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MCMAHON #1 BLK 6 LT 6
McMahon #1 Lot 6 Block 6 #017-361-28 Municipality of Anchorage Development Services Department ;•4 Building Safety Division r, , On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 - Anchorage, AK 99519.6650_ w www.muni.org/onsit6 343-7 onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 17- 3 G/ - AS COSA# O a Q 1. GENERAL INFORMATION Expiration Date: 11-17-09 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MCMAHON SUBDMSION N1, LOT 6, BLOCK 6 3960 DOROSHIN DRIVE 'ANCHORAGE, AK 99516 STEVE MARTIN Day phone 764-2419 3960 DOROSHIN DRIVE *ANCHORAGE, AK 99516 Day phone CLAIR RAMSEY W/DYNAMIC PROPERTIES Day phone 261-7553 3111 "C" STREET *ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 6 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 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 samples. (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 8 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 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 riles 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SURE 101 * ANCHORAGE, AK 99507 / Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date �r z%5 Engineer's Comments: In conducting this evaluation, GEG. LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines B Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identitable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. S. DSD, SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: l tltttY OFrr,,,r�� ONSITE c= WATER AND WASTEWATER .: PROGRAM �yyvl/1111 Ux1 Attachments: l COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineers Report Nitrate Advisory Other p By: t Original Certificate Date: 19 JR. 111051 \ Municipality of Anchorage Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsile (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST 0 Legal Description: MCMAHON SUBDIVISION #I1, LOT 6, BLOCK 6 Parcel ID: O 1 % - 3 to 1 —Z$ A. WELL DATA *BASED UPON SURROUNDING WELL LOGS Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) NO Date completed 1975 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth —185 ft. Cased to '40+ ft, Casing height (above ground) 12 in. FROM WELL LOG AT INSPECTION Date of test 7/28/09 Static water level ft. 149 ft. Well production g.p.m. 4.38 g.p,m, WATER SAMPLE RESULTS: Coliformcolonies/100 mL Nitrate l ' &�5mg./L. Other bacteria 0 colonies/100 ml. Arsenic: w oug./L. Date of sample: 7/27/2009 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA TWO SYSTEMS ON THE LOT Tank Type/Material SEPTIC/STEEL Date installed 5/1975 & 12/1993 Tank size 1000/1250 gal Number of Compartments 1&2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping -3 0) 0 9 Pumper i. McDONALD'S PUMPING 4 a109 C. ABSORPTION FIELD DTA "El.Ow EXISTING GRADE Date installed 371975 & 12y1997 Soil rating.p.d./ o /bd 125 & 1.2 System type DEEP TRENCHES Length 49/25 ft. Width 3/3 ft. Gravel below pipe 5/5 ft. •10.58/ 490 Total depth +9.16 ft. Elf. absorption area 250 ft' Monitoring tube YES Depression over field NO Date of adequacy test "7/28/2009 1:1 Results (Pass/Fail) PASS For 4/2 bedrooms Fluid depth in absorption field before test 40 DRY in. Water added 610/68 gal. New'depth 60/39 in. Elapsed Time: 112/100 min. Final fluid depth 40/4 in. Absorption rate >= 600+/300+ g,p,d, . Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date **TESTED ,BOTH SYSTEMS D. LIFT STATION Date installed "Pump on" level at_in. E. SEPARATION DISTANCES Size In gallons "Pump off" Manhole/Access water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 50+ Absorption field 51+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 1009+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineers Printed Name JEFFREY A. GARNESS Date StI2.ID01 COSA Fee 3 Y13 0 Date of Payment Receipt Number h Fi a 7 5 O (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number SCS ReEk 1093670001 PQL Units Client Name Gess Engineering Group, Ltd Printed Date(1'ime 08.'042009 11:21 Project Name/q P 6,L6 Collected Date(1'ime 07272009 11:20 Client Sample 11) 5999 i n B6,L6 Receieed Date/Time 07272009 14:00 Matrix Drinking Water Technical Director Stephen C. Edc Sample Remarks: Parameter Results PQL Units Method Container ID Allowable Limits Prep Analysis Date Date Init Metals by ICP/MS IlardncssasCaCO3 141 5.00 mg/L SM202340B C 07/31/09 08/03/09 NRB Waters Department Total NitratcNitrite-N 4.25 0.100 mg/L S%1204500NO3-F I) 0728109 LCE Private Individual Analysis Aluminum ND 20.0 ug/L EI1200.8 C 07/31/09 08/03/09 NRB Antimony ND 1.00 ug/L EP200.8 C (<6) 07/31/09 08/03/09 NRB Arsenic ND 5.00 ugtL EP200.8 C (<I0) 07/31/09 08/03/09 NRB Barium 3.90 3.00 ugfL EP200.8 C (<20U0) 07/31/09 08/03/09 NRB Cadmium ND 0.500 ug/L EP200.8 C (<5) 07/31/09 08/03/09 NRB Calcium 43800 500 ug/L EP200.8 C 07/31/09 08/03/09 NRB Chromium 13.8 2.00 ug/l. EP200.8 C (<I00) 07/31/09 08/03/09 NRB Copper 421 1.00 ug/L EP200.8 C (<1300) 07/31/09 08/03/09 NRB Iran 3240 * 250 ugA. EP200.8 C (<300) 07/31/09 08/03/09 NRB Lead 28.8 * 0.200 ug/L E11200.8 C I<15) 07/31/09 08/03/09 NRB Magnesium 7770 50.0 ug/L E11200.8 C 07/31/09 08/03/09 NRB hfangancsc 14.5 1.00 ugtL EP200.8 C (<50) 07/31/09 08/03/09 NRB Chloride 12.6 0.100 mgA. EPA 300.0 D (<250) 0729109 0729/09 LCE Fluoride ND 0.100 mg/L EPA 300.0 D (<2) 0729/09 0729/09 LCC Selenium ND 5.00 ug/L EP200.8 C (<50) 07/31/09 08/03/09 NRI3 Sodium 4260 500 ug/L EP200.8 C (<250000) 07/31/09 08/03/09 NRB - Silver ND 1.00 ugtL EP200.8 C (<IW) 07/31/09 08/03/09 NRB Thallium ND 1.00 ug/L EP200.8 C (<2) 07/31/09 08/03/09 NRB Sulfate 11.9 0.100 mg/L EPA 300.0 P (<250) 0729/09 0729/09 LCC Zinc 489 5.00 ug/L EP200.8 • C (<5000) 07/31/09 08/03/09 NRB wqS SGS ReEN 1093670001 Client Name Gamess Engineering Group, Ltd Project Name/# McLean 91 B6,L6 Client Sample ID Mclean k1 B6,1-6 Matrix Drinking Water Printed Datefrime Collected Date/time Received Datelrime Technical Director 08/042009 11:21 07272009 11:20 07272009 14:00 Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Private Individual Analvsis Total Dissolved Solids 199 Nickel ND I ICO3 Alkalinity 111 CO3 Alkalinity ND OI I Alkalinity ND Conductivity 322 pI l 7.60 Alkalinity III Colony Count 0 Total Coliform 0 Fecal Coliform 0 10.0 mg/L S%120 2540C D (<50()) 0728/09 OLT 2.00 ug/L EP200.8 C (<100) 07/31/09 08/03/09 NRB 10.0 mg/L S\120 2320B 1) 0729/09 MI'L 10.0 mg/L S%120 232011 D 0729/09 MPL 10.0 mg/L S\120232011 D 0729/09 MPL I.