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MCMAHON BLK 3 LT 16
McMohon Block 3 Lot #017-042-16 Municipality of Anchorage Development Services Department Bo~'Idlng Safety Division On-S;te Water and Wastew3ter Program. 4700 S. Rragaw SL P.O. Box 196650 Anc~orage,.a~ 99519-6650 waw. ci. and~orage.a~.us (907) 343-7g04 Permit Number. ~'/4./0~0 ~ ~ ~ LEGAL DESCRIPTION o Page I cf ~ ON-SITE WASTEWATER DISPOSAL SYSTEM ,~U~IDIOR WELL INSPECTION REPORT PlDNumbe~. Ot T '-O qZ -/~' WastewaterSystem: [] New ~Upgrade Well: g:y4$?"' [] New [] Upgrade SEPARATION DISTANCES ~ Septic Absorption Lift Holding Tank Iqeld Station Tank ABSORPTION FIELD TANK Septic [] HoMing [] S.T.E.P. LIFT STATION [] Other. [;;,%.. · BENCH MARK Inspections performed by: ~c'l~,b,,~o~ 7-,,c4 ~'uc Dates: 1" Z~/I~/oZ 2ncl Developmert Services Department Approval Reviewed and approved by:z"-~ Date: / Engineer's Stamp PERMIT NO: SW020232 PID NO: 017-042-16 SWING TIES: FROM: COR."A" COR."B" TO: DBL C.O. #C" 41' 47' S.T.C.O. #D" 40' 49' S.T.C.O. "E" 37' $3' DBL. C.O. "F" 37' 54' S.P.C.O. "G" 29.5' 64' PAGE 2 OF 2 EXISTING LOG CRIB SEEPAGE PIT R10~ BLOCK 3 . "" McMAHON GAR. DECK ~"~'I~M SEPTIC TANK PLAN VIEW SCALE: 1" -- 30' TO --SEEP. PIT 93.0' FINAL GRADEj ELEV. 100.2' 10004~ALLON SEPTIC TANK CROSS-SECTION NOT TO SCALE FROM "HOUSE ~___INV. 93.3' LOT t6, BLOCK 3, McMAHON SlD SEPTIC TANK REPLACEMENT AS-BUILT INSPECTION REPORT FLATI'OP TECIINICAL SERVICES SCALE: AS NOTED 14~30 ECIIO STREET DRAWN BY TFM ANCIIORAGE, ALASKA 99516 IOCTOBER, 2002 MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 90519-6650 (007) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jul 18, 2002 Expiration Date: Jul 18, 2003 Permit Number: SW020232 Legal Description: MCMAHON BLK 3 LT 16 Design Engineer: 0019 Flattop Technical Services Owner Name: Dan Mattson Owner Address: PO Box 81761 Fairbanks, AK 99708- Parcel ID: 017-042-16 Site Address: 003940 FURROW CREEK RD Lot Size: 30467 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail 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: 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 SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Permit Number SW Property owner(s) Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) /--~, Legal description (Section, Township & Range) Lot Size z~ ~)t'(G "~ Acres/~____._ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Day phone ~5' 7 - ¥ ~'// Zip Code I~, ~/c,c~ :$ /wa ~c.,~on Number of Bedrooms 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. (Signature of property owner or authorized agent) Permit Fees: '~/~,/,,'3 or_. Date of Payment: Receipt Number: (Rev. 1Z/00) Waiver Fees: Date of Payment: Receipt Number: CIVIL & ENVIRONMENTAL ENGLNEERP~G * ENERGY CONS ERVA'HON & ANALYS !S TIIEODORE F. MOORE, P.E. Pti: (907) 345-1355 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 995 ! 9 July 15, 2002 14530 ECHO ST. ANCHORAGE, ALASKA 99516 Dear Sirs: The purpose ofthis letter is to provide the required design narrative in support ofour application for a permit to replace the septic tank on Lot 16, Block 3, MeMahon S/D located at 3940 Furrow Creek Road. A site plan is enclosed for your review. The existing septic tank is 30 years old and is on the verge ofcollapse. We plan to install the new septic tank outside the 100-foot radius around the well on this lot. The cleanout for the existing log crib seepage pit is approximately 109 feet from the well. On the site plan I have illustrated a possible configuration of the seepage pit excavation. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space-surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. LOT 13, BLOCK 2 q~ WELL ..... ~_ _,~ -- -- FURRow CREEK ROAn ,' ', -;,, ..... --. :~,~__,,__ _'~,,-- ~ LOTI$ ! c) R100' R ~oo' McMAHON ~ WELL LOT 17 LOT 15 ~ ......... McMAHON I---- ~: HOUSE I , ~3-BDRM~ (VACANT) I [HOUSE ~ ' CHAIN ,J _. INSTALL · LINK '-'~',,, DECK ~- i~-~----~cLEANOLIT '" ~ ~ -' ..