HomeMy WebLinkAboutMCMAHON #2 BLK 10 LT 4McMahon #2
Block 10
Lot 4
#017-362-27
Municipality of Anchorage
Development Services Department ry:
Building Safety Divison
On-Site water and Wastewater Program. 4700 Elmore Road
P.O. Box 196650 Anchorage. AK 99507 Page' 05
wwwcLantxorage ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWD80162 PID Number. 017362.27
Rob & Malinda Kingsley
Wastewater System: ❑ New ❑ Upgrade
�en.aa
3701 Leyden, Anchorage
ABSORPTION FIELD
Prb"• Na of 9aaeony
4
O DW Trwn O Sn Tlwn O Bea O Mann O oeyr
LEGAL
LEGAL DESCRIPTION
ter"° °
Toa DM eom ongm papa
LOX
x`10 aaan+aat McMahon#2
GPnrFt�
DaMwpveOaMn *g.W fr a
FI.
Gnw eewbamote, pps
Townaip Rage Saint
Fl.
Fa aurae Mba aprW O•ea
Fl
Gaal Laegm
FI.
FI.
Well: ❑New ❑ Upgrade
Nn dlya GwabaeMweal lnr
GNaM1aeon (Pana+, A, 9. Cl T" own b
Fl.
Taal awapoon odea
Pey Mawr
Fl. Ft
Fe
ASTM D3034 / F810
or'•a
My Dm
st a wra Lava
MIaIIa
pay kowsw
FL
A• Home Services
8111/09
Tyle
a sal
pl a
wiy
CWV a Moa cane
GPM
Fl.
FL
TANK
SEPARATION DISTANCES
EI Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
LM
Holding
tibiwPnVat!
iq -
y
Fran
Tank
Field
Station
Tank
sower Lkw
Anchorage Tank 8 Welding. Inc.
1250 Gr
v M
100.1
103
NA
NA
77"
Maww
steel
twepr a Conwaanaeaa
2
aw.awMM
100•.
100'•
NA
NA
LIFT STATION
La uoa
43
5
NA
NA
G.I
Fai°'0p`
24
23
NA
NA
•MpYn YwlM
•{jnv ory al
Ho~Moena
in
o
b
C M D—
NA
NA
NA
NA
FueV Maw { 4aaM
Ewmal ImPa It rk a eT
It n
Installed new tank and connected 1977 drainfleld. Installed a
BENCH MARK
diverter valve. Installed a monitoring tube In the 1977 field.
twoon ane D•ruvaen
garage floor
awn
100.40 Ft
Inspections performed by: CindyEn
W. Ellis, P.E. Dates: 1' 8111/08
Inaera Stamp
..
n
2
1
Development Services Department Approval4
,. •
a 49 Ttt *"
Conditional Approval Date:
Y
` .........
IN W. EuJIs
CE - 10571
Reviewed and approved by:ate:
'p` ....08: ••�
•
r
t�
`M, aaulaaJ t'
WELL 100 j
E —
I
I
1
1
mea I
Well radius was staked
prior to construction /
B
A
FC
PT" �
DECK
r _ ASPHALT
DRIVEWAY
I GRAVEL
I PARKINGAREA
L_
LEYDEN ROAD
AS -BUILT
McMahon #2 Blk 10 Lot 4
Record Drawing of Septic Upgrade
Rob & Malinda Kingsley
Parcel ID; 017-362-27
Permit No. SWO80162
Cindy W. Ellis, RE
August 13, 2008
Scale 1 inch - 30 ft
A
T201 T1
nv
GREEN
HOUSE
A
B
FCO
28.0
17.8
STI
28.6
29.7
ST2
31.8
36.9
DCO
33.5
39.4
DV
34.4
40.6
C01
40.7
39.9
MTI 1
45.4
44.6
T201 T1
nv
GREEN
HOUSE
Watkins Engineering, Inc.
P.O. Box 110443
Anchorage, Alaska 99511-0443
Phone: (907) 349-1851, Fax (907) 349-1934
OFA t_O`�4
•.........el p0➢
<`? 49 TH "
;ZvW
CIVDY W.••ELLIS
"- CE - 10577
...3'Q.... °oG
A
B
CO2
19.4
37.0
MT2
20.1
36.2
CO3
55.6
73.5
Sump
98.7
100.5
Watkins Engineering, Inc.
P.O. Box 110443
Anchorage, Alaska 99511-0443
Phone: (907) 349-1851, Fax (907) 349-1934
OFA t_O`�4
•.........el p0➢
<`? 49 TH "
;ZvW
CIVDY W.••ELLIS
"- CE - 10577
...3'Q.... °oG
FINAL GRADE
FCOSTI 100.40 ST2 DCO
95.17
91.51 1250 GALLON
STEEL SEPTIC TANK 91.41
N.T.S.
To Diverler Valve &
Existing Drainfields
Invert of pipe for 1988 field 94.20
Invert of pipe for 1977 field 94.14
AS -BUILT
McMahon #2 Blk 10 Lot 4
ry�0000p4p
OF
Record Drawing of Septic Upgrade
�' A�
�0 •........ t
S'00
Rob & Malinda Kingsley
Parcel ID: 017-362-27
Watkins Engineering, Inc°;?
� OD
49iH�a� `9 D
Permit No. SW080162
p................................
G p
DDp'; `• 01 cL-"1057L7L'S . GO
0 •- 'S'13-GlS..•'o:��
�C
Cindy W. Ellis, P.E. P.O. Box 110443
August 13,
g 2008
Anchorage, Alaska 99511-0443
•-.,
No Scale
Phone: (907) 349-1851, Fax: (907) 349-1934
MUNICIPALITY OF ANCHORAGE
Development Services Department C I
On -Site Water 8 Wastewater Program
4700 South Bragaw Street 0
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Aug 11, 2008
Expiration Date: Aug 11, 2009
Permit Number: SW080162 Parcel ID: 017-362-27
Legal Description: MCMAHON #2 BLK 10 LT 4
Design Engineer: 0844 WATKINS ENGINEERING Site Address: 003701 LEYDEN RD
Owner Name: ROB & MALINDA KINGSLEY Lot Size: 37852 SQ. FT.
Owner Address: 3701 LEYDEN RD Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE. AK 99516 -
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 Date: 4 ) U
Issued By Date: 1 / Q
Municipality of Anchorage
( rr**002:~� Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519.6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 017-362-27
Property owner(s) Rob & Malinda Kingsley Day phone
Mailing address 3701 Leyden, Anchorage Zip Code 99516
Site address same Zip Code
Legal description (Sub'd., Block & Lot) McMahon #2 Blk 10 Lot 4
Legal description (Township, Range & Section)
Lot Size 37.852 Sq. Ft. Number of Bedrooms 4
THIS APPLICATION IS FOR (® all that apply):
Absorption Field
❑
Septic Tank
Q
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
THIS APPLICATION IS AN:
Initial
Upgrade
Renewal
ZD
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 property
Permit/Rush Fees:
Date of Payment: 8
wot�. jP.E
authorized agent)
Waiver Fees:
Date of Payment:
Receipt Number. Receipt Number.
(Rev. I IM5l
Watkins Engineering, Inc.
RO Box 110443, Anchorage, AK 99511
(907)349-1851 cwellis@gcLnet
August 6, 2008
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
RE: McMahon #2 S/D, Bilk 10 Lot 4
Proposed Septic Tank Replacement and
Reconnect Old Drainfield
To Whom It May Concern:
Attached please find an application to install a new 1250 gallon steel septic tank and to
reconnect the old drainfield at the referenced 4 bedroom house in Anchorage. The
house is proposed to be sold, and the existing drainfield is surcharged. The tank was
installed in 1977, and it is proposed to install a new tank due to its age.
