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Home My WebLink AboutMCMAHON BLK 1 LT 11 Municipality of'Anchorage ., . .. Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box196650 Anchorage, AK 99519-6650 Page l' of..~ www. ci.anchorage.ak.us (907) 343-7904 O.-SrrE W^STm^,E. D~S.OS^L S.STEM ~/O. WELL ~.S.ECT,O. REPO.T · Permit Number: 5l.,L.~qt~/tg Z.)/ PID Number: D/'~-0 ~/'/-- Z-/// ~,~,..~O,T"t/,'~ Wastewater System: [] New [] Upgrade LEGAL DESCRIPTION 0.'6' ,,. G,.C- .,. Well: [] New [] Upgrade ~ c,~ ~x,~f,m',.. ~r,WY"~ ...-----"~- ~ ~'~'~~,, o~'v (~o~ ~ I0 (~puI [' Fl.I ~ FI. SEPARATION DISTANCES ,1~ Sep~c ri Hold'rog [] S.T.E.P. [] Other:. From~T~T° Septic Absorption l. Jlt Holding =ubr~/Private Tank Field Station Tank Sewer IJne /"~ ~/"' .-~C~ c~. w~, JO~' 1~5' -~ ~ ~5~ ~ ~¢~/ "~~~: ,..w.I00'+loft; /\ / LIFTSTATION Remants: N E,,~ THor ~)o~,.,.~s ~,~o.r~o,-,~,~, r"oo c,.,~,.~.~~ BENCH MARK - ' 14 r'r.~ct4f;t~. ~4~rt,,~ /~4 4 o~ T,~<,~.d = 60 ~- ,.,,.~'.,o.~,~,orm~,~,:''o''''0''"'"''~"""'"°',°'. _. ...... .... ...._.,.., o,,: ," 7"~t-0¢ · ,....~....,.,_,_~__.~~.~/. ~'~, ":'.'~... Developme~Services Department Approval ~}~~--8s-(Ji ..... ...-.~..~_~ Rewewed and approved by: Date: ,,.. ::,. , ,~:,,-..',- ::.-::.:-::.i,~,,.¥.,~ PERMIT NO. SW040134 PAGE · 2 OF 3 Municip. o, ti'tV oP Anchor"o, oe DEPARTMENT OF HEALTH AND HUMAN SERVICES ~ ENVIRONMENTAL 'SERVICES DIVISION p. FI. Box 196650mAnChoroge,:Atosk~ 99519-6650·Tetephone~.343-4744 ON-SITE WASTEWATER'DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 11, BLOCK 1, McMAHON S/D P.I.D. NO. 017--041--41 LOT 1 10' ELECTRIC ----*' 1 F ............ MT2tx'xC02 '%kkk iT. ~ I ~ I %%5 · ..X ~ I EXISTING gRIB~ '~ ~ I~ I T.~~ ~ md m ) ~BL~s I~ I m ~~ NEW 500 GALLON ~ '~' --SEPTIC TANK J m~ ~1000 GALLON ~ ~ ~ z m I { MAHON AVENUE PERMIT NO. SW040154 PAGE ,.~ OF ,-~ Municip. al, it:v oF Anchor"aae DEPARTMENT OF HEALTH AND HUi'4AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.B. Box 196650 e Anchor'o, ge, Atosko, 99519-6650·Tetephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 11, BLOCK 1, McMAHON S/D P.I.D. NO. 017-041 -41 FINAL ST1 ST2 /99.9' __ ~,/I NEW 500 '-~ 95.5'/ I GALLON [ ~96.,.5' I FINAL GRADE-~ MTI =85.3;_~ MT2 84.9 MT1 =99.3' 2=97.7' ~-- C02=8ff.6' NO WATER FOUND 78.9' B.O.H. A B C ST1 ,58.5' ,52.0' - ~T2 48.0' ,36.0' - ST,5 51.5' ;55.5' - DBL1 55.5' ,50.5' - DBL2 57.0' 29.5' - C01 44.0' ,34.5' - MT1 68.0' 26.5' - C02 - 7,.3.0' 76.5' MT2 - 74.0' 77.0' Performed For: Legal Description: Muflicipality of Anchorage Development Services Department Building Safety Division On. Site Water and Wa,qewater Program. 4700 South Bragaw SL P.O. Box lg6650 Anchorage,/g( 6951g~650 www.ci.anchemee, ak.us (.cOD 343-7-c04 o 10- 11 12 14- 15- 16- 1 18-~ 19- 20- Soils Log - Percolation Test ,.( 1~7- WAS GROUND WATER ENCOUNTEREO? c,/"Jh/h~' S'//J'ovmsNp. Range. SecUon: Slope Site Plan $ --"" L IF YES, AT WH. AT DEPTH? O Depth to Water After p Monitoring? ~A~/ E I I I COMMENTS Reading Date Gross T~e Net Time Depth to Water Net Drop ~/~s~ r/a,/o¢ o - ~" - ~ o ~o ,,,,,,, ~ %. " I '/,z " ~o - s-% ,, _ PERCOLATION RATE (~,/- ~ ,-~.