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Home My WebLink AboutMCMAHON BLK 2 LT 15 Apr 2 ' 2102:11 P A'.nchU''HC9VVell & Pump Ser 9072430742 P.1 MUNICIPALITYH Development Services Department Ik(�- � � Phone: 907-343-7904 Cin -Site Water ,& Wastewater Section ' Fax: 907-343-7997 Well Drilling Permit Number: Parcel Identification Number. 0l %- dYI--) (0 Legal Description Slosh iot�t MCMajiv,�-) ' P-52 Ll Pitmp Installation Hate: Pump Intake Depth Below Tap of Well Casi-tig.�feet Punip -M;tnufacturer's Narne: tffc.'GA G �-� Pump M adel: W Pomp Site: 1�_ hp_�_______.__ Pitless Adapter Burial Depth: � � � feet Pitless Adapter It-lanufacturer's Name:`�`-- Pitless .adapter Installer: Well Disinfectrd Upon > ompig�tton? Cir''�'es 11 No Method ofDisinfectiort: Comments: Pomp installer Name: ANCHORAGE WELL Sc PUMP SERVICE 7640 KII?g, Stl-eet Company: Anchorage, PK 99513 PH. (907) 243-0740 M1 ailing Address: City: State: zip: Date of issue: - Owner Nance & address: Attention: The pomp installer shall prtw de a pomp i ;stallat or la1.0 On-si+x within 30 clays of pomp installation. 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: '~[..,~ ¢J'~-O"~2'~-- [ PID Number: ~ I "~O~--~ ~: %Upgrade l~ ~. 4 ~~L~ ~.~~ WastewaterSystem: ~ New Address: ~t ~~ ~~ ~. q~ / ABSORPTION FIELD Phone: No. of Bedrooms: ~ eepTrench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION SoilRating: ~-~ GPD/Sq. Ft. Total Depth from original g~a~e~ Lot: [~ Block: ~ ~Subdivisi°n:~ ~.Depth to pipe bottom from originel~¢]grade: Ft. Gravel depth beneath p~pe ~ ~ Ft. Township: Range: ~ Section: Fill added above original gra~ I Gravel length: ~t. WELL: ~LSTl~W B Upgrade Gravel~l~ . ~/ Number of lines: Bislancebelweenlines: Classification (Private, A,B,C):~¢¢ [ ~ TotalDepth: Ft. CasedTo: Ft. Total absorption are~ SQ. Ft. Driller: Date Drilled: Static Waler Level: Date Yield: Pump Set at: Casing Height Above Ground; SEPARATION DISTANCES ~Septi~ ~ Ho~di,g U S.T.E.P. TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons; Fro~ Tank Field Station Tank S .... Lines ~~~ ~¢~ Well t [%1 [~1 ~ ~ ~ I~ Materia[~ ~ ........ Number oft Compartments: SurfaCewater I~ I~'~ ~ ~ ~ LIFT STATION LineL°t ~1 ]~l ~ ~ ~ Size in gallons: Manufacturer: ~ "Pump on' level at:~ at: High water alarm at: Foundation 1'~' bDI ~ ~ Cu~ainDrain ~ ~ ~ ~ Pump~Mode] Electrical~nspectionspeMormedby: Remarks: ~ ~ ~ ~~ BENCH MARK Location and Description: ' :. ENGI~AL S & S ENGINEERING Inspections performed u ...... ~..nc. Dates: l st Y~gle KIvor, ~ Department of Health and Human Services approval Reviewed and approved by: ~~ Date: / ~.~ .....~..:,~ 72-013 (1/01)MOA 25 Per~t No. ~1 ~ '?~ ~-~'~-! Page ~ of ~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: 72-013 A (2/91} MOA 25 SHAFER / PAGE 1 OF 1 NICI A ITY OF A C ORA E DEPARTMENT OF HEALTH AND HUMAN SERVICES~,/, ANCHORAGE, ALASKA 99519-6650 / ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERI~I'T- '---- ------- PERMIT NUMBER:SW920321 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:TIDEMAN PHIL P & DEBBIE A OWNER ADDRESS:3851 FURROW CREEK RD ANCHORAGE, AK 99516 DATE ISSUED: 9/30/92 EXPIRATION DATE: 9/30/93 PARCEL ID:01704116 LEGAL DESCRIPTION: MCMAHON BLK 2 LT 15 LOT SIZE: 32614 (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 (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ISSUED BY: DATE: DATE: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST S~TE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER OISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E ROGER SHAFER, P.E. September 17, 1992 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: McMahon Subdivision, Block 2, Lot 15 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 the neighboring properties by the installation of the proposed upgrade. If you have any questions or require additional information for your review, please contact us. Sincerely, Roger J. . . RJS/JPW/lsu 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 /"= 40' SCALE UPGRADE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED;.