HomeMy WebLinkAboutMCDOWELL LT A-2Doi5 z.w'c
,~' ~i MUNICIPALITY OF ANCHORAGE '
! DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE I [~I~Ew
MAI LIN G ~[~ DR E~
LOCATION 5~] % J~ ~ %5 ~ %. ~, NO' OF BEDROOMS
~' PERMIT NO.
~(~, Manufacturer ~C~. '~~ Matxs~c NO. of com~ments
Liq~n gallons IF HOMEMADE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O l ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation Nearest lot line
~]~i~ N°'°fDISTANCE TO:lines / Length~e~h Jine Total~g~o~ lines Tr~dth'~/~ inches Distance~ lines
[~ TOp of ti~Jinish grade , Material beneath tile
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS-
SOl L T~ATI N G
I NSTAELER "'
DEPARTMENT OF' H['.:.:AL. TH AND ENVIRONMENTAL PROTECFION
825 L STREE'T.". ANCHORAGE, AK 9950
~-= 6 4.- !-7,~:.(,
I='ERM I T NJ) ."
DATE ISSUED:
8,50487
F" E R I~! I
AF'F'L I DAN]":
ADDRESS:
CONTACT PHONE:
WALKER CONTRACTING
P.O. BOX 771974
ANCHORAGE~ AK 99577
694-4858
SECTION'. '21 ' :TOWNShi'P
LOT SIZE: 101,-_-,J (SQ. FT. OR ACRES)
MAX BEDRO(]M~: ~;
Listed below are the options available to you in designing your septic
system. Choose the option that best fits your site.
TREI'~(:]H BE'I) W . BRA I N
DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0'
GRAVEL DEPTH (FT.) 8.0 0.5 3.5
TOTAL DEPTH (FT.) 12.0 4,5 7.5
GRAVEL WIDTH (FT.) 2.5 15.0 5.0
GRAVEl... L. ENGTH (FT.) 17.0 27.0 30.0
GRAVEl_ VOLUME (CIJ. YDS.) 13.4 15.0 22.3
TANK SIZE (GALS) ],,0()0.0 *~ 1,000.0 ** 1."000.0
SI]IL. RATING (SQ.FT,/BR) 90 90 90
~ TAIXlK MUST HAVE AT LEAST TWO COMF'ARTMENTS
I cer'Li£y that:
1. I am familiar w:ith the requirements £or on-site sewers and wells as set
£orth by the Municipa]~ity o£ Anchorage (MOA) and the State o£ Alaska.
2.. [ wi].] in=-i'L'all the system in accordance with all MOA codes and regulations.,
and in complY, ante with the design criteria o[ this permit.
3. I wi].] adhere to all MOA and State o~' Alaska requirements [or the set back
distances l"rom any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot,
4'. I understand that this permit is valid for a ma;.:imum o£ ~"~ bedrooms and
any enlargement will require an additional permit.
IF A L..IFT S]"A'T'ION IS IN~TALL. ED IN AN AREA CGVERED BY MOA BUILDING (][)DES.,
THEN (1) AN ELECTRICAL. F'ERMIT AND INSF'E. CTION MLIST BE OE~AINED, (2) AS-BUILTS
WILL. NOT BE APPROVED WITHOUT AN EI..ECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICA~WORK M~.~ BE DONE BY A L, ICENSED EL. ECTRICIAN.
AI::'F'L I CA~: WAI...KEF~ONTRACT I NB .
DI::I" AI'~ :. , Eli::' I"~IEAL..'f'H AN[ ENV I RONMIEN"FAL ~' 1" [.) I E:[, I I ON
c ,=,..~ L.. S"FREET ~ ANCHORAGE ~ ~-.~t'::: 9950 ].
~:64'""4'7;.~ ()
PERM I 'f' 1'40:
DA I E. I SE;UEED ::
() J. ~ (.L.. /,-,6
APE L ICAN'T:
A D D R E S S:
,CJN~AC t F:'HONE:
HANK WIL..SON
9601 BU1;)DY WERNER
ANCHOR AG LE, AK 995 ]. 6
246-2000
I cer't.:i..Fy tha'L:
I am Familiar wi. th tLhe I*e?qLtir'efiien~.~.~ For' ol'].--sj.t~ sewers and wells as set
¢'or"Lh by t. he Nun:[c::ipa~ity oF ~ncho~age (MOA) and 'Lhe~'.~tate '~" ' , of Alaska.
;'%, I will ins'La11 'Lhe system in acco"darJce wit. h a:l. 1 MOA codes and r'egu].ations,
arld irl compJ, ianEe with t:.h~:e design cr'J. ter, ia of' this p'el~m:[.l:..
E~;, I w:L11 adher, e to ali. MOA and 'State of' Alaska r'eqLt&r'eifJelTLs FoP ~he set back
d:Ls'Lalic::es f'rom any existing well., wastewa'Lep disposal sys'Lem or' public
seL~ep&tgf. D sys'[.eiil 01"1 th:i.s or' arly ,~AE.j&w::eI:'I'[L or' neEll"by ].o't..,,
.~f'l t...~CAlqT= HANI< HZL..SON
unicipai yof
nchora ¢
P.O. E,~ X 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
June 23, 1986
Hank Wilson
9601 Buddy Werner
Anchorage, Alaska
Subject:
99516
Lot A2D Mc Dowell Subdivision
On-site Well Permit #860002 - Issued January 3, 1986
On May 20, 1986, The Anchorage Assembly approved a new ordinance
regulating on-sit~ wastewater disposal systems (septic systems).
