HomeMy WebLinkAboutMCMAHON #1 BLK 3 LT 32mDepartment Phone: 9a7-343-79 Development Services Det}4 � p Fax: 9Q7-343-997 On -Site Water & Wastewater Section \ Well Drilling Permit Number: Parcel Identification Number:0/7 - 36t --I ?— Date 12 - Date of issue: - - Legal Description=Block Lot Pro erty Owner Name & A ress: � yl'a, Pump Installation Date: Pump Intake Depth Beloiv Top of Well Casing: feet Pump Manufacturer's Name: - ti�x Pump Model: S Pump Size: fi 2' hp Pitless Adapter Burial Depth: 1.5 feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Co letion? 8' -Yes ❑ No Method of Disinfection: Comments: Pump Installer Name: Company: Mailing Address: Cite: _ ANCHORAGE WELL & PUMP SERVICE 7540 King Street Anchorage, AK 99518 PH: (907) 243-0740 State: Zip: Attention: The pump installer shall provide a pump installation log to on-site within 30 days of pump installation ~' '~'" MUNICIPALITY OF ANCHORAGE ¢~,., ~t.~ p .~ ~.../~"~ ~__. DE, .,RTMENT OF HEALTH AND HUMAN SER, ES '~' Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~. H]~~O~ ~. ~ ~/~ ~ SEPTIC ABSORPTION WELL Address ~ --~--'- ~ TANK FIELD Phone(s) Perm,t No. No. or ~ooms WELL ,~- ~ ~O H~ LOT LINE LEGAL DESCRIPTION LOlffi~ B'O~ S~bdiVl~"~ ~.. FOUNDATION ~ I~j ~ ~ ~) ~ ~ dr,vewayl water bodies, etc., TANKS ~ SEPTIC ~*lS%la~ a HOLDINe ST~gL T~O TYPE OF SYSTEM / /, :,0 ~TRENCH ~ BED ~ WiDRAIN ~ OTHER ~ FT ~ FT ~ FT ~ ~/ FT Tota[graVeiabsorpbonlenglh a~ Gravel w~dth ~ Number ol lines Sod rabng Pipe material WELLS ,~ ~1~ ~ PRIVATE ~ OTHER (Identify) Classdicatlon (A,B,C) i Total Depth FT Cased to FT O L REMARKS: Health Oepadment Approval: // . 72-013 (3/85) D. H ]: NF:;'. :I: C. HS[)N C;'ID dgfi:;l<: NH:liTE PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: LoT ~,~, 1 i,,~c~.~.~,~Township, Range, Section: - I"ID.N1 ~(~' ~.C_ P-~ SLOPE S TE PLAN 8 10 11 12 13 14 15 16 17 18 19 2O Gross Net Depth to Net Reading Date Time Time Water Drop ,~ ,o ~ 2'~ ~/~ WAS GROUND WATER y~ ENCOUNTERED? , S IF YES, AT WHAT DEPTH? q p E Deplh l0 Water Alter I ,,,,,.,,or,.,:' Oa. PERCOLATION RATE TEST RUN BETWEEN COMMENTS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72~008 (Rev. 4/85) 1059' LOT 33 -~150'+ ~o well X--X X--X X~XTX 20 X 35 X 3 ~edroom House LOT 31 88' ~o well CENTER LINE DDROSHIN AVENUE GRAPHIC SCALE 1" = 30' I ~-A 3~ FT 0 MONITORING TUBE 0 0 II CU. 4' THREE RUNS OF PERFORATED PIPE ~ SPACED AT 5 FT, b- ~ ~1 oc r- J MONOTORING TUBE 0 IONITORING TUBE ~ ~ 11/20/86 A Existing Tank SECTION A-A A~ BUILT NOV. 84, 1986 TOBBEN SPURKLAND P.E. 803 W 15TH. AVE. ANCHORAGE, ALASKA JLDT 38, SEC 88, BLOCK 3, McMAHONI T1EN, R3U SEPTIC SYSTEM DESIGN NOVEMBER 5, [986 109' to weO LOT 33 ~150'+ to wol~ ] : X X X X--X X~X X X ~ ~ 3 ~edroo~ Hou.o X ~\ CENTER LINE DDRDSHIN AVENUE GRAPHIC SCALE l' : 30' LDT 21 BP' to ~o~! I ~A--35 FT MDNITDRING TUBE THREE RUNS DF 4' -- PERFDRATED PIPE SPACED AT 5 FT, -- M~N~T~RIN~ TUBE BDTTDN DF TESTHDLE Existing Tank SECTIDN A-A TDBBEN SPURKLAND P.E. 203 W 15TH, AVE. ANCHQRAGE, ALASKA LOT 3S, BLOCK 3, McMAHBN SEC 28, TlaN, R3W SEPTIC SYSTEM DESIGN NDVEMBER 5, 1986 e 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 NAME PHONE ~"N EW LEGAL. DESCRIPTION LOCAT, ON ~oro~k;- r~J ,o.o~,~.~o~s Well Absorption area Dwelling PERMIT NO. ~ ~,s,~c~ ~o= too' .