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HomeMy WebLinkAboutMCMAHON BLK 2 LT 17McMahon lock 2 17 017-041 -18 /-~ MUNICIPALITY qF ANCHORAGp~ Ha .th and Environmental Prot~ lion Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION ~'C¢,.(f-'~(,~.) ("~'¢'L'¢~(~-i( LEGAL DESCRI T O __ SEPTIC TANK: (~Lig(z~l~/Cl-O ~ / /~FC), DISTANCE NUMBER OF FROM WELL /, ~O ~ MANUFACTURER ~Y~.E.~' MATERIAL ~,~ L COMPARTMENTS J INSIgE LENGTH ~J ~ INSIDE WIDTH ~J ~ LIQUID DEPTH ~IC)~ LIQUID CAPACITY q~GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL l~O ~FOUNDATION.(¢~' ~ ii # o£ T,ines (7_)¢0¢~ DISTANCE BETWEEN LINES ABSORPTION AREA ~ ~ NEAREST LOT LINE_ ~ ~S~ t TOTAL LENGTH OF LINE 33 '¢IE.¢-~- b'~L(~ TRENCH WIDTH~ IN. TOTAL EFFECTIVE FT. LENGTH OF EACH LINE ~'~ ~ '-~e ~- W DEPT, OF =,LTER MATERIAL BENEATH TILE ~:' IN. ABOVE TILE ~ IN, SEEPAGE PIT: DIAMETER -- OR WIDTH ,, ILENGTH Log Crib Rings BUILDING FOUNDATION__ ,, DEPTH Crib Size: DIAMETER_ NEAREST LOT LINE ~)EPTH DISTANCE F ROIv~: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. Well Class:~, Depth: iJ Well Distance To: Lot Line lO'~t Bldg: ~¢¢ Sewer Line: i¢©~iI Pipe Materials: ¢,% CL~ylO ; # of Bedrooms: ~ '' Installer: ~6uoio~ Remarks: , ' I I Ft F' F' L ]: C I:::1 I",I T t.... O E: I:::1T ]; O ?':! L EEi t::i L. I"1¢::1::.:: ;1: ."i _ l'"l '.. htE J::..:F' O1:::' t31i.~Z:,F.:(%3I"1'.".':'; =:: .-~ ~ ::ii;O .'[ L.. F;:I:::I"!" ]: i'.4G ,:: ':.~;J;:! FT,.-*'EJF.: :: ..... ::L THIE I:;:E::(;:¢J 't: I;;:!EI:) '-":.'; :1; ZE Ed::' 'THE :E;O .1; !... RE',SEq:;i:!::'T~t ¢.')t"4 S'¢STIEf'!~i]: S,.~_~,,g D ~ ....6,,,n,,.,~,_,~,/b II~"::, r'-'"' IF:::" .....E:::.. '"tF' ll.-...IJ == ":::"-- L... }*_::!i~; !]'"4l ,;]._.~ ....~.... ~.....~. ::... .... ~ ~];.~.~. }:~ ,:::::~ ",,," E!E .......... ,~ . 11'"'::~ 1f~5; ":::::" "T' tt...41 = .... 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C FIt",I T MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONIVIENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2224 SOILS LOG- PERCOLATION TEST ~SOI LS LOG [] PERCOLATION TEST PERFORMED FOR: ~"~ ' Y~ ~ ' LEG^LDESOR,PT,ON:~',~/ ×~ .~--.~' ~ DATE .EREO.ME.: SLOPE FI-N-! SITE PLAN 10 11 12 14 15 16 17 18 19 2O b-,5 -/7 COMMENTS ENCOUNTERED? IF YES, AT WHAT DEPTH? PERFORMED BY: ~t[., ii'St Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT CERTIFIED BY: /.U ~ 72-008 (7/76) GRE:'~ER ANCHORAGE AREA BOF~tlGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /,,/~/Z'/~.~t:- ./.~/..~.Q~'/:?/ MAILING ADDRESS ."~:~Y/~"~ J',~"~ PHONE · OCAT,ON LEGAL DE CR,PT,ON SEPTIC TANK: DISTANCE //'/Iu/~¢~/ : ~/ FROM WELL''/)d' !-dZ~/{/~r~UFACTURER NUMBER OF MATERIAL ,~ ~":'~/- '~ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH ..... LIQUID CAPACITY /~/;'(~/~ GALLONS. SEEPAGE PIT: NUMBER OF PITS // DIAMETER /7 / OR WIDTH '-' LENGTH --' DEPTH LINING MATERIAL/'~,~C/Z¢~:///?-~CRIB SIZE: DIAMETER [,~ DEPTH ~ DISTANCE FROM: WELL BUILDING FOUNDATION ~]r- NEAREST LOT LINE ~. TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ADDITIONAL ABSORPTION WELL: TYPE '~/~Y~'~:(U/)~: CONSTRUCTION DEPTH BUILDING NEAREST NEAREST SEPTIC FOUNDATION LOT LINE SEWER LINE TANK ~ CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: INSTALLED BY:/"C/~Zu'~?7,~ 4'.'