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Home My WebLink AboutMCMAHON #2 BLK 8 LT 12 ~--~UNICIPALITY OF ANCHORAGE " Hea! ~ and Environmental Protec 'on ' Fourth Floor West ~ 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOC AT I Oi"J SEPTIC TANK: DISTANCE FROM WELL~ INSI[)E LENGTH MANUFACTURE R~~ -- INSIDE WIDTH MATERIAL COMPARTMENTS- LIQUID DEPTH LIQUID CAPACITY/,-~"~ALLONS. TILE DRAIN FIELD: TOTAL LENGTH DISTI\NCL [:ROb~ \'V~LI~__~r~¢__'~ FOUNDATION ~'~[ NEARi~ST LOT LINE._J5 ~ of Lines / DISTANCE BETWEEN LINES_ ~/~ TRENCt WIDTH~L IN. TOTAL EFFECTIVE [)EPIlt: ~OP OF TILL: 10 I'H,JISII GRADE ~.i DEPTlt OF FILTER MA]ERIAL BENEATH TILE ' SEEPAGE PIT: Di,.~,METER __ OR WIDTH __ LENGTH ,, DEPTH Log Crib Rings BUIL_DIt.'O FOUNDATIO!'~ ___ ell lass: Depth: ell Distance To: Lot Line ldg: Sewer Line: ipe Materials: of Bedrooms,: nsta~ler: ~ emarms: Crib Size: DI/.\METER .... DEPflI____ DISTANCE FROM: WELL __ NEAREST LOT LINE ABSi~'~)ON ARE,'", (WALL AREA) :-t-','l ..... ~'"i--- ' : .... ' -.i- , [._4 .-!- I -[ , ~- ' ' --!- 4- -; ...... F--d- - I , I / . i ' I · ' '~ !' : ! SQ. FT. L~. ,.m L. TI.liE L..E?.4{:JTH i) I i'"ii;i'..P.:/, i ON :i::i:.'; THE L.E:NGt'H ( i N FEET > OF 'T'HE 'T'I:~:ENCH OF?. DR!:~ Z i'-,ii= i EL.E:,. TH¢;E i":qEP'FH OF Fi 'TRENCH Oi~'. PIT iE; 'T'HE E:, ]: E;TI::'tNCE E~E'FHEE;N THE] 51JRFF:!CE OF THE' (~f.?.OUNE:, RNC, 'f'H(E ~3CYT"T'EIH CiF THE E',:.,:CA',/I~T i Oi",l ( Z N FEET ::,. 'Fl.{ERE 1:5 NO SET i.4iPTH i:OR: TR'.ENCHEE;. THE GRR',,.'EL i::,EF'TI .i ]1S 'I"HE i"I1[ N i HUH [)EF'TH ;:::IND "['H[E E:(3'I"'TC'I~¢t OF' THE E::.::Ci::I',/R'T]:Cfi"~ ~::i F'FiC:i--'::i:iGE:: F'L.:;:I, NT I"iFt? E:Ei: :[Ng.;TR!..L..[i;t') R"i'' THE F'E[;:H]:TTEE"E; EIF:q" )': ON :E;!..jB..:rEE:'i" T'O THE :1.. F: :[ 'f'HF:%-: i::t (.'.';L.~:~SS ]1 EIF.'.: :Ii f',i:"SF F:IPPi:~'.C!VEi:D i:>LF!NT t"iR"¢ BE: It"4:E;'T'RLLED. 2. !:::i C:(:)NT']:t"~UOU~; hiFIZi",ITENRNCE FtGREEHENT ZS F::Ei:g!UIF.':E:L':'. i1:: Ft t'I!::IIN'T'ENRNE:E fiGI~:EEi"!ENT Z:~; NEFF KfEFrf FiE',2?,.'3F.'tF'T]:ON S'¢:~;TEt"t FtF,!D,.."OR 1[ HUH [.':':[ :~;'i'F:!hhi:i:~: 8ETI.4EEN f~ i.4EiL. L.. FIND, FIN"," ON"..-E; I 'f'E L-';fZHI=IGE F:'EET F'Oi.::: FI F:'F?.tVF~,TE i.4ii:L.L L'ff~: :2.0¢ F'EET f:'E~F', i::I, F'L.iE',L. ZE: t.,,~ELL. !.,iE=.LL. LOEiE; FIRE: F?.EL::!LIZRED RNg, HI...IE;T' E',E RE'T'URNE[.':, 'TO THE THE: i4ELL COi"tF'L.ETION. Ei"!'HEf-:': Ri.:~:(;:E_IIi'~'.Ei'4ENT~4; PiR'.,.' FIF'PL."r'. E!;F'EiCIF:':[CR'TiEtNS Rlq[.':, CI:IF,i'=Z.;"i"i:iiS..It:J:T.T. OI'-4 ',::l',/t::i i L.F'IE~[.E 'f'C.i i H:~;[.JI:;-".iE F'R. OF'ER i N':!;TFIL.i.~.f:I'T' ]; (:.iN. iil CE}-~:'Tii=~'¢ 'T'I'"ii:;:tT :i.: )i F:ff"i F:'F:ii"iILif=!i7 NZ'i}'i THE REQLtti;;:iEi*IEi:'4T!~; [:'OR C)i'4-'%iTE 5E[q[~[;:E; FIND i.4ELL,,:E; 2: 'Z I.,~ZLL ZNE;'T'RL.L THE %S.%TEH ZN FiE:COH;:[i:,F~NCE t.qZ'TH THE 1/:: :i7 t.iNC, iERSTRN[::, THFIT THE: ON--.:~;t"i"E E;EHER 5h.%T'E:H HR'.¢ REQLi]:RE iENL. F:ti:;:GIEHENT CONSULTING GEOLOGIST BOX 476-M, STAR ROUTE A * ANCHORAGE, ALASKA 99507 "' PHONE 344-7071 SOILS LOG Date Soil Type Water Level Remarks 0 2 4 6 16 18 2O Groumdwater Bedrock No t..Reached Depth, if Reached.