The URL can be used to link to this page

Home My WebLink AboutMCMAHON #1 BLK 3 LT 24 ,,*' "L, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS I LEGAL-D~SC~IPTIO~"- LOCATION DISTANCE TO: I Well/ ~ ~¢' Manufacturer Liq. capacity in DISTANCE TO: Manufacturer DISTANCE TO: IF HOMEMADE: No. of Top of tile to finish grade,/ Length~.~ ~ Tyl~ e~.Qf crib DISTANCE TO: DISTANCE TO: Absorption area I Dwelling Material Inside length Width Dwe ng ,H ON E ~(~UPGRADE NO, OF BEDROOMS No. of compartment~..~ Liquid depth PERMIT NO. Material Liquid capacity in gallons Foundatio~ ~ ~. PERMIT NO, Total le .t~; lines Nearest lot line Trenah inches inches Material beneath tile~., ~' l'/' Width Crib diamete~.~ Well /.~ ,~ : Building foundation Distance between lines Total effectiv¢ absorption area PERMIT NO. Total effective aJ~orption area Nearest lot line Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIA LS~ T / C SOlE TEST RATING INSTAELER REMARKS APPROVED .~ 72-~ (Rev. 3/78) DATE LEGAL PERMIT NO. FIPPL.. i CF~NT HILLiRH GraTES LOCFIT I Oi'.,i LEC'iFIL LOT 24 Bt._[.':'. 2, MCMFtHON :'StJB DEPFIRTf'iENT OF HEiaLTH FIN[:, EN'v'IIROI"]HENT.FtL PF.'.OTECt"]:ON 8~5 "L.'" STREE]'~ FtNC:HORFff]iE', FIK. 87:0:394 ) ._-..... 4~. I)f)F.:OSt~I I FI [:,R. L.OT SIZE '"":~':"':':~':L~.- .. - -, ~ S[.:.!I..IFtRE FEE"[' TYPE OF 'SOIL FIB'$EF.'PTION :L':;YL-STEH IS: TRENCH I~ {-l' , THE fE~..IRE[:, SI'ZE OF THE SOIL FiEv:;'F.'PTION S'.r'STEM IS: "FHE LENGTH DII',IENSION IS THE LENGTH ,.'.IN FEEt') OF THE TRENCH OR [:RBINFIEL.'. THE DEF'TH OF R TRENC:H JF:. PIT IS THE DI..THhtL. E 8ETHEEN THE SURFBC:E OF THE 3DOUN[:i ~N[:, THE E:OTTOI'q OF THE EXC:fiB/[~TION <IN FEET). THERE IS NO :~;ET WIDTH FOR TRENCHES. THE GRFI',/EL DEPTH I5 THE klINIPiUM [:,EF'TH OF GR~VEL DETWEEN "FHE OUTFFILL F'IPE ~f.,l[:, THE BTTTEM OF :FHE E}:;CFIV~TION ,'IN FEET.)..:~ _ F'ERM I T i:~PF'L, i C:FiNT HFS':; TH~' F,E',:;P~nNS I E:I L I TY TO I NFORH TH ~ S INSTFILL_FtTION IN:,FEL. TI..N_, OF BNM HELLS ~[:,JFiCENT TO THI~ F'R"PERT'~" ~N[:, THE NUHE:ER OF RESIE:,ENCE:5 THFIT THE HELL WILL SER',)E. BFICKF']:L. LING OF Fif',IY S'~ STEM H! THOUT F I~.4FIL. INSPECTION BN[:, Fi~'PROVF~L 8¥ THIS [.,EF'~RI"HENT HILL BE :~_E.IE}]' "1"0 F'RF~]ECUTiON; · ' ' MINIMLIM [:,ZSTRNCE E:ETHEEN R 14ELL FINE:, ~N"F CIN-~ITE SEHFIGE DISPOSal.. :S'~:STEM IS i00 FEET FOR Ft PRZVFtTE !4ELL OR j.~lIZl .TO 200 FEET FIE:OM ~. P.IBLII:: HELL. E:,EF:ENDING UPON THE T'YF'E I]F F'L.IEL~C HELl .... :,EHER LINE I~ 2'Pq FEEl" MtNtMUH DISTI:~NCE FROM f~ F:'RIV~TE WELL TO i~ PRIVlaTE c" TO Ft CEIHHUNI'F'~ SEP. IER LINE Z~ 'Z~ FEET. r'THER RE(:!LIIREHENTS HR¥ BF'PLY. S:F'EI]~FIC. FITICINS ~P,ID ':EH':STRUC:TION E:,IF~EiRFIHS FIRE F~VFtILFiBLE TO INSURE PROPER INST~LI..~T~ON. t::. .---. F' ]: [RE:'.E: [,,. E3_-E~I 1E..EF. :.[~.:~ .... ::L i CERT I F"r' THFIT ,-. ~ L, SE'[' ::L: I FtH FFII'"IILIFIR HITH THE REQUIREMENTS FOR ON-:SITE .:,E. HEF.... FIN[:' WEL. L::': FORTH E:"r' THE HLIIqlCIPFIL]:T"t OF FINCHORFIGE. :~: I HILL. II',L, THLL THE '-=,¥STEM IN FICCORDFINCE FILTH THE bEE. E:,. 2]~.: I LIN[:'EFISTFII'"I[:' THFIT THE: ON-L::I1-E SEWER S~TEH i'"IFI"r',.~iRE ENLFIRGEHEhlT IF' THE /:..:///. / · .,;._ ,' - FIPPL. IC:F-INT l,.lILLilal'l C, iFITEb / 0~D _ _ ,, GRP'-]'R ANCHORAGE AREA BO ]GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /:U.",'~'J-"/~¢"/ :<?,4; F':~?:;~.2:~:/L~ MAILING ADDRESS/9 ~ '¢¢¢~:'/f' ~'::) /*¢/ LOCATION ~/g~t':):/'/// .~2~>/F LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH NUMBER OF MANUFACTURER ~<-~"¢..