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HomeMy WebLinkAboutMCMAHON #2 BLK 9 LT 8McMahon Lot 8 Block 9 #0 ! 7- 362- ! 5 r Municipality of Anchorage Community Development Department Page 1 of 3 On-Site Water&Wastewater Program 4700 Elmore St. •P.O. Box 196650 Anchorage,AK 99519-6650 •http://www.muni.org/onsite (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181193 PID Number: 017-362-15 ❑ New ■Upgrade Name: JIM HUTTO ABSORPTION FIELD Address: 0 Deep Trench 0 Shallow Trench 0 Bed 0 Mound 3800 TAIGA DRIVE*ANCHORAGE,AK 99516 0 Other Phone: No.of Bedrooms: Soil Rating. Total Depth from original grade: (907) 244-5414 4 GPD/Sq.Ft Ft Depth to pipe invert from original grade: Gravel depth beneath pipe: LEGAL DESCRIPTION FL Ft. Subdivision: Block: Lot: Fill added above original grade: Grave - gth: MCMAHON#2 9 8 ��NG _ Ft. I ownsFIlp: - Range: - Section: - Gravel width- ! ..S� Beds Number of lines: Distance between hoes. ' Ft. Ft. SEPARATION DISTANCESTotal absorption. Number of trenches: Dist.between trenches: To Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines so.FL Ft. Well - - - - 25+ TANK • Septic 0 S.T.E.P. ❑Holding 0 Other • . Manufacturer Capacity: Surface Water 100'+ ANCHORAGE TANK 1250 Gal • Material: Number of compartments. Lot Line 5'+ - - - N/A , STEEL 2 Foundation 1. 10'+ _ _ - LIFT STATION Curtain Drain l I Manufacturer C ' NONE KNOWN Gal Remarks: EXISTING TANK DECOMMISSIONED PER UPC PER CONTRACTOR -Pump on'level at: "Pump off'level at: High water alarm at: Pump Make 8 Moder Electrical Inspections performed by PIPE MATERIAL EXISTING/ Tank tEXISTING/ o House to tank D3034 k told D3034 draiInstaller A+ HOME SERVICES Drainfield EXISTING CO/MT EXISTING Inspector GEG, Ltd. BENCH MARK (Assumed elevation) Inspection 100.00 Ft. Dates: 1st 8/2/2018 2nd - Location and Description 3rd - 4th - BOTTOM OF TRIM AT NE CORNER OF HOUSE ENGINEER'S SEAL Community Development Department Approval Q oOF okO 4 Conditional approval: Date: if Q'•'. 1_ 1--00 i tr- .-: 4 y liiii . %Tn. OA e 0.. :.. ., .-p : D Qh 1 •.J- .i' . - ess. � `(f X00% ' , E-795 ." A roved: QLIJWA Date: 1a 15 1IppLICENSE Q ofess o #AECC884 0�0000 ''� Inspection Report_1-1-12 doc PERMIT NUMBER: PARCEL ID NUMBER: OSP181193 RECORD DRAWING 017-362-15 y I / - B C / \ I / ST1 28.2 15.1 32.0 / \' / X / VI ST2 36.2 20.6 36.5 / \ MCMAHON#2;BLOCK 8,LOT 4 DBL1 37.8 21.9 37.5 1 � \ DBL2 38.5 22.6 38.1 / A/�A / 100'WELL RADIUS \ DR/ti / I I 100,WELL gpDW / 4.•:'. ;. :• / / ' •t / \ / EXISTING DRAINFIELD / \ \ •f'' DRIVEWAY ' ••• / / �.;• DBL1&2 Y \ -------- BEDROOM HOME AT \ MCMAHON#2;BLOCK 9,LOT 7 f / 4."),7,4p. �/ NEW 1250 GALLON ,� STEEL SEPTIC TANK r EXISTING FCO MCMAHON#2;BLOCK 9,LOT 7 SOUTH-END OF DRAINFIELD WAS SHIFTED EAST ` (FROM THE DESIGN DRAWING AND AS-BUILT I SURVEY)TO SHOW 5'SEPARATION FROM EDGE I OF NEW SEPTIC TANK TO EDGE OF DRAINFIELD. Q THE EDGE OF THE TANK WAS PHYSICALLY MEASURED IN THE FIELD TO BE 8'FROM THE EDGE OF THE DRAINFIELD CLEANOUT SCALE: :V 111 1"=40' SCALE: il MCMAHON#2;BLOCK 9,LOT 12 1•=40' $ oF4 I •14GARNESS ENGINEERING GROUP Ltd ' �• % `'� II. ENGINEERING.SALES•CONSULTING ,•.. -7v-- � __ . _ _ i S 3701 E TUDOR ROAD SUITE 101•ANCHORAGE.AK 99507.PHONE(907)3374179•FAx(907)336-3246•WEBSITE w,wi.gem g nng corn 0, • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 t •.Garn: s =JIM HUTTO 907-244-5414 2 OF 3 •�� _ •�♦ LEGAL DESCRIPTION: DRAWN BY: ��� 9 03 Ia MCMAHON#2; BLOCK 9, LOT 8 D.J.G. •�� •.. !..• ���♦ TYPE OF WORK: DATE: LICENSE4o PR°FEJJ`4♦♦♦ SEPTIC TANK RECORD DRAWING 9/18/2018 #AECC884 �ll%WM%� J c PERMIT NUMBER: PARCEL ID NUMBER: ` OSP181193 RECORD DRAWING 017-362-15 FINAL GRADE=99.36.99.05 TOP OF TANK ST1 ST2 AT INLET=94.57 c c TOP OF TANK AT OUTLET=94.64 111. INVERT OF BUNG NEW 1250 GALLON AT INLET=93.93 SEPTIC TANK INVERT OF BUNG AT OUTLET=93.85 I v oixas ii. EOE • .111'• • • 30' . f . . ' 49 =� • GARNESS ENGINEERING GROUP Ltd l' . ENGINEERING k SALES.>CONSULTING - j /• j 3701 E TUDOR ROAD.SUITE 101'ANCHORAGE AK 99507'PHONE(907)3370179'FAX(907)338-3246 A.08SITE www 9amessengneenng corn 0 ,,, , , • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ��; .1: rey A.Gamess W: JIM HUTTO 907-244-5414 3 OF 3 �j�'i =. 