__ Not Reached Depth, if Reached Classification Method Visual ( ) Sieve Analysis Gary F. Player, Consulting Geologist ~ WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 8~ Geophysical Surveys Drilling Permit No, A.D.L. NO. LOCATION OF WELL (Please complete either la, lb or IC.7 .......... ,-~.lBorough Suhdivieio. Lo,B,o=k '~.J V4gtre- Se.*io. ,o. Tow..hiPNO Re.ge ~ ~lc D STANCE A~D D~RECTION FROM ROAD INTERSECTIONS ~. OWNER OF WELL: Feet Below 4. W~ OEPTH: (final) 5. DATE OF Moteriol Type Top Bottom 6. ~Coble ,oo' QRofory DDt[yen ~Dug /~ 8. CAS)~' 0 Threaded ~ Welded diam. ia. to.~ ft. Depth SHckup ~.-~-; ft. "~" ~ ~ Slot/Me ~h Size: Length; ~,~ ft ofter~e.) hrs. pumping ,~ g.p.m. ~ ,~ 7' ft. after hrs. pumping ,.p.m. Length of Drop Pipe ft. capacity ~9.P.m. ,~. WAT,R WEEE CONTRACTOR'S CERTIFICATION: 15. ~[er Te~perolur, ~ F ~ C ' Authorlze~ Repr.~entofive WATER WELL LOG FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 9950! LOCATION SIZE OF CA~ING~DEPTH OF HOLE~_~T. CASED STATIC WATER LEVEI~FT.. YIELD~GAL.PER.MIN. FEET OF DRAWDOWN. REMARKS DATE COMPLET~~?~_~_~_~__PUMP TO BE SET AT~ to~ .to __to ___.to ___to __to ___to ___to ___to to. Parcel I.D. # 1. 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 Io CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING (~\~- °3ini -~ L"")["~'"') HAA# ~'~c~ -'~-(~r~l GENERAL INFORMATION Complete legal description .- Location (site address or directions) ~'~ ~:¢/-) / Property owner Mailing address Lending agency ,~"~,"~/ oA/¢',~/ ~//'~--;~- Day phone Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: /7' TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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 s,' o STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm .Z~,~'~'7- '~/--//-/,,0-~- Address //~ /~ ~"~°/ '~-/~ Engineer's signature D.~S SIGNATURE ~-/ZZ.,~ Approved for ~z.~x,,'~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze.data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the p?ofessional engineer's work. 72-025 (Rev. 1/91) Back MOAfY21 Municipality of Anchorage /~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, Well Data Well ~pe Log present (Y/N) Total depth Sanita~ seal (Y/N) Parcel I.D. Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number Date completed //~/~7 Driller Cased to :/ Casing height .~ o '/ Wires properly protected (Y/N) / / AT INSPECTION FROM WELL LOG ,/:/, ? ~,-- g.p.m. ,~-~ / g.p.m. SEPARATION DISTANCES FROM WELL TO: / Septic/holding tank on lot .> / O o / Absorption field on lot ~> /o Public sewer main /v'/~ Sewer service line ~ ~' 7½.,~ ~/~ ~ 'F~ J~-~ePetroleum tank ; On adjacent lots ; On adjacent lots ~' / '~ o Public sewer manhole/cleanout ? WATER SAMPLE RESULTS: Coliform 5'~/-<~'~:~'¢¢ Date of sample: //~,//::¢.~ Collected b~: Other bacteria :~-7¢¢' /' '--:-~7~¢~'~ B. SEPTIC/HOLDING TANK DATA Date installed ./~,//¢-/./? ? ~ Tank size ./-%~ ~ 0 Cleanouts (Y/N) // Foundation cleanout (Y/N) ./ High water alarm (Y/N) Date of pumping Compartments ~- ~/~ Depression (Y/N) ,/[// Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: /' Well(s) on lot ,-~/o To property line ~> '2~° Absorption field Surface water/drainage 72-026 (3/93)° Front Foundation '/¢/ Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off' Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D, ABSORPTION FIELD DATA Date installed /'~//~-//? Soil rating.