HomeMy WebLinkAboutMCMAHON #1 BLK 3 LT 9AOnsite File McMahon #1 Block 3 Lot 9A #017-042-55 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201301 PID Number: 017-042-55 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JACQUELINE & CECIL OSBORNE ABSORPTION FIELD ® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 12721 KILLEY STREET, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.$ GPD/SF 12 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.5 Ft. Gravel depth beneath pipe 7.5 Ft. Subdivision Block Lot MCMAHON #1 3 9A Fill added above original grade VARIES 0.93-2.32 +/- Ft. Gravel length 50 Ft. Township Range Section Gravel width 2 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Stion ta Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 750 FtZ Ft. Well 100'+ 100'+ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1250 Gal. Surface Water 1001+ 100'+ Material HDPE Number of compartments 2 Lot Line 10'+ 10'+ NA Foundation 101+ 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks Diverter installed to other existing diverter to be able to serve all 3 fields. Alarm location Electrical installed by Installer NORTHERN EXCAVATION Tankto PIPE MATERIAL House to tank 3034. d a nfield 3034 Drainfield 3034 Co/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspectio 1� 8/27/2020 2nd 8/27/2020 Location and description 3`d 8/28/20 4`" BOTTOM OF BRICK SIDING (FOUND) ON-SITE WATER AND WASTEWATER SECTION APPROVAL OF A Conditional Approval: Date •:tQ QJ 49 TH ....�:* v ,r '. •' Septic System Appro d�,% Date g Z(J Curtis Huffman CE 128991 •.•���/� itF�• . 8/29/2020. •ti��� F�pROFES510NA\\,�11� �.� Note: this approval does not include well permit requirements. kNev uoiuziid/ /PERMIT: OSP201301 ASa -- �R/�k'AY �v 'Z? V M 4BR B HOUSE FCO LIGHT 9M POLE 26,g MH C NEW 1250 -GAL CO D HDPE SEPTIC TANK A DCO E DCO & DIV DIV DIV 1996 TH1 CO 0 w n eklSTllyG 196 OFG� z FlfCO CO F Sj,Do uFi � X 70 w MT PID: 017-042-55 L, Y z z a x U 2' 10' UTILITY EASEMENT I PL / ESMT I STAKED PRIOR -- -- CO TO CONST. N 88 05' W ---- 10' UTILITY ESMT. SCALE: 1" = 30 A -C=23.5' B -C=16.1' A - D = 2 2 8' FCO H CO DCO DIV CO MT MT CO B - D = 21.3'99.22 100.6 FINAL GRADE 99.21 �:(98.28 A - E = 2 2.5' ORIGINAL GRADE B - E = 2 4.3' J /— I ,-- 95.12 2.5- ORG-FILL TOP SOIL FILTER FABRIC 3.51 GM/SM A -F=55.8' 94.54 94.37 3.78 93.78 ML/GM SEWER ROCK A -G=57.0" 1HDPE GANK" ERES 1996 TH B - G = 6 7.7' 86.28 86.28 DRY 6/3/96 A -H=1015' B -H=1016' SEPTIC SECTION 16' GM A -I=102.1' 10.21 B$" B -I=101.8' SCALE: NTS MCMAHON #1 BLOCK 3, LOT 9A SUPPORT, SERVICES: - F PREPARED FOR: Idw AZ�A,�j� 1 JACQUELINE OSBORNE 5Ao 12721 KILLEY STREET d * 9 TH* ANCHORAGE, AK 99516 FIRST WATER CONSULTING DATE: 8/29/2020 kk�� � SURVEY: HOLT , rtis Huffman W �'�?, 13030 SUES WAY DRAWN: FWCS 1 �� CE 128991 OA1 SCALE: 1" = 30' 8/29/2020e o ANCHORAGE, AK 99516 1 A�FESSIOZSPy � 907-350-9566 firstwaterAK®gmoil.com OF q jq�;4p 0 CO: 49 TH 0�0 AS -BUILT SURVEY 1 " = 30' THE SURVEYOATA AND MEASUREMENTS HEREONAREPREPAREO FOR THE / / D ANY USE OF THIS O AWING BY THIRD OF SURVEY. ANYUSEOFTH/SORAW/NROVIDERO PART/ES /S PROHIBITED UNLESS NO CORNERS SET THIS DATE /� WR/TTENPERM/SS/ON/S PROV/OEO. r SHANE A. HOLT...' p LS -6914 0` Q�a d o �Arofessiona% foo O��DO�o�� SURVEY ORDERED BY: MATT DIMMICK (9 KELLER WIIIIAMS THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT ARE NOT SHOWN HEREON, UNLESS NOTED. NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 9 A, BLOCKS, MCMAHON SUB FIRST ADD'N. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 29 TH DAY OF AUGUST 2020 14734, FB 207-25,208-7 O Z HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 ' ""''Q• MUNICIPALITY OF ANCHORAGE On-site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage. Alaska9951M650 Phone: (907)343.7904 Fax, [907y343-7997 l h1lp`-#wWw. mun r. orglonslte i �/Ca❑ w ASE On -Site Wastewater Disposal System Permit Permit Number: OSP201301 Work Type: Septic Upgrade Tax Code Number: 01704255000 Site Legal Address: MCMAHON #1 BLK 3 LT 9A G:2835 Site Mailing Address: 12721 KELLEY ST, Anchorage Owner; OSBORNE CECIL C & Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: IE Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: r- n L•11:I 1'[]110 111 8/1412024 8/14/2021 Lot Size in Sq Ft: 42852 Total Bedrooms: d ❑ Private Well ❑ Water Storage All construction shall be in accordance with: i. 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 (1 BAAC72) and Drinking Water Reg ulatians (I8AAG80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65- Provide notification by calling (907) 343-7904 (2417)- 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By. Date, 8114/2020 Issued By: Le Date: Iunicipali of Anchorage uc�.arctttcttc P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 a (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV201046 COSA#: Permit#:OSP201301 PID#: 017-042-55 Legal Description: McMahon #1 Block 3 Lot 9A Engineer: First Water Consulting Applicant: Jacqueline Osborne Your request for a waiver of the required horizontal separation from the proposed absorption field to the existing absorption field has been approved. The approved separation distance is 10.0 feet. See engineer's waiver request for justifications. