HomeMy WebLinkAboutMCMAHON BLK 4 LT 7 Onsite File McMahon Block 4 Lot 7 #017 - 041 - 04 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number OSP 181197 PID Number: 051-351-22 Dwelling: 0 Single Family (SF) ❑ Duplex(D) ❑ Multiple (SF and/or D) Project: ❑ New 0 Upgrade Name: DONALD CALKINS ABSORPTION FIELD Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed LI Mound LI Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. MCMAHON BLK 4 LT 7 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Lift Station Tank Line Ft2 Ft. Well 100'+ 50'+ TANK ❑! Septic CI S.T.E.P. 0 Holding ❑Other Manufacturer Capacity Surface Water 100'+ ANCH TANK 1250 Gal. Material Number of compartments Lot Line i 101+ NA STEEL 2 Foundation } 10'+ LIFT STATION Manufacturer Capacity Curtain Drain UN I Gal. i Remarks Pump on level at Pump off level at High water alarm at in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 _ drainfieldTank to Installer3034 MIKE ANDERSON Drainfield CO/MT3034 Inspector MIKE ANDERSON, P.E. BENCH MARK (Assumed elevation) 102.6 ft Inspection 1s 7-22-18 2"d 7-22-18 Location and description da3'° 4th CORNER OF THE BLDG, SIDING COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL ....tRQ' 'NAKmp �P�� OF q•zq it Conditional Approval: Date ::::'‘).• `��• s y��l i*. 49TH A . * . 1 ---.4.•.•••. .. .. .......... . - I vs..MICHAEL N. ANDERSON • e % CE 469 •:;`.-j l e___ _ _ Approved ! ty ` Date? fit, PRaFEs v3s;k��= Inspection Report_9-1-12.doc Permit No. OSP181197 Page 2 of 2 Alaska Dept of Environmental Conservation DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION On—site systems On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: MCMAHON BLK 4 LT 7 PID No.: 017-041-04 MARK IB // \� �� CO1 48 30 / \ TC01 50 33 / \ / TCO2 58 40 I N N i/ CO2 60 43 I "- - -603 41 • 16 - -- 1 N ° I° ° • Iit C WELL P. 1 • NEW 1250 4ALL0N STEEL TA ' /,-.._ ° /° / it £41TCO2 '/ CO2 CO3 -- ---- r N Ii \ / \ / \ / \ \ / \ .N / I — — \ N / 1 N \T P ,EXISTING WELL I, I \ `\ I ASBUILT \ I \ I SCALE: 1"=50' / rco+ rc07 rcc+ r CO2 'IN`\\\\r 1, TCO 2 j .�'. �,I. t/ ,•h II lUll40. %.,. L2S50 rEEI UNK v-1?GktCN • r • T o0,• %MICHAEL N. ANDERSON.:, 00. No 9469 .:,` SEPTIC SECTION .I �....1•• . .. 40 N.T.S. 4 i 1'' -_*,U.144 ` "Tr MUNICIPALITY OF ANCHORAGE �menr f • \\ On-Site Water&Wastewater Program \o Sr,^ r' ', ! PO Box 196650 4700 Elmore Road • Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 . ' 43-7997 ,� "/ http:/lwww.muni.org/onsite " : < Z 1 ehnrtment 44'C-hop AGE On-Site Wastewater Disposal System Permit Permit Number: OSP181197 Effective Date: 7/17/2018 Work Type: SepticTank Upgrade Expiration Date: 7/17/2019 Tax Code Number: 01704104000 Site Legal Address: MCMAHON BLK 4 LT 7 G:2835 Site Mailing Address: 12600 ELMORE RD, Anchorage Owner: CALKINS DONALD G & JANET L Lot Size in Sq Ft: 40459 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field El Septic Tank 0 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: Date: 7 Issued By: / /tCC.;m' £/Ut.4Z/ Date: ef MUNICIPALITY OF ANCHORAG dommumihe