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Home My WebLink AboutMCMAHON BLK 3 LT 11 0t7 0q it MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 NAME ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE [] NEW MAI LING ADDI~ ESS LEGAL DESCRIPTION LOCATION D:STANCETO: I IO0 Manufacturer Liq. IF HOME,DE: Well Inside ]en~t'J~ /(~ Dwelling Well No.DIo~ ]~nAeNsC E~ TO: Length of eac~.~ Top of tile to finish grade DISTANCE TO: Width Dwelling Width Foundati? Total length of Material beneath tile Depth Crib depth Building foundation Driller Sewer line Material Nearest lot line Trench width( ~ inches fl ~tnches NO. OF BEDR(~S PERMIT NO. .r/~ 0'763 No. of com~ments Liquid depth PERMIT NO. Liquid capacity in gallons PERM'T NO--/ ~Oq (;3 Distance betweeAI~ Total effecti~.~c.~r¢on area PERMIT NO, Crib diameter Total effective absorption area Well Nearest lot line Depth Distance to lot line Building foundation Septic tank OTHER PIPE MATERIALS SCI L TEST RATING ~NSTALLER ~.~{ REMARKS PERMIT NO. Absorpt on area(s) APPROVED DATE LEGAL F'EFd'"i Z T l'.,IO. i:::iF' F'I... l C:Ftf',Ft" L. ! !..OC:f:TF.I Oi'.,I i'"IC:i"iFiHOIq S?."i_::, L..E':C"iF:Ii._. Lt.J.. E? !"IC':i"IF!HOi'.~ S;,.."F.:, "I"T'PE': OF SOiL F'!BSOF.:E,'TZC!N Cfi= "f'!'IE LEiNGTH DIi'"ti.::'i',t::.:i;ICff',i IS THE: LEt'.~G'['H (.'!:.N [:'.r:~:ET) OF THE 'I"[;.'.EiA!C:I--! THE: DEPTH (:it:-" f:l "I'll:FiNCH OP. P.'(T IS THFC D:[:::',TFI!.,PE:[~: E:[:H'!4[EE:I'-,t THE [3[;~:OL!.I'.,ID F!i'.~[::, 'TH[E BOT"f'Oi',l OF: THE E::.::CF:I'41::f)-IOiq ,::IN Fi~[ET:). TPIE.[~'.E IS:, i'.,10 ::SET .[,.t ]: [::,TH FOI:~'. TF.'.ENCH[-ZS. THt:.:: C:iFtFi'v'E"L DEPTH t:.'::; THE 1,IINtHLIM DEF']"I--.! C)F C~.I-;:F!'v'EL.. 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CLUD[f i-'!OI:~'.E THI::!i",! ~: 2 3 5- 6- 7- 8 9 [] SOl LS LOG -MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6.6§0, Anchorage, Alaska 99502 276-2224 PERCOLATION TEST SOILS LOG - PERCOLATION TEST DATE PERFORMED: SLOPE SITE PLAN ~,~ 10 11 13 14 15 16 17 18 19 2O COMMENTS WAS GROUND WATER ENCOUNTERED? DEPTH?IF YES, AT WHAT Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TESTRUN BETWEEN ¢ , FTAND ¢ FT CERTIFIED BY~--~~ DATE: 72 008 (7/76) ' MUNICIPALITY OF ANCHORAGE ~PTJ( DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE0'fI~''IRONM[ ]AL P~OTFCTION 825 L Street-Anchorage, Alaska 99501 JUL 6 1979' ENVIRONMENTAL ENGINEERING DIVISION Telephone 2.4-4720 RECEIV[D ~EQUEST FO~ APPfiOVAL OF INDIVIDUAL WATE~ AND 8EWE~ FAGILITIE8 DI~EOTION8: Oomplete ~11 psrts on psge ~. Incomplete requests will not be proCessed. Plesse ~ilow ten (J0) d~ys for processing. 1. PR~RTY OWNER PHONE MAILING ADDRESS ' 2. BUYER PHONE MAIL~N~RESS [ 3. LENDING INSTITUTION ~ / [ PHONE MAIEI~G ADDRESS ~ PHONE MAI LING ADDRESS 5. LEGAL DESCRIPTION 6. TYPE OF RESIDENCE ~[~/ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY 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.) /:ff'~ '~ 8. SEWAGE DISPOSAL SYSTEM **If individual/on-site, give installation date ~/7~ INDIVIDUAL/ON-SITE** ~ If system is over two (2 years old an adequacy test is required ' [] PUBLIC UTI LITY by this Department. X/'~ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) ~~.~ THIS SIDE FOR OFFICIAL USE ONL~ DATE RECEIVED :' INSPECTION APPOINTMENTS : TIME TIME TIME DATE ' DATE DATE I NSP ECTOR INSPECTOR I NSP ECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO BI FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED E]PUBLIC UTILITY (~'~ 1 F Connection Verified INSTALLER __~) ,, []Septic Tank or []Holding Tank Size: ~_~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTALABSORPTIONAREA MATERIAL ~/~ ~ ~ ~.~/,~?