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Home My WebLink AboutMCMAHON BLK 1 LT 10Onsite File McMahon Block 1 Lot 10 #017-041-51 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181207 PID Number: 017-041-51 Dwelling: ❑■ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New Upgrade Name: SUE WAGNER ABSORPTION FIELD ❑� Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.8 GPD/SF 12.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6.0 Ft. Gravel depth beneath pipe 6.5 Ft. Subdivision Block Lot MCMAHON S/D BLK 1, LOT 10 Fill added above original grade 5+ Ft. Gravel length 58 Ft. Township Range Section Gravel width 2.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 750 Ft Ft. Well 100,+ 100,+ 50'+ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCH TANK Capacity 11250 Gal. Surface Water 100'+ 100'+ Material Number of compartments Lot Line 10'+ 10'+ STEEL 2 NA Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Curtain Drain Uhf UN 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 PIPE MATERIAL House to tank 3034 Tank drainfield 3034 Installer MIKE N ANDERSON Drainfield 3034 CO/MT 3034 Inspector MIKE N ANDERSON, PE BENCH MARK (Assumed elevation) 114.4 ft Inspection 1" 11 /15/18 11 /15/18 Location and description dates: Z�, 3m 4th GARAGE SLAB COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp OF A.��, Conditional Approval: Date ��`• 1 • P is *!4 9 T o e e o s e• e e o e o o e o 0 0 e o p �fl 7 �o O e 0 0 e e e 1• O e p ....... e e e•. p rF ;� • MICHAEL N. ANDERSON e � rl • d9 L/ �3 �0�20 Z Approved Date � ° Inspection Keport_`J-"I-iz.aoc Permit No. OSP181207 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: MCMAHON S/D BILK 1, LOT 10 I ELL MARK A C01 14 51 CO2 15 51 CO3 75 40 TC01 76 41 TCO2 83 49 CGGA5 109 86 — MT2 MT1 135 110 85 9 i _ — OLD TANK—DECOMMISSIONED H U F F M A N R 0 A D 1 10' UTILITY EASEMENT /� M �VC06 / M i C05 C04 TCO2 I % TC01 CO3 B I I 1 / — BENC d,—C. HOUSE JJ / CO? / A / / 110' UTILITY EASEMENT � 1 � ASBUILT \\ \ SCALE: 1"=50' \ PID No.: 017-041-51 w z a WELL OO P 31 DRY JULY 14, 2018 '\-'.MICHAEL N. ANDERSON; Av No. CE 9469 j ''•,3-18-20 ,..•• i d 00.09 L 4som t=O 9L -M X6'9 ----- - co 0 X - v` cin o ¢ 713M cq w 1 r•U'� rn tt mA w [�lOVII!i 1-111 .DO1 n waw cod co CD co � f ° cmn cdn coo / z o { ", `" C) T: ipj r. c Ln C O Gr o n o O n J 00 �nfb o °° om� pHA T @ �p0� ��yrrfin �"! m �y y IFT-1 CD w m p . *-I � FTIa�aes O O 12. N O (D.f� p�hyp�o� by C °p -S eb o p .pOD er IA 0 L �5 (D (D c a CD o r* r� �.'* p• oeeemth `N - G•mm�pm� r S 1 Kra m00 1 0 60 a c °o�p � � � ado NVyWAA 1Ho 6 p 09 N 5L o SLCD D 37V,? ii 0 tv C4 0 0 0 o MUNICIPALITY OF ANCHORAGE � On-Site Water&Wastewater Program PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 .41; , httpalwww.muni.org/onsite 4NC HOR"VE On-Site Wastewater Disposal System Permit Permit Number: OSP181207 Effective Date: 8/13/2018 Work Type: Septic Upgrade Expiration Date: 8/13/2019 Tax Code Number: 01704151000 Site Legal Address: MCMAHON BLK 1 LT 10 G:2835 Site Mailing Address: 12400 LORRAINE ST, Anchorage Owner: WAGNER SUE S Lot Size in Sq Ft: 34307 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 4 This permit is for the construction of: 0 Disposal Field I J Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: //P/k/ - Date: i 7 Issued By: /l/' /� Date: 0 AMI; MUNICIPALITY OF ANCHORAGE ice ; Development Services Department �;' Phone: 907-343-7904 On-Site Water & Wastewater Section - Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-041-51 Property owner(s) SUE WAGNER Day phone (# o-a Mailing address 12400 LORRAINE ST Site address SAME Legal description (Sub'd., Block & Lot) MCMAHON BLK 1 LT 10 Legal description (Township, Range & Section) Lot Size 34,307 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (EI all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ (w/wo ADU) Septic Tank ❑ Upgrade - D ❑ Holding Tank [I] Renewal ❑ e5 6 7 ; V4r. . :v0;ggs ❑ Privy ❑ -••/or 4 Private Well ❑ Q ✓U -0 Water Storage ❑ 'X418 THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: G 689S `' � istance: 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 authorized agent) Permit/Rush Fees: 6(04- Waiver Fees: Date of Payment: 1 !le($ ck 10591 Date of Payment: Receipt Number: 0),3/4(00 Receipt Number: Permit No. OSP 18 I-2-01 Waiver No. G:IDevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc • • July 16, 2018 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic permit Legal: MCMAHON BLK 1 LT 10 To Whom it may concern: This is a request for a new septic permit on the above referenced lot. A new test hole was completed and found sandy gravels (SP) starting at 6 feet for the entire depth with no water observed during the excavation or after the 7 day monitoring period. A fill layer above 6 feet was observed and will not be used. The perc rate was 5.5 minutes per inch. The new design will be a 4 bedroom system with a deep trench and 6.5 feet of effective depth, see site plan. The lot slopes to the northwest at about 20 to 30 percent then flattens out near the bottom , see the drawing.The owner has requested a new 4 bedroom system therefore we have included the reserve area on the site plan. This new system will not impact any of the neighboring properties due to the lot layout. Please call me if you have any questions. Sincerely`// Michael N. Anderson, P.E. 4661 Natrona Ave. Anch, Ak 99516 Ph 727-8864 DESIGN CRITERIA: I MOUND OVER (TH#1) -6.‘ -- GRADE 4 BDRM X 150 = 600 GPD I ORG ______I SOILS = 600/0.8 = 750 GPD FILTER FABRIC 750 GA/13 = 58' -6.0 -6.0 4"0 PIPE (1) TRENCH I SP SEWER ROCK 12.6' DEEP 6.5' EFFECTIVE -12 5 2.0' WIDE 2.0 58' LONG -19.0 SEPTIC FIELD SECTION I I - HUFFMAN ROAD - (------ PROPERTY LINE-\ S' 7 LOT 8 LOT 9 LOT 10 .i.:;) i /04/ / .\EXISTING HOUSE 4-1 PROPOSED DRAINFIELD • WELL OLD DRAIN FIELD TO BEJ Ia. • , ABANDONED L--E, .:�•�.�. ii . L :w iw rcc F- cn WELL w z LOT 18 LOT 19 a cc cc 0 J I WELL - McMAHON AVE 1 UE - Septic Design Prepored for .'��i1, IVIi%4 SUE WAGNER 4,4114 ,.... � ........... . ,i. MCMAHON BLK 1 LT 10 " � �i Anchorage, Alaska 49 TM �\ ■ / iel, * I•• Anderson, Michael N. P.E.. . ♦�•• MICHAEL N. ANDERSON: DATE: 7/7/2018 • • 4601 NATRONA AVE �O� No., E 4 DRAWN: DJ ANCHORAGE,ALASKA 99516 SCALE: 1"=100' fat ..'.. SS` �� (907) 727-8864/FAX: (907) 345-1391 44...0 PROPERTY UNE \`‘` /� U 411, LI k-s;:..":',-;.:.' :::: ,: - ------ �' I _ i _ �r�_ TOg,OF STEEP SLO i ,j \it • // / /A/ // • / / // NEW 1250�GAL_ON X69/ \\ //./.