Ail septic systems constructed after the effective date of this
ordinance are subject to the provisions of this ordinance.
Our records show that you currently hold a permit for the installation
of a septic system. We strongly urge that you contact this office
prior to constructing your system. Any changes in the code that could
impact the construction requirements of your septic system will be
identified and brought to your attention. Please contact the
Environmental Services Division at 264-4720.
Thank you for your cooperation.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/SSM/ljw
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DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13-
14-
15
16
17
18
19
20
ENCOUNTERED?
S
IF YES, AT WHAT ~
DEPTH? p
E
Depth to Water After
Monitoring? Dale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __
~ ~ ~ ~-.~EST RUNJ~ETWEEN ~ .F,T Ai~D FT ~
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-O08(Rev. 4/85) .,G? ~-- ~ ~3
PERFORMED iN
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date Z~_~ /, [~'
GENERAL INFORMATION
· (a)
(b)
(c)
Legal Description (include lot, block, subdivision, section, township, range)
/_o-r' 2.,9
Location (address or directions)
Applicant Nam~f¢/~ ~/~ Telephone: Home 2~ ~ Business
Applicant Address
Applicant is (check one): Lending Institution ~; Owner/builder; Buyer ~; Other ~ (explain);
(d) Lending Institution
Address ~¢- .~.
(e) Real Estate Company and Agent
Address
Telephone
Telephone
(f)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family,~r Multi-Family [] Other
Number of Bedrooms
WATER SUPPLY
Individual Wel, J~ 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
Onsit~,~' 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 I of 2 72-025 (11/84)
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 m compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm ~_.~L..~ ~'.
Address ~ ~:~"
Date "~' ~"//. /' ~' ,~,~
Appro;ed for -~ ' ': bedrooms by
Approved ~ ' ' '" ', "'Disapproved
T~rms of Conditidnal Apl~roval
Date /2-2-
Conditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 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 requirements. 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 in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Descr[ption~ ~'~ '~ 7.,-
A WELL DATA
Well Classification
Well Log Present (Y/N) y
/
Total Depth /' ~' ~ / Cased tc
Static Water Level /'~ ~'
Casing Height Above Ground '/
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot ,--~
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line '~"/~"~"
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~-~ ~'' ~ Yield
/~'~
Depth of Grouting ~ AC
Pump Set At /~ ·
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
Y
On Adjoining Lots
: On Adjoining Lots + 1~
To Nearest Public Sewer
~/~ ~ To Nearest Sewer Service Line o~
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) y
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Wel
To Property Line
To Water Main/Service Line
Course
Size / g O,12,,~ No. of Compartments
Air-tight Caps (Y/N)
Foundation Cleanout (Y/N)
Date Last Pumped /L~ ~'M.)
[or
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /../dM' ~'"
Width of Field "~ ~' w/
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~ /'00
To Building Foundation
Lot ~
To Water Main/Service Line -~' ,.~"4:~ /
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area. or Vehicle Storage Area
Comments /~ w"~vl t 7~ ~'.-.~'" g) ~ ~"7
Type of System Design
Length of Field
Depth of Field /7_ t
Gravel Bed Thickness '~ '
Standpipes Present (Y/N)
Date of Last Adequacy Test
/
To Property Line ~ /4:3
To Existing or Abandoned System on
; On Adjoining Lots ~ ~'<~ ·
To Cutbank (if present) ,AM /'Jr
-/- / o~ ~
D. LIFT STATION
Date Installed
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
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **~./ //~
~ .
I certify t h a~J~h,~,j/e,~h~ecke,d, verified, or conformed to ~ a~d HAA guidelines in effect on the date of this inspection.
Signed .,~A~_f~[~/¢'''~ ~''''''~ Date ~ ! / ? ~'~' '.
Company ~---~_w/.~/~'/?~,~ ~-~.w MOANo.
Receipt No. 2~ /
Date of Payment /2"/
Amount: $ ~-~ ~"-'
Page 2 of 2
72-026 (11/84)
NoRIHERN TESTING BORAT0 , .
~7~79-3115
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY CLIENT
[] PUBLIC WATER SYSTEM I.D. #
:~b-~,% PRIVATE WATER SYSTEM
Mailing At'dress ~ ~'
,:x~' ~ ~ ~ ~ :' ~, ,, ~.~.,~ Zip Code
SAMPLE DATE:
Mo. Day Year
Purchase Order No.
SAMPLE TYPE:
[] Routine
[] Special Purpose
[] Check Sample (for original contaminated
sample with lab reference no.
Sample Time
No. ~, L ~o~.~..t.[o n Collected
[] Treated Water
[] Untreated Water
)
Laboratory Ref. No.
Collected by ~
9
10
Signature of Reptese
CASH CHARGE
TRANSMITTAL
SPECIAL INSTRUCTIONS MAIL
HOLD FOR
PICKUP
Received at: /[~Anch. [] Fbks.
Date Received
Time Received
Next Sample Due
COMMENTS:
SATISFACTORY ~
UNSATISFACTORY U
RESAMPLE R
OTHER BACTERIA OB
TOO NUMEROUS TNTC
TO COUNT
Direct Verification Final
Count LSB BGB Result*
Comments
*~[~:~tal/C~iform Colonies per 100 mis.
Reported by . ~
I0
Date
Time