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HomeMy WebLinkAboutMCMAHON BLK 2 LT 3McMahon Block 2 Lot 3 #017-041-25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS LEGAL DESCRIPTION LOCATION Well Absorption area ~ ~ DISTANCE TO: ~ ~ I Manufacturer~ NG m [Liq. capacity in gallons IF HOME,DE: .,S=A,C TO: I""'' ~ Manufacturer ~ I Well ~= I DISTANCE TO: I ~ ~ No. of linesl I L.~gth of.a¢d? ~ Top of tile to finish grade ' I ~ ~ I Type of crib -- ~ TO: Well ~ lCl~ Depth ~ ~ ~ TO: Building foundation Inside length Dwelling Dwelling Material Width Foundation Material beneath tile Depth Crib depth Building foundation Driller Sewer line OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS qq Material Nearest lot line~ Trench width ~- ~ inches inches NO.'OF BEbROOI~S PERMIT NO. No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines Total effe?~a~o~.~on area PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Absorption area(s) Septic tank APPROVED DATE LEGAL J"-'I~LJ~,.~ ]E C~. [ F'~'~L ][ T'"¥' OF" DEF'ARTMENT O' rlEALTH AND ENVtRI]NMENTAL ['"~"~TECTION S25~'L STREET, ANCHORAGE, AK 995~_~1 264'"4720 F'ERMIT NO: I)ATE ISSUED: AF:'F'L I CANI" ." ADDRESS: CONTACT I='HONE: LEGAL DESCRIP: LOT SIZE: MAX BEDROOMS: 06/25/85 JOHN HENDON 5700 PIC MAHON ANCHORAGE, Al< 99516 345-6695 SUBDIVISION: MC MAHON SECTION: 28 TOWNSHIP: 30000 (SQ.F"I". OR ACRES) 3 12N LOT: RANGE: 3W ELOCE .... 2 Listed below are the options'available to you in designing your septic system. Choose the option that best fits your site. DEP"t'H TO F'IPE BOTTOM (F'T'. GRAVEL DEPTH (F'T. ~ 'T'OTAL DEPTH (F"I".) GFCAVEL WIDTH (F'¥.) GRAVEL LENBTH (F'T.) GRAVEl_ VOLUME (CU. YDS. TANK SIZE (GALS) SOIL RATING (SO.FT. /BR) ----4.0 '~ '~ 4.0 4.0 7.0 k~ O. 5 3.5 ~ ~ 4.5 7.5 2.5 27.0 ' 5.0 91.0 ~ 54~0 137.0 ~ 63.'2 54.0 101.5 000.0 *~ 1,000.0 .~.~ ~,000.0.~.~ 424 320 424. *~. GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 Fl". EACH) *.~ TANK MUST HAVE AT LEAST TWO COMPARTMENTS I ce~*'Liry that: 1. I am £amiliar with the requirements for on-site sewers and wells as set. ¢orth by the Municipality o~' Anchorage (MOA) and the State of .Alaska. 2. I will install the system in accordance with all MOA codes and regulatians, and in compliance with the design criteria o¢ this permit. 3. I will adher'e to all MOA and State a~ Alaska requirements for the set back distances Crom...any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid Cot a maximum o¢ ~; bedrooms and any enlargement will r'equire an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA covERED BY MOA BUILDING CODES, THEN (1) 'AN ELECTRICAL PERMIT AND I'NSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL N[]T BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE: ELECTRICAL WORK MLIST BE DONE~A LICENSED ELECTRICIAN. ' ' DATE PERFORMED FOR: LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SILT SLOPE SOILS LOG PERCOLATION TEST DATE PERFORMED:~~ SITE PLAN Il: 10 11 12 -~13 15- 16- 17- 18 19- 2O WASGROUND WATER S ENCOUNTERED? N~ L O P E Gross Net Depth to Net Reading Date Time Time Water Drop , -.- 'o~t o~ I4OL~ PERCOLATION RATE ~"y (minutes/inch) TEST RUN BETWEEN ~ FT AND ~ Y~'", FT COMMENTS PERFORMED BY:. CERTIFIED BY: 72-008 (6/79) G?~TER ANCHORAGE AREA BORO/;"~%H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279,z511 N? 687 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCAT,ON /NC-/e/,O MA,L,NG PHONEZ?¢'/ m ADDRESS SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY /~/-)-~ MATERIAL .~"/~}/'~:~ COMPARTMENTsNUMBER OF / ?~'"'///~,,1{'" ~"/~Z:~--~' /~'¢7 ~ ~] ] ~/~/ ',~ '7 LIQUID GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH__ SEEPAGE SYSTEM: SEEPAGE PiT: NUMBER OF PITS / OUTSIDE DIAMETER LINING MATERIAl NEAREST LOT LINE ,'~ '~/~ ~' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) / / - '~ OR WIDTH , LENGTH ~ ~ , DEPTH DISTANCE FROM WELl //~/'~/ ' - , BUILDING FOUNDATION SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL r~ ---- ~'~DUND~,TI~'~ , NEAREST LOT LINE NUMBER OF LINES , DISTANCE BETWEEN LINES TRENCH WIDTH ABSORPTION ~R SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH . OF LINES ,--,"1~. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__ WELL: TYPE ~'~'~,z//';:'~) DEPTH 2C~)~2/:'' DISTANCE FROM , BUILDING FOUNDATION. LOT LINE ~:~) / ~:' /~ NEAREST SEPTIC ~ / SEEPAGE . SEWER LINE '~ , TANK , SYSTEM 76~7 WATER -~ S AM pL E ~_~?