~, ~' 3s' ~ ~ ~ Liq. capacity in gallons Inside length Width Liquid depth ) eeo IF HOME'DE: ~ _ ~ ~ ~ Manufacturer / / Material Liquid capacity in gallons ~=~ DISTANCE TO: Well + ~O O Foundat,o~ Se' Nearest Iotlin~o. PE.MIT~.~ -- of each~n~ t Trench widt ~ ,o.o,,i~s~ ~.;,~ B~ ,.~h~s ~o,.,~.e~t,v~s~,F~.~ ~ ~ot., ,.n~,~ oI~~ ~is,~n~ RtT~.. ~ ~ ~ Top of tile ~o finis~r~de ~ - ~ Material beneath tile ~ Classy, Depth Driller Distance ~ line PERMITNO.~00 ~ Building foundation Sewer ,i~. S~pti~ t~OO Ab*o,ptio2~*~ ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL T[ST REMARKS I ~ '~ -' ~. A P~~ DATE LEGAL 72-013 (~ ~v. 3~78) BOX I1~(~9, STAR ROL*TE A ANCHORAGE, ALASKA 99~02 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH Of DRILLED AT ThE rATE OF ~1~° PER FOOT. ProPErtY OWNER //~. ?o~ ~o~ LOCATION OF WELL SITE ~o 32 /~/~o ~ Su~, /~cJ~a~o~ DRILLEr /~n~ ~ 100 ~e~. WELL LOG: 0 ..... 18' 18 .... 43 ' .97 .... 100' ~o..t.'~ L, eo.w>.¢ ¢zat~e2. /~odgc~¢ 89~11l ~,i/ck 15 ~.eo_2. o~ om.re.*..o,tand2~¢. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLINg WORKS FOr THE SUM OF ~1,900.00 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS SERVICE CHARGE O F 1~% PER MONTH WILL BE A~$E~$ED ON PAST DUE ACCOUNT~. i::i[::'F:'LICFI.'NTt..R~:~:k::Y-,.' PEF,'~i.':ON '_:;Fi:FI E',O'?:; }-'::::!2:.~-13 L.OCR'TI ON [:,OI:;'.O~:_:;H i N Fi'.[) LEGFI[. !.... ]: .:~1 .4CC:~ MCMFhL'!OI",I 't""r'f::'E OF .'::!;O I I.. RE','J'~;ORE:T' 1: ON ~j;'-~"i:?l'Ei'"l ! ~i;: TR[.T.t",!CH MF:/::.::Z!'"IUM I'.,IL.IME:['::R OF [~[;.{[')F?I']I..']I'"i~5 :::: THE F .[: ......I F.F.[.. '.:::; I :.-~:k:~: CIF THE: SO ! I... .::IF.':'SOF?F'T I O1",! ., ~ =, I El 1 1: 'E;: THE LENGTH [:' !' ME!',!~:!; i ON ! :5 THE: L. ENGTH ( :[ r.,I FEET .'.', OF THE TF;.'F.']",II]:!-"! I)l:;~: [::,RI::I 1[ I',!F 1i: E!....[). THE L':'EPT'H OF F:I "!-'RE:]',~CH OR PIT I¢i!; THE: [:,I'.'a;TFINCE EJE]"H. EEN THE ':'::L.IRFRCE OF GROUN[:' FIND TIqE': [?,c'rT ]'OM OF' THE E:qCI:':I'v'FIT :i: ON ,:: Z iq FEET ). T!..!ERlii~ I:i!!; N'" :SE:T ,t,.! ! [:,TH I:::'OR TRF:]qCHE::.'.:; _ . ' .... ' '" ' [::,E:. I I.,IE.[:.N THE F tTFF:IL.I .. 1:::' ): F::'E "FHE GRt:~',,,'f~!:L [)EPTH T :5 THE M :[ t",] 1t: MUM [:,EPTH OF: .at:~.r- , E.L '"' .............. Fhi'.,![:, 1'i-.1[: [3OT"I"Oi"l OF THE E::.::Cfq'v'lqT i ON ".: t t",t F:'EET). PERM ]: T' Ft[':'F'L I Cf::II".!T HFI:ii; THE i::::E':5t:::'Ol",k~i; ! B I L.. ! T"r' "I'1:1 'J: FJ,,FC$::M TH ! ~i!; I}Et::'FIRTMENT [:,L.IF;~: :!i hi(ii THE IN'}.'~;TI:::tLL..FI]']:"Jq",I ):N':'~;F'I!~:CTI(]N'.E; (iF::' I::lN"r' !.,.l k! l... !.... :~:!; I::i[:,..IF:ICE':f',IT TO NLJMSEI:;:: OF: F::IC~.:, ! I.)E]',IL]:,~:!!i; ]'HI::IT THE I.,.IELL I.'.! E!IFII]:I-::]::']:t..L.I.r,I:i IJ)F' I::tN"? ~:';"r':!!!;TEM t.,.tI]"HOI. J]" I::'INFIL. t'I'-,I~;P[:.7. CT]:I}I",I F:IN[) "FI: I.'.. ,I'-L"FH!':5 I}EF'I::II:;::Tt'"IEt",IT I,.1 ! LL 8E :~UEk:rE]::T TO F'P."C C};F'C:L.Ft" ]: M I ?',11 MUM D I :STRNCE: E:ETI,.IEEI'.,! R HELl.. FINE:, :L[!iu;!) F'EET FOR FI PR!"v'FIT'E I.,tEL. L.; OR ::L':!5.~!!] TO ;:?.(i)~!l FEET FI:;?.OPI I::i PLI[:i~L.!C: WEL.L. [:,EF'EI'.,I[:,Z!",IEi LIPON ']'I...IE Tq.'I:::'E OF F'iJE',I....IC I.,.!E:]...[ .... MEI....L L.OC-iS FIRE F.'.':E!:;!U ]: RE[:, FIN[) MU'.:.:.';T [!!