HomeMy WebLinkAboutMCMAHON BLK 1 LT 14Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP231001 PID Number: 017-041-38
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
JOSEPH OWEN DANIELS
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
3755 MC MAHON AVENUE, ANCHORAGE
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
MC MAHON 1 14
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft2
Ft.
Well
100'+
-_
25'+
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1250 Gal.
Surface Water
100'+
--
Material
HDPE
Number of compartments
2
Lot Line
10'+
-_
NA
Foundation
10'+
__
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks Tank insulated.
Alarm location
Electrical installed by
Installer NORTHERN EXCAVATION
PIPE MATERIAL House to tank 3034 Tank
d a n to 3034
ld
Drainfield CO/MT 3034
Inspector FWC
BENCH MARK (Assumed elevation) 100 ft
Inspection ddates: 151 1/30/2023 2nd 1/30/23
Location and description
3'd 4'h
BOTTOM OF SIDING
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
-� OF �\
' • • "'
Conditional Approval: Date
i �'�,l
*: 49 Z-.
Septic System�•%
Approved -
Curtis Huffman
Date C/n
�F� • CE 128991 . <<`4�/�
�� i�lF�F
• : /10/2023. - N'zi ,�
�PROFESSION�.�
Note: this approval does not include well permit requirements.
krctty vaivci 1 o)
Lot 3
I
Lot 4
147.50'
FENCE
DECK
a1
/^ -- - ui 23.5'
1 STORY RESIDENCE
Lot 5
10' UTILITY
EASEMENTS
NOTE: DUE TO SNOW & ICE COVER,
SOME SURFACE LEVEL
FEATURES ARE APPROXIMATE.
Lot 15
o
O
29.4'
CV
12.2'x16.2' SHED--
HED
21.3' DECK
\
6.0' LEAN—TO
6.0'
WOODEN FENCE
MANHOLE—
i
b
29.3'
O
Lot 14
N
/
Lot 13
`"
<:.
RETAINING
J
�
r
POST &
RAIL FENCE
a
> `
o .
Cl!
WALL
O
/z
Lot 4
147.50'
FENCE
DECK
a1
/^ -- - ui 23.5'
1 STORY RESIDENCE
Lot 5
10' UTILITY
EASEMENTS
NOTE: DUE TO SNOW & ICE COVER,
SOME SURFACE LEVEL
FEATURES ARE APPROXIMATE.
Lot 15
o
M 22.8'
29.4'
21.3' DECK
\
i
Lot 14
/
�
32,450 S.F.
<:.
RETAINING
J
�
r
POST &
RAIL FENCE
a
> `
o .
WALL
WELL
�yp0��5
I
WEST 147.50'
/
O
/
McMAHON AVENUE /
PLOT PLAN ___ AS BUILT _x SCALE _1"= 40' GRID _ SW 2835Project
No. 23-04QJR1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
�
,r Associates,inc. (907) 522-6476 Phone
Lang & A S S O c i a t e S
9 kenQlangsurvey.com
Professional Land Surveyors JonathaMDlangsurvey.aom
travis0longsurvey.com
QF �(•q���
't s,�c
,�
I hereby certify that I have surveyed the following described property:
co -
LOT 14, BLOCK 1, McMAHON SUBDIVISION (PLAT No. 65-86)
�d 71T; 4TH •,
Anchorage Recording District, Alaska, and that the improvements situated thereon are
the lines
• • • • • • • • • •
WA
within property and do not encroach onto the property adjacent thereto, that
no improvements on the lying adjacent thereto encroach on the surveyed
.�
• • • • • • • • •
•'
property
/� •
premises and that there are no roadways, transmission lines or other visible
KENNETH G. LANG • s--
easements on said property except as indicated hereon.
,
c No. 5202 •�
��'FD•
Dated this the i Day of "`t%'t�`'�st ' '� �afi Anchorage, Alaska
�� '��I�7' • ' •p5��.
���
4fESS(OM`�
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plot.
