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HomeMy WebLinkAboutMCMAHON #2 BLK 11 LT 4A-1McMahon #2 Block I I Lot 4A -I #017-362-33 Municipality of Anchorage Page of 72 -013 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: SkI g76P6q PID Number: 6/-7 - 36r2`33 Name:n Wastewater System: EI New Upgrade ICo T Q Address: e o/G 110/ ♦ /- ABSORPTION FIELD Phone:3y5-0s1 j No. of Bedro ;(Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: GPD/S . Ft. Lot: n Block: �//I bdivision: � Depth to pipe bottom from original grade: , 5's Gravel depth beneath pipe � 1 - I 1 / !C O/✓ # Ft. Ft. Township:_ Range:Section: Fill added above original grade: ®.r —Z / Gravel length: C^� J Ft. Ft. WELL: �,q New ❑ Upgrade Gravel width: 'Si Ft. Number gf lines: / Distance between lines: Ft. Classification (Private, A,B,C): Total De P2;e1,47 0 Ft. Cased To: Ft. Total absorption area: 6-oe Od" SQ. Ft. Pipe material: %M Driller: Date Drilled: Static Water Level: Installer: �1 ,/ Date installed: dF - 7 5, Ft. i7 fi/r1G�Tl Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manu cturer: 4Ay : Capacity in ga�S`_� `�" From Tank Field Station Tank Sewer Lines Q//�6 C E Well -100. r /06 \ Material:� Number of Compartmppts: Surface V lea LIFT STATION Water eo Lot�F Size in gallons: Manufacturer: Line /U /G Foundation �� IQ 1 "Pump on" level at: "Pu evel at: High water alarm at: Curtain �B/L% Jot/ Pump Ma odel Electrical Inspections performed by: Drain — BENCH MARK Remarks: Location and Description: CZ6 <A P, Assumed Elevation: /00 FtE �cVol. '•� 1s Inspections performed by: 5 C-161MERIbib Dates: 1st %- 9:2 17034 15831e ever Loop Road, HAWi 2nd - 7- 9 r �,,.. ................ ��°�•% ROBCEERT C. COW a agie River, Alaska "5V,, 8801 vim? ' Wit Department of Health and Human Services approval r 41 ...„........ � .L 4 Reviewed and approved by: L Date: 949A2- 72-013 (Rev. 9/91) MOA 25 PERMIT NO. SW9701 89 PAGE 2 OF 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O, Box 196650 ® Anchorage, Alaska 99519-6650 ® Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4. BLOCK 11. McMAHON S/D NO. 2 P.I.D. NO. 017-362-33 31 Ft 0 14 c a/ i 01� PAGE 1 OF 1�- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970189 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DENISON ROBERT T & MAUREEN E OWNER ADDRESS:13100 KILLEY ST ANCHORAGE, AK 99511-0167 PARCEL ID:01736233 LEGAL DESCRIPTION: MCMAHON *2 BLK 11 LT 4A-1 LOT SIZE: 42202 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 7/15/97 EXPIRATION DATE: 7/15/98 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 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED B ISSUED BY: DATE:' DATE: HEALTHAUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN S&Sl ,Tn eizing June 18, 1997 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 4, Block 11, Mcmahon No. 2 Subdivision Request you issue a permit to upgrade the septic system serving the existing four bedroom house on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. The monitoring tube within the test hole has been cheched and found to be dry. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/mg Enclosure 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1" = 50' DESIGN SITE-PLAN SCALE 0 rw It, 3r � cnpcn� � 00 � tTJ �xr ��z SCJ �cn�� tml- o opo O tJ ,moIWO o p o N � m O 4'� t�7 y `d II r, I in CJ] Don u (A ty Cfl m0 m+r�*t "x" �' 000 _ l7 •0 � �O� zco n SDC H yV]d0 V1• to nit C) -. =jnD Nd .O�"a O r m m 1-4t7 F� V! •C - T ("1 O -t - 013 D ()I " -:c Q-IZ y� M� uziao�n n�� D D o Z O � c --I N AnA= j z� Z F-d m m z-------------------------��_mo-ia �_ p r� �!nmmW�zm 70' SCREEN 3c FENCE EASMENT D - o_----_� �_ t7 •• ZZONr-1=• ---_ 70_ UTILITY EASEMENT r r o c ---m---= -------------- vmz Atnm ---0 l O-zim_Qmm G7 NO WELLS/SEPTIC z �O m-y((j)omo WITHIN 200'+ OF I 0 1-3 _<m `Oy PROPOSED SEPTIC trrJ x -27 p OZ�-<Z O O O Z ,m CO mm 3 mm mmm noz O�z 0 m>� 0 ;c >mOpn z C� �, o A' 'o z o O ~n c o Z t-- n G O oG jJ1 z s ����_ V) O ZK0 nW v {n r 0 r9 m ro3 z r ('l mo 0a COAD -3 O O m �o=mZo m m I -- - �ooxy t co KILLEY STREET o��Omz Pi DA V zy O C y - O I Z7A cn m nomn t�JD < y C L O p O v r z O _o _o O C: xH –zi — o r�° a1-3 o 9� m �" on n HO N b t.n Y W ozoA 0 9H N.13 O p , e Municipality of Anchorage, DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST / �' ROBERT C. COWAN t♦ '`g : CE -8801 PERFORMED FOR: MtlRr/�y� �%t✓h�)SDATE PERFORMED:tt�'/'.d./``," LEGAL DESCRIPTION: L07 y 13LK 11 McP h1"d'v'QTownship, Range, Section: SLOPE SITE PLAN DEPTH (FEET) 1 t77 Si�-T Z eE2 © 2. i; 4/UIcS 4- N - 2 °drtl.v: �= s� 3 �� (y Wf S GSA y L SAS 7- S vitAL r-,�f S.4 -'d -a 17 GrRA✓� L 19- 20 COMMENTS WAS GROUND WATER 0 ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E Depth to Water After OP 7 Monitoring? y Date: Reading Date Gross Time ."tet Net Drop 4-1 0 9 S -j — 3 5 J�l,w 6 ?� S 9 7 ✓ i 8 4 9 10 11 0� x 12 13 i' 14- 4 15 15- C C ,3 16 "a=D �r u 7- S vitAL r-,�f S.4 -'d -a 17 GrRA✓� L 19- 20 COMMENTS WAS GROUND WATER 0 ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E Depth to Water After OP 7 Monitoring? y Date: Reading Date Gross Time Net Depth to Time Water Net Drop P sD a 0 9 S -j — 3 s / J�l,w S 3 ?