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HomeMy WebLinkAboutMCMAHON #2 BLK 8 LT 4McMahon #2 Block 8 Lot 4 #017-361-45 3 ' Municipality of Anchorage Page ( of 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 � �qq 00 80 ©I7 -36 L7i Permit Number: PID Number: Name: ,Wastewater System: ElNew bi Upgrade Address: 4000 ko[vfAer l)l,', ve ABSORPTION FIELD Phone: j0.7 J - i5m0-aq No. of Bedrooms: 4 IWDeep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Q Total Depth from original grade: 10,5 o t� GPD/Sq. Ft. Lot: Block: y/[� Subdivision:. Depth to pipe bottom from original rade: ��� Gravel depth beneath pipe % 0 1'IcMe.hri Ft. J Ft. Township: Range: Section: Fill added above original grade: Gravel length: - - 5q o S Ft. Ft. WELL: El New13 Up Gravel width: d Number of lines: Distance between lines: 14 ^ 01< Ft. Ft. Classification (Private, A.B,C), L al Depth: Cased To: Total absorption area: —751 Pipe material, S D303q/F110 \ Ft. Ft. Static Water Level: SO. Ft. Installer:j + Lea 1 /41 Date installed: 5—' 95 Driller: Date Drilled: Ft. rwed Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES kSeptic 0Holding ❑S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer, L %rlGhniei Tan k Capacity in gallons (���. From Tank Field Station Tank Sewer Lines e Welh' Q\� oo\� a� ,�s,�\� Material:' ��� Number of Compartments: Surface Water 00�+ ICO LIFT STATION Lot .q \ Size in gallons: Manufacturer: Line I �' Foundation 16"% 3 Y \ "Pump on" level at: mp off" level at: High water alarm at: CurtainPump �� kv10 h` Ma Model Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: b �- ` A Assumed Elevation: 0 017/ ........... _444%1 �1q1' ��� R•'' If S & S ENGINEERING Inspections performed bYi0 ates: is o - Eagle River, Alaska 39577 2nd S ��y``•^9 „ROBERT C. COWAN +?` S`h, C) CE CE -8801 � �� +� Department of Health and Human Services approval Al/ e 7` ;2�-� ..., Reviewed and approved by: Date: 72-013 (Rev. 9/91) MOA 25 PERMIT NO. SW990080 qk PAGE L OF Municipalit of Anchora e DEPARTMENT OF HEALTH QUAD HUKAN SERVICES EW RONMENTQL SEWCES DWISION P.D. Box 196650 *Anchorage, Alaska 99519-6650 • Tel^ephone: 343-4744 ON -&TE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 8, MCMAHON #2 S/D P.I.D. NO. 017-361-45 SEPTIC AREA DIVERTER VALVE QV) / \ MT1 �Fl� DBL1 \ 0 DBL2 \\ CO3 MT3 \ �� B Col TH 0 ST2 ST1 FCO A yGs�L T2 sF c \ \ c02 0 \ \ NEW 1250 GAL. \ SEPTIC TANK G\\ LOT SEPTIC \ AREA LOT 12 \\ \ i�? LOT 5 O O ti SCALE: V = 40' Et @ 4 C2r T >� ROBERT C. COWAN �C CE - 8801 , �t .. lF. S�'a, • A PERMIT NO. SW990080 PAGE 3 OF 3 Municipalitof Anchora e DEPARTMENT OF HEAUH AND HUKAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Tent^ep hone; 343-4744 OSI—&TE WASTEWATER DISPOSAL SYSTEM AND/OR WELL WSPECTIoN REPORT LEGAL LOT 4, BLOCK 8, MCMAHON #2 S P.I.D. NO. 017-361-45 ST1 ST2 FINAL GRADE 97.0' A B FCO 3.0' 27.5' STI 18.0' 35.0' ST2 26.0' 40.0' DBL1 28.0' 41.5' NEW DBL2 29.0' 42.0' DV 30.0' 43.0' 1250 GAL 93.1' 92 g' C01 35.0' 46.5' SEPTIC MT1 89.0' 95.5' TANK CO2 40.0' 61.5' MT2 1 40.0' CO3 1 78.5' MT3 1 75.0' FINAL GRADE CO2 = 96.3' CO3 = 95.0' N CO2 = 92.3' SR CO3 = 92.3' N. T. S. Ekil �T \a1 MT2 = 85.1' �2��•""'....:L MT3 = 85.1' �A �,. • �^1 ' A th i.\.L.¢Rw..