~/~/ PIPE MATERIAL: LOT SLOPE: REMARKS: '._/'c:<_~- ~_.,.::,- _ - Form No. EQ~O31 DIAGRAM OF SYSTEM /, ._~-.. ~-- -/7 v ]' E ..... ..,, ., ~ / ~ / / DATE /F~'4~/-Z/~7~ APPROVED / G.A.A.B. GREATEr ANChOraGe Area BorouGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 'C" STREET ANCHORAGE, ALASKA 9950:3 TELEPHONE 274-4561 PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT 'EGAL DESORIPTION X~ ~ /~ ~ Z INSTALLATION OF: SEPTIC TANK SEEPAGE PIT , DRAIN FIELD OTHE~ 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. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~/ FOUNDATION TO SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. DIAGRAM O[~ SYSTEM CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIBCROSSING GAP Of ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK seePAGE PIT DRAIN FIELD SEPTIC TANK, · SEEPAGE PIT ., DRAIN FIELD TO RIVER, LAKE. STREAM. EXCAVATION 5 FEET INTO UNDISTURSED 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. 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. DATE APPLICANT'S SIGNATURE ., _ . GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAl QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Performed For ~-~ ¥[01~$~'~ Legal Description: Lot ~ Block ~ This Form Reports Soils Log ~q Case # Depth Feet Percolation Test - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Soil Characteristic~ Was Ground Water Encountered? If Yes, At What Depth? · I I LL_LJ~__I I I l ] Reading Date Gross Time Percolation Rate Proposed Installation: Net Time Depth to H20 Net J ~ M i n I~ 't e Seei~a¢~: Pit Drain Field Depth of Inlet , Depth t;o Bottom of Pit Or Trenc'h' COMF~ENTS: Dro Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DVVELLING 017-041-18 GENERAL INFORMATION Complete legal description COSA# O~:)~ i~ /0.~-'~ ExPiratiOn Date: ,_'~-"- ~ - / / McMAHON , LOT 17, BLOCK 2 Location (site address) 3801 FURROW CREEK ROAD, ANCHORAGE, AK 99516 Current Property owner(s) lAMES & PATRICIA STEGALL Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless othen4/ise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 6 Day phone 3801 FURROW CREEK ROAD, ANCHORAGE, AK 99516 Day phone DERRICK SUFFER w/PRUDENTIAL Day phone 273-7285 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class' Well Public Water System TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [~ [] Individual Holding Tank ]-"] [] Community On-site [] [] Public Sewer E~ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 vedfy 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. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 01/26/2011 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate dUring the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a ~~!~~~"-'-' - system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ..: ;~. ~i'i-...'" "' ." '..:~' encroachments, deficiencies or discrepancies exist. ~~'." DSD SIGNATURE ~~. ~ Approved for ~ bedrooms. Disapproved. ~~ ~.... Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory ~ Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: McMAHON, LOT 17, BLOCK 2 A. WELL DATA Well type PRIVATE IfA, B, or C provide PWSID # Well Log (Y/N) N Date completed 1975 Sani.tary seal (Y/N) ~_ Total depth 170 lt. Cased to 17o ff. FROM WELL LOG Date of test - Static water level - lt. Well production - g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100mL Nitrate Arsenic: ND rng/I Date of sample: 1//1_3/2011 B. SEPTIC/HOLDING TANK DATA __ mg/L Parcel ID: 017-041-18 Wires properly protected (Y/N) Y_ Casing height (above ground) 24 in. AT INSPECTION 