State of Alaska AECC963
PID: 017-041-38 PERMIT: OSP231001
EAST 147.50'
q WOODE FENCE '
L® 1 EAS
i
APPROX. 100'
C T CO MT WELL RADII
�
O
cN
:.2'x16.2' SHED O
DIV
DIV Lot 15
6.0' LEAN-TO co
0
,h M
)EN FENCE DF c INSTALLED O co I w
E 1250—GAL HDPE
A -C=12.1'
B -C=54.8'
A -D=16,0'
B -D=57.2'
A -E=19.7'
B -E=58,7'
A -F=25.0'
B -F=60.1'
SEPTIC SECTION
SCALEi NTS
MCMAHON BLOCK 1, LOT 14 surruKlStrtvicts:
PREPARED FOR: ��� OF�j�,
JOSEPH DANIELS & BONNIE YOUNG
3755 MCMAHON AVE *� 9 TH
ANCHORAGE, AK 99516
FIRST WATER CONSULTING DATE: 2/17/23 tis Huffman
04
SURVEY: LANG CE 128991
13030 SUES WAY DRAWN: FWCS 2/17/2023e
ANCHORAGE, AK 99516 SCALE: 1" = 30' 1 X
ss>0��'
907-350-9566 FirstWaterAK®gmail.com
MD
SEPTIC TANK
EXISTING FIELDS
O
O
W/DFCO
do DCO
I
APPROX. 100'
29.3'
D FCO o
DECK
N
WELL RADIUSN
m
B" — --
N
WELL RADII'//
STAKED AT
t00' WELL
23.5'
_
I—
CONSTRUCTION
RADIUS
O
o
N 4 BED HOUSE
Lot 13 Z
44.7'
or
;n
-i 22.8'
29.4'
\
21'3 DECK
BM: BOTTOM OF SDING
A -C=12.1'
B -C=54.8'
A -D=16,0'
B -D=57.2'
A -E=19.7'
B -E=58,7'
A -F=25.0'
B -F=60.1'
SEPTIC SECTION
SCALEi NTS
MCMAHON BLOCK 1, LOT 14 surruKlStrtvicts:
PREPARED FOR: ��� OF�j�,
JOSEPH DANIELS & BONNIE YOUNG
3755 MCMAHON AVE *� 9 TH
ANCHORAGE, AK 99516
FIRST WATER CONSULTING DATE: 2/17/23 tis Huffman
04
SURVEY: LANG CE 128991
13030 SUES WAY DRAWN: FWCS 2/17/2023e
ANCHORAGE, AK 99516 SCALE: 1" = 30' 1 X
ss>0��'
907-350-9566 FirstWaterAK®gmail.com
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP231001
Work Type: SepticTank Upgrade
Tax Code Number: 01704138000
Site Legal Address: MCMAHON BLK 1 LT 14 G:2835
Site Mailing Address: 3755 MC MAHON AVE, Anchorage
Owner: DANIELS JOSEPH OWEN &
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
inen1,
c !•
fi
J
�. R" RaMm
Department
1/13/2023
1/13/2024
32450
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
`S.S(J6,-D
r— tv L
Date:
Issued By: Date:
4
I
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 017-041-38
Property owner(s) JOSEPH DANIELS & BONNIE YOUNG Day phone_
Mailina address 3755 MCMAHON AVENUE, ANCHORAGE, AK 99516
Site address 3755 MCMAHON AVENUE, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) MC MAHON B1, L14
Legal description (Township, Range & Section)
Lot Size 32,450 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) El
(w/wo ADU)
Septic Tank
El
Upgrade 0
Duplex (D) ❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES
A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: A)
Date of Payment: 1/1()12025
l 2
Receipt Number: 310160
Permit No. (35pz. loot
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No,
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
!!
January 10, 2023
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: MCMAHON BLOCK 1, LOT 14
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install a 1250-gallon HDPE tank per the
attached design to serve the existing 4-bedroom residence. We would recommend a 1500-gallon
HDPE tank be installed for future consideration or flexibility. No groundwater was noted in the
MOA on-site file. The lot and area are served by private wells. The design will not impact any
of the neighboring properties. Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231001, Curtis Townsend, 01/13/23
FIRST WATER CONSULTING
MCMAHON BLK 1 LT 14
DESIGN DETAILS:
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231001, Curtis Townsend, 01/13/23
Municipality of Anchorage Page
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: '-~/V' c~O,~---:~'~ RID Number:
Name: ~t~ ~%O~% WastewaterSystem:D New ~ Upgrade
Address: ~/~ /~ ~/L ABSORPTION FIELD
No. of Bedrooms:
Phone: ~ -- ~&fl ~. ~ Deep Trench ~ Shallow Trench U Bed ~ Mound U Other
LEGAL DESCRIPTION SoilRating: 0,6 GPD/Sq. Ft. Total Depth fro~orCginal grAde:
Lot: I~ Block: ~ S.bdivision:~ ~/~ Depth to pipe bottom ,to,or, gl.al grade: Ft. Gravel depth be~a, pipe Ft.
Township: Range: Section: Fill added above original grade: ¢ Gravel length:
0,~ - I,g ~. /58 ~.
Number of lines: ~ D s ance belween lines:
WELL:~%t5~ UUpgrade .Gravelwidth: 2,¢ ~,. ~ I
Classific~ (Private. A.B.C): Total Depth: Cased To: Total absorption area: Pipe material:
Driller: Date Drilled: Static Water Level: Installer: Date installed:
~t. ~ECP E~
Yield: I P.mp Set at: Casing Height Above Ground: TAN K
GPM~ Ft. Ft.