(.~2)/~2.,~j ~,~,/./'F,~ System type g '/ ~-/% Gravel thickness ~' /~ Total depth /// .-'* Well on lot To building foundation On adjacent lots ~/' Sudace water // Curtain drain Total absorption area /-~ ~'~' ~' Cleanout present (Y/N) //~/ Depression over field (Y/N) Date of adequacy test /~//~/F~,;~ Results (pass/fail) ,?~_ ~ 5' for -~,/ Bedrooms Water level in absorption field bef0re test /,~/- ~/ ~/~~.,~£.o, Aftertest /,2-~'/~ ~,,~/-,,/ou-~ Peroxide treatment (past 12 months) (Y/N) .// \ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: ~ '/ / On adjacent lots "~ / a o Property line ,'// To existing or abandoned system on lot 4//9' ,,,V/~*z/..~ Water main/service line ~---,-, ¢7",¢.~-,.- ~¢.,~/~-~ Cutbank Driveway, parking/vehicle storage area ~ ~7~/~Y-¢''- 2'",' / E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of.th~$;insp.¢¢({on. EngineeCs Name >7~/~ ~'~' / Date / HAA Fee $ Date of Payment Receipt Number · < · ~"~>L' ','. hi .,', \ '¥,-'~ ,':':~;' ' Waiver Fee $ Date of Payment Receipt Number 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 /-- ~--.S 7 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) (b) Legal Description (include lot, block, subdivision, section, township, range) /_',z /> 2> Location (address or directions) '/ (] ~ '~.. :¢ ,:_' . ..~ fropertyOwner,-"~'/-"~','~'/' /~'~,/-'¢,~ Telephone:Home -,.~.~..~-'~'::'":~,~ Business '""' ~"/-' ~ Mailing Address Z/,'~ ~C2z/ T'~'~l,~ ~72'"'., "'~' ~'*"J-/~ ':' "¢'"~-~,~ :/~'~'~/'"~' (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here.~', if hold for pick up. List contact person and day phone number below. ' ' V A//.o.., TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms 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, SEWA~,ISPOSAL Onsite l::2 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 IRev 8/86~ Front 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 ~,/~'~'.s' ~'-- '¢/'-' /,¢.-¢ ¢' ,'..L Telephone Address / Date //,// ,. DHHS APPROVAL Approved for Approved bedroomsby .z~l,~ ¢ ~Date Disapproved Conditional Terms of Conditional Approval CAUTION 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 fRev 8/86) Back WELL DATA Well Classification .,~/~/~'~-~'~ If A, B, C, D.E~C. A,pproved (Y~N) Well Log Present (YIN) ,/~ Date Completed /~/~/~ / ~ Yield Total Depth ~ d'' >~2 Cased to Y/ Depth of Grouting Static Water Level ~/~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot '~ / ': o" Pump Set At ~-:,¢~7~-.:..~--~ ~-' ~--,,.z..?// Sanitary Seal on Casing (Y/N) h Depression Around Wellhead (Y/N) ; On Adjoinir~g Lots ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole ,/'K/''~ To Nearest Sewer Service Line on Lot _/. ::,.,/,'Y'.',",~" ~ ~ / Water Sample Collected by Water SamCe Test Besu ts SEPTIC/HOLDING TANK DATA Date Installed /~//~'/ ~ Size /~5:-~ 0 No. of Compartments Standpipes (Y/N) ,/P"~'.,~ Air-tight Caps (Y/N) Depression over Tank (Y/N) /'~/2 Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~ /0 0 To Property Line ~ ~' ~ TO Water Main/Service Line ~ ¢~'~¢"/'- Course Foundation Cleanout (Y/N) Date Last Pumped¢~- ;for