� S 9 PERCOLATION RATE ---y_ (minutes/inch) PERC HOLE DIAMETER 6 Q TEST RUN BETWEEN FT AND 2 FT PERFORMED BY: 17034 Fagle River Loop Road No. 3 CERTIFY THAT THIS TEST WAS PERFORMED IN � a lg River Alaska 99477 ��/ g % ACCORDANCE WIT �e STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) S&S\ �tn��ninG ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS HEALTH I REFERENCE: Lot 4, Block 11, McMahon No. 2 Subdivision June 18, 1997 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX(907)694-1211 SEWER & WATER MAINEXTENSIONS 1. The scope of this project includes the installation of a foot wide drainfield to serve the four bedroom residence on the referenced property. The existing septic tank is to be excavated, pumped, crushed, and SEWER&WATER abandoned completely, and replaced with a new 1250 INSPECTION gallon septic tank. The existing trench. >sto be abandoned such that they may be used in the future. 2. Construction shall be in accordance with the approved ENGINEERING STUDIES site plan and design drawings, Municipal permit with ANDREPORTS any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. CTION WELOWTES onsor o 3. The contractor shall be responsible fbtainin p g any BPLOW TEST necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas SITE PLANS subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. ROADDESIGN 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own SOILTEST systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: PERCOLATION TEST 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. STRUCTURAL& MECHANICAL 2. The septic tank shall be sufficiently bedded to INSPECTIONS prevent settling or shifting of the tank. ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 4, Block 11, McMahon No. 2 Subdivision June 18, 1997 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (roughed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 4, Block 11, McMahon No. 2 Subdivision June 18, 1997 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 4, Block 11, McMahon No. 2 Subdivision June 18, 1997 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 4, Block 11, McMahon No. 2 Subdivision June 18, 1997 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME Qti PHONE y� -oq2 NEW ElUPGRADE MAILING ADDRE LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS V Y DISTANCE O: Well O Absorption area /Qd Dwelling keg, PERMLT NO. 7 Q eo F- Z w H�e�+ Manufacturer Mate ' 4... No. of compartments y Liq. capacLy in gallons -ZJ IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. _ F Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well �N Foundation ( Nearest lot line �® PERMIT NO. w LL v F Z w No. of lines r Len th of ea h line g �'4 Total len th o lines gs Trench width inches Distance between lines �/ // / I.- p Top of tile to finish grade I - Material beneath tile 610 inches Total effective absorption area .5070 LU (7 Length Width Depth PERMIT NO. CL ~a LU Type of crib Crib diameter Crib depth Total effective absorption area LU DISTANCE TO: Well Building foundation Nearest lot line .j J Class Depth Driller Distance to lot line PERMIT NO. w 3 DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS c z SOIL TEST RATING a57 ` INSTALLER D f C REMARKS d I 6 ` Q A T 7' 16 APPROVED DATE LEGAL 12 /r y �3/ i/ /h 72-013 (Rev. 3/78) ____V PERMIT NO ( 780Z00 ) �PPLICHNT GENE JHNIGO P0 ROX 4~1805 24] 0292 LOCHTION LEYD�N 8 KILLEY LEGHL L4 Bi1 �CMHHON S/� #2 LOT SIZE 29000 SQUHRE FEET TYPE OF 5OIL HBSOR8TION SYSTEM I�� TRENCH MHXIM;M HUMBER OF BEDROOMS � 1 5OIL RHTINS (SQ FT/BR)�,'1�5 y THE REQUIRED SIZE OF THE SOlL HBSORPTIO� SY5TE� IS� THE LENGTH DIMENSION lS THE LENGTH (IN FEET) OF THE TRE�CH OR DRHINFIELD PIT IS T�E DISTHH BETi�EEN THE SURF�CE OF THE THE DEPTH 0F R TRENCH OR GROUND HKD THE BOTTOM GF THE EXCHVHTION (IN FEET) THERE IS HO SET WI�TH FOR TREHCHE5 THE G�HVEL DEPTH IS THE MI�IMUM DEPTH OF GRHVEL BETNEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE EXCRVHTlON (IH FEET) TO INFORM THIS DEPHRT�ENT DURI�G THE PB�MIT RPPLIC�NT HHS THE RESPONSIBILlTY HNY N�LLS HDJHCENT TO THIS PROPERTY HND THE lNSTHLLHTIUN lHSPECTIONS O� NUMRER UF RES�DE��CES TH�T THE WELL WILL SERVE ���L����� FINHL I�SPECTION H�D HPPROVHL BY THI5 6HCKFILLIHG OF HNY SYSTEM NITHOUT DEPRRTMENT NILL BE SUBJECT TO PROSECUTION MINIMUM DISTHNCE BETNEEN H WELL HND HNY ON~SITE SEWHQE DlSPOSHL SYSTEM IS 100 FEET F0R 8 PRIVRTE WELL/ 0R UPON THE TYPE OF PUBLIC NELL i50 TO 200 PEET FROM H PUBLIC W�LL DEPENDI�� R�D MUST BE RET�R�ED TO THE DEPHRTMENT WITHIN ]0 DHYS !�ELL LOGS HRE REQUIRED OF THE NELL COMPLETION SPECIFICRTIONS HND CONSTRUCTION DIHGRHMS HRE OTHER REQUIREME�TS MHY HPPLY HVHILHBLE TO INSURE PROPER INSTHLLHTIOM ���� I��SED BY a MUNICIPALITY OF ANCHORAGE `\ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6.85, Anchorage, Alaska 99502 276-2224 SOILS LOG — PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION- DEPTH (FEET) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS ln--- SOILS LOG PERCOLATION TEST - C,. DATE PERFORMED: d-rl �� �Z7c �2lee h c. —7 . SLOPE SITE PLAN //- /y ' SGIYt��. 