HomeMy WebLinkAboutMCMAHON #2 BLK 10 LT 1McMahon
Block
Lot !
#017-362-06
O
.,,,~ ~, Municipality of Anchorage .,_,,-~ .~-;,
-~ Development Services Department .-. :-
Building Safety Division~-~'~-~ ' ~
On-Site
Water
&
Wastewater Program, 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number:. SW010466 PID Number:. 017-362-06
Nam':ANNE HEXTRUM Wastewater System: [] New · .Upgrade
13061 KILLEY STREET * ANCHORAGE, AK 99516 ABSORPTION FIELD
Ph°ne:(907~ 345--0205 3 · Deep Trench n Shallow Trench ~3 Bed 13Mound 13Other
LEGAL DESCRIPTION 0.60 ~o,,~ ~ 11.o MAX
1 10 McMAHON ~2' 2.93 MAX. r~ 8.07
- - - SEE DWG. ~ 50
WELL: [] New [] Upgrade 2.5 r~ 1
~. A+ HOME SERVICES 12/10-11/2001
SEPARATION DISTANCES =s.,,. =,~,~., .,.T.~,.
To Sept;c AbaF~ie~dt~°nSt~flonLiftHold;ngTank.~,.~..~' ANCHOR.ACE TANK 1500
From Tank
Well 100'+ 100'+ 100'+ - 25'+ STEEL 2
;u,oce Water 400'+ tOO'+ tOO'+ - - LIFT STATION
Let Une 5'+ 10'+ 5'+ -- -- 1500IANCHORAGE TANK/ORENCO SYSTEMS
Foundation 5'+ 10'+ 5'+ -- i"''''-' '
- 42" 42" 46"
Curtain Dmln NONE KNO~ ~1 ~20 OSl 05 HHF M.O.A.
I
~emarks: -EXISTING DRAINFIELD 3'0 BE USED BENCH MARK
AS A RESERVE SITE. BOTTOM OF SILL ON WINDOW AT SOUTHWEST
-EXISTING SEPTIC TANK ABANDONED PER UPC, CORNER OF HOUSE
-OVERSIZED SEPTIC TANK INSTAl LED, 100.00
Inspections performed by: AWWC, INC. Dates: 2ndlSt 12/10/200112/11/2001 .....
3rd 12/11/2001 ~..~'..I ...........
Department of Health and J-I~uman Services,approval ~0~.J ". t (~1~-7953 .."~,~
.........
R~vlewed and approved by: _.~'~"///~/. ~,,~--Date: ~.;;::z. I-~2...
AS BUILT DRAWING
SW010466 - 017-362-06
DBL1 55.825'21.725
~ ~ / NOTE: ~E ~0 CLOS~ WE~ DB~ 56.540 22.505 [
~ ~1 72.965 ~2.225
~ ~ ~Nn~-- ~2 43.485 91.190
~ / ~ xx ,/
/
Al AS~ 5VATER & ~STEWATER ~
, co~sotxanxs, ~ac. ~' = 30'--~-.~t "'l '~" r~'[ ........ .
ANNE HEXTRUM (907) 345-0205 2 OF 5 ~[~ '
.... [' ~"s~.....'~,~
McMAHON SUBDIVISION ~2; LOT 1, BLOCK 10.
AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE '~%~
SW010466 - O17-362-06
FINN. CRADE - ~.~+
~t ~ MH
~P OF T~K~ = = ~ ~ ~P OF T~K
AT ~ - 95.02
~SI~ ~TER & WASTEWATER ~ .." '"..
CONSULTANIS, INC.
ANNE
HEXTRUM
McMAHON
PROFILE AS-BUILT
12/15/2001 06:06 FAX 9078686770 A+ llome Services, Inc.
/,~ ~ .~ u '" J~SP£CIZON REPOR~
~001
I
MUNICIPALITY' OF 'ANCHORAGE - BUILDI~G SAFETY DIVISI(
470~ ~ BBAGAW a~.p'lf~T, Ab~HORAGE, ALASKA
II~gP£C~IOA~: Fda: (IJY) 3U.4.M~
Afmfgl~, 1306L ~ ...'.
l,zmar~: 01-9
Z~rg: 12/14/2001
iq~O~ll: 272.4~91 Jq~ll~ lO:
ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
December 4, 2001
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650,
Anchorage, Alaska 99519-6650
Ref: _Redesign of Sewer Upgrade for Lots 1, Block 10, McMahon Subdivision #2
To whom it may concern:
A permit was issued for a septic upgrade for the referenced property {Permit Number
#SW010466). After the well radii were flagged by a registered land surveyor, a pre-construction
site visit was performed to determine the layout of the proposed drainfields. Given the location
of the neighboring well radius, the setback from the existing septic system, the topography, and
the limited area around the test hole, we are unable to use the permitted design. An additional
test hole was excavated noah of the test hole #1 in the area of the proposed septic system
upgrade. The system will be designed around the 30 foot radius of test hole #2. We are proposing
that a 1500 gallon S.T.E.P. tank and a pressurized deep trench type drainfield be installed.
Comments regarding the redesign are summarized as follows:
1. SOILS: Attached is the soils log which shows the soil classifications, groundwater
monitoring, and the percolation test results for TH#2. Given the wide variation between the
percolation tests, It is our opinion that an application rate of 0.60 gallons/day/fi2 should be used.
2. REVISIONS TO TRENCH DESIGN:
a. Percolation Rate: 3.33 to 40 minutes/inch
b. Allowable Application Rate: 0.60 gallons/day/ft2
e. Number ofBedrooms: 3
d. Design Flow: 450+ gallons per day
e. Minimum Absorption Area: 750 ft2
f. Total Depth: 11 feet (max.)
g. Effective Depth: 8
h. Width: 2.5 feet
i. Reduction Factor: N/A
j. Minimum Length: 50 feet long
k Effective absorption area = 800 fl:
Note: The distribution lines are to be 1-1/4 inch diameter schedule 40 pvc with 1/4 inch diameter
holes spaced every 20 inches on center (30 holes total).
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
3. SURFACE WATERS: There is no surface water within 100 feet of the proposed septic
system.
