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HomeMy WebLinkAboutMCMAHON BLK 3 LT 13  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 i r NEW MAILING AD. ESS ~ LEGAL DESCRIPTION LOCATION ~0, OF Well Absorption area Dwelling PERMIT NO. DISTANCE TO: ~ ~ Manufacturer ..... ' Material ~o. of comoartmonts ~ Li~ty in gallons IF HOME~ ~nside length ~ ~ - ~i~ dept~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~_~O Z ~ Manufacturer ~ Material Liquid capacity in gallons DISTANCE TO: ~/0~ -r h Z 3~ ~ ~ ~ No. of lin~ ~ Length of each line Total length of li~s Trench width Distance between I~nes _ '~ ~ ~ _~ ~ inches To'al ~ ~ ~ Top of tile to finish grade Material beneath tile ~ effective ~sorption area a Z~ ' ~ inches Length Width Depth PERMIT NO, ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO, ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER / ~ MAT.~A~S SOl L TEST RAT, NG INSTALLE~ ~ REMARKS ~ APPROVED ~) . DATE LEGAL 72-013 (Rev! ) ), ?,EF'RRTMENT , HEALTH AND EN,,,IRONMENTRL .i'.OTEE:TION ~" s // ~J!J~/ ."- ' * 825 '"L'" STREET., RNCH~RRGE., AK. L~95¢1 "~ '~~ 264-4'," 27. C~f"~--S I ]-E SEI..-.tEF: tJF ~3F:RE:.E F'E~:f4 PEF~'MZT Nn "=~am~,~- ': ~ '- RF'PLZCFtNT AUE:,RE¥ MERCER pR Bi-i;:.,; 184B2 CLIRRE¥'"S C(~RNE~-~' 4~6-~:687 L 0 C R T ~ 0 N LEGAL Li2 B3: MCMRHON LOT SIZE ~:2t~88 SQURRE FEET TYF'E OF SOIL HE,_,ORFTION :,~_,TEH I=,. TRENCH MR'.'TMUM NUME:ER OF BEDRrICMS = ~: S~]IL RATING (SQ FT,.'BR)A ~._,8 /~ 'rile REQLIIRE[:, SIZE OF THE SOIL RE:SORPTION =TzTEM IS: ) L-iF r~-- LE~-~STH= THE LENGTH DIMENSION IS THE LENGTH ,::IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETI.4EEN THE SURFRCE OF THE GROUND AND THE BOTTOM OF THE E::.:iCAVRTION ,::IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCRVFITION (IN FEET). PEF.:MIT RF'PLIZRNT HRS THE RE_FBN_,IE, IL!T¥ TO INFF~RM THIS [:,EF'RRTMENT [:,tJF.:ING THE INSTALLATION INSPECTIONS OF RNV WELLS AD.TRCENT TO THIS FR_PEF.,T~ RN[:, THE NUMBER OF F..E:,I[EN_E=, THRT ]"HE WELL WILL SEF.:VE. .... - ' ' '-' - TH!E, EFICKFILLING L'iF RNV =,~=,TEM 14ITHOLIT FINAL INSPECTI]N AN[:, HFFROVHL DEPARTMENT WILL BE SUBJECT TO F'ROSEZ_TI'N MINIMUM DISTANCE BETWEEN A HELL AND ANM ON-SITE SEWAGE DISPOSAL SYSTEM IS !80 FEET FOR R PRIVATE HELL OR t58 TO 288 FEET FROM A PUBLIC HELL DEPENDING UPON THE TVPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY' SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MA~ APPLS. SPECIFICRTIONS AND CONSTRUCTION DI~GRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'ERI',I I T E::-::P I !F~:ES [:,EL-:-E['-'~BEF." gJ--. I CERTIF"r' THAT ±: I BM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS tis SET FORTH B'.t THE MUNICIPALIT"r' OF RNCHORAGE. 2: I WILL INSTALL THE S"r'STEM IN ACCORDANCE WITH ]'HE CODES. ]:: I UNDERSTAND THAT THE ON-SITE SEWER S"tSTEM MA"t REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 2: BEDROOMS. !SSLtED E:'¢_ .... -~ .................... C, RTE_ - ',,,'4. E~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG-- PERCOLATION TEST ~ ~OILS LO~ [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: /1 //3 4 9 ~.~ d/. DATE PERFORMED: -% SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN 13 ~_~ ~4 18 17 18 20 COM.M_.E NTS Gross Net Depth to Net Reading Date Time Time Water Drop PEREORMED ,¥: i Z.,2 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN ~ FTAND FT CERTIFIED BY: f~__~~ ~_~--~r DATE: 72-008 (6/79) GREATER ANCHORAGE AREA BOROU?U-~ uepartment of Environmental Qu .y 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - PEROLATION TEST Performed for ~¢~<~ ~,~'~-'~ Legal Descripti on~:~ This form reports: Soils log__~/_ Depth Feet Date Performed Percolation test 11 - 12- 14 Was ground water encountered? I ~:.