The original drainfield was installed in 1977 and consisted of a 61 ft long x 3 ft wide
deep trench, with 5 ft of effective depth. The original sump is still in place at the end of
the field. An adequacy test was performed on August 5, 2008, and it passed for 4
bedrooms. The second drainfield, installed in 1988, was designed for only 3 bedrooms.
It is being retained for future use, and a diverter valve will be installed. In order to
qualify for a 4 bedroom COSA, the 1977 field must be tested in the future. After the
1988 field rejuvenates in about 3 years, the fields should be alternated annually.
There are no private wells within 100 ft of the septic system and there are no slope or
surface water concerns. I do not believe that this work will have any adverse affect on
any adjacent properties' water and wastewater needs.
Thank you for consideration of this permit application. If you have any questions or
need further information, please call me at 349-1851.
Sincerely,
(,6lZtt!G l/'
Cindy dEllis, P.E.
President
BLOCK 7
3
16/
septic \ `. \ 5 OGS 9
/ area 15
,Sr septic.\ septic
�RFFT area area
\ /
WE
14
2 i I WELL /\
3
/ septic x 13 \ 8
3 ` area \ /O \ �.t . WELL
G� 12
Z`'O / S/ppe ` WELL I
0 WELL\ J
\\ /
I WELL.
5 4
3701 \ \ \\
/LEYDEN DRIVE
PROPOSED SEPTIC
EXISTING HOUSE DRAINFIELD
EXISTING.SEPTIC \ TO BE RECONNECTED
SYSTEM
PROPOSED
THERE ARE NO SLOPE CONCERNS SEPTIC TANK
SOUTH ANCHORAGE HIGH SCHOOL
to south - served by AW WU water & sewer
McMahon #2 Blk 10 Lot 4 00000a
Site Plan for Septic UpgradeWatkins Engineering, Inch OF,q�
Malinda & Robert Kingsley 'V o4f
Parcel ID:017-362-27 0, e : 49 THW
P.O. Box 110443 'e" '•: c yl
Cindy W. Ellis, P.E.0•; •. e -
August 6, 2008 Anchorage, AK 99511-0443 �� •,''$..-(,
Scale: l' =100' Phone: (907) 349-1851 Fax: (907) 349-1934
3701 Leyden
S 89°5749" E
LEYDEN DRIVE
McMahon #2 Blk 10 Lot 4
Proposed Septic System Change
Malinda & Robert Kingsley
Parcel ID: 017-362-27
Cindy W. Ellis, P.E.
August 6, 2008
Scale:1* - 30'
Watkins Engineering, Inc.
P.O. Box 110443
Anchorage, Alaska 99511-0443
Phone: (907) 349-1851, Fax (907) 349-1934
Note: Based upon a survey
by Kenneth L Dreyer, LS -8202
May 14, 1993
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name \\ DISTANCES
�To TO SEPTIC ABSORPTION
Address FROM TANK FIELD WELL
o/ WELL fill r
PhoPermit No. No. of Bedrooms
- is -0j 1 LOT LINE
LEGAL DESCRIPTION
Lot Block /O Subdivision 1
� ds FOUNDATION
Township, Range, Section
AS-BUILTDI,
dtj 5g-&yG6' driveway, water
TANKS
❑ SEPTIC ❑ HOLDING
Manufacturer Capacity in gallons
Material No. of Compartments
TYPE OF SYSTEM
TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER
Depth to pipe bottom from Total depth from original grade
original grade
FT d FT
Fill added above original grade Gravel depth beneath pipe
FT FT
Gravel length Gravel width
FT � FT
Total absorption area Distance between lines
7® SQ FT FT
Number of lines Soil rating Pipe material
SQ FT ff �/d
Installer ?2AK I I� Date Installed j
I../ ,i 62S / 1
jfP JO WELLS
PRIVATE ❑ OTHER (Identifv)
Classification (A,B,C) Total Depth Cased to
FT FT
Installer Date Installed:
REMARKS:
3 ftyLr 06f,
Municipal and State guidelines in ellect on this date:
Health Department Approval' &?rn
)13(3/85)
location of well, septic system, property lines, foundation,
u mpcuwuo r y
Date: �✓ `r _
that this inspection was perlormed according to all
Date:of d -46 6A
ENGINEER'S SEAL
` MUNICIPALITY OF ANCHORAGE
Department o� Health & Human SePvices
825 L Street, Anchorage, Alaska 99501 343~4720
ON~SITE SEWER PERMIT
Permit Number: 880199 Upgrade
Date Issu�d: 09/21/88 Engineer Desig�ed
�wner Name: JOHN HARRINGTON Day PhoOe:
Owner Address: J701 LLI: YDON 4443
ANCHORAGE, Al::' 99516
Parcel id:
017~362�27
1v250 gallons"
��'�
tank must have at least 2 compartments.
Subdivision:
MC MAHON
Lot: 4 Block:
over tank(s)"
Section: 28
Township:
12N Range: 3W
Lot Size
37852 (sq"[L.
or acres)
Max Bedrooms:
This Permit:
3 Total
Capacity: 4
SEPTIC TANK: Minimum total septic tank
capacity:
1v250 gallons"
Each septic
tank must have at least 2 compartments.
Depth to
top t --)r septic
tank(s) < 4"0
over tank(s)"
NFRM , T & 2ND INGP�CTIONSB� LUNEERFIDHS` Q
343~4681 AND LEAVE A MESSAGE.
C�N�lKUCT PER ENGINEERS ATTACHED ON
}8lb PERMI7 VALID FOR A SINGLE FAMILY RESI1,11E1\11.."E ONLY
l GF: KTf. 1 |1 AT:
1 1 am �amiliar with trequirements for on~site sewers and wells �s set
;orth by the Municipality oI Anchora e (MOA) and the State o[ Alaska.
2" I will install the system in accordance with all MOA codes �nd regulations,
aod in compliance with the design criteria of this perroit,
ere to all MOA �nd State o� Alaska requirements �or the set back
distances [rom any existing well, wastewater disposal system or public
sewerage system on thjs or any adjacent or nearby lot"
4" I onderstand that this permit is valid for a maximum o{ 3 bedraoms. I
also understand that the capacity o{ the total system is 4 bedrooms and
any enla dditional permit"
~~�^~_... .... .... ..~~.... -~~~'-~-
(Own�r} JOHN HARRlNGTON
By: DATE:
~���~~~�����~��-~__� ^~�_�_�~_~_~~�~
Municipality of Anchorage
K Department of Health and Human Services t1h5
825 "L" Street
Tom Fink,
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
September 22, 1988
Lee Reid, P.E.
Alaska Environmental Control
Services, Inc.
1412 West 33 Avenue
Anchorage, Alaska 99503
Subject: Waiver Request for Lot 4 Block 10 Mc Mahon Subdivision #2
Waiver Request #WR88-058, Permit # 880199
Dear Mr. Reid:
Your request for waiver of the required 100 foot separation of
a septic system to a private well has.been approved. The
approved separation distance is 96 feet.
This waiver approval applies to the existing septic system to
well separation only. Any future upgrade to either will
require all separation distances be met or another approval
from this department.