1773 ''•_� LEGAL DESCRIPTION: DRAWN BY: ..�1•••e, MCMAHON#2; BLOCK 9, LOT 8 D.J.G. •••a � I�.,.'..'�.. TYPE OF WORK: DATE: LICENSE,1 I 1 `S" .��• SEPTIC TANK PROFILE 8/7/2018 #AECC884 1 MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program S • PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r. http://www.muni.org/onsite \. / I)charNicht 4NCNORPO. On-Site Wastewater Disposal System Permit Permit Number: OSP181193 Effective Date: 7/18/2018 Work Type: SepticTank Upgrade Expiration Date: 7/18/2019 Tax Code Number: 01736215000 Site Legal Address: MCMAHON #2 BLK 9 LT 8 G:2835 Site Mailing Address: 3800 TAIGA DR, Anchorage Owner: HUTTO JAMES A & GAIL E Lot Size in Sq Ft: 31743 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well 0 Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Install a groundwater monitoring tube if a HDPE septic tank is installed. o I Received By: A _ fta1110 Date: ! ( r C r / Ii Issued By: ` r Date: 9� / 6 789 MUNICIPALITY OF ANCHO axifts,. 4is Community Development Department I— Phone'9,7-343-7904 Development Services Fax: 907- 343-7997 ' On-Site Water & Wastewater Program Mayor Dan Sullivan On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 017-362-15 Property owner(s) JIM HUTTO Day phone 907-244-5414 Mailing address 3800 TAIGA DRIVE*ANCHORAGE,AK 99516 Site address 3800 TAIGA DRIVE*ANCHORAGE,AK 99516 Legal description (Sub'd, Block& Lot) MCMAHON#2; BLOCK 9, LOT 8 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial ❑ Single Family (SF) Absorption Field ❑ ® (w/wo ADU) Upgrade Septic Tank ® Duplex (D) ❑ Renewal ❑ Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP. Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: d S Waiver Fees: Date of Payment: 1)I2J0 � 0 Date of Payment: /' Receipt Number: 8-71 c-t"1 Receipt Number: Permit No. PI 0 H X13 Waiver No. (Rev.01/11) t ..,AIC—ab. R GARNESS ENGINEERING GROUP, Ltd AOvsnc+ed TrrJtmcvrtt SystcM ENGINEERING SALES CONSULTING Dealer July 17th. 2018 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for McMahon #2; Block 9, Lot 8 To whom it may concern: The existing 4-bedroom home is served by a private well and septic system. Per the "Review Comments" by MOA onsite employee Tim Ecklund, the existing septic tank is in a state of failure and needs to be upgraded. We are proposing to install a new 1250-gallon HDPE septic tank if burial depth allows, if not, a 1250-gallon steel septic tank will be installed. See attached design drawings regarding the tank location. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Sincer ly, J1 2 Jeffrey A.1 ess, .E., M.S. Presiden i 3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com • V Q Q MCMAHON#2; Z / MCMAHOI�* : BLOCK 7,LOT 7 BLOCK 8,LOT Tft� i / pp / /?•. \ JMICM,e,PON#2; / N �� ../4/47. / 7. 7 I i BLOCK 820?; 4 /'\ I '.• pp, I / N MCMAHON#2; / T BLOCK 9,LOT 6 • A / / • \\ / / \\ P 1 z / DR \ /l wF 4417" / 1 N I u <f, // I �O/US'00/ I I RA°' .: I / I \ I ,;1;' / / 1\ / A —— l \� ` 'Pp ROk/ / \ MCMAHON 7(2; / Or / 4/q / \ BLOCK 9,LOj\7 /fi / \\ I /14,-,,/00, / / MCMAHON#2: \ \ — ' // MCMAHON#2; \ 1 —_ i BLOCK 9,LOT 14 BLOCK 9,LOT 9 / / \\ \ /, MCMAHON#2; / / 9A BLOCIN9,LOT 13 / \ -off \ — ��— itlo G 'oo. // I \ I /US I MCMAHON#2\ I I / App% I BLOCK 9,LOT 12j \ we<4,74/4 7 I J�OUs70p I BLOCK 9,LOT 1 / // I \ / A —. N. / \N \ / / i --- � moi �� �� \ / // \\ \ / \ / / \ / \ N -- w 'k•/ e<<Rqo Slop, i SCALE: ii I 1"=100' LEYDEN ROAD �/ **.... 111111 I. *• `�• *�i GARNESS ENGINEERING GROUP, Ltd ; : ••��a I ENGWEF ING-SAI FS.CONSULTING -=-'_g Lama • �: 3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507•PHONE(907)337-6179•FAX(907)338-3246•WEBSITE:www.gamessengineenng com •• ' •• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0. ,y - Games : 4/= JIM HUTTO 907-244-5414 1 OF 2 •�/ , • C 79 ...,4,_ PROJECT/LEGAL DESCRIPTION: DRAWN BY: .. 0 A.