~E RETIJRF,!ED TO THE I}F..i:PFff;?.TME.I'.,F!' NITHIN :~:Et [)l::!"r'% OF:' THE HELL cor,iPLETZON. ccr'HE.]q'. RE(-:!U Z F~::EI'qENT:5: MFI"r' FtF:'F:'L"r'. ~;F:'[.:_C: I F ! CFI'F l' O!",P.~5 FIN[:' C:Oi",I~?FRLJCT :[ OIq [:, I I:::IGRFII'"I':'5 FI.RE Fi~,,,'I::I :~ L!::IE',L[!~ TIll I ~',I~-.:L.II:~'.[!!: .PI::::OF'ER I N:E;"I'I::ILLFIT Z ON. ::L: F:'OI;?.TH 8"/ 'FI-..!E MI...INi!:C:IPF:I!...~"t"'-/ OF:' RI',ICHORF!(:iE. 2: Z I.,.I~!...L ZN:5:FRLL THE S"/:F:I'EM Zl"d FICCOR!}FINCE [,.!Z"I"["I THE CODES. ]:: :[ UN[)EF;t:~STFIN[) THf:IT THE ON-":~;ZTE :SEI.qER :5'f~STEM i"!Ft"r' RE('::~LIIF::E ENLt:::IRGEMENT' [;i:[~::~; I !}ENCE I ~; ~:[fiP'IOf)EL..[~:[) TO I P~(:::[ .t.I[:,E: MORE THF:IN ]: E:EE:'ROOI'd:5. L..! .F. I 1 I' THFIT I l::lh'l F:'I:::fI'"I.'I:LIFII:;?. WITH THE I:~::E::I.III-?I:::ZM[::J",IT'~5 FOR ]II'.4...-'Z:;~T"I"[: L:i;[:_:'I.,-IER~i; F:II",I[:' I.,.I[:L.t....:~i; F:I:!~; :i:~f::J"[r' I F 'T'HE [-;,qv~n'A. Johnson P.O. Bo~76 Ch~giak, AK 99567 Phone: 907-688-3085 SOILS LOG- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: marr,~r ~erson DATE PERFORMED: Lot 32 Block 3 :~c_,,:ahon Sub. Add n. #1 12/2/?8 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 O'to'l' Brown gravellv sandy silt l'to 16' Brown sandy gravel with trace slit (O~v) lO0ft2/bdrm Total Depth=l 6' COMMENTS PERFORMED BY: Steven A. Johnson 72 008 (7/76) WAS GROUND WATER L~0 ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE ~V~ SITE PLAN < !-~o I Gross 'Net Depth to Date Time Time Water PERCOLATION RATE {minutes/inch) TEST RUN BETWEEN FT AND -- FT AVERAOE ABSORPTION AREA REQUTR?D ~ .qOTLS LOG -- 110 £t2/bdrm Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ParcelI.D. 1. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 017-361-12 HA,A, GENERAL INFORMATION Expiration Date: ,) ~ - / 4~. - O .,~ Completelegaldescription MCMAHON ~/1 L32, B3 Location (site address or directions) 3601 DOROSHIN AVENUE Current ProperS/owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MYRON & TERESA MEINHARDT 3601 DOROSHIN AVENUE. ANCHORAGE. ALASKA 99516 Day phone Dayphone C/O AGENT CENTURY 21 CRAWFORD; JOSEPH SHAW Dayphone 2739 C STREET ANCHORAGE. AK 99503 562-5592 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3, TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site [] Individual Water Storage [] Individual Holding tank J'-I Community Class Well [] Community On-site [] Public Water System [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority 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 title (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 pdvate or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Cellificates 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 professianal engineer's work. Note: Alaska Water and Wastewater Con'sultants, Inc. shall be paid $ at, or pdor I to closing for the engineering services provided, I 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy that based on the information obtained frern the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS. INC. Phone Address 6901 DEBARR ROAD. SUITE 2B · ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Date 357-6179 Engineer's Comments: In conducting this evaluation, AIGt, VMC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 wells and septic systems depend on the local soils condition, groundwater 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 of the evaluator of the system. Sab~factoty test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKVV14/C, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other pereon cr party is not authorized, nor will it confer any legal dght whatsoever. 