Sincerely,
&li- 49�
Daniel J. Roth
Civil Engineer
On-site Services
DJR/ljw#6
ALASKA i FIUIROI meFI'TAL CORTROL SeRUlCeS,
~nqi~eerinq ~.. ('."nuironmenlal Studies
September 13, 1988
Municipality of Anchorage
Department of Health and Human Services
825 L Street
Anchorage, AK. 99501
Attn: Dan Roth
Re: Lot 4, Block 10, McMahon Subdivision
Dear Dan:
In 1977 when the original system was installed the distance from the well to the
septic tank was.reported to be 100 feet. lChile doing the Health Authority the
distance was determined to be 97.5 feet well edge to standpipe.
A recent soil test, attached, shows no water to 14 feet below ground level. The
septic tank, when installed should have had caulder type couplings on the inlet
and outlet of the tank. It would be water tight.
If the tank integrity is still maintained then the danger of a health hazard is
minimal if the well-septic tank separation distance were.waived from 100 to 96
feet.
Therefore, I request that a waiver of distance be granted from 100 feet to 96
feet for the distance between the well and the septic tank.
Sincerely,
Leroy C. Reid Jr., PhD, PE
President
1200 UJest 33rd ,quenue. Suite E~ * Anchoraqe./~laslca 99503-(907} 561-5040
ALASKA ellUlROIlmerlT^L COI1TROL SeRUlCe$, II1C.
SPECIFICATIONS FOR A TRENCH-TYPE ~'ASTEWATER DISPOSAL SYSTEM -
MCMAHON SUBDIVISION, BLOCK 10, LOT 4
1.0 GENERAL
1.1 The'drawings, sheets I through 6, shall be a part of this
specification.
1.2 All materials'and workmanship shall meet the requirements of
the Municipality of Anchorage, Department of Health &'Human
Services (DHHS), the conditions of the permit, and all applicable
rules and regulations currently in effect.
1.3 All elevations and depths are advisor~, and are to be verified
or modified in the field by the engineer or inspecting agency.
1.4
1.5
It is the responsibility of the owner or installer to adhere to
approved designs for installation, maintain the specified separation
distances, and have the appropriate inspections.
If the installation is not inspected by an AECS engineer, AECS will''
not be responsible for the.installed system. An engineer at AECS
should be consulted prior to construction to determine the number of
inspections that will be required and to explain what these
inspections will involve.
2.0 SEPTIC TANK
2.1
2;2
If there is an existing septic tank, it may be used if it meets the
capacity requirement for the residence and tile approval of tile MOA.-
The septic tank shall'be a UPC-Approved two-compartment tank,
constructed of 12-gauge steel with bitumastic coating and set
level on undisturbed soil. If the tank is buried at a depth of 4
feet or less, it must be insulated with an overlying layer of 2 inch
burial type polystrene rigid board insulation.
2.3
The septic tank and trench shall be a minimum of 100 feet from any
private well or body of water, 150 feet from Class C wells, and 200
feet from Class A or B wells, unless otherwise specified. Less than
the required separation distance must have prior approval or waiver
by ADEC or MOA.
2.4 The septic tank shall be a minimum of 5 feet from the house
foundation, and a minimum of 5 feet from the absorption area.
2.5 Piping shall be fitted with a mechanical watertight calder coupling
on the outlet and inlet of the septic tank. Piping shall be 4-inch
solid PVC ASTM D3034 or cast iron, sloped a minimum of 1/4 in6h per
lineal foot. If the piping is buried at a depth of 4 feet or less,
1200 [Uesl 33rd Auenue. Suite B · Ancl~oraqe. Alasl~a 99503 .[907) 561-5040
it must be inSulated with an overlying layer of 2 inch burial type
polystrene rigid board insulation.
2.6
Cleanouts shall be installed as designated and capped with air-tight
rain caps (Jim caps or equivalent), and extended a minimum of 1 foot
above ground level.
3.0 Absorption Area
8.1
The gravel for the trench shall be 0.5 to 2.5 inch, screened rock
with less than 3% passing #200 sieve residual. All substitutes must
have prior DItHS approval.
3.2
The bottom and sides of the excavation shall be raked with the
backhoe blade to insure that it has not been compacted during
excavation. The bottom elevation shall be level.
3.3
3.4
Monitor standpipe(s) shall be placed as shown in the drawings, and
shall be 4 inch rigid PVC ASTM D3034, or cast iron. The section
shown with holes may be 0.5 inch holes drilled on 6-inch centers on
opposing sides of the pipe, or a regular section of perforated sewer
pipe clamped to a solid section with either a no hub coupling or
a solvent joint. A rubber rain cap (Jim cap or equivalent) shall be
installed over the top of the pipe.
The distribution pipe 'shall be perforated 4 inch rigid PVC wlth a
minimum crush strength of 1500 lbs and shall meet the approval of
DHHS for use as drainfield pipe. Ail distribution pipes shall be
laid level.
3.5
Trenches may be paralleled, but must have a minimum separation
distance between the trenches of 10 feet or 2 times the gravel depth
(whichever is greater). 75 feet is the maximum allowed linear length
of any trench.
3.6
3.7
If the final grade over the trench is less than 4 feet above gravel,
insulation is required, using burial type polystyrene rigid board
insulation. There shall be 1 inch of insulation for every foot of
soil less than the required 4 feet of cover, but there must be at
least 24 inches of soil cover even though insulation is used. The
solid pipe extending from the septic tank to the drainfield shall
also have 4 feet of cover or an equivalent layer of insulation to
prevent freezing of the line.
If insulation is not necessary, the gravel shall be covered with a
layer of nonwoven Geotextile fabric (such as Mirafai, Fibretex 200
grade, Poly Filter X or equivalent).
4.0 INSPECTIONS
4.1 A minimum of two inspections are required for the installation of the
trench. The first inspection will be of the open excavation to
assure that the system is installed in the proper soil strata,
correct depth and meet minimum specified design parameters.
4.2 The second inspection will be after placement of the gravel, monitor
standpipe and distribution pipe to verify proper installation and
position prior to backfill.
4.3 ~The inspection of the septic tank installation can be incorporated
with any one of the above listed inspections.
L:JJ
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
(ENGINEER'S SEAL)
PERFORMED FOR: -T// �L1-��- /5'O '' ?'-31-e? PERFORMED:
LEGAL DESCRIPTION: "Ty/ �'� /U He f1,4 /Trl Township, Range, Section: may.✓ 'e3'j 56- C I �
DEPTH �-r SLOPE SITE PLAN
1 j QL
2-
3
3
4
5
5/LT✓
d �C�7/ea%rtt �c ^K
S GFAvSu/ iP.iJ)
7
8
jj
O P(s`I ?7rr1,'Lr CK
to-
0
12
12 -
13
13
Eli
15
-7-W
16-
17
18
19
20
Yx
WAS GROUND WATER %
ENCOUNTERED? fit/
S
IF YES, AT WHAT L
O
DEPTH? P
E --
Depth to Water After k / % 8
Monitoring? Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
COMMENTS /
PERFORMEDBY: / %^� I ` CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /
72-GO8 (Rev. 4/85)
jY m
a 17 A4'CNEER'S SEAL)
Oesa•e.7 '9
Municipality of Anchorage O y%0 ( `•�1r
DEPARTMENT,OF HEALTH & HUMAN SERVICES••• •••••••••• os• •.• 8
825 "L" Street, Anchorage, Alaska 99502-0650 •� •,• 0.�
SOILS LOG — PERCOLATION TEST .A tR C, REID, JR- ;
•; --2251
7t ,/ J �7�fD6••••000••••4� r
PERFORMED FOR:X
. E 7/ 1kt�J2 — sIHPs� �" - DAT
LEGAL DESCRIPTION: 1-07- ?/ /0 11�[ /(14,4v / Township, Range, Section:
DEPTH PT
1 pL
2e-
.�•,�,,
3 '
S ) 1 51t-rl '5M
12
13
14
E>J yj
15 -r4 41
16-
17-
18-
191
6171819
20
)tjL
$tL�
S°a'
6RAt/Err� If}13
SLOPE
WAS GROUND WATER /
ENCOUNTERED? O
S
IF YES, AT WHAT L
O
DEPTH? p
E
Depth to Water After
Monitoring? Date:
SITE PLAN
/' r-,
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
COMMENTS SO'L- ,�R�)' � /SO ��2 `7 %7�'�i�76 /O/O .
