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Home My WebLink AboutMCMAHON #2 BLK 7 LT 6 GRI: , ER ANCHORAGl: AREA BOF,.,JGH Depsrtment of Environment@l Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATE RIAL.~---& ¢_ ~ LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY/,~ c'~ GALLONS. TILE DRAIN FIELD:% / ~ DISTANCE FROM WELL FOUNDATION O _NEAREST LOT LINE NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH ABSORPTION AREA (~-'~ (~ ¢ SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE ~'~ f __ IN. ABOVE TILE ~//" IN. WELL: TYPE _ BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST NEAREST LOT LINE__, SEWER LINE . OTHER SOURCES DISAPPROVED DEPTH SEPTIC SEEPAGE TANK , SYSTEM REMARKS DISTANCE FROM: DISTANCES: SEWER LINE DEPTH: PIPE MATERIAL: LOT S L OpE:, ~---~'A,)~(~- REMARKS: DIAGRAM OF SYSTEM DATE '7--'7-- 7'? APPROVED Form EQ-032 [iii';i:(]i .ii",ii) ~:':!i;',li;;:, 'i'!"'i!:~; :-: '" 'i "i"ti'/ t. d:::' Ti-iii::; ~:ii;)':;[;:i:::I',,,'!::I'i' ;i; O1"4 '" ;[ i",i .'" I'z.i::. ~" 'i'i'!Ei:;itE iii :5 bio :i~,E'T ~,.J iil Ii?TH i:::'El!;~: 'i'l"!i:!; (;iii:;i:!::'i',,,'ii:i'i [;:,F:?'"il'i ] :i::; 'THE i"i ]: i",i [i; hil. ii'"i [::'E!'::'"i'H Ed:': ;]i..:;:.:::¢,?i::.. i!i?,ii.:.['!"l.'.!!':i:li~:t",t 'TH~? ..... ['!::'1:::11 i F:' ;f PiE ~::'!i",!i) 'i i'!~'( i:!i:f3 I" !t'd'i C~i'::' 'i'i'"ii:¢' F:;;:':;C:I:::¢,,,h:iT ;i[ Ed",i ':: ;[ t",t i:'t!i!:iE'i' ;* 10 12 14 16 18 20 Performed For Leaal Qescrintion: "O.e ~es~ is wm11~ a thous,,.d o~i.io.s" 2204 CleVeland Anchorage, Alaska 99503' ~So~'~ Co~S'/~O~O~-- Date Performed 7 /'77 Lot ~ Block ? Subdivision ~~-/~.~ ~- This Form Reeorts Soils Loq .~/~_~.~ / PeDth Feet ~,,iO~m,31 S~z? ~har~ctg5is~ic} , / Percolation Test Was Ground Water Encountered? I~ Yes. At what Denth? I I ! I i t I i Readinq Date Gross Time Net Time Depth to H20 Net Dron Percolation Rate Uinute Prnposed Installation: SeenaQe Pit Drain Field Deoth of Inlet Deoth To Bottom Qf Pit On Trench Test Per for,ed By l/~ K~ ~ Data Certified B*: 7~> Date: . . ,_ WATER WELL LOG FOSS DRILLING 1336 Ingra Street Anchorage, A/aska 99501 LOCATION LoT ~. J?] MUNICIPA[IW OF DEPT. OF HEALTH ENVIRONMENTAL ,(3?0 ,. ~.; 2 i977 SIZE OF CA~ING ~ ~DEPTR OF HO~.E/~,b~. CASm TO / ~/~ FT. STATIC WATER LEVEL / FEET OF DRAWDOWN. REMARKS DATE COMPLETED PUMP TO BE SET AT ~to mto/ __t° to to___ ___to __tO NHA",,¥THORNE- - ENGiNEEP. ING 7127 Old Sewarct Highway Anch., AK 99502 344-471 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. # O1~--~(o1-~- 1. GENERAL INFORMATION Complete legal description ~-~' ~ HAA# H~ ~ ~tO0~ L~ Location (site address or directions) ! Property owner Mailing address Lending agency Mailing address Agent Address Day phone 72/ Day phone Day phone Unless otherwise requested, HAA will be held for pickup. ,....-.- NUMBER OF BEDROOMS: "~ TYPE OF WATER SUPPLY: Individual well NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: Community well Public water If community well system, provide written confirmation from State lng to the legality and status °f system. If community wastewater system, provide Written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Front MOA~21 C STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the valida;d~)n date shown below, 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 verifythat 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 compliancewith all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name ~f Firm Engineer's signature ~~'~, ~ Phone ate DHHS SIGNATURE ,/k~ .... Approved for ' ........ Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: · . · ' Additib'nal Comments Date 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 p.rofessional engineer's work, 72-025(Rev. 1/91) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /- ~' , ~ ~ //~¢/~ ~/~ Parcel I,D, A. Well Data We, type Cr;v ¢ Log present (Y/N) ~ Total depth /~C3 / Sanitary seal (Y/N) "// Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number. Date completed ;¢/~)/~z ~_ Driller ,,'~<; Cased to /~/~) ' Casing height Wires properly protected (Y/N) ~ FROM WELL LOG /22 ~ SEPARATION DISTANCES FROM WELL TO: / Septic/holding tank on lot I Absorption field on lot Public sewer main Sewer service line g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~) Date of sample: Z/~/? Nitrate I, 1 ? ~.5//-- Other bacteria Co,ectedb : B. SEPTIC/HOLDING TANK DATA Date installed '~/~/~- Cleanouts (Y/N) "~ High water alarm (Y/N) Date of pumping Tank size /.) ~'00 ¢__-~.A'£. Compartments Foundation cleanout (Y/N) "¢ Depression (Y/N) Alarm tested (Y/N) I/~]/~ Pumper Af' ,~.~/~¢e, ,~:. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot "P/D~ / On adjacent lots -/'-/CrO ~' Foundation To property line ~ ~ / Absorption field ~' / Water main/service line Sudace water/drainage ./~ 72-026 (3/93)° Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed ,//~ Size in gallons ~ Vent(Y/N) ~ High water alarm level ~' Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at .Cycles tested ~ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot -- On adjacent lots Sudace water I), ABSORPTION FIELD DATA Date installed '~/"~/~- Length z../~' /'~'7~. Width Total absorption area (/~ Date of adequacy test 2L/~'/~.~' Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) .5 FT: Gravelthickness Cleanout present (Y/N) Y Results (pass/fail) F"r-~8 P~/"t System type ~_~'- P ~-7-- Total depth // /~"~' Depression over field (Y/N) for ~' Bedrooms Aftertest ~ ~¢ " ~??-~K If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot +/D Cb To building foundation On adjacent lots Sudace water //~/~ Curtain drain / On adjacent lots 'f-//-2~ Property line To existing or abandoned system on lot Cutbank /'Vo},u~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Engineers Name _/-/,~.z_g ,,~o~'~^N Date 72-026 f3/93)' Back HAA Fee $ , -~ ('¢: d'~ Waiver Fee $ Date of Payment ~- ~ ~ - ~'2'~/ CD ) Date of Payment Receipt Number ~7 Receipt Number 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 Parcell.D.# ~\'~- 1. GENERAL INFORMATION ' ' " Complete legal description Lot 6; B~°ck"/';"' ;~a~on": -isUbd~vision #2 13000 Hinchey St. Location (site address or directions) Anchorage, AK 99516 Property owner Mailing address Chris Howard Day phone message 277-0700) (sister 0 City Mortgage-Jackie) Lending agency Mailing address Day phone Agent Gene. Rash/Polar Re. alty 1101 E. 76th Suite B Anchorage., Address Day phone 349-7681 AK 99518 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: xxX Public water If community well system, prov(de written confirmation from State AD£C attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Communityon-site NOTE: XXX Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (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, ordi.nances, and regulations in effect on the date of this inspection. Name of Firm s & $ ENGINEEEING Phone 17034 Eagle River Loop Road No. 204 Address Eaqle River, Alaska 99577 Engineer's signature Date DHHS SIGNATURE ~ Approved. for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given m 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 professionai engineer's work. Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type /O~lu/q-/'-~ Log present t~)'N) Y Total depth /~ O r Sanitary seal(~N) ,~-..~ f Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter, Date completed Cased to / /a 0 r Wires properly protected ,~4) ADEC water system number ~")//J~/~"~ "~ '~Driller Casing height /2- FROM WELL LOG fi.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ,/'~ Absorption field on lot /(~y..~ Public sewer main ~Uo,,.~d Sewer service line 7~.,~ AT INSPECTION Z/l / 3 /il ~' E'NVIkGNM[NTt,L L. ER~, IC..~5 i)lVlSlON '.,?. I 9 1993 .~, S --- g.p.m. ; On adjacent lots /~O ; On adjacent lots /OO Public sewer manhole/cleanout Petroleum tank /(JoyJ~- WATER SAMPLE RESULTS: Coliform ~)//o o,'~ Date of sample: Z//'(o Nitrate fi__..). ~ '~ ,/v' ,~q~/.~-- Other bacteria ~ Collectedby:'¢ --~''1~--~- ~'/L/~/'/L/~/'~'~-"~ - B. SEPTI~ TANK DATA Date installed 9/7/?9 Cleanouts (Y~4) ~"E-j "~ High water alarm (Y~_~ /x_~o Date o pump nfi SEPARATION DISTANCES FROM SEPTIC/~TANK TO: Tank size /~"O O G,~ L- Compartments ~ ~ Foundation cleanout (~)N) ~ ~ Depression (Y/~_.~ ./,~O ~ Alar~ te~ted (W~):~' W/~ ' 'w'ell(s) on lot /d.~ ~7~ On adjacent lots TO p, operty line ~' O ~¢- Absorption field Surface water/drainage /~O/t/~- Foundation Watermain/service line ~-~;;~ 72-026 (Rev. 7/91) From CONTINUED ON BACK PAGE .I~.L~,IFT STATION ./(J'o/.J/~ /'O~EJT~/J;~'~ D~led Size in gallons ~--. Vent (Y/N) "Pump-"p'-or~evel at Manufacturer Manhole/Access {Y/N)_.. -- .... "Pump off" level at High water alarm level ~ r --~1 Cycles tested Meets MOA electrical codes (Y./_N) -- '-~ ~-~- SEP~NCE FROM LIFT STATION TO: ..~/efFon lot On adjacent lots I). ABSORPTION FIELD DATA Date installed r~/r~ Length ~'~ Width Total absorption area Depression over field (Y~ ResultS/fail) ~ Surface Soil rating /~.~ :~-E>/¢~/1- System type Gravel thickness Total depth // Cleanouts present ~.J,~N) Date of adequacy test for ~ ~-/(/~..) bedrooms Peroxide treatment (past12 months) (Y/N) '"'U'/~5/C/~ /~-tf'JOow''-J Ifyes, givedate /(/////~- SEPARATION DISTANCE FROM ABSORPTION FIELD TO: VVell on lot_ To building foundation /(7 On adjacent lots Surface water ~O~/:- Curtain drain ~ On adjacent lots /'OL3 ~- Property line To existing or abandoned system on lot Cutbank ¢l..~¢o/E-/'c/Cf~£~'/-Watermain/service line Driveway, parking/vehicle storage area /(--) F.', ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on.t.b,e..~d~l(¢ of this inspection. S & S ENGINEERING :~:~, .. .., .,, ,:...,,, S,gnu~u,~ ........ 17034 Eagle River Loo~ Road N~ Eagle River, Alaska ~577 ....... Engineer's Name ..... Date , ~ ~ / ~ ~ .~i~:;~.; ,~.. :~,~.,~. :: :- ..- HAA Fee $ / Date of Payment ' Receipt Number ~2~-~'~/ Waiver Fee: $ Date of Payment Receipt Number HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS ',';ELL iNSPECTION & FLOW TEST DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E ROGER SHAFER. P.E WELL FLOW TEST DRTR CIVIL ENGINEERS (907) 694-2979 FAX 694 !211 ~ DEPTH, , DATE DRI~IN~ CO~LETED~ ~//~/~ DRI~ERt ~ST D~ CLOCK DEPTH TO DRA~MY6N PUMPING REMARKS TIME WATer RATE(GPM) 1:3o III' sw! o 5-.~+ £0¢~ o~ ~, .:4 IZz ' /1' ~, ~ ~;~c~ ~y ~ :oo IZ~ ~ R, ~,~ MISC. DATAI CASING HEIGHTI /~-" SANITARY SEAL?