();(;~'r , NEAREST OTHER , CESSPOOL , SOURCES DISTANCES: . t DATE DIAGRAM OF SYSTEM '-.,~: '' NAME OF APPLICANT [NSTALLATION LOCATION LEGAL DESCRIPTION iNSTALLATiON Of: SEPTIC TANK GREAter ANCHORAGE AREA BORuUgh DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO,./S9/ 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-868E SEWAGE SEEPAGE PIT / . DRAIN PleLD . ., OTHER FINANCED THROUGH - /- TO BE iNSTALLED BY WITHOUT ~OIL FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMEI~TS FOUNDATION TO SEPTIC TANK 2c2~i~: /~ FOUNDATION TO SEEPAGE PIT ¢ , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL / ~ / ' , SEEPAGE PiT ,DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK ~ / w~. ~. ~o ~,~ ~ /22 ~' SEPTIC TANK, SEEPAGE PIT ALSO CONSIDER AREA WELLS. · SEEPAGE PIT . SEEPAGE PiT //~0C/~ ~', DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRib CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 iNCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. DIAGRAM OF SYSTEM GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION, JHEALTH AUTHORITY OR LICENSED DESIGNER I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM ISIN ACCORDANCE WITH SAID CODE. /~/~/~/~///~ DA APPLICANT'S SIGNATURE / . , CASE' f'eet Soii ;%' =~", ....... -'- tan clayey silt (CL) Perfo~,med For Jim Brown . .. ~ ..................... Date Per.~o.vmed 5/19/71 Legal l)~:,'~C~'~.otic, p, · Lot 3 q~ ~- ~ 9 '~¢~"'~'~'?~ gray sand & silt, inter- mixed ~,(ML) with poorly graded sand seams and pockets below 7' Was Ground Watex, Encountez, ed? if Yes ~ A*, '.--~hat Dep~.h Gross Time Ne'~, Time Location ~" ~- - o~e~ch Dept.~ To P2r~ ,~et D~op Data Certified By~ National Testin~ Services. Inc. Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. 1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING o 7-o4 -25 Expiration Date: ~/'/~/¢ ~' Completelegaldescription McMAHON SUBDIVISION; LOT 3, BLOCK 2 Location (site address or diractions) 3700 McMAHON AVE * ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Ageni Mailing address SUE MILLER Day phone 345-8549 3700 McMAHON AVE * ANCHORAGE, AK 99516 Day phone Day phone Unlessotherw~e requeste~ HAAwillbehe~byDSD~rpickup. 2. NUMBER OFBEDROOMS: 3 3. TYPE OF WATER SUPPLY: individual Well 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 samples. (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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ d'~ at, or pdor I to closing for the engineering services provided. . I 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 in the Health Authodfy 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 bedrroems and type of structure indicated heroin. I further verify that based on the information obtained from the Municipality of Anchorege 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 ALASKA WATER &: WASTE'WATER CONSULTANTS. INC. Phone Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE, AK 99504- Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 337-6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD 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, groundwater 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 perfon'nance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will conbhue to meet the operational requirements of the ADEC or MOA DSD. 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 parry is not authorized, nor will it confer any legal ~fght whatsoever. 5. DSD SIGNATURE Approved for .~ Disapproved. Conditionalapproval for __ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms. bedrooms, with the fllowing stipulation~.';.X~...' '.. Manitenance Agreements Supplemental Engineer's Reort Other Odginal Certificate Date: Municipality of Anchorage Development Services Department Building Safety On-Sife Water & Wastewafer Program 4700 ~outh 8mgaw P.O, Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (9O7) 343-79O4 Legal DescrlpUon: A. WELL DATA Well type pI~IVATI~ If A, B, or C provide PWSID# Date completed * 7,/1971 Sanitary seal (Y/N) YES Totaldepth 1274-lt. Casedto 40+ ft. FROM WELL LOG Date of test Static water level ~ It. Well production / g.p.m. WATER SAMPLE RESULTS: Collfo~m 0 colonles/100nd. Nitrate 4.15 ragA.. Arsenic: N`/A mg./L. Date of sample: 6`/6`/2002 B. SEPTIC/HOLDING TANK DATA *INSIDE: CRAWL SPACE Tank Type/Material 5rE~L HEALTH , UTHORITY , ,PPROVAL CHECKLIST McMAHON S,/D; LOT ,3~ BLOCK 2 Parcel ID: * PER U.O.A. fiLES Well Log (Y/N) Wires propedy protected (Y/N) Casing height (above ground) AT INSPECTION 6`//6`/2002 123 If. 5.7 g.p.m. 017-041-25 NO YES 12+ in. Other bactetta 0 colonies/100 mi. Collected by: AKWWC: INC. Date installed 7,//1971 Tanksize 1000 gal. Number of Compartments 2 Cleanouta(Y/N) Foundation ctaanout (y/N) eYES Depression over tank (Y/N) NO High water alarm (Y/N) Date of pumping : 6`/5`/2002 Pumper CHUOACH PUMPIN0 C. ABSORPTION FIELD DATA # ,~,-'.. TRD~ ON1.Y Date installed Soil rating (~or fla/bdrm)262'/424 System type CRIB/ql~ENCH Length ,28`/06 lt. Width 14`/2.5 It. Gravel below pipe 10/7 ft. Totaldepth 13/~4 ft. Eff. absorptionareae4O/~3441ta Monitoringtupe YES Depression over field NO Date of adequacy test 6/8/2002 Results (Pass/Fail) #PASS For 3 bedrooms Ruiddepminabsort~onfletdbeforetast 25 in. Watereddedl000gaL Newdepth45.Sin. Elapsed Time: 349 min. Final fluid depth 42.5 in. Absorption rote >- 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (y/N & type) NONE: KNOWN If yes, give date - D. LIFT STATION Date installed Size in gallons ~~ ~ 'Pump on" level at in. 