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Home My WebLink AboutMCMAHON BLK 2 LT 5 GRE' 'ER ANCHORAGE AREA BO: UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 NAME INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM /~/~/,/'~/~ //'~//~/~/Z/~ MAILING ADDRESS ~"~' ~/~' ~ ~''Tz~ PHONE SEPTIC TANK.~'-/:~~/~:':~ ~ '/~'/J/"' ~'~' ~';;~7/~'~//x' D STANCE FROM WELl ?[-'~ MANUFACTURER ~',/~<~/" ,/~z~ MATERIAL INSIDE LENGTH ----' INSIDE WIDTH ~ LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY ~'~'~ GALLONS. SEEPAGE PIT: NUMBER OF PITS // DIAMETER ~<'~" OR WIDTH ~2~,/ LENGTH-2'~, DEPTH LINING MATERIAL,~2-4~-;~' ',~.'~'~-~z~'~'CRIB SIZE: DIAMETER~"~ DEPTHr DISTANCE FROM: WELL / BUILDING FOUNDATION -2'ZI?/-, /2~,/;~'.~/ TOTAL EFFECTIVE . NEAREST LOT LINE ' ~'~-~/. ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE BUILDING FOUNDATION CESSPOOL -- APPROVED CONSTRUCTION /2~/~c-~. / %. Z~-/]/L _/J NEAREST /d/,/?z; ~' ' NEAREST LOT LINE 2~z/ , SEWER LINE /./)?¥ OTHER SOURCES /t~ ~ /~/~/~/~_//~2 DISAPPROVED REMARKS DEPTH .... DISTANCE FROM: SEPTIC /'//~/,,X~? SEEPAGE TANK. /~YO' , SYSTEM / DISTANCES: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. EQ-031 DIAGRAM OF SYSTEM DATE GreaTer ANChorage AReA BOrOUgh /, ] -' ~ !" ' il~'' ': PERM T NO. DEPARTMENT OF ENVIRONMENTAL QUALITY ,L' %:' 3330 "C"STREET ANCHORAGE, ALASKA 99503 / /~ SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT DRAIN FIELD ~ ., OTHER TO BE INSTALLED BY NOTE= THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINANCED THROUGH SOIL TEST RESULTS J FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUI~J DISTANCES, REQUIREMENTS ) FOUNDATION TO SEPTIC TANK POUNDATION tO BEEPAGE PIT . DRAIN FIELD . SEPTIC TANK TO SEEPAGE PIT WALl SEPTIC TANK ., SEEPAGE Pit ~ DRAIN FIELD WELL tO sePTIC taNK /~ ) , seepage Pit DRAIN FIELD /~ ] ALSO CONSIDER Area WELLS, WATER MaIN TO SEPTIC tANK /~ ~ SEEPAge Pit DRAIN FIELD SEPTIC TANK, /~/ SEEPAGE PIT/~ ., DRAIN FIELD /~ ] I EXCAVATION 5 FEET INTO UNDISTURBED SOIL· 4 INCH DIAMETER CAST IRON S~PHON PIPES ON SEPTIC TANK AND seePAGe PIT FITTED W~TH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION· OR LICENSED DESIGN DIAGI~AM OF SV'STE~I I 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. Performed For Legal Description.: This Form Reports ANCHORAGE, ALASKA 99502 Richard J. Blumer Date Performed,, August 3, 1973 Lot 5 Block 2 Subdivision McMahon Soils Log ~ Per'c01ati0'h' ~est Depth Feet 6-- 8-- 10-- 16.--- 18-- Soil Characteristics Tan Sand - Silt Mix (ML) Gray Silty Sand (SM) with silt and poorly graded sand seams With scattered gravel to 14' Ground Water Yes,,'At What Encountered? No Depth? I Reading Date Gross Time Net Time I Depth to H20 [ Net Drop I · nu te . Proposed Insta~'l'ation: Seepage Pit xx Drain-Field Depth Of Inlet Depth To Bottom Of Pit Or Trench 'COMMENTS;..250 square ~etofdrainage area isrequired per bedr'oom below 7 ~otdepth. ' .... Yest Performed By R.F~__C~li.m, le.__ Data Certif'ied BY: ,-'//ex/ - '~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) o Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent ~c~! h1~(~- /~f~_~k~ Address [.¢ ¥_7 ~" ..o/.., Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ..3 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: Day phone 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 ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT 'OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature DHHS SIGNATURE /~ Approved for Disapproved. Conditional approval for Phone Date bedrooms, with the following stipulations: By: Additional Comments Nmi-e: Municipal Codes. There Tb~ well for this~me~ts the State and are nitrates present. It is suggested that periodic testing be performed f~ ~n~3r~ the wells confinu~d. suii'abilitv. ~ate/~/~re 8.3 mg/1. EPA maximum is 10 mg/1. ~?/~/~--~/q3/~.¢~/~ Date~////~/~- ~ 7~., 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 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) 8ack MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L ~ '~2 ~¢M/tI~0N Parcel I.D. ~/~-~ RECEIVED SEK ] ...,-' o~.l~oiLiil 8 1991 A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C. attach ADEC letter. ADEC water system number (,~,-~ ec4) Date completed / / Cased to ~ 7 /'/~ Driller Casing height Wires properly protected (Y/N) 12" Y Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Ici~ F'R.