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Home My WebLink AboutMCMAHON BLK 2 LT 2McMahon Block 2 Lot 2 #017-041-24 Municipality of Anchorage Page / of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~/~/O ~ ~t q ~' PID Number: ~ Name: ~CU~ ~ I~b. ~ ~ /~olcn ~[t~ Wastewater System: D New ~Upgrade "~"": ~ ~l~/~ah~ ~ ABSORPTION FIELD Total OeDt~ from ~ngmal gra~e: LEGAL DESCRIPTION so,,R.,,.~: O.~ ~.o~ Towns~ID: Range: S~t,o.: ~0 ', ~ ~ Ft I WELL: ~"~ ~ Upgrade G,.ve,.,~m: ~. O ~r~ ~"~ u.~.~ ~'.l /'~ ~' TANK SEPARATION DISTANCES ~,.t,c m Holding w~ ~/o/~ /~o ~ /uo~ ~ Su~ace I~O ~ Water I~[~ ~0 ~ LI~ STATION Lin. ~ /~ /~/F S,..n=..o.: Foun~at,on ~dI, ~0; ~ ~ I 'Pure' °n" leve'~vel It: IH'g~ water .'a~ at: Remarks: BENCH MARK 2nd~ Department of Health and Human Se~ices approval Reviewed and approved by: ~-/ ~- ~ate: ~-I~ Permit No. SW010193 2 2 Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 1966.50 Anchorage, Alaska 99519-6650 Telephone: .343-4744 On-Site Wostewoter Disposal System and/or Well Inspection Report Legal Description: LOT 2, BLOCK 2, McMAHON SUBDIVISION PID No.: 017-041-24 - M c U ~'H 0 Nf AV E N U E - CRND PIPE I MARK A B ELEV. [LEV. I C01 12 114.8 99.84 96..34 C02 40 41.4 98.88 96.05 I ( ' TC01 42.4 44 99.64 J TC02 48.3 50.4 99.6 ~ · WELL CO3 50.7 53.8 99.58 95.76 C04 52 54.3 99.58 95.76 j MT 56.8 69.4 98.74 C05 58.8 72.0 99.24 95.01 C06 67.6 58.3 98.72 95.02 / ~ -' ~ ~ ~ ~ BENCH MARK / ~I / I / ~ / / I I ~ ~ A~ CONCRETE HOUSE X N / ~ ~ ~ / I N WE L RADIUS / I ~100' ~ELL RADIUS x ~100' / / ~ ,SBUILT / I GRND PIPE MARK A B ELEV. ELEV. CO1 12 14.8 ~9.84 96.34 C02 40 41.4 98.88 96.05 TC01 42.4 44 )9.64 TC02 48.3 50.4 99.6 CO3 50.7 53.8 )9.58 95.76 C04 52 54.5 99.58 95.76 MT 56.8 69.4 98.74 C05 58.8 72.0 99.24 95.01 C06 67,6 58.5 98.72 95,02 MUNICIPALITY OF ANCHORAGE Development Services Department On-Si~e Wa~er & Was~ewa~er Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 15, 2001 Expiration Date: Jun 15, 2002 Permit Number: SW010193 Legal Description: MCMAHON BLK 2 LT 2 Design Engineer: 0014 Anderson Engineering Owner Name: Steve Miranda & Karen Brown ' Owner Address: 3650 MCMAHON AVE ANCHORAGE, AK 99516-2820 Parcel ID: 017-041-24 Site Address: 003650 MCMAHON AVE Lot Size: 29564 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Weft [] Water Storage construction must be in accordance with: 1. The attached approved design. 2. AJI requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ~ Issued By: ~ / Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWEPJWELL PERMIT APP.LICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Permit Numb e r SW O_..