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Home My WebLink AboutMCMAHON #2 BLK 11 LT 2A-1McMahon Block 11 Lot 2A-1 #017-362-31 GREA ER ANCHORAGE AREA BOR,. iGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS ~/-?//Z~ ~&'"~,~':~C~,.~ ,/~-~/~.. LE~^L DESCR,PT,ON Z.. ,2, .,¢'// ./~,,¢,¢,:,Z.," 5"1/_) 'ff~'-- SEPTIC TANK: DISTANCE FROM WELL It'D iNSIDE LENGTH NUMBER OF MANUFACTURER C/''~-¢~1~ MATERIAL ,~'T'~L,{ COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY/~(]GALLONS- DISTANCE FROM WELL //~2~:~ / FOUNDATION F / NUMBER OF LINES { DISTANCE BETWEEN LINES ABSORPTION AREA ~~l~)~' SQ. FT. DEPTH: TOP OF TILE TO FINISH GRADE ~,, TOTAL LENGTH~'// / NEAREST LOT LINE OF LINES TRENCH WIDTH~ IN. TOTAL EFFECTIVE LENGTH OF EACH LINE t~/ / DEPTH OF FILTER MATERIAL BENEATH TILE_ ~'(~ IN. ABOVE TILE ¢ IN. WELL: TYPE pC I' BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION ~" ~' ( ~/¢~.~'~/,~1~ DEPTH'7- DISTANCE FROM: NEAREST NEAREST SEPTIC SEEPAGE LOT LINE__, SEWER LINE ~ TANK [~/, SYSTEM /~ [ OTHER SOURCES DISAPPROVED DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: ~,~Z"--~ LOT SLOPE: ]~'~ REMARKS: /~ ~.~,2"' ,,~;~2~ DIAGRAM OF SYSTEM G.A.A,B. Form LQ-032 Well Log~ ,~n~.,d~' ~, ~..~ ~ ... Location ............. ~..:..(...~-: .......... ~f..xf.~:?::-::~-(~:~:<~.~ .......... ~::~'::~:J~.... ................... Date completed ..... Depth of well. ........... f ..... ~.~ ....... ~2 '.'.:; .................................................................. Size of ea~ng ....... ~..~ ........... :~-...,~-~ . ...................................... Distance to water ........ :.~...~....~,.-.~J:~..: ............................................................ .... Dist~ce to water w~le pumping.... ...... ,.:..;:..,:.: ...... ~4~z ................. at r~te of ................. ~ ............................. gallons, per hour. · ' ~o~m~tionI ~:om J to .:-'~ ~ ,~ ',: ~- ~ ~ . -~"-'-?" :~' -'-' ' ;.h' I I .I DELTA DRILLING COMPANY SRA BOXY394 [] ANCHORAGE, ALASKA 99507 L.Cr!" Ei;:[Z:E~ ;;;i%r4!SE~ ;iii;(;!U!:::lRE I:::'!!ii:ET F;'f::iJ"l:[i....:i:t:::t!:;;: I.,.I:[]"H THE [:;;:E:(;:!LI:[REHi~!~:NT:i!i; FOR ON'""5~;];'f'E ]'HIE i'"iUi",I:[C:[F>I:::I[_]:T'~'' Ed:::' Z I',kST!::'it..L THE S;?S;-FEH ]: ['4 I:::ICCO~:C'I:~i",](;;E Uhli)IE',:;;::S'i"i::;iNi::' ]"HFF'i' Ti"~E ON'"":S3;TE :~:~;E].'.IER S~","?i"EM HFi"r' RE(;;IU;[I:;;:E E~hIL..F:IF;;:GI~:ME:i",FT' ];F:' 'iHIE '"": ~~~., ... ;~:;; 1:::~' i:: ~;~' ~:: '~:' ~'L'"'; 0 ................................................................................. G LEGEND: ~t Brass Cap Monumenf 0 Iron Pipe · Stesl Pin I~ Survey Hub &Tock I hereby certify that a survey of Lot -~ , Block // .Subdivision was made on ~~ ~ - ? ~ and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska, this ,2 day of ~ ~'/~. , 19 ?~ , CONSTRUCTING ENGINEERS SRA Box 60, Anchorage, Alaska 99507 344-0817 344-7960 / '/..-..?0/ Dep~'rtment~ , of Health and Environment?'?rotection 2516 E. Tudor Road Anchorage, Alaska 99507 276-2221 S()II,S I,O(1 I'EI{()I,ATION TEST Perfornled for ~/::~ A/~/~ZQ 0 ',)ate Perfornled.._..~_~_~-_7~_~-- Legal t)escripLl'Oh?-~]-~-~i]~'-/-/~_"_-_/.~_~m.~,~, .d. mZ~'~ .............. This form reports: Soils log ~ Percolation lest Depth Feet ll - 14- Was ground water encountered? If yes, at what de;th? ............. Reading Date Gross Time Net Time Depth to Water Net bnop [ L] ................ Percolation rate minute. -Proposed installa~h: Seepage Pit _~(~.K_Az~_~ .... Urain Field .......................... I)epU~ of I.nlet ................. . Depth to bo[tom or pi Parcel I.D. Municipality of Anchorage On-Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL 017-362-31 Expiration Date: GENERAL INFORMATION Complete legal description McMahon #2 Block 11 Lot 2A-1 Location (site address) 13000 Killey Street, Anchorage, AK Current Proper~y owner(s) ACHEE .