•...Y NO WATER FOUND ROBERT C. cOWAN 78.6' B.O.H. ��� :� U-8801 :5 1JFL+ s MUNICIPALITY OF ANCHORAGE a a Department of Health and Human Services 1 ! On -Site Services Program h��� ' 1 • �� 825 L Street, Room 502 "1 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW990080 Legal Description: MCMAHON #2 BLK 8 LT 4 Design Engineer: 0003 S & S Engineering Owner Name: Sandy Hayes Owner Address: 4000 Kutcher Drive Anchorage , AK 99516-2845 Date Issued: May 04, 1999 Expiration Date: May 03, 2000 Parcel ID: 017-361-45 Site Address: 004000 KUTCHER DR Lot Size: 36551 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank E]Holding Tank [_]Privy E]Private Well ❑Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: 0-, Date: s- /j—/c Date: L S& HEALTHAULHORITY April 21, 1999 ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 APPROVALS MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 SEWER&WATER Anchorage, AK. 99519 MAN EXTENSIONS REFERENCE: Lot 4, Block 8, McMahon Subdivison SEWER & WATER INSPECTION Request you issue a permit to install a septic system upgrade to serve the four bedroom dwelling on the referenced property. ENGINEERING STUDIES One test hole was excavated and percolation test was performed. The approximate ANDREPORTS location of the test hole is located on the attached site plan. At the time of excavation 4/19/99 water was not found. After seven days of ground WELL INSPECTION water monitoring the monitoring tube was dry. & FLOW TEST We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The SITE PLANS construction of this system will not prevent any future development on any of the adjacent properties. ROAD DESIGN If you require additional information, please contact us. ShicerJely, SOILTEST C/Cow/a/nft�+—P.E. PERCOLATION RCC/jhm TEST Enclosure STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1 " = 50' DESIGN DETAIL SCALE mo F+ 4 9 x z Q 22 c,�a rnNw, ] rnyrP d _ C) �r �`'ci' y� 0o0 Co mm C�7 x " fTl r W C co M o co a m �x�� Zcppmm 00cf)mq II O�yz II Z i "so�ART,; +VNp O �z0 m O z wMM 0 0 0 � Cv' 70 _ � N p SNI b / a�O-3 Y -ti AD�-O O m oAmo om>X= A Z Zn.A➢m D ti m>O T.AZA-mm-V13 010 z.>D 20 O N <� yam �mm / < � _om NO / /Mih a v m K w Ozo� �e<C o m m=N< �ITHI // a WELL n N 100' nmp �mZD 100, // // RADIUS x O m m -o . s F- 0 "o r // / x~ o Z O moo= O // // air m ✓r `tin /� // ti i/► Nm cmZ n .. > zpp O z�my � 1y 3rm l;0 a�n� 4�1 O / O I / D o I I 10 =x I I 0' A o I I L RADIUS F y Y O _ ZN z A I O OI c:m zc IC y'^ 'm m Oo ro A N m I m mIo m Oz z� Z m A I I ui Cl m; i h14 tm = -.W�mZ I I 100' / ���` m~ v ` tQ c >0 A No pp :Y9 n nI I L12g �'t on x o= f y � y .• Z w I I F�/ST/NG o I I y E4 Municipality of Anchorage . DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: `S At--, 9 y h 4 y 1-s DATE PERFC L I Fr;AI nFsr.RIPTION: �� ��-� I CK ��yq'dl,:,'✓ Township, Range, Section: 0 A- C, 14,j 1 C S i 3 1 L 2 0. Y & �W 3 5 6 7 8 �!'7//h L 9- 10- 12- 13- 14- 15- 16- 17 10121314151617 18 19 20 COMMENTS w✓� L G -&A 4lp-0 I G./'4119L r- I/v&- Yr-, NA ivrTN 51 L,'7 - WAS , T WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN IF YES, AT WHAT DEPTH? _ Depth to Water After AR y Monitoring? Date: NO S L O P E 1]&I / 1 l Reading Date Gross Time Net Time Depth to Water Net Drop �0 717 Vy I I/yry 6 © 30 ,3 1/1 „ ya 30 C?01/y3:y,. PERCOLATION RATE 2_ a (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN b FT AND FT S & S ENGINEERING PERFORMED BY:17034 Eagle Rivet, Loop wadjxv.Av% t-�c'LJ�� CERTIFY THAT T IS TEST WAS PERFORMED IN ACCORDANCE WITH�i9IPSVYXAR[T'fVfUNtC'R7GUIDELINES IN EFFECT ON THIS DATE. DATE: y a� r 72-008 (Rev. 4/85) ROBERT C. COWAN, P.E. a ea, CIVIL ENGINEERS AtA ON-SITE WASTEWATER DISPOSAL SYSTEM (907) 694-2979 FAX (907) 694-1211 CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS HEALTHAUT HORill TY APPROVALS REFERENCE: Lot 4, Block 8, McMahon Subdivision April 21, 1999 SEWER&WATER MAIN EXTENSIONS GENERAL: 1. The scope of this project includes the installation of a 1250 gallon septic tank and leachfield trench for the four bedroom house located on the referenced property. NSPECTIONTER 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and ENGINEERING STUDIES ANDREPORTS Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. WELL INSPECTION & FLOW TEST 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. SITE PLANS 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. ROAD DESIGN SEPTIC TANK INSTALLATION: SOILTEST 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. PERCOLATION TEST 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER 5 & 5 ENGINE MNG DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page 2 Lot 4, Block 9, McMahon Subdivision April 21, 1999 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. 