~.:',~:~'i~' MATERIAL ~'"~""-¢'~-": ~''' COMPARTMENTS '¢';'>'/"~- INSIDE WIDTH LIQUID DEPTH __LIQUID CAPACITY /~:L527 GALLONS. SEEPAGE Pit: NUMBER OF PITS ~2/'//'~ DIAMETER .... OR WIDTH __ , LENGTH ":? ~, DEPTH / '-~./?¢.~,:/.i'. LINING MATERIAL $-/!//~.,,?:'. CRIB SIZE: DIAMETER / .' TOTAL EFFECTIVE BUILDING FOUNDATION / NEAREST LOT LINE J~¢~' . · ABSORPTION AREA (WALL AREA) ¢'~'~'-~' .SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE ///-//:'/ BUILDING //.; //.~ FOUNDATION CESSPOOL APPROVED //.~;;..- ~.~:,..~:¢..-"2/.~:'?-2~' CONSTRUCTION DEPTH ,/~"~'}~5'¢- /'J:~/ ' DISTANCE FROM: NEAREST ~. // NEAREST SEPTIC -~ / SEEPAGE / LOT LINE' SEWER LINE /'// :/ TANK--/:>& SYSTEM OTHER SOURCES DISAPPROVED REMARKS DISTANCES: PIPE MATERIAL: LOT SLOPE: REMARI~s: DIAGRAM OF SYSTEM DATE / b'//'/?/; ~/'APP ROV ED G.A.A.B. ~/h¢-:'.,%,~' Form No. EQ~031 GrEATEr ANCHOrAgE ArEa Borough DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456! PERMJT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT Name of APFUCaNT INSTALLATION LOCATION ~)~//~JS/~//~/ /L) .K/~~ , INSTALLATION OF: SEPTIC TANK JZ:~ SEEPAGE PIT ~ . DRAIN FIELD , OTHER 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 MINIMUM DISTANC~ES, REQUIREMENTS ./ fOUNDation TO SEPTIC TANK ~ FOUNDATION TO SEEPAGE Pit SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK , SEEPAGE PIT TO NEAREST LOT LINE. / WELL TO SePTiC TANK ~'~)~:~ DRAIN FIELD DIAGRAM OF SYSTEM WATER MAIN TO SEPTIC ~;aNK J~/ / DRAIN FIELD /~ / SEPTIC TANK, SEEPAGE PIT TO RIVER, LAKE, STREAM. , DRAIN FIELD , DRAIN FIELD ALSO CONSIDER AREA WELLS. ? , SEePaGE P~t ~ · DRAIN FIELD. 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 BACKFILL CONFORM TO BOROUgh REGULATIONS REGARDING INSTALLATION. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE'REQUIREMENTS OF GREATE~ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCEs. / .- WITH SAID CODE. l ~/~-~~ ~// //~ ~ ~ .~ // Performed for !Jta~;,~ ~__~'iF~m Legal Description: /~'~ ~ ~ ~hg'ao~ This form reports: Soils log ~ department of Environmental Q~ 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - PEROLATION TEST GREATER ANCHORAGE AREA BOROU cy Date Performed Percolation test Depth Feet 6- lO- ll - 12- 13- Was ground water encountered? ..~C? If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rate minute. _J Proposed installation: Seepage Pit Drain Field [)epth of Inlet Depth to bottom of pit or trench COI.1IIENTS: EQ-040 (6/74) On-Site Sewer Study 'by R~bert Neale ,10/21/74 Owner: 'Location: Legal: Soil Sample: Marston Realty Doroskin Ave. off Huffman Road Lot 24, Block 3, McMahon Subdivision 146 ave. to 14' Conditions: 2 3 4 5 6 7 8 9 l0 ll 12 13 14 2' to 7' sand and gravel 7' to 9' clay layer - 250 soil 9' to 14' sand and gravel 1,250 gallon septic tank - Greer Steel 4 diameter steel ring cesspool - Greer Steel Approved 10/17/74 IVI-VV ~fllLLINL~, InC. P.O Box 110378 · 10330 Old Seward H~ghway (907) 349.8535 ANCHORAGE, ALASKA 99511 Well Owner Location H.E. Guenther DRILLING LOG Useof Well Domestic (address of: Township, Range, Section, if known;or distance main road Lot 24, Block 3, McNann Subd Size of casing 6~ Depth of Hole Static water level 179.7 ft. Screen ( ); Perforated ( Describe screen or perforation Well pumping test at__.LO__gallons pe~' of drawdown from static level. · Date of completion ~/10/86 " 200' feet Cased to 200' feet (below) land surface. Finish of well (check one) open end ( X ). (minute) for 1 hours with [00% WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO 178' 01d Well TO_LRS___ _~TO 2DO TO. TO. TO. TO TO TO. TO . TO. TO TO TO ); ft. Silty Gravel; with seapage Water bearing ~rav~a~some sand ~ r~O[EL[iO~ NWWA Certified Contractor Certificate No's. 814 & 973 I --CUSTOMER Location (address of: To~,-aship, Range, & Section [if known); distance.from rosa: Sizo off Casin2 ~ Depth off Hole (check one) Open end ~: Screen ( ): Perforated ~escribe screen or perforations: Well pu~)ing .test at ~gallons per. (hr) (m~ for ~ hours with . ~/ feet of 'drawdown from static level. _~epth in feet from Give details of formations penetyated, size of material, ~ound surface color, ~d hardness. 