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be: met or another approval from this department. ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ 1 Waiver is Granted: X Waiver is not Granted: Date: 0 � Y � � 2 � Approved by: Name of Reviewer **** VARIAN C E/WAIVER REVIEW **** 13030 Sues Way, Anchorage, AK 99516 907-350 -9566 / firstwaterAK@gmail.com August 4, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: MCMAHON #1 B3, L9A - SEPTIC SYSTEM UPGRADE PERMIT W/ WAIVER The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one deep trench and 1250 -gallon tank to serve the existing 4-bedroom residence. The design has 2 trench location options, which will be determined at excavation. The design is based on the MOA record test hole conducted in 1996. Per this testhole, no groundwater was observed at excavation or monitoring. Due to elevations and to minimize negative property impact, a field-to-field waiver of 10’ between the existing and proposed trench is requested. This waiver is justified with the tighter, silty soils and shows any potential effluent transference or interaction between the existing and proposed fields will be marginal or nonexistence. The property is best served by retaining the original fields for future use due to the lot’s characteristics. The mitigating factors of soil type j ustify the issuance of the waiver and indicate the proposed field will have no effect on the functionality of the existing fields. The slopes are moderate at 0-3% at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201301, Rebecca Carroll, 08/14/20 FIRST WATER CONSULTING MCMAHON #1BLOCK 3, LOT 9A DESIGN DETAILS Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201301, Rebecca Carroll, 08/14/20 FIRST WATER CONSULTING MCMAHON #1BLOCK 3, LOT 9A Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201301, Rebecca Carroll, 08/14/20 Municipality of Anchorage Page / of ~-- , 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: -.~/4/ ~/_,, ~/~-oc' PID Number: 0/~ Name:~ ~pgrade ~, ~~ Wastewater System: C New Address: / ~?~1 l~/~y ~ ~1~ ABSORPTION FIELD Phon.~ ~/~ ~ I.o.o~droom,: ~eepTrench ~ Shallow Trench ~Bed ~Mound ~Other Total Depth from original grade: LEGAL DESCRIPTION SoilRating: ~, ~ GPD/Sq. Ft. Lot~ Block: Subdiv~ion: Depth to pipe bo~om from odginal grade: Gravel depth beneath pipe Township: ge: S~tion: Fill a~ded above original de: Gravel length: Ft. ~ Ft.  Number of line~: 0istance ~n WELL: ~ New ~ ~ Upgrade Gravelwidth: ~ Ft. / ~ Ft. Clarification (Private, A,B,C): Total/Depth: ~- Ft. Total absorption~ SQ. Ft. Pipe~material:~ Drille~ ~ ~ateDrill~: S~tic Water Level: Installe~ Datein~:~/~ Y'~GPM PumpSeta,: Ft. I~ingHe[ghtA~veGrOund:Ft. L~S~'~>~- TANK SEPARATION DISTANCES ~eptic a Holding a S.T.E.P. TO Semic Ab.mtion Li. Ho,ding ~Pdvat, Manufacturer: Capac'~ i7~°~ Welk /~1 ~/ ~/~ ~/~ /~1 Mated~ ~E ~ Number of Co~a.ments: Sudace Water ~/~ ~ ~ ~M LIFT STATION LOt Manufacture~ Fou.datio~ /~, ~, ~j~ "~u~on",~.~,~,: Cu~ainD~in ~//~ > ,um~ctr'~l Inspections pedo~ by: Remarks: BENCH MARK Location and Description: Inspections pedormed by: ~ ~ Dates: 1st O~/~/~C Depadment of Health~d Hum~ Se~ices approval ~"~ ~,.." ~ ~,-" '~.~-'~ Reviewed and approved by ~ Date: 72-013 (Rev. 9/91) MOA 25 Permit No. -- ~'~t,) ~]Z~ Page 2 of 2 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 MCMAHON .1 L9A BLK3 FURROw CREEK ROAD SWING TIES [] - TEST HOLE · - MONITOR TUBE o - SEWER CLEANOUT + - EASEMENT WELL NEW LEACHFIELD mm- EX(S~.(~ 9A SSS°05'00'[ 253,10 ELEVATIONS (NOT TO SCALE) ~ CONC, STEP ~ BACK DECK N86,7 DRIGINAL GRDUN~ LEVEL AT, 9B,7B SCALE 1" =60' 7~2/96 ENGINEER'S SEAL ~.."' 49 r~ "..~ ~'-. ~ou~s ~. ~u*~ .-'~ %". ...... MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960128 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:PARKIN ROBERT O OWNER ADDRESS:12721 KILLEY ST ANCHORAGE, ALASKA 99516 PAGE 1 OF 1 PARCEL ID:01704255 DATE ISSUED: 6/19/96 EXPIRATION DATE: 6/19/97 LEGAL DESCRIPTION: MCMAHON #1 BLK 3 LT 9A LOT SIZE: 42852 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION 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 (18AACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. ~SPECIAL PROVISIONS: IF ONLY ONE CLEANOUT EXISTS ON SEPTIC TANK THEN INSTALL A CLE OUT ON THE SECOND COMPARTMENT AT THE TIME oF CONSTRUCTION WHILE cHEcKING INT~SRITY. RECEIVED BY: ISSUED BY: m~--~"////~ ~/f DATE: Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax June 3, 1996 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: McMahon #1 Lot 9A, Block 3 Narrative & Permit Application Dear Mr. Cross: The existing system has been in place since 1976. The upgrade will be located 10' from the existing This layout is the best fit for this lot. The existing We are submitting for an upgrade permit. We will provide a tank integrity check. trench, but in a perpendicular orientation. trench will be retained for its limited absorption value by a diversion valve or overflow arrangement. The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \1996\96-032A-NAR.DOC NO SURFACE WATER j ~x~ EASEMENT ' PROPOSED LEACHFIELD NO KNOWN CURTAIN DRAINS SEPTIC AREA I-- EXISTING LEACHFIELD S E P T I C S I T E P LA N LEGAL: MCMAHON ffl LOT DA, BLK 5 co,~c~o~: ,/A ~P:~9~ ' ~o~ff 9~-0S~A/DATE' 06/0S/geI SCALE 1" k ~ ' CE-6736 .' ~ RIVER, ~. ~577 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: McMahon #1 Lot 9A, Block 3 06/03/96 Bo GENERAL 1. The s~ptic plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 9. Any remaining open test hole excavations shall be filled. SEPTIC TANK 1. The top of the existing septic tank shall be exposed to the elevation of the inlet and outlet, and its integrity verified by the engineer. 