~j 4. DISTANCES Septic/Holding Tank Absorption A I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS APP.OVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate} [] DISAPPROVED ~j DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) AC _14"~'~__?_~"., & eEOLOGICAL LABORATORIES OF ALAS~ lNG. P.O, BOX 4-1276 ANCHORAGE, ALASKA 99509 4649 BUSINESS PARK BLVD. TELEPHONE (907) 279-4014 Drinking Water Analysis RePOrt for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER 'PJJBL-~ WATER SYSTEM: ' ~ ) ~ , ~ I.D. NO. Public Water System ~ 0 ~- ~ Mal~ city State Zip Code Mo. Day Year sAMpLETYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose ) [] Treated Water [] Untreated Water SAMPLE NO. L~C;TION,~ i IL- . I 4 I Time Collected Collected By TO BE COMPLETED BY LABORATORY LABORATORY: NAME . " Date Received Time Received Analytical Method: [] Fermentation Tube ,~ Membrane Filter Lab Ref. No. Result* Analyst 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310 (3-78) Date Collected Source a.m. Lab. NO. Presumptive 10mi 1Omi /Omi 10mi /Omi 1.0mi 0.1mi 24 Hours 48 Hours Confirmatory 24 Hours EMB Broth 24 hours: Multiple Tube Report: Membrane Filter: Direct Count Verification: LTB Final MembTne Reported By"--'~-~-~-(.. ~.~'~' ~roth 48 hours: 10mi Tubes Positive/Total 10mi Portions Collform/100ml BGB Collform/100rnl Date am AU.~USt 1, 1978 Ron Kaylor S~ Box Anchorage, Alaska SubjeQt: Lot 11 Block 3 Mc}~hon Subdivision Per your phone inq%%ry t~e following inforn~tion i~ provided regarding obt~ining a health authority approval from this department: 1. A septic tank must be installed with a minimu~..L capacity of 1000 gallons for 2~3 bedrooms and 1250 gallons for 4 bedrooms. A permit at a cost of $20.00 is required along with installation inspections. 2. ~he cesspool must be 100 feet from the well and absorb 3~0 gallons per day for a 2 bedroom redidence with 150 gallons additional for each bedroom above.2. Absorption adequacy tests are conducted by private engineering firms with a listing available from this office. In the event the cesspool is too close to the well or is inadequate, a new absorptio~ system will be required. A permit for installa~ion at a fee of $20.00 is necessary. ~o obtain a permit you must have too, perculation ability Of the soil evaluated by testing firms. The report is submitted to this d~partment for design specifications 'upon applying for a permit. A listing of firms is available from this department. Sincerely~ L~,s Buchholz 'o Sen~.r Environmental Specialist LB/da GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received August 3, 1976 Time Date of Inspection' " REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR of Inspection ~/ ' Cony. 1 Approval requested by: Dynamic Realty Inc. % Mike Messick Mailing Address: 501 West Northern Liqhts Blvd. Phone: 279-7611 2. Property Owner: Ronatd W. & Jean K. Kaylor Phone: 344-8970 Mailing Address: Star Route A Box 1555B 99507 3. Legal Description: Lot 11 Block 3 Mc Mahon Subdivision 4. Location: Furrow Creek Road 5. Type of facility to be inspected 6. Well Data: Individual A. Type C. Construction 7. Sewage Disposal System: A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal 8. Distances: A. Well to: Septic tank Single Family No. of bedrooms 2 B. Depth D. Bacterial Analysis On-site system 1967 B. Installer 1. Size 2. Manufacturer l. Absorption Area 2. Material Field: Total length of lines 160' , Absorption area , Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (l/74) Page 1 of two pages .Page,2 of two pages - Re/ st for Approval of Individual ;r & Water Facilities Legal ~esCripti0n Lot 11 Block. 