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Home My WebLink AboutMCMAHON #1 BLK 5 LT 1McMahon #1 Block 5 Lot 1 #017-361-37 bevelopment Services bepertrnent Building Scfeiy Divisicn On -Site Wcter & W=tewcter Prccram 4700 ErcEcw Street P.O. 6ax 196650 Marx ae;ich Ancharaye, AK 99519-6650 Mayer --- muni aro/nnpr! (907-1343-7904 Pump Installation Log Well Drilling Permit Number. SW_ Date of Issue: _ Parcel Identification Number: Lead Desc tiptian Pro erty Owner Name & Address: Mr✓l�Aho.l �I �5 z I ',�-� s� pump Installation Date: pump Intake Depth Below Top of Well Casing: .2 ?5eet pump Manufacturer's Name: pump Model: v pump Size 1 hp pitless Adapter Burial Depth: J feet ,,,, pp pities$ Adapterhlanafsc urer'-1VFw s Name: rea pitiess Adapter Installer: /)yor Nell Disiafee_ed Upon Camoledoa? Z",Yes Cl No tilethod orDis:='ec=*on: G C� Comments: pump Installer Name: /410 5 -iqa el( - Attention: The pump instill= shall provide a pump installation log to the DSD widlin 30 days of pt:p irsalli iom. Municipality of Anchorage Page i of DEPARTMENTOF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW 9400 (o$ PID Number: 0173 (o l37 Name: Wastewater System: ElNew. 15'Upgrade WILLIAM SEVER Address: ABSORPTION FIELD loo DoRo51{IN AVE ANON Ak 9951 Phone: Z lo% -2430 No. of Bedrooms: 3 1Deep Trench ❑Shallow Trench Deed ❑Mound 00ther LEGAL DESCRIPTION Soil Rating: Total Depth from, original grade: r �' GPD/S . Ft. lo Lot: Block: Subl1RHdivision: (Jr, Depth to pipe bottom from original grade: Gravel depth beneath pipe 1 .S Mc 0N 1 —2- Ft. Ft. Township: Range: Section: 28 Fill added above original grade: Gravel length: 3 w t - 2 Ft. 36 Ft. WELL pX(S El New El Upgrade Gravel width: 2 S Number of lines: 1 Distance between lines: )- Ft. Ft. Classification (Private, A.B.C): Total Depth: Cased To: Total absorption area: Pipe material: PRt✓/ATE Ft. Ft. 57(6 SO. Ft. I'�'f" SCNED Llo PVC Driller: Date Drilled: Static Water Level:Installer: Date Iled: Ft. LPINE ENTERPRISES (o! 9 - 13 �94 Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑Septic 0Holding XS.T.E.P. To Septic Absorption Lin Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Slalion Tank Sewer Lines At4cgoRAGE TANTANk 1.2 50 Well I OW I I L,l,I t i 04 — a4 I Material: STEEL Number of Compartments: 2— Surface Water >loor >too' >too' — >ldo' LIFT STATION IN s-rer Tr4Nt< Lot Line r 50 1 15 I 50 — r 52 Size in gallons: Soo Manufacturer: ORENCO Foundation g r z1 I g r _._. O "Pump on" level at: "Pump off' level at: High water at: of 44 40 Curtain Pump Make & Model-, Electrical Inspections performed by: Drain _ — _ — —'0 I `/s M P M.o. A. Remarks: S fiG raoe tnsl�eellerr BENCH MARK Location and Description: 11,er a r'o v2d ee-nt7f. Gre tno ( OUTSIDE METAL DooR 5 ILL ffV Se kit izenk baekPlifew in lueG WEST SID0 00= FIiaSfi90.A1CI5 Assumed Elevation: 100.0 ENGINEER'S SEAL • Inspections performed by: FLATTOP IE -64 Svcs Dates: lst 6�9 �9`/ V T vy �� ' • 2nd 6%iol9z/��Z` �.yy ; t Jv.1144l4l40l641}!.. l.11{>4?-.. Department of Heal d u Lervices approval r4"4.� ,06.00. 466 N i:1!l.Of Y► T11Eoo0� F. ;aoRE CE - 3539 4V 0'••444=+•'' Reviewed and approved Date:? Syer• �llt� c-vwlnay. ail rJ mvA zo .. .,.'Ttf$@9la`�4�'�-�T" Permit No. SW 94go(o Page 2 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LoT I BLk 5 Mc MA Noel SUB. PID No.: 01-73(0131 oROSH IN; pR, i err DRIVEWA I 3 0 '4-4,/DECK YTN p„ 1250 GAL T Q.M, mob' STEP TANK IZ ASS. TRENCH-) it Houusc WE t.4 Flattop Technical Serf 14530 Echo Street Anchorage, Alaska 9 House CORNERS A B ENGINEER'S SEAL ,��„'is'y.4.40.�� SEPTIC tANk _) _ �) ,x e. t1F Al I 72-013 A (Rev. 9/91) MOA 25 •& 9'f' to e� e THEODGIRE F. MOORE- Permit No. SIA/ 940005 Page 3 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Leqal Description: LoT I , UK 5, Mc MA NON SU$. PID No.: 0173!, 137 sm ��Jp0.0 1 DISTRISOTIOM PIPE IrAVERT ELEV - 100.8 BOTH, EMD$ _J 12SO GALLON STEP TANK �IRVERT- INvERT / ELEV = 96.7 ELeV= 76.6' .90� BOTTOM OF TRENCH N.Jo SEEP @ SS.2 BOTTOM T-9."�1 =2S.2' Flattop Technical Servi 14530 Echo Street v> ?1�cALscgLt` Anchorage,: Alaska 99 ENGINEER'S SEAL NU 1409120NTAL SCALE 4 AV X TH __.pP}{��//t 't//sAt/Hstts ■s t)fsfwer>.- .��Yift fss s� f•st.asG :•THE000H F. A;oou f .••• C€ - 3589ve C�'4 .9_ma A Ma 01011 AMA 99 IidSPECT 10N RP.Pf_1R'.i.. .. . . "�. i✓ UNJC iPAL I PY OF ANCHORAGE., BUILDING SAFETY D IU IS ION 3500 EAST TUDOR ROAD INSPECTIONS (90")563-3464 CORRECTTLONS INFORMAT ION (907)786-82111 NAME 4 t3Ai SWAY ELECT Y — Z83S` r— CAI,11 POR 11WPECT1rjN — PERMIT t-.0 94-7763 ADItRESS" 4100 DOUSHON t.'.OT REiWOV:E PHONE 4: 5GI-0'059 I.i]T: 1 ILCl.Y: 5 SUI:D: MAHON 41 IiA.t ;i3Ih/j 1 i99 COMMENT SEWER I.IF'C � u(IG r 34 0—% � �J7 �t�t — 345—r4/6 wk -- %C -TYPE TYPE OF INSPECTION: ELECTRICAL; Ii0tJG1I 0 o 1 --- {:. :I NO NONCOMPLIANCE Ok:ERVED C I CORRECTIONS ESSENTIAL AS EXPLAINED BELOW C I WILL REEXAMINE AT NEXT IUSPECTIOC! C 3 DO NOT CONCrAL UNTIL REINSPECTED COMMENTS /11 1 yvvecc i. td5pECT0R Dr.i:F 1 %WHEN CORRECTTLONS ARE. MADE, PLE11SE CAI,11 POR 11WPECT1rjN .00 t.'.OT REiWOV:E T1I^; Mt-r':CDCI] PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940068 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:SEVER WILLIAM J & OWNER ADDRESS:4100 DOROSHIN AVE ANCHORAGE AK 99516 PARCEL ID:01736137 LEGAL DESCRIPTION: MCMAHON #1 BLK 5 LT LOT SIZE: 24521 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 1 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 4/07/94 EXPIRATION DATE: 4/07/95 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING S. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: SYSTEM MUST BE CONSTRUCTED BY A DHHS PERMITTED CONTRACTOR. ENGINEER WILL MONITOR FOR GROUNDWATER THROUGH MAY 15, 1994. RECOMMEND THAT A DIVERSION VALVE BE INSTALLED TO FACILITATE FUTURE USE OF THE EXISTING TRENCHES. RECEIVED BY: J HE:c /j1te�— DATE: It ISSUED BY: J04N tT4 DATE: n%¢ CIVIL & ENMONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS IIEODORE F. MOORE, P.E. 1111: (907) 345-1355 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: March 23, 1994 14530 ECHO ST. ANCHORAGE, ALASKA 99516 The purpose of this letter is to provide the required design narrative in support of our application for a permit to upgrade the wastewater disposal facilities on Lot 1, Block 5, McMahon S/D #1, located at 4100 Doroshin Avenue. While still functioning, the existing system failed to pass a recent adequacy test, and thus must be upgraded. A soils log, perc test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil log, the native material between 2.75' and 14.75' is a somewhat silty sand with a measured perc rate of 3 minutes per inch. Using the slightly conservative soil application rate of 0.8 gpd/sq. ft. specified in the wastewater ordinance, this 3 bedroom residence requires a total absorption area of (3 x 150)/0.8 = 562.5 square feet. The proposed 36' long soil absorption trench with 8 feet of sewer gravel beneath the horizontal distribution pipe has a total absorption area of 576 square feet. Because of site constraints the proposed trench will pass through test hole #1. The specifications call for the contractor to make sure that the soil underlying the trench in the vicinity of the test hole is fully consolidated. The topography of the lot slopes gently towards the northwest, with the proposed construction site being on a level bench on the north side of a vehicle parking area. The proposed project will have no impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any impact on reserved space/surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, �� Ted Moore, P.E. r , I ' , I LOT 21, BLOCK 3 WELL i (APPROX LOCATION) , r , r -------r - - DOROSHIN AVENUE ----- �--------- I I I I I I I I I t I I I I I I I I I I it O,��,' x" z l i ZE.Da '.'ap Ta# pa G6tn ,iJ'LAyM1yla fO:a aawV¢s 0% r>'::>::»i I ............:.:..:.