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Home My WebLink AboutMCMAHON BLK 2 LT 9 ~--.. MUNICIPALITY OF ANCHORAGE ' '~ DE' ':ITMENT OF HEALTH AND HUMAN SER ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ~) / ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT N~ DISTANCES Address ~ ~'~/~"~ ~"'~ ~'/~' '~ ~/ ~ SEPTICTANK ABSORPTIONFiELD WELL Pho..(~) I P~r~,, No. No. ol Bedrooms ' WELL Bmock~ Subd~ --~ e C ~, ~/~ ~, ~ 3 ~ dr,veway.AS'~JLTwater~lAG"AMbodles, etc.,(Sh°w location of well. seplic system, property lines. IounOabon. ~ SEPTIC ~ HOLDING TYPE OF SYSTEM ' Fill added above o,,gina, grade Gravel depth beneath pipe r o5 ~ Number ol lies Soil rabng Pipe material Inslaller Date Installed ~ PRIVATE ~ OTHER (Identify) e~, ~ I nspect ons Pedormed by Muni~ipal and Stat idelines in eflect on this dale: /3 ¢.~-~ ~ / ¢¢Z Realth Depadment Approval:~I0 Pate: , _ 72-013 (3/85) McMAHBN AVENUE LEIT ~ bP-ri C LOT 14 EAST 140,00' 0 TEST HOLE 0 6' C,O. 20 ~F__ L.-L I DT 10 INSTALL 50' OF TRENCH- 10' DEEP G' OF ROCK~' ~-C.rl.'S 1-M,T. LFIT 11 ~PT! C 40 80 GRAPHIC SCALE 1' = 40' 180 TOBBEN SPURKLAND P~, [ ] 203 W. 15TH, AVENUE II ANCHDRAG~ ALASKA (907) ~79~3916 LOT 5, BLOCK ~, McMAHBN ] SEC,28,, T12N, R3W JACK LAVERTY~ 3950 MCHAHDN SEPTIC SYSTEM ]]ESIGN DATE~ OCTOBER ~3., I987 SHEET~ 1/1 GRID~ 2835 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Township, Range, Section: 1 2 3 5 6- 7 8 9 10 11 12 13 14 15 16 17 18 20- COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? N I~ SITE PlaN S L IF YES, AT WHAT O DEPTH? p E Deplh to Water A~ter e J Monitoring? J~ Dale: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~ (minutes/in.~) PERC HOLE DIAMETER __ TEST .~.U' BETWEEN ~ FT AND ~,,'~7~.. FT I PERFORMED BY: CERTIFY TH ~ATZIS TEST WAS PERFORMED IN 72-008 (Rev. 4/85) UNIFIED SYSTEM ASTM D-2487 10/21/87 MCMAHON SUBDIVISION BLOCK 2 LOT 9 SAMPLE IDENTITY 1 PASSING #200 SIEVE: 51.96% RETAINED: 30.45% PASSING # 40 SIEVE: 82.41% RETAINED: 6.67% PASSING # 10 SIEVE: 89.08% RETAINED: 3.81% PASSING # 4 SIEVE: 92.89% RETAINED: 4.08% PASSING 1/2 IN SIEVe: 96.97% RETAINED: 2.40% PASSING 3/4 IN SIEVE: 99.37% RETAINED: 0.61% PASSING 1 INCH SIEVE: 99.98% RETAINED: 0.02% PASSING 2 INCH SIEVE: 100.00% RETAINED: 0.00% PASSING 3 INCH SIEVE: 100.00% RETAINED: 0.00% THE LIQUID LIMIT IS UNKNOWN THE PLASTIC LIMIT IS UNKNOWN THE PLASTICITY INDEX IS UNKNOWN CU IS UNKNOWN CC IS UNKNOWN FINE GRAINED SOILS ~-~%E~t'/~.,.~, ~ THE SOILS ARE INORGANIC SILT. (Mit)-~ .~ ~ S~ -- GRE,-.. 