2. If required, the existing septic tank shall be pumped and disposed of properly. The replacement tank shall be with a MOA approved 1,250 gallon septic tank placed in the location of the existing tank. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5 ". 3. The total depth of the trench excavation is not to exceed 12' at any point. 4. The sewer line is to replace the existing sewer line that leads to the existing field. The effluent line within the trench shall be laid level within 0.03'. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 12' GRAVEL DEPTH = 7.5' under pipe, 2" over pipe TRENCH LENGTH -- 50' TRENCH WIDTH = 3' SOIL RATING = 0.8 GPD/ft2 BEDROOM CAPACITY = 4 SEPTIC TANK = 1,250 gallons, if required Twenty-four (24) hours notice required for all inspections. \ 1996\96-032a-spc.doc Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax LEGAL: McMahon #1 Lot 9A, Block 3 06/03/96 Single Family 4 Bedroom Dwelling 4BR x 150gpd = 600gpd Percolation rate = 3.5 minutes per inch Conservative wastewater application rate for trench system = 600 gpd / 0.8 = 750 SF required area 750 SF / 2 / 7.5' gravel depth = 50' trench length Recommended trench dimensions: Gravel depth = 7.5' Total depth = 12' Gravel length = 50' Gravel width = 3' 0.8 gpd/SF \1996\96-032a-cai.doc Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: /fv/C/~/f//'/~)/V/ '/~/ Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- COMMENTS SLOPE WAS GROUNO WATER ENCOUNTERED? S IF YES, AT WHAT -- /'V'/~'-, " ~ DEPTH? p E Oepth Io Water After ~ Monitoring? //'~d.7' Dat,' ,~"- 3-?,~ SITE PLAN Gross Net Depth to Net ~ ~e~j~.g Date Time Time Water Drop ~ - ~:o~ ~ el/u" ~ , ~ /~ ~ /~//~' ~ ~//~" /~ ~ ~5~ /~ ~ ?//U" ~ /3//~" PERCOLATION RATE ~'; 5- (m~nuLes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN__£'? FTAND FT PERFORMED BY: ~"""J I F~ :"'~: CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ' "' / ( 72-008 (Rev. 4/85) [NV©ICE Ea le River En ineerin Services Louis Butera, P.E. P.O. Bo× 773294 (907) 694-5196 tel E~I~ Riwr, AK 99577-3294 (907) 694-3297 fa× DATE: TO: pc: May 29, 1996 Sherry Mustain Robert Parkin 12721 Killey Street Anchorage, AK 99516 Alliance Mortgage Alaska International Realty INVOICE NO.: 96-074-1NV.doc LEGAL DESCRIPTION: McMahon #1 Lot 9A, Block 3 Buyer: Sawlyer, Christopher TERMS: PAYMENT UPON RECEIPT PROFESSIONAL SERVICES DESCRIPTION CHARGE Test hole excavation Percolation test Design and permit submittal to MOA MOA septic permk fee PLEASE PAY THIS AMOUNT $ 300.00 350.00 400.00 320.00 $ 1,370.00 PLEASE PAY FROM THIS INVOICE DUE UPON RECEIPT PLEASE REFERENCE INVOICE NUMBER WHEN MAKING PAYMENT FEDERAL TAX ID 92-0119547 11/e% PER MONTH, 18% PER ANNUM SERVICE CHARGE WILL BE ADDED ON ALL INVOICES AFTER 30 DAYS THANK YOU! > GREA,ZR ANCHORAGE AREA BOR,, _iGH '~-- ' "Department of Environmental Quality .... 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL /Cc~) /~7~-MANUFACTURER- INSIDE LENGTH - INSIDE WIDTH COMPARTMENTS ~"J LIQUID DEPTH '~ LIQUID CAPACITY/~'~GALLONS. TIL,- ,-,,,,~,,,' FIEL-D~- ~-OTAL LENGTH ~ -- DISTANCE FROM WELL/~'~ ~'''7~FOUNDATION /~_~ ~TNEAREST LOT LINE ~0 ~ OF LINES NUMBER OF LINES / DISTANCE BETWEEN LINES TRENCH WIDTH~ IN. TOTAL EFFECTIVE / ABSORPTION AREA ~~ SQ. FT. LENGTH OF EACH LINE ~ DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE --~/~ MATERIAL BENEATH TtLE~ ABOVE TILE IN. / WELL: TYPE DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION_ LOT LINE SEWER LINE__ TANK__, SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM DATE G.A.A.B. Form EQ-032 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT '"*ME OP APPL,OANT ~M";¢"~O ,h,2~',~ O . MA,L,NG ADD.ESS ~'~/~ ,NSTA''-AT,ON LOOAT,ON 'EGAL DESGR,Pt,ON 7 '7-,n . c ,¢yn//¢ ,NSTALLAT,ON OP: SEPT,O TAN'~ ¢¢'~,.