SEPARATION DISTANCES ~ Septic B Holding Q S.T.E.P.
To Septic Absorption Lift Holding Public/Private Manufa~urer: ~ Capacity in gallons:
From Tank Field Station Tank S .... Lines ~~ ~
Number of Compartments:
w~,, i~s' i~' ~/~~/~;~'~ ~t.,i~,: %~
.rfac , ., '
Water 100 ~ /O0 LIFT STATION
~ot s,~ ~n ~,~
"Pump on" level at: ~l~gh water alarm at:
Foundation ~ ' I~'+
~1.... ,~
BENOH ~ARK
Remarks: ~¢~lC ~1~ ~~
Location and Description:
Inspections performed by: 17o~4 E~ale River Lo~ Road, NO~s; 1st ~-[6-ff~
EaCe River, Alaska 995~ 2nd R-/~-~ L .
Department of Health ~d H~man Cervices approval '*'¢-"~
Reviewed and approved by: ..... ~ Date: ~ ~-
72-013 (Rev. 9/91) MOA 25 ·
P~rmit No.
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: ~J..~'T /¢.~ /~- !
72-013 A (Rev. 9/91) MOA 25
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PERMIT NUMBER:SW920275
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:ISLEY CHARLES B &
OWNER ADDRESS:3755 MCMAHON AVE
ANCHORAGE, ALASKA 99516
PAGE 1 OF 1
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT ~/'~
DATE ISSUED: 9/09/92
EXPIRATION DATE: 9/09/93
PARCEL ID:01704138
LEGAL DESCRIPTION: MCMAHON BLK 1 LT 14
LOT SIZE: 32450 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
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 (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: ~ [~'
ISSUED BY: ~/~P~' /
August 28, 1992
ROBERTSHAFER, P.E.
ROGERSHAFERiP.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, AK 99519-6650
REFERENCE: McMahon Subdivision, Block 1, Lot 14
We request you issue a permit to upgrade the septic system
serving the referenced property.
An adequacy test was performed on the existing system and the
absorption capacity of the system was found to be inadequate.
A test hole was excavated and a percolation test performed.
The approximate location of the test hole is located on the
attached site plan.
We do not anticipate any adverse effects on neighboring
properties by the installation of the proposed septic system.
If you have any questions, or require additional information
for your review, please contact us.
Sincerely,
RJS/LSU/lsu
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
I"= 40'
SCALE
DRIVE
UPGRADE
SEPTIC
· AREA
,I
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
1
6-
7
8
9
10
12
13
14
15
16
17
18
19
20
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SITE PLAN
Depth to Water Alter .,
Monitoring?~""~ Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
z 7.-"4"+' 37/0 '
PERCOLATION RATE--'~ "'~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~'- FT AND ~' FT
COMMENTS
S & S ENGINEERING I ~ ~'~-/ ~/-J CERTIFY THAT THIS TEST WAS PERFORMED IN
PERFORMED
BY:
17034 Eagle River Loop Road No. 204~ ~ ~ .- [ .~ ~
ACCORDANCE WITH ~T[~e~,N~,~II~r~-~iUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME t-/~~-~/~A/ ,/~/J~--¢ ~-~ MAILING ADDRESS 2~Dz-/ ~"
LOCATION /~, ,/'~/Z~/'C/4~x¢EC¢./ LEGAL DESCRIPTION /~/
SEPTIC TANK:
DISTANCE
FROM WE LL~-//e/~/MAN U FACTU R E R
INSIDE LENGTH INSIDE WIDTH
~.(,~ ~ /~'.~...2, NUMBER OF
MATERIAL ~/'~'Z. ~,~, COMPARTMENTS /
LIQUID DEPTH
LIQUID CAPACITY //~n~'~/~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS ~/ DIAMETER__~_~ OR WIDTH O~"'"~i LENGTH~'¢, DEPTH ///
LINING MATERIAL~4L/~<~, ~/~¢ CRIB SIZE: DIAMETER u DEPTH ~, DISTANCE FROM:
BUILDING FOUNDATION 0~¢/~ /¢~/¢~ TOTAL EFFECTIVE /~ ~
NEAREST LOT LINE . ABSORPTION AREA (WALL AREA) ,- SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE //~4~~4~ ~f/~'
BUILDING
FOUNDATION --
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
NEAREST
SEWER LINE
REMARKS
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TAN K SYSTEM
DISTANCES:
INSTALLED BY: ~"¢Z'x~g~/g~ ~./{".
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No. LQ~031
DIAGRAM OF SYSTEM
O
APPROVED ~x~- G.A.A.B.
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 27~-456 !
¸'3
SEWAGE DISPOSAL SYSTEM -- APPLICATIOH AHD PERMIT
pERMIT NO.