+ , EXISTING C.O. i>DRNE:[tl`z , t TRENCHES TO BE WELL i ABANDONED I 1 rT.H. R15% #1 � LOT 1, L7 I SHED p 3 BDRM o BLOCK 5 B6II °° HOUSE oQ ..... . O PARIN NEW 1250 GAL. i STPTANK 'LL NEW 36 L R 100' Cc ABS.TRENWL. C�:5EPTIC ��IIIIIIIIItI 1250 GAL. TANK 15% TO BE ABANDONED 'LLEXIST. r IIIIIIIIiiii' ' ccOZ L8. SEPTIC B6 SYSTEM HOUSE LOT 21 BLOCK 5 WELL — NEW 1250 GALLON STEP TANK 36' LONG SOIL ABSORPTION TRENCH WITH 8' SEWER GVL. BELOW DIST PIPE 1.25" SCHED 40 PVC W. 3/16" HOLES IN BOT. 2' O.C. M.TLo . A cj N 36 M.T. A PLAN VIEW 1ff=10' MOUND COVER MATERIAL 0.5' ABOVE ORIG GROUND TUBE RIGINAL GROUND RIGID INSULATION TER FABRIC i 1.25" DIA. SCHED 40 PVC o W. 3/16" HOLES IN BOT. 2' O.C. J )ii>1a .25' SEWER GRAVEL (8' BELOW PIPE INV.) SECTION "A -A" SCALE: 1" = 5' O O 4" D3034 FROM HOUSE 1.25" DIA SCHED 40 PVC F ,y �deosr.veozeat doaeot`. 3�OSBf3 Jt�9pte ey9y � TEST HOLE #J, FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: LOT 1, BLOCK 5, MCMAHON S/D#1 DATE PERFORMED: _MARCH 9, 1994 PERFORMED FOR: BILL SEVER nE=u (fE SM SILTY, SANDY FILL (FROZEN) Pt SM SANDY LOAM SP/SW CLEAN COARSE GRAVELLY SAND SM SOMEWHAT SILTY SAND LENSES OF SILT POCKETS OF SP (BECOMES CLEANER BELOW 10') H2O SEEP SM SILTY SAND DAMP POCKETS OF ML B.H. SLOPE fi'.yec+.eon eeu. o..........c . ,. • `. �3 CL -3539 SITE PLAN Depth to Groundwater Date See at 14.75' 3 9 94 Net Drop (inches) [ M.T. D— 3 21 94 271/2 3:58 191/2 W EL O J N .....:.....:.....0% ........:.....:.....:.....:.....:..... .` Date Reading 9 Clock Time Net Time (minutes) Percometer Reading Net Drop (inches) 3&9 94 12" Presoak 3:48 PM 271/2 3:58 191/2 Add Water 3:59 273/4 Add water & start 4:10 231/2 #1 4:15 5 21 Add water 4:15:30 233/8 #2 4:20:30 5 21 1/16 25116 Add water 4:21 231/2 #3 4:26 5 21 1/8 23/8 Add water 4:27 239/16 #4 4:32 213/16 23/8 I I PERCOLATION RATE 3 (minuteslnch) PERC HOLE DIAMETER 71, II�JJJ TEST RUN BETWEEN 7,5 FTAND 8.0 FT COMMENTS: Design soil absorption trench between 2.75' and 10.75' with size based on 0.8 GPD/sq. ft. PERFORMED BY FLATTOP TECHNICAL SERVICES. I �.�/ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Ma,rcl) 23 M'X Flattop Technical Services 14530 Echo Street, Anchorage, AK99516 Phone (907) 345-1355 Lot 1, Block 5, McMahon S/D #1 4100 Doroshin Avenue Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of abandonment of an existing 1250 gallon septic tank and installation of a new 1250 gallon STEP tank which pumps effluent into a 36' long soil absorption trench containing 8 feet of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The new 1250 gallon, 2 compartment STEP tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4"' per foot. 3.0 Lift station: 3.1 The lift station shall be installed either in the second compartment of the STEP tank. The lift station package shall be an "Orenco" system as supplied by Anchorage Tank. 3.2 The contractor shall be responsible to obtain the necessary Municipal electric permit and inspection, and shall provide a copy of the electrical inspector's report to the engineer overseeing the construction of the wastewater disposal system. 3.3 The lift station shall be equipped with a watertight, insulated manhole riser and cover extending a minimum of 6" above final grade with positive surface drainage away from the manhole. The contractor shall be responsible for determining the necessary length of the manhole riser. 3.4 The on, off, and alarm floats shall be set at the elevations specified by the lift station supplier, and their proper operations shall be verified by the contractor. 3.5 The discharge line from the lift station to the soil absorption system shall be 1.25" dia. Sched 40 PVC. All pipe connections in the distribution system shall be glued, and the ends of all pipes capped. 4.0 Soil absorption system: 4.1 The soil absorption system shall be constructed by excavating a 36 foot long trench to a depth of 10.75 feet below the original ground elevation in the vicinity of test hole #1. 4.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. Since a portion of the trench will pass through test hole #1, the contractor shall add water to thoroughly soak the bottom of the trench in that area to be sure the backfill material is fully consolidated before placement of sewer gravel. 4.3 A total of 8.25 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 8 feet above the bottom of the sewer gravel. The horizontal distribution pipe shall be 1.25" diameter Schedule 40 PVC with 3/16" holes drilled in the bottoms on 2 foot centers. All PVC pipe joints shall be glued and the ends of the pipe capped. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 4.4 Monitor tubes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 4.5 Approved inter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 2 feet of soil cover is to be placed over the filter fabric. Two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 4.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 4.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 5.0 Inspections: 5.1 A total of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The STEP tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 5.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. �...� GREh,ER ANCHORAGE AREA BOkvJGH �ICIr!,,1i,,1, Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM � NAME ^/a//n&k0tYV MAILING ADDRESS Ip;�enj ��_ PHONE LOCATION LEGAL DESCRIPTION 1915 yl WAIIC�f SEPTIC TANK: DISTANCE /-� NUMBER OF FROM WELL �%` l/N MANUFACTURER g1 MATERIAL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY Z��$QALLONS. TILE DRAIN FIELD: TOTAL LENGTH J� �- DISTANCE FROM WELL FOUNDATION/7 NEAREST LOT LINEOF LINES._—_/__.� — I S NUMBER OF LINEDISTANCE BETWEEN LINES /l �� NN026Ne9- TRENCH WIDTHSS— IN. TOTAL EFFECTIVE ---7n I ABSORPTION AREA �5 SQ. FT. LENGTH OF EACH LINE In // j DEPTH OF FILTER l DEPTH: TOP OF TILE TO FINISH GRADE `I MATERIAL BENEATH TILE3t** ABOVE TILE Z11 IN. WELL: 1Vb % //V TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED PTH NEAREST SEPTIC SEEPAGE SEWER LINE , TANK , SYSTEM_ REMARKS DISTANCE FROM: DISTANCES: DIAGRAM OF SYSTEM fievc) !�Illly r INSTALLED BY: .5(' 4.1 L/ eP moo' 7 ' iv' P,eo�s 1 /Iv SEWER LINE DEPTH: 46�e/l *T � 3/3'arruSs_F.D. J IIr�� PIPE MATERIAL:yQQ>,k LOT SLOPE: REMARKS: DATE( ,t 7APPROVED G.A.A.B. Form EQ -032 r� M -W DRILLING, INC. DRILLING LOG Dom. Well Owner Dennis Marion Use of Well Location (address of: Township, Range, Section, if known; or distance main roar] Lotti Block 4 McMahon Subdivision 1 6- Size'of casing 6" Depth of Hole 30; feet Cased to 188' 2 feet Static water level 120 ft. ZJEZ94 (below) land surface. Finish of well (check one) open end ( X ) ; Screen ( ); Perforated ( xx ). @ /�/ 4479 Describe screen or perforation Mills Knife Perforations, 3�� @ 95 to 105' y Well pumping test at 3/4+gallons per ($i f (minute) for 1 hours with 100'/0 of drawdown from static level. Date of completion 7/13/77 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO 3 Casing stickup 3 TO 5 Organics . .5 To 13 13 To 40 40 To 70 Silty sand - � C, VED Silty gravel Silty cobbles Mu„• R 1 X991 70 TO 90 Sil 90 TO 100 100 TO 183 __IU To 300 TO TO TO TO TO TO 1 Sandy gravel HealthN,f Gravelly hardpan Bedrock, water seaps in sporaAic fractures throughout -"-1�-.