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Home My WebLink AboutMCMAHON BLK 2 LT 18Name MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES (~/ '70~"/ /? Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCES Address LEGAL DESCRIPTION Lo,/r I Township, Range, ~eclion TANKS [] SEPTIC ~='~)(//<7~'/~ [] HOLDING Capacity in gallons Material NO. of Compadments TYPE OF SYSTEM Manufacturer [] TRENCH [] BED [] W. DRAIN ~OTHER Depth to pipe bottom from original grade · :ill added above original grade Total depth from original grade Gravel depth beneath pipe '~t ~'" FT Gravel length ~ravel widlh ,/.~, ~' ET /~ ET Total absorption area Distance between lines Number of lines Soil rating Pipe material Installer Date Installed /% 7 SEPTIC TANK ABSORPTION WELL FIELD !WELL ; LOT LINE ! ! FOUNDATION /O AS-BUILT DIAGRAM 18how location of well, septic system, property lines, foundation, WELLS '1~ PRIVATE [] OTHER (identiiv) Classilication (A,B,C) Installer Total Depth FT Cased to Date Installed: FT REMARKS: Municipal and State guidelines in effect on this date: Health Department Approval: ~:~L_~ 72-013 (3/85) Scale: Ir Performed by: certify that Ihjs, insp~ction Nas performed according to all ENGINEER':s SEAL : - Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCR,PT,ON: .4~' ~L/<' ~-' l~//~l/~:v¢/ Township, Range, Section: ---/~'~'."-/" .'~'-J .-~'~ h~ 12 13 14- 15- 16- 17- 18- 19 2O SLOPE SITE PLAN COMMENTS WAS GROUND WATER ENCOLJ NTER ED? IF YES, AT WHAT DEPTH? Depth to Water After ~) 4 Monitoring? ,1~ Date:. Gross ' Net Depth to Net Reading Date Time Time Water Drop ~ ' · --..., ~-.~. ---..~ PERCOLATION RATE __ {minutes/inch) PERC HOLE DIAMETER __ TEST RUNBETWEEN __ FTAND FT . f ~ ~"/~b.~ ~ t,-~ ' -~ / ~ · ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: C,.'..T; ~¥.. L~t 17 hereby cerhf~ tho! on occurat~ lur¥~y of following d~ecr~bed property property hn~ on~ do nOt over.lop o~ encrooch i~prov~me~t~ On g~opert~ I~mg adjacent fh~re- ~ ~/~ZA ..................... T~YCK, NY~AN & HAYES. ENGINEERS ~ S~RVEY ORS oJ MUNICIPALITY OF ANCHORAGE DEPARTME.T dP .E^'T. & .UMAN SERV,CES D,V,S,O. OF E.V, RO.~E"~^' SE.V,CES CERT.~,CATE Or ~NSPECT. ON ~OR HEALTH AUTHOR~T~ APP.OVAL OF ON-$1TI= $F:WE~ AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivi;,&ion, section, township, range) Location (address or d,ire~'tions) · ~7 7 ¢'/ ' F-~,, z/z,,J ~, £/z. ' .. p_ ~, . (b) (c) (d) Property Owner '/~)E_7.4... "~-~'O Telephone: Home Mailing Address F~"¢/~ /~_xpP-~-~ C_~/& ~--~. Business Lending Institution ' ' ' "" Mailing 'Address ' ' -' Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the followin(~ address: or; Check here BI, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family~ .£ 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 the legality and status. 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 I of 2 72-025 CRev 8/86~ Front abed '~JOM s,JeeU!bUe leUO!SSejoJd eq] u! suo!ss!uJo 4o sJOJJe Joj elq!SuOdSeJ ~ou s! ebeJoqouv jo ,~h!led!o!un~ eqJ. 'penss! s! e~eo!j!p@o e eJojeq e~ep eZ~leUe 4o suo!hoedsu! honpuoo ~ou op SHHQ jo see/,oldUJ3 'slueuJeJ!nbeJ ehels pue leJepej u!epeo ~¢s!hes oh Jap Jo u! suo!~nh!~su! bu!puel J!eql pue seuJoq jo sJeseqoJnd oh/tsep noo e se s!qh saop SHHQ eqJ_ 'e~Sel¥ jo eiehS eql u! p@Jehs!beJ Jeeu]bue leUO!SSejoJd huapuedepu! ue ,~q e^oqe ~ qdeJeeJed u! ua^ih suo!heluese~deJ eqh uodn ~lUO peseq se~eo!J!peo le^oJddv /qpoqhn¥ qlleeH senss! (SHHQ) s@o!