Development Services Department t; Phone: 907-343-7904 On-Site Water & Wastewater Section - Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-041-04 Property owner(s) DONALD CALKINS Day phone Mailing address 12600 ELMORE RD Site address same Legal description (Sub'd., Block & Lot) MCMAHON BLK 4 LT 7 Legal description (Township, Range & Section) Lot Size 40,459 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank El Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ 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. MAA— (Signature of property owner or authorized agent) Permit/Rush Fees: � 4 Waiver Fees: Date of Payment: }' �3`l g Date of Payment: Receipt Numin! Pad x13 Receipt Number: Permit No. 059171 tql Waiver No. G:1Development Services\Building Safety\On Site Water and WastewaterlForms\Client Forms\Permit Application.doc July 12, 2018 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Septic tank replacement Legal: MCMAHON BLK 4 LT 7 To Whom it may concern: This is a request for a tank excavation permit to replace the existing septic tank. The tank was installed in 1977 and needs to be replaced. This replacement tank will not impact any of the neighboring properties due to the lot layout or pose any health or safety risks. Please call me if you have any questions. Sincerely 4/1-__ Mike Anderson, P.E. 4661 Natrona Ave. Anch, Ak 99516 727-8864 ill { • 1 ' 1 / `\ / `\ \ !/ \ / \ \ / \\ / \\ \)/ \ / \• \\ i! \ \\ / \\ • / \ \ / \ ,i. \ • I I \ 1 N\ -' I .• • �� - I I i'•' •.a :. . WELL. .. 1 1 / • e • . • •.. I r—I •\. .. .4•,c-: SI I „a �... , .0 -_ / EXISTING , /1 I S r DRIVEWAY / / . j ! '/ r CO 4� ��EXISTING 1250 TANK TO REMOVED CO ��� AND REPLACED WITH NEW 1250 EXISTING HOUSE CO DCO GALLON TANK AND i DECOMMISSIONED PER UPC !/� `\ PROPERTY LINE \ / I \ /1 L ‘.\ 11 r _ J WELL RADIUS :. `\1 I TO BE STAKED I\ I BY SURVEYOR 1 ® PRIOR TO 1 1TION \ I WELL INSTALLATION 1 \ I 1 I \ 1 I / 1 1 / \ 11 / \ \ / \► I I / Septic Design Prepared for ���s`1ivii1 DONALD CALKINS •••7� OF '4♦ C) �1, .'.• ,t .i MCMAHON BLK 4 LT 7 ::• 49 rH . ' } .j Anchorage, Alaska : • • • :: */1 • • Michael N. Anderson, P.E. DATE: 7/12/2018 0� :MICHAEL N. ANDERSON;: ♦ No. CE 9469 4601 NATRONA AVE DRAWN: DJR �• .• • ANCHORAGE, ALASKA 99516 #�,t6 .... �4 (907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=50' 444, E, SS GREt'"',:R ANCHORAGE AREA BOR )GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME P_/~A/j~/z'~ i~J:)'//("'//Y(;' MAILING ADDRESS LOCATION ~/~'~ ~"'/4~'/'/m'~<:)/~! LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER ~',~'~/' INSIDE WIDTH MATERIAL ~-~'~/'~ / NUMBER OF COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY I~'"'C'~)GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES , ABSORPTION AREA DEPTH: TOTAL LENGTH I FOUNDAT,ON /o ~-/-- NEAREST LOT L,NE /o f-,,- OF L,NES ~/~ DISTANCE BETWEEN LINES N/~ TRENCH WIDTHZ~:'IN. TOTAL EFFECTIVE ! SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE ~ ABOVE TILE IN. WELL: TYPE _ BUILDING FOUNDATION__ CESSPOOL APPROVED CONSTRUCTION NEAREST NEAREST LOT LINE__, SEWER LINE__ OTHER SOURCES DISAPPROVED REMARKS . DEPTH SEPT lC SEEPAGE TANK__, SYSTEM DISTANCE FROM: DISTANCES: INSTALLED BY: /~//~.