5 & 5 MINMIN6 Page 3 Lot 4, Block 9, McMahon Subdivision April 21, 1999 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated 59W Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 5 & 5 ENGINFFMNG Page 4 Lot 4, Block 9, McMahon Subdivision April 21, 1999 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple, trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER 5 & 5 �WNMI% MUNICIPALITY OF ANCHORAGF- ,.- He, _h and Environmental Pr.ote -'ion m Fourth Floor_ West 825 L Street Anchorage, Alaska 99501 264-472.0 INSPECTION UPPORT ON-SITE SEWAC?E DISPf'WS at. SYSTEM NAME_- _ - -(-+I__— MAILING AL -) LOCATION PHONE=_ LOCATION ._______ LEGAL SEPTIC TANK: DISI ANCE I NUMBER OF FROM WELL100 00 —__ MANUFACTURER ", -�:Q= ,._,____ ��AiERIAL _ .. __e. ._._-_._.__—COMPARTMENTS. _� INSIDE: WIDTFI________,___ E_IOUID DEPTH LIOUID CAPACIT` &>g, _GALLONS. TILE DRAIN FIELD: I r TOTAL LENGTH DISTANCE I ROM VdLLE_ %00 __—FOUNDATION oto .____NEAREST LOT LINe_..��i-__..._..,oF L.INE _ Sa n Of L1rieS ___-! _— — DISTANCE BETWEEN LINES __/_,LC_/�__—TRENCH WIDTHH3 IN. TOTAL EFFECTIVE A i 15: O H i= i 10F4 A R L ASO. FT. LENGTH OF EACH LINEDEPT[[ OF OF FILTER / DFPlli: TOP OF TILE l -O FINISH GRADE _—.d-__ MATERIAL BENEA-i-fl TILE 'rC1. AROVE TILE SEEPAGE PIT: _ DIAMIETER _—OR WIDTH -___., LENGTH__., DEPTH Log Crib _Rings Crib Size:DlnnnETrlt___._UFPiH..Dfs;TnNCC:F'r( : TOTAL EFFEcTIvE BUILDING FOUNDAT ION _- , NEAREST LOT LINE _ A@.SORPTION AREA (WALL AREA) __.___SGi. FT. 'ell -lass: _ Depth: ;ell istance To: Lot Line _ >ldg: Sewer Line: ipe Materials: fZ_Af of Bedrooms: y nstall.er: :emar_ks: DATE/ APPROVE: , I 1 DATE/ APPROVE: n��ohs �������'1^(10 W �As W 01 C% fit lot C71 P.O.. ' DEPHRTMENT OF �EHLTH HND ENVIRONNEWTHL PRQTECTION L' 825 '�REET/ HNCHORH8E/ HK9950� � ^`` 279�251i ' I Al Q R.. Vol in! i> P*�,.,!~-15 11 W K MWEYME050 1=1 EZ, 1 Fit vwl I: W, PERMIT WE ( 7791] ) HPPLICANT HERZFM CONS024i8 E 20TH 277 3166 LOCATION KUT: LEGHL L 4 B 0 NCMHHON SUB LOT SIZE ]6551 SQUHRE FEET TYP£ OF SOIL IS: TRENCH MAXIMUM NUMBER OF SOIL RATING (SQ FT/BR)­ 150 THE REQUIRED SIZE GF THE SOIL HBSORPTION SYSTEM IS: ED N 11 -1 - 1-1 — K 91) ������ -1 M= �:-A_ M M "Y' K Q. FEE F��`_ 11 - F—q — � THE LENGTH DIMENSIQN IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DI, THNCE BETWEEN THE OF THE GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ��� ������ �����X (:0 J- p=f 841 F.Q NET 3-, �sit �04-'h�fl C3 F:� 1_ U 11) P41 K& ���������� ���~����� ���������� H PHCK�GE WANT MY BE INSTHLLED AT THE PERMITTEE/S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: ` A. EITHER H CLHSS I OR II NSF HPPROYED PLANT MHY BE INSTALLED. 2. H CONTINUOUS MAINTENANCE AGREEMENT IS REQUIREU IF H MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLHRGE THE SOIL. ABSORPTION SYSTEM HND/OR YOU MAY BE SUBJECT TO PROSECUTION. 'T, 1.4 C� �is! 1. ��no, ����I C1 t* -JR ' r� 60 Fat FEE X EE=--- G� �_J -.q-' F�-': ­___ ­ BHCKFILLING OF ANY SYSTEM WITHOUT FIHHL INSPECTIUN AND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJBCT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND HNY ON—SITE SEWAGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE WELL QR 200 FEET FOR H POBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DAYS OF THE WELL COMPLETION. OTHER REQUIRFMENTS MHY FPPLY, SPECIFICHTIONS AND CONSTRUCTION DIAGRAMS HRE HYHILHBLiP TO INSURE PROPER INSTHLLHTION. 