HomeMy WebLinkAboutMCMAHON BLK 2 LT 5
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON -SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP251013 PID Number: 017-041-27
Dwelling:* Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 9 Upgrade
Name
MICHAEL & SHERYL GALE
A ORPTION FIELD
❑ De Trench ❑Wide Trench ❑Bed ound
Site Address
3800 MCMAHON AVE, ANCHORAGE, AK
Other
Phone
Number of Bedrooms
Soil Rating
Total depth f original grade
907-242-3925
3
ISF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original de
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
MCMAHON 2 5
Fill added above original gr
Ft.
G I length
Ft.
Township Range Section
'
Gravel width
Ft.
Beds: Number of Lines
-
Dis a between lines
Ft.
SEPARATION DISTANCES
To,
Septic
Absorption
Lift Station
f Holding
Sewer
Total orption area
Number of trenches
Dist. between fiches
From
Tank
Field
Tank
Line
Ftz
Well
l 100'+
EXIST.
-
_
25'+
TANK ® Septic ElS.T.E.P. ❑ Holding El Other
Manufacturer
D&S CONCRETE
Capacity
1000 Gal.
i
(EXIST.
�
Surface Water
1 QQ'-�-
I -
-
Material
CONCRETE
Number of compartments
2
Lot Line
5'+
EXIST.,
-
-
{ NA
Foundation
5'+
EXIST.
-
-
ATION
Manufacturer :;:>41
pacity
Gal.
I
Remarks
7Alarmlocatione;Rr
ailed by
PIPE MATERIAL House to tank D3034 Tank drainfie ld D3034
Installer
NORTHERN EXCAVATION
Drainfield EXIST. co/MTD3034
Inspector GARNESS ENGINEERING
BENCHMARK (Assumed elevation) 100.00 ft
Inspection �,
1 2/17t2025
Location and description
dates: 2„"
-
FRONT DOOR THRESHOLD
3ra 4,,
ON -SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date5��
'1 V
49
— — - ---- --------- -- - — ----- — — -- --
D
Septic System
Approved Date 7/
frCrness, E , 7Q`o3
Note: this approval does not include well permit requirements.AEccse4
�1�o���d�
(Rev 05/02/18)
I PERMIT OSP251013 RECORD DRAWING PARCEL NUMBER:
017-041-27 I
I
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1
1
1
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1
1
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MCMAHON;
BLOCK 2,LOT 4
11
A B
FCO 1 21.5 1 22.3
nRl 1 I q41 I 3(1.6
NOTE: PIPE LOCATIONS
ARE SHOWN PER GEG
SHOTS TAKEN WITH LEICA
DISTO S910 LASER
DISTANCE METER.
SWING -TIES TO HOUSE
CORNERS WERE
GENERATED IN AUTOCAD.
w
V
McMAHON AVE
\
00' WELL RADII
GENERAL
LOCATION
\
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1 I
1 I
1 I
1 I
1 I
\ j
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EXISTING \\
3-BEDROOM \
HOUSE �\ j
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Le\
DOUBLE CLEANOUTS
FQyl�-0,1
(DBL1 & DBL2)__--
.—HOT
CGS %
STi TUB
O�
NEW 1000-GALLON
\ CONCRETE SEPTIC TANK
DOUBLE CLEANOUTS
(DBL3 & DBL4)
CO/MT �
SHED
'A —EXISTING SEEPAGE PIT AND
ASSUMED PERIMETER OF EDGE
W OF DRAINROCK. PASSED SEPTIC
V) ADEQUACY TEST RECENTLY
NOTE: GEG CONSULTANT, JODY MAUS, NOTE: PER THE CONTRACTOR, THE
OLD SEPTIC TANK WAS
PHYSICALLY MEASURED 115'+ FROM
WELL ON LOT 4 TO CO/MT FOR SEEPAGE DECOMMISSIONED IN PLACE PER UPC.
PIT. PERIMETER OF DRAINROCK IN
UNKNOWN AND WAS NOT VERIFIED.