__ LEGAL DESCRIPTION://~e/V~A/fO/~ --~/~)//~r/g,/~ 2, Township, Range, Section: SLOPE SITE PLAN I0 WAS GROUND WATER ENCOUNTERED? 11 12 13 14 15 16 17 18 19 2O ~.O,N, IF YES, AT WHAT ~ O DEPTH? P EI Deptl~ Io Water Monitoring? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE '~"~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ FT COMMENTS PERFORMED BY: S & S ENGINEERING ~ ~4-~ CERTIFY THAT THIS TEST WAS PERFORMED IN AOOORDA, CE WiT H Ai~f~/~eD~¢&[~O~.~ii~D~E~ON'E{ j0~ EFFECT ON T~HiS DATE. DATE: 72-008 (Rev. 4/85) o,~,,.-.o-. ~ GR?~ER ANCHORAGE AREA BOROU-~'H D~... ~RTMENT OF ENVIRONMENTAL QUALI, 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION MAILING ADDRESS '-"¢-'~.~. r LEGAL DESCRIPTION SEPTIC TANK: / NUMBER OF LIQUID CAPACITY /'/~'~" GALLONS. INSIDE LENGTH ~ INSIDE WIDTH ~ / LIQUID DEPTH__~._ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PItS ,/ OUTSIDE DIAMETER LINING MATERIAL/~'~' NEAREST LOT LINE / .OR WIDTH /,~,~), LENGTH /~' , DEPTH (/~'~J~', . DISTANCE FROM WELL.~ /~ BUILDING FOUNDATION TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELl ~UA'flOiq-~--._ , NEAREST LOT LINE NUMBER OF LINES ///~D STANCE BETWEEN LINES ~ TRENCHWIDIH A BS~ SQ. FT. LENGTH OF EACHLINE~ ~ ~ DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH , OF LINES IN. TO~ EFFECTIVE IN. ABOVE TILE ,/,~/~',.-~ "~F ~/. ~,//-~, ~ ' DISTANCE FROM WATER WELL: TYPE,.~/,~--~ , DEPTH / , BUILDING FOUNDATION. ~ SAMPLE / NEAREST / SEPTIC SEEPAGE ~ LOT LINE , SEWER LINE , TANK / , SYSTEM_ , CESSPOOL NEAREST OTHER SOURCES DISTANCES: /j~.ST~, ~,~, ' DIAGRAM OF SYSTEM G.A.A.B. DATE ~'///~/--~)/~'~' APPROVED GREA~ER ANCHORAGE AREA BOF,~UGH 2223 DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAME OF APPLICANT PHONE~ LEgal DESCRIPTION ~:~ /~: ~: Z- ~ INSTALLATION OF: SEPTIC TANK ~EEPAGE PIT. _, DRAIN FIELD , OTHER TYPE aND SIZE OF FaCilitY TO Be SERVED ~, ¢~ ~,~ .~/~'~z- ~//~ ~-~ FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS ~/A/~,/~/~ :~:d~ ~/~~'~ NOTE~ THIS PERMIT IS NOT VAMD W~THOUT SO~L ~ / co~[~o. D~ ~Cm~D ~ FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE /~--~) ~/~/ TYPE '~ ~)~'J SEEPAGE AREA SIZE ~//~//b//~j~///~E ~ ~)~ FOUNDATION TO SEPTIC TANK SEPTIC TANK TO SEEPagE PiT WALL SEPTIC TANK SEEPAGE PIT TO NEAREST LOT LINe. WELL TO SEPTIC TANK WATER MAIN TO SEPTIC TANK SEPTIC TANK, -~,~w'/ , SEEPAGE PIT / ~)~x..)., DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. seEPAGE PIT TO RIVER, LAKE, STREAM, CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OP EXCAVATION 5 PeET INTO UNDISTURBED SOIL. 4 INCH DIAMETEr CAST iRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. or LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE rEQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 25.58 AND THAT THE ABOVE DESCRIBED SYSTEM ISIN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE 2 3 6 7 ,.-~9 lO EATER ANCHDRAGE AREA BOROL ' DEPARTMENT OF ENVIRONMENTAL QUALITY CASE 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 Performed For ~ ~ ~¢VV\~V~ Date Performed Leoal Descriotion: Lot I~-~Block~ Subdivision This Form Reoorts Soils Log ~ Percolation Test Depth Feet Soil Characteristics Was Ground Water Encounter~r.~e~4~?