(N) umhos/cm SM20 251011 D 0727/09 OLT 0.100 pl l units S\120 4500.11 B D (6.5-8.5) 0727/09 OLT 10.0 mg/L S\120232011 D 0729/09 MPL col/100mL S\1209222B A 0727/09 DLC col/100mL SM209222B A (<I) 0727/09 DLC col/100mL SM209222B A 0727/09 DI.0 ■v g 07 09 06:43a 6i1' !„ DcnaldA (907) 337-0558 ■ ■ ■:■ inn x ■ : rf"/c�lJona�d d Purnriry �ervice i■ 3932 E. Northern Lights Blvd, Suite 4466 Anchorage. Alaska 99508 (907 3354476 Invoice #5895 r.jio tnteresi mitt be charged Monfhlti on unpaid bills unlil paid ate oj.Strvicc Phone: CumomerP Nambther. C°ataee Peaon: Description price pn au Amount Septic tank pumped Sludge in tank Leach treatment Bio -mat in leach Wi7ter level in leach Cap on Stand Pipes Other - Recommendations: Total r.jio tnteresi mitt be charged Monfhlti on unpaid bills unlil paid .'ul 31 09 05.181 Bill McDonaldA (907) 337-0558 p.2 Mc2ona[d d 1'etinpincy Service 5432 E. Northern Lights Blvd, Suite #466 Anchorage, Alaska 99505 (907) 338-4476 Invoice #5883 Sold Tui ` Date: �� V+ C .rim, y7 ate of Se tee. Phoee: Customer P.O. Number: IConwet P, r: Description Price per ma Amount Septic tank pumped Sludge in tank Leach treatment Bio -mat in leach Miter level in leach Cap on Stand Pipes 190 r Other: o Recommendations: ! Total /&r}d 1.5° interest will be charged iminth v on unpaid bills until paid. 1n F IMr; �✓ v/ 1 R 1 A J DOROSHIN AVENUE W O N 88'0500" W 135.00 O G%... G44 EXISTING HOUSE 7f o 33.II 4j ti sr.4 d Z1 �=�a G'/1• yr � - °° �4 9 O 5 O O1 C s o s N O ao LOT 6 5�nI'rr meal 12 ,s 42 Mc""'. CAROL E3UTLER with RC/MAX PROPFRTaFS 440 NIST 6CNSON BLVD. S 103 ANCHORAGE. ALASKA 99503 Vn$IK ORUER XUMI7[k M1F- Wa :A'PT 12 2000 2 0a0—L-607A �. v a : 4911� i DOa •.K neth L. Dreyer. ; LS -8202 Q �OressSo�°1� F� o ��ODDo�o 7 I 1 -le - 93-03 Municipality of Anchorage Page of 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 S140tv.;0504- n li - 1Name: Permit Number: PID Number: .�I,1--a-1- Name C-It'jor courugr. Wastewater System: 'New ❑ Upgrade Address: 39cc� poRcS�lu•4 'DR. 945110 ABSORPTION FIELD Phone: ?AS ^Zal &P d 7''i No. of Bedrooms: Deep Trench L1 Shallow Trench El Bed ❑ Mound El Other LEGAL DESCRIPTION LEGAL Soi Rating: �IZ grade: \ TottaalD Rthfrom 6.o �'�O•S VIES% GPD/Sq. Ft. 1• Lot: Block: SuAb/division: �AlA, � Depthto pipe bottorR from orAiginal gr de: �-! `�� Ft S� Ft. Gravel epth bene�th pipe lI—'� Ft. Township: Range: Section: Fill added above original grade: Gravel length: �+ ^ Z O Ft. :7• L.I Ft. WELL: t3/,116,16 ❑ New ❑ Upgrade Gravel width 2 Number of lines: Distance between lines: N/^ . Ft Ft. Classification (Private, A,B,C): Total Depth: Cased To: I* Total absorption area: Pipe material: Ft. FL 7z✓ SQ. Ft. Driller: -� Date Drilled: Static Water Level: Installer: EAL�E sYS7,EM5 Date install d: ---- Ft. Yield: Pump Set at: Casing Height Above Ground: TANK GPM "" Ft. Ft. SEPARATION DISTANCES XSeptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Pw~Private Manufac urer:V - ' Capacciitty in gallons: 1000 From Tank Field Station Tank Sewer Lines T_#.44 i"44 Well `� l�l•51 r. ./• /_g'� Material: STI Number of Compartments: Surface Water LIFT STATION //�AI� �"T•{..1 1 .. i t5.5 Size in gallons: .