~~ SEPTICTANK m,~ SEPTIC EX~ST~NG ..... ~ ~ ~ INSTALL NEW LOG CRIB DB'~. ~ 1000-GALLON '~ a= ~,--. ,EA SEEPAGE PiT c.G.' ............................... SEPTIC TANK SEPTIC o AREA SEPTIC AREA LOT 25, BLOCK 3 McMAHON S/D, #1 I LOT 24, BLOCK 3, McMAHON #1 LOT 16, BLOCK 3, McMAHON SID SEPTIC TANK REPLACEMENT SITE PLAN FLATTOP TECHNICAL SERVICES I INCH = 50 FEET 14530 ECIIO STREET DRAWN BY TFM ANCIIORAGE, ALASKA 99~ I 6 JULY, 2002 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. GAAB-,HDd GR~ TER ANCHORAGE AREA BOROLr~"'I ~.rARTI~IENT OF EN¥1RONMEI~TAL I1UALh . ' 3~500 TUDOR ROAD ANC:HORAGE, ALASKA ggE07 27~)-8§86 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION ADDRESS PHONE_ SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY /~(~J,.,~ GALLONS. MATERIAL NUMBER OF cOMPARTMENTS INSIDE LENGTH LIQUID INSIDE WIDTH. ~ DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS J OUTSIDE DIAMETER NEAREST LOT LINE /~/~,~1 OR WIDTH j 9 DISTANCE FROM WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) BUILDING FOUNDATION SQ. FT. TILE DRAIN FIELD: DEPTH: TOP OF TILE TO FINISH GRADE TOTAL LENGTH N , NEAREST LOT LINE , OF LINES ...i DISTANCE BETWEEN ~ ___ TRENCH WIDTH J. IuTAL SQ. FT. LENGTH OF EACH LTN~ / .DEPTH OF FILTER MATERIAL BENEATH TILE. EFFECTIVE IN. ABOVE TILE WELL: TYP 'E~},Z~, DEPTH NEAREST LOT LINE . SEWER LINE DISTANCE FROM WATER , BUILDING FOUNDATION.. SAMPLE NEAREST SEPTIC SEEPAGE OTHER , TANK , SYSTEM , CESSPOOL , SOURCES DIAGRAM OF SYSTEM DISTANCES: G.A.A.B. GRe^TeR ANCHORAGe ARea BORuUgH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-El686 SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT Name OF APPliCaNT I NSTALLAT[ ON LOCATI~N INSTALLATION OF' SEPTIC TANK ~ ~ EEPA e Pit /~ Drain Field TypE ANDSIZEOF'fACILITYTO BE SERVED ~ / , /~4 ~ FINANCED THROUGH TO BE INSTALLED BY [ I I SOIL TEST rESULTS /t~ ~0(~/ COUPLET[ON DATE ANTICIPATED 2200 PERMit NO, . PHONE OTHER NOTE: THIS PERMIT IS NOT VALid WITHOUT SOIL TEST FINAL INSPECTION= 24 HOUR NOTICE REQUIRED. HEALTH DEPARTMENT AUTHORITY WILL BE SU~4~CT TO S,PTIC TaNK SIEE /~ TYPE Z~ MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~-~ )_..c ' SEPTIC TANK TO SEEP^GE PIT WALl SEPTIC TANK I . sEePAGE PIT TO NEAREST LOT LINE. WATER MAIN TO l~' DRAIN FIELD SEPTIC TANK, SEEPAGE PIT TO RIVER, LAKE, STREAM. ~AST iRON INTO AN~ OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON ~[~E$~ SEPTIC TANK AND SEEPAGE PiT ~[TTED W]TH Airtight REMOVABLE CAPS. lNG OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE CUTION. DIAGRAM OF SYSTEM , DRAIN FIELD ,SEEPAGE PIT /~ ALSO CONSIDER AREA WELLS. · SEEPAGE PIT Sa , DRAIN FIELD GRAVEL BACKFILL CONFORM TO BOROUGH F~EGULATIONS REGARDING ~NSTALLATION. LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE ,. pATER ANCHORAGE AREA BOROb ~ DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 CASE # Performed For J.~E3 B~O~ Legal Description: L°t-~t--Bl°ck 3 This Form Reoorts Soils Log x Date Performed ~._~ Subdivision~.~ ~ ~T~6~"a~l~n Test 5 6 7 8 9 l0 Demth Feet Soil Characteristics topsoil sw well graded sands & gravel silt, fine sand (250) ~ we~ graded sands & gravel Was Ground Water Encountered? If Yes, At what Depth? I Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation Rate Hinute Proposed Installation: S.eeDage Pit ~ Drain Field Depth of Inlet Depth To Bottom Of Pit Or Trench C~MMENTS: 200 sq, ft. of seepa~eare~sh~l~ be ~r~._e~ ~e~ bedroom hole 25'x25' recommended Test Performed By '/,Fd~./~'m~c ~ ~T Data Certified By: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-042-16 GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: //0- ~-- 0 - ,// Lot 16, Block 3, McMahon Subdivision 3940 Furrow Creek Road Anchorage, AK 99511 Current Property owner(s) Dan R. Mattson Living Trust Mailing address P.O. Box 112174 Anchorage, AK 99511 Day phone 240-0024 Lending agency Day phone Mailing address , R(~'al Esthte Agent Mailing Address ,~: ~, , ?. Unless~therwis~'r~uested, COSA will be held by DSO for pickup. 2. NUMBER OF BEDROOMS: Three (3) Day phone 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 On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. Phone 522-7773 bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other :~"~~ Original Certificate Date: 7'~'~-' C.