HomeMy WebLinkAboutMCMAHON #2 BLK 5 LT 4MCMAHON-42
Block 5
Lot 4
#017-361-34
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
G! 8L
4700 Elmore Road
P.O. Box 196650
Mark Begich Anchorage, AK 99507
Mayor www muni orq/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number:(9t7- 3G I.3 q
Legal Description Foe�70wner
� Name &
AdTs:
�)✓1
CA a _ �>�kTL
12 S� L
59S�L
Pump Installation Date: V//Z'//`
Pump Intake Depth Below Top of Well Casing: Cif,e/ feet
Pump Manufacturer's Name: g__05�(<tl"
Pump Model: es/2-
Pump Size !Z hp
Pitless Adapter Burial Depth: /0 feet
Pitless Adapter Manufacturer's Name: 94&a 4i\a50^r
Pitless Adapter Installer: ed 74
Well Disinfected Upon Completion" N -Yes ❑ No
Method of Disinfection:
Comments:
Pump Installer Name: AW*P!5
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Inspection Report_t-1-12.iCG�
Municipality of Anchorage
Community Development Department Page 1 of 3
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP151130
PID Number: 017-361-34 ❑ New ❑✓ Upgrade
Name:
Donald & Carla Williams
ABSORPTION FIELD
✓❑ Deep Trench ❑Shallow Trench ❑Bed ❑Mound
Address
13001 Norak Pl.
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
1.0 GPD/SF
12 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
6 Ft.
Gravel depth beneath pipe
6Ft.
Subdivision
Block Lot
McMahon #2
5 4 -
Fill added above original grade
0 Ft.
Gravel length
50 Ft.
Township Range Section
Gravel width
2.5 Ft.
Beds: Number of Lines
I N/A
Distance between lines
N/A Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
600 Ftz
1
N/AFt.
Well
140.3
132.6
N/A
N/A
100+
TANK O Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
I 1,250Gal.
Surface water
100+
100+
N/A
NIA
Material
Number of compartments
Lot Line.
25.3
10.4
N/A
N/A
STEEL
2
NA
Foundation
6.6
11.3
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
N/A
NIA
N/A
N/A
Gal.
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Installer
to
PIPE MATERIAL House to tank 3034 Tdrainfield n eld 3034
A+ Home Services
Drainfield 3034 CO/MT 3034
Inspector Pannone Engineering Services
BENCHMARK (Assumed elevation) 100ft
Inspection
dates: t 6/4/2015
2w 6/4/2015
Location and description
3" 6/5/2015
e
Back door threshold
COMMUNITY DEVELOPMENT DEPARTMENT 0PROVAL
Engineer's Stamp
At
Conditional Conditional Approval:
Date
• ....
���Q°(�G.
��* 49 T—H
�/. n . F�annorae`
CE 8149
Approved
.W`7–�,S ��>,��'vlypt.,+�
Date
Inspection Report_t-1-12.iCG�
\ l M
WELL (E)
i
SEPTIC AREA (E)
�l.
0
Q
0
o'
w
0
0
ZF
Wim= W_=W�
i
_132.1
� V
' DRIVEWAY
—WELL (E)
<) r \
v -L.QT 4
"
O \
z �
W-
DRIVEWAY
EWAY \
M2
l� 11
40R A
OUSE
(E)
UPGRADED DRAIN FIELD NEW /
5OLF x 2.5'W x 6.0'ED x 12.0'TD L
10.4 TH-1 I /
PREVIOUSLY ABANDONED - -
SHED
\ L
\ SNED
DRIVEWAY
DRAIN FIELD (E)
REMOVED ANY PART ENCOUNTERED
WITHIN 12' OF NEW DRAIN FIELD
AND REPLACED WITH SAND
1 WELL (E)
DRAIN FIELD (E) IN FAILURE
—RE -USE AS 4BR RESERVE WITH
THE (FUTURE) ADDITION OF i
12LF x 3'W x 6.0'ED x 10.0'TD (NIC) I
1000g SEPTIC TANK I
-DECOMMISSIONED PER CODE
INSTALLED 1,250g SEPTIC TANK
NEW WITH DC & DV - \ W
z 1 �o
1 I
\ 0 \
z
SEPTIC AREA (E)
\77 / / 0 -
/ o
I / .
WELL (E) RI
i KUTCHER DRIVE
f
\I
NOTES: PANNONE ENG IVC LLC �`�OF A ',,k Date
RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 �(�p�r4S�+l', s/u/2o15
PHONE (907) 272-8218 FAX (907) 272-8211 ig�p 'lb.t scale
McMAHON #2, BLOCK 5, LOT 4
DONALD & CARLA WILLIAMS
13001 NORAK PLACE
PLAN ANCHORAGE, AK 99516
{7 �/ 1"=50'
P.I.D. NO
.,.*-017-361-34
inone� PERMIT NO.
OSP151130
2 OF
A
B
T1
21.1
59.3
T2
21.8
58.8
DC
22.2
58.8
DV
22.7
58.9
M1
13.0
47.1
C1
14.6
48.2
M2
40.3
16.9
C2
40.4
17.7
NOTES: PANNONE ENG IVC LLC �`�OF A ',,k Date
RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 �(�p�r4S�+l', s/u/2o15
PHONE (907) 272-8218 FAX (907) 272-8211 ig�p 'lb.t scale
McMAHON #2, BLOCK 5, LOT 4
DONALD & CARLA WILLIAMS
13001 NORAK PLACE
PLAN ANCHORAGE, AK 99516
{7 �/ 1"=50'
P.I.D. NO
.,.*-017-361-34
inone� PERMIT NO.
OSP151130
2 OF
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE
STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE
WASTEWATER DISPOSAL SYSTEMS AND ATTACHED SPECIAL PROVISIONS.
2. SCOPE OF WORK: DECOMMISSIONED EXISTING SEPTIC TANK PER CODE AND INSTALLED NEW 1250g SEPTIC TANK AND
SOIL ABSORPTION SYSTEM. _
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 18. FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. NO AN APPARENT WATER TABLE WAS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 18 FEET BELOW
EXISTING GRADE. - - - -
-
_
-
-
FILTER FABRIC -
4" 0 DRAIN PIPE -
- DRAIN ROCK 6" ABOVE PIPE INV
TH-1
ABBREVIATIONS -
R. 1.
RIGID INSULATION
TANK SIZE: 1250 SEPTIC
CU
-0.5 R
DCO
DOUBLE CLEAN OUT
LEGEND
DIP
DUCTILE IRON PIPE
DV
DIVERTER VALVE.