1/_5 IL- I W 4L f PERFORMED BY: (! 1 5 72-008 (7/76) WAS GROUND WATER IV! �.' S ENCOUNTERED? OL 1 . P E IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN / Y, /C ✓ ". _ 'I- CERTIFIEDBY:: FT AND (minutes/inch) FT DATE: r 1 1 r M V b r4 N � ^ N -P •rl CH t� S .64 a z e 0® 0 0 0 0 A w O 0 0 0 0 0 x o wv 14 cG SZ 9 W W 94 ca rd cG n ik q >� _w �w w ;L. ON W E, s @ a cd Sa cd a ca o to W . b.o � b.O f 4 [d -3 . hO s n3 . . s :ld S d: i d i rii N cif k1O : -t : w i rl : S•r cd w q Cd ri ; w i : O i-' i O i HW w w w w w w w tti Ga 0: U 4O 4 i o ± O N: ti/-) [d i O i S O N?00O O O O O O O O O O O S; i *-q i 0 0CO H H H F F H H H F H F H N ; N GO 0 0 0 0 0 0 0 Cd C4 f4 9 C4 V. f4 x t•� di wrod w w w w w w w w w W W ° ® z A H H q z z 0 e 0 N z H F CA�Dy \c-) uk,sC-S- Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. COSA #0SC t t. 103 1 Expiration Date: R — 17 —1 n 1. GENERAL INFORMATION Complete legal description Lot 4A-1; Block 11; McMahon subdivision 02 Location (site address) 13100101ley St. Anchorage, AK 99516 Current Property owner(s) Ted a Leslie Kramer Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone 965-2416-Dea5 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site ✓❑ Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm s a s Engineering Address 15861 S. Birchwood Loop Rd. ChuOak, AK 99567 Engineer's Printed Name Roberta sharer Phone 694.2979 _ Dat 5 I t 1 0 44 5. DSD SIGNATURE t J R Approved for _ L4 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: ��• Original Certificate Date: S O (Rev IINS) Municipality of Anchorage••, Development Services Department ' j Building Safety Division -- On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lott -4A• I a1\ Mc, f'1ahert VO f 2 Parcel ID: �t�— 36i "33-goJ A. WELL DATA Well type PdJr.V-e__ If A, B, or C provide PWSID # _ Date completed /ig Sanitary seal (Y/N) -\1 Total depth If- ft. Cased to FROM WELL LOG Date of test Static water level ' t)A owA ft. Well production ISS g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL NitratelT `Sm /L LAII Arsenic: J`_fiC ug/L date of sampte:� O B. SEPTIC/HOLDING TANK DATA Tank Type/Material 5e t' Ste, Tank size 12 -Cb gal Number of Compartments Well Log (Y/N) Y Wires properly protected (Y/N) Casing height (above ground) in. + AT INSPECTION 41`7 ft. d g.p.m. Other bacteria U colonies/100 mL Collected by: 1t Date installed g -i I Y9 i Cleanouts (Y/N) Foundation cleanout (Y/N) Depression over tank (Y/N) �/I _ High water alarm (Y/N) N Date of pumping 5/10 10 Pumper R //b+Nt SvcS� C. ABSORPTION FIELD DATA Date installed ") Soil ratin(g.p.d./ft r ft2/bdrm) 1.7— System type Tr-cAc-h Length So ft. Width 3 ft. Gravel below pipe S ft. Total depth l2_S ft. Eff. absorption areaS�bb fe Monitoring tube Depression over field Date of adequacy test LO Results (Pass/Fail) tiS5 For _q_ bedrooms Fluid depth in absorption field before test Q in. Water addegat. New depthj] in. Elapsed Time: 410 min. Final fluid depth Z in. Absorption rate >= �00 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) M0 If yes, give date � D. LIFT STATION Date installedr+' 'Pump on' level a E. SEPARATION DISTANCES Size in gallons off" level at —in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot IW -t Absorption field on lot Ibn r -f Public sewer main At Jr - Sewer /septic service line 2f f y Animal containment areas 'Sb r+ High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots / O D ,'f Public sewer manhole/c cleanout Al Holding tank N 1/ - Manure/animal excrete storage areas [o(3 r4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 6-1 'f Property line <-4 Absorption field S'rf Water main /6 If Water service line /Orf Surface water tco If Wells on adjacent lots�j D� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 { Building foundation /Or* Water main /b ->: Water Service line U r r Surface water /Uo f-! Driveway. parkingfvehicte storage (0 Curtain drain Hone Wells on adjacent lots _(Cuff,* F. COMMENTS ' G. ENGINEER'S CERTIFICATION I certify that I have determined review of Municipal records t conformance with MOA COSA t Engineers Printed Name Date _S I:TO COSA Fee Date of Payment V1 I I / d Receipt Number (Rev. 11/05) h field inspections and above systems are/in J Waiver Fee $ _ Date of Payment Receipt Number A, ndas 141ya 491y* Ieth L. D. LS -8202 LOT 3A-1 5 89'53'00" W 190.00' I—x x—p— x�—x—+—•—A paaEa 10' TELECOMM., ELEC. k UTILITY EASEMENT 35.0 1D.D I I II 21;'0 At EXISTING HOUSE n 30' ttl ELEG IS CAAKNi v? N A —vw v1v—x�x�aw—v.—.__r— D — 30' OV Imo. W 190.00' I�I�I�I O O i LEGEND: SET TWO H l a l l y l SNEO ]/9lb a/r @ 5/r M O 1wot em N. wa.r.xi® with RE AX PROPERTIES Irar na elrewaalmea rNwa on,ala he. a wa fr n y � f I Ile $UoYEV URIIFK:A : LAHTEUI has emeuelao a arawANG- I D m A baainV ma Val Ma Ynyanr^r'la e1w1.E Ivan I�I' I~I m e. IM weer lY wa• MW ne Mwcn- wyxKT_ ti 0) 1 AS—BUILT OF; UGK OES Tqn I I I I i I +o VEST BENSON BLVD. 103 ANCHORAGE, ALASKA 99503 (907) 562-5291 LOT 4A-1 BLOCK 11 r oRUER'- ;!,Pr. 9. 1997 vii". I I I I I LOT 4A-1 ]e ADDITION TO AIcMAHON SUBDIVI�ON i ,a;/3"I„COND I I I I y I I I I I I I I 35' AWWU WATER EASEMENT At EXISTING HOUSE n 30' ttl ELEG IS CAAKNi v? —vw v1v—x�x�aw—v.