Temporary Holding Tank Permit (Y/N) To Building Foundation z/'~'~ / 7~a ~ C).. To Disposal Field ~--%'-- / ~ ~"~' ~"~ To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026 (Rev 8/861 Front ABSORPTION FIELD DATA Soils Rating in Absorplion Strata J~-'--¢'"'-- ~' Date Installed / ~/'h/~//'/? Width of Field Square Feet of Absorption Area Depression over Field (Y/N) ,4 Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well "~ / To Building Foundation Lot /~A/~ TO Water Main/Service Line Type of System Design Length of Field ~/z'-5~ "~ Depth of Field 'Cz / Gravel Bed Thickness "~ / Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line //~ To Existing or Abandoned System on Adjoining Lots ~ / ~ ~/"¢'T~ Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ,'I/'~'~ To Driveway, Parking Area, or Vehicle Storage Area Comments ._~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h~h.~ke.d.,~ve/~, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Si g n e d .~ ..¢,~.~--~_.,,,- ¢-'--,---¢-~' Date Company Z%~./~.,'.¢~' ~¢' ,'~'~-¢-¢' ~'~ ' _ MOA No. Receipt No. ,,/(,/'r'~.) / Date of Payment /i/ / 2.-.-/~ ~ Amount: $ /. Page 2 of 2 72-026 (Rev 8/86~ Back ' ~----qUNICIPALITY OF ANCHORAGE /-~m~Zf DEPARTMEN1 'F HEALTH AND ENVIRONMENTAl 3ROTECTION 825 L Street, Anchoraa~. Alaska 99501 264-4720 Date Received: October 19, 1977 ~2: Time #3: Time Date Date Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER F~CI$~TIES~m Gc tC' °l Lending Institution Request: Alaska Pacific Bank Mailing Address: Post Office Box 420 99510 Phone: 276-3110 2. Property Owner: Mountain Enterprises Phone: 344-0491 Mailing Address: Star Route A Box 1582N 99507 / 3. Legal Description: Lo% 12 Block 8 Mc Mahon Subdivision ~2~ 4: Single Family Residence: (x) Multiple-Family Residence: ( ) Number of Bedrooms: Number of Bedrooms: Five Se Well System: Individual well (x) Community/Public System ( ) Permit # Depth of Well Well Log on File Construction Bacterial Analysis Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System (x) Public Utility ( ) Installed 1977 Installer Manufacturer Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Pa~e~wo. '- Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 12 Block 8 Mc Mahon Subdivision #2 Comments: Af fadavit Attached Approved: ~-- Disapproved: Letter Attached: ( ) Date: Department Worksheet: ~'IUN I C I PAL I'~AG E ': "" ' ~">~ ° DePartment of Health and Environmental Protec'ti~n "..! /(~-~ 825 L Street, Anchorage, Alaska 99501 ~ ~'~~equest for Approval of Individual Sewer and Water Fac, ilitiesi Property. Owner: ~[7~ Mailing Address: 2o Name Of Buyer: Mailing Address: 3. Lending Institution: Mailing Address: 4. Realtor/Agent Mailing Address: Legal Description: Street Location: Phone: Single Family Residence: Multiple Family Residence: Water Supply: *Individual Well If Individual Well, well depth If Community System, name of system Number of Bedrooms: Number of Bedrooms: (/Public/Community System ? Sewage Disposal System: On-site System If On-site System, date of installation: Public System ( ) *NOTE: 3/77 A well log is required on ALL wells drilled since 6/75· IOUNICIPALITY OF ANCHOP, AG~ __ ~ ,.~ ' ~ ~ ~IRONME~Ar PROTECTION OCT 8 lg77 gECEIVED 7£¢%