~;tes.tnch.) PERC HOLE DIAUEYER ~ "' T:STRUNEET, VEEN G'/~.,FT L"ID "7 '/~ FT To Whom It May Concern: My name is Darin Applebury; I am the owner of 12501 furrow creek road Lot 11 Block 1 McManon sub. I have worked constution form 1983 to present. I have operated 580's to cat 245. I have worked for wilder, R and B, Quality and many others. I am very fimiler with water mains and septic systems. I am extremely confident in my abilities to add this 500 gal. and misc. works to this project. Thank you 907-345-2926 907-250-3737 , MUNICIPALITY OF ANCHORAGE Development Services Department On.Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 20, 2004 Expiration Date: May 20, 2005 Permit Number: SW040134 Legal Description:£MCMAHO~--B-'~-I ,LT-1.1" Design Engineer: 0003 S & S Engineering Owner Name: Darin Applebury Owner Address: 7701 Upper Dearmoun Road Anchorage, AK 99516-2832 Parcel ID: 017-041-41 Site Address: 012501 FURROW CREEK RD Lot Size: 31307 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: [] Disposal Field [~] Septic Tank [] Holding Tank r~ Privy r---] Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. . Yhe following neeas.to.15e.subm~tted w~th the as-bu~lt:-The .undocumented ex,sting trencl'i needs .to_be.documented .~ §nd ~'~ean:out needs'to'b~'i~'~{~lled ~'t"~-d"~fi{~'~h.-~Ne-e-d itdlp-r'6'~ide'~calC~l~ti0nS~showing the absorbtion~;ea Of' [~ e.'~s-e P~i g~ ~ ~! ~_~.'~.~.~ ~t~q_u_a !~ .fp_r; .al'..5.1'b~[l~:65hi; _hb~i~7.;N(f~d .td;d6;~'~a~eqiJacy.test :0~ -th~' s~tiEfieidS;''-: ..... Received By: ~f~~ ~ Date: ~"'/3-o/o ~ Issued By: ~ Datei .5'/Z::o/o ,~ MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 20, 2004 Expiration Date: May 20, 2005 Permit Number: SW040134 Legal Description: MCMAHON BLK 1 LT 11 Design Engineer: 0003 S & S Engineering Owner Name: Darin Applebury Owner Address: 7701 Upper Dearmoun Road Anchorage, AK 99516-2832 Parcel ID: 017-041-41 Site Address: 012501 FURROW CREEK RD Lot Size: 31307 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: [~] Disposal Field [~ Septic Tank [] Holding Tank [~ Privy Private Well [--] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DaD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. Th"~"~(~i~n-~h~e-~(~ §-._to~ '~'d b~itt6'd*~{~t h-~a-~b~iilt :":T h e undocumented 'existin g trer~h~'~-d.~t~lSi~-d6~.im ~yit ~d and-a 'dean-out needs'to'bi~'iri§t~ll6d i~t ~'r~l ~fltrench'..~Need t° PrOvide_calculations showihg the absorbtion'a~-~of! l~it~'~l~{i~::~'~t6~':i§*.~*d ~i-uate for a-5 ~droom'house:' N~ *t6"do~a'~h~{~'t*~~ ~' s~ti~fi~lds:~ Received By: ~v/~2 ~'~- Date: Issued By: . ~ Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ' - ON_SITE SEWER/VVEL',-L..PERMtT APPLICATION- FOR A SINGLE FAMILY DWELLING Parcel I.D. ~ 1'7-- O HI '-HI Permit Number SW Property owner(s) J)/~- R ! ~J R £/~-'~.-'B °/t'Y Day phone Mailing address (1) ~0 ~ ~ff[~ Mailing address (2) ~ cH~ ~ / ~ Zip Code es r . ,on Legal description (Section, Township&Range) Lot Size ::' ~::~, .:~ ~ Acre~ Number of Bedrooms ~ THIS THIS APPLICATION IS FOR: Sewer Only ['-I Well Only [] Sewer and Well r-~ Water Storage [] Sewer Upgrade ~ PROPERTY CONTAINS: Hot Tub r-] Jacuzzi [] SWimming Pool [-[ Water Softening Unit [] Therapy Pool D I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. ~L/Z ~ S & S ENGINEERING 170~4 Eagle River Loop Road No. 204 · "--' ...... A:.