The URL can be used to link to this page

Home My WebLink AboutMCMAHON #1 BLK 3 LT 38McMahon lock Lot 38 017-361 -14 --~-,, MUNICIPALITY OF ANCHORAGE DE. ~TMENT 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 Address~. TAN K FI ELD W ELL ~- t ~37 ~¢05 LOT LINE LOt ¢~/ ~ B,OC~ Township, Range, Section 5 ~¢ ~ ~ ~ ~ ~ A$-BUILT .IAGRAU {Show location of well. septic sys(emI property hnes. foundation. ~ S[PTIC ~ HOLOIN6 / ~ TYPE OF SYSTEM ~p~ ..... ~TRENCH ~ BED ~ W. DRAiN ~ OTHER Depth to p,pe bottom from ~otal depth lrom original grade ~ original grade ~, FT I~I FT ..... FT I FT SO FT ~; ~..,V.T~ ~ OT.~..~mm 6 ~ / , Ctassllicahon (A,B,C) Total Depth Cased to ~ .~ / Y / Installe, Date Installed: REMARKS: / I ¢~*~¢'c~¢Z~ ce.fly that Ibis inspectio, was pedormed ,ccording to all DATE] .,. :::~...[ .D ~ C ,'3 i2:'.2~: i~6 A F' F:'!_ I C A N'T' ~ (] f"IN'I"ACT J::'H[)F.IE; ~ RICHARD Kt. JL..LBERG SRA BOX 155]. AIqCH[)I:;:AC.")Ei; ~ AK <79~507 786.-!239 : ~: .{.. I .,.tJt J: ,::4, 'f'(]WNt':JI"I:[ l'::'= L..E}T S I ZE ~ J ~ ()~3A ( ,':':. 5}. F"I'. OR A.']F,:EXC ) ~-. ,~ BE).}FeC)OMS :: 3 EOT: ;..'58 RANGE: 3W £L. OC} ..... > )DEPTH 'T'O !:::' t PE BE:} 'F'TOM (F'"I".) 4.. 0 4 ,, 0 GF;:AVEL. DE]::'T'H (I::"T.) 8~ 0 3,, 5 . .TOTAL. DE,r'::'q"H (F']".) :L2..:'. ,, C' 7. ,5 fSRAVE:L. WID]'H (F'T.) 2.5 5.0 GRAVE}CL. L.,ENG"FH (F:"F.) ;~'~9.0 49,, 0 GRAVEL VOL. L.JPIE (EX.!. YDS. ) 22.9 3,/:,. 3 "i-ANK S ! ZE (GALS) 1,000.0 '~"~' 1., 000.0 ~"~' Si:)]:',_.. RATING (SQ. FT'. /BR) 150 150 ' · :"~' FANK tqUST HAVE A'T' I-..Ei]clS]'' TWO COMF'ARTMENTS f"'f~-~..m ...,~ ,..,,*"~./ the ..... ML,'.r'~:i.c:Lpal:i. ty (::).f Anchor'age (PIOA) and t. he S'Lat. e oF Alaska,, 2. I ~¢J.].l '..'".stall ':.he system :i.n ac:cc)r'cJar'~ce v.~it.h all MOA cc)des ancJ j-'egulat:i, ons, ar':..' in compliance w:i.t,h t. he design cpiter'ia of t. hi~ per'mit,. ::5, ]: t,.~:i.].i adher, e t.o a]' FIOA and StatE? of Alasl.::a pequir-ements fop t. he ,='p" ~q ...... Wc:; => t..E:ztMcs, t.E.r(::J i sp.osa ! syst em c,r' c: '"5 -,~,OT BE OBTAINED; (2) AS-BUtI....'TS PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Mo IA~,f/jO~]Township, Range, Section: "~7_.tJ (7~ '3 [~ ~ ~8 1 2 3 4 5 6 7 8 9 10 11 12 13- 14- 15- 16- 17 18 19- 20- COMMENTS 5if_,T [~i ¢~. e~ SLOPE SITE PLAN WAS GROUND WATER ~O ENCOUNTERED? IF YES, AT WHAT O DEPTH? p E Depth to Wate,~r~ d Moniloring? V Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN FT AND __ FT PERFORMEDBY' ~OF]S~C'6~Y'~' '-~---Y~(~'~ , {J ~ /.~{.~1.[:~ ~'v'%. CERTIFY TRAT THIS TEST WAS PERFORMED IN · ¢-? ...... 72-008 (Rev. 4/85) GRE ER ANCHORAGE AREA BOIr"!JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~'"-~/-K'L C'~. /~-~ ~X}/Jc~/,/////J~'/~.~AILING ~ ' ADDRESS,~ ~ ~ /~'~ g~/ PHONE / // /, SEPTIC TANK: DISTANCE ////~//'~f g /~ ' /~,c2×.,~'~:~/I/~gz~ FROM WELL . MANUFACTURER ~/~/~- INSIDE LENGTH ~ INSIDE WIDTH MATER IAL LIQUID DEPTH_ NUMBER OF COMPARTMENTS / LIQUID CAPACITY /~J GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER LINING MATERIAL.~' . CRIB SIZE: BUILDING FOUNDATION ~¢ , DIA ETER__DEPTH'~'~'- DISTANCE FROM: NEAREST LOT LINE ':~ ''/- TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ,¢L/'°'2~ SQ. FT. /7"1.4///.