PERFORMED BY: 14F --e t%EJ I - v' �'-- CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ' GCro-
72-008 (Rev. 4/85)
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite 8
ANCHORAGE, ALASKA 99503
(907) 561.5040
joB,eo7- e/ '5zom le) Pe
SHEET NO. OF
CALCULATED BY DATE
CHECKED BY DATE
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LEGEND
19 Brot• Cop Monument
o Iron Pipe
• Steel Pin
o Survey Hub a Tock 'r
I hereby ceitify that a survey of Lot r Block
Subdivision was made on :I'in e and *-,A,
that th t 't d th h' ther rt lines Z' C7
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a e �mprovemen s si uate ereon are wit n pope y
and do not overlap or encroach on the property lying adjacent thereto,
a - -6.
*rostill, /4 : * TJ
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that no Improvements on property lying adjacent thereto encroach on
the premiss in question and that there are no roadways, transmission...°
...,
lines or other visible casements on said property except as indicated
100
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Dated at Anchorage, Alaska, this f l day of .1rJ &,l Fti F
CONSTRUCTING ENGINEERS
SRA Box 60, Anchorage, Alaska 99507
1440817 344.7960
ALASKA ENVIRONMENTAL JOB X07 Bzx
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B SHEET NO. OF
ANCHORAGE, ALASKA 99503 CALCULATED BY 14' DATE
(907) 561-5040
CHECKED BY DATE
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s� GREk , �R ANCHORAGE AREA BON _JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME�j2_gir�l
MAILING ADDRESS 9z"
e_C'0
p/�AOL-
PHONE
LOCATION C7tT/
LEGAL DESCRIPTION
T
/Sl�S
/0A
1;41 ` /0w
SEPTIC TANK:
DISTANCE % / NUMBER OF
FROM WELL /� MANUFACTURER —MATERIAL}� COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY/ SOGALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL 00 / TOTAL LENGTH
FOUNDATION�NEAREST LOT LINE r
.
"TRENCH
OF LINES
NUMBER OF LINESDISTANCE BETWEEN LINES yC_�L�TRENCH WIDTH,%�IN. TOTAL EFFECTIVE
ABSORPTION AREA 60/SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER ?
DEPTH: TOP OF TILE TO FINISH GRADE G� MATERIAL BENEATH TILE 4f�ABOVE TILE _YIN.
LVJANR
TYP64kq�CONSTRUCTION DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION LOT LINE , SEWER LINE , TANK , SYSTEM
CESSPOOL , OTHER SOURCES
APPROVED DISAPPROVED REMARKS —
DISTANCES: DIAGRAM OF SYSTEM
INSTALLED BY:
INS D Q
SEWER LINE DEPTH: � a3� 8`
PIPE MATERIAL:
LOT SLOPE:/ --/SPL
REMARKS: D _L//� �-�
DATEAPPROVED.
G.A.A.B.
Form EQ -032
low -
t 1 T 1 r T � ;41_TFH�r'it D Lel I !_ fgfl 1�9 aIt !nlam/-� 7
'=�'_F_� ''L'' =,�"I"FI'L'ET, t=tP+li':HI_'IF'i'ifiE=� H�' 'yy,S
279-2511
PERMIT NO. 77174 �
APPLICANT F:L14ARD HE1=ZOG 24.18 EAST 20TH AVE rr-..:•... f;
L_OCATlt:N LEYDEN DR. l
L.EGAL. L4 B10 11!_ MAHON _ UBD Lt]l- SIZE _''EWjC°i0 t._0 iF:E' FEE'K
'TYPE OF SOIL, HE `ORBTiON SYSTEM IS: TRENCH
riffir;It'IUN NUMBER OF BEDROOMS _- 4. SOIL- RATING <SQ i=T/BR:: :I_50
THE REQUIRED SIZE: OF THE: SOIL." ABSORPTION SY :TEt-I IS:
� _ a E_ G =` -�`S•—� = ��� _ .�=� � _ ' R"-.� ems �� �--➢ — �=�:� _�_ ®:.: � !I�' �-�¢ �R a �:=: �_ �:�a g= 6=° _H- y_ _q � :�: �-_�
THE LEtd(aTH I_: I felENS I _ N IS THE LENGTH (IN FEET) OF THE TRENCH OR 1-?F?A INF I EL_1).
THE. DEPTH OF Ft TRENCH OR F' I T IS 'THE DISTANCE BE WEEN 'THE: St_IRF'A(*-:E OF THE:
GROUND AND THE BOTTOM OF THE E,>;+_;H'• ATION i IN FEET).
THERE IS NO 'SET WIDTH FOR TRENCHES.
THE: GRAVEL DEPTH IS' THE MINIMUM DEPTH OF ialT'AVEI._ BETWEEN THE OUTFHI_.L.. L='IF`E.
AND THE BOTTOM OF THE: E}-;C:i=1'v'ATION !:IN FEET ?.
F;'" IE=_ B'D U -1 P?FE E -a "E° F-:--- F:° -F l C. 1 F:l %°-4 F! f f --mf E -1- e_-':: !-.--n 92H Ham! "F i_-.. L._ C-4
BA(..:KF I t_t_ I N 7 OF' ANY SYSTEM Id I TH jUT FINAL. It•dSPEC:TIis N AND HPPRO':+t=ll.._ BY THIS
DEPARTMENT WIL_.L. BE SUBJECT TO PROSECUTION.
t`1INIt'Ull DISTANCE BETWEEN H WELL I=ii'•D ANY ON—SITE SEWAGE DISPOC_'.t=il.... `-:k`.=TEM 1::
.1.0 0 FEET FOR A PRIVATE WEL.1- OR 200 F'E'ET FOR A PUBLIC: WEI._L.
WELL. L.0GS ARE REQUIRED Rt•,It? I, IU •T BE RETURNED Ti_! THE: DEPARTMENT' T' WITHII'd
OF THE:. WEL-L. C:C I IF'LET I ON.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE G'u`f=f I I_..ABL.E: Ti i INSURE PRO 'EI',:
T ta_ TAI—L.NT I ON.
.1 -€-' '�v5FA IL_ IF E _a P° � ® t" -1 E- °v" FE 9=1 F? !t._. k
I CERTIFY THAT
1: I Ftt'I FAM I L. I AR WITH THE REQU I REt'1ENTS FOR ON—SITE SEWERS FIND WEL.I._.=.' AS : E'T
Fl: RTH BY THE I'•1UNIC:IF'HL.ITY OF ANCHORAGE.
2: l: 1,;IL.L. INSTALL. THE SYSTEM IN ACCORDANCE WITH THE f.10DES.
