HomeMy WebLinkAboutMCMAHON BLK 2 LT 21
WATER WELL LOG
FOSS DRILLING ASSOCIATED
909 CHUGACH DR. #37
ANCHORAGE, ALASKA 99503
WELL OWNER Merle Beeter USE OF WELL Dorflestic
WELL LOCATION Lot 21 Block 2 McMahon Subdivision
SIZE OF CASING 6" DEPTH OF HOLE 80 FT. CASED TO 80 FT.
STATIC WATER LEVEL 66 FT. G. P. M. t WITH 12 FT. OF DRAWDOWN,
REMARKS
DATE COMPLETED 11/16/79 PUMP TO BE SET AT 79'
-0to_5 Alluvium; brown color, medium hardness
—5—to300 Alluvium; light brown and soft
30to3-? Alluvium; grey color, medium hardness
3,5 to Till: erey and hard
5,5 to76 Alluvium; grey color, medium harcness
76to78 Sand and gavel; grey with water
78to80 Sand and gravel; brown with water
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MUNICIPALITY OF ANCHORAGE
to DEPT. OI' C t0
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u6-244
M-w DRILLING, Inc.
P.O. Sox 110378 • 10330 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner Dennis Strong Use of Well DO2�STTC
Location (address of: Township, Range, Section, if known; or distance main road
Lot 24 Block 2 McMahon Subdivision
Size of casing 6 Depth of Hole 100 feet Cased to 10 0.1 feet
Static water level 7 ft. ab '► ( low land surface. Finish of well check one o en end ''
Screen ( ) ► Perforated ,( .
Describe screen or perforation_
Well pumping test at_L'i gallops per ;{ OW (minute) for 1 hours with 100111? ft,
of drawdown from static fevel _
ft'd
Date of completion Mnv, 9 `"
WELL LOG
Depth in feet from
ground surface Give dtails of formations penetrated, size of material, color and hardness
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unicipa i y
Dept. Health & HumanServices
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.N,,i,1v1VA Certilleil
Certificate No's. 314 & 973
TO
3 — CONTRACTOR
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
$ ~ '- ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage. Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
IPHONE I..~ NEW
LEGAL
~ Z Manufactur~
Liq. ~a~,t~lons IF HOME.DE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~ ~ ~ Manufacturer Material Liquid capacitv ]n gallons
PERMIT NO.
~ No. oflines/ Lengtgf~,ine TotaJlen~of~ines Tren~wiOth '
7 inches
O~ ~ Top of tile to finish grade ~ ( Material eath tile (~ inches Total effective~b¢orption~O area
Length Width Depth PERMIT NO,
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot Hne PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
PIPE ~AT~IALS
A~ DATE LEGAL
72-013 A 3/78)
FJ',,,'i!iEd",! OF:F: I"'IUI:::'Fi"'IFiN
!..,2::i. i?:",2 !'"1 ": i"l.::]H ":
i'"I :[ ['q :i: HUH i::'-:1: :5'T'!::IIqCE Edii:'TI.,.IE%N !:i i.,.iE!....L FIN[::,
(l.i;ilil;!!i i::'EE"i" F:'OF: I::1 F:'i::~:Z',,,'FI'T'E !.,.!!EL_L. O1:;;'.
!..tl:::'Cd",l TH[ill 'T'"¢F'E (:iF:' PI...!EiLZ(::: 1,.IE:L.[ ....
i.,.i[i!:l...,i..., t...[%ii:!!!; !~I:;;:E Fi:!E[;:!i...!Zi:;i:E[)!::tl",!E:' I"i!...I;~!;T
Oi::: "i"i"l[~: i,.IE:LL..
[3"l?'iE~:¢~: Fi:[ii:(;:¢...l :[ l:,[:l!;i;J"'t[!?,!"i":~!; t'"ff:!"¢ FiI::'F'I..."¢.
i:::t',,,'!::i:[L.l::ili:i',L.[E Ti:) ]:i'4:~!;LII:?.tE PF;:Cd:::'E:i:;:
::i.: ]: !::ff'1 I:::'Fii'd):LZF:!F~: !.,.! :[ 'T['-i 'THE
F:OI:~i:TH Ei',"r' 'THE i"'ILliq:I:E:ZPF!LZi:T"¢
2: :[ !.'.i Z L.L. :!: N:~F!"F:!!..L. THE :i;~;"r':STE:H
'~"CONSTRUCTION TEST L~B <"/ .......