4. TOPOGRAPHY: The average topography of this property is a 5 to 10 percent slope
running from approximately northeast/north to southwest/south; in short, there are no slope
concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
Presijflerit~!
lmess, P.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, a soils log, and a 7page construction
specification letter which are aIl part of the design package for this septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwe.com
it ! ~.~' °~---- I LOT 16. BLOCK
III ~
III /
LOT 15, BLOCK ~. LOT 17. BLOCK .g ~./~'
I I I MckV, HON jI2 S/D I
It! I
---" ~ ~ / ~uu~ o~ \
I III I- ~ ~ ~ ~ ~ II!
I I I I ~.~
.. ,,,,.,
II I X ~ // / ~
II I I
12/4/2001 ~-
~SI~
WATER
&
WASTEWATER
ANNE HE.RUM (907) 545-0205 1 OF 2
McMAHON SUBDIVISION ~2; LOT 1, BLOCK 10,
(REDESIGN) SITE P~N FOR PROPOSED SEPTIC UPGRADE
/ AKULA DRIVE
~ -- ~ ..- ~" NOT[: TH~ CONT~CTOR S~ ~ THE 100'
WE~ ~11 SHOWN, ~D ~E ~ LOT UNE
~GGED ~ A REGI~RED ~D SU~OR
PRIOR TO CON~U~ON.
~D[ ~ ~ ~ ~NO. ~O 6 ~ OF
X ~E DI~IB~ON UN~ ~E ~ BE 1~5
X IN~ ~ SCH~U~ ~ ~ ~ 1/4
~CH HO~ SP~ ~ 20 INCH~ ON
~ (~ .o~ ~.~-- / -
/ ~,~ ~N.~ ~ TO BE ~ ~ A R~
~ REVISED
~1~1~oo~
~.cu. ~,."~ ~ /- ~ '..~
Al ASI~ WATER & ~S~VATER ~ ~::' 4 91 ~ [ .~ (
PR~ ~R: PHONE NUMBS: P~ NUM~
ANNE HEXTRUM (907) ~45-0205 2 OF 2
~;~ ~.. "cl:-~.~ ..".q
......
McMAHON SUBDIVISION ~2; LOT 1, BLOCK 10,
~E OF WOR~
REDESIGN OF PROPOSED SEPTIC UPGRADE
ALASKA WATI~R & WASTEWATER ~'~"" /'~' '""?"~
ISOl~ LOG - PERCOLATION TESl] ~...i-..[~V/T~..k;,:jL.:::.......:
IIrGAL DDSCRIFTION: Mct4AHON S/D 1~2; LOT 1. BLOOK 10,
PERFORMED FOR: ~NE H~U" OA~:
~[~ORGANICS ITEST HOLE ~2I
I I
TO GM/SM SW HH , ._~V~
~SM OH ~/'. X , ,
DEPTH TO DATE
GROUNDWATER
o~ ~ ~/~/o~
12/4/01 ' ~ ~l S~E P~
P~.
11 DATE READING CLOCK NET TIHE WATER LEVEL NET DROP
TIHE (HINUTES) READING (INCHES)
1/27/2001 1 5:00 - 6- -
12 SM 2 5:10 10 1'
13 3 5:15 -- 6" -
4 5:25 10 1 3/4' 4 1/4'
14 5 5:25 - 6' -
6 5:55 10 1 5/4' 4 1/4'
15 7 5:35 - 6, -
8 5:45 10 3" 3"
16 9 4:45 - 6' -
17 10 4:55 10
11 4:55 - 6' -
18 12 6:05 10
19 PERCOLATION RATE 3.53 (HIN./INCH) PERG. H~E DIA. 6' (INCHES)
TEST R~ BETWEEN 7.0 FT. ~D 7.5 FT.
2
COHHENTS: PERC HOLE W~ PRE-SO~ FOR 4+ HOURS. PERC ~ W~ PERFORMED ~ ~CH ~L
PERFORMED BY A~ WA~R & W~ATER I, dEF~ ~ ~NESS, CE~ ~T ~IS W~ ~ERFORMED
IN ACCORD~CE W~ ~ ~A~ ~D MUNICIP~ GUIDEENES IN E~CT ON ~IS DA~:
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Nov 13, 2001
Expiration Date: Nov 13, 2002
Permit Number: SW010466
Legal Description: MCMAHON #2 BLK 10 LT 1
Design Engineer: 0041 AK Water & Wastewater Consultan'
Owner Name: Anne Hextrum
Owner Address: 13061 KILLEY STREET
ANCHORAGE, AK 99516-2867
ParcelID: 017-362-06
Site Address: 013061 KILLEY ST
Lot Size: 32807 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail 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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 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 1o prevent freezing.
Received By:
Issued By:
Date: //'
Date: //--/.~ --' ~/
Municipality of Anchorage
Development Sentices Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.anchorage.ak.us
(90?) 343-79o4
Parcel I.D.
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
017-362-06
Permit Number~
Propertyowne~s) ^NN~ HE'XTRUM
Day phone ~45-o2o5
Mailing address (1) 15061 KILLEY STREET * ANCHORAGE. AK
Mailing address (2) Zip Code g9516
Legaldesc~ption(Lot, Block&Sub'd.) LOT 1. BLOCK 10: McMAHON SUBDMSION g2
Legal description (Section, Township & Range) N/^
Lot Size ,~o.~ c~-~).---/ Acms/Sq.Ft. Number of Bedrooms ~
THIS APPLICATION IS FOR:
Sower Only
Sower and Well
Sewer Upgrade
Well Only
Water Storage
THIS PROPERTY CONTAINS:
Hot Tub
Swtmmlng Pool
Therapy Pool
Jac
Water Softening Unit
I certify that the above Information is correct. I further certify that this application is being made for a
Single Family Dwelling and Is In accordance with applicable Municipal codes.
ALASKA WATER &: WASTE'WATER CONSULTANTS~ INC.
Permit Fees-' ~, ~'~ ~ .~-"C~
Date of Payme,nt: ~ J ~ ~' -(~ /
Receipt Number:. <~/c~ t/_ ~ ~
Waiver Fees:
Date of Payment:
Receipt Number..