~ If yes, at what depth? Reading Date Gross Time Net Time Depth to Wate~ Net Drop Percolation rate minute. .Proposed installat-T~-ff~ Seepage Pit Drain Field ..................... i)eptt~ of Inlet ................. · Depth to bottom of pit or trench COI,1I'.IE[iTS: .... Certified By: Date: ............ '__ EQ-040 (6/74) _ I. MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Location (address or directions) (b) Property owner ~ J-J"~ rt$ Telephone: (home) Business Mailing Address ,.~4>-z-~'¢7 ~"~',,,--:A/ (~ J-o ~r t~ (~ /~.~,,¢~,d'" /_/~)/]/;~;,,-~",¢.~ (c) Lending Institution ~"[-.c.~"'¢.~_~ T;'t4'te Telephone Mailing Address (d) Real Estate Company and Agent ~t.~'~ ~x~ ~_ Address '~%0 Telephone ~ ~ ~ -j (e) Mail the HAA to the following address: (or check here g, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family'l~ Number of bedrooms ~ 3. WATER SUPPLY Individual Well'~ 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 I~ Public [] Community [] Holding Tank [] Note: Iflcommunity/ ' 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 I 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, Iverifythat 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 regula.!ions in effect/'~°n th~ date of this inspection. Name of Firm "[ CL~'C.-~.~..'~ --~J/_.CL~U~L.~/~ Telephone / Address ~ '% gl..~. //,~'%~- ,~'~ 6. DHHS APPROVAL Approved for .~'~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional Date TheMunicipalityofAnchorage 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 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. 7/88} Back Page 2 of 2 A. WELL DATA Well Classification Well LOg Present (Y/N) Total Depth /~ Cased to /8 ~"~epth of Grouting Static Water Level / ~ q ~ Casing Height Above Ground /¢¢ ''/ ~ Electrical Wiring in Conduit (Y/N) ~" f MUNICIPALITY OF ANCHORAGE (MOA) ~ ,H,ca.IA~ Authority Approval (HAA) :~:N'rAL ,:,<V~,:: p,VMO~43.4744 ?' ,"¢ :.:'uO~q" Legal Description: A¢'~ Date Completed If A, B, C, D.E.C. Approved (Y/N) N///'%' Yield ~. '~ ~3p,~4¢ ~ Pump Set At ~-~o Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) /'4 SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date 'D--~t, c~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed jd/(¢ ¢ Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) [t~e_:9~ No. of Compartments (~,~ ~/~- 'Z,~. Air-tight Caps (Y/N) / Foundation Cleanout (Y/N) tk~ Date Last Pumped I?-/~ ~/~, ~- ~//>~- ; for J~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well q J To Property Line '~C, ~ To Water Main/Service Line ~h////t% To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field Comments 72-026 (Rev. 7/88) Front Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ,/¢¢~ ¢ ~ Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test "~¢, .¢ ¢ /¢~¢ v 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 St,orage Area Comments ~ 72-~,,~ ..~.~ ~?'~ %~', ~,~ To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~' To Cutback (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (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 checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. Receipt No Date of Payment Amount: ""~",~".' .' ' ' Engineer's Seal '" 4 ,;;. '.. , Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE ( DIVISION OF ENVIRON~b~fAL HF~TH DEP~JtTMENT OF P~EALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH A~£HORITY APPROVAL CERTIFICATE 1. General Information (a) Legal Description (include lot, block, Location (address or directions) Application Date ~/~ ~7~ L/ subdivision, section, township, range) (b) (c) Applicants Name / ~__~~ ..~g Applicants Address Telephone - Home Business Applicant is (check one) Lending Institution Buyer ~ ; Other~ (explain); (d) Lending Institution Owner/builder Telephone Address (e) Real Estate Co. & Agent Address ___~ ~ ~/ C~ Telephone (f) Mail the HAA to the following address: 2. %yp~ of Residence Single-Family~ Number of Bedrooms 3. Water Supp1M- Individual Well~ 0 Multi-Family ~ Other (describe) Community~-~ Public~--~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewage Disposal Onsite.