-�. vv•alaay\Vl l .dYtirir,+1'r iv r1. `�14 & f�%a 1 —CUSTOMER CA F=7 lot phl CIO PH 91) Fit Ps C73. ` DEPHRTMENT� � HEHLTH HND ENVIRONMENTHL <OTECTl0 N STREET/ HNCHORHGE, HK� 9'��1 "^ 279�2511 X�F� �� HPPLICHNT BOX 865 LOCHTION [-11�J7--MM �5 NORHK LEGHL L1 B5 MCMHHON #1 LOT SIZE 24521 SQUHRE FEEl—~� TYPE OF SOIL HBSORBTION SYSTEM IS� TRENCH MAXIMUM NUMBER OF BEDROOMS � ] SOIL RHTING (SQ FT/BR)� 150 THE REQUIRED SIZE OF THE SOIL HBSORPTION �YSTEM IS� 110 BE: to, T- Ps jQ H ��INII �F--!4 lkvu 0� THE LE|GTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OFH TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCHVHTION (IN FEET). HE! EVE CIT U 101 HT M 110o ��Ic-:: �F F�i fNE 11-:::: E � �H.A.1 1:0 12, Do 1: P.-.11 IF-", 9- ]E, 'I:�Ig �� Lfi 1: F !! BE:: E.,.0 BHCKFILLING OF HNY SYSTEM WITHOUT FINAL INSPECTION HND HPPROVHL BY THIS D�PHRTMENT WILL BESnBJECT TO PROSECUTION MINIMUM DISTHNCE BETWEEN H WELL AND ANY O&SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FORH PRIVHTE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS HRE REQUIRED HND MUST BE RETURNEDTO THE DEPHRTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION. SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INSTA LLATT ON. � 00, NE! HE: 1-0 X -y- Kvu 0=1 71: EA W 1-1 1f;? M3 Sm BEE IEEE 1=--*I! IFT? W Not KT) owl X As EEL Qq M I CERTIFY THHT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON~SITE S�WERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF ANCHORAGE. 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]� I UNDERSTHND THHT THE ON~SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENET�-InkREMODELED TO INCLUDE MORE THAN ] BEDRUOMS E SIGNED HPP['I(ANT DENNIS M�RRION PERFORMED FOR: —+ SOILS LOG MUNICIPALITY OF ANCHORAGE ❑ PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST Pouch 6-650, Anchorage, Alaska 99502 276-2221 SOILS LOG - PERCOLATION TEST n C DATE PERFORMED: l0 7 LEGAL 14 DESCRIPTION: / N I - % " G �p ^56`L SLOPE d DEPTH (FEET) Depth to Water Net Drop 1 od �rAv e� C&P) 2 SA euD15 L frecQ -- 3 • .• F W l�(� JrIL(�5 T-f/l 4 /2 J7 0,0- M L 5 , WWRM 6- o 7 7 S L -I-- -8 8- 12- 9 9 10 11 / L S! L' AS GROUND WATER �� p� S L 12-v ENCOUNTERED? _,I ""_ O h4 C9 ��eL E !G u IF YES, AT WHAT ' 3 13- DEPTH? 14 15 v 16-L3 o H 17 19- W (, - , RITF PI AN Reading Date Gross Time Net Time Depth to Water Net Drop 7 40 AwN /5`" /2 J7 3110 7 " o 77 12- 20 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND Z_ FT COMMENTS t/` 6gyp, PERFORMED BY: ` IM i' 1 n` C CERTIFIED BY: 72-008 (7/76) TE: t7 V di LA -4 U!_ -L) 04 -al C., �/- �rd, to A' ��Z.J&/- b � 9 'rll-t� L m 678970 0 ND • �� 1/ e° •, t Municipality of Anchorage ^ r- _ i.V Z On-Site Water and Wastewater Program MAR 06201 -" ' (907) 343-7904 T" Certificate of On-Site Systems Approva 1/01 6 8 L 9 5e‘ Parcel I.D. 017-361-37 Expiration Date: 67 —cii—1 0 1. GENERAL INFORMATION: Complete legal description McMahon#1; Block 5, Lot 1 Location (site address) 4100 Doroshin Ave.99516*Anchorage,AK Current Property owner(s) Bryan Underwood Day phone Mailing address Real Estate Agent Kathleen Poulin Day phone 242-4223 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ' ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual El Individual Water Storage ❑ Holding Tank D Community Class Well ❑ Community ❑ Public Water System Cl Public Sewer 0 WaiverNariance request for: Distance: Received by: Date: q /1 X COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 5-aa Waiver Fee $ Date of Payment 3/7-/I ' Date of Payment Receipt Number 016t1,3(7 Receipt Number COSA# OS(ft/073 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road,Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: ? 6//13 0000000 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o" OF A �'N% in accordance with the guidelines and regulations established by the Municipality of Anchorage and `C� industry practices. The reported results describe the condition of the system/s on the date/sgof the QIP,•• •'•7v O11 evaluation. Separation distances were measured to readily identifiable features. Hidden defects or QQO� TH i.b..1`�- % *vencroachments may exist that were not identified during the evaluation. The operational life of all wells 4 , v0 and septic systems depend upon a variety of variables, including but not limited to, soil conditions, �• ••••• • groundwater levels (that may fluctuate during the year), quality of construction (materials and 4 workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and a, are outside the control of GEG. Satisfactory test results do not guarantee future performance of the f'r: A. Gor ess system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of V0n Q the well or septic system. GEG makes no representation whether an alternative well or septic system VO ns I. CE— • 3 , ••'•`ce4p can be installed on the property in the event either of the current systems fail to perform adequately in u� .� 6 ./.6 o,o the future. The content of this report is for the sole benefit of the person/party that retained GEG to ��ea p • o\�o perform the evaluation. Reliance upon the information provided in this report by any other person or 0v�0fessi c:7 party (including subsequent property purchasers) is not authorized, nor will it confer any legal right �O�Oo� whatsoever. #AECC884 6. DSD SIGNATURE 3 System #1 Approved for bedrooms ��;� pq _ P� NC System #2 Approved for bedrooms .\Q tp Disapproved J ON-SITE G, . WATER AND �t Conditional approval for bedrooms, with the follow sW ATER o PROGRAM J OV, '4 / gFRy\(� 4 , By: \ � Original Certificate Date: 3 " _/R The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheeLl0-10.12.doc If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: McMahon #1; Block 5, Lot 1 Parcel ID: 017-361-37 A. WELL DATA *Bedrock ® 183' Well type Private If A, B, or C provide PWSID# N/A Well Log (Y/N) Yes Date completed 7/13/1977 Sanitary seal (Y/N) Yes Wires properly protected (YIN) Yes Total depth 300 ft. Cased to *188.2 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 7/13/1977 2/23/2018 Static water level 120 ft. 86.1 ft. Well production 0.75 g.p.m. 0.9 g.p.m. WATER SAMPLE RESULTS: q Coliform 0 colonies/100 ml. Nitrate 1 • 1 limg./L. Collected by: GEG. Ltd. Arsenic: N 0 ug./L. Date of sample: 2/27/2018 B. SEPTIC/HOLDING TANK DATA *See Maintenance Log by A+ Home Services Tank Type/Material STEP/Steel Date installed 6/9-10/1994 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Yes Foundation cleanout (Y/N) Yes Depression over tank(Y/N) No High water alarm (Y/N) Date of pumping * Pumper C. ABSORPTION FIELD DATA *Below Existing Grade 0 West MT Date installed 6/9-10/1994 Soil rating .1(:2 ::___):1./for ft2/bdrm) 0.8 System type Deep Trench Length 36 ft. Width 2.5 ft. Gravel below pipe **8 ft. Total depth *11 ft. Eff. absorption area 576 ft2 Monitoring tube Yes Depression over field No Date of adequacy test 2/23/2018 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 13.5 in. Water added ***894 gal. New depth 55 in. Elapsed Time: 240 min. Final fluid depth 41 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date — **East MT appears to be set approximatley 1 foot shallow (assumed West MT is set to correct depth) ***Last 500 gallons introduced only caused a rise of 15 inches (33.3 gallons per inch) *Second compartment of 1250 gallon STEP tank D. LIFT STATION **See maintenance log by A+ Home Services Date installed 6/9-10/1994 Size in gallons *416 Manhole/Access (Y/N) ** "Pump on" level at ** in. "Pump off" level at ** in. High water alarm level at ** in. Datum ** Cycles tested ** Meets alarm & circuit requirements? ** E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75 + Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain None Known Wells on adjacent lots 100'+ F. COMMENTS oo�Opikx G. ENGINEER'S CERTIFICATION 0F. .q�� oma'''` , s`r��0 I certify that I have determined through field inspections and Q TH �O review of Municipal records that the above systems are in "' conformance with MOA COSA guidelines in effect on this 1 date. .