~ · If Yes. At what Depth Readin~ Date Gross Time Net ime Depth to H20 Net Drop Percolation Rate Hinute Proposed Inst~!latio~-: See~ame Pit ~ Drain Field /"~" De~th of Inlet Deoth To Bottom Of Pit Or Trench cnM?ENTS: ~) _..~:~ ~k~/~'~v~- ~. ~r- ~ Test Performed By Data Certified By: ~Da te: ~/~,~/~ NAME OF APPLICANT GRE', ,ER ANCHORAGE AREA IBO,~ UGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT ~, i'), .~'~r,,~ o~o.5MA,'..,NG ADDRESS~'a R-~ INSTALLATION Of: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS /i~ COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BA~ DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORII PHONE ,NST^LLAT,ON LOCAT,ON /--~''," ~t'"(-'d 0 ~e. P b SEEPAGE PIT / ~ , DRAIN FIELD ~ OTHER O~l~%~.T~/s PERMIT IS NOT VALID WITHOUT SOIL TEST ~ANY SYSTEM WITHOUT FINAL INSPECTION BY THE WILL }3E SIJ~3JECT TO PROSECUTION. SEPT,C / iU ! MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE P~T WALL AREA WELLTO SEPTIDTANK 'e,~:~/.C~/-"(?SEEPAGE PiT WATER MAIN TO SEPTIC TANK DRAIN FIELD , SEEPAGE PIT SEPTIC TANK, ,, SEEPAGE PIT TO RIVER, LAKE, STREAM. , DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. LICENSED DESIGNER 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 ~:CCORDANCE WITH SAID CODE. EQ-016(3-75) 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 Lot 15; Block 2; Mc Mahon Subdivision Location (site address or directions) 3851 Furrow Crz~k Road Property owner Mailing address Philip Tid~man Day phone 345-7777 3851 Furrow Cr~zk Road Anchorage, Alaska 99516 Lending agency Mailing address Agent Address Cit~ Mort~ag~ Anchorag~ Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well XX Community well NOTE: Public water If community well system, provide, written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: XX Public sewer If community wastewater system, provide written confirmation from State AD£C attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #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. Phone Name of Firm_ 17034 Ea,qle River Loop Road No, 204 Address -- - Engineer's signature DHHS SIGNATURE __ _ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments ~-c o-~,,_,.,_..-- /;:~ ~{-~ Date By: 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. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: //~ ~/¢~/4rl/,j ~/~ ? ~:).7/~ / ~_,~-Y'2_ Parcel i.D. ~ ("~-- ~ L~£-- [ Co A. WELL DAT~.,2 Well type Log present (Y/¢ Total depth Sanitary seal If A, B, or C, attach ADEC letter. ADEC water system number Date completed 1 ~, '7~- '~ Driller Cased to ZFO '~- Casing height Wires properly prOtected (~¢YN) Y'~'-~ FROM WELL LOG Date of test (J{./'V/'4tJPr-I, c Static water level / Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I I~. I Absorption field on lot / E~ Public sewer main Sewer service line g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: /(~ --//'"/--~ ~- Collected by: Other bacteria _(~ .. SEPT.C/.OL.,. , / Date nstalled¢,/2-o/~3--/ IO/~,]'~'b manksize //~ /~od~cCompartments / / I Cleanouts ~N)' ~ ~A. Foundation cleanout~N) ~./ ~,,~, ~Depression (Y/~ ~ High water alarm (Y/~ ~o ~ ~/~ Alarm tested (Y/~ //~ Date of pumping ~ 0 - J~ -~ % Pumper ~ S ~ S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: , Well(s) on lot / I ~- ' On adjacent lots l~0 Foundation To propertyline ~,~ ¢ AbSorption field .~..