SOIL RATING: 1 GPD/SF
TH
TEST HOLE
FS
FLOW SPLITTER
AREA ROD: 600 SF
FC
FOUNDATION CLEAN OUT
BFG
W -
WATER LINE/
-5A
�
-
-
T
- #
WELL RADIUS
FG
FINISH GRADE
- -
C#
CLEAN OUT NO.
-TOPSOIL
sM/
6.0 sw--
TS&V
�—
SS
NEW SEPTIC
MONITOR TUBE NO.
NIC
NOT 1N CONTRACT
-
87.0
-
-
SECTION 6.0
L
w
w
m
m
00
0
0
w0 w
- o
FILTER FABRIC
o
o
�w
z
w
o
4"m DRAIN PIPE
0
:F
womWw
o >_
DRAIN ROCK 6"
u
n
n
n
nn n
n
n ABOVE PIPE INV
In In
93.7 I 1,2509 SEPTIC
TANK NEW
-PROFILE
DESIGN PARAMETERS
PRIMARY SEPTIC. SYSTEM
- -
NO. BEDROOM: 4 (600 gpd)
ABBREVIATIONS -
R. 1.
RIGID INSULATION
TANK SIZE: 1250 SEPTIC
CU
COPPER -
DCO
DOUBLE CLEAN OUT
PERC RATE: <1 MPI
DIP
DUCTILE IRON PIPE
DV
DIVERTER VALVE.
SOIL RATING: 1 GPD/SF
TH
TEST HOLE
FS
FLOW SPLITTER
AREA ROD: 600 SF
FC
FOUNDATION CLEAN OUT
BFG
BELOW FINISH GRADE
SYS. TYPE: DEEP TRENCH 6.0'EDTANK-CLEAN-OUT
OG
ORIGINAL GRADE
MIN LENGTH: 50 LF
T
- #
N0.
FG
FINISH GRADE
- -
C#
CLEAN OUT NO.
-TOPSOIL
TS&V
AND VEGETATE
USED: -
M#
MONITOR TUBE NO.
NIC
NOT 1N CONTRACT
50 LFx2.5'Wx6.0' E.D.; 12.0' TD
TOTAL AREA: 600 SF -
-
-
NOTES: PANNONE F,NG-SVC, LLC
RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
DRAWN BY:
NJC
DESIGN DETAILS
McMAHON #2, BLOCK 5, LOT 4
DONALD & CARLA WILLIAMS
13001 NORAK PLACE
ANCHORAGE, AK 99516
7/30/2015:
- '•'Fy%I Scale
•.••. *1/ NTS
P.I.D. NO
-atT`351-34
roen R� Pannone PERMIT NO. -
CE 8149 OSP151130
P�'PR�OFESSIOVE Sheet
X OFES -. 3 OF 3
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP151130
Tax Code Number: 01736134000
Work Type: Septic Upgrade
Permit Effective Dates: June 02, 2015 to June 01, 2016
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: MCMAHON #2
Site Legal Address: MCMAHON #2 BLK 5 LT 4 G:2835
Owner/Address: WILLIAMS DONALD W & CARLA J
13001 NORAK PL ANCHORAGE AK 995162848
Site Mailing Address: 13001 NORAK PL, Anchorage Lot Size in Sq Ft: 30150
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
ld'3-d
37 3�
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: If the existing 3 bedroom system is not decommissioned but a diverter valve is
used, a note must be made on the Inspection Report stating that if the fourth bedroom is added,
only the system designed for 4 bedrooms shall be tested for any future COSAs.
6151j.s
Change QW er �vfa f
D�fh
e 7-1-rc icK 12' -ho 9ef
9ruvc�y
�Irvw
S r0M 7%A 1S
Received
Issued By:
6 MW_1r
IM
MUNICIPALITY OF ANCHORAKIBITTA`
MAY 18 2015
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 017-361-34
Propertyowner(s) Donald & Carla Williams Day{phone
Mailing address 13001 Norak PI., Anchorage, AK 99516
Site address 13001 Norak PI.
Legal description (Sub'd., Block & Lot) McMahon #2, Block 5, Lot 4
Legal description (Township, Range & Section)
Lot Size 30,150 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑x Initial F-1 Single Family (SF)
19
(w/wo ADU)
Septic Tank Upgrade ❑x Duplex (D)
❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings
❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or
Permit/Rush Fees:
Date of Payment: _
Receipt Number: _
Permit No.
Permit App_:; :'-._c,
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Pannone Engineering Services uc
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve(cDpanen¢ak.com
June 2, 2015
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Rd.
P. 0. Box 196650
Anchorage, Alaska 99519
Subject: McMahon #2, Block 5, Lot 4
Septic System Upgrade Permit Request
Ladies and Gentlemen:
I am writing request a permit to construct an upgrade four (4) bedroom septic system on this property.
Currently the lot is developed. The existing drain field is in failure and will be re -used as a reserve, with a
future addition to accommodate an additional bedroom. An upgrade drain field will be constructed. The
existing 1000g septic tank will be decommissioned per code and a 12508 septic tank will be installed. This
lot and the surrounding lots are served by private wells. There are no wells within 100' of this system.
Soils. P.E.S. performed one test hole in the vicinity of the drain field in May of 2015, and groundwater
was monitored for seven days. Ground water was not observed to a depth of 18.0 feet below the ground
elevation in the test hole monitor tube after the seven day monitoring period. It is my opinion, based on
the results of the soils tests and overall soils appearance; an application rate of 1 gallons/day/square feet
should be used for a conventional wastewater system.
1. Soil Absorption System Design.
a. See Sheet 2 of the design package.
2. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain
field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
3. Topography: The existing topography slopes generally from west to east in the area of the septic
system, with a slope of approximately 2% in the immediate area of the upgrade. There are no steep slopes
within 50' of the proposed drain field location.
4. Drawing Markings: The Drawings are marked "For MoA Review Only'. When written notification
that the review is complete and that there are no further comments is received from MoA On -Site
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
Page 2 of 2
Department, the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of the surrounding or existing lots. There
are no surrounding wells within 100 feet of the proposed septic location.
