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MCMAHON #2 BLK 8 LT 6
McMahon #2 Block 8 Lot 6 #017-361-47 Nov 1620 C14:19p Rncnorag@ VV©Il Fti Purnp Sir 90724307422 p.1 w„e On— 6f';'%: 470()7-1,,nore Rocs, u Mark 8!4gich AK ltii 8•pCd• r.r'iJ'U.ni`C:_b ' t I' Pump Installation Lo Well Drilling Permit Number: SW Date of Issue: Parcel Identificavart Number:—Q(9- 3(o l - T-1 Ugal Inscription � .^ ( pf. e 1tv 0 r I rrsa & Adalress: 1 CA aR0Y\ 74 Pump last:all:atioa S ate: J� it L /12A) l.' mp Intake De tb Below Top art'Well Casing: foo feet Fump Ala nufacturerIs Name: ' MCD FcRtnp :°viodel: i/3 j Pump Sipe �y lily Pjil€ss Adapter Burial Depth-. � � fect n f'itless Adapter .Manufacturer's '.'dame: laitle:ss .kdvi rter Installer: Well Disinteetf-A Upon Completion? Method of Disinfection: C;oa�traents; Pump M1 11 & Pump Serriic;;, 334 laza 76th Atten„e kc.horave, AK 39518 Phone: 907-243.0740 tteatirrn: 'the P! :irp iris!ailCr shall plc- � & a p, n insa;lation loc, to the DSD withir, ,0 days ©f r !unr installation, Municipality of Anchorage '';•, Development Services Department �yli Building Safety Division Onsite Water and Wastewater Program, 4700 Elmore St. P.O. Box 196650 Anchorage, AK 995196650 Page of www.cl.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: S U) 090091- PID Number: OI + - 361- 4 i- N'n" ki,n6,14 GA11rqeA Wastewater System: [3New (Upgrade Adoresa ABSORPTION FIELD PhotsNumbar of e.druoma. 3 9(0aap Tranal O Snabor Trento t] Bad O MWrM O Oche,: LEGAL DESCRIPTION sbditatipg I.0 Total Depth he,nII-gponai ra0a GPDIFT F f. elotic Lor- M 1S1,01vwvm. (( 82 Depth to ppe t»nen ftm ongin" pnde Gmtl viably; beneath pips: 8 l0 M nh i.tp Fr. Fr TovmemP' Nar.pa-. Section: Fill Booed Wow mg." grade Grata Length: 0-1 Ft. Ft. W [I New El Upgrade Waw enotn: •L Number M mail: D.atana Decree, I",Well: — ly Ft I Ft Clawh000n IPnvat.. B. C): Tota Depth'. caved to Tota ablimmW ere* P.Pe me al: Ft. Fl. 919 ,2 Ft= Fa)o 303 D,~ Dab DOW: Supe wave, Lev Meatier ,�,t 1 A A116 AnJf Det. tn""4d. Ft rT Y.e,d Pump Sat at. CarngNegloAbo.GlW TANK GPM FI. Fl SEPARATION DISTANCES Cy Septic []Holding ❑ S.T.E.P. ❑ Other. To From Septic Tank Absorption Field Lill Station Holding Tank ubiemovate Sewer Line itlY1if LL oJorr, r T41L °P•a'y Gat. IZ50 way 1 t• q4511- 100 + N q /VIA IMbnal S,<ee Nur CO Cbmpedmenb: 2 Sudace water R.Q. Al -D, NIA A q Z LIFT STATION Lot L.m 5 )} t ID, S+ N q N Q6. Gal nu aUWBr. 1.t 'Pump pn leve, at, 'Pump olrNWe, Kill, rater Nm at Foundation S ID {' N N N n h. Dunrn Drrn /� N,p• N.o. N /Vq Pump Make a Mod Lleancal F.epecom, pedp by. fi.m.h. T.,,h Ah,� I PL, MO BENCH MARK L, Loratim aro Deaa.ptim. a car S c WIMd I.,aLm. 00 FL Inspections performed by: l ACS A Dates: 1 " *9°9 `S201M�a \ = A4 X11 _&wa,, b o _ OFa Development Services Department Approval' y' 49TH Conditional Approval Date: / LAnS E. L'RKLA\O; /1 �41 c, Reviewed by: Date: -31-0 9 (l� ��iOrES�10`— and approved \�\\�� fRw ams) LOT 10 Well � 101 \INSTALLED v 4 -BEDROOM S£ 1250 CALLON ST££L TANK TRENCH LENGTH 1 X 72' WIDTH 2 FEET TOTAL DEPTH 11.4 FEET ROCK DEPTH 8.8 FEET l I LOT 5 Are, CL ell t 6 1 I LOT 5 1 O G MODONED LX1SnNG TAN 1 1 1NSIALLED OWRTER Vu N I LOT 10 I v LOT 9 I P� V I I NOTE: THE 1S NOT A SURVEYED PLAT. WILL 3 SEP77C I LOCATIONS TAKEN nW ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTARM ALL LOCAMNS SHOWN ARE APPROXNATE. I I 25 0 25 50 75 100 125 150 SCALE+ I' = 50 FT. DRIVE Well C7 LOT qe In SPURKLAND ENGINEERING McMAHON 12 BLOCK 8 LOT 6 11 SEPTIC SYSTEM ASBUILT 103 W 15TH. AVENUE DA TE. JULY 23, 2009 ANCH. AK. 99501 K/MBfRELY BELANCER SHEET. 213 GRID 2835 (907) 279-3916 11 4100 KUTCHER DRIVE, ANCHORAGE, AK 99516 PERMIT # SV090097 PID # 017-361-47 McMahon#2B8L6D1dwg Standard Trench 2' Wide 72' Long 11.4' Deep 6.8' Sewer rock 4.5' Cover TH £.G.= 98.6' ELEV.= 9 ctrl B.O.H.= 80.1' NO SCALE Monitor Li; " �y 49th ` N ti 6.8 Ft of Septic Rock E/leclive 1250 Gal. Septic Tank NO SCALE BENCH MARK GARAGE SLAB ASSUMED ELEVATION 100 FEET SPURKLAND ENGINEERINGSEPTIC SYSTEM ASBUILT 203 W15th Ave McMAHON 2 BLOCK 8 LOT 6 Anchorage Ak 99501 KIM ERELY BELANGER DATE, JULY 23, 2009 4100 KUTChO ORM, ANCHORAG& AK 99516 SHEET, 3/3 GRID, 2835 I PERMIT # SVO90097 PARCEL ID # 017-361-47 HchAH3NN2B8L6D3.BWG i O 1250 Ga(. Septic Tank p 8 yam, � G a 3 V i G G v+ a0. d 3 O h H Monitor Li; " �y 49th ` N ti 6.8 Ft of Septic Rock E/leclive 1250 Gal. Septic Tank NO SCALE BENCH MARK GARAGE SLAB ASSUMED ELEVATION 100 FEET SPURKLAND ENGINEERINGSEPTIC SYSTEM ASBUILT 203 W15th Ave McMAHON 2 BLOCK 8 LOT 6 Anchorage Ak 99501 KIM ERELY BELANGER DATE, JULY 23, 2009 4100 KUTChO ORM, ANCHORAG& AK 99516 SHEET, 3/3 GRID, 2835 I PERMIT # SVO90097 PARCEL ID # 017-361-47 HchAH3NN2B8L6D3.BWG MUNICIPALITY OF ANCHORA GE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO90097 Legal Description: MCMAHON #2 BLK 8 LT 6 Design Engineer: 0007 SPURKLAND ENGINEERING Owner Name: KIMBERLY BELANGER Owner Address: 4100 KUTCHER DRIVE ANCHORAGE, AK 99516-2845 Date Issued: Jun 26, 2009 Expiration Date: Jun 26, 2010 Parcel ID: 017-361-47 Site Address: 004100 KUTCHER DR Lot Size: 26903 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit Is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 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: ��l� W1►N Date: ( �� Issued By: Date: Ott Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www.muni.org/onsite (907)343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 01-7 - S6 1- 4 Property owner(s) k;4.,,e1v &1d^5 e� A Day phone 3 Y5 - IB53 T Mailingaddress 4100 k.,kclfe DriVali�nc�ccm5Q, Ak Zip Code 99516 Site address — 5c.« P_ — Zip Code Legal description (Sub'd., Block & Lot) me IN1210 r, & Z 3L 8 Lt� Legal description (Township, Range & Section) Lot Size 26' 903 Sq. Ft. THIS APPLICATION IS FOR (® all that apply) Absorption Field 19 Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms Zq THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of propbrty owner or authorized agent) Permit/RushFees: 53DOO Waiver Fees: Date of Payment: 6 ZZ oq I'' Date of Payment: Receipt Number: 0134167-4 NIW Receipt Number: (Rev. 11/05) Spa N@nd Engonewong Environmental Consulting and Design SEPTIC SYSTEM DESIGN 111c111ahon #2 Block 8 Lot 6 Municipality of Anchorage June 17, 2009 Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 Subject: Septic System Installation Permit 4100 Kutcher Drive Ladies and Gentlemen: I am writing to request a permit for the upgrade of the septic system for the above referenced property. The proposed system will serve a 4 -bedroom single-family residence. The existing septic system did not meet COSA approval standards and must be upgraded. A soils log, site plan, design drawings and construction specifications are enclosed for your review. Design Cates: No ground water observed to a depth of 18.5 feet (6/10/09) Use 1250 gallon tank with a deep trench absorption field Soil Rating. From Testhole 6/2/2009 <1 min/in = I gal per sq.11/day No. of Bedrooms Required Area per Bedroom: 150/1 =150 sq.ft. Total area required: 150 x 4 = 600 sgft System: We are proposing a 1250 gallon septic tank, and a deep trench absorption field. The absorption field will be 70 feet long and 2 feet wide and contain 6.5 feet (effeetive}of sewer rock. ( 95 }' a.