—.__r— —r _ _ _ _ — — _ — 30' N 89'57'49" W 190.00' C%CLU90N NOBS: It Y Ina amri napm•ewy le alr,niry LEGEND: SET TWO o an BONNIE MEHNER IIw .r4lmca .1 mY .oar"ml. eawnmla s raalr4nma anq a nal appar m Me a odou.uea•w.4n pal NOR: ]/9lb a/r @ 5/r M O 1wot em N. wa.r.xi® with RE AX PROPERTIES Irar na elrewaalmea rNwa on,ala he. a wa fr em.Uwlb1 w for 4•Iew4nH9 yaartx M. rtN¢-x x $UoYEV URIIFK:A : LAHTEUI has emeuelao a arawANG- PhAkd ra••x of IN. yearly e• .6.ar1 m IN. o=) "Cos- baainV ma Val Ma Ynyanr^r'la e1w1.E Ivan ONU[ Crt- m e. IM weer lY wa• MW ne Mwcn- wyxKT_ a.a.t al emr Man al mu n.a.lcmc ® AS—BUILT OF; UGK OES Tqn ��rtv ES -m LAND A CDNSTRUCTIOLI SURVEYORS-PLANNERS-ENGIkEERS +o VEST BENSON BLVD. 103 ANCHORAGE, ALASKA 99503 (907) 562-5291 LOT 4A-1 BLOCK 11 r oRUER'- ;!,Pr. 9. 1997 vii". (fa.) 561-6626 97—L a,AE r OeNFN^ ADDITION TO AIcMAHON SUBDIVI�ON -484A ,; ,a;/3"I„COND SGS Refp Client Name Project Name/p Client Sample ID Matrix Sample Remarks: 1101784001 S R S Engineering L4A-I;D I I;McMahon p2 L4A-I;R I I;McMahon 82 Drinking Nater Printed Date/Time Collected Dale/Time Received Date/Time Technical Director 05/102010 9:09 04292010 13:15 04292010 13:25 Stephen C. Ede Allowable Prep Analysis Panm eter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic 5.00 U 5.00 ug/L EP200.8 C (<10) 04/30/10 05/07/10 KDC Waters Department Total Nitmtc/Nitritc-N 4.25 0.100 Microbiology Laboratory Colony Count 0 Fecal Coliform 0 Total Coliform 0 mg/L SM204500NO3-F D (<IO) col/IOOmL SM2092220 col/IOOmL SX12092220 col/IOOml. SM2092220 04/30/10 AYC 04/29/10 DLC 04/29/10 DLC 0429/10 DLC 05/17/2010 11:15 8686770 494 4•1,l6Mi ft •� also- lt� `t♦ ♦ ~ 1 • W �llF� ♦♦ ae �fA r• A i•Lt +p S�R�CS 7501 E• 140th Avenue Anchora3ge laAa 99516 CUSTOMER APLUS PAGE 01 INVOICE # 3 7 9 7 2 !NC. AMOUNT f'4 /2L -[–)Gallons V, Septic Leach Area Holding Tank � Standpipes `D- %Time ❑ PROBLEM AREA — CALL FOR MORE INFORMATION 15�, NEEDS TO BE DONE AGAIN IN 6 MONTHS ❑ Good Shape &S. Sludge buildup on bottom j Floater on top ❑ Jim cap missing or ❑ Cut standpipe to 11 above ground ❑ Needs Septictrine needs replacing Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Pmgrsm :4700 South Bragaw St. P~O. Box 196650 Anchorage, AK 99519-6650 · www.d.anchorsge.alLus (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR 'A' SINGLE FAMILY DWELLING P~rcel I.D. 017-362-33 1. GENERAL INFORMATION Expiration Date: oIOi7o O-O l Completalegaldescrtption LOT 4-A; BLOCK 11 MCldAHON S,/D ADDN. #2 Location (site address or directions) 13100 KILLEY ST. Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BRIAN PATRICK 13100 KILLEY ST. Dayphone 265-1299 Dayphone 261-7600 PEGGY KELLY / DYNAMIC PROPERTIES Dayphone 3111 "C' ST. ANCHORAGE, AK. 99503 261-7625 Unless otherwfse requested, HAA will be herd by DSD for plckup. 2. NUMBEROF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ~ Individual Water Storage Community Class Well [~] Public Water System TYPE OF WASTEWATER DISPOSAL= Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Cerbf~cates of Health Authority Approval ara required for the transfer of title (except between spouses) for properties served by a single family on-sita wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Ce~ficetes of Health Authority Approval are valid for 90 days from the date of issue for preperiJes served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year wlth valid water samples.) Certificates are valid for one year for prope~es served by Class A or B wells er a public water system. The Munlclpality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. Note: Alaska Water and Wastewater Consultants, In~ shall be paid $1110.00 a& or pdor to dosing for the engineering services provided. , 4. STATEMENT OF INSPECTION BY ENGINEER - * ' As ce~fied by my seal affixed hereto and as of the validation date shov/n below, I verify that my Invesb'gation, based on I~r~:~chJt~S outlined Ih *ti~e H~atth Authon~ Approval Guidelines for this application, shows that the on-site water supp~ and/or wasteWater disposal system is(are) safe, functional and adequate for the numbe~' of bedrooms and ~ of structure indicated herein. I further veri~, that based on the information obtained from the Municipality of Anch~'age files and from my lnvestigation and Inspection, the on-site wate~ supp~/ a~d/or~ste~/ater disl~esa] system is(are) in compliance with ~1 applicable Municipal and State codes, ordinances, and regulations In effect at the t/m,e of Installation. ' Name of Firm ALASKA WATER &: wASTE'WATER CONSULTANTS, INC. Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504. Englneer's Printed Name JEFFREY A. GARNESS, P.E. Phone 337;6179 Engineer's Comments: In conduc~'ng this e~aluaffon, AWWC, Inc. attempted to provide a thorough, conscientious englneadng analysis of the system In accordanoe with ADEC and MOA DSD Guidelines & Regulations. The reported msul~s descnT~d the performance of the system under the condiffons encountered at the time of the test, and separaffon distances measured to readily Identifiable features. The operational life of all wells and sep#c systems depend on the local se/Is cond~on, groundwater levis that may £uc~a~e during the year, and the water usage of the family being served by the system. These conditions am outside the ¢n:~Yol of the evaluator of the system. Satisfactory test results do not guarantee futura perlorn3ance of the system, nor do they guarantee that thera am no hidden defects or encreachmen~s. AWWC, Inc. can therefore not provide any warranty or futura estimate of how long the system will ¢onb'nue to meat the operational requirements of the ADEC or MOA DSD. Tho content of this repo~ Is for the solo bono§t of the owner listed above. Any reliance upon er use of this report I;y any other person er party is not authorized, nor ~fll It confer any legal right wha 5. DSD SIGNATURE ~" Approved for ~" bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory ~,. Manltenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: ~ - Municipality of Anchorage Development Services Department OmSlM W-~r 8, Waatw~ter I~ 4700 Sol~h Bragaw 6L P.O. Box 196650 AncO, AK 99519-665O ~Mw.d.~homge.alcus (907) ~.3-7904 Legal Dascrlp~on: A. WELL DATA Welltype PmVA~ ifA, 6. or Cprovkle PWSID~ N/A Date completed 6-24-76 ~ ~ (Y/N) YES Total depth 75' lt. Cased to 40'+ f~ HEALTH AUTHORITY APPROVAL CHECKLIST MCUAHON LOT 4A-1 BLK 11 Parcel ID: FROM WELL LOG 6-24-78 .g.p.m. Date of test Stefie water level UNK Well production 15 WATER SAMPLE RESULTS: Collfom~ J~ colonies/lO0 mi, Date of ~ample: 4-18-01 B. SEPTIC/HOLDING TANK DATA 2 Dapresalon over tank (Y/N) NO Pumper BE NN. GRADE Soil rating (~or ~FDdn~) 1.2 W~Jth 3° It. Tank Type/Material =~CCL "'Tank'Sl!ze 1250 gal, NumberofCompe~tments Foundafien cleanout (Y/N) YES Date of pumping 4/19/01 C. ABEORP'nON FIELD DATA Date Instelled o-?-o7 Leng~ 50' ~ AT INSPECTION 4-18-01 47' .ft, 6.07 .g,p,m, AWWC~ INC, 017-562-33 Y t2.75 lt. Eft. absorpfien ama 500 ft' System type DEEP TRENCH Gravel below pipe 5' MonlteHng tube YES . Depmsalon over field NO For 4 bedrooms New depth 16.0 In, 600+ g,p.d. ffye~, give date - Total deplh Dateofedequacytest. 4-18-01 Resulte(Pass~all) PASS Rulddepthinal:~orp~flaldbefomtest 1,0 In, Wateradded 966 gal, Elapsed Time: 15 min, Final auld depth 13.0 In, Abeorpfien rate Any mJuvenafien treatment (past 12 mo,) (y/N & type) NONE KNOWN YES 12' In, Date Installed 6-7-97 High water alarm (Y/N) N/A MCDONALD~ D. UFT STATION Date Installed Size in gallons 'Pump on' level et in, 'Pump n. High water el;Inn level et in. ~ Cycles tested Meste elann & circuit requirements? E. SEPARATION DISTANCE~ SEPARATION DISTANCES FROM W~ ~ ON LOT TO: Septic tenk/llft eteUon on lot, 100'+ Absorplion field on lot 100'+ Publlc sewer meln Sewer/esSo service line 25'+ On adjacent in~, 100'+ On adjacent lots, ~ 00'+ Publlc sewer nmnhole/cteanout Holding tank 75+' N/A SEPARATION DISTANCES FROM SF..PT;C/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ A~on field Water main N/A Water ~en'lce line 10'+ Surface water Wells on adjacent lots lOO+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line. 10'+ Water esn~ce line. 25'+ Curtsln drain. NONE KNOWN F. COMMENTS Bulidlng foundation lO'+ Surface water 10o'+ Wells on adjacent lots. 100'+ 5'+ 100'+ Water main N/A Driveway, paine/vehicle storage 30'+ G. ENGINEERS CERTIFICATION I cerffy that I have determined through field inspecflons end rm4ew of Mun/c/pa/n~:ords fi]at ~e ebove eystem8 ere/n conformance with MOA I. JA4 guidelines in effect on this date. Enginee?e Print/pal Na/~e Date ~'~.~_./¢2 / JEFFREY A. GARNESS Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number. Parcel I.D. # 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 - CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 017-362-33\' 1. GENERAL INFORMATION HAA# 0 CVAc 1i �L 1 - Complete legal description McMahon S/D Addn. #2. Lot 4A-1 , Block 11 , Location (site address or directions) 13100 Killey Stree Property owner Jeff and Sandy Shaffer Day phone 345-5665 Mailing address 1 31 00 Killey Street Anchorage, AK 99516 Lending agency Day phone Mailing address Agent Beth Mehner w/ Jack White R.E. Day phone 563-5500 Address 3201 C Street, Suite 200 Anchorage, AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well xx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 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 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. ALASKA WATER & WASTEWATER Name of Firm CONRULTANTS ) IN C• Phone 6901 DEBARR ROAD, SUITE 213 Address ALlnunonn_c Al AQUA wenn Engineer's signature Alaska Water & Wastewater Consultants, Inc. shall be paid $1100.00 at closing for the engineering services performed. , 6. Dr SIGNATURE _ Approved for i—OU7' bedrooms. Disapproved. Conditional approval for Additional Comments 0 _ Date a41V V — � . Jeffr A.. Garnen ; C .7953 p�FROFESSIO���v .. bedrooms, with the following stipulations: Date Z -23 -?C) 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Pe .1/91) Back MOA #21 Municipality of Anchorage FEB 16 1999 DEPARTMENT OF HEALTH & HUMAN SERrb(QEEkurr OF ANCHORAGE _ Environmental Services Division ENVIRONMENTAL SERVICES DIVISIO 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Me. JAANod _!!