HomeMy WebLinkAboutMACBETH BLK 1 LT 2AMacb
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Lot 2A
01§-§11
-15
O
Municipality of Anchorage
Development Services Department ':"~
Building Safety Division
On-Site Water and Wastewater Program, 4700 EImore Road
P.O. Box 196650 Anchorage, AK 99507 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: OSP101096 PID Number: 015-511-15
Name: Joe & Beverly Mulcahy Wastewater System: [] New [] Upgrade
Address:
6655 Macbeth Drive Anchorage, AK ABSORPTION FIELD
Phone: Number of Bedrooms:
4 [] Deep Trench [~ Shallow Trench [] Bed [] Mound [] Other:
Soil Rating: Total Depth from odginal grade:
LEGAL DESCRIPTION 1.2 GPD/Ft2 6 Ft,
Block: 1 Lot: 2A Subdivision: Depth to pipe bottom from odginal grade: Gravel depth beneath pipe:
Cross View Estates 3 Ft. 3 Ft.
Township: Range: Section: Fill added above original grade: Gravel Length:
0-3 Ft. 59 Ft.
I I~ New I I~U 0 ' 'pgra-e Gravel width: Number of lines: Distance between Ii ....
Well:
5 Ft. 1 - Ft.
Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
Existing Ft. Ft, 508 Ft2 ASTM D3034 PVC
Ddller: Date Drilled: Static Water Level: Installer: Date Installed:
Ft. Phillips Construction North
Yield: GPM PumpSetat: Ft. CasingHeightAboveGround:
Ft. TANK
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
T~ To Septic Absorption Lift Holding =ublic/Pdvate Manufacturer: Capacity:
Tank Field Station Tank Sewer Line Anchorage Tank 1,250 Gal.
Material: Number of Compartments:
we, >100' >100' >100' N/A >25' Steel Two (2)
Surface Water >100' >100' >100' N/A i~ /' ' LIFT STATION
Size: Manufacturer:
Lot Line .5' .5' N/A N/A Gal.
"Pump on" level at: "Pump off" level at: in. High water alarm at:
Foundation >5' >10' >5' N/A in. in.
Pump Make & Model Electrical Inspections performed by:
Curtain Drain None Noted
Remarks:
See Lot Line Waiver For Tank and Trench. BENCH MARK
Location and Description:
NE Corner Concrete Slab at Doorway East of Garage.
Assumed Elevation:
100.0 Ft,
A Harala
Inspections performed by: ........ _ Dates: 1st 7/12/10 ~,...~.~_~.
Development Services Department Approval ,
Conditional Approval Date:
Permit No.: OSP101096
LOT1A
S2 67.7' } 83.7'
C4 90.1' 1104.0'
C5 87.3' 101.6'
M1 57.3' 62.7'
M2 78,6 62.9
UNSUBDIVIDED
M1
M u nicipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
2006-157
MACBETH SUBDIVISION, ADDN. NO. 1
LOT 2A, BLOCK 1 /
-----.- ~ -.-.-.-.- -.-.-.. 59,815 S.F. /
-- -- ~0' X 20' Anchor Easement
~10o' Streom Setbock
Existing
Well
Three Bedroom Home
\
\ /
2~9.70
PLAN AS-BUILT
SCALE 1" = 50'
Page 2 of 3
PID No. 015-511-15
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP101096
Page 3 of 3
PID No. 015-511-15
y96.5
2"
1,250 Gall
Septic Tank
I \ //
, 9~0,//
~ ,- 99.8 04 ~
rgb. ~d Finished Ground
_ ~iFinished Ground
Existing Ground
2" Insulation
, ~ , , / / / / / GeotextileFabric
92.55 ~, Drainfield Rock
89'5--/
Groundwater 84.5 -~-/--- 78.5 89.
6/21/10
92.55
59' (Trench Length)
I
PROFILE AS-BUILT
No Scale
On-Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 EImore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP101096
Tax Code Number: 01551115000
Work Type: Septic Upgrade
Permit Effective Dates: July 02, 2010 to July 02, 2011
Design Engineer: ANDERSON ENGINEERING
Subdivision: MACBETH
Site Legal Address: MACBETH BLK 1 LT 2A G:2639
Owner/Address: MULCAHY JOSEPH F JR &
BEVERLY A 6655 MACBETH DR ANCHORAGE AK 995160000
Site Mailing Address: 6655 MACBETH DR, Anchorage Lot Size in Sq Ft:
Total Bedrooms:
59815
4
This permit is for the construction of:
Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with: 1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: Permit includes waiver OSP101097 allowing the drainfield to be within 0.5
feet of the south and west property lines.
'?- i : - / c,,~ ~. ~.~. / ,,!cc(' ~ --r-I.,~. ~,: ~
Received By: .,/
Issued By:
/
Date:
Date:
Municipality of Anchorage
ONSITE WATER. & WASTEWATER. PROGRAM
CHANGE ORDER
PERMIT # SP101096
PID No: 015-511-15
SUBD Macbeth
TRACT BLOCK 1 LOT 2~A
CONTACT PERSON Michael E. Anderson, P.E. PHONE 522-7773
FAX 677-7766
PLEASE GIVE A DESCRIPTION OF THE CHANGE: The absorption
trench was originally designed in three sections. The owner
decided to abandon a section of the driveway and complete the
absorption trench in one segment. This will eliminate the need
for three splitter valves and result in a more effective system.
CUSTOMER SIGNATURE
On-Site
Reviey
Comments
Issued
(date)
Review
Time
(hours)
APPROVED (date)
TOTAL HOURS ~'~
HOURLY RATE $130
TOTAL TO BE PAID
Municipality of Anchorage
P.O. Box 196650 ® 4700 Elmore Road
Anchorage, Alaska 99519-6650 ® (907)343-7904 · Fax (907)343-7997
http://www.muni.or.q/Onsite
Development Services Department
On-Site Water and Wastewater Pro,qram
VARIANCE/WAIVER REVIEW ****
WR#: OSP101097 HA#: Permit~: OSP101096
PID#: 015-511-15
Legal Description: Macbeth Block 1 Lot 2A
Engineer: Anderson En,qineerin,q
Applicant: Joseph & Beverly Mulcahy
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 0.5 feet.