~k,, ..... (Signature of property owner or authorized agent) Permit Fees: Z./(~ (.,O. eo W'zf~r Fees: Date of Payment: ~'"'//c~/0 't'~/ Date of Payment: Receipt Number: O ~ ~ ~ 3 / Receipt Number: (Rev..12100) - ~ ~ ',meemnq ROBERT C. COWAN0 P.E. May 18, 2004 CML ENGINEERS (907) 694-2979 FAX (907) 694-1211 SEWER & WATER MNN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUOIES AND REPORTS WELl. INSPECTIO~I & FLOW TEST SITE ROAD DESIGN SOILTEST ONSITE WASTEWATER I~SPC~C~. S'f~TEM DESIGN MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 11, Block 1, McMahon Subdivision It is requested that you issue a permit to install a new 500 gallon septic tank to upgrade the existing three bedroom dwelling on the referenced property to five bedrooms.. The existing trench xvill be documented during installation of the new septic tank. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic tank. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCCfojj Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577 ',tneee nq ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 SEWER & WATER MNN EXTENS~3NS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ,~DfLTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPEC~ONS ONSITE W,a~TEWATER DISPOSAl. SYSTEM I:~..SIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 11, Block 1, McMahon Subdivision May 18, 2004 GENERAL: o The scope of this project includes the installation of a new 500 gallon septic tank to upgrade the existing three bedroom residence located on the referenced property to five bedrooms. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal ' Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" eleanouts for pumping access. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577 Page 2 Lot 11, Block t, McMahon Subdivision May t8, 2004 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 fi. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). Page 3 Lot 11, Block t, McMahon Subdivision May 18, 2004 INSPECTIONS: Typically there will be a minimum of two (2) inspections required during the installation of the septic tank. These inspections will occur as follows: The first inspection must be conducted after 'the septic tank is set in Place, but may not be backfilled until after this inspection. 2. The final inspection is to occur upon final grading of the property. The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and wjjll inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR / INSTALLER Munici ,ality of Anchorage Development Services Department i: i B~ilding S~fety Division · ir,.. On-Site w~ter and Wastewater prOgram i i4700 South Bragaw St. ~,: : P.O. Box ,196650 IAnchO'ragel AK 199519-6650 ~ · - ' www.ci.anchorage.ak.uS : I · ~' i(907) 343-7904 ON-SITESEWER/VVELI' SUB'MITTAE COMMENT,!SHEET 'hoUse. Ne~d t0"put'a Statement'l ropbsal leffei'', {tatin~l ~vill to 6 an adequacy Name of rev~ewer:~: ,,~_,:J°eO°°dall., ~,~ ~.~ :~ !~: ~' ~"" :~~ :Date: 5/~9/2004 ...... ~~ ' ' ' ii : ' ' i '1 ~ioase supplg ~o ~necessa : : 6 !and ~o~Sub'mit, ~uour reuuest. 'LEA VE THIS ¢ ~ERWORK GR"~"t, ER ANCHORAGE AREA BOROt' '""! DI:rARTMENT OF ENVIRONMENTAL OUALI'I r 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM j,.,¢,,-,~/ MAILING NAME ~/~,,~f~ ,/~.~'~'-~,.~ ADDRESS ~¢'~"/J//~'~'~;;~".-. ~-:"~"~ PHONE LOCATION ,.~--~,/~'/~'~'~ 4~¢L~ ,~,/~/r~ ...r~, ~-:~'~,/'///~AL DESCRIPTION ,~.~7~/,~'/ ,~",,Y~./~'~ SEPTIC TANK: DISTANCE FROM WELL ~'~"~ LIQUID CAPACITY GALLONS. NUMBER OF MATERIAL ~/~ ~ ~.,¢/~¢"'~,~/~-.