~._~2L~_ Property owner(s) ~,-(..e,,~ c..,, Mailing address (1) ~,~,~"q~ ~ddress (2~ ~ Legal description (Lot, Block ~-.O~ ~ '~uJ ~ Day phone Zip Code Legal description (Section, Township & Range) Lot Size ~Acres/Sq.Ft. Number of Bedrooms "~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Not Tub Swimming Pool Therapy Pool Well Only Water Storage Jacuzzi Water Softening Unit I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: Michael N. Anderson, P.E. Civil/Structural Engineering & Excavation 4640 Shoshoni Avenue Anchorage, Alaska 99516 907-34:5-3377 Fax 907-345-1391 Date: June 3.2001 Municipality of Anchorage On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Phone 343-7904 Re: New septic for Lot 2 Blk 2 McMahon S/D To Whom It May Concern: This letter is an application for a new on-site septic system for the above residence. The system was tested and failed to meet the required absorption rates for a three bedroom leach field. A new test hole was excavated on the west side of the properly with a perc rate of I 1 minutes per inch. The soil logs consisted ofpoorly graded gravel from I to 5 feet then loose sandy silt from 5 to 7 feet, with tighter silty sands from 7 feet to the bottom ofthe hole at 14 feet. The old system (1985 constmetion) appears to have been constmeted in the deeper tight silty sands. After checking the grades at the house clean-out it appears that there will be en0~gh eievation drop to install the new $ wide system between the good gravel and the loose sandy silt layer. The tench design will consist ora $ wide by 65 foot long field along the west property line as shown. Ifeievation from the house allows it, 4 feet ofgravei will be used instead of 3 feet, this would make the system shorter by approximately 10 feet. The existing tank will be inspected for holes and replaced if necessary during the installation of the leach field. All the neighboring lots have been built-on and this new upgrade will not impact any other adjoining properties for future development. The slope to the west is 10% to 15% on the neighbors lot and shallow on the south and east of this lot, the new system will be installed on a flat area near the west property line as shown. I have spoken with the neighbor to the west concerning the possibility ofponding water in the spring, he has lived their for 9 years and never had any standing water, so I feel this location will work for the new system. Please call me ifyou have any questions concerning this design at 345-3377. Michaei N. Anderson, P.E. -HUFFMAN ROAD- I II -McMAHON AVENUE- ~Is"nNG 100' 100' -FURRow CREEK ROAD- SEPTIC DESIGN PREPARED FOR STEVE MIRANDA AND KAREN BROWN LOT 2. BLOCK 2 McMAHON SUBDIVISION PREPARED BY MICHAEL N. ANDERSON, P.E. 4640 SHOSHONI AVE. (907) 345-.','5377 / FAX (907) 345-1391 SCALE: 1 "=200' MAY 25, 2001 OF - MC U,A"HON/ AVENUE- ~. ! ! N~ P~P~NG L F~u"~ c.c. ' ' I I ~ %~ 181 ~[ -. I ./ '¢~ ~co .......... HO~E ~ . m~ ~ ~ ~I~NO' ' S~ 100' ~lUS '-~.o. , "~'- , , SEPTIC DESIGN PREPPED FOR ~E MI~NDA AND ~REN BROWN ~.~ A LOI 2, BLOCK 2, McMAHON SUBDIVISION PREPARED BY MICHEL N. ANDERSON. P.E. 4640 SHOSHONI A~. ~'.. CE~94~9 SCALE: 1'=40' MAY 25. 