This waiver approval applies to the existing absorption field to property line separation only.
Any future upgrade to the on-site wastewater disposal system will require all separation
distances be met or another approval from this department.
Waiver is Granted: X Waiver is not Granted:
Date: 7/2/2010___ Approved by:
//N~me
of Reviewer
Recf¢: 065513 Amount: $200.00 Date Paid: 6123/2010
**** VARIANCEhNAIVER REVIEW ****
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
V,.~... ~.: 0$'~l°~q 7 FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-511-15
Property owner(s) Joseph & Beverly Mulcahy
Mailing address 6655 Macbeth Drive Anchorage, AK
Site address 6655 Macbeth Drive Anchorage, AK
Day phone 727-3111
Zip Code 99516
Zip Code 99516
Legal description (Sub'd., Block & Lot) Lot 2A, Block 1, Macbeth Subdivision
Legal description (Township, Range & Section)
Lot Size 59,815 Sq. Ft. Number of Bedrooms
Four (4)
THIS APPLICATION IS FOR ([~ all that apply):
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
THIS APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
June 21, 2010
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Subject:
Lot 2A Block 1, Macbeth Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The existing absorption system on the subject lot has failed and must be upgraded prior
to issuance of a Certificate of On Site System Approval for the property. We are
therefore requesting a permit be issued for the upgrade of the septic system to
accommodate the three-bedroom home on the lot. The system however is designed for
four bedrooms. The attached Site Plan and backup documentation identify the location
and configuration of the existing and proposed septic system. The existing 1,000 Gallon
Septic Tank will be pumped, crushed and backfilled. The existing absorption trench
system will be left intact for possible reuse in the future. Also identified on the plans are
the locations of the existing well on this and adjacent lots and adjacent septic systems.
No conflicts exist between the proposed septic system and the wells on this or adjacent
lots. Protective radii are shown to the adjacent wells. Drainage arrows are shown
indicating the current drainage patterns. The drainage patterns will be maintained after
construction.
The well on the lot is located in the approximate center and the lot is bordered on the
east and north by a stream. The 100' setbacks from the well and surface water
severely limits the location for the septic system. The only available area is near the
southwest corner of the lot which is in front of the house. The existing septic system is
located in the back of the house as shown on the attached Site Plan.
The test hole recently placed on the lot indicated well graded gravel with some silt
(GW/GM). The percolation rate was determined to be 1.7 minutes per inch in the
accepting layer. We have designed the new trench in two sections to straddle the
existing driveway. We are proposing to place a 51' long trench, 5' wide with a 3'
2006-157
MACBETH SUBDIVISION, ^r"r~N ~'~
1
LOT 2A, BLOCK 1
59,815 S.F.
Well Radius and South & West Property
Lines Must be Staked by a Surveyor Prior
to Start of Construction.
/
UNSUBDIVlDED LOT 5 /
~$5.49
-- ~ ; n~ ~"'~ -10' X 20' Anch°r E°sement
Under Drivewoy. Xx / Kennell)
1,250 Gallon /~//B~qc~..~ or~e~
6 NSy53'~O"E
1' Long x 5' Wide MA~OR~~ --
x ~' Effective Depth --
.....
SITE PLAN
SOA~E ~"= ~o'
LOT 2A, BLOCK 1, MACBETH SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom System 5' Wide Trench System
Perc. Rate: 1-5 Min./Inch 1,000 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 3' Drainfield Rock
4 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 500 SF Absorption Area
500 SF/5 SF/LF*.58 (Red. Factor)= 58 LF Trench Length
THEREFORE: Construct a 61' Long x 5' Wide x 3' Effective Depth Absorption Trench at the
Location Shown. Flow Line Elevation in Trench to be 3.0' Below Original Ground Surface. Total Depth
to be 6' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption
Trench. Maintain 100' Separation from Wells in the Area. Place 2 Flow Splitter Valve to Insure Even Flow.
1611
1011
Natural
Backfill
Geotextile
-- Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away. ~
Minimum 6', Separation From Bedrock. ~:;Z..~...i~.~...i.~,~.~
Minimum 4 Separation From Groundwater. ~~~..~
Minimum 100 Separation From Wells in the A .
' Minimum 100' Separation From Surface Water or Streams.-
&700
DEPTH
(feet)
1
2
3
4
5
6
7
8
9
11
[VlUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
BRAGAW STREET ANCHORAGE, AK 99519-6650
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: 6/18/2010
PARCEL ID#:
SOILS LOG - PERCOLATION TEST
LOT 2A, BLOCK I, hflACBETH SUBDIVISION
OB/OG
CLEAN GRAVEL
GW/GH
iVlORE SILT
WITH DEPTH
BOH @ 17.0'
JOE lv]ULCAHY
?RO]ECT Bio.:
TECHNICIAN:
TEST HOLE 1
WAS GROUND WATER ENCOUNTERED? __
IF YES ~ WHAT DEPTH?
DEPTH OF WATER AFTER MONITORING:
DATE OF MONITORING: 6/71/10
IV1. ANDERSON
SLOPE
No
SITE PLAN
SEE SITE PLAN
O%
DATE
6/20
I
DEPTH
TO
READING GROSS TIHEINET TIHEIWATER NET DROP
(INCHES)
(MINUTES) I (MINUTES) ] (INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
3.25"/9.50"
6.25"
1 10:15/10:25 10
2 10:26/10:36 10 3.13"/9.00" 5.87"
3 10:37/10:47 10 3.25"/9.06" 5.81"
4 10:48/10:58 10 L25"/9.00" 5.75"
10:59/11:09 10 3.13"/8.88" 5.75"
6 11:10/11:20 10 3.06"/8.81" 5.75"
PERCOLATION RATE: 1.7 (MrN/rNCH) PERC. HOLE DIA. 6" .(rNCHES)
TEST RUN BETWEEN: 3.5 FT. and 4.5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 9/10/£007
4700
DEPTH
(feet)
1
2
3
4
5
6
7
8
9
11
1
20
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LOT 2A, BLOCK I, MACBETH SUBDIVISION
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: 6/18/2010
PARCEL ID#:
JOE MULCAHY
PROJECT No.:
TECHNICIAN:
TEST HOLE 1 [
OB/OG
CLEAN GRAVEL
GW/GM
MORE SILT
WITH DEPTH
WAS GROUND WATER ENCO~D? 1
IF YES ~ WHAT DEP~?