~'// (Rev. 11/05) Municipality of Anchorage elopment Services Department · Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type Pdvate Date completed Pre 1972 Total depth >165 ff. Lot 16, Block 3, McMahon Subdivision IfA, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to >165 ft. FROM WELL LOG Date installed 6/9/72 Length 17 Total depth 13 Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Arsenic: N/D ug/I SEPTIC/HOLDING TANK DATA Tank Type/Material SepUc/Stee~ Tank size 1,000 gal. FoundatiOn cleanoUti(Y/N) Date of pumping 7/1512011 ABSORPTION FIELD DATA Parcel ID: 017.042-16 g.p.m. Nitrate 7.59 mg/L Date of sample: 6/30111 Number of Compartments. 2 Y** Depression over tank (Y/N) N Pumper A Plus Home Services Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 7/9/2011 140.2 ft. 7.7 g.p.m. Collected by: ^. Harala Date installed 8/19/2oo2 Cleanouts (Y/N) Y High water alarm (Y/N) N Soil rating (g.p.d./ft2 or ft2/bdrm) 200 SF/BDRM System type Absorp~n P~ ft. Width 17 ft. ft. Eft. absorption ama 612 ft2 Monitoring tube .. Date of adequacy test 7/9/11 Results (Pass/Fail) Pass Fluid depth in absorption f.~Jcl before test 41 in. Elapsed Time: 1,245 min. Final fluid depth 40 Any rejuvenation treatment (past 12 mo.) (YIN & type) >18 in. Gravel below pipe 9 Y Depression over field N For 3 bedrooms Water added 470 gal. New depth 47 in. in. Absorption rate >= 450 g.p.d. N If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at .... in. "Pump o~ level at ~ Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift'station on lot >100' Absorption field on lot >1oo' Public sewer main N/A Sewer/septic service line >25' · Animal containment areas in. Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A None SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Absorption field >5' Water main N/A Water service line >10' Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main N/A Water Service line >10' Surface water >100' Driveway, parking/vehicle storage Curtain drain None Noted Walls on adjacent lots >100' COMMENTS: ** Double Cleanout Prior to Septic Tank. G. ENGINEER'S cERTIFIcATION I certify that I have determined through field inspections review of Municipal records that the above systems are En-'ineer's Printed Name Michael E. Andemon, P.E. D-'- 7/17/2011 COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Community Development Department Development Services Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # 111253 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 16 of McMahon subdivision. This inspection revealed a nitrate concentration of 7.59 milligrams per liter (mg/L) was reported for the property's well water sample. 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. 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. SGS Reft# 1112834001 Client Name Anderson Engineering Printed Date/Time 07/11/2011 15:36 Project Name/tl McMahon Svbd L I6, B3 Collected Date/Time 06/30/2011 10:00 Client Sample ID Private Well Water l¥om Hose Received Date/Time 06/30/2011 11:30 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 07/01/11 07/08/11 NRB Waters Department Total Nitrate/Nitrite-N 7.59 0.100 mg/L SM20 4500NO3-F B (<10) 06/30/11 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 06/30/11 CR Total Coliform Negative I 100mL SM20 9223B A 06/30/11 CR Aarow Pump & Well Service LLC (907)346-9355 Inspection Report I ran a camera 60' down the well at 3940 furrow creek road and did not find any holes/cracks i.n the casing or leaking around the pitless. Beau Maxim~ ~ A+ HOME, SERVICES,INC 750i E. 140th Avenue Anchorage, Alaska 99516 345-1890 CUSTOMER INVOICE # Block Lot DESCRIPTION AMOUNT $165~ akdamttsoa~otm aikeota 06/10 2000 galloas, 3 standpipes, 5 hoses REMARKS TOTAL PROBLEM AREA -- CALL FOR MORE iNFORMATION ~NEEDS TO BE DONE AGAIN ~N 6 MONTHS Good Shape [~ Sludge buildup on bottom Jim cap missing or ?_ Cut standpipe to 1' above ground needs replacing Floater on top Needs Septictrine MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date ~*/*'~ GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) (b) (c) Location (address or directions) Property Owner ~ Mailing Address Lending Institution Mailing Address Telephone: Home ~?5'- '~_,c,t~ ,J._ Telephone Business (d) Real Estate Company and Agent Address 7 ~C~ L) ~-~ ~) '~ Telephone '~(,~ , ,¢_.d),/ ~J (e) Mail the HAA to the followina address: or: Check here~], if hold for pick up. List contact person and day phone number betow.....