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Home My WebLink AboutMCMAHON BLK 2 LT 7 Municipality of Anchorage Page I of~L- 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: ~W q'~-O0~-~' PIDNumber: O/ 7-~c/'/-~'~ Name: ~, ~)~ G~0~.(~ Wastewater System: D New ~Upgrade Address: ~60 ~c~.A~O~ ASE, ~c~A(,~ ABSORPTION FIELD Phone: ~-O~ No. ot~edr~oms:'- ~DeepTrench ~ Shallow Trench ~Bed ~Mound BOther L E G A L D E S C R I PT I O N so, Rating: Total Depth from original g rads: ~, ~ GPD/Sq. Ft.I ~, 5 Subdivision: Deplh to pipe bottom from original grade: Gravel depth beneath~ipe Township:__ Range: ~ Section: Fill added above original grade: Gravel length: [~N ~8 Ft ~ Ft. WELL: Q New ~ Upgrad~ 6rave~ width: Z, ~ Ft. Numberl of lines: Distancebetween lines:Ft. Classification (Private. A.B.C): ~ Cased To: Total absorption area: Pipe material: 'Drd,~: _~ Date Drilled: Static Water Level: I~ Oate installed: Casing Height Above Gro,Fn,~: ~C~ ~O~ ~O~ ~. . TANK SEPARATION DISTANCES ~Septic B Holding U S.T.E.P. TO Septic Absorption LiFt Holding ~ublic/Privale Manufacturer: Capacity in gallons: From Tank Field Station Tank S .... Lines ~66 ~¢( SurfaCewater WellLineLOt ~'~//' lC I / ~, / ~ ~ ~ Material:~,;/,, /~Size in galrons: Manufacturer:I/ LIFT STATIoNNUmbor of Compart/ents:~ Foundation ~0 ~ ~ "Pump on" level at: ~~ela,: ~H,~hwa,~,ala~mat: Curtain ~ Pump Mak~ / Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: I Assumed Elevation: I OO, oO ~l, ENG N EE~S;~L Inspections performed by' ~,~R¢'~,P& Dates' 1st w. Department of Health and Human Services approval .~,%"~'~/~.." RevieWed and approved by: ~ ~ Date' ,~ G'-~ ' ~0~Ess~~ Permit No..'~V'] q3~o04~' Page ~' of ~ Municipality of Anchorage 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 Legal Description: LoT' Iq, O,C,O Perml! No. ~k~J ,o~ ~ _ (~ O 4~ Page ~ of '~ Municipality of Anchorage 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 Legal Description: LOT "7 [~t.,OO~ 7_ ~c'"}~tk~0~ S~&D. PID No.: ~) r' ?_ O z~/_...~' PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930045 DESIGN ENGINEER:A.W. MURFITT COMPANY, INC. OWNER NAME:GEORGE HENRY F III OWNER ADDRESS:3860 MCMAHON AVE ANCHORAGE, ALASKA 99516 DATE ISSUED: 4/01/93 EXPIRATION DATE: 4/01/94 PARCEL ID:01704129 LEGAL DESCRIPTION: MCMAHON BLK 2 LT 7 LOT SIZE: 32479 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 (iSAACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~ ~ ~,~,-~ '. ,-?- OF ,< . ..........,; ,~;~ , /~ Municlpallly of Anchorage .; /~'0~~'~ ;~, ~ ~] DEPARTMENT OF HEALTH & HUMAN SERVICES · ~.~~~ ~..~ ~ . 825 "L' Slreet, Anchorage, Alaska 99502-0650 . / '{,~'~ AII~. W~ ]~ ~ SOILS LOG -- PERCOLATION TEST ' : ~.~ No,?~ ,~;G~; , . -- . . · -~ROFESS~U~ ~.'~ LEGALDESCRIPTION:LT,~Z ~k~0~Z TownshiP, Range, Sectio.:~ '~W 5~C.Z~ S~ 2 3 5 ? 8 9 10 ~2 ~3 14 15 ~8 17 18 19 20 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? PO COMMENTS s IF YES, AT WHAT L DEPTH? pO E Deplh Io Waler Aller Reading Date Gross Net Depth to Net Time Time Water Drop __ N~ ~ ~]~1¢~ PEnCOLATI.ON RATE ~ .(minutes/inch) e~nc HOL~ ~T~n ~ ~ ~EST RUN BETWEEN ~ FTAND ~, ~ FT PERFORMED BY: ~k..'~,.~10 t,k), TJk'~¢,,,~, IT['i'~,~.' I ~ ~' ~,~¢ [~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; 72-~8 (Rev. 4/85) A. W. MURFITT COMPANY Consulting Engineers & Testing 13810 Venus Way ANCHORAGE, ALASKA 99515 (907) ~5~J'1 CHECKED BY DATE SCALE Permit No. Page ~ of .-~ Municipality of Anchorage 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 Legal Description: PID No.: k) OT6 '. -3660 ~p4~.~k~l 14LO,O~ 72-013 A (Rev 9191} MOA 25 GREA ':-R ANCHORAGE AREA BORv,,IGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL ~_~-O INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS ~--~ LIQUID CAPACITY"~) GALLONS. TILE DRAIN FIELD:' DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OFTILE TO FINISH GRADE FOUNDATION DISTANCE BETWEEN LINES SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER ~ r MATERIAL BENEATH TILE (~ IN. ABOVE TILE TOTAL LENGTH ~ NEAREST LOT LINE OF LINES ~ TRENCH WIDTH (~C0~ IN. TOTAL EFFECTIVE WELL: TYPE_ CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION LOT LINE SEWER LINE__ CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DEPTH SEPTIC SEEPAGE TANK SYSTEM DISTANCE FROM: REMARKS DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE:~''~ {'~ REMARKS: DIAGRAM OF SYSTEM DATE I~/'~(~ APPROVEB 'G.A,A.B. Form EQ-O32 GREA,ER ANCHORAGE AREA BORN, ,.UGH ". ~ DEPARTMENT OF ENVIRONMENTAL QUALITY PE'RMI~" NO. ,,,o ..c.. ,TRE¢.'