DEP~ OF WA~R ~TER MO~TO~G:
DATE OF MO~TO~G: 7/I/t0
BOH @ 17.0'
M. ANDERSON
SLOPE
No
SITE PLAN
SEE SITE PLAN
O%
DEPTH TO
DATE READING GROSS TIME NET TIME WATER NET DROP'
(MINUTES) (MINUTES) (INCHES) (INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
6/20 1 10:15/10:25 10 3.25"/9.50" 6.25"
2 10:26/10:36 10 3.13"/9.00" 5.87"
3 10:37/10:47 10 3.25"/9.06" 5.81"
4 10:48/10:58 10 3.25"/9.00" 5.75"
5 10:59/11:09 10 3.13"/8.88" 5.75"
6 11:10/11:20 10 3.06"/8.81" 5.75"
PERCOLATION RATE: 1.7 (MIN/INCH) PERC. HOLE DIA. 6" fiNCHES)
TEST RUN BETWEEN: 3.5 FT. and 4.5 FT.
CO~ENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PE~O~ED BY A~ERSON ENGINEE~NG. I, ~C~EL E. A~ERSON CERTIFY T~T
THIS WAS PERFO~ED IN ACCO~ANCE WITH ALL STATE AW ~ICIPLE GUIDEL~S ~ EFFECT ON THIS
DATE: 9/10/~007
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 2A, MACBETH SUBDIVISION
GENERAL:
The scope of this project includes the pumping, crushing and backfilling of
the existing 1,000 gallon septic tank currently on site. Work also includes the
placement of a new 1,250 gallon septic tank and construction of a new 51'
long X 5' wide X 3' effective depth absorption trench in three sections at the
locations also shown on the Site Plan. The distribution line in the trench will
be placed at 3' below the existing ground surface. Total depth of the trench
will be 6' below the existing ground surface. The new absorption trench must
be placed a minimum of 100' from all private wells and any surface water in
the area and 10' from the water service line on the lot. A minimum of 3' of
cover is required over the absorption trench. Two flow splitter valves must be
placed to insure even flow to each of the trench segments.
Construction shall be in accordance with the approved site plan, design
drawings, Municipal Permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the location
of all lot lines. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
Unless specifically agreed otherwise, the contractor shall be responsible for
final grading areas subsequently depressed from soil settling. Property
owner shall be responsible for revegetation of affected areas unless
specifically agreed otherwise.
Contractors installing wastewater disposal systems must be certified by the
Municipal Development Services Department Building Safety Division On Site
Water and Wastewater Program for system installations. Owners installing
their own systems must receive prior approval from the On Site Water and
Wastewater Program before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,250-gallon septic tank must be procured from an approved source
and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
Lot 2A, Block 1, Macbeth
June 21, 2010
Page 2 of 3
3. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial
insulation.
6. A foundation cleanout shall be installed one to four feet from the building
foundation. Two cleanouts are required between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive slope exists away
from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the design.
The bottom of the trench shall be within 2" of level.
Distribution piping must be placed level with perforations down atop a level
bed of drainfield rock. Rock should then be placed over the pipe to provide a
minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield rock
and the natural soil backfill.
Monitor tubes must be 4" in diameter and installed at the locations shown on
the design. The portion below the distribution line must be perforated.
Contractor shall verify the septic tank and drainfield are a minimum 100' away
from any private water wells in the area, 150' from a Class "C" Well or 200'
from any community well.
Direct bury insulation must be placed over the distribution system if less than
3' of backfill depth is available. Finish grade over the trench must be
mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
A minimum 2' of accepting soil is required below the drainfield rock for a 5'
wide trench. Contractor shall verify this condition prior to placement of the
rock. All pockets of unacceptable materials must be removed and replaced.
Lot 2A, Block 1, Macbeth
June 21, 2010
Page 3 of 3
MATERIAL SPECIFICATIONS:
1. Septic tanks 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:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and
solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662
or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Co. Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the
#200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These inspections
must be conducted under the supervision of a professional engineer registered
in the State of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled.
The second inspection must be conducted after the placement of the geotextile
fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No
backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction notes
for use in preparing the certified as-built of the completed system.
Municipality of Anchorage
'Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-511-15
GENERAL INFORMATION
Complete ,legal description Lot 2A, Block 1, Macbeth Subdivision
Location (site address) 6655 Macbeth Drive Anchorage, AK 99516
Expiration Date:
Current Property owner(s) Joseph and Bevedy Mulcahy
Mailing address 6655 Macbeth Drive Anchorage, AK 99516
Day phone
Lending agency
Mailing address
Day phone
Real Estate Agent
Mailing Address
Unless otherwise requested, COSA will be held by DSM for pickup.
2. NUMBER OF BEDROOMS: Four (4)
Day phone
3, TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
......... qndividual-Well ..................... ~ .................... Individual On=site ..... []
Individual Water Storage [] Individual Holding Tank []
Community Class ~ Well [] Community On-site []
Public Water System [] 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.
Municipality of Anchorage
'Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-511-15
GENERAL INFORMATION
Complete legal description Lot 2A, Block 1, Macbeth Subdivision
Location (site address) 6655 Macbeth Drive Anchorage, AK 99516
Expiration Date: / O '- ~,,~ -' / ~
Current Property owner(s) Joseph and Beverly Mulcahy
Mailing address 6655 Macbeth Drive Anchorage, AK 99516
Day phone
Lending agency
Mailing address
Day phone
Real Estate Agent
Mailing Address
Un/ess otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: Four (4)
Day phone
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
........ q ndividual-Well ...................... ~] ............ dndividualOn=site ........ []
Individual Water Storage [] Individual Holding Tank []
Community Class ~ Well [] Community On-site []
Public Water System [] 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.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & 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 CHECKLIST
Lot 2A, Block 1, Macbeth Subdivision
Legal Description:
A. WELL DATA
Well type Pr~ate
Date completed 516/68
Total depth 200'* ft.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL
Arsenic: N/D ug/I
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,250 . gal.
Foundation cleanout (Y/N) Y
Date of pumping New Const.