ALASIG WATER & WASTEWATER
CONSULTANTS, INC.
November 6, 2001
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650,
Anchorage, Alaska 99519-6650
Reft Proposed Septic System Upgrade for Lots 1, Block 10, McMahon Subdivision/12
To whom it may concem: ~[N- I~x:~O
The existing 3 bedroom house is served by a private ~'ell and septic system. The existing .septic
system is backing-up into the house and needs to be u}pgraded. A test hole was excavated In the
area of the proposed septic system upgrade. The s~tem will be designed around the 30 foot
radius of this test hole. We are proposing that a~allon S.T.E.P. tank and a dual pressurized
5-wide trench type drainfield be installed. Comments regarding the design are summarized as
follows:
1. SOILS: See the attached logs .which sh.ow.s the soil class?cations, groundwater monitorin~
and the percolation test results. It is our oplmon that an apphcation rate of 0.45 gallons/day/ft~
should be used.
2. TRENCH DESIGN:
a. Percolation Rate: 40 minutes/inch
b. Allowable Application Rate: 0.45 gallons/day/ft2
¢. Number of Bedrooms: 3
d. Des!gn Flow: 450+ gallons per day
e. Mimmum Absorption Area: 1000 ft2
f. Total Depth: 7.5 feet (max.)
g. Effective Depth: 4
h. Width: 5.0 feet
i. Reduction Factor: 0.5
j. Minimum Length: I00 feet long total (50 feet long each)
k Effective absorption area = 1000 ft2
Note: The distribution lines are to be 1-1/4 inch diameter schedule 40 pve with 1/4 inch diameter
holes spaced every 40 inches on center (32 holes total).
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
3. SURFACE WATERS: There is no surface water within 100 feet of the proposed septic
system.
4. TOPOGRAPHY: The average topography of this property is a 5 to 10 percent slope
running from approximately east to west; in short, there are no slope concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance. Ih
~it G'amg~, P.E., M.S.
NOTE: ,4ttached is a site plan drawing, a design drawing, a soils log, and a 7page construction
specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
. -
~ ,,, ,,~~' //~
mil I k
mm m mmmmm / II' ///_~ '
mmm ~ /
I, ~ON ~2 S~ m
I
~S~ 5VATER & ~STE~TER
,~.~.~...d. ~.~..C~
OONSULTANTG, INC.
SITE P~N FOR PROPOSED SEPTIC UPGRADE
.. / AKULA DRIVE
~ ~ ~ "'"' NOTE: IHE CONTRACIOR SHALL HAVE THE 100
'" WELL RADII SHOWN, AND THE EAST LOT UNE
~ ~ ~ FLAGGED BY A EEGISTERED LAND SURVEYOR 1
PRIOR TO CONSTRUCTION.
~ PROPOSED DRNNFI~.DS. EXCAVA~ 'IV/O
'~ENCHES THAT AR[ 7.5 t.r~.tj DEEP UAXiUUU
~ BY 5 t'LLt WIDE BY 50 ~ LONG EACH (100
~" [ ~ *~. pAj:O~Ai ! FL TO SLOPE CONTOURS. 'II-IE
/ t DISTRIBUTION UNES ARE TO BE 1-1/4 INCH
/ ~ DIA;dL"T[R ~CHEDULE 40 PVC ~ 1/4 INCH
/ / O~L~t~< HOLES SPAC~ [~mY 4O ~NCHES OH
~ ~ c[~rr~ (32.0L[S TOTAL).-~ ;y /
.. ~ EX.NO SEP~C TANK IS TO BE / / /---'E~ISTINO DRNNnELD IS TO BE \
USED ~ A RESE3~'~ SITE
?
DRAWN I~': ·
C.J
ALASIr WATER & WASTEWATER ,
CONSULTANTS. lNG.
~REPARED FOR: PHONE NUMBER: PAGE NUMBER: ~"":*1 k~. ,-~...~
ANNE HEXTRUM (907) 545-0205 2 OF 2 ~,, .der e)'S,. Oomess..
DESIGN OF PROPOSED SEPTIC UPGRADE
CO.SULT^"TS. ,.C. · ........ 'tFJ~,/"/~Y .... ~ .....
oo-
PERFORMED FOR: ~NE H~UU DATE: 10/29/2~1
~'~[~ - ORO. ITEST HOLE
~ ~U~ OR~
~ gw :~ ORG
GH CL
GC OL ~x ~N~ ~R~
SW ~H --~ ~.
o.
DEPTH TO DATE
D~ , o/2~/o, ~~J
10 ~'- -~/// 1"-100' , ~,
11 DAT~ ~I~G C~OC~ ~T TI~ ~AT~ LEVEL ~T DROP
TIME (MIN~ES) RE.lNG (INCHES)
12 1°/3°/2°°1 1 2:10 - 6- -
2 2:20 30 5 1/4' 3/4"
13 3 2:20 - 6- -
4 2:30 30 5 1/4' 3/4'
14 5 2:30 - 6- -
6 2:40 30 5 lj4'
15
16
17
1 PERCO~TION ~TE 40 .(MIN./INCH) PERC. H~ DIA. 6" (INCHES)
TEST R~ BET~EN 5.0 ~. ~D 6.0
20I
COMMENTS: PERC. HOL~ W~ PRE-SOAKED FOR 4+ HOURS. PERC. ~ W~ PERFOR~ BY ~LEB ~L.
PERFORMED BY A~ WA~R ~ W~I[WATER I, J[~ k ~NGS, CER~ ~T ~IS W~PERFORMED
ACCORD~CE W~ ~ ~A~ ~D MUNICIPAL GUIDEUNES IN E~LCT ON ~IS DA~:
IN
MUNICIPALITY OF ANCHORAGE
Hes ~ and Environmental Prote( on
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
REPORT ON-SIT~ SEWAOE DISPOSAL SYSTEM
SEPTIC 'rANK:
DISTANCE ,. ) ~. . NUMBER OF
INSIDE LENGTI- ........ INS DE WIDTH .~__ LIQUID DEPTH I.IQUID CAPAC T--~GALL ONS.