~_,¢ SEE".',GE P,T DRA,N P,ELD TYPE AND:' S,.E OP PAC,L,tY TO SE SE.VED Z'~ '~ ~. TO SE INSTALLED SY SO,LTEST ReS~,LtS ,C'it Y)~',¢- . OTHER NOTE: THIS PERMIT IS NOT VALID wITHOUT SOIL TEST COMPLETION DATE ANTICIPATED / ~ '~%~ 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. SEPTIC TANK size /~ ~ tYPE FOUNDATION TO SEPTIC TANK ~ i FOUNDATION TO SEEPAGE PIT Septic TANK TO seEPagE~H~CCA~I /~/~ SEPTIC TANK . SEEPAGE PiT TO NEAREST LOT L~Ne. WELL TO SEPTIC TANK ~/~_~} WATER MAIN TO SEPTIC TANK /¢~ '/ /60 / DIAGRAM OF SYSTEM , DRAIN FIELD. DRAIN FIELD. . SEEPAGE Pit ~ ~/ , ALSO CONSIDER AREA WELLS. SEEPAGE PiT //~/~ / /O~/ .DRA,NF1ELD/~/ CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRib CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL SACKFILL 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 DAte itop- }soil 2 to Gw compact with a low moist~e ' [ ;, t ~ content. The contact the Gw to Gm and Gm was gradational and erratic with respect to depth. There wer~ some erratic silt and clay bodies in the lower sedi- ments and some erratic sand pockets in the upper soils. MUNICIPALITY OF ANCHORAGE <:_±: Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-042-55 1. GENERAL INFORMATION Complete legal description MCMAHON #1 BLOCK 3, LOT 9A Expiration Date: Location (site address) 12721 KILLEY STREET, ANCHORAGE, AK 99516 Current property owner(s) JACQUELINE & CECIL OSBORNE Day phone Mailing address Real estate agent 12721 KILLEY STREET. ANCHORAGE. AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ � I d Date of Payment Receipt Number I U-1 JJ�� Receipt Number COSA # 0 5c 0- 0 1 —I 1r�3 Waiver # Waiver Fee $ Date of Payment 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, 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 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 (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 8/28/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to +q/ these various and dynamic characteristics and are outside the control of the evaluator of the �y well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q: • ..,9 for current or future occupants or guarantee that no unseen encroachments, deficiencies or f discrepancies exist can be given by First Water Consulting & fWf.S *' A 11•I .'* / . ... .. ......... . .. Curtis Huffman •/ System #1 Approved for Li bedrooms +����%T ...CE 128991 �i�FRFoI'F System #2 Approved for bedrooms 1�\\ ROSS ESSIO � Disapproved Conditional approval for bedrooms, with the following stipulations: ON-SITE TT A ser. �m WAS TLvi.'ATER z PROGRAM 01\ By: Lz Original Certificate Date: g ZD The Municipality of Anchordge Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: MCMAHON #1 BLOCK 3, LOT 9A Parcel ID: 017-042-55 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled UNK & 10/11/2007* Total depth 183 ft Cased to 180 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 7/29/2020 Static water level at beginning of test 122 ft. Well production at time of test 4 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 6.32 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample 7/29/2020 Comments *WELL DEEPENED IN 2007, WHICH HAS RESULTED IN LOWER NITRATE LEVELS – SEE ATTACHED M-W WELL LOG. B. TANK DATA Age of tank(s) NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank * Standpipes/foundation cleanout per record drawing Date of pumping * C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: *NEW SYSTEM D. ABSORPTION FIELD DATA Which system tested (date installed) 8/27/20 ALL standpipes present per record drawing Total measured depth from grade 12.93 ft (max) Measured depth to pipe invert from grade 5.43 ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date NA- NEW SYSTEM Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies: E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10’ Yes if No ft Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 8/29/2020 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Nitrate Advisory Certificate of On-Site Systems Approval # OSC201473 Subdivision: MCMAHON #1, Block: 3, Lot: 9a A water sample revealed a nitrate concentration of 6.32 milligrams per liter (mg/L). 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. Since nitrates are known to slowly increase, we recommend you monitor the water quality. 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. Municipality of Anchorage Development Services-Department Building Safety .Division · On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL " i-OR A-~INGLE FAMILY I~WELLIN~ " Parcel I.D. OI7-o~?-Z£ .... GENERAL,INFORMATION Complete legal description Jvlr, ~'~/O LOcation (site address or directions) Current Property owner(s) Mailing address Le.ndjng agency · 'Mailing address. Real Estate Agent · Mailing Address e Day phone Day phone Day phone Unl~ss othen/vise.requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: ~ C e TYPE OF WATER SUPPLY: · Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWA'i' ER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer D F'I [] The Municipality of Anchorage Develoj3ment Services Department (DSD) Issues Certificates of Health Authori~. Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of ~itle (except between spouses) for properties served by a single-family on-site wastewater disposal and/or, water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority 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. pa ~~,, ~i! ..... MuniCi lity of Anchorage ((~~)) " DevelOpment, Services Department ::: :,~~:~ ._" ~ii ! Building Safety Division : <~" On-Site Water & Wastewater Program il i:~ . i' !: 4700 South Bragaw St.. . 