INSTALLATION OF: SEPTIC TANK
fINANCED THROUGH
oOMPLeT,ON DATe A.T,C,PATeD 19
SEEPAGE PIT--
, DRAIn{ FIELD , OTHER
NOTE~ THIS PErM T IS NOT VALID WITHOUT
PINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPT.° TANK S.ZE I'PA-o ~.~)
MINIMUM DISTANCEs, REQUIEENIENT$
SEPTIC TANK TO seePAGe PIT WALL-- /~'
SEP"',D-'-AN'< 3-' .~.~ ~,. ~' ~..,~ ~,~I0 ~
/!gO '
SEPTIC T~N~. /LgO I. SEEPAGe PiT /PP) . DRA'N FIELD/P~/
TO RiVEr, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP Of
EXCAVATION 5 FEET INTO UNDISTURBED SOIL·
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL I~AO~(FILL
CONFORM TO E~OROUGH REGULATIONS REGARDING INSTALLATION.
DIAGRAM OF SYSTEM
1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE·
GREA'[LR ANCHORAGL AREA BOROUGtt
DEPARTMENT OF ENVIRONMFHTAL QUAI.[TY
3330 "C'l Street
ANCHORAGE, ALASKA 99503
Case #
Performed For JohnJones, Jr. Dated Performed April 12, 1974
Legal Description: Lot 14 Block 1 Subdivision McMahan
This Form Reports Soils Log xx Percolation Test
Soil Test Must Be Logged To 4' Below Proposed Seepage System -
Depth Lotl4
Feet Soil Characteristics
'Amorphous - granu£ar peat
1--
2-- ' Coarse, clayey gravel
3__ ~5~
4~
(CH)
8--
20~
Uniform fine sand with trace of
clay and silt
- 150
Uniform fine to medium sand with
3/8" minus gravel
(HL-SP)
(sw)
Was Ground Water Encountered? No
If Yes, At What Depth?
Farrow St. 147'
Reading
Date
Gross Time Net Time Depth to H20 Net Dro
Percolation Rate Minuke
Proposed Installation: Seepage Pit xx Drain Field
Depth of Inlet Depth to Bottom 6~F-Pit Or Trenc~T
COMMENTS: Based on GAAB ~standards, we recommend that198 sq. ~. per bedroom be used.
Test Performed BY John Jameson
ALASKA MINERAL & MATERIALS LAB
Date Certified BY:
Date: ..................
March 21, 1973.
WILLIAM A. EGAtl, GOVE,~NOR
$OUTHCENTRA£ REGIONAL OFFICE
MACKAY BLDG.
338 DENALI STREET
ANCHORAGE 99501
IvY. John T. Jones, Jr.
3251 East 42nd
Anchorage, Alaska 99501
SUBJ~: Lot 14, Block 1
- -~cYm~hon Subdivision
Dear Mr. Jones
We have revimved your situation in light of the interpretation of
the 40,000 Sq. Ft. -20,000 Sq. Ft. requirement contained in Section
18 AAC 72.030 of the Depar~nent of Envirorm~ental Conservation Waste
Water Regulations. It is our finding that since you had o~ership
of the lot on or before February 5, 1973 and that you intend to
construct a private residence for your personal use, that this particu-
lar Section of the Waste Water Regulations is not applicable in your
case.
We would however advise you that of course all existing Borough
Regulations are in effect and are applicable in all cases except
where State requirements are more stringent.
truly, .
Engineer
cc: GAAB-DEQ~
I~ECEIYED~
FPLAWS
f lUNMPAUTY of ANCHORAGE
n ;
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 017-041-38 Expiration Date:
1. GENERAL INFORMATION
Complete legal description McMAHON BLOCK 1, LOT 14
Location (site address) 3755 Mc MAHON AVENUE, ANCHORAGE, AK 99516
Current property owner(s) SEAN & KRISTI LAMB Day phone
Mailing address
Real estate agent
3755 Mc MAHON AVENUE. ANCHORAGE. AK 99516
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑T
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 55c)
Date of Payment 5 0l
Receipt Number
COSA # 0 S C j °I 11 X11
Waiver Fee $
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377
Address 4640 SHOSHONI DRIVE ANCHORAGE AK 99516
Engineer's Printed Name MICHAEL N. ANDERSON PE Date 6/7/2019
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
�+
Ol'
�
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
,
��
r� . ' �'
vl.
system and maintenance. The operational life of all well and septic systems are subject to
* g Tx
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory
:•4
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given byand Anderson Construction & Engineering.