'Pump off' n. High water alarm level at ~ in. ~ Cyciee tasted Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot*50'+ Absorption field on lot 100'+ Public sewer main N./A Sewer/septic service line. 25% On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manholaldeanout Holding tank N,/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Abserptlon field Water main N,/A Water service line 10'+ Sun'ace water. Wells on adjacent Iota 100'+ 5'+ 1 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line . 10'+ Curtain drain NONE KNOWN Building foundation 10'+ Sun'ace water 100'+ Wells on adjacent lots. 100'+ Water main N,/A Driveway, parking/vehicle storage 10'+ F. COMMENI~ * INSTALLATION PRIOR TO 10,//1973 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections end mt/few of Municipal records that the above systems ere in conformance with MOA I.IAA guidelines in effect on this date. Engineer's Pdn~ed/Name JEFFREY A. GARNESS Data Date of Payment Receipt Number (Rev. lwol) Waiver Fee $ Data of Payment. Receipt Number .TI ..... :..'1.~ ~ . ~:. I -i ', ~ ~' :".' "T,4'i""'['": ;.'. ~'. "'2". ' EASEMENTS OF RECO.RD, OTHER THAN THOSE SHOWN ON THE RECORDED '. pLAT ARE I~OT SHOWN H~REON. I ~S.BUILT NO CORNERS SET THIS DATE' '1 · .:-~.'I :~.~ ..--~ · .... : ~:,~ · : ? :.:". · .~? I hereby ceflify that I have pedmmed a Mortgagee's I~ et the'~l~ving described prope(~7: ~ .-'-'-'-'-'-'-'-'-'~'; Anchorage Recording Precinct. Ate~ka. and '~M' ,~h ~ the premises ~ quests a~ ~ ~[~ ~a~. tm~ml~n a~ or ~ ~ e~ DaI~ at ~chorage. Ala~ ' ~is ~C+~ , day et O~O~ER FRED WA~ & ~ 2~-1~ Englneem end ' ~'~ DEPARTMENT OF HEA£TR & HOMAN SERVICES ~ Division of Environmental Services On-Site Services Section P.O, Box 196650' Anchorage, AlaSka 99519-6650 343-4744" MAY 1 9 1997 - CERTIFICATE OF HEALTH AUTHORITY RECEIVED - . ~ .APPROVAL FORA8 NGLE F~MIL~ DWELLING ~ 1, GENERALINFORMATION ' ' -~': .... ' - :~:':.-. Complete legal description ~o~ 3; BZock 2; HcHahon ~u~v~s~on Location (site address or airections) pr~.'.~'f,.,,.~,'.' .~,~ '~ Bill MJ? ~er 3700 McMahon DRive Anchorage, AK p...wi~hon~ 345-8549 >" v'--.~, .. "-.'~ :B700 McMahon Drive Anchoraqe, ~ ~.~ ;Madlng address ~,ddress - '" AK 99516 Unless otherwise requested, HAA will be held for pick'up. Day phone Day phone NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water RE E1VED MAY 19 1997 ~umc~pah[y ot Anchorage Health & Human NOTE: 4. TYPE OF.WASTEWATER DISPOSAL: Individual on-site Community on-site Public sewer ' If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. .' :, 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 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 waste,w, ater disposa system is safe, functional and adequate for the number of bedrooms and type of structu re 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 '.SUppiy arid/or' wastewater disposal, system is in compliance with all Municipal and State codes, ordinances, and regulations in effectNO~ the date of this inspection. s & SENGI NEER/N¢ Name of Firm 17034 Eagle River Loop Road No. 204 Phone Gct 5/-;~ ~ '7 ~ Eagle River, Alaska Y951/ Engineer's signature -. Date 5- ///~/~) ? 6. DHHS SIGNATURE Approved for Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: -"- "Additional Comments The Municipality of'.A, nchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates' based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not res ~onsible for errors or omissions in the professional engineer's work. 72-0'2.5(Rev. 1/91) Back MOA~'Zl Legal Description: 'LO T 3 A. WELL DATA Well type P/'{~ Log present (Y/~) /v 0 ~.~.~J'j3ase d to Sanitary seal CH) ¥ ~ ~ FROM WELL LOG Date of test Static water level Well producti.on ~IvIRONIvlENZAL '~C~ . .. '. SE,~ViCE~ Municipality of Ancnorage '~, DEPARTMENT OF HEALTH & HUMAN SERVICES ~AY 79 1.qe~ Environmental Se~ices Division ~_ -~) 825 L Street, Room 502- Anchorage, Alaska 99501. (907) 3~-~1 Vr Health Authority Approval Checklist GL~c~ ~ ~c~a~¢~ ~Parcell.D.: 0,~ -0HI -~¢ If A, B, or C, attach ADEC letter. ADEC water system number Date completed /°A/°P' ]-¢ '?/"~/ -' ~._~,-.~s.I Casing height (above ground) WATER SAMPLE RESULTS: Wires properly protected AT INSPECTION I /'/- g.p.m. Coliform O Date of sample: ~/j 6 / ~ 7 T^N DATA Date installed '7 / '~ / Tank size Foundation cleanout (Y{~). Nitrate Collected by: Other bacteria S & S ENGINEERING ........... Eagle River~ Alaska ~577 / 00 0 Number of Compartments .! Cleanouts~)'N) )'~ .5 Depression (Y/~ ,v O-~- High water alarm 0f/~) Ar ~ Date of pumping 3~: 6 Pumper I C. ABSORPTION FIELD DATA . -.-' Length.~ ~ ~ ~ Widthlq ~ V~ / . Gravel thickness below pipe Effective absorption area ~ qo ~ W ~Monitoring Tube present ~/N) Date of adequacy test &~/0 / ~ 7 Results (Pass/Fail) ~ ~J For ~ bedrooms Fluid depth in absorption field before test (in.); Immediately aRer ~ ~ ~ gal. water added (in.): Fluid depth ~ f ) /* ~'ns) Minutes later: )~ / Absorption rate = ~ ~0 ~ .g.p.d. Peroxide treatment (past 12 months) (Y/N) ~v 0,~£ /~ ~o ~ If yes, give date 72-026 (Rev. 3/96)* L4. v¢[_ /"'~ ¢ ' '/ '4,- '/, ~ ,,;,: ,, .: .