~;~/V SEWER LINE DEPTH: /?/ -~Z~ / PIPE MATERIAL: /-~'/~, S"~/~',~IV Y~' LOT SLOPE: S, ~/, REMARKS: I',~O¢ DIAGRAM OF SYSTEM Form LQ-D32 LOE:FYf' :1: ON E:F.:FIGFll,.I ST LJEGFIL.. LT' E:d. t"IC:HF~H[:Ii'.4 '._=;LIEd:::, 75 ~t,4 i'.,IF:ITHFIN I.":,R LOT :.=; I ;E:E 'TYi:::'E OF' S=.';L") ]: L.. FIt.'='.rE;[:iREFr' 113t'.,1:5'-?S. Yf'E"t i I S: TF.:ENE:H Ii:" IE !Fa:.'. ih"ti ::1[ '"'if'- ,:!.En.31;.3iE'l '.5~;:!LIFIF::E F'EIE'I" I'.iFJX ]: HUH i'._,IUHE:ER OF E:E[::,F.:OEd','IS = 4 S'"~ZL. F..HFZt4 ~ ':'.:::T! F'T,.-'E:R>= THE R'E"J. '[t~'EE, SIZE OF THE '=7'Z]:L FIE'E;OF.'PT]':H :'.~;YSTEH I'.E;: THE LE:NGTH [:, I HENS I ON IS:, THE I...ENEiTH <T.N FEIE:T::, OF THE TREI'.,ICH OR DRFIINFIELD. ]"HIE DEPTH O1:= I::-I 'T'I:;::EI'-,tCH OR F'IT :I:S THE E:,IS:;TFINCE BE'I"NEEN THE SURF'FtCE OF THE GF.'.'OUI'qD, I::IND ]"HE E',OT]"OH (:.'il:' THE E;=-.','CFt',,,'FITZEd'.4 ,:::[i'.,I FEET.':,. 'Tt-.tEF::E ]:S..; NO SET 1.1:[t:::,"1"1--I F'OR "I"RIENC'HE%. THE (3RFt'v'IEI.... L':,EF'TH Z'.E; THE H:[NIHLIH DEPTI--I OF GF.:FI',,,'EL E',ETt4EEN THE OLITFRLL. P:[F'E FIi'.,I[> THE E~OT'I"OH OF THE EXC.'Ft',,,'FITI'Ed'.,I ,:: :I:N FEET::,. ""1t'- It..-..li ~::::u , :' ;::~-.:it ::, %' th.J1 _"~.~ F" ~£: C: ""If- .'1[.: ~:Z:~ IP-4i '.'~;;, IF~ ~." E-FZ F~.". [+ZE g::.,. !LH % II~{'. ~% IE:::, E;FICI-:::F :[ L.L I NEi OF' Rl",i"r' :E;YSTEH N :[ THEIUT F' :[ NFIL. [!;EPFIR'T'HIENT 14 ]: LL BE .?.;UE:J'ECT TL3 F'F4'C SE:CUT I hi ): I",! ]: HUH L":, :[ ::=;TFIhlE:E E:ETI.'.IEEN I=1 NEI-L. Ri'q[:, FIi".IY ON-'S l 'T'E SEI,.IFIGE [:, d..En.Z1 FEET FOR Ft PR:['v'FITE IqEL. L. OR ;;:='~ZtF~ FEET FOI?. F:I F'UE~L.]:C I..IELL.. !-,.tEL. I_. L. OG:i5 RF.:E F.':E(;:!U:[RIE[':' RN[.'-" I"IUL=.,T E',E RETUFd".IEI:> TO THE [:,EF'FIRTHEI",IT NITHIi",I OF' THE I,.IEL..L CCd"IPLETION. SF:'EE: :t: F ]: CI::tT ]: Ol",t:~5 RI'-,IE:, CON'.'STRUE:T :[ ON D :[ F:IGRI=IHS FiF.:E FI',,,'FI T.L. FIBLE TO I I",tSURE F'ROF'E'];?. Z 1"4'-:;"f'F~LI_ R T Z ON. I E:IER]" I FY "f'HFFF :i.: 't: f~l'"l FI=tI'"IILIFIi:;.: t,.tI]"FI THE: RE:QUIREHENT':~; FOR ON-SITE SEt,-!EF:'.S F~NI::-" I,.IEI....I...:E; R::".'.:, SET F~OF;.".TH E',Y THE HUI',I:I:CIF'FIL:[TY OF FtNCHORF:IGE. 2: I 14tLL. ]:N:='5,]'RLL THE S"r".'STEH IN FtE:CORC, FII",ICE I..IITH TI'rE CODES. :ii:: ]: IJN[)EI;:'.L:.;TFIi'-,II:.':, THFIT THE OI"4-':5:I:'TE ':':.:;IE!-,.IEI:;.': S"r'S]"EH J"IFIY F.:EQU]:RE EI",ILFII;~:EiEHENT :IF THE F.:ES ]: [:,IE~: :I::E; F.:EHO[:,IEL.Et3 ]"O I bI~:L.U[:'E HORE 'T'HF~N ,4. BE[:'ROOHS. ::_T, :[ GNE[: ........ ..".. ................................ I:::IF'F'L :[ CFIhlT L':'(3~2f~J) C:FIL.I< ]: ,: .............................. ............. ~-. Depa?-~-.nent of Health and Env~9onmental/n.otectmn '~- ' ' Anchorage, Alaska 99507 S()II,S 1,()(; -- ['EI{i)I,ATI()N TE~T crfor,,ed for ....... l~._9..~.f~ ................ I~ C~_~LJ/44~-,~--- ' ................ .- ........ ',)ate Pcrfor,,ed :.~S~,_Z7_ . Legal t)escri~t'ion:__~2__ ~ ~ -~ ~.