I' UNDERSTANDTHAT THE ON --SITE SEWER lEL SYSTEM l E 11 I'1F1 s k'L!_ Ulf,"['.-" F_'tal_FtF'i:;E:t'1Etl T IF." THE.
RESIDENCE IS REMODELED TO INC:i_t_iDE: MORE. THAN 4. BEDROOMS--;.
1GNE:L::
APPL.I C AI` EtR ;;E -w ID
ISSUED BY-..-.,(
Dt tment of Health and Environmei. .'Protection
Anchorage, Alaska 99507
- Kna & . .7C/' Z
T
SOILS LO(. PERt)I,ATION TEST
Perforvu-,d for v to Ile rforri".i
Legal Ucscrihtiun: L4 _i3 i Q_ 2hd 1+70 w1_�ctnr}_r��al
This form reports: Soils log,_ ✓-_ - -�—_ Percolation test ---'------�4
Uel) th
Feet
02ic-5
2 S/k71J�7
't
5 -
fi -
^ i"j
S P
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f #ya -
r
1I -as ground water encountered?
,
_PJ® If ves, dt viiiat de,,tfi?
-- -- - --_ _.-.._---- .._. -
Iteadiny Date Gross Time r---------II6rC(IaLfoi
ime , Uepth to Nater (let Drop—
, -
rL
- - - -- --- rate minute.
Proposed i lis f"I 110 ion: cepa lc Pit Ora i n f i e l d
UupLIi of Inlet i)epth to Bottom of pi t or trend
COI TIL P1TS: -
y �or7sodc-'=�q -�J7 (ittifickl fay: '�(7 ��:-> )ate: ]/?✓°iio, (`f7
---- ---- --
10 Y
11 _
12 -
13
S P
�.
f #ya -
r
1I -as ground water encountered?
,
_PJ® If ves, dt viiiat de,,tfi?
-- -- - --_ _.-.._---- .._. -
Iteadiny Date Gross Time r---------II6rC(IaLfoi
ime , Uepth to Nater (let Drop—
, -
rL
- - - -- --- rate minute.
Proposed i lis f"I 110 ion: cepa lc Pit Ora i n f i e l d
UupLIi of Inlet i)epth to Bottom of pi t or trend
COI TIL P1TS: -
y �or7sodc-'=�q -�J7 (ittifickl fay: '�(7 ��:-> )ate: ]/?✓°iio, (`f7
---- ---- --
.gallons per hour.
·
Formation
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Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division /�
Onsite Water and Wastewater Program y/
4700 Bragaw Street V
P.O. Box 196650 h/
Anchorage. AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
017362.27
1. GENERAL INFORMATION
Complete legal description McMahon #2 Blk 10 Lot 4
Location (site address) 3701 Leyden, Anchorage
COSA # AMA"
Expiration Date: f F —/ 5� " D g
Current Property owner(s) Roe a Malinda Kingsley Day phone
Mailing address 3701 Leyden Rd., Anchorage, AK 99516
Lending agency Day phone
Mailing address
Real Estate Agent Becky Brewer/ Prudential Real Estate Day phone 301.4750
Mailing Address 3801 Centerpdnl Dr., Anchorage, AK 99503, suite 200
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well✓❑
Individual On-site❑
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 Onsite 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, 11frify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guid�i4s-fgr this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, fdr�pt 64173 adequate adequate
for the number of bedrooms and type of structure indicated herein. l further verify that based omtheIfonnation
obtained from the Municipality of Anchorage files and from my investigation and inspection, theloii-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 Finn Watkins Engineering, Inc.
Phone 907.349-1851
Address PO Box 110449, Anchorage, AK 99511-0443
Engineer's Printed Name Gndyw.Elis Date 9,-/3-08
49 n1
5. DSD SIGNATURE
J�Approved for ___�L bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: O Original Certificate Date:
(11" run)
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onshe
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: McMahon #2 Block 10 Lot 4 Parcel ID: 017-362-27
A. WELL DATA
Well type Pri If A. B, or C provide PWSID # _
Date completed 4/30/77 Sanitary seal (YM) Yes
Total depth 85 ft. Cased to 85 ft.
FROM WELL LOG
Date of test 4-30-1977
Static water level 66 ft.
Well production 12 9 -p.m -
WATER SAMPLE RESULTS:
Coliform 0 colon'Ies/100 mL Nitrate 2.80 mg/L
Arsenic: 0 mg/I
Date of sample: 700/08
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel Septic Tank
Tank size 1250 gal. Number of Compartments 2
Well Log (YM) Yes
Wires properly protected (Y/N) Yes
Casing height (above ground) 17 in.
AT INSPECTION
8-5-2008
56 ft.
7 g.p.m.
Other bacteria 0 colonies/100 mL
Collected by:, Rocky Trainor r Watkins Engr
Date Installed 8/11/2008
Cleanouts (Y/N) Yes
Foundation cleanout (YM) Yes Depression over tank (YM) No High water alarm (YM) N/A
Date of pumping NA -new Pumper
C. ABSORPTION FIELD DATA
Date installed 1977 Soil rating (g.p.d./ft2 or f?/bdrm)150 System type Deep Trench
Length 61 1L Width 3 ft. Gravel below pipe 5 ft.
Total depth 11 ft. Eft. absorption area 600 ft" MonRoring tube Yes Depression over field No
Date of adequacy test 8-52008 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added2676 gal i . New depth 52.25 in.
Elapsed Time: 270 min. Final fluid depth 39 in. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date
D. LIFT STATION
Date installed NA Size in gallons
'Pump on' level at _ in. 'Pump ofr level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100.1
Absorption field on lot 103'
Public sewer main 100'+
Manhole/Access (YIN)
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 1001+
Sewer /septic service line 77' Holding tank N/A
Animal containment areas 100'+ Manurelanimal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 24 Property line 43
Water main 100'+
Wells on adjacent tots 100'+
Water service line 25'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field 5'+
Surface water 100'+
Property line 17' Building foundation 23' Water main 100'+
Water Service line 67' Surface water 100'+ Driveway, parking/vehicle storage 46'
Curtain drain N/A Welts on adjacent lots 100'+
F. COMMENTS: Tested the 1977 drainfield.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Cindy W. Ellis
Date 5-13-o$
COSA Fee $ ��
Date of
Receipt Number
(Rev. 11105)