"One Test is worth a Thousand Opinions"
,,22'04 Cleveland Anchorage, Alaska 99503 277-0231
Perfo~ned for ~ .~-- ~~-~~Q% C~ . Date Performed /~-~
Legal Description: Lot ~ 'Block ~. Subdivision ~ ~ ~&_~_~
This Fo~n reports: SOILS TEST ~ PERCOLATION TEST
Depth
Feet
Soil Characteristics
las Ground Water Encountered.
f YES, What depth?
~ading Date I Gross TJ~e Net TLme Depth to H20 Net Drainage
,
I
arcolation Rate Minute
Proposed Installation: SEEPAGE PIT DPt, lIN FIELD
Depth of Inlet Depth to Bottom of Pit or Trench
'h -%0 ..0
-~st Performed by tl'l~ ~a/~ Data Certified By: ~ ~'-~
~' Date: ~.~ -'~
t5 0 30
GRAPHIC SCALE
t" 30'
I
N
Co Co 8.2'x9.9'
W SHE
O
0
S?
O
1)
30' r- 58.0'
LOT 1
17'21 "E 145.07'
HOT TUB
49.6'
r�
i'
z
w 2-sr,
'yQljSe1
_ 7
5'X20' UTILITY f '
EASEMENT (R)
7'
2ND FLOOR
6
CANTILEVER
I
LOT 21
N
27,162 SF
STAIRS ®
LOT20
0.62 ACRES
b,
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N
W
O
O
`oR�NEP:i.:>
V)
LEGEND
O
FOUND REBAR
p
GAS METER C
G
ELECTRIC METER
®
JUNCTION BOX \ \
S86"4011 E
-
B
SEPTIC VENT \
22.60' (R)
®
WELL ��
O
M
(R)
RECORD PER PLAT 65-86
M
MEASURED NOTES
- -
(C) COMPUTED
OF
*� 49TTHH ?* �1
% '... •�•
!j p WERNER MACEDO
NO. 141895
R Sep. 05, 2024 , •' JQ /
ESS I ONAL
\\\\��,
I HEREBY CERTIFY THAT AN ACCURATE
SURVEY OF THE FOLLOWING DESCRIBED
PROPERTY;
LOT 21, BLOCK 2, MCMAHON SUBDIVISION
WAS MADE ON AUGUST 14, 2024
AND THAT THIS PLAT REPRESENTS A
SURVEY MADE BY ME OR UNDER MY
DIRECT SUPERVISION, AND THAT ALL
DIMENSIONAL AND OTHER DETAILS ARE
TRUE AND CORRECT TO THE BEST OF
MY KNOWLEDGE.
1. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN
ON THE RECORDED PLAT, ARE NOT SHOWN HEREON.
AIS DRAWING REPRESENTS A MORTGAGE LOCATION SURVEY PREPARED IN
CORDANCE WITH THE ASPLS MORTGAGE LOCATION SURVEY STANDARDS.
THIS MORTGAGE LOCATION (AS -BUILT) SURVEY IS A REPRESENTATION OF THE
CONDITIONS THAT WERE FOUND AT THE TIME THE LOCATION SURVEY WAS
PERFORMED AND DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT
TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE.
INFORMATION CONTAINED HEREON SHALL NOT BE USED TO ESTABLISH ANY FENCE,
STRUCTURE, OR OTHER IMPROVEMENTS
UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE
PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES
IN PREPARATION OF THIS PRODUCT.
00
engineers LOT 21, BLOCK 2, MCMAHON SUBDIVISION
surveyors AS -BUILT SURVEY
PREPARED FOR:
FLORENCE COSTELLO
ell DRAWN BY: MQ/VS FLO BK.- FRBA24-02
CHECKED BY: WEM
01 W. FIREWEED LN. 1201 JOB NO.: 2024-2819 MOA GRID: SW 2835
ANCHORAGE, AK 99503
(907)274-5257 SCALE: 1" = 30' DATE: 09/OS/2024
CoA No. AECC582
LOT SURVEY CERTIFICATION:
I HEREBY CERTIFY THATI HAVE SURVEYED THE
PROPERTY SHOWN AND DESCRIBED HEREON AND
THAT THE IMPROVEMENTS SITUATED THEREON
ARE WITHIN THE PROPERTY LINES AND NO
ENCROACHMENTS EXIST.