• '%. ,i ! TANK CO TCO -6" I -a' ;`: ..• W�L ,- MTCO 1 �r /r•NG HO •'.' °. . '•.' ''''.Cr. ; . . 1_—:—ice- •<' ` / \ ___ / EXISTING TANK TO BE �'-----+–'`` --DECOMMISSIONED PER \ r UPC �i i `.\/ WEL �, \\ _m r" �1 10� TkE EASMENT \\ ;i; T \ — ! / \ \ ! i \\ 1 / I SELL -,' i Septic Design Prepared for 4:001.1WaIIii,, SUE WAGNER �.•,.P.c OF q/ .S-•i• MCMAHON BLK 1 LT 10 49TH 7\ Anchorage, Alaska ,• • , i 0 MiP.E.hael N. Anderson, P. DATE: 7/7/2018 �0. ';MICHAEL N.E 94 •ANDERSON/pit 4601 NATRONA AVE �� ANCHORAGE ALASKA 99516 DRAWN: DJR �j�% '. 1VC/1 •,. '' • • (907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=50' 1 ,\t-f-tSS _� p F ,) INEERS•S%At,r�•% Municipality of Anchorage ,` •. ./_ i, j Development Services Department r �.• . •.17 t) On-Site Water and Wastewater Section *.49T • .r r: ,0 i -ere 4700 Elmore St. P.O. Box 196650 Anchorage,AK 99519-6650 / �► — www.nluni.orq/onsite /. .• ;r (907)343-7904 0 v^•• MICHAEL N. ANDLRSCN ..,..?.c: i' � c-' CE-9469 ..•4;-,i Soils Log - Percolation Test 1��Q�f�F''••..•• '�c� .•�'. Performed For: �u � X1/4 t/ Date Performed: /•17, Legal Description: h/l tMO p/4 ( 1✓ vf'( 0 Township, Range, Section: Slope Site P'an Depth (Feet) c I 1- � trc1 '�`\ l ` 2- �'� 'C—,/ 3- Cil: G (12(0/1 4- 5 6-••- 7- i 8- WAS GROUNDWATER? 9- ENCOUNTERED'? V y�T 10- IF YES.AT WHAT DEPTH? I Depth to Water After 11- 5 P Monitoring? 1Fr 12- 1 $//0�$ Dale: 7//`7 /V vU4 n 13- 1, Der ��m PO--C —4z.r1a CU C4 11v4 -h.t p, 14- 4'a n ! Reading /Date Gross Time Net Time Depth to Water • et Drop 15- 9 �+�e • 7/ 75/ Ow'i., 7r l 737/60 16- t^-/ 4410 c-- C, V' 7 c3/(r0 17- 4, 1 7/-; VI ( 1V/C° 18- (3/((0 19,- _ (o r/ ( (Y(O 20- PERCOLATION RATE `S,c .minutes/inch) PERC HOLE DIAMETER CO TEST RUN BETWEEN CP FT AND FT COMMENTS PERFORMED BY: /L 4NLA t I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 7/ 71/(/ North 230.00 r 1 50 i 0 O o a A o a c r o v n Z7 a o —{ o f o c (n \ \ -' c) r<l1 rte-+- m \ a T Ulliciw r Z N I _, -1 \ O n Cn 63.15 0 N � I n O 00 iv 383�N//,q O r a) 0 D Ui !1 1 00 STON0'yFF M 2S52.14 Rf � CA 13 > o-A� u o_ rO �a I ti\ OF At r S.uth 200.00 j<S'.* 4S4". Y : • LA 1 `A *49TH /\ * +r 0 0 Bobby F. Burnett R.L.S. _ Q_ _ _ _ BOBBY F. BURNETf / • t R. A I E_;; .� .S7H E E:T .•:'.: s 5,84 Ai 2941 Carriage Drive 1Leo Air Anchorage, Alaska 99507 • • • ‘ SSIONAL AI (907) 350-5541 11%.,..`�4111". Date Scale Legal Description 6/28/2018 1" = 30' I hereby certify that the property described hereon has been surveyed Lot 10 Block 1 by me, or at my direction, and that the improvements situated thereon Grid are within the property lines and do not overlap or encroach on the SW 2835 AS-BUILT property lying adjacent thereto unless otherwise shown. That no McMAHON SUBDIVISION improvements on the property lying adjacent thereto encroach on the Drawn by Field Book PLAT # 65 86 premises in question and that there are no roadways, transmission \ BFB ASB-2018 lines or other easements on said property except as shown. J/ GREA'I_, INSPECTION REPORT ANCHORAGE AREA BORC 3H Department of Environmental Quality 3330 C Street Anchorage, Alaska g95~p,~ / L.LJ~LZ~', 0 N- 5 IT E!~;Ew A U ~--~'15 PO SA L SYSTEM SEPTIC TANK: DISTANCE ~j ~ FROM WE LLJVg'~r //~/ INSIDE LENGTH MAN U FACTU R E R ,,~/¢.