'ER ANCHORAGE AREA BOk,.,UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS ,/~%~'"'"~'~(~' -- "~'~'//~J PHONE LEGAL DESCRiPTiON.,~'~l', C j~/b~ SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL ~ LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CA PAC I TY/,~,~'~-~GA L LO NS. TILE DRAIN FIELD: DISTANCE FROM WELL'~~)/ NUMBER OF LINES ~ / ABSORPTION AREA ~'~)~) DEPTH: TOP OF TILE TO FINISH GRADE .,.q/' FOUNDATION /~ /~ TOTAL LENGTH NEAREST LOT LINE /~ / - OF LINES DISTANCE BETWEEN L'NES NAg' TRE, CHW,DTH..Z N. TOTALEEFECTIVE SQ. FTi LENGTH OF EACH LINE ~ DEPTH OF FILTER MATERIAL BENEATH TILE ~/ j ~ ABOVE TILE IN, WELL: j TYP Ei~_ _~) ~, BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE_ OTHER SOURCES DISAPPROVED NEAREST SEWER LINE DEPTH SEPTIC SEEPAGE TANK __ SYSTEM_ REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: ~ LOT SLOPE: REMARKS: ,') Form EQ-032 · t:::'EF::H F:IF::'F'L :1: CI::ItqT LOC:FiT ]: 4:.'ID..., I...E:GFII.. I_ :F:~ Ii.'".', ;i.~: i'"IE:HF::IHEd",I ::,. I.. L. OT t~i;:I:ZE ]i!:[!~:i~;~',i.".',O :i~;L-:!t...tF:tF~:E/ FEET THE: R:IEQLJ]:I:;::ED :E;IF~:E: OF THE THE L. EI'.,tG'T'H [:, :t: I"tEN.':.'5 ]: ON .'t::.7, 'T'HIE LENGTH ,:: I i'.,I F'E:E:'I" .':, OF' THE I"RE:I',!CH OR I:::,I:,'~:FI :t: I",IF' ]: EL.t:::,. THE DEF'TH OF F't ']"t:i:I:'ENCH C)[;.: P]:T :[~.:; TI. II::". D)."J.:::;TF:INC:E BEFFI.,.IEtiEI",! THE '.51...IF::FFICE: OF: THEE Gt:;;.'C)LIN[.':, F:ff.,ll:::, THE E.':OTTOH OF ']"HE:.' E',:-:',CI:::I'v'FrT:[CIN (]:lq I'.--IEET). 'THE:RE: Z'.E; 1'.,IO' :SE:T 14 ]: [::, 'T' H FOl::;'. TF..'IEIqCHE:L:..:. "FHE: GP::F:I'v'EL ['.:,EF'TH .'t.' '.::.; THE I','1 :[ I'-,I :[ I',ILIH DEF:'"FH OF (:~iF.'.Fi',/EL.. E[E'T'HIEF£N "1"1~'11!'2: OI...Ft"Fi:::ILL I:':']: F'E FINE:, 'T'H[E E:CFTT'OH OF' THIE E::.:',C:F:I'v'FIT :[ i.")t'.,l ,:: ]: t'-,] F::'EET.':,. E:RC:I-:::F:' ]: I...L.. ]: NG OF' Fli",t"r' :FJ;"F"-.-';'I'EH I,.I ]: 'T'HIEILI'I' F'.~ I",!I::t1_ :r. I'-,I'.'.~;F'E:CT ION I:::IN[.':, F:IF'F'F-'~:O'v'FII.... lii:"r' 'T'H ]: '-'(~; E:,E I:::'F:IF:~: T HtEN T HILl.... I'"1:1:1"4 t HUH D :[ S TFINE:E EiE"I"HEEi"4 FI I.,.IE:LL FII'.4[.':, RN"r' O1",1-'-::~; I 'T'E SE:t4A(.:iE: D I :i~;F'O'.:~;F:IL fS"r':i~:';'l"EH :1: :~i; ::L.(i!~O FEET I::OF~: t::1 F'I:;.:IYI'aTE HEL.L. OF:'. ;:200 FIEIET FOI:,'?. I::1 F'I...IE.-31....ZC HE:L[ .... t,.tEi:LI_, l_.(:)l]~i'.:J:'; Ftl;.':E F4:E:(..':.dJ]:F.:E.~[) FINE:, I',11..17]" E:E F..'Ii.:.'"I"LJF4'.N,~Z[) "Fi:) THE E:,IEI::'FIFi:'TT"I[ET.,tT I.,.IZ-FH]:t'q ]:i:O [::'l:t"r'~; OF "t"HtF.: HELL. COHF'LIET].' O1",i. :E;I:::'E:.:'C :1: F' ]: C:FIT ]: ON:E; FIN[:) C:ONt:':';T'I';..'UCT :[ O1",1 [.':' :[ RGF'.RHE; FII::~:tE Fq',,,'FI .T.L.I'aEH._E: TO '.r. NSL.Ii:;;:E PF..:OF:'IEFi: ]: t'.,1 :i.::; 'T' F:t L L I:"t T .]: O i'.,I. ): C:liEi:;;:'l":t:F"-r' TI...IFIT' ::1..: ]: RI'"I F'FtH]:L.I:FIF:: t.,-!.'L'TH THE; F.,.'I:.:.:I.:..'¢,..I:[REHEI'-,IT:i~:'; I::'OWT'H B'¢ THE: I','ilJN :[ C ].' I:'F:IL ]; '1"'¢ O1::: F:It'-,ICHL31:;::FIGEi:. ;;;i',: :[ I-,.1:1: LL..T. NS'I"RL.L THE S',r".::i;TE:H ]: I'.,! RCC:OF;:t)F:tt",IC[.:.: I.,.I ]:"fl"'l THE: E:C~DE:'..-'5,. ::~:: Z Ui'.,IE)EI:;?.STF:IND THFIT T'l-Ili.:.: Ot',,I..-.S]:TE '.:.~.:,IEHEI:;~: :E;"r'tE;TE:P'I P'II::I~" I:;.'.EQIJ:[I;i:E E:NI..,:FII;~:GE:HIENT ]:F:' THE i:~:E:5.'