F ~~/~ /IMI~/ TOTAL LENGT~
~ of Lines ----A .... DISTANCE 6ETWEEN LINES_ ~/~___TRENCIt WIDTH ~N. TOTAL EFFECTIVT[
AFJSORPTION AREA ....... ~"7 ~ ...... sm. FT. LENGTIIOF EAC[t LINE ....... ~_r /
DEPTli OF FILTER
: TILE TO PINISIt GRADF ~ MATE ]IAL BENEAT[ T LE _~ ' _ . ABOVE
L)~F)TJ J TO~ OF .............. _ ................................ / TILE .~
SEEPAGE PIT:
DIAMETER OR WIDTH ___, LENGTH ., DEPTFI
Log Crib Rings Crib Size: DIAMETER ...... DEPTH DISTANCE FROM: WELL
TOTAL. EFFECTIVE
BUILDING FOUNDATION__, NEAREST LOT LINE .... ABSORPTION AREA (WALL AREA) SQ. FT.
Well Distance To: Lot Line
Bldg: Sewer Line:
Pipe Materials: ~,
# of Bedrooms: ~ j
Installer:
Remarks:
I='ERM I"f' NO.
FIPPL I E:FIIq T
I.... 0 C F:I T I 01'.,I
L E G R L...
L::L E:::LEI I'"ICMFIHEd',I ~1:;2
T'¢F'E OF' S :' '[ I. I::IE::=Z, ORE:'T' I ON ~.:]"r'~=5'TEM I S: TREI'4CH
I'"IFI::':: I MUH IqLIHE',EF.: 31:= 8EI:)ROOHS = :~: SO I L F.:I=fTI NG
]"HE t:;E:EQU I [;.:Et-':' :!~; ~:;ZE OF TFIE E;O I I... FiE 'J: OF.'F'T ]: ]fl'-,l :'5"r'STEM Z '.5:
TtaE LENGTH DIPIEt'q'.:~]:ON :[% ]'PIE LENGTH <IN FEET) OF THE TRENCH I::)l:~: [:,F:I::III'-~F'IEL.[:'.
THE DEPTH I]F' FI TRENC:H OF..' PIT I.S THE DI'.STRt'.,IC'E BETklEEN THE ~::LtI:~:FI::~CIE OF THE
Gi:~:OUNI'.':, FINL':, THE E~OTTOH OF THE E:,.:X]FI'v'FITION ,::IN F'EET>.
"[HERE IS NO .'.C, ET t.,.It[:,]"H FOR 'TREi',IC:HE'.5.
THE GRFF,,'EL.. DEPTH ZL-'.; 'THEE t"IZNIMUM [:,E:F'TH O1:= GRFIVEL. BETI.,.IEEi'.,I ]"HE OUTFFIL. L PIF'E
FtNI::, THE .F..:OTTOH OF THE EXCFIVFrTION (IN FEET).
-IF' ,b,Jl C} ,:.. ....... ,::.." .-::,, ]E ~".-~ :~; F" E: lC:: 'T ][: C, li"..,tt .?; F~ F-: EE: F:: E: E.;:4 L...~ :if:.. IFil: IIE}]
BFI(::kZF I L.L. I ~'.,~13 OF Rt",l"r' :5'~"E;']"Ei"l t.4 1 THOUT F ;[ l'-,ll:ll... INSPECT I ON RI'4[:' FIF F F. = , F L.. E:"r' 'T'H 15.:.;
DEPFII:~tTHEI",IT 14 Z LL E:E %I..JI3JEC]" TO F:'E:O~:;EX]UT I ON.
MINIMUM [)I:==,TRI",ICE BE'Tll4EEI',I F:I I*IE:L..L RIqD Ftlg'? OH-SITE 'Z, EI.,.IFIGE F.:'I:~;F'OSFI[... S~;"r'STIEM
::LOE~ FEET FOR R F'RI',,,'FFrE t.4EL..L. OR 2~;3';£~ FEET FOR Fl PUBLIC t.,.IEI.J._
I.,.IEI...L.L. OGS RRE REX.:~UIRE:D RI'.,I[:, i"ILJ~;T BIE RE'TURNED TO 'T'HE DE:F'RRTHENT I.,.II'THIN :i!:E) Pl:l"r'~;
OF' THE WEL. L. COI'qF'LET].'ON.
:E;F'EC :1: F I CFIT I ON:L:; RN[:' COI",I'L=;TRUC]" I ON [.':, I FIGF.:F:IH% FIRE R',,,'R I LRBLE 'T'O 1'i",1%1...11:4'.E
]: I'.,IE;*T'IqI....LFtT I ON.
I
±:
FORTH B"r' THE MUNICIF:'F~L. IT"r' OF FINCI4i:ff4:FIGE.
;-.2: I 1.4 1 LL I NSTRLL. THE '}.'.:,'.?:~,'T'EM 11'.4 FIE:E:OR[:,FIIqC:E kl I TH THE CEIE:,E~.:;.
7..-':: I I.Ji',IDE]R?TF~i',I[> THRT 'THE: ON-f.'.;]:TE ~;E!-4ER SYSTEM HFt'¢ REQUIF:E ENL..I":tR(:~iEHEI'.4T
RES I C, Ei",ICE I E; REHO[)EI...EL':, TO INCLUDE MCIF.'.'E THFIN ]: 13EI}ROOMLq;.
CEI:;.fT I F'"r' THFIT
:[ RM FI=IH I L ]: F:tR !-41 ]"H THIZ RE .:, _ ]' [~%i'"IENT:==, FOR ]N-'Z', ]' 'TE SIEI.,-!ER':_:] Fli'.,l[:, I.,.tli:.::l...L.:iE; RL:~; SET
I F' THE
Akula Drive
Lot 1, Block 10,
McMahon subdivision
Addition Nuttier 2
30.0'
TH-1
Not to Scale
The Test Hole Location is
approximate and has not
been located by survey
methods.