If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor Ave, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
u
J M
WELL (E)
AtA`� i
�'\ \ SEPTIC AREA (E)
11 J
0
0
0
CEw
Of
0
DRIVEWAY l II
WELL (E) , j1
48R 11.2
HOUSE
—LOT 4
a
o y ��. SH
\N z \N��
��-- W_—DRIVEWAY \ SHED 1
DRIVEWAY)
UPGRADE DRAIN FIELD (P)
POLE x 2.5'W x 6.0'ED x 11-.O'TDFf /
TH-1 /
\ PREVIOUSLY ABANDONED —
DRAIN FIELD (E)
REMOVE ANY PART ENCOUNTERED
WITHIN 12' OF DRAIN FIELD (P)
AND REPLACE WITH SAND
j 1 WELL (E)
3 i
DRAIN FIELD (E) IN FAILURE -
RE -USE AS 4BR RESERVE WITH
THE (FUTURE) ADDITION OF i
'- 12LF x 3'W x 6.0'ED x 10.O'TD (NIC)
w
1000g SEPTIC TANK (E)
DECOMMISSION PER CODE
w , INSTALL 12nOg SEPTIC TANK (P) W�
WITH DCO
:�. -S
z
(
SEPTIC AREAA(E)
777
WELL (E) 1� x
i
! [ KUTCHER DRIVE
I
NOTES: s�t��n�\\ Date
PANNONE ENG SVC, LLC or-. a4 �i 6/2/2015
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 r'��' •'"qS 1�
PHONE (907) 272-8218 FAX (907) 272-8211 /ig�`p �y+/) Scale
.
/ 4 /
..... .. .. . / R.I.D. No
McMAHON #2, BLOCK 5, LOT 4.... .. ... 77-T61-34
DONALD & CARLA WILLIAMS / St .. ..even R. Pannone / PERMIT NO.
13001 NORAK PLACEl��P�cJ CE 8149��/ OSP151130
PLAN ANCHORAGE, AK 99516 ii1PF�PROFESSIONPV� Sheet
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON-SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED SPECIAL PROVISIONS.
2. SCOPE OF WORK: DECOMMISSION EXISTING SEPTIC TANK PER CODE AND INSTALL NEW 1250g SEPTIC TANK AND SOIL
ABSORPTION SYSTEM.
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 18 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 18 FEET BELOW
EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
FILTER FABRIC
4" 0 DRAIN PIPE
DRAIN ROCK 6" ABOVE PIPE INV
TH-1
--OSR -iT�Aa
I -TEA -
LEGEND
DM =L
W WATER LINE/
-5.0 -
-
WELL RADIUS
I
SM/
sw
— SS NEWSEPTIC
7.0
SECTION L
e.a
w w
m m
'o 0 0
o a FILTER FABRIC a o
w w
w z 4" 0 DRAIN PIPE z w
w
00 0 0
M DRAIN ROCK 6" M
ABOVE PIPE INV
i-aIF-
L___j
j�
L
—
12508 SEPTIC
%' -x�v a _
PROFILE
DESIGN PARAMETERS
PRIMARY SEPTIC SYSTEM
NO. BEDROOM: 4 (600 gpd)
ABBREVIATIONS - R.I. RIGID INSULATION
TANK SIZE: 1250 SEPTIC
CU COPPER DCO DOUBLE CLEAN OUT
PERC RATE: <1 MPI -
DIP DUCTILE IRON PIPE DV DIVERTER VALVE
SOIL RATING: 1 GPD/SF
TH TEST HOLE FS - FLOW SPLITTER
AREA ROD: 600 SF
FC FOUNDATION CLEAN OUT BFG BELOW FINISH GRADE
SYS- TYPE: DEEP TRENCH 6.0'ED
OG ORIGINAL GRADE
MIN LENGTH: 50 LF
T# TANK CLEAN OUT NO. FG FINISH GRADE
C# CLEAN OUT NO. - TS&V TOPSOIL AND VEGETATE
USE: -
_
M# MONITOR TUBE NO. - NIC NOT IN CONTRACT
50 LFx2.5'Wx6.0' E.D., 11.0' TD
TOTAL AREA: 600 SF
NOTES:
77���� �'+T�T �{�
Ptll`l19G1V1'.. ENG SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-82
��QF q \\l -
�gsll1
P. fF9
7F{ -��
..... .. .. ..
•. ...... . .. ....
. .
Date
s/z/zo15
CONSTRUCTION
NI
NTS
McMAHON
#2, BLOCK 5, LOT 4
P.LD. NO
361-34
DONALD
& CARLA WILLIAMS
S
St R- Pannone /
CE 8149
PERMIT NO.
13001
ANCHORAGE,
NORAK PLACE
AK 99516
9.•,
clir
1 0 ESSI
OSP151130
DESIGN DETAILS
sheet
2 OF 3
READING
SOILS LOG - PERCOLATION TEST
CLOCK
TIME
TEST HOLE 1
WATER
LEVEL
READING
NET DROP
1
SLOPE `
\\1
ITE I LAN \
OR ORGANICS
1.25
---
1
� �
2
7.25(DRY)
/3
GM SILTY GRAVEL
I
TH-1
---
\
g
a
DRIVEWAY
10:45
5 MIN
7.25(DRY)
6.D0
6 -
x 4BR
10:45
---
TH
HOUSE
---
7
(E)
j
�
5MIN
7.25(DRY)
6.00
8
�T 4
wl
10
SHEuI
11 SM/ SILTY SAND/
DRIVEWAY \ \ aED
12 SW SAND.
w \
DRIVEWAY �-
13
WAS GROUND WATER
SLOPE
14
ENCOUNTERED? N
15
IF YES, AT WHAT
TH
DEPTH? -DRY
x
1s
17
DEPTH TO WATER AFTER
MONITORING? -DRY
18
DATE: 5115/15
BOH
DATE PERFORMED: 05/08/15
PEROLATION RATE <1 (min/inch) PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 5 FT AND
6 FT
COMMENTS: Test hole excavated
by A+ HOME SERVICES. Prec hole was presoaked.
Test run for at least one hour. Last 3 readings reported
PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUID7L�IINNES IN EFFECT ONTTHE
OF THIS TEST.
NOTES:
�rDATE
PL-11�I1VONE ENG SVC, LL,C
P.O. BOX 102954 ANCHORAGE, AK 99510
���QF Q \�l
S�� • Cgsl�+
�*f
Date
x/2/2015
FOR CONSTRUCTION
Scale
PHONE (907) 272-8218 FAX (907) 272-8211
%6j�p
�.�.: .*�/
..... ....
NTS
P.I.D. NO
McMAHON #2, BLOCK L, LOT 4
.. ...... .. .. ..
017-361-34
DONALD & CARLA WILLIAMS
Steven R Pannone
CE 8149
PERMIT NO.
13001 NORAK PLACE
.•<?%
f..
