HomeMy WebLinkAboutMCMAHON #2 BLK 9 LT 6
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
~ Municipality of Anchorage Page
~ ~ r'~ 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
Permit Number: ~ ¢.P cf ~ O~.¢ I PID Number:
Name: Wastewater System: O New ~ Upgrade
Address:
~7~ ~A~A ~¢~ ABSORPTION FIELD
Phone: NO. of Bedrooms: ~Deep Trench ~ Shallow Trench B Bed ~ Mound Q Other
LEGAL DESCRIPTION so, Rating: Total Depth from original grade:
~ ,~ GPD/~.
Lot: Block: Subdiv~ion', ~ Depth to pipe bottom lmm original grade: Gravel depth beneath pipe
Township: I Range: Section: Pill added above original grade: Gravel length:
/ ~ Ft. ~O Ft.
Number of lines: Bistance between lines:
WELL: D New ~ Upgrade Gravel width: ~ Ft. J ~ FI.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Oriller: _~% Date Drilled: Static Water Level:Ft. Installer: ,~A~ L Date~¢onStalled:
Yield:~ GPM Pump Set at: Ft. ~Casin~Height, Above Ground:Ft. TANK
SEPARATION DISTANCES ~septic ~ Holding ~ S.T.E.P.
TO Septic Absorption Lift Holding )ublic/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank S .... Lines AH CH ~AN 14
Material: Number of Co~rtments:
Surf~c. , LIFT STATION
Water
Lot Size in gallons: ~anufacturer:
Line 5~
"Pump on" level at: "Pump off" level at: J High water alarm at:
Foundation ~ ~ ~
CurtainDrain Pump Make & Model Electrical Inspections performed by:
Remarks: BENCH MARK
Location and Description:
Assumed Elevation:
E N ~~%L
Inspections performed by: ~ ~ ~ates: 1st ~o~ ~ g ~ '~~
Department of Health and Human Services approval (.<,
72-013 (Rev. 9/91) MOA 25
AD 17
! BD 33
AE 51,5
BE ??
! ~ pHONE
!
STANDARD
1250 GAL S,LTENGTH 40 FT
~' .~. ~. DEPTH 10 FT
RE]CK DEPTH 7
~. gBVER 3 FI
!
®~fl ! /
/
/
/
/
/
//
/
/
/
25 0 P5
Nell
N
50 75 /100 1~5 150
SC/)LD l~ = 50 F/f. /
BENCH MARK: BOTTOM SIDING
ASSUt~ED ELEVATION: I00.00 FT
?OBBEN SPURKLAND P.E, II
205 W 15TN. AVENUE
II
ANCH. AK. 99501
(907) 279-5916
Mcilgaibon £t6 Blk 9
5726 Taiga Drive
Joe Newhouse
II SEPTIC'.!SYSTEId AS BUILT
DATE: "Aug. 12, 1998
SHEET: 2/5 GRID: 2855
PEtFM]T # SW985281
PIP # 017-362-13
McMggO51, d~9
PRIt,,iAK'Y TRENCH
Standard ?tenth:
IV/de
Lan9
Peep
7.0' Sewer rook
EXISTING TI~ENCH
FLOW DIVENTER
ND SCALE
/-- Moni%om
-- Cleonouts
IE 94.4
87.2
ND SCALE
INSULATION
1250 9at s~pt.,'c tank
Bench Work: Bottom Siding
Assumed Elevotlon: 100.00 ft
TOBBEN SPURKLAND P.E.