'tO tO tO tO 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 (~/~2 - '~/~/. -~ q-'~ .HAA# 1. GENERAL INFORMATION Complete'legal description - /...o~- '~/~-~g~cl< ~ Location(siteaddressordirections) ¢~ ~ ?' ff / ?~'l e~ o 3#/.<,/ S l' b ProPer~Y'o~ner Mailing add'ross Lending agency Mailing address Day phone Day phone Unless othe~ise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ ~' TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water 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, 1/91) Front 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~--'~A/u-'ue/u~ ~-,,uc,. ~¢C Phone C/¢o:~) Address "=~:~- e,':~o'v-- ~'o --~ 9 ~-~-~' Engineer's signat~r~ ' DHHS SIGNATURE L'// Approved for F0U//~ bedrooms. Disapproved. Conditional approval for bedrooms, with th'e following stipulations: Additional Comments 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. 1/91) Back MOA~21 RECEJVED Municipality of Anchorage ~ .¢m DEPARTMENT OF HEALTH & HUMAN SERVICESApF( ~ 1999 Environmental Services Division /n~u-~lk'/u~'qlFJ~°l'A;~'ch°lr~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · [~..~()~1~4g~(~man S~rvices Legal Description: A. WELL DATA Well type ~:::¥2 ~u'A'~-~. Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production Health Authority Approval Checklist Parcel I.D.: IfA, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to '~ ~¢ Casing height (above ground) Wires properly protected (Y/N) It FROM WELL LOG g.p.m. AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform ~-- ~ ~ Date of sample: /---¢'/~,C/ Nitrate '~ '4~ '~ Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed '?--~.7 Tank size Number of Compartments ~/t Cleanouts (Y/N)___ Foundation cleanout (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Date installed 4-'~0 Length ~-~. , Width Effective absorption area ~'~,~--- Date of adequacy test Depression (Y/N) Pumper Soil rating (g.p.d./fF or fF/bdrm) ~ ' Gravel thickness below pipe Monitoring Tube present (Y/N) Y' Results (Pass/Fail) High water alarm (Y/N) O..P- ~'~ /~2 ,~ System type .5---u-~,¢ / ~'~,, ~ Total depth ..~ . Depression over field (Y/N) ~ Fluid depth in absorption field before test (in.); '~ Fluid depth ~0~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) For /-'/ bedrooms Immediately after ~ gal. water added (in.): ~ q '~ Absorption rate = /~oc; 'f- g.p.d. If yes, give date 72-026 (Rev. 3/96)* O. LIFT STATION / , / Date installed /'~~~- Manhole/Access (Y/N) _...-.---'"'~u~p on" level at* _ "Pump off" level at* High w ~Datum _ C..~,les~tested E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / 0 c~'r Absorption field on lot /c~'/ Public sewer main ,4//~ Sewer/septic service line Zee 7-- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation --~ r, Property line / ¢ ~ Absorption field Water main/service line -5'o~ Surface water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station ~t Wells on adjacent lots Building foundation "3 ~ Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ZC~ F. ENGINEER'S CERTIFICATION HAA Fee $ Date of Payment Receipt Number I certify that I have determined t~bru field inspections and review of Municipal records~~.