Disapproved.
Conditional approval for
,~.,.~,~?.'i,, ~ ( d- ( (' El ~ ' ' "..4,~i~.~.~,;,.$~' ,0,~,
bedrooms. , ~"~"°°-
· .,~.,,' ON-SITE
sti~ulation~.~.~.'' WATERAND :
bedrooms, with the fllowing _. ,_ ~ [ WASTEVVATER .' :
_, . PROGRAM :
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
Original Certificate Date: ~-- ~ Z/Z,--.' O/
Municipality of Anchorage
Development Services Department
On. Site Water & Wastewater Pmgmn
4700 ~x~h Sragaw St
P.O. Box 196650 Anchorage, AK ~951~-6650
legal Oescdptlon:
A. WEld. DATA
Well type P~A~
Date completed
Totel depth
HEALTH AUTHORITY APPROVAL CHECKLIST
McMAHON S/Di LOT 2, BLOCK 6. ~' Jf Parcel ID:
lO/8O
lOl It.
If A, O, orC provlde PVV~lD~ N/A
FROId WELL LOG
~o/8o
82 .ft.
5 g.p.m.
Date of test
b'ta~ water level
Weft produclion
WATER SAMPLE RESULTS:
Date of ~ample: 9/17/2001 Collected by:.
B. eEPTICfltOLDING TANK DATA
Torik 'l~tedal :~ ~'EEL
Tankelze 1250 gal. Number of Compartments 2
Depression aver tank (Y/N) NO
Pumper
FoundaUo. deanout (Yn~) ~s
Oats of pump~g 9/~ 7/ol
C. ABSORPTION HELD DATA
017-561-24
Wen Log (Y/N)
vare~ propedy protected (Yn~)
casco be~ht (above ground)
AT INSPECTION
9/17/ol
84 , It,
4°6
AW1NC~ INC.
Date ~nstaled 8/25/80
Caeanou~ (Y~)
High water alarm (Y/N) N/A
NORTHLAND PUMPING'
YES
YES
12'+ ~
IOnd.
Date Installed e/2$/eo Soft rating (g.p.d~ 125
Length 35 fl. Width
Total depth 12.8 tr. Eft. abemT)UOn area 560 ft' ~ tube YES
Date of adequacy test 9/17/01 Resut~ ([~__ _~F_ ~1]) PASS
Fluid depth In at~ field before test 48.5 in. Water added 780 gal
I~apeedTIme: 18 min. Flnalflulddeplhsg.251n. AbeorplJon rate >m
Any re.luvenatlon tmalment (past 12 mo.) (Y/N & type) NONE KNOWN
System type TRENCH
Gravel below pipe 8 ft.
Depl'~ overfleld NO
For 4 bedrooms
New depth61.251n.
600+ g.p.d.
If yes, give date -
D. UFT STATION
· Pump on' level ~t In. 'Pump n. High water Mann level ~t ~ Jrt.
~ Cycle~ tested Meets alarm & circuit requirements?
E. 8EPARATION DISTANCES
SEPARATION DISTANCES FROM W~q [ ON LOT TO:
Septic te~ ~tel~ 011 lot .93'
Absorption field on lot. 100'+
Public sewer main N//A
Sewer/cep~c ~enace line 25'+
*MOA WAIVER GRANTED IN 1999
On adjacent lots 100'+
On adjacent lots .84'
Public ~war manhole/cteanout
Holding tank N/A
N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Bulidlng foundatlon 5'+ Property line 5'+ Absorplion field.
Water main N/A Water ~ewlce line 10'+ Surface water.
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION F];I n ON LOT TO:
,5'+
100'+
Property llne 1 o'+
Water ~etvlce line 10'+
Cuflaln drain NONE KNOWN
COMMENI'~
Building foundation 10'+
8un'ace water 1 oo'+
Wells on adjacent Iote, lOO'+
Water main N/A
Driveway, petldngNeNole storage
10'+
G. ENGINt=;R'8 CERTIFICATION
~ cerfffy that Ilave determined ~hmugh fleldA=pectk~s end
review of Municipal recorrls that the above syatems are In
conformance vrl~h MOA HAA guidelines In effect on e;ls date.