//./ 7/ ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED. NEAREST SEWER LINE REMARKS DEPTH SEPTIC TANK DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: INSTALLED BY, ~/;/~/: ~_~L¢, PIPE MATERIAL: Form NO, EQ-031 DIAGRAM Of SYSTEM G.A.A.B. GrEaTf-r ANCHOrage Area BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. NAME OF APPLICANT INSTALLATION LOCATION/ INSTALLATION OF: SEPTIC TANK SEEPAGE PIT ., DRAIN FIELD OTHER FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS //-~-- _ 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 TYPE DIAGBAM OF SYSTEM FOUNDATION TO SEPTIC TANK ~- CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF FOUNDATION TO SEEPAge PIT ~--~ ~ j DRAIN FIELD £ SEPTIC TANK TO SEEPAGE PIT WALL / ~ SEPTIC TANK ., SEEPAGE PIt ~--~/ _, DRAIN FIELD TO NEAREST LOT LINE. WELLTO SEPtiC TANK /~) ~) f . SEEPAGE Pit f~O DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MA~N TO SEPTIC TANK SEEPAGE Pit DRAIN FIELD · , SEEPAGE PiT /~ ~ . DRAIN FIELD /~ r TO RIVER, LAKE, STREAM. EXCAVATION ~ FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED With Airtight REMOVABLE CAPS. GRAVEL BACKFILL [ CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ~-'~. GREATER ANCHORAGE AREA BOROUO-~'~ Department of Environmental Qu~ ty 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - PEROLATION TEST Performed for .__~~ Legal Descrip ' n~.' S~~ This form Percolation test reports: s log ~. Depth Feet i- 3- 4- 6- 7- 8- Date Performed lO - II - 12 - 13 - 14 - ~ Was ground water encountered? If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rate minute. -Proposed installation: Seepage Pit Drain Field Depth of Inlet Depth to bottom of pit or trench COI,1HE[tTS: EQ- 040 (6/74) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-361-14 COSA# ~3~ I/~~ EXpiration Date: GENERAL INFORMATION Complete legal description Lot 38, Block 3, McMahon Subdivision No. 1 Location (site address) 12800 Killey Street Anchorage, AK 99516 Current Property owner(s) John and Barbara McMullen 12800 Killey Street Anchorage, AK 99516 Mailing address Lending agency Day phone Day phone Mailing address Real Estate Agent Mailing Address · Unless otherwid~ requested, COSA will be held by DSD for pickup. , NUMBER OF BEDROOMS: Three (3) Day phone TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding Tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site SysteYn,s 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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 omissiot~s in the professional engineer's work. 4. 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. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. DSD SIGNATURE J,/' Approved for ~.~ Disapproved. Conditional approval for bedrooms. Phone 522-7773 Date 10/17/2011 bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: / ~) - ~/7/-// Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: WELL DATA Well type Private Date completed Unknown Total depth 63+ ft. Lot 38, Block 3, McMahon Subdivision No. 1 IfA, B, or C provide PWSID #~ Sanitary seal (Y/N) Y Cased to 63+ ft. FROM WELL LOG Parcel ID: 017-361-14 Date of test Static water level Well production WATER SAMPLE RESULTS! ~Coliform 0 colonies/100 mL Arsenic: N/D ug/I SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Foundation cleanout (Y/N) Y' Date of pumping 8/30/11 ABSORPTION FIELD DATA Date installed 9/3/86 Length 3o ft. Total depth 12 ft. g.p.m. ' Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 10/11/11 73 ft. 7.o g.p.m. Nitrate 9.20 mg/L Date of sample: 10/9/11 Other bacteria Collected by: Number of Compartments Two Depression over tank (Y/N) N Pumper Northland Pumping Y >18 in. 0 colonies/100 mL MEA N Date installed 8/7/1974 Cleanouts (Y/N) Y High water alarm (Y/N) Soil rating. (g.p.d./ft2 or ff~/bdrm) 150 SF/BDRM System type Deep Trench Width 2.5 ft. Gravel below pipe 8 Eft. absorption area 480 ft2 Monitoring tube- Y Depression over field 95 Date of adequacy test 10/11/11 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 55 in. ' Water added 512 gal. New depth Elapsed Time: 1,440 min. Final fluid depth 55 in. Absorption rate >= 450 Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date in. g.p.d. LIFT STATION