�tt tJ� Soils: A test hole was excavated on June 2, 2009. See the attached soil logs. Ground water was monitored for through June 10ih, 2009. Groundwater was not observed. Surface Water: No surface waters were observed within 200 feet of the proposed septic system. 203 West 15'h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 351-1597, LspurklandCaa`gci.net �•� . Environmental Consulting and Design Topography: The lot is generally level. Waivers: No waivers are required The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or concerns, please contact me at 279-3916. Sincerely, Ll Qv." Lars Spurkl'and, P.E. Civil Engineer. 203 West 15iA Avenue Suite 203, Anchorage, AIS 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, LspurklandCagei.net LOT 4 I � I I yy � LOT15 QLOT jell Ne W 1 I LOT L T 7 I I , I II ___� _ Q _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ LOT 10 LOT 9 I , T8 II G cI lei1 I Y won: nRS IS NOT A SURVEYED PUT. WELL a c LOCAnONS TAKEN ROM ON-= WA7R AND WASTE WAM DCPARTMENT DOCUMLA4A7I0N. ALL LOCAnONS SHOWN ARC APPROXIMATE. 50 0 50 100 150 200 250 300 SCALE, I' = 100 FT. 9% 49th 's 20 J4rvnnW 5 ."YA'W'N" D MCMAHON ,Z BLOCK 8 LOT 6 SEPTIC SYSTEM DESIGN ANC W 15TH. AVENUE DA TE. JUNE 16, 2009 ANCH. AK. 99501 K/MB£R£LY BELANG£R (907) 179-3916 11 4100 KUTCHER DRIVE, ANCHORAGE AK 99516 SHEET. 1/3 GRID: 2835 PERMIT 1ISV090XXX Pip # McMDhonk2B8L6Dl.dwg LOT 10 5 I LOl 5 Are a Y — — 2 ER DRIVE p ell o 0, well ell I L O LOT 6 I y c.s. LOT 7 INSTALL -BEDROOM S£PHC SYSTEM 1150 GALLON STEEL TANK TRENCH Lmom 1 X 70' t WIDTH 1 FEET TOTAL DEPTH 11.5 FEET I ROCK DEPTH 6.5 FEET COVER 6 F£Er LEVE( LOT 5 ' rH ABANDON EXISANO UNK t Septic Area INSlAL1 DIKRIER YALK -------- �L— ---- ——— ——--——-- —— ———— I LOT 10 I ' M LOT 9 My n T �S*vasualiffi fit I OT 8 � ............. •�� 49t........ NOIE.• MIS S NOT A SURVEYED PLAI. WELL a SEPTIC w ••• ••••LARS SPURKLAND ••• •, LOCAl7AV5 TAKEN TROY ON -SNE WRIER AND WASIF WA/ER I / RS DEPARTMENT DOCWENTA770N. ALL LOCATIONS SHOWN AR£ APPROXIMATE. ♦ t� # f`•. No. CE -11500 �Z 25 0 25 50 75 100 125 150 I ••� ,"` ,'Qt�•�•• SCALE, 1' = 50 FL 0Vrtnl CIAVrN KIND 2 15 03 W 15TH. AVENUE MCMAHON 2 BLOCK 8 LOT 6 11 SEPTIC SYSTEM DESIGN ' 2 ANCH. AK. 99501 KIMB£RELY BELANGER DA TE: JUNE 16, 2009 (907) 279-3916 1 4100 KUTCHER DRIVE, ANCHORAGE AK 99516 SHUT • 2/3 GRID: 2835 PERMIT # PID / McMohonR2B8L6D1.dwg a-00do L w w 1250 Gat. Septic Tank � a y a a u i 1 O A a 3 kn r.. t ti Standard Trench: 2' Vide 70' Long 12.SDeep •••• V�� 6.5' Sewer rock••• PSE •• ••.• •• • 6' Cover ... i...n.. ...`."K^:" .......... i LAR SPURKLA ND �, f'•. NO. CE -11500 too NO SCALE Monitor Cleanouts 6' Cover Silt Barrier 6.5 ft of Septic Rock Ewoc iw 9.5 (a8tAive) 1250 Gal. Septic Tank NO SCALE SPU203 W1AND ENGINEERING NOMAHON #2 BLOCK 8 LOT 6 SEPTIC SYSTEM DESIGN 203 W15th Ave11 K/AIBERELY BfIANCER DATE, JUNE 17, 2009 Anchorage Ak 99501 IIOa KUICHCR DR1VL; ANCNORAC[, AK 99516 SHEET, 3/3 GRID, 28.75 PERMIT # SVO90OXX PARCEL ID # M[MAHON12B8L6D3.DVG Municipality of Anchorage Development Services Department Building Safety DMsion y1 On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519.6650 www.munLorg/onsite (907) 343-7904 SoilsLog - Percolation Test Performed For. _ VSMIi EQ� Re' 4n 5t, Date Perk Legal Description: Mc Mr.%, . k -4 QIK a Lui (0 Township. Range. Section: Depth 21- I Srlt W)Smme. 54.01 CAL-) oisl. 64 Silt (ML) 9_ - O 1a �; S IF YES. AT WHAT DEPTH? �• L 12- 2-13-14-15-16- 0 13- Vey E 14- (0 O 15- CS w) 16- 17- 7-18. 18. 19-1 1 b'DA COMMENTS WAS GROUND WATER ENCOUNTERED? - O S IF YES. AT WHAT DEPTH? �• L Depth to Water Aha 0 Monitoring? Vey E Date:(e (0 O y'h97HY �? p�7t'. LARS E. URKLAND. pG I Reading I Date I Gross Time I Net Time I Depth to Water I Net Drop I PERCOLATION RATE TEST RUN BETWEEN 1�~) PERC HOLE DIAMETER FT AND of FT 1, PERFORMED BY: `d13 SDw hlAnq I =. _ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WTH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: (e p o�g Environmental Consulting and Design Single Family On-site Wastewater Disposal System Construction and Material Specifications Subject Property: McMahon #2 Block 8 Lot 6 Date: June 17, 2009 General: 1. The owner shall contract with a contractor to perform the work outlined in these specifications and plans In accordance with the attached MOA permit. There is not contractual arrangement between the contractor and the Engineer. The Engineer shall be the owner's representative and will Inspect the work to document the contractors activities. Final acceptance of the contractors work rests with the owner and the MOA. 2. The scope of the project includes the procurement and Installation of a 4 -bedroom on- site wastewater disposal system at the location depicted on the attached site plan drawings. The scope of the work also includes the installation of a new 1250 gallon septic tank, a drain field comprised of 1 trenches,2-feet wide x 70 -feet long, 124eet ILS' deep, with 6.5 feet of septic rock below the distribution piping. The location of the drain field is shown on the attached site plan drawings. The total depth of the field will be 19' IZ.S' feet below the existing ground surface. All components of the proposed septic system must be constructed a minimum of 100 feet from any surface water or water wells in the area. A minimum of 4 feet of earthen cover is required over the septic tank and a minimum of two feet of cover is required over the drain field. In addition to the required earthen cover, 2 -Inch thick, 40 psi, direct bury board foam shall be installed directly over all installed piping. 3. Construction shall be in accordance with the approved site plan and design drawings and any special provisions noted on the Municipal well and/or septic permit. All materials, components, workmanship and construction practices shall comply with the Municipality of Anchorage's latest ordinances regarding wells and septic systems, as well as MOA, Development Services Department, On-site Water and Wastewater Program (DSD) policies. 4. The contractor is responsible for obtaining all underground utility locates, layout of the proposed system, and verifying and maintaining all required separation distances to lot lines, surface water, wells, steep slopes, etc. S. The property owner shall be responsible for final grading any depressions formed from settlement of ball material. The property owner is also responsible for vegetation of all areas disturbed by septic system Installation activities. 6. Contractors installing wastewater disposal systems must be certified to do so by the MOA DSD, On-site Water Wastewater Program. Property owners installing their own systems must receive advanced approval from MGA DSD prior to system installation activities. 