•184. MCMAHON#2; BLOCK 9, LOT 8 D.J.G. ../;• `ESS�•�, 44p TYPE OF WORK: S EPTIC SYSTEM DESIGN UPGRADE DATE/10/2018 #AECC884 I�imivi�� J Y I 7' \ i \- GEGLtd.HAS A B PAGE SPECIFICATION \ . NOTE:THE CONTRACTOR SHALL HAVE THE EAST LOT - LETTER THAT PERTAINS TO THIS DESIGN.TO LINE,ALL PERTINENT WELL RADII AND SURFACE \\\ / OBTAIN A COPY OF THE LETTER CONTACT WATER SETBACKS FLAGGED BY A REGISTERED LAND \ GEG.BY PROCEEDING FORWARD WITH THIS SURVEYOR PRIOR TO CONSTRUCTION \-� INSTALLATION,THE ENGINEER.WELL DRILLER. -\ CONTRACTOR AND PROPERTY OWNER AGREE \ / THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE \ / _ TERMS&ND CONDITIONS OUTLINED. / Til/ O e / 100'WELL RADIUS 1 \ Rit/I I I I I I 100 WELL RPDtU / ID/ / \ / / \ // /// / ' / N; as ''',Z:-: ,,:i: •' / EXISTING 4 ` `� / \ — BEDROOM HOME MCMAHON#2;BLOCK 9,LOT 7g �` / APPROXIMATE DRAINFIELD ;��� , LOCATION PER CLEANOUT/SUMP "0. LOCATION AND MOA RECORDS , ,/ ./ •ROPOSED 1250 GALLON HDPE SEPTIC TANK IF BURIAL DEPTH ALLOWS;IF NOT,A 1250 GALLON STEEL SEPTIC TANK WILL BE INSTALLED;INSTALL DOUBLE CONTRACTOR TO VERIFY COVER CLEANOUTS BEFORE AND AFTER TANK OVER TANK PRIOR TO DELIVERY OF CONCRETE SEPTIC TANK i APPROXIMATE LOCATION OF EXISTING SEPTIC TANK TO BE N DECOMMISSIONED PER UPC SCALE: MCMAHON#2;BLOCK 9.LOT 7 1"=40' MCMAHON#2;BLOCK 9,LOT 12 ���\\\111 4,\*7v, oF , ,41 a • ••)gratoj•�i .. GARNESS ENGINEERING GROUP, Ltd . • • • I ENGINEERING.SALES CONSULTING - • , , • 3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507•PHONE(907)337-6179•FAX(907)338-3246•WEBSRE:www.gamessengi,eeing.tan ,�••,x�i : ; 'PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ♦c�: .Je*- ' Gam,ss JIM HUTTO 907-244-5414 2 OF 2 •�o••.;••��1�� CE-7953 DRAWN BY: �l ii/,I/(.lti ' PROJECT/LEGAL DESCRIPTION: ��i MCMAHON#2; BLOCK 9, LOT 8 D.J.G. h�FO Q�. �• �� PROFESS\C44• TYPE OF WORK: li"`* SEPTIC SYSTEM DESIGN UPGRADE DATE: #AECC884 I, �� MUNICIPALITY OF ANCHOP~AGE. : He~-'~h and Environmental Prot£ %ion Fourth Floor West 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 INSPECTION REPORT ON*SIT,SEWAGE DISPOSAL SYSTEM_ -7- ...................... DISTANCE -- / NUMBER OF INSIDE LENGTH...:. _m/_. INSIDE WIDCH .............. t. IQUID DEPTH ______~ .... LIQUID CAPACIT~ ...... GALLONS. . ¢'O~ ~es ..... /__~_ DISTANCE BETWEEN LINES _ _ _TRENCH WJDT N. TOTAL EFFECTIVE ABSORPTION ARE~ SQ. FT. LENGTH OF EACH LINE ~l-t: T¢P OF-rILE TO FINIStt GRADE _ _ MATERIAL BENEATH T LE ............. ABOVE TILE ~ .....~= ..................................... SEEPAGE PIT: LOg Crib Rings BUILDING FOUNDATION __ DIAMETER _ OR WIDTH _, LENGTH__, DEPTH Crib Size: DIAME1 ER___DEP/'IE_ _ DISTANCE FROM: WELL. '¥OTAL EFFECTIVE NEAREST LOT LINE__ ___ ABSORPTION AREA (WALL AREA) __ SQ. F'r. Class:'~ Depth: Well::Distance To: Lot Line Bldg: Sewer Line: Pipe Materials:¢~~ ~¢~ # of Bedrooms:V~ ~ Installer: _~~[¢~ Remarks: , : I PERMIT NO. ,.'] ??642 ) APPLI CFINT LOCATION LEGAL SEASONAL CONST. ~ P. 0. BOX :1.0-422 ':;F't S;TATION 5:4442:82 LB B~ I"iCMRHON ~2 LOT .:,I~.E ]J. 800 SQU~RE FEET TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH P1AXIMLIM NUMBER OF BEDROOMS = 4 SOIL RATING ,::SQ FT,.."BR)= :1.2'5 THE: REQUIRED SIZE OF THE SOIL ABSORPTION 'SYSTEM IS: E-; F' T H = d_ 2 L_ E r'-,! n::i T H = 2: ;l: Ci l~: A %." E-_- L_ [:. E F' ]- H = ~E: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFIINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND ]''HE BOTTOM OF THE EXCAVATION (IN FEE]'). ]'HERE IS NO SET WIDTH FOR TRENCHbS. THE GRFtVEL DEPTH IL=., 'THE MINIMIJM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND ]''HE BOTTOM OF THE EXCA',,,'BTION (IN FEET). F~: If__-.': L---.~ L.m ][ F--: E: IE:, S E F' T :E C: ]" R I'-41 ~-::.' :S ][ ,?:.'. E = :_IL 2 5 ~,Z'~ u.'E~ F-~ i_ L_ C~ l'-.t :S F"RC:~-=::RC-~E F'L.F-mI'-4iT n]uF'T :I. E~'-,~ R PACKAGE PLANT MAY BE INSTAL. LED RT THE PERMITTEE'"S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: ±. EITHEF.: R CLASS t OR II NSF APPRO'¢Ef':, PLANT MAY BE INSTALL_E[:,. 