Prepared by: GERALD V. RANDALL, JR. Reg. Land Surveyor
1135 WEST 8TH AVE., SUITE 5
Phone: 279-7414
ANCHORAGE, ALASKA 99503
IT IS THE CONTRACTOR'S RESPONSIBILITY
TO CHECK TOP OF FOUNDATION IN RELA-
TION TO FINISH GRADE AND BUILDING
SET BACKS IN RELATION TO LOT LINES
AND EASEMENTS.
LEGAL DESCRIPTION:
PLOT' fUq-I
i'"/I ~' I"-q ~qorq
L~q'"'~l BLIx. Z
LEGEND:
· 5/8 REBAR RECOVERED
o 5/8 REBAR SETTHIS
SURVEY
~ 2'k2" HUB & TACK SET
[] EXISTING ELEVATIONS
DATUM ASSUMED
SCALE: J : ~ ~.~"0 '
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE'
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmerital Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
: 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
LoT ,.t--I ~1(, '2.
Location (site address or directions)
Property'owner
Mailing address
Day phone
Lending agency
Mailing address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: q //~
Day phone
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State AD£O
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.
Address ~o~ ~ 1~ ~4 ~o~
Engineer's signature ~~ Date I/,qlq¢
DHHS SIGNATIJRE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph' 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev, 1/91) Back MOA~21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type ~,
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Y
Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed I~/~ l'/~ [' 'l/t/18(=, Driller
Cased to l ~ Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
AT INSPECTION
; On adjacent lots ~>'~ I
; On adjacent lots ~"~ l
Public sewer manhole/cleanout
Petroleum tank
t~
WATER SAMPLE RESULTS:
Coliform .~
Date of sample: [/,"~-I I
Nitrate
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed { I/t ~/7?
Cleanouts (Y/N) y
High water alarm (Y/N)
Tank size /~_ 5o
Foundation cleanout (Y/N)
Compartments ~
Depression (Y/N) ~'~
Date of pumping
Alarm tested (Y/N)
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /10
To property line '7 ¢2
Surface water/drainage
On adjacent lots
Absorption field
Foundation I~
Water main/service line
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION ~,~,~
Date installed
Size in gallons
Vent (WN)
High water alarm level
Meets MOA electrical codes (WN)
"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 It I 1(0 1-'/R
Length ~¢-~-~ Width
Total absorption area ¢/'~
Date of adequacy test I I ~-] IR
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF) I 2 ~ System type
"~ Gravel thickness Total depth
Cleanout present (Y/N) ~ Depression over field (Y/N)
Results (pass/fail) ~ for ~ Bedrooms
~ After test
If yes, give d~te
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~ I 1 ~
To building foundation /~ LG
On adjacent lots__ ') ~O
Surface water I"~ ~ ~
Curtain drain t~'l l O
On adjacent lots '~ ! ~ Property line '7 / O
To existing or abandoned system on lot
Cutbank ~ o ~ 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 guidel/nes'in effect,-'~n the'date' Of this inspection.
Date '/* 7/¢//
HAAFee$ -..~OC") ~ ~
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
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
t'~ ~'-'~ - ICh~ ~ ~,~,~ HAA# ~/(?~0/ ~) ~,~ (,..,c~ ,~..~
1. GENERAL INFORMATION
Complete legal description /..~- ~/~ E~'o c~ 8~ h~t_~/~o,~ ~'/~
Location (site address or directions)
Property owner P¢_nm.~ ¢-¢,7'
Mailing address
Lending agency
Mailing address
Day phone
~ o, f~
Day Phone
Agent 13¢~.r' 6~r'~,~ ~To~uMen '- ~RA pz-o_~.c, c t~,,,~/ Dayphone
Address '870 8
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
/f community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system,
72~25 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by.myseal 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 ¢(~/'~/' 7%o4 _,c~.,~. Phone
Engineer's Signature %~ ~ ~ Date
6. DHHS SIGNATURE
~ Approved for ~"~(~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date
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.