001501101 X -Y F00=01 1 10005 ����M W F-7.-4 fl.- I I CERTIFY THHT 1: I HN FHMILIHR WITH THE REQUIREMENTS FQR 8N—SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. 2: I WILL INSTALL THE SYSTEM IN HCCORDHNCE WITH THE CODES, ]� I UNDERSTHND THHT THE ON^SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN 4 BEDROOMS. SIGNED�_~_~� H CONST ISSUEDB —�_,—^^ Y]�0 DCI?7r'tinent of health mid F.nvironment9l protection 2516 Ii. Tudor Rond hnchorlll;'e, rUasll—n 99501 276-7.221 .;MLS I,OI: I'1{1?OI,A'I I : I1.1, IT perfornir)1 for �i� t(�r� c?C� - - „ate PCrfon.r)J Od Lct),II (I(';cripl OH: illi; form rci»I1ts. 50Percolation Les ) 1 ; 1 cry v _+r i L- ,� Ucpth Feet 5 to s'Or a i;a5 �lrounJ r1aL(:r ��hco:iN?�)r'(�ll? r If vcs, ,)t 1Jirlt c!e;,th? ,.;;lny uiU;s Tl iiet lIn'L --- - - DepL;I t0 r - tv"ItPr i!l'L 01-0O - - - -- - - - -- — - -- - ICoiilt foil I"�1t�-- -1-- -i•il.l ILCiii !'1-�l)U5l'l( III', !,J1 is II01, :. .;,Ct7,1'11,, flL (irdlil Fie DepLII to 1)Ott0iil of 1)it or I,reIiCli �r fUl-;'_�( I;y �U5'ij j, _`IY'> -" - LCrLI F1(�l; �;-V: / r%-04zx JdL(': PU I() iiii i l) is s _iYI1LL Lt�<. t7a = 5-29-86 Legal Des critiOn Lot 4 Blk. 8 _ c s C:rr ( 170 Gallons Per Ninue 20 " N/A Total Ft - et of Ca i n g 'lXJ?t.. M tw rial drilled -0,Yee, t to Deepened "well from 17"5 ft. ,to 216 ft. to to to to to to to :to to to _ HEFTY DRILLING _ 3540 UIJLJ ' DRIVE nd0i'iORAGf, AK 99516 (807) 345093 MUNIWALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION FEB 2 71987 REC IVES For. ..........................................: . `fa..°i.: ?c`............... r.................................................... Depth of v7elt .�"...'.� ,.: �,�' �'�% ............................... v Size of Distance.to wt'.fi l er..... .. .ee,............................ .................................. . . . Distance to water whit pumping...:.. ...................................at rale of.— ...... A7 ..........................gallons. pe.° hour. Formation iF from to 01 „r^ s X:2 ( .y` i...� ------ OP, d 1 i Driller DELTA ORIL ,I G COMPANY SRA BOX :30.3 U ANCHORAGE. ALASKA 99507 • • • _-�-� Municipality of Anchorage 0,440 rov. kk 140,4 On-Site Water and Wastewater Program a 0otti (907) 343-7904 SA ETY CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-361-45 Expiration Date: 0-21 1 1. GENERAL INFORMATION Complete legal description McMAHON#2 BLOCK 8, LOT 4 Location (site address) 4000 KUTCHER DRIVE,ANCHORAGE,AK 99516 Current Property owner(s) GREGORY A. ROSS Day phone Mailing address 4000 KUTCHER DRIVE,ANCHORAGE,AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class_Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance r=•uest for: Distance: Received by Date: CO/ /L COSA to be released o the engineer,unless otherwise requested by the engineer. COSA Fee $ '521, Waiver Fee $ Date of Payment 5[IS h8 Date of Payment Receipt Number 3 -*OT) Receipt Number COSA# C35(t?1aL3 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 5/17/2018 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's 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 � 1.\ encroachments,deficiencies or discrepancies exist. OF A�\ 4- 1 6. DSD SIGNATURE 9TH )C System #1 Approved for � bedrooms. - � rr� KEhrECH DI. � A. 71System #2 Approved for bedrooms. 1 <r›, ` t/ Disapproved. \'Fes. 00"\���Air Conditional approval for bedrooms, with the following4t uMenLs: 0 v4 • .2 W PIERPo ‘,16,10-& � �i se• 044% M;c!9\1 \C By: Original Certificate Date: 1 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: ,(.