~;'~' INSIDE WIDTH /~/'/;.,%,'//~/~'~L~ NUMBER OF MATERIAL COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY/~ GALLONS. TILE DRAIN FIELD: ABSORPTION AREA ~J~/'/ DEPTH: TOTAL LENGTH(., FOUNDATION /~) ('~- NEAREST LOT LINE ~'~C.~ '~/'-' OF LINES /~ ! DISTANCE BETWEEN LINES ~¢/~ TRENCH WlDTH-~)~ IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LINE ¢¢¢ I TOP OFTILE TO FINISH GRADE /~1 DEPTH OF FILTER /_,~)~ i.~ MATERIAL BENEATH TILE~_ .... ABOVE TILE ¢ IN. WELL: /~ ~- TYPE _ BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE __. OTHER SOURCES DISAPPROVED NEAREST SEWER LINE DEPTH SEPTIC SEEPAGE TANK , SYSTEM REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: /'~:~'*,,~¢'~'~¢ SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: _ REMARKS: DIAGRAM OF SYSTEM Form EQ-032 M-W DRILLING, Inc. P. O. Bo~ 4-1224 · 1310C International Airport Road (907) 274-4611 ANCHORAGE, ALASKA 99509 MUNICIPAUTY OF ~E DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIOI'~ JUN 1 7 DRILLING LOG RECEIVED Use of We]l <~' )~r~' Location (address of: Township, Range, Section, if known; or distance main road Depth of Hole 2~ ~ feet Cased to ~-.)-~ ~ 5 feet Size of casing. .5' Static water level 2! 5 ft. (~/1559%~) (below) land surface. Finish of well (check one) Screen ( ); Perforated ( ). Describe screen or perforation Well pumping test at 3 gallons per [~'~) of drawdown from static level Date of completion ~ Jun~ t970 open end ( ); (minute) for 1 hours with ~ ~:~;' ft. WELL LOG Depth in feet from ground surface GiVe' details of formations penetrated, size of material, color and hardness TO. .TO " TO. ~- .TO. i? TO. -/': .TO '~ 0{.) TO. ;:,)O _TO ~:-!- r~ .TO ? '~(~ _TO TO_ TO TO_ .TO TO 2 20O 250 C~ino 5 ~ick. Sii~V ?.and ~ Cobbles Cc~-ti£~eate No's. 814 ~ 973 2 -- STATE P~ELL PERMIT NO. ( 76138 ) AF'PLICANT LOCATION LEGAL ~-~.1_i~-~ ~ C · PAL I TY OF DEPARTMENT OF HEALTH AND ENYIRON~ENTAL PROTECTION 25i0 E. TU~OR RD., ANCHORAGE, AK. 276-222t HUFFMAN & LESLIE LiO Bi MCMAHON PSC #i BOX 2i8~ ELMENDORF AFB 752-~008 LOT SIZE ~4~07 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MA×IMUM NUMBER OF BEDROOMS = 4 SOIL RATING <SO FT?BR>= 150 THE REO. UIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C~EPTH= 7. 5 LENGTH= 86 GRA%~EL ~-,EPTH= '~-. THE LENGTH D'I'MENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTAl.iCE BETWEEN THE SURFACE OF THE GROUND AN[:' THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET), REQI_I I RED ~EF'T I C TAk~K ~ I ZE= ~_250 GALLOr-~S BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS ~i~iDEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR ~00 FEET FOR A PUBLIC WELL. WELL LOGS ARE' REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. SPECIFICATIONS 8ND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER I NSTALLAT I ON. F'ER~4 I T %"AL I P FOR O~E YEAR FROM I 5SUE I CERTIFY THAT t: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. APPLICANT DALE WS~NER I SSIJED B,-- DATE ,A ~ ANCHORAGE · FAIRBANKS CONSULTANTS, INC. JUNEAU May 3, 1976 R & M No. 656220 Mr. Dale Wagner PSCI Box 2183 Elmondorf AFB Anchorage, Alaska Dear Mr. Wagner: In accordance with your request of April 22, 1976, two test holes