Date installed "Pump on" level at~ Datum in. E. SEPARATION DISTANCES Size in gallons "Pump off" level at ~ Cycles tested in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >100' Absorption field on lot >100' Public sewer main N/A Sewer/septic service line >25' Animal containment areas >50' Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots >1oo' On adjacent lots >1oo' Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas >1oo' 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 >1o' Water Service line >1o' Curtain drain None Noted COMMENTS: Building foundation >1o' Surface water >1oo' Wells on adjacent lots Absorption field >5' Surface water >.1oo' >100' Water main >10' Driveway, parking/vehicle storage >25' in. 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. Engineer's Printed Name Michael E. Anderson, P.E. Date 4/27/2010 COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Community Development Department Development Services Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # oscl 11397 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 3 8 of McMahon# 1 subdivision. This inspection revealed a nitrate concentration of 9.2 milligrams per liter (mg/L) was reported for the property's well water sample. 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. 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. SGS SGS ReL# 1114957001 Client Name Anderson Engineering Printed Date/Time 10/14/2011 9:05 Project Name/# Lot 38 Block 3 Mc Mahon Sub O' ] ~ t~ -~,~ z,.o ~q Collected Date/Time 10/09/2011 11:00 Client Sample ID Lot 38 Block 3 Mc Mahon Sub Received Date/Time 10/10/2011 9:00 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/11/11 10/12/11 NRB Waters Department Total Nitrate/Nitrite-N 9.20 0.100 mg/L SM20 4500NO3-F B (<10) 10/10/11 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 10/10/11 DLC Total Coliform Negative 1 100mL SM20 9223B A 10/10/11 DLC / / / / / / / ,f / _/:/Js /~ / / / / / / . / . / / / / / / / A~OT / / / /, -//0'~--~<':"~' .~- c.,- ~---/A~L-~/~'''./~,. co- ~ s~ + hereby ce~ that I have s~eyed the fo~owJng describ~ property: ~~.~ZOO~ ~, , ~D~/T/ Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adj,acent thereto, that no improvements on prop- erty lying l.~djacent thereto encroach on the premises m ~uesti0n and that there are no roadways, transmission hnes or otl:er visible easements on said property except as indicated hereon. Dated at A:,;chorage, Alaska this /~/-/z/ day of ~.~/~"~LZ'~.~,T ,19 ,~4/~ FRED WALATKA & ASSOCIATES Engineers and Surveyors ~tORTHLAND PUMPING SERVICE, ~NC. Your Professiona! septic Pumping Service company 750! E. 140th Avenue ANCHORAGE; ALASKA 995~6 ¢9071 344-7148 -FAX (907)888~¢~770 DATE RO~# ...... ~ Jim caPmiSs'ing o[ t'above~¢ourfd ~ Needs ......... Lesch Area ___ ~eedS replacing Aarow Pump & Well Service, LLC P.O. Box 110496 Anchorage, AK 99511 Office: (907) 346-9355 · Fax (907) 333-8976 Eagle River: (907) 622-9335 No. 9158 CUSTOMER JOB SITE INVOICE~.~,,~.,c~/.DATEWELL DEPTH.~ I SWL J I CHLORINATED~ PUMP DEPTH.~. ~----~'~.xSALESPERSON "'"~"~"~"~'/~ ~O~NTITY DESCRIPTION ~RIOE AMOUNT EABO~ HOUr8 ~ATE A~OU~T TOTAL ~ATE~IAL I TOTAL LABO~ ~O~ O~DE~E~ BY DATE OO~P. TOTA~ ~ABO~ ThankYou SIGNATURE (I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not ,paid for in 90 days I agree to allow Aarow Pump & Well Service, bEC. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment,) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include t0t, block, subdivision, section, township, range) (b) (c) Location (ad'drb~s or directi,o,n, si~, '; ~ '. Property owner-/;¢/F.