2. R CONTINUOUS MAINTENANCE AGREEMENT I'_=; REQUIRE[:,. IF R MAINTENANCE AGREEMENT IS NO-[' KEP].' CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL_ ABSORPTION SYSTEM FIND/OR YOU MAY BE :_-]trJBJECT TO PROSECUTION. BACKFILLING OF ANY SgSTEf'I WITHOUT FINAL INSPECTION AND RF'PROVRL BY 'I'HZS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R 1.4ELL AND ANY ON-SITE SEWAGE DISPOSAL. SYSTEM IS :tOO FEET FOR A PRI',,,'ATE WEI_.L OR 200 FEET FOR R PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETLIRNED TO THE [:,EPARTMENT WITHIN ]:8 DRYS OF THE NELL. COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRLICTION DIAGRAMS ARE A',/RILRBLE ]"0 INSURE PROPER INSTALLATION. I CERTIFY THAT ±: I AM FAMILIFtR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS F~S SET FORTH BY THE MUNICIPALITY OF FtNCHORFtGE. 2: I WILL INSTI=tLL. THE SYSTEM IN ACCORDANCE WITH THE CODES. 3:: I UN[:,ERS].'AN[:, THAT ]'HE .iN-SITE SEWER SYSTEM MAY RE]~_IRE ENLRF..:GEMENT IF THE RESIDENCE IS REMODELED TO INE:LLIDE MORE THAN 4 BE[:,F.:OOMS. PL., Y F V NTUR E; co. NsuLTI NG GEOLOGIST BOX 476-M,.STAR ROUTE A · ANCHORAGE, ALASKA 99507 ' PHONE SOILS LOG Performed for~~ ~ 6 16 Soil Type Water Level Remarks 18 2O Total Depth of Excavation. Groundwater. ~ot Reached Depth, if Reached__ Classification Method ( ) Sieve Analysis () Material at Total Depth Bedrock '~Not Reached Depth, if Reache~____ Gary F. Player, Consulting Geologist WATER WELL LOG FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 99501 WELL OWNER % 10.,~'~1~,~ ~ )*,~., ~.~ Z3/,Q MUNICIPALITY OF ANCHORA(~E DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION NOV 2 1977 RECEIVED __to to ,to__ __to ,,tO __to to __to to__ ___~o __to · ,,tO tO to __tO FEET OF DRAWDOWN. REMARKS DATE COMPLETED / ~/~/q~ Oto/~O ;~Oto;~'~ FT. SIZE OF CA~ING~ "DEPTH OF HOLE/~To CASED TO USE OF WELL 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community Public Water System ❑ Public Sewer ❑ WaiverNahance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $�� Waiver Fee '$ Date of Payment 7 Date of Payment Receipt Number 017 7 3r . Receipt Number COSA # OSC 8 - Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 9950 Engineer's Printed Name: Jeffrey A. Garness In conducting this evaluation, GEG provided an engineering evaluation of the well and, in accordance with the guidelines and regulations established by the Municipality o1 industry practices. The reported results describe the condition of the system/s on evaluation. Separation distances were measured to readily identifiable features. H encroachments may exist that were not identified during the evaluation. The operatior and septic systems depend upon a variety of variables, including but not limited to groundwater levels (that may fluctuate during the year), quality of construction workmanship), and the water usage of the family utilizing the system/s. These conditic are outside the control of GEG. Satisfactory test results do not guarantee future pe system/s; therefore, GEG makes no warranty (express or implied) regarding the futun the well or septic system. GEG makes no representation whether an alternative well can be installed on the property in the event either of the current systems fail to perfo the future. The content of this report is for the sole benefit of the person/party that perform the evaluation. Reliance upon the information provided in this report by any party (including subsequent property purchasers) is not authorized, nor will it confe whatsoever. 6. DSD/SIGNATURE y System #1 Approved for bedrooms N � � � z �v WASTEWATER o^ System #2 Approved for bedrooms PROGRAM Disapproved �ii�0,0, �lO,`�� Ji )gyNT SER . �Z . Conditional approval for bedrooms, with the�bly��l�tt,��latlons: By: Q cc %im Cc1-417,1 Original Certificate Date: N I The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet10-10-12.doc COSA Checklist Legal Description: McMahon #2; Block 9, Lot 8 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled 1015/77 Total depth 155 ft Cased to 155 ft ❑■ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 5/30/18 Static water level at beginning of test 125.3 ft Comments B. TANK DATA Age of tank(s) 'f1 years Tank type/material septiclsteel Measured operating fluid level in septic tank X Standpipes/foundation cleanout per record drawing Date of pumping <1 year old D. ABSORPTION FIELD DATA Which system tested (date installed) 1977 ❑■ ALL standpipes present per record drawing Total measured depth from grade 10.3 ft (max) Measured depth to pipe invert