%:...:.¢: . .: ,: ..,. · D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycle~s._t.?s~ E. SEPARATION DISTANCES Size in gallons RECEIVED MAY 19 1997 D Municipality of Anchorage Health & Human Services SEPARATION DISTANCES FROM WELL ON LOT TO: ~-- tptpt~holding tank on lot__ ,5'-O '7~(?,t,¢,'~ ;r~ ~o/~_~/)Dn adjacent lots Absorption field on lot / 0 o W-- Public sewer main ),Y/~ / Sewer/septic service line ,~ S- ~ Lift station SEPARATION DISTANCES FRO~~-~¥-IOLDING TANK ON LOTTO: Foundation ~- / Property line ~ O ¢- Absorption field Water main/service line /0 '¢'- /OO ~L On adjacent lots Public sewer manhole/cieanout Surface water/drainage } 0 ¢ ~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / Property line lo /4- Building foundation ~ O 7-~ Water main/service line Surface water ~ 0 o -~ Driveway, parking/vehicle storage area Curtain drain ?v o ~,& /¢,~ o ~,, ,,~ Wells on adjacent lots ¢ o 0 ENGINFER'S CERTIFICATION I certify that l have determined thru field inspections and review of Municipal rec~.~$~.e~.~'.~tems are in conformance wi~h MOA HAA~uideljnes in effect on this date. Date HAA Fee $. k-~ ' ~'(-~ Date of Payment ~-~i/¢/¢'/~ ?- Receipt Number '~"/, ~//~"~'//~/'" ~/r,~'/(~ C ~,~/ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES_ Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage,'Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# HPi'~L~)~-~~-'~z~r~ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) ~' 7 o0' ~'c/'~/~,o m Property owner Mailing address Lending agency Mailing address Agent Day phone Day phone Day phone Address ~,~o/ 'c" 5 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well ~'~ Community well .,,, ...... Public water ....~,'~,., ~ ~,: .'-. If community well system, provide written confirmation from State:ADEC attest% . .~ t ing to the legality and status of system. ~ :,_.; ~t : ~ * ~ , ,; 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system ..... ' ' .... 72-025(Rev. 1/91) Front MOA#21 '-"; ' 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 ~hat 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. NameofFirm F (~ f'/c? 7-~,c/*~;c~f _c~,,'~¢ ~ Phone '5"-/~-- / 3 5-5- Address I'./5'3d/ ~cf, o _c /..~ ,,~,,cAc, r-~ /~ ~"ld' Engineer's signature '~--~ ~. ~ Date DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: ",. \ i Additional Comments % , ~y: ::~ /~..~:;'? '~,, / ~ -~- Date / ' .,. ~ ~ ,,,:.:.'.-~ /. - ..... The M~'nioipali~ of Anchorage Dep~nment of Health and Human 8e~io~ (DHHS) i~ue~ Health Authori~ Approval Oe~ifio~te~ b~ only upon the representations given in paragraph 5 ~bove by an independent profe~ional engin~r registered in the State o~ Ala~, The DH H8 does thi~ a~ a oou~e~y to puroha~ of homes and their lending ln~titution~ in order to ~tis~ o~in f~eml ~nd state requirements, Employ~ of DHH8 do not oondu~t ln~peotion~ or ~n~l~e d~t~ before ~ ~e~ifio~te i~ l~ued, The Munioip~li~ of Anchorage ~ not responsible for erro~ or omi~ion~ in the pr~f~lon~l engin~(~ wor~, : : .: Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /...o(- ~/ G (I," ~ /"~(~c~/~ o,~ Parcel I.D. A. Well Data Well type {%'¢' Log present (Y/N) /,/ Total depth '~o.¢' (/~r Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 la ~' //w~) Cased to Y If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~- I ~ '7 1 Driller '~ o.¢' Casing height 15-- Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION I0 15't9¥ g.p.m. .5-. ~ ~- .g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot '7 ~-' ~, c. o, ,0~'t lA I; n ad'acentl lots Absorption field on lot Its-' ~ c, o, Public sewer main Iq, A. Sewer service line , ; On adjacent lots ~ too' Public sewer manhole/cleanout N./4. Petroleum tank /Vo,~ ~ .5 e ~',~ WATER SAMPLE RESULTS: Coliform ~;) Cc~( /(O0 ~-~ Date of sample: lC' / 5-/ Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed 7 ( 7 ! Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size ( OOo ~' ~ ! Compartments I Foundation cleanout (Y/N) Depression (Y/N) N~. fi. Alarm tested (Y/N) /V. A. I0 tt5- I ? ¥ Pumper ..~"~c.r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 7 Z' ~,, ¢. c,, To property line Surface water/drainage On adjacent lots ~> ( oo ' Foundation Absorption field "~ ~.' Water main/service line 72-026 (~)' Front CONTINUED ON BACK PAGE C. LIFT STATION ~(./~. Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LiFT STATION TO: Manufacturer Manhole/Access (Y/N) "Pump off" Level at .Cycles tested Well on lot D. ABSORPTION FIELD DATA Date installed '7/'7 ( Length _ '~ g) Total absorption area Date of adequacy test Width On adjacent lots Sudace water Soil rating (GPD/FF) ¥2,/ r'J'//5'~,'r,, Systemtype ~',.,? P,,' Gravel thickness I 0 Total depth t 3 ' Cleanout present (Y/N) 't' Depression over field (Y/N) A/ Results (pass/fail) P ~'-/ for "3 Bedrooms Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot Il5'' ~r~,~ To building foundation ~' ~' On adjacent lots ~, 3r.J' Sudace water ~ { oo ' Curtain drain Hon:, E, ENGINEER'S CERTIFICATION After test 3'~" If yes, give date ~J./~. On adjacent lots ;> ~ oo' Property line To existing or abandoned system on lot IV,/~. Cutbank /Vo,~ Water main/service line '~, Driveway, parking/vehicle storage area ~, 5-0' HAA Fee $ Date of Payment Receipt Nurnber 72-026 (W~)' ~ck Waiver Fee $ Date of Payment Receipt Number I ce~'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect,~(~.clate of this inspection. Engineer's Name Date ' '~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PR~JTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILIT¥ 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~ ~ ~L~O~O~ Telephone: Mome Business Applicant Address ~~ (¢) Applicant is (check one): tending Institution.J7.: Owner/builder []: Buyer [] ~ Other [] (explain): (d) Lendinglnstitution ~'~ .~Cj~u~e,[t ~..,}UlO/14 Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms ~> Other 3, WATER SUPPLY Individual Well I~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation · attesting to the legality and status. 4. SEWAGE DISPOSAL :,]:..Onsite [~,-- . Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation fro m the State Department of Environmental Cc nservation attesting to the legality and status. :' 72-025 {11/84) Page 1 of 2 ' . : 5.' ENGINEERING FiRM PROVIDING INSP As certified by my seal affixed hereto and as of the validation date Authority Approval shows that the on-site water supply and/or wastewater disposal systef~ for the number of bedrooms and type of structure indicated herein. I further verify that based on the information 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 Engineer's Seal F : Conlitional _ ~ Approved .)~' Disapproved Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MuNicIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHOI~LTH AUTHORITY APPROVAL (NAA) DEPT. OF HEALTH & ENVIRONMENTAL p,~OI'EC'~ION CHECKLIST - FEBRUARY 1984 264-4720 r_B 'i 1986 WELL DATA Well Classification Well Log Present (Y/N) Total Depth ~-~--~ Cased to Static Water Level ~' ~., ~ Casing Height Above Ground /i~ Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Legal Description: t,, If A, B, C, D.E.C. Approved (Y/N) Date Completed "~'~. ~'7~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot JO/../~O On Adjoining Lots To Nearest Public Sewer Line ~N,I~OI~I I~. To Nearest Public Sewer Cleanout/Manhole ~@-~,~ To Nearest sewer Service Line on Water Sample Collected by ~"~ .~.¢.~ ; Date "~// Water Sample Test Results ~.,L'~, ~/~*! Comments B. SEPTIC/HOLDING TANK DATA 1~71 Date installed Standpipes (Y/N) ~:)-~ Depression over Tank (Y/N) P~mping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Welt To Property Line ~ ~ To Water Main/Service Line Course Comments Size /O~;~ ~ No. of Compartments ~:)N/..~ Air-tight Caps (Y/N) Y~ Foundation Cleanout (Y/N) Date Last Pumped ~'~1~ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation ~' To Disposal Field ~'"~/ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72 026{11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ Width of Field ~ ~ '( Square Feet of Absorption Area /.~/"~¢ Depression over Field (Y/N) ~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well / '~O To Building Foundation 7~ Lot ~,~,. To Water Main/Service Line ~ lC) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field c/, ~, Depth of Field I ~ ! Gravel Bed Thickness 7 t Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) NO~-~ D. LIFT STATION NO~E Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to ali, MOA and HAA guidelines in effect on the date of this inspection. Signed ~'~'"_ ,~.~,,~1,~ /-} Date MOA No. Company' "~ ~ Receipt No. ~'~'~ ,~- 't et, Date of Payment Amount: $ Page 2 of 2 72-026 (11t84) Engineer's Seal MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORIVIATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name '"t~h~ ~l~,,~'~o~. _Telephone:Home '~V'~"Ce~9~ Business Applicant Address .~7~ ~ ¢~. ~.~ ~ ¢'J (c) Applicant is (check one): Lending Institution []; Owner/l~; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address I~'~ ~ Telephone ~ ~ ~ (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ~ Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 SEWAGE DISPOSAL OnsiteJ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11,84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AS certified by my seal affixed hereto and as of the validation date sh,~wn below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or waste.~vater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, i1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigati~Dn and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, end regulations in effect on the date of this inspection. Name of Firm ~'"~,~ ~"~g,~ ~'~..~,J Tel~phone ~7~ - ~ ~ Date ~ ~ ~; ~ ~ ~ DHEP APPRQ.~_.~ ~ .~? Approved for /~JqD2..