'i. . . ':'i . ~, :: : P.O.'Box 1961~50 Anchorage, AK 99519-6650' r ~ ~ :~:': ~; -: www.cl.anchorage.ak.us . ' ~ .. .- ::; ~: l '(907) 343-7904 '" AUTHORITY APPROVAL CH , ~,, ~,' , LTH ": "": " f4 rl : ' ' '"' ' Legal D~s'cription: ¢. i,2~//:'d=/ 9,/r ~'U<' % ' PArcel ID: ¢IT-Z::xCZ WELL DATA ;' '.. :' ' '~. ; . '; , I ,i , kog(Y/N) We,,type P~,} e~, . ~f A, B, or Cprovide PWSlD #. ;Welii~ !:!i iiii ': :: 'i1'~ ' ~/., , .,~.I-!.. gaie:co~:Pleted - :. ':i' 'Sanitary:seal .(Y/N) 7 Wires prope'rJ~ protected (Y/N) \//' Totald6pth g:~ . ft. ;: '.Cased t~ . ft. ' Casing heightl(above ground) .'~- ~- in. ;i' ,!,i '- -- ,: ' .: '!,1:'! ": '::'!':: i, ~ ' , " '. ' I ' ' ' ,' . . . FROM WELL LOG :t AT INSPECTION... Dateoiiest .. M0¢g O~ I=Z~-b-l;; ' / S[~Jtic~terle~;el ; ; ~J/A- :~i: ! :fL ¢ ft. p~:oauctiori. ,;/d [,4--.. . ..... . g.P.m. . g.p.m. wATER SAMPLE.RESULTS: ....... , , ~ :'. '"' :'" ' c'olonies/'lOO mi..: Ni' Cohform, t~ ~ :. e I ~> rog.II. Otherbactsria : O c°lonies/100 mi. Da, e. ,,i ,.. , . . ,.~ 'of,sample: [OC~ C~" Cted by:., ~ tf ¢--.~' ~ t,-3 OOL~'.,::!~ i' B. SEPTI?ROLDINGTANK'DATA ' , ' ... , . ' . - ' ,, ' Ta~ikTii~/i~.t~:i.al ~~L. ]. ~.;..2:..:: Dateinst~li'ed '~:/2c~ /~ ~> ,- .I: ..... ii .... - ': '~' . . ;. i ' " i - . ,i,!,-.. ,' Tank size J'Z-SO.oal ~ r Number of Compadments .. ~- Clean0tjt~ !y!N):.{ k// :. ~,~ ..~.:." '... ::;~ . .:. ~ : ,:' ~,,, 'l,,!: iil~: :,,:;i :, : 't ' ~' ' ' I?'; ' , ' . "' :i , : '.Foundation cleanout (Y/N) ~"/ Depresmon over tank (Y/N) A) High water, alarm (Y/N) 'i:.':' .i~ .!!-.' ...... i~ ....... :! ' :ii' :, ..~ ' ::i'!:', ' Dateofpumpnq-- .... "7 ~/~"~ Pumper ~ ,, '.., ' ' , ~ ' :'. ". Z":;i,')., ' :~ 'i'..' .. : .... :'. '~ ..,: . I, · , ' ,' ' ' ~¢.'v . " ,Il t ' "' ' ' ' ~ ' 'C. ABSO,R.P~TION FIELD DATA ' I '~ ,. '.. . .' :. I:,' .i:.' ~,,. (¢ . , i ,,: ,,:. Da, re installed /Z'~/~, Soil rating(g.p:d./ft~ or fl~lbdrm) (:2. ~ System type Tt~ b..'~ Length;',,[ ' O ".ft. ;' ' :. Width ~':' ,'~ ,: fl.. : Gravel below p~pe 7.~' ft. l;i. '.~: ' :: i: -:"I:'--'-'. '~- ',',:"i'":- :' To'tal depih I ~. ' ft. Eft. absorption ar. ed'/~;O ft~ Monitoring tube )z .?, !, Depression over field il i..:..:.: .:: ,=or ¥ ' ~ . , ~ "2..~' ; , . ' , , , Fluid depth in absorption field before test /7~i/:ln.,.' - Water added f~, gal.; :':- :.,., Newdepth ~/-/ in. ! II t'! ,' ' ,,' i Ela.pse8 Time: I~0min. !' Firial fluid;depth "'7-,(~ in.i AbsorPtiOn i'ate ~.= ~'OO g.p.d. !" ' ". ' ~ Ii',!~ : ~' . i,Ji I . , ~ : ~ii: ': :'=:, Any~,: : .' rejuvenation.. 'treatment. r (past 12 mo.). (Y/N, :''1' & ty~e)' -'-T" : /u//'/} :: ' ;?if[ii.. Ye,S.":t give date :. t ; ~ :., . . '' ;, i ,,ii f ', - . . :~ .: . , ! .,. , : ! ' ~ ., :, , . . , / / FE~--02--04 02:85 PM VICKI.GRIER 907 $49 Sr.-t*' (3 ,. , ' -' ....... ;o--.,.~_2~-~. _ bl the& I I IM~U~ d ~l foU~ln8 I'Sug ptvt5 II~u .~ de ~9} ~10~ or .~mseh on_t~e pro~tt~ ~_ ~r~ der ~ ~AY 10 7 7 I%D W~A & ASA~IA~S ' P.02 _04-30-04 04:i4PM FROM-CT&E ESl, SGS ENV SERVICES SOS Ret.# Client Name Project Namem Client Sample ID Matrht 1O40472001 Eagle River Engineering McMahon #1 Lg~ B3 McMahon #1 L9A, B3 Drinking Water 9075615301 T-233 P.02/03 F-244 All Date~/Tlmes are Alaska Standard Time Printed Dale/Time 01/30/2004 12:42 Collected Date/Time 01/2~/20O4 14:00 Received Date/Time 01/26/2004. 16:40 Technical Director _. StephezrC. £de Sample R~mrl~: Parameter Results PQL Units Method Allowable Prep Analysis Contain~ ID i _(mi!~ Date Date In Wa~ers Department Nitrate-N 8.13 0.100 mgR. EPA 300.0 ' B (<=10) 01/27/04 Microbiolo!Iy Laboratory Total Coliform colllOOmL SMI8 9222B A (<=1) 01/26/04 D' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES . Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-474'4 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY GENERAL INFORMATION Complete legal description Location, (site ad.d. ress or directions)'~ 2_'3T ~./ ~---~.~,\ ¢. L,,.~ Day phone :{'L;nd~g-agen~ ~'{-~' ~¢c'1 ¢0 %(~ Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: Individual well Community well 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Public water ~.-'- ..~ .. If community well system, p~:ovi)e v~r[tten Confirmation from state ADEC attest- ing to the legality and status of:system. · Individual on-site Holding tank Community on-site 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 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. Name of Firm Phone '" Address l~a~le Pdver ]~n~JneerLn~ ~ervices P.O. Box Z7329~, ~.a~e I~ver, m~ ¥~7-329-~ Engineer's signature '.~:; :z:7-'.~:~. :?,'-? .... Date DHHS SIGNATURE '/,/ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. Ther~ ~ra n~tr~a~ pr~n~_ Tt ~ ~.~gR~Pad that paranoia te~t~nE h~ performed to insure the wells continued suitability. Current nitrate em%~~ ic 7.99 mg/!. EPA maximum concentration is !O.O mg/!. More information on nitrates is available from the On-site Services Program, D~HS, 343-4744. Additional Comments ? 