~ _ ~ ~~ TYPE OF RESIDENCE Single-Family'~ Number of Bedrooms 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. SEWAGE DISPOSAL Onsite~' Public [] Community [] Holding Tank [] / Note: I~ community well System, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 fRev 81861 Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this ins~on~.~ . ...~zz~. Name of Firm ,---}~z~-c~-z~ NN Telephone Address Date Engineer's Seal DHHS APPROVAL Approved for -/'~"¢~(':~,~ bedrooms by ~ '~ ~"-~' Approved / Disapproved Conditional Date Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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 responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025/Rev 8/86) Back MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: ,LoT WELL DATA Well Classification Well Log Present (Y/N) Total Depth ~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from ,Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot '~ ~ If A, B, C, D.E.C. Approved (Y/N) / ~'~ Date Completed ~.~ ~,1~,~ j~¢(~ ~ ~ Yield Cased to .2 / G.~~ Depth of Grouting /~ O ~ Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots [~© '{'° ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date ~///0/g 7 To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~.~', 7.~.. Standpipes (Y/N) ¢/'V~'- Depression over Tank (Y/N) r-~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~"/,//¥ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Size I~ No. of Compartments ¢/~'~' Air-tight Caps (Y/N) J Foundation Cleanout (Y/N) Date Last Pumped ~/1~/~ Temporary Holding Tank Permit (Y/N) To Building Foundation /'-~ ~ To Disposal Field ~ ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Type of System Design Length of Field / 7}4'/7 ~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line leom To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Depth of Field Gravel Bed Thickness 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) 1',4 o ~ ~ ,~'o 'f D. LIFT STATION ~O I~/-% 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. Signed ¥ ~ .,~~4~ Date Company MOA No. Receipt No. ~OO Date of Payment Amount: $ MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVIS[ON Page 2 of 2 APR 1 3 !987 72-026 (11/84) RECEIVED Engineer's Seal CONSULTING ENGINEER ~203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: LOT 16, BLOCK 3, McMAHON SUBDIVISION 3940 FURROW CREEK ROAD JAMES JACOBS SINGLE FAMILY, THREE BEDROOMS PRIVATE, ON SITE FROM MUNICIPAL RECORDS: TANK: STACK STEEL, ONE COMP. ABSORPTION SYSTEM: ABSORPTION AREA: SOIL RATING: 200 INSTALLATION DATE: ~ " ~ ' " ','; '! ' ~, " ?" 7 LOG CRIB 8XSX9 6OO SQ. FT. SEPTEMBER 1972 DATE OF PUMPING: APRIL 10, 1987. ISAACS PUMPING SERVICE DATE OF TEST: APRIL 10, 1987 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH 4.5 FEET OF COVER AND 51 INCHES OF LIQUID. CRIB WAS FOUND 12 FEET DEEP AND WITH 44 INCHES OF WATER. 600 GALLONS OF CLEAN WATER WAS ADDED TO THE CRIB WHILE THE WATER LEVELS IN TANK AND CRIB WERE MONITORED. TANK LEVEL DID NOT CHANGE. LEVEL IN CRIB ROSE 12.5 INCHES. AFTER 2 HOURS WATER LEVEL IN CRIB HAD DROPPED 4 INCHES, INDICATION AN INFILTRATION RATE OF 100 GALLONS PER HOUR. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, 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 this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. ~, ~ ,~'~'~ ANCHORAGE, ALASKA 9950'~ CONSULTING ENGINEER TELEPHONE: (907) 279 3916 RESIDENTIAL WELL INSPECTION LEGAL: LOT 16, BLOCK 3, McMAHON SUBDIVISION LOCATION: 3940 FURROW CREEK ROAD OWNER: JAMES JACOBS TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: NO INSTALLATION REQUIREMENTS MET: YES PUMP YIELD: 7 GALLONS PER MINUTE DATE OF INSPECTION: APRIL 10, 1987 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 7 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND AT 164 FEET BELOW TOP OF CASING. WHEN PUMPING STARTED LEVEL WENT IMMEDIATELY TO 165 FEET AND STAYED AT THAT LEVEL FOR THE DURATION OF THE TEST, 1.5 HOURS. RECOVERY WAS INSTANTANEOUSLY. ' TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON APRIL 11, 1987. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. THIS WELL WILL DELIVER MORE THAN 7 GALLONS PER MINUTE FOR HOURS OR MORE. FOUR The Municipal requirement for well flow is 150 gallons of w. ater 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 f~e~.i~q the well. ,,-"~'~-"*"' ~ - . ~.~. ,,~ ~ .' ~.. -~ . ~ ,~ '~ ~?..~'. %': .~.. ' . ...,., bCO~ICIPALITY OF ANCHORAGE DIVISION OF ENVIRO~R~ENTAL HEALTH APPLICATION FOR h~ALTH AUTHORITY APPROVAL CERTIFICATE Information Application Date (b) Legal Description (include log~ block, subdivision, section, township, range) Location (address or directions) , _ q o Applicants ~ Applicants ~dress Business (e) Applicant is (check one) Lending ' (d) Lending Institution J~>~,~%~- Address 'fV~Z~ ~ <~>,~v (e) Real Estate Co. & Agent Address ~&:/7 d~/ Telephone ~'/D / ~ ~¢ / (f) Mall the ~ eo the follo~ng ~dress: ~',xtJ !.,,X,¥~.,~ '¢<~'.~-~W ( OC'..~:~ ; C~mer/butlder ~-~; Telephq~ne 2. T_y_pe of Residence Single-Pamily~ Number of Bedrooms Multi-Family ~ Other .(describe) Note: If community well system~ must have written confirmation from the Stage Department of Environmental Conservation attesting to the legality and status. S._ewage Di~.osa~l 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] En~ineerin$ Firm Provtdin~ Inspe..ctions, TestsuFile Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, verify that my investiEation of- this Health Authority Approval shows that the on-site water supply amd/or wastewater disposal system is safe~ functional and adequate for the number of bedrooms and type of structure indicated herein.. I further verify · based on the information 'obtained from she M~nlctpaltty of Anchorage files and from my investigation and inspection, the On-site water supply and/or ~rastewa~er disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of ~his inspection. Na~e of l~'irm,~~_~5 f~/M'z~Z__- __ Telephone Address Date DEEP Approval Approved for ~ Approved T~ Disapproved~ Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPART~IENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TPr~ REPRESENT= ATIONS GIVEN IN PARAGRAi~ 5 ABOVE BY ~M INDEPENDEbTf PROFESSIONAL ENG!I~EER REGISTER?-~ IN THE STATE OF ALASKA. TEIE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES THEIR LEN~OING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AMD STATE REQULRE~ b~NTS. 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) [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE. (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALh-Y OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RFCEIVED Legal Description: Well Classification ~(~/~ If A, B,'c~ C, D.E.C. Approved(Y/N) Well Log lhtes~nt (Y~ Date cc~leted ~m~r~__ ?t _ Yield Total Depth ' ~/~ Cased to ~ ~/d /~ Depth of G~outing Static Water Level /~c-~--/~ Pump Set At ~ Casing Height Above G~cund /,9// Electrical Wi~ing in Conduit~N) Separation Distanoes f~c~ Well: To Septic/Holding Tank on Lot ~ ~ ~ To Nearest Edge of Absorption Field on Lot TO Nearest Public Sewe~ Line ,/~/~ Sanitary Seal on Casing ~N) Depression A~ound Wellhead (Y~ cleancut/Manhole /"~' TO Nearest Sew~ service Line on Lot Wate~ Sample Collected By i~~ ;Date O~//~/~'- ~ Wate~ Sample Test ReSults . ~/~7-/5~/~ Z-D~ t/ B. SEPTIC/HOLDING TANK DATA ; On Adjoining Lots ~/~ /.~ z~6- ; On Adjoining Lots To Nearest Public Sewer Date Installed ~/~//~k Size Standpipes ~/N) Ai~-tight Caps _~N) Foundation Cleanout (Y~ ~t Holding Ta~ High-Wate~ ~a~ (Y~) Holdi~ Tank (Y~) ~p~ation Distance ~ ~ptic~olding Ta~: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Abso~ptio,n S,t~ata Date Installed k/~ ,//'~z~ Width of Field /7 ~~ Type of System Design Length of Field /4/ Depth of Field Gravel Bed ThickneSs Square Feet of Absorption A~ea ~ ~ Standpipes Ihtesent ~p~ession ove~ Field (~ ~te of ~st A~a~ Test~ Results of ~st ~a~ ~st ~ ~ ~ ~p~ation Distan~ f~ ~s~ption ~i~ld: · o ~te~-su~ ~ I~ ~ ~o ~om~t~ ~ TO Building Foun~tion ~ ~ To Existing or ~ndo~d System Lot ~ ; ~ ~joining ~ts 'F g/~/~ To Wate~ Sain/~vi~ Line .