• f "k A. Gorne s Engineer's Printed Name JEFFREY A. GARNESS 03(h1(4. . CE 79 •. of 16 •3 3? /v•0,00 Date /� 4OaPro fessloo�' %Op�o�o #AECC884 (Rev. 11/05) MUNICIPALITY OF F ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT (.A(t7 907-343-7904 On-Site Water and Wastewater Section j Fax: 343-7997 www.muni.org/onsite \` Nitrate Advisory Certificate of On-Site Systems Approval # OSC181073 Subdivision: McMahon #1, Block: 5, Lot: 1 A water sample revealed a nitrate concentration of 9.14 milligrams per liter (mg/L). 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. Mailing Address: P.O. Box 196650* Anchorage,Alaska 99519-6650 *www.muni.org Municipality of Anchorage '::R� • ' Development Services Department J Building Safety Division a On-Site Water and Wastewater Program $aY f !Y 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On-Site Systems Approval (COSA) # OSC 181073 During a recent COSA on-site inspection and test of the potable water supply well on Block 5, Lot 1 of McMahon subdivision, the well's productivity was determined to be .9 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3-bedroom residence is .31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On-Site Water and Wastewater Section � Fax: 343-7997 N www.muni.org/onsite 0 Septic Tank Advisors' Certificate of On-Site Systems Approval # OSC181073 Subdivision: McMahon Block:5, Lot: 1 The septic tank for this property is 24 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is a picture of the steel of a Septic Tank that is 20 years old. Mailing Address: P.0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org 02/22/2018 08:46 8686770 APLUS PAGE 01 Q;CI-Z(( MUNICIPALITY OF ANCHORAGE 3_ Development Services Department ` Phone: 907-343-7904Fax: 907-343-7997 On-Site Water &Wastewater Section b t a 'I 42- ja\loc). Lift Station/Pump Vault Maintenance Log Owner--akic.r, Street Address I Orn "n om Phone '&11)14 ••kZ• 71/ s Legal Desc. ti , re°jY'c\- 1 - PID Septic Tams; -Sludge level a- inches -Pumping: required 01_10 •Pumping completed no Liftstation: q.21. 17 -Pump basket cleaned ( 3 no -Effluent fitter cleaned yes no •Control floats cleaned 0) n9 -Proper float settings confirmed( n -Operation satisfactory E9 no Alarm System -Dedicated electrical alarm circuit C3.. no 'Audible and visual alarm inside dwelling ves no * -Alarm system operation , a • = f- • Man ole Riser -Ground water intrusion at riser to tank connection -Ground water intrusion around pipe penetrations yes r14. -Weep hole functional yes no. 'Manhole lid: Functional *Jul Insulated gliasL Properly Secured C4Jio t "All manufacturer required inspections and maintenance completed yes no Comments; sk- c.2,:�....�.a.�Q C L; Sec u C4 Maintenance Provider; Technician tIATIO lit A.k-151 c c Date of maintenance 2 -cz1—t e" Company A rn Atte Cd-ri'1 cA Signature /; Date -./ r Mailinci Address: P. 0. Box -196650 " Anchoracle. Alaska 99519-6650 ' optiw.milm.orci DOROSHIN AVENUE k . METAL FENCE T ]� o .LV • L=48.18' S 88'0.'00"E 165.10' R=30.00' :0/ ! rri Z 7.9'x11.3'— • momo Q SHED H — \ MANHOLE 5.0' DEC \ m I Z • •i 44.1 ,-i 73 LOt 1 vi Q 2 STORYRES. o ri 24,521 s.f. 4 \ X ° W/ Fuu. esMr. o Xi o Q, .� c 72.6' 44.1 C O D � : A 0 1 0 SEPTIC rn w PIPES I 0bi 10.8'x10.0' DECK rn 2.0' CANT w WELL cc I 30.0' ' / 50.0' S 89'54 00"W 225.00' / 10' SCREENING &1 I \ FENCING EASEMENT I / ' I \ Lot 2 I I I / I \ I / PLOT PLAN AS BUILT X SCALE 1" = 40' GRID SW 2835 Project No. 18-057/R1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates , inc . (907) 522-6476 Phone (907) 522-4625 Fax 0000Op0�4 Professional Land Surveyors kenOlangsurvey.com F A L 00 jonathanOlangsurvey.com 4,:f7, ...� .....<1 �s�4 I hereby certify that I have surveyed the following described property: fc/)/• =v;;7•... �O LOT 1, BLOCK 5, FIRST ADDITION TO McMAHON SUBDIVISION (PLAT No. 71-317) 0 49� . *00 Anchorage Recording District, Alaska, and that the improvements situated thereon are v within the property lines and do not encroach onto the property adjacent thereto, that 17 Q no improvements on the property lying adjacent thereto encroach on the surveyed O'to'" KENN• ••• ••LANG) .• premises and that there are no roadways, transmission lines or other visible •�, o easements on said property except as indicated hereon. h ' 2 1$ GD Dated this the 'Gl.° Day of l=•� 44tiQ1ll , `e-il\'`, , at Anchorage, Alaska 4�46,0 ••• Noo I OpROFrsSioNl+I-� It is the responsibility of the owner to determine the existence of any easements, ‘OpOoo� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 s CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-361-37 Expiration Date: 0 1. GENERAL INFORMATION Complete legal description MCMAHON S/D #1; BLOCK 5, LOT 1 Location (site address) 4100 DOROSHIN AVENUE, ANCHORAGE AK 99516 Current Property owner(s) ROBERT & RUTH SHAW Day phone 244-1262 Mailing address 4100 DOROSHIN AVENUE, ANCHORAGE, AK 99516 Real Estate Agent JOHN BLAINE W/ PRUDENTIAL Day phone 229-8050 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by. 1 4Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Yqd •� Date of Payment Receipt Number COSA # DSC 13132) Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. 1 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name Engineers Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering ana"Is of the system in accordance with ADEC and MOA DSD Guidelines & Regulations The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identeble features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to most the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD�TURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following Phone 337-6179 Date 7 I 1� 1.3 OF `Trey'A.S) . j,. E t�. 7 // uL OpOaz153 ,� !, ��Ar o f essi0000� Certificate Date: ON-SITE WATER AND WASTEWATER The Mtf pality brrAngrforaiieffevelop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon t e relpresenat ions given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist ' Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 11105) If more than 1 septic system is on the lot: COSA Checklist # _of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: MCMAHON S/D #1; BLOCK 5, LOT 1 ParcellD: 017-361-37 A. WELL DATA *BEDROCK ® 183'. Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 7/13/1977 Sanitary seal (YIN) YES Total depth 300 ft. Date of test Static water level Well production Cased to *188.2 ft FROM WELL LOG 7/13/1977 WATER SAMPLE RESULTS: 120 ft. 0.75 g.p.m. Well Log (YIN) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 5/29/2013 0.77 g.p.m. Coliform d colonies/100 ml. Nitrate o ' ' ` mg./L. Collected by: GEG, Ltd. Arsenic: NVO ug./L. Date of sample: 5/29/2013 B. SEPTIC/HOLDING TANK DATA Tank Type/Material S.T.E.P./STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (YIN) YES Depression over tank (YIN) NO Date of pumping (0 Pumper 5 k cc C ` C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 6/9-10/1994 Soil rating .p.d./ orft2/bdrm) 0_8 Date installed 6/9-10/1994 Cleanouts(Y/N) High water alarm (YIN) YES System type TRENCH Length 36 ft. Width 2.5 ft. Gravel below pipe 8 ft. Total depth *10.8 ft. Eff. absorption area 576 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 5/30/2013 Results (Pass/Fail) PASS For E bedrooms Fluid depth in absorption field before test 32 in. Water added **845 gal. New depth 61 in. Elapsed Time: 120 min. Final fluid depth 49 in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date **620 GALLONS INTRODUCED ON 5/20/2013. 