from grade 3.75 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective a.s R,FVIseo Parcel ID: 017-362-15 Structure served by this system Well production at time of test 5+ qpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes 0 No N Coliform bacteria is Negative Nitrate 9.76 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by GEG, Ltd. Date of Sample 7/15/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 5/30/18 Results [D Pass For 4 bedrooms Fluid depth prior to test 50 in Water added 605 gal New depth **73 in Elapsed time 185 min ❑E Code -required soil cover over field Final fluid depth 61 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) _ If yes, enter date Gallons introduced n/a gallons Comments/Deficiencies: '60', of liquid in sump on 7/15/19 •*a.s below invert COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes if No Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft [z] Yes if No ft Neighboring Tank > 100' ❑r Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' El Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Yes if No ft Q Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft ✓❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' 0✓ Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Q Yes Absorption Field > 5' Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10'❑ Yes if No ft Community Wells > 200'✓0 Yes if No ft Water Service Line > 10' Q Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Q Yes if No Water Service Line > 10' Yes if No ft Community Wells > 200' ❑r Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION OF �4 1 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. e f A. Gar ess: QO � E— 95 �t o`O COSA Checklist yellow sheet 4 4ea Pr"o� o� ofessio 0 #AECC884 00��0�00 ft ft \ £tom w Sal, k?... DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Nitrate advisory Certificate of On -Site Systems Approval # OSC181271 Subdivision: McMahon #2, Block: 9, Lot: 8 A water sample revealed a nitrate concentration of 9.76 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. I,��ailitgAc�d es P';. U��nx.�i650����ior#�laska 5� 65b���Ww m n �r '� �`�`- From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. P110 - alai ing Aid es,�9�ncFs�O65QAt�ora'k 19 nnur SGS SCS Fief.# 1193811001 LOQ Units Client Name Garness Engineering Group, Ltd (GEG) Printed Date/Time 07/24/2019 8:24 Project Name/9 3800 Taiga Dr. Collected Date/Time 07/15/2019 13:53 Client Sample FD 3800 Taiga Dr. Received Date/Time 07/15/2019 14:41 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks Parameter Results LOQ Units Method Container ID Allowable Limits Prep Analysis Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/l. EP200.8 B (<10) 07/19/19 07/22/19 DSR Waters Department Total Nitrate/Nitrite-N 9.76 0.400 mg/L SM214500NO3-1: C (<10) 07/17/19 EWW Microbiology Laboratory E. Coli Negative 1 100mL SM21 9223B A 07/15/19 AI Total Coliform Negative I 100mL SM21 9223E A 07/15/19 AI .. M„ I I m .- E z N N m y `y (D • u u E.; v c= L / O` 0 C I I a'� o Eoj c c O Ijr��iyl; Ll ED �-{ w 0 c } 75 00 -� a r1i III t0 a Lo \ n OO I ; 15 v v / : y0 ° . m m 3. V U I m m 0 N m '� O C 00 U1 \ uJ .� L %m y O �/ _ 14 V) 0- j�n � > U '^ C 0) V c m 'C O Qi w y O ( I .. " O y o Y rj E v m G u j 01 w C 1n \ Z i/i I I 00 Li .ta O u0 N O N Ln a 0 Q` N 0- O 0' mM-0 C 7 Q> W on Es m Q' mqM s a`i v a ° m= O .° U Q E /� p•a I69 SCJ > Q J rj mom / o x E 3 � � � � + C >. Ln p cu 2 p �F :� c! a p M 3 / ° "ommo a U w v '� / C 0,2 0.y L Z '�Op o o / o `m 0Yyo� Z v v �s�v V .�. m e u m u u 3 0 'Q N y l0 ++ t N a v h .v c c A m >, '„ 1 0aj 000 c-4 c Cb O O �nj Ln / ,` 0 ox oz.a �o 2 E S0 v E �w t9 C y �. F ° .c '+c' '� Q 0 _ 7 LL t.0 Op'1 2i tU LE Oast p ~�`1VPh/ Y ®CL G � a m X OF c i V ' z /// vwi LL O O O v w i LL : 3 m O Z o ° c a / OZ t+�++ .