~ 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 1 of 2] e e Engip~ering Firm Providing Inspections~ Testsz 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 wmstewater 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 ~stewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. (ENGINEER SEAL) DHEP Approval Approved for ~' bedrooms Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION TH~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH Ab~HORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESEWf- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY ~N INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES TSIS AS A COURTESY TO PURCHASERS OF HOBOS AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 Be WF. LI', DATA Well Classification MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) DEFT. OF I',I!ALTH & HEAL,/{ AUTHORITY APPROVAL (HAA)~Nvh~°;''' ':?m',L ??,orEcl'ioN CHECKLIST - FEBRUARY 1984 if A, ~, ~ ¢, O.~.C. ~proved(Y~) Well Lcg Present (Y~ Date Completed Total Depth /~--r ~ Cased ~ ~/6 Static Water Level /~-~' Pump Set /At Casing Height Above Ground /, ~' Electrical Wiring in Conduit (Y/N) Separation Distances f~cm Well:0~ To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot ~ On.Adjoining Lots ~' o / 6~)~ ~ On Adjoining Lots To Nearest Public Sewer ALhe ~//~ To Nearest Public Sewer Cleanout/Manhole Water Sample Collected By Water Sample Test P~sults ~,ell ~,~ ~/~k SEPTIC/HOLDING T~/~/< DATA Date Installed IA/~ kw~w/L Size /~/9~//&~x No. of C~,'g~nts ~.k ~ Standpi~s ~) Air-tight Caps ~) F~ndation Cleanout (Y~ ~ ~pression o~r Ta~ (Y~ ~te ~s~ P~a ~//g~ ~ '/ P~ing~intenan~ ~n~a~ ~ File (Y~)~ ; for ~ ~ Holding Ta~ High-Water ~a~ (Y~) ~/~ ~ra~y Holdi~ Tank Pe~t (Y~)~ [Page 1 of 2] Separation Distances from Septic/Hol_d~J~g To Water-Supply Well 'fo Property Line To Water Main/Service Line . Tank: ' 'CD TO Building Foundation To Disposal Field ~ To Stream, Pond, Lake, c~ Major Drainage 2-15-84 ABSORPTION FIELD DATA Soils Rating in AbsorDtion Strata Date Installed Width of Field -~'~ $~C Type of System Design Dep of Field ? Gravel Bed Thickness J~-" D. Lt~FT STATION Square Feet of Absorption A~ea ~O'.~~ Standpipes PresentO) Depression over Field (Y/~ Date of ~st A~a~Test Results of ~st A~a~ ~st /~.~ Separation Distan~ f~s~ption Field: To ~te~-Supply ~11 /D~ ~ ~ To ~o~rty Li~ To Buildin~ Foundation' ~ ~ To Existing or ~ndo~d System ~ Lot ~/~ ; ~ ~jgining ~ts To Wate~ Main/~vi~ Line ~/~ To ~t~(if pre~nt) To St~e~ond~ke/~ Majo~ ~aina~ C~se To ~iveway, Pa~ki~ ~ea, ~ Vehicle St~a~ ~ea - .. Dat~ Dimensions Size in Gallonst~'~~ Jf "Pump On" Level a Manhole/Access (Y_/N~/ "Pump~at ~ Vent (Y/N) /~in~C~'~l~s du~ing Adequacy Test. High Water Alarm Level at Tested for Electrical Codes (Y~ Comments J Meets MOA ** -~heck Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, o~ conform~=d to all MOA effect on the date of this inspect.ion. Co. any · KB1/d5/s [Page 2 of 2] Date ~OA ~o. g q"(P'P- ~--,~'.-' % ? ·'*e ~ /.;5', 2-15-84 ALASKA el iVIROFlmenTAL COllTROL SEF VIC $, ~nqincerinq $ ~nuironmenlal $1ut]i*s InC. August 16, 1984 Leonard Hyde Anchorage, AK Seller - Dan Lowe Buyer - Subdivision - McMahon Block = 3 Lot - 13 Adequacy Test For Sewer System The type of absorption system is a trench with an area of 320 Sq. Ft. The system is capable of accepting 450 gallons of water per day= ..... ~ The surge capacity of the system is 637 gallons, y~ Based upon the test data the system is accepable for a home bedrooms. / ' The septic tank was pumped on 8/19/84 ~/ J Flow ~es't on Well / The Well Flow Rate Was 3.~.,GPM for 3 hours. Septic Tank Adequacy The existing septic tank volume of lO00is adequate for this 3 bedroom house. These tests are necessary for Municipality approval. 