5. DSD SIGNATURE X Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Note: The well on this property meets existing State and Municipal Codes.There ere nitrates present. It is suggested that periodic testing be performed to insure the:wells continued suitability. Current nitrate concentration is 6.76 mg/1. EPA maximum concentration is 10.0 mg/1. More information on nitrates is available from the On-Site Se~ices Program, at 343-7904. Attachments: HAA Checklist J Manitenance Agreements Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other (Rev Original Certificate Date: ~ -- /,,,'~- ~) ~ Municipality of Anchorage Development Services Department Building Safety OIvlsio~ On-alta Water & Wastewater Program 4700 ~out~ Bragaw SL P.O. Box 19~650 Anchorage, AK 99519-6650 www.cLanclx~raga.ak.us Legal Description: A. WELL DATA Co HEALTH AUTHORITY APPROVAL CHECKLIST MCMAHON ill L32, G3 Parcel ID: Nitrate _~P_~mg.lL. 017-361-12 Well type pmvA~ If A, B, or C provide PWSID~ N/A Well Log (Y/N) YES Date completed 4/25/79 Sanitary seal (Y/N) YE._...~S Wires properly protected (Y/N) YES Totaldepth 100 ft. Casadto 100 ft. Casing height (above ground) 12 in. FROM WELL LOG AT INSPECTION Date of test 4/25/79 8/30/02 Static water level 85 ft. 73 ft. Well production 8~0+ g.p.m. 6.0+ g.p.m. WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi. Arsenic: . N/A rngJL. Date of sample: 8-.30-02/9-3-02 SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Date of pumping 8/30/02 ABSORPTION FIELD DATA Date tnstafled Length 35 lt. Total depth Other bacteria Collected by: I~ I~ colonies/100 mi. AKWWC, INC. Date of adequacy test 8/30/02 Results (Pass/Fall) PASS Fluid depth in absorption field before test 0 in. Water added 736 gal. Elapsed Time: 26 min. Final fluid depth 0 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type BED Gravel below pipe 6" fl. Depression over field NO For 3 bedrooms 6 in. g.p,d. New depth Absorption rate >~ 450+ NONE KNOWN If yes, give date Depression over tank (Y/N) NO Pumper pBELOW EXlSliNO GR.ADLrl Soil rating ~r ft~odrm) 150 Width 20 ft. ft. Eft, absorption ama, 700 fi2 Monitoring tube '(ES Date installed 11/24/86 Cleanouts (y/N) YES High water alarm (Y/N) N/A A+ HOME SERVICES D. UFT STATION Data irmtalled "Pump on' level at in. Datum E. SEPARATION DISTANCES SIze in gallons 'Pump of~ I~vel bt __ Cycles tested ¸in. Idanhole/A~-'~.~$ High water alarm level at Meets alarm & circuit redu rements?. SEPARATION DISTANCES FROM WEII ON LOT TO: Septic tank/lift station on lot100'+ Absoq:)tion field on lot 100'+ Public sewer main N/A Sewer/septic service line 25% On adjacent lots 100' + On adjacent lots 100'+ Public sewer manholeJdeanout Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10' + Water service line 10' + Curtain drain ~ NONE KNOWN COMMENTS Building foundation 10'+ Surface water 100'+ Wells on adjacent lots 100'+ N/^ Absomtlon field 5'+ Sun'ace water 100'+ Water main N/A Driveway, perking/vehicle storage G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and mt4ew of Municipal records that the above systems are/n conformance w~th MOA HAA guidelines in effect on this date. Engineers Printed Name JEFFREY A. GARNE$$ Date Waiver Fee $ Date of Payment Receipt Number in* I I ~ ~r~..