GARNESS ENGINEERING Ltd
9
ENGINEERING SALES CONSULTING
3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, ALASKA -PHONE (907) 337-6179' WEBSITE: www.gamessengineemg.com
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
SHERYL GALE 907-242-3925 2 OF 3
PROJECT/LEGAL DESCRIPTION: DRAWN BY:
MCMAHON; BLOCK 2, LOT 5 J.L.M.
TYPE OF WORK: DATE:
RECORD DRAWING OF SEPTIC TANK UPGRADE 3/11/2025
z
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J_
in
MCMAHON;
BLOCK 2. LOT 6
0
...:...................
♦ r^i e 7 Y A. ss
LICEN +44, ®�dFESS� ®®•
#AECC884 >o®®�®�
PERMIT NUMBER:
OSP251013 RECORD DRAWING PARCEL 1NUMBER:
017-04-27
I
TOP OF T
INLET =
INVERT OF FERt
BUNG @ INLET =
1000-GALLON D&S CONCRETE SEPTIC TANK
GARNESS ENGINEERING GROUP, Ltd
ENGINEERING SALES CONSULTING
3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE. ALASKA -PHONE (907) 337-6179' WEBSITE: w .ganre ngheef4v.=n
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
SHERYL GALE 907-242-3925 3 OF 3
PROJECT/LEGAL DESCRIPTION: DRAWN BY:
MCMAHON; BLOCK 2, LOT 5 J.L.M.
TYPE OF WORK: DATE:
RECORD DRAWING OF SEPTIC TANK UPGRADE 2/25/2025
27
=FERNCO
TLET = 91.01
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#AECC684
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
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP251013
Work Type: SepticTank Upgrade
Tax Code Number: 01704127000
Site Legal Address: MCMAHON BLK 2 LT 5 G:2835
Site Mailing Address: 3800 MC MAHON AVE, Anchorage
Owner: GALE MICHAEL J & SHERYL D
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
1 /29/2025
1 /29/2026
31317
❑ Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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: , S S �'� `' C r C
Issued By: L
Date:
Date: S f I 14o Z 5
3
UU-11UNICIPALITY OF ANCHORAGE
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. 017-041-27
Property owner(s) MICHAEL & SHERYL GALE Day phone 907-242-3925
Mailing address 3800 MCMAHON DRIVE, ANCHORAGE, AK
Site address 3800 MCMAHON DRIVE, ANCHORAGE, AK
Legal description (Sub'd., Block & Lot) MCMAHON; BLOCK 2, LOT 5
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms
3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field
❑
Initial 0
Single Family (SF) FX-1
(w/wo ADU)
Septic Tank
f X-1
Upgrade N
Duplex (D) ❑
Holding Tank
0
Renewal 0
Multiple Dwellings D
Privy
0
(SF and/or D)
Private Well
M
Water Storage
El
THIS APPLICATION
INCLUDES A 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 authorized agent)
Permit/Rush Fees: 2 2 Waiver Fees:
Date of Payment: Date of Payment:
Receipt Number: Receipt Number:
Permit No. l�P 2 5101 � Waiver No.
GADevelopment Services\Building Safety\On Site Water and WastewaterTorrns\Client ForrnsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251013, Curtis Townsend, 01/29/25
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251013, Curtis Townsend, 01/29/25
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251013, Curtis Townsend, 01/29/25
ASPLS MORTGAGE LOCATION SURVEY NOTES:
(Z)
Al-CMAHON AVE.
(EAST -140.001)
56 8'
1
247 247
31.6'
AD
TWO STORY
z
RF'SIDENCE
20.7'
z 63,9'—
0
TV
14.3'
lJO T 4
100'WELL
BLOCK 2 RADIUS c\j
A.ppx� TLOC
Sj" i,,\ K F 1) B Y 0'VvN EIR, HOT
TUB 75; ry
0 10
CD
0
CD LO T 5
CD
CT BLOCK 2
CD
FSHED
0)
m SHED
C/)
10' UTILITY ESMT.