FWC��
-MICHAEL N. ANDERSON:
No. CE 9469
6. DSD SIGNATURE
6/7/19 .----"0
.,.. c,
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
�llttttt((flf
1A, 0AI-SITE
m BAST €�"y�T� m
f PROD` R z
o„ RAAA �1))))?))111111
By: 6&6Original Certificate Date:
The Municipality of Anchorage Development 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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other TaAk ave= X
COSA Checklist blue sheet
111� 111� 111 111111
11, Is
1,
Legal Description: McMAHON BLOCK 1 LOT 14 Parcel ID: 017-041-38
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _
A. WELL DATA
❑ Well log is filed with Onsite (or attached) Water storage tank volume NA gallons
Date drilled 1974 Well disinfected for coliform test? ❑ Yes ® No
Total depth 100+ ft ® Coliform bacteria is Negative
Cased to 66 ft *Nitrate 7.37 mg/LE] Nitrate less than MRL (ND)
® Sanitary seal is functioning correctly Arsenic ND ug/L ® Arsenic less than MRL (ND)
® Wires are properly protected
FW€;
Casing height (above ground) 18+ in. Collected by WES
Date of flow test for COSA 3/29/2019
Static water level at beginning of test 68 ft. Date of Sample 5/16/19
Well production at time of test 5+ gpm
Comments *See 907 Water Wells scoping letter.
B. TANK DATA — 9/17/1992 - 1250 -gal
Age of tank(s) 27 years
Tank type/material STEEL
Measured operating fluid level in septic tank 48.5"
® Standpipes/foundation cleanout per record drawing
Date of pumping 3/29/19
C. LIFT STATION - NA
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA — 63'L x 3'W x 7'ED — 0.8 GPD/SF = 882 SF
Which system tested (date installed) 8/8/2008
® ALL standpipes present per record drawing
Total measured depth from grade 14.3 ft (max)
Measured depth to pipe invert from grade 7.4 ft (min)
❑ N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective 1§11
Adequacy test date 3/29/2019
Results Z Pass For 4 bedrooms
Fluid depth prior to test 23 in
Water added 850 gal
New depth 39 in
Elapsed time 1410 min
® Code -required soil cover over field Final fluid depth 23 in
❑ System presoaked Absorption rate 600 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test) If yes, enter date
Gallons introduced gallons M
Comments/Deficiencies:
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
❑ Yes
if No 6
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No ft
Neighboring Absorption Fields > 100'
Surface Water > 100'
® Yes
Animal Containment > 50' ® Yes
if No ft
® Yes
if No
ft
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No 6
ft
Wells on Adjacent Lots:
Property Line > 5'
® Yes
if No
ft
Private
Water Main > 10'
® Yes
if No
ft
Wells > 100' Yes if No ft
®
Absorption Field > 5'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
Community Wells > 200' ® Yes if No ft
Water Main > 10'
® Yes
if No
ft
If septic tank is under driveway comment below
Water Service Line > 10'
® Yes
if No
ft
Surface Water > 100'
® Yes
if No
ft
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No —ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
Septic Tank to Foundation met code at time of installation.
G. ENGINEER'S CERTIFICATION
/ certify that / 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.
COSA Checklist.docx
OF. ;A.L
.4 9 TH
MICHAEL N. ANDERSON:
No. CE 9469
''�Mssio-0-, AV
r�
i
707
rr
RESIDENTIAL & COMMERCIAL WATER AND WELL SERVICES
24HR EMERGENCY SERVICES AVAILABLE
FREE ESTIMATES
907-0-.
6/6/2019
A well camera inspection was conducted at 3755 McMahon St. Anchorage AK 99516 the results are as follows:
Swl 100'
Casing stick up 18" +
Cap and conduit sealed
Pitless at 13'. No cracks breaks or perforations were found. Top 40' of casing were in good condition.
If you have any questions please feel free to call or text John at 907-230-1868.
Thanks John
DEVELOPMENT SERVICES DEPARTMENT n
a
On -Site water and wastewater Section
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC191191
Subdivision: McMahon, Block: 1, Lot: 14
907-343-7904
Fax: 343-7997
A water sample revealed a nitrate concentration of 7.37 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Mailing Address P O Box 196650 o Ala
Anch rage, ska 99519x6650 *www
3. 4. ... k„ s,.�.. ..u. �. .,.ia,.SS H..4 s+Y+ �: ..,f :v.'�..-_. 's., sr.. ..a . F. .,< �•s.. _4 �u .�... . _,..�. 3� r. � r,'--,. <i 'c. x,..._.,,.'r r„.
murn org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Septic 'Tank Advisory
Certificate of On -Site Systems Approval # OSC191191
Subdivision: McMahon Block:1, Lot: 14
The septic tank for this property is 27 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
v
Address P OBox 196650*Anchorage, Alaska 99519 6650 *www muni org
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. # at'") -~3~--/\- ~'5~
1, . GENERAL INFORMATION
Complete legal description
Lot 14;
HAA#
Bl~ck I; Mc'Mahon Subdivision
Location (site address or directions)
3755 Mc Mahon Driv~
Pro perty owner
Mailing address
Lending agency
Chuck Isl~
Day phone 762-4569
Day phone
Mailing address
Agent
Address
Day phone ,~"~\' "'
Unless otherwise requested, HAA will be held for pickup.