~2~ bedrooms by //~" ~ Approved ;'~ Disapproved~'~-?/ lerms of Conditional Approval Conditional) CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 ~- CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND SOCIAL SERVICES JUNE 27,1985 Re: Health Authority ApprOval, Lot McMahon Subdivision 3, Block Madame; On June 19, for subject system. 19~85 an Health Authority Application was lo% due to inadequate absorption of the rejected existing This system has now been replaced. Please issue a Certificate. Tobben Spurkland P.E. i,,~UN!CIPALITY OF ANCHORAGE D£PT. OF HEALTH & ~NVtRONMENTAL pRoTECTiON,: MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL kr~ALTH DEPAR~/~ENT OF h~ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal DescriptionA °T ~ (include~ ~( ~l°t' ~cbl°ck'~-~subdivisi°n'~ ~-~.secti°n'7'/~/~t°wnship'f~ ~ ~nge) Location (address or directions) (b) Applicants Name ~ ~..~J~ Telephone - Home Applicants Address ~D ~,~.~ (c) Applicant is (check o~) Lending Institution ~ ; ~er/builder ~; Buyer ~ ; 0ther ~ (~plain); (d) Lending Institution Telephone Business Address (e) Real Estate Co. & Agent Address ~1~ ~ ~ (f) Telephone ~7~-- /~--9~ Mail the HAA to the following address: 2. T~pe of Residence .Single-Family~ Number of Bedrooms 3o Water Supply Individual Multi-Family~ Other (describe) Comuunity~ Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status° 4. Sewage Disposal Onsite ~ Public ~-~ Community ~ Holding Tank ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status° [Page 1 of 2] 0- 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, 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 regula- tions in effect on the date of this inspection. Name of Firm ~$~..M ~/f~~ Telephone u~.~ ~F''0''~-'''~''~ ~,~ ~/ ~-'... A ".C. _ fl Z PP PP Tems of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPA/~TMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES ~E. ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A® DEPT. OF HEALTH & ENVIP. ONM~NTAL p,~OTECTION MUNICIPALITY OF ANCHORAGE (MOA) ,~i'l 'l '[ ~g85' HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 _~ E C E I V E D Legal Description: ~,~ Well Classification ~ ~ If A, B, or C, D.E.C. Approved(Y/N) Well Log Present (Y/N) l~ Date Completed Jg~ } Yield~ ~. Total Depth ~O~ Cased to ~O.~ Depth of Grouting Static Water Level ~, ~ Pump Set At ; WO Casing Height Above Ground l ~" Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) )/ Depression Around Wellhead (Y/N) Separation Distances f~om Well: To Septic/Holding Tapk on Lot ~ ~) ~ <~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot IOJ' ; On Adjoining Lots To Nearest Public Sewe~ Line NO~ To Nearest Public Sewer Cleanout/Manhole ~OA~. To Nearest Sewe~ Service Line on Lot Wate~ Sample Collected By 7~. ~ ; Date ~//~/~ · Wate~ Sample Test Results ~, ~ J, ~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed J~.~//~ 7/ Size ! D ~ ~ No. of C~)artments d) Standpipes (Y~) ~- Ai~-tight Caps (Y~) ~ Foundation Cleanout (Y~) ~p~ession o~ Ta~ (Y~) ~ Date ~st P~d H~ J~ ~ P~ing~intenan~ ~n~act on File (Y~)~/~ ; fo~ Holding Ta~ High-Wate~ Ala~ (Y~) ~ Te~ra~y Holding Tank Permit (Y~) Sep~ation Distance ~ ~ptic~olding Tank: To Water-Supply ~11 ~ 6~ To ~ilding Foundation To ~o~rty Li~~ ~O To Dis~sal Field To ~ter Main/Se~vi~ Li~ ~O ~ To S~esm, Pond, ~e, ~ ~jor ~aina~ course NoNE Comments [Page 1 o~~ Receipt Date Paid: Amount: 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) ~,_~--~=D~~~% Adequacy Test Results of last Adequacy Test,/ Separation Distance from Absk~r.~ption Field: To Water-Supply Well 70 t To P~operty Line ~ 7 Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) To Building Foundation ~/ Lot A~0 ~qk- ; On Adjoining Lots ! ~ ~ {' TO Water Main/Service Line ~'O f- To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course ~69 g/f-~- To Driveway, Parking Area, or Vehicle Storage Area b-O ~ Comments To Existing or Abandoned System cn D. LIFT STATION Date Installed Si?~ in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dinmnsions Manhole/Access ( Y/N ) "Pump Off" Level at Vent (Y/N) Purmping Cycles c~aring Adequacy Test. Meets FDA Co]~nts ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, o~ conform~=d to all MOA HAA C~idelines in effect on the date of this inspection. Signed ~~~~!