• COSA Checklist X Nitrate Advisory' 1. Septic System Advisory Arsenic Advi§,ory .. Well Flow Advisory Other •�, ter. COSA blue sheet 10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist# of_ Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: McMAHON#2 BLOCK 8, LOT 4 Parcel ID: 017-361-45 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # Well Log (Y/N) Y _ Date completed 1.118/1977&5/29186 Deepened Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth 216 ft. Cased to 40+ ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 5/2911986 5-9-2018 Static water level 170 ft. 143 ft. Well production 20 g.p.m. 3.5+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/1 00 mL Nitrate 2-?7 mg/L Arsenic: ND ug/L Date of sample: 5/10/22018 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Date installed 5/8/1999 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y_ Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping 5/9/2018 Pumper One Stop C. ABSORPTION FIELD DATA Date installed 518/1999 Soil rating (9p.d./ft2 or ft2/bdrm) 0.8 System type DEEP TRENCH Length 54 ft. Width 2.5 ft. Gravel below pipe 7 ft. Total depth 11.4 ft. (Measured 5/9/18) Eff. absorption area 756 ft2 Monitoring tube Y Depression over field N Date of adequacy test 519/2018 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 50 in. Water added 760 gal. New depth 72 in. Elapsed Time: 1440 min. Final fluid depth 51 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 Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ 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 100'+ Driveway,parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 1001+ F. COMMENTS 1977 field MT was dry. 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 ALiar , Engineer's Printed Name KENNETH M.DUFFUS _ , t Date 5/17/2018 * 49 TTH ` * COSA canary sheet_2-6-15.doc �, „� , ,... FESS 00' AW `_.. Municipality of Anchorage Development Services Department Building Safety Division :' „''• Onsite Water and Wastewater Program 4700 Bragaw Street s 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. 017-36145 COSA 1. GENERAL INFORMATION Expiration Date: _ i3 - 3 - tO 7 Complete legal description MCMAHON it2 BLK 8 LOT 4 Location (site address) 4000 KUTCHER DR. ANCHORAGE, AK 99516 Current Property owner(s) SANDRA T. HAYES Day phone Mailing address 4000 KUTCHER DR. ANCHORAGE, AK 99516 Lending agency Day phone Mailing address Real Estate Agent BETH SIMPSON / KELLER tfVILLIAMS pay phone 907-865-6555 Mailing Address 101W. BENSON BLVD. SUITE 200, ANCHORAGE, AK 99503 Unless otherwise requested, COSH wN be held by DSD /or pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well✓❑ Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Weil ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of OnSBe 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 On -Site 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 samples.) Certificates are valid for one year for properties served by Class A or B wells or a public watwith new water sample results. (Certificates may be reissued for a period of up to one year with valid water er system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 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 Watkins Engineering, Inc. Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis, P.E. 6. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Phone 907-349-1851 5 -29,07 Date bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Az/zMz A). � Original Certificate Date: (Rw 11005) Municipality of Anchorage o ' Development Services Department Building Safety Olvlelon Or -Sb Water a Wastewater Program : • . , 4700 Bragew Street P.O. Box 196850 Anchorage, AK 9951943650 www.muni.org/onsNe (907) 343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MCMAHON 02 BLK 8 LOT 4 Parcel ID; 017-381-45 A. WELL DATA Web type PRI If A, B, or C provide PWSID # _ WON Log (YIN) YES Date completed 1 U8477 Sanitary net (YM) AS Wires property Protected (YIN) YES Total depth VP. Cased to 40+ R. Casing height (above ground) 24 In. FROM WELL LOG AT INSPECTION Date of test #1/8171 Static water level 150 R. Well production -.'A( 2p g.p.m. WATER SAMPLE RESULTS: CoNforrn 0 co'onlesH00 ml Nitrate 2.10 mg/L Arsenic: -0_005 ngN Date of sample: 5/11107 B. SEPTICIHOLDING TANK DATA 5/112007 140 R. 4.b g.p.m. Other bacteria 0 c010niea1100 mL Collected by: Rocky Trainor Tank Type=aterW STEEL Dete installed 618189 Tank site 1250 gal, Number of C rnpartmants 2 Cleanouts (YIN) YES Foundation cleanout (Y" EMS Depression over t8nk (YRO NO High water alarm (YIN) WA Date of pumping 5M 112007 Pumper Isaacs Pumping Service C. ABSORPTION FIELD DATA Date w ata8ed 648199 Sob rating (9.p.dJR' or R=Ibdrm) 0 8 System h1" DEEP TRENCH Length 34 Q Width 2.5 R. Gravel below Pare 7 R. Tota' depth 10._5 _R. ER. absorytbn area Z&-je Monitoring tube YES Depression over field NO Date of adequacy test 6111/07 Results (Pass/Faip PASS For 4 bedrooms Fluid depth in absorption field before test 46.6 in. Water added688 gal. New depth 68 In. Elapsed Time: 182 min. Final fluid depth 61.76 in. Absorption rate >= 8110 p.p.d. AnY rejuvenation treatment (past 12 mo.) (YIN &type) NO If yes, give date D. LIFT STATION Date installed NA 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump ofr level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 102 Absorption field on lot 115+ Public sewer main 100+ Sewer /septic service line 85+ Animal oontainment areas 100+ ManhoWAecess (VIN) High water alarm level at in. Meets alarm b circuit rawrenrerrls? On adjacent lots 100'* On adjacent kks 100'+ Public sewer manholeldeanout 100+ Holding tank WA Manurelanimel excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 15+ Property dna 45+ Absorption flew 8+ Water main 100'+ Water Service one 50+ Surface water 100'* Welts on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 18 Building foundation 35+ Water main 100'+ Water Service line 50+ Surface water 1001+ Driveway, parkirghenide storage 50+ Curtain drain WA Wella on adjacent lots 100'+ F. COMMENTS: Tested the 109 Md and switched clverter VsNe to 1977 laid. Olverter valve should be Svritdted Me tank is G. ENGINEER'S CERTIFICATION i&f 49TH I cerldy that 1 have determined through field inWecfions and review of Munttpel records that the above systems are in conformance with MOA COSH guidelines in etled on this date. CI Y W EMS CE. toSn Engineers Printed Name Cindy W. Egli, P.E. .... 4 Date May -29- 2007 COSA Fee E O r7 Waiver Fee S Date of Payment ' �Q bate of Payment Receipt Number Sg Receipt Number (Rev. I IM) ;2 w °RA"awJ X4 test A3 E 2169, ASPHALT DRIVEWAY THEE NOCRI&A 1U HER ANOPUIETEp LOT LREg OR EASEMENT NO�TOBELEEOFORPOSRKNSNL%=EN ExtsTSTRUCTURES OR FENCELI B EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PUT. ME NOT SHOWN HEREON MIEW EO,ATEM ANYNC NOTE iEELRIRBBOW HII ME LOGTEDAPPROKEA,LTELYANDME OR ED STRUCT S HOT TO BE USED TO DETERMINE PROpERTy LINES ANY PAVING SHOWN MAY BE APPROMIATE DUE TO SHOW CO OITONS dLu rIt Q, QF, A. ,S;�Jtk 4, /TA4ie__ p SHANE A. HOLT : °e LS•6914 O .............. ..... . A90 AS -BUILT SURVEY (NO CORNERS SET THIS DATE ) I'•SD EBYCERTMY THMTI HAVE PERFORMEDNA=TDAOEEYI RISPECTON OF THE FORWO DESCRIBED PROPERTY. LOT A, BLOCK S. MACMugN BUB. NO. E ANLHIOgAOE RECORdNO pBTRICT. AUSKA ANOTHAT THE VRLBIE SA°ROVEMENTB BRUATED THEREON ME HRMN THIS PROPERTY UHES AND NO VISIBLE INCRpADIYEN{g EAKtt OTTER THMN NOTED. DATED AT ANCHORAGE,AUSKATMe ISTM DAYOF_My MY MOLT URO SLMVEYWG IOUB, F813115 TEL SISSSIS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date a IAS LS 7 1. GENERAL INFORMATION (a) Legal Description (include lot, block,, subdivision, section, township, range) 4 i+r 4. �.'