E E E E r r p
E E E E
(S 88" 17'21 pt E
140-07')
LOT 18 LO T 17
B I _jOCK 2 BLOCK 2
NO TITLE REPORT WAS PERFORMED FOR THIS SURVEY, EASEMENTS SHOWN PER THE
RECORD PLAT. THERE V/;Y BE ADDITIONAL EASEMENTS NOT SHOWN HEREON. THIS
MORTGAGE LOCATION SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH ASPLS
MORTGAGE LOCATION SURVEY STANDARDS. IT IS A REPRESENTATION OF THE
CONDITICNS THAT WERE FOUND AT THE TIME OF THE SURVEY. THIS SURVEY DOES
NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT
A SUBSEQUENT BOUNDARY SURVEY MA" DISCLOSE, THE INFORMATI01N CONTAINED IN
THIS DRAWING SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OR
OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIAB - ILITY
EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED
FOR SERVICES IN PREPARATION OF THIS PRODUCT.
A
RECORD DATA PER PLAT #65-86
0 FOUND 1/2" IkEBAR, NO CAP
EDGE OF AS PHAL T
FENCE
E E- OVERHEAD UTILITIES
pp
POWER POLI
NVELL
(R SEPTIC PIPE
[A DECK
LOT 6
13LOCK 2
kk
OF At,41 S� kt
of 3o" '
9 a 0 * &
60AMW
Z+qTH
SCALE: V =- 30 FEET
fl
(11 X.1.7 01F
-Ryon G.0 Johnsona-,,,, Low
WINTEJZ S UR VE Y NO TE: +/- 6 DVCHES OF
a, No. 192159
S NO W SITE A T T1 ME OF S UR VET: ONLY t�'
e�lb-.1211612OZ4"C«
•
VISIBLE IMPROVEA41,,NTS SHOWN HEREON. AW
AS-BUILI'OF:
1-JOT 5�; BILOCK 2
Mcl\4A,_H0T�Z S_UTBE)'IVISIOT,�*4
PEAT #-(-86
ADDRESS: 38 McMAHON AVE, ANCHORAGE., -A-K
LOCATED IN: ANCHORAGE ]_ CORDING DISTRICT
LO T 16 TIMBERLINE SURVEYING AND MAPPING MOAGRID:SW2935
1703 5 13ARONOFF AVE FILE ]KO.: 24.237
BLOCK 2 EAGLE RIVER, AK 99577 SCALE: 1 3 0 FEET
907-242-5320 DATE: 12/16/2024
ryan@ti.mberlinealaska.com SHEET: I of I
GRE' 'ER ANCHORAGE AREA BO: UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
NAME
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
/~/~/,/'~/~ //'~//~/~/Z/~ MAILING ADDRESS ~"~' ~/~' ~ ~''Tz~ PHONE
SEPTIC TANK.~'-/:~~/~:':~ ~ '/~'/J/"' ~'~' ~';;~7/~'~//x'
D STANCE
FROM WELl ?[-'~ MANUFACTURER ~',/~<~/" ,/~z~ MATERIAL
INSIDE LENGTH ----' INSIDE WIDTH ~ LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY ~'~'~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS // DIAMETER ~<'~" OR WIDTH ~2~,/ LENGTH-2'~, DEPTH
LINING MATERIAL,~2-4~-;~' ',~.'~'~-~z~'~'CRIB SIZE: DIAMETER~"~ DEPTHr DISTANCE FROM: WELL
/
BUILDING FOUNDATION -2'ZI?/-, /2~,/;~'.~/ TOTAL EFFECTIVE
. NEAREST LOT LINE ' ~'~-~/. ABSORPTION AREA (WALL AREA) SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOL --
APPROVED
CONSTRUCTION /2~/~c-~. / %. Z~-/]/L _/J
NEAREST /d/,/?z; ~' ' NEAREST
LOT LINE 2~z/ , SEWER LINE /./)?¥
OTHER SOURCES /t~ ~ /~/~/~/~_//~2
DISAPPROVED REMARKS
DEPTH .... DISTANCE FROM:
SEPTIC /'//~/,,X~? SEEPAGE
TANK. /~YO' , SYSTEM /
DISTANCES:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No. EQ-031
DIAGRAM OF SYSTEM
DATE
GreaTer ANChorage AReA BOrOUgh /, ] -' ~
!" ' il~'' ': PERM T NO.