^J@S ueuJnH pue q~leeH to hUeUJpedeQ ebeJOqOU¥ jo ,q!ledio!unlAI eqJ. le^oJddv leuo!I!puoC) jo suJJel leUO!h!puoo peAoJddes!c] ~/~ paAoJddV Well Classification MUNICIPALITY OF ANCHORAGE (MOLl HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y~(~ Date Completed Total Depth ~F~'7~~ Cased to, ~') ~F-O'Y~' Depth of Grouting Static Water Level L~ ~'~'~' ' Pump Set At Casing Height Above Ground Electrical Wiring in C°nduit (~N) Separation Distances from Well: To Septic/Holding Tank on Lot Yield Sanitary Seal on Casing~N) Depression Around Wellhead (Y~ To Nearest Edge of Absorption Field on Lot / To Nearest Public Sewer Line ,~j/;~ ; On Adjoining Lots /~r,-~ ! ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on /~' ~/")/&-'~'~ ; Date 5% 2-' Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments SEPTIC/HOLDING TANK DATA Date Installed / ~' '7 Standpipes~N) Depression over Tank (Y[N~ Size ~.-.~oo ~¢t-f-,~ No. of Compartments / Air-tight Caps(~)N) Foundation Cleanout (Y~) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) i/ Holding Tank High-Water Alarm (Y/N) Separation Distances from septic/Holding Tank: To Water-Supply Well ~¢ To Property Line /O To Water Main/Service Line Course /-.J/~4~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation /0 To Disposal Field /~ '7'~ To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field / Square Feet of Absorption Area Depression over Field (Y~. Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot /8//4 To Water Main/Service Line //2 'F-- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field /~ '~""~"~' Depth of Field /~¢}- Gravel Bed Thickness 7*-~ Standpipes Present~N) Date of Last Adequacy Test To Property Line ~'7-.,¢-//hP/.P¢ To Existing or Abandoned System on ; On Adjoining Lots Z-O To Cutbank (if present) Comments D. LIFT STATION Size in Gallons "Pump On" Level at ~ High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ~ Vent (Y/N) P~equacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that.~ c,~c~e~,, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~---'-~w~/~I Date Company ,/¢F//~ % MOA No, Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11184) MUNICIPALITY OF ANCHO~A _QE ENVIRONMENTAL SERVICES DIVISION JUN 2 ? 1988 REC,EIVi!t) CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order .~ 6913 Date Report Printed: JUN 2 88 @ 12:14 Client Sample ID:L1S, 52, MCMANON PWSID :UA Collected MAY 27 88 @ 12:30 hrs. Received MAY 27 88 ~ 16:45 hrs. Preserved with :NONE Client Name : AECS Client Acct: AKECSRP P.O.~ NONE REC'D geq ~ Ordered By : Analysis Completed :JUN 1 88 Send Reports to: Laboratory Supery%sor,:STEPHEN C. EDE 1)AECS ~elaased Ey: .d~~. ~ 2) Special Instruct: Chemlab Ref 4:1200 Lab Smpl ID: 1 Matrix: Water Allowable Parameter Tested Result/Units Method Limits NITRATE-N 1.2 mR/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: ================================================================== ...... === ....================ .... I Tests Performed ' See Special Instructions Above UA=Unavailable ND= None Detected ** See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT~Greatez Than TELEPHONE~(90~ 502-~ 56~ B St?et Drinking Wat~AnalY~s Repo~ for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D.# '~ PRIVATE WATER SYSTEM\ Name ~ . Phone No., /z.~ ~ $.~ .~, m- $ '.' Mailing Address City I' State !. \ MO. Day Year Zip Code SAMPLE TYPE: ..Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose .) [] Treated Water ~. Untreated Water SAMPLE ,~- NO. LOCATION :" 3 I 4 I Time Collected Collected ~ READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TNTC --- Too Numb~ OB = Other Bacteri TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Ii'at isffi'~tory [] Unsatisfactory [] Sample too long in transit; sample should not be'over 30 hours old at examination to indicate reliable results. Please send hew s~mple via special delivery mail. Date Received Time ReCeived Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. 1 Result* I ~ I ~ I MC1 I I MCI Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count ; ~ IVerification: LTB BGB !Final Membrane F'~e~lts ~ /~./~.~' 0 Reported BY~7~-~_ ..~~'.. _ . Date ,.-~. ,~. _ ?~-~ Coilform/lOOml Coilform/100ml PARr ! OF 2 REMAINDER TO FOLLOW ALASKA e IUIRO[lmenTAL COI1TROL SeRUICeS, IrlC. {~n§in~erin§ ~ {~nuironmenid ~u~ies MUNICIPALI~ OF ANCHO~GE DEPT. OF HEALTH ENVIRONMENTAL Municipality of Anchorage Department of Health & Hmnan Services 825 L Street Anchorage, AK. 99501 Attn: Dan Roth June 27, 1988 JUN 2 8 t988 RECEIVED Re: Lot i8, Block 2, McMahon Subdivision On 6/20/88, a soil test was done and verification of the crib size. Soil is 150 square feet per bedroom. The crib size is 13.5 feet by ]3 feet with 7.5 feet of sewer rock. The side wall area equals 897.5 square feet. Bottom area equals 175.5 square feet for a total of 578 square feet. With 150 soils, this 4 bedroom house needs 600 square feet of area, The crib is only 27 square feet shy of the requirement. An adequacy test was performed on 5/27/88 and results show it to be more than adequate for 4 bedrooms. We request tile you approve the ex~stiug crib for 4 bedrooms. If you have any questions, please call. PE Sincerely, Alan C. Wien Engineering Technician 1200 [Uest 33rd ~uenu¢. Suile B*/~ncl~oroge./~leska 99503e(907) 561-50Z10 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection C. Septic Tank: D. Seepage Pit: E. Disposal Field: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES ~ 1. Approval'requested by: ~~ /~c~. ~//~ ' Mailing Address: /Og) ~- ~ ~-~* Phone: 2. Property Owner: ~~'~~ '~~~ Phone: ~~ ~/~ Mailing Address: 3. Legal Description: ~/~ ~- ~ 4 Location: ~~ ~ /~ ~ ' u ' 5. Type of facility to be inspected ~~, No. of bedrooms 6. Well Data: A. Type ~ B. Depth C. Construction ~~/'~ 6~JvJ~ D. Bacterial Analysis. . / 7.Sewage Disposal System: A. Installed / ~ ? B. Installer ~m~ 1 Size ~,~ ~j~ 2. Manufacturer ~h~/r 1. Absorption Area /~X/~Xz?'*2. Material ~,~/~ Total length of lines Distances: A. Well to: Septic tank //~ / , Absorption area Nearest lot line ~-~0 ~ , Other contamination / B. Foundation to septic tank C. Absorption area to nearest lot line Sewer Lines , Absorption area EQ-034 (1/74) Page 1 of two pages ~-.~-,P~ge 2 of two pages - Req~t for Approval of Individual ~ ~er & Water Facilities ~Legal Description ~---~ ;z~/ ~... ,~'- ,-.~. ~ ~F/'??~/~?