1200 ~Jesl CHEMICAL & GEOLOGICAL LABORATORIES OF ALASI~A, INC.  TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking ~ater Analysis Repo~ for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: A Water System Name I.D. NO. Phone No. Mailing ~ldress i State Zip Code City MO. Day Year SAMPLE TYPE: _0'utlne Check Sample (for routine sample with lab ref, no. [] Special Purpose SAMPLE NO. LOCATION El_Treated Water ~l~.Unt re-'%,d Water Time Collected Collected By , I I TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: I /J~ S~tisfactory Unsatisfactory [] S~mple too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: /; [] Fermentation Tube ~. ~,,Membrane Filter Lab Ref. No. Result* Analyst I-FI r-I-I F1-] I J 0~-1220 (b) ReY. 1993 BACTERIOLOGICAL WATER AI'IALY$15 RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTB~ Final Membrane Filter Resulls /-~ ~ BGB Ti;ne: TNTC-- Too Numerous To Count Coilformll00ml '" INsPECT(oN APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSPECTOR~ , MUNICIPALITY OF ANCHORAGE ~UNICIPALITY OF ANCHORAGE DEPT. Of i:-'.LTH &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~ON~Y[ENT,LL ; ,.Ol ECTION ) 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION FEB ~J ~98i Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAOlLITIEg DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proce~ed. Please allow ten (10 days fo'P prbC~ssing. MAILING ADDRESS ~ / ~ ~ , . PROPERTY RESIDENT (If different from above) ~/ / PHONE 2. BUY, ER PHONE MAI LING ADD~ESS 3, LENDING INSTITUTION PHONE MAI LING ADD~ESS / PHONE 4. ~ ~.EALTOR/AG ENT , MAI LING ADD~ESS 5,LEGAL DESCRIPTION :.¢ £52,4-- :¢' STREET LOCATION ~,.~t ',~?'? 6. TYPE OF RESIDENCE r  S INGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Other__ [~] Two [] Five ~ Three [] Six 7, WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *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.) ~t, Ol?p~l,~d~,5 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 ' r 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 LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER F-]Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS J//~APPROVED FOR ~ BEDROOMS ~ CONDITIONAL APPROVAL {letter mus~ccompany certificate) 72-O10 (Rev. 6/79) · Al CHEMICAL & GlzoLOGICAL LABORATORIES ,~£ ALASKA, INC.~. Z.; ......... ~ Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO. Water System Name Phons No. Mailing Address !,', '~.,~ .I ~,-. Zip Code City SAMPLE DATE: Mo. State Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. , I 4 I LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sam Die. Date Received Time Received Analytical Method: r- Fermentation Tube [] Membrane Filter Lab Ref, No. Result* Analyst I I · No. of colonies/100 mi. or No. of Posltwe DOrt~ons READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTE R IOLOG ICAL WATER ANALYSIS RECORD Date Collected Source Presumptive /Omi 1Omi 1Omi 1Omi /Omi 1.0mi O.lml 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours EMB Broth 24 hours: Broth 48 hours: Multiple Tube Report: 3Oml Tubes Positive/Total 10mi portlo~11s Memhrsne Filter: Direct Count Collform/lO0ml Verification: LTB BGB__ Final Membrane Filter Results ' Collform/100~ll ALASKA nuIRo[lm nTAL CO[1TROL Inc. I~nclJneefinc1 ~ (~nui~onmental Studies MUNICIPALITY OF A.F!CEIORA®E DEPT. f~i: : ".i ! 8: ENVIROhh!,r'.; :, :. , ZCT ON RECEIVED 2-11.... 81 MUNICIPALITY OF ANCHORAGE DEPT. OF i' '!'ill & [NVIRONh,',Z,,J. ,L : .i:.CTION RECEIVED St::'OKANE MORT(3AGE COMPANY ,=. ,, 0 .~. Cc.""' '"'~ ""r', ~::.""'~::. ..... i A r~c,t ,..,r..r.:~b . AK 99503 SEL. L. ER .... MERCER S UI]H:)::C V]:S:?::C)N-H C H A HON BJ...OCK-3 !...OT'"' 13 Tl"i!i.~ 'TYPt~: OF' AIi!:Sc)ir<:,::"¥':)ZC)N SYST~.:'.H ]:S A F'::CT NZTH AN UNKNC)NN (:ii:;:E:A, THE SYG'i"EH ]:S CAF:'APd_E OF:' ACCEPTZNC:; ;.;:20 [:;ALL. ONS OF WATER PER i)AYo P. ASED UPC)N THE 1"EST DATA 'Tl"l!