845 GALLONS INTRODUCED ON 5/30/2013. NOTE: TRENCH WAS INSULATED PER 1994 INSPECTION REPORT. 2'+ SOIL COVER ACHEIVED. D. LIFT STATION Date installed 6/9-10/1994 Size in gallons 1250 Manhole/Access (Y/N) YES "Pump on" level at 44 in. "Pump off' level at 40 in. High water alarm level at 46 in. Datum BOTTOM OF BASKET Cycles tested 3+ Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /O 4- Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION ( 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 JEFFREY A. GARNESS Date 7 101 r3 (Rev. 11105) Driveway, parking/vehicle storage V+ 0 D a 2d'sH-rry AVE, EASEMENTS Of RECORD, OTVi R THAN THOSE SHO' -VN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. At Built No (`yrnart $at This Data i hereby M IRIntl t NW euNey►o tPA WlOWtnp deec*IOed property, Lot t 81ock 1�1chfAflOA/ 5'eODI Anchorage record,np.,Cltltlftr Awoke. and that the NM,O.' M"If situated thafeon are wpthm the proportY limo and do nor 0"(40 Or enaoocn on the oroperty lying ocia"M thereto, that no Inwrovementt On poverty ty,Aq ld,&Canl thereto Inc/oath on the prem,"e in OuNtion and that thR1 are no roaaveeyt, arenrm,u,On rrn" or other vniole ""merits on said property ek Copt to InOW04 "moat. AnchOreq, Alaska 25 ✓<1LY 0,15 Book No. - Re 50,0 A Pape Pb. N *�49Td P� eM• eMe •NMaeew U• 'c S '"I'1 eatta H,lefenatl j Jf ee. t1a. 1�OtFi�e %?AlrFt�,d1lA4 L'� jllr I Municipality of Anchorage y` Development Services Department a Building Safety Divisiont a SA Eix On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 131321 During a recent COSA on-site inspection and test of the potable water supply well on Block 5, Lot 1 of McMahon subdivision, the well's productivity was determined to be 0.77 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage Community Development Department Development Services Division 4 SA ETY c 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 # 131321 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 5, Lot 1 of McMahon subdivision. This inspection revealed a nitrate concentration of 8.71 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. S-G$-- SGSRef.# 1132069001 Client Name Garness Engineering Group, Ltd Project Name/# McMahon 91 B5, Ll Client Sample ID McMahon #1 B5, Ll Matrix Water (Surface, Eff, Ground) Sample Remarks: Parameter Metals by ICP/M3 Arsenic Waters Department Total Nitrate/Nitrite-N Microbiology Laboratory E. Coli Total Coliform Results LOQ ND 5.00 8.71 0.100 Negative I Negative 1 Printed Date/Time 06/04/2013 16:03 Collected Date/Time 05/29/2013 17:15 Received Date/Time 05/29/2013 17:30 Technical Director Stephen C. Ede Allowable Prep Analysis Units Method Container I Limits Date Date Init ug/L EP200.8 C mg/L SM214500NO3-F B 100mL SM219223B A IOOmL SM219223B A 05/31/13 06/03/13 ACF 06/03/13 AYC 05/29/13 DSH I 05/29/13 DSH MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # Ali 3l0 (- 31 HAA # _ b W6 0,Q_ 1. GENERAL INFORMATION Complete legal description l.at li B /vc k'S Mc rlahan Location (site addressor directions) H/rJa. Daror/1;n - .4ue Property owner wtfll u,— : Se v« Day phone 2 66 - Z y3o Mailing address _ 1100 0&ror A;n ' Ave':, AAcA ,4 4gS .V d' i Lending agency Day phone Mailing address Agents E1l1sa,*, Fcr htne Pro 0 li 2, Day phone 56 Z- 7653 Address ss -2S ,C/`"-5 f.: ` fin chc�crsr� AGc 99503 t, r Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 =•- rn 3. TYPE OF WATER SUPPLY: - z rn.. m Individual well ✓ — ` �z Community well r'r7 a' Public water r Q . NOTE: If community well system, provide written confirmation from State ADEC attest in g to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: 1 Individual on-site ✓ ;' '� Holding tank - Community on-site3113 Public sewer )I NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. - 72-M (Rev. 1/91) Front MOA #21 - - 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my 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 Fla f�94 Tec%n r'ca / Serrir'c-er Phone 3 YS'- 1-7,rs- Address l yS3 a -cAo Sf. 99S161 Engineer's signature � O-°"`— Date S14 11X2 199s `:-wpm $ 1*0 0#400.940.90.0.99#14¢-* ; 11S . '.b #4094099 ••.• • 0:9.9••4f - - 77777 THEODORE F. MOORE W�. • � .• CE - C589 W. 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. - Conditional approval for bedrooms, with the following stipulations: 1 gy Date 7 CAUTION The Muniglpality of.Anchorage Department of Health and Human Services (DHHS) issues Health Authority `Approval bertificatjS based only upon the representations given in paragraph 5 above by an independent ", V- professlo�al 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(Fiev.1/91) BaCk MOA921 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L. of 1161 k S M c M aL on S /J) Parcel I.D. A. Well Data Well type P V,4" if A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 7 / 13 / 77 Driller M -k/ Date of sample: 7 / 6/ LE Total depth 300, Cased to I &8' Casing height a ' Sanitary seal (Y/N) Y Date of test Static water level Well flow Pump levell Wires properly protected (Y/N) FROM WELL LOG 7/13/77 Ito' 31Y g.p.m. SEPARATION DISTANCES FROM WELL TO: AT INSPECTION 9'7' R RECEIVED -g-P-mJ U L 1 21995 —ti,:, :y of Anchorage oept. Heaith & Human SerY ct Septic/holding tank on lot 1 d y ` ; On adjacent lots > «� ` Absorption field on lot 1 1 ti' ; On adjacent lots > IGa Public sewer main > 1&01 Public sewer manhole/cleanout > 100' Sewer service line > 25' Petroleum tank Nonc S eeh WATER SAMPLE RESULTS: Coliform 0 col B. /roo n, J Nitrate 1,7f 24 1-( Otherbacteria None reeorl-eo( Date of sample: 7 / 6/ LE Collected by:1= /u /1C� 7'6-c4 uc Sur - B. SEPTIC/HOLDING TANK DATA Date installed 6l 13 19 Y Tank size / 2S0 Gut STS P Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) K High water alarm (Y/N) Y Alarm tested (Y/N) Y Date of pumping Pumper rSaac1 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 10 RI' On adjacent lots > /0o' Foundation To property line SG' Absorption field r 2' Water main/service line > 26' Surface water/drainage > 100' 72-026(3W)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed 6Y 13 / 9 Y Manufacturer O ren co / /fin e h % an Size in gallons - SOU a l 2 n d Cam ' t, Manhole/Access (Y/N) Y Vent (Y/N) Y "Pump on" level at H y" "Pump off" Level at Ho ' High water alarm level H61' Cycles tested N. A. ( new.) Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot lot/,- On adjacent lots > /001 Surface water > / o0 D. ABSORPTION FIELD DATA Date installed 6 / 13 19Y Soil rating (GPD/Ft') 0.9 System type Tien ch Length 36' ' Width 2.5" Gravel thickness 8 ' Total depth 10, Total absorption area S76_ r3 ' _Cleanout present (Y/N) Y ( M, T.) Depression over field (Y/N) /u Date of adequacy test N. A. ( n(.tcw) Results (pass/fail) Pa.0 for 3 Bedrooms Water level in absorption field before test – After test Peroxide treatment (past 12 months) (Y/N) N If yes, give date N. A. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I I y ' On adjacent lots > I oa' Property line ► 51 To building foundation 2 r ' To existing or abandoned system on lot % *a0' On adjacent lots > 70' Cutbank N . R Water main/service line > Ss- Surface SSurface water > t CIO, Driveway, parking/vehicle storage area Ha i excel) f � 20r'� 02a Curtain drain I\Ione seen E. ENGINEER'S CERTIFICATION 1 certify that l have checked, verified, or conformed to all MOA and HAA guidelines in,e(%ton the date of this inspection. Signature �y �•� Engineer's Name Theo ara re T= Moore Date ITU � l 2� 19 9S HAA Fee $ 3 Co �G Date of Payment '//�5 �J Receipt Number 72.026 (3193)' Back asV � r.rlt C`: i I 4 9 9 0 Y c wyp.;1. CMWWA M1W4 6:w: anae ••r�ea"e avaoo aoa� �a TI'1801)Oi:i F. � BOOR[ . r C ,a ' °i. .ai.:y,. Waiver Fee $ Date of Payment Receipt Number 07/11/95 13:54 COMMERCIAL TESTING - 91773451355 'etiLME Environmental Services Inc. Laboratory Division Laboratory Analysis Report CT6E Ret.# 95.2782-1 Matrix NATER Client Sample ID L1 SLKS MCMAHON S/D Client Name FLATTOP TECHNICAL SRV Ordered By TED MOORE project Name Project# PASID UA Sample Remarke: SAMPLE COLLECTED BY: T.F. MOORE. NO. 844 D02 WORK Order 16027 Printed Date 07/11/95 Q 11:51 hre. Collected Date 07/06/95 m 10:20 hre. Received Dace 07/06/95 w 10:50 hre. Technical Director STEPUSN C. BD2 Released By -s_'4 �r QC Allowable Ext. Anal Parameter Reeults Qual Unita Method Limits Date -_.------------------ Date Init -------"'------- ---------- ------------------------------- Nitrate-N 1.71 D --------------------------__------ mg/L BPA 353.2 10. 07/10/95 CMR • See Special Instructions Above UA . Unavailable E' See Sample Remarks Above NA + Not Analyzed (L - Undetected, Reported value is the practical quantification 11Nit. LT a Lass Than 15"z Secondary dilution. GT - Greater Than u 200 W. Potter Drive, Anchorage, AK 99518.1606 — Tel! (907) 562-2343 Fax: (907) 561.5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND. MICHIGAN, MISSOURI. NEW JERSEY, OHIO, WEST VIRGINIA b+-C— MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES- Division ERVICESDivision of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# HAA# 6\Q00-iD55a 1. GENERAL INFORMATION Complete legal description i of 1, 6 foci S ti r MctAol) SID 4�-1 Location(siteaddressordirections) y/00 ve Property owner Wril part Sever Day phone 266 --2'&130 Mailing address Y100 oorOSAIA AV(E i Al)ch A -k 99s/j5� Lending agency Day phone Mailing address Agent For fun primer Kej Day phone S6 Z- 76s3 Address 2S 2S ? " SftI}n�,, A -k 9QS-0 3 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well ✓ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: It community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1191) Front MOA#21 A C.l M STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my 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 r= fafolv Technr cecl Sery rc of Phone 3 yS- / 3,51 - Address /HS30 Ectio 5�., /}ncApr7,0 /}Gc 99S1� Engineer's signature J Date_ Tu IV S, 199Y UTH ,f •aThEODO:'E F. SSOORc • c�' �';,., ••� CE - 3589 ,IL cY DHHS SIGNATURE —/—I- Approved for bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: a - The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services 44 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1o1 fi 6tock9, 1`1cNahonSID Parcel I.D. A. Well Data Weil type Pri v nJe If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 7/ 1V 77 Driller M -K" Total depth 3001 Cased to I$B' Casing height 2' Sanitary seal (Y/N) Y Wires properly protected (Y/N) `r FROM WELL LOG AT INSPECTION _ 3 Date of test 7 / 13 / 7 7 12/25- 19 Y 0 z 7 <= n Static water level 120, 77 r' z l -r7 0 Well flow 3/Y g.p.m. 1.1 g.p.rn ,, A O < Pump levell - - Z d�rI ti = SEPARATION DISTANCES FROM WELL TO: ® N O rt' Septic/holding tank on lot I O, ' ; On adjacent lots > too ' z Absorption field on lot ) I Y' ; On adjacent lots > 100, Public sewer main > 100' Public sewer manhole/cleanout '> too' Sewer service line -> 2S' Petroleum tank N04e s e en WATER SAMPLE RESULTS: Coliform O co/ ltoc m-� Nitrate 1.30 my IX Other bacteria O ca///0c, Date of sample: 6 / 13 /9 Y Collected by: F/df -? Tec/i Svc B. SEPTIC/HOLDING TANK DATA Date installed ir / 13 / 9 Y Tank size 1250 Gal S1�ej� Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) High water alarm (Y/N) Y Alarm tested (Y/N) Y Date of pumping 'N. A. ( n e -a) Pumper N. A. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I Oy' On adjacent lots -,,,1001 Foundation V, To property line SO' Absorption field f 2' Water main/service line ;;. 25'' Surface water/drainage > 10O' Im 72-026(3193)• Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed 6'113 / 9 V Manufacturer /4n c -A Tun k / 0rep c0 Size in gallons SG0 u/ seco�c! Cvr( 'f Manhole/Access (Y/N) Y Vent (Y/N) Y "Pump on" level at N all "Pump off" Level at `f0 High water alarm level H6 ° Cycles tested N' A. n� Meets MOA electrical codes (Y/N) Y SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot I 0 H 1 On adjacent lots > 100' Surface water > 100' D. ABSORPTION FIELD DATA Date installed 6I 13 19 y Soil rating (GPD/Ft') 0.8 System type Trench Length 36 Width 2,sI Gravel thickness B' Total depth (o Total absorption area 57K a' Cleanout present (Y/N) M, 7' Depression over field (Y/N) N Date of adequacy test N. A. C n Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: for rtest If yes, give date 3 Bedrooms Well on lot III I —On adjacent lots > /Ga' Property line IS To building foundation 2/' To existing or abandoned system on lot a: 20 ' On adjacent lots > 3 0' Cutbank N. A. Water main/service line > 2s" Surface water > 100 Driveway, parking/vehicle storage area cenf L arw( Curtain drain Mone Seen E. ENGINEER'S CERTIFICATION / certify that t have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Ti/� _ T 9,ne � Engineer's Name TheOdto✓e F. 111aare Date Ju14 S (99V HAA Fee $ 300 f� Date of Payment 7— Receipt Receipt 72-026 (3/931' Back ialy ra - , 3 Waiver Fee $ Date of Payment Receipt Number r 9 NCEA908 Commercial Testing & Engineering Co. Environmental Laboratory Services000000 LABORATORY ANALYSIS REPORT CT&E Re£# 94.2913-3 Client Sample ID Ll BLK5 MCMAHON S/DN. HOSE BIB Matrix WATER ClientName FLATTOP TECHNICAL SRV WORK Order 79412 Ordered By Printed Date 06/27/94 @11:43 Ins. Project Name Collected Date 06/13/94 @14:30 hrs. Project# Received Date 06/13/94 @ 16:45 hrs. PWSID UA Sample Remarks: ROUTINE SAMPLECOLLECTED BY: T.F. MOORE. QC Parameter Results Qual Units Nitrate -N Technical Director STEPHEN C. E -DEE ReleasedB Method 1.30 mg/L EPA 353.2/300.0 Allowable Ext. Limits Date 10 * See Special Instructions Above UA–Unavailable ** See Sample Remarks Above NA=Not Analyzed U =Undetected, Reported value is the practical quantification limit. LT= Less than D =Secondary dilution. GT= Greater Than n 5633 B Street, Anchorage, AK 99518-1600 — Tel: (907) 562-2343 Fax: (907) 561-5301 Anal Date Init 06/17/94 CMR ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 41 -7 -.Tel, /T .�7 HAA # / /7 M9112 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) 404- Location of Location (address or directions) `i/GG porosh',., j�vG J (b) Property owner At'an !,lam, Iso^ Telephone: (home) SY.S--2603 Business 263' Y346 Mailing Address Y/00 Dorosti;n Alle.. hncA&no eye, AAr 99Pt,( (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent — 200 / /?Pa4n L'a�+,�, 6C Address 2tSdG fiB/1aliy .S«t�e V06 fil�tl7o/ 2 �pS�� V Telephone 2 76�— 200 / t. (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 3. WATER SUPPLY Individual Well Number of bedrooms 3 &�_ Community ❑ Public ❑ Ted Mo o -- 3 lu -I _T � 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 R1 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 verifythat 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 F/_gin l ec" I ca/ Svcr Telephone 3 yS- / 3 Ss - Address L' ,S'30 A/r Date W / to / 9 M .4Y ��✓•••e ose OoA.,I jp�.. •�, ••••.di...,..E` gineer's Seal }.