1/19/2011 126 lt. 4.3 g.p.m. Tank Type/Material Septic/Steel Number of Compartments 1 + 1 High water alarm (Y/N) N Date of pumping 1/18/11 Pumper C. ABSORPTION FIELD DATA Date installed 1975 / 1978 Soil rating (g.p.d./ff2 or lt2/bdrm) 125 Length 17/33 lt. Width17/3 Eft. absorption area 320 / 396 fi2 Date of adequacy test 1/19/2011 Fluid depth in absorption field before test Elapsed Time: 1260 min. Final fluid depth Collected by: ArcTerra Date installed 1975 / 1978 Tank size 1000/750 gal. __ Cleanouts (Y/N) X Foundation cleanout (Y/N) X Depression over tank (Y/N) Northland System type C_zJb / Treach _ lt. Gravel below pipe 6 / 5.83' lt. Total depth 10.1 [ 9.3 ff. (Measured 1/19/11) Monitoring tube Y Depression over field N__ Results (Pass/Fail) Pass For 6 bedrooms 47/0 in, Wateradded ~30/800 gal. Newdepth 65/17.5 50 / 0 in. Absorption rate >= 900+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N__lf yes, give date --_:- in. LIFT STATION Date installed ~Pump on" level at .. Datum in. E. SEPARATION DISTANCES Size in gallons "Pump off' level at _. Cycles tested Jrl. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot lo0'+ Absorption field on lot ;tOO'+ Public sewer main ~3'+ Sewer/septic service line 25% Animal containment areas $0'+ Manhole/ACcess (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots ;tOO'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank ;too'+ Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation $% Property line 5% Absorption field Surface water 100'+ Water main 10'+ Driveway, parking/vehicle storage Wells on adjacent lots 100% Water main lO'+ Water service line 10'+ Wells on adjacent lots lOO'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation lO'+ Water Service line lO'+ Surface water ;too'+ Curtain drain 50'+ (None Known) COMMENTS lO0'+ 10'+ G. ENGINEER'S CERTIFICATION I c~.rtify t.ha. tl have. determined through field inspections and review or Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Pdnted Name KF. NN"ETH M. DI. rFFUS D ate 0;t'26'2011 COSA Fee $490.00 Waiver Fee $ Date of Payment Receipt Number (Rev. 11/05) Date of Payment Receipt Number Municipality of Anchorage Community Development Department Development Services Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # 111022 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 17 of McMahon subdivision. This inspection revealed a nitrate concentration of 5.71 milligrams per liter (mg/L) was reported for the property's well water sample. 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. 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. Hinchey & Associates Real Estate Appraisers and Consultants AS. BUILT rro~f SGS Ref.# 1110167001 Client Name ArcTerra Engineering and Surveying Printed Date/Time 01/26/2011 12:09 Project Name/# McMahon B2,L 17 Collected Date/Time 01/13/2011 15:00 Client Sample ID McMahon B2,L17 Received Date/Time 01/13/2011 16:20 Matrix Drinkin~ Water Technical Director Stephen C. Ede Saml~le Remarks: 4500NO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements. Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Hardness as CaCO3 199 5.00 mg/L SM202340B C 01/17/11 01/25/11 NRB Waters De~ar tment Total Nitrate/Nitrite-N 5.71 0.100 mg/L SM204500NO3-F B 01/14/11 AYC Microbiolo~ Laborator~ E. Coli Total Coliform Negative 1 100mL SM20 9223B A 01/13/11 DLC Negative 1 100mL SM20 9223B A 01/13/11 DLC Private Individual Analysis Alkalinity 146 10.0 mg/L SM20 2320B D 01/14/11 ACF Aluminum ND 20.0 ug/L EP200.8 C 01/17/11 01/25/11 NRB Antimony ND 1.00 ug/L EP200.8 C (<6) 01/17/11 01/25/11 NRB Arsenic ND 5.00 ug/L EP200.8 C (<10) 01/17/11 01/25/11 NRB Barium 6.06 3.00 ug/L EP200.8 C (<2000) 01/17/11 01/25/11 NRB Cadmium ND 0.500 ug/L EP200.8 C (<5) 01/17/11 01/25/11 NRB Calcium 60600 500 ug/L EP200.8 C 01/17/11 01/25/11 NRB Chloride 22.5 0.100 mg/L EPA 300.0 D (<250) 01/18/11 01/18/11 SDP Chromium 2.96 2.00 ug/L EP200.8 C (<100) 01/17/11 01/25/11 NRB CO3 Alkalinity ND 10.0 mg/L SM20 2320B D 01/14/11 ACF Conductivity 419 1.00 umhos/em SM202510B D 01/14/11 ACF Copper 33.6 1.00 ug/L EP200.8 C (<1300) 01/17/11 01/25/11 NRB Fluoride ND 0.100 mg/L EPA 300.0 D (<2) 01/18/11 01/18/11 SDP HCO3 Alkalinity 146 10.0 mg/L SM20 2320B D 01/14/11 ACF Iron ND 250 ug/L EP200.8 C (<300) 01/17/11 01/25/11 NRB Aarow Pump & Well Service LLC (907)346-9355 Inspection Report Lot 17, Block 2 McMahon Run camera down well to 45'. No perforations or leaks found in casing. Brian R. Wille Aarow Pump & Well Service 4. 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 Health Authofify 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 tiles 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. Address L~'.2.'5 ~ ~ ~ JO~ Engineers PHnted Name ~ ~mu ~ ~ ~ ~ I bedrooms. DSD SIGNATURE ,.~ Approved for .. ~, Disapproved. Conditional approval for Phone bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: (Rev. Odginal Certificate Date: MtmJcipnlity of A~cborage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage,ak.u$ (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type g* Date completed Toteldepth }'7D ff. Parcel ID: O17- O~1- I 12~ IfA, B, or C provide PWSID # ~ Sanitary seal (Y/N) y FROM W~LL LOG Well Log (Y/N) J~:J Wires properly protected (Y/N) y Casing height (above ground) ~ ~ in. AT INSPECTION Dateoftest ~/l~l I~ ?- Static water level ff. J'~ Or ff. Wall production g.p.m. ..~ g.p.m. WATER SAMPLE RESULTS: Coliform .~colonles/100 mi. Amenic: rng./L Date of sample: Other bacteria ..~ colonies/100 mi. Collected by: PUP. ~ B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~ Date installed I Tank size ~ gal. Number of Compartments ~ f [ Cleanoute (y/N) Foundation cieanout (y/l~,) ~ Depression over tank (Y/N) I~ High water alarm (Y/N) Date of pu~ping ~ Pumper ~ C. ABSORPTION FIELD DATA Date installed Ae~.~°&7 ~-, Soilratiog (g.p.d./flJorft2/bclrm) 12~ Systemtype (~It-'l~, CT,4,4'~ Lengm/7~. ~,5'r ft. Width .~l ff. eravel below pipe ~, ft. Total depth 9 ff. Eft. absorption ama '~'1~.~ Monitodog tube y Depression over field I~ Date of adequacy test ~ Results (Pass/Fail) '~ For ~ bedrooms Fluid depth in absorption field before test ~ in. Water added//_/_~gal. New depth ~; ~ in. Elapsed Time: .~-.~. Final fluid depth ~ ~.- in. Absorption rote >= C~4r~ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 11~ If yes, give date v'/ D. LIFT STATION Date installed 'Pump on' level at __ in. Datum E. SEPARATION DISTANCES ize in gallons/ ~Manhole/Access (Y/N) Pump .~le'vel at / High water alarm level at Cycle~estad / Meets alan~ & circuit requirements? ' irt. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot Absorption field on lot Public Se~er main ~ Sewer/septic sewice line On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation I_~ Water main l'4/k Wells on adjacent lots I ~ O '~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ,~- ~ ~ Water Service line ,~..