[E:'E'.T',IC[E ]:% F.:EHOE:'IEI...ED TO :I:NCLLI[.':'[F. P'IOF:'.E THFIN '.E:; F"II'-'" F'I.i ]: C F:It'.,t'T ~-~E~ F::I~L'~.~: [[Gi'.,IIED: ................ ~ ......... r ' ~1 r'r .............................................................. ..... ~"l //,~, F:'.,.' '-k,' ,' ['--L,'~ ~~'"" .' GREnlER ANCtlORAGE AREA BOROUGH DEPARTMENT OF ENVTRONMENTAL QUA£.[TY 3330 "C" Street ANCLIORAGE, ALASKA 99503' Case # Performed For -S !' Dated Performed Legal Descrip~i'on: Lot__~B16ck ~_~: Subdivision~ This Form Reports Soils L~g_~o~. ~l $i~'~ Percolation Test - Soil Tes~ Must Be logged To 4' Below Proposed Seepage System Soil Characteristics Depth Feet Oround ~a~er [ncountered? · If Yes, At What Depth?. ,. Date GroSs Time Net Time Depth to H20 Net Drop Mi n u l:e Reading 'Percolation Rate 10-- 11-- 12-- 14-- Proposed Installation: Seepage Pit' Drain Fi~-~___.~ Depth of Inlet ~5" Depth to Bottom o{--Pit Or COMMENTS: ~~ ~~ ~/~ ~ ~ c~¢~ ...................... · Test Performed B ~ ,~-~ ~ertif]ec,~~,.w~tac~ WATER W~ELL LOG FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 99501 USE OF WELL ~_~ ._ SIZE OF CA~ING ~ 'DEPTH OF HOLE~. CA~ED TO I e~ STATIC WATER LEVEL I A 9 FT. YIELD /~ GAL.PER.MIN. WITH oF D A OOW.. FT. REMARKS DATE COMPLETED PUMP TO BE SET AT to__ __to to__ tO__ ___to __to ,to tO____ ___to ( MUNICIPALITY OF ANCHORAGE ....... DEPARTMENT OF HEALTH & HUMAN SERVICES · Division of Environmental Services · - - . · ..... , .. On-S.ite Services Section ' ' ' . P.O. Box 196650 Anchorage,Alaska 99519-6650 ...... ;._ 348-4744. . CERTIFICATE OF HEALTH AUTHORITY -' ..... APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL Complete legal description L~ cA- ~, /w~/~/~o,~ .~/_D Location (site address or directions)': '3 ~-~ /we/w~</~o,, /~,< ' ) ~- ii-_..-' - ......... ' ' -:.': .... i".-':~.:'-~'.-':'-_~:: ..... . . : -' Mailing address. ~ ,5-o ~c ~fl'-~,~-- ~," '.:A-~'CA0r-og,~, '/).~ ~,~.~- IF - Lending agency ............ Day phone · - -, 2, -. NUMBER OF BEDROOM · ' ' -,---::',' ..... "~ --'~ Individual well .. ~ . ...... ,. - ,-.: Individual on-site '---.". ' ~ · . .' - ..' -.; ¢ ,,~ ".~ .' -. · -- .... Communltyon-slte ..:. - · . .... ; :::,.,~., · ..- -~ --....,~:-.. - . NOTE: If community wastewater system, provide written confirmation from State ADEO attesting to the legality and status of system. 72-025 (Rev. 1tgl) Front MOA~I 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 Munici pal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~ f~ ,z.~,/, 7'~c,4n/¢~1 ~ ~ Phone ~ Address /V~ ~c4o 2/~ ~c~or~ ~ Engin~ffs signature ~ ~~ Date ~il .;...-;':.'-7 . ','~"_ _' . . · . , '.; .... ;.:. .: . .._ ........ '"' Additional Comments ~oee= ~b~' ~eZZ ~o= eh2s ~ope'=e~"meees ,ex&se2~g .... ~: .... State and Municipal Codes. There are nitrates present. It is . -'~" '"->';':'-SUqqested that a periodic-'tes%inq he'performed to insure the wells''~ '::~;~" ~";~;~.~'.