~EAN Mailing address same Real Estate Agent Midniqht Sun, Marlene Day phone 272-6580 Day phone 229-9002 TYPE OF DWELLING: [] Single Family (w/wo ADU) [] Duplex [] Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class C Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual [] Holding Tank [] Community [] Public Sewer [] Received by: COSA to be release td td td td td td t~to~e engineer, unless otherwise requested by the engineer. Date: COSA Fee $ Date of Payment Receipt Number COSA # Date: Date Of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems 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 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Phone 694-7028 Date 6. DSD SIGNATURE / System #1 Approved for System #2 Approved for Disapproved, Conditional approval for J_../L bedrooms. : bedrooms., .,:}.. *,,. bedrooms, with the follow ng st p'd[~t ~i;. ~'- * ¥¥~ ~" .... By: The Municipali'~ orr-Anchorage Devlopment Services Division (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheeL9-1-12 doc X Nitrate Advisory Arsenic Advisory Other Certificate of On-site Systems ApprOVal checkliSt : - '. If more th~n t'septlc system is on the lob COSA Checldist # ': : of Structure sewed by. this system ~ ·"".. .: · Well type P If A, B, or C provide PWSID # .:..~....'Datecompleted ?~/t//'~ Saniteryseal(y/N)_.~_ · "'': ,.. TotaldePth '7-5' ~ Casedto '75 It, ..' . FRoM.WELLLOG WATER SAMPLE REsuLTs: ". ' : Coliform....-.0' coleaiedlOOmLz Nitrate ~ o~? mg/L · ': B:' SEpTIC/HOLDING TANK·DATA ~'- . ~;...Tan~sze/~-?_5"(~ gal.. Number of Compartments ~_... "'. '~: Foundation cleanout (Y/N) ~ Depression over tank (Y/N). C, ABSORPTION FIELD DATA Date installed. ~_~ Soil rating (g,p,d./ft. Length ~'// ,~ ff Width ft,' · Parcel ID: (~/' Well Log (y/N) Wires properly pmtectad (Y/N) Casing height (above ground) 'AT INSPECTION 0C~ g;p,m. in. · Collbc~ed by:. Date installed Cleanouts (Y/N) y'. · High water alarm (Y/N) System type G~'avel below pipe ' ,.~ fl, · ._~ Depress on oVer field/`/ Totaldepth ,// lt. Eff. absorptionarea~'/~+~ Montoringtube . · Date of adequacy test ~/'//.~/"/*.~ Results (Pass/Fail) /~,-~' For ~-~ bedrooms / / '. · - · :.. ·Fluid depth in absorption field before test ,~.-/~/ in. Wateradded"~'~:3...gaL Newdepth_~:~' in.". Ela'psed Time: ~/~::) ' min, Final fluid depth ~--~r..// in, Absorption rate >= ~"~::~ 0 g.p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type), If yes, give date D. UFT STA ON Date installed ':Pump on' level at//// Datum / Size in gallons in. 'Pump CYdes tes(ed in. High wate/~arm level at Meet~rm &'circult requirements? ire E, SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot PUblic sewer main SeWer Iseptic service line ~nimal containment areas SEPTIC/HOLDING TANK ON LOT TO: /-- Building foundation ~' ~''~ Water main · ~; Wells on adjacen{ lots ..ABSORPTION FIELD ON I~GT TO: .Property line u'~ ~' Water Sen/ice line /~ ~ Curtain drain _/,/A,,// On adjacent lots . ,/d ~ r~'~-' Onadjacentlots /do' '("- Public sewer mantmle/cleanoul '. Holding tank · Manure/animal excreta storage areas PrOl~-ty line ./~"'P Absorption field Water sewice line. / ~ ~' Surface water /'~0 ~' Building foundation /4d/~ Water main .~ Surface water ~'~E' ~ Driveway, parking/vehicle storage Wells on adjacent lets ,~4~43 ~ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through .field inspections and review of Municipal records that the above systems are in conformance With MOA COSA guidelines in effect on this date. Engineer's Printed Name '~'-/"-~rv/~' ~ ~ Date ~/~'~/tt-~ COSA br(~vn sheet_10-10-12.doc 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ~T'ocu~ ~_ ~'/#~ A~,oc~cX - 5,~'d'6 Day phone Mailing address ~.~ o0 $¢--. ~h,~ pr;¢~ / ¢ , Lending agency N ~A - I<~,y ~o~a~ Day phone ~7 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ ~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng 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 i=(~f/-r.,f, 7-~CA~;cc~f Address /'Y,,C30 ~cAo ~J;, ,,,z~,~c,~o,"~'~/ /'+-~ Engineer's signature '~~ ~. ~ Phone DHHS SIGNATURE . Approved for~ ~[ ~/ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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. 