~Date Con~pany ~ MOA No: ~ ~' $ ;--~/~ 2-15-84 CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 SEPTIC SYSTEM A~9~A~ TEST LEGAL: LOCATION: OWNER: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: TEST PROCEDURE: TEST RESULT: LOT 3, BLOCK 2, MC MAHON 3700 MC MAHON JOHN HERNDON SINGLE FAMILY, THREE BEDROOMS ON SITE WELL FROM MUNICIPAL RECORDS: TANK: 1000 GAL, STACK STEEL ABSORPTION SYSTEM: LOG CRIB ABSORPTION AREA: 840 SQ.FT. SOIL RATING: 262 INSTALLATION DATE: JULY 1971 THE SYSTEM WAS INSPECTED ON JUNE 13, 1985. THERE WAS SIGNS OF OVER FLOWING OF THE LOG CRIB. AND THE TANK WAS FOUND TO BE SURCHARGED. THE SYSTEM WOULD NOT MEET THE MUNICIPAL REQUIREMENTS. THE SEPARATION DISTANCE BETWEEN THE WELL AN~THE SEPTIC TANK IS 60 FEET. THE REQUIRED DISTANCE IS 100 FEET. WHEN THE SYSTEM WAS INSTALLED THE REQUIRED DISTANCE WAS 50 FEET. THE MUNICIPALITY DOES NOT REQUIRE THAT THE TANK BE RELOCATED. ? AN UPGRADE OF THE ABSORPTION SYSTEM IS REQUIRED BEFORE AN HEALTH AUTHORITY APPROVAL CAN BE GIVEN. BASED ON THE EXISTING soIL LOG A TRENCH 12 FEET DEEP, WITH 5 FEET OF ROCK AND 92 FEET LONG MUST BE INSTALLED. I RECOMMEND THAT THE SOILCONDITION BE REEVALUATED BY DIGGING A TEST HOLE AND RETESTING THE SOILS. CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 2'/9-3916 RESIDENTIAL WELL INSPECTION LEGAL: LOT 3, BLOCK 2, MC MAHON LOCATION: 3700 MC MAHON OWNER: JOHN HERNDON TYPE OF WELL: WELL LOG AVAILABLE: RESIDENTIAL NO INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: NOT AVAILABLE PUMP YIELD: 5.75 GALLONS PER MINUTE DATE OF INSPECTION: juNE 13, 1985 TEST PROCEDURE: WELL WAS PUMPED AT A STEADY RATE OF 5.75 GALLONS PER MINUTE. THE WATER LEVEL IN THE WELL WAS MONITORED. TOTAL WELL DEPTH WAS FOUNF TO BE 205 FEET WITH STATIC WATER LEVEL 132.5 FEET BELOW GROUND SURFACE. DRAWDOWN AT 5.75 GPM WAS 3.5 FEET TO 136 FEET BELOW SURFACE. TEST FOR COLIFORMS: NEGATIVE TEST RESULT: THIS WELL SURPASSES THE MUNICIPAL REQUIREMENTS. The Municipal requirement for well flow is 150 ~gallons of water per bedroom per 24 hours. This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from [the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. --~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR ,t INSPECTOR INSPECTOR ,~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF ~,.d 825 L Street - Anchorage, Alaska 99501 ENVIR©NMENTAL ENVIRONMENTAL SANITATION DIVISION ~'~0~J 4: 1981 Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be processed. Please allow ten (10) days for processing. 1. PROPERTYO~ ~ ¢ PROPERTY RESIDENT (If different from above) I ~ PHONE MAI LI N~pDR ESS 5. LEGAL D/E~CRIPTiON ,~ , STR E ET"LOCATI ON 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four ,{~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * 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 J~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY //P Z/ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [~ SINGLE FAMILY [] ONE ~] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY I~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~ INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ,~2_ ~_~ ~/ ~ ~/' Connection Verified INSTALLER I~Septic Tank or [] Holding Tank Size: //g2/~2 If Tank is homemade 8OILSRATING give dimensions: TY P~E,~_F TANK MAN L~F~ACTUI~ ER 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 5. COMMENTS ~A~PROVED FOR ~-~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79) ~ ¢ DATE RECEIVED -- INSPECTION APPOINTMENTS TIME I TIME TIME DATE DATE DATE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~IOI~I~EpT' OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL pRoTECTION ENVIRONMENTAL SANITATION DIVISION 0C~' Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~I~I[I~I~ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER I PHONE Philip E. ReecerJ 349-4760 MAILING ADDRESS SRA 1552 A Anchoraqe, Alaska 99507 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE Robert Bentz MAILING ADDRESS Seward Alaska 3. LENDING INSTITUTION I PHONE MAILING ADDRESS 4. REALTOR/AGENT [ PHONE Violet Hulce at Totem N~alty Inc.I 272-0571 MAILING ADDRESS 724 E. 15th Avenue Anchorager Alaska 99501 5. LEGAL DESCRIPTION Lot 3 Block 2 McMahon Subdivision STREET LOCATION NHN McMahon Street 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [] Other [~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [~ Three [] Six 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * 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.) 210 f~et deep 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY 1971 YEAR ON-SITE SYSTEM WAS INSTALLED, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~]INDIVIDUAL/ON -SITE DATE INSTALLED E] PUBLIC UTILITY Connection Verified INSTALLER E]Septic "Fank~or [] Holding Tank Size: ~/ ~) r.~© If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIALl (~, ~ir~a"~' 4, DISTANCES Septic/Holding Tank Absorptio Sewer Line J Nearest Lot Line WELLTO: Absorption Area to nearest Lot Line 5, COMMENTS J~"'/APPROV E D FOR ,~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev, 6/79) ALASKA EnUIRO MEnTAL COI1TROL SERUICES, I[/C. ~ncjineerinc~ ~ ~nuJronmental Studies MUNICIPALITY OF ANCHORAGE DEPT. OF I4.