~ T Cudain drain 1'4 / O F. COMMENTS G. ENGINEER'~ CERTIFICATION Property line I O + Absorption field e~.'7 Water sewice line ~ Surface water I'q I 1~' Building foundation .,~ 7... Water main ~4/p, Surfacewatar 1'4 }:.o ~" '" Driveway, paddng/veh C~e storage ~" O '~ Wells on adjacent lots J~-e~ '~ I certifl/that I have determined through field insl~ectlons and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name/ . T,o~Jo.~'H ~)u~'~,<.l,,K~ Date HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number CT&E Enwr nmental Services Inc. "" {" Drinking Water Anab~s~s r~epon mr RE&D INSTRUCTIONS ON ItEV~ItSE SIDE BEt=ORE COLLECTING SAMPI. E 200 W. Po~er Drive [' Anc~or~e, AK 99518.1~5 MUST SE COMPLETED BY WATER SUPPLIER PRIVAT; WATER SYSTEM ABalyU~1 SAMPLE SAMPLE TYPE: ~_ Routine .,~ Treated Water ~ Re~t Sample ~ Un~at~ Water (r~er ~ lab no. ) ~ Sp~iaI Pu~ose L~lon CoIle~ ~= t. ab Ref No. Analyst :. Sent to ADEC: ANC FBI( JUN D Client notified of unsatisfactory results: [] ~,~ ~'~ Member o* ~e 8G~ Gn~p (Sucl6t~ Gb~le ¢~e ~ ~lllt~ Ap~ sad ~oeaulLm'tis 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 GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Day phone Unless otherwise requested, HAA will be held for pickup. NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Public sewer 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. NameofFirm ~l ~*~-~b/0~1 ~q~¢~'~/-.l~ -'~. ~ Phone ~7~-~/~ Address ~ ~ ~ ~ /~ ~"~ ~ ~ ~ ~ EngineeYssignature '~-~-~_ ~.~~ Date G/~/~ ~ DHHS SIGNATURE /~_ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department oi Health and Human SenAces (DHH$) issues Health Authority Approval Certificates based only upon the representations given in paragraph 6 above by an independent professional engineer registered in the State of Alaska. The DHH$ does this as a courtesy to purchasers of homes and their lending institutions in order to ~tis~ certain federal and state requirements. Employe~s of DHH$ 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. 72-02,5(Rev, I/91) Back MOA~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: LI7 B 2 ParcelI.D. 01"2- g) L~ -- A. Well Data Well type Log present (Y/N) Total depth I Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed I ~ 7 ~ Driller Cased to I ~7 D Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ~g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank i=n WATER SAMPLE RESULTS: Coliform ~ Date of sample: ~ ~ / 2_~ / Nitrate c~. ~ Other bacteria Collected by: ~'~ , B. SEPTIC/HOLDING TANK DATA Date installed ~/~7,~.,1'~7~ Tanksize /4~-~ ¢ 7~O Compa~ments Cleanouts (WN) ~/ Foundation cleanout (Y/N) X~ Depression (Y/N) High water ala~ (Y/N) ~ Alarm tested (WN) Date of pumping ~/~ /qq Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot t I _g To property line ~ / Sudace water/drainage On adjacent lots /~o ~ /~-o ~'~ I~ ~ Foundation Absorption field ~ '7 Water main/service line 72-026 (3/93)° Fro~t CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) 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 Soil rating (GPD/Ft2) /~ ~ System type ~'~-,' ~ '/ -~/c/~.¢~ Total depth Date installed I ~'7'c-~F, / ~'?(.~ ~ Wi~h /~ ~ ~ Gravel thickness 7~ '/ Leah Total ab~tion area ~~ Cleanout present (Y/N) ~ Date of adequacy te~ ¢~ ResuEs (pasCfail) ~ Water level in ab~tion field before test ~ ~ T~ ~Y (~; ~ Peroxide treatment (pa~ 12 months) (Y/N) ~ If yes, gbe date Depression over field (Y/N) for ~) Bedrooms Aftertest .