2.~-NUMBER OF BEDROOMS: 4 "~
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. 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
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 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
Add ress
Engineer's signature
DHHS SIGNATURE
i XX Approved for
Disal~proved.
Conditional approval for
~, & S ~NGINI~RING
17034 Eagle RNer Loop Road No, 2~
Phone
Four (4) bedrooms.
bedrooms, with the following stipulations:
By:
ACctJticnalComments Note; m_he -w-ell
State and Municipal Codes. There are nitrates present. It is
continued suitability. Nitrate concentration is 6.0 mg/1. EPA
,[LLc~X..LLLLU~LL cunc~nt~'ation/~,s t0.0. rog/1.
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.
72~)25 (Rev. 1/91) Back MOA #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescription: /~'~ /~-, ~'~(..J~/, /~¢/'//~,-.,-.~///'~ ParcelI.D. D,/'?
A. WELL DATA
Well type P~tUA--t~
Log present (Y~)
Total depth
Sanitary seal (~N)
If A, B, or C, attach ADEC letter. ADEC water system number Date completed I V'~ ~' Driller
cl 0 ~ Cased to ~ '~
Casing height
\/~___5, ,--"- Wires properly protected (~/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/h~_~.'.. tank on lot I ],--~ t
Absorption field on lot
Public sewer main
Sewer service line
g.p.m.
AT INSPECTION
~(: '+
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
[00 '+
WATER SAMPLE RESULTS:
Coliform (~ "'" Nitrate ~3,(-.) ~'/-~ Other bacteria
Date of sample: c~,[(,.)_~.~_ ~ Collected by: ~:-~{~ ~ '~/%~"/'JI~'~'fL~/~C'
To Property line
Surface water/d rainage
72-026 (Rev. 7/91) Front
B. SEPTIC/HOLDING TANK DATA
Date installed c~/~-c/~' Tank size I,,D"~O ~/~-¢- Compartments
Cleanouts ((~Y_)N) Tt~o ~ Foundation cleanout ~'N) ~'~ ~ Depression (Y/~__.~
High water alarm (Y/~) ),d//~ Alarm tested (Y/~ ~J//,~
Date of pumping /xJ//~ r~E~w' '7-A-,~r,. Pumper
SEPARATION DISTANCES FROM SEPTIC/~ TANK TO:
Well(s) on lot II,~r On adjacent lots · /(~0~+ Foundation ~:~
Absorption field ~O ~ Water main/service line.
I0o '+
: ; CONTINUEDON BACK PAGE
C. LIFT STATION ~/'J//~l
Date installed Manufacturer
Size in gallons ~ Manhole/Access (Y/N)
Meets MOA electrical codes (Y/N)
SEPARATION DIS~TION TO: '~.
Well on lot ~.---~ On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed ~-!~-9 ~--
Length I~ ~O~, /~ fid' Width
Total absorption area
Depression over field (Y/~
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/~
Soil rating O,~ G?P/S/= System type
Gravel thickness .~ ~
Total depth c~ _ /O
¢" Cleanouts present ((~YN) ~E.~q
Date of adequacy test
for ~
bedrooms
If yes, give date )k)//~-
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellonlot I IT' -
To building foundation
On adjacent lots ~co~/'
Surface water ~(0(~
On adjacent lots /00 '.f Property line ~,[ ~4- ¢
I -~ ~r To existing or abandoned system on lot / 0 ~¢
Cutbank /'J/~ Water main/service line . ¢~-~ ~'
Curtain drain ~O~F-- ~t'4,~.,~,
Driveway, parking/vehicle storage area
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.
S & $ ENGINEERING
17034 Eagle River Loop Road No.
Signature ..... ,_ ~t ..... n I~,h,~
Engineer's Name
Date c;~-'~.I
HAA Fee $ ./'~
Date of Payment
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
-, L
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
ANALYSIS RESULTS for INVOICE # 58227
Chemlab Re£.~ 92.4915 Sample ~ 1 Matrix: WATER
Client Sample ID : DRINKING WATER L14 B1 MCMAHON S/D
PWSID UA
Collected SEP 10 92 ~ 16:05 hrs.
Received SEP 11 92 @ 15:00 h~s.