~'co~'inued 'suitability. ,-.-Nitrate¢,concen%ration~'~is:,5','36~'' mg/1.,; EPA ::.. · . . -~¢~.. ~ ,~ ,~, ~ · . . . . _ ,: Depa~ment of H~lth and Human So.ices (DHHS) i~ues Health Authofi~ '[~;;. ~koval f~s~ only upon the representations give'h' in paragraph 5 above by an independent' ~r registered in the State of Alaska. ~he D H HS do~ this as a couaesy to pu rchasem of homes : t":.' a~'ih~[~iending institutions in orderto ~tis~ ceaain f~eral and s~te r~uirements. Employ~ of DHHS do not ' -': conduct inspections or anal~e data before'a ceaifi~te' is i~ued.",The Municipali~ of Anchorage is not r~ponsible for errom or omi~ions in the prof~ional engi a~Fs work. -~ 72-~25(Rev, 1/91) Back MOA~21 Legal Description: Lo~' A. Well Data Well type Log present (Y/N) Total depth 1 9.3' Sanitary seal (Y/N) Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~t' Z..~ / 7 7 Driller ~',~ Cased to f 9 3 ' Casing height Wires properly protected (Y/N) 'r' Date of test Static water level Well flow Pump level1 FROM WELL LOG ~/~3/77 AT INSPECTION 31'8Z /95'- IO g,p.m. 6',$- -h SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ! o $' Absorption field on lot I 342' g.p.m. ; On adjacent lots ; On adjacent lots Public sewer main N, Sewer service line WATER SAMPLE RESULTS: Public sewer manhole/cleanout Petroleum tank Coliform ~ col //o o r.J._ Nitrate Date of sample: _3/87_/9,5- B. SEPTIC/HOLDING TANK DATA Date installed ~¢/'7 7 Tank size Cleanouts (Y/N) 1' Foundation cleanout (Y/N) High water alarm (Y/N) N. ,4. Date of pumping b- / z.~- ¢' ~ ~' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I o $' To property line '~,~' Sudace water/drainage Collected by: Other bacteria I ~5-~ ,~/ Compartments Y Depression (Y/N) Alarm tested (Y/N) /~. A. Pumper f~ot~ On adjacent lots > ~,~,' Absorption field ~ .30 ' Foundation 3 7 / Water main/service line ;~ ~-$ ' 72-026 (3/93)° Front CONTINUED ON BACK PAGE C. LIFT STATION l,,I. A. 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 Soil rating (GPD/Ft Gravel thickness Cleanout present (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed lO / ,~ 7 Length 5'0 ' Width Total absorption area f¢oO c~' Date of adequacy test :3/8 ~-/ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N). SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Sur/ace water Well on lot 2> To building foundation On adjacent lots ;> Surface water .~ too' Curtain drain ~(o,~ g E. ENGINEER'S CERTIFICATION Results (pass/fail) /2 for 3 S" After test If yes, give date o'/¢br<M System type % ~'¢~, ~/~ Total depth Io' Depression over field (Y/N) Y Bedrooms On adjacent lots ~ ~ o0 ' Property line To existing or abandoned system on lot Cutbank t, io,~ 5 ~,~ Water main/service line Driveway. parking/vehicle storage area ~ 1 d'¢ ' I certify that I have checked, verified, or conformed to ail MOA and HAA guidelines in effec, t op;t~;'~t~t.e...qf this inspection. ,(:',.' ,,' ~ ~:" ~. %-., :;4 ¢~ ~ ....... ~ ~. ;.' '~' ~¢ .,: ............... '" [:!::-!.; '::~:i: ~;.:" fingineo~s ~amo Date ~r~/ ~¢ I HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)° Back ~ ,,. ,,.