�. Manufacturer: 0- Line ,� .. Foundation 1 q,4•'� 1 5� d ,i. +i' / 0 "Pump on" level at: "Pump off' level at: 1 •^ High water alarm at: I r Curtain r ' Pump Make & Model Electrical Inspections performed by: Drain ^ Remarks: '56PTIc-SrS 2 BENCH MARK M Lurvt113 Location and Description: VA ff. DCeA 100.0 5 Arta S'r OF its HouSE. Assumed Elevation: 00•01 FL ENGINEER'S SEAL Inspections performed by: .4 A011 hAS Dates: 1st 2nd R; icce Department of Heal and Human Services approval h'aa r ) a@'000ssero'� / Reviewed and approved by: - .�C�yIGVDate: 72-013 (Rev. 9/91) MOA 25 Permit No. SW 93t�3o4 Page 2 of 3 W.O. 93063 Municipality of Anchorage Date 11-15-93 Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 6 BLOCK 6 McMAHON SUBDIVISION ADD'N #1 PID No. INVERT = 88.30 93� 6 TANK OUTLET INVERT – 88.20 BEGINNING OF TRENCH INVERT = 88.00 a n I 4" 0 MON TDR END OF TRENCH 9'I INVERT = 88.00 EXISTING HOUSE 51 DECK/ ' I SHED —,&TBM FF DECK ( , ELEV 100. 00 w \ \ 24.8' ` 1 100D GALLON SEPTIC TANK fj TP 1_-\ \\ \ \\ I \\�97 CLEANOUT W/ \ \� �96 �AIRTIG H\CAP\\P)�\ \ 04 10, 7 \ 1 PROPERT111NE / 88 _ - - OFFSET RECORD DRAWING AS PER \ / CONTRACTORS REDLINES SCALE: 1" = 15'1 OF At SIN . �f- �: TH j • �DENNIS DEE (G�i� � f CE 5807\// 9 ••' gyp i It re �••••••••••�\ �� i 72-013 A (2/91) MOA 25 f._ He, (163-a4b3 Permit No. S VJ 7 U O Page 3 of 3 W.O. 93063 Municipality of Anchorage Date 12-01-93 Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 6 BLOCK 6 McMAHON SUBDIVISION ADD'N #1 PID No. GEOTEXTILE FABRIC 0- 0q% SEWER ROCK PER o MINICIPAL SPECS % 4"0 MONITOR TUBE W/ AIRTIGHT CAP GROUND SURFACE ELEV. 92.5± 3.5'± COVER 4" 0 PERF. PVC PIPE INVERT 88.0 5-0" GRAVEL BELOW PIPE INVERT BOT GRAVEL 83.0 6=' -6' -'SEPARATION DISTANCE 7ELEV. BOTTOM OF • TEST PIT 76.5 rte; TYPICAL TRENCH SECTION SCALE: NTS RECORD INFORMATION AS PER CONTRACTOR'S REDLINES 72-013 A (2/917 MOA 25 G. He: 663-5A.S9 �:rAEVA /��j���\ CONSULTING ENGINEERS Civil Surveying Planning November 3, 1993 W.O. 93063 Mr. Robbie Robinson Municipality of Anchorage Department of Health & Human Services Environmental Services Division P.O. Box 196650 Anchorage, Alaska 99519-6650 RE: Lot 6 Block 6 McMahon Subdivision Addition # 1 / Permit # SW 930304 Dear Mr. Robinson, This letter is to inform the Department of Health and Human Services that the septic system has been installed on the above mentioned lot. It was installed by Acreage Systems, Inc. No changes were made from the design drawings so no new as -built drawings will be submitted. Please call if you have any questions. Very Truly Yours, DHI CONSULTING ENGINEERS 'LL -1 Dee High, P.E. Principal cc: Gail High, DHI DDH\CA\lfc DA psi\dWW3�1n.wps PO Box 111349 Anchorage, Alaska 99511-1349 • (907) 345-1385/Fax 345-1386 PAGE 1 OF 2 " 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:SW930304 DESIGN ENGINEER:DEE HIGH ENGINEERING OWNER NAME:COUTURE GREGORY A & OWNER ADDRESS:3960 DOROSHIN DR ANCHORAGE, AK 99516 PARCEL ID:01736128 LEGAL DESCRIPTION: MCMAHON #1 BLK 6 LT 6 LOT SIZE: 37069 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 8/16/93 EXPIRATION DATE: 8/16/94 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 343-4329 OR 343-4681 AFTER BUSINESS HOURS 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: THIS PERMIT IS FOR A SECOND INDEPENDANT ON-SITE WASTEWATER DISPOSAL SYSTEM SERVING ONLY TEO BEDROOMS. THIS IS SATISFACTORY PROVIDING THAT THE NEW TWO BEDROOM ADDITION IS PLUMBED SUCH THAT ONLY THE WASTEWATER GENERATED FROM THE NEW MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ADDITION (TWO BEDROOMS) IS DIVERTED INTO THE NEW SYSTEM AS INDICATED ON THE ATTACHED PROPOSED PLUMBING DIAGRAM. RECEIVED BY: ISSUED BY: PAGE 2 OF 2 DATE: DATE: L 6c� . hn�M4Clanh SuB aoo'N �4 I fl-UM61A16 7-0 a�n �ilrv,�,o,s PQoPoS�,p . 