Preserved with AS REQUIRED
Client Name :S & S ENGINEERING
Client Acct :SNSENGP
BPO# :
Req~ :
Ordered By :R. S~ER
PO~ :NONE RECEIVED
Analysis Completed : SEP 14 92
Laboratory Super~ :,STE~PHEN C. EDE
Send Reports to:
1)S ~ S ENGINEERING
Parameter Results Units Method Allowable Limits
NITRATE-N 6.0 / mg/1 EPA 353.2
Sample ROUTINE SAMPLE COLLECTED BY:
Remarks:
1 Tests Performed * See Special Instructions Above UA=Unavailable
ND= None Detected '* Ssa Sample Remarks Above
NA- Not Analyzed LT-Less Than, GT~Greater Than
~Sr~$ Member of the SGS Group (Soci6t~ G~n~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
GENERAL INFORMATION
(a)
Application Date
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b)
Applicant Name ~'~' f~'~'/'/~'~ Telephone: Home 3'%,z-'-C'-f'-,4"X' Business
Applicant Address $ 73-5' /~ h/~fio,~ /-J~-~
(c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution 'frs ~,,~/ee
Address ~7 ~. No~4 &~¢4~ ~/~ ~4c4or~ ~'~
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family r-~ Multi-Family []
Number of Bedrooms 3,
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 r'~ Holding Tank []
Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 (11~84)
4'¸.
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm ~(~f'/~'/~
Address ! ¥ 5'$ ~
Date /4~/0 ~ /
7-¢04 ~'~r~/ .¢'¢~'~-','~'/ Telephone
/ '7,,, /¢87
Engineer's Seal
DHEP APPROVAL ..~=~..,,-
Approved for
Approved ~ Disapproved Conditional
Terms of Conditional Approval
Date "~-/'~'--~' :~
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84}
MUNiCiPALiTY OF ANCHOI~I~?NICIPALITY OF ANCHORAGE (MOA)
ENVi~,.ONMF-NTAL $£RVICE$ D~OLI~.H AUTHORITY APPROVAL (NAA)
CHECKLIST- FEBRUARY 1984
APR 1 4 1.987 264-4720
RECEIV£D Legal Description:K/c./t./~ ~,~ $ ~'~ ,~
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth ?C~ ' Cased to
Static Water Level
Casing Height Above Ground !
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot ! 15- '
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line I% A-
Cleanout/Manhole N,
Water Sample Collected by
Water Sample Test Results
Comments
IfA, B, C, D.E.C. Approved (Y/N)
Date Completed 17 ~' ~ Yield
Depth of Grouting
Pump Set At -~, ,¢0'
Sanitary Seal on Casing (Y/N) ¥'
Depression Around Wellhead (Y/N) ~
.J~ c.c. ; On Adjoining Lots '7~ I°°~
lr./j~ ~ ¢.oo; On Adjoining Lots '~ Icc,
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date ~/l~ ~ ~7
B. SEPTIC/HOLDING TANK DATA
Date Installed ~/7/7 ¥ Size [ ~,,~"~d~'~{ No. of Compartments
Standpipes (Y/N) ~' Air-tight Caps (Y/N) ~' Foundation Cleanout (Y/N)
Depression over Tank (Y/N) ~ Date Last Pumped ~ / I~ t'~ 7
Pumping/Maintenance Contract on File (Y/N) N,A, ; for
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well I 15" ~ro~ C.O.
To Property Line ~, 3~ ~
To Water Main/Service Line
Course ,.~ ~ co '
Temporary Holding Tank Permit (Y/N)
To Building Foundation ~/.$- '
To Disposal Field I ~ ~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date installed 6"/ 7 [ ? 8.
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N) N
Results of Last Adequacy Test J'~
Separation Distance from Absorption Field:
To Water-Supply Well I ~1
To Building Foundation '~ ~o '
Lot N, ,~-,
Type of System Design
Length of Field '~- ¢
~4~-~of Field ?-- ~
Gravel Bed Thickness '7.5"
Standpipes Present (Y/N)
Date of Last Adequacy Test
Co O.
To Water Main/Service Line N,,4.
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~:>
To Cutbank (if present) N, ,4.
v
LIFT STATION ~1.
Date Installed
Size in Gallons
Dimensions
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify tha~ I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~'~~ ~ ,~ Date '7'//Z/~'7
Company r~"~ (~ 'z'-/~/
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11184)
Engineer's Seal
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
treet, Anchorage, Alaska 99503 274-4561
· Date Received February 1, 1977
Time of Inspection I I',~/),-qrr~
Date of Inspection ~-S~-~]~I k3__%
REQUEST FORAPPROVAL OF L~/~
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by:
Mailing Address:
2. Property Owner: John & Vance Kay Jones
Phone:
Phone: 349-2340
Mailing Address: % 115 West Northern Lights Blvd. #208
3. Legal Description: Lot 14 Block 1 Mc Mahon Subdivision
4. Location:
McMahon Street
5. Type of facility' to be inspected Single Fa]nily
6. Well Data:
A. Type Individual
Sewage Disposal System: On-site system
No. of bedrooms
A. Installed
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
Distances:
!