203 W15th Ave
Anchorage Ak 99501
MoMAHON BE 9 LOT 6
5726 TAIGA DRIVE
JOE NEWHOUSE
II S£PT]C SYSTEN SCHEMATIC
rATE, Aug. 12, 199~
SHEET, ~/~ GRIB, ~835
PERMIT ,// S1'1/980281 PARCEL ID ,// 017-362-1J IdCMO906$.DWG
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Aug 04, 1998
Expiration Date: Aug 04, 1999
Permit Number: SW98028'1
Legal Description: MCMAHON #2 BLK 9 LT ~6
Design E n g i n e e r:--~-?¥c~ ~c~:~.o,
Owner Name: JOE NEWHOUSE
Owner Address: 3726 TAIGA DRIVE
ANCHORAGE , AK 99516-2856
Parcel ID: 017-362-13
Site Address: 003726 TAIGA DR
Lot Size: 24028 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
~ Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
ToSPURKL
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 6 BLOCK 9 McMAHON
3726 TAIGA DRIVE
JOE NEWHOUSE
Municipality of Anchorage
Department of Health and Social Services
820 1 Street
Anchorage, Alaska 99501
June 13,1998
We are submitting an application for the installation of a septic system upgrade for this lot. The
submittal consists of three (3) drawings showing the present improvements on the lot and the
adjoining properties, (sheet 1/3), the proposed improvements o£the lot, of which only the septic
system is subject to this permit application, (sheet 2/3), and a schematic of the septic system,
(sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic
system design is based on the following:
No Ground Water or impervious soil to 16 ft.
Use Standard Trench
Soil Rating. From Testholes May 22, 1998
5 min/in = 1.2 gal per sq.ft/day
No. of Bedrooms 4
Required Area per Bedroom: 150/1.2 = 125 sq.ft.
Total area required: 125 x 4 = 500 sqft
Testhole depth 16 feet
Bottom Rock At 10 feet
Top Rock At 3 feet
Rock Depth 7 feet
Total Trench Length 500 / 14 = 35.7 ft. Use 40 ft..
SYSTEM CONFIGURATION
STANDARD TRENCH
TOTAL LENGTH 40 FT
TOTAL WIDTH 2 FT
TOTAL DEPTH 10 FT
ROCK DEPTH 7 FT
COVER 3 FT
SEPTIC TANK 1250 GAL
The installation of this septic system will not prevent wells from being installed on the adjacent lots.
There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface
runoff will not result from this installation.
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16-
17-
18-
20-
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG h PERCOLATION TEST
~ I/~ q..,. I.o~' ~,~ Township, Range, Section:
SLOPE
SITE PLAN
WAE GROUND WATER
ENCOUNTERED?
s
L
IF YES, AT WHAT O
DEPTH? p
E
Dep,h to Waler AIter_~_.. ~/'~i ~,~
Meniloring? ~ Date:
Gross Net Depth to Net
Reading Date
~ I Z./.. Time Time Water Drop
gYV
PERCOLATION RATE ,~..,.b ~'w*/~O0 '~ '
(minutes/tach) PERC HOLE DhOWS,ER
TES'[ RUN BETWEEN ~ FT AND .~ Y'~* FT I -
PERFORMED
BY:
~ I __ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE~'~ AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Ar chorage, Alaska 99502-0650
SOILS LOG .... PERCOLATION TEST
PERFORMED FOR: tt'~-
~.' (ENGINEER,S SEAL)
DATE PERFORMED:
Township, Range, Section:
~P
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
s
L
IF YES, AT WHAT O
DEPTH? p
E
Depth t~ Water Alter/
MonitorinB? ~..I, ~ hale: ,
Reading Date Gross Net Depth to Net
FI.~ ~ Time Time Water Drop
: qH IO qa
PERCOLATION RATE ..~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~P FT AND Z~//'~.~ FT
COMMENTS
72-008 (Rev. 4/85)
5O
5O
SCALE:
/
/
$oo
/
/
/
/
//
//
~ If ell
/
/
/
/
TOBBEN SPURKLAND P.E.
205 lY 15TH. AVENUE
ARCH. AK. 9950!