~i: SYSTEH ZS NOT ACClii:!::'T~IiH...E FOR A Fi 0 M E C) F' :'~E, r..., r',~.) ~.~ ~: o 'THE SI'Zt::'T::CCTANK NAS PLiHF:'ED ON 2'"-:i. 2""8:!. ,, The Sep£J.e t. ank J.s ZOO0 ga'lions, 1220 LUest 25th ~uenue ·/~nchoraqe, /~laska 99503 "[907) 276-1361 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M, SULt. lVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION February 9, 1981 Audrey J. (Wetherell) Mercer Post Office Box 10482 Curry's Corner Fairbanks, Alaska 99701 Subject: Lot 13 Block 3 Mc Mahon Subdivision Approval for you~ individual sewer and water facilities cannot be granted until the following items have been completed: A well log submitted to this department for our review. The top of the well casing sealed with a sanitary seal so that it is water tight. The depression or pit around the well casing needs to be filled with impervious type soil so that it slopes away from the well casing. The well casing extended twelve(12) inches above ground level. ( ) Exposed electrical wires to the well head are in violation of the Municipality of Anchorage codes and must be encased in conduit. ( ) ~(l) ( ) The water facilities were not turned on at the time of the scheduled inspection. Please call this office for another appointment. The wa~:er analysis report needs to be delivered to this office from the Chem Lab, 5633 B Street, for our review. Expose the well for our inspection to determine proper construction, also to insure minimum distance requirements are met between the well and sewer system. Audrey J. (Wetherell February 9, 1981 Page Two Mercer ( ) The septic tank pumped.with a receipt submitted to this department. (2) The septic tank pumped with a receipt submitted to this department. The total number of gallons pumped needs to be on the receipt and verified by a registered engineer as to the actual numbem of gallons pumped. This is to verify the size of the septic tank. Expose the septic tank manhole to verify its existance. Locate and expose the standpipe to the seepage pit for our inspection. This is to insure the minimum distance requirements are met between your well and sewer system. A four(4) inch cast iron cleanout needs to be installed to the septic tank and/or leaching area. (3) An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this department for our review. ( ) The permit for the installation of an on-site sewer system has expired as of December 31, 19 We have not received the as-builts of the installation in this office. If a private engineer inspected the system, please send us the report for our files and review. ( ) The application shows the number of the bedrooms exceeds the number the sewer system was originally designed for. An upgrade will be required. Prior to any upgrade, a permit needs to be issued from this department. Please notify this department for a reinSpection when the noted descrepancies have been corrected. If there are any further questions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw SWP/059 . "~-"-')NICIPALITY OF ANCHORAGF'-~'-'' WDE'PARTMENT~:.~F~. HEALTH AND ~NVI RONMENTA'L ~,~OT'ECTI ON ..... ?. ~ '. 825..,L- S~reet, ~cnorage, Alaska 99501 ~ 279-2511, ext. 224~ 225 ~ ~- Date Received: March 25, 1977 1st Inspection: Time~9: ( k Date 3-~ Inspector Pr. acm. 9-77 Tuesday 2nd Inspection: Time Inspector REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: First National Bank of Anchorage Mailing Address: Post Office Box 4-2'090 99509 Phone: 274-1521 Property Owner: Robert B./Carol A. Griggs Phone: 344-22t9 Mailing Address; Star Route A Box 1558N 99507 Legal Description: Lot 12 Block 3 Mc Mahon Subdivision %1 Single Family Residence: (x) Multiple Family' Residence: ( ) Number.of Bedrooms: Number of Bedrooms: 5. Well Data: Type Individual COnstruction Depth Well Log Filed (.) Bacterial Analysis Sewage Disposal System: Permit ~ Septic Tank Size