-' ,~. Lending Institution Telephone: (home) Telephone Business Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here [;~ if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family/'~ Number of bedrooms --~ 3. WATER SUPPLY Individual Well/l~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On~site~ 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. 72-025 (Rev, 7/88) Page 1 of 2 5, 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 ~, ~-~'~% Address )'¢¢ Telephone ¢'7.. ,~ ~, ~j'"-.j'~j'-- _.7 6. DHHS APPROVAL Approved for -~ bedrooms by Approved ~'/~. Disapproved Terms of Conditional Approval Conditional Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 DHHSdonotconductinspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageisnot responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) eack Page 2 of 2 MUNICIPALITY Of ANCHORAGE (MOA) ,,~kc_~_ealth Authority Approval (HAA) .... ~\~/\sI~ECKLIST - FEBRUARY 1984 ~u ~J ,~~ ~C~5 : 343 4744 ~" .~ Legal Description: ~'~ ~-~' Well ClaSsification ~ ID' 2~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y~. Date Completed /¢~%' Yield 3, Total Depth ,//~ Cased to //~ Depth of Grouting ~¢~¢--~¢~ ~ Static Water Level ~/ Pump Set At ¢),,~'¢~¢¢~- / Casing Height Above Ground ~ Sanitary Seal on Casin~N) Electrical Wiring in Conduit ~) ~ Depression Around Wellhead~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~/O ; On Adjoining Lots ~ To Nearest Edge of Absorption Field on Lot / z_O ; On Adjoining Lots To Nearest Public Sewer Line ~/~ To Nearest Public Sewer Cleanout/Manhole ~-~ To Nearest Sewer Service Line on Lot _~ ~ / Water Sample Collected by /, ~ , ~ ; Date ~~ Water Sample Test Results ~ c¢.' ~ ~, ~a~; /, ¢ Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~/7/?,~/' Size ~/D¢*O NO. of Compartments Standpipes ~'~N) Air-tight Caps~N) Foundation Cleanout ~/~N) Depression over Tank (Y~ :Date Last Pumped ~//~//~'¢' Pumping/Maintenance Contact on File (Y/N) ,4.~3 ./~ ;for Holding Tank High-Water Alarm (Y/N) /~/~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well /'/~') ' To Building Foundation To Property Line ~c'-// To Disposal Field /o · To Water Main/Service Line :- _~ To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorptio~trata Date Installed ~/$/~'g Width of Field ¢'/-¢ ,:*(- / Square Feet of Absortion Area Depression over Field (Y~t Type of System Design~72'C.--,~:~ Length of Field Depth of Field Gravel Bed Thickness ~/' Statndpipes Present Lt~N) Date of Last Adequacy Test ~'///~/~2~ Results of Last Adequacy Test //c¢~,.~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at ") High Water Alarm Level at Tested for ~./'' Meets MOA Electrical Codes (Y/~)~~ Comments DimensJ~~~/' Manhgle~cAccess (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have c~ked, verified, or conformed to ail MOA and HAA g inspection. Signed Company "'¢~"? ~ ~----]- Date MOA No. /C~.~'-- Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) 8ack Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ~e date of this Seal CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 Dale Report Px_int~d: JUl{ 15 96 ~ 13:$2 ReceiYed ~UN !2 90 ~ 09;30 h~s. Client A¢ct: ARECS~? O~dezed By : L, REiD Che;a].ab Rei ~,: 901821 Lab Smpi ID: 1 i~atrix: Allol;able Pazamet~ Tested ~esu!t Onit~ ],~thod 4~ e~it s NiTRATE-I; i.8 ~f,g/1 EPA 353.2 Tests ?ezfoxi~,ed ~ See Special In~truct~om; Above }~ona Detected ~' See $mnp!e 4. 5. 6. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received ~- ~'-~-~-~ S !Time of Inspection C~ ~ Date of InSpection ~-~o-~-l~ Phone: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Approval ·requested by: ~ ~ ~ Mailing Address: ~o (~~r~c~~,PhOne: Property Owner :~q_ ~ ~ ~'-~c~ Mailing Address: ~-~.