2001 DESIGN CRITERIA: ,3 BDRM X 15D == 450 (;RD SOILS = 450/0.8 = 562 SQ FT REQ'D 562/5 X (0.50) = 57' TRENCH: 6' DEEP 7' MAX 4' EFFECTIVE 5.0' WIDE 57' LONG SYSTEM SHALL BE CONSTRUCTED TO AMC 15.65.060.E STANDARDS TYP. ~MOUND OVER -5' -- GM "I ~'-?RA]~ ' 'ROCK -14'__ ML --,- ~ 5.0' , _- TRENCH SECTION: STEVE MIRANDA AND KAREN BROWN -.'2~".. . ..~'~l, .-. ;3'~ " LOT 2, BLOCK 2 · ..... ***"~. McMAHON SUBDIVISION ~TH ,.~ MICHAEL N. ANDERSON, P.E. ~'. (~E/94~9 4640 SHOSHONI AVE. (907) 345-~77 / ZAx (907) 345-~9~ SCALE: 1"=200' MAY 25, 2001 -~.~.\-,,.-~:'~.'- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anct~orage, Alaska 99502.0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION= 2 3 6 7' 8- 9- 10- 11- 12 13 14, 15 16 18- 19- :20- =OMMENTS · -r,,~6 $/,,.., p,..t,'l-h. WA~ GROUND WATER ENCOUNTERED? Township. Range, Section: SLOPE SITE PLAN IF YES. AT WHAT DEPTH? j I PERCOLATION RATE // Im,nute~,,',ncnl PERC HOLE DIAMETER TEST RUN SETWEEN '~"/'~' FTAND ~"~ FT ~' ¥ -"'" C h ~ .:-[,,.4,:., . PERFORMED BY; ~4v1"~:~'" { .~'~' J '¢'~'~ I ~/~- CERTIFY'HAT THIS 'EST WA~ PERFOR~EO IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE ,'--',. MUNICIPALITY OF ANCHORAGE -~ DB. .RTMENT OF HEALTH AND HUMAN SER ES ~ Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Address TANK FIELD Phone(s) I Permit No. No. of WELL LEGAL DESCRIPTION Lot& 8'oo% S.b ~~¢ FOUNOATION T .... hip, Range, Section '~ AS-BUILT DIAGRA~ lShow location of well, septic system, properly hnes foundabon, %1 ~ ~ ~k~ ~ ~, ¢¢ Or,veway, water bodies, etc.) TANKS N ~ SEPTIC ~ HOLDING Manulactu~er Capacity in gallons Material No. of Compadments TYPE OF SYSTEM ff ;;;~h t; p,pe bottom from ~otal depth , ...... iginal grade ,~ original grade ~ FT [ 0 FT Fill added above original grade Gravel depth beneath pipe 7oral aBsorphon area~ ~istance ~etween lines ~ g ~ '~umber ol hnes Soil rating Pipe material ~1 ~ .~ Installer Date Installed WELLS - ~ PRIVATE ~ OTHER fldentifv) REMARKS: ~ Scale: 72-013 (3~85) ~'.. MUNICIPALITY OF ANCHORAGE / _,.~ DE ,'ITMENT OF HEALTH AND HUMAN SER~ '-'S ~ Environmental Heallh Division ' 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT N.me DISTANCES ~ C. ~ v,. ,' I ~ ~ ¢ s ~ SEPTIC ABSORPTION WELL Phone{s) ~ Permit~N°.%~O ~ & C[ NO' of~dr°°ms WELL ~ ~t~ _ LEGAL DESCRIPTION LOT LINE lO w . - Township, Range, Section AS-BUILT DIAGRAM (Show Iocahon ol well, septic system, property hnes, foundm~on, driveway, water bodies, etc TANKS ~ SEPTIC ~ HOLDING Manulac~ure¢ Capacity in galtons TYPE OF SYSTEM ~TRENCH ~ BED ~ W. DRAIN ~ OTHER Depth to p~pe bottom from Total depth from original grade original grade FT FT ~e[ length' Gravel width FT FT SO FT Pipe material FT F WELLS ~ PRIVATE ~ OTHER (Identify) Classification {A,B,C) i Total Depth FJ Cased to FT REMARKS: '~ Scale: ENGINEER'S SEAL I ~~ ~ - " cmily Ih alt his inspection was p eft or m ed a c cordino lo all Municipal and State guidelines in eflect on this date: - [~ 72-013 (3/85) ]]'EPAFRTMEIXI'I' OF: HE:.AL.'I"H AND EI"-!VIRSNMli]]"JTAI- Fzq:r<8'I:ECTIOIW ¢:1~:'~,.