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 DH HS does this as a courtesy to purchasers of homes · and their lending institutions in order to satisfy certain federal and state requirements. Em ployees of DH HS 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-O25(Re¥.1F31) Back MOA~21 IffCEiVED , MUNICIPAL fly SERVIc,~OF ANCH~~ ~unicip~lRy of Anchorage S~VI~RO~NT~G~ DEPARTMENT OF H~ALTH & HUMAN .... Environmental Semites Division 825"L" Street, ~oom 502 · Anchorage, Al~sk~ ggS0~ · (g07) 343-4744 Health Authority Approval Checklist ) A. WELL DATA Log present (Y/N) ~x,~O Total depth ~ ~2\ / If A, B, or C, attach ADEC letter. ADEC water system number Date completefl (~(~ \ C~4~.0 Cased to -~' ,~)[01 Casing height (above ground) Sanitary seal fi/N) ~ Wires properly protected (y/N) \/q~ FROM WELL LOG AT INSPECTION Dateoftest ~0 0,)~1~ tt~9, ~C/ ~IC ~)Jl~]q,~ Static water level U3 I OL ( ~ (~ ! Well production V'~ /O~ g.p.m. ~ g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate "~t, Oq (Y~(9 / t_- Other bacteria Collected by: ~-.~ ~> Bo Co SEPTIC/HOLDING TANK DATA Date installed O{oJgq/qLo Tanksize 1~5/-~ Number of Compartments ~- Cleanouts(y/N) Foundgfion cleanout (y/N) ~/C ~ Depression (y/N) ~O High water alarm (y/N) 3,f 'Date 6~Pumpfig ~r; Pumper A" / Date installed ' '~) '~ Soilrating (g.p.d./Worfi%ctrm) ~, ~ Systemtype Length ~C)~ Width ~ Gravel thickness below pipe -~, c.~ Total depth [ Effectiv~ absorption area :-'~(~ ~L Monitoring Tube present(Y/N)"/~ Depression over field (Y/N) /~J Date of adequacy test ~)~,,.~ ~/gt Results(Pass/Fall) pO,.~ For Z_~ bedrooms Flufd depth in absorption field before test (in.); ~ Immediatelyafter~gal. wateradded (in.): Fluid depth ~C~ (ins.) Minutes later: Peroxide treatment (past 12 months) (Y/N) Absorption rate = -Y ~i9 (~ (-~ g.p.d. If yes, give date:~, · Date installed Size in gallons Manhole/Access (Y/N) '~at* High water alarm leve~ *Datum cy te, eraW t d "Pump off" level at* E. SEPARATION DISTANCES Absorption field on lot Public sewer main S~'cr/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: S eptic/t"~l'~'n'gtank °n l°t //C~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTICLH ...... ~ TANK ON LOT TO: Building foundation \'~ / Property line ~ Cq.~/ Absorption field Water m-ai~service line ~/ Surfacewater/drainage~r/~lDt Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~ ~> / Property Line 1 5/ Water mr2rdservice line Surface water ~[~/ Driveway, parking/vehicle storage area Curtain drain ~O~X~ t~ .~Q~Hells on adjacent lots ~-[~(.~)C) / F. ENGINEER'S CERTIFICATION I certify that I have determined thrufield inspections and review c in conformance with MOA HAA guidelines in effect on this date. Signature ~-'~ Engineer's Name Date Date of Payment Receipt Number Munici al record t t b nfs are k re -' wa ~ Louis ~ B~era ]~ ~ W~ver Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc CT&E Ref.# Client Name Project Name/# Client Sample Ill Matrix Ordeeed By PWSID Sample Remake: 982852001 Eagle River Engineering Lt 9A Blk 3 MclVlahon No 1 L~ 9A Blk 3 McMahon No 1 0 Client PO~ Printed Date/Time 06/13t98 17:30 CoHered Date/~ume 06/11/98 1 ] :~ ~ived ~ateff~e 06/1t198 1~:~ T~M Dir~or: St~hen C. Ede Rel~ B~ ~ R~utts Date Init: Total Coliform 7.09 o.100 mg/L EPA $00.0 0~/1Z/98 ~./12/98 R~,V 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 017-042-55 HAA # GENERAL INFORMATION Complete legal description MQMahon #1 Lot 9A, Block 3 Location (site address ordirections) 12721 Killey Street, Anchorage Property owner Robert O. Parkin Mailing address 12721 K~]]~y .qtrec_t. Anchorage, Ak 99516 Alliance Mortgage Services Lending agency Mailing address 2603 Eaqle Street, Anchorage, AK 99503 Alaska Int'l Realty/J.Jemison Agent Address Day phone Day phone Day phone P.O. Box 244224, Anchorage, Ak 99524 345=2458 258-2103 346-2612 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ '~ TYPE OF WATER SUPPLY: NOTE: Individual well x .. Community well Public water : ;- i.. ',' If 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 Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 {Rev. 1191) Fronl MOA #21 o 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. Name of Firm Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294, Eagle River, Ak 99577 Engineer's signature DHHS SIGNATURE Approved for / Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additi0nalComments Note: The well for this property meets existing Sta~e and Municipal Codes. There are nitrates present. It is ~g~ -~h~ ~ per~od~c t~stinq be performed to insure the wells Continued ~:uitability. Nitrate concentration is 5.42 mg/1. EPA ~um co~cc~atzon ~ !O.O. mg/1. BY :~~'"'¢/,"¢~ j~-¢¢-''*'- - Date ~,/~ 0/..~,,, 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. 72-025 (Rev. 1/~J1 ) Beck MOA ~21 MUNICIPALITY OF ANCHORAGE ~.NVIRONMENTAL ~RVICE$ DIVISION Municipality of Anchorage JUL ]996 DEPARTMENT OF HEALTH & HUMAN SERVICE.