C. ABSORPTION .FIELD DATA
Parcel ID: 015-511-15
IfA, B, or C provide PWSID # Well Log (Y/N) Y*
Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Cased to >40 ft. Casing height (above ground) >18
FROM WELL LOG AT INSPECTION
5/6/68- 3/14/10
153' ft. 141 ft.
3o* g.p.m. 4.61 g.p.m.
Nitrate .193 mg/L
Date of sample: .4/15/10
Number of Compartments Two
Depression over tank (Y/N)
in.
Pumper
Other bacteria 0 colonies/100 mL
Collected by: Gamess Engineering Group'
Date installed 7/12/2010
Cleanouts (Y/N) Y
N High water alarm (Y/N) N
Date installed77.13/2(~lO Soil rating (g.p.d./ffz or ft2/bdrm) 1.2 GPD/SF
Length 59 ft. Width $ ft.
Total depth 6-9 ft. Eft. absorption area 5o8 ft2 Monitoring tube
Date of adequacy test New Const. Results (Pass/Fail) .__
Fluid depth in absorption field before 'test in. Water added
Elapsed Time: min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
System type 5' Wide Trench
Gravel below pipe 3 ft.
Y Depression over field N
For bedrooms
gal. New depth in.
in. Absorption rate >= g.p.d.
N If yes, give date.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Eimore Road
P.O. Box 196650
. Anchorage, AK 99507
www. muni.org/onsite
(907) 343-7904
CERTIFilCATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
LOt 2A, Block 1, Macbeth Subdivision
IfA, B, or C provide PWSID #
Sanitary seal (Y/N) Y
g.p.m.
'Cased to >40
FROM VVELL LOG
5/6/68*
Nitrate .193 mg/L
Date of sample: 4/15/10
Number of Compartments Two
Depression over tank (Y/N)
Pumper
Legal Description:
A. WELL DATA
Well type Private
Date completed .5/.6~6
Total depth 200'* ft.
Date of teS{ ~ '.".
Static water level 153'
Well production 30*
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL
Arsenic: N/D ug/J
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,250 . gal.
Foundation cleanout (Y/N) .¥
Date of pumping New Const.
C. ABSORI~FION FIELD DATA
Date installed 7/13/2[~10
Length 59 ff.
Total depth 6-9 ft.
Soil rating (g.p.d./ftz or ft=/bdrm) 1.2 GPD/SF
Width 5 ft.
Eft. absorption area 508 ft2 Monitoring tube
Date of adequacy test New Const. Results (Pass/Fail) ~
Fluid depth in absorption field before 'test in. Water added
Elapsed Time: min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Parcel ID: 015-511-15
· Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) __
AT INSPECTION
3/14/10
141 ft.
4.61 g.p.m.
Other bacteria
Collected by:
o colonies/100 mL
Gamess Engineering Group
System type 5' Wide Trench
Gravel below pipe 3 ft.
Y Depression over field N
For bedrooms '
gal. New depth in.
in. Absorption rate >= g.p.d.
N If yes, give date
Y
>18 in.
Date installed 7/12/2010.
Cleanouts (Y/N) Y
High water alarm (Y/N) N
UNSUBDIVlDED
N
SCALE: 1"= 30'
LOT1A
10' X 20' ANCHOR EASEMENT
overed storage
I
I
L._J
\
\
~lanter
/
Well
.3 Oh
36.0
2 Sto~ Frame c~
House b
17.5
b 18.5
Conc.
wall
~,eg,(~c '~
/
/ /
/ /
/ /
/
/
LOT 2A
~ /Chain link fence
:~--~ x ~(Kennell)
.......--f
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON.
FB 10-1, pg 2
BE
8347'O'
25
25
RECERTIFIED 7~21-10~, i~''
AS-BUILT NO CORNERS SET THIS DATE
I hereby certify that I have perfor~ned a Mortgagee's inspection
of the following described property: LOT 2A, BLOCK 1,
MACBETH SUBDIVISION. ADDITION No. 1
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not ovedap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 10th day of March ,2010
FRED WALATKA & ASSOCIATES
Engineers and Surveyors
(907-248-1666)
dUI.ZU. ZU U IZ'd~FlVl harness bn¢[neer~nS Mroup, Ltd. No.92b6 P, 3
SGS Ret# i 101592001
Client Name Garne~ Engineering Group, Ltd Printed Date/Time 04/20/2010 16:19
Project Name/# MacBeth B1,L2A Collected Date/Time 04/15/20] 0 14:35
Client Sample ID MacBeth B 1,L2A Received Date/lime 04/15/20] 0 15:20
Matrix Drinking Water Technical Director Sfeohen C. Ede
Sample Remarks:
Allowable Pr~p Analysla
Parameter Rcsult~ LOQ Unlra Method Container iD Limit~ Date Dalg Init
~'~, ~ zc~/~
lqardness as Cae03
185 5.00' mg/L SM20 234011 C 04/19/10 04/20/10 SCL
Waters Depa:, ,'c~mnt
Total N itrate/Nitrite-N
0.193 0.100 mg/L SM20 4500NO3-F B 04/16/10 AYC
Priv~t~ In,iv&dual AnalysiS,
Aluminum 20.0 U 20,0 ug/L EP200.8 C 04/19/i 0 04/20/10 SCL
Antimony 1.00 U 1.00 ug/L EP200,8 C (<6) 04/19/10 04/20/10 SCL
Arsenic 5.00 U 5.00 ug/L EP200.8 C (<l 0) 04/19/10 04/20/10 SCL
Barium 11.9 3.00 ug/L EP200,8 C (<2000) 04/19/10 04/20/10 SCL
