HomeMy WebLinkAboutMCMAHON #2 BLK 8 LT 2McMahon #2 Block 8 Lot 2 #017-361-43 Municipality of Anchorage Page l of 3 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 Permit Number: SW AC'Jt03 PID Number: 01-� 6fq?� Name:*9:11l_I. Sda 4 Wastewater System: KNEW ❑ Upgrade Amp AWKINS Address: �anrua. lU ABSORPTION FIELD Phone: No. of Bedrooms: Deep Trench ❑Shallow Trench ❑Bed O Mound Other f�❑ LEGAL DESCRIPTION Soil Rating: Total Depth from origina�grade: .t� . GPD/Sq. Ft. Lot: Block: Subdivision: (j CsiA,fI./t $/�% Depth to pipe bottom from original grade: Lf " S # Gravel depth beneath pipe 6.5 ` ", t5 Ft. Ft. Township: Range: Sectio�n::1 Fill added above original grade: Gravel length: t o.5 ` Ft. / 663 Ft. WELL•New ❑ Upgrade Gravel�:W(07N it 34 Number of lines: 1 Distance between lines: 1 NIp- S STlnf❑ Ft. Ft. ClassificatiQ�cJ�(Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ;=SJO PERFORMI!J? t %VA7>✓ Ej Ft. IUO Ft. SC. Ft. S M D30.3 PVL Drillerzwpom Date Drilled: Static Water Level: r Installer: �f ,,C 90& Date installed:: / q " `l2 l.l.tNri 'S`�•+' 1 Ft. �.(J I O> (2— Yield: Pump Se/t1at: t Casing Height Above Ground: tt TANK Z,V GPM 'TS '�'• FL is SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in grallloons:� From Tank Field Station Tank Sewer Lines K, w y 67 -C WellMaterial: lo' i `� N ,4 N g�'4- Number of Com artments: Surface Water , lid �- 10(} t „ LIFT STATION LotSize Line in gallons: Man urer: Foundation "Pump on" level at: "P off' 10-eHigh water alarm at: Curtain Ndel 1dw� mp M oPu I Electrical Inspections performed by: Drain NONE Remarks: oLp LEAUWIND AND S15T71C 7/livk BENCH MARK aftLjoridEp,F«. Pwzv Awtoo w Location and Description: ToP saw N es calNer, r,F- z Assumed Elevation:O O ENGINEER'S SEAL o n O A, � n N a'l "a S EN&INF-En lst Inspections performed by: 7Dates: oea aue non 2nd e' age 97 ao e. ueaeo aas ROG :R � . SHAFEn 5 Department of Heapand Human Services approvalo N0 3215o °a Reviewed and approved by: Date: AE �q� wrsss\Q N\ � 72-013 (1/91) MOA 25 I Permit No. 1�aolos Page 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: LC)T MWAHuN S/0 PID No.: 011361y3 11 1 :40 LOT 1 C'yE-R oR�� 1�1 WEL LOT U)VE / f3M loo TOP o ONT ; POPC44. M64 a S,W, CORNER R£F FLZU loo° TWoo 481P1A HoWJ SE A / ,1 10 UTIL rN7, , LDr 3 NEW `p1z j Iz56 &nom s N� Lura MT STAND OUSE 1'*t'c \ _ P)pez A 3 C TWD ratxHFS \ 4� Co 1 65 (5� 115 gra' Coa 1-4 COy 39 ao W,p,N �°a¢s9®ea ama Rir ae ieao _._ C� __ _.... ` \.... e ea °eneae°° oen s a°a ° co; 61P 38 ��< Ft:iGE J. HARM ; Ew MT a� 31 f Lo T !i3 \ �� �I� �'Ya No. ez 5 s ` Co 6. a95 330 ��CA� 10 mo. F-RoA& OFES FC,o C sF..' Ir Mr, � � 72-013 A (2/91) MOA 25 Perrriit No. SW 'IA0I03 Page of 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: Lm a RU(S M,MAtbli S�0 PID No.: 01'436143 ry CAI �Sy co2� To ThX HSE (CO3 cosi F01A a 72-013 A (2/91) MOA 25 2ti= NF -W Q6C) GrALLON If mo17 i'/i 7o LEAcFi F)WL —93$ ,MT I z FARil t c 3 B F11.1� 0Qo �VV 0 UJB © oo(9a^dJ�V0 -� O_vU�p r��j�C� 0 OJT 0 't kb Q�, ' d vl0 0 °Oed �8�% oco 13 d 6 OLtl G 0o 0Ua0 0(CD 0Z;f 0v D ENg�§�G U_SEAL AV O Tco3 m009 a: sae Sec o arOn?mC oe° oF�� noa pxd (S 5 iE JAFFu°).cy _dz "eW 9v°°at.:�a 000, ®%®7?arEsst0 - PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE 3L� DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT NUMBER:SW920103 DESIGN ENGTNEER:S & S ENGINEERING OWNER NAME:HAWKINS RICHARD W & OWNER ADDRESS:2410 BANBURY DR ANCHORAGE, AK 99504 PARCEL ID:01736143 LEGAL DESCRIPTION: MCMAHON #2 BLK 8 LT 2 LOT SIZE: 30426 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: (UPGRADE) PERMIT 4/ DATE ISSUED: 5/26/926 EXPIRATION DATE: 5/26/93 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: ISSUED BY: -� DATE: May 19, 1992 HEALTH AUTHORITY APPROVALS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 SEWER& WATER MAIN EXTENSIONS REFERENCE: McMahon Subdivision, Block 8, Lot 2 SEWER & WATER INSPECTION ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Request you issue a permit to upgrade the septic system serving the referenced property. ENGINEERING STUDIES ANDREPORTS An adequacy test was performed on the existing system and the absorption capacity of the system was found to be inadequate. A test hole was excavated and a percolation test performed in WELL INSPECTION &FLOW TEST pg Attached the area of the proposed u rade. Atthed is the proposed osed upgrade design. We do not anticipate any adverse effects on neighboring SITE PLANS properties by the installation of the proposed septic upgrade. If you have any questions or require additional information for your review, please contact us. ROAD DESIGN Sincerely, 1 r_��,� . SOIL TEST ROGER J. S FER, P.E. RJS/lsu PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 I" = 40' SCALE f00' / WELL RADIUS m / N m C)N.4 O O o � �*-n,m n 44 C(a n7 C) C� V o O � a �O � / to n n RAD/US m 0 � a � o � 44 m ' � a � 100' WELL / n RAD/US / mAyon o � o � m ' � a � / O �a fA N ��e w$ 0 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: M—� /y 1/4)( 1)(00IJ'-kT1t S JCtpy DATE LEGAL DESCRIPTION: LT;� I CK t'� f /VI CAtkN �,WTownship, Range, Section: SLOPE SITE PLAN 10 WAS GROUND WATER �O ENCOUNTERED? S 11 L IF YES, AT WHAT 0 DEPTH? P 12 E Depth to Wall / 13 LS_a0- 2 Mnnitnrinn9 �' Bale: 14- 15- 16- 17-- 4151617 18 19 Reading DEPTH (FEET) Gross Time Net Time Depth to Water Net Drop (� lC 1 URG U 2 I Sl'A/WTGG (Skulja(- cz�3 3 o I II 4V5 AvDEDtOtziZ [-A t n 33 5 3/ SM r do 5 % '(k `' 4 SP �C(,EAr t 3t.t_ S 4N D) 5- 6- SM � 7 FINE- SANG W /SILT. IN£tj> COMPACT /PkE 8- 9 10 WAS GROUND WATER �O ENCOUNTERED? S 11 L IF YES, AT WHAT 0 DEPTH? P 12 E Depth to Wall / 13 LS_a0- 2 Mnnitnrinn9 �' Bale: 14- 15- 16- 17-- 4151617 18 19 Reading Date Gross Time Net Time Depth to Water Net Drop (� lC T --CL I o YD U cz�3 _ 5 4V5 AvDEDtOtziZ [-A t n 33 5 3/ r do 5 % '(k `' 20 t r ` PERCOLATION RATE �� (minutes/inch) PERC HOLE DIAMETER �^ LL5 TEST RUN BETWEEN FT AND -4 FT COMMENTS _ -- PERFORMED BY: S & S NGINEE€i:ING I �THISDATE CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loo Road 1' ACCORDANCE WITH AIS.