+l`li�\
OSP151130
SOILS LOG
ANCHORAGE, AK 99516
Sheet
DFES
3
READING
DATE
CLOCK
TIME
NET TIME
WATER
LEVEL
READING
NET DROP
1
05/08/15
10:35
---
1.25
---
2
10:40
5 MIN
7.25(DRY)
6.00_.
s
10:40
---
1.25
---
4
10:45
5 MIN
7.25(DRY)
6.D0
5
10:45
---
1.25
---
8
11:50
5MIN
7.25(DRY)
6.00
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
>
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 d
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
DISTANCES
oRF
TO
SEPTIC
ABSORPTION
WELL
Address
FROM
TANK
FIELD
2-Le-2—Lo obi
Phone(s) Permit No. No. of Bedrooms
WELL
, pp \ 'ir-
C%:>
LOT LINE
LEGAL DESCRIPTION
Lot
q
Block
S
bdi
Suvision
t, M "-D to It
FOUNDATION
'k--
` +
Township, Range, Section
AS-BUILT DIAGRAM
(Show location of well,
septic system, property
lines, foundation,
driveway, water bodies,
etc.)
TANKS
64 SEPTIC ❑ HOLDING
'
l t +7
Manufacturer , 1
specify
yin-�gallons
VO D
Material
No. of Compartments
Z
l
TYPE OF SYSTEM
TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER
Depth to pipe bottom from -
Total depth from original grade
original grade FT
Q FT
Fill added above original grade -
Gravel depth beneath pipe
0 FT
to FT
Gravel length
Gravel width 4t
Q
5& FT
+2,
Total absorption area
Distance between lines
^
445 L.0 SQ FT
D FT
c VS
Number of lines
'
Soil rating
I \zjb SQ FT
Pipe material
'pV t -34
Installer S`r� ^ I I
Date Installed
10 � 4 -tet co
FIF
WELLS
fvf
i..�10
•
k ^ un
L.
PRIVATE El OTHER (Identifvl
_
C
W S
O
Classification (A,B,C)
Total Depth
Cased to
.r�'�
f D
if15Tt/`lLei
FT
FT
Installer
Date Installed:
iAS
>?:
REMARKS:
(� (
Scale: ` I
Inspectlonormed by:
ENGINEERS SEAL
gS
i-2rS
° }
t
Date: 1 ��� �%reF_q�i
00 %
1
z�,5
4�s'
Z75`
E9
'
ryry SF, GIS4E¢ING
�t q,��95nyI�®orf D610 2Q4 cedily that this inspection was performed according to all
a: _
Municipal aneoril. M rirf alliptifis ifale?
R<o.
L2'v
�S� Ltd
Health Department Approval: Date:
�1 n '°'U,•� ��`'';;,;'
<'Dri
72-013 (3/85)
~
Signed: DATE:
�Dwner) JOHN ��ESS
lssued 8y: DATE:
MUN1C1PA1..ITY OF
ANCHORAGV-
I' Health & I-
ITE SEWER
1 'FIE
PERMIT
Permit
Number: 90028 Upgirade
Uate
lssued: 09/11/90 Engineer Designed
Day Phone:
Dwner
Name: JOHN kRESS
Owner
Address: 2626 GLENWOOD ST,
786-1489
ANCHURA�E,AK 99508
J
�
Parce] I�: 017~+�,�f��
Lot Lega]: Subdivision: MC MAHON 412 Loix 4
Block: 5
Section: 29 Township: 12N Range4
3W
Lot Size 30150 (sq,Ft. or acres)
Max
Bedrooms: This Permit: 3 Total Capacity:
3
SEPTIC
TANK: Minimum total septic tank capacity:
1�000 gallons, Each septic
tank
haveleast 2 Depth to
top of septic tank(s) < 4.0
must at compartments"
feet
requires insulation over Lank(s),
INSTALL
PER ENGINEERS ATTACHED PLAN` NOTIFY DHHS
PRIOR TD EACH
INSmCTION.
THIS PERMIT IS ISSUED FOR THE EXISTING
3 BEDROOM
SINGLE
FAMILY DWELLING ONLY AND EXPIRES ON 12/31/90,
I CERTIFY
THAT:
1.
I am /amilWar, with the or on-site
sewers and wells as set
!orth by the Municipality o� Anchorage (MOA)
and the State o� Alaska.
2.
I will install Lhe system in accordance with
all MOA codes and regulations;
and in compliance with the design criteria o
this permit.
3,
I will adhere to all MOA and State of Alaska
requirements for the set back
distances from any existing well�j wastewater
disposal system or public
sewerage system on this or any adjacent or, nearby
lot"
4,
I understand that this permit is valid for a
maximum o[ 3 bedrooms. I
that the o{ the iotal
system is 3 bedrooms and
also understand capacity
any enlargement will require an additional permit"
~
Signed: DATE:
�Dwner) JOHN ��ESS
lssued 8y: DATE:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
(ENG INEER'S'SEAL)
N Y>
y05��> OU JU6Y4iB:ll 119 <0.�<e �. +f
YJ
r. aev ea •oao e° ,
V
PERFORMED FOR: ,MP `.J 0/1 Pj l\ (<C, DATE PERFORMED:
LEGAL DESCRIPTION: /�'r/-I) I&KS- A&c AA jHCA.) /W,j ; TON
DEPTH
(FEET)
r ti
2
r
n �
r
3
°.
0
4-
5 5
6
° a
-o '
0o
7
u
13-
14-
15-
16-
17
314151617
18-
19-
20-
COMMENTS
81920COMMENTS —
;tion:
SITE PLAN
INN
■■ A
.■M■
MEFAN
■■I.■
MEMO
■ENE
ORION
MEMO
WAS GROUND WATER
ENCOUNTERED? �C)
s
L
IF YES, AT WHAT O
DEPTH? P - '-
E
Depth to Water After
Monitoring? &— Dale: 0
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN —G)FT AND FT
PERFORMQ&q:Ei33�££,,i''{E$,F(i1C ��Jj (ry�� ryry�p�d� I CERTIFY THAT TH S TE T WAS PERFORMED IN
ACC0RDA IWtL�TnlEEOANII op U MPAFRIDELI N EFF;CT ON THIS DATE. DATE:
Eagle River, A asks
72-008 (Rev. 4/85)
NAME z
LOCATION �\
GRE,.. , ER ANCHORAGE AREA BW
JGH00""!
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM t�
MAILING ADDRESS /1900 'X04 e�Q` PHONE,
5
LEGAL DESCRIPTION L/ tl?(f
SEPTIC TANK:
DISTANCE `} NUMBER OF
FROM WELL MANUFACTURER_ MATERIAL .-� / COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY/a-YJ GALLONS.