~ L 8""I:'?EE'T'~ Af ILJ-IOr,.AbE:, AK 995() 1 2.64-47'.7.~:() 850689 ;. 0/~?, 1/85 BC BU I LDE:RS F'.8.. BOX 87-11].6 WASILLA, AK 9968'7 SUBDIVISION: MC MAHON LOT:~.. SECT I ON: ,~.L 'I"OWI'4SH)LP: 12N RANGE: ?E 8C~ (SQ. F:'T. OR ACRES) :5 I L [,)L,~ .... ~,? [...istE?d be.l.c~w ape., th~.'~, op-L:J, or'~s E~w*aJ.].able to you. :i.n desiglqing yc, ul- syst(.~mi,, Choose the C,l:)t:i. or~ ti'la'l:x youp si{e. DE:F'TH T.':. I::'~F'E BDT'TOM (F'"I", 4,, 0 Zl-~ 0 .4.~ 0 GRAVEL DE:PTH (FT,,) 6,, () (),, 5 :~;,, 5 ~ 0, AL DEt:::'TFI (Fr'T' ,, ) 1(). () 4.5 7. '3. ..... , .... ~ ......... ' ~' ' 5 ,, 0 bF~?~v,::.L WIDTH (F']".,) ,::.c . 0 Cl:bq,/E].... ~..ENGTFI (I::'T.) 88,, 0 ~' 50,, 0 11:];. 0 '~-'~' L:n~Avc, l_ VOI...UME r~" '" ..... -'~... ~.. 83,, 8 'I"~NK 81ZE (G~L.S) 1 ~ 0()(). 0 ~.~. ~ ~ 000.0 :~'~' 1 ~ 000.0 ~'-~ c~dll... RATIItlG (SQ.FT,,/BR) 349. 284 ~'zc~ [..l~¢-vl::L LIL:]qGT'Fi > 75 FT. MLJLTIF'LE IMJt,lo (NLTI" EXCEEOIIttG '?"::i F'T,, EACH) MUST HAVE". AT L.EAST TWO COMPARTMENI'S ! ceFt:i.f'y t. hat: I,, I am f'amil:i, ar with the r'equi~-ements for' :on-site sewer's ar'id wells as set f'or'th by the Municipaii'Ly of' Anchor'age (HDA) and the State of' Alaska. 2.. I t,.ti:l. 1 install the system in acco~dance w:i. th all MDA codes and r, egula~t:[ons, and in compliance with the design cr'iter':i.a of' this per'm:i.t,, :];. i ~,g:i.!l ac~l"i~r'(.~) to all MOA al]d S'C~CIL~, distaiu:::es fr',om any existing well, wast. ewatet' d:i. sposal system of public · se~k~epage system on 'Lh:L~ of any adjacent, cu" near'by lot, Zl.~I undepstand tha'L 'Lhis per'mit :i.s valid fop a maximuril c:)f 3 b~?dcooms and any en]:ar, ge~x~,nt will r"equiPe an add:i.t:Eor~at IF' A L.:i:I::'I' STATIDixl IS INS]"ALX..IED IN AN AFRE:A COVERED BY MOA BUILDING CODES, 'I"FIEN (1) AN ELECTR]:CAL.. F:'E:RMi]" AND INSF'ECTiON HUST BE OBTAINED; (2) AS-.BUIL. TS WILL. NO'T' BE AF'I::'F~OVED WITHSUT AN ELECTRICAL. INSPEC'T'ION RE:F)SRT; AND (3) THE}: ELECTFRICAL. WORI< MLIST BE DONE BY A L S!GNED ) ' , OATF: AF:'P!_tCANT: E,C. BU~_L,E:FRS . I 2-- 3 4 5 6 7 8 9 10 11 12 17 ~8 2O ~'--%~~~ S SEAL) ¢~/'~7 Municipality of Anc.orage DEPARTMENT OF HEALTH & HUMAN SERVICES ~, 825 "L" Street, Anchorage, Alaska 99502-0650 /f~~~7~ DATE PERFORME Township, Range, Section: ENCOUNTERED? SLOPE SITE PI S L IF YES, AT WHAT O DEPTH? p E Depth to Water After Monitoring? Date: Reading Date Gross Net Depth to Net Time Time Water Drop / /o -/?-&£ .--, PERCOLATION RATE ~ (mi.utes/inch) PERC HOLE DIAMETER G PERFORMED BY: _ __ RTIFY THAT THIS TEST WAS,~.PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDE~ECT ONTH S DATE. DATE: /(~ ~ f7-'''''~'~. 