~'~ COMPARTMENTS INSIDE LENGTH ~ INSIDE WIDTH ~ LIQUID DEPTH ~'~ SEEPAGE SYSTEM: SEEPAGE PIT: / NUMBER OF PITS OUTSIDE DIAMETER LINING MATERIALZ OR WIDTH '-~ g2 DISTANCE FROM WELL ,,//'~"J / , LENGTH ~:~--/~ , DEPTH BUILDING FOUNDATION NEAREST LOT LINE r~'('~. ~ ,~-~'C~ tOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) TILE DRAIN FIELD: DISTANCE FROM WELT FOUNDATION NEAREST LOT LINE ~;~-~..~ ~ SQ. FT. TOTAL LENGTH , OF LINES NUMBER OF LINES D._.gJ.5,JA4~S~EEN LINES ~ TRENCH WIDTH ABSORPTION ARE,,~ SQ. FT. LENGTH OF EACH LI DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. TOTAL EFFECTIVE IN. ABOVE TILE.__ W E L L: TYPE ,~"~'~/-~'~' , DEPTH LOT LiNE .r~ DISTANCES: NEAREST SEWER LINE ,' SEPTIC ,.~'~,:/¢> ~. TANK DISTANCE FROM r- WATER , BUILDING FOUNDATION. ¢.-~ SAMPLE ./~//~/(/'~? , NEAREST OTHER ~.~.,~ ~ , SEEPAGEsYsTEM DIAGRAM OF SYSTEM G.A.A.B. DATE GRE:A~ER ANCHORAge AREA BOroUgh DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-6EO ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO,. 2131 INSTALLATION OF: SEPTIC TANK ~/~ SEEPAGE Pit / , DRAIN FIELD . OTHER FINANCED THROUGH TO be INSTALLED "Y ~Oig T~ST .~SUL~S .[~]~ -~ ~/~~D NOTe: THIS PeR~IT IS NOT VALID WITHOUT COMPLETION DATE ANTICIPATED //~ FINAL INSPECTION: ~'4 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION, MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO seePAGE Pit ~ / DRAIN FIELD SEPTIC TANK TO SEEPAGE Pit WALL ,/ SEPTIC TANK SEEPAGE PIT ~-- -, , DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK ~/~ E SEEPAGE Pit DRAIN FIELD ALSO CONSIDER AREA W~LLS. WATER MAIN TO SEPTIC TANK /~ , SEEPAGE PIT DRAIN FIEld , SEEPAGE PI~ / ~ , . DRAIN FIELD TO RIVEr, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CribCROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTUrbED SOIL. 4 INCH DIAMETEr CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit F~TTED WITH AIRTIGHT REMOVABLE CAPS. DIAGRAM OF SYSTEM GRAVEL BACKFILL CONFOrm TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH A~/THORITY or LICENSED DESIGNER i CERTIFY THAT I AM FAMILIAR WITH THE rEQUIrEMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE Municipality of Anchorage Development Services DePartment' Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-041-41 GENERAL INFORMATION Complete legal description Lo t Location (site' address or directions) Expiration Date: 11; Block 1; McMahon Subdivision 12501 Furrow Creek Rd. e Current Property owner(s). Darin Applebur¥ Mailing address 7701 Upper DeArmoUn 'Lending agency Ma!ling address Real Estate Agent Mailing Address Un/ess otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 Day phone 345- 20 26 Anchorage; AK 99516 Day phone Day phone TYPE OF WATER SUPPLY: ° Individual Well [] Individual Water Storage [] Community Class __ Well [] Public Water System I--I TYPE OF WASTEWATER DISPOSAL: Individual Omsite Individual Holding tank [] Community On-site [] Public Sewer I The Municipality of Anch(~rage 'Development. Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates 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. (Certificates may. be reissued for a period of up to one year with valid water Samples.) Ce~t[fiCate~ a'r-~ valid for One' year for properties Served by ~lass A o~: B well's' 'o~'-~-'~Ubii~' w~t~r' System. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Legal Description: !Municipality ot' Anchorage ,Development ServiCes Department ~ ! ' Building Safety Division On-Site Water & Wastewater Program "' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us : (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type P/~ t ~'~ Date completed I f~o/*ff Total depth I ~.O ft. Date of test Static water level Well production If A, B, or C provide PWSID # ~ v' ~'"Sanitary seal (~N) Y~..J' - Cased to I ~-.0 ft. FROM WELL LOG / o't '~ O g.p.m. Well Log (~1) Wires properly protected~ltN) Casing height (above ground) AT INSPECTION p[~/~ ft. §.p.m. in. WATER SAMPLE RESULTS: Coliform O colonies/100 mi. Ar~ mg.ll. Other bacteria d) colonies/100 ml. ' ; Collectedby: ,/3r~R-0t~ P U' ~ ~ B. SEPTIC/HOLDiNG TANK DATA Tank Type/Material 5 ~/° 7"~ c' / Tank size ! O ~ O gal. ' Number of Compartments Foundation cleanout (~N) Date of pumping C. ABSORPTION FIELD DATA Date installed Cleanouts I~IN) yF_..5 Depression over tank (Y/4~_.) ,,u O High water alarm (Y~I~ .Pumper J~ ~/Lr'lt I.,hto ~ Date installed 6/15/''/z Soilrating (g:.p.dJfttorft~/bdrm).~5-° Systemtype . C~I ~ Length 9--0 ft. Width ~- O ft. Gravel below pipe ~ ft. Total depth I ~ . ft. Eft. absorption a(ea ~ ~o .ft~ Monitoring tube ~ Depression over field 'N ~.. Date of adequacy test )//11 lO 3 Results~Fail) ~ For 3 bedrooms Fluid depth in absorption field before test ~ in. Water added Jg~Ogal. New dept~ ~ ,_ in. Elapsed Time: ~ ~.. min. Final fluid depth~ ~in. Absor¢ion rate >= ~ ~ 9.p.d. Any rejuvenation treatment (past ~2 mo.) (YIN & t~e)_~ ~ ~ / ~ ~ ff yes, 9ive date. 2- 2--04; 3:35PM; ;907 5615301 # 2/ 3 SGS RtL# Client Name · Project Name/# Client Sample ID Matrix 1040322001 Am'ow Pump & Well Service 12501 Furrow Creek 12501 Furrow Creek Drinking Water 0 Sample l~mml~: All Dates/Times are Alasl~ Standard Time Printed Date/Time' .01119/2004 17:01 Collected Date/Time 01/15/2004 10:20 Received Date/Time 01115/2004 10:35 Technlcnl Director _ Slep, hen,~. Ede Allownblc Prep Analysis. Parameter R~ults PQL Units Method Container ID Limits Date Date Init Waters Department Ni~t~-N 8.83 0.100. ms/L EPA 300.0 B (<=-10) 01115/04. Microbiology Laboratory Coliform 0 col/100mL SM18 9222B A (~1') 01115/04 DKC ii -/- '% "69 · I .hereby certify that I have surveyed the followin ' ,.:':,...,, / described property: ~g)/"-/// "' / ~'' /~',4~:~,//.4:/~, ,..'~', ,<./,/.': ,~S' . Anchor'age Recording Precinct, Alaska, and that tt improvements situated thereon are within the prope~ lines and do not'overlap or encroach on the properi lying adjacent thereto, that no improvements on prol erty lying adjacent thereto encroach on the premises: .question and that there are no roadways, transmissic hnes or other visible easements on said property excel ns indicated hereon· Dated at Ah. chorage, Alaska ..... this //~')7'//day of ~"'~/'~'~ ,' 19 74 FRED WALATKA & ASSOCIATES Engineers and Surveyors FE~--1~--2004 · HEFTY DRILLING' · ' . 3540 AKULA DRIVE. E, ALASKA 99516 (907) 345-0593. Subdivision/USS: ;W · · DATA: (h'om ground surfnce) Depth Color & wetness [ ~ ~ _To S'I A'i'I,, OF DEPARTMENT OF NATUR~:~SI MINING, LAND, WATER Property Ow'ncr N.~me & Addrc,s,~: .. ~ownsh/p ............. l~ge .~ Section ......... ~NAD: 27 OR Drilling method: Welt'use: 13 Public suppl D~th of hole: Casing ~;ype: ~ Elev-~tlon: Cable tool, Casing Thickness · .. 