DEPARTMENT OF ENVIRONMENTAL QUALITY ,L' %:'
3330 "C"STREET ANCHORAGE, ALASKA 99503 / /~
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
INSTALLATION LOCATION
INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT
DRAIN FIELD ~ ., OTHER
TO BE INSTALLED BY
NOTE= THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINANCED THROUGH
SOIL TEST RESULTS J
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUI~J DISTANCES, REQUIREMENTS
)
FOUNDATION TO SEPTIC TANK
POUNDATION tO BEEPAGE PIT . DRAIN FIELD .
SEPTIC TANK TO SEEPAGE PIT WALl
SEPTIC TANK ., SEEPAGE Pit ~ DRAIN FIELD
WELL tO sePTIC taNK /~ ) , seepage Pit
DRAIN FIELD /~ ] ALSO CONSIDER Area WELLS,
WATER MaIN TO SEPTIC tANK /~ ~ SEEPAge Pit
DRAIN FIELD
SEPTIC TANK, /~/ SEEPAGE PIT/~ ., DRAIN FIELD /~ ] I
EXCAVATION 5 FEET INTO UNDISTURBED SOIL·
4 INCH DIAMETER CAST IRON S~PHON PIPES ON SEPTIC TANK AND seePAGe PIT
FITTED W~TH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION·
OR
LICENSED DESIGN
DIAGI~AM OF SV'STE~I
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
Performed For
Legal Description.:
This Form Reports
ANCHORAGE, ALASKA 99502
Richard J. Blumer Date Performed,, August 3, 1973
Lot 5 Block 2 Subdivision McMahon
Soils Log ~ Per'c01ati0'h' ~est
Depth
Feet
6--
8--
10--
16.---
18--
Soil Characteristics
Tan Sand - Silt Mix
(ML)
Gray Silty Sand (SM)
with silt and poorly graded sand seams
With scattered gravel to 14'
Ground Water
Yes,,'At What
Encountered? No
Depth?
I
Reading Date Gross Time Net Time I Depth to H20 [ Net Drop
I ·
nu te .
Proposed Insta~'l'ation: Seepage Pit xx Drain-Field
Depth Of Inlet Depth To Bottom Of Pit Or Trench
'COMMENTS;..250 square ~etofdrainage area isrequired per bedr'oom below 7 ~otdepth. ' ....
Yest Performed By R.F~__C~li.m, le.__
Data Certif'ied BY: ,-'//ex/ - '~
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC251090
Parcel ID 017-041-27
Legal description MCMAHON BLK 2 LT 5
Expiration Date: 51zo Z -5
site address 3800 MC MAHON AVE
Current property owner(s) GALE MICHAEL J & SHERYL D
X The On -site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Development Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist
X Well Flow Advisory
Absorption Field Advisory
Tank Age Advisory
Nitrate Advisory
Arsenic Advisory
Other
MUNICIPALITY OF
Development Set -vices Department
On -Site Water & Wastewater Section
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 017-041-27
Complete legal description MCMAHON; BLOCK 2, LOT 5
Location (site address)
3800 MCMAHON AVE, ANCHORAGE, AK
Current property owner(s) MICHAEL & SHERYL GALE Day phone
2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS
907-242-3925
3. TYPE OF WATER SUPPLY: RE Private Well R Private Well serving 2 dwelling units
F-1 Private Well serving 3+ dwelling units Fj Community Well or Public
R Water Storage
4. TYPE OF WASTEWATER DISPOSAL: � Private Septic E] Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: 0 Steel E] Plastic 0 Concrete F-I Fiberglass
Age NEW _ See advisory if steel older than 20 years
6. ABSORPTION FIELD: 0 AWWTS R Bed R Deep Trench R Wide Trench X Seepage Pit
Waiver request for:
Expedited review requested: El
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA Fee$ -5 SO Waiver Fee $
Date of Payment Date of Payment
COSA # D 5 C— Q 0 Waiver #
COSA Applicalion—June 2022
COSA Checklist
Legal Description: MCMAHON; BLOCK 2, LOT 5 Parcel ID: 017-041-27
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1
A. WELL DATA
M Well log is filed with Onsite (or attached)
Date drilled 611611974 Total depth 99 ft
Cased to 99 ft
FS-1 Sanitary seal is functioning correctly
X Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 12/19/2024
Static water level at beginning of test 54.4 ft
Comments
B. TANK DATA
Measured operating fluid level in septic tank NEW
Date of pumping NEW
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 611974
F01 ALL standpipes present per record drawing
Total measured depth from grade 15.9 ft (max)
Measured depth to pipe invert from grade *6•9 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
R Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced _gallons date
Any rejuvenation treatment (past 12 months) NIA
If yes, enter date
Well production at time of test 6.1 gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes FM No
0 Coliform bacteria is Negative
Nitrate 9.48 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L X Arsenic less than MRL (ND)
Collected by GEG, LTD.
