HomeMy WebLinkAboutMCMAHON #2 BLK 6 LT 9McMahon #2
Lot 9
Block 6
#017-361-31
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• Municipality of Anchor. e1 B 9 1° 114
On-Site Water and Wastewater Prog,- ��.; ; ;!) "%• .,LI i -
(907) 343-7904 N ;'1Trf SA ETV
Certificate of On-Site Systems A • •roval
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Parcel I.D. 017-361-31 Expirat o s't'ate: – (q
1. GENERAL INFORMATION
Complete legal description McMahon #2, Block 6, Lot 9
Location (site address) 12946 Norak Place Anchorage, AK
Current Property owner(s) Kenneth & Joanna Walch Day phone
Mailing address P.O. Box 520172, Big Lake, AK 99652
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Four
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Q Individual CI
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: ` -PA7, ✓(%A—D7 G; Date: ////O//6
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment -7 ))7-hr Date of Payment
Receipt Number 0112-4F Receipt Number
COSA# 1332-- Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Forge Engineering Phone (907) 522-7773
Address PO Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 7/11/2018
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6. DSD SIGNATURE 014/ «
System #1 Approved for if bedrooms / .. Michael E.Anderson .�
System #2 Approved for bedrooms ��# w
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Disapproved ll1\Fop ION
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Conditional approval for bedrooms, with the following stipulations:
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By: L-_ T Original Certificate Date:
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The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
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7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory - Other
COSA blue sheet • c
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: McMahon #2, Block 6, Lot 9 Parcel ID: 017-361-31
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y
Date completed 8/3/1975 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 102 ft. Cased to 102 ft. Casing height(above ground) '24 in.
FROM WELL LOG AT INSPECTION
Date of test 8/3/1975 6/20/2018
Static water level 45 ft 54 ft.
Well production 20 g.p.m. 5.0 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate 5.89 mg/L
Arsenic N 0 ug/L Date of sample: 7/5/1 8 Collected by: Forge Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 8/2000
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) NA
Date of pumping
6/21/2018 Pumper A Plus Home Services •
C. ABSORPTION FIELD DATA
Date installed 8/2000 Soil rating (g.p.d./ft2 orft2/bdrm) 1.2 GPD/SF System type Deep Trench
Length 73.5 ft. Width 3 ft. Gravel below pipe 4.15 ft
Total depth 9 5 ft. Eff. absorption area 610 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 6/20/18 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test •5 in. Water added 637 gal. New depth 13 in.
Elapsed Time: 1 ,440 min. Final fluid depth •5 in. Absorption rate >= 600 g p d
Any rejuvenation treatment(past 12 mo.) (Y/N &type) None If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
100'
Absorption field on lot >1001
On adjacent lots
100'
Public sewer main >75' Public sewer manhole/cleanout >100'
Sewer/septic service line 5>2 '
Holding tank
>75'
>50'
Animal containment areas Manure/animal excrete storage areas �1 00'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 1 01 Property line >5' Absorption field >5'
Water main
>101 Water service line >101 Surface water >1001
Wells on adjacent lots 100'
ABSORPTION FIELD ON LOT TO:
>10'Property line Building foundation >10 Water main �1
Water Service line 1 Surface water 100 Driveway, parking/vehicle storage
10'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
Absorption trench presoaked prior to adequacy test.
G. ENGINEER'S CERTIFICATION ...„......,,,..-.-0p90`�
I certify that I have determined through field inspections and ���.• '9� l��
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date. 0*.49 TI-1• Ar .*
Benjamin Schiller, P.E. r • • ' • • y
Engineer's Printed Name0 •`�� �J �'%""•� Q
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Date BenjamoiSchiller
• v. Af�'.•. CE 12592 •.` d�
V �J'F•. 10/9118 .••'`-.-
�111h PROFESSIO '..�
COSA brown sheet 10-10-12.doc