7. The contractor shall ensure that ALL materials being used are in compliance with the most current guidelines established by the Municipality of Anchorage. Refer to "Standards and Specifications for Component Parts and Materials Used in the 203 Nest 151" Avenue Suite 203, Anchorage, AIC 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, LspurklandCa`gci.net SparrM and Engonswolmg Environmental Consulting and Design Construction of On-site Wastewater Disposal Systems", Dated December 2000, as provided by MOA DSD, On-site Water and Wastewater Program. Septic Tank Installation: 1. A new septic tank, of the size specified in the design drawings, shall be procured from a qualified manufacture/supplier if the existing septic tank is found to be defective. Construction shall include two 4" diameter cleanouts for pumping access. 2. The burial rating of the tank shall be adequate for the actual burial depth encountered. 3. The tank shall be level and sufficiently bedded to prevent settling of shifting of the tank. 4. All standpipes on the tank shall extend a minimum of 12inches above the final grade. S. Tanks Installed with less than 4 feet of cover shall be insulated. 6. The sewer service line from the house to the tank shall have a minimum slope of 2% unless prior approval Is obtained from the engineer. 7. The inlet and outlet lines from the tank shall be bedded in drain rock or the soil shall be sufficiently compacted to prevent future settlement of the soil. S. Septic tank Inlets, outlets and cieanouts shall be fitted with water tight couplings. 9. A cleanout shall be Installed 1 to 4 feet from the foundation. 10. Post tank deanouts shall be Installed per MOA requirements. Does not apply to pressurized lines. 11. In areas with high ground water, the septic tank shall be sufficiently anchored to resist buoyancy forces when there is not adequate soil cover to resist uplift force. The contractor shall refer to the engineer for direction regarding this matter. 12. The tank backfill shalt be graded sufficiently to ensure positive drainage away from the tank. 13. All holding tank and lift stations shall have an audible and visible alarm inside the residence being served. 14. All lift stations shall be wired In compliance with all MOA guidelines and the Uniform Electrical Code. A municipal electrical permit and inspections must be obtained where required by the MOA. 1S. The contractor shall verify that the septic tank/lift station is a minimum of 100 feet from any residential water well, 150' from any class'C well and 200 feet from any community water wells. Additional separation distances must also be maintained. 16. The contractor shall remove or abandon the existing tank in compliance with the Uniform Plumbing Code. Drain field Construction: 1. The drain field shall be excavated to the dimensions outlined in the design drawings. If any discrepancies are noted, contact the engineer Immediately for clarification. 2. The drain field shall be Installed parallel to slope contours. 3. The bottom of the drain field shall be within 2" of level. If the sidewalls or bottom of the excavation become smeared, they must be raked or scarified prior to the placement of filter sand or drain rock. 203 Nest 15'" Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurklandas gd.net LL" -� .',an Environmental Consulting and Design 4. The drain field must be a minimum of 5 feet from the test hole excavation. S. Distribution pipe Is to be installed level with perforations facing downward, atop a level bed of drain field rock. Septic rock shall then be placed atop the distribution piping to provide a minimum of 2" of cover, level across the entire width and length of the trench, above the piping. 6. A silt barrier must be Installed at between the final drain rock and the native soil backfill. The silt barrier shall cover the entire drain rock surface. 7. Monitor tubes must be 4" in diameter, installed In the locations depicted on the design drawings, and extend a minimum of 12" above final grade. The portion of the monitoring tube below the septic rock must be perforated and the portion above the drain rock shall be solid. S. Backfill over the final gravel layer must not be less than 2 feet. Insulation must be installed when the backfill depth Is less than 3 feet. 9. Drain field back fill shall be mounded to prevent depressions from forming due to subsequent settlement of backfill material. 10. The contractor shall verify that the drain field is a minimum of 100 feet from any residential water well, 150' from any class'C well and 200 feet from any community water wells. Additional separation distances must also be maintained. inspections: 1. A minimum of two Inspections are required by the Municipality of Anchorage. These Inspections must be conducted under the supervision of a Professional Engineer licensed to practice in the State of Alaska. 2. The first Inspection must be conducted after the excavation of the drain field and before the placement of any gravel. The septic tank may be set in place, but may not be backfilled. 3. The second Inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, stand pipes, cleanouts, and Insulation, but before the placement of any backfill. 4. The contractor shall provide a legible copy of all field notes relating to system layout and construction to the engineer for the use in preparing the record drawings. S. The contractor shall coordinate all Inspections with the Engineer. A minimum of 24 hours notice is required prior to the start of construction. If necessary, a preconstruction meeting will be held on-site. 203 Nest 15'b Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.nct n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME /•�/a PHONE NEW_ ❑ UPGRADE MAILING �DDS 2.4,1 C r��h /`f'��. %T/`�C•/� a/l� l !J LEGAL DESCRIPTION J W 31,9 fA A c4- ur%, LOCATION NO. OF EDROOMS DISTANCE TO: WellAbsorpti��area 'f"%� Dwellingf /cam PERMITNO. �D Q PZ ~a Za w I.- Manufacturer 6 � � �. +� Material �� %�6 No. of compartments N Liq. copaci!y-in gallons z Q 1IF HOMEMADE: Inside length Width Liquid depth 6 J�7Z DISTANCE TO: Well Dwelling PERMIT NO. O Z F Manufacturer - Material Liquid capacity in gallons = DISTANCE TO: Wel I-fO� Foundation Near�t�tline PERMI�LNO�� 'y Z w No. of lines Length of each line gg Total le of lines Trench width inches Distances between lines - F Top of tile to finish grade Material beneath tile 0 inches��`� Total effective bsorpJ;'on area w Length Width Depth PERMIT NO. t7 Q F w ° Type of crib Crib diameter Crib depth Total effective absorption area LU m DISTANCE TO: Well Building foundation Nearest lot line _j J Class Depth Driller Distance to lot line PERMIT NO. Lu � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER V� L— PIPE MATERIALS CL. - it, _ SOI L TEST RAT[ NG 140 INSTALLER REMARKS °#yc. ,em E � t �&aO p"Cg9*tA LLL APPROVED e4o1�_S J/ / !� jDATELEGAL [ P7-7i/j/�� 72-013 (Rev. 3/78) ^ �4�������K�������� DEPRRTME�T OF �EHLTH HND EHVIRGNMENTHL PROTECTION ��� /L/ STREET/ �NCHORRGE/ RK99501 264-4720 ��v��.