Date 12/19/2024
STATION
❑ Require
Age of lift station
Lift station r
Adequacy test date 12/19/24
Results Q Pass
Fluid depth prior to test 96 in
Water added 519 gal
New fluid depth 108 in
Elapsed time 130 min
Final fluid depth 101 in
Absorption rate 450+ gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 108 in
Effective depth used 101 in
Effective depth remaining 7 in
Comments/Deficiencies: *ASSUMED. BELIEVED TOP OF CRIB IS 5.6 BELOW GRADE. SYSTEM IS ALMOST 94% FULL.
IT IS REASONABLE TO BELIEVE THAT THE DRAINFIELD IS APPROACHING THE END OF ITS USEFUL LIFE.
COSA Checklist June 2022
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100'
Community Sewer Manhole/Cleanout > 100'
EYes
if No
ft
ME Yes
if No ft
Neighboring Tank > 100' R] Yes
if No
ft
Private Sewer/Septic Line > 25' Q Yes
if No It
Absorption Field on Lot > 100' no Yes
if No
ft
Holding Tank > 100' RYes
if No ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' Yes
if No ft
❑i Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' nnYes
if No
ft
R Yes
if No ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10' E Yes if No ft Surface Water > 100' R Yes if No ft
Tank to Property Line > 5'
Field to Property Line > 10'
Water Main > 10'
Water Service Line > 10'
■❑ Yes
if No ft
n Yes
if No ft
Yes
if No ft
0 Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100'
Community Wells > 200'
M Yes if No ft
0 Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
*PHYSICALLY MEASURED 115'+ FROM WELL ON LOT 4, BLOCK 2 TO SEEPAGE PIT ON LOT 5, BLOCK 2.
EXACT PERIMETER OF DRAINROCK FOR SEEPAGE PIT IS UNKNOWN.
G. CERTIFICATION & 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, indicates that the on -site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Garness Engineering Group, LTD. (GEG) Phone 907-337-6179
Engineer's Printed Name Jeffrey A. Garness Date
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in
accordance with the guidelines and regulations established by the Municipality of Anchorage and industry
practices. The reported results describe the condition of the system/s on the date/s of the evaluation.
Separation distances were measured to readily identifiable features. Hidden defects or encroachments may
exist that were not identified during the evaluation. The operational life of all wells and septic systems depend
upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate
during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing
the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not
guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding
the future performance of the well or septic system. GEG makes no representation whether an alternative well
or septic system can be installed on the property in the event either of the current systems fail to perform
adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG
to perform the evaluation, Reliance upon the information provided in this report by any other person or party
(including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever.