93ob3 RECEIVED y m ..: <. LL 4 _ it tr - a $ LL 43 a� ai W mIfl h � �F p!I ro - �meWS - to � i I N 2 93ob3 RECEIVED RE(Ei E.D AUG 1 61993 Municipality of Anchorage )ept. Health &:Human Services c, £ t- 1, r.;'.z i i it 3 41 j'1{ er Fi��t Q k b r r•. F Q t h P o-.: Permit No. Page 1 of 8 " Municipality of Anchorage W.O. 93063 Department of Health and Human Services Date 8-02-93 ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 6 BLOCK 6 McMAHON SUBDIVISION ADD'N #1 PID No. SITE NARRATIVE Lot 6, Block 6, McMahon Subdivision Addition #/ 1 is bordered by 3 lots. The lot and the surrounding lots are all developed. The lot has an existing system sized for 4 bedrooms. The proposed system is being installed to handle the wastewater flow of a 2 bedroom addition. The lot has sufficient area for a replacement system for both the 4 bedroom system and the proposed 2 bedroom system. This was confirmed with two percolation tests. WELLS: None of the well setbacks from lot 6 or the surrounding lots pose a problem to the location of the proposed system or the reserve areas. (See Site Plan) WASTEWATER SYSTEMS: The proposed system does not encroach into any of the required protective well radiuses, nor do the reserve areas. ( See Site Plan) DRAINAGE: The lot slopes naturally from the North to the South. All fills will be sloped to drain in the direction of natural drainage. The system will receive topsoil and seeding to prevent erosion.; �j 1 � / �� .••..►tea • ••, "—OIJ 1. 13/911 HOA 23 rn "r W%j4 SvJ!'1 L Permit No. Page 2 of 8 W.O. 93063 Municipality of Anchorage Date 8-02-93 Department of Health and Human Services. ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 6 BLOCK 6 McMAHON SUBDIVISION ADD'N #1 PID No. 700, I'J'F \ 1 7 00 I II s4 we<< RADIUS II 1� /I I / LOT 6 BLOCK 6 \ < ss 96 I EXISTING HOUSE 9 DEC K_ I 98 I W PROPOSED 1 a I U SYSTEM I / I \CDw l a J I� I O I I s;7 I � ss I o i -7 \ 5 94 I RESERVE AREA 4 BEDROOM 10' PROPERTY LINE OFFSET — 100' WELL RADIUS 77-01.1 A NMI MOA 9.R RESERVE AREA 2 BEDROOM I \ I ` �D, v !I �1=A`EMENT — J SCALE: 1 " = 40' Permit No. Page 3 of 8 • Municipality of Anchorage W.O. 93063 Department of Health and Human Services Date $-02-93 ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 Ori—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 6 BLOCK 6 McMAHON SUBDIVISION ADD'N #1 PID No. SYSTEM DESIGN CALCULATIONS 1. NO. BEDROOMS = 2 2. USE TRENCH SYSTEM r! r?J���"1 Al V1 1 /0 1, 3. ABSORBTION AREA = (# BEDROOMS)(150 GPD/BR) TRENCH APPLICATION RATE 250 'SF 1.2* 4. TRENCH AREA = (2)(DEPTH .OF GGRAAVEELL)(LENGTH) = 250 SF IF DEPTH !OF GRAVEL = 5' I THEN LENGTH OF TRENCH PERCOLATION RATE PIT & TRENCH MOUND & BED APPLICATION RATE APPLICATION RATE MIN/INCH GPD/SF GPD/SF 0-1 NOT SUITABLE NOT SUITABLE * 1-5 1.2 0.8 6-15 0.8 0.5 16-30 0.6 0.4 31-60 0.45 0.3 GREATER THAN 60 NOT SUITABLE NOT SUITABLE FILTER LAYER 1.0 .7 72-013 A (2/91) MOA 25 C. Flle. 063CSB Permit No. Page 4 of 8 W.O. 93063 Municipality of Anchorage Date 8-02-93 Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 6 BLOCK 6 McMAHON SUBDIVISION ADD'N #1 PID No. INSTALL CO 2' FROM _ s\ \ BUILDING FOUNDATION \ INVERT = 92.00' / g5 \ \ j \ 94 EXISTING HOUSE 15.81 LF @ 8.0% TREES \ SEE NOTE 17 // \ DECK/ 7.