Absorption Area On-site system (x) Public U~ility ( ) Installed 1974 Installer Manufacturer Soils Rate Material Distances: Well to Septic Tank to Sewer Lines Nearest Lot Line Absorption Area to Nearest Lot Line ~g~O to Absorption Area -:-i:'-, ,,.: ~': : ..' .'' D~partment Of' Health:and Environmental :ProteC't'ion ~eques% for Approval of IndiVidual Sewer and War.er Facilities Legal Description: Lot 12 Block 3 Mc Mahon Subdivision #1 Affadavit Attached: ( ) Disapproved: Letter Attached: Date: Department Worksheet: MUNICIPALITY OF ANCHORAGE ~AUNICIPALIT,, oi~ ,',NcHOP, A~E DEPARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION D~PT'. ©;: i; ~.:., 7. ~ ,". 2510 Ea~ Tudor Road, Anchorage, Alaska 99504 276-2221 ;~NV~ONMENT,~L REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA_ FHA RECEIVED CONV XXXX 2. Property Owner: Robert B. & Carol A. Gri~;g~s Mailing Address: SPA Box 1558N Day Phone: 344-2219 3. Name of Buyer: Robert B. & Carol A. Griggs (Refinance) Mailing Address: SPA Box 1558N Day Phone: 344-2219 4. Name of Lending Institution: First National Bank of Anchorage Mailing Address: P.O. Box 4-2090 Phone: 274-1521 5. Name of Realtor or Agent: None Mailing Address: Phone: 6. Legal Description: Lot 12 Block 3 McMahon Subdivision #1 Location: 1558 N. Furrous Creek Road Type of Facility to be Inspected: SFD Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served No. Bdrms. 3 If Individual, depth of well Sewage Disposal System Type of SYstem: Public Utility rlndividual, yJLY-~ If Individual, date of installation Individual (on-site) 72-003(3/76) 06-1220(a) ~ev. 1973 DATE AL.r~ EPARTMENT OF.HEALTH AND SOCIAL ,~-"'-"~S DIVISION OF PUBLIC HEALTH : Lab Na. INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL ·WATER ANALYSIS INDIVIDUAL [~]..-' SEMI-PUBLIC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO NAME ADDRESS " ~ ? ~ ' CITY .... ' ~ '~ } '~ ZiP CODE ADDRESS OF SOURCE COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY " ~ : / / ? ; TIME COLLECTED DATE COLLECTED Sample Collected From .l~l Kitchen Tap [] Bathroom Tap [] Other (List) [] Basement Tap OFFICE Analysis shows thi~ Water SAMPLE to be: [~] ~alisfactory [] Unsatisfactory [] QuestlonabJe [] Sample too long in transit; ~ample should not be over 48 hours old at exam naton fo indlcale reliable results. Please send new sample. [] Bottle broken in transit, please send new sample. SANI"rARIAN'S REMARKS Well -- [] Dug [] Driven [] Drilled [] Bored SOURCE: [] Spring [] Cistern [] Other_ Dug Well or Cistern Construct~om Walls--[] Wood [] Concrete [] Metal [] Tile Brick 0~ Top -- [] Woad [] Concrete [] Metal [] Open Top [] Concrete LOCATION: [] In Basement I~ Basement Offset [] Under House I~ln Yard [] Other Building Sewer -- Septic DISTANCE TO: or Other Drainage Pipe Feet. Tank -Peet. Til~ Seepage Cess- Field __ Feet. Pit Feet. Pool Feet. PrJvy .__ Feet. Other Possible ~: Sources of Contamination MATERIAL: Building Sewer- [] Cast Iron ~t Woad [] Tile [] Fibre [] Asbestos Cement [] Plastlc Joint Material - Type No GENERAL: Does Water Become Muddy.. or Discolorec~? [] Yes [] ~. When? . Diameter of Well L=-' Depth Feet. : Well Casing J ' ~ · - :.Materlal Diameter Depth ~ ~ ~' Length of Water Depth Drop P~pe F.'Om' Bottom . Feet· Offset in In Utility PUMP LOCATION: [] In Well [] Basement [] In Basement [] Room On Top [] Of Well [] Other PURPOSE OF EXAMINATION: Illness Suspected? [] Yes- [] No New Source of Supply? [] Yes [] No Repairs to System? [] Yes [] No Signature READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1973 ~'~ ~ Time Rece;ved i ( om j . ~ Lab. No. Lactose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc 1.0cc 24 Hours 48 Hours EMB AGAR Lactose Broth, 24 hrs. 48 hrs~ Oram's stain Coliform Density (Most probable No. per 100cc) MF Results Reported by This analysis indicates Coliform Oi'ganlsms to be: Absent Present