~.---~ ............. . .... ~ ....... This form reports: Soils--]~ Percolation.ces~ Depth Fe~t 2- 3- 13- 14 - gas 9round water encountered? S/oho If yes, at wnac do .~th? Readin.q Fe-~-~-o'l ~{tTo-~' Fa't~ .............. i,fi iFU-t-e-. ....... L)a to Gross Time Net ~ime __U.e_~_t?__to W. ater Net UcoP Ura{n I-ield f~Proposed ins tal la'tl~-~}~-:- --~'e~-Pa--ge pi t OupLI of lnle~ ................ COHI~ILIil' S: ....................................... ~ --: ................................................. ~= ..... -c-e-r-tTf-i-e~F '~s -: ...... bate :" ................. EQ 0,10 (6174) WATER WELL LOG FOSS DRILLING 1336 Ingra Street Anchorage, AZaska 99501 · ~UNICIPAUiV O DEI~. OF HEALTH ENVIRONMENTAL PEOTEC¥1ON, SEP "~ ..:_, I977 FEET OF DRAWDOWN. FT. REMARKS DATE COMPLETED,,, OtoZ /__~to~ tom tom .~to to~ tO .....tO to~ ...._tO to to to ~to ~: /-~qUNICIPALITY OF ANCHORAGE ~ /~~'~ ',~ ,DEPARTMEN1 JF HEALTH AND ENVIRONMENTAl. ~PROTECTION k~_,lo{ ///~-~ ~}~.~ <'' 825 L Street, Anchorage, Alaska' 99501 ~ / ~.- ,~ ~ , 1978 Date ~ ;-~ (~ ~a~e ~ate REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Mailing Address: 2. Property Owner: Mailing Address: Alaska Mutual Savings Bank % Ruthanne Overstre( Post Office Box 1120 99510 Donald G/Janet L Calkins Star Route A Box 1561-M 99507 Phone: 274-35~1/237 Phone: 279-8414/w 344-0929/h 3. Legal Description: Lot 7 Block 4 Mc Mahon Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Three Number of Bedrooms: Well System:' Individual Well (x) Community/Public System ( ) Permit # ~1~6~ Depth of Well Well Log on File~) Construction Bacterial Analysis Sewage Disposal System: On-site System (x) Public Utility Permit ~ 'ql~ Installed ~-~i-~ Installer ~ Septic Tank Size ~,~c~. Manufacturer ~k~¥- Absorption Area ~ ~' Soils Rate ~>. Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line P'~k~e T~lo ' Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal· Description: Lot 7 Block 4 Mc Mahon Subdivision Comments: Affadavit Attached Approved: .~ Disapproved: Letter Attached: ( ) Date:. ~~/~ ~ Date: Department Worksheet: llV~ 1VNOIIVN~;INI NO3 O08T IZ6I ':dV m~o~ S,I .................................... (pa;!nba,i aa} oJlxe) A~I3AI13O 3VlO3d$ POg ...................................................... AqNO 33553BQOV Oi B3^I]3Q --~§B ............,quo aassaJppe o~ ~:Jaar ap q~r~ ~ S:tOIA~I3$ ~g£ "paJa*!Iap a~aqm puc a~ep 'm~qm o~'smoqs ': ~§9 ............,quo aassadppe o~ ,(da^ ap ql ~ ,Ld133:llJ ~g[ ........... paJaallap alep pue moqa o~ smoqs 't NIJfll:]a $33] qVNOIllgQV ~0~ S~OlA~]$ 1VNOIldL.~.~/~ 3QO0 dlZ e~¥ 31VIS "O'd 'ON ON¥ 133~1S (e~le~,sod Snld) ~O£--'IIVIAI (]31JIl~13O ~JOJ ld1303~J MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 279-251]., ext. 224, 225 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: VA 2. Property Owner: Donald G. & J~net L. Calk±ns _FHA CONV Mailing Ad'dress:. SRA Box 1561-M, Anch. Ak. Name of Buyer: Same Wk. Home Day Phone: 279-8&1/, or Mailing Address:_ Same 4. Name of Lending Institution: Mailing Address: P.O. Box 1120, Anch. 5. Name of Realtor or Agent: None Mailing Address:. 