��4jID1�J1 �l'�t11DELTNI=�T� EFFECT ATE: 72-008 (Rev. 4/85) 88 ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 ROBERT SHAFER, P.E. P.E. ROGER SHAFER, CIVIL ENGINEERS (907) 694-2979 t May 29, 1992 FAX 694-1211 f4GE RECEIVED RIVER,FLP`'�P HEALTHAUTHORITY MAY 2 91992 APPROVALS p Mun.cc c.patity o6 Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES A;iuniclp alty of Anchorage 825 L Schee t Dept. Health & Human Services P.U. Box 196650 SEWER&WATER Anchorage, Alaska 99519-6650 MAIN EXTENSIONS REFERENCE: Lot 2; Bloch 8; Mc Mahon Subdivision 02 SEWER&WATER Request you .issue the attached Conditi..onat Health Authority Approval. INSPECTION There are no special c.i,%cumstanca preventing the neca.6any septic upgrade at this time, howeveA, .i4 a Heatth Certi4ica.te is not %ecetived and the -sale opo the prope✓ ty etosed by June 5, 1992, the owner wiU ENGINEERING STUDIES incur a 4inancca/ loss o6 approximately $2,000.00. AND REPORTS An adequacy test 6ound the existing septic system to be .in a state o4 4aiture. A sons test was per6ormed, design completed, and a permit obtained on May 26, 1992 (SW#920103). WELL INSPECTION &FLOW TEST Un6ortunately, the time delays a,6sociated with the septic upgrade process is preventing an unconditional Health Certi6icate Brom being obtained prior to the June 5th deadline, thus, the penalties o6 approximately $2,000.00. SITE PLANS Bids have been obtained 4or the upgrade, monies are to be a crowed, and the upgrade process wilt continue. ROAD DESIGN There i.6 no eminent heat th hazard cAeated or prolonged by granting a cond.itiona2 approval. There .is no over4low.ing sewage nor should there be any adverse e64eat as a resuf-t o4 granting the conditional approval. We anticipate the completion o4 the septic upgrade by June 10, 1992. SOIL TEST As always, your expedient review is appreciated. Sincerely, PERCOLATION TEST ROGER J. SHAF R, P.E. RJS/gm STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 MUNICIPALITY OE' ANCHORAGE Hei `h and Environmental Prot� c'pion n Fourth Floor West 825 L Street Anchorage, Alaska 99501 264--4720 - -- --- ----- -----------._._.._ -- ----- INSPECTION REPORT ON-SITE SEWAGE DISPOSAL 55 STE"A ASAI LING ADDRESS, 71-4_ .p%�� _`-----_-��-j---�-�/-._ PE-iONEj__.��-- LOCATION ______-________-_-________-_— LEGAL DESCRIPTION' -)U!- p-&Ki_?11 c111oi1-,oA- SEPTIC TANK: DISTANCE ��// J NUMC[_R OF FROibt WLLL/_L�� NIANUFACIURER _. ___.. MA(`tRIAL_. ^ ___._______-COMPARTMENT5_� INSIDE LENGTH LEJGTH--- .---- INSIUG VIDTLIQ LIOUID CAPACITY_/ � GALLONS.UID DE TILE DRAINFIELD: ,�/ DIST AVICE f ROPA WE /d� _FOUNDATION O _NE^^A//REppST LOT TOTAL LENGTH �/ LINE:_ _,._._._..OF 1_WE _ 1! _ of Lines ___.__[[�^^_-_ DISTANCE PETWEEN LINES__1!�/h_.__„TREr!CI-I WIDTH�� IN. TOTAL EFFECTIVE C±GSORP-TION AREA -_-,7_��_-_—..__— SCT. FT. LEND-fH Of EACH LINE __--- %--/-----------------_---� i IJH'JII: TOP OF TILL 10 FINISII GRADE _— _.___MAIERIA.L. DEPTH OF FILTER BENEATH 1 FILE &-____01,ABOVE TILE SEEI'AGL PIT: DIAMETER _ OR WIDTH ___- LENGT' I.__.._, DUIT11 Log Crib Rings Crib Size: DIAMETER____DEPTIi__-^_DISTANCE FROM: WELL. -- TOTAL EFFECTIVE. GUILDIf`!Cd FOUfNDATION.___ , NEAREST LOT LIN'----. . ABSORPTION ARCA "WALL AREA) SC?. FT. ell ,lass: Depth: fell Distance To: Lot Line ldg: Sewer Line: 'ipe Materials: Crl-o of Bedrooms: y nstaller:i�,�r�_�,, remarks: — DATE:_8-.- -D /vPPROVrD ���� 1310�� ����� DEPFIRTMENT OF/ HLTH AND ENVIRONMENTHL PF �EC71UN *' 825 'L' WREET/ HNCHORHGE/ HK995&� 279~2511 W FEE D.. I.. ��HE.'A ��--- ��W F -E.] PER1M.UT HPPLICHNT NST 2418 E 20TH 277 ]166 LOCHTION KUTCHER`DRIVE LEGHL L2 B 8 MCMHHON SUB LOT SIZE ]0426 SQUHRE FEET TYPE OF SOIL HBSORBTION SYSTEM ISRENCH ` MAXIMUM NUMBER OF 4 140 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� 110 Is: Fo" -T- 1-1 :1.101 R.- It Ci -T H-11. == 4- ���T- 1-1� THE LENGTH DIMEN'ION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFACE OF THE QROUND HND THE BOTTOM OF THE EXCHYHTIQK| (IN,FEET). THERE IS NO SET WIDTH FORTRENCHES THE QRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHYEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCHVHTION (IN FEET). �Ap.[: to! 1TE RT- Am. vii: 1=1 -1- -T 1=1 Wj If< ����==�������p-Al� H PHCKHGE PLHNT MHY BE lNSTHLLED HT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS� 1. EITHER H CLH�S I OR II NSF HPPROVED PLHNT MAY BE INSTHLLED Z H CONTINU8US MAINTENANCE AGREEMENT IS REQUIREA IF H MHINTENHNCE RQREEMENT IS NGT KEPT CURRENT YOU MAY BE 'REQUIRED TO ENLARGE THE SOIL HBSORPTION SYSTEM HND/OR YOU MHY BE SUBJECT TO PRQSECUTION US FQ: EF Fit FH By! R -H 1: f�� BHCKFILLING OF ANY SYSTEM WITHOUT FINAL. INSPECTION AND APPROVAL- BY THIS DEFHRTMENT WILL BE SUBJECT TO PROSECUTIONL MINIMUM DISTHNCE BETWEEN H WELL HND ANY ON-SITE SEWHQE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED HND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION OTHER REQUIREMENTS MAY HPPLY� SPECIFICHTIONS HND CONSTRUCTION DIAGRAMS ARE HYHILHBLE TO INSURE PROPER INSTALLATION. 11", KEE KA 6-R X -T- 0107 VC M 1 Ism! RTE :1, ���5-1 - D, I -E -L F;�� � I CERTIF HHT 1: I HM �FFMILIHR WITH THE REQUIREMENTS FOR SEWERS HND NELLS AS SET � FORTH BY THE MUNICIPHLITY QF HNCHORHGE, it: I WILL INSTHLL THE SYSTEM IN WITH THE CODES ]� I UNDERSTHND THHT THE ON-SITE SE�ER,SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMSI � n s HPP .21O6 CONST VIS Derartment of Health ,,.rid Environment°._� Protection 2516 E. Tudor Road Anchorage, Alaska 99507 276-2221 l,Oc - rl;l��>>,n rl��ti TEST Performed for t= �F� Ce�C )r to Perforce Legal Ucscripliun: �p 7- (.