��^�� El PERMIT "'I'll ( 780082 ) RPPLICHNT ED HERZOG 2418 E� 20TH 277 ]156 I- !J .1 KUTCHER RD LEGHL L6 -HN S/D LOT SIZE 20000 SQUHRE FEET TYPE OF SOIL 8BSORBTION H MHXIMUM NUMBER ClF BEDROOMS � 4 S8IL RHTING <SQ FT/BR)� 140 THE REQUIRED SIZE OF THESO-L HBSDRPTION SYSTEM IS� ��_llL �F__l��� ������������� THE LENGTH DIMENSIQN IS THE LENGTH (IN FB�T) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNC� BETWEEN TO PROSECUTIQN THE SURFHCE OF THE GROU�D HND THE BOTTOM OF TGE EXCHVHTlON (I� FEET) R WELL RND HNY ON~^SITE SEWHGE DISPOSHL THERE IS NO SET WIDTH FOR TREWCHE5- WELL.; OR OF HNCHORHQE. THE G�GVEL DEPTH IS THE MINIMUM DEPTH GF GRfVEL BETWEEN THE OUTF�LL PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET) WELL LOGS HRE REQUIRED H�D MUST BE RETURNED TO PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEpHRTMENT DURING THE INSTHLLHTICIN INSPECTIO�S OF HNY WELLS �DJHCENT TO THIS PR3PERTY HND THE NUMBER OF RESIDENCES T�HT THE WELL WILL SERVE ��~ ��� ��� ������������� ��� �������� GHCKFILLING QF RNY SYSTEM WITH8UT FINHL INSPECTION HND HPPROVHL BY THIS DEPRRTME�T WILL BE SUBJECT TO PROSECUTIQN THE REQUIREMENTS FOR MINIMUM DISTHNCE BETWEEiNI R WELL RND HNY ON~^SITE SEWHGE DISPOSHL SYSTEM I5 100 FEET FOR H PRIVHTE WELL.; OR OF HNCHORHQE. 150 TO 200 F�EET FROM A pUBLIC WELL DEPENDI�G UPQ� THE TYPE QF PUBL�C WELL WELL LOGS HRE REQUIRED H�D MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION THHT THE OTHER REQUI��EMENTS MHY HPPL�� SPECIFIC�TIONS HND R..:1 .1. DIH8RHMS H�E HVHILPip. E TO INSURE PROPER INSTHLLHTION REMODELED TO L 31-����� ���������� ��� ���� I CERTIFY THRT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR QN-SITE SEWERS HND WELLS H5 SET FORTH BY THE MUNICIPHLITY OF HNCHORHQE. 2� I WILLINSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES� ]� I UNDERSTHND THHT THE ON_SI�E SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESID�NCE IS REMODELED TO INCLU�E MQRE THHN 4 BEDROOMS SIGNED HPPLI MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6.650, Anchorage, Alaska 99502 276.2221 SOILS LOG - PERCOLATION TEST L�SOILS LOG ❑ PERCOLATION TEST PERFORMED FOR: &V /' 'C2 ��J / DATE PERFORMED: LEGAL DESCRIPTION: �G% / � ltic ' llyd 111. 2•� DEPTH SLOPE fl(s T PL"-%%��/c1(FEET) f'!—�{---�-7 I 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 PERFORMED BY: 72-008 (7/76) { SOL Gl Gv I �iC G�ej C,e, WAS GROUND WATER J/) �� S f,5 ENCOUNTERED? L O i/� E IF YES, AT WHAT DEPTH? /7 Reading I I Net Time i ' 7 I Reading Date Gross Time _ Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT CERTIFIED 6Y. _. ox s a. _ , ,.> g ci. Ai : A 90 , l SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 711 3'eet DRILLED AT THE RATE OF $18.00 PER FOOT. PROPERTY OWNER at. F -d Keltpq, 277-33166 LOCATION OF WELL SITE a � as /f Ste• lee 00 WELL LOG: 0 26' s4Atet 3a� i.�.. 26 62' sap4 gaavet wuh 15% aLgy�- 62---95' Cabb.Le4 and .Loo je q�z avet 95-1111 S i;Ltc4 4=44 water drea&Zlq matet a" good c -Lean wateh hea&y iaS� Vmu-e,L aot bottom at Oruna t.Loa. 111 Peet Shotob4 a x044, &tz 4 gm with a 60 AOt .Mand Of- wateA in ca4.ir*. Pump. 4houtd &e inAtab4 feet Og trattom. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF $1998.00 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS gime 10th, 78 DATE— y SERVICE CHARGE OF 1 /,% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. Municipality of Anchorage Development Services Department =' 3 Building Safety Division :"` •'. �_- On -Site Water and Wastewater Program s 1r J 4700 Elmore 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. OI-+- 361- 4-- COSA# OCIof �� Expiration Date: /.2 Z 1 6 C 1. GENERAL INFORMATION Complete legal description _ Mr- Location c Location (site address) 4100 KMkcL. eL Drivt t Ats_6nnc. AY, `Mup Current Propertyowner(s) kivwloQ�l &Xon;e� Day phone -346-653-1- a 853} Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: lot 3. TYPE OF WATER SUPPLY: Individual Well K Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site 2 Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site 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 with new water sample results. (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. 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 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 SPya-k\c%v..A Fng incerino Phone 7-77-37/6 Address 203 W. IS}t' A& . She. 2o2 , Anlomya• AKs 10501 Engineer's Printed Name LA¢s $ovtL%\ctnd Date q/1 40 OF .. L ill ��, i r( 49TH10 5. DSD SIGNATURE �%� i �; a5 E. B=UR:{lA.\D'� 1,1_11, Approved for bedrooms. ►1�` t' 1 g1l.5 0.'r Disapproved. FE Conditional approval for bedrooms, with the following stipuI tions. Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory NitRte Advisory_ Fc 1^ Z t. (Rev 11105) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: �o Municipality of Anchorage • --�'� '_ Development Services Department i Building Safety Division ` - Onsite 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 CHECKLIST Legal Description: RiK9,U: (o Parcel ID: 01-4-3E(-4} A. WELL DATA Well type FnJATtr If A, B, or C provide PWSID # = Well Log (Y/N) y Date completedb X 4 i Sanitary seal (YIN) i� Wires property protected (YM) Total depth ]L(_ft. Cased to I11 fL Date of test Static water level Well production FROM WELL LOG ft. g.p.m. WATER SAMPLE RESULTS: Coliform _colonies/100 mL Nitrate 2a2 mg/L Arsenic: AM mgll Date of sample: _4�7 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Ans-6m5C Tana/ Sfeei Tank size � 1a50 gal. Number of Compartments a, Foundation cleanout (Y/N) Y Depression over tank (YIN) Casing height (above ground) 6Z in. AT INSPECTION 70 n 43 g.p.m. Other bacteriacolonies/100 mL Collected by: ; Leas S4wA&n q Date installed 119ho" Cleanouts (YM) y High water alarm (Y/N) N Date of pumping h/ew Pumper /Vew C. ABSORPTION FIELD DATA Date installed l0 0 Soil ratingp.d.Ift ypp Deep Trenck, Length y ft Width a ft. Gravel below pipe X0.8 R Total depth __tt Eff. absorption area J91fe Monitoring tube / Depression over field A/ Date of adequacy test NQW Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test — in. Water added – gal. New depth in. Elapsed Time: min. Final fluid depth --' in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Absorption rate >= — g.p.d. 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 High water alarm level at in. Datum Cycles tested Meets alarm & circu' quirements7 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: i Septic tank/lift station on lot IGD A• Absorption field on lot 100+ Public sewer main A/ JA Sewer /septic service line '15 Animal containment areas Al. D• On adjacent lots 100 1+ On adjacent lots 100'+ Public sewer manhole/cleanout N 018 Holding tank 64A Manure/animal excrete storage areas N, 0. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r r r Building foundation 5+ Property line 5 + Absorption field S i Water main 10t r + Water service line ID f• Surface water t Wells on adjacent lots 1CO + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: N. o. I I Property line 1o'+ Building foundation 10+ Water main 104- Water 0+Water Service line 10 + Surface water JV. 0. Driveway, parking/vehicle storage Drt Curtain drain At, 0. Wells on adjacent lots (00 Ii. F. COMMENTS: G. ENGINEER'S CERTIFICATION qE•�F' A..gS tII i ,LP'• �y I certify that / have determined through field inspections and �}gTH w review of Municipal records that the above systems are in i „ ... conformance with MOA COSA guidelines in effect on this date. a 2 ;+ �f I 11 / G}'•I.ARS E. yFK Engineer's Printed Name LAm sn4i C'A� Date 8I5( uoq f IIIS D`�JA, all COSA Fee $ �J d Waiver Fee $ Date of Payment q - ,rf{ - 0/ 1 Receipt Number �%✓76e0 fi t� (Rev. I MS) Date of Payment Receipt Number 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 # 090288 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 6 of McMahon #2 subdivision. This inspection revealed a nitrate concentration of 7.29 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. 5 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 ALITHORI..Y'' APPROVAL FOR A SINGLE FAMILY DWELLI /�NG O Parcel I.D. # i 7 -?6-1 ' 7 HAA #S� 11A�?i%130 1. GENERAL INFORMATION �2i Complete legal description l �f 6,_ 13 /c,c tT �} nc />u40 S 2o,( ,4te-6) Location (site address or directions) Property owner ✓ol n t <<s e r Day phone 3V5-- 3SF8 Mailing address 1/100 ZA&6 e,- Ar- �4nctiar e A -1-r 9,9s /5 IF Lending agency Se«ffie Day phone S6a -S6 2G Mailing address SGU E 3Y i9 �e AncA� P Ak 99SG3 Agent✓ewe rr�11, 8e MaA Day phone Address 2�UD fo��o�a Sf. Su<lyf too I+Ar-60 96T r Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: y 3. TYPE OF WATER SUPPLY: Individual well V__� Community well - Public water NOTE: lf,community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank - Community on-site Public sewer NOTE: 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 on the date of this inspection. Name of Firm Fle4, TecL1n Tca./ S'ervfcpi Phone 3 ys,�i3sS' Address 1YS30 Ec/10 5�,, fir+c�iarcrq� Engineer's signature 99'2 Date Y111197 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments M NUTIC /���a °c 99••9x•9. •••. "a ���// i°9p969999 Y1'.s•oea..e y CF of ,A bedrooms, with the following stipulations: Date g-25-�7 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) Beck MOA e21 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage APR 11 1997 DEPARTMENT OF HEALTH & HUMAN SERVICR�' "� Environmental Services Division a® CY 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Lo f 6 0/ /c F me hrccAom S/b #2 Parcel I.D.: O t 7 36'1 '/ 7 A. WELL DATA Well type P ✓ t If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 6/10/76 - Total /Io/78Total depth 1/1 Cased to /11' Casing height (above ground) 2Y " Sanitary seal (Y/N) i Wires properly protected (Y/N) `i FROM WELL LOG AT INSPECTION Date of test 6 / t a / 78 y/ / / 9 7 Static water level 5-1 7 3 Well production y' g.p.m. 11.61 9 - p.m -WATER SAMPLE RESULTS: Coliform O cc / / t oO m ..Q. Nitrate 3, V m 9 / Other bacteria I co ! / I ua m C Date of sample: Y / 1/ / 9 7 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 6/ 2 / '7,P, Tank size 12,5-01 Number of Compartments 4&& n Cleanouts (Y/N) Y (i Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N. A. Date of Pumping y/9 /9 7 Pumper Pe-naI i C. ABSORPTION FIELD DATA Date installed K' (2 17 8 Soil rating (g.p.d./ftz or ftz/bdrm) I yo /% System type Length tl Width Hol SA& Gravel thickness below pipe 7 ' Total depth I 1' 4, H/Y/R 7 Effective absorption area 5'71/ Monitoring Tube present(Y/N) Y Depression over field (Y/N) N Date of adequacy test H / `/ / 9 7 Results (Pass/Fail) Parr For `>' bedrooms Fluid depth in absorption field before test (in.), 2 3 Immediately a8er786 gal. water added (in.): Y, Fluid depth 3 8 (ins.) Minutes later: 2 2 Absorption rate = '> bop g.p.d. Peroxide treatment (past 12 months) (Y/N) Alarm Gcnow , If yes, give date N. A D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot (0 6 f "Pump off' level at* On adjacent lots > 10o' Absorption field on lot (16— ; On adjacent lots 7 tcc-1 ' Public sewer main N• A Public sewer manhole/cleanout N. A, Sewer /septic service line > 2S' Lift station N. 9 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 115� Property line Z,5-, Absorption field_ Water main/service line > to' Surface water/drainage > (00' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 11 Property Line t O ' Water main/service line > / 0 ' Surface water —> 10 o ' Driveway, parking/vehicle storage area > 670 Curtain drain None Sea) Wells on adjacent lots > t c-�o ' Car F iron o(tr ch arf e l y oe 1, r ft� e e, 74--^ l' i frenC/, F. ENGINEER'S CERTIFICATION rep (aceoC W,fh 707'I Pve c oeriuyle c• b, 14s-%r/✓ee( -& C,V, c, 2/?0C Co^/,/ aF �/Atr 00 4//9/97 by t^ortS CKC. 1 certify that have determined thru field inspections and review of Municipal records that thQab`o.ve "tems are in conformance with MOA HAA guidelines in effect on this date. ` J gn Si ature /� �_'Ul 18`ittty9d 4/0 Pp .• g orge En e ng Fier y� f Engineer's ! h�o�r F. PtG Se - s' 3a SYa atl �lB oe •ocov«.,;, Date flrr;l ll, 19�9' ': <<+foo V. HAA Fee $ X�300� 77 Date of Payment 7//,r // Receipt Number 1Z O .7 O (,4 cW / Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number Il MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Maj T Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# E)0 " 'L>in1- LlD r HAA# VAa91:1bQ91a 1. GENERAL INFORMATION Complete legal description Lot 6; Btock 8; Mc Mahon SubdiV.(zion Second Addition Location (site address or directions) 4100 Kutehetc Djr i ve Property owner' Bfth'nks 9 Malty C. Chand.P_ea Day phone Mailing address ' P : 0:. Box 263 GiAdwood, A.2 ka 99587 Lending agency Day phone Mailing address Agent George Mc Coy JACK WHITE COMPANY Day phone 563-5500 Address 3201 C Stkeet Anchorage, A2azka 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 IFA VOW HOe6 (l6/L'AGW) SZtrdL -doom s,aaeuibue leuolssa;oid ay; ul suolsslwo ao saoaaa ao; alglsuodsaa IOU sl 96eaogouy ;o AllledlolunN agl panssl sl aleollluao p aao;aq elep azAleue ao suolloodsul lonpuoo IOU op SHHQ;o saaAoldw3 •sluawaalnbai alels pup 1paapa; ulelaao A}sl;ps olaapao ul suollnl!lsul bulpual alagl pup sawog;o siesegoand of Asel.(noo a se slgl saop SHHd ayl'eiisel`d;o alelS agl ul paaalsl6aa aaaul6ua leuolssa;oad luepusdapul ue Aq anoge g gdeibuied ul uanlb suolleluaseidaa a41 uodn Aluo paseq saleol;lPaC) lenoaddy Allaoglnd UlleaH sanss! (SHH(l) saowaS uewnH pup glleaH;o luawlaede] abeaogouy;o Al!ledlolunW agl NVI111VJ �z 1::-!T alpd mollelndlls 6uimollo; agl ullM 'swooapaq .ON K, —Z -ocU- oleo :A9 sluawwo0 leuoll!ppd ao; lenoidde leuoll1puo0 •panoaddeslQ __ •swooapaq P ao; panoiddy -x- 3unIVNJIS SHHO '9 ainleu6ls s,aaaul6u3 ssaa ppy t,09 *ON pooa dool .aaAla 61Be3 17£OLt auogd MMBMEM S T S wa13 ;o aweN •uolloodsul slgl;o alep agl uo loage ul suollpinbaa pue 'saoupulp.(o 'sepoo alelS pup ledlolunW llp gllM eouelidwoo ul sl welsAs 1psodslp aalumalsum ao/pue Alddns aalum alls-uo agl'uolloadeul pup uollp6llsanul Aw woo; pup salt; obeaogouy;o Al!led!o!unw agl woo; paulelgo uollewio;ul eql uo paseq legl A;laanaaglan; I ulaaag polpolpul einlonals jo adAl pue swooapaq;o aagwnu agl aol alenbope pup leuolloun;'a;es sl welsAs lesodslp aalennalsem ao/pue Alddns jejuni ells-uo agl legl smogs uolleolldde lenoaddy Allaoglny glleOH slgl;o u011e611sanul Aw legl l;loan I 'Anolaq umogs alpp uo!lpp!len agl;o se pup olaaag paxl;;e leas Aw Aq palllliao sy E133NIEM AS N01103dSNl 40 1N3MIVIS 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:Lo`r to &LK- e> I-AAtlatib '2't7 Parcel I.D. `zas Pep0, A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number 111A. Log present &N) V Date completed - iD-76 Driller '<�Pit- r Total depth l 1 I Cased to m Casing height t2l •t Sanitary sealY&N) Wires properly protected &N) 4 FROM WELL LOG AT INSPECTION Date of test (o •- l t-> -' $ 14- 2.9-12- 9 -1z - � Static water level t I •72 70 o n Well flow '" 9.