•THEO^ORE F. SAOORE 4 CE - 35309 { l 0 6. DHHS APPROVAL Approved for --I—bedroomsby Jo( -4R �SvK (T1-4- Date 44b/11 / Approved _-4—Disapproved Conditional Terms of Conditional Approval CAUTION 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 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 ", MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 - 343-4744 L l 6 3 Mc Legal Description: riANoN # A. WELL DATA Well Classification FRIVATE If A, B, C, D.E.C. Approved (Y/N) N R Well Log Present (Y/N) i Date Completed 7113/77 Yield 0-90M r»ral y/2/9 / 68, Total Depth '30,0 to 1"Depth of Grouting N.A, Static Water Level 15, o N 4 (2 /91 Pump Set At 2 9 b Casing Height Above Ground 30 le Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y/N) IN SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 1 t0 , TO C.D On Adjoining Lots l l R To C.O . To Nearest Edge of Absorption Field on Lot On Adjoining Lots > 119' To Nearest Public Sewer Line '> 00 To Nearest Public Sewer Cleanout/Manhole � (00 To Nearest Sewer Service Line on Lot Water Sample Collected by W-rToP tFol Sacs ; Date -3/2S/9/ Water Sample Test Results 504;_( OrO+c/01- y - O ca(J&r--" lid 0.7S my// n� fru/,=N Comments //Ah cvec( (o A p H�fl F(e- CU X c .f' <� _ro/n ardl-e,- cC Cis ed. Y �LrJI AQ/ �2 rL r a �rof cr$ Q r B. SEPTIC/HOLDING TANK DATA Date Installed 1077 Size 1250 G No. of Compartments Standpipes (Y/N) Y Air -tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Vi n 2 Foundation Cleanout (Y/N) Y Date Last Pumped 91tt l9 0 �v *r7' iV r+cQ ;for Holding Tank High -Water Alarm (Y/N) 1A A Temporary Holding Tank Permit (Y/N) N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 110' FROM C. 0. To Building Foundation I7 r FROM (',o. t To Property Line So r To Disposal Field 7 PER INSP �S REPORT - To r 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 Absorption Strata 150 n` ( gpRM Type of System Design 7RENC H Date Installed 677 Length of Field 78 r Width of Field 3 Depth of Field 7 Square Feet of Absortion Area 1+SO Gravel Bed Thickness Statndpipes Present(Y/N) Depression over Field (Y/N) K Date of Last Adequacy Test `f �2 Results of Last Adequacy Test Ade-iFuu�E dor 3 bedr'oom_j SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 117 To Property Line 10' AQP ',nseecl4on re.por't To Building Foundation 19 To Existing or Abandoned System on Lot N.A. ; On Adjoining Lots y0 To Water Main/Service Line 5 12 To Cutback (if present) N A To Stream, Pond, Lake, or Major Drainage Course 7 loo' To Driveway, Parking Area, or Vehicle Storage Area IS r 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/N) Comments Dimensions Manhole/Access (Y/N) "'Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA,,-guiftlfnes�n effect on the date of this inspection. SignedFIV 4o�.t Company %Cc(Ao P%titinrccd Ser"(C-. rae°aocaaeoaaaa°caa°aoa aea. Date q/10 ¢ / t Engineer's Seal MOA No. 90 – 01.9 a z TI; _occ Receipt No. ` `mel d els Receipt No. Date of Payment r—� Waiver Fee: $ — Amount: $ Z – Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ,%TWISTS R'EPOR'T' BY "SAMPLE for F1ORKo::der# 32846 Date Report Printed: APR 1 91 i 15:43 Client. Sar.,nie 1_1):Ti. B` 11CbtAliON WRIT ROSE BIB Client Name :FLATTOP TECIMICAL SRV Client Acct- :FLATTOT CoTlaetce, IW, 91 a 15:00 his. BPO it PO ;1 NONE RECEI'1RD Receiveu IiAR 27 91 c. 11:15 hrs. Ray 1; Preserved. with :AS REQUIRED Ordered By :TED 1,90RE Analysis Completed :164P, 27 91 Send Reports ':o: aLar.ar.nr.y .`iun=r;isyr 3101 ii C. EDE 1)FLATTOP TECHNICAL SRV I.elen�('d By �� moi; � �� 2) Chemlab Pei 4; 917.1192 Lab Smpl ID: 1 tbatrix: EATER Allowable Parameter Testoo Result Units tdethod Limits NITRATE -11 0.75 Ing/1 EPA 353.2 10 Sample ROUTINE SA?*LE COLLECTED BY: CILRIS. Rom.irks: u 'r 1 Tests Performed Jv J1 Sae Special_ Instrur..tio.ns Above UA-AUnaveilablo ND- None Detorted San Sample Remarks Above 14h- ldo+. Analyzed LT -Less Than; CT -Greater Than Parcel I.D. # MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services M DIVISION OF ENVIRONMENTAL SERVICES M}t 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING HAA# AA21--C)LA 1Q 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) /o -I I inIUGo- /%wl le ^11_144-,41 Location (address or directions) (b) Property owner 1074 ri'o of Telephone: (home) Business Mailing Address (c) Lending Institution Telephone Mailing Address 1 / / n (d) Real Estate Company and Agent / ��r f/ � N `� /1 414 tfr� Ale U0 A,/ kv d Address Telephone 9"? ` z Fo (e) Mail the HAA to the following address: (or check here I$, if hold for pick up.) List contact person and day phone number below: P PSSa 2. TYPE OF RESIDENCE Single -Family X 3. WATER SUPPLY Number of bedrooms 9 i d Individual Well K 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 X 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 �Pssa. 'ir'f �` �:s f Telephone 3 y9�yS� Address z�v � � �n'�l /Ale Fc7507 Date C?— /i — Fry 4J.�./- t 4,'.s 'tI�� li n� flT nngineer'S SNl eal ,.Ct142 i t ^ 6. DHHS APPROVAL ? q Approved for 3 bedrooms by �' v "� Date Approved X Disapproved Conditional Terms of Conditional Approval CAUTION 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 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 v S\0� MUNICIPALITY OF ANCHORAGE (MOA) py\� �s • Health Authority Approval (HAA) �\\L\e ��P CHECKLIST -FEBRUARY 1984 M j �J o�� ` 343-4744 Legal Description: 1071- A. 1071 - A. WELL DATA Well Classification Pte,' u0r,0 If A, B, C, D.E.C. Approved (Y/N) NSA Well Log Present (Y/N) Y Date Completed -711,7177 Yield Total Depth -33-00 �[ ased to Depth of Grouting Static Water Level Pump Set At '<00 i Casing Height Above Ground 3 Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) X Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot //0 ; On Adjoining Lots Zoo To Nearest Edge of Absorption Field on Lot //7 ; On Adjoining Lots '-7-004- To To Nearest Public Sewer Line IV14 To Nearest Public Sewer Cleanout/Manhole /VM To Nearest Sewer Service Line on Lot Water Sample Collected by !%/Iv,i%,�Bess� ��s d 0/ts� • Date 971S-9? Water Sample Test Results Df 7,,s P 4c rro r y Comments Well 4odvc_'5449ro © �n GAMe /wke� t4a ,5-1.114 / /sus �i �y`s Frani �ff�l�S it'ccord5" B. SEPTIC/HOLDING TANK DATA Date Installed 6177 *-Size 2510No. of Compartments Standpipes (Y/N) X Air -tight Caps (Y/N) i Foundation Cleanout (Y/N) ly Depression over Tank (Y/N) N .Date Last Pumped S -88 �S/}AC 7S Pumping/Maintenance Contact on File (Y/N) �� ; for Holding Tank High -Water Alarm (Y/N) N fA Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well /1O To Building Foundation To Property Line '5101 d To Disposal Field To Water Main/Service Line 60 To Stream, Pond, Lake or Major Drainage Course /V//7 Comments )� FroM VNNs' / cC_Q')_5 72-026 (Rev. 7/88) Front Page 1 of 2 A9 s 7e C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 0NXa0wAt Type of System Design Date Installed . e 7 - Length of Field n Width of Field 36 Depth of Field Gravel Bed Thickness Square Feet of Absortion Area 41-50 1' Statndpipes Present (Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test agt, 41a CJs' o f f �i,'3' d4l-e SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 17 To Building Foundation Lot /Y / To Water Main/Service Line To Property Line To Existing or Abandoned System on On Adjoining Lots BOG �,- To Stream, Pond, Lake, or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area To Cutback (if present) &Z4 Comments // ltro n///JNli3 Kala/rdSt/J/ f�s7`��J /jde�u�l/i nh/ccvtvc/ �4 e r1i9d1 iT I[eEe Lduc/ 7L491 'el� �'a.li'eiJl 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) ""Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have chec erified, or conformed to all MOA and HAA guidelines jn,effp,�> on the date of this inspection. t Signed Company o }�j�r naaco.E" inper's Seal Date J MOA No. ��'[��'��® �. r.4 ori J� os C3,307)- Receipt No. 11 d Date of Payment o r) Amount: $ Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 EI TESTING LABORATORIES, INC. "U iIE".J.1 iL: .7Ia. -:r�C .:Ji—.c .