72~25 (Rev. 1/91) 8ack MOA#21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescription: 9.1 / ~ t"t c__t..rc~loon
Parcel I.D.
A, WELL DATA
Well type P~'~'.
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Ioo
If A, B, or C, attach ADEC letter. ADEC water system number P/,,4-.
Date completed l?'7p Driller
Cased to ( OD Casing height
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG AT INSPECTION
~ (¥ f~( e-/'¥/~-
~ b° g.p.m. ~ ~ 'f- g43.m.
- > 67~
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot I I 0 ~
Absorption field on lot I ~0 '
Public sewer main N, 4.
Sewer service line hi, /~',
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank None O~;eru~o~ N, /~.
WATER SAMPLE RESULTS:
Coliform 49 col [IOO ro~_
Date of sample:
Nitrate
Collected by:
Other bacteria 0 col/too
B. SEPTIC/HOLDING TANK DATA
Date installed Il { I 6' ( 7 ? Tank size I 9-5'0 ~q~/ Compartments 'Z
Cleanouts (Y/N) '/' Foundation cleanout (Y/N) Y' Depression (Y/N)
High water alarm (Y/N) H, b-, Alarm tested (Y/N) /q,/B.
N
Date of pumping . ~./'5' / ? ~. Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I I o '
To property line 8 o'
Surface water/drainage
Onadjacentlots ~ {oo,
Absorption field t o,
too '
Foundation I 0 /
Water main/service line ~> z~-*
72-026 (Rev. 7/91) Front ~ ' CONTINUED ON BACK PAGE
C. LIFT STATION NJ, ~.
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D, ABSORPTION FIELD DATA
Date installed II lIE' / '? ~ Soil rating
Length ~-? ' Width :~ '
Total absorption area H~' r~ '
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot ! ~- 5" On adjacent lots ~ too'
Surface water
System type
Gravel thickness ¢ ¢ Total depth
Cleanouts present (Y/N) Y
Date of adequacy test
for
('~ ~ o ~.,,,~ o~ If yes, give date
-Fr c n C/~
bedrooms
Property line
To building foundation I~0' To existing or abandoned system on lot N,/I-.
On adjacent lots "~ ?o' Cutbank /~(on~_ Water main/service line > ~.,,¢"
Surface water ;:> Icc' Driveway, parking/vehicle storage area 2o '
Curtain drain fVon~ o~£¢r~(
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 Name
Date
HAA Fee $ /7
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA
Waiver Fee: $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
' DMSION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTEYITION
APPLICATION ~)R HEALTH AUTHORITY APPROVAL CEI~FIFICATE
1. General Information
(a) legal Description (include lot, block, subdivision, section, to,~nship~ range)
Location ~add~ess .or directions)
Appl'ican~s %~am~
(b)
Appl~cants~ Ad~k~e~s.s.~_~O- / ~_~F~ ~ ~/ n ~-c~ _~5 ~ ///, ~/ ~33-t/
(d) ~nding Institution ,~ .~ Telepho~
Telephon~ ~ ~ F~- 3 ¢~
Addre ss
(e) peal Estate Co. & Agent
Address
Tele phor~
2. ~koe of pesidenee
Single-Family ~
Numbe~ of Bedrooms
3. Wate~ Suppl~
Individual Well
Multi-Family ~--~
Othe~ (describe
Conmunity [---~ Public
Note: If community well system~ must have %~itten confirmation fr~m the State
Depa~r~nt of Environmental Conservation attesting to the legality and status.
Is the ~11 adequate for the number of bedrooms specified in this HAA~N)
4. Se%~_9~__qisposal
Onsite ~ Public ~ Community ~ Holding Tank ~--~
Is the. wastewater disposal system adequate fc~, the numbe~ of bedrocms~/N)
[Page 1 of 2]
2-15-84
5. Engine~ l~oviding Inspections, Tests, Data and Informat~ion '
I oertify that I have checked, verified, or conformad to all MOA HAA Guidelines in
effect on the date of this inspection.