3 Mc Mahon Subdivision Approved Disapproved ~-~C~ Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I c'ertify 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 EQ~034 (1/74) Date MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES Type of Inspection: CMRO VA FHA CONV ×X Property Owner: Ronald W. and Jean K.Kaylor Mailing Address: SRA Box 1555B 99507 Name of Buyer: None Yet Day Phone 344-8970 Mailing Address: 4. Name of Lending Institution: N/A Mailing Address: 5. Name of Realtor or Agent: Dynamic Realty Inc. Mailing Address: 501 W. Northern Lights Blvd. Day Phone Phone Mike Messick Phone 279-7611 6. Legal Description:. Lot 11, Block 3 Mcl~{ahon Subd. Location: Furrow Creek Road 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: House Public Utility No. Bdrms.' 2 Individual XX If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: If Individual, date of installation 160Approx. Public Utility 1967 Individual (on-site) XX EQ-037 (1/74) ADHW- ~B-2W DATE STATE OF ALASKA Dm'~'RTMENT OF HEALTH AND WEL~"'~E DIVISION OF PUBLIC HEALTH BACTERIOLOGICAL WATER ANALYSIS OFFICE REPORT RESULTS TO SAMPLE COLLECTED BY ~ ~ ~ ~' .2. pm ~ Other {~st} Well- [] Dug [] Driven [] Drilled [] Bored SOURCE: [] Spring [] Cistern [] Olher Dug Well or Cistern Constructlon: Brick or Walls - [] Wood [] Concrete [] Metal [] Tile [~ Concrete Top - [] Wood [] Conerefe [] Metal [] Open Top LOCATION: [] In Basemenl [] Basement Offset [] Under House [] In Yard [] Olher Building Sewer Septic DISTANCE TO: or Other Drainage Pipe Feet. Tanb Feet. Tile Seepage Cess- Field Feet. Pit Feet. Pool Feet. Privy Feet Other Possible Sources of Contamination Asbeslos MATERIAL: Building Sewer - [] Casl [] Wood [] Tile [] Fibre [] Cement Iron [] PJasEc Joint Material -- Type GENERAL: Does Water Become Muddy or Discolored? [] Yes [] No R~.~rds in this office indicate this WATER SUPPLY to be ~J~*'~atlsfaclory [] Questionable [] Unsatisfactory Sanitary Status; When? Diameter of Well We{I Casing Ma er al Length at Drop Pipe PUMP LOCATION: [] In Well On Top [] Of Well [] Other PURPOSE OF EXAMINATION: Illness Suspected? New Source of Supply? [] Yes [] No Depth Feel. Diameter .Depth Water Deplh From Bottom Feet. [] BasemenlOffset In [] In Basement [] Room [] Yes [] No Repairs to System? [] Yes [] No Analysis shows this Water SAMPLE to be: [] Satisfactory [] Questionable [] Unsatisfaclory. If an "Unsatisfactory" or "Questionable" status is indicated above you should take immediate action as recommended below. __1. Notify consumers water is polluted. Boil or chemically treat this water as outlined in the enclosed leaflet "Drink It Pure." Increase chlorination sufficiently 1o meet recommended residual standards. Determine source of contamination and take action necessary lo maintain a safe water supply at all times. 3. Check chlorinatinn and other mechanical equipment. Make ceHaln it is functioning properly. 4. If after checking equipment a disinfectlng residual is not obtained, please wire this office for emergency assistance or advisory services. 5. This Js a surface water source and subject to pollution by man and animals. An approved water supply source should be developed. 6. Improve your [] spring [] dug well [] driven well [] drilled well [] cistern. 7. Relocate your well to a safe location in relatlonshlp to your sewage disposal system. [] see enclosure 8. Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results, please send new sample. [] Bottle Broken in transit, please send new sample. 9. Contact your nearest [] Local Health Department or [] Alaska Division of Public Health, sanitation office for bulletins, consultation and assJstct nee. SANITARIAN'S REMARKS ADHW - tAB - 2W DATE STATE OF ALASKA' '. -' - -' Dr'?"'