~ ~f~6$ WIRES. IN CONDU'~T? ~ ~.f O~ING O.K. ? ~ ~ BACTERIA & NIT~TE S~LES CO~CTED~ ~ ~S0~TSJ ~.T. ~y PRODU~S ~.~ OPM W[~ A , /~' D~ 17034 EAGLE RIVER LOOP, SU TE[204, EAGLE RIVER, ALASKA 99577 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 ~-// GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ! (b) Applicant Name ~'~r~.~6 ~vwi'ff[~ Telephone: Home .'34-.~ .~4-'7~ Business Applicant Address . ,4~nV¢ (c) Applicant is (check one): Lending Institution []; Owner/builder'S; Buyer []; Other [] (explain); (d) Lending Institution _ ~o~,/~ ~¢',-vlw~ .r Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family I~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well EEr" Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. 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. 72-025 (~ ~/84) Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health." Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date .~"//zJ. /~(',~ WATER WELL NOTE: This Health Authority Approval inspection merely certifies that the subject water well produced 150 gallons per bedroom per day and that certified laboratory tests showed no presence of colifor~ bacteria in a sample of that water. No warantee or certification is expressed or implied concerning the long term adequacy or safety of the water supply. ON-SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval inspection merely certifies that the subject on-site sewage disposal system accepted at least 150 gallons of water per bedroom per day as determined by methods approved by the Municipality of Anchorage Department of Health and Human Services. No warantee or certification is expressed or implied concerning the long term adequacy of the on-site sewage disposal system. Construction data reported on buried system components is from MOA files and was not verified during this inspection. DHEP APPROVAL . Approved for ./'~',/~/~--- bedrooms.by/~'"'"~';~ Approved ~ Disapprovei:l 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 MUNICIPALITY OF ANCHORAGE (MOA) MUNI¢IPAUTY OF ~L'~IJ~T0k~(~UTHORITY APPROVAL (HAA) DI~PT, OF HEALTH ~CHECKLIST- FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264-4720 MAY 1 5 1986 Legal Description: L o V LLDATA RECEIVED Well Classificatk~n ~- $ Well Log Present (Y/N) Total Depth /(~0' Cased to Static Water Level I Casing Height Above Ground Electrical Wiring in Conduit (Y/N) .)/ If A, B, C, D.E.C. Approved (Y/N) Date Completed ¢ /"7 "'7 Yield 2o Depth of Grouting Pump Set At (,/r~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Y Separation Distances from Well: > too To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole A) Water Sample Collected by Water Sample Test Results ; On Adjoining Lots ~ ~Oo ~ ; On Adjoining Lots /% To Nearest Public Sewer To Nearest Sewer Service Line on Lot >¢oo ! I oo Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed 7/7 7 Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /'~/./~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line /~ ~,~0 ! Course /'~)/,'~ Size ./~¢-~¢ No. of Compartments Air-tight Caps (Y/N) )/ Foundation Cleanout (Y/N) Date Last Pumped ,~'.,//~/E~· ,/~//Z~I ; for Temporary Holding Tank Permit (Y/N) / To Building Foundation > ~ o To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7-//~7 ? Width of Field ~ .