/~/~-~/~''~'' . · Comments Date Approved ~ ~/~~ Disapproved ~~J Approval ~Valid for one ~ear from date signed Greater Anchorage Ar6a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify-that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. EQ-034 (1/74) Date 08-1220 (a) Lab. No, DATE , ~ATE OF,~ALASKA DEP, ' . ENT OF EALT AND SOCIAL SF" CES DIVISION OF PUBLIC HEALTH .. BACTEm0LOeCA, WAT£R AHAL S S .. REPORT RESULTS TO NAME ADDRESS ZiP · ,. . .. . - CODE CITY ADDRESS . . ., ~.OF SOURCE ' '; ' ' ~ . - ' ?J~' "-.'"" "- SAMPLE COLLECTED BY ..... : ~ , . r DATE COLLECTED ' ~; :'' -J / TIME COLLECTED ~ ~'--~' Sample Collected From [] Ki[chen Tap [] Bathroom Tap [] Basement Tap [] Other (List) Well [] Dug [] Driven SOURCE: [] Spring [] Cistern DuB Well or Cistern Construction: Walls [] Wood [] Concrete Top -- [] Wood [] Concrete LOCATION: [] In Basement [] In Yard []Other Building Sewer DISTANCE TO: or Other Drainage Pipe Tile Seepage Field Feet. Pit Other Possible Sources of Contamlnation Cast MATERIAL: Building Sewer -- [] Iron [] Wood [] Plastic Joint Material -- Type GENERAL: Does Water Become Muddy or Discolored? [].D~illed [] Bored [] Other ' : Brick or [] Metal [] Tile O Concrete [] Metat [] Open Top O Basement Offset [] Under House - Septic -~ Feet. Tank~~ Feet.. When? Asbestos []Tile []Fibre F~Cam~nt~.' OYes [] No -~, Diameter of Well Deptl~. Well Casing Material Diameter - Depth Length of Water DePth Drop Pipe From Bottom PUMP LOCATION: [] In Well [] ~sement [] in Basement On Top [] Other [] Of Well PURPOSE OF EXAM %IATION: IIInessSuspected? FIYes []No New Source of Supply? [] Yes [] No Repairs to System? [] Yes 06-1220 (b) READ INSTRUCTIONS ON REV'ERSE SIDE -~ BEFORE ' ~; COLLECTING SAMPLE OFFICE Records in this office indicate this WATER SUPPLY to be of: i-]Satisfactory []Questionable [] Unsatisfactory Sanitary Status. Analysis shows this Water SAMPLE to be: ~Satisfactory [] Questionable [] Unsatisfactory. If"' an "Unsatisfactory" or "Questionable" status is indicated above y~u should take immediate action as recommended below· 1. Notify consumers water is polluted. Boilor chemically treat this water as o.utlined in the enclosed leaflet . . "Drink It Pure." Increase chlorination sufficiently to meet recommended residual standards. Determine source of contamination and take action necessary to maintain a safe water supply at all times. Check qhlorination and other mechanical equipment. Make certain it is [unctio~ing properly. If after checking equipment a disinfecting residual is not obta ned, please wire this office for emergency assistance or advisory services. This is a surface water source and subject to pollution by man and animals. An app[oved water supply source should be developed. Improve your []spring -[~dug well Odriven well []drilled well •cistern Relocate vour well to ~ safe location in relationship to your sewage disposal system. ~, [] s~e enclosur~ Samp e too ~.~..~,~, in transit sample should not be over 48 hours old at examin,a~)~ td~b,I;~cate reliable results, please send new sample· . [] 9ot~i~Broken i~';~ansit, please send new sample. 9. Contact your nearest []Local Health Depa~tmentor []Alaska Division of Public Health. sanitation office for bulletins, consultation and SANITARIAN'S REMARKS'~ ~ Feet· In Utility [] Room ~ Signature BACTERIOLOGICAL WATER ANALYSIS RECORD Date Received -- -- ~':/ Time Raceived .... -..{~m ~ab. "O, Lact~se B~dth ' _,, 10cc ?, 10cc 107 10cc lOcc 1.0cc 0.1cc ' 24 ho. rs'~ ~- -' "'~S ho'urs Brilliant Green .... I / ' EMB AGAR -Lactose Broth, 24 hrs.___. - 48 hfs, ' Gram's stare ' ~ (Most p¥obabl~ No. per 100cc.) --Coliform Density --Mr results --Detergent Test ' pm --Reported by , _ · ~/·~. ;~ . Date r ' ~ ." ~ This analysis indicates Cblifo.rm Organisms to be: ~.-Absent / ' Present