~ /~ To ~t~(if preent) To St~e~ond~ke/~ Majo~ ~aina~ C~ ~/~/~ To ~iveway, Pa~king ~ea, ~ Vehicle St~a~ ~ea ~/~ ', , D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High ~te~ Alarm Level Tested fox Co~-,~ents / ** Check Permitted Bed~ocm Rating AGainst HAA Request I oertify that I have checked, verified, oF conformed to all MOA HAA -Guidelines in effect on the date of this inspection. KB1/dL/s [Page 2 of 2] MOA No. 2-15-84 ALASKA eIiUII OFlmeFITAL COFITF OL InC. TRANSAMERICA RELOCATION POST OFFICE BOX 8026 WALNUT CREEK CALIFORNIA 94596 SELLER-PAT CAREY MAY 17 1985 WILL PICK UP FROM OUR OFFICE 50204 LEGAL:MCMAHON SUBD/BLOCK 3/LOT 16 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN AREA OF 648 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 544'GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/FACKAGE PI.,ANT WAS PUMPED FLOW TEST ON WELL WELL FLOW DATE~NOVliE' !984/ A FLOW TEST WAS PERFORMED ON THE WELL. 630 GALLONS OF WATER WAS 2.5 HOURS. 20 MINUTES PUMPED AT A RATE OF 4.2 GPM OVER A DURATION OF THE DRAWDOWN WAS .61 ' WITH A RECOVERY TIME OF AND THE STATIC WATER LEVEL WAS 155.5 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. I200 LU~sl 33rd Aucnu¢. SuJl¢ J~ e A,chorage, Alaska sssos,[go7) 561-50/40 MIJNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Info rmatton Application Date .//? ~/~ (a) Legal Description (include lot, block, subdivision, section, tq.wnship, range) Location (address or directions_.) . (b) Applicants Name ~. II~'~ Telephone - ttome B~ (C) Applicant is (check one,)Lending Institution ~-~ ~~r_~ Buyer ~--~ ; Other ~.(explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single-Family~ Number of Bedrooms Multi-Family ~--~ Other (describe) 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. Sewage Disposal Onsite ~ Public ~ Community ~-~ HOlding Tank ~-~ Note: I~f community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. E~ineerin~ 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 .~fC~') Address /~) ~ ~J~t/ Approved for - ~' bedrooms By Disapproved Approved Coedition~ Tems of Conditional Approval Telephone 2251-E ~.,~ ~ CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES NEALTH 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 [Pase 2 of 2] 7-19-84 03A!333 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALT~ AUI~ORITY APPROVAL (FIAA) CHECKLIST - FEBRUARY 1984 Well Classification Well Log p~eSent (Y~ Total Depth ~= Cased to Static Water Level AON ,NOIID]IO~d ::IOV'~OHDNv ~0 ~IIVdlDINfl~ Legal Description: If A, B, ~ C, D.E.C. ~o~d(Y~) ~te ~le~d' /~ Yield ~. ~pth of ~outing Pump Set At Casing Height Abo..ve; Ground / ~ ~' Electrical wiring in conduit ~) Separation Distances f~c~ Well: To Septic/Holding Tank on Lot ~L~~ Sanitary Seal on Casing ~/N) D~p~.ession A~ound Wellhead (Y~) ; On Adjoining Lots +~lOc~/ ~ To Near. st Edge of Absorption Field on Lot IOO?~ ; On Adjoining Lots To Nearest Public Sewe= Line ~ ~/~ To Nearest Public Se~r Cleanout/Manhole ~ \~ To Nearest Sewer se~vic~ Line on Lot Water Sample Collected By ~-~dr~'? ; Date 4~ Water Sample Test ReSults B. SEPTIC/HOLDING TANK DATA Date Installed ~'[~ Iq ~. Size I~DO No. of CQ.~a~tments I Standpipes .~) ' ' Ai~-tight Caps.) Foundation Cleanout (Y~ ~p~ession o~ Ta~ (Y~ ~te ~st P~d ///~/~ P~ing~intenan~ ~n~a~ ~ File (Y~) ~; fo~ ~ Holding Ta~ High-Wate~ ~a~ (Y~) /~ ~a~ Holdi~.Tank ~t (Y~) ~ ~ ~p~ation Distance ~ ~ptic~olding Ta~: To Water-Supply ~11 ~ ~ To ~ilding F~ndation ~ /~ To P~operty Line + .~D; To Water Main/Service Line co se To Disposal Field ~1x To Stream, Pond, r~ke, c~ Major D~ainage [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption ,_S.t~ata Date Installed Width of Field / Square Feet of Absorption A~ea Depression eve= Field (Y~ Results of Last Adequacy-Test ~2~9~' Type of System Design Length of Field ~p~ of Field Grail ~d ~ick~ss Separation Distance f~om Absorption Field: To Water-Supply Well /~d wE To P~operty Line ~/F~/ To Building Foundation_ ~/~ To Existing or Abandoned System cn Lot ~/~C · ; On Adjoining Lots To Water Main/Service Line +..-~)K;/~ To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course ~l DOf To Driveway, Parking A~ea, or Vehicle Storage A~ea D. LIFT STATION Date Installed I 1 ~. Dimensions _ .