�'�. >c WlVie�_ -_. — - -- This form reports: soils log Percolation C_ Depth Feet J 0-( c2c,����ic5 - c� IZCz (1c>L� lc5 2 -1,4 Cl 5 - - 6-g i$ 7 - I1 S �� K t1 T c- l-1 c l:. (» 9 10 - PSL SJo11 � -- -- - - - -- - - // o 12 Ot- -- -- -- - — 13 - l - - -- -- ---- - - 1n - - - Was ground laciter enc untered? FL1 fl'- - If ves, at what (It"Ah? — ------- -- - ---- - 7 MAWL.KaMIT IUM111198 IMIM Uox 1 svrzma 1-'R'au'vm- A A\ rU, -D109 B 4t z I -" V'71 L41 - SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED AT THE RATE OF PER FOOT. PROPERTY OW1NER?M8 E. 20th 186 Foote LOCATION OF WELL DRILLER Jiernie— Claus of--Rmpaxt Drill jLig I-lorks, WELL LOG: o --.61s by DATA IMMINGo 61---981 Gravel and small boulders,, 20% clay binder. 108-1599 Silty 6arAy gravoL lArge cobbles. 30% clay binder. 159-1851A wot silty sard. 15% &waval. I -later bearing however no usable vieldo _-- 18 186, Water bearing gravel producing F)'VE GPY 1, with a 40 foot head stand of water in casing, Pump should be installed five feet off bottom 125 Feet of Drilling by 1partj Paid in full by Mr, Herzog. $2-375.00 COST INCLUDES ALL LABOR AND MATERIAL. FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE, TO RAMPART DRILLING WORKS FOR THE SUM THANK YOU VERY MUCH. BERNfT- US OF RAMPART DRi ING WORKS SERVICE CHARGE OF 1V2% PER MONTH WILL SE ASSESSED ON AST DLTffACCOLJNTS. 1'1!�GE eG • Municipality of Anchorages_ On -Site Water and Wastewater Program 2" ., (907) 343-7904 5 . * r CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-36143 1. GENERAL INFORMATION Complete legal description McMAHON #2 BLOCK 8 LOT 2 Expiration Date: - I Location (site address) 3900 KUTCHER DRIVE, ANCHORAGE AK 99516 Current Property owner(s) MICHAEL BECKWITH Day phone Mailing address Real Estate Agent 2508 W 43RD COURT ANCHORAGE AK 99517 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class —Well ElCommunity ElPublic Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released t�qp.th gineer, unless otherwise requested by the engineer. COSA Fee $ S. z (. O',0' Date of Payment Receipt Number COSA # (OSC l+ IS'4 `lt 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, 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 ARCTERRA CONSULTING. INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 11/21/16 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen r OF A� encroachments, deficiencies or discrepancies exist. V �* 4QTII 6. DSD SIGNATURE el System #1 Approved for bedrooms. ' xr""eT" M. n F u r 716 System #2 Approved for bedrooms. ,T�o �a i n Fes.rohb� � Disapproved. Conditional approval for bedrooms, with the following stipulations: "vvnt[K Z_ m` PROGRAhA 63 _ Original Certificafe-VRW�� 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 forerrors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sMet_m0.10.12 dm 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 #2 BLOCK 8 LOT 2 Parcel ID: 017361.43 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # Date completed 121511977 Sanitary seal (Y/N) Y Total depth 166 ft. Cased to 186 ft. FROM WELL LOG Date of test 121511977 Static water level 434 14(a ft. Well production 3A- S g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 8.1ie mg/L Arsenic: ND ug/L Date of sample: 1111512016 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping IIT/°1-l(p Pumper 61ME •S>DP Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18 in. AT INSPECTION 11.15-2016 ft. g.p.m. Collected by: ARCTERRA Date installed 61411992 Cleanouts (Y/N) Y High water alarm (Y/N) N C. ABSORPTION FIELD DATA Date installed 61511992 Soil -rating (Q.q_d'/ft2 or ft2/bdrm) 0.8 System type DEEP TRENCH Length 63ft., .Width 3 ft. Gravel below pipe 6.5` 'ft. Total depth 11.1 ft. (Measured 11/15/16)' Eff. absorption area 819 ftZ Monitoring tube Y;: Depression over field N Date of adequacy test.:11.15.16. Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 610 gal. New depth 0 in. Elapsed Time: A min. Final fluid depth 0 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Manhole/Access(Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 54 Water main 104 Water service line 101+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 1004 Driveway, parkingtvehicle storage 10'+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS 1-2 occupants per owner. &L fT14mio p/AEY Rita --VT TO G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. OF 44 '"\ Engineer's Printed Name - KENNETH M. DUFFUS/ �45 1 t. Date 1112112016 TH It COSA canary sheet_2-6-15.doe `- KE\REIH DU a i PESSIOI+ab Municipality of Anchorage Development Services Department ° Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # OSC161569 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 8, Lot 2 of McMahon#2 subdivision. This inspection revealed a nitrate concentration of 8.16 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. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test', and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. ON OR TO EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT. ARE NOT SHOWN HEREON.(UNLESS I NOTE: ANY EENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY OR LOCATE STRUCTURES. ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. I HEREBY THATMORTG GEE'SRTIFY INSPECTION PERFVE ORMED FOLLOWING A DESCRIBED PROPERTY. LOT 2, BLOCK 8. SECOND ADD'N. TO MCKAH04 SUB. ANCHORAGE RECORDING DISTRICT, ALASKA AND THP THE VISIBLE IMPROVEMENTS SITUATED THEREON WITHIN THE PROPERTY LINES AND NO VISIBLE �EENNCROACHMENTS EXIST OTHER THAN NOTED. RD AT ANCHORAGE, ALASKA THIS --22ND--- AY OF JANUARY _____-_ 2004__. HOLT LAND SURVEYING 9248, FBI10-11 I JGitte-s Ida � y Municipality of Anchorage Development Services Department / Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street '" "� P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Of 7 - 3 6/ - 1-y3 COSA # 05P_C (&Da r Expiration Date: I I' f 0" O co 1. GENERAL INFORMATION Complete legal description 1-o Z Q /ark b. Ito Matson -C /D s# 2 Location (site address) Dr# Current Property owners) .%. r e, Dace Tv ha Day phone _ Mailing address _3900 t-ukhar- psiVv'+f1eA0fd„o Me 99ss149r-ZSa3 Lending agency Day phone Mailing address i Real Estate Agent M4r'#anwL 6:ean4, Pe%-dentic-1 Day phone 6-29 -6607 Mailing Address 3 501 (enfafp o,nlD.-i n n , A� e /1- 99,rr.I? Unless otherwise requested, COSA will be held by DSD for pickup. P I Cavoto // o u+nC 2. NUMBER OF BEDROOMS: �1 766-1350 0r- 229-7753 wl+en _ Gcth �aory � M real -,k, 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site 12 Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the'transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with 4alid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. I I 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of Onsite 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 FfaF%P Tcch,4ce.1 Serv.Cei Phone 3 VS- 13b -S' Address /Hs'3o Ec4e Slt. /M640rug4, A -4c 99S/6 Engineer's Printed Name Theo--e6,e F r+oo.e Date 30. 2-c.- 5. DSD SIGNATURE ✓ Approved for _f bedrooms. Disapproved. Conditional approval for bedrooms, with the following OF Alt �,�C}7y (yam • � fir* 1 "MORE F. AlOCRF�: �•.� Ci: - 3599 (e • 4,, � Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report x .Other By: Original Certificate Date: S -" O - (96 (R• .11/05) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHI Legal Description: Loo- ?, a /a c 1- 8 14c M0060n *L Parcel A. WELL DATA Well type reva.fl If A. B, or C provide PWSID # fJ A. Date completed J3L.S/77 Sanitary seal (YIN) Y Total depth l 8d ft. Cased to f $ ft. FROM WELL LOG Date of test 12 / S Static water level I if IC ft. Well production f 9 P•m• WATER SAMPLE RESULTS: Well Log (YIN) Y 1 Wires properly protected (YIN) Casing height (above ground) AT INSPECTION 7/ 10 Oe S• 8 + g.p.m. Coliform _)Zcolonies/100 mL Nitrate S. l Z mg/L Other bacteria 0 colonies/1DO mL I Arsenic: ppb date of sample: _7"f/Age Collected by: P!a fAW T"rC+ Svc B. SEPTICIHOLDING TANK DATA Tank TypelMaterial 5spe & IS /,e t / Date installed 6 /S / 9 Z Tank size f ZSD gal. Number of Compartments 2 Cleanouts (YIN) Y i I Foundation cleanout (Y/N) Y Depression over lank (Y/N) moi!_ High water alarm (Y/N) Al- A Date of pumping 5' / 2 /06 Pumper. A* C. ABSORPTION FIELD DATA Date installed /S/9 Soil rating (g.p.d./ft= or ftZ/bdrm) 0.8 9'P'r System type TnencA Length S.3 ft. Width 3 ft. Gravel below pipe 6:S ft. I Total depth I / ft. Eff. absorption area gLLft2 Monitoring tube Y_ Depression over field N I Date of adequacy test 7 / 'AResults (Pass/Fail) Pati For 4Y bedrooms I Fluid depth in absorption field before test S'4 in. Water added731 gal. New depth7z.,Cin. Elapsed Time: 1149 min. Final fluid depth 0. I in. Absorption rate >= 41901 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N/awe bwec..., If yes, give date I V-A D. LIFT STATION N. k. Date installed "Pump on" level at_ in. Datum Size in gallons "Pump off" level at _ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot = 1 t G ' Absorption field on lot = 120' Public sewer main N. 4 Sewer /septic service line ? 2 c' Animal containment areas N. A, Manhole/Access (Y/N) High water alarm level at Meets alarm ti circuit requirements? On adjacent lots 7 too ' On adjacent lots > r 0o ' Public sewer manhole/cleanout N. A _ Holding tank P. .f Manure/animal excrete storage areas P-.4, in. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation I Z Property line ?X Absorption field S Water main N. A. Water service line > t0 Surface water �> repo' Wells on adjacent lots rr✓o' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1!" Building foundation = 2,0' Water main P. b. Water Service line, (o' Surface water > tooDriveway. parking/vehicle storage > So' Curtain drain OP -70 S iin Welts on adjacent lots > I F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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. Engineers Printed Name 7Aeo t'arr F: "�&ne Date 37tAIV Sri. 200 iC T COSA Fee $ YSO `* Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 11105) .. * y •.'� 49TH INk TMOOORC f.'�:OOkE Municipality of Anchorage • Development Services Department Building Safety Division - On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 060361 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 8, Lot 2 of McMahoWi Oubdivision. This inspection revealed a nitrate concentration' of 5.12 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. Municipality of Anchorage • Development Services Department p � � a Building Safety Division S On -Site Water & Wastewater Program. 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-361 =9�_ HAA# 1 L(O O 1. GENERAL INFORMATION Expiration Date: S ' 0 Complete legal description MCMAHON SUBDIVISON #2: LOT 2. BLOCK 8 Location (site address or directions) 39b0 KUTCHEk DRIVE * ANCH6 AG%, AK * 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOANNE & ALFRED DANNER Day phone 349-4002 3900 KUTCHER DRIVE * ANCHORAGE AK * 99516 F.S.B.O. Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon'the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B'wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. I Municipality.of Anchorage ' 'y6 t fise.Vi • �-` Development Services, Department I I Building Safety Division 3„ t.. I On -Site Water & Wastewater Program 4700 South Bragaw St. - P.O. Box 196650 Anchorage, AK 99519-6650 ` j www.ci.anchorage.ak.us . (907) 343-7904 . 