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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
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POPC44. M64
a S,W, CORNER
R£F FLZU loo° TWoo 481P1A
HoWJ SE
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NEW `p1z j
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Lura
MT
STAND OUSE 1'*t'c \
_ P)pez A 3 C TWD ratxHFS \ 4�
Co 1 65 (5� 115 gra'
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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
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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.
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