~g 7:,~.4,¢--/~., SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / :~ / To building foundation ,~ ~- On adjacent lots ~ ,~ O Sudace water h-./~ ,4 ~ Curtain drain f"tI ~ On adjacent lots ~ / ~ © Property line To existing or abandoned system on lot Cutbank ~ c, ~ ~ Water main/service line 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. Engineer's Na -- ~ ~- ~- HAA Fee $ '~42)¢ Date of Payment ~. Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number CT&E Ref.# Client Sample'lD Matrix ClientName Ordered By ProjectName Project# I?WSID Commercial Testing & Engineering Co. Environmental Laboratory Services ~~~ LABORATORY ANALYSIS REPORT 94.3233-1 MCMAHON LOT17 BLK2 WATER TOBBEN SPURKLAND, P.E. TOBBEN SPURKLAND UA WORK Order 79882 Printed Date 07/05/94 @ 17:35 hrs. Collected Date 06/28/94 ~ 15:20 hrs. ReceivedDate 06/28/94 ~16:00 hrs. TectmicalDirector STEPHEN C. EDE Sample Remarks: ROUTINE SAMPLECOLLECTED BY: BJORN S. QC Parameter Results Qual Units Method Allowable Ext. Anal Limits Date Date Init Nitrate-N 2.8 mg/L EPA 353.2/300.0 10 06/29/94 ClvlR * See Special Lnstru~tions Above ** See Sample Remarks Ab ove U = Undetected, Rep orted value is thepractical quantification limit D = Secondary dilution. UA = Unavailable NA = Not Analyzed LT= Less 3hah GT = Greater ~han 5633 B Street, Anchorage, AK 99518-1600 --Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska' 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. Date Received September 2, 1976 Time of Inspection ~:~ ~/77. Date of Inspection c~_~ ~ l. Approval requested by: National Bank of Alaska Mailing Address: Post Office Box 3-3859 99509 Phone: 2. Property Owner: Torulf Hofseth Phone: 344-3518 Mailing Address: 3. Legal Description: Lot 17 Block 2 Mc Mahon Subdivision 4. Location: ~ Furrow Creek Road ]5. Type of facility to be inspected 6. Well Data: Individual A. Type C. Construction Single Family No. of bedrooms ~_~_~ 7. Sewage Disposal System: B. Depth D. Bacterial Analysis A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: Distances: 1 1. On-site system B. Installer Size Absorption Area Total length of lines 2. Manufacturer , Absorption area , Other contamination 2. Material , Sewer Lines , , Absorption area A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages ~ge 2 of two ~ages~- Req,~.st for Approva% of Individual S ~r & Water Facilities Legal Description Lot 17 Block 2 Mc Mahon Subdivision Comments Approved ~ ~~/~ Disapproved Date ~-~/J~-~ Approval ~Valid for one year from date signed Greater Anchorage Ar~a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I c'ertify 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) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3,3~0 "C" £trcct, Anchorage, Alaska 99503 - 274-4551 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUN[CIPALII'Y OF /dqCHO,U. AGE DEPT. OF HEAl,TH & ENViY, ONMENTAL PROTECTION, SEP 2, 1976 .RECEIVED 1. Type of Inspection: CMRO VA 2. Property Owner: Mailing Address: FHA CONV J Day Phone ,-~',/','/- ~J~7,~'" 3. Name of Buyer: Mailing Address: 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: Day Phone .J Phone Phone 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: No. Bdrms. Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) EQ-037 (1/74)