~.,ti~~V~stems are Engineer's Name ~~ ~~W t~' Date ~ ~/~ ~ Waiver Fee $ ' Date of Payment Receipt Number 72-026 (Rev. 3/96)* Steven R. Pannone, P.E. Consulting Engineer P.O. Box 102954 Anchorage, Alaska 99510 (907) 272-8218 SEPTIC SYSTEM ADEQUACY TEST Legal: Owner: Residence: Lot 24, Block 3 McMahon S/D Mr Frank Winfield 3941 Doroshin Ave, Anchorage AK 99516 Septic System: Tank Size: 15 0 gallons. Absorption System Type: Crib/3\5-wide (from Municipal records) Absorption System Size: 20xl 8x9/76x5x2 Absorption 3,rea: 456 + 625 s.f. Installation Date: 6-74/7-83 Soil Rating: 125 sf/br Date of Pumping: 4-23-99 By: A+ Home Services Date of Test: 4-23-99 Test Procedure: System was inspected visually and measured. Tank was found with 4 feet of cover. Liquid depth was measured to be 4 Inches. The drain field was found to have 46" of cover and a total depth of 52". There was 20 inches of liquid measured in the field's monitor tube. Water was at a rate of 6.5 gallons per minute (GPM) to the fields monitor tube. Water levels in the tank and drain-field monitor tubes were monitored. A total of 600 gallons of water xvas added. During the test, the liquid level rose 4 inches in the drain field. There was no rise in the septic tank. The infiltration rate was monitored for 1.0 hours. During this period, a total of 600 gallons were absorbed. By the observations made, this system has an absorption rate 600 gallons per day at the time of the test. The well xvas tested at the same time as the septic system. The well had a static water level of 153 feet below the top of the casing. It was drawn doxvn to 154 feet below the top of the casing while it was producing water at a rate of 6.5 gallons per minute. The casing stuck-up 26 inches above the'ground. The sanitary seal and wire protection needed to be upgraded. Hefty Drilling xvas contacted by the Owner to upgrade the sanitarty seal and protect the wires. Water was tested for bacteria and Nitrates. Test results are not available at the time of this writing, and will be forwarded once they are available. TESTS RESULTS: This system meets the code and operational requirements of the Municipality of Anchorage. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all xvells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control ofthe evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. We can therefore not give any estimate of how long the system_.,}llig.~,l~nue to meet the operational requirements of the Municipality and State. 18:$0 F RO)~-CI~ ENVlRON~NTAL m~ OT&E EnvirOnm=n,al Services T-40Z P.02/03 F-Z6I Ctiea~ Name {Eroj ~'1 Name/# Client S~ple ~ Or~ By PW~ 9917OO00 l ['au-none E~, S~, L24 B3 Back Hose Wu~r ($~rf~¢, ~ff., Orou~) Clien~ PO~ t~-i~ed Dale/Time 04/29199 15 02 Collected Date/Time ~/25/9g 1~ ao R~cived ~e~'img 04/26/99 09 ~ Te~ical Dir~or: ~teph~ll C. ~d,' Nitrmts-N 3.03 0.500 ,'ni{tk EPA 300.0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner,~'/'/~'//-- ~~ Telephone: Home ~ ~ Business M ilin Address (c) Lending I~stitQt!on; :~:,-~ ~ / ~ Telephone Ma~hng Address ~ ,, "'~ ~/~¢ ~ ~~ (d) ReaF~state Company,and AgenJ" ~/ / . Tele~dde- ...... ~¢~ ~ ~,. (e) Mad,the;HAA to, the follow~nq address: or: Check here ~, if hold for pick up. List ContaCt person and pay. phone number below. TYPE OF RESIDENCE . , Number of Bedrooms , . . WATER SUPPLY" Individual Wel~ Community Note: If community well system, must have written confirmation from the State Depadment of Environmental Consolation attesting to the legality and status· SEWAGE DISPOSAL OnsiteA 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 fRev 8/86~ Fronl 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 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 .,~z,,'~.