Cadmium 0.500 U 0,500 ug/L EP200.8 12 {<51 04/19/10 04/20/10 SCL
Calcium 51900 500 ug/'L EP200.8 C 04/19/10 04/20/10 SCL
Chromium 2.00 U 2.00 ugfL EP200.8 C (<100) 04/19/10 04/20/10 SCI,
Copper 1.61 1.00 ug/L F, P200.8 C (<1300) 04/19/10 04/20/10 SCL
Iron 250 U 250 ug/l. EP200.8 C (<300) 04119/10 04/20/10 SCL
I~..ad 0.200 U 0.200 ug/L EP200,8 C (<15) 04/19/.10 04/20/10 SCL
Magnesimn 13500 50.0 aWL EP200.g C 04/19/10 04/20/10 SCL
Manganese 194 * 1.00 ug/L F, P200.8 C (<501 04/19/10 04/20/10 SCL
Chloride 6.82 0. I00 mg/L EPA300,0 D (<250) 04/16/10 04/16/10 RIT
Fluoride 0,100U 0.100 mg/L EPA300.0 D {---2) 04/16/I0 04/16/10 RIT
S~lmium 5.00U 5.00 ug/L EP200.8 C (<50) 04/19/10 04/20/10 SCL
Sndium 4670 500 ag/L EP200,8 C (-o_50000) 04/19/I0 04/20/10 SCL
Silver 1.00 U 1.00 ug/L EP200.g C (<100) 04/19/10 04/20/10 SCL
Thallium 1.00 U 1.00 ug/L EP200.8 C (<2) 04/19/10 04/20/10 SCL
Sulfate 8.71 0.100 mgg.. EPA300.0. D (<250)' 04/16/10 04/16/10 RJT
Zinc 32.9 5.00 ug/L EP200.g C i<5000) 04/19/10 04/20/10 SCL
Jul,20, 2010 ]2:39PM Garness Engineer n~ Group, Ltd,
No,9256 P, 4
$G$ Ref.#
Client Name
Project Name/#
Cllcnt Snmple ID
Mutrix
1101592001
Ga-ness Engineering Group, Ltd
MacBeth B 1,L2A
MacBeth BI,L2A
Drinking Water
printed Date/Time
Collected Date/Time
Receiv~l Date/Time
Technical Director
04/20/2010 16:19
04/15/2010 14:35
04/15/2010 15:20
Sleuhen C. Ede
Allowable Prep Analyr&
Param ~t ex R,~ul~ LOQ Units Melhod Containe~ ID I.imit~ Dam Da~ Init
Toad Dissolved Solids 201 I0.0
Nickel 2.00 U 2.00
HC03 Alkalirdly 156 10.0
C03 Alkalinity 10.0 U 10.0
OH Alkalinity 10,0 U 10.0
Conducdvily 342 1.00
pH ~.10 0.100
Alkalinity 156 I 0.0
Colony Cotmt 0
Total Coliform 0
Fecal Coliform 0
mg/L SM20 2540C D (<500) 04/19/I0 AYC
ug/L EP200.8 C (<I00] 04/19110 04/20/10 SCL
mg/L SM20 2320B D 04/16/10 lOT
mg/L SM20 2320B D 04/16/10 R.IT
mg,/L SM20 2320B D 04/16/10 KIT
umhos/crn SM20 25IOB D 04/19/10 KIT
pH uaits SM20 4500-H B D (6.5-8.5) 04/16/10 loT
mg./L SM20 2320B D 04/I6/10 R.Yf
col/100mL SM20 9222B A 04/15/10 DLC
col/100mL SM20 9222B A (<I) 04/15/10 DLC
col/lOOmL SM20 9222B A 04/15/10 DLC
IVIUNICIPALITY 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 PHONE iXUPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION ' ' ~ ~ NO. OF BEDROOMS
I Wel ' ~ Absorption area
DISTANCE TO'.
Manufacturer --
[Liq. capacity in gaTIons I .......... ns de length
~,~ ~ ~ IF nu,v,:,v,~uc:
DISTANCE TO'
Well ~ Foundation
DISTANCE TO: I ~ i /~
No cfi n~ I Length of each line l Tota e%gt%o~l .es
Topofftofmlshgrade ~] Materlalbe.eathtlle
I Length Width I Depth
Type of crib Crib diameter I Crib depth
DISTANCE TO:
~Cl~s Depth ~ Driller
DISTANCE TO: Bud ngfoundation Sewer line
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
IWidth
Material
Nearest 7tBe
ITrench width
,~O inches
APPROVED DATE LEGAL
PERMIT NO.
No. of com~
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Total effecti.~s~tion area
PERMIT NO.
Total effective absorption area
Nearest lot line
Distance to lot line PERMIT NO.
Septic tank Absorption area(s)
.Lo-r $
It is the tes~onsik;ility of I]~e o.mer or
builder, prior to etm,~-uction, to verify
propo~ lmil~ng b~:de re!a~ve to
grade and utility cotmccgons :md to detemgno
O~e exl fence of any e:t~:ments, covenants, or
rt:stdctiqns wMch do not appe:,r on t!te r~
corded mbdivi:::on
MLJ~"~ ][ (Z; ]] F'~L. ! 1-Y OF' J:~N[.],}qOF<~qOE
DEF'ARTMENT OF HEALTH AND ENVIRGNHEN'rAI_ F'RGTECTIGN
82~5 L !.~TREET, ANCHORAGE, AK 99501
264-'4720
F'ERMIT NO:
DATE ISSGED:
850466
08/() J./85
APPLICANT: JOSEPH F MULCAHY.~ JR HILLSIDE CONSTR
ADDRESS: F:' 0 BOX 4-2657 ~~
CONTACT PHONE: 276-5211
LEGAL DESCRIP~ SUBDIVISION: MACBETH LOT,
SECTIGN: 2~ TOWNSHIP: iRN RANGE: 3W
LGT SIZE~ 59815 (SQ.FT. OR ACRES)
MAX BEDROOMS:
Listed below ~re the eptions available to you in designing your septic
system. Choose the,option that best Fits youp site.
DEF'TH TO PIPE BO'¥TOM (FT.) 4.0 4.0 4.0
GRAVEL. DEPTH (Fl'.) 5. () O. 5 3.5
I'OTAL DEPTH (FT'.) 9.0 4.5 7:5
GRAVEL WIDTH (FT.) [~!. 5 22.0 5.0
GRAVEL LENGTH (FT.) 64.0 42.0 69.0
GRAVEL VOLUME (CU.YDS.) '.].~2..6 54.5 51.2
TANK SIZE (GALS) 1,000.0 ** 1,000.0 *'~ 1,000.0
SOIL RATING (SQ.FT. /BR) 212 205 212
.~* TANK MUST NAVE A"F L. EEAST TWG COMF'ARTMENTS ~ ~ ~ logo ~~
I certi~'y that:
1. I am ~'amiliap with t~e requirements ~ on-site sewers and wells as set
~'c~pth by the Municipality oF Anchclpage (MGA) and the State o~' Alaska.