M, Waiver Fee $
Date of Payment
Receipt Number
49 TH l�
SGS Ref.N
1083792001
Client Name
Watkins Enginccring
Project Namt/N
3701 Layden Dr.
Client Sample ID
3701 Layden Dr.
Matrix
Drinking Water
PWSTD 0
Samplc Remarks:
lac �ahan'�z
gv/lj
All Datesnimes are Alaska Standard Time
Printed DateMme
08/11/2008 15.27
Collected DateMme
07/29/2008 15:22
Received Daterrime
07/29/2008 15:40
Technical Director
Stephen C. Ede
Parameter
Results
POL
Units Medved Container ID
Allowable
Limits
Prep Analysis
Date Date
lnit
Metals by ICP/MS
Arsenic
ND
5.00
ug/L EP200.8
C
(<10)
07/31/08 08/01/08
NRB
Waters Departmeint
Tota] Nitrate/Nitrite-N
2.80
0.100
mg/L SM20 4500NO3-F
B
(<10)
08/06/08
]DZ
Microbiology Laboratory
Colony Count
0
cot/100mL SM20 9222B
A
(<200)
0729/08
DLC
Total Colifonn
0
coU100mL SN1209222B
A
(<I)
0729108
DLC
Fecal Coliform
0
coUl00mL SM209222D
A
(<1)
0729/08
DLC
1 N�2/239
1
co
$>
4 /
I ` i
s co /
s m a
o
� 1 / Q00000�
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FORA SINGLE FAMILY DWELLING
Parcel I.D..-o17 -36 36 Z - 2
7 HAA 1
1. GENERAL INFORMATION Expiration Date:
Complete legal description Lo f I Slack IG,
Location (site address or directions) _ 3 7G/ 4.ev ortn Road
Current Property hre-1a harv,o Ic�e� fZ�/
P Y owner(s)n� Day phone 3 Vs 7- 755.3
Mailing address 3701 4 e y e-Peo Rte, A r c 4ar�y� -cc 9 9s,
Lending agency Day. phone _ 2 Z Z - 6,5 D�
Mailing address 1100 GU, 13tnta" 8/4a/,
fcJlrfC
Real Estate Agent 130 6 1; ee< fR en kr- Prod J« c4r- ^ Day phone _ 2 V 4 - 3 Z ZI
Mailing Address _3 Z G / 'c " Sf. 5�,, /� ZvG �¢� ch A 4-99so-_-.'
Unless otherwise requested, HAA will be held by DSD for pickup. C� ?,VS,:. 7s &�
2. NUMBER OF BEDROOMS: WAe/7 #,+,4 reaal
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank ❑
Community On-site []
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 iri the Health Authority 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 F'la f -lot? Tech n rcut Seel;f CIOPhone 3 J-7 S:r
Address `153 O ECAo SA , Am c6efeze, A- Ar 99S,16,
—V
Engineer's Printed Name- _neo,�,6nl T'• Pwore Date man 26_ 2GGV
. 4F At
•
.Ni�///e/��•{{{f{{{{{{{{{{{{{{�tiM�
5. DSD SIGNATURE { THEODORE F. Mooae ;
Approved for bedrooms. r' •{{cE - 35x9.{r 1�
Disapproved.
Conditional approval for bedrooms, with the following stipulations:` "l'
Additional Comments
Note* The well for this proRerti}� meets e_ xiding State and Mnnieinnl (ndpc_ There are nitrates -_
present It is suggested that periodic testing be performed to insure the wells continued suitability.
Current nitrate concentration is 5.07 mg/l. EPA maximum concentration is 10.0 mg/l. More
information on nitrates is available from the On -Site Services Program, at 343-7904.
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: r Original Certificate Date: Ll o
(Rev. 01102)
Municipality of Anchorage
• Development Services Department w °_
Building Safety Division i k
On -Site Water & Wastewater Program
4700 South Bragaw St. i
I c P.O. Box 196650 Anchorage, AK 99519-6650 .
www. 6i.anchorage.ak.us
(907) 343-7904 ;
HEALTH AUTHORITY APPROVAL CHECKLIIST,
p
Legal Description: 1 G m e He
n S //> #Z Parcel ID: of 7 Z 7
A. WELL DATA
I .:Well type _p f If A, B, or C provide PW51D # N• i4. Well Log `(YIN) Y
Date completed `Y 13017 7 Sanitary seal (Y/N) Y Wires properly protected (Y/N)
Cased to Casing height (666v6 'round) 18 n.'
Total
I
FROM WELL LUG AT INSPECTION
Date'of test
-7.7 1 / 2G Y ?��y
'
Static water,level 68 ft. 6vl ! ft
f Well production i 9 p.m. 7. y ��A g.p.m.
.,WATER SAMPLE RESULTS:
k'
I
.€
, l
i
S•l a7 r bacteria D / 0 mL
I Coliform D. colonies/100 m1 Nitrate I mg./l. Othe b to is colornes 1 0
• ,
Arsenic: mg./l. 'Date Eof sample: j / ZU �GY Collected by j �� !�'/� Tec4 -S�c,
B. SEPTIC/HOLDING TANK DATA
I Tank Type/Material 5e f' 'l 5 �t e�' i Date installed` `' 6 19 7 7
I P
I
i Tank size 12S0 gala Number of Compartments 2 Cleanouts (Y/N) Y < <
y Foundation cleanout (Y/N) Depression over tank (Y/N) N High water alarm (YIN) N. A
I r ! Date of pumping ~/ / Z t(/ 03 Pumper
I
C. ABSORPTION FIELD DATA !
j Date installed . 6I 7 77 Soil rating (g p:d /ft2 or ftZ/bdrm) 15V, System type Trench
1 Length 61 ft. Width€`I i ft. Gravl 1 below pipe S� ft.
. 7a �' j is , I. N
! Total 'depth ft. Eff. absorption area �6 Monitoring tube `t Depression over field N
..i.
1' Date 1of adequacy test I / 2 �/ ?lxi y j Results (Pass/Fail) c%U G !:For bedrooms
1 5-6.3
I , `
Fluid in absorption field before test 6: m ; Water added o2 gal.' New depth in.
i Elapsed Time: 12s min. Final fluid depth > D in. Absorption rate >_ 6UG g.p.d.
I An rejuvenation treatment ast 12 mo.) (Y/N &type) llllv�e �cnG u» II yes, give date Al. A.
l I
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 96' u•a✓��' iss• 1
9/Zt/fsS/
Absorption field on lot 1 404/
Public sewer main N• A
Sewer /septic service line > 2S
On adjacent lots >
On adjacent lots � ! oo '
Public sewer manhole/cleanout ".;4.
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 2 3 Property line I &' Absorption field & '
Water main Water service line > !U ' Surface water > Iyca •
Wells on adjacent lots > 100
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:,
Property line 10,
Building foundation
23
Water main !� • d
Water Service line _� rU '
Surface water >
! ao
Driveway, parking/vehicle storage SG '
Curtairi drain NGne Sven Wells on'adjacent lots >
F. COMMENTS
Fain c. a. u.cri SAaw17 on )n1 ,ecAcjn r^a 6rf'. t%1c, ble exi�` e,- Gni
G. ENGINEER'S CERTIFICATION «ndt f-tCJn/ ni-Qvct�/, on cPG �� o �`C�f f�•c+ccy :�4
1 certify that / have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date..
Engineer's Printed Name -T7�.?o r, ire' F. /`1001-e
Date '!' J orhu� r y Z 1,
HAA Fee $ ` S 67 oG
Date of Payment I Zyh`/
Receipt Number Z
(Rev. 12101)
r
Waiver Fee $
Date of Payment
Receipt Number
.I, r � •• R ••� iJ ..fw Y
fy kiyta�JjI QtH •�� •'v `�
:.THEODORE F. A:OORE J
r:� ••. CE _ 3589
01-26-04 01:30PM FR01.1-CUE ESI, SGS ENV SERVICES
SGS Ref.N 1040391001
Client Name Flattop Technical Srv.
