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HomeMy WebLinkAboutMCMAHON #2 BLK 9 LT 13' b2- GRE' -,,ER ANCHORAGE AREA BOk,..JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~'~ LOCATION PHONE SEPTIC TANK: INSIDE LENGTH INSIDE WIDTH MATERIAL ~ LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID C A PAC I TY/~')GA LLONS. TILE DRAIN FIELD: DISTANCE FROM WELL .~."~',~'~'-OUNDATION NUMBER OF LINES ~ DISTANCE BETWEEN LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE ( TOTAL LENGTH ~' NEAREST LOT LINE /0 OF LINES ~' N//"~SL TRENCH WIDTH 3~,N. TOTAL EFFECT,VE SQ. FT. LENGTH OF EACH LINE ~'~//' g { DEPTH OF FILTER ~. ~' WELL: ~/0'T' TYPE BUILDING FOUNDATION CESSPOOL _ APPROVED CONSTRUCTION NEAREST LOT LINE __, OTHER SOURCES DISAPPROVED NEAREST SEWER LINE__ DEPTH SEPTIC SEEPAGE TANK , SYSTEM_ REMARKS DISTANCE FROM: DISTANCES: SEWER LINE DEPTH: PIPE MATERIAL: ~'~"~"~ LOT SLOPE:_ ~ _~ ~, REMARKS: DIAGRAM OF SYSTEM Form LQ-032 ii':> i!::::" ii.:::.~' '} !~"' i :' :':: .:i :!!! - .. '~---", .......... · ..............· ..... ........ :....,~ ..... !~-..... ', ~i :~ ~ '"" i::'::" "'~"' Ii...-.[! :::':: :.: ~ '?lEi' i FN~¥'F':i D :i: HEi?'.?ii!: ]: (':iN ]: 9: '!"!"EE:: t i:N(Ei'! i .... ( :il N i::.::F'i" ) OF Ti"tE! TJ:iU::i',iii:H lip ~', :~' :::~ T i" F T ::'i 3) "r~.4: FE,!::Ei::"J'f.f i"'~i:;;' F:~ 'F~:;E:]:E]N(.::H i'd:? :::'T": ']"::: ¥'~4F' ~::~:::EE~'~"~::J~",~:':~' EE::FNEE:E:N 'r~.4r:' ,::: :?:~:::ff':E: ~"~:':' THE TH: ". ...... ."' , '" - ............ ,_.,,. ......... i:::'4:::. !!41:::.l:::.Jq 'i"HI:[ i"II r'l"i::;'l:::!l. L.. I:::' i.,~ ?.r,.,,... F)i:;.i::'"fi...i :':: 'HE rl'i'i'.,l?i,i!..ij'q i)h:.l-..'i~.i l ii:: "::"::~--q:::~ .....................- ....... .., ........... ~.;'!iqi":, '!-]..ii;:' i:;:il'*i'i"~'l"ii"i J'"~i::: 'i'Hi: w'-,;::j,..,,;:::'T 'ii:.,i :'ii'.,i i'"i:::Zl:::.i · ~'"' ::"7 '"~ ~i i* ~i' ~:?, ii::: i ;), .c;:::;; !i.::::' I;::;:" '"]~' 'il" ii]]:]: '"ii'" IF:ii ?:",,~i i~-::: ?};; TM ...... "'" ................ "" ' .......... ~,.-,~. ~: :: .......... i~ ........ . .... .... .,. ;:;~}:.~'. E:~: ::~: .... ~.~'~ ......"' -;:::: I~ ..:;~ ii-"i~ IL... II....... s.....~ Ii "4~ PLAYER V NTUF S CONSULTING GEOLOGIST [3OX 476-~4, STAR ROUTE A ' ANCHORAGE, ALASKA 99507 · pHONE 344-Y071 Location SOILS LOG Soil Type Water Level 16 18 Goo 2O Total Depth of Excavation Groundwat er ot Reached Depth, if Reached__ Classification Method ~isual ( ) Sieve Analysis () Remarks Material at Total Depth Bedrock Not Reached Depth, if Reache~ Gary F. Player, Consulting' Geologist WATER WELL LOG FOSS DRILLING 1336 Ingra Street MUNICIPALITY OF AI.,ICHOR,:',G2 DEPT. OF HEALIH & ENVIRONMENTAL pROI'FzqT[tO;'4 SEt' o SIZE OF CA~ING ~ # DEPTH OF HOLE ~ ~ ~, CASED TO ? ~. STATIC WATER LEVEL ~ ~ FT, YIELD ~ ~GAL,PER,MIN. WITH FT, FEET OF DRAWDOWN. REMARKS DATE COMPLETED~--/~- PUMP TO BE SET AT Z)_to/ /Pto _ f /~.~t 0__~2__~ ___to ___to to__ ___to ___to ___to __to to____ ___to ___~o to__ ___~o to to to__ 017 3 ,2 20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~..J (~-~)3 ~q OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date ?'-'~ GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description {include lot, block, subdivision, section, township, range) ,Eo~tioh4address'o~:directions) Telephone: Home '~,~ ,Mai r)g,Addre~s. : ~'~ ._'~f'b''~ ~ (c~..Le'r~d ng. nst talon -,~ '" ' / (d) R~ai Est~[d;~o~Pa3Y and Agent Address ~ ~ ~¢ Telephone ~7~ -~7~ / 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. TYPE OF RESIDENCE Single-[am,v Number of Bedrooms WATER SUPPLY Individual Well~[ Community [] Public [] Note: If comm unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite'J~ 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 fRev 8/86~ Front ')~JOM s,Jeeu!eue leUO!SSejOJd eql u! suo!ss!buo Jo sJoJJe JOj elq!SuOdSeJ lou s! eSeJoqouv jo Aj!led!o!un~ eqj. 