~ Water main/service lin Surface water/drainage /00 ¢- / : CONTINUED ON BACK PAGE 72-026 (Rev. 7/91) Front C. LIFT STATION Date installed ~t~' 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 /(~/~/~ '~ Soil rating Length '~'~ r Width Total absorption area Depression over field (Y/~ ¢'~ Results (pass/fail) ~%) ~-acJ Peroxide treatment (past 12 months) (Y/¢ Gravel thickness Cleanouts present (~:v'N) Date of adequacy test for z~ System type '~--4~f~ ~-~-/~6[¢_ Total depth //I If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot /~ t On adjacent lots /0{3 ~' bedrooms Property line To building foundation ~(~ To existing or abandoned system on lot On adjacent lots ~ ¢ ¢ Cutbank /'J/~ Water main/service line Surface water ,/0(~ ¢' Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect Signature S & $ ENGINEERING 17034 Eagle River Loop Road No. :Z04 r-'r,~l~ r,'ive~-: Alask~ 9957'/ Engineer's Name Date ct o_nJh, e date of this inspection. HAA Fee $ Date of P.yment 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99516 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS fez INVOICE % 59~d~- Chemlab Ref.~ 92.5619 Sample # 3 Matrix: WATER Client Sample ID : DRINKING WATER L15 B2 MCFAHON S/D PWSID : UA Collected : OCT $ 92 ~ 17:30 h~s. Received : OCT 9 92 @ 13:10 hrs. Preserved with : AS REQUIRED Client Name :S & S ENGINEERING Client Acct :SNSENDP BPO# : Req$ : Ordered By :R. SH~FER PO# :NONE RECEIVED Analysis Completed : OCT 12 92 Laboratory Supervf.sot .L..~-~I~N C. Released Ey: Send Reports to: 1)3 & S ENGINEERING Parameter Results Units Method tllowable Limits NITRATE-N 3.8 ~/1 EPA 353.2/300.0 10 Sample ROUTINE SAMPLE COLLECTED BY: Remarks: I Tests Performed ' See Special Instructions Above UA-Unavailable ND- None Detected "See Sample Remarks Above NA- Not Analyzed LT~Less ~han, CT-Greater Than ~SGS Member of the SGS Group (SociOtO G~n~rale de Surveillance) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) (b) Location (address or directions) Property owner ~.~.4~/¢- (~l'lv~'~¢ ~ Telephone: (home) Mailing Address ~/~ F~~ ~, ~ Business (c) Lending Institution 'Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here~if hold for pick up.) List contact person and day phone number below: TYPE OF RESIDENCE Single-Family~l~ Number of bedrooms WATER SUPPLY Individual Well Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site~ Public [] Community [] Holding Tank [] Note:I 'if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72~25 (Rev. 7/88) Page 1 of 2 5, ENGINEFRING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ,~scertified by myseala~fixed hereto and as of the validation date shown below, Iverifythat my investigation of this Health Authority Approval shows tllat 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 ~"~ ~ ~ 10~ Date Approved for ~// bedrooms by _ . ~ Date Approved ~ Disapproved Conditional Terms of Conditional Approval __ The MunicipalityofAnchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph5abovebyanindependent 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 DHHSdo 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. 72-025 (Rev. 7/88) Back Page 2 of 2 M~PAL MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 ITY OF ANCHORAGE 343-4744 ENVIRONMENTAL SERVICES DIVISION Legal Description: SEP 2 i 1988 RF VED If A, B, C, D.E.C. Approved (Y/N) __ Yield 5~ prr~ A. WELL DATA Well Classification Well Log Present (Y/N) ix,[ Date Completed 1 c~ Total Depth ~,~'~ Cased to ~ Depth of Grouting Static Water Level I ~7 Pump Set At' '~0'7/?