2. I will install the system in accordance with all MGA crudes and regulatl~ns~
and in compliance with the design cr~iteria oF this permit..
3. I will adhere to all MOA and State oF Alaska requirements for the set back
distances ~rom any mxisting well, wastewater disposal system er public
sewerage symtem on this or any adjacent or nearby lot.
4. I understand that this permit is .valid For a maximum ~o ~ bedrooms and
any enlargement will require an additional permit.
IF A L. IF'¥ STATION IS INSTAL. LED 11'4 AN AREA COVERED BY,MOA BUILDING CODES,
THEN (1) AN ELECTRICAL F'ERMIT AND INSPECTION.MUST BE GBTAINED; (~) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL. INSPECl"IGN REPORT; AND (3) THE
ELECTRICAL ~RK MUST BE DONE BY A L. ICENSED ELECTRICIAN.
......SIGNED ' ~ ~ ~ ' DATE_:
DATE /w --
I ! 3 ! E. 76th Ave. ~ 10 I
AnChorage, Alaska 99518
(907) 344-8042
SOILS LOG [-~
pERCOLATION ]-EST____ []
DAT E___.?/~__~_~//. ~ ~'
Job No ~c~'
LEGAL DESCRI PTION~g~~ ~-~ ~.~--.~ ~-~-~': ~.-Z---~-<--~.;
SO~ TYPE DEPTH DESCRIrTIgN SLOPE SITE PLAN
The Municipality of Anchorage Department of Health and Human S~i~e~ (DHHS) issues
ApprOval Certificates based only, upon the representations given Par~graPl~ 5 above by an
professional engineer registered in the state of AlaSka; The DH HS doesthisasa cOurtesy to purchasers of homes '~'
g institutidns in order;to satisfy certain,
"'~ a, ~e'~ifi~t~
Municipality of Anchorage
~ Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~ ¢.A)~ h' ~./~. ~ ~ ~_~/ Parcel I.D.
A. Well Data
Welltype ¢i~c'~1~ IfA, B, orC, attach ADEC letter. ADECI
water system number
Log present (Y/N) y Date completed /~'F ~') ~ ~ Driller
Total depth ~' ~-'(~/' Cased to Casing height
Sanitary seal (Y/N) Wires properly protected (Y/N)
jCROM WELL LOG AT INSPECTION
Date of test /¢'Y~ y* (~) ~ "~'~ ! ~-~
Static water level j ~ ~ r /~ ~
Well flow ~ ~) g.p.m. ~ g.p.m.
Pump level1 [?~ -- ~ ~O/' ¢__ ~:)~:) /
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot j ~ I ; On adjacent lots
Absorption field on lot ~ (,¢ -Z/£ ; On adjacent lots
~ / ~ PubliC sewer manhole/cleanout /~/'~
~ ~ Petroleum tank ,/tV'
Public sewer l)3ain
Sewer service line
WATER SAMPLE RESULTS:
Coliform /~/,/~
Date of sample: /~//~/~/~[
B. SEPTIC/HOLDING TANK DATA
Date installed 4~
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
/
Nitrate 0 ~ /
/ ¢ ¢~ Collected by:
Other bacteria
Tank size l (~ 0 ~ Compartments
Foundation cleanout (Y/N) y Depression (Y/N)
~ Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
!
Well(s) on lot
TO property line
Surface water/drainage
On adjacent lots
Absorption field
Foundation / ~/
Water main/service line ~>,
72.026 (3/93)* Front ~ : ,, CONTINUED ON BACK PAGE'
C. LIFT STATION ~
Date installed Manufacturer
Size in gallons ~ Manhole/Acces~(~t)''/
Vent(Y/N)__ ~~~...~._ ~Pump off" Level at
SEPARATiO,~J31~NCE FROM LIFT STATION TO:
Well on lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed.~ ~ ? / ~ /' ~' ~ Soil rating (GPD/Ft2),_, [[ ~--~
Length Width .'~ ~ Gravel thickness
Total absorption area ,~ ~-~O Cleanout present (Y/N) /h/
System type -~-/'~.~FPd2~
Date of adequacy test ~"/~/~/J j~'J?~t.
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Total depth /~ x
Depression over field (Y/N) ~
Results (pass/fail) F~:~ ~ ~ for ,-~ Bedrooms
, ?7, ~/ After test ~-~ "O
~ !f yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
/
?
Well on lot J(~ ~- ,On adjacent lots ~ ~/(~:~) Property line
/
/
To building foundation 6~ ~' To existing or abandoned system on lot
On adjacent lots ~.~ (rp /
Surface water -~ ,/
Cutbank ',A,~ O/C?~ Water main/service line '/ ~ /
Driveway, parking/vehicle storage area ~'~ ~ '
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe~tonthe,date of this inspection.
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)° Back
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE
2505 FAIRBANKS STREET
FAIRBANKS, ALASKA 99701
ANCHORAGE, ALASKA 99503
(907) 456-3116 · FAX 456-3125
(907) 277-8378 · FAX 274-9645
James sizemore & Assosiates
6410 Switzerland Drive
Anchorage AK 99507
Attn: James Sizemore
Report Date:
04/22/94
Date Arrived: 04/18/94
Date Sampled: 04/18/94
Time Sampled= 1550
Collected By: JS
Our Lab #: A130292
Location/Project: -
Your Sample ID: Lot 2A B17 MacBeth
Sample Matrix: Water
Comments:
Lab
Number Method Parameter
* Definitions *
B = Below Regulatory Min.
H = Above Regulatory Max.