� vii LW QE' VA :. m E 0 yA. C LL � �N �FLLaO N ► Itt R ` .. Z Parcel I.D. # MUNICIPALITY Of ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Sita Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 017-562-15 GENERAL INFORMATION Completelegaldescription McMAHON SUBDIVISON ~2: LOT 8. BLOCK 9 Location (site address or directions) .3801 TAIGA DRIVE ANCHORAGE. AK 99516 Property owner BEVERLY PRUflq' Mailing address .3801 TAIGA DRIVE Lending agency Mailing address ANCHORAGE, AK Day phone 99516 Day phone (907) 345-5796 Agent BETH SIMPSON w./ DYNAMIC PROPERTIES Day phone Address .3111"0" STREET ANCHORAGE. AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4- 3. TYPE OF WATER SUPPLY: ~ndividual well xxx Community well Public water NOTE: (907) 261-7658 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 Holding Tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC lng to the legality and status of system. 72K)25 (Rev. 1/91) Front MOA #21 Computer Version Note: Alaska, Water. and Wastewater Consultants, Inc. shaft be paid $1000.00 at, or prior to, closing tor the engineering services providea. 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 vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation and ins~dcfion, the on-site water supply and/or wastewater disposal system is in compliance with all Munic[p,,Cyand State codes, ordinances, and regulations in effect on the date of this inspection. ' ,// / Name of Firm ALASKA WA,'IVE'I~& ~AS'tC~I~A~ER CONSULTANTS, INC. Phone (907)337-6179 Address 6901 DEBARR P-.O/AD,/S~E/2FAN(~HORAGE, ALASKA 99504 Engineer's Signature (.___ ~-/~"/,r~,.~''''~ Date -7/~!/C, ___ Inconductingthisevaluation, AWWO, ,nc/a~o.~.~.t_.ed~toprovideathorough, consciont,busong/noor/n¢analysisoftho system in accordance with ADEC and MCPA DH~IS Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water ~ , / usage of the family being served by the system These conditions are outside the control of · the evaluator of the system. Satisfactory test results do not guarantee future performance of the syatem, nor do they guarantee that there aro no hidden defects or encroachments. AVCWC Inc. can therefore not prot4de any warran~y for future estimate of how long the system will continue ,o meet the operational requirements of the ADEC or MOA DHHS. ~..cf.. :....?.. ~.-'.'~, '/'.~ ~. ..... ;'..'. ~...(~ The content of this report is for the sole benefit of the owner listed above. Any ~ reliance upon or use of this report by any other person or party ,'s not author,2ed, ~"'"'~: nor will it confer any legal right whatsoever. ¢~^ 6 DHHS SIGNATURE /// Approved for ~ bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existin~ State and Municipal Co_des. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 6.3 mg/1. EPA maximum concentration is 10,0 mg/1. More information on nitrates is available from the On-site Services Program~ DHHS, 343-4744. By: ¢'~/>,.~ ~ ~.~-'" /~/ ,¢"~'~ Date_ "?-"~- ~'¢ O The Municipali~ of Anchorage DepaAment of Health and Human Semites (DHHS) issues Health Authod~ Approval Cedificates 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 couAesy to purchasers of homes and their lending institutions in order to satis~ ceAain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a cedificate is issued. The Municipali~ of Anchorage is not responsible for e~ors or omissions in the professional engineeFs work. 72K)25 (Rev, 1/91) Sack MOA ¢~21 Computer Version Municipality of Anchorage JUL 2 DEPARTMENT OF HEALTH & HUMAN SERVICES -. Environmental Services Division ~uN~/~u~ o~- 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4~44!~ENYAL Legal Description: McMAHON SUBDIVISION#2; 155' YES Health Authority Approval Checklist LOT 8, BLOCK 9 Parcel I.D.: A. WELL DATA Well Type PRIVATE Log present (Y/N) Total depth Sanitary seal (Y/N) IfA, B, or C, attach ADEC letter. ADEC water system number YES Date completed Cased to 155' FROM WELL LOG 10/5/77 124' 017-362-15 N/A 12"+ YES 10/5/77 Casing height ~bove ground) Wires pmpedyprotectad(Y/N) ATINSPECTION 5/31/2ooo 123' 5 g.p.m. 5.6 g.p.m. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 6.3 mg/L Collected by: Other bacteria A.W.W.C., INC. Nitrate Date of sample: 7/11/2000 B. SEPTIC/HOLDING TANK DATA Date installed 8/77 Tank size Foundation cleanout (Y/N) YES Date of Pumping 5/31/2000 C. ABSORPTION FIELD DATA Date installed 8/77 Length 37' Width Effective absorption area 500 SQ FT Date of adequacy test Fluid depth in absorption field before test (in.); Fluid depth 82.5" (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* Computer Version 1250 Number of Compartments 2 Cleanouts (y/N) Depression (Y/N) NO High water alarm (Y/N) N/A YES Pumper DENALI ~* SUMP EXTENDS 112" BELOW DRAINPIPE INVERTI Soil rating (g.p.d,/ft2 or ft2/bdrm) 125 System type TRENCH 3' Gravel thickness below pipe 8' Total depth 13.4' Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO 5/31/00 Results (Pass/Fail) PASS For 4 Bedrooms * 77.5 lmmediatalyaftar 1425 gal. wataradded(in.):: 112" 405 Absorption rate = 600+ NONE KNOWN If yes, give date .... D. LIFT STATION ~'"~' Date installed Size in..~..ga Manhole/Access (Y/N) ~vel at* "Pump off" level at*  *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line 100'+ 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Lift station N/A __ SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK ON LOT TO: Foundation 5% Property line 5'+ Water main/service line 10'+ Surface water/drainage 100% SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Building foundation 100'+ NONE KNOWN )ldinspections and review Fstem$ are in conformance ~ t.h~his date. JEFFREY A. GARNESS Absorption field 5'+ Wells on adjacent lots_ 100'+ Property line 10'+ Surface water Curtain drain F. ENGINEER'S CERTIFIC I certify that Ih~a~ ~ of Municipal ¢cords1 with MOA H/~ gui~ Signature ~ ~ Engineer's Nam7 Date 7/~., ~0 10'+ Water main/service line.. 10'+ Driveway, parking/vehicle storage area 10'+ Wells on adjacent lots 100% HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Computer Vemlon Waiver Fee $ Date of Payment. Receipt Number APPLIC -'NT FILLS OUT UPPER HAL ,,ONLY Property Owner /~//.~".J~_/'~'~-~/ .~-' · -~,~.z . - '-~-';, '.,~,-~ ...... ~ ~; ..... '-'~. , , / ~ ~-,. ¢ ~'~-/~/ .2, M~iiing Addres~'~/~.~:?/~..~.,. /,:~;~ /.'2. ~?~.,? r/.,./~:~:¢.~/., . ..~/'~///~,,/_::,~/~.5~,,/ Zip Code ,L2/ / /-~-' Buyer '-' ,' >' ,).~ ~',d/~.y¢ ~/~ Phone Lending Institution / -'"/ ~'W -- ; ' :;~ : Address ,~ , / 7 ,'? ~,~,,,(:,.~1 ?_1,:-,~ /?,~., Zip Code '- '// _,,/~ ' '- ' i_..~,~ ,~.~(~., ~ , "~'/~.~/::~'~<:r~,-' Phone Realty Co. & Agent' ~:~f/~. /'t!~,~:2'/; Type of Residence [[~,¢~i n g le Family [] Multiple Family No. of Bedrooms [] Other Water Supply G~"fndividual ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. [] Community ¢~ For wells drilled prior to that date, give well depth (attach Icg if available). [] Public Utility OA Sewer Disposal [] Individual Year individual installed: [~ Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector., Inspector Inspector Inspector~ Field Notes: ~.~ ~r..~.,~e.~l~ ~z~ (..~ ~,..~,.. T,~-~ ~ .......ENVIRONMENTAL ~'~' ~F ~ 5A~;k~*~'''' RECEIVED (~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED CONDmON* * RO L DATE ~ I ~ Soils Rating Date ~wer Installed Well To Absorption Area { ~ Well Log Received l.~ Well ,o Tank /~ O' Septic T~k Size 72-023 (3182) / ASEMENTS OF RECORD, OTHER THAN ?JOSE SHOWN ON TI'IF. RF'GORDED. LAT ARE NOT SHOWN ~3,~3'~-~[,~' NO CORNERS SET TPhS horeby cez'tiiy that I ha~o performe(i spaet, ion of the fo]towing described property: ................... jy~'~Z;-~--(a.=L~:..~ _,.'~ZL=L :~.ZLt::Q .......... . ...... men(s situa'[,a~ ~hereon are within Lhc pro})e:ty t,.,._.: an,! c,w~v!ap ~ encroach on tho property lying' that i:o improvements on pro:party lying adj:.,'c:¢. 2hoc,.., sa:t~ pro:2e~%y ex~ep~ ~s im'!k'ated h~zreoa. Pa'~cil ;t~ Anchorage, FP, ZD WAL~tTXA &,,~..-'' Engineers and Survcyo;:, E1 June Cherry and Mires R. Jones c/o Jaunita Little Route 2 New Hebron ~ Mississippi 39143 Subject: Lot 8, ~,1o,, 9, i,lc?!ahon Subdivision ~2 Approval for the ind' 4 ,- lv~dual sewer and water facilities cannot be granted until the following items haw~ been completed: ~. ~] The water analysis report needs to be submitted to this office from the Chem L~]b, 5633 % Street, for our review. ?xpose the well for o%~r inspection to determine proper on.-'4tuuction, also to insure minimum distance requirements re met between the well and sewer s-~stemo o 'i'he septic tank pumped with a receipt submitted to this department. Please notify this Department for a reinspection t,~hen the noted discrepancies have been corrected. If there are any ~urt]er ~2uestions, please call this .... ~-~ ozzl.