TH-1
4-14-77
Ail Samples A
0.0I
ORG~JIC b~TERIAL
Brown, Moist Soft
(Log from 0.5' to 1.5')
(o)
2.5~
SAND W/SO~,~ SZLT
kND GRAVEL (SM)
Grey~ Moist~ ~,~edium
Dense
5.0'
SAND W/TRACE GRAVEL (SW)
Brown, Slightly Moist,
Medium Dense
10.0'
SAND (SW)
Brown, Slightly Moist,
Medium Dense
16.0'
SAND ~/SO~ GRAVEL --(SW)
Brown, Slightly Moist, f~ ~
Medium Dense 18.0' TD
No Water Table
Encountered
[oWN:
KD: EY
aYE: 4-18-77
SCAhE: 1"=3'
]~RB/D: 2835
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
Parcel I.D. 017-362-06
Legal description MCMAHON #2 BILK 10 LT 1
Site address 13061 KILLEY ST Anchorage AK
Current property owner(s) RISING
Expiration Date: _ ' 7 0 Z `y
X The On -site system(s) is/are approved for 3 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
Original Certificate Date:
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
Tank Age Advisory X Arsenic Advisory
Other
COSA ApprovNjune 2022
lMUNIUPAk UTY OF ANCHORAGE
`4 s
Development Services Department r' 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. 017-362-06
Complete legal description MCMAHON #2 BLOCK 10, LOT 1
Location (site address) 13061 KILLEY STREET, ANCHORAGE, AK 99516
Current property owner(s) KURT & KELSEY RISING Day phone
2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ® 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: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 22 - 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 $ 9 S-0 Waiver Fee $
Date of Payment c /Z t1-2-?, Date of Payment
COSA # �35C �_ 3 19 il 4 Waiver #
COSA Application.doc
COSA Checklist.docx
COSA Checklist
Legal Description: MCMAHON #2 BLOCK 10, LOT 1 Parcel ID: 017-362-06
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 5/4/1977 Total depth 77 ft
Cased to 77 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 10/17/2023
Static water level at beginning of test 39 ft.
Well production at time of test 3.1+ gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 3.75 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 11/17/23
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank *NA
Date of pumping 10/17/23
Required maintenance completed, if AWWTS
Comments: *STEP TANK FLOAT LEVELS
C. LIFT STATION
Required maintenance completed
Age of lift station 22 years
Lift station material STEEL
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 12/11/2001
ALL standpipes present per record drawing
Total measured depth from grade 12.8 ft (max)
Measured depth to pipe invert from grade NA ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective. (ED)
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) N
If yes, enter date
Adequacy test date 10/17/2023
Results Pass
Fluid depth prior to test 10 in
Water added 500 gal
New fluid depth 20 in
Elapsed time 1350 min
Final fluid depth 8 in
Absorption rate 450 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 96.8 in (MOA 8.07’
ED)
Effective depth used 8 in (Final Fluid Depth)
Effective depth (ED) remaining 88.8 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per measurements, visual
observations, MOA IR & appears approximate.
COSA Checklist.docx
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 FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 11/30/2023
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
11/30/23
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC231447
Subdivision: MCMAHON #2 Block:10, Lot: 1
The septic tank for this property is 22 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.
Ma�lmg Address P �O Box 196650 *Anchorage, Alaska 99519 6650 * www muni org �.
Certificate of On -Site Systems Approval
Parcel I. D. 017-362-06
1. GENERAL INFORMATION
Expiration Date: )0—! —Y
Complete legal description McMahon #2, Block 10, Lot 1
Location (site address) 13061 Killey Street Anchorage, AK
Current property owner(s) Anne Marie Hextrum Living Trust Day phone 787-9360
Mailing address
Real estate agent
301 White Oak Drive, # 165, Santa Rosa, CA 95409
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
F
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 $ 5 5 ®•O 0
Date of Payment �2.� 1JlJn
Receipt Number o a 3 I
COSA # OS C ["I I od LP 1
Waiver Fee $ _
Date of Payment
Receipt Number
Waiver #
6. 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 Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503
Engineer's Printed Name Michael E. Anderson, P.E. Date 6/25/19
®®®a
®®4P�E • OF
'• 49th
6. DSD SIGNATURE ®' y - "°"" "" "°"".; " °'i
® 7 1C I
®
.........................................
..�;. smi
` System #1 Approved for 3 bedrooms ®� �'; FdICHAEL E. ANDERSON •
®®�- °% No. CE -4381 �®
System #2 Approved for bedrooms ®®®'F�;••.•, 6/25/19 ..•••'���'®
F•............
Disapproved ®®®e®®aO®®S®®®�®®®®
Conditional approval for bedrooms, with the following stipulations:
'`��1111�►�111�'''
r
1
By: Original Certificate Date: 7
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
CSA Checklist
Legal Description: McMahon #2, Block 10, Lot 1
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 5/4/1977
Total depth 77 ft
Cased to 77 ft
is❑ Sanitary seal is functioning correctly
❑® Wires are properly protected
Casing height (above ground) 20 in.
Date of flow test for COSA 6/12/19
Static water level at beginning of test 48 ft.
Comments
B. TANK DATA
Age of tank(s) 18 years
Tank type/material S.T.E.P./Steel
Measured operating fluid level in septic tank 37"
X Standpipes/foundation cleanout per record drawing
Date of pumping ( Z 7-
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 12/11/2001
❑® ALL standpipes present per record drawing
Total measured depth from grade 12.4 ft (max)
Measured depth to pipe invert from grade ft (min)
❑® N/A — pressurized field
❑■ Monitor tubes go to bottom of effective. If not, state
depth into effective
R Code -required soil cover over field
❑® System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced 2000 gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 017-362-06
Structure served by this system
Well production at time of test 5 gpm
Water storage tank volume None gallons
Well disinfected for coliform test? ❑ Yes No
❑e Coliform bacteria is Negative
Nitrate 9.93 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L X Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 7/1/19
C. LIFT STATION
❑M Required maintenance completed
Age of lift station 18 years
Lift station material Steel
Comments:
Adequacy test date 6/12/19
Results Q✓ Pass For 3 bedrooms
Fluid depth prior to test 14 in
Water added 800 gal
New depth 18 in
Elapsed time 1288 min
Final fluid depth 0 in
Absorption rate 450+ gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
None
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'
Q Yes
if No
Community Sewer Manhole/Cleanout > 100'
(/ Yes
if No
ft
0 Yes
if No
Neighboring Tank > 100' Fv Yes
if No
ft
Private Sewer/Septic Line > 25' F,71 Yes
if No
Absorption Field on Lot > 100' 0 Yes
if No
ft
Holding Tank > 100' Q✓ Yes
if No
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' Yes
if No
Q✓ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 Yes
if No
ft
E] 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'
Q Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q Yes
if No
ft
Private Wells > 100' Q Yes if No.