�I SHED TBM FF DECK @ 8.0%% �( / @ 8.ELEV 100.00 l \ TANK INLET lb INVERT = 88.30 _24.8 93 O 9,3 TANK OUTLET 100 GALN I / INVERT = 88.20 j / SEPTIC TANK / BEGINNING OF TRENCH Iw o/ SEE NOTE 2 INVERT = 88.00 192� TP 1� \ \\ \ \ v� rW a \ \ SCALE: 1 " = 15' 4" MONITORUBEJ \ END OF TRENCH —CLEANOUT W/ INVERT 88.00 AIRTIGHT CAP\ YP)� QEF' OF \ . \ \� \ \\� \��\9s � • gTH •�•*/, \ / • :••• 00000 • ••• 0000/ 89— \ /•• **DENNIS Aft •• • 0:000/ r-- 0 0, 3 DE IG 0 '•• CE 580PROPEIRTYLINE OFFSET • • j \ \ a �G; Professes �i '2-013 A (2/91) MOA 25 0. Re: 063CSR40 Permit No. Page 5 of 8 W.O. 93063 Municipality of Anchorage Date 8-02-93 Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 6 BLOCK 6 McMAHON SUBDIVISION ADD'N #1 'PID No. 4"0 MONITOR TUBE W/ AIRTIGHT CAP SLOPE FILL TO DRAIN SEE NOTES 15 & 16 BACKFILL / r EXISTING GRADE SEE NOTE 14 —___� VIN�- SLOPE TRENCH WALLS AS REQUIRED TO MEET ALL LOCAL, STATE, AND GEOTEXTILE FABRIC FEDERAL REGULATIONS SEE NOTE 13 4 0 PERF. PVC PIPE INVERT 88.0 SEWER ROCK PER 09% 5'-0" GRAVEL BELOW MINICIPAL SPECS PIPE INVERT SEE NOTE 10 ° ffig�� If BOTTOM OF GRAVEL 83.0 TYPICAL TRENCH SECTION SCALE: NTS 12-013 A (2/91) MOA 25 f., Flt 11211:-5D Permit No. Page 6 of 8 W.O. 93063 Legal Description: LOT 6 BLOCK 6 McMAHON SUBDIVISION ADD'N #1 Date 8-02-93 NOTES: 1 ALL CONSTRUCTION SHALL BE IN ACCORDANCE WITH CHAPTER 15.65. WASTEWATER DISPOSAL REGULATIONS OF THE MUNICIPAL CODE AS CURRENTLY AMENDED. 2 INSTALL NEW 1000 GAL SEPTIC TANK AS SHOWN ON THE DRAWINGS. RECORD INLET AND OUTLET ELEVATIONS OF THE TANK. TANK SHALL BE PLACED ON UNDISTURBED NATIVE SOIL. 3 SITE TOPOGRAPHIC SURVEY CONDUCTED BY DHI ON 6-24-93. EXISTING STRUCTURES, WELLS, SEPTIC SYSTEMS OBSERVED WITHIN 200 FT. OF PROPOSED SYSTEM SITE ARE SHOWN ON DESIGN DRAWINGS. 4 ANY DEVIATION FROM THE DESIGN MUST BE AUTHORIZED BY THE ENGINEER PRIOR TO ITS INCORPORATION INTO THE SYSTEM. 5 CONTRACTOR TO LOCATE ALL UNDERGROUND UTILITIES, PROPERTY LINES, EXISTING WELLS, WATER WAYS, SURFACE AND SUBSURFACE DRAINAGE FACILITIES, LAKES, PONDS, AND OTHER FACILITIES REQUIRING SEPARATION DISTANCES FROM THE PROPOSED SEPTIC SYSTEM. CONTRACTOR TO STAKE PROPOSED SYSTEM PRIOR TO CONSTRUCTION. NOTIFY THE ENGINEER OF ANY OBSERVED CONFLICTS PRIOR TO CONSTRUCTION. 6 CONTRACTOR TO NOTIFY THE ENGINEER AND DHHS 24 HOURS PRIOR TO COMMENCING WITH CONSTRUCTION. A MINIMUM OF THREE INSPECTIONS ARE REQUIRED. THE FIRST INSPECTION SHALL BE OF THE SUBGRADE PRIOR TO PLACING THE SEWER ROCK. THE SECOND INSPECTION SHALL BE AFTER THE PLACEMENT OF GRAVEL, DISTRIBUTION PIPING, STANDPIPES, TANK, AND OTHER COMPONENTS AS SPECIFIED. THE THIRD INSPECTION SHALL BE AFTER THE WORK IS COMPLETED. 