Englnee~ I~tnted Name
Date '~ /z.//o/
JEFFREY A. GARNESS
Fees°°
Recelpt Number
Waiver Fee $
Onte of Payment
Receipt Number.
SEP-2O-01 17:2Z FROM-CT&E ENVIROItIENTJkt. SRV
,M~T~- CT&E EnvIronment,,I Services Inc.
90?5615301
T-58Z P.02/03 F-856
CT&£ Ret.#
Client Name
Project Name/~
Client Sample ID
Matrix
Ordered By
PWSID
S~.mple Rerr~rks:
1016245001
AK, Water & Wastewater Consultants
3800 Doroshin 1.2 B6 McMahon #2
3800 Doroshin L2 B6 McMahon #2
Drinking Water
PQL Units Mc~hod
Client PO#
Printed Date/Time 09/20/2001 15:52
Collected Date/'rlme 09117/2001 8:15
Received Date/Time 09/17/2001 12:15
Technical Director Stephen C. Ede
Released~Y~~~,~
Nitrate-I'[
0.500 nxg/L EPA 300.0 (<10) O9/l?/01 SC
Mlcrobiolo~¥' Labo~al:oz'y
To~al Coliform
col/100mL SMIS 9222B
(<11
O9117101
--al ::' . ' ' : ~ DEPARTMENT OFHEALTH&HUMA,~SE~i~E~
"'" "'. '" \~-~'7/ Division' Of En~ir°nmentai
/-:--'-'" "'- '"~ - -' ':~ On:Site
' ~ :. ' P O Box 196650; Anchorage;A
'~ '" -:" ' "" ' ' 'CERTFCATEOF
',; -., ~ ~,: ,, ,., . ~ APPROVAL'FOR A's~NGEE':k~iLY',DWE~Li'~
' Parcel I'D. ¢ ' 017-361-24
1. GENERAL INFORMATION
Complete legal description T,Ot '2; Block 6;~;McMahon. S~b'~±V~S±On~ ¢~
Loca~i0'Cv(Site address or directions)
3800 Doro~hin Avenue
Anchorage, AK
.~, ;. : ,.., 345-2433
~roperty. owner Roy Glass Day-Phone
'~ " 1 2914 Lindsey Anchorage, AK 9951 6
M~jlingaddress .
Day phone
Lb~ing agency
M~ii]-h~j!.~'~i-~lress-- .:-::.. . _
Agent .. "-:Day phone _.
Address
&
Unless 'otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
4.- TYPE OF WAS:rEWATER DispoSAL: . ' -
- '- - - ' XX '~ '
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legalitY and status of system. - -: · v - .:,'
5. 'STATEMENT OF INSPECTION BY;ENGINEER , :-~
AS cerb~f~ed by my seal affixed hereto and as of the validation date shown below, I verify that my
,=-~;~ :.~ !.'?m~,~;~,~a~,on of ~his' Health Author,~ ~pProval appl,cation shows that the on-site water supply
and/or ,.w. astew, ater disposal system s safe, funct onal and adequate for the number of bedrooms
. ~ ':.and type'0f;structUre indicated herein. I furtherver fy 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:disPo$~i~i.r~/~li/.q~mp!.!ance w th all Municipal and State codes,
ordinances, and regulations in, effe¢ o~.the da/e ~f-tl'~Cl~spection.