~_E¢,%%",~E. A,,., pKA ,,,0, ..,..~ ,,,,.,,. ,,,,,,o,,,,. ,,.,,.,,~ _ ,,,,:q,,,{~o'".[..-%,.,%" r,,.¢ INSTALLATION OF: SEPTIC TANK ~/ SEEPAGE PIT . DRAIN FIELD SEPT,CTANKS''E ?? SEEPAGE AREA SIZE MII~I~pUM DISTANCES, REQUIREMENTS FOU~.DATION~ TO SEPTIC TANK -- SEPTIC TANK ¢'O SEEPA~t PIT WALL~ SEPTIC TAb __ ~ SEEPAGE IT ., DRAIN FIELD TO NEAI LOT gI WELL TOMPTIC TAN~' ~ SEEPAGE PIT TYPE DIAGRAM OF SYSTEM GAAB-HD- I GRi' ,ER ANCHORAGE AREA BOROL' DErAFITMENT OF E~VIRO~MENTAL QUALI1~' 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ADDRESS SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY_ GALLONS. '(:: 77.~'i:./- Z NUMBER OF MATERIAL ~ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: / NUMBER OF PITS OUTSIDE DIAMETER NEAREST LOT LINE OR WIDTH DISTANCE FROM WELL /'~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) / , LENGTH , DEPTH BUILDING FOUNDATION TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA .~ DEPTH: TOP OF TILE TO FINISH GRADE TOTAL LENGTH ~ --7%OgNEZ~ON , NEAREST LOT LINE , OF LINES ~'~ WEE~ DISTANCE BET TRENCH WIDTH IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LI DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE _ ~ t WATER WELL: TYPEi)I(,// (~l~ DISTANCE FROM ~.:/) I [~J~ DEPTH , BUILDING FOUNDATION SAMPLE ll->/~t("~7 NEAREST ~ ,," ,t NEAREST SEPTIC J SEEPAGE .~r;" OTHER ~'~ /~ - /~7 . , SOURCES SEWER LINE , TANK /'~)~ , SYSTEM CESSPOOl LOT LINE DISTANCES: D AGRAM OF SYSTEM DATE GreAtEr ANCHORAGE AREA BOrOUgh DEPARTMENT OF ENVIRONMENTAl- QUALITY 3EOO TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. PHONE INSTALLATION OF* SEPTIC TANK ~ Pit /~ DRAIN FIELD OTHER / :'~x'~x~-~"//~-~ NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST SOIL TEST RESULTS COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE {/OW) TYPE 5:~g ~'~ SEEPAge AREAS ZE .~d ~X-- TYPE ~'~' /~ DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~- / FOUNDATION TO SEEPAGE PIt ~0 F /K' SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK , SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK-- '-'--'~'~'C) DRAIN FIELD WATEr MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, , SEEPAGE PIT TO RIVER, LAKE. STREAM. DRAIN FIELD ~,0c ., DRAIN FIELD ALSO CONSIDER AREA WELLS. SEEPAGE PIT /(20 / DRA,N F,ELD. CAST IRON INTO AND OUT OF SEPTIC TANK ~r) LT~T~ CR!~ .... i~, {~AP OF 4 INk__CH D~AMETER CAST irON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit FITTED WITH AirtiGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH AUTHORITY OR LICENSED DESIGNER ] CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUgh ORDINANCE NO. 28-68 AND THAT THE ABOVE DaTE ~2:/~/ aPPli,aNt'S SigNatUrE ~ / - / .,Al'ER ANCHORAGE AREA BOROUGH : .. }tEALTH DEPAkTI.IENT 'CASE ~ 327 EAGLE STREET , ANCHORAGE, ALASKA 99501 '. Performed ror__r~J-O~ ~--/O~-q~3 .... , Dat~ Performed I~Od,~, ID Legal Description: L°~__~___Flock ~2~,__~ubdlv/~zon ~H~OA3~ This Fc~m RepoPts a: So~ls Log ~ . · .~e~colation lest .... Depth Feet t., '.._~ '.,' ~ ~.,_, ,.L_ Was Gmound Watem Encountered? If Yes, At wh'~t Depth Location Sketch '/971 Reading Date Gross Time Net Time Depth To H20 Net Drop ;e Pro?osed Insral'l~-ion:: Seepage Pi~ ,/,.,,..--,;, Drain' Field Depth' Of Inlet 'Depth To Bottom Of' Pit Or T~ench ' ' "- COMMEIi'fS: ~ ' ' ' ....... ', ' · ...... : - Z ~,~ , , ' ' ...... Data Certified By:__. . , 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 ~.~ i~c- ..~/_?//-,~, ¢' NAA # GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner I~./j~¢.~. ~lk)~ ¢0~-0~.. Mai i i n g ad dress _~9 ¢:~) ~c'~:~/O A.~. ~v~J~ Lending agency Day phone Day phone Mailing address. Agent Day phone Ad dress 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requestedl HAA will be held for pickup.- NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer 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 waste.water 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 ~k.~J .~L~ |"IT ¢j:)~,~ltv~ Phone Address J~JO V~'/~Jl./.