were drilled and logged on Lot 10 Block 1 McMahon Subdivision. Test Hole No. t was to identify the soils in the area of the proposed sanitary sewer system, and Test HOle No. 2 was to identify the soils Where the foundation of the dwelling is to be located. The Drilling was initiated on April 29, 1976 and completed on April 30, 1976. The Soil borings were accomplished using a track mounted auger type drill rig equipped with a hydraulic head. The boreholes were ad- vanced using 6 inch O.D. Continuous flight soil stem augers. Represent- ative samples Were obtained from the returns off of the auger flights and visually identified at the site. The final logs prepared for the test holes has been included in Drawing A-01. As illustrated by the log for Test Hole No. 2 the soil profile under the proposed foundation consisted generally of sandy silt with minor amounts of gravel and clay. A layer of gravelly sand was found to extend from 11 to 13.5 feet. It is our opinion that the strenght of the soil located in the area of the proposed foundation is sufficient to withstand normal loading sub- jected upon it by a single family dwelling with a standard foundation. Ground water was not encountered in either test hole. We appreciate b~ing 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. JWR/PJ/pe xc: Municipality of Anchorage '~T.H. 1 4-2 SANDY SILT (ML) ~6 0.5' SAND (SM) ~0 2.0' SANDY W/SOME GRAVEL ~ AND TRACE TO SOME ~ 4.0' SANDY W/TRACE T~ S~E~ 7.5' GRAVELLY SAND W/TRACE SILT (S~-SM)~ 12.0' SANDY (SP) 15.0' SANDY SILT W/ TRACE GRAVEL (SM-ML) (260) T.H.2 4-30-76 SILT W/SO~'~ S~X~D (ML) SANDY SILT (l-fL) SILT W/SOME SAND AND TRACE GRAVEL AND CLAY (:~) GRAVELLY S~ND (SP) SANDY SILT (~'~) No Water Table 4o51 11.0' 13.5' 15.0' T.D No Wate~ Table 19.0' T.D. Dw~ V~ CKD: pJ DATE: 4-30-76 SCALE: V Dale Wagner Log of Test Hole Anchorage, Alaska GRID: I PROJiNO. 656220 DWG. NO. Sanitary · T.H.1 DATE: ~-30-76 ] SCALE: no sca]si , . &M CONIIU , · Dale Wagner Location of Test Hole Anchorage, Alaska '~ F.B. ' I GRID: I PROd. NO.656220 I.~,~o. NO. 6PIANS MUNICIPALITY OF ANCHORAGE r Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-041-51 1. GENERAL- INFORMATION Expiration Date: U wL91 a Dao 0 Complete legal description MCMAHON BLK 1 LT 10 Location (site address) 12400 LORRAINE ST Current property owner(s) SUE WAGNER Mailing address Real estate agent 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic El Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: MNA Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 55U Waiver Fee $ Date of Payment f �l 2_6 Date of Payment Receipt Number W66 - Receipt Number COSA # 05 C:20 113 9 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 Mike N. Anderson, P.E. Phone 727-8864 Address 4661 Natrona Ave. Anch Ak 99516 Engineer's Printed Name Mike N. Anderson, P.E. Date 3/25/20 6. DSD SIGNATURE a `�9�H �0000esr,'s,'.a:'aS.es000.y.00rj 4 System #1 Approved for bedrooms MICHAEL N. ANDfRSOfU System #2 Approved for bedroomsCE- 445 •;`'°' a� *fit Disapproved Conditional approval for bedrooms, with the following stipulA 3bi 'Q,� \` i %f OFA �j l ON-SITE WAT ER AND m TEV{ATER o PRbbkAM �))J3f13)11111�` By:.. tka' ��Original Certificate Date:— 3 D � 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. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: McMahon S/D Blk 1, Lot 10 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑Q Well log is filed with Onsite (or attached) Date drilled 5/6/76 Total depth 258 ft Cased to 255.5 ft ❑■ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 12"+ in. Date of flow test for COSA 3/13/20 Static water level at beginning of test 211 ft. Comments B. TANK DATA Age of tank(s) NEW years Tank type/material 9`a"""'S1e,l Measured operating fluid level in septic tank NEW A-1 Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA NEW SYSTEM Which system tested (date installed) NEW F ALL standpipes present per record drawing Total measured depth from grade 13.5 ft (max) Measured depth to pipe invert from grade 7 ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective ❑■ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 0 gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 017-041-51 Structure served by this system Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ■❑ No ❑■ Coliform bacteria is Negative Nitrate 4.11 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L XArsenic less than MRL (ND) Collected by MNA Date of Sample 3/13/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date NEW Results [Z]Pass For 4 bedrooms Fluid depth prior to test 0 in Water added NEW gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft✓0 Yes if No Neighboring Tank > 100' 0✓ Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' ✓❑ Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ❑✓ Yes if No 0 Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0✓ Yes if No ft ❑✓ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q✓ Yes if No ft Surface Water > 100' ft ft ft ft ft Q✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q✓ Yes if No ft Private Wells > 100' Yes if No. Water Main > 10' 0 Yes if No ft Community Wells > 200' Yes if No. Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓0 Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Service Line > 10' 0 Yes if No ft Community Wells > 200' ❑✓ Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ft ft ft ft �, B 4 9 M ............. �9 "MICHAEL N. ANURSON s•• CE 9409• ,� ~ ? APPLI('~",NT FILLS OUT UPPER HA'~'''' ONLY ~operty Owne MailingAddre~ ~ ~ /~(~ _~ ZipCode Buyer ~ Address /' /~'~ ~' '( Zip Code Lending Institution Phone Address Zip Code Type of Resi~nce ~gle Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply ~vidual A~ACH WELL LOG. A wal 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 Sewer D~osal ~ividual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector In spect<im,~ 4UNICI?ALIIY OP ANCHOP. A~ Field Notes:"~ DEPT. OF HEALTH & ~NViRONM~NTAL PROTECTION RECEIVED ( ~ APPflOVED BEDrOOm8 *GONDITION8 OF APPROVAL ( } DISAPPROVED ~ ~ co~mo~L~OWk' DATE ~ '~~ Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received ~ ~ 72-023 (3182) : ' 60' DEDICATED" BY~EED ' 660oo ~ ~' ~.. . . . ~>~ ~ -' ~p . o~ ~ 0 NOT A PART OF z THIS SURVEY IEET ~,. SHEET:: MATCH LINE S4EET SOUTH SOUTH 180,[2 SOUTH 185.40 .... :---~-22000 .... f'-i ........ ~ 230.00 ..... - - ~ I I - ~ ~ . ¢ 190.op ' I I 200o0 ,~ STREET s~o.oo 50.00 MATCH· LINE SHEET I