TILE DRAIN FIELD : jjjf_td
)))1""""""l,p///+++,,L,_L
DISTANCE FROM WELL FOUNDATION
NUMBER OF LINES DISTANCE BETWEEN LINES
TOTAL LENGTH
NEAREST LOT LINE OF LINEjf 4t
/6 J
TRENCH WIDTH— IN. TOTAL EFFECTIVE
ABSORPTION AREA �`C5 SQ. FT. LENGTH OF EACH LINE
f DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE :% MATERIAL BENEATH TILE—.1—SA. ABOVE TILE
WELL: i�
TYPE_ f� CONSTRUCTION
BUILDING NEAREST NEAREST SEPTIC
FOUNDATION LOT LINE , SEWER LINE , TANK_
CESSPOOL . OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY:
5
SEWER LINE DEPTH:
PIPE MATERIAL: `-Z?
LOT SLOPE:
REMARKS:
Form EQ -032
`/ I N.
EPTH DISTANCE FROM:
SEEPAGE
SYSTEM_
DIAGRAM OF SYSTEM
1 '
G.A.A.B.
�
� . DEPARTMENT Or HEHAH HND ENVlRONMENTHL PECTION
^ 2516 E�� TI RD./ HNCHORHGE3 HK� *�9507
. 276-2221 ^'
' �
����, ��_�����'o
. �
PERMIT NO ( �6559 ) `
HPPLICHNT JOH' ESS ' 1800 MCKIN�EY HVE �77�5�96 �
�
Ci L: NORHK PLHCE
/ �
� � i L�� ��IZE�� ]�150 SQUMRE FEET
LEGHL L4 B5 MCMHHON'5UB� �* � �� ' `
' .
`'/'
TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH'
MHXIMUM NUMBER OF BEDROOMS (SQ T/BR)= 150
THE REQUIRED SIZE OF THE SOIL HBSORPTI(IN SYSTEM IS:
��P" A 4 A =:- �C�-D �1"11 C� -I- I—P -=. zoos, fill If: Vol Rvu TE. 1, Ell �F" -T- &A�=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET)
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
HND THE BOTTOM OF THE EXCHVHTION (IN FEET).
10MEATTU 1 IFTIMICIA STUM-1- :1, (11 lT" I? IWO Ul 9 a �����Nil ��
BHCKFILLlNG OF HNY SYSTEM WITHOUT FINAL INSPECTION AND HPPROVHL BY THIS
DEPHRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTHNCE BETWEEN H WELL HND HNY ON—SITE SEWHGE DISPOSAL SYSTEM IS
100 FEET FOR H PR -1.` -.4 -'ITE WELL OR 200 FEET FOR H PUBLIC WELL
WELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DHYS
OF THE WELL COMPLETION.
SPECIFICHTIONS HND CONSTRUCTION DIAGRAMS ARE HYHILHBLE TO INSURE PROPER
INSTRLLHTIOhl.
low ERRI A! 141 1: 0- MIR U 1 RD I C INH E,---. "ru K Fol F=- O -v I �=o-, L -P FEE'
I CERTIFY THHT
1: I HM FHMILIHR WITH THE REQUIREMENTS FOR ON ----SITE SEWERS HND WELLS HS SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE.
2: I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES-
]: I UNDERSTAND THHT THE ON --SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE
RESIDENCE IS REMODELED TO I NCL E MORE THAN ] BEDROOMS.
SIGNED~�~
This log represents subsurface
soil conditions within McMahon
Subdivision Lot 4 Block 5
DW N: o o F.B.
Sanitary Sewer Sy Stean GRID
CKD R&M CONSULTANTS 1i�iC
Dp �. 7/21/76 EH °,v..». a.° a,,,.a a off .A A e.°A. John Kress PROJ.N0 656272
SCALE Anchorage, Alaska DWG.NO. A–01
Test
Pit 1
f
0°
a ti
ORGANIC MATERIAL
This log represents subsurface
soil conditions within McMahon
Subdivision Lot 4 Block 5
DW N: o o F.B.
Sanitary Sewer Sy Stean GRID
CKD R&M CONSULTANTS 1i�iC
Dp �. 7/21/76 EH °,v..». a.° a,,,.a a off .A A e.°A. John Kress PROJ.N0 656272
SCALE Anchorage, Alaska DWG.NO. A–01
Test
Pit 1
7/20/76
0°
a ti
ORGANIC MATERIAL
`• � .
—_ — ---51
—
SILT W/SOA1E TR SAND
U'
SANDY SILT – SILTY SAND
W/TR ORGANIC MATERIAL
41
SAND W/SOME SILT TR
GRAVEL
ro••
6.5'
GRAVELLY SA14D W/TR SILT
(SP)
b•
- -
-• -
SAND b4/SOME TR GRAVEL
:•:
(SP)
o
11'
5 G0
.0-0.
Gravelly Sand (SP)
o"g
�'•a
15' TD
NO WATER IN TEST PIT
This log represents subsurface
soil conditions within McMahon
Subdivision Lot 4 Block 5
DW N: o o F.B.
Sanitary Sewer Sy Stean GRID
CKD R&M CONSULTANTS 1i�iC
Dp �. 7/21/76 EH °,v..». a.° a,,,.a a off .A A e.°A. John Kress PROJ.N0 656272
SCALE Anchorage, Alaska DWG.NO. A–01
o
NJ-
R &M C0-,4SJLTAN-rS, INC. 249 EAST 51 ST. AVE.- SOX 6087 - ANCHOPAGE. AK.995O2 - P.M. 907279-0483 - TLX. 00023360
July 22, 1976 R & M No. 656272
Mr. John Kress
1800 McKinley Avenue
Anchorage, Alaska
RE: Test Hole and Soil Log Report for Sanitary System
McMahon Subdivision Lot 4 Block 5 Section 28 T -12N R3W
Dear Dir. McKinley:
We are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This investigation
was performed in accordance with your request of July 10, 1976 and those
procedures outlined in a letter dated July 15, 1975, by Mr. Rolf Strickland
of the Greater Anchorage Area Borough Department of Environmental Quality.
A single test pit was put down within subject site for the purpose of
defining general subsurface soil conditions for the proposed sanitary
system. Excavation was accomplished with a tractor -mounted Backhoe.and
the test pit was extended to a total depth of 15 feet below ground
surface. The final log prepared for the test hole has been included in
Drawing A-01.
Ground water was not encountered in the test pit while drilling.
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate to contact us.
Very truly yours,
R& M CONSULTANTS, INC.
James W. Rooney
Vice President
JWR/ddp
xc: GAAB
ANCHO=IAGE FAIRBANKS - - JUNF-AU
•
00 hgl
M 900oo rj ----�
LO
D
z Z o�
a
QO
2KQ •� fm1
ti V gni
LO
6 FU
pews
W
Ica
/
�.
°
� �.q`•Bpee t ••n••o b7s
ti • • �7
ry }
O ! Y 1
�
LIJ
� s e •_ tlr • J A
LL.