Projcct Nante/N Lot 4, Blk 10, McMahon SID h2
Client Sample ID Lot 4, Bik 10, McMahon SID 112
Matrix Drinking Water
Samplc Rcmarks:
9075615301 T-185 P.02/03 F-157
All DateslTimes are Alaska Standard Time
Printed Date/Titne 0123/2004 17:05
Collected Dateffirne 01/20/2004 13:30
Received Date/Time 01/20/2004 14:45
Technical Director Ste hA C. Ede
Released B�Y�
Allownbic Pup Analysis
Parameter Rcsults PQL Units Method Container 1D Limits Date Date snit
Waters Department
Nitratc-N 3.07 0.100 mg/L EPA 300.0 I1 (<=)Q) 0121/04 JIB
Microbiology Laboratory ,
Total Coliform 0 col/100m1. SM18 9222B
A (<=1)
0120/04 DKC
MUNICIPALITY OF ANCHORAGE �}
• DEPARTMENT OF HEALTH & HUMAN SERVICES y
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. # 0/7 -
CERTIFICATE
/7
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING,
36Z " -z'-7 HAA#
9/o3v3-
1. GENERAL INFORMATION
Complete legal description �� �- /�Lo' C /�' /✓/� l�o�� ��i
Location (site address or directions)
P_ripOrty owner K i Ui,iu r{� iln [z� Day phone°
Mailing address 37o
Lending agency�_�ds r�r�yLa )`�``'^ �— Day phone
Mailing address
Agent l,a r
Address'"I
c.G l:Li-il e Day phone
Unless otherwise requested, HAA wiil�ll//be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well x
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 X
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
A
CSI
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 6 V S��'���� J Phone � yb –.So ys�
Address
Engineer's signature
DHHS SIGNATURE
_X.— Approved forbedrooms.
Disapproved.
Conditional approval for
Date l 2 1 �Ly
F9e°4,1Z�
C)
~�M O D�
pp Y J'
I�00.0:00 0009°i Ga 'J O`0990 Y9 n
e09°OU O• LS O0a 090Oa 090 p0•'•
f'°tea ..T�.rE•; E..-_ODINjo
4209 °
— o°. &&
Q
91`��4� °OO°YeY9o•°°° ����
bedrooms, with the following stipulations:
VAdditional Comments Note: The well for this property meets existing
State and Municipal Codes. There are nitrates present. It is
suggested that a periodic testing be performed to insure the wells
continued suitability. Nitrate concentration is 8.5 mg/1. EPA
Maximum --- - 10-0. /1
0
Date T 'Z3 — moil
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 orderto 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) Back MOA 621
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Parcel I.D.
Lag'al Description:.
WELL DATA
Well type.
Log present (~)
Total depth ~'.-~
Sanitary seal Y~N)
0/7-
ADEC water system number
If A, B, or C, attach ADEC letter.
~/ Datec°r~Pleted ,~0 ,/J~Z~(_. /~/ 77
Driller
'Cased to ~nv/~'~,~/~ ~:'r,~/~ /~r__~asing height
'Wires properly prOtected ~N)
Date of test
Static wate'r leVel
Well flow
Pump level
FROM WELL LOG ,. AT INSPECTION
Septic/holding tank on lot
Absorption field on lot
Public sewer main
SEPARATION DISTANCES FRoM WELLTO:
· ?'.7~_i"
IO '
~b'~/ ,~0~; 0n ': ,~
adiacent °ts
, On adjacent lots
Public seWer manhole/cleanout
Public sewer service line /V//~l :
WATER SAMPLE RESuLTSi
Coliform (~ Nitrate
Date of sample: c~ ~r',,,(..~' ~/'
Petroleum tank
Collected by:
Other bacteria
SEPTIC/HOLDING TANK DATA
Date inStalled "~/I~:. i? 7 '7 Tank Size ! ~5-~0 Compartments
Cleanouts (~N)' Foundation cleanout (~N) Depression (Y~)
High wateraiarm (Y/N) . ' /~/~ Alarm tested (Y/N)
Date of PUmping ~/~/o ~'?'{. /r.,~.~c ~ "'
SEPARATION DIST ANK TO:
Well(s) on lot ~7 [ On adjacentlots }~0 ~- Foundation ~-/7/
' 't'"g ~ '-/' Water main/service line
To property line ' [0 ~ Absorption field ~ ·
t
! 0~ ''/-
Surface water/drainage
72-~.6 (Rev. 3/91) Front MOA21 "' CONTII~IUED'ON BACK PAGE
HAA Fee $
Date of Payment
Receipt Number'"
Date installed' ' ...... ' .......
Manufacturer .-' : '.-'--
Size in gallons ~._~! --." ':Uanhole/Access (Y/N) ___ , .....
Vent(y~U)' ...... '~ ' ' ' '''"'~'.,,RUm,,.nJ.~e~ ~~'":"~;:"~ ;r: -*" * '~" ::" ~ "Pump'- ' '"*:"off" ' ''>'level' /''''''* '-at ": :'~;" ';' '
High water alarm level ~ ~~ Cycles tested
Meets MOA electrical codes (Y/N)..~ _ ~ ....
. . . . .: ~ . ,-,; :, . '~ :.: _ ::"~.". · ~ ~ , ,:,~:~~. ,.. , ........... _ ·
S~PAR~TibN' DISTANCE FROM LIFT STATION TO: t ~.~:: ;~ ::? .,
Well on.lo{ ........ ~_,._..On adjacent ,0ts' .'2,
'D. ABSORPTION FIELD DATA
Date installed 6-L~ ec~ 1~ ,. Soil rating 8-~ - t~. S~tem type
~- ~1 ....... ~d~ 3~ ~-[,~ o-~
Length *-~'q~7 Width 0-~ Gravelthickness 8-u~ )~.'.. ~otaldepth.0
To'{alabsorPtion area ~- L~- ~ ~7~ Cleanouts present ~N)
Depression over field (~ ' , = Date of. adequacy, test
Results ¢;)fail) ~ for ff bedrooms
- . -; ~, ,~ .... . . .... ., - ,~: =,'~ .::~,~ ,:'
5'if:yes, g ve daie ....~/~
Peroxide treatment (pas~ 12 months) (Y~) " ' -' '~ ; i
SEPARATION DISTANCE/~ ~. ~FROM ABSORPTION FIELD TO: '~- :,..Pr0 ''~ .........
Well on lot ,-- On adja,cent lots
I.
To building foundation , ~'~ ~ , ,~. To existing or abandoned system on lot
....... . . t . .... ;.. ~ - , . ,, , ~ ,~,.~ ....... ~ . . .,, --
On adjacent lots ~ Y- Cutbank ~ Water main/se~ice line
;,.' .~.',~ ~;,~.;' : "':r
Sudace water / ~¢ {~ DriVeway, parking/vehicle storage area ~
' "" ~ ". ' ' _. , ~. '[ ~ ...... ' -' ........
d~'~n
, ~.:.. ~ , ' .;:;. , ~ :'~
· .. ~.; . '.;'.~..~ :'1: ,- ........
E, ENGINEER'S CERTIFICATION
I cedify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature ~~ ' 2 ~' ~ ~ ~.,~l~, ~ ~. . .
· ~eeee~'e~'~'~e~'e'ieeeeee~eeee~' ,~,
En-ineefs Name ~~- ~ ~/~ ~ ~~,~,~ ~':~~~/ ' -
~' ' E · ~ · :'"
, .....
· . ~ _ .. . . . ~ ~
.................. ,, .............................. .- ~ P~t~,
--~ waiver Fee: $
' ·Date'Of Payment
~ Receipt Number
72-026 (Rev. 3/91) Back MOA 21
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
ANALYSIS REPORT BY SAMPLE for WORRorder# 35998
Date Report Printed: JUL 10 91 @ 15:19
Client Sample ID:L4 B10 MCMAHON 3701 LEYDEN OUTSIDE '
PWSID :UA
Collected JUL 9 91 @ 12:30 hrs.
Received JUL 9 91 @ 14:18 hrs.
