HomeMy WebLinkAboutMCMAHON #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
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-//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