�/ AD DO- JU Z. Parcel I.D.: 01-7 - M(OZ -33 LoT 14A-1; 8:L c v, Ili; A. WELL DATA % Well type PRrQN--r% If A, B, or C, attach ADEC letter. ADEC water system number �/ A Log presentON) YE -5 Date completed !Co f Z4/1-6 Total depth I Cased to 401+ Casing height (above ground) , ✓ I �i Sanitary seal ON) Wires properly protected O/N) 7� FROM WELL LOG Date of test fo /Z178 Static water level V i( Well production AT INSPECTION -Z /16 A � q4:5 1 g.p.m. -7.0 WATER SAMPLE RESULTS: Coliform Nitrate 4' �a vv^A` � Other bacteria Date of sample: Z�fv��e1 Collected by: A -W,w, c. tNC B. SEPTIC/HOLDING TANK DATA 9.p -m. Date installed 8/-11/11 Tank size M;0 Number of Compartments 2- Cleanouts (,7/N) YeS Foundation cleanout ON) VC -5 Depression (YS tJo High water alarm (Ye N �' Date of Pumping `- i&)qc1 Pumper OL -P r&jbaR1.01s PDwvPrwC. C. ABSORPTION FIELD %DATA Date installed S / / °h7 Soil rating g.p.d./ or ftp) t System type 'r2EN� Length So Width a i Gravel thickness below pipe I Total depth 17-7S' Effective absorption area VO q6 Monitoring Tube present (VN) TSS Depression over field (YO) (4 0 Date of adequacy test Z/e 4lo' Results ltas Fail) PASS For I bedrooms of Fluid depth in absorption field before test (in.); OR's Immediately after1�11 gal. water added (in.): Or Fluid depth 0 (ins) Minutes later: Absorption rate = (0004- g.p.d. Peroxide treatment (past 12 months) (YO Ivv,te Kovo m If yes, give date �r 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) Fligh water alarm level at* E. SEPARATION DISTANCES *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons "Pump off" level at* SepticMa tank on lot 100�On adjacent lots 1001 IF Ahenrnfinn fialrl nn Int lora' i- nn nd isrpnt Ints 1001 Public sewer main N/ k Public sewer manhole/cleanout N 1 Sewer /septic service line Z S f Lift station SEPARATION DISTANCES FROM SEPTIC/JNNPWG TANK ON LOTTO: I Foundation Z©1.� Property line 10 � Absorption Water main/service line 101f' Surface water/drainage 10al + Wells on adjacent lots 10014 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line X01 Building foundation y1f Water main/service line to f f Surface water 1,00 I f Driveway, parking/vehicle storage area Curtain drain t4014E kwcwj Wells on adjacent lots 1v01 t F. ENGINEER'S CERTIFICATION I certify in confc inspections and review of Municipal re fs in effect on this date. Signatur Engineer's Name ���^ ""� / fit' `''"7 WSJ Date 2h9�- HAA Fee $ Waiver Fee $ Date of Payment cx �� Date of Payment Receipt Number ` `7` ` Receipt Number 72-026 (Rev. 3/96)* y0 OF A v eff A. Gar s ow 'v 'f-7953 are MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services IPALITYOFANCHORAGE On -Site Services Section MENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 AUG 1 343-4744 8 199 7 CERTIFICATE OF HEALTH AUTHORITY i / RECEIVED APPROVAL FOR A SINGLE FAMILY DWELLING i v C Parcel I.D. # o) -7 _ 3 b a — 3 HAA # �` t�31 a 1. GENERAL INFORMATION �� Lbs uli Complete legal description Lot 4; Block 11; McMahon Subdivision #2 Location (site address or directions) 13100 Killey Anchorage/ AK Property owner Robert & Maureen Denison Day phone 345-0315 sR` Mailing address P.O. Box 110167 Anchorage, AK 99511-0167 Lending agency G.M.A.0 Mortgaqe Day phone Attn: Mina Odell Mailing address Agent Geri Crowley/ Remax Properties Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water 562-2181 276-2761 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone- Cg y _ -2cf -77- Address Eagle River, Alaska 99577 Engineer's signature J`�` C�ADZ_ Date ?// S/ 9 7 R06ERT C. COWAN /,:k - CE - 8801 f �� 6. DHHS SIGNATURE Approved for pp bedrooms. 1�18aa"����• Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: s Date -� 4UTIC 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 �l Municipality of Anchorage MUNICIPALITY OF ANCHORAGE p y ncg ENVIROAL SERVICES DIVISIONa DEPARTMENT OF HEALTH & HUMAN SERVI ; 1 Environmental Services Division AUG 1 Rfgg7 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist E C E I V L. Legal Description: Lor 7000K 11 & A&A) SID -a c;? Parcel 1. D.: 0/7-10 -� A. WELL DATA Well type Idfi(T/G If A, B, or C, attach ADEC letter. ADEC water systemnumber Log present(ON) (ES Date completed � -�� 7Io Total depth -75 r Cased to y0 �¢ Casing height (above ground) X74' Sanitary seal 0) T icz Wires properly protected (PIN) FROM WELL LOG AT INSPECTION Date of test / &✓j-�7 o 7 Static water level VI �A/off 1� Well production 15 g.p.m. 9 -P.M. WATER SAMPLE RESULTS: Coliform 0 Nitrate 3. 7,Y Other bacteria 0 Date of sample: 63 / 01-7 Collected by: S & S ENGINEERING 7034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDIINNrG TANK DATA Eagle River, Alaska 99577 Date installed D "7-� % �T/ank size ��� 0 Number of Compartments Cleanouts�}y N) v�S Foundation cleanout'./ 1),. / Depression (Y®1® High water alarm (Y/N)_24N Date of'Pumping, Pumper .y C. ABSORPTION FIELD DATA.; ~. Date installed7 ' .