(7 g•P•m. 4.Z g a Pump level 10 tJ4 o A o Z SEPARATION DISTANCES FROM WELL TO: �9 co w y = t Septic/holding tank on lot ) Z� ; On adjacent lots DO ' a9 Absorption field on lot l� ; On adjacent lots �\�` 2 m ` Public sewer main Public sewer manhole/cleanout Sewer service line ZS (, Petroleum tank ZS t WATER SAMPLE RESULTS: �/ Coliform O LJ L. L (//i600M �- Nitrate Z .4 )w Wall Other bacteria Date of sample: 4- 2-7' 9 Z Collected by: S & S ENGINEERING 17034 Eagle Kiver 00p KOad Na. 204 Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed &%7e Tank size 125 Compartments 2- Cleanouts (RIN) Foundation cleanout &N) Hiah water alarm (Ya YJ Alarm tested (Y/N) Date of pumping 4 - 2 $ -q Z Depression (YAN) 4 Pumper A-'' 4°elE S'62L//6E.s SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 7-0 On adjacent lots 1 O 14 - Foundation To property line ° ( b- Absorption field Water main/service line Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N Manufacturer Manhole/Access (Y/N) off" level at Cycles tested SEPARATIOND4&T'XNCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed (0-78 Soil rating 140 4/A2 System type 'C�--�44-t4 Length 1411 Width 2 .S� Gravel thickness ( Total depth �7 Total absorption area 5-74 9E Cleanouts present (9N) V Depression over field (Y,®) Date of adequacy test Results' as fail) ASS for %Goin (4) bedrooms Peroxide treatment (past 12 months) (Y& N6dF -'-Jov✓'4 If yes, give date�- SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1 +0 / On adjacent lots 1 DD t Property line ! b / 4- To building foundation ZC� h To existin or abandoned s stem on lot /_J/_1a, On adjacent lots 3011- Cutbank Surface water l UD 14 - Curtain drain /i E. ENGINEER'S CERTIFICATION 9 Y hWater main/service line 1 v t ¢ Driveway, parking/vehicle storage area i certify that I have checked, verified, or conformed to all MOA and HAA guidelines in S & S ENGINEERING 17034 Eagle River hoop Road No. 204 Signature Fugle Alaska 995n . Engineer's Name Date HAA Fee $ L Cate of Payment Receipt Number 72.-626 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment — Receipt Number /t of this inspection. FZ RQG; Ft . SqFER Gln. ©21. A'` V110 'a Ao a0 Oo6°� �"ea3 MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services r ` DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # u1 HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 6; Btock 8; McMAHON SUBDIVISION 0a Location (address or directions) CJ (b) Property owner Fedeaat Home Loan Telephone: (home) Business on gage Cmp. Mailing Address 2231 Ca.y4.ta2 D7tive Sui. e #900 A)uUngton Va. 22202 (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address 3601 C Stneet A Telephone 563-5500 Telephone JACK (UNITE COMPANY ATTN: Kn.i.6 Kuntz e, AK 99503 (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: 5-'1- -ENGINEERING- 17034 Eagle River Loop Road No. 204 Eagle Alaska YqS77 2. TYPE OF RESIDENCE ✓ Sing le-Familyl / Number of bedrooms 4 3. WATER SUPPLY Individual WeIIXX Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-siteXX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 & S ENGINEERING Telephone 17034 Eagle River Loop Road No. 204 Address Eagle River, Alaska 99577 Date p nurto�• 6. DHHS APPROVAL Approved for ¢ bedrooms by Date i " Approved Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 G� p\-\ \QP�\�� ps����pp • MUNICIPALITY Hea Health Authority Approval(MOA) (HAA) 'o CHECKLIST -FEBRUARY 1984 343-4744 Legal Description: A. WELL DATA / Well Classification i r1 til JI V, If A, D.E.C. Approved (Y/N) Well Log Present qi9V) Date Completed (-P Yield Total DepthCased to _Depth of Grouting Static.Water Level j 1 i Pump Set At L) Casing Height Above Ground iZ� / Sanitary Seal on Casing (WN) —T Electrical Wiring in Conduit (*N) Depression Around Wellhead (YWR I� SEPARATION DISTANCES FROM WELL: . To Septic/Holding Tank on Lot X20 ; On Adjoining Lots ) To Nearest Edge of Absorption Field o Lot 1Q'o ; On Adjoining Lots To Nearest Public Sewer Line � To Nearest Public Sewer Cleanout/Manhole A To Nearest Sewer Service Line on Lot ih Water Sample Collected by � 'S Lr�L- 'L-ti-�G ; Date �7— Water Sample Test Results o � Comments B. SEPTIC/HOLDING TANKpAATA / Date Installed Size No. of Compartments Z- Standpipes&9/N) y—Air-tight CapsC7N) y Foundation Cleanout 4?N) — Depression over Tank (Y& Qa Last Pumped —7—f �'� Pumping/Maintenance Contact on File (Y/N) (� ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well �2'� To Building Foundation To Property Line t o To Water Main/Service Line nt To Stream, Pond, Lake,or Major Drainage Course Comments To Disposal Field 72-026 (Rev. 7/88) Front Page 1.of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption('1$tXrylta, ����`Y Type of System Design Date Installed lv I/2Length of Field �1 Width of Field 2-1-57 �'� Depth of Field Grave Bed Thickness 71 Square Feet of Absortion Area e�5'/ Statndpipes PresentQ01\1) Depression over Field (Y/6 J) r-'� Date of Last Adequacy Test 7 j �9 Results of Last Adequacy Test etfl� k -1--r l —> --- SEPARATION DISTANCE FROM ABSORPTION FIELD To Water -Supply Well To Property Line �o I To Building Founda io%%To Existing or Abandoned System on Lot !A `^ ; On Adjoining Lots To Water Main/Service Line k u_�_ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course t� To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION ra / Date Installed Size in allons "Pump On" Le High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments _ Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date gf;this inspection. _Aea�,�1• Signed g & 5 ENGINEERING _ ��, o g•°•' ;��o`$ 17034 Eagle River Loop Road No. 2lw. Company �,�^°• `°• 7 �. age 1 OA 0• 'gyinei9r°5 Date J �° o a•. -:,� ,` MOA No. ��l i9 /3Receipt y p Receipt No. Receipt No. .•tet° Date of Payment 7—,4 C7 41—J9 Waiver Fee: $ Amount: $ 170. �La_ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date R �� 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lo T (eV, t4LVA�o 4 SCS A(9, r 121,1( f23>1�/ Location (address or directions) 41 t'—0T G YL (b) Property Owner 17n.