(907) 279-J916
PERMIT # Sb/9800XX
$726 Toigo Drive
Joe Newhouse
SEPTIC SYSTEIv/ DESIGN
DATE: June 15, 1998
SHEET: l/J GRID: 2855
PID # YY McMO?OSl, d~/9
/
!
pHONE
STANDARD T
LENGTH 40 FT
DEPTH ]0 FT
RBCK DEPTH 7
CDVER 3 FT
25 ~ 25
~ ?gert
N
$0 7.5 /100 125
£CALE; 1r = 50 F/T, /
/
150
TOBBEN SPURKLAND P.E. [ [
20J W fSTH. AVENUE
ANCH. AK. 99501
(907) 279-$916
MoMahoz~ £~6 Blk 9
5726 Taiga Drive
Joe Newhouse
SEPTIC SYSTEM DES/ON
DATE: June 15, 1998
SHEEh 2/5 GRID: 2855
P£t~MIT # S~/9800XX PID # YY McMOgOO],dw9
PRIMARY TRENCH
£tono/oi"d 1-rench~
~' Wide
40' Lan9
7,0' Sewer rock
3' Covel~
EXISTING TRENCH
FLOW DIVERTER
6
SCALE
1000 9of Septic tank
Silt Barrier -
/-- Monitor
~ CZeonouts
// 3'£over
7,0 Pt o£ Septic /~ock
EffecHve
ND SCALE
1250 gal, septic fonk
TO,BEN SPURKLAND P,E. [[
II
~03 WlSth Ave
Anchorage Ak 99501
MoMAHON BI( 9 LOT 6
5726 FA/GA DRIVE
dOE NEWHOUSE
SEPTIC SYSTEM SCHEMATIC
DATE: JUNE 25, 1998
SHEET, GRID:
PERMIT ff SW9800XX PARCEL ID // XX MCMO9065. DWG
GRE' ER ANCHORAGE AREA BOR dGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION ~ 'C~d--- ~ ,
MAILING ADDRESS '~-'~-" ~: '~C:,~ 1,..~2' )~ PHONE ~'~ ~' ("~<::~-'~/
LEGAL DESCRIPTION L G ~) ? ~?~- mg~-~'b?~'
SEPTIC TANK:
DISTANCE
FROM W~ELL
INSIDE LENGTH
INSIDE WIDTH
MATERIAL
LIQUID DEPTH
NUMBER OF
COMPARTMENTS ~'~
LIQUID CAPACITY ~,',,%.5'O GALLONS.
TILE DRAIN FIELD.'~/~.m~--
DISTANCE FROM WELL FOUNDATION
NEAREST LOT LINE
TOTAL LENGTH
OF LINES ~'7/'~ /
NUMBER OF LINES [ DISTANCE BETWEEN LINES
TRENCH WIDTH__ IN. TOTAL EFFECTIVE
ABSORPTION AREA ~'~/6
DEPTH: TOP OF TILE TO FINISH GRADE
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
MATERIAL BENEATH TILE
IN. ABOVE TILE ~ t/ 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:
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
D AT E<::~/Bc3t ~ ~'" APP R OV E D ?'' ~j'~'G.A.A.B. Cj
Form LQ-032
M-W DRILt, ING, INC.
Box 4-1224
ANCHORAGE, ALAS,KA99~09
Phone 274-46~]
START
COMPLETE
DATE ~'...q:. :~/
ADDRESS
CITY PHONE
DEPTH WELL LOG ~ DEPTH WELL LOG
' k-> , I
.-.,... , / ;~..,~
STATIO '~' ~ ~P~ -'YIE ~D
PEF.:H'r T NFL ,:: "'-"- :' '-
FIF'F'L I CRNT
LOCRT t 0N
L. EGRL
DEPRRTMENT: HERLTH RND ENVIRONMENTRL ,tOTECTION
251.6 E. TUDOR RD., RNCHORRGE. RK. 99507
276-222i
I"tCIUNTRIN ENT ,
L6 B9 MCMFIHf]I",I SUE~[:,
SRR E,']F~ _L._,:,.cN
LOT SIZE
~.-::4 4 - 0 4 9 ~1..