Water Main > 10'
Yes
if No
ft
Community Wells > 200' Q Yes if No
Water Service Line > 10'
F� 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' [✓ 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'
ED
Yes
if No
ft
Private Wells > 100' U Yes if No
Water Service Line > 10'
F/1
Yes
if No
ft
Community Wells > 200' Q Yes if No
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
Im
1 certify that I have determined through field inspections and review"tie�,,
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date. :` 49th
+ :
MICHAEL E. ANDERSON
No, CE -4-381
"saq 7/1719
COSA Checklist yellow sheet
ft
ft
ft
ft
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC191261
Subdivision: McMahon #2, Block: 10, Lot: 1
A water sample revealed a nitrate concentration of 9.93 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. 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.
Al
�,.
�65d
r
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.
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MUNICIPALITY OF ANCHORAGE
Pi-ione� �It—,7-3,1 '2, 790 1
DeVejopment Services DePa Ttment Fax: 907-34- 997
-Site Nvater & \� -,I_gtekvater Section
lift statmatpump Vaull.
Maintenance Log
PID-
-.Pumping- requitt'd 7umping completed -f Q.
-sludge tevel
-porno basket cleaned Q -Effluent filter cleaned C14at.-RIQ
-Control. floats cleaned <S' xn -proper flt>2t settings confirmedCR72-11a
-operation Satisfactory
-Audi� - nd visual alarm jr.sikje ddiallingC_!�_--Cltrjoal alarm circuitble a
-i-varm system DPOraft! E �Uap` �mL
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-Ground water intmsion ,:0 hS-P-r tO tank COnnecton Y -e Co I
Del n3ti 71. ,
Avatet int-ms71011 arDLE-1d �)iDe 1, C
f�t -0 ,
(-i� �ured 6394_1_if�
-manhole lid: Functional tnsulat ,ed Properly &
-All rnanui:acturer required inspectjons and maintE.,nance r�om 0'eted xe,5- 110
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N 89*53'00"E 135.00'
Lot 1
32,807 S.F.
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30.4'x23.5' EASEMENT
ROOFTOP DECK
[RMS
PLOT PLAN AS BUILT -A— SCALE 1 50' GRID SW 2835 _ Project No. 19-275/A1�
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone
(907) 522-4625 Fax
Professional Land Surveyors ken*langsurvey.com C) F .A,
lonothan0longsurvey.com �r>P
.........
.. .......
9TH I hereby certify that I have surveyed the following described property: Ar
49TH
LOT 1, BLOCK 10, McMAHON SUBDIVISION — 2nd ADDITION (PLAT No. 72-78)
........ ..... ............
Anchorage Recording District, Alaska, and that the Improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed .. .......
T
WNW&W : Or
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premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
L 202..--
Dated this the Day of of Anchorage, Alaska . ....... .
It Is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963
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
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner, ~z
Mailingaddress ~-~.~,~ /l';... ~,~'~_
Lending agency
Mailing address
Agent
Day phone
Day phone
Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: ~ "~
3. TYPE OF WATER SUPPLY:
Individual well
Community well
public water
4. TYPE OF WASTEWATER DISPOSAL:
· Individual on-site
· : ' :": : ~"' i. ' ' ":
Holding tank
Community on-site
Public sewer
NOTE: If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system:~ '" ,~s~,, - :) ! ,'? ,,
'5)}.'i ~) ;,.,,, ~,.
NOTE: If CommUnity wastewater system, provide written confirmation from State ADffC
attesting to the legality and status of systeml
72-025 (Rev. 1/91) Front MOA ¢F21
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.
Phone -~-.'7 g-~:~o 9~
Address ~:~-(~-~ /~z~..~' ¢,¢¢o~: ¢~ ~¢¢~5F/~
Engineer's signature- ~
bedrooms.
DHHS SIGNATURE
Approved for
Disapproved.
, ~ Conditional approval for
Date ~--~o~-
bedrOoms, with the following stipulations:
Additional Comments
'f;q,'lil'li
· :~h'e Mdni~ipt,a, lity of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
· Approval Certificate~'~b~s~d only upon the representations given in paragraph 5 above by an independent
professional engineer registered m the State of Alaska. The DHHS does th~s as a courtesy to purchasers of homes
ano the r lending nst tutions n orderto sat sfy certa n federa 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.
72qY25(Rev. 1/91) ~ack MOA#21
Municipality of Anchorage~
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L. [~ ~,~o [',~c-h.~ At-~o~4 ,~'z., Parcel I.D.
A. Well Data
Well type L j~_~,.~,~ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) ~'-.-g¢', Date completed
::~ :7" _.~t Casing height
Total depth Cased to
Sanitary seal (Y/N)
Wires properly protected (Y/N) "C' ~
FROM WELL LOG AT INSPECTION
Date of test
Static wate r level ~ N ~,~,,-,, ~ ¢' - ~'
Well flow g.p.m. ~--_~. ~
Pump level1 Dr3' ':/-~ ~
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line "[-- ~ '
; On adjacent lots
g.p.m.
; On adjacent lots
Public sewer manhole/cleanout '"J~'~
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~
Date of sample:
Nitrate
'~.
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed g'-/~,- ;~ ~
Cleanouts (Y/N) '-~
High water alarm (Y/N)
Date of pumping
Tank size ~ ~.,~ c, Cqmpartments
Foundation cleanout (Y/N) 1,~ Depression (Y/N)
~ Alarm tested (Y/N) ------
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot °,3 ' ~, On adjacent lots
To property line ~ ~ o ' /~.