~t~,k'~ ~k-~' Legal Description: ~ Location: ~ ' ~~ ~. Type of facility to be inspected~~~N~o~, of bedrooms Well Data: , A. Type ~~ ~ ~-~-; Depth C. Construction ~ ~ ~ D. Bacterial Analysis Sewage Disposal System: ~ C, Septic Tank: 1. Size /?~"~,~ ~-~',~ ~ 2. ManufactUrer D. Seepage Pit: 1. AbsorptiOn Area 2. Material ':~?'~' E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank , Absorption area Sewer Lines Nearest lot line B. Foundation to septic tank , Other contamination ~o , AbsorptiOn area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages ~ge 2 of two pages - Re St for Approval of Individual "~r & Water Facilities Legal Description ~<~ ~ ' %i ~ ~ Comments Approved}~ :. ~~~ Disapproved Date (~/~ Approval ~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) \', · GREATER AHCHORAGE AR~..',BOROUGH ' i Departmea~ ef En,;iron:~:~ntal Oual ty 3330 "C" St., Anchorage, Alaska 99503 -. 274-4561 REQUEST FOR APPROVAL OF ItlDIVIDUAL SEWER & ',,lATER FACILITIES 1. Type of Inspection: 2. Property Owner: Mailing Address: Name nf 5uyer: CidRO ._ VA _ Jack G. and Janet L. Hansen FHA CONV )~ .- SRA BOX 1551 U, Anchorage AK Day Phone 349 1785 (Mrs. 1-Iansen) n/a Mailing Address: 4. .Name of Lending Institution: Mailing Address: 44__50.~Buainess Park B~vd. A~cho~ge~ AK 99503 5. Name of Realtor or Agent: DaX_ Phone Coast Mo~tgag~ e Co. Phone Phone Mailing Address: Lot 38, Block 3, ~cMahon Subdivision Legal Description: Locati on: N~n~ Killey Road fi// 7. ·.Type of Facility to be inspected: single family No. BdrmS. 8. l,lat e r SuPply Indi{,idual Type of Supply: Public Utility_ ~ - If Individual, number of dwellings presently served If Individual, depth of ,,.;ell /~_~__/ Sewage Disposal' System Individual Type of Skstem: Public Utility_ If Individual, date of installation 3 (on-site)·/. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received FebrUary 2, 1977 Time of InspectionS! , Date of Inspection ;REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER fACILITIES. FOR Cony. 1. Approval requested by: National Bank of Alaska Mailing Address: Post Office Box 3-3859 Property Owner: B.G./Judith Sabo Mailing Address: % Ruth Phone: 279-2506 Phone: 349-1785 3. Legal Description: Lot 38 Block 3 Mc Mahon Subdivision 4. Location: Killey Street Type of facility to be inspected Single Family Well Data: A. Type Individual C. Construction Sewage Disposal System: On-site system A. Installed C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank , Absorption area Nearest lot line , Other contamination B. Foundation to septic tank C. Absorption area to nearest lot line No. of bedroOms 3 B. Depth D. Bacterial Analysis B. Installer 2. Manufacturer 2. Material , Sewer Lines , Absorption area EQ-034 (1/74) Page 1 of two pages age 2,of two pages - R~"~st for Approval of Individual '~',er & Water Facilities ,Legal Description T.ot 38 Block 3 MC ~1ahon Subcl£v±s±on Comments Approved Approval Valid for one year from date signed Greater Anchorage Ar~a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2Fe~0 E_~s~Tuder R~ad, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNIcIPALi~, OF DEPT ANCHo £AIVIRoN~.OF HEALTH ~ ON,AL PROTECHo~ 2 1977 RECEIVED 1. Type of Inspection: CMRO VA FHA_ ,ro,ert, Owner: Mailing Address: , 3. Name of Buyer: ~/~ ~~' Mailing Address: ,-~ 4. Name of Lending Institution: Mailing Address: CONV Day Phone: Day Phone: 5. Name of Realtor or Agent: Mailing Address!. 6. Legal Description: Location: Phone: 7. Type of Facility to be Inspected: 8. Water Supply TYpe of Supply: No. Bdrms. Public Utility. ,Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: If Individual, date of installation Public Utility Individual (on-site) 72-003(3/76) H UFFM ] [ Rabbit Creek Area Reference Map-P13 173 178 ~'" 180 185 179 ,~') 1974 JH J