;.-240E,;.:a ':]~7!_ RRE FEEl"
T'.?PE OF SOIL RE:SORE:TION S'M'STEM IS: TRENCH
MRXtHUM NUMBER OF E,E[.F.._UII_, = 4 SOIL RRTING ,":,,E~ FT,-."E:R)= .:L¢:._
THE RE6!UIRED SIZE OF THE SOIL RErSORPTION S'gSTEM 15;:
U--' "--' "--' ".." L-:. []:" EZ F' 'T H :=
[:. E F" "'[- H = i C-~ L E t"-.t u_3 T H = 4 ~ I~ ~N ~ '
THE LENGTN DIMENSION IS THE LENGTH ,:;IN FEET) OF THE TRENCH OR D, RFIINFIELX:,.
"['HE DEPTH OF ~ TRENCH OR PIT IS THE [.',ISTRNCE BETWEEN THE SI..IRFRE:E OF THE
GROUND RN[.', ]'HE BOTTOM OF ]'HE EXCRVRTION ,.':IN FEET).
-['HERE IS NO SE]' WIDTH FOR TRENCHES.
THE GRR',,,'EL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RI'-4D THE BOTTOM OF THE E',,~',C:R',,,'RTION (IN FEET::,.
BFIC:KFILLING OF RN'9 S'¢STEM WITHOUT FINRL INSPECTION RN[:, RF'F'RO',,,'RL E:'m' ]'H.T.S
[:,EF'RR"I'MENT WIL. L BE SUE:..IECT TO F'ROSECUTION.
MINIMUM [:,I'::;TRNCE E:ETWEEN R WELL RND RNh-' uN-z, I TE SEWFIGE DISF'EISRt_. S'¢STEM IS
2LO0 FEE]" FOR R F'RI',,,'RTE WELL OF.: ;E'O0 FEET FOR R FU6LI_. WELL.
WELL LOGS RF.:E REQUIRE[:, RN[:, MUST BE F.:ETURNED TO "['HE DEF'RRTMENT WITHIN ~:0 [:,Rh.'S
OF THE WELL COMPLETION.
'E,F'EC I F t ]I:Y[' I ~IIZ~F~; R~B~[) INZ ONSTRI--ICT I ON D I RGF.'.Rf'I:~ RRE R',,,'R I LRE:LE Ti] I NSI_.IRE PROF'ER
Z NSTRLLRT 1 ON.
F" E F~: ~'"1 Z 'T '-.-" R L .'[ [:, F' C, F: C, 1'-.t E %-" E R IF:-': F- R C, ~'-1 ::E .".-_-'.': 2'F; Lit tf:~]
I _.EF..FIF? THRT
t.: I RM FRMILIRF-: WITH THE REQUIREMENTS FOF,: ON-SITE SEWERS FINE:, WEL. L_S RS SET
FORTH E:'¢ ]"HE MUNIC:IPRLIT'¢ OF RNCHORFtGE.
2: I WILL INSTFtLL "['HE S'gSTEM IN RCCORDRNCE WITH THE CODE'..:.,.
~;~-S IDI"~I:I~'ERSTR''~[:.'E ~.E""MTH"]E.~'f~E'ET:'HE ONffr,3 '~-NL~LZ ~E:S~I'J~F'E.'' ~''~;Ef'41 I"EI"~'~:R 'F-zi~'~i'~:.I RE ENLRR,3EMENT IF .THE
DeP~ artment of Health and Environmental Protec{ion
2516 E. Tudor Road
Anchorage, Alaska 99507
276-2221
S{)II,S I,()(; I'I.~I.~)I,ATI()N 'I'EST
HOUNT~.I N ENTEnPRISES
Performed For_HB.__.C~,_E..J$c.~<so.N~, ......................................