'penss! s! eleo!j!peo e eJoleq ejep eZXleUe Jo suo!joedsu! ~onpuoo ~ou op SHHC] ~o see,~OldUJ3 'siueLuej!nbeJ e~eis pub leJepel u!e~Jeo/qs!les ol JepJo u! suo!inj!~su! 6u!puel J!eql pue seu~oq jo sJeseqoJnd o~ XselJnoo e se s!qi seop SI-IH(] aq.L 'e>iSelV jo a~eiS eqi u! peJels!beJ J@eu!Sue leUO!SSejoJd juepuedepu! ue/,q eAoqB ~ qdeJl~Jed u! ueA!6 suo!je~ueseJdeJ eq], uodn ~lUO peseq seieo!~!peo le^oJddv Xlpoqlnv qlleeH senss! (SI-INa) seo!^JeS uetunH pue qlleeH ~o lueuJpedeQ e6eJoqouv jo /,j!led!o!unlAI eqJ. NOI/FIVO - le^oJddv leuo!l[puoo ~o suJJ@l leUO!]lpuoo pe^oJdd~s!C] ~ pe^oJddv WELL DATA · ~.~i~;I~t~ALITY OF ANCHORAGE (MOA) ," ~i~ '- 9 1'"9~)B 264-4720 R¢C[~ ¢¢ Legal Description: ~/~ Well Classification Well Log Present,N) ,, Total Depth · '~' Cased to Static Water Level "~ ~ · Casing Height Above Ground Wiring in Conduit ~N) Electrical Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot Cleanout/Manhole To Nearest Public Sewer Line Water Sample Collected by Water Sample Test Results Comments ~:~/?/1'//¢¢'¢" If A, B, C, D.E.C. Approved (Y/N) Date Completed ~:',~/¢7. ~¢ 7 Yield '~'" Depth of Grouting Pump Set At / ~' Sanitary Seal on Casing~N) Depression Around Wellhead (Y~) ! ,/~ ¢" ; On Adjoining Lots /crc) /¢' ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot '~ //~'/~¢"A'/ ; Date ¢~'-Z~,'(¢~ B. SEPTIC/HOLDING TANK DATA Size / ~'~"'~ No. of Compartments ~ ....... ,~on Cleanout (Y(~) Date L~L.Pu~_~j~.e.~d _. ~ ~/~/ ,'for Temporary Holding Tank Permit (Y/N) Date Installed Standpipes ON) Air-tight Caps Depression over Tank (Y(~ Pumping/Maintenance Contract on File (Y/N) / Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream. Pond. Lake, or Major Drainage Comments Page 1 Of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot /J/~¢ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ~,~! '* Depth of Field 9 · Gravel Bed Thickness ~' ! Standpipes Present,N) Date of Last Adequacy Test To Property Line /¢ To Existing or Abandoned System on ; On Adjoining Lots ¢/~ ~"~' To Cutbank (if ~resent) ,~/~4 Comments D. LIFT STATION Size in Gallo-'t'~..-~ "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)  e.s during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h~d, v~rif~ied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company '~'~"~-~"~ MOA No. Rece,pt No. Date of Payment Amount:$ ~/ 7°00 Page 2 of 2 72-026 (11/84) CHEMICA '°~""~ L & GEOLOGICAL LABORATORIES OF ALASKA, INC.~,~ ~ FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE £o~ ?~ozk O'rd.e~: ~ 6039 Date Repo~t Pz~nte~: SE? 2 88 ~ 1.5:37 Client Sample IU:Li3, PWSID :UA Collected AUG 26 88 Received ~UG 26 88 ~ 14:00 P~eserved with :4 DEG. C Client Nome : AECS Client kect : AKECSRP ?.0.$ llOilg ~EC'D Ordered By : A. WEIN lnsly~l~ Completed :AUG 26 88 Send geporta to: t)~cs !nst~uct: Chm~ab lei g: 2387 Lab Smpl ID: 1 Matrix: ¥~ATER Allowable Paramete~ Tested Result/Units Method Limits I~ITRATE-~ 1.6 mS/1 EPA 353.2 Sample ROUTINE BA[~PI, E Remarks: SAt,fPLE COLLECTED BY A. WEIN. Tests ?er£or~aed " See Special Inat):uctions Above UA*Unavailable None Detected '* See Sample Rema×k~ ~bove }lot Analyzed l,T-Lese Than, OT~Gzeator ~han 6A~I'E RECEIVED INSP,£CTION APPOINTMENTS ~: TIME TIME TIME DATE DATE DATE MUNICIPALITY OF ANCHORAGE ~UNICIPALI~ OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPt. OF H~ALTH  825 L - Anchorage, ENvIROnMENTAL P2OTECTION Street Alaska 995O1 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 o. DIRECTIONS: Complete all parts on page 1. Incomplete requests will n'ot be processed, Please allow ten (10) days for processing. I PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) ~ PHONE 2, BUYER PHONE 3. LENDIN%INSTITUTIO~ k~J'~'t~ ~ CU~LS ~ PHONE MAILING ADDRESS PHONE I MAI LInG ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE [~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OFtBEDROOMS [] One I-~ Four [] Two [] Five [~ Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY *ATTACH WELL LOG. Awell log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.). 