~t ¢.0. Absorption field on lot ~%"/ F~o~t ~,O. Poblic sewer main ~/~ Public sewer service line ~\//~ ; On adjacent lots ;,/oo ' ; On adjacent lots ~/oo Public sewer manhole/cleanout '~//~ Petroleum tank WATER SAMPLE RESULTS: Coliform 0 Date of sample: ~'/3/~// Nitrate m~/~- Other bacteria Collected by: ~ LATToP 'TECt-). B. SEPTIC/HOLDING TANK DATA Date installed ~/'7~ ~/~ ~"/~' Tank size [OOO Compartments Cleanouts (Y/N) ~ Foundation cleanout (Y/N) ~ Depression (Y/N) High water alarm (Y/N) ~/~ Alarm tested (Y/N) N/,~ Date of pumping 5-/ 7 / 21 ~ ~/ ! SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot lot ~ F~ C.O, Onadjacentlots //(o ~ F~'~h C.O. Foundation Topropertyline ~/o~ Absorption field L/O' ¢.0, ~-o ¢.o. Watermain/serviceline Surface water/drainage ~/o0' 72-076 (Rev. 3/91) Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION ~,1,/~. Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed (o/ [~1~ p~ Rtlv~TE R. J~rrcjt h Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating 250 ~'/BDRN Systemtype 5E-EP, ~IT Total depth If yes, give date Gravel thickness Cleanouts present (Y/N) Date of adequacy test for bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: To building foundation On adjacent lots Surface water ,~, /oo Curtain drain Onadjacentlots II 5'~ F¢or~ ¢.0. Propertyline To existing or abandoned system on lot Cutbank ~.~. Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION Signature Engineer's Name Date /~ c~, I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. . ,:':, · ;.'~: ', ' % C( - 35;3 2 ?,,.;;' HAAFee$ / ~0 Date of Payment ~'-~ / Receipt Number ~%~-~'7 ¢ 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number Star E;o~t e .'-..ncC. oz'.age, f.~aska 5."9j32 inch cased water well drilled out to the depth of 99 feet. Drilled at the 'rate of $15o00 por foot. Property ovmer: .('~o Dick ~i~z~a?.er 333-5105 Location of we~ elto:' Lt. ~, B~;. ~ S~odi~sion: ~ ~z'~¢~ ~ L~ill~r: 2er~s Claus of F~part ~ill~g works 3~'-7714 ~el! ~g~ 0-~37' S~ndy clay ~tha few l~ge coppies. ~' 37--63.' ~&~P~-Gravel ~d blue clay compress~. .~. '~ ......63-j~7' dravel~ ~e~ he ~i~l~ug -~th one boulder d. rill¢ through ~ 90 fe.-t~ 97-99~ ',,¢%T&& be~g gravel~ 24 ~ches only me.;Lug 8GP;4- There is only 15 feet of w~ter hazd ~ c~s~g but ~-~th ~ %~ediate recove~*. Oost includes ~ll labor ~ud material for completion of said ?~611. ~':&ke check payable to ~%part ~il~g Wo~4(s for the s~:~ oF $1485.00 Th~2< you very much Bernie Claus of P~mpa~-'; L¥ii_k~,~.' Wor?:s RECEIVFD ./¢¢, & Dept. Health & Human Ser_vices CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562.2343 5633 B Street · Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria' · TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D.# SAMPLE DATE: ~ PRIVATE WATER SYSTEM F LA-r-T(3P 'TEc. H Name I'-f 530 Ec Ho $ T, Mailing Address City State Zip Code Mo. Day Year SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no, [] Special Purpose ~hone No. [] Treated Water "~ Untreated Water SAMPLE NO. 2 I 4 I s I Time Collected LOCATION Collected By L5 ~ HcN/tlto~ I t~::~ CHe~ I TO BE COMPLETED BY LABORATORY is shows this Water SAMPLE to be: ,~ Satisfactory [] Unsatisfactory [] Samp!e too long in transit; sample should not be over 30'hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: Membrane Filter * No. of coloniesll00 mi. Lab Ref. No. Result* Analyst 91. 1794 A.I:),E.C. BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter. Direct Count Verification: LTB Final Membrane Filter Results TNTC -- Too Numerous To Count OB = Other Bacteria BGB Date pART ONE OF TWO REMAINDER TO FOLLOW Collformtl00 mi ColiformtlO0 mi CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASI~ 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAMPLE fox WORKorder~ 33889 Date Repo~ ?tinted: I,~AY 3 9I ~ 16:10 Client 3emple ID:L5 B2 MCI&\NON. SOUTH HOSE BIB ?WSiD ;Ui Collected ]~Y 3 91 ~ 10:30 hrs. ReceiYed ~Y 3 91 @ 12:R5 hrs. Prese~Yed with :AS REQUIRED Client Name :FLATTOP TECHNICA5 SRV Client Acct :ELATTOT BPO ~ Req ~ Ordered 5y :TED PO $ NONE RECEIVED Anaiysis Completed ;MAY 3 91 Send Reports to: i)FLATTOP TECHNICAL SRV Laboratory Supervisor, :STEP}lEI] C. EDE Chm~lab Ref ~; 911794 Lab Smpl ID: 1 Matrix: WATER Allowable Par amot er Tested Result Unite ~4et hod LlmJte NITRATE-N 8,3 ~g,/].' ~PA 353.2, lO Sample ROUTINE SAMPLE COLLECTED BY: C~I/IS. Remarks; Teste Performed ~ See Special Instructions Above UA=Unavailable None Detected *~ See Sample Remarks Above Not l,na].yzed I,T,.Lees Than, GT=Gzeatez Than