ILJ
y'
• B
OU.
J —M►
coW
al
:2
A m
I
J:tea®
M,90.00N
00 hgl
M 900oo rj ----�
m� �•LU
fff
z Z o�
a
QO
2KQ •� fm1
ti V gni
LO
6 FU
pews
W
`
/
°
� N
CD °'
LIJ
m O UO a�
s
J —M►
coW
al
:2
I
00 hgl
M 900oo rj ----�
L�f
�
11.E
�
s
s
n
m
4
D
t
`
r
f
Jj
1
z
G)
n
D
z
l/'i.``
`
t
D
o
'\
1
�!
�
-
-
�
G3
+�
r
1"
h+
n
>
y
q
0 -
m v
S
1
l
m
z
z
O
1
C
1
rO
v`
m
r
r,.
::
n
Parcel I.D. 017-361-34
Municipality of Anchorage
On -Site Water and Wastewater Program 'c
(907)343-7904 sne e.rx
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Expiration Date: / / — 7 I
Complete legal description McMahon #2, Block 5, Lot 4
Location (site address) 13001 Norak PI.
Current Property owner(s) Donald & Carla Williams
Mailing address
Real Estate Agent
Day phone
13001 Norak PI. Anchorage, AK 99516
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Fx_1
Individual
n
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment 1311145 c Date of Payment
Receipt Number 09C'.i35WZ Receipt Number
COSA # i5C✓i 51 1,�Co 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe the performance of the system under theconditionsencountered 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 soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sale benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC
Address P.O. Box 100217, Anchorage Alk. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
1 .y System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Phone (907)272-8218
Date 0/11/2015
Conditional approval for bedrooms, with the following stipulations:
By: Original Certificate Date: j / - Ls
f
The�.Munici)S�fty�1[if chorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSH Checklist X Nitrate Advisory .�.
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet � - ,
If more than 1 septic system is on the lot:
COSA Checklist # + of
Structure served by this system I
Certificate of On -Site Systems Approval Checklist
Legal Description: McMahon #2, Block 5, Lot 4 Parcel ID: 0 17-361 -34
CWYA :110 17-34 0
Well type Private If A, B; or C provide PWSID #
Date completed 10/30/1976 Sanitary seal (Y/N) Y
Total depth 100 ft. Cased to 100 ft
Date of test
Static water level
Well production
FROM WELL LOG
10/30/1976
Well Log (Y/N) .Y
Wires properly protected (Y/N) Y
Casing height (above ground) 12+ in.
AT INSPECTION
6/10/2015
Unknownft 67
3 2.1
g.p.m. —
ft.
WATER SAMPLE RESULTS:
Coliformcclonies/100 mL Nitrate i�mg/L
Arsenic 1 ug/L Date of sample: '� Collected by: S
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,250 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y
Date of pumping New
Depression over tank (Y/N) N
Pumper N/A
Date installed 6/4/2015
Cleanouts (Y/N) Y
High water alarm (Y/N) N
C. ABSORPTION FIELD DATA
Date installed 6/5/2015 Soil rating (g.p.d./ftz or fe/bdrm) 1 GPD/SF System type Deep Trench
Length 50 ft. Width 2.5 ft. Gravel below pipe 6 ft.
Total depth 12 ft. Eff. absorption area 600 if Monitoring tube Y Depression over field N
Date of adequacytest New Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test New in. Water added New gaL New depth New in.
Elapsed Time: New min. Final fluid depth New in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date
M
J
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons Manhole/Access (YIN)
in. "Pump off" level at in. High water alarm level at
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION -DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 50+
SEPTIC/HOLDING TANK ON LOT TO:
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal,excrete atorageareas 100+
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that l have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone
Date 6/11/2015
COSA canary sheet_2-6-15.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 10+
2
0
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 # 151400
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 5, Lot 4 of
McMahon #2 subdivision. This inspection revealed a nitrate concentration of
8.97 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.
0 0
vv
o
0
N N 22
�ja O
A m�
rnAD Vl
(N/1Nm
G N
-.� •o o m
a z
x ° D
3
O a
NORAK PLA — —
m — —
ELMORE. STREET
3M-sr6
n'
°
,
I
3nv =O
=S
smwa -4a.
Sfa
q a
M
Y a e 60. °
�.
'c
m
3asaQws
mq
�
°meq®a. 7f-.
3ac
-ter
- e°i
O
am m q-giiG
g�
�
�a9�cyiSe
3°
-`
M. p q
X = and ZC.
a
00
a a
a a p m
o_
vm,
n,t`uo z o
�'
S3s�som'
• a m ° Z a
Tm
oo
tr
2z°`m"o
o=
a,a
3.. a
qao
s9
qr
S q iV
c
0 n "140
ea
CL
a
+
0 1
'
uA
r a
M'
<nV
o °
a
w a..
rt
=O
Qq rw
oZo�
v3
aS
.ar.7
to
�a O
p
®
a0 7
q
Ym
0 0
vv
o
0
N N 22
�ja O
A m�
rnAD Vl
(N/1Nm
G N
-.� •o o m
a z
x ° D
3
O a
NORAK PLA — —
m — —
ELMORE. STREET
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH i£ 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
Parcel I.D.# 0\-I — 6ln\ " )q
HAA #
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) V3, I N 0 -ra- V, L--) la. ce
Property owner Dyo,2,( P V ,1 11 + ac vz-r g Day phone a&
Mailing address / 30 0 'F7 14 -
Lending agency
Mailing address.
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
V
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well t"'
Community well
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL: 6"
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 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 furtherverify 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.
Name of Firm - �v 4� l o-, v t t ✓ Phone �:7q ` Srl 16
Address
Engineer's signature
6. DHHS SIGNATURE
l� Approved for
Disapproved.
2
Conditional approval for
Additional Comments
bedrooms.
Date
bedrooms, with the following stipulations:
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 ii dependent
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.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 111, plt Parcel I.D.
l
L�
A. Well Data
Well type If A, B, or C, attach ADEC letter. ADEC water system number jj __NA.
Log present (Y/N) y Date completed I �/-A0I �� Driller UV11vt-licl ./"
Total depth too Cased to Casing heights
Sanitary seal (Y/N) Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump levell
SEPARATION DISTANCES FROM WELL TO:
AT INSPECTION
q
rR
rri
g.p.m. �� g.p.m. C oo
NO rrl w
Septic/holding tank on lot � l V 0 ; On adjacent lots i 14 a
Absorption field on lot > &C ; On adjacent lots ~l 1 L1 O
Public sewer main NIA Public sewer manhole/cleanout !/A
Sewer service line �> So Petroleum tank q 10
WATER SAMPLE RESULTS: r
Coliform / Nitrate s, L"> 63 Other bacteria
Or
Date of sample: 7! c�3 /a _3 Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 16 l ® Tank size" Compartments 411
Cleanouts (Y/N) ' Foundation cleanout (Y/N) Depression(Y/N)
High water alarm (YIN) / /A Alarm tested (YIN) g t -//A
Date of pumping f la 3 Pumper G,1J dwk [. S
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ! l q L On adjacent lots ® L/O Foundation 81.