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE E~] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [~] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED ~.t/.g._ ?/~.~ p.~.~ 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER / []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Conllection Verified INSTALLER [~]Septic Tank or [] Holding Tank Size: /'~.5~.) __ If Tank is homemade SOILS HATING TYPE OF TANK MANUFACTURER TOTAL ABSORPT~N AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [~;]~'~PP ROV ED FOR L~' BEDROOMS [] CON DITI ONAL APPROVAL (letter must accomp/~t~y--c~ertificate) [] DISAPPROVED 72-010 (Rev. 6/79) ALASKA [1UIROnm r TAL CONTROL $ RUIC S, Inc. I~Mineering f.- I~nuirenmental Studies N E: OF A L.Z L-,I-i ~ .::, 301 W NOR'I"HfERN ~ '~"' ANCHORAGE AK 99',503 4.- 13"-81 ~UN1CIPAUTY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL F;~oTECTION APR 1 7 RECEIVED SELLER - LYNN BURNS SUDD~ZV:ZS]EON--MCMAHON ~:2 E:LOCK-9 LOT-13 THE TYI::'EE OF' ABSORF'T~ON SYSTEM ~S A ]"RIENCH N~TH AN AREA OF 255 SQF'T. TI"lIESYSTEM ~S CAPAEJLE OF' ACCEPTING 600 GALLONS OF' NATER PIER I)AY~ THE SOZL.S RA"C:ENG OF TFIE SYSTEM AT COi~STRUCTZON NAS 85 AND NON ~S 64 SQi::'T/ BEDROOM, BASED UPON THE: TEST DATA THE: SYSTEM ZS ACCEPTADL. E FOR A 4 BEDROOM I-IOME:, THE SEt::'T:[C T~NK NAS PUMPED ON 9'-80 · C. Reid, 1220 LUest 25th Auenu¢ · Anchorage, Alaska 99503 · (907) 276-1361 #1: Time Date Insp ~'"~4UNICIPALITY OF ANCHOR,.. ~,1 DEPARTMENi 3F HEALTH AND ENVIRON~IEF"rf ,'PROTECTION 825 L Street, Anchorane. Alaska 99501 9:30 a.m. ~2: 12-7-77 Wednesday Pratt 264-4720 Date Received: Time Date Insp December 5, 1977 #3: Time Date insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska Pacific Bank Mailing Address: 601 West 5th Avenue 99501 Phone~ 276-3110 2o Property Owner: C.E. Jackson/Mountain Enterprise~hone: 349-5200 Mailing Address: Star Route A Box 1582N 99507 3. Legal Description: Lot 13 Block 9 Mc Mahon Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Four Number of Bedrooms: Well System: Perrai% # Construction Individual Well (x) Co~mnunl~/Puo .ic System ( ) Depth of Well [ 9.7'_ 2 Well Log on Pile 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 S~ptic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Pqge Two ....... Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 13 Block 9 Mc Mahon Subdivision Co~ents: Affadavit Attached: /~) Disapproved: Letter Attached: ( ) Date: Date: Department Worksheet: ,UNICIPALITY OF ANCHORAGE Protection Department of Health and Environmental '995 825 L Street, Anchorage, Alaska 264-4720 ~equest for Approval of Individual Sewer and Water Facilities Property Owner: ~_~,-~/~/~9A.J Mailing Address: __~ ~ [~,~2_ /~ 2. Name of Buyer: Mailing Address: Phone: Lending Institution: ..~.~'?~'//_ Mailing Address: Phone Realtor/Agent: Mailing Address: Phone: 5. Legal Description:~ Street Location: e Single Family Residence: (~' Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: o Water Supply: *Individual Well (/ Public/Community System If Individual Well, well depth ~7 If Con, unity System, name of system ( ) Sewage Disposal System: *'~©n-site System (/ Public System ( ) If On-site System, date of installation: 7~/---~ / *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