72-008 (Rev. 4/85) DEPAR'FMEIqT OF: HEAL 'T'H F~ND ENV:t:RONMEN]"AL. P~OTECTZON ~B25 L STREET~, ANCHORAGE, AK 9950:[ 264-'4720 F'EFU"! t T NO: DA]'Ii:7. ISSUEi}: 850a2 7 09125185 AF:'F:'L 1 (:}ANT: ADDRIESS: CONTACT PHONE L..E. GAL DESCRZP~ L. 0"I' S t Z E: DURBIN DRIL. LING P.O,, BE]X 8'71:348 WASILL.A~ AK 9~687 3;76-93',55 SUBDIVISION: MCMAHON SECTION: 28 TOWNSHIP: 29500 (SQ. FT. :]IR ACRES) L. OT: 2 BLOCI<: 2 RANGE: 3W cer't, i ,~'¥ that: I am ~am{i].iap wi'U] the r'ecluiPements {'or' on-site seweps and wells as set ~..~l c.,, by the Munic:ipality o{' Ancl'~opaqe (MOA) and the State 'o{' Alaska. .I ~:i.].] ins'l:.all the system in accor'danc:e ~i'Lh ali MGA codes and Pe~LI].atiiul'lS~ al]d {.r) c:c)~q:)lJ, ance with thE, desJ. gn c~'iter'ia oF .this per'mit;, ][ ~-~i].]. adher'e to all M[IA 'and State o{ Alaska {~equipemer'YEs {'(:]{' the set bac:l< dis'Lances {'Porn any e>(is'Eing we].], ~astewater' d:i. sposa] system oi" public sewer'age system .on this ch" any adjac:ent o{- i"~ear'b'y lo'L. ........ : ~~j~: ..... M~ ...................... ' '" . ............. ~_~..= .............. Ai::'PI...ICAWf': I>L.i~flxl DRZLLIN~ CO,, ~ 'T~h~e ' Drill Lo~] Casin~ ¢,, ,'-' Durbin Dri~Jng Co. Mile 1.2, Lucas Road P.O. Box 871348 Wasilla, Alaska 99687 (907) 3~;~:3.05 . Name: ~ :L, [, '" ' Phone: v~ . ' ,~'. i Job · Location: Crew: Date: Notes: Well Log Municipality of Anchorage Development Services Department Building Safety Division , ,, -, ·.. On-Site Water and Was!evrater Program , .4700 South Bragaw St. ~ ' P.O. Box 196650 Anchorage. AK 99519-6650'. www.cl.anchora ge.ak.us (907) 343-7904 , ' ' ~ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY-DWE~LLI'NG.. ;. Parcel I.D. '~['~- 1.- GENERAL INFORMATION Compiete i;gal deS:c~ipiion LoCation (s!te address or directions) Current Properly owner(s)' ~-~'~---- Mailing'address ' Lending agen~ ' Mailing ad&;es§ Real Estate Agent. Mailing Address /v~t r ~ ~. Day phone .... ' Unless otherwise requested, HAA will be hem by DSD forgickup. NUMBER OF BEDROOMS: ~'~ Day phone Day phone 3. TYPE OF WA'i;ER SUPPLY: · .'. IndividualWell '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 Muni(~i~ality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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. Certilicates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown belo~v, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system ts(are) sat'e, functional and adequate for the number of bedrooms and type of sh'ucture 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 i~staIlation. 5. DSD SIGNATURE J Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X ldaintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: '~' ,J~.. -"~ [ (Rev. 12. C0) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastawatar Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchoraga.ak.us (907) 343-79O4 Legal Desc~ipfl0n: WELL DATA Well ~pe PCt.w~ Data completed Total depth ~II'~E~ ff. · Date of test HEALTH AUTHORITY APPROVAL CHECKLIST /..?... I~/.e...9-- ,,'V'~c/~,~*v'l' 7/f,,) ParcellD: Static water level Well production ~ ~ WATER SAMPLE RESULTS: / Coliform ~ coionies/100 mi. Data of sample:-- B. SEPTIC/HOLDING TANK DATA If A, B, or C provide PWSID # Weil Log (Y/N) ~ · Sanita~ seal (Y/N) '"/"' Wires properly pmtacted (Y/N) ~ Cased to ~'C ft. Casing height (above ground) / ~ In. AT INSPECTION ~ (/ g.p.m. FROM WELL LOG g.p.m. Nitrate ~, ~ mgJI. Other bacteria _.