-ZALTi'! & ENVIRONMENTAL ?F:OTECTION OCT 2, $ !980 RECEIVED OCTOE:ER 20 1980 PHILIP REESER SRA E:OX :L552'-A ANCHORAGE AK 99507 SELLER PH~[LIP REESER SUE:DIViZSION-MCMAHAN E:LOCK-2 L. OT-3 THE TYPE OF AE:SORPTION SYSTF'M IS A PIT NITH AN AREA OF 84Q SQF'¥o '[HE SYSTEF] ZS CAPAE:LE OF ACCEPTING 450 GALLONS OF WATER PER DAY~ THE SOILS RATING OF THE SYSTEM AT CONSTRUCTION NAS ~ AND NON IS 280 SQFT/ BEDROOM, E:ASED UPON THE TEST DATA THE SYSTEM IS ACCEPI'AE:LE FOR A 3 8EORO0~ HOME~ THE SEPTIC TANK WAS PUMPED ON OCTOBER 22 1980 ¥~, ~ % ker~ C. Re;d, Jr. ;~ ~. ~) %,. No. 2251.8 1220 LUest 25th ~uenue · Anchoraq¢,/~laska 99503 · (907) 276-1361 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION October 13, 1980 Philip E. Reecer Star Route A Box 1552A Anchorage, Alaska 99507 Subject: Lot 3 Block 2 Mc Mahon Subdivision Approval for the individUal sewer and water facilities cannot be granted until the following items have been completed: (1) The water a~alysis report be delivered to this department from Chem Lab, 5633 B Street, for our review. (2) The septic tank pumped with a receipt submitted to this department. (3) An adequacy test be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A li§ting of private firms performing the test is enclosed. This report Will need to be submitted to this office for review. If there are any further questions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw CC: Violet Hulce % Totem Realty 724 East 15th Avenue 99501 ~o,9 k~rli/y Ihol I ho'do svrYoyed lbo [ollowk~g do~c6bod'proporl¥, 'Lei :/~ S'-ock_:_ ~ .. 'Addifien /'~/~'/'/IflOI4 'Suf~ ~.C~ ~ecotdin~ Preci~cl, Alo~ko, ond Iha~ I:',o :'.Jmptovomenh 61uolod lhor~on are ~[Ihin lbo prop~rl-/ Jino~ end 'do no~ 'ovorJop o~ encroach 'o~ leo ptopoth' lying odiocon~ Ihorom, Ihol no improvomonh on proporly lyin~ odjo~ont lhotolo ~ncr~ach on lbo p;omlses in question and lhal Ihoto oro no ro~dwoys, lrans~h;ion [inoi or ~fhot Yhiblo .aiomonh on'said propotk/ excopl ot ind;calod hofioon. #1: Time Date Insp ~.~UNICIPALITY OF ANCHORAGE . ,DEPARTMENi ~F HEALTH AND ENVIRONMENTA" ~PROTECTION 825 L Street, Anchorage. Alaska 99501 264-4720 #2: Date Received: Time Date Insp September 12, 1977 #3: Time Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Coast Mortgage Company Lending Institution Request: Mailing Addressf Post Office Box 1200 99510 Phone: 279-0665 Maurice E. Belisle Phone: 344-8114 Mc Mahon Ave Property Owner: Mailing Address: 3. Legal Description: Lot 3 Block 2 Mc Mahon Subdivision 4: Single Family Residence: ~ Multiple Family Residence: ( ) Number of Bedrooms: Three Number of Bedrooms: Well System: Permit # Construction Individual well ~ Community/Public System ( ) Depth of Well 210' Well Log on File ( ) Bacterial Analysis Sewage Disposal System: On-site System (~x Public Utility Permit # Installed 1971 Installer [~---~-~ /~ Septic Tank Size Absorption Area Distances: Well to Septic Tank to Sewer Line ~--' Manufacturer Soils Rate ~ ~'P-- , Nearest Lot line M&terial C~ ¥ ~K/O to Absorption Area [ O / ~J) ! Absorption Area to Nearest Lot Line MUNICIPALITY OF ANCHORAGE · ,~ DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO 2. Property Owner: Ma.urloe E. ]3e1181e VA FHA CONV __ Mailing Address: McM~hon Avenue, Anchorage 3, Name of Buyer: Philip E. Reeoer Mailing Address: SAR Box 38M, Anchorage, Ak. 99507 4. Name of Lending Institution: Coast Mortgage Company o Mailing Address: P.O. ]30× 1200 Anohorage, Ak. 5. Name of Realtor or Agent: T,arrY T.ue82¢.e, ]3owden Oompany Mailing Address: 301 ]3. :Flreweed, Anoho~age, Ak. Day Phone 344-8114 Day Phone 344-7400 Phone 279-0665 Phone 277-1482 6. Legal Description: Lot 3 Block 2 McMahon Subdivision Location: off Huffman Road 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Single family Public Utility No. Bdrms. 3 Individual X If Individual, number of dwellings presently served 1 If Individual, depth of well 210 feet Sewage Disposal System Type of System: If Individual, date of installation Public Utility 1971 Individual (on-site) X EQ-037 (1/74) Twd' Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 3 Block 2 Mc Mahon SubdiVision Comments: Affadavit Attached: ( ) Letter Attached: ( ) Approved: ~ ~--~ Date: Disapproved: Date: Department Worksheet: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received ~/~<//~ 9 Time of Inspection Date of Inspection ,-~'~/~/~fi~ Approval requested by: Mailing Address: 2. Property Owner: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR ~ :5'-o ? Mailing Address: 3. Legal Description: 4. Location: 5. Type of facility to be inspected 6. Well Data: A. Type ~~--- (~ B. Depth o Phone: No. of bedrooms t /- C. Construction . ~z~z~,,~_~/~-~ D. Bacterial Analysis Sewage Disposal Systen~'.:~w~L<-~~ C. Septic Tank: 1. Size 2. Manufacturer ~ ~ ~L~ D. Seepage Pit: E. Disposal Field: l. Absorption Area ~'~-~/-.[~ 2. Material Total length of lines Distances: A. Well to: Septic tank Nearest lot line ~0! B. Foundation to septic tank C. Absorption area to nearest lot line , Absorption area /(~/ , Sewer Lines Other contamination x</~2? ./~ ~/~,m~..~ z , Absorption area EQ-034 (1/74) Page 1 of two pages two pages - Request for Approval of Individual ~ ,er & Water Facilities .gal Description Comments Approved ~ X~z_~-'~'~.....-~.~ Disapproved Date Approval Valid for one year from date signed Greater Anchorage Ar6a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)