�Z-L He 1Telephone: Home 3VJ -016 Business X76 -,L7CO Mailing Address a"%<, C ov-'�/y ✓ (c) Lending Institution (�T K & C-- Telephone Mailing Address 70 14 a Je_y_ H i H k (d) Real Estate Company and Agent (e) Address Telephone Mail the HAA to the following address: or: Check here, if hold for pick up. List contact person and day phone number below.r -Ir ,n ( l A P_ N _Q q] ' I J 2. TYPE OF RESIDENCE Single -Family t Number of Bedrooms _ 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If ommunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Pagel of 2 72-025 Wev 8/861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspKction. /n Name of Firm U Telephone o�79 -�9 Address ok � � / 5r Date DHHS APPROVAL�n/ , Approved for T bedrooms by �' �/ Date Approved x Disapproved Conditional Terms of Conditional Approval CAUTION Engineer's Seal 1-21-97 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. Page 2 of 2 72-025 (Bev 8/86) Back •J 2225-E J U K 2S. i 9 l ). i DHHS APPROVAL�n/ , Approved for T bedrooms by �' �/ Date Approved x Disapproved Conditional Terms of Conditional Approval CAUTION Engineer's Seal 1-21-97 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. Page 2 of 2 72-025 (Bev 8/86) Back A. WELL DATA . AN,,,*9 %CIPALITY OF ANCHORAGE (MOA) MU141 c�E(HAA) pEP1.o AL?ROSOCHECKIST-FERUARY984 ttv.tRCMENT 264-4720 Legal Description: L,�)76{F1l<e P, P& 4 s� 0-6 aig-Nif 1?3 Well Classification L If A, B, C/, D.E.C. Approved (Y/N) N/ Well Log Present (Y/N) Y Date Completed �ilb 1-78 Yield Total Depth [it Cased to Depth of Grouting N ON L Static Water Level' 7;2- Pump Set At d 1 7 �( Casing Height Above Ground 3y Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) V Depression Around Wellhead (Y/N) N Separation Distances from Well: To Septic/Holding Tank on Lot 1 an ; On Adjoining Lots > l o-0 To Nearest Edge of Absorption Field on Lot ( t4D ; On Adjoining Lots 7 To Nearest Public Sewer Line N 0 I•t a To Nearest Public Sewer _ Cleanout/Manhole M0 IQ la To Nearest Sewer Service Line on Lot 7 J O n Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA S ; Date f i t7 [i Date Installed 700 Size 1A5Cy No. of Compartments 14-7 Standpipes (Y/N) ONE Air -tight Caps (Y/N) X, Foundation Clean /Qut (1Y/N) _ Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) WIA- ; for Nle Holding Tank High -Water Alarm (Y/N) NI -V Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 12 O To Property Line t C-> To Water Main/Service Line i 30 Course Comments Page 1 of 2 72-026(11/84) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ! q Type of System Design l r?_EWC4 Date Installed �t u-�� 078 Length of Field 4 Width of Field 3 Depth of Field 'L Gravel Bed Thickness Square Feet of Absorption Area 57 Ll Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test f a ss Separation Distance from Absorption Field: To Water -Supply Well f �To Property Line D 1L) To Building Foundation '7 3 To Existing or Abandoned System on Lot On Adjoining Lots > 3 <S To Water Main/Service Line >I t] To Cutbank (if present) 0 NL- C To Stream/Pond/Lake/or Major Drainage Course N To Driveway, Parking Area, or Vehicle Storage Area q Comments D. LIFT STATION '\` C) N 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 ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I`have checked, verified, o 7onformed to all M A and HAA guidelines in effect on the date of this inspection. Signed Date y ! i (/e 7 Company MOA No. Y) "__0ll Receipt No. /0 Oy Date of Payment Amount: $ lv o Page 2 of 2 72-026 (11184) Engineer's Seal �V o o UV 20A ANCHORAGE, ALASKA I 99501 CONSULTING ENGINEER w lJ\J� TELEPHONE: (907) 279-3916 R E S I D E N T I A L W E L L I N S P E C T I O N LEGAL: LOCATION: OWNER: TYPE OF WELL: LOT 6, BLOCK 8, MACMAHON 4100 KUTCHER DAVID MILOT SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 4 GPM. PUMP YIELD: 5 GPM. DATE OF INSPECTION: AUGUST 22, 1985 AND JANUARY 16, 1987 TEST PROCEDURE: ON AUGUST 22, 1985, WELL WAS PUMPED AT A CONSTANT RATE OF 5 GALLOMS PER MINUTE. THE DRAW DOWN WAS MONITORED. THE STATIC LEVEL WAS 72 FEET, TOTAL DEPTH OF WELL 112 FT. AFTER 60 MINUTES OF PUMPING AT 5 GPM. THE WATER LEVEL STABILIZED AT 97 FEET, A DRAWDOWN OF 25 FEET. TEST FOR COLIFORMS: WELL WATER WAS TESTED FOR COLIFORMS ON JANUARY 17, 1987. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours. This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. V .i 2-225 V; y JUNE 25. 191 ; i ..4. V VS U V ----'203 � 2 ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 S E P T I C LEGAL: LOCATION: OWNER: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: S Y S T E M A D E Q U A C Y T E S T LOT 6, BLOCK 8, MC MAHON 4100 KUTCHER:" y; DAVID MILOT SINGLE FAMILY, FOUR BEDROOMS;', " r• 2 ' f ON SITE WELL _ FROM MUNICIPAL RECORDS: TANK: 1250 GAL GREER STEEL. TWO COMP. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 574 SOIL RATING: 140 INSTALLATION DATE: JUNE 1978 JANUARY 16, 1987. ROTO ROOTER AUGUST 22, 1985 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH FOUR FEET OF COVER AND 47 INCHES OF LIQUID. 4 -INCH CLEANOUT TO TRENCH WAS 5 FEET DEEP AND DRY. TRENCH SUMP WAS 11 FEET DEEP AND WITH 22 INCHES OF WATER. WATER WAS ADDED TO THE TRENCH AT A CONSTANT RATE OF 5 GALLONS PER MINUTE. THE WATER LEVELS IN THE TRENCH AND TANK WERE MONITORED. A TOTAL OF 460 GALLONS WERE ADDED CAUSING A RISE IN THE TRENCH WATER LEVEL OF 10 INCHES. THERE WERE NO RISE IN THE TANK. WITHIN 15 MINUTES THE LEVEL IN THE TRENCH HAD DECREASED 2 INCHES, SHOVING THAT THE TRENCH ABSORBED THE LIQUID. ON JANUARY 16, THE WATER DEPTH IN THE TRENCH STANDPIPE WAS MEASURED TO BE 19 INCHES. NO INCREASE IN WATER DEPTH IN 16 MONTHS. TEST RESULT: THIS SYSTEM MEETS THE REQUIREMENTS OF THE MUNICIPAL CODE. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requirements of the Municipality and State. 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L07 b) Tax a IdL 9-Qct%0 S e L�$ % IAN, Location (address or directions) �lgo KuT&14a R (b) Applicant NameDCLv'A1.0 { Telephone: Home ���`�1la 7 Business ;L7&"0-76 Applicant Address 6��O /,eV r GA4jEPZ. (c) Applicant is (check one): Lending Institution ❑ ; Owner/bn*d-er 21; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution ALAgm Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: Vol t'p 2. TYPE OF RESIDENCE Single -Family] Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite IX 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, DATA AND INFORMATION G , As certified by my seat affixed hereto and as of the validation date shown below, I verify 4hat my investigation of this He. £_ Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequai, 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. „ °, /f Name of Firm R] Address Date — DHEP APPROVAL IZZ Approved for 6ZIA bedrooms by Approved —lo�c - Disapproved Terms of Conditional Approval Telephone 12 -11 171 6 CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION oG 23 X95 264-4720 UX V [rD Le al Description: �� I ` A. WELL DATA Well Classification 'Res If A, B, C, D.E.C. Approved (Y/N) 4/A Well Log Present (Y/N) Date Completed 4P h 0 Yield "/�� Total Depth Cased to /it Depth of Grouting N ©W E Static Water Level Pump Set At 730 MGM4/I �f Casing Height Above Grounder Sanitary Seal on Casing (Y/N) i Electrical Wiring in Conduit (Y/N) Separation Distances from Well Depression Around Wellhead (Y/N) W To Septic/Holding Tank on Lot iad ; On Adjoining Lots >/00 To Nearest Edge of Absorption Field on Lot 140 ; On Adjoining Lots > To Nearest Public Sewer Line N ON To Nearest Public Sewer Cleanout/Manhole N 0 N 1= To Nearest Sewer Service Line `on Lot > Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed UN l %6 Size /450 No. of Compartments i W/o Standpipes (Y/N) ONE Air -tight Caps (Y/N) ?r Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped ahs A -s Pumping/Maintenance Contract on File (Y/N)pp IIIA ; for N/A Holding Tank High -Water Alarm (Y/N) �/A Temporary Holding Tank Permit (Y/N) N/A Separation Distances from Septic/Holding Tank: To Water -Supply Well 1A0 To Property Line % _ 0 To Water Main/Service Line Course N 0 N IS— Comments Page 1 of 2 72-026(11/84) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata I q Z) Type of System Design Date Installed __ J ONrf 19163 Length of Field W , Width of Field Depth of Field Gravel Bed Thickness 0 d Square Feet of Absorption Area _ 51V Standpipes Present (Y/N) '% Wo Depression over Field (Y/N) ►NDate of Last Adequacy Test &/Zg- Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 1410 To Property Line r To Building Foundation #'5 To Existing or Abandoned System on Lot IN oN i=_: ; On Adjoining Lots °7 .5 5 To Water Main/Service Line ..