Signed by
Date
6. DHEP Approval
App~ov~ d for~
App~,ox,~ del~
( ENGINEER SEAL)
Disapproved
Terms of Conditional Approval
The Municipality of Anchorage Dapa~tmant of Health and Environmental P~otection dces
not guarantee the continued satisfactory perfcanuance of the water supply and/or the
wastewater disposal system. This approval indicates that, as of the validation ck. nte
shc3~n above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func~
tional fo~ the number of bed~oous and typ~ of sf~uctue, e indicated.
(~PSEAL)
7. Mail the HAA to the following add~ess:
KB2/d5/s
[Page 2 of 2]
2-15-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MUNICIPALITY OF ANCHoRA(~E
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
gUN 2 9 1984
RECEIVED
Well Classification
WelI Log P~esent _'~)
Total Depth ~(p / Cased to
Static Water Level ~-~,/
Legal Description:
If A, B, o~ C, D.E.C. App=oved(Y/N)
Date ~leted J~/~&/~ Yield
~O[ ~pth of ~outing ~~
Pump Set At ~Z ~ /
Casing Height Above G=ound (, ~ / Sanita~f Seal on Casing ~N)
Electrical Wiring in Conduit _~) Depression A~ound Wellhead (Y~
Separation Distanees f~cm Well: . ~o '
TO Septic/Holding Ta6k on Lot ' L C{~%~l/O ~ On Adjoi. ing Lots .~ ~.
To Nea=est Edge of Absomption Fie{d o~ Lo----6' i(P~-! ~ i On ~djoinin9 Lots
TO Nearest Public Sewer Line ~I/~ To NeareSt Public Sewer"
~leanout/MaFJ~ole ~//~ To Nearest Sewer Service Line on Lot
Wats= Sample Collected By ~, ~cc~i~¢¢- ; Date ~
Wate= Sample Test Results
B. SEPTIC/HOLDING TANK DATA
Date Installed ~i/~/~ Size i~g~'~-~ No. of C~artments
Standpipes ~N) Air-tight Caps ~'~/N) Foundation Cleanout
~p~ession o~ Ta~ (Y~ ~te ~st P~d ~//~/~ ~
P~ing~intenan~ ~n~a~ ~ File (f~) ; fo~
Holding Ta~ High-Wats= Ala~ (Y~) /~/~ Te~ra=3 Holdi~ Tank ~t (Y~)
~p~ation Distan~s ~ ~ptic~o~ing Ta~:
To Water-Supply ~11 /~¢~+ / ~ To ~ilding F~ndati~ J~ & / o
To ~omrty Li~ ~~ To Dis~sal Field ¢ ¢
[Page 1 of 2] 2-15-84
Soils Rating in Absorption Strata
Date Installed ~ / [~/~
Width of Field ~ ~/
Square Feet of Absorption A~ea
Depression over Field (Y~
Results of Last Adequacy Test
Type of System Design
Date of Last Adequacy Test
/
Separation Distance from Absorption Field:
To Water-Supply Well ~,O~f/ C) To P~operty Line
Length of Field ~,~/
D~pth of Field I'~//
Gravel Bed Thickness ~P~//
Standpipes P~esent ~N)
To Building Foundation ~ / ~ To Existing or Abandoned System cn
Lot ~/~/ ; On Adjoining Lots ~/~,~
To Wate~ Main/Service Line /~7~F~ To Cutbank(if present)
To Stream/Pond/Lake/or Majo~ Drainage Course ~ /~/~p~ O
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
Elect=ical Co~
Dimensions
Manhole/Access ~
el at
/ Vent (Y/N)
/~ Pumping Cycles du~ing Adequacy Test.
Meets MOA
** Check Permitted Bedrc~nRating Against HAARaquest **
I certify that I have checked, verified, or confoInred to all MOA HAA Guidelines in effect
on the date of this inspection.
Date
X0A No.
KB1/d5/s
[Page 2 of 2]
22,~ i.~ .; ~-,~
2=15-84
· '-' DEPT. OF IY',,",LTH &
MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL , ,.oi'ECTION"-
~--~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
RECE.IVED
Telephone 264-47'20 '.
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AN'D SEWER FACILITIES '
DIRECTIONS~ Complete ali parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing. ~ "
1'. ' PROPERTY'OWNER PHONE '
Merle K. Beefed' and Jane% C. Beater' 344-6778 :'
MAILING ADDRESS - ~ ' .--"
SPA Box' 1546-E Anchorage, Ak. '99507
PROPERTY RESIDENT (If different from above) PHONE
;2, BUYER ' PHONE. ; · ·
Dennis N. & Susan G. Strong .