E = Estimated Value
M = Matrix Interference
D = Lost to Dilution
MDL = Method Detection Limit
Units
Date Date
Result * MDL Prepared Analyzed
A130292 EPA 353.3 Nitrate-N mg/1 <MDL 0.10 04/20/94
Chemistry Supervisor
J. Lange
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE
2505 FAIRBANKS STREET
FAIRBANKS, ALASKA 99701
ANCHORAGE, ALASKA 99503
(907) 456-3116 * FAX 456 3125
(907) 277 8378° FAX 274-9645
DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA
James Sizemore
Public Water System I.D.#
Date Received:
Date Analyzed:
Date Reported:
Next Sample Due:
04/19/94 Time Received:
04/19/94 Time Analyzed: 14:00
04/21/94 Time Reported: ll:ll
Collected by: js
sample Type:
Routine
Method of Analysis:
MMO-MUG (Colilert)
Comments:
S =
U =
POS =
ND =
TNTC =
CG =
HSM =
SA =
Old =
Comments: R =
NT =
Satisfactory
Unsatisfactory
Positive Test Result
None Detected
Too Numerous To Count (>200 Colonies)
Confluent Growth
Heavy Sediment Masking, Results May
Not Be Reliable
Sample Age >30 Hours But <48 Hours,
Results May Not Be Reliable
Sample Age >48 Hours, Too Old For
Analysis
Resample Required
No Test
* # Colonies/100 ml
** # Colonies/mi
Sample Sample Total* Fecal* Other* HPC**
Location Date Time Lab# coliform Coliform~ Bacteria Result Comments
............................................................... ..75~'~.~,~,. - ......................
1 Lot2A BK I Macbeth 04/18/94 15:50 AB3980 ND ND ~/ NT NT S
Drinking Water Analysis Report for TOtal Coliform Bacteria
READ INSTRUCTIOHS ON REVERSE SIDE BEFORE COLLECTING SAMPLE
Commercial Testing & Engineering Co.
Environmental Laboratory Services ~~'t~r.~'~"~'j,~r~'t~',~rj,~-j.,~.
5633 B Street
Anchorage, AK 99518-16OO
Tel: (907) 562-2343
Fax: (907) 561-5301
M-UST BE COM?LETED BY WATER SUPPLIER
[] UBL C WA= SYS=MI. .
~L~mv^r~ wAr~R sYsTm
: [] SendResubs [] SendInvo~Ce
Month Day Year
S AzMPLE TYPE:
E/ Routine [] Treated Water
12 Repeat Sample (for routine samp{e .,~ Untreated Water
with lab ref. no. )
-\
[] Special Purpose
Time Collected
SAMPLE LOCATION Collected By
Pl~e
TO BE COM?LETED BY LABORATORY
Analysis shows dais Water S.~V2LE to be:
Satisfactory,
Unsatisfactory,
Sample over 30 hours old, results may
be u~reliable
[] Sample too long in transit; sample should
not be over 48 hours old at exam/nation
to indicate reliable results. Please send
new sample via special del/very mail.
Time Received
Analysis Began
AnatTtical Method:..~"~vr"embrane Filter
[] lvLMO-MU O
* Number ofcolodes/100 mi.
Lab Ref. No. Result*
405023 ~
Analyst
Sent to A.D.E.C. )tach Fbks Jun
Date: Time:
Client notified of unsatisfactory results:
Phoned Spo'kewlth
Date: Time:
Faxed
[]
Faxed
C O1TIIII~I1TS:
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG Result: Total Coliform
Membrane Filter: Direct Count
~ Coli
~ Colonies/100 ml
Verification: LTB BGB COLIFIRM
Fecal Coliform Cou!rmnatlon
Final Membrane F~ilter Results /~ ColiforrrfflO0 nfl
TNTC - Too Numerowt To
OB - Other
~,~ g'~'~--~-~ Member of the SGS Group (Soci6t6 G6n6rale de Surveillance)
Parcel I.D. #
1.
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
HAA # .
GENERAL INFORMATION
Complete legal description /~_~-~L
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
UnleSs otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev 1/91) Fronl MOA #21
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~l!Joqln¥ q~l~eH senss! (SHHC]) seo!AJes ueuJnH pu~ q},leeH ~o ~,uetuiJ~dea e§~Joqou'v' jo/~l!led!3!unDl eqJ.
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'9
Id:a~lNIONg AE! NOIIO:adSNI dO .LN::qRglV.LS
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Descr pt on:,/---~T'~---/:;/~j ,~/~E-~ ~/_../~'~ Parcel I.D.
A. WELL DATA
Well type /::::?//7~?~?_r'~ If A, B, or C, attach ADEC letter.
Log present (Y/N) ~'
Total depth
Sanitary seal (Y/N)
ADEC water system number
Date completed Driller
Cased to ~'~"~/' Casing height
Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test / '/- [ ~) -~' ~-'
Static water level ~/'¢:~ ~
Well flow g.p.m, ~
Pump level ~-----" <::~(~ /
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main ,~,2,~
Sewer service line ~ ~ /'
; On adja'cbnt lots
;On adjacE~nt :i6ts
Public sewer manhoie/Cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: ~ ~ ~ ~/~-~ 3
[ f//~// Other bacteria /'~/~-2//~ ~
Collected by: ,, /" ~("¢z~"~i~/~
B. SEPTIC/HOLDING TANK DATA
Date instal,ed Tank size Compartments
Cleanouts (Y/N) 7 Foundation cleanout (Y/N) ,~/:' .Dep.r..e,~§ion (Y/N)
High water alarm (Y/N) /~v// · Alarm tested (Y/N)
Date of pumping //~ ? /~ ') ,.~ "~ Pumper
SEPARATION DISTANCESfFROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /L¢'~ ~ -- On adjacent lots ~ /~"~ [Foundation
Topropertyline ~'% /_(~/1 £ Absorption field /~,~/- Watermain/serviceline~'/~'£
Surface water/drainage ..~ / (~)~) /
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent(Y/N) _~m.~n" level at ~~33~off" level at
High water alarm level '",.~.~_ .----~C-ycles tested
Meets MOA electrical codes (Y/N).~_...~ ~
SEPARATISM LIFT STATION TO: ~,
Well on lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed
Length Width
Total absorption area .
Depression over field (Y/N) _
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
Soil rating ~ / ~' ~/,~
~ O // Gravel thickness --~ /
Cleanouts present (Y/N)
Date of adequacy test
for ~
System type ,'~/~L~'/~
/
Total depth
?
_
l/ If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well lot /~2
on Property line
To building foundation / ~'~ ~' / To existing or abandoned system on lot
On adjacent lots
Cutbank //",~ (?/'~ ~ Water main/service line
/
Surface water ~ /
Driveway, parking/vehicle storage area
Curtain drain /~
E. ENGINEER'S CERTIFICATION
I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effe~ft_~l~o~his
inspection.
