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Home My WebLink AboutMCMAHON #2 BLK 9 LT 12 [~r-~.MUNICIPALITY OF ANCHORAGEs., . Hea ~ and Environmental Prote, Lon , Fourth Floor West · 825 L Street ~ ~chor age, Alaska 99501 279-2511, x 224, 225 ......................... i~S-~,CTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION ........................ LEGAL DESCRIPTION SEPTIC TANK: DISTANCE,/V,.~///~^"~ _J~ ~] "'~"~'/~ COM PA RTM EN'f'sNUMBER OF _.~---~ FROM WELL/4~J~__'~_L_% ...... MANUFAC1URER ........ MA'rERIAL ........ .... INSIDE LENGTH ................... INSIDE WIDTH .... LIQUID DEPTH ..... IIQUID CAPACI'I-'F_/~)GALLONS. TILE DRAIN FIELD: .~ / / TOTAL LENGTH~ ,.- ] DISTANCE FROM WELt-~_/__/~/_.FOUNDATION-/P--'~- ..... NEAREST LOT LINE Z~ ~ .... OF L NE ~ ~ Of Sines ..... l .... gmTANCE ~TWE~N LINES _~/~-----T~ENCH W,O'rH~&iN. TOTAL. EFFECT,'./r ABSORPTION AREA ._.~4__ ' SQ. FT. LENGTH OF EAC,, LINE ~ ' j DEPTH OF FILl'ER t DEPTlt: TOP OF TIt_E TO FINIStl GRADE ___~_ ~ MA1ERIAL BENEA1H TILE ._~' ___~ABOVE 'rILE _~ ..... iN. SEEPAGE PI'f: DIAMETER ___ OR WIDTH__, LENGTH .... DEPTH Log Crib Rings Crib Size: DIAMETER___ BUILDING FOUNDATION__ NEAREST LOT LINE DEl)i'll .... DISTANCE F P, OM: WELL ............ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) _SQ. Fi'. Well' Class :~[/~.__ Depth: Well Distance To: Lot Line Bldg: __ Sewer Line: Pipe Ma--~rials: ~~ # of Bedrooms: ~/ Installer: ~.~' ' . __ Remarks~: · i ?. i ~ :h:;,i' ~..~ ;12i iV.(% i ih:' i , i'4";!;' i-)l:';:.'~i~ ¢:.&:i.~ i,.'i i.,ii'-~' ! iq~:~.,,' i.[~, i~. ' l~i i GARY PLAYER VENTURES CO.NSULTI NG GEOLO6IST BOX 476-M, STAR ROUTE A " ANCHORAGE, ALASKA 99507 · pRONE 344-~'071 SOILS LOG Performed for ~~-~O Location Soil Type Water Level 0 2 ~ 4 6 12 18 2O Total Depth of Excavation Groundwater ~ot Reached Depth, if Reached__ Classification Method ~Vi'sual ( ) Sieve Analysis () Remarks Material at Total Depth Bedrock ~ootReached Depth, if Reached Gary F. Player, Consulting Geologist MUNICIPALITY OF WATER WELL LOGFr'NViRON' f;'AL FOSS DRILLING 1336 Ingra Street : ) ,,, LOCATION SIZE OP CA~ING ~ I, DEPTH OF 'H'OLE/~FI'o CASED TO /,..C~) .. FT. FE~T OF DRAWDOWN. REMARKS DATE COMPLETED,. PU~P To sS s~ AT /~ ~/ to~ to ...... to to ...... ~o ,,, to tO~ tO ,, to ~to ~o to ~o to ..... 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING <:D I '"~-- - ~ ~,"Z.- 1':) NAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) '~':?'~-/ /-/-- ,~%¢~ ~A~ Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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 HoMing 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. 1191) 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 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 q~r~JrUc~ Phone Address Engineer's signature~ DHHS SIGNATURE J~ Approved for L~ bedrooms. Date W- Z,-~- ¢ ~ Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date The I'~lu~'i¢ipality 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 DH HS 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. 1191) Back MOA #21 Municipality of Anchorage i~s~;~o /~--~kt~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNtCIPALfl¥ Of ANL, 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (l~7~tF4~4~t S~,RVt¢~ Health Authority Approval Checklist RECEIVED Legal Description: ~, 12./1~ c~ r'~t~Iv,~Ho~ s~, ~c--2., A. WELL DATA Well type'-¢~l o/~"r-~. If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ParcelI.D.: O1'-¢ - ~go~-/9 g-ZS-77 Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Log present (Y/N) Total depth /~'o' Sanitary seal (Y/N) Date of test ¥ FROM WELL LOG Static water level //c/- Well production g WATER SAMPLE RESULTS: Coliform ~ C> - Date of sample: /Y- ~l - ~ ~ B. SEIrrlC/HOLDING TANK DATA Date installed ~ - t~-~- Tank size Fom~dation cleanout (Y/N) "C Date of Pumping /-4-'z~*76 C. ABSORPTION FIELD DATA Date installed ~ -I?~ 7-7 Length ~ Width Effective absorption area ~ t/O Date of adequacy test ti- 2'?