This form report~: Soils log ~ Fe~d~u. u~ _ _
Depth
2 - LOAM
3-
~ - SA~D AND
lO-
tl -
12-
13-
SILTY SABD$~ WITH SOME
GRAVEL$~ TO 3t! DIAMETER
GM - 225
14-
16-
Was ground water encountered? No
( ~)I='EN F.0R DAY~ OF' RAI N~ TOO) ............
Reading Date Gross Time
If yes, at wi~aL deptlff ...............
-Proposed install~]--'~ge Pit L)rain Field
I)upLh Of Inlet ................... · .....
.E() O4O (6/74)
MUNICIPALITY OF ANCHORAGE
o
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 017-362-13
Certificate of On -Site Systems Approval
Expiration Date:
Legal description MCMAHON #2 BLK 9 LT 6
Site address 3726 TAIGA DR Anchorage AK 99516
Current property owner(s) NEWHOUSE REVOCABLE TRUST
X The On -site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
2
Original Certificate Date: I r• 2 2 'Z02_3
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 Services 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 work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory x
Tank Age Advisory x Arsenic Advisory
Other
COSA ApprovaLJune 2022
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 Application
1. GENERAL INFORMATION
Parcel I.D. 01736213000
Complete legal description MCMAHON #2 BLK 9 LT 6
Location (site address) 3726 TAIGA DR
Current property owner(s)
NEWHOUSE
2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: ❑E Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 25 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑■ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
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 $ SD Waiver Fee $
Date of Payment I t (o 'zo Z 3 Date of Payment
COSH # S C 31 ll `13 waiver #
COSA Application —June 2022
COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
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)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
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’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
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’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F.ENGINEER’S COMMENTS
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 Phone
Engineer’s Printed Name Date
C&M ENGINEERING
CHARLES BALZARINI, PE 11/13/23
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC231443
Subdivision: MCMAHON #2, Block: 9, Lot: 6
A water sample revealed a nitrate concentration of 8.48 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.
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.
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC231443
Subdivision: MCMAHON #2 Block:9, Lot: 6
The septic tank for this property is 25 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more,
not including engineering, surveying or MOA permitting fees.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
�' � `Mahn Address P O Box i96650 * Anchora a Alaska 99519 6�650 * www murn or � �
C&M ENGINEERING SERVICES
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: COSA for McMahon#2 Block 9 Lot 6
Dear Reviewer,
The septic tank at the above referenced property was recently pumped, however we have not been able
to obtain a “proof of pumping”. On 11/22/23, we checked the level in the tank and confirmed that there
was zero inches of sludge in the tank and the tank had been recently pumped.
Sincerely,
Charles Balzarini, PE
11/22/23
Lot 6, Block 9
Second Addition To McMahon
Subdivision
24,028 Sq. Ft. +/-
3726 Taiga Drive
2 Story Wood Frame House
With Attached 3 Car Garage
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LOT 14
PROFESSIONAL SEAL
Date:Frontier Surveys, LLC Project No:
650 W. 58th Ave. Suite E Anchorage, Alaska 99518
As-Built Survey of:
www.frontiersurveys.com
Frontier Surveys, LLC
I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or
under my direct supervision on
Plat:Grid:Ordered By:
907.460.1686 - info@frontiersurveys.com
This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and
conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any
inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the
existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances
should this document be used for construction or for establishing a boundary or fence line.
October 25th, 2023.
Legend:
Scale 1" = 30'
Deck
Septic
Telephone Pole
MailboxOverhead Utility
Lot 6, Block 9 Second Addition To McMahon Subdivision
General Notes:
1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws.
2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey.