To property line } 1 i? Absorption field Water main/service line > Eo
Surface water/drainage
72-026(3/93)`Front CONTINUED ON BACK PAGE
C. LIFT STATION 4 V 0 vtt
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off" Level at
Cycles tested
Surface water
Date installed j 0 �� � g D Soil rating (GPD/Ft2) '� System types r �L i
Length -3 6 Width ' Gravel thickness Total depth
Total absorption area Y =; %7, Cleanout present (Y/N) Depression over field (Y/N)
Date of adequacy test 6/1 1 /q-'5 Results (pass/fail) for T� Bedrooms
r
Water level in absorption field before test �� �% After test b
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot On adjacent lots —a
If yes, give date
Property line !> 10,
To building foundation '7�7 ;i--- To existing or abandoned system on lot
On adjacent lots 1>i/ V c� Cutbank N 0 w -_ Water main/service line > 9L)
Surface water N` to V 4;-�- Driveway, parking/vehicle storage area > 9 O
Curtain drain t\) to
E. ENGINEER'S CERTIFICATION
1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
HAA Fee $ ` 6 « Waiver Fee $
Date of Payment 7 -�-A' S� Date of Payment
Receipt Number la-zf xs-Z t <l/Q,0 Receipt Number_
72-026 (3103)' Back
MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES •�
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # (n 1 - i� ' " — HAA #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 4;.Block 5; McMahon Subdivision Addition
Location (address or directions)
13001 Norak Place, Anchorage, Alaska
(b) Property owner John Kress Telephone: (home) 277-5482 Business 7R6-1 4RA
Mailing Address 2626 Glenwood Street, Anchorage, Alaska 99508
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
Telephone
(e) Mail the HAA to the following address: (or check here E�, if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING/694-2979
17034 Eagle River Toop Road Suite 204
Eagle River Alaska 99577
2. TYPE OF RESIDENCE
Single -Family 0 Number of bedrooms 3
3. WATER SUPPLY
Individual Well KX Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ® Public ❑ Community ❑ Holding Tank ❑
Note: if community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7788) Page 1 of 2
Z 10 Z abed
NOU9 (99/L A@8) 96o-ZL
-�joM s,aaauibuo jeuoissaload ay} ui
suoissiwo ao saoAn aol apsuodsw lou si abeaogouy }o Aj!jedioiunW all'panssi si aleoilpao e aao}aq elep azo leue ao
suoiloadsui lonpuoo lou op SHHa 10 saa (oldw3 'sluawaiinbei alels pue leaapa} uieliao Alsiles olaapao ui suoilnipsui
buipuaj aiagl pue sawog }o saasupind of Asolinoo e se sigl saop SHHCI aq.L 'u�seIy }0 9lelS aq} ui paaalsibai
aaauibua Ieuoissaloid luepuedepui ue (q anoge g ldea6eaed ui uanib suoileluasaadaa agl uodn Aluo paseq paleoilpoo
Ienoadcly fluoglny 1-11129H sanssi (SHHG) saoina9S uewnH pue glleaH }o luawliedaa abeaogouy}o Alijedloiunw aql
lenoaddy leuoilipuo0 }o swial
Jeuoilipuo0 panoaddesi(j \, panoaddy
0/ area � ,� (q swooapa � y�Jo} panoaddy
r
IVAOdddV SHH(3 .9
Y / 9124
11c66 z',1313I'd `aaniM ajFie3
--- t'M'ok eo cloo 3n1 t ssaaPpy
n
—�`� � auolda�al `l�L; (3S\i'�N3 5 3 S (uaid }o aweN
'uoiloadsui sigl }o alep all uo Joa}}a ui suoiJelnbei pue 'saoueuipio 'sapoo 91215
PUB jeclioiunW ale glint aoueildwoo ui si walsAs [esodsip aaleMalseM ao/pue Alddns aaleM alis-uo all 'uoiloadsui
PUB uoilebilsanui (w woal pue saki} abeaogouy }o Aj!padioiunW aql woal pauielgo uoiJe(wop aql uo paseq
Jell (}iaan aagl.)n} I 'ulaaag paleoipui ainJonals }o adAl pue swooapaq to .iagwnu all ao} alenbape pue peuoiloun}
'a}es sl (ualsL S lesodsip jaleMalseM Ao/pue /\Iddns jaleM alis-uo aql legl smogs Jenoaddy Alijoglny glleaH
sigl }o uoileEiilsanui AW Jell AI!AE)n I 'Molaq UMogs alep uoilepiIen aql }o se pue olaaaq Paxil}e leas (w Aq poilpeo sy
NOLLifIM»03M1 9NV *Ilya 1-108h213 3"?I:! `30.1-331 '31IOLI MSM ONICIAM+d Mild ONIH33NION3 'S
e
�°�\�5�°: MUNICIPALITY OF ANCHORAGE (MOA)
"G yo Health Authority Approval (HAA)
°FP��L� ` CHECKLIST - FEBRUARY 1984 �'-
��� 343-4744
P P
Legal Description: L10T moi- t3u�'LiL S
A. WELL DAT&
Well Classifidation .Yr►%_-)+y(k->yati If A, B, C, D.E.C. Approved (Y/N) r'l
Well Log Present ®/N) Date Completed 10 -22o-'1 V Yield Z O QPA&
Total Depth100-L6" Cased to 4D�� Depth of Grouting g' �a"gbl
Static Water Level Pump Set At VK -
Casing Height Above Ground 1Z Sanitary Seal on Casing 6%) y
Electrical Wiring in Conduit (DN) Depression Around Wellhead (YQ
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot �boti� ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot Db ; On Adjoining Lots oa
a-
To Nearest Public Sewer Line P To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot LS��
Water Sample Collected by S4 S Ln ; Date 10 `-C (D
Water Sample Test Results 5AeT156�'���
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed � 0-4 `t,o Size 100 C� No. of Compartments Z
Standpipes (9N) N/Air-tightCaps ON) N Foundation Cleanout/N)
Depression over Tank (Y/@) �1 I Date Last Pumped
Pumping/Maintenance Contact on File (Y/N) alp ; for r►1
Holding Tank High -Water Alarm (Y/N) K Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well O'I L. _ To Building Foundation
To Property Line IV t To Disposal Field
To Water Main/Service Line C>
To Stream, Pond, Lake or Major Drainage Course \ b0
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 1Sa'/�� Type of System Design �ef�s-ae x1
Date Installed 4 --cl o Length of Field
Width of Field :S Cit Depth of Field c,
Gravel Bed Thickness LO,
Square Feet of Absortion Area 4S L'4 Statndpipes Present &N)
Depression over Field (Y& Date of Last Adequacy Test N
Results of Last Adequacy Test ►J �A—
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well \ nod k— To Property Line
To Building Foundation \nTo Existing or Abandoned System on
Lot _ l2\'t" ; On Adjoining Lots
To Water Main/Service Line i r:>\ r To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course \ r> o 1-4—
To Driveway, Parking Area, or Vehicle Storage Area 3 0 �-
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump (fin" Level at
High Water Alarm
Tested for
Meets MOA Electric
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
ent (Y/N) _
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in eff
inspection. & 5 ENGINe.KWNG
17034 gaggle Illnrer Loop Road N9, 294
Signed ---Eagle fiver, Al ROW 99tiZZ � c
J ti
Company
Date
MOA No. _
02 asy
Receipt No. �35z) Receipt No.