~ fJ~Aq ~(2~., ~ Enginoor,s sig nat~_~/~', ~ Date ~JL o DHHS SIGNATURE %/~ Approved for ~'/-¢~(~/) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Additional Comments . ,~)/~) ~ ~ ~/¢(:- %¢~'~ ~ ~ot~." The well for this proper~y~meets existi g State and -M-unici~a! Codes. There are nitrates ~resent. It is suggested that a periodic testing be performed to insure the wells m~~on~~n~ is 10.O. mg/1. Date ~¢ ~ ~ ~' ?' ~ 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. 724)25 (Rev. 1/91 } Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKDST Legal Description: i~'~-'~ ~L~ ~. ~k~'(V~01~ %%~.~0, Parcel I.D. A, WELL DATA Well type ~ ,~/~,,-')7'~f A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/~ Total depth Sanitary seal (Y/N) Date corrmleted i~ -? ~ Driller i'~ ~ ~ -~ Cased to ~"7 ~ F~. ~ Casing height ~ Wires properly protecte~N) FROM WELL LOG AT INSPECTION Date of test \~,~ Static water level Well flow g,p,m. Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ; On adjacent lots I0o +-- Absorption field on lot 1'2_O ~'-~ L[J,~..~.~,~); On adjacent lots Public sewer main I,J ./~. Public sewer Sewer service line c~_~ (¢,J.~,~ OL.~ lat0Lt.%~ Petroleum tank WATER SAMPLE RESULTS: Coliform O Date of sample: Nitrate ~, (0 dC W~ / ~ Other bacteria Collected by: &~l~,~. I,4. ¢,'~.UIP-,F' (lT.' ~ .~..~ _ B. SEPTIC/HOLDING TANK DATA Date installed Cleanout~'N) High water alarm Date of pumping Tank size J~Oo ~¢v( ,~' 'TED c{~,i Compartments '~-.~ Foundation cleanout(~N) L( ~_~ Depression (Y/N) Alarm tested (Y~ lOC -~10)~'~ Pumper ¢0TO 'j~("~OT~ . ~O SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) onlot i ~ .~ ~t-. ' 'Onadjacentlots I 0 0 -~ ~(~ Foundation ~ "7 ~"~--, To property line ~"~ ' Absorption field Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date_ installed Manufacturer Size in gallor~ ................. Manhole/Access (Y/N) Vent (Y/N) "P6~'pon'.' level at 'P~ump'off" level at High water alarm level ..... ::>_<---"~:3ycles tested Meets MOA electrical codes (Y/N) .~--~'~'~'~ ............. SEPARAT~t~E FROM LIFT STATION TO: ~~ On adjacent lots Surface water __ D. ABSORPTION FIELD DATA Date installed Soil rating t,Z- O~°~)/~ Length ~PS,, Width '~,5 ¢(., Gravel thickness Total absorption area '7~ "f ~' '¢~ '~ Cleanouts present (Y/N) Depression over field (Y/N) Results (pass/fail) ~'~i:ST~P6 ¢&[L~,D Peroxide treatment (past 12 months) ( .... .' ~o System type ¢:'~, Total depth Date of adequacy test for :-~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot / '2. O ~-8.. On adjacent lots ICC ,~- ~.. Propertyline To building foundation '-~ ~ 1¢'~; To existing or abandoned system on lot Cutbank J~ O-k/¢ Water main/service line Driveway, parking/vehicle storage area On adjacent lots Surface water Curtain drain bedrooms E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ',' · EngineersUame J-~L-C~i0 U¢. iFLL,[~F ITF' Date HAA Fee $ / Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number Parcel I.D. # 1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# GENERAL INFORMATION Complete legal description ~,'~ -[ Location (site address or directions) Property owner Mailing address Lending agency Day phone Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~' TYPE OF WATER SUPPLY: Individual well v" Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State AD£C attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA fl21 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 k'~'~b[~.~ I1'~' (,¢O~'/~&J~ Phone 6. DHH,~; SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for -~ bedrooms, wit, h the f¢lowing stipulations: Additional Comments ~.,<C/¢¢b./ Flf~,z~.r To ,4t~',~,vPZ. 15/¢ T/-//E /¢gDP~.~'D The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Hea~th 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. 72~)25 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. Legal Description: A. WELL .DATA Well type ~l~l~'['~ If A, B, or C, attach ADEC letter. Loqpresent (Y~d~ ~j u. IDa~co m p let ed Total depth I '7 ~ Sanitary seal~N) Date of test Static water level ADEC water syStem number I ~'1'( Driller. Cased to I-~ ~ Casing height ~-OI' Wires properly protecte(~_.~N) FROM WELL LOG Well flow g.p.m. Pump level SEPARATION DISTANCES FROM WELL TO: III~ Septic/holding tank on lot ; On adjacent lots Absorption field on lot IZ~ ! ; On adjacent lots Public sewer main Ik)t~ Public sewer manhole/cleanout ~ ~' C(,L~ O[.L~ KT t~Od.~,~~.~l~Nl~'~etr°leum tank Sewer service line AT INSPECTION o~..