~ ...,~, .... . ,~.. Waiver Fee $ Date of Payment Receipt Number CT&E Ref.# Matrix CT&E Environmental Services Inc. Laboratory Division ~,a,~F,e,~,,e,~-~F~p-j,~',~'J~p'~-~-J-,~'~p',~,,~ 5.1o7 -1 Laboratory Analysis Report WATER Client Sampie ID L9 BLK2 MCMA~ON S/D - BATHROOM SINK Client Name FLATTOP TECHNICAL SRV WORI( Order 13396 Ordered By TED MOORE Printed Date 03/27/95 @ 16:53 hrs. Project Name Collected Date 03/22/95 @ 12:30 hrs. Project# Received Date 03/22/95 ~ 13:15 hrs. PWSID UA Technical Director STEPHEN C. EDE Sample Remarks: ROUTINE SAMPLE COLLECTED BY: T. F. MOORE. Qc Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 5.36 D m~/L EPA 353.2 10. 03/24/95 CMR * See Special Instructions Above UA = Unavailable ~*~ See Sample Remarks A~ove MA = Not Analyzed = Undetected, Reported value is the practical quantification limit. LT = Less Than 3 = Secondary dilution. GT = Greater Than 200 W, Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE 0 [ '7 DEPARTMENT OF HEALTH & HUMAN SERVICES o,v,s,o. OF E.V,.O..,E.TAL SERV,CES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date /O · ~ o, ~ '7 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, toWnship, range) (b) Location (address or directions) Property Owner ~-.~ Mailing Address Telephone: Home ~.-~G -' q,.~/(o Business (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Telephone P'74 / Mail the HAA to the followina address: or: Check here [~. if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single-Family ~' Number of Bedrooms 3. WATER SUPPLY Individual Well~ Community [] Public [] . - Not~:lf cornmunity well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. ' i-'4. - SEWAGE DISPOSAL Onsite.~/,, Public [] Community [] Holding Tank [] ' Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 IRev 8/86~ Front 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 ~~ Telephone ,~7 ~ ~ ~ ~/'~, Address /' ~ ,'/-~'/ Date ~,..~ ~¢_..,1, [ ,~ ~¢' 7 Engineer's Seal DHHS APPROVAL Approved for /~'~"f~) b~drooms by _ _ Approved ' //~ Disapproved Conditional Terms of Cor~ditional Approval Date CAUTION The Municipality of Anchorage Department of Health and Human Services fDHHS) issues Health Autho~:ity Approval certificates based only upon the representations giver] 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. Page 2 of 2 72-025 fRev 8/86) Back WELL DATA MUNICIPALITY OrN~J~J~ITY OF ANCHORAGE (MOA) ENVI~,ONMENTAL SE~ri-S~VJ~'IORITY APPROVAL (NAA) CHECKLIST- FEBRUARY 1984. ~ NOV 0 2 1987 264-4744 RECEIVED ,-'--MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Well Classification Well Log Present (Y/N) Total Depth J q ~' Static Water Level · - Casing Height Above Ground Electrical Wiring in COnduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot NOV t987 RECEIVED Legal Description: ""~ ~ ~ if A, B, C, D.E.C. Approved (Y/N) 7 Date Completed ~' ~.