° Soil rating (g.p.d./ft2 or ft2/bdrm) % a System type ejF-�UC�� Length. �� ' Width 'S ✓ , Gravel thickness below pipe Total depth /G.5 Effective absorption area t Monitoring Tube present/ J) / E5 Depression over field (YA0 A0 Date of adequacy test' WE Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.); Immediately after= gal. water added (in.): _ Fluid depth ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level E. SEPARATION DISTANCES Size in gallons eve at` "Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot i UO If "Pump off" level at` On adjacent lots /0011 1 , Absorption field on lot IC) o f On adjacent lots 1G v >< Public sewer main _ iUy �f Public sewer manhole/cleanout /Oy ' F Sewer /septic service line o? 5 4 Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: r i i Foundation �0 Property line 0 '_ Absorption field Water main/service line /O Surface water/drainage 0e -- Wells on adjacent lots 104 / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /dBuilding foundation Zd ,� Water main/service line 9 Surface water ��rdo / Driveway, parking/vehicle storage area Curtain drain /`a//'NO� M/a /� Wells on adjacent lots F. ENGINEER'S CERTIFICATION l certify that l have determined thru field inspections and review of Municipal in conformance wi�M� g. 'defines effect on this date. Signature Engineer's Name _ o a �,e/ C C& tie Date HAA Fee $ �U Date of Payment/ Receipt Number ��f7 72-026 (Rev. 3/96)' Waiver Fee $ Date of Payment Receipt Number , �0 f ROBERT C. COWAN 1,1>- CE•8801 Ate, ; are c c sk MUNICIPALITY OF ANCHORAGE MUNICIPALITY 0i ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 O DEPT. Of . '! 8, EN'VIRONiv,GCTION ENVIRONMENTAL ENGINEERING DIVISION JUIV 1 j'jCl,tl� Telephone 264-4720 NUMBER OF BEDROOMS ,, pp jj�� EQ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE�?C���TYEE DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER ❑ Two ❑ Five PHONE MAI LING ADDRESS 7. WATER SUPPLY v c a wleD 9 PROPERTY RESIDENT (If differe�nt fromabove) + / ❑ COMMUNITY PHONE ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM 2. BUYER I INDIVIDUAL/ON-SITE** PHONE �o f T, c�ivi If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY MAILING ADDRESS - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 3. LENDING INSTITUTION PHONE MAI LING ADDRESS 1�204-t GLI 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One CO Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM **If individual/on-site, installation date I INDIVIDUAL/ON-SITE** give If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) wjr THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY Cl INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES WELL T0: Septic/Holding TanT bsorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APP OVAL (letter must accompany certificate) ❑ DISAPPROVED DATE zlzc,-� BY (Title LEGAL D SCRIPTION 72-010 (Rev. 3/78) #l'i�,clM0.hav� a 04�j - �►� sal eL4 ckj4,.,. 1,94 MUNICIPALITY OF ANCHORAGE ECONOMIC DEVELOPMENT AND PLANNING P.O. Sox 196650 OFFICE USE Anchorage, Alaska 99519-6650 PRELIMINARY PLAT APPLICATION RECD BY., \� \ VERIFY OWN: A. Please fill in the information requested below. Print one letter or number per block. Do not write in the shaded blocks. 1. Vacation Code 2. Tax Identification No. 017-361-01000 lolll-71.314 I2 0 2 odd 3. NEW abbreviated legal description (T1 2N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34). �eeo■ae■■ean��ei .. ■c■r�ii■ 0i7 -36Z.-03000 617362-61-000 4. EXISTING abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34) full legal on back page. Ann■a■n■n■n■r�n�ee■■■n■■■■■ e■eede�■der�n■■n®■oen■ene■ 5. Petitioners Name (Last - First) 6. Petitioner's Representative Address 3390 W1flnoc-r9 r2CL6 City {It.)Cffpeftz State Phone #34S''8537 Zip CN5/(o Address 340 Pears City AfJC"RA6E State h4 Phone # 319 4619 zip ! 95/5- 7. Petition Area 8. Proposed 9. Existing 10. Grid Number Acreage Number Number Lots Lots � � I I 8 3 12. Fee $ 11. Zone f 13. Community Council Ou rfwll1 D M 899( B. I hereby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to subdivide it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment of the basic subdivision fee is nonrefundable and is to cover the costs associated with processing this application, that it does not assure approval of the subdivision. I also understand that additional fees may be assessed if the Municipality's costs to process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may o be po poned by Planning Staff, Platting Board, Planning Commission, or the Assembly due to administrative reasons. Date: 7 "o�3` Signature *Agents must provide written proof or authorization. 20-003 (Rev 6/89)MOA-24 e C. Please check or fill in the following: 1. Comprehensive Plan — Land Use Classification Residential Commercial Parks/Open Space Transportation Related 2. Comprehensive Plan — Land Use Intensity Special Study 3. Environmental Factors (if any): a. Wetland 1.