~ 4.13 g.p.m. -~ WATER SAMPLE RESULTS: Coliform (~ Date of sample: Nitrate :~.6~- v~/,,~. Other bacteria ~E' ~ Collected by: ~.LI~/0 ~,0. ~/~'C~ ~ ) ?.~; B. SEPTIC/HOLDING TANK DATA Date installed ~lO~lC~ ~ Tank size lOGO CleanoutQN) ~S Foundation clean ou(~'N) High water alarm (Y/N) k.~ 0 Date of pumping ~r¢..~--.~ Compartments "~"L'O0 ~ ~'~ Depression (Y/~ ~ O Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot II I / To property line ~'~' ! Surface water/drainage ~ Onadjacentlots lO0 -i. p-'~_. Foundation ~.0 f Absorption field ~ '4~ater main/Service line ~/~. ~/~. 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Eh~t~ Man ufactu rer Size in gallons"'"~-~._~..... Manhole/Access (Y/N) Vent (Y/N) ' "~l~h"'p-en2]~evel at "Pu High water alarm level ~ % .._~es tested Meets MOA electrical codes (Y/N) .-----~/ ' SEPARATION D~ FROM LIFT STATION TO: WefF~on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ,~t Width Soil rating ;.'~ ~-.~O/~F System type Gravel thickness ~ I Total depth Total absorption area ~'~ Depression over field (Y~ Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Cleanouts presentGN) Date of adequacy test for bedrooms If yes, give date __ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot J~-'~ To building foundation 4,~ On adjacent lots ~'0 Surface water Curtain drain On adjacent lots I O0 ff'l'~ , Propertyline To existing or a~bandoned s~zstem_, on lot __ Cutbank ~2k,3 ~' Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelin¢~ in,effect on the date 2f this inspection. Engineers Name Date ~)[- HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-028 (Rev. 3/91) Back MOA 21 II rRTUNE Fortune Properties, Inc. 2525 C Street, Suite 100 Anchorage, Alaska 99503 (907) 562-SOLD (7653) Residential FAX 276-4508 Investment FAX 276-4507 March 15, 1993 Mr. Allen Murfitt, A W Murf~tt Company 13810 Venus Way Anchorage, AK 99515 3860 McMahon Avenue McMahon Subdivision L7 B2 Mr. and Mrs. Henry George Dear Mr. Murfitt, Although the septic system at 3860 McMahon Avenue owned by Henry and Kathleen George originally met standards for a four bedroom home, this house is in actuality a three bedroom house. Please feel free call me on my direct line at 265-9108 if you have any further questions. Thank you. Sincerely, Calt Associate Broker cc: Henry and Kathleen George INVOICE SEWER AND DRAIN ",'~'~ ~ "],~c4 CLEANING SERVICE RO. BOX 112688 PHONE 345-2513 ANCHORAGE, ALASKA 99511-2688 Job Address ,4' ROTC-ROOTER SERVICE gALL HRS. @ STEAM THAWING TRIPCHARGE OVERTIME CHARGE HRS. @ HRS. @ HRS. @ ADDITIONAL LABOR CHARGE HRS. @ ~'~"-PUMPINGSERVICE ~.'7(2~ (GAL.) HRS. / @ HYDRO-J ET SERVICE HRS. @ PLEAS E PAY FROM THIS INVOICE / TOTAL TOTAL FOOTAGE CLEANED OR THAWED BLADES USED LINE CLEANED [] ,.lOB NOTGUARANTEE~fO,~F%LOWING REASON WOR"ACOE':'TE":'S"'. CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 Chemlab Re£ .~ :93.0915-1 Client Sample ID :L7 E2 MCMAHON SUBD 3860 MCMANON AVE Matrix : WATER REPORT of ANALYSIS FAX: (907) 561-5301 Client Name :A.W. Mb~FITT CO. INC. Ordered By :ALLAN M UR[ITT, P.E. P~oJect Name : Pzojectt : PWSID :UA Collected :03/08/93 ~ 11:30 hrs. Received :03/08/93 @ 12:45 hrs. WORK Orde~ :63790 Repoxt Completed :03/09/93 Tec~-~[cal Dizector iSTJP~3~L~. EDE . Sample Remazks: ROUTINE SAMPLE COLLECTED BY: ALLAN QC Allowable Extract Analysis Parameter Results Qual. Units Method Limits Date Date Init NITRATE-N 5.64 ~X3/1 EPA 353.2/300.0 lO 03/09/93 LLH See Special Instructions Above UA - Unavailable See Sample Remarks Above NA - Not Analyzed Undetected, Reported value is the practical quantification limit. LT - Less Than Secondary dilution. CT = Greater Than ~S~S Member of the SGS Group (Soci~t6 GGn~rale de Surveillance) 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name /¢,/ey/ Applicant Address (c) Applicant is (check one}: Lending Institution []; Owner/builder~; Buyer []; Other [] (explain); (d) Lending Institution (e) Real Estate Company and Agent /¢y~. Address Telephone Mail the HAA to the following address: ,,.\ (f) TYPE OF RESIDENCE Single-Family,~ Mu~ Number of Bedroom~ other 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. 4. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page I of 2 ENGINEERING FIRM PROVIL,..