1i HEALTH.AUTHORITY APPROVAL CHECKLIST ; r . Legal Description: MCMAHON SUBDIVISION ##2; LOT 2, BLOCK 8 Parcel ID: 017-361 A. A. WELL DATA. r Well type; E PRIVATE If A; B; or, C provide PWSID# N/A Well Log (Y/N) YES Date completed 12/5/1977. Sanitary seal (Y/N) YES Wires properly protected (Y/N), YES I Total depth 186 ft; _ ;Cased to 186 ft,'' Casing height (above ground) ` 12 in. FROM WELL LOG AT INSPECTION Date of test 12/5/1977 1/14/2004 i Static water level 124 ft. 126 ft• 3.1 ..m. 1.9' .m. Well roduction _ k 9 p 9P WATERi SAMPLE RESULTS: { Coliform'l 0 colonies/100 ml. Nitrate. 6.01 mg./L. Other bacteria 0 colonies/100 ml. al Arsenic:1 mg./L.' Date of sample: 1 /15%2004 Collected AKWWC, ;INC. B. SEPTICIHOLDING TANK DATA f '+ lg STEEL/SEPTIC F' Date installled 6/4/1992 Tank Type/Material Tank size- 1250 gal.4 Number of,Compartments 2 Cleanouts YES N/A Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) , lid , . �ooH ' i, . f , C PumperMCDONALD'S PUMPING Daae ofpumping-1/14/219-94 . C. ABSORPTION FIELD DATA "BELOW EXISTING GRAD Dadeinstalled 6/5/,1992 Soil �atrng p.d.lft rlft2/bdrm) 0.8 System type DEEP TRENCH '1 IF � j Length 63 �'ft: Width + 3.0 ft. Gravel below pipe 6 5 ft. Total depth 11.2 'ft. Eff, absorption area 819 ftZ Monitoring tube YES Depression over field NO Dat of adequacy test; 1 /14/2004 %Results (PasslFail) PASS 6' For 4 'bedrooms Flu' lid depth in absorption field before test i�67 ' in. Water added 619 gal. New depth 64 in. � 11i i Elapsed Time: N/A min.. Final fluid depth N/A in. Absorption rate >=— r., = 600+' d, 9•P• An'y rejuvenation treatment (past 12 mo);(Y/N &type) NONE KNOWN If yes, give date � – j •i'I.i �C - � i i 'i ALASKA..WATER Ee WASTEWATER cmc ea:+ s: crow r, �ersrru:r anttrrxara xs:rucre r:=aer. r CONSULTANTS, INC. �� uimu imttrrec:tt r�anacanr:nmrearu rrnrnott+n.o3 mnnrmcrer cruor February 10, 2004 Municipality of Anchorage Department of Development Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Subject: HAA for Private'Well & Septic System. Lot 2, Block 8, McMahon S/D #2. To whom it may concern: The subject lot has a 4 bedroom house on it which is served by a private well and septic system. The results of the field investigation and adequacy tests are summarized as follows: SEPTIC SYSTEM ADEQUACY TEST: The drainfield is a 3 foot wide trench, which is 63 feet long, and has an effective depth of 6.5 feet. Prior to starting the adequacy test, the M.T. had 67 inches of liquid in it. The first 219 gallons of water introduced rose the liquid level to 71 inches. An additional 330 gallons of water was added which at some point caused the level in the drainfield drop to 64 inches. 70 more gallons of water was added to the drainfield to confirm that the liquid level would remain the same level. Based upon this data, it was determined that the absorption rate of the trench exceeds 600 gallons per day, as required for a 4 bedroom house. If you have any qups�ons, please contact us at 337-6179. 3701 E. Tudor Road, Suite 101 * Anchorage, Alaska 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com p v� ................................ SHANE A. HOLT : ,0 kP LS -6914 a'=5 15 a _ A~�fess(oro�400 Or ��040v000 S1 N 31�16/p1'/E AS -BUILT SURVEY ( NO CORNERS SET THIS DATE ) I' - 30' 1 HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 2, BLOCK 8, SECOND ADD'N. TO MCMAHON SUB. ANCHORAGE RECORDING DISTRICT. ALASKA AND TH nc N uf%mA IVh nLKLUn 17 f K IML ud6 Ur LLhVINV NZi u1 Nj JrL Iri.ALLI Smo" AniUWUr bLiVML THE VISIBLE IMPROVEMENTS SITUATED THEREON EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL WITHIN THE PROPERTY LINES AND NO VISIBLE STRUCTURES OR FENCELINES. ENCROACHMENTS EXIST OTHER THAN NOTED. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON.(UNLESS INDIC DFA4jD AT ANCHORAGE, ALASKA THIS __22ND_-_ �1AY OF __JANUARY2004__. ________ _ NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY UN 7iOLT LAND SURVEYING 9246, FB110-11 OR LOCATE STRUCTURES. TEL. 345-5513 ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. Parcel I.D. # 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 017-361-43 HAA # of ilei CC 1. GENERAL INFORMATION Complete legal description Lot 2, Block 81 McMahon Subdivision #2 Location (site address or directions) Property owner Mailing address Lending agency Mailing address. Susan Isaacs 3900 Kutcher Drive 3900 Kutcher, Anchorage, AK 99516 Day phone 345-3382/223-6609 Day phone Agent Day phone Arlrlrccc Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX 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: XXX Individual on-site Holding tank Community on-site Public sewer NOTE: 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 furtherverify 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 onthedate of this inspection. Name of Firm S & S ENGINEERING Phone ag+ MDr oop Roa No.204 Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. 