/~ ~'/ Casing Height Above Ground / cf '~ Electrical Wiring in Conduit (Y/N) y SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot I To Neakest Edge of Absorption Field on LOt To Nearest Public sewer Line J~f,~ ' To Nearest Sewer Service Line on Lot Water Sa.rnple Collected by '~. ~ Water Sample Test Results ~¢-- ~'-~¢ Comments Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) tx~ ; On Adjoining Lots t,~ ,~ ; On Adjoining To Nearest Publi'c Sewer Cleanout/Manhole ; Date B. SEPTIC/I~I~I;;~I~G TANK DATA Date Installed ~/'~'~' Size Standpipes (Y/N) ~f~/~" Air-tight Caps (Y/N) Depression over Tank (Y/N) N Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) 1~/~/,,~ No. of Compartments y Foundation Cleano, ut (Y/N) Date Last Pumped ~f/' 7/'~ ~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well I O~ To Property Line .50 To Water Main/Service Line .~/¢.~ To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ._ Date Installed CP-.I~ Width of Field Square Feet of Absortion Area z/'_¢cP ./. ,4/gO Depression over Field (Y/N) ___ /~ Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot IX/c, -¢,~ To Water Main/Service Line ItS0 Type of System Design 1776 Depth of Field · Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test Length of Field ! To Property Line To Existing or Abandoned System on ; On Adjoining Lots ,~' To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA gui_d~lines in effect on the date of this inspection. .' :'>.' (~F ¢~';'"'-~',~, Signed .- .- ~ .... ::- Company Date MOA No. Receipt No. '-~'-~2~' Date of Payment Amount: $ /~. 0~) 72-026 (Rev. 7~88) Back ),,it' ,~, ~:,;. Receipt No. ' "' Engineer's Seal Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICA'~E OF INSPECTION FoR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) , (b) AppliCant Namet'~,~J~_ ~,t ~,~O_~_1_~, Telephone: Home Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/bei~der~l~; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address /'//(2 ,~¢ ~&T~¢ (e) Real Estate Company and Agent Address (f) Telephone Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Family~ Multi-Family~r~ Other Number of Bedrooms ~4~ WATER SUPPLY Individual Well~, Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite"~ Public [] Community [] Holding Tank [] Note:!lf community 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) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF AN~LiST . FEBRUARY 1984 DEPT. OF HEALTH & 264-4720 ENVIRONMENTAL P,~OTECTIoN MAY 2 8 1986 Well Classification Well Log Present (Y/N) Total Depth ,,~-~ Cased to Static Water Level / ~ (~ Casing Height Above Ground / Y Electrical Wiring in Conduit (Y/N) Y Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line J~OI,4~ Cleanout/Manhole t~1.O 1~[~' Water Sample Collected by '~- ~', Water Sample Test Results Comments Legal Description: RECEI_V_ED ~ Ii A, B, C, D.E.C. Approved (Y/N) Date Completed J ~il'/~,,~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~ ~ ; On Adjoining Lots j ~._,.,.~ 4' ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date ~"'/~ ~ l $ & lOO4t lOo~' SEPTIC/HOLDING TANK DATA Date Installed ]~,~rl,~- J4~'"l~-size JOOO ~' No. of Compadments ¢ ~ Standpipes (Y/N) ~ Air-tight Caps (Y/N) ~ Foundation Cle~o~t (V/~) Depression over Tank (Y/N) ~ Date Last Pumped / ~/~ ~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-W, ater Alarm .(Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well [~ J To Property Line ~ To Water Main/Service Line ~/A ;for ~/'A Temporary Holding Tank Permit (Y/N) Course To Building Foundation ~.1~ To Disposal Field ~0 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 ~ Width of Field 1 50 Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments 1 7 ype of System Design 7'~'~&t4;~ Length of Field ¢/'(,0 Depth of Field __ J O ! Gravel Bed Thickness -' ~ ! '0 Standpipes Present (Y/N) Date of Last Adequacy Test To Properly Line ,~(::~ To Existing or Abandoned System on ; On Adjoining Lots '~'~) '1~ To Cutbank (if present) ~'",~O ~ ~" D. LIFT STATION 