Wa ewarer uonsum
Name of Firm ~l-t~, ~~1~ Phone
Address
Engineer's signature Date .?~/~c~'
DHH8 SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additiona~ Comments
By:. : ', . Date ,~::'-.P'-"- ~"~'
q';l'lll'ii
The Municipality of Anc~l~'~rage Department 0f'He'alih and Human sen/ices [DHHS) issues Health Authority '
App?Val Certificates .based'0nly up0r~ i the rePresentations g ived id' paragraph 5 'above by an independent
profg-.Ssi0 nal,e ngin e~"registered in the state Of Alaska. The DH HS does this as a c°u rtesy t° purchasers of homes
and their I~i~ding i~nstitufions in order'to satisfy Certain federal and state requ rements. Emp oyees Of DHHS do not
conduct inS~tions or~'.analyze :~i.~ta,-bef~r~ e~'icertificate is-is~ed,,.mh~,. Manic pa ty of Anchorage s not
' resPOnsible for e~r°rs 0rioi~issi~ns i~ the Pr~)f~ona!.engi'n~e~S.W~3~i~,~'i,-' ':,' :'... ".: ,. :-'. ·
'72.~25(Rev. 1/91). BaCk ' MOA #21. ,':. -..._:' ,; :.'' ::: -",' -'.' · ,-:.;' "'.-: ' : ':.' ': ," ', . ,
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division JU1 1 4 1999
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907~34.~7W~ ^NCHO~AGE
Health Authority Approval Checklist
101'
Legal Description:
A. WELL DATA -
Well type PRIVATE
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
McMAHON S/D: LOT 2. BLOCK 6 Parcel I.D.:
If A, B, or C, attach ADEC letter. ADEC water system number
017-~R1-P4
YES Date completed
Cased to 100
Date of test
Static water level
Well production
WATER SAMPLE RESULTS;
Coliform NC]NF r') FTF~..TFn
Date of sample: 6/14/.9.9
B, SEPTIC/HOLDING TANK DATA
Date installed R/'P.~/Rn Tank size
Casing height labove groundl 2'+
Wires properly protected (Y/N) YFS
AT INSPECTION
6/4
g.p.m. 4 72 g.p.m.
Foundation cleanout (WN)
Date of Pumping 6/1~r/99
C, ABSoRPTIoN FIELD DATA
Date installed R,I~.~,IRn
Length 55' Width
Effective absorption area .~Rn FT
FROM WELL LOG
10/80
82'
5
yES
Pumper
Nitrate
5.5 mg/L
Collected by:
Other bacteria ?!O?!E DETECTED
AWWC.
!_~50 Number of Compartments ? Cleanouts (Y/N)yES (1)
Depression (Y/N) NC) High water alarm (Y/N) N,/A
A-F
Soil rating (g.p.d./fF or fF/bdrm) 1 ~5
3'. Gravel thickness below pipe
~q Monitoring Tube present (Y/N)_Y_ES_ Depression over field (Y/N) .....
Date of adequacy test 6/14/.99
Fluid depth in absorption field before test (in.);
Fluid depth ?,-~ (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
Results (Pass/Fail) pA~$ For ~.
21" Immediately aften ~.~n gal, water added (in.):
?~ Absorption rate = 600+ g.p.d.
NC] If yes, give date -
Systemtype DEEP TRCH.
g6" Total depth 1 ? 8'
NO
bedrooms
4¢_0"
D. LIFT STATION ~~
Date installed Size
Manhole/Access (Y/N) ' .... ' "Pump off" level at*
High water alarm level at* _~---'~- *Datum
o~~ TO TANK C/O PER
E. SEPARATION DISTANCES FIELD MEASUREMENT
SEPARATION DISTANCES FROM WELL ON LOT T
Septic/holding tank on lot 93' / On adjacent lots 100'
Absorption field on lot
Public sewer main
100'+
On adjacent lots 84' TO CO END OF TRENCH
N/A Public sewer manhole/cleanout N/A
25'+ Lift station N/A
Sewer/septic service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation 5'+ Property line 5'+
Water main/service line 25'+ Surface water/drainage
100'+
Absorption field
Wells on adjacent lots
5'+
100'+
25'+
10'+
lO0'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main/service line
Surface water 100'+ Driveway, parking/vehicle storage area
Curtain drain NONE KNOWN Wells on adjacent lots
/'
,n conformance/~ith~g/~ll/¢A~,delil ;sin effecton this date. '"
Signature ///f~///~- /,~L~ ,
Engineer'sName~~ JEFF O%RNESS
%~..