~ ECEIVED Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Health Authority Approval Checklist Parcel I.D.: Well type Log present (Y/N) Total depth ~-~ / ~ Sanitary seal (Y/N) Date completed Cased to ~'~; ~' If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly protected (Y/N) Date of test Static water level Well produCtion FROM WELL LOG g.p.m. AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform ~- Nitrate Date of sample: ~'/~ ~/~ ~/ B. SEPTIC/HeL-Bff~IG TANK DATA Date installed O~/~/~/ Tank size Foundation cleano,ut (Y/N) ~/~--5 Depression (Y/N) Date of Pumping x/Y/~ Pumper -'"'- ~'~,/-~ ~-- Y~b/g---- Other bacteria Collected by: Number of Compartments ~-- Cleanouts (Y/N) ~-~ High water alarm (Y/N) C. ABSORPTION FIELD DATA Date installed (~-//;~/~.~ Soil rating (g.p.d./fF~r R~/bd,-m) O~ ~ System type Length ~'~) / ' Width ~-~ / Gravel thickness below pipe ~ ~ /To,al depth'. Effective absorption area ? ~'O ~ Monitoring Tube present (Y/N) Y~'~ Depression over field (Y/N) Date of adequacy test /A/~.2 Results (Pass/Fail) P~'~' For Fluid depth in absorption field before test (in.); .~/.~-' Fluid depth /'~'///~ (ins) Minutes later: ~- Peroxide treatment (past 12 months) (Y/N) ~/./~ ImmediatelY after -'~gal. water added (in.): Absorption rate = ~ g.p,d. if yes, give date bedrooms 72-026 (Rev, 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) High cYele~Tested E. SEPARATION DISTANCES Size in gallons "Pum~_j:~o~' "Pump off" level at* *Datum F. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/hekiing tank on lot //~¢~ / Absorption field on lot /c~ / Public sewer main /k///'//~ Sew'eT'/septic service line //_,/Z~) / On adjacent lots On adjacent lots Public sewer manhole/cteanout Lift station SEPARATION DISTANCES FROM SEPTIC/I IOLDiNG TANK ON LOT TO: Foundation / '~ / Property line ~ ~,~ / Absorption field / Water mcln/cervice line ¢~:20 Surface water/drainage 7c/(~O / Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /¢~ / Building foundation Surface water /"/0~ / Curtain drain /,t./~)/(~ ./:¢p/c/C;~E:~/-'~/ ENGINEER'S CERTIFICATION ~--/0 / Water maiR¢service line //~(P / Driveway, parking/vehicle storage area /,~2~, / Wells on adjacent lots 7/--'/~..~/..,,3 / I certify that I have determined thru field inspections and review in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name Date are HAAFee $. t.~Oc), ~ Date of Payment 2 ¢ ~ "- ~,~ 72-026 (Rev, 3/96)* Waiver Fee $ Date of Payment Receipt Number 0?./02/96 1G:~O CT&E ESI A~3~:GRAGE + ~07 694 ~297 N0.959 ~ CT&E Environmental Services Inc. Laboratory Division -- Laboratory Analysis Report CT&E Ref.~ Cltem Sample ID Matrix PW$1D 0 962635.962635002 McMahon LgA B3 Sample Rmnad~: Collected Date 06/28/96 Tedmical Diredor: Sf~/~hma C, Ede N|trata-N Nitrlte-N Total Coliform Quet 5.G2 -- Z,~O rng/L EPA 353.Z 0.100 U 0.100 mg/L EPA 0 0 Cel/lOOmL SHl~ Aliowabia Prep Analya(u Init Lfmit$ 0ate Date 06/29196 E~8 06t29/96 ~NB U6/ZS/q& TAV U - Ur~t'ect~ LT - Less than GT - Greater th~n ~ - seccr~ar¥ oilution d - Below ~he cslibr~t(on re~( 200 W. Potter Drive, Anchorage, AK 99B18-1605 -- Tel: (907) 562-2343 Fax: [907) ~61.5301 3180 P~ger Road, Fairbanks, AK ~9709-5471 -- Tel: (907) 474.6656 Fax: {907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA. FLORIDA, ILLINOIS. MARYLAND, MICHIGAN, MI~OUI~I, NEW JERSEY, OHIO, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~Iarch 10, 1987 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 9-A Block 3 ~c~ahan Subdivision #1 Location (address or directions) 12721 Killey (b) Applicant Name Orris Presley Telephone: Home _345-52?2 Business Applicant Address 12721 K~_lle¥ (c) Applicant is (check one): Lending Institution []; Owner/builder i~; Buyer []; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: Hold For Pick Up Roy Inman Telephone TYPE OF RESIDENCE Single-Family}~[ Multi-Family [] Number of Bedrooms 4 Other WATER SUPPLY Individual Well l-7[ 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: If corem unity well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page I of 2 72-025 (1~/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with alt Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Whitewater Engineering Telephone ~L~-7008 Address 11600 Cange Road, Anchorage, AK 99516 Date ~areh 10, 1987 Engineer's Seal DHEP APPROVAL Approved for "~"~ C~) bedrooms by ~ "~' '~'""~ Approved // Disapproved Conditional Date Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) icuNtCiPAUTY OF ANcHOrAGE MUNICIPALITY OF ANCHORAGE (MOA) ~Nyj~.ONMENT^t' SE~vtCES OtVt$1ONHEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MAR 1 0 1967 264-4720 REE£IVED WELL DATA Legal Description: Lot 9-A Block McMahon #1 Subdivision Well Classification Private Welt Log Present (Y/N) No Total DepthEST 92' Cased to 50+' Static Water Level Casing Height Above Ground 24" Electrical Wi~ing in Conduit (Y/N) yes Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) N/A Date Completed EST 1976 Yield Depth of Grouting - N/A PumpSetAt EST 92' Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) 8GP~ No 100 +' ; On Adjoining Lots 100 +' To Nearest Edge of Absorption Field on Lot 100 +' ; On Adjoining Lots 100 +' To Nearest Public Sewer Line ~]/A To Nearest Public Sewer Cleanout/Manhole N/~. To Nearest Sewer Service Line on Lot Water Sample Collected by Roy Inman ; Date ~/5/87 Water Sample Test Results Satisfactory Comments B. 'SEPTIC/HOLDING TANK DATA Date Installed 7/30/7~, Size 125~ Standpipes (Y/N) ye.