. L1:� 'Y `2'Y%G c/4Af/D,t/ _,Tez- A/ CCClllzJ 1.11 Location (address or directions) (b) Applicant Name A-1AA16kJ L1serG, Telephone: Home Business SIo.2- /SSS Applicant Address 4060 Kuru f4<57 'All c•1, 4/L (c) Applicant is (check one): Lending Institution ❑ ; Owner/bw4dec ® ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution as.4 Fad Telephone Address (e) Real Estate Company and Agent A Address WA Telephone At A (f) Mail the HAA to the following address: X74 -S34 w6h re�acly` 2. , TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 4 - 13edroo6n 3. WATER SUPPLY Individual Well o Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite0 Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA) A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm _D'Nr6,,q &A16I 6E9W4 Telephone 776_551+ Address 3 (003 AIZCVC Af F9X 4171, ,4W, 95-503 Date &I/ 4!T18 6. DHEP APPROVAL Approved for Approved — bedrooms by a� Date Disapproved Conditional Terms of Conditional Approval CAUTION 3 -2—g' -,;- The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE - ENVIRONMENTAL SERVICES DIVISION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) FEB 2 719$7 CHECKLIST - FEBRUARY 1984 264-4720 i EG E I V E D Legal Description: 407- 4 �z�r✓ ll —/'lc i,"lfff/o/N A. WELL DATA Well Classification j?65iP&A)-T1AL= If A, B, C, D.E.C. Approved (Y/N) 01A Well Log Present (Y/N) Y Date Completed_ 5 b I Yield Total Depth /4 Cased to 77 .91& Depth of Grouting Alo'g Static Water Level 7U/(Z) Pump Set At �-0 / Casing Height Above Ground J-9 I Sanitary Seal on Casing (Y/N)p v 0 Electrical Wiring in Conduit (Y/N) ( Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot �G 3 To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line NSA To Nearest Public Sewer 1 ; On Adjoining Lots /50 1t /5o'f p Cleanout/Manhole N/A To Nearest Sewer Service Line on Lot 6VA Water Sample Collected by _'Dez A//%h ; Date x205187 Water Sample Test Results T4TISCTOK� Comments d Jute Or) -511-9 m6P5u1Lm•n49 a1;5187 an pe'P muA C pHePJ �E c15 I3> i�E2 N/cU GGH - B. SEPTIC/HOLDING TANK DATA t Date Installed 11/f/77 Size lZSa� No. of Compartments Z' Standpipes (Y/N) Y_ Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) tVo Date Last Pumped ;:V" Pumping/Maintenance Contract on File (Y/N) 1.10 ; for Oo Holding Tank High -Water Alarm (Y/N) N/A Temporary Holding Tank Permit (Y/N) m JA Separation Distances from Septic/Holding Tank: To Water -Supply Well /03 To Property Line 30 ` t To Water Main/Service Line To Building Foundation To Disposal Field 8 Course lv d Comments Pett 01`5187 91) f?—Cr ryulq L OHEPJ r2=eorcls Page 1 of 2 72-026(11/84) v To Stream, Pond, Lake, or Major Drainage C. ABSORPT[N FIELD DATA 0 4J Soils Rating in Absorption Strata 150 �' (' Type of System Design %WGF/ ;i [jai' I istalled tl1 8� �� Length of Field 52� Width of Field 3 Depth of Field y� Gravel Bed Thickness Square Feet of Absorption Area (Voo 3-x% Standpipes Present (Y/N) }' Depression over Field (Y/N) N Date of Last Adequacy Test 87 Results of Last Adequacy Test SATISI-Y)CTOrr�/ Separation Distance from Absorption Field: To Water -Supply Well — 65�0 (?D To Property Line 2 TU .S vuTH To Building Foundation 33 + O To Existing or Abandoned System on Lot mzq ; On Adjoining Lots 274' To Water Main/Service Line !