3. All measurements/setbacks are to the visual/apparent building footprint.
4. All dimensions to property lines are plus/minus 0.1ft.
Emily Selix
23-454 11/03/2023
72-87 2835
Water Well Tel. Pedestal
Concrete MBS
TW
Nov 03, 2023
R
E
GISTEREDPROFESSIO N A L L A N D S URVEYORPierre M. Stragier
No. L.S. - 9812
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF FtEALTH & 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.# ~)\'"~- ~q'3t~ -'~ ~ HAA# ~
1. GENERAL INFORMATION
Complete legal description
Location (site add'ress or directions)
Property owner
Mailing address P, o, .rs ox
Lending agency
Mailing address
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well ~'
Community_well
Public water
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 fl21
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sewoq ,to sJesl~qoJ nd o~ ~se~noo e se s!q~ seop SH HQ eqJ. '~)tS~lV,to e~m,S eq~ u! peJe~,s!§e~ Jeeu!Due I~UO!Sse~oJd
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'sepoo e~e~,S pue led!o!un~ lie q~!t~ eoue!ldLUoo u! s! Lue~s~S lesods!p ~e~e~e~se~ ~o/pub ~lddns
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uJoJj peu!m, qo uo!~euJJo~u! eq) uo p@seq ),eLl~ ~!Je^ ~eLIMnJ I 'u!eJeq pe]eo!pu! e~mon~s ~o ed/q pue
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X~u ~eq~ ,~jpe^ I '~oleq u~oqs e~w_.p uo!~ep!le^ eq~, ~o se pue o~eJeq pexwe leas Xw/~q Oe!;!~eo sv
'9
I:{ZI'=INIIDN'=[ Al3 NOIJ..:D~tdSNI 40 J.N=IIN~.LV.LS "g
Legal Description:
A. WELL DATA
Well type ~Or
Log present (Y/I~
Total depth
Sanitary seal (~N)
Date of test
Static water level
Well flow
Pump level
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
If A, B, or C, attach ADEC letter.
ADEC water system number
Cased to ¢,~ I~¢0~-, Casing height
Wires properly protected (~N)
AT INSPECTION
~0/
g.p.m.
FROM WELL LOG
SFPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot / /
Absorption field on lot
Public sewer main
Sewer service line /d
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout /"//~
Petroleum tank ~,~//~-
WATER SAMPLE RESULTS:
Coliform -~/,'~,a[~a
Date of sample:
Nitrate -~./ Other bacteria
Collected by:
B. SFPTIC/HOLDING TANK DATA
Date installed /~ 7 ¢,
Cleanouts (~/N) ~¢5
High water alarm (Y,~ /Uo
Date of pumping, 8/Z 7/e~'
Tank size /Z 50 Compartments
Foundation cleanout ((~/N) ~'¢.s Depression (Y~i~
Alarm tested (Y~d~)
Pumper A¢~
SFPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot //~ /
To property line '~/'¢ '
Surface water/drainage
On adjacent lots
Absorption field
/
Foundation ilo
'Z,.~ ' , Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
,Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Cycles tested
Surface water
D. ABSORPTION FIELD DATA
Date installed lq '7
Lbngth - d£' _Width
Total absorption area ~'~,/O ~.
Depression over field (Y/.~
Results (pass/fail) /O~
Peroxide treatment (past 12 months)
Soil rating ~ ,~ (~ o ~.J ~ System type
Gravel thickness ~,~ I¢,~ ~ Total depth
Cleanouts present (~,~1)
Date of adequacy test ¢/'~
for
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot /Z'~ ' On adjacentlots :/~
To building foundation ~ ~ ~
On adjacent lots ~o ¢
Surface water /~//~
Curtain drain U
E. ENGINEER'S CERTIFICATION
Property line
To existing or abandoned system on lot
Cutbank f J/4, Water main/serviceline
Driveway, parking/vehicle storage area 5
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Date
h,~o. :!0.5 L;.,E ..