-- ~?6, Nitrate g.p.m. ~, o g.p.m. q, "~ I Other bacteria Collectedby: L~ Ix., ~ t,s p,q Oa"rc / S,TZ,'-7:P~,~,,)¢,o ~ 1 2..S-E> Number of Compartments '7_ Cleanouts (Y/N) ~ Depression(Y/N) r4o High water alarm (Y/N) ~[ & Pumper h4crce.-~ tAr.q> Soil ratin~ or ft2/bdrm) Gravel thickness below pipe Monitoring Tube present(Y/N) Results (Pass/Fail) q"~lh Fluid depth in absorption field before test (in.); ~2g" Fluiddepth ~ (ins.) Minutes later: Peroxide treatment (past 12 months) (Y/N) A9 O ~5'-~ System type ~33 -T- ~ t Total depth ~ ~ t Depression over field (Y/N) ~ For ~/ bedrooms Immediately after6oO gal. water added (in.): 6,~ t' Absorption rate = ~, c, t~ %- g.p.d. If yes, give date D. Lllq'r STATION Date installed Manhole/Access (Y/N) ..~3~4efftested -- ' E. SEPARATION DISTANCES Size in gallons .._------------ Pmnp off' level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / O O ~ Absorption field on lot Public sewer main Sewer/septic service line ; On adjacent lots .; On adjacent lots Public sewer manhole/cleunout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK 01~ I~OT TO: Building foundation ~d:> r Property line ~C:> t Absorpfi6n field Water main/sendce line c~0 -~ Surface water/drainage !oo'* Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Property Line 'gO c Water main/service line ~o '+- Driveway, parking/vehicle storage aria .~ t Curtain drain 4/[/X ENGINEER'S CERTH*ICATION Wells on adjacent lots I certify that I have determined thru field inSpections and review in conformance with MOA I-IAA guidelines in effect on this date. Signa~ Engineer's Name Date m AFee $ Waiver Fee $ Date of Payment Rev. 8/95 OSS: haa.wk, doc Date of Payment Receipt Number '~MUNICIPALITY OF ANCHORAG~'~'' DEPARTHE OF HEALTH AND ENVIRONMEN = PROTECTION 825 L Street, Anchoraae, Alaska 99501 264-4720 Date Received: December 5, 1977 #1: Time #2: Time #3: Time Date Date Insp !nsp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES I, Lending Institution Request: State of Alaska - Veteran's Administration Mailing Address: Phone: 2. Property Owner: C.E. Jackson/Mountain EnterprisesPhone: 349-5200 Mailing Address: Star Route A Box 1582N 99507 3. Legal Description: Single Family Residence: (x) Multiple Family Residence: ( ) Lot 12 Block 9 Mc Mahon Subdivision Number of Bedrooms: Four Number of Bedrooms: Well System: Permit ~ Construction individual well (x) Community/Public System ( ) Depth of Well 151' Well. Log on File Bacterial Analysis Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System (x) Public Ut?=~Ly ( ) 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 ]%et Line Page Two Department of Health and Envlronmentam Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 12 Block'9 Mc Mahon Subdivision COltmlen t s: Affadavit Attached Approved: Disapproved: Letter Attached: ( ) Date: Date: Department Worksheet: ~-o~~Q ~r:o~o~ llVW IVNOIIVNBHNI ~OJ 1ON (ept$ Jeq~o ee~) --O]OIAOad ]9VB]A09 ]~NV~flSNI ON .................................... (ped!nbe~ eej od4xe) X~3^1~30 3¥103d$ PO~ ...................................................... X?NO 33S$3~00¥ 01 ~3AI330 P§8 ............ XlUO eesseJppe o% ~Ja^ilap qll~ J $301AB]S ~£ "peJeAlleP oJ8q~ puc elep 'moq~ o~ s~oqs '~~ ldl]3]a ~S9 ............ XlUO eessaJppe o~ ~JeA!Iep qHM 3000 dlZ 0N¥ 31¥1S "O'd 'ON ON¥ 133B15 01 IN3S (e~elsod Snld ~O£--91VIAI (]31JI/BS3 ~lOJ ldlSO3B P MUNICIPALITY OF ANCHORAGL Department of Health and Environmental Prot~ection 825 L Street, Anchorage, Alaska ~ 99~O1'~ ~quest for Approval of indiVidUal0sewer264 472 and Water~.NacilLt%,es o Property Owner: Mailing Address: ~]~4 /~---~---~/ Name of Buyer: Mailing Address: Phone: 3. Lending Institu'tion:S/T'~Z-~ ~. /~. Mailing Address: Phone: Realtor/Agent: __~_~ Mailing Address: 5. Legal Description: Phone: Street Location: Single Family Residence: (~"~Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: *Individual Well (~.~ Public/Conm~unity System ( ) If Individual Well, well depth /~'-/ If Community System, name of system Sewage Disposal System: *~Dn-site System (~ Public System If On-site System, date of installation: ?--/--.27 *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77