- Developable 2. Conservation 3. Preservation Marginal Land Commercial/Industrial Public Lands/Institutions Dwelling Units per Acre Alpine/Slope Affected b. Avalanche ,1 c. Floodplain Alpine/Slope Affected Industrial Special Study d. Seismic Zone (Harding/Lawson) D. Please indicate below if any of these events have occurred in the last three years on the property. Rezoning Case Number Novi Subdivision Case Number Conditiona! Use Case Number. .Zoning Variance Case Number Enforcement Action For Building/Land Use Permit For Army Corp of Engineers Permit E. Legal description for advertising. F. Checklist 30 Copes, of Plat .Reduced Copy of Plat (81/2 x 11) Certificate to Plat Fee Topo Map 3 Copies Soils Report 4 Copies Aerial Photo Housing'Stock Map Zoning Map Water:y Private Wells Sewer: Private Septic 20-003 Back (Rev. 6/89)MOA-24 Waiver Community Well Public Utility Community Sys. Public Utility VACATION OF RIGHT-OF-WAY OR EASEMENT APPLICATION • Municipality of Anchorage DEPARTMENT OF COMMUNITY PLANNING & DEVELOPMENT P.O. Box 196650 Anchorage, Alaska 99519-6650 A. Please fill in the information requested below. Print one letter or number per block. /296 0, /30150 0. Case Number (IF KNOWN). Street Address /3 pQ01 1. Vacation Code eoeoo■■■■ oeoomo■o�ii 11 2. Abbreviated Description of Vacation (EAST 200 FEET SOME STREET). OFFICE USE RECD BY: VERIFY OWN:- AFFIDAVIT:- POSTING: WN:AFFIDAVIT:POSTING: Tax I.D. Number 0/"1-36;� -o/ loll 171316121017-1 of 7 362 03 d/7 362 04 3. Existing Abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOT 34). ee■■a■e�■■■e■eee®®■®s■■eee�ee■eeee■■ eased■■■doe■oe�■■■■■■■■■■■■■■■■■■■■ r.s.©©ioen■e■■■■■■■■■■■■■■■■■■■■■■ 5. Petitioner's Representative. Address: 33KO W Hf iQJEi 152. City: PoX eW ti6t- State: A-1� Zip Code: 019,/6-; 7%W Phone No. 34.x"^ F5737 Address: 340 P&TrIS 40A City: kC({606E State: Zip Code:99S/'r Phone No. 34'9 -149 6. Petition Area Acreage. 7. Proposed Number Lots. 8. Existing Number Lots. 9. Written Justification. 10. Grid Number. 11. Zone. 3 Ld I IRI-I&I t 12. Fee $ 13. Community Council .4L[F9 E. , nereby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to vacate it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment of the basic vacation fee is nonrefundable and is to coverthe costs assP-iated with processing this application. that it does not assure approval of the vacation. I also understand that additional fees may be assessed if the Municipality's cost to process this application exceed the basic fee. I further understand that assignpd hearing dates are tentative and may have to be postponed by Planning Staff, Platting Board, Planning Commission. or the Assembly duP to ad istrative reasons. Date: 7 —A? -f=3 200191Rev 9:927Front Signature Agents must provide written proof or authorization. C. Please check or fill in the following: 1. Comprhensive Plan -Land Use Classification Z_ -Residential 0 Marginal Land 0 Commercial 0 Commercial/Industrial O Parks/Open Space 0 Public Lands/Institutions 0 Transportation Related 2. Comprehensive Plan - Land Use Intensity: 0 Special Study 3. Environmental Factors (if any): a. Wetland 0 1. Developable 0 2. Conservation 0 3. Preservation 0 Dwelling Units per Acre: 0 Alpine/Slope Affected b. Avalanche 0 c. Floodplain 0 0 Alpine/Slope Affected 7 Industrial 0 Special Study d. Seismic Zone (Harding/Lawson) 0 D. Please indicate below if any of these events have occurred in the last five years on the property. 0 Rezoning Case Number: 0 Subdivision Case Number: 0 Conditional Use Case Number: J Zoning Variance Case Number: 7 Enforcement Action For 0 Building/Land Use Permit For E. Legal Description for Advertising. kUS �.�� 3 . ef X/ Ar hr- (r PAC /V R f�,O S 0Q�0 E&C00_0' HD1776A) F. Attached written statement in accordance with AMC 21.15.130.6. stating reasons in support of the vacation. G. Checklist 0 30 Copies of the Vacation Request 7 Reduced Copy of Vacation (8 1/2 x 11) 7 Certificate of Plat 7 Fee 7 Topo Map 4 Copies 7 Soils Report 4 Copies 7 Aerial Photo 7 Housing Stock Map 7 Zoning Map 7 Water: P ivate Wells 7 Sewer: TPrivate Septic 20 019 9921' Back Waiver 7 Community Well 7 Public Utility 7 Community Systems -1 Public Utility Vacation of Right -of -Way We propose to vacate the East 35 feet of right-of-way on Pintail Street along the West line of Block 11 McMahon Subdivision. This portion on Pintail Street is not used by local resident for access into their properties. The vacation of right-of-way would not adversely effect or deny any property owner in any direction access to their property. There is a vacant area South of McMahon that unauthorized use takes place on a regular basis of 4 -wheeling, parking, drinking ect. . This vacation would stop this non -local traffic from traveling between Kempton Park Subdivision and Block 11 of McMahon Subdivision. w m , m t n n0 1 ¢ ° °n°AO v¢i ybnc e o mccI / a - rn. - 9NI8G39 d0 sisye tto e t Ileal I a rm al ee zeal a _wio co v - ^ m n I' .9fl' ma as m oc -- Oi _9g t22 � .a9'OE2 auF 40 6I-- M cava 91. 133EI1S 11tl141d 9� � E1r Im K �• S I SA. O T I Ll!�< \1 �� •' - - - 133SIS A311Ir I¢ ^ oc.gym F =� 4e� I Ini cp mO s m 4C w B r v, o IJ I 1 E iJ C D D a [n o> D R s s om 1 - ` e` L:q s s P s may- a o m D D > Z O - r 91 angio � ^ iu➢ c9 m p90 mzl< �� oyao- c o � ec y, J w h m ®y D O O O D y m b x °. Z D' pecan 'b C07 nm MM or m 6' 9 oma 000 �- and -zmmrc 7z SZty AU n°vi n z ao "aAx.w n t, o 0 _ as ° N� _ y Fmo � b e➢