Date of Payment �~ �°) — Waiver Fee: $
Amount: $ 17000 Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
�4ate of this
4uf°'l,
5
❑ PUBLIC WATER SYSTEM I.D.# I 1 I I I I I
'16 PRIVATE WATER SYSTEM
Name Phone No.
Mailing Address
1��Pf(;7 1, (G et Cf57-7
City StateZip Code
� DIE
SAMPLE DATE:
Mo. Day Year
SAMPLE TYPE:
R�-Routine
❑ Check Sample (for routine sample
with lab ref. no. 1 ❑ Treated Water
❑ Special Purpose ❑ Untreated Water
SAMPLE Time Collected
NO. LOCATION Collected By
1 ►� rg g� I �: 4s
2 1M�
3
4
5 1
Fs
si shows this Water SAMPLE to be:
atisfy ctory
nsatisfactory
❑ Sample too long in transit; sample should
not b6over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received
Time Received
Analytical Method: Membrane Filter
` No. of colonies/100 ml.
Lab Ref. No. Result* Analyst
90.4086 .Z
M
BACTERIOLOGICAL WATER ANALYSIS RECORD /
READ INSTRUCTIONS Membrane Filter. Direct County Coliformn00 ml
BEFORE Verification: LTB uuu
COLLECTING SAMPLE Final Membrane Filter Results / CollformhOO ml
Reported By= — Date —70
Time: lam% a.m.
p.m.
TNTC = Too Numberous To Count
PART ONE OF TWO
OB = Other Bacteria REMAINDER TO FOLLOW
of
J
g4
LABORATORIES
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET E ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562-2343
FEDERAL TAX I.D. #92-0040440
ANALYSIS REPORT BY SAMPLE fox Work Order # 29020
Date Report Printed: OCT 10 90 @ 09:25
Client Sample ID:14 B5 MC14AHON #2
PWSID :UA
Collected OCT 4 90 @ 18:45 his.
Received OCT 5 90 @ 14:00 his.
Preserved with :AS REQUIRED
Client Name S & S ENGI14EERING
Client Acct SNSENGP
P.O.# NONE RECEIVED
Req #
Ordered By : R. SHAFER
Analysis Completed :OCT 5 90 Send Reports to:
Laboratory Supervis x HEN C. EDE 1)S & S ENGINEERING
Released By I(,f— 2)
Special /
Instruct:
Chemlab Ref #: 904086 Lab Smpl ID: 1 Matrix: WATER
Allowable
Parameter Tested Result Units Method Limits
-----------------------------------------------------------------------------------------------------------
NITRATE-N 1.8 mg/l EPA 353.2 10
Sample ROUTINE SAMPLE.
Remarks: SA14PLE COLLECTED BY RAY.
1
Tests Performed
See
Special Instructions Above UA=Unavailable
ND=
None Detected
See
Sample Remarks Above
NA=
Not Analyzed
LT=Less
Than, GT=Greater Than
DF.�NDFVFryDF
Ht!
2� 9
a o
O y
J
E
MUNICIPALITY OF ANCHORAGE
\9 �W
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
NUMBER OF BEDROOMS
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for. processing. ,
1. PROPERTYOWNER,/
30ffN _ I� • ,26-5 S
PHONE
4-513 - //-5
MAILING ADDRESS
S A)Cq 9`3s�oZ
Three ❑ Six
PROPERTY RESIDENT (If different from above)
PHONE
/009,4K P1 -a -C -e
3 giq-s37L
2. BUYER
PHONE
❑ PUBLIC UTILITY
depth (attach log if available.)
MAILING ADDRESS
3. LENDING 1 STITUTION !�
SANK C
PHONE
L/4$lCO &-F 0 124 ,w G�C.G
If system is over two (2) years old an adequacy tet is required
MAILING ADDRESS_
S'
by this Department.
(Z- 13 944. NGld
4. REALTOR/AGENT
PHONE
ti
MAILING ADDRESS(
5. LEGAL DESCRI TION
E0 i 5 Lo C.
-
S� ly% !,4rfo v Sd Z Na 1W
STREET LOCATION
owwq-K A- r4z�
6. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
SINGLE FAMILY
❑ One ❑ Four ❑ Other
❑ Two ❑ Five
❑ MULTIPLE FAMILY
Three ❑ Six
7. WATER SUPPLY -
Q INDIVIDUAL* *.ATTACH
WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE SYSTEM
,DISPOSAL
s� INDIVIDUAL/ON-SITE** **If
individual/on-site, give installation date -1
If system is over two (2) years old an adequacy tet is required
❑ PUBLIC UTILITY
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONL.
INSPECTION APPOINTMENTS
DATE RECEIVED
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
>' SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE 9� THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PEGR-�MIT NUMBER
/10��
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
;'�eINDIVIDUAUON -SITE
❑PUBLIC UTILITY
Connection Verified
PEQJMITNUMBE R
DATT(.FF INS ALI ED
d/ /
INSTAL ER
`�b
Septic Tank or ❑Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
- D
TYPE 7 -fly
JG /t loDl)
M , FACTUR�R
)r -e- L,
TOTAL PTIONAREki 0
MATERIAL
4. DISTANCES
WELLTO:
Se t' /Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS Ll
` 1 O UW
6--APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
BY (Title)(
LEGAL DESCRIPTION
72-010 (Rev. 3/78)