~G INSPECTIONS, TESTS, FILE SEARCH, ~,,~TA 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. Nfime of Firm,~/~$/~'~ ~¢ec~';C~ C¢.'~¢v/1~;~ Telephone ~ ~-~0 ' Address ~0~ ~c~ ~r~ ~~ . ~/~ ~ DHEP APPROVAL ' Approved for ~ '.' bedrooms by ~¢~--~¢/-~-~ .42. '~~ Approved ~ '' '~isapproved Conditional Terms of Conditional Appr6vfil Engineer's Seal 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) A. WELL DATA A~.~'~' Well Classification //~/// if A, B, C, D.E.C. Approved (Y/bi) ~,[ ,l~_/Well Log Present (Y/N_.~) ~ ~_~e]/~,~d~ -- /~Yield I ¢ /'T°t*al Depth / :-.Cased to \? r-~.~-~r---~._ · o~Def;~:L~f Grouting ~, lt'~J~ , ~'iC Water Level O'4'~r~''~'''~ ~. ~',~ l/~_.~.P, umpSetA.t ~/)~~ ng Height Above Ground ,,~.~/"' ~'-' '~'~n~t~<r~ Seal o/~'% Casin g (Y/N y Electrical Wiring in Conduit (Y/N) ~ Depression Around Wellhead ' I Separation Distances from Well: · To Septic/Holding Tank on Lot ./0.~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot / ~-~ ; On Adjoining Lots To Nearest Public Sewer Line ...~j.4' To Nearest Public Sewer Cleanout/Manhole ,,,~'~/4 To Nearest Sewer Service Line on Lot Water Sample Collected by ~' ~, ~/'e, ,~z.,~.. ; Date Water Sample Test Results ~ .~.~2~',~c/,~,-..~· z 0 ~,/-',~,"~, ...'/./~',~ ~'~-~. Comments .~,.z,~.~-..~ /~',~.~.-"~. ..~'.-'~.'/-~ ~ '~,~<~ MUNICIPALITY OF ANCHORAGE (MOA) ~*C~,~ALTH AUTHORITY APPROVAL (HAA) 264-4720 SEPTIC/HOLDING TANK DATA Date Installed ~ F'~ Size ~'6',~ No. of Compartments ~ .,~'~,jL? ~ Standpipes(Y/N) t/~ Air-tight Caps (Y/N) /.,V~.~ Foundatio~(Y/N)...b/..~~ '/¢--/~ ~ Depression over Tank (Y/N) ,,,4,'/e · Date Last PumPe ~,..~ Pumping/Maintenance Contract on File (Y/N) /4'/~,'~ ' for Holding Tank High-Water Alarm (Y/N) .,~/~,4' Temporary Holding Tank Permit (Y/N) ..¢//.,.".4~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line ~z¢9 To Water Main/Service Line Course /~/"'/~ Comments To Building Foundation /~3 To Disposal Field '~ / To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Datelnstalled ~(~ /¢Y/,~,~,~. Width of Field ~'~-'/~ ~ ~ff~ ~ Depth of Field ~ /~' Gravel Bed Thickness Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To E~uilding Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line /~.~ t To Existing or Abandoned System on ; On Adjoining Lots ¢~"~' ' To Cutbank (if present) D. LIFT STATION /~,/O/~/~.- Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level 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 that I have checked,'~qfied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S i g n e d.~./~,~.,,--/_~ ~o '~ Date Receipt No. ¢-[C)O~" C:(TJ ~ ~ Date of Payment ~ O- ~'~ ~&~ ,.,' ?0% ~.~ ~ Engineer's Seal Alaska Geotechnical Consultants September 29~1986 Mr. Henry George 3860 Mershon Avenue Anchorage, Alaska Subject: Adequacy Testing of Well and On-Site Septic Lot ?, Block 2, ~e~ahon Subd.~ Section 28, T!tN, R3W, S.M., Alaska Dear Mr. George: At your request, on September 22, 1986 we performed an adequacy test of -the individual well and on-site septic system at your residence° We understand the test was required for refinancing your home. The existing on-site wastewater system was researched at the ~unicipality of Anchorage, Department of Health and Environ- mental Protection to determine the design and performance his- tory of the system. The wastewater system consists of: a ~000 gallon septic tank~ an additional ?~0 gallon septic tankl a l~ft by ~?ft timber crib seepage pit~ and a 2~ft long drain- field. The location and separation distances reported in the ~un3_c~.pality files were verified in the field by cloth tape and pacing measurements. There is no recorded history of inadequate performance of the system~ and a 1978 adequacy test showed acceptable results. You stated that you have not experienced any problems with the wastewater system, except the drain pipes became clogged last year. You also reported the pump in the water well was lowered about 3ft last year and the water supply has been subsequently adequate. The wastewater system was filled using water from ~he ~n-site well and the rate at which water drained from the system was measured over a period of approximately 2 hours. The system refilled and the drainage rate measured for an additional 3/~ hours. The system initially took 260 gallons to fill, indicat- ing an adequate surge capacity under normal use. The absorption rate the system was measured at ?