~ colonies/100 mi. Tank Type/Matarial ~-~ ~- ¢ ~' (. Tank size ! ~ gal. Number of Comparlments Foundation cteanout (Y/N) ~' Depression over tank (Y/N) / Date of pumping ~ r ~ Pumper ~ Data installed (.~//[ ~'~/~ ( Cleanouts (Y/N) High water alarm (YIN)~' C. ABSORPTION FIELD DATA ' · Dateinstalled.~__l:~ Soilra.ng (g.p.d./ft~orft;/bdrm) ~'~ Systamtype Length ~' ~} ft. Width '~'-, O fi. Gravel below pipe t-~t O fl. Total depth K0 ft. Eft. absorption area Monitoring tube Y' Depression over field ~ Data of adequacy tast /~¢~..J Results(Pass/Fail) ~,(~*~.~ ' ~' '' For "~ bedrooms Fluid depth In absorption field before test -----'-"~. Water added...-~: ' Elapsed Time'~'~'~m. Final fluid depth.---"~. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~ New deptl¥-----'-f~. ~.~ g.p.d. If yes, give date ~ D. LIFT STATION Date installed .~. Size tngallons~/N) E. SEPARATION DISTANCES in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt-Meflofr~n lot /ot2 fl~ ~ On adjacentlots Absorption field on lot /' u~ f.r/ On adjacent lots Pub,ic sewer main ,V'/,4 Publlosewer Sewer/septic service line ' /' ~. (~ Holding tank Property line ~ /~' Water se~ice line / # o f~ Building foundation ~'O Water main ~ Wells on adjacent lots SEPARATION DISTANCES FROM SEPTI~ TANK ON LOT TO: Absorption field Sudace water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ./0' /'~ Building foundation ~o [~ Water main /~ ~'~ Water Sewice Dine Curtain drain COMMENTS Sudacewater f~ I/-- Driveway, parking/vehidest~raoe. /~ ~'~' · Wells on adjacent lots / ~ e (/ ~ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this data. Engineer's Printed Name HAA Fee $ Date of Payment Receipt Number (Rev. 12/00) · Waiver Fee $ Date of Payment Receipt Number JUL-:)6-31 C8:06 FRO~CTtE EIIVIE~FN'AL SRV 9~TSEIS~01 t~i'& £ Re f.t~ 101388500] Cll~t Name Mike N. Anderson. P.E. ProJKI Name# L2 B2 McMahon S.~ ~ient SAmple ID L2 B2 ~cMahon S~ Malria DrYing WnT~ Orde~d B} PWSID 0 Client I>O~ Printed Da~./Tlme 07/05/2001 23:41 Collated I)ata/flme 06,~29/2001 12:00 PQL Units Total Nitrate/NiXie 0,~30 L 0.50~ m8/L EPA 300.0 Allowable ~p Analysia 0'7,'03/Ul SCL T.~I Colit'ot m O 0 col/tOO;rtL SMI8 9232B (<1) 06.r29~1 K.AP 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 Application Date ////~/~ ~' GENERAL INFORMATION (a) Legal Description (include lot, block, §ubdivision, section, tow.qship, range) ./~.