B. Depth
D. Bacterial Analysis
1. Size 1,.~]]~. 2. Manufacturer
1. Absorption Area ~ 2. Material
Total length of lines
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C. Absorption area to nearest lot line
, Absorption area
, Other contamination
, Absorption area
, Sewer Lines
EQ-034 (1/74) Page l' of two pages
Page 2 of two pages - Req it for Approval of Individual S ir & Water Facilities
i'~'gal Description Lot 14 Block 1 Mc Mahon Subdivision
Comments
Approved ~~.m-~~g, DisaPproved Date ~
Approv~alid for one year from date signed
Greater Anchorage A~rea 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 (]/74)
MUNICIPALITY OF ANCHORAGE
.,, MUNICIPALITY OF ANCHORAGE DEFli', OF HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIONENVtRONMENfAL PROTECI'IQN
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF FEE 1. 1977
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA FHA. ,CONV
2. Property Owner: %,J'~
Mailing Address://.~/~7, ~P&/~ ~5 ~ 0 ~ Day Phone: ~¢~- ~)
Mailing Address:
4. Name of Lending Institution:
o
Mailing Address:
Name of Realtor or Agent:
Day Phone:
Phone:
Mailing Address: ?/-~ /b)' /LJOA~CZ~L~, L{~.~ ~'~0,~ Phone:
Lee Description: ?¥ /
7. Type of Facility to be Inspected: ~L~77/~?~/ No. Bdrms. ¢
Water Supply
Type of Supply: Public Utility.
If Individual, number of dwellings presently served
If Individual, depth of well
,I ndividual ~
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation /~ '7'-//
Individual (on-site)
72-003(3/76)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
Approval requested by: ~-~ J. ~c-~
Mailing Address:
Property Owner:' ~c_~
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Mailing Address:
3. Legal Description:
4. Location:
5. Type of facility go be inSPected
6. Well Data:
A. Type
C. Construction ~
Phone:
Phone:
No. of bedrooms L/
/
B. Depth /~'/
D. Bacterial Analysis
Sewage Disposal System:
A. Installed ~'~.-~,~?, /~?~/
C. Septic Tank: 1. Size'
/~J-~ 2. Manufacturer //~ -~
D. Seepage Pit: 1. Absorption Area
2. Material
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank /~'~, Absorption area
Nearest lot line ~0 ~+' Other contamination
B. Foundation to septic tank
I0-~
, Sewer Lines
, Absorption area ~ /-~
C. Absorption area to nearest lot line
EQ-034 (i/74) Page 1 of two pages
.~].~ ~ge 2 of two pages - Req
Legal Description
for Approval of Individual S ~& Water Facilities
Comments
Approved~ ~. ~~>~} Disapproved Date ~/-/~-
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I 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)
AT~.~ ANCHORAGE ARk/, BORO,
Department of Er~vironm~:i;tal Quali. ty /0
..
3330 "C" St., Anchorage, Alaska 99503 -'274-4561.
REQUEST FOR APPROVAL OF
INDIVIDU.AL SEWER & WATER FACILITIES
1. Type of Inspection: CMRO
VA FHA
CONV xx
2. Property Owner:
Maili,ng Address:
3. Name of Buyer;
Mailing Address:
John T~ Jones, Jr.
('3251 E. 42nd Avenue)
Star Rt. A,Box 1574 A
John T. Jones, Jr.
Da.y Phone
Same as above DaS Phone
349~2340 .,..
Name of Lending Institution: First National Bank of Anchorage
Hail ing Address: P' o. Box 720, Anchorage
Ala~k~ 99510
Phone 279-4481 xtn 223
5. Name of Realtor or Agent: n/a
Mailing Address:
Phone
Legal Description:
Location:
Lot 14, Block l, McMahan
Huf fman Area
4
7. Type of Facility to be inspected:
8. Water Supply
Type of Supply: Public Utility Individdal
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal-System
Type ,of S~stem: Public Utility individual
if Individual, date of installation
single Fam.. Res. No. Bd rms.
(on-site)
PROM
· '~frs. Joh~ T~-3bnes, Jr.,
Star ~.oute "A",
Anchorage, Alaska 99507
r
The Fir: atlonal Bank of Anchorage
BOX 720
ANCHORAGE, ALASKA 99510
SUBJECT:
FOLD ~
Sewer & I~tater Facility Approval DATE: l+/11/75
Per our conversation this date~ t am enclosinR necessary items to obtain
complete information in connection with the water ~nd sewer System on your
property.
Enclosed also, is a return, prepaid, envelope for your convmnienc~ in
~eedeil.'-'~ .~ : ~ ~
the
returning
items
Thank you,
~frs ~
RSTURN TO > SIGNED ( .... ) g~xie 0'Ouinn
DATE
SIGNED
PERSON ADDRESSED RETURN THIS COPY TO SENDER