7 CONTRACTOR SHALL DELIVER TO THE ENGINEER A SET OF RED -LINED, AS -BUILT DRAWINGS SHOWING ALL DATA AS SPECIFIED IN SEC. 15.65.F.2, 3, 4, 5, 6 OF MUNICIPAL WASTEWATER DISPOSAL CODE WITHIN FIVE DAYS OF THE FINAL INSPECTION. INVERTS AND SWING TIE LOCATES SHALL BE TO THE NEAREST TENTH OF A FOOT. THESE AS-BUILTS SHALL BE USED BY THE ENGINEER TO PREPARE AND SUBMIT RECORD DRAWING TO DHHS. 8 ALL EXCAVATION DEPTHS ARE ADVISORY. THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE ENGINEER IF ACTUAL FIELD CONDITIONS VARY FROM THOSE USED TO PREPARE THE DESIGN. 9 EXCAVATE THE ABSORPTION TRENCH. BOTTOM OF EXCAVATION SHALL BE LEVEL AND SCARIFIED. RECORD ELEVATIONS AT BEGINNING, MIDDLE, AND END OF TRENCH BOTTOM. CONSTRUCTION EQUIPMENT SHALL NOT OPERATE ON THE FLOOR OF THE EXCAVATION. ANY MATERIAL COMPACTED BY THE OPERATION OF THE CONSTRUCTION EQUIPMENT SHALL BE REMOVED AND REPLACED WITH UNCOMPACTED MATERIAL. 10 PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK WITH NATIVE MATERIAL OR SPOILS FROM EXCAVATION. LEVEL ROCK SURFACE TO f 1" PRIOR TO INSTALLING THE PERFORATED PIPE. 11 ALL PIPE SHALL BE PVC CONFORMING TO ASTM D3034 OR ENGINEER -APPROVED EQUAL. MINIMUM SOIL COVER SHALL BE 3 FT OVER PIPES, 4 FT OVER THE SEPTIC TANK. 12 GEOTEXTILE SHALL BE MIRAFI 140S OR ENGINEER -APPROVED EQUAL. LAP ALL JOINTS 2' MIN. 13 COVER THE DISTRIBUTION PIPE WITH MIN 2" SEWER ROCK, AND COVER WITH GEOTEXTILE BEFORE BACKFILLING. 14 MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS. 15 SLOPE ALL FILL MATERIAL TO DRAIN AT 2% MIN. SLOPE, AND 3:1 MAX SLOPE, AND IN SUCH A MANNER THAT PONDING AT OR NEAR THE DRAIN FIELD DOES NOT OCCUR. THE FILL SHALL BE LEFT AT 6" HIGHER THAN SHOWN TO ALLOW FOR SETTLEMENT. SEED SURFACE AFTER COMPLETING INSTALLATION AS PER MUNICIPAL SPECS. 16 RECORD THE FINISH GROUND ELEVATION OVER TOP OF TRENCH. 17 CONTRACTOR TO REMOVE EXISTING TREES AS NECESSARY. COORDINATE WITH OWNER. 72-013 A (2/911 MOA 25 r.. ma 060c.S0.41 Municipality of Anchorage 0* DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: L' �o & (o VA c.tMA:I- 04 SU6 AID 0 4�- 1 DATE LEGAL DESCRIPTION: T� I Township, Range, Section: 930('3 SLOPE SITE PLAN DEPTH 1 (FEET) 0(-E(AAIIGS /moors Al N 2 ' LOAM 3 S � � 4 • ° S I T 1= 5 i P L A /'i I�InIE SAe�4 w� Ea2AVE,L 6- 78 7- 13 • o 9- 10- 10 WAS GROUND WATER A I 0 .o 14- 15- 16- 17 4151617 18 19 Reading Date ENCOUNTERED? Net Time Depth to Water Net Drop S 11 O 4" L qn IF YES, AT WHAT O 11 4 n o DEPTH? P 12 10 Y4" E 13 Depth to Water After Monitoring? Date: .o 14- 15- 16- 17 4151617 18 19 Reading Date Gross Time Net Time Depth to Water Net Drop 41'.11'50 O 4" �- qn 11 4 n S ;/411 q" `I : W:5S 10 Y4" 4 ;/4 � 4' 9:54:21 g11 44 ci.'. Zci -7 9/4 3 5/a 4" o:3q:Do '7'/w 3111t A' 11:25: S 1'?S3 3`I3� 20 PERCOLATION RATE 3' Z (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 4.5 FT AND ('7 FT COMMENTS M PERFORMED BY: Q,*,tA! e wt r I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THI ATE. DATE: P �� 72-008 (Rev. 4/85) P e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: L—r��Cc oLP �c-M�N �il Ai)o� �" I DATE PER LEGAL DESCRIPTION: t f -" 2- Township, Range, Section: SLOPE SITE PLAN 1 DEPTH fEE� p GC � 129 A!J IC5 /Q -DDT" $ Net Time Depth to Water Net Drop 2 10,32% 39 Lt7Ar� '/21 " to, 41: to ID 7/1 L, 4NIi.. oo•• 14 10 9 T/A 3 `r t : z -t : ss 10 3 3/ 3/ 4 u' `1 '/8 +,/b 11'•53'4'cl 10 3/4 33/4 6 0' C.0AACX SAf sD poo(L.L7 C.SaA•DED 12-', ZZ) -' 02 10 5 12 "2'3.3co 10 7 8 0 d SDNAE Gt4e+4VSLr Dcf-. Cxn&&LFS �uw1� S t LT 9 6 ' WAS GROUND WATER 10 ENCOUNTERED? NO e S 11 IF VES, AT WHAT L0 DEPTH? P 12- E Depthto Water Atte 13 Monitoring? Q Monitoring? �� Oate: 14- 15- 16- 17 415 16 17 18 19 Reading Date Gross Time Net Time Depth to Water Net Drop 10,32% 39 ? '/21 " to, 41: to ID 7/1 L, 4NIi.. oo•• 14 10 9 T/A 4 S/G `r t : z -t : ss 10 3 3/ 3/ 1', 41'. 