~ II ,~:¢......~.~ ?~ ~,~ ~. ..,.d..~¢. //-,/~8/~ ,.-,,~.,,,~ AS- BUILT it,e...4 d. Me emi.,., .,(,.,,cJ* .. d*. P,M..-vNS,4 PllE~'AltED L]4t: SEP-0$-02 0]:04~ FROI~-CT&E ENVIROHI~NTAt. SRV ,~Tr~ CT&E Envlmnmenlal Service, lnG, 9075615301 T-31:~ P.02/63 F-680 CT&E Ret.# Client Name Project Name/~ Client Sample ID Matrix Ordered By PWSID Sample 1025637001 AK Water .e. Wnstewater Cm~-'ultnnts Inc. McMahon #1 Lot 32 Bk 3 McMahon #1 Lt 32 Bk 3 Dr~g Water All Dates/Times are Atuk~ Standard Time Printed Date/Time 09/03/2002 15:05 Collected Date/rime 05/30/2002 16:44 Received Dare, Time 08/30/2002 17:00 Tee)mlenl Dl~-~ StTh~Ede Released By Rcs. Its PQL Units AHowabte Prep A.n~Tysi~ Limits Date Date Init ~ate~n De~&~uenb Nitrate-N 6.76 0.200 mg/L EPA 300.0 (<-10) 0~V30/02 JDT ~.crobJ. ology' ~.abo~ato~y Total Colitorm 9 OB. W/Coil-No FC ¢oVlOOmL SMI89222B 0g/3~/02 KAP T~H6 P.OI/OI CT&E Environmental Services Inc. Laboratory OJvJlJoll 200 W. Pnt~er Dri,~e )rinking Water Analysis Report for Total Colifom~ Bacteria A,~ho,.... AK 99518-1608 Tel: 190?) 582-2343 MUST B~ COM~L~D ~r w^T~R su~mE~ PUBLIC WATER SYSTEM I.D. # {Jill PRIVATE WATER SYSTEM SAMPLE DATE: SAMPLE TYPE: 61/ Routine · 13 Repeat Sa.mple(for routlnesample with lab t:ef. no. ) SAMPL£ LOCA. TIO~ Month Da)' Year II D TrestedWat~r · ~/" Untreated%W/olaf Time Collected. TO BE COMPLETED BY LABORATORY alysls show'~ this Water SAMPLE ~o b~: Satisfactory · Unsatisf~to~ Sample nv. 30 hon. old, rcsul~ may be un.liable Sample ~ Ion~ in ~nsll; sample ~hould eot ~ ov.~ o1~ at examination ~ indicate ~li~le tesul~. Ple~e s~d ~ew s&mp~ ~a ,~,~[ivt..maiL Aaal~lcil MCThM: ~Membnne Filt~ 'n · MM~MUO Numar ofcolonf~t~ mi. Lab ~r. Ne. Result' ~nt lo ~D.~C. Anc~ F~ Jun Analyst Foxed Client notified of unsatisfactory res~lts: Date: , , Time: ..... £a~ed CommonLy: BAC'TEIaJOLOGICAL WATER ANALYSIS RECORD MMO-MUG Rflult: 'Total Membrane Fllte~ Direct Count Verification: LTB Fecal Coliform Confirmation Final Membrane ~lter Resulu nC;l{ F.. ('all ,.. Colonies/tOO mi COLIFIRM Coltfotm/lo~ mi \bt% .. t~l~ Member al the 9GS Grouu ISeci614 Gini~llo ~l Sun~aillance) · ' ....... ,'., ~g'.,v JERSEY. OHIO. WEST VIRC MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 321 Bl~k~.3;'MeMaho~ Subdivision Location (site address or directions) 3601 Doroshin ' Property owner Mailing address Lending agency Mailing address Bruce Falkoner Day phone Vista Real Estate At, n: Donna Gunn 3000 Anchorage, AK 99503 Day phone Agent DONNA GUNN/VISTA REAL ESTATE Address 3000 "¢" St~e~ Anchorage, AK 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: NOTE: Day phone 273~7267 XXX Individual well Community well Public water /f community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. XXX TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State A~Ec attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 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 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 inves.tbgation 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 th!