72q)25 (Rev. 1/91) Back MOA~21 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type ?,'iu~ ('c If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~ Date completed ? ! 7~' Driller Total depth ~,¢' Cased to '75" Casing height ~" Sanitary seal (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG Wires properly 3rotected (Y/N) SEPARATION DISTANCES FROM WELL TO: sePt c/holding.tank on lot J O 3 ' ¢-~ ¢,o. Absorption field on lot f o~/' ~ 'tn. tc. Public sewer main N. ~. Sewer service line "~ ~,~ ' g.p.m. AT INSPECTION ~1~o l?~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank N o,, Y ~ WATER SAMPLE RESULTS: Coliform 0 col Date of sample: Nitrate ~'. ~? ~' [-'~ Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Id /"7 /' 7o" Cleanouts (Y/N) ~ High water alarm (Y/N) Date of pumping /~ / ~$/~ ~ Tank size ! 85'~ t~'~/ Compartments Foundation cleanout (Y/N) ~' Depression (Y/N) N, ~. Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 10.7 ' To property line ~, to' Surface water/drainage On adjacent lots Absorption field (OO ' Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 1<2 /' 7 /TK' Soil rating I,¢¢ c~'/[Ycfr,~ System type ~/ Length4~' ~ Width 3~ Gravel thickness ~' .Totaldepth Total absorption area ~4r ~. r~f Cleanouts present (Y/N) Depression over f eld (Y/N) N Date of adequacy test 3/]~/¢~ Rpsults~pass/fail) ~¢~ for Y ~ Peroxide treatment (past 12 months) (Y/N) ~fen¢ Nno~n ~ ~ If yes, g ve date SEPARATION D STANCE FROM ABSORPTION FIELD TO' ~--~-. ~ ~'~- -- ' ' Well on lot 10~' On adjacent lots ~ ~o~' Propertyline To building foundation '8o' To existing or abandoned system on lot N, 4. Onadjacentlots ~. ~'c, ' Cutbank /q-,~. Water main/service line .~. Surface water _ ~' (oo' Driveway, parking/vehicle storage area '8o ' Curtaindrain Nr~,~' ~'~,n ~ Io~- h'~ ~x.,a)ucr' n¢¢~t' ~c~l~d ~/~/~ ~. E. ENGINEER'SCERTIFIOATION ~~ ~ ~_~ ,~/¢, I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature _¢~~..¥ ~ Engineer's Name ?-/~Eo~¢r*~. ¢='. /--t~,o~.~ Date bier',! ~/ /¢¢_7 HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 · THEODOkfi Waivor Foe: $. Date of Payment Tom Fink, Mayor uni pality of AncL ra ¢ Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 April 21, 1993 Ted Moore, P. E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 2 Block 11 Mc Mahon Subdivision ~2 Waiver Request #WR930018, PID #017-362-02, HA930167 Dear Mr. Moore: Your request for waiver of the required 10 foot separation between a septic system and a lot line haS been approved. waived distance is 8 feet from the south property line. The This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Susan Oswalt On-site Services ljm/SO MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR9 WR930018 PID~ 017-362-02 HA# HA930167 Date Received: April 16, 1993 Legal Description: Lot 2 Block 11 Mc Mahon #2 Engineer: Permit Ted Moore, P. E., Flattop technical Services 14530 Echo Street, Anchorage, Alaska 99516 Applicant: Joanne F. Fleetwood Waiver Requested: Lot line - ~ feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. -Special Cunditions: Waiver is Granted: ~// Waiver is NOT Granted: List Conditions or Reasons for above: Other: ~ ~¢~c~ ~ ~2~7~ /~_~~ z~¢~_~ Date: ~ame of Reviewer Rec ~: 24602 Amount: $ 70.00 Date Paid: 4-16-93 OP NIC!AL, CIVIL& ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. April 15, 1993 PH: (907) 345-1355 14530 ECHO ST. ANCHORAGE, ALASKA 99516 Susan Oswalt, M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Ms. Oswalt: Per your "pink slip" request, I am supplying additional information regarding the undocumented upgrade to the wastewater disposal system serving the residence on Lot 2, Block 11, McMah0n S/D #2, located at 13000 Killey Street. I was able to obtain a copy of a 1978 as-buik lot survey which shows the location of the standpipe accessing the undocumented portion of the system. Using the comers of the residence as fixed points, I have also plotted the