0 r �UlZ bedrooms. Date CCly-a::17q b RCEERT C. Co WAN f•2 a<,'t CC -8801 Conditional approval for _ bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concent --a r; nn ;G S. 57 mg/1 EPA maximum concentration is 10.0 mg/1 More information on nitrates is available from the On-site Services Program, DHHS, 343-4744. Additional 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 professional engineer's work. 72-025 (Rev. 1/81) Back MOA N21 t { 1s : fi i b RCEERT C. Co WAN f•2 a<,'t CC -8801 Conditional approval for _ bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concent --a r; nn ;G S. 57 mg/1 EPA maximum concentration is 10.0 mg/1 More information on nitrates is available from the On-site Services Program, DHHS, 343-4744. Additional 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 professional engineer's work. 72-025 (Rev. 1/81) Back MOA N21 f a L I _4 LU Municipality of Anchorage 22 1999 DEPARTMENT OF HEALTH & HUMAN SERVICES FFB Environmental Services Division MUNICIPALITY OF ANCH 825 L Street, Room 502 • Anchorage, Alaska 99501 • (90+4 SERVICES Health Authority Approval Checklist Legal Description: LCA i 1 6 i.oc K V s70tigya,j Parcel I.D.: 0I -7 - 3 t - Y' 3 A. WELL DATA Well type P ii, v 4 T 4- If A, B, or C, attach ADEC letter. ADEC water system number Log present 6 Y 0 S Date completed I s 7 Total depth 6 I Sanitary seal (N)/N) Date of test Static water level Well production Cased to LID t Y& S FROM WELL LOG !IK S g.p.m. WATER SAMPLE RESULTS: Coliform `o Nitrate _ Casing height (above ground) Wires properly protected &N) _ AT INSPECTION alail�� S', S- a Other bacteria Y*_j am Q Date of sample: Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA R egle River, Alaska 99577 Date installed 3" %Z Tank size I �,s O Number of Compartments Cleanouts &/N) y'S! Foundation cleanout &/N) Depression (Y/@ tv 0 High water alarm N9 !' 0 Date of Pumping o� q Pumper C. ABSORPTION FIELD DATA Date installed ( / el a Soil rating g. .d. 2 r ft2/bdrm) 0- System type r2 N N Length C 3 Width 3 Gravel thickness below pipe /� Total depth I1 � Effective absorption area $ i `t Fr z Monitoring Tube present( /N) yes Depression over field (Y/& 0 Date of adequacy test _aL a I / 9 Results Pass Fail) /04 -ss For q bedrooms Fluid depth in absorption field before test (in.); y II Immediately after63a gal. water added (in.): 6 Fluid depth S I1 " (ins) Minutes later: l g Absorption rate = G 6 0 � g.p.d. Peroxide treatment (past 12 months) (Y/N) Kwovj./ If yes, give date 72-026 (Rev. 3/96)` D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycle"ste� E. SEPARATION DISTANCES "Pump on" I *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ° (� Absorption field on lot 1 0p Public sewer main N /A Size in gallons On adjacent lots On adjacent lots "Pump off" level at` /00 4- 1 0 u ' -1- Public sewer manhole/cleanout Sewer /septic service line '- S Lift station 'V / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 10 Property line Absorption field Water main/service line 0 1' Surface water/drainage / °0 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: R t "//4 Property line 1 0 .t Building foundation _,AU Water main/service line Surface water f Curtain drain N e,.: i K N c u F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area _ Wells on adjacent lots IOU S- U a- 1 �L �+ I certify that I have determined thru field inspections and review of Municipal records t .tfig aba(/WsyN are in conformance with O HAA Veil es in effect on this date. w c9;2e�d Signature ✓�C�� ;t'� Engineer's Name C. COWAN r ;a 9 ROBLRT �2 Od CE 8801 Date - E,6+ � �e c> u >'66 HAA Fee $ Waiver Fee $ Date of Payment O i a -)_ , 19, . Date of Payment Receipt Number V�Z ��e 07 L Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE } DEPARTMENT OF HEALTH & HUMAN SERVICES j 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 2, Parcel I.D. # nim- �n l -'L�; HAA # 0 Q') 1. GENERAL INFORMATION Complete legal description Lot 2• Btock 8• McMahan Su.bdivizion #2 Location (site address or directions) 3900 Kutchen naive Property owner Biu 9 Sonia Hawiuvt6 Day phone 337-7714 Mailing address 2410 Bavlbuay 12,ive, Anehanage, A aska 99504 Lending agency Day phone [VI"I". .y u,,.,..,.... Agent Ludy 7nhvi,tnv1 REIMAX PROPER77FS Day phone 276-2761 Address 2600 Coadova Road AnchaiLage A.Paska 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XX 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 XX Holding tank — Community on-site — Public sewer — NOTE: 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 IZk VON yaey (L6R 'nay)9ZO-ZZ -i jom spaul6ua puoissa}o.)d aqp ui suoissiwo ao saoaaa Ao; opsuodsai IOU si ebeaogouV to Al!ledioiunVq aql •panssl sl aleoi;iliao e aaolaq epep az lvue ao suoiloodsui lonpuoo IOU op SHHC1 to saalojdu)3 -spuawaiinbei aleps pue leaapal uiel.(ao l4siles of iepio ui suoilnlilsul buipual aiagl pue sawoq to saasegoand op (sol.(noo e se slgp saop SHHG aql T� MV;o apepS aql ui paaaps169a AGO uIbua leuoissaloid puapuadapui ue Aq anoge 9 gdeAbIMA ui uanib suolpeluasaadaa all uodn Aluo paseq sapeoiplioo 1enoaddV AliaogpnV glluOH sonssi (SHHCD saoinaOS uewnH pue RBOH po luawuedaQ a6eaogouy 10 AlllediolunN aql ' aElm= molle1ndils 6ulnnollo} aql gl1M 'swooapeq a 5G Q Ohl ia39M :n oennq ao DHEA o0yyooVgaoa 114r r�q -Be 0000wooN F 4%p% ----7. "' (o "Gi ale(] ZF sluawwo0 leuoilippy JOJ Jenoidde leuollipuo0 •panoaddesll] swooapaq T a01 panoaddy x �j 3l nIVNJIS SHH® '9 '13N N3N 3M 3661 `63 /AVN a3nm 7VAO?1ddV AMIOH111V H11V3H 341 JO 001116NOD 3H1 aanleu5is s,aaaui5u3 ZZS66 e119eld01Ge:] NVON peo?l CIOOJ aan1-a 01BER J7COZ L Ssaippy auogd ONIZIEMJN3 S T S wal o awe 3d N •uo1loadsui slgl 10 alep aql uo loaga ui suoilejnbw pue 'sooueulPao 'sepoo alelS pue jedlolunlN Ile ql!m eouelldwoo ui sl walsAs psodsip aaleMalsem Ao/pue Aiddns .lalem ells-uo eq; 'uolloadsul pue uo1le6llsanu1 Aw woal pue sail a6eaogouV to Al!ledioiunW eql woal paulelgo uollewaolui aql uo paseq legl A}laanaaglan} 1 -ulaaaq paleoipui ainlonals to odAl pue swooapaq }o aagwnu aql Aol alenbape pue jeuoilounl 'ales si walsAs lesodslp Aalemalsem ao/pue Alddns AeleM ells-uo aql legl smogs uoileoildde JenoaddV Aliaoglnd ReaH slgl 10 uollebllsanui Aw legl !peen I 'Molaq uMogs alep uollep len aql to se pue olaaaq poxllle leas Aw Aq pallilaao sy 833NION3 1113 N01103dSNI d0 1N3W31`d1S 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T a• &J02 McA14 O./ �//% Parcel I.D. A. WELL DATA Well type UPRF— If A, B, or C, attach ADEC letter. ADEC water system