�I/P To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course MIA To Driveway, Parking Area, or Vehicle Storage Area 70 / 10 Comments 0 Pcfz 445%187 CD P.Vl? IVO q � fi cor,/S D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Checqlave te Bedroom Ratin Against HAA Request ** I certify t c ecked, i -or formed to all MOA and HAA guidelines in effect on the date of this inspection. Signed �� Date 7� �7 I Company A/ MOA No. Receipt No. A".f,p �p Date of Payment rl –�d`1 , A )1,02.00, 4� �p TmSeal Amount: $ •0 OBpfp000eD . f - •.ff• nneene De f ponnb a U a< Page 2 of 2 s` 72-026 (11/84)�6R,�,Sgy'+" "•MUNICIPALITY OF ANCHORAGE. ® DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchoraap. Alaska 99501 264-4720 Date Received: April 18, 1978 #1: Time 1:30 p.m. Date 4-19-78 Wed #2: Time Date #3: Time Date Insp Pratt Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FA``CI`L-ITI �1C�L3 �1U 1 L' 1. Lending Institution Request: Alaska Statebank Mailing Address: 310 East Northern Lights Blvd. Phone: 279-7637 2. Property Owner: Ed Herzog Mailing Address: 2418 East 20th Avenue Phone: 277-3166 3. Legal Description: Lot 4 Block 8 Mc Mahon Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) 5. Well System: Permit # Construction Number of Bedrooms: Number of Bedrooms: Four Individual Well (x) Community/Public System ( ) Depth of Well 175' Well Log on File (x) Bacterial Analysis 6. Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # Installed 1977 Installer Septic Tank Size Gts-o Manufacturer 1;k� Absorption Area ('P® ® Soils Rate jis'() Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page rfwo „ Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 4 Block 8 Mc Mahon Subdivision Comments: Affadavit Attached: ( ) Letter Attached: ( ) Disapproved: Date: Department Worksheet: 666-086 - O 668T a Od0 V �apl: ,ay,o aadV S) 11VW 1tlN011VN831N1 Vol !ON 03OIA08d 38VU3AO3 30NVNRSNI ON 008£ I,;;;d,Sd ............................... ... (pailnbai aaJ DJ4" - ) AH3A 1130 1tl103dS ....................................a.......... AlNO 33SS3HOOtl 01 H3AI130 0SS 61u0 aau puL, 0l FJ'amap wm >55E " paTaAyap a6ayM pue Slip 'w04M 0l SMOyS Z S331AH3S 0S[ ........"" 61u0 aassaJppe 01 liaAllap gl1M 1d1333H __ "" pS Ijep Slip Pug w64M 01 sMo •� NH013H S33d 1tlN011100tl HDd S301A N011d0 3003 dIZ ONV 31tl1S "0'd 'ON 0Ntl 13381S 31VO HO — AHVW1SOd (ale;sod snld) 0pg-111/W 031:111a30 80A 1d13038 e - MUNICIPALITY OF ANCHORAGE I' Department of Health and Environmental Protection X41'; 825 L Street, Anchorage, Alaska 99501 �e �. 264-4720 quest for Approval of Individual Sewer and Water Facilities 1. Property Owner: Mailing Address:%���Q Mailing ,�� Phone: Phone: 2z�,�6s7 2. Name of Buyer: Mailing Address: Phone: 3. Lending Institution: z���� Mailing Address: Phone: 2z�,�6s7 4. Realtor/Agent: Mailing Address: Phone: 5. Legal Description:/ f3i,� ,f�,Gt%!%�i24� Street Location: 6. Single Family Residence: Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply:__ *Individual Well (><) Public/Community System ( ) If Individual Well, well depth If Community System, name of system 8. Sewage Disposal System: *�bn-site System `x) Public System ( ) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 I , .-\ 1jU. MUNICIPALITY OF ANCHORAGE 0' Department of Health and Environmental Protection 825 L Street, Anchorage, Alaska 99501 J 7.64-4720 is U+1equest for Approval of Individual Sewer and Water Facilities 1 2. 3. 4. 5. Property Owner: Mailing Address: Name of Buyer: Mailing Address: Lending Institution: Mailing Address: Realtor/Agent: Mailing Address: Legal Description: Street Location: 7c 6. Single Family Residence: od Multiple Family Residence: ( ) 7. Phone: Phone: Phone: Phone: Number of Bedrooms: X Number of Bedrooms: Water Supply: *Individual Well (<) Public/Community System If Individual Well, well depth If Community System, name of system 8. Sewage Disposal System: *tn-site System ( ) Public System ( ) If On-site System, date of installation: %,�jQirr *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