~RTMENT OF HEALTH AND WEI;'-'~",,E Lob. No. DIVISION OF"PUBLIC HEALTH BACTERIOLOGICALWATER ANALYSIS OFFICE CITY ADDRESS OF SOURCE SAMPLE COLLECTED BY ' om DATE COLLECTED TIME COLLECTED ~m Sample Collected From [] Kitchen Top [] Bothroom Tap [] Basement Tag [~ Other (List1 Rec~ords in this office indicate this WATER SUPPLY to be of: []'Satisfaclory [] Questionable [] Unsatisfactory Sanitary Stalus. Analysis shows this Water SAMPLE to be; [] Satisfactory [] Questionable [] Unsatisfactory. If an '~Unsalisfaclory" or "Questionable" status is indicated above you should take immediate action as recommended below. 1. Notify consumers waler is polluted. Boil or chemically treat this water os outlined in the enclosed leafJel "Drink It Pure." -2. Increase chlorination sufficiently to meet recommended residual slandards. Determine source of contamlnatlon end take action necessary tc~ ~naintain a safe waler supply at ali times. 3. Check ~hJori~atinn aaa other mechanical equipmenL Make cerlai~ it is functioning properly. 4. If after checking equipment a disinfecting residual is not obtained,, please wire this office for emergency assistance or odvlsory services. Well- [] Dug ~] Driven [] Drilled [] Bored SOURCE: [~ Spring [] Cistern E] Othel. Dug Well or Cistern Construction: Walls - [] Wood ~ Concrele L~] Metal [] Tile [] Concret& Too - [] Wood [] Concrete [] Metal [] Open Too LOCATION: [] [n Basemenl [] Basement Ogsel [] Under House [] In Yard [] Othe~ MATERIAL: Building Sewer - [] C~st [] Wood [] Tile [] Fibre [] Asbest~ This is a surface water source'and subject to pollution by man and animals. An approved water supp,y source should be.developed. Improve your [~ spring [] dug well [] driven well [] drilled well [] cistern. Relocate ~our well to a safe location in relationship to your sewage disposal system J-- see enclosure Sample too long in transit; sample should not be over 48 hours old__at examination to indicate reliable results, please send new sample. [] Bottle Broken in transit, please send new sample. Contact your nearest ' [] Local Health Department or [] Alaska Division of Public Health, sanilatio~ office For bulletlns, consultation and assistance. GENERAL: Does Water Become Muddy or Discolored? [] Yes When? [] No glameler of We L Depth Feet, Well Casing MalerlaJ Diameter Oeplh Length of Water Deplh Drop Pipe From Boffom Feet~ Ol~set In [] n Basemenl [] Room PUMP LOCATION: J~ In Well [] Basemenl On Top PURPOSE OF EXAMINATION: Illness Susl~ct'~d? [] Yes [] No New Source DJ Supply? [] Yes [] No Repairs Io System? [] Yes [] No SANITARIAN'S REMARKS Signature READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Date Received ,~ ' ~ Time Received 'p'm .:Lab. No Lactose Broth24 hours J 10cc J 10cc J 10cc J f0cc J 10cc f.0cc .J 0,1cc 48 hours - ..~ "' Brillio nl Green 24 hours 48 hours j EMB AGAR Lactose Broth, 24 hrs. . 48 hrs. Gram!s slain Coliform Density . .(Most probable No. per IOOcc.) MF results ' ~ Absent --, ' ~J~T~/')u ICl',___l-~,~6E !~ .BOROUGH UEPARTm~T_OF b~vmo,,~rrAL -0.uALrn' 5500 TL~OR ROAD _ ~CHORAGE, ,aaASKA 99507 279-8CB6 2ATE ~ECEIVI~:__ INSPECT:_ TIME: REP. UEST .FOR APPROVAL OF II~DIVIDUAL SB'ER AND ~IATER FACILITIES · '> ~.. ..... -- ~, ~..~,~, FOR APPROV~ RE~EST~ BY:__ ~, _~ ~ ~ ~ESS:,,. 6, SP_.,'IAGE DisposAL SYSTEM: SEPTIC TANK (IF HOtVEHADE, SHC~'! DIAGRAM ON BACK) 1, s~ZE_ /?Z~,~---~ 3. H~,~UFACTURER. /-t, I NST/tI.~ APPROVAL R..~,U~_ST FOR SP..!ER "LATER FACILITIES · PAGE ~ ~0 B, .%T,~r~,- PIT C, DIS~SAL FI~ ~, JUIbc. OF LI~iE~ 2, TOT~ LENG~ ~'{EOUI R~ iEASUR~qENTS ~, ~ELL TO SEPTIC B,' ~E~ TO *~° ~, AG=. PIT C, "'ELL TO ~ ~P D, HE~ TO PROPER~ E, WELL TO O~]ERm, OS..,I_~U.. F, FOU~'~ATION TO SE~IC FOUP~ATION TO SEEPAGE PIT SEEPAGE PIT TO PROPER~ LIN~ ~J~P_.g$,T~l~ ANQ=IOr",Ac E ARF....A BOROUGH DEPARTMEI..FF OF ~¥IRO~,rrAL OUALITY A~chora,qe ~..Al ~ ~,~:~a ' ~ · reg~rd,)'{g ti)e abov~ p]ea~e do cc: aim Cook First F~d~ral Savings