13 Serrated; Start: Screen type: D Perforated;Start: Start: Note: .. Depth; from ~' Casing diamct'er: ~ ~'! i,ches Casing depl Liner type: Diamutcr: .inches Static water firm, t,p ,r Pumping level & yield: fcct after .___;h0i~ Recov'cry rate: o~ gpm, Method Dcvelopmcm method: Well intake opening type:XOp¢n end, ~ 0 ft, ~iop,~ed Copy brthis s.v~.,ll hq: I~.' ,soul l- Ihu ~lUl¢ Of A~Sk~ (AK s~mtes 38.~.020, 38.05.03~. l I AAC 93.140): T OF NATU~L RBS~URC~ ":, .' Mlnln~ ~nd & W~ter Hydrologic gusty :'.": ': · ~: · ~$0 W 7th Ave, ~ulte 900A :'"' ' '=:'; '" Anchorage, AK 99~01q57~ /=';T~lePhoaa (907) 269.8~9 and FAX (907) ~g2-1384 :i:'" '. "' Was well disbffecled upa, completion? O Yes, VI 2q'o .' .: ',." '"'.' :' Method ofdisinrcction: ' ' "' "'":"' ~'''' '" Drillercommems/disclaimer.~: " .. ' ' ' · . ... ::,~ ~;- -...;.;,~., Weft Driller Name: . '.i' '...ri.: · Company Name:. HgI:Ty DRILLING · ' .i.. '.'".': '~:'. :,..;. Mailing Address: -3540 AKULA DRIVI~ ' ' " -- .' ..":'7.~.,',,,,:.?': City: ANCHORAGE State' ALA ,, 2 ' . ' · .-- e IXlUmOor · I ..... ,.;; ;,~s',~ '.'. · · -907-345-, 5 ..... ."...':':. ,,c~;- ',.;,~ · .. ,~9~ ...:, ....... ::,~:.:,.ti/:. [ Drillers Signalure: ~..t~k.4-,X~/..~7'~' ':'i( :'~,'"~,'~:~..'.;4:."' : '] · .....: :.;~. -~,,:.¢'.:.½~*.; :, ~y or ^nchoragc i! ~, requlr~.d tha'- ~'--- -'"' '""-;"-"-':" · · .' . scat to the appropr,ate c,y or'rice whh,a 60 ~ys aad that' thc well lo 'be sent t ~ . .I~O. flier co~y o~' Date oflssuc: / ~ .......... !. "'.':.';."':.;:' :.'::"..:. ZdenUne.t " . ' g.: ........... ' ' ' ..... · ]'s ~cll ]o¢~lcd ~! approv ...... '-- .......... ' '"'""" - -- *' "- ,C.. :'~.- " C) Yes or 12 ~ .'" '3 '.:.....~". 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 ' Parcel I.D.# (~)L'q- ((~L~\= ~-~ 1, .GENERAL INFORMATION . Complete legal description . .~-~.~..L~. . Lot 11, ..Block li' McMahon Subdivision Location (site address or directions) 12 501 Furrow Creek Road ~..:ProPertygwner;~: .Jeane_tte Applebury Dayphone 345 0291 ... aailingaddress 7701:'Upper DeArmoun Road Anchorage, AK 99516 ' Lending agency';'~'' *~:'";"~ L: . Day phone' ~ ;.' .... ~ ...... ~ ~ ,_~ None ._. . ~ , , ,3~ ,, '-.-;~ :~; - Agent?. .............. ~'"~ ........ ' ' Day phone '. ,' -: 7~?~?,?;;~Un~'othe~ise;requested;~HAA wdl be held for - 2.'~NUMBER OF BEDROOMS, ,~ "'"'"~" ~ - - -.~.-.,,'-, '--",-~ ",'- ~.~-, '~' ......... ~ ' ~.3-:~,~PE-OFWATER SUPPLY: -:~?~;--~'~ ....... ? .~:~, t-~,?~,~-t:,~,~..,-~- E~I~S~S?IVISION - weu ............................ ;2 NOTE: ':'If community wastewater system, provide*Written confirmation from'State ADEC "~, - ~, ~ ~""::attesting to the legality and statu~'of s~,s~'em~ . ~,~ I: ...... 72-025 (Rev. 1,.'91) Fronl MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by r~, 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. 563 7155 Name of Firm Anderson Engineer.±ng Phone Address- ' P.O. Box 240773 Anchorage, AK 99524 Engineer's signature Date 6/27/96' 6. DHHS SIGNATURE -~-~ %[~ '-- - .~'i~ ~ . . ............ /' roved bedrooms. ~:,- ~: Conditional approval for ..... bedrooms, .with the, following, stipulations: ..~':, Add tiona Comments Note: The well for th~s Droperty meets exls q 2.~, : ~/~a~e and~un~c~pal Codes. There are nitrates present. It zs ~ :~'~'~'~':~. · ~'~-i- --.~7 ....... . ~ ehtration is 9.02 m /1, EPA ~ , ~ ~~,~ui~zllty. Nltrate cons -, . · .. g ,~,)~,, ,~-,,,.,K~~'., _ _ ... . , ~ 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 DH HS does this as a sou rtesy 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'swork. 