Sudace water/drainage
Foundation //'5
Absorption field
/C~O(
Water main/service line
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
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 Sudace water
D. ABSORPTION FIELD DATA
Date installed ~"-,('/~- '~ '-~
Length '~ t
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/Ft
Width ~ t Gravel thickness
q..~ Cleanout present (Y/N)
~'~~-- ~.~ Results (pass/fail) '~:>~,r._%~
.System type
-7 ' Total depth
Depression over field (Y/N)
for ..~
After test '2.~z. 5-~
If yes, give date
I
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~ l (~
To building foundation
On adjacent lots
Sudace water ~
Curtain drain
On adjacent lots '~-.,.~-oI Property line
To existing or abandoned System on lot
Cutbank ~o Water main/service line
Driveway, parking/vehicle storage area .'~ '~ o
E. ENGINEER'S CERTIFICATION
I ce¢'fy that I have checked, verified, or conformed to all MOA and HAA guidelin'e~ in ~ffe'~t o'~ th~-d~'tb"Of:thlE~.n~C~ction.
Signature
Engineer's Name
Date ~-I~-
HAA Fee $ ~/~.), ¢./O Waiver Fee $
Date of Payment ~/~,'~///~ :~ ~ Date of Payment
Receipt Number ///~3~' ~,~/~-~ Receipt Number
MUNICIPALITY OF ANCHORAGE
DEP^RTMENT OF .E^LTH & HUMA" SERWCES (~ / ? -5
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property Owner .~
Mailing Address ~
(c) Lending Institution
Mailing Address
(d)
Telephone: Home ..~'~:~- ?/..5'"~., Business
Telephone
Real Estate Company and Agent
Address
Telephone
Mail the HAA to the followina address: or; Check here~, if hold for pick up.
List contact person and day phone number below.
(e)
TYPE OF RESIDENCE
Sin gle-Family~l~.
Number of Bedrooms
WATER SUPPLY
Well~.~ Community [] Public []
Individual
Note: if community wett system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite.~ Public [] Community [] Holding Tank []
Note: If community wetl system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 fRev 8/86~ Front
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 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 flies and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with ail IVlunicJpal and State codes, ordinances, and regulations in effect on
the date of this inspection. /
Name of Firm /~---"'~'~ Telephone '~' /
Address /-¢¢r&~ ~,J .~.,~¢¢-"/~---.,¢~?/7~~ ~' /~. ~ ~"-~.~
Date ¢
DHHS APPROVAL
Approved for "TZA'"~'~ C'"¢',~bedrooms by~
Approved Disapproved Conditional
Date
Terms of Conditional Approval
CAUTION
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 DHHS does this as a courtesy to purchasers of homes and their lending institutions in
order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data
before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
Page 2 of 2 72-025 fRev 8/86) Back
, ~: ,~x~.~C',i,0~/s.C'E
[~Vt[~O~M~'~UNICIPAEITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
: ~ L~CH~KLIST- FEBRUARY 1984
264-4744
.~ ....... ~ ~] '~" ~ Legal Description:
WELL DATA
Well Classification
Well Log Present (YI~
Total Depth '~"~ · Cased to
Static water Level ~ ~"'_,~,
Casing Height Above Ground
Electrical Wiring in Condui Yt~)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ,,2//4
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
~,~z~j,f,/.~--~4 If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~'"--z//- ? ¢ Yield
'~? / Depth of Grouting
Pump Set At
/, ~' f Sanitary Seal on Casing(~)
Depression Around Wellhead (YO
& <~' ; On Adjoining Lots /~"~ '~-
/07 / ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
Stand pipes/~)N)
Depression over Tank (Yi~ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ////4, ; for
Holding Tank High-Water Alarm (Y/N) ,,,J'//4 Temporary Holding Tank Permit (Y/N)
Size /~'~"~ No. of Compartments
Air-tight Caps')
Foundation Cleanou~,~ ~'-/~"'~'
Separation Distances from Septic/Holding Tank:
TO Water-Supply Well
TO p~operty Line
To Water Main/Service Line
:' ,.. Course /¢.rT) ~',~
To Building Foundation ~-) /~'-
/
To Disposal Field /6
To Stream, Pond, Lake, or Major Drainage
~commenis & ,/'/'Z~'/~#~'~'¢ /~---~/'/ 'P';r/CW~/~//CZ:--
Page 1 of 2 .
72-026 fRev 8186) Front
C. ABSORP'rlON FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y~.~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ,/O 'J
/
To Building Foundation
Lot ~ /
To Water Main/Service Line /O ¢'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
/
Length of Field --~/
Depth of Field /'~
Gravel Bed Thickness ~ /
Standpipes Present&N)
Date of Last Adequacy Test
/
To Property Line /-¢¢
To Existing or Abandoned System on
; On Adjoining Lots ,¢O' ,4-
To Cutbank (if present) ,0///9
/6 /
Comments
D. LIFT STATION
Date~'tstal4.ed J/
Size in Gallons ~*-~--~-~,._~_. /"
"Pump On" Level at --' '~"~-~
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
~- Vent (Y/N)
-"~-u~Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request ** ~----
I certify that ~/¢~c h,~ked/: v~i.fied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~' ~"//-" .... Date ~' ~'¢~ "~ '~
Company ~-'¢ MOA No. ..-~ 7'-~/'
Receipt No. c:~ - O d / ~ CO// 7
Date of Payment ~ -- ~ O ~ 2 7
Amount:$ "~?_~ ~ ~¢~¢~dC-")C~--)~t'~4.- L/~J'l')
Page 2 of 2
72-026 trey 8!86~ Back
nchora ¢
P.O. BO. ,96650
ANCHORAGE, ALASKA 99519-6650
(907) 343-4200
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
October 1, 1987
Alan C. Wien
Alaska Environmental Control Services
1200 West 33rd Avenie, Suite B
Anchorage, Alaska 99503
Subject: Lot 1 Block 10 McMahon Subdivision Unit #2
Waiver Request WR87-057
Dear Mr. Wien:
Your request for a waiver of the 100 foot separation required
between the septic tank and well on the subject property has
been granted. This distance has been waived to 92 feet (the
measured distance to the tank cleanout is 95 feet). This
waiver is based on your assessment that this small encroachment
on the required well setback will not pose a threat of
contamination of-the well.