HAAFee $
Date of Payment ~'~_/L/-
Number
Receipt
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
~~,~ CT&E Environmental Servicv~/~.~/~7/~s Inc~j/~
CT&E ~ef.#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
992693001
AK Water & Wastewater Consultants Inc.
N/A
3800 Doroshin L2 Bk 6 McMahon
Drinking Water
Client PO#
Printed Date/Time 06/17/99 15:38
Collected Date/Time 06/14/99 15:07
Received Date/Time 06/15/99 12:15
Technical Director: Stephen C. Ede
Released By
Sample Remarks:
Results PQL
Uni ts
Method
Attowable Prep Analysis
Limits Date Date Init
Total Coliform
Nitrate-N
0
5.50
coL/100mL SM18 92228
0.500 mg/L EPA 300.0
10 max
06/15/99 fi. AP
06/15/99 06/15/99 SCL
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
http://www.ci.anchorage,ak,us
August 5, 1999
Jeff Gamess, PE
Alaska Water & Wastewater Consultants, Inc.
6901 De Barr Road, Suite 2B
Anchorage, Alaska 99504
Subject:
Waiver Request for Lot 2 Block 6 Mc Mahon #1
Waiver Request #WR990043
Parcel ID #017-361-24
HA990345
Dear Mr. Gamess:
Your request for a waiver of the required 100 feet horizontal separation fi.om the
septic tank to private well has been approved. The approved separation distance is 93.0
feet. The request for the 100 foot separation between the private well on property to the
adjacent drainfield on Lot 3 Block 6 Mc Mahon #1 of 84 feet has been approved.
This waiver approval applies to the existing on-site wastewater disposal system to
private well separation only. Any furore upgrade to the on-site wastewater disposal
system will require all separation distances be met or another approval fi'om this
department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Water Quality Program
WR# WR990043
Date Received:
Legal Description:
Engineer:
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
Applicant:
On-site Services Section
Wa'iver Review Worksheet
PID~ 017-361-24 HA# HA990345
3uly 14, 1999
Lot 2 Block 6 Mc Mahon
Permit
Jeff Garness, Alaska Water & Wastewater Consultants, Inc.
6901 De Barr Road, Suite 2B, Anchorage, Alaska 99504
Roy Glass
*****&
Waiver Requested: Private well to septic tank on property of 93': and private
well on property to the adjacent drainfield on Lot 3 Block 6 McMahon of 84'
Criteria:
e
1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Special Conditions:
POints:
3. Other:
Waiver is Granted: ~ Waiver is NOT Granted:
List Conditions or Reasons for above: ~ff ~[~E~
Date
Name of Reviewer
Rec ~: 05075/6665 Amount: $ 920-.00
Date Paid: July 14. ]qqq
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Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Rd., Suite 2B ~ Anchorage ~ Alaska 99504
Phone (907) 33%6179 ~ Fax (907) 338-3246
July 13, 1999
Municipality Of Anchorage
Department of Health & Human Services
P.O. Box 196650
Anchorage, AK 99519-6650
RECEIVED
umci alit,/ot Anchorage
M ' P - ---an Services
Oept, Health & Hun,
Attn: Dan Roth
REFERENCE: Lot 2; Block 6; McMahon Subdivision; Waiver of separation distance
between well serving the referenced property and septic on Lot 3; Blk 6
Dear Mr. Roth,
The referenced property has a 4 bedroom house and is served by a private well and a
private septic system. Records from your department indicate the septic system was
installed in August, 1980 and well was drilled in October, 1980, by Vern's Drilling (see
attached well log).
We performed an adequacy test on the well and septic on June 14, 1999 for the purposes
of obtaining a Health Authority Approval. During our field investigation, we found the
separation distance between the tank and the well to be only 93 feet. Also, the separation
distance between the subject well and the drainfield on Lot 3; Block 6 McMahon
Subdivision is only 84 feet.