~%ction. Name of Firm .... ~" / Phone ~'"~/~'~/' ~'~;'/~ ~'/ Address $ & s ENGINEERING 17034' Eagle River Loop Road Engineer's si~l~l~t~'er, Alaska 99577/,//// DHHS SIGNATURE ____~ Approved for J Disapproved. Conditional approval for bedrooms. bedrooms, with the 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 Municipality of Anchorage //~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.o?- 3~. /~L~ Z ~c~Af/o~ .E//z~,/Parcel I.D. A. Well Data Well type Log present(~N) Total depth Sanitary sea~l) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ [ 2_~/~7~ Driller Cased to //~>O t Casing height Wires properly protected~N) FROM WELL LOG AT INSPECTION Date of test Static water level Well flow Pump level1 ~:~ g.p.m. 6,~ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/het~ tank on lot Absorption field on lot // Public sewer main ~' ''¢'- Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (~ /[ ~(~ ~ B. SEPTIC/I,[G~,~BH~ TANK DATA Date installed /[/~.Z~/~. Cleanouts ~) ~'E'~' High water alarm (Y~ "/MO Nitrate 4,00 /~/~ Other bacteria d3,//C~~,'~ .. Collected by: ~'~- ~' Tank size Foundation cleanout (i~N) Compartments Depression (Y~.) Alarm tested (Y/N) Date of pumping Pumper A-~' SEPARATION DISTANCES FROM SEPTIC/~LDff.~,G-TANK TO: Well(s) on lot /0~' ( ,)~ On adjacent lots /O© To property line '~ ~ / '~ Absorption field Surface water/drainage //~'~ 72-026 (3/93)* Front Foundation ,~ ,_)~L- Water main/service line ~-~'/¢' CONTINUED ON BACK PAGE C, LIFT STATION ¢tJ©ik-)~ /O..,~-~'~-/'~JT~ Manufacturer Date installed Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at ~vet at High water alarm level C~d Meets MOA electrical codes (Y/N) ~_~ SEPARATION DISTANCE ~FT STATION TO:  On adjacent lots Surface water Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) I._~'0 ~'//~f~_ ~ System type £~E~ ~-' Gravelthickness O.~ ' ~ Totaldepth .~",~' ' -~ Cleanout present~,l) '7~'-~ Depression over field (Y~D~ --'.J6 Results (~s~ail) ,/:::>~.~' for 'T'f¢~¢_~ ~-_~_) Bedrooms D. ABSORPTION FIELD DATA Date installed Length ,-~-~ / ~- Width 4~ After test /O,~/..,¢ ,k~/,c¢~/-J If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot /[~" "~ Onadjacentlots ,/'E~~'~- Propertyline To building foundation .~'~-" /~ To existing or abandoned system on lot On adjacent lots ~. c~ (¢_ Cutbank /OO¢-JE'~ /0~E3'87--¢- Water main/service line Surface water Curtain drain /~JD~d /~,C~5~/'J f O nveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES REPORT of ANALYSIS Chemlab Ref.~ :93.6732-3 Client Sample ID :LOT 32 BLK 3 MCMAHON S/D ~1 Matrix :WATER Client Name :S & S ENGINEERING Ordered By :RJS Project Name : Project% : PWSID :UA 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 WORK Order :74215 Report Completed :12/21/93 Collected :12/16/93 @ 10:00 hrs. Received :12/16/93 @ 12:30 hrs. Technical Director:STEPHEN C. EDE Released By Sample Remarks: SAMPLE COLLECTED BY: S.S. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 4.8 mg/L EPA 353.2/300.0 10 12/17 CMR * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than Member of the SGS Group (Soci~t~ G~n~rale de SurveilJance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA 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 ~T OF HEALT~ 8. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) . (b) Applicant Name ~)- .~._Jl~_~.lC.,J~5,~'/~/ Telephone: Home ~ Business Applicant Address ~Ot ~o¢o~ (c) Applicant is (check one): Lending Institution ~; Owner/~r~; Buyer ~; Other ~ (explain); (d) Lending Institution ~,ia.'T'F~ FT- ~o~-'~,S, ~ ~A~,DJ~.~5. Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms .~ Other WATER SUPPLY Individual Well~[~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite/l~' 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 (11/84) 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 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 ~'~"~ ~'P ~ Telephone Address --~~' ~z~ ~¢' ,/~'/~ Engineers Seal DHEP APPROVAE , Approved ~ ~;" 'Disapproved Terms of ConSitional Approv, al Date Conditional 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) WELL DATA NOV P, MUNICIPALITY OF ANCHORAGE (MOA) "EALT" AUT'ORITY APPROVAL (HAA) RECE! V E D CHECKLIST - FEBRUARY lg84 264-4720 Legal Description: ~/'" ~'~' ~/'~,~z/, ? ,//,//~ $~-~ ,2R T~ -~Z/'~.Z-;- "P"' u ,-- I)E~T. OF HI~ALTH & ..... ENVIRONMENTAL PROTECTION Well Classification Well Log Present (Y/N) Total Depth //)-'9/.~z"Cased to Static Water Level Casing Height Above ~3round /~.~/ Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot J~__ / To Nearest Edge of Absorption Field on Lot ,,/t~-~' To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ff A, B, C, D.E.C. Approved (Y/N) Depth of Grouting ~//~ Pump Set At ' ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots ~./~VI//Z~ To Nearest Public Sewer ,/~/~/~. TO Nearest Sewer Service Line on . ;Date SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) I~///~ ;for Holding Tank High-Water Alarm (Y/N) }"¢~4.% Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: ' To Water-Supply Well J~.---~ To Building Foundation ~ ';7 To Property Line ~=~'7 To Disposal Field Size J ~ NO. of Compartments -r't.,¢~/ Air-tight Caps (Y/N) ~ Foundation Cleanout. (Y/N) J~ Date Last Pumped To Water Main/Service Line Course 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 111 P'-~ I ~:;~ Width of Field Square Feet of Absorption Area ~7' ~ E) Depression over Field (Y/N) ~ Results of Last Adequacy T~st Separation Distance from Absorption Field: To Water-Supply Well //g~t¢ Type of System Design Length of Field ~' Depth of Field Gravel Bed Thickness ~;~ Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line /¢~2/ ./,~ '~'-.r ~ To Building Foundation Lot ¢/~)'~'¢'~"'~'" '¢-'~"~'~'"'~/"~'~//'// ¢~'-~ To Water Main/Service Line /'¢~ z ¢- To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area /~¢' ! ''~ Comments "~'~ "~ -~- "~'/74"'~-~-' To Existing or Abandoned System on Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have;;hecked, verified, or, conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No. Receipt No. ~) Date of Payment /f/"'~ Amount: Page 2 of 2 72-026 (11/84} Engineer's Seal 203 W. 'i.