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, v,,erifj,6¢"¢, or conformed to ail MOA and HAA guidelines in effect on the date of this inspection. Signed .a,e /' Company MOA No. Receipt No. ~,~ ~ ~' ~ '7 ~ Date of Payment ",~' (:;~0¢~ '~:~ ,~ Amount: $ ~::¢,,S~', ¢ O Engineer's Seal Page 2 of 2 72-026 (11/84) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST (ENGINEER'S SEAL) DATE PEhFORiv1ED; ,, Township, Range, Section: SLOPE WAS GROUND WATER N ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Net Time Depth to Net Water Drop 5 9 10 11 12 13 14 15 16 19 Deplh to Water After Monitoring? ~-- Date: ~j~:q~ Gross Reading Date Time 20- PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN FT AND __FT ~ OOMME.TS 'l::) . m ., ,. AOCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFE(T ON THIS DATE. DATE:~~ ~ ~,/~ 72~008 (Rev. 4/85) '- L 07' 7 " 'I I'IO, O? $ 85" 17~2I''r .... · ~ ' ~ ~o' ur/urn; ~r,.-... ~P tlc ~o~. ~o ~ ~ / · ~ ~%, ' ~. ~ ~.,:;;~'/.~ , I i~ I I ~ ~ ~ 8~° 40'//'~ ~.~ AS BUILT 30USY F Btf~N[:~ 5 ~SOClAT~ M.S. 1~41 BARTLLII DRIVE SCALE/,~ 40' zol~ll~ ~_~ &*ICIIO~E, AL~KA 99501 ~~k_ J IfEREBV CE~IFY TIlE FOLL~'ITflO P~CRIBEP ~OPERTVc LOT 1~ BLOCK ~ ~~~~ ~~..~~J..' ~- IT IS,TIlE RES~NSIDILITF OF THE ~UER OR BUILDER, ~lOg TO COIISTRU~IOtl, TO VERIFF "~~~~.~ ~O~SEP BUILUIHO G~DE RELATIVE TO F,,,S,,~ O~DE A~ ,glillY CONNE~,O,,, A,W TO qWC~.".q .~ 0"~ APl'gAR O~ Tf{~ R~CORPgP {I~PIVIgION PLAT. qj~ ",....,' ~ ~ LI~gIL'ITV 19 LHIITEO TO TI{~ ~lOll}H' OF COIII'EHSATIOtl -~~- COPV OF ORIOI~AL {~V CAUSE UISTORTIOII~ LI{T~ ~i~TA~C~ PREVAI~ OVeR SCALI~. CONSULTING ENGINEER '~--~'. 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279.3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL LOT 15, BLOCK 2, MCMAHON LOCATION: 3815 FURROW CREEK ROAD OWNER: RESIDENCE: CLYLE SIMONS SINGLE FAMILY, FOUR BEDROOMS WATER SYSTEM: · ..,,~'c..- ,~' .."_,,/'- · ~ . ~'~ DATE ~ ?~T: ON SITE WELL FROM MUNICIPAL RECORDS AND CHUCK FARRELL: TANK: POURED CONCRETE ABSORPTION SYSTEM: ABSORPTION AREA: SOIL RATING: INSTALLATION DATE: 1176 GAL. ONE COMP. LOG CRIB, TRENCH 448 CRIB, 480 TRENCH 150 JUNE 1972 CRIB, 1976 TRENCH MAY 20, 1986. ANCHORAGE CESSPOOL PUMPING MAY 19, 1986 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH 3.5 FEET OF COVER AND A LIQUID DEPTH OF 59 INCHES. CRIB WAS TEN FEET DEEP WITH 82 INCHES OF LIQUID. TRENCH DOES NOT HAVE ANY MONITORING TUBES. WATER WAS ADDED TO THE CRIB AT A STAEDY RATE OF 5 GALLONS PER MINUTE. THE WATER LEVELS IN THE TANK AND CRIB WERE MONITORED.THE WATER IN THE CRIB ROSE TWO INCHES PER 60 GALLONS. THE WATER LEVEL IN THE TANK ROSE .5 INCHES. 300 GALLONS WERE ADDED. THE INFIL- TRATION RATE WAS MONITORED FOR 60 MINUTES. AT THE END OF THIS TIME WATER LEVEL WAS DOWN 4.25 INCHES, SHOWING AN ABSORPTION OF 130 GALLONS IN ONE HOUR. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, §roundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL:' LOCATION: OWNER: TYPE OF WELL: LOT 15, BLOCK 2,~ MCMAHON 3815 FURROW CREEK ROAD CLYLE SIMONS ~ ~ SINGLE FAMILY WELL LOG AVAILABLE: NO INSTALLATION REQUIREMENTS MET: YES PUMP YIELD: 5 GALLONS PER MINUTE DATE OF INSPECTION: MAY 19, 1986 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 5 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND AT 160 FEET BELOW TOP OF CASING. WATERLEVEL STABILIZED AT 171 FEET AT A PUMPING RATE OF 5 GALLONS PER MINUTE. BACTERIA ON TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM MAY 20, 1986. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. 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 _,_%,o ....... ,~.,,~,.~. the conditions of the aquifer feeding the ~,~-~.- A ''r~"~- well.