We are requesting that your department waive the subject separation distance to 93 feet
between the existing well and tank on the referenced property and also waive the
separation distance to 84 feet between the subject well and the neighbors septic system on
Lot 3; Block 6; McMahon Subdivision. The subject well was drilled in October, 1980
and the neighbors septic system was installed in April, 1978. The encroachments have
existed for over 19 years.
It is our opinion that the required 100 ft. separation distance t~om the tank to the well to
93 feet and from the private well to the neighboring drainfield to 84 ft. could be waived
to a lesser distance (as it has been for the past nineteen years) without implementing any
health hazard for the following reasons:
Page Two
Waiver request
Lot 2; Block 6; McMahon Subdivision
· Recent analysis of the water (well serving Lot 2; Block 6) indicated no bacteria, and
nitrate levels of 5.50 mg/L. There are no previous water analysis records to use as a
comparison with the current water samples submitted. The original owners still own
the property.
· The well on Lot 2; Block 6 is uphill from the septic system on Lot 2; Block 6.
· The neighboring septic system (Lot 3; Block 6) is located on the opposite side of a
knoll. Even if there was surfacing effluent, due to the topography of the land, it could
not flow towards the subject well.
· The attached well log shows hard pan soils between 38 ft. and 58 ft. and is cased to
100 feet. With these conditions, it is unlikely the tapped aquifer is being effected by
subsurface migration of contaminates from the drainfietdsin the immediate vicinity.
· McMahon Subdivision has a history of elevated nitrates, please see attached sample
results from random locations throughout the McMahon Subdivision.
If you need additi~
S' el
Pregid/znt I
1 information, please contact us at 337-6179.
.E.M.S.
__/. DOROSHIN AVENUE /' /
t / -~ .......
/ / __ /
// ~: -~ ~ ~
/ / ~ ~o~ou s/o
/ o= ~ ~o~
~ x /
~ ~ /
~AS~ WATER ~ WASTEWATER CONS~T~TS, ~C.
~o, .~ .o~, ~u~ ~.. ~c.o~. ~. ,,~0~
LEGAL DESCRIP~ON:
~,I~;...~7~
MoMAHON, LOT 2, ~K 6: 3800 DOROSHIN
WAIVER: ~ELL TO NEIGHBORS DR~INFIELD AND SEPTIC TANK ON LOT
786-7i 24
~0~ o~ss (907) ~_'....~ ...'
Date ~
All ~k , ~'~;
--'~ DATE RECEIVED
.... INSPECTION APPOINTMENTS
'TIME TIME TIME
INSPECTOR I NSP~CT~/~ INSPECT~ ~¢~ ~ , ,
MUNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCHORAGE
PROTEnTio~EPT. OF H~ALTH
DEPARTMENT OF HEALTH & ENVIRONMENTAL ~VIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99~01
ENVIRONMENTAL SANITATION DIVISION NOV ~ 9 1980
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER PHONE
~O~fi~TY B~SI~[~T {If d~fferent from about) PHONE
2, BUYER PHONE
MAILING ADDRESS
3, LENDINg INSTITUTION PHONE
4, REALTOR/AGENT ,[ J PHONE
MAILING
5. LEGAL DESCRIPTION
STREET LOCATION
E. TYPE OF RESIDENCE NUMBER OF,,BEDROOMS
[] One ~ Four [] Other
~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
7. WATER SUPPLY
~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE** ~"0
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(Rev. 6/79) ~\\ ~L~
THIS SIDE FOR OFFICIAL USE ONLY
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
[]PUBLIC UTILITY
Connection Verified iNSTALLER
[Z3Septic Tank or []Holding Tank C'~ '~.~.,
Size: ~ b.%'t~ If Tank is homemade SOILS RATING
give dimensions: ! ..~ ,.~'"-
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
;PROVED BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[Z3 DISAPPROVED
DATE BY
72-010 (Rev. 6/79)