locations of additional septic system standpipes on the asr built, and have sketched in the apparent configuration of the originally permitted trench and the undocumented upgrade, as well as the locations of nearby wells. The present owner of the lot says she purchased it in 1979 and is unaware of any modifications to the system made prior to the time of her purchase. Since the original system was installed in 1976, and the undocumented standpipe shows up on a 1978 as-built, it can be deduced that the undocumented portion was installed at or near the time of the original construction. Since there is no indication that the originally permitted system is (or ever was) in a state of failure, the mason for construction of the extra leg is unknown. One can hypothesize that the original owner simply wanted to build an extra large system to ensure its longevity, which goal seems to have been accomplished. Assuming the upgrade is configured as indicated, the length of the trench segment is 32 feet from the 6 inch diameter sump at the end of the originally permitted trench. We were able to get a float down into the undocumented 4" cast iron standpipe to approximately the same depth (11 feet beloTM ground level) as in the 6" sump, indicating that the bottoms of the two legs are at approximately the same elevation. Assuming that the distribution pipes are also at approximately the same elevation, the effective gravel depth is 5 feet and the effective absorption area of the undocumented trench is 320 square feet. There is no way short of digging the system up (which would partially destroy it) to absolutely verify this information or to detemfine the material the distribution pipe is made of. The new double cleanout and monitor tube shown in the vicinity ot~ the septic tank on the plot plan were installed by Carl's excavating in September of 1.992 , in the course of repairing a displaced pipe on the outlet of the s~ptic tank.'~ i~t :tha~'time no:diScrepancieS: ~ .,from the Originally permitted and:inspeCted c0nfi~atiOn were~h0ted. ~ Based on this as-built survey, the standpipe in the undocumented trench leg is 8.5 feet from the south property line, common with Lot 3. Since this is less than the required separation distance of 10 feet specified in the wastewater ordinance, we are hereby paying the additional $70 fee and amending our HAA request to also include issuance of a lot line waiver allowing the system to be within 8 feet of the lot line~ Given the configuration of the existing well and septic system serving the residence on Lot 3, issuance of the requested waiver will have no impact on the ability to perform any necessary future upgrade to the septic system on Lot 3. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. ..: 'l I MUNICIPALITY OF ANCHORAGE ) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L - Anchorage, Alaska Street 99501 ENVIRONMENTAL ENGINEERING DIVISION' Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE CLEA AND BEVERLY MEYERS 349-2878 MAILING ADDRESS NHN Killey Str. PROP ERTY R ES ID ENT (I f different from above) PHONE 349-2878 2. BUYER PHONE TIBOR AND BARBARA BATHONY 243-0347 MAILING ADDRESS 2641 Curlew Cir Anchorage, Alaska 99502 LOMAS AND NETTLETON CO/Bill LongI 274-7661 MAILING ADDRESS 4449 Business Park Blvd 4. REALTOR/AGENT I PHONE MARSTON REAL ESTATE/Penny PefanisI 349-4476 MAI LING ADDRESS 2060 W. Dimond Blvd. Anchorage, Alaska 99502 ,,, 5. LEGAL DESCRIPTION Lot 2, Blk ll McMahon Subd STREET LOCATION NHN Killey Str. 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [~] Four [] Other~ ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [~ Six 7. WATER SUPPLY [~] INDIVI DUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** If individual/on-site, give installation date 1976 If system is over two (2) years old an adequacy test is required [] PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-o10(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME 'IME TIME DATP~ DATE DATE INSPECTOR DIRECTIONS: INSPECTOR INSPECTOR 1. TYPE OF RESIDENCE [] SINGLE FAMILY E.~ MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX [] OTHER 2. WATER SUPPLY E--] COMMUNITY [] PUBLIC UTILITY Connection Verified INDIVIDUAL 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified _ [~5~eptic Tank or []Holding Tank Size: _./~.,~'~3 f Tank is homemade give dirnensions: TYPE OF TANK TOTAL ABSORPTION AREA DISTANCES WELL TO: PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE NSTALLED INSTALLER jo- -") SOILS RATING Septic/Holding Tank IAbsorDtion Area Sewer Line INearest Lot Line Absorouon Area to nearest Lot Line 5. COMMENTS ~"~ISAPPROV ED DATE LEGAl:. DESCRIPTION APPROVED FOR ~-~ BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) BY (Title) 72-010 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE t DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF I!~ALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL F'F:OTECTION ENVIRONMENTAL ENGINEERING DIVISION MAR Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEIF~F~¢~I~'~IVsE D DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing, MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHO~ 2. BUYER PHONE MAILING ADDRESS MAILING ADDRESS MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATI ON 6. TYPE OF RESIDENCE I~ SINGLE FAMILY . [] MULTIPLE FAMILy NUMBER OF BEDROOMS [] One [~ Four [] Two [] Five ~ Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] 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 ~]- INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date //~,z 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 I NSP ECTOR I NSP EOTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOIV]S [] 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 []Septic Tank or []Holding Tank Size:. If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev, 3/78) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received March 2, 1977 Time of Inspection Date of Inspection ,~-}/~]7 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. 1. Approval requested by: Mailing Address: Post Office Box 720 2. Property Owner: Edward Herzog Mailing Address: 2418 East 20th Avenue First National Bank of Anchorage Type of facility .to be inspected Well Data: A. Type Individual Phone: Phone: 276=6300 x 572 277-3166 3. Legal Description: Lot 2 Block 11 Mc Mahon Subdivision #2 4. Location: NHN Killey Street' /~f~, 5. Single Family No. of bedr0omsC_~../ 6. C. Construction Sewage Disposal System: A. Installed 1976 C. Septic Tank: D. Seepage Pit: B. Depth D. Bacterial Analysis On-site system, Permit #76711 B. Installer Gorder Excavating ]. Size 1,250 gals/ 2. Manufacturer Greer ]. Absorption Area 600 sq,' 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank Steel Absorption area / Od9 t , Sewer Lines , Other contamination /0 , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages fPage 2 of two pages ' Reqt'~ for Approval of Individual S~~''~ & Water Facilities 'L~gal Description T,ot 2 Blo¢]~ 11 ~Ic ~Iat~on Subctiv±s±on #2 Comments Appr~v~l Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) t.lyers MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAl. PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO 2. Property Owner: Edward Herzog Mailing Address: 2/~1 g E. 2Deb 3. Name of Buyer: VA FHA_ CONY × Day Phone: 277-3166 Mailing Address: Tn] er Tn,,,~,-~ #qnq Day Phone: 276-6144 4. Name of Lending Institution: The First National Bank of Anchorage Mailing Address: P.O. Box 720 Anchorage Phone: 276=6300 x572 5. Name of Realtor or Agent: Penny Pefanis - Marston Real Estate Mailing Address: 2804 Northern Lights Blvd. Phone:_ 277-3511 6. Legal Description: Lot 2, Block 11 Mc~.fahon S/D #2 Anchorage Location: NHN Killey St. (off of Huffman Rd., 1 block E. of Pintail Rd.) 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility. If Individual, date of installation New Single Family Residence No. Bdrms. 3 Individual. Well Individual (on-site) Septic Mary Ann Dodge 72-003(3/76) 3 / 1/77