> 10 To Cutbank (if present) N ON 19 To Stream/Pond/Lake/or Major Drainage Course NON ! - To Driveway, Parking Area, or Vehicle Storage Area --;, 4 Comments D. LIFT STATION NO N �= 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 °` Check Permitted Bedroom Rating Against HAA Request'" Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or onformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No. I -S_5! ' 0!/ Receipt No. FJc1 r - Date of Payment -�g " -'5'-° � Amount: $ 4-5� Page 2 of 2 72-026 (11/84) C.' f 1 s Engineer's Seal �Q y, 127.5-E: ,1 .10" 2b, 1971 _e+ 4 09 CONSULTING ENGINEER ,-1 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 S E P T I C S Y S T E M A D E Q U A C Y T E S T LEGAL: LOT 6, BLOCK 8, MC MAHON LOCATION: 4100 KUTCHER OWNER: DAVID_MLOT RESIDENCE: SINGLE FAMILY, FOUR BEDROOMS WATER SYSTEM: ON DITE WELL SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: 1250 GAL GREER STEEL. TWO COMP. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 574 SOIL RATING: 140 INSTALLATION DATE: JUNE 1978 DATE OF PUMPING: DATE OF TEST: TEST PROCEDURE: TEST RESULT: SOF/aft ..... .. ........iY.Yi N . 2225-E 1UN� 25, 1971 Ov./ AUGUST 23, 1985 AUGUST 22, 1985 WATER WAS ADDED TO THE TRENCH AT A CONSTANT RATE OF 5 GALLONS PER MINUTE. THE WATER LEVELS IN THE TRENCH AND TANK WERE MONITORED. A TOTAL OF 460 GALLONS WERE ADDED CAUSING A RISE IN THE TRENCH WATER LEVEL OF 10 INCHES. THERE WERE NO RISE IN THE TANK. WITHIN 15 MINUTES THE LEVEL IN THE TRENCH HAD DECREASED 2 INCHES,` SHOVING THAT THE TRENCH ABSORBED THE LIQUID. THIS SYSTEM MEETS THE REQUIREMENTS OF THE MUNICIPAL CODE. _ The operational life of all septic systems. depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requirements of the Municipality and State. 3 W. 15th AVE "C" SUITE 203 A �O �7Y V �li lJU .1WL�lsvIND9 pvCo 2 'ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 R E S I D E N T I A L W E L L I N S P E C T I O N LEGAL: LOT 6, BLOCK 8, MACMAHON LOCATION: 4100 KUTCHER OWNER: DAVID MILOT TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: WELL YIELD FROM WELL LOG: PUMP YIELD: DATE OF INSPECTION: YES 4 GPM 5 GPM. AUGUST 22, 1985 TEST PROCEDURE: WELL WAS PUMPED A^1 A CONSTANT RATE OF 5 GALLOMS PER MINUTE. THE DRAW DOWN WAS MONITORED. THE STATIC LEVEL WAS 72 FEET, TOTAL DEPTH OF WELL 112 FT. AFTER 60 MINUTES OF PUMPING AT 5 GPM. THE WATER LEVEL STABILIZED AT 97 FEET, A DRAWDOWN OF 25 FEET. TEST FOR COLIFORMS: WELL WATER WAS TESTED FOR COLIFORMS ON AUGUST 19, 1985. TEST WAS NEGATIVE. TEST RESULT: 0ti �°�• •n rti �,e ' e •oeao a •ea• asa�'j j'.91Mo• • ••••9 i1• i -Y y o. 2225-E JUNd 25, .1971 �Ytdo 9 . THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours. This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. 5. LEGAL DESCRIPTION Lo 7- DATE RECEIVED INSPECTION APPOINTMENTS TIME 6. TYPE OF RESIDENCE TIME TIME ❑ One Four ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six C) Q! DATE INDIVIDUAL* DATE DATE since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INSPECTOR >� INDIVIDUAL/ON-SITE** INSPECTOR INSPE' NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION FEB 2 5 3981 Telephone 264.4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEVRE(kjLVrkD DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER rc PHONE MAILING ADDRESS S p 1A K f FS , &j<_ cA 5 c9 "7 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS - 3. LENDING INSTITUTION K v—'v L s 0 vr'ry S 9 63 fR ry fL PHONE ,�?7 MAILING ADDRESS /Sp� ._ z.i S?' 4. REALTOR/AGENT _ PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION Lo 7- STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS P!P ❑ Other ate{ SINGLE FAMILY /�- ❑ One Four ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM WAS INSTALLED. >� INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79)' �� � Ct ��/� L :i7�� �ti✓f�C_ l {'�� �=�k�(.CS — rs_'fCl Gbt_ L-_6 b-�l THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER - ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ❑ APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 72-010 ( Rev. 6/79) DETACH AND FILE FOR FOLLOW-UP TO ` T,a tr» (`-rnw -- F R -- �i'f i -h Pl aor - M � f t_z /97/ ES SUBJECT Lot 6 Block 8 Mc Mahon Subdivision 42 DATE 2 ; MESSAGE Please make arrana car a v far,rl for }hP iol 7 owingg he called on this d.atn and cancelled the health antiroval request xg Acc o to A 2460 Receipt 4&gjS S25,00 T awren -...G, Ru t"pr, ir Nawar and Igh er OfhQr -- ' magRc ufe A Box 15ciO-R A-nn-hni-Aan, All aaka SEMI a L_ SIGNED" Sewer and water program REPLY x 4920 141 SIGNED DATE If 61 45 4%Z SEND PARTS 1 AND 3 WITH CARRON INTACT - Par P" (SO SETS) V472 ®` PART 3 WILL BE RETURNED WITH REPLY. DETACH AND FILE FOR FOLLOW-UP e5? -�rary 5. LEGAL DESCRIPTION � S1/n /—P,—e� MUNICIPALITY OF ANCHORA STREET LOCATION DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO EC ION • 825 L Street - Anchorage, Alaska 99501 _ 6. TYPE OF RESIDENCE ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER ❑ Three ❑ Six PHONE MAILING ADDRES° INDIVIDUAL* y ❑ COMMUNITY PROPERTY RESIDENT (If different from above) PHONE 2. BUYER 8. SEWAGE DISPO L SYSTEM PHONE MAILING ADDRESS **If individual/on-site, give installation date 3. LENDING INSTITUTION If system is over two (2) years old an ade cy test is required PHONE MAILING ADDRESS - 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION � S1/n /—P,—e� STREET LOCATION �r 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUP INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPO L SYSTEM INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an ade cy test is required ED PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ON. INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME - TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ES-Septic Tank or ❑ Holding Tank Size: J.)Z-6 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL J 4. DISTANCES WELL T0: Septic/Holding Tank - Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR / BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Title) A, LEGAL DESCRIPTION 72-010 (Rev. 3/78)