~0 gallons per day, which is adequate for the 5 bedroom residence. The on-site well was pumped at a rate of ~.8 gallons per migute for a period of ~ihours lO minutes, indicating the well has an adequate yield. A water sample was taken on September 22, 1986 for measurement of total coliform bacteria. This sample was found to be un- satisfactory at 2 colonies per 100ml. This iow coliform count 909 Bench Court · Anchorage, Alaska 99504 · (907) 337-3890 Henry George September 29, 1986 Page 2 could have been the result of sample contamination either during sampling or in the laboratory. A second sample was taken on September 24, 1986. The second sample tested sat- isfactory. The water analyses were performed by Chemical and Geological Laboratories of Alaska, Inc. The final approval of the system is the responsibility of the ~unicipality of Anchorage, Department of Health and Environ- mental Protection. The necessary forms for your submittal to the Department are attached. If you have any questions regarding the test procedures or the results, please call. Sincerely, Alaska Geotechnical Consultants Howard K. Weston, P.E. Attachments MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street Alaska 99501 Anchorage, 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 I PHONE JACK N. COODY and BEVELYN V. COODY 349-5106 MAI LI NG,~I~D R ESS PROPERTY RESIDENT (If different from above) PHONE PHONE MAILING ADDRESS 3, LENDING INSTITUTION I PHONE MAILING ADDRESS 4. REALTOR/AGENT ] PHONE Ed G~n~ile - CENTURY 21 Heritaqe Homes & InvestmentsI 276-1333 MAILING ADDRESS 5. LEGAL DESCRIPTION Lot 7, Block 2, McMahon Subdivision STREET LOCATION McMahon Avenue 6. TYPE OF RESIDENCE NUMBER OF BEDROOM~ [] One ~ Four [] Other__ ~ SINGLE FAMILY [] Two [] Five [] ' MULTIPLE FAMILY ~,.~ ~ Three [] Six 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) SEWAGE DISPOSAL SYSTEM INDIVIDUAL/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 INSPECTION APPOI N'FM EN'rS )ATE RECEIVED TIME TIME 'IME )ATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: · NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY [] ONE '[]' THREE [] FIVE [] OTHER [] TWO [] FOUR [] SiX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 2. WATER SLJPpI.Y INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE E~PUBLIC UTILITY Connection Verified [~Septic Tank or [] Holding Tank Size:_l (~:)~C¢) If Tank is I]omemaje give dimensions: .'~o~ _O-dl"J~4z~ TYPE OF TANK TOTAL_ ABSORPTION AREA 4, DISTANCES WELL TO: PERMIT NUMBER DATE INSTALLED I-~A L L E R SOILS RATING ___ 135- MANUFACTURER MATERIAL Septic/Holding/~),.~ Tank ' Absorptionl ~Area Sewer Line INearest Lot I_in~ ---- Absorption Area to nearest Lot Line 5. COMMENTS ,/ I~}--APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED BY (Title)(~_ ~,,~~ DATE LEGAL DESCRIPTION 72-010 (Rev. 3/78) Jack N./Bevelyn V. Coody Post Office Box 3~357 ~nchorage, Alaska 99501 Subject: Lot 7 Block 2 MC Mahou Subdivision A~proval for your individual sewer and water facilities will not be grante~ until the follo%~ing it¢~ have been co~pleted ~ ( ) A well log is submitted to this ( ) The top of ~the well casin~_; is ~a!ed wi-~h a sani-aary seal so that it is water tight. () The depression o= pit around the well casing should b~ filled with i~pervious %yp~ soil so that it slopes at,ay from the well casing. ( ) The well easing is extended twe!v~(t2) inches abov~ ~round level. ( ) the well f~Tr our inspection to deters%tine proper con~truction, also, to insul~e the mini~.~ distance (X) Tho septic tank is pu~ped with a receipt submitt~d ~o this office. ( ) A four(4) ir~ch cast iron c~eanou% be installed to the septic tank or leaching area. (x) A p~rcolation t~st b~ perforD~ed om the existing leaching 'area. This ~i!l determine if the system is adequate according to National Standards. A list of private firms %~ho perform the test is enclosed. Jack ~../BevelS? . yn u.~ Cood. y Dece~.~ber 4~ 1978 ( ) Y.o~/r application show?, the nu~er of bedrooms exceeds the number %he s~wer system was originally approved for, therefore, an upgrade will b~ ( ) Connect to ~e public sewer which is available you o Notify ~his dapartment for a re-inspc~Jtion when have been correcte~!. If there are any fur%her please contact this office a% 26~-4720. Sincerely, Robert C. Pratt~ R.