6. Legal Description: Lot 7~ Blk 4, McMahon S/D Location: NHN Bragaw Day Phone:. Alaska Mutual SavinKs Bank - Ruthanne Overstreet 99510 Phone:_ 274-3561-237 Phone: 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Public Utility. If Individual, number of dwellings presently served If ,n~,,v dua, d~pLh of well 9. Sewage Disposal System Type of System: Public Utility. If Individual, date of installation S~n?le Fami]y No. Bdrrns. ~ Individual X __Individual (on-site) X .... DEPT. OF HEAt-in ENviP, ONMENTAL pRoTECTION t t 1978 72-O03(3/76) MUNICIPALITY OF ANCHORAGE Rat+ 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. 017-041-04 Expiration Date: I© - 1-1- 1(1 1. GENERAL INFORMATION Complete legal description MCMAHON BLK 4 LT 7 Location (site address) 12600 ELMORE RD, ANCH AK Current property owner(s) DONALD & JANET CALKINS Day phone Mailing address SAME Real estate agent Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ((f. 3456❑ Duplex 4 �p9 ❑ Multiple Dwellings (Single Family and/or Duplex) �� l 4 6 3. NUMBER OF BEDROOMS: 4 I! f) N o-- 1gp 0 4. TYPE OF WATER SUPPLY: TYPE OF WA' '+ -TER DI 0 AL: Private Well 0 Private Sept 9 'x £ Z N. Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ %SO Waiver Fee $ Date of Payment 1-tt q Date of Payment Receipt Number it 9,461 - Receipt Number COSA# 6 (..141303. 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. I acknowledge that On-Site staff may visit the site to verify the information submitted. 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 7-15-19 OFAikvw •r moi. .S i �,' 17 6. DSD SIGNATURE p :49TH /� ';* /t diAT System #1 Approved for ci bedrooms vs..MICHAEL N. ANDERSON :� System #2 Approved for bedrooms f;.,.• rS 9. \��; Disapproved M` .... ‘‘\�f S`` Conditional approval for bedrooms, with the following stipulations: t0.1 ITy�p�/(i,'�, w OTS S0TF o O p73, /4/19S7-; ►-n, R�vRgM R /its �CESC)�"���� By. ..— Original Certificate Date: 7_('7_17 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 BLK 4 LT 7 Parcel ID: 017-041-04 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Well production at time of test 3.8 gpm Date drilled 813177 Water storage tank volume 0 gallons Total depth 115 ft Well disinfected for coliform test? ❑ Yes ❑■ No Cased to 115 ft Coliform bacteria is Negative ■❑ Sanitary seal is functioning correctly Nitrate 2.8 mg/L ❑ Nitrate less than MRL (ND) ■❑ Wires are properly protected Arsenic ug/L ❑� Arsenic less than MRL (ND) Casing height(above ground) 18 in. Collected by MNA Date of flow test for COSA 7/2/18 Date of Sample 712119 Static water level at beginning of test 98 ft. Comments B. TANK DATA C. LIFT STATION Age of tank(s) 1 years ❑ Required maintenance completed Tank type/material STEEL/cpf IG Age of lift station years Measured operating fluid level in septic tank 48 Lift station material ❑� Standpipes/foundation cleanout per record drawing Comments: Date of pumping NEW TANK INSTALLED D. ABSORPTION FIELD DATA Which system tested (date installed) 