~ ~-~-_ ~-....-~-~.,,~ Telephone Address ~:;~2t/ //~?,J~.-5" ~ D ate .,/~-~'~ / -..;-..;-..;-..;-.-~' ~ . Approved for T,"?' ~ bedrooms by Date Approved ~"" / ' ' ', "'/ "Disapproved Conditional Te~rms of Cond, itional Approval CAUTION 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. Page 2 of 2 72-025 fRev 8/861 Back WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: -,,~'~'~' ~'~ .~"/'~ '-~ Well Classification ,,~/,/a,¢; ;~ Well Log Present (Y/N) / Total Depth ~',~"~ Cased to Static Water Level /7~, ~ ""~.,,~ u,, Casing Height Above Ground ~'~' Electrical Wiring in Conduit (Y/N) If A, B, C, D.E.C. Approved (Y/N) Date Completed o- ~ /o-~Z~Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead Separation Distances from Well: To Septic/Holding Tank on Lot /~'~' ; On Adjoining Lots ~ To Nearest Edge of Absorption Field on Lot /~'~" ; On Adjoining Lots ,,,Go ''~" To Nearest Public Sewer Line ,'~,,'~ To Nearest Public Sewer CleanoutYManhole ~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~.~_//4' .'/~'~.~ ; Date ~"-/'/~ Water Sample Test Results ~/./~ -~.~/ Comments ~)~'///' ,'-/~,.~'/")~'-'~-~' '=''' ~'-"'~ "~ ~ B. SEPTIC/HOLDING TANK DATA Date Installed L~--/~- ~'~ Standpipes (Y/N) Depression over Tank (Y/N) Size Air-tight Caps (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~,~5- / To Property Line ./z~ r/ / To Water Main/Service Line '~/,,~ Course . ~, No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped /"~/./- ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ~?/ / To Disposal Field /¢ ~' To Stream, Pond, Lake, or Major Drainage Page 1 .of 2 ABSORPTION FIELD DATA Soils Rating in Absorp, tion Strata ,,'/~'--~" ' Date Installed ~'/~ · Type of System Design Length of Field Width of Field ~ ~ "' Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ,/~ ~ '~ ' To Building Foundatior~' Lot To Water Main/Service Line "~,,/~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking A~:ea; or Vehicle Storage Area To Property Line /.,:, To Existing or Abandoned System on ; On Adjoining Lots ,,,~ c,/-~ To Cutbank (if present) . Comments Do LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for -- - Electrical Codes (Y/N)' h" ' Manhole/Access (Y/N) "Pump Off" Level at ' V~n{ (Y/N) ': Pumping' ~;ycles during AdequaCy'Test. Meets MOA Comments- - - '' ' " ** Check Pe~'mitted Bad'room Rating Agair~st HAA Request ** "' -" " I ce rtify t ha.~.,,~a/v.e./~c~/e~ed, verified, or conformed to all MOA and HAA guidelines in effect On the date of this inspection. Signed ~-~:--~-..~ '"' Date __.'/~-/~",~'~' _. ' ""' ' Company/~///-~,~'-~-,', ~'~" MOA No. '~-)'"'/~'~'~ -~:~ ~ .... ' Receipt"Nol 1 0 O'/ O i~/// Date. . of_ Payment Amount: $ Page 2 of 2 72-026 ~Rev 8/861 Back BEVAN ENGINEERING P.O. Box 112852 Anchorage, AK 99511 Approved Well & Septic Engineers (907) 522-1383 (907) 258-0584 December 12:, 1986 Municipality o.~ Anchorage Depar"tfaent o~ Health & Environmental Protection 825 "L." Street Anchorage, Alaska 995~J1 Re ~, Harry Guentlner, Health Authority Approval (HAA) Application Lot 24 B.1. k 3 McMahon Subd. :~l Gent .1. eraer) : During the period ~rom December l~.~l to December 12, 1986 we per.~ormed research., site investigations., well ¥1ow testing and absorption ~ield testing pursuant to Health Authority Approval on the above ) =,erencud lot We per.