$. Associate Sp~cia!ist Security Pacific Mortgage 101i East Tudor Road, Suite Rg0 Anchorage, 99507 December 1, 1978 R&MNo. 851600 Heritage Homes 207 E~ Northern Lights Anchorage, Alaska 99503 Attention: Mr. Ed Gentile Re: Adequacy Test on Existing Sanitary Sewer System; Lot 7, Block 2, McMahon Subdivision, Anchorage, Alaska. For Professional Services Rendered November 30, 1978. Gentlemen: The following is our invoice for professional services rendered on the above- referenced project. Invoice No.851600-1 Professional Services Fixed Fee $155.00 Total Invoice No. 851600-1 $155.00 Please note our invoice number on your remittance. Should you have any questions concerning this invoice, please contact me or the Project Manager, Mr. Gary Smith. Thank you, R&MCONSULTANTS, INC. C. J. Parisena Anchorage Office Manager CJP/kah/20-D ANCHORAGE FAIRBANKS JUNEAU VALDEZ WASILLA December 1, 1978 R&M No. 851600 Heritage Homes 207 East Northern Lights Anchorage, Alaska 99503 Attention: Mr. Ed Gentile Re: Adequacy Test on Existing Sanitary Sewer System; Lot 7, McMahan Subdivision, Anchorage, Alaska Gentlemen: Block 2, Per your request of November 20, 1978, we conducted a test of the sanitary sewer system on the above described property. The upgraded system includes two septic tanks, a seepage pit and a drainfield. 1000 gallons were pumped from one septic tank, and 500 gallons were pumped from a second tank prior to the performance of the test on the seepage pit. During the test the liquid level in the seepage pit was monitored as 600 gallons were removed and 900 gallons were pumped back into the seepage pit to the inlet level. All liquid levels were measured below the top of the stand- pipe and are shown in the following table: Initial Liquid Second Water Third Total Reading Removed Reading Added Reading Drop (gallons) (gallons) in 60 min. 4.9' 600 6.5' 900 3.9 .82' The average specific capacity is 30.05 gallons per inch based on two sets of readings showing 31.25 and 28.84 gallons per inch. If the 4 bedroom residence on the property is to house 8 people, the average load on the system can be expected to be 600 gallons per day or .42 gallons per minute. During the test, the system accepted 295.7 gallons in 60 minutes. This indicates an average effluent acceptance rate of approximately 4.93 gallons per minute at the time of the test. Because the house on the lot is occupied, we assum~e that the leach field was at its normal degree of saturation. We can therefore conclude that the system is disposing of effluent at an adequate rate for a 4 bedroom resi~ deuce. ANCHORAGE FAIRBANKS JUNEAU VALDEZ WASILIA December 1, 1978 Heritage Homes Page -2= We appreciate this opportunity to be of service to you. Please contact us if you have any questions concerning this test or if we can be of additional service. Very truly yours, R&M CONSULTANTS, INC. Ernest R. Rahaim Staff Geologist Project Manager JMB/kah/12-E GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Septentber 23, 1976 Approval requested by: Mailing Address: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR National Bank of Alaska Time of Inspection 9:00 a.m. Date of Inspection 9-24-76 Fr±day Pratt % Ruth Brown 630 East 5th AVenue Phone: 279-2506 2. Property Owner: Stuart Richardson Phone: 344-4471 Mailing Address: 3. Legal Description: Lot 7 Block 2 Me Mahon Subdivision Location: Type of facility to be inspected Single Famil~ No, of bedrooms Well Data: Individual C. Construction B. Depth ~ D. Bacterial Analysis Sewage Disposal System: A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: On-site system ~.~ i B. Installer 1. Size ~. 2. Manufacturer _.(~-,;~_%~ ~~-~ ]. Absomption Area 2. Material Total length of lin.es 8, Distances: A. Well to: Septic tank , Absorption area iL ! , Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank , AbsorptiOn area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages · Page 2 of two pages - Re,~ .t for Approval of Individual '. .'r & Water Facilities Legal De~ripti0n Lot 7 Block 2 Mc Mahon Subdivision ' Comm;nts~~ '/~~.'~~ ~y~ ~_~ ~- ,, ' APproved : ~ ~2L~ DisaPproved · . Date ApprovaliValid for one year from date signed Greater Anchorage Ar~a 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) RE. OU,_.~T FO[-i AP?ROVAL OF INDIVIi}L!AL SEWER and t~i;ATER FACILITIES 1. Type of Inspection: CMF~O VA 2, .Property Owner: _~..