~_~dress or directions). (b) Applicant Name~c~¢/¢¢~% Telephone: Home 7¢~-~/7D. Business ApplicantAddre~~ ~¢~ /~¢~0¢ ~7-///¢ . ~¢'~, ~~~ (c) Applicant is (check one): Lending Institution ~; Owner/builder; Buyer ~; Other ~ (explain); (d) Lending Institution //~' ~)- ,~' Address / (e) Real Estate Company and Agent Address Tel.ephone (f) ~"~HAA to the following address: Telephone )C S & S E.,r~jineeri~ Eagle ~,|'¢er, A~ae'1[~1 TYPE OF RESIDENCE Single-Famil~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Well,J~ Community [] Public [] Individual Note: tf community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsit,~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-o25 {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 shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water .supply and/or wastewater disposal system is in compliance with ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. "' ' Telephone ~, ~?Z/~',. ~?_..~'~::;' ~ Name of Firm :~ & 5 Engineering Address SRB 196x Date Eagle ~.iVer, ~lasl<a ~9577 APR 2 0 Ig86 Approved for "~"~<~ bedrooms by~' ~/~ ~.~-z..-~,.~z ,/~ Approved ~~ ,~N Disapproved Conditional Terms of Conditional Approva~ 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 (MO~l HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHOP. A. GE DEPT. OF HEALTH ENVIRONMENTAL PROTECTION APR lg8 WELL DATA Well Classification ~'~/Vf'z/'~-~' Ii A, B, C, D.E.C. Approved (Y/N) Well Log Present~(,N) Date Completed /0~ ~'~ ~ ~?'~'~ Yield Total Depth c~, I Cased to Static Water Level ~¢/o/ Casing Height Above Ground Electrica'l Wiring in Conc~uit'-(~N~ Separation Distances from Weli: To Septic/Holding Tank on Lot ' Depth of Grouting Pump Set At ~ c4~ / i Sanitary Seal on Casing(~,bl-~ Depression Around Wellhead~,~ JO~ / /- ; On Adjoining Lots //¢--¢ o /~- To Nearest Edge of Absorption Field on Lot To Nearest P~bi~ic SewerXLine Cleanout/Mahhole Water Sample Collected by Water Sample Test Results ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Comments B. SEPTIC/HOLDING TANK DATA /¢-~-~E",--(~Size /0/.2 c, Date Installed Standpipes ~i;/,N'~ Air-tight Caps~/N'~ Depression over Tank~(~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line No. of Compartments Foundation Clean out~'.N-)' Date Last Pumped -- ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Water'Maiu/Service Line Course To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /C'~ "~.~-~-- Width of Field '"~ ~ Square Feet of Absorption Area Depression over FielC-(-'YT,~i Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water.Mai~/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Pr ese n~h4')' Date of Last Adequacy Test f To Property Line [ c:;~'~' To Existing or Abandoned System on ; On Adjoining Lots Lie, ~L To Cutbank (if, present) Comments D. LIFT STATION 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 all MOA and HAA guidelines in effect on the date of this inspection. S & $ E'ngi~eeHng Signed _ $_P.B !95~. Date Company Eagle ~,iYer, Receipt No. "'~ "7 '7 C'~_/9 Date of Payment Amount: $ Page 2 of 2 72-026 (11/84)