%..��. L. A ..:l 1OJ I1S ANKS T=.c=- A%'-- `+.AGE SKA S�c03 �;7.337c Besse, Epps, & Potts 2220 E. 88th Avenue Anchorage, Alaska 99516 Attn: Andy Potts Source: McMahan Subdivision/L1-B5 Sample ID#: A091588-112 Parameter Unit Result Date Arrived: 09/15/88 Time Arrived: 1700 Date Sampled: 09/15/88 Time Sampled: 1600 Date Completed: 09/23/88 ADEC MCC* ---------------------------------------------------------------------------------- --------------------------------------------------------------------------------- Nitrate-N mg/1 0.45 10 Reported By: Date: 09/23/88 --------------------------------------------------------------------------------- --------------------------------------------------------------------------------- Francois Rodigari, Anchorage Operations Manager * MCC = Maximum Contaminant Concentration d@�`�R5`�y H s:�(N i� � N 9 H 3 Y% I.� TESTING BOR T 1RIES. / INC. Jl^. ..:`NVC ^`SJ. i -.L �.SKA 9977 . i:I9.-1' ANCHORAC -.A Lr 5KA ?503 9C4-27�,. Quality Control Report Client: Besse, Epps & Potts ID#: A091588-112 Listed below are quality control assurance reference samples with a known concentration prior to analysis. The acceptable limits represent a 95% confidence interval established by the Environmental Protection Agency or by our laboratory through repetitive analyses of the reference sample. The reference samples indicated below were analyzed at the same time as your sample, ensuring the accuracy of your results. Sample # Parameter Unit Result Acceptable Limit ---------------------------------------------------------------------- ---------------------------------------------------------------------- 0.4 mg/l Nitrate -N mg/1 0.43 0.36 - 0.44 Standard Reported By: Date: 09/23/88 ---------------------------------------------------------------------- ---------------------------------------------------------------------- Francois Rodigari, Anchorage Operation Manager ---------------------------------------------------------------------- ---------------------------------------------------------------------- MUNICIPALITY OF ANCHORAGE , DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date��/�V 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lnr I SL*_ S /y)cmR-Ho.l -:tr Location (address or directions) 410a, j�otcost.a�wz' " 7 ..>y�z NVPL Telephone: Home '� ' 3�a'F3 — Business 2-79 5-6, T6 (b) Applicant Name �L�_—� P Applicant Address ig80JE (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer ❑ ; Other ❑ (explain); (d) Lending Institutio ` Telephone e �(2J Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: %"e7/Z==/ � /� GNU 2. TYPE OF RESIDENCE Single -Family g Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well R1 Community ❑ Public[] " Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite.Z 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 (11/84) Page 1 of 2 5. ENGINEERING FIRM PROVIDIN. INSPECTIONS, TESTS, FILE SEARCH, DA.,% 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 3FS5E E4�sv- oT1� Telephone 3�IR-(P4s) Address 9V21- Date TH Date b f (.p 16 (e, % 'n Engineer's Seal COe o Oa094a�Yasee�eadca:%�^°�' Ca e S. Me 5W 6353 J ° �• l�� o��Cr ��• �814%ZRQFESSO " 6. DHEP APPROVAL Approved for —{Ll,e bedrooms by / Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHORAGE- CHECKLIST - FEBRUARY 1984 DEPT. OF HEALTH & 264-4720 gNVIP.ONMENTAL PROTECTION Legal Description: LOT a- I u N1986 1Y90 �'I� LOQ A. WELL DATA RKEIVED Well Classification If A, B, C, D.E.C. Approved (Y/N) ^}�� Well Log Present (Y/N) Date Completed '713j7-7 Yield 3/4+�P^1 Total Depth 3a_ ased to Z60 Depth of Grouting JA Static Water Level 1�5' Pump Set At Z150 Casing Height Above Ground Sanitary Seal on Casing (Y/N) — Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ; On Adjoining Lots ZC:)O+R, To Nearest Edge of Absorption Field on Lot //7Gr ; On Adjoining Lots zc;70} To Nearest Public Sewer Line .'01A To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by /l7�ke K>��:F $>ras��pps+ ��/ ; Date�j t� gig Water Sampl Comments 'n 4V pn' l 5u_ Fl -ow B. SEPTIC/HOLDING TANK DATA Date Installed 62 1-7-7 Size /Z,SO Cr t� No. of Compartments Standpipes (Y/N)— Air -tight Caps (Y/N) -- Foundation Cleanout (Y/N) Depression over Tank (Y/N) AJ Date Last Pumped (�� Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) __n4 Separation Distances from Septic/Holding Tank: ;for Temporary Holding Tank Permit (Y/N) 46 To Water -Supply Well /10 F7 To Building Foundation 10 F -r To Property Line So" F -r To Disposal Field "7 r -T To Water Main/Service Line Cno PT To Stream, Pond, Lake, or Major Drainage Course (A Comments S55 ATTA 150 ltJ1aPOVUO P 1'?7KT VJi11(�IN�j tLCbIcf1T. Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level " Check Permitted Bedroom Rating Against HAA Request " nt (Y/N) Pumping Cycles during Adequacy Test. Meets MOA 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 Receipt No. Z) Cr L,) Date of Payment q, Amount: $ /-� Page 2 of 2 72-026 (11/84) Date MOA No. PON [ape ��D as �daeaaD60Da6% DOas•e�q yr o 4 �OCCs • CAO�OOo •e�y C CO CO .e rv% Car . Mayo 353 4a �"ROFESStON��`' Engineer's Seal Soils Rating in Absorption Strata (,).JK+-Jo%A_�^t 1&0 Type of System Design—Meaeb Date Installed 1. /77 Length of Field -78 Pr V Width of Field -3G 1,J T - Depth of Field 1---r- Gravel Bed Thickness 3 rr v Gravel Square Feet of Absorption Area l Standpipes Present (Y/N) `1 Depression over Field (Y/N) Date of Last Adequacy Test (a! tij {R Results of Last Adequacy Test rm Separation Distance from Absorption Field: To Water -Supply Well I I'7 rT To Property Line zS + Pr To Building Foundation tai r -r To Existing or Abandoned System on Lot nr)A On Adjoining Lots )00-4"17_r To Water Main/Service Line '7 1=T To Cutbank (if present) ) A To Stream/Pond/Lake/or Major Drainage Course rJ 1 1G To Driveway, Parking Area, or Vehicle Storage Area I(!j,Gr Comments � ArWA50 ,'IEPti'M D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level " Check Permitted Bedroom Rating Against HAA Request " nt (Y/N) Pumping Cycles during Adequacy Test. Meets MOA 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 Receipt No. Z) Cr L,) Date of Payment q, Amount: $ /-� Page 2 of 2 72-026 (11/84) Date MOA No. PON [ape ��D as �daeaaD60Da6% DOas•e�q yr o 4 �OCCs • CAO�OOo •e�y C CO CO .e rv% Car . Mayo 353 4a �"ROFESStON��`' Engineer's Seal Location: BESSE, EPPS & POTTS 2220 EAST 88 AVENUE ANCHORAGE, AK 99507 (907) 349-6451 WATER WELL TEST Date: Subdivision: McMa,Ao. -+'-1 Lot: Block: Client's Nam: �tN*.7�5 1�1<'CZ1Z1c��J L{ -i on "10205 u i 2C Address: -pd 3Q ►oog�S A+eu a),_gQS(% Tester: rnkv-L �C21s�Z Initial Reading on Meter: '78oS /CRS Fj . ao i. QEgr�l b' 8zSs G/at_ TIME GALI.0NS GPM ® VOLUME GAUL S TOTAL VOLUME 9: AM sra-.c�r 0 0 IL: V7 0 1.7-I 145- )45- 4s100 100 Z45' 3(09 o s PM 4 Q '. 03 P(A 0. sn3 0 _ NOTES: Production Rate: DA64 GPM 24 -Hour Capacity 916 Ga110n3