724~5 (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4'J~J~ 2 7 1996 Health Authority Approval Checklist RECEIVED A. WELL DATA Welt type Log present (Y/N) Total depth Sanitary seal (Y/lq) Date of test Static water level Well production If A, B, or C, attach ADEC letter. ADEC water system number Date completed /el 7~.- Casing height (above ground) Cased to bi ' y Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION g.p.m. ~',~' g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of sample: ~/Z,~/'~ B. SEPTIC/ItOLDING TANK DATA Date installed ~/'Tg-- Tank size ~]~ 0~ m~/L. Otherbactefia. Collected by: A' Number of Compartments [ Cleanouts (Y/N) 'X( Foundation cleanout (Y/N) Date of Pumping O/Z.I C. ABSORPTION FIELD DATA Date installed Length ~ * Width '~r" Depression (Y/N) /X~ High water alarm (Yflq) d Soilrating (g.p.d./ft2orft2/bdrm) ZS'E' F/; System type .~--g:PAO P~' Gravel thickness below pipe ~ t Total depth //qt.~ Z n Effective absorption area ~O FT. Monitoring Tube present(Y/N) Y Depression over field (y/N) A/ Date of adequacy test--~/Z'5"/q/,, Results (Pass/Fail). ~5S For ~ bedrooms Fluid aepth in absorption held before test (in.); ~'~ ~ Immediately after 5-~'0 gal. water added (in.): 7dY, 5'- Fluid depth 57d, (ins.) Minutes later: gg. //blS, Absorption rate = ~> t,.~'O g.p.d. Peroxide treatment (past 12 months) fi/N) /k] ffyes, give date /~/~ LL~T ETATION Daie installed Size in gallons · Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: J Septic/holding tank on lot q~' ; On adjacent lots Absorption field on lot /l~ t ; On adjacent lots Public sewer main /~i/.~'$ Public sewer manhole/cleanout Sewer/septic service line ~ 't~9 t Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation '>/~> Property line ),/~ Absorption field Water main/service line > Z~ ~ Surface water/drainage ')'/~9 t Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ~ t Building foundation >/~ Property Line >/0 Water main/service line Surface water /X/O~ t Driveway, parking/vehicle storage area '). / Curtain drain A/O~e~ Oat ~,-r' Wells on adjacent lots )'/~0~ ENGINEER'S CERTIFICATION I certify that I have determtned thrufield inspections and revtew ofMumctpal recordg~ .tha~!~e ~:Oyo ~2~ems are m conformance wtth MOA ~ gutdehnes m effect on thts date. . :, . '[~- ~ -,' Engineer'sName M i~C ff Date HAA Fee $ ~, e.~ Receipt Number/7/OeY~f0//5;?~) Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number CT&E Environmental Services Inc. Laboratory Division ~~f,~'.~,~'.~JJ,~.~,~JJ~J-~,~ Laboratory Analysis Report CT&E Ref.# Client Sample Matrix 962519.962519001 Lll, BI, McMahon Subd. Drinking Water Collected Date 06/23/96 Technical Director: Stephen C. Ede Sample Remarks: Nitrite~N Nftrate-N Total Coliform Results QC Qual 0.100 U 9.02 D PQL Units Method Allowable Prep Analysis Init Limits Date Date 0.100 mg/L EPA 353.2 -- ~6/25/96 Elizabeth 2.00 mg/L EPA 353.2 06/25/96 Elizabeth 0 co[/lOOmL SM18 9222B 06/24/96 TAV U - Undetected LT - Less than GT - Greater than D - Secondary Dilution J - Below the calibration range 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 3180 Peger Road, Fairbanks, AK 99709-5471 -- Tel: (907) 474-8656 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MI~[SOURI, NEW JERSEY, OHIO, WEST VIRGINIA