~ 7'-~ Yield Cased to J ~ ~ Depth of Grouting t~ O t4 ! ~ 1. 1,=, Pump Set At ~ 0 / ~ ~f Sanitary Seal on Casing (Y/N) 'Y" Depression Around Wellhead (y/N) To Nearest Edge of Absorption Field on LOt ~ -~ ~ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Nearest Sewer Service Line on Lot !o¢ '!" ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~°~' '~"~ Standpipes (Y/N) "r'~O Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) 1~/~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course N t~ ~/E Size i~-~" 0 No. of Compartments 'r Foundation Cleanou. t (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field Comments To Stream, Pond, Lake, or Major Drainage MUNICIPALITY rOi" ANCHORAGE ENV!RO.N!MFNITAI SERVICES DIVISION] Page I of 2 72-026 fRev 8/861 Front NOV o 4 ]987 RL CEIVED C. ABSORPTION FIELD DATA Soils Rating in Absorption S. trata Date Installed I O/,~//~ '~ Width of Field ~ I Square Feet of Absorption Area ~ Depression over Field (Y/N) N Results of Last Adequacy Test ~/~"~"' Separation Distance from Absorption Field: To Water-Supply Well · J ~) ~ To Building Foundation "~ ~ Lot I 0 '¢" To Water Main/Service Line ~ I O To Stream~Pond~Lake~hr Major Drainage Course To Driveway, Parldng Area, or Vehicle Storage Area Comments Type of System Design Length of Field ~.~,,- Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. L,FT ST^T,O, N e t4 Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions 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 that I have checked, verified,~r conformed to al!, MQA and HAA guidelines in effect on the date of this inspection. Signed ~~ Date ~/'~/~'""7 / Company MOA No. Receipt No. Date of Payment Amount:$ /' ¢;; ,': ~' Page 2 of 2 72-026 fRev 8/86} Back Engineer's Seal ALASKA IJ.tBO[1B nTAL COnT[ OL IIqC. JACK LAVERTY 3950 MCMAHON ANCHORAGE AK 99516 SELLER- SA~ME JACK LAVERTY 3950 MCMAIION ANCHORAGE AK 99516 10/15/87 70251 LEGAL:MCMAHON SUBDIVISION BLOCK 2 LOT 9 FLOW R~EST ON ~WELL WELL FLOW DATE-10/05/87 A FLOW ~EST WAS PERFORI~ED ON THE WELL. 625 GALLONS OF WATER WAS PUMPED AT A RATE OF 6.25 GPM OVER A DURATION OF 1.6 HOURS. THE DRAWl)OWN WAS 9.4 ' WITH A RECOVERY TIME OF 30 MINUTES AND THE STATIC WATER LEVEL WAS 181.6 FEET. THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME. ,-'~'--203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 CONSULTING ENGINEER RESIDENTIAL WELL INSPECTION LEGAL: LOCATION: OWNER: TYPE OF WELL: WELL LOG AVAILABLE: LOT 9, BLOCK 2~ McMAHON 3950 McMAHON AVE. JACK LAVERTY SINGLE FAMILY YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 10 GALLONS PER MINUTE PUMP YIELD: 6.25 GALLONS PER MINUTE DATE OF INSPECTION: OCTOBER 5, 1987 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6.25 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED. STATIC WATER LEVEL WAS FOUND AT 181.6 FEET BELOW TOP OF CASING. AFTER 100 ~MINUTES OF PUMPING WATER LEVEL WAS AT 191 FEET. WELL RECOVERED 100% IN 30 MINUTES. A TOTAL OF 625 GALLONS OF WATER WAS WITHDRAWN.. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA AND TOTAL NITRATES ON OCTOBER 1, 1987. E.COLLI 0, TOTAL NITRATES 1.7 TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE ~UNICIPALITY OF ANCHORAGE. THIS WELL WILL PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR MORE THAN FOUR HOURS The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer 'feeding the well. #1: Time Date Insp f--~UNICIPALITY OF ANCHORAGE,~-~ · 'DEPARTMEN~ 9F HEALTH AND ENVIRONMENTA .'PROTECTION ~825 L Street, Anchoraa~. Alaska 99501 10:00 a.m. ~2: Time #3: Time 11-4-77 Friday Date Date Buchholz Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES (call when ready, will handcarry) Lending Institution Request: Alaska National Bank of the North Mailing Address: 3301 C Street, Calais II Phone: 2. Property owner: Robert B. Griggs Mailing Address: Star Route A Box 1558N 99507 Phone: 344-2219 3. Legal Description: Lot 9 Block 2 Mc Mahon Subdivision 4: Single Family Residence: (x~ Multiple Family Residence: ( ) Number of Bedrooms: Number of Bedrooms: Four Se Well System: Individual well (x) Community/Public System ( ) Permit ~ 27~.~ Depth of Well Well Log on File ( Construction Bacterial Analysis Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # ~~ Installed 1977 Installer Septic Tank Size /~dD Manufacturer ~ , Absorption Area Soils Rate Material ~ e Distances: Well to Septic Tank to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area P~e ~wo Department of Health and Environmental Protection Request for Approval of Ind±vidual Sewer and Water Facilit±es Legal Description: Lot 9 Block 2 Mc Mahon Subdivision Comments: Affadavit Attached: (') Letter Attached: ( ) Approved: ~~~//~ Date: Disapproved: - - - ~/~ Date: Department Worksheet: !, ~O;OO ' /-'""MUNICIPALITY OF ANCHORAG[' ~ ,'~',',''.' ". ~ .~. Department Of Health and Environmental Pro'tebti~0n ', *'/~'~,' 825 L Street, An chorawe, Alaska. 9~501 'o "~/ ' ' 1. P=ope=ty Owner: ~~ Mailin9 Address: ~ ~x~g--~ ~g/~ Phone: o 5o Name of Buyer: Mailing Address: Lending Institution: Mailing Address: Realtor/Agent: Mailing Address: Legal Description: Street Location: Phone: Single Family Residence: Multiple Family Residence: (~ Number of Bedrooms: ( ) Number of Bedrooms: Water Supply: *Individual Well If Individual Well, well depth (~Public/Community System If Community System, name of system ( ) 8 o Sewage Disposal System: *~n-site System (/Public System ( ) If On-site System, date of installation: ~d~/K/~~/~ //~ *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is ever twe(2) years eld, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77