~_'~'-~-~ ~~~ M~iling Address: Name of Buyer: Mailing Address: FHA _ CONV ......... 4. Name (.f I_ending Institution: DF.y Phone Mailing Address: ............................................ Phone. Mailing Address: .......................................... Phone I_.ega D~o~, t,r).lon.. Loc:~tion: 7. Type of Facility to be inspected: 8. Water Suppl'¢ Type of Supply: No. Bdrms Public Utility Individual If Individual, nun~ber of dwellings presently se~ed If Individual, depth of well Sewage Dispo~_i System Type of Sy.e;em: Public Utility If h'Mividual, date of i~stallation Individual (on-ste) __ / EQ.037 (1H4) · he ~ing ~ystem on ~b.~ above re~erenue~ lot iS approv~ ar~a. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Qusltty 3500 Tudor Road, Anchorage, Alask~ 99507 279-8686 Time of Inspection ~,' /~ Date of Inspection 7// REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR ,. Type of Facility.to be Inspected: Number of Bedrooms: '¢{el 1 Data: A. Type C. Construction SeWage Disposal System: C. De D. Bacteria] Analysis' Septic Tank: 1. Size~2. Manufacturer,~7~a~,~ Seepage m, i. Disposal F~eld: Total Length of Lines ., _ Distances: A. Well To: Septic Tank,/OO O,, Absorption Area/BT/,, Se,er ~ , Nearest Lot Line , Other Contamination Foundation to Septic Tank [ ~_/"~'Ab~orption Area Absorption Area to Nearest Lot Line ~lo /{ quest, for Approval ¢~ ~,ividual Sewer & Water Faeill' '~ ~Page Two ' Approv~,~ - pproved Date Approval Valid for One Year From Date Sianed G-tearer Anchorage Area Borough, DeFartment of Environmental QuaL.i~y O~AGRAM OF SYSTEM /- ]' cert.if¥~ that the information contained in this request for approval ~o be a true and accurate representation of the subject', sewer and water facilities located at: Signed Date Request- for Aporoval page Two 9. 'Comments: Sewer & Water Faetli"' Approval lalid for One Year From Date Siqned U6"W- "' ¢8' ~ certify that the information contained in this request for approval to be a true and accurate representation of the sub.~ec~ sewer and water facilities located at: FHA FORM NO, 2573 U,S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT FEDERAL HOUSING ADMINISTRATION HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART h--;TO BE COMPLETED BY MUD/FHA Form Approved Budget Bureau No. 63-R0296 ~nnsuring Office Anchorage, Alaska Mor%~e~ -'Name, Address and Zip Code F--First National Bank of Anchorage / / TOTAL NUMBER Blg. DBOOMS I BATHS WATER SUPPLY BY: [] Public System BASEMENT Yes ~ No FHA Case No. Stephen H. & Tanya J. Maurer Prop erty Address: NHN McMahon Avenue Subdivlsion: McMahon SubdJvision, Block 2, New Installation CanAttic or otherAreabe made into additional bedrooms? (If yes, how many?) [] Yes [] No SYSTEM DESIGNED FOR ~ Community System )~ Individual No. of · · Bedrooms Garbage Disposal SEWAGE DISPOSAL BY: [] Public System [-7 Commu0i'ty System )~ Individual [] Yes [] No. PARTII. ,, TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the. opinion of the [] State [] County~Local Department of Health thatthis individual water-supply system D is []is not satisfactory as a domestic water supply for the subject property. It is the opinion of thei ~] State [] County ~ Local Department of Health that this individual sewage-disposal system with proper maintenance: ~7~Can be expected to function satisfactorilY, and [~ Cannot be expected to function satisfactorily is not likely to create an insanitary condition DATE SIGNATURE ~ ~1~ I TITLE ~/ //NOTE: The health authority should complete the appropriate opnion statement above and affix date, signature and title in the spaces provided. Use of the above grid for Health Department Inspector's sketch as well as use of the back of this form is at the opinion of the health authority. 'PARTIII.- · FOR USE OF FIELD OFFICE TO THE CHIEF UNDERWRITER, OR ASSISTANT DIRECTOR SINGLE FAMILY MORTGAGE INSURANCE BRANCH: I have reviewed the foregoing and the pertinent Compliance Inspection Report, and recommend that the Individual water-supply system be considered ~ Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. )ATE i SlGNATUR E J [] CHIEF ARCHITECTURAL SECTION J []DEPUTY FOR CHIEF ARCHITECT HEALTH AUTHORITY APPROVAL FHA FORM NO. 2573. INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM R.~v. 11/7~