7121/77 Adequacy test date 717"$ ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade 13 ft(max) Fluid depth prior to test 24 in Measured depth to pipe invert from grade 9 ft(min) Water added 600+ gal ❑ N/A—pressurized field New depth 35 in ❑■ Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min depth into effective ❑■ Code-required soil cover over field Final fluid depth 24 in Absorption rate 600+ gpd ❑ System presoaked UN (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet 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' Community Sewer Manhole/Cleanout > 100' p Yes if No ft Q Yes if No ft Neighboring Tank > 100' E Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' E Yes if No ft Holding Tank > 100' E Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' 0 Yes if No ft -D Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft —0✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water> 100' 0✓ Yes if No ft Property Line > 5' E Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' ✓0 Yes if No ft Water Main > 10' ✓0 Yes if No ft Community Wells > 200' ✓0 Yes if No ft Water Service Line > 10' p 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' ElYes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' 0 Yes if No ft Surface Water > 100' p Yes if No ft F. ENGINEER'S COMMENTS ta..\AN` G. ENGINEER'S CERTIFICATION ,�gfG OF At vk t� I certify that I have determined through field inspections and review •'• (?•'�• NIS •y�I of Municipal records that the above systems are in conformance with elf*: 49TH IN . *�/t. MOA COSA guidelines in effect on this date. j"". .•' /r rtet.MICHAEL N. ANDERSON Ow r i •C�-9469 �. . .. COSA Checklist yellow sheet l���E�N,"•:4-~~ . 7i GRAPHIC SCALE: 1 Inch = 40 Feet 20 0 20 40 80 -0 I ; N=. V EAST 188.47 50 75.0 1. 0 o ,WELL 6 N" N . • 4 N r Z • IX w 's U)v) n M CNI W N, in 1 0 • 1 Nnv ,. o a tf) O ��o W o o U Z 0 >11 IC)p I J LJ 0 Z • WEST 188.78 50 No property corners were found or set during BobbyF. Drive F. Burnett this survey. House placement is based on an As—built survey dated 2/03/1977 by R.L. Button 2941 Carriage Land Surveying. Improvements from previous Anchorage, Alaska 99507 survey have been Re—Certified during this (907) 350-5541 survey, and are as shown. •410:41,74111k NI.. Date Scale Legal Description w OF 7/12/2018 1" = 40' Lot 7 BLOCK 4 A�S�. 4,6- ,14 Grid SW 2835 AS-BUILT �G?.' ��- Drawn by held Book McMahon Subdivision e* 49 TH A� . . * TA BFB ASB-2018 PLAT # 65-86 j I hereby certify that the property described hereon has been surveyed r by me, or at my direction, and that the improvements situated thereon BOBBY IS——5F. BURNI;TT 464 are within the property lines and do not overlap or encroach on the �' � , property lying adjacent thereto unless otherwise shown. That no , 7—/ •�f-/v ' improvements on the property lying adjacent thereto encroach on the p • ' • • ' Ar premises in question and that there are no roadways, transmission \\\........ �FL'SSIONAL�' Air Linea or other easements on said property except as shown. ®Ntlic®"40.- .40.-