~-~- .... Size in Gallons ] I fl Manhole/Ac~c~'TY/N) "Phu,%3 ~" ~1 at ~/ [ . /"~ ~f" ~vel at__ ___ High Water ~ ~vel~ ~t .. ~'~ Vent (Y/N~ ___ Tested fo~ ~/~'~ ~ing Cycles ~ing Adeq~a~ ~st. Electrical C~lt~t~ts ~ets MOA ** ** Check Permitted Bedroom Rating Against HAA 9equest I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date~f th~.ine~e~iC~. Signed ~'t/~ ~' , KB1/d5/s Date. [Page 2 of 2] 2-15-84 ALASKA EFIUIROFImI FITAL COFITROL SERUIC[ S, IBC. ~n§ine~rinq $ ~nuironm~nlol $luclics NOV 1# 198# lRf/qS~ I ~ RELO~T IC~ FOST OFFIC~ 133X 8026 WALNUT GqEEK CA 9#596 SELLER - PAT C~Y BUYER - SUBDIVISION - M~ BLO~ - 3 LOT - 16 ADEQ1JACYTEST FUR SE~SR SYSTEM THE TYPE OF gI3SCRPTICN SYSTEM IS A CRIB WITH ~ AREA OF 6/48 SQFT. THE SYSTEM IS CAPABLE OF ACiCEPTING /450 C,O~LONS OF WATER PER DAY. THE SURGE CAP/~ITY OF THE SYSTEM I S 5/4/4 GALL(~S. BASED UPON THE TEST DATA THE SYSTEM IS ]~U.7.EPTABLE FOR A 3 BEDRO~ FO/E. THE SEPTIC TAr, K WAS PUtvPED ON NOV 9 198/4 . A FLOW TEST WAS FREFCRrVED ON THE V~ELL. 630 GALLCXqS CF WATER WAS PULVPED AT A RATE OF /4.2 GPM OVER A DURATION OF 2.5 I'-IZ1JRS. THE DRA~ 'WAS 0.61 ' WITH A REODVERY TIIVE OF 20 MINUTES AND THE STATIC WATER LEVEL WAS 155.5 FEET. THE V~ELL IS /~EQI.IATE FOR THIS 3 BEDRCCM I'-l~. SEPTIC TAhKgI)EQ_L~CY THE EXISTING SEPTIC TA~K VOLULVEOF 1000 IS ADEQ1JATEFOR THIS 3 BEDROCMHOUSE. itL-/ 1200 [Uesl 33rd Auenue. $uite [~ ° Anchoroqe, Alaska 99503.(907] 561-50z10 , ,., , INVOICE N~ 2566 M-W DRILLING INC. DATE P.O. BOX 110378 UNIT ANCHORAGE, ALASKA 99511 QTY. MATERIALS PRICE AMOUNT PHONE 349-8535 NAME LEOAL D~SCRIPTION BANK OR LENDING INSTITUTIONS CURRENTLY HOLDING DEED Of TRUST HOME PHONE WORK PHONE TOTAL MATERialS WELL NUMBER DIAMETER DEPTH STATIC LEVEL GPM I DRAWDOWN PU~P MAKE HP SETTING VOLTS PHASE AMP RATe SERIAL ~UMBER MODEL SCREEN LENGTH SLOT SIZE L~NER/SCReE~ DESCRIPTION OF WOrk DATES WO MAN DATE IN OUT HOURS J RATE days un/ess other arrange,ments are made ' prior to drilling. The customer shall pay in- MATERIALS (FROM ABOVE} terest at the rate of 1 ~ % per month on any OTHER CHARGES amount not paid within ten days. Failure to pay may result in a lien against the property. CUSTOMER SIGNATURE J, // PAY THIS AMOUNT ~ , · APPLiC~:~IT FILLS OUT UPPER HAL~'~ ONLY Property Owner , ~-.~C~t ~ ~'~-)"~'~ ' ~.Jt'~ ~ ~ ~ Phone Buyer / 0 Address Zip Code Lending Institution ,~ ~.~.~ ~_~ ~.~ [ ~~ Phone Address Zip Code Address ' F ~- ~-[ ' ~- ~ ' C, r Zip Code Legal Description Street Locati~ ~ ~ ~ ~ ~ ~ ~ , Type of~esi~nce ~ngle Family ~ Multiple Family No. of Bedroo~ ~ Other Water~pply ~ndividual A~ACH WELL LOG. A wall log is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Se~er ~posal ~ndividual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Inspector Inspector/'~ Inspect/ ~. Inspector / -~ ~ ENVIRONMENTAL PROTECTION ~ ~ JUL I i 1~83 ECEIVED ( ~ ~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAP~OVED ( ) CONDITIONAL APPROVAL' Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received ~ ~ ~ w~, to ~n~ S~.~*c ~ S~ /~ 72-023 (3182) ALASKA I uIROIqm rlTAL CORTROL irlc. JULY 14 1983 ALASKA MUTUAL BANK/FERN POUCH 4-9003 ANCHORAGE AK 99507 SELLER - PAT REYES SUBDIVISION-MCMANN BUYER-ROBIN HESKETH BLOCK-3 LOT-16 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 648 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 699 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 7/14/83 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 3 BEDROOM HOUSE. ~,~_~. ..... ......o~,¢,'~, '~ / No. ~s~-~ ..'~ '~ ~Z".. ....... '" <~7~" 1000 IS ADEQUATE FOR 1200 JdUcsl 33r(J J~ucnue, Suite J~ ,. Anchoraqe, Alaska 99503 · (907) 276-1361 ,;: ~/- (..~1 I DAT~-FIECEIV ED '~' INSPECTION APPOINTMENTS DATE DATE DATE MUNICIPALITY OF ANCHORAGE MUNICIPALITY~, OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~EP~,' & 825 L Street - Anchorage, Alaska 99501 [NVIRO ENVIRONMENTAL SANITATION DIVISION ~0 ~ ~9~0 Telephone 264-4720 PHONE MAILING ADDRESS PROPERT~ RESIDENT (If different from above) 2. BUYER PHONE MAILING 3. LENDING INSTITUTION I PHONE MAILING ADDRESS ~AILING ADDRESS ;TR EET LOCAT, I ON / 6. TYPE OF RESIDENCE E~/SING LE FAMILY [~3 MULTIPLE FAMILY NUMBER OF~BEDROOMS F-I One I-3 Four [] / Two [] Five [~ Three [] Six [] Other 7. WATE.