MAILING ADDRESS ' "
3311 C Street Anchorage, Ak. 99503
3, LENDING INSTITUTIO'N I PHONE '
Alaska Pacific Bank ;I 274-96~1 " ' .i
MAILING ADDRESS ..... ' ' "' ! ' ' ,:
P.O. Box 420 Anchorage, Ak. 99510
4. REALTOR/AGENT ~ · PHONE '.
Barbara Block - Marston 248-2804
2804 W. Northern T~ights Blvd. Anchorage~ Ak. 99503...
NUMBER OF BEDROOMS
I-- One [] Four
[] Two [] Five
E~ Three [] Six
[] Other
5. LEGAL DESCRIPTION
L21, B2, McMahon Sub.
ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
STREET LOCATION
NHN Furrow Creek Rd. Anchorage
6, TYPE OF RESIDENCE
"'"' ":[] LSINGLEFAMILY
[] MULTIPLE FAMILY
**If individual/on-site, give installation date
If system ~s over two (2) years old an adequacy test ~s required
by this Department.
7~ WATER SUPPLY
:'-'' [] INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
8.' SI~WAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010{3/78)
. ["~'"THtS SIDE FOR OFFICIAL USE ONLY "
~.~ DATE RECEIVED · ,
INSPECTION APPOINTMENTS
TIME
TIME
DATE DATE ' ' ? ' '' " - DATE ~ . '.
INSPECTOR . ·INSPECTOR INSPECTOR · " ,
1, TYPE OF RESIDENCE ~ NUMBER OF BEDROOMS
· [] $1NGLE'FAMILY [] ONE [] THREE [] FIVE.
[] MULTIPLE FAMILY - ' ;, [] TWO ~ [] FOUR [] SIX
PERMIT
NUMBER
2. WATER SUPPLY
· [] INDIVIDUAL DEPTI-~ OF WELL .. . . .
[] COMMUNITY DATE DRILLED ' ' ' ,'
: [] PUBLIC UTI LITY " '
. ~ Connection Verified LOG RECEIVED~" ~..,p_.,,~ . .. . ,. ,' '
PERMIT
NUMBER
3. SEWAGE DISPOSAL SYSTEM '
[]INDIVIDUAL/ON -SITE DATE INSTALLED · ..
'[]PUBLIC UTILITY '~1 --'-~ ~
Connection Verified INSTALLER · : . -
ff-IS.epti~ Tank or []Holding Tank '
Size: t ~_~'1:~ If Tank is homemade SOILS RATING · . " ·" ' .
give dimensions: [ ~L ~' '' . '" TM
TYPE OF TANK MANUFACTURER ' · ,, ' · .
TOTAL ABSORPTION AREA ' MATERIAL ~ '~ ....
4. DISTANCESwELL TO: Septic/Holding-rank~jlAbsorption~Area Sewer. Line I Nearest Lot, Line
Absorption Area to nearest Lot Line . ·
5. C~OMME NTS .
· ~/~PPROVED FOR ,~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate) ~ '
[] DISAPPROVED
DATE BY (~
LEGAL DESCRIPTION
72-010 (Rev, 3/78)
ALASKA U I OFlmEnTAL COI TROL $EI4dlCeS,
~r, gineeHn9 $ ~nuironmenlt, I $luJi~s
InC.
JUNE 28 1984
DENNIS STRONG
P.O. BOX 11-1388
ANCHORAGE AK 99511
SELLER - DENNIS STRONG BUYER -
SUBDIVISION - McMAHON BLOCK - 2 LOT - 21
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 500 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 631 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
4 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED 0N6/18/84 .
FLOW TEST ON WELL
THE WELL FLOW RATE WAS 5.2 GPM FOR 2.5 HOURS.
SEPTIC TANK ADEQUACY
THE EX/~TING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR
T~S 4 BED~.aOM MOUSE.
1200 ~¢sl 33r~ Auc~ue. SuJl¢ ~-~,cbr~ge. Alaska 99503,(907) 56]-5040