numbe Log present O/N) YES Date completed �� 1221? }? Driller 7 i2Kur�- Total depth 19C Cased to g6 ( Casing height ►//8'/ Sanitary seal OI) RaPL CED r�5�92 Wires properly protected (j�N) FROM WELL LOG Date of test ) DL - S- }y' Static water level R K Well flow Is rg.p.m. U Pump level K SEPARATION DISTANCES FROM WELL TO: Septic/hah6iseg tank on lot AT INSPECTION S -b -i2 3'I g.p.m. IySrt ; On adjacent lots 106 r+ Absorption field on lot JA0 f ; On adjacent lots 106 t *- Public sewer main 10/A Public sewer manhole/cleanout NI Sewer service line SS r� Petroleum tank Yn,ONJE KN6WrJ WATER SAMPLE RESULTS: YV1 Coliform Nitrate 4r U f Other bacteria _ Date of sample: 5--9-cl z Collected by: � � � �NGIA1Frketl�. B. SEPTIC/HOLDING TANK DATA Date installed Tank size /a -so Compartments Tw6 U Foundation cleanout N T �lCX)De Depression Y/9 N6 Cleanouts �Y�J) ) p ( ) High water alarm (Y/110 NlA Alarm tested (Y/191 Date of pumping N//� ' Paw (qyi< Pumper N/`) SEPARATION DISTANCES FROM SEPTIC/F TANK TO: r ' Well(s) on lot /10 On adjacent lots 100 14 Foundation To property line a5 r� Absorption field r4 -Water main/service line Surface water/drainage �6d rf 72-026 (Rev. 7/91) Front CONTINUED ON BACKPAGE C. LIFT STATION D�Fled Size in gallons Vent(Y/N) — High water alarm level "Pump " level at Meets MOA electrical codes Manufacturer Manhole/Access (Y/N SEPARATI-ON-D- STANCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water Date installed �` —�(2 Soil rating 01� G24SY System type Tl?i=,cN Length 3 Width fir. Gravel thickness 6 Total depth Total absorption area 817 SF Cleanouts present &/N) VAS Depression over field (Y/6 Nb Date of adequacy test /-J/,4 —1 E)EW VS, Results (pass/fail) N�i� for bedrooms Peroxide treatment (past 12 months) (Y/QI N6 If yes, give date /J/%4 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot [;;�6 �1 On adjacent lots /66 14 Property line To building foundation oZ0 To existing or abandoned system on lot 0 �t On adjacent lots Cutbank 1J 1A Water main/service line oZ S r Surface water 16d (I Driveway, parking/vehicle storage area Bio NvaCurtain drain l �Zfi v KNOVN E. ENGINEER'S CERTIFICATION l certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effectgp,.og,date of this inspection. g Ufa c ene" 5j �fk: S & S ENGINEERING 17031 Eagle River Loop Road No. 204 Signature Eagle Rivet-, Alaska a _{1.6P e04i9a "iq A?appOO.' ❑04 ^Of1 (/,e 9 . Engineer's Name �o -�I - 61'L- Date , cr >.G ;ta�:,r: t :1. t16a'ai 3 HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE�� • DEPARTMENT OF HEALTH & HUMAN SERVICES y }i 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 �y Parcel I.D.# OZ7-��ro L�3 HAA# .1197zQ3<7 1. GENERAL INFORMATION Complete legal description Lot 2; B.2ock K; Mc Mahon Subd,%visi.on #2 Location (site address or directions) 3900 KuutcheA Dkive Property owner B.c,U 9 Sonja Hawk.i" Day phone 337-7714 Mailing address 2410 Banbury Dti.ve Anchorage, A&,ska 99504 Lending agency Mailing address. Day phone Agent Judy Johnson RE/MAK PROPERTIES Day phone 276-2761 Address 2600 Cordova Road Anchorage, A&.6ka 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XX 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 XX Holding tank Community on-site Public sewer NOTE: 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 421 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 SJ& 5 £NGIMEERING Phone 1705" %age River Loop ROAd No. 204 Address iaa`^ Ph=, Alaska 99!M Engineer's signature Date -C�vf-trt�� i�'T��✓l� � ri� 6. DHHS SIGNATURE Approved for bedrooms. OF aocRR a. ai Ea 4 t 82 5 Disapproved. Conditional approval for bedrooms, with the following stipulations: I uD� `/i~J / Additional 0 11iT1r 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 professional engineer's work. 72-025 (Rev. 1/91) Back MOA N21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST a,r e�tn r -� /' Legal Description: LT 2, 3wk$, ,v` lv(Atb" .1uav -2 Parcel I.D. 7 361" I_A5'l4, a By -A f_1 Well type t'iz1U( TIL If A, B, or C, attach ADEC letter. ADDEC water system number Log presentY( )N) 1FS Date completed DEC Nil Driller RR* -7 I)J?(t /k* Total depth 186 Casedto 186 t Casing height + Sanitary seal (Y/® To g>= Rt=PL4C-r:D Wires properly protected l&N) YAC Date of test Static water level Well flow Pump level FROM WELL LOG /A -s- *�4 lA AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot cly 1 0 ?ANrc ; On adjacent lots Absorption field on lot ��� + ; On adjacent lots Public sewer main "/A Public sewer manhole/cleanout N/A p V�` Sewer service line 85r 4 Petroleum tank �N oiv� NNowtj WATER SAMPLE RESULTS: Coliform C Nitrate �� U Other bacteria 0 Date of sample: J - Collected by: S �IUG�n�ctt2allo- 4—SEPTIC/PIMMOM TANK DATA Date installed //-g'}?_ Tank size /aSC Compartments Cleanouts 6/N) ONE Foundation cleanout ON) b)Depression (Y/@) High water alarm (Y/9 AA Alarm tested (Y/6 IVA Date of pumping !J-1;"9 �_ Pumper A t 4wcr_- SEPARATION DISTANCES FROM SEPTIC TANK TO: Well(S) on lot 9 L1r fo Cl0 On adjacent lots /00 r / 1- Foundation 10 To property line .�-Absorption field do t Water main/service line Surface water/drainage /(36 r� 72-026 (Rev. 7/91) Front 4- p iL -T; ,G' --Fn E - CONTINUED ON BACK PAGE T�n N `]t g.p.m. g. + c r N SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot cly 1 0 ?ANrc ; On adjacent lots Absorption field on lot ��� + ; On adjacent lots Public sewer main "/A Public sewer manhole/cleanout N/A p V�` Sewer service line 85r 4 Petroleum tank �N oiv� NNowtj WATER SAMPLE RESULTS: Coliform C Nitrate �� U Other bacteria 0 Date of sample: J - Collected by: S �IUG�n�ctt2allo- 4—SEPTIC/PIMMOM TANK DATA Date installed //-g'}?