~R ~UPPLY ~] 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.) 2~o ~'/h 8. SEWAGe/DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY .J 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS "'F~ SINGLE FAMILY [] ONE ~ THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER "~] IN DIVI DUAL/ON -SITE DATE INSTALLED EZ]PUBLIC UTILITY Connection Verified INSTALLER '~Septic Tank or []Holding Tank Size: ]~){Z)l~) 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 I WELL TO: Absorption Area to nearest Lot Line 5. COIVlMENTS [~'"'~,PPROVED FOR ~--~' BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE B~.~.~,~ 72-O10 {Rev. 6/79) ALASKA [1UIRO[lmerlTAL CO[1TROL $ RUIC $, Inc. I~ncjineerin§ 8 ~nui~'onmcntol $luclies MUNICIPALITY OF ANCHORAGE DEPT, ©~: ~[ & ENVIRONM';['qi ,:,,L :- i.:CTION RECEIVED DEC 9 J. 980 DA~,~]:[) I..10(..3 G SRA 8(]X 1~56S N ANCI..IORAGE Al.( 99[.:; 07 SEL. LER .-. DAVID SUE:D](V]ES]]]N--HCHAHON E:LOCF(-..3 L. OT..-16 TI"IE '¥YF'E OF' AI~:SOF~F"¥J:ON SYSTEM ."£S A PIT H:T,"i'l"l AN AI:~Ii':A [)1:: 6'tH:} SQFTo THli'"SYSTEM ]".S CAF'ABLE OF ~'~CCEPT~N(~ 450 £;(=fl..L[)NS OF WA'¥ER PER [)AY, Ti"ti:.:: SOZI..S R~¥1'ZNG ElF' TI"tE SYSTEM A'¥ CONSTRiJC'I".".CON NAS 200 AN[) NON IS 216 S£.IF'T/ E:EDROOMo BASED LJF'ON TI"IE TEST DATA THE SYSTEM ~S ACCEP"£AE:LE I::OR A ~l BEDI:;~OC}H I"i(]ME · "('HF.~: SIFF"J']:C TANK NA,~; PLJHF'ED ON 12"'9-80 1220 ~est 251h Augnu¢ · Ancbre§¢, ^bb 99503 · (907) 276-1361 J MORT~,AGOR O~ S~OR MORTGAGEE /'~'"1! [ SERIAL NO. First >Tational Bank of .... mhora~ James Brown -Seller Clifford & Patricia 5~estbrook -Purchaser ~c~Iahon Subdivision TOTAL NUM~J~: V~'ATEll SUPPLY BY: [] Public system BASEMENT J-'q~,~qew installation [~] Community system PROPERTY ,ADDRESS ~ Furrow Creek Road,Anchora~e~Alaska ] *tack NO. j tO',' ~O. J~ Individual SEWAGE DISPOSAL BY: [] Public system [] Community system [] Individual PART il.--YO GE CO/~PLETED BY M~:ALYH gE~A~i"~ENT SYSTEfi'I PESIGNED I J. I J~] '~'e~ HEALTH DEPARTMENT, INSPECTOR'S SKETCH It is the opinion of the [~] State ~ Coun~ ~ Local Departm?nt of Health that this individual water-supply system [~[is [] is not .~tisfactory as a domestic water supply for the subject propert3,'. ltis the opinion of the ~ State tem with proper maintenance: r~] Can be expected to function satisfactorily, and is not likely to create an insanitary condition DATE [ SiGNATUJlE / I/,. ./ / 7// 1 2 - 1 2 - 7 2 ~//.~/--.-:-~ .~...~' ~ ./..-.- "-]County [] Local Department of Health that this individual sewage-disposal sys- ]Cannot' be. expected to function satisfactorily . : 7~-/'~ J TITLE NOTE: Tho health author!fy should complete the appropriate opinion statement above and affix dote, signature end title in tt~e Ipacos provided. Use of the above gdd for Health Department Inspector's sketch as well as uso of tho back of this form is at the option of the health authority. PART Ill.--FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the ibregoing and the pertinent FHA Cofftpliance Inspection Report, and recommend that the InAi.iA.al water-sunDlv ~v~rem be considered r-"] Arcer~table r--1 Not Acceptable ARc., BOROUGH ' '-~GREATER ANCHORAGE Department of Environmental ©umlitv, ~ . 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Approval Requested Address: REQUEST FOP_ AP~RO',.!AL OF INDIVIDUAL SE~IE~ & WATER. FACILIT!£S F OR Phone: A. Installed d-- ~ ~- a. Instal!er C. Septic Tank: 1. D. Seepage Pit: ].. Distances: A. Well To: ! B. C. Disposal Field: Sep io Tank ...... , Absorption Area_j~___~ .... , Sewer Lines , Nesres~ Lo~ Line/~ Foundation to Septic Tank ~'~- "~ Absorption Area ~.~ Absorption Area to Mearest Lot Line :-<uest for Approval of T~'tvidual Sewer & Water Fec~lzt]e '\, TWO Approve] Valid for One Year F',..-om Date $!anad Greater AnchOreae Area Borough, Department of Environmental Quality I certify that the information contained in this request for approval to be a true and accurate repre~entat}on of the sub~e~t sewer and water fact!it'ies located at: Signed Date