COSA Checklist June 2022
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MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT f 5 907-343-7904
On -Site water and wastewater Section Fax: 907-343-7997
www.muni.org/onsite
Septic System Absorption Field Advisory
Certificate of On -Site Systems Approval # OSC251090
Subdivision: MCMAHON , Block: 2, Lot: 5
Prior to the absorption field adequacy test, 101 inches of standing water was
observed in the absorption field. This indicates approximately 94% of the
absorption area is inundated. Although this system passed the adequacy test, the
remaining life expectancy may be limited.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
; 4700 Elmore'R *;4nchorage Alaska 99507,`�
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT I` '�� 907-343-7904
On -Site water and wastewater Section a r Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC251090
Subdivision: MCMAHON , Block: 2, Lot: 5
A water sample revealed a nitrate concentration of 9.48 milligrams per liter (mg/Q.
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. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. 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.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
ANCHORAGE WELL & PUMP SERVICE, INC.
7640 KING STREET
ANCHORAGE, AK 99518
PH. 907-243-0740
Bill To:
Sheryl Gale
3800 McMahon Ave
Anchorage, AK 99516
Invoice
Ship To:
Sheryl Gale
3800 McMahon Ave
Anchorage, AK 99516
20252875
SALESPERSON
YOUR NO.
SHIP VIA
COL
PPD
SHIP DATE
TERMS
DATE
PG.
RIDGWAY, TYLER S
39784
Net 30
1/20/2025
1
TY.
ITEM NO.
DESCRIPTION
PRICE
DISC %
EXTENDED
PRICE
TX.
1
Service Call
HIGH NITRATES -CAMERA WELL FOR
INCURSIONS
1
FIELD SERVICES
01/17/25 - Check system. Open up 6X1 well
$258.00
$258.00
seal to gain access to well casing. Camera
well to search for incursions. No incursions or
damage found in interior well casing. Reinstall
6X1 well seal.
NO INCURSIONS OR DAMAGE FOUND IN
INTERIOR WELL CASING.
1
ST5-Tyler
Service Tech
1
ST19-Dennis
Service Tech Helper
1
CAMERA
WELL CAMERA
$400.00
$400.00
SALE AMT.
$658.00FREIGHT
We appreciate your business. Thank you!
$0.00
SALES TAX
$0.00
TOTAL AMT.
$658.00
PAID TODAY
$0.00
BALANCE DUE
$658.00
S HED
SHED
31.6'1.5
'24.7'
27.3
'
20.3'1.6
'20.7'
16.0
'
14.3'
16.0
'
1.0'
24.2
'
100' WELL
RADIUS
RESIDENCE
TWO STORY
ELEC.
GAS
HOTTUB
LEGEND
FOUND 1/2" REBAR, NO CAP
DECK
FENCE
OVERHEAD UTILITIES
POWER POLE
EDGE OF ASPHALT
RECORD DATA PER PLAT #65-86
SEPTIC PIPE
WELL
SEPTIC TANK LID
TIMBERLINE SURVEYING AND MAPPING
17035 BARONOFF AVE
EAGLE RIVER, AK 99577
907-242-5320
ryan@timberlinealaska.com
FILE NO.: 24.237
SCALE: 1" = 30 FEET
DATE: 3/17/2025
SHEET: 1 of 1
MOA GRID: SW2835
SCALE: 1" = 30 FEET(11"x17")
30'0' 60'
AS-BUILT OF:
ADDRESS: 3800 McMAHON AVE, ANCHORAGE, AK
LOCATED IN: ANCHORAGE RECORDING DISTRICT
LOT 5, BLOCK 2McMAHON SUBDIVISIONPLAT #65-86
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
o
Property owner
Mailing address
Lending agency
Mailing address
Day phone
Day phone
Agent ~c~! h1~(~- /~f~_~k~
Address [.¢ ¥_7 ~" ..o/..,
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ..3
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
Day phone
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
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
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 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 inspection.
Name of Firm
Address
Engineer's signature
DHHS SIGNATURE
/~ Approved for
Disapproved.
Conditional approval for
Phone
Date
bedrooms, with the following stipulations:
By:
Additional Comments Nmi-e:
Municipal Codes. There
Tb~ well for this~me~ts the State and
are nitrates present. It is suggested
that periodic testing be performed f~ ~n~3r~ the wells confinu~d.
suii'abilitv. ~ate/~/~re 8.3 mg/1. EPA maximum is 10 mg/1.