~ at 264-4720. Sincerely, Ct45/ej/E2 Cory Willis DATE RECEIVED ~' INSPECTION APPOINTMENTS TIME TIME TIME DATE D,.~?j~ ~7 DATE INSPECTOR INSPECTOR INSPECTg~ ~UNICIPALI~ ur ~l~ ........ ~UNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~NVJRONMENTAL pRoTECTION  825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION N0~ I 0 1981 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAClUTIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing, 1. PROPERTY OWNER PHONE MAILING ADDRESS /25'7 PROPERTY RESIDENT (If different from above) PHONE MAILING A ~'O~ 3, LENDING INSTITUTION J PHONE I MAILING ADDRESS 4, REALTOR/AGENT J PHONE MAILING ADDRESS q-3o 5. LEGAL DESCRIPTION 6, ~YPE OF RESIDENCE NUMBER OF~BEDROOMS ~ One ~ Four ~ Other ~ SINGLE FAMILY ~ Two ~ Five ~ MULTIPLE FAMILY ~ Three ~ Six 7, WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY * ATTACH WELL LOG. A well 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 ,l~/uD /c/ 77¢%"YEAR ON-SITE SYSTEM WAS INSTALLED. UST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVl DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLE?~f []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []HoldingTank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line [Z~'~APPROVED FOR "~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) __ ~ DISAPPROVED BY 72-010 (Rev. 6/79) STANLEy BRUST & ASSOCIATES Engineers - Planners - Surveyors 1317 East 74th Avenuc Anchorage, Alaska 99507 (907) 349-6577 S F~-!T l C SYSTEM ADEQUACY REPORT .JOB .o. ~ 5 - / 7-- LEGAL DESCRIPTION ' LOT __, BLOCK / OR __ SECTION S UBDi ViSiON ""/~ -, T.__N, R__W, S.M. , ALASKA PERFORMED FOR: F HO~IE NO. '~/ TYPE OF SYSTEM ' NUNtBER OF BEDRO©~dS SEPTIC TANK WAS PU!/PED ~ SEPTIC TANK - SIZE [] CRIB OR SEEPAGE PIT []/ LEACH FIELD YES E~NO " OBSERVATIONS / . _- ,7.. ~i' ,'J' TEST PERFORMED BY: ~..~_.?'..~.~t._~_._ REPORT PRLF:A~Er) BY] '~/'2~'*':;~ AP/ROVED BY: ........ :-., MUNICIPALITY OF ANCHORAGes. ~-oX~ DEPARTME "OF HEALTH AND ENVIRONMEN ~_ PROTECTION 825 L Street, Anchoraa~. AlaSka 99501 264-4720 Date Received: December ~1: Time Date Insp #2: Time #3: Time Date Date Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Lomas & Nedtleton Mailing Address: 4449 Business Park Btvd Phone: 2. Property Owner: James E. Jackson Phone: Mailing Address: P.O. Box 10-422 So. Sra. 99502 3. Legal Description: Lot 8 Block 9 McM~on Subdivision 344~4282 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: four Number Of Bedrooms: Individual well (x) 5. Well System: Permit # Depth of Well Construction~,,~/t?~~ 6. Sewage Disposal System: On-site System (x) Permit ~ Installed I~'~. Septic Tank Size Absorption Area Community/Public System ( ) Well Log on File Bacterial Analysis .~_-- Public Utility Installer Manufacturer Soils Rate [~ ~Material Distances: Well to Septic Tank to Sewer Line \ ~ Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area Page Two Department of Health and Environmental Protection RequeSt for Approval of Individual Sewer and Water Facilities Legal Description: ~6q- 8 ~c3~ q ~~o~ ~1,~ Comments: Affadavit Attached: Letter Attached: ( ) Approved: ~~~--~v _ ~ _ Date: Disapproved: Date: Department Worksheet: MUNICIPALITY OF ANCHORAGE ~ Department of Health and Environmental Protection 825 L Street, Anchorage, Alaska 99501 264-4720 -.~kequest for Approval of Individual Sewer and Wat~r Facilities 1. Property Owner: Mailing Address: Name of Buyer: Mailing Address: Phone: Lending Institution: Mailing Address: %¼u~ Phone: Realtor/Agent: Mailing Address: ~©~q)~O~ %100 Phone: ~q~/~7g Legal Description: ~-0~ ~, ~//~ ~ Street Location: .~I~ B~, ~ ~ Single Family Residence: (~ Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: *Individual Well If Individual Well, well depth If Community System, name of system Public/Community System ( ) Sewage Disposal System: *~n-site System (~) Public System ( ) If On-site System, date of installation: *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