Preserved with :AS REQUIRED
Analysis Completed :JUL 9 91
Laboratory Super is r : STEPHEN C. EDE
Released By : '*ff C L
Chemlab Ref #: 913261 Lab Smpl ID: 1 Matrix: WATER
Client Name :0 & E ENGINEERING
Client Acct :ONEENGR
BPO # PO # NONE RECEIVED
Req #
Ordered By :STEVE FLODIN
Send Reports to:
1)0 & E ENGINEERING
2)
Parameter Tested Result Units Method
------------------------------------------------------------------------------------
NITRATE-N 8.5 mg/l EPA 353.2
Sample ROUTINE SAMPLE COLLECTED BY: STEVE FLODIN. 'HOSE BIB.
Remarks:
-=L = I Tests Performed= {_ _ '= See Special Instructions =Above UA -Unavailable
ND- None Detected See Sample Remarks Above
NA= Not Analyzed LT=Less Than, GT=Greater Than
Allowable
Limits
%� E3GS Member of the SGS Group (Societe Generale de Surveillance)
10
MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services w
DIVISION OF ENVIRONMENTAL SERVICES dj
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel 1. D. # L) � __� ~ ./')Q - Q- HAA # 109 - C) LA \ �
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
/-07- #' i3z'oG< /a /t%_�'�r �r,� a Tz�c� 1,-31f Sc`C Zb'
Location'{addressor. directions)
.
(b) Property owner
Mailing Address
.� crlcf . I4;b,J6 Tal
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
Telephone: (home) -55/k4M; Business
Telephone
(e) Mail the HAA to the following address: (or check here], if hold for pick up.)
List
''c)�onnntact person and day phone number below: r
2. TYPE OF RESIDENCE
Single -Family( 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 th legality and status.
4. SEWAGE DISPOSAL
On-site 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 Telephone
Address %s�/y 0 33
Date
+•"'sae
oF• At�s�,�
f
s * ; 4�T • ,r 4•
9 • LE C. RE D, JR. m
�Q� '•
CE -22 I , •�'
C••••.....••"•'�4�F
6. DHHS APPROVAL
Approved for—,bedrooms by Date mG_ ,�8e
Approved Disapproved Conditional
Terms of Conditional Approval
CAUTION
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 orderto 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.
72-026 (Rev. YM -Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA) Mfi�j
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
A. WELL DATA
Well Classification' ��If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/ ) Date Completed '� Yield
Total Depth Cased to �� r Depth of Grouting AZA
Static Water Level �� / Pump Set At
Casing Height Above Ground t Sanitary Seal on Casing 6Y
Electrical Wiring in Conduit (Y N) Depression Around Wellhead (YO
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot 4 916
To Nearest Edge of Absorption Field on Lot —
To Nearest Public Sewer Line IJIA
To Nearest Sewer Service Line on Lot
/
; On Adjoining Lots l0-0 .e-
105,
�
/0� � ; On Adjoining Lots %416 '7L-
To
tTo Nearest Public Sewer Cleanout/Manhole
Water Sample Collected by S '� ; Date
Water Sample Test Results
Comments --i(
-4 Gilt-Iya
B. SEPTIC/HOLDING TANK DATA
Data Installed 6--71 Size 17-561 No of Compartments
M
Standpipes N) Air -tight Caps ` N) Foundation Cleanout ON)
Depression over Tank (YO Date Last Pumped
Pumping/Maintenance Contact on File (Y/N) ; for
Holding Tank•1-ligla-WojerAlarm (Y/N) Temporary Holding Tank Permit (Y/N) /J
SEPARATLON DISTANCES:FRO.M SEPTIC/HOLDING TANK:
To Water,-Supply�,Well yG f To Building Foundation
To Property Line To Disposal Field
To Water Mgin/Service Line . AQ
To Stream, Pond, Lake or Major Drainage Course
Comments �� 60 Biu
72-026 (Rev. 7/88)Front Page 1 of.2
L 4 aye, FieMI�Xl
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Stra a SSD Type of System Design 7,2ZW64,5"
Date Installed Length of Field OelO &/ / ofd
r r r
Width of Field Depth of Field 0,1416 9 Z/U /U
Gravel Bed Thickness
Square Feet of Absortion Area /O FO Statndpipes PresentCY)N)
Depression over Field (Y/N Date of Last Adequacy Testi
Results of Last Adequacy Test d°A 3 A04 11P6.P hg- -7-
SEPARATION DISTANCE FROM ABSORPTION FIELD
To Water -Supply Well ��� 7 To Property Line ,�a
To Building Foundation Z`� To Existing or Abandoned System on
Lot On Adjoining Lots -o r�
c
To Water Main/Service Line — To Cutback (if present)
r
To Stream, Pond, Lake, or Major Drainage Course /°-`' fi
To Driveway, Parking Area, or Vehicle Storage Area /o `t
Comments
D. LIFT STATION
� 7at� e hh7 d
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
'Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Check Permitted Bedroom Rating Against HAA Request"
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
I certify that I have checked, verlified, or conformed to all MOA and HAA guidelines i q4i[Q�t on the date of this
inspection.
�, h
L/
�,>•" OF AZ N
Signed41r
��
Company
# �; �'if H . p 4
s.°°o *er's Seal
Date
°°*g°*° ° feEn�
es
MOA No.
Dy�
y...°..°..........
®d o IJ:R C. RCID, JR. � g
as #
•. CE -2251
°
Receipt No.
t6 `7
Receipt No.
Date of Payment
Amount: $ � ,�
y
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORi, _ p4b
® DEPARTME OF HEALTH AND ENVIRONMEiv PROTECTION
825 L Street, AnchoraaP, Alaska 99501 boy
264-4720
Date Received: September 16, 1977
#1: Time 1:30 P.M. #2: Time #3: Time
Date 9-16-77 Friday Date Date
Insp Bringle/Pratt Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
will hand carry when ready
1. Lending Institution Request: Coast Mortgage
Mailing Address-:' Phone:
2. Property Owner: Herzog Construction
Mailing Address:
91
Phone: 277-3166
Legal Description• Lot 4 Block 10 Mc Mahon Subdivision
4: Single Family Residence: (X)
Multiple Family Residence: ( )
Number of Bedrooms: Four
Number of Bedrooms:
5. Well System: Individual Well (X) Community/Public System ( )
Permit # Depth of Well Well Log on File ( )
Construction Bacterial Analysis
6. Sewage Disposal System: On-site System (X) Public Utility ( )
Permit # Installed 1977 Installer
Septic .Tank Size Manufacturer
Absorption Area Soils Rate Material
7. Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorption Area
PV,ge Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description:Lot 4 Block 10 Mc Mahon Subdivision _
Comments:
Affadavit Attached: ( ) Letter Attached: ( )
Approved: Date: I IC7
Disapproved: Date:
Department Worksheet:
0
2.
3.
M
5
0
7.
MUNICIPALITY OF ANCHORAGE
Department of Health and Environmental Protection'
825 L Street, Anchorage, Alaska 99501
264-4720
t for Approval of Individual Sewer and Water Facilities
Property Owner:
Mailing Address:
Name of Buyer: _
Mailing Address:
Lending Institution:
Mailing Address: _
Realtor/Agent: _
Mailing Address:
Legal Description:
Street Location:
Single Family Residence:
Multiple Family Residence:
a
Phone:
Phone:
Phone:
Phone:
( Number of Bedrooms:
( ) Number of Bedrooms:
Water Supply: *Individual Well ($4 Public/Community System
If Individual Well, well depth
If Community System, name of system "r-
8. Sewage Disposal System: On-site System Public System ( )
If On-site System, date of installation: 94W4 19
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77