~ Air-tight Caps (Y/N) Depression over Tank (Y/N) 1')O Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) N/A Separation Distances from Septic/Holding Tank: To Water-Supply Well 100' To Property Line 65' To Water Main/Service Line 2_5 +' Course 100+' No. of Compartments ye.~ Foundation Cleanout (Y/N) Date Last Pumped Oct.. 31 1976. N/A ;for Temporary Holding Tank Permit (Y/N) To Building Foundation .LO To Disposal Field 10' 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 211 sq Square Feet of Absorption Area 844 Depression over Field (Y/N) no Results of Last Adequacy Test Satisfactory Separation Distance from Absorption Field: To Water-Supply Well 100 +' To Building Foundation ~- 6 ' I_ot · To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ft Type of System Design Length of Field 43' Depth of Field 14' Gravel Bed Thickness 10 ' Standpipes Present (Y/N) Date of Last Adequacy Test Trench 3/9/8? To Property Line 1 .~ ' To Existing or Abandoned System on ; On Adjoining Lots 3© +' To Cutbank (if present) D. LIFT STATION [Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for e~, Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA R * Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify~..~ave cjqecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signe'~?~"Tcc~z'~.~¢~ ,-~;¢2L?~-~/'~<.~/_. Date March 10, 1987 Company ~hitewater Eng MOA No. Amount:$ ' /~ ~ ._~" .~:"'~ Engineer's Seal Z2-026 (11/84} ~ ~ ~ ~[e~~ ~ ~'=~ - -~ (~- DATE RECEIVED --, INSPECTION APPOINTMENTS M~~__~_...~ ~ TI.~M E TIME TI DATE DATE DATE DEPT. OF I: D",LT, [ MUNICIPALITY OF ANCHORAGE ENVIRONMENT,,~L FL.AZCTION  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street- Anchorage, Alaska 99501 MAR 2 ~ ~gS0 ENVIBONBENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER ~ PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION ~ PHONE MAILING ADDRESS 4. REALTOR/AGENT J PHONE MAILING ADD~ ESS~ 5. LEGAL DESCRIPTION J STREET LOCATION SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [~ Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~] INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6179)-- THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] S~X PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL -~3EPTH OF WELL [] COMMUNITY -DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED Connection Verified. 'iNSTALLER []Septic Tank or []Holding Tank Size: I '-~,~ z~'~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area ISewer Line I Nearest Lot Line WELL TO: I Absorption Area to nearest Lot Line 5, COMMENTS :. _ PROVED FOR 4-- BEDROOMS [] CONDITIONAL APPROVAL {letter must accompany certificate) [] DISAPPROVED DATE 72-010 (Rev. 6/79) Time ,~,. MUNICIPAL~'f~$ ~' ANCF'O~:;.r~P-'--, OF HEALTH AND ENViR~iti[',7.~ ; PROTECTION 825 L S_~eett-~ ', Anchorage,. Alaska 99501 279-2511, ext. 224 or ~25 Date Received: ~.A~u~9~~%~2 ~3: ' Time Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES .z, end~ng In'=tltutmon Request: National Bank of Alaska % Ruth · .Mailing Address: Post Office Box 3-3859 99509 Phone: 279-250( Property. Owner: Mailing Address Alfred E./Doris J. Mead ~ 344-1187 Phone: , Star Route A Box 1550-0 99507 3', Legal Description: Lot 9A Block 3 Mc Mahon Subdivision 4~ 7t Distances:~ Well to Septic Tank 4~. ~ to Sewer Line to Nearest. Lot Line Single Family Residence: (x) Multiple. F~mmiJ. y Residence: ( ) Well System: Permit Constructions. Individual well (x) Depth of Well Sewage Disposal System: On-site System (x) Permit ~ Installed N".~mber of Bedrooms: Three Number of Bedrooms: Con~unity/Rublic System ( ) -. Well Log on File ( ) Bacterial Analysis Public Utility ( ) installer Septic Tank Size Absorption Area Manufacturer Soils Rate . ~ Material to Absorption Area Nearest Lot line Absorption Area = -~., Departmen ....... and Water 't of Health and ~nvlron~lental ProtecZlon Reque'.~![.' ~or Approval of In'dividual Sewer Facilities ~gal DO. script~i0n: Lot 9A Block 3 Mc Mahon Subdivision Let eer Attached. Date: .... IVIUNICWALFf'Y OF ANCI4OI.~AGI_:. DEPARI'MEIgT OF EFJVIItONMEP~TAL QUALITY 825 L Street Anchorage, Alas]ca '- 9951)1 REQUES7~ FOt~ APPP:OVAL OF INDIVIDUAL SEWER and WATER FI;,OIt_ITII.:S 1. Type of Irtsl)ection: CMRO VA 2. Property Owner: MEAD, Alfred E. and Doris J. o · FI4A . CONV XX M~iling Address: SRA Box 1550-0, Anchorage, Ak. Name of Buyer: Owner/Bu i lder Day Phone 344-1187 Mailing Address: Same Name of l..ending Institution: National Bank o~: Alaska Mai!in§Address: P.O. Box 3-3859 Name of Realtor or Agent: NONE · Mailing Address: 'NA ,¢~y Phone NA Phone 279-2506 Phone NA- 6. Legal Description: Lot 9A, Block 3, McMahon S/D __ o Location: Corner of Furrow Creek Road and Killey Street . ' Anchorage, Alaska Type of Facility to be inspected: Wa~er Supply 7yp~! of Supply: Frame Tril-level Sgl Family Res. No. Bdrms. P~blic Udiity individuM Well 3 finished If Individual, number of dwellings presently served If Individual, depth of wel 100' + Sewag~ Disposal Systern Type et System: Public Utility If Individual, date of ins[allation Individual (on-site) XX EO-037 (1174)