~ Square Feet of Absorption Area ~, ~0 Depression over Field (Y/N) "~ Type of System Design -'T'~'¢~ Length of Field ~/- ~' Depth of Field /! /-¢' ,~'¢ Gravel Bed Thickness '7' Standpipes Present (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test ~ -~' Separation Distance from Absorption Field: To Water-Supply Well ~> ! cO To Building Foundation ,~ Lot To Water Main/Service Line /~ ~'-<2 t To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments "/VF ~'~ef ,,~Jc 'L-¢,~-~ CJ To Property Line /.¢' To Existing or Abandoned System on ; On Adjoining Lots' To Cutbank (if present) 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 at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that~L~X?/che~¢, ver~, or conformed to all MOA and HAA g uideli ridS in effect on the date of this inspection. Signed 2//-~'~ , v-~._~ Date t~'~// Company /tJzC¢-~,-~ ~¢¢-¢ MOA No. Receipt No. Date of Payment ~ ~-~ Amount: $ ~ Page 2 of 2 72-026 (11/84) DEPT. OF ~NViRONMENTAL CONSERVATION / ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR 274-2533 May 30, 1986 John Kennedy Municipality o? Anchorage Department of Health and Human Services PO Box 6-650 Anchorage, Alaska 99502-0650 SUBJECT: Lot 6, Block 7, McMAHON SUBDIVISION Anchorage, AK Dear Mr. Kennedy: On May 21, 1986, I inspected the subject property. A drainage pipe oas located over the septic drainfield. The area that oas drained by the pipe appeared to be very small in size. Only small amounts o? snoumelt or rain runo?f uould be drained by the pipe. i do not believe that the septic system will be adversely affected by the drain pipe. Please contact me for any additional information. Sincerely, SWE:pkk /'~-~MUNICIPALI'FY OF ANuHORAGEr-~ DEPARTMEii OF HEALTH AND ENVIRONMENT,~ 825 L Street, Anchoraoe. A].aska 264-4720 Date Received: PROTECTION 99501 December 6, 1977 ~1: Time 10:00 a.m. #2: Time #3: Time Date 12-7-77 Wednesday Date Date Insp Pratt Insp ~nsp_ .......................... --.. REOUEST FOR APPROVAL OF INDIVIDUAL SEWER AND ~/ATER FACILITIES ,! x~ Nailin9 Add~ess: 535 D Street 99501 Phone: 272-~45~ Property Owner: Mailing Address: James E. Jackson Phone: 344-4~'82 Post Office Box 10-422 South Station 99502 3. Legal Description: Lot 6 Block 7 Mc Mahon Subdivision 4: Single Family Residence: U ) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Five Well System: Permit ~ Construction individual well (~ Comanunity/Public System ( ) Depth of Well Well Log on File (x) Bacterial Analysis Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System (~ Public Utility ( ) Installed Installer Manufacturer Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line ~age '['wo . . ~ ro~ec ~ion Department of Health and Environmental Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 6 Block 7 Mc Mahon Subdivision Co[Fa-ael'it s: Affadavit Attached: Approved: Disapproved: Letter Attached: ( ) Date: Date: Department Worksheet: '~'//~'~ 'Dep~rtment of Health and Environmental ?ro~dctio~ //~~/ 825 L Street, ~chorage, Alaska,? oi 2.-erY ...... ~quost for Approval of Individual sower and War .~ili~i'os 1. , ProPert~ owner: /~_ ~, Mailing Address: ~. ~,__ /0-~$~ 2. Name of Buyer: ~D~ ~1 p~ ~ Mailing Address: Phone: Phone: 3. Lending Institution:--~/~_~ Mailing Address: Realtor/Agent: Mailing Address Phone: Legal Description: ~7~ Street Location: Single Family Residence: Multiple Family Residence: 7 Number of Bedrooms: Number of Bedrooms: o Water Supply: *Individual Well ~) If Individual Well, well depth If Community System, name of system Public/Community System ( ) Sewage Disposal System: *~n-site System ~ Public System If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77