~ormed a well flow test and found the well production to be .3.2+ gallons per minute (gpm). This exceeds the required ~L. 4167 gpm ¥or a 4 bedroom home. We took a water sample ~or Coliform analysis and the results were )negative. W~: performed an adequacy 'best on. the septic system and determined that it absorbed at a rate o¥ lf_~f:!~ gallons per day (gpd). This exceeds the 6~Z~ gpd required ¥or a 4 bedroom home, The septic tanks were pumped and the volumes verified to be 1~ii~..'3 and 5~#) gallons respectively. To our knowledge ail o¥ the information requested on the HAA Checklist and App.1. ication has been assembled. We are submittir~g this data to you ~or your review,, Please contact us if we can provide: any additional in¥or'mation. Sincerely, Hugh R. Bevan F'.E. Attachments : HAA Application HAA Checklist Sewer As--bui 1 t Or:i. ginal Soils Investigation Original Well Log Improved Well log Total Coliform Analysis Septic: Tank Pumping receipt c:c: Har"ry Guenther 862~?]9-ws APPLI(~"'~NT FILLS OUT UPPER HAI'-~ONLY Phone Address .~'f?f?) ,~_ / Zip Code Lending lnstitution /' ~..~/ /,-////~F*d ~',~,-( TM ~ ~, ~Z~ / /~/'?z.--Z~.< Phone Address ,'~ .-"? Zip Code Realty Co, & Agen~2~/~ .~ .~ /~., d.~'~ i.~- ? Phone Type of Residence ~>4~'ingle Family [] Multiple Family No. of Bedrooms [] Other Water Supply 'Jndividual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community . For wells drilled prior to that date, give well depth (attach log if available}. [] Public Utility Sewer Disposal - ~individual Year individual Installed: [] Public Utility Whsn Connscted to Fublic Dtility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGE ' t~bL:;'' DEPT. OF HEALTH & ~/t~ ~o JUN 2 8 - RECEIMED ( ~?) APPROVED BEDROOMS *CONDITIONS OF:APPROVAL ( ) DISAPPROVED ( ) CON DIT/IONA)E,~=APPROVAL* DATE ~//~'~2/~//c ,'~ ,~ BY: .: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72-023 (3/82) ALASKA IidlROI meFITAL COF1TROL $1 RUICe$, IFIC. I~nqineerinq $ ~nuironrncnlal Stu,:lics June 27, 1983 Municipality of Anchorage Department of Health & Environmental Protection 825 L. Street Anchorage, Ak. 99501 Re: Health Authority MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH ENVIRONMSNTAL PROTECTION RECEIVED On June 21, 1983 our company collected a water sample from the house located on Lot 24 Block 3 McMahon Subdivision. The water analysis was satisfactory. The well has a seal and the casing stands approximately 1 feet above the ground. The electrial wires are completely enclosed in metal conduit. All of the standpipes are capped. The well is located 100 feet from the septic tank and 100 feet to the leach field. The results of the bacterial test for the water is attached ..... 1200 LUcsl 33rd Augau¢, Suite [~ · J~nchora§~, Alasko 99503 · {907) 276-1361 ALA.$KA E FILIIROFIm FITAL COF1TROL SeRb'ICeS, IFIC. I~nqineerin9 6 ~nui~onmenlol Studies MUNICIPALITY OF ANCHORAOE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED BILL GATES SRA BOX 1572-X ANCHORAGE AK 99507 SELLER - BILL GATES SUBDIVISION-MCMAHON BUYER- BLOCK-3 LOT-24 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A SEEPAGE PIT WITH AN AREA OF 456 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 232 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 116 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A HOME OF 3 BEDROOMS. THE SEPTIC TANK WAS PUMPED ON 11/5/81 SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 3 BEDROOM HOUSE. 1000 IS ADEQUATE FOR 1200 LUcsl 33rd Auenu¢, Suil¢ [~ · Anchoro§e, Al~sk, 99503 · {907) 276-1361