This waiver is valid for the existing three bedroom single
family dwelling only. This waiver does not apply to any future
upgrades or enlargements of the septic system.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
cc Gus Andress, P.E.
Manager, On-site Services/Water Quality
Municipality of Anchorage
Department of Health & Human Services
825 L Street
Anchorage, Alaska 99501
ALASKA E IIUIROI'ImeFITAL COFITROL SeRUICg ?I,Q .
~nqineerincI ~ ~nuJronmental $1udies
September 28, 1987
Re: Lot 1, Block 10, McMahon Correction: Unit #2
Waiver Request - Well to Septic Tank
On 9/16/87, an adequacy test, well flow test and Health Authority inspection
were performed. Adequacy test results are satisfactory. The well flow test was
run for 4 hours at a flow rate of 5.$ GPM. Static water level was 55.5 feet
with a total drawdown of 3.2 feet and recovery in approximately 2 minutes.
From the Health Authority inspection, we find the separation distance from the
well to septic tank cleanout is 95 feet. The well was drilled 5/4/77 and the
sewer system installed 8/16/77, There is no well log available for this lot.
The sewer installation was inspected by John Kennedy of the MOA and reports the
separation distance to be 100 feet from well to tank. From the attached site
plan, there is a garage between the well and tank. At the time of installation,
this garage did not exist, which would have allowed a straight line measurement.
The tank is a 1250 gallon, 2 compartment, steel tank. Water tight couplers were
being used at the time and should be on this tank. The well is 77 feet deep.
Attached are sample well logs of the area. Total depths are all within 15
feet. Layers of clay and hardpan are present throughout all of these wells.
Surface drainage from the tank would flow to the south - south west. There is
a retaining wall along the north edge of the driveway to further protect the
well. Water samples taken 9/15/87 are satisfactory.
We feel that this 5% reduction of the required separation distance will not pose
a threat of contamination to the well. We request that you grant the
appropriate waiver.
If you have any questions, please call.
Sincerely,
Alan C. Wien
Engineering Technician
1200 [Uesl 33rd Aucnu¢, $ui1¢ ~ · Anchoracl¢, Alaska 99503-[907) 561-50~10
DELTA DRILLING CO.
, SRA-Box 394 B.
Anchorage, Alaska
344-7831
R~di~prm
8588:z S I AI'E M E
0352
~ CHEMiCAL
& GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
Ci lent POg : V~P,[i,~L
S~pie Reo'o : SEP !5 87
~eports To: AE6S
Special SAMPLE TAKEN 9-15-87, 1620
Work Order No. : 2838
Client Account : ^[ECSPY
Date Report Prinked: SEP 18 8? 9 1[:47
Reports Address
chem.~b Ret ~: 7705 Lab 8mpt ID: I ~Iatrix: Water
Al lol,abie
Paraeter Tested RemmttAJnits Hethod Limits
ROUTI~g
g~fi~YSlS COHPLkTED: 9-17-87
Tests Performed ~ See Special Instructions &bore
~one ~eterted ~ See Sample Remarks Above
Not Analyzed : L?=Lesa Than, ~=6reater Than
~2407
12601
4
12540
5 12600
5A
-AVION
-J-JEROME
HUFFMAN
MCMAHON AVE.
3650 3700I 3750 3800 ;58;50 3860 :5910 3950 4000
/ 2 ,.,= 4 5 6 7 8 9 /O
:~ 12600
//
E1 20 19 I
-LORRAINE
38 1280C
DOROSHIN AVE.
4101
13OOO
6
375O
LEYDEN RD.
6/9
6
/0 J G' 8
4045 J 4101 4145
GR. 2835
241
COPYRIGHT 1985 JMR
229
240 -<((~ 242
251
Rabbit Creek Area Reference Map--P13
~-~ MUNICIPALITY OF ANCHORAP-~
DEPART~ ~[ OF HEALTH AND ENVIRONME. tL PROTECTION
825 L Street, Anchorage, Alaska 99501
279-2511, ext. 224 or 225
Date Received:
#1: Time Time #3:
~2: Time
Date Date Date
Insp Insp Insp
REQUEST FOR APPROVAL ~F INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Security National Bank
Mailing Address: 880 H Street 99501 Phone: 278-1541
Property Owner: Marston Construction Phone: 277-3511
Mailing Address: 2804 West Northern Lights Boulevard
Legal Description: Lot 1 Block 10 Mc Mahon Subdivision
o
Single Faraily Residence: ~x)
Multiple Family Residence: ( )
Number of Bedrooms: Three
Number of Bedrooms:
Well System:
Permit #
Construction
Individual well (x) Co~nunity/Public System ( )
Depth of Well 80' Well Log on File ( )
Bacterial Analysis
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site System (xk
Installed Installer
Manufacturer
Soils Rate Material
Public Utility ( )
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorption Area
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water ~'acilities
Legal Description: Lot 1 Block 10 Mc Mahon Subdivision
Comn~[ent s:
Affadavit Attached: ( ) Letter Attached: ( )
Approved: Date:
Disapproved: Date:
De[~artment Worksheet:
,/'--'~, :
'qUNICIPALITY OF ANCHORAGE ....
Department of Health
Protech~on
and
Environmental
825 L Street, ~chorage, Alaska 99501
279-2511, ext. 224, 225
~equest for Approval of Individual Sewer and Water
e
Property Owner:. /~///~/(~'~--~'A/
Mailing Address: .:-~) ~'~/ /~4
Name of Buyer: X/~ f ~/~'
Lending Institution: t~'f~/~/z , ~ ~T/~'/~F/¢J ~//~
~- 7~7
Mailing Address: ~2O //. ~r, ~O'~ Phone:
Realtor/Agent: ////~ a,-~-T-~
Legal Description,
Street Location:
Single Family Residence: (~' Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply: * Individual Well (VI' Public/Community System ( )
If Individual Well, well depth ~O /
If Community System, name of system
Sewage Disposal System: On-site System (Vi Public System ( )
If On-site System, date of installation:
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77