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
LOCATION:
DALE R. MF RRELL
Professional Engineer · Registered Land Surveyor
; Utility Engineenng · Planm'ng · Management Consulting Electric · WoZer, Wazte~mer, Teleplmn~
Pho 907-349~451
~ ~11766 W~dernCss DHv~'~- 9072345-1387
%Anchorage, Alaska 99516 '.... : - -. Fax 907-344-1352: '.~ Date
Subdivision: /~a /d ~&o~ 5oSg,
Lot:
Block: 9
Client's Name:
Address:
TESTER:
Initial Reading on Meter: ~ ~ Z /
DRAW GALLONS GALLONS FIELD METER
DOWN TIME GPM VOLUME TOTAL MONITOR LEVEL READING
9.,~' ~;5,~ ~.~ Z~ ~/~ .d~l' $'" . . ~/Z~7
1'7" ~otoo I,a Z ~/ ?C~ ~'~',"" ~3/7
,., .~," i~;[~ Z.t 3~ /z6. &~' o,, ~15>1~;
i'& ,' ~o~ l,&, Z.y Zo$ ~Z / ~'/ ,t/z-/Z./
/d ,,,~v
az'o ,
~'q" ~1~o 3,~ F.~ 2~ ~Z' 3"
.. ~'.~'lz" ~oo ~3 C~ ~-I1o ~ ; ~'/z'> ~ ~1
~, /,, ~ q,~ 7. Z ~b~ ~ Z , 7~, ~70~ .......
~ 'o". lz,'~ 3,/... ~B ~6~ ~ 3 '~,~ ~/775 ..
Z" ] [Off ' ~0 ' ~ '~
NOTES:
Production Rate: Z, S~ GPM 24-Hour Capacity 337~' Gallons
~ GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
./~./~ 3330 "C" Street, Anchorage, Alaska 99503 274-4561
fil~>~i Date Received February 1,
1977
~ +C'~ Time °f InspectiOn 11:30 a.m- ~2
Date of Inspection 2-2-77 Wednesday
REQUEST FOR APPROVAL OF Buchholz
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv.
]. Approval requested by: Alaska Statebank
Mailing Address: 310 East Northern Lights
Phone:
2. Property Owner: Mountain Enterprises, Bud Jackson Phone: 344-0491
Mailing Address: Star Route A Box 1582-N
e
4.
5.
6.
Legal Description: Lot 6 Block 9 Mc Mahon
Location: (~ Drive
Type of~~
Well Da~: ~ u~t]L\ Lo~ ~
A. Type Individual
C. Construction tgl~~
Sewage Disposal SyStem: On'site system. ~[o~.
A. Installed
C. Septic Tank:
D. Seepage Pit:
Single Family
B. Depth ~84'
D. Bacterial Analysis~
No. of bedrooms 4
B. Installer ,h~,-Jr-~l, 0 ~-~ipos-~
l. Size \,.~k~]) ~Q/. 2, ManufactUrer C~_~.
1. Absorption Area ~2~[].~ 2. Material
E. Disposal Field: Total length of lines
8~ Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
, Absorption area
, Other contamination
, Absorption area
,, Sewer Lines__
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
/P. ag'e~.2~of two.pages - Re~'-~st for Approval of Individual ?~r & Water Facilities
Legal Description Lot 6 Block 9 Mc Mahon Subdivision
Comments
Approved
~/~~_.~L Disapproved
Approval ~id for one year from date signed
Date ~--7
Greater Anchorage Ar~a Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
Certify that the information contained in this request for approval tO be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
~tClP^Lrr~F A~CHOR^GE
MUNICIPALITY OF ANCHORAGE DEPT. OF HE~TH &
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECT~RO~ENT~PROTECTION
2510 Ea~ Tudor Road, Anchorage, Alaska 99504 276-2221
FEB 1 1977
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
2. Property Owner:
Mailing Address:
3. Name of Buyer:
FHA
Day Phone:
CONV
Mailing Address:
Name of Lending Institution:
Day Phone:
Mailing Address:
Name of Realtor or Agent:
Phone:
Mailing Address:
Legal Description:
Location:
.?
Phone:
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply:
No. Bdrms. ~/
Public Utility.
If Individual, number of dwellings presently served
/
If Individual, depth of well (~ ~/
Sewage Disposal System
Type of System: Public Utility
,Individual
Individual (on-site)
If Individual, date of installation
72-003(3/76}
0