~?/~/~--~/q3/~.¢~/~ Date~////~/~- ~ 7~.,
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 DH HS 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.
72~]25 (Rev, 1/91) 8ack MOA #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L ~ '~2 ~¢M/tI~0N Parcel I.D. ~/~-~
RECEIVED
SEK ] ...,-' o~.l~oiLiil
8 1991
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C. attach ADEC letter. ADEC water system number
(,~,-~ ec4) Date completed
/ /
Cased to ~
7
/'/~ Driller
Casing height
Wires properly protected (Y/N)
12"
Y
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
g.p.m.
AT INSPECTION
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot Ici~ F'R.~t ¢.0.
Absorption field on lot ~%"/ F~o~t ~,O.
Poblic sewer main ~/~
Public sewer service line ~\//~
; On adjacent lots ;,/oo '
; On adjacent lots ~/oo
Public sewer manhole/cleanout '~//~
Petroleum tank
WATER SAMPLE RESULTS:
Coliform 0
Date of sample: ~'/3/~//
Nitrate
m~/~- Other bacteria
Collected by: ~ LATToP 'TECt-).
B. SEPTIC/HOLDING TANK DATA
Date installed ~/'7~ ~/~ ~"/~' Tank size [OOO Compartments
Cleanouts (Y/N) ~ Foundation cleanout (Y/N) ~ Depression (Y/N)
High water alarm (Y/N) ~/~ Alarm tested (Y/N) N/,~
Date of pumping 5-/ 7 / 21 ~ ~/
!
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot lot ~ F~ C.O, Onadjacentlots //(o ~ F~'~h C.O. Foundation
Topropertyline ~/o~ Absorption field L/O' ¢.0, ~-o ¢.o. Watermain/serviceline
Surface water/drainage ~/o0'
72-076 (Rev. 3/91) Front MOA21 CONTINUED ON BACK PAGE
C. LIFT STATION ~,1,/~.
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed (o/
[~1~ p~ Rtlv~TE R.
J~rrcjt h
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
Soil rating
250 ~'/BDRN Systemtype 5E-EP, ~IT
Total depth
If yes, give date
Gravel thickness
Cleanouts present (Y/N)
Date of adequacy test
for
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
To building foundation
On adjacent lots
Surface water ,~, /oo
Curtain drain
Onadjacentlots II 5'~ F¢or~ ¢.0. Propertyline
To existing or abandoned system on lot
Cutbank ~.~. Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
Signature
Engineer's Name
Date /~ c~,
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
. ,:':, · ;.'~:
', ' % C( - 35;3 2 ?,,.;;'
HAAFee$ / ~0
Date of Payment ~'-~ /
Receipt Number ~%~-~'7 ¢
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
Star E;o~t e
.'-..ncC. oz'.age, f.~aska 5."9j32
inch cased water well drilled out to the depth of 99 feet.
Drilled at the 'rate of $15o00 por foot.
Property ovmer: .('~o Dick ~i~z~a?.er 333-5105
Location of we~ elto:' Lt. ~, B~;. ~ S~odi~sion: ~ ~z'~¢~ ~
L~ill~r: 2er~s Claus of F~part ~ill~g works 3~'-7714
~el! ~g~
0-~37' S~ndy clay ~tha few l~ge coppies. ~'
37--63.' ~&~P~-Gravel ~d blue clay compress~.
.~. '~ ......63-j~7' dravel~ ~e~ he ~i~l~ug -~th one boulder d. rill¢ through ~ 90 fe.-t~
97-99~ ',,¢%T&& be~g gravel~ 24 ~ches only me.;Lug 8GP;4- There is only 15 feet
of w~ter hazd ~ c~s~g but ~-~th ~ %~ediate recove~*.
Oost includes ~ll labor ~ud material for completion of said ?~611.
~':&ke check payable to ~%part ~il~g Wo~4(s for the s~:~ oF $1485.00
Th~2< you very much
Bernie Claus of P~mpa~-'; L¥ii_k~,~.' Wor?:s
RECEIVFD
./¢¢, &
Dept. Health & Human Ser_vices