_ Tank size /aSC Compartments Cleanouts 6/N) ONE Foundation cleanout ON) b)Depression (Y/@) High water alarm (Y/9 AA Alarm tested (Y/6 IVA Date of pumping !J-1;"9 �_ Pumper A t 4wcr_- SEPARATION DISTANCES FROM SEPTIC TANK TO: Well(S) on lot 9 L1r fo Cl0 On adjacent lots /00 r / 1- Foundation 10 To property line .�-Absorption field do t Water main/service line Surface water/drainage /(36 r� 72-026 (Rev. 7/91) Front 4- p iL -T; ,G' --Fn E - CONTINUED ON BACK PAGE LIFT STATION Date ins d Size in gallons Vent (Y/N) High water alarm level "Pump "level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water Date installed U-8–�1? Soil rating klrn� System type TZENCH Length Lig Width 36 rr Gravel thickness 6 Total depth Total absorption area t;c6 Cleanouts present &N) Depression over field (Y/No Date of adequacy test Results (pa fail) ! `_FA � (- for y bedrooms Peroxide treatment (Past 12 months) (Y/U N07 KNOW ry If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot Wo * On adjacent lots Ion I� Property line— _D r To building foundation ,0 r To existing or abandoned system on lot NIA On adjacent lots �$ (� Cutbank 0114 Water main/service line_ Surface water (o0 + Driveway, parking/vehicle storage area �0 rfi Curtain drain ONE KmwN IT 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. 17034 Ea,la River Loop Read No, 204 r Signature Rupl-, Rival, Alaska 99577 Engineer's Name r'e Date �ti j f nY. HAA Fee $ 1 7W I�CV Date of Payment ��" A- 7 Receipt Number ;Z 37r3� -9-307 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: '$ Date of Payment Receipt Number Tide - Time ie Date Date Date Inspector Inspector Inspector Comments Conditional Approval 6-140-w v Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size P Soils Rating Well To Absorption Area Well Log Received Well to Tank Y�r' APPLICANT FILLS OUT LOWERHALF ONLY PropertyOwner r d Z'J'✓ Phone Mailing Address Buyer 4 w 1% Address Lending Institution .• Phone Address 0 e, -J 4 ` l / , r 6j is ? ?F Realty Co. & Agent Phone Address dc Legal Description Y, Street Location k U `'G/ -r,c Type of Residence !� Single Family i ❑ Multiple Family No. of Bedrooms ❑ Other Wat ,Supply ,j Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available. Sew@ge Disposal /C7 Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MOM 6PUN M047 PAQ AN HORAGE,VALASKAIT 203 u099501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 June 21, 1982 Mr. Jerry Dewhurst ReMax 2702 Gambell Anchorage, AK 99503 LEGAL: LOCATION: RESIDENCE: WATER: SEWER: DATE OF TEST: TEST PROCEDURE: SEWER ADEQUACY TEST Lot 2, Blk. 8, McMahan Subdivision. On Kutcher. 4 -bedroom single-family. On-site well. From Municipal Records Tank - Steel, 1250 gal, two compartments. Absorption System: 47 ft. trench, 6 ft. of rock. Total Absorption Area: 564 sq. ft. Soil Rating: 140. Installation Date: November, 1977. June 16 and 17, 1982 System was inspected on June 14, 1982. Tank is 8'-8" below ground, liquid depth: 47". Liquid was light with no noticeable sludge buildup. Sump was dry with some dark sludge deposit. On June 16, the tank was pumped and the trench was charged with water in 500 gal. increments. The following readings of the water level were made. Water Volume 0 500 1000 1500 Time: 11:00 a.m. 4:00 p.m. 9:00 a.m. Water Depth in Trench 0 17-1/2 32-1/2 46-1/2 39 31 Tobben Spurkland P.E. Mr. Jerry Dewhurst June 21, 1982 Page 2 Test Result: In 22 hours the water level dropped 15-1/2 inc e'4F s.trapolated to 24 hours, this is equivalent to 607gal./24 hrs. The Municipal Code requirement is 150 gal. per bedroom per 24 hours or 600 gal. per 24 hours for a 4 -bedroom house. % �epF`% This residence meets this requirement. '* � 49>� YV '• I T•�� (._ ••fi 0.000 • •••. �L o. 2225-E �: • JUNE 25, 1971 iia Sn:!•.•..• ��1Gi r MUNICIPALITY OF ANCHORAGE,. DEPARTM T OF HEALTH AND ENVIRONMEI L PROTECTION 825 L Street, AnchoracrP, Alaska 99501 ` 264-4720 Date Received: January 16, 1978 #1: Time 10:30 a.m. #2: Time #3: Time Date 1-18-78 Wednseday Date Date Insp Pratt Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Mailing Address: 2. Property Owner: Ed Herzog Mailing Address: 2418 East 20th Avenue Phone: Phone: 272-3166 3. Legal Description: Lot 2 Block 8 Mc Mahon Subdivision 4: Single Family Residence: " Multiple Family Residence: ( ) Number of Bedrooms: Number of Bedrooms: Four 5. Well System: individual Well " Community/Public System ( ) Permit # Depth of Well 186' Well Log on File ( ) Construction Bacterial Analysis _ 6. Sewage Disposal System: On-site System ( Public Utility ( ) Permit # Installed 1977 Installer Septic Tank Size Manufacturer _A4 � ��� Absorption Area Soils Rate )(/C-) y Material 7. Distances: Well to Septic Tank to Sewer Line Nearest Lot .line to Nearest Lot Line to Absorption Area Absorption Area -r,(Age Two' Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Comments: Lot 2 Block 8 Mc Mahon Subdivision Affadavit Attached: ( ) Approved: Disapproved: Department Worksheet: Letter Attached: ( ) Date: 1"o-3 -"7 Date: MUNICIPALITY OF OF ANCHORAGE Department of Health and Environmental Protection h� :equest 825 L Street, Anchorage, Alaska 99501264-4720 for Approval of Individual Sewer and Watcr Facilities 1. Property Owner: Mailing Address: 2. Name of Buyer: 3. M Mailing Address: "Lending Institution: Mailing Address: Realtor/Agent: Mailing Address: Phone: Phone: Phone: 5. Legal Description: /'a ';V�- 02 zz' d e pl Street Location: /f/%Q Ad S.OG 4/ 6. Single Family Residence: ( * Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: *Individual Well Public/Community System ( ) 10If Individual Well, well depth . M6 If Community System, name of system 8. Sewage Disposal System: *'On-site System (j() Public System ( ) If On-site System, date of installation: -y Ar *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