~lh AVE "C" SUITE_ 203 ~ ANCI-tOP, AGE. ALASKA S E P T I C S Y S T E M A D E Q U A C y T'E S T LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: DATE OF PUMPING: LOT 32, BLOCK 3, MCMAHON 3601 DOROSHIN D. HINRICHSEN SINGLE FAMILY, THREE BEDROOMS PRIVATE, ON SITE FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: SOIL RATING: INSTALLATION DATE: 1000 GAL. 378 SQ. FT. 110 JUNE 1979 DATE OF TEST: OCTOBER 16, 1986 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH FOUR FEET OF COVER AND A LIQUID DEPTH OF 48 INCHES. TRENCH SUMP WAS 12 FEET DEEP AND WITH 5.5 FEET OF LIQUID. A TOTAL OF 170 GALLONS OF CLEAN WATER WAS ADDED TO THE TRENCH. THIS CAUSED THE WATER LEVEL IN THE TANK TO RISE 2.5 INCHES AND THE WATER LEVEL IN THE SUMP TO RISE 25 INCHES. THESE READINGS' INDICATE THAT THE TRENCH IS FULL OF WATER AND THAT THE SYSTEM DOES NOT MEET THE REQUIREMENTS OF THE MUNICIPALITY. IT MAY OPERATE SATISFACTORY AT THE PRESENT TIME, BUT FAILURE OF THE SYSTEM MAY BE EXPERIENCED WITHIN A SHORT TIME. THIS SYSTEM WAS INSTALLED IN 1979 AND DESIGNED WITH A SOIL RATING OF 110. THE SOIL WAS VISUALY RATED. IF THE SOIL RATING WAS CORRECT AND IF GROUND WATER DOES NOT AFFECT THE OPERATION OF THE SYSTEM THIS SYSTEM SHOULD NOT BE FAILING. SINCE IT IS FAILING EITHER THE SOIL RATING IS INCORRECT OR GROUNDWATER IS PRESENT. A TEST HOLE MUST BE DUG AND THE SOIL TESTED TO ESTABLISH THE REASON FOR FAILURE, AND REDESIGN OF THE ABSORPTION TRENCH. -~. <©3 W. 15th AVE "C" SUITE 203 ANCHORAGE, AL,~SKA. 99501 TELE PHO,"~E: (807) 279~3916 RESIDENTIAL WELL INSPECTION LEGAL: LOT 32, BLOCK 3, MCMAHON LOCATION: 3601 DOROSHIN OWNER: D. HINRICHSEN TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 8 GALLONS PER MINUTE PUMP YIELD: 6-7 GALLONS PER MINUTE DATE OF INSPECTION: OCTOBER 16, 1986 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND AT 79 FEET BELOW TOP OF CASING. AFTER 12 MINUTES OF PUMPING WATER LEVEL WAS 85 FEET. WATER LEVEL REMAINED AT THIS LEVEL FOR 20 MORE MINUTES. WELL RECOVERED 100% IN 5 MINUTES. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON OCTOBER 17, 1986. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. ~m,, DATI~ RECEIVED /' INSPECTION APPOINTMENTS TIME TIME INSPECTOR ~ INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF I'.:ALTH & ~,~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTL:~IRONMEN]'AL J .,L.:J'ECTION  825 L Street - Anchorage, Alaska 99501 i ENVIRONMENTAL SANITATION DIVISION FEB 2 0 1980 Telephone 264-4720 DIRECTIONS: Complete aH 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 MAI LING ADDRESS 3. LENDING ~ PHONE MAILING ADDRESS 4. REALTOR/AGENT ~ PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION ;TREET LOCATION TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY .~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY NUMBER OF~BEDROOMS [] One [] Four [] Other__ [] Two [] Five ',~ Three [] Six *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. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified ~OG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ~ERMIT NUMBER ~ I NDIVI DUAL/ON -SITE DATE INSTALLED Connection Verified ~NSTALLER -- ~Septic 'Tank or ~ Holding Tank ~. Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAl_ ABSORPTION AREA MATERIAL 4. DI~TXNCESwELLTO: Septic/HoldlngTank AbsorptionAroat ~O ~ t ~o Isewer Line INearest LOt Line Absorption Area to nearest Lot Line 5, COMMENTS ~ APPROVED FOR j') BEDROOMS ~ CONDITIONAL APPROVAL (letter must acco~y certificate) DATE /¢ ' 'B BY '. 72-010 (Flev. 6/79)