;
Signature
Engineer s Na ,me ~.~,/'//~
HAA Fee $
'ment
Date of Pay
Fleceipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
Sizemore & Associates
6410 Switzerland Drive
Anchorage AK 99516
Attn: James Sizemore
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 27L8378 · FAX 274-9645
Report Date:
11/16/92
Date Arrived: 11/11/92
Date Sampled: 11/10/92
Time Sampled: 1030
Collected By: JS
Our Lab #: A121388
Location/Project: Macbeth Subdivision
Your Sample ID: Lot 2A Blk 1
Sample Matrix: Water
Comments:
Lab
Number Method Parameter
* Definitions *
B = Below Regulatory Min.
H = Above Regulatory Max.
E = Estimated Value
M = Matrix Interference
D = Lost to Dilution
MDL = Method Detection Limit
Date Date
Units Result * MDL Prepared Analyzed
A121388 EPA 353.3 Nitrate-N mg/1 <MDL 0.1 11/13/92
Reported By: Susan ~. T~tal
Microbiology Supervisor
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date */¢///"° °~
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions1
(b) Applican~ Name ~ ~~ _Telephone: Home ~ - ~/~ Business
Applicant Address ~ ~ ~ ~ ~¢-'~--r~ ~ ~
(c) Applicant is (check one): Lending Institution ~; Owner/builder ~: Buyer~;
Other
(explain);
(d) Lending Institution .~":¢~¢~; /~¢~/~¢",~.~74~- -- Telephone
Address _ __b]~_¢. ¢,$ ~/4~,~
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Famity~ Multi-Family []
Number of Bedrooms
Other
WATER SUPPLY
Individual W'ell~' Community FI Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
OnsJte~' Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of fha validation date shown below, I verify that my investigation of th~s Hea~th
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functiona~ and adequate
for the number of bedrooms and type ot 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 suppJy ancot
wastewater disposal system is in compliance w~th all Municipal and State codes, ordinances, and regulations in efle~ on
the date of this inspection.
Name of Firm _~,~ ~/ ~_~"~¢~'~ Telephone _ ~-37/~
Address ,~0 L~ ~ /,~ ~
Date ~ ~0, ~
Approved f'~rr ~, ~ ¢-1,_ _ bedrooms by.
Approved ,*J .'Di~~
Terms of Conditional App?oval
_ Conditional
CAUTION
The Muncipatity of Anchorage Department of Health and Environmental Protection (DHEP) issues HeaJth Autho~ty
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
WELL DATA
Well Classification
Well Log Present (Y/N) N
Total Depth ~' ~) ""~Cased to
Static Water Level I
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
If A. B, C. D.E.C. Approved (Y/N)
Date Complete~ ~,)14 ~,44 *~'~"~ Yield ~'~ ~,~'
-'~ /'~0''~''' Depth of Grouting
Pump Set At ~
,,~:~ ,t Sanitary Seal on Casing (Y/N)
~Y' Depression Around Wellhead (Y/N)
[ O ~ / On Adjoining Lots
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line N Oh/' ,~
Cleanout/Man hole
Water Sample Collected by
Water Sample Test Results
Comments
~ ; On Adjoining Lots
To Nearest Public Sewer
Nearest Sewer Service Line
· ~ . Date ~/
SEPTIC/HOLDING TANK DATA
Date Installed 8/"//.~'~J~Siz e /'OOO No. of Compartments
Standpipes (Y/N) ~ Air-tight Caps (Y/N) "'~)/ Foundation Cleanout (Y/N)
Depression over Tank (Y/N) [~ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ~'/'A ;for
Holding Tank High-Water Alarm (Y/N) ~'//"/'¢
Separation Distances from Septic/Holding Tank:
To Water-Supply Well [ ~)/'/~
To Property Line ~ O
To Water Main/Service Line '~ /12~;;~
Temporary Holding Tank Permit (Y/N)
To Building Foundation '~ i O'O
To Disposal Field ~ I ~
To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page I of 2
72-026~ 11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy 'rest
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field '~',~
Depth of Field
/~ravel Bed Thickness
7'~C~ ~' Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Linb
To Existing or Abandoned System on
On Adjoining Lots
To Cutbank (if present) ~,/O/¥ ~
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
CommeRts
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, cOr conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed T S[,~I.~.A~ Date /I 0/~'~
Company ~/0~4a~l ,~v.~,( le/"MOA No. ,,~',~'r'"O /f
Receipt NO.
Date of Paymem
Amount: $
Page 2 of 2
72-026 11/84)
Engineer's Seal
LEGAL:
LOCATION:
OWNER:
LOT 2A, BLOCK 1, MC BETH SUBDIVISION
R.E S I DE N T I AL WELL I N S P EC T I O ~
JOE MULC
INSTALLATION REQUIREMENTS MET~ YES
WELL YIELD FROM WELL LOG: UNKNOWN
PUMP YIELD: 6 GALLONS PER MINUTE'
DATE OF INSPECTION: 9/9/8 _
TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF ~
GALLONS PER MINUTE wHILE ~THE DRAWDOWN W
MONITORED WITH AN ACOUSTIC PROBE. THE WEL~
WAS 'PUMPED TILL THE DRAWDOWN sTABILIZED-
THE STATIC WATER LEVEL WAS FOUND AT 145 FEET
wiTH A~6 FOOT DRAWDOWN AT 6 GALLONS PER
MINUTE. ~ - .
TEST FOR COLIFORMS: WATER ~WAS TESTED FoR COLIFORM BACTERIA 0
SEPTEMBER 7, 1985 TEST WAS NEGATIVE~~''~'~ -
TEST RESULT: '~ THIS WELL' MEETS THE REQUIREMENTS OF THE
MUNICIPALITY-OF ANCHORAGE. ~ -
'ci al re uiremeht for we'll~ flow is
The MULl P q
150 gallons of water per bedroom per
hours.This Well surpasse~ this require~ent~
The assessment of the condition of this well
applies only to the conditions as of th'
date~ The fl0w fa~e'of the Well may change
due to subsurface conditions that may not be
observed from the surface, and changes
- and other-factors that may impact
land use
the Conditmons of ~the aquifer feeding th
well.