55 10 `1 '/8 +,/b 11'•53'4'cl 10 3/4 33/4 12:07: 05 10 12-', ZZ) -' 02 10 5 12 "2'3.3co 10 20 (� `' PERCOLATION RATE 3.2 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 515 FT AND 15 FT COMMENTS r PERFORMED BY: �� j4,v 49--5 I i• CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON T DATE. DATE: l 72-008 (Rev. 4/85) I 8 GREQ- 1 ANCHORAGE AREA BOR'- `'H I Department of Environmental Quality y ° 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ' fF -i��� 'fIJ?'--MAILING ADDRESS PHONE LOCATION LEGAL DESCRIPTION SEPTIC TANK: DISTANCE (/f7lu�!�� 1� _ yr (/, NUMBER OF FROM WELL MANUFACTURER!/ - �JL MATERIAL COMPARTM/ENT/Sf INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY/'' ; GALLONS. TILE DRAIN FIELD: TOTAL LENGTH � F.• •moi DISTANCE FROM WELL/V d FOUNDATIONNEAREST LOT LINE %r7 r' OF LINES NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH `� IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE (DEPTH OF FILTER' DEPTH: TOP OF TILE j0 FINISH GRADE MATERIAL BENEATH TILE IN. ABOVE TILE �. %E IN. WELL: grz /;ramal'( TYPE / CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE , SEWER LINE , TANK , SYSTEM CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS - DISTANCES: INSTALLED BY: r 0 ' 6` " SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: 111 REMARKS: Form EQ -032 �v`-;�r*-r -2Ct DIAGRAM OF SYSTEM z Ate. GREAT t ANCHORAGE AREA BOR ^3HPERMIT N mow" °r 4 O�� 4 DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 \\4\\VV"I1I14¢m ua�Illlll^%%//J// SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT /3 J ' "lJ�c k* a5�lf}� MAILING AI INSTALLATION LOCATION �r Y 4 �J'�j v ���` LEGAL DESCRIPTION / c (j.' ` e E, A� INSTALLATION OF: SEPTIC TANK SEEPAGE PIT Y TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH --1 TO BE INSTALLED BY f � SOIL TEST RESULTS -y- COMPLETION DATE ANTICIPATED �( 'd d^?" T (�7 � P FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLIN"imm"WAU DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJEI SEPTIC TANK SIZE /,2 S� TYPE / SEEPAGE AREA SIZE MINIMUM DISTANCES, REQUIREMENTS 4— FOUNDATION — FOUNDATION TO SEPTIC TANK ' FOUNDATION TO SEEPAGE PIT �- DRAIN FIELD £/ r o�,1 SEPTIC TANK TO SEEPAGE PIT WALL E�7��� SEPTIC TANK --. SEEPAGE PIT—. DRAIN FIELD TO NEAREST LOT LINE. / WELL TO SEPTIC TANK ( SEEPAGE PIT L— DRAIN FIELD y� / ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD Q d SEPTIC TANK, �-6 , SEEPAGE PIT %/ DRAIN FIELD � TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL '�C CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. 3 n DATE ~/ APPLICANT'S SIGNATURE FORM NO. EQ -616 PHONE DRAIN FIELD , OTHER 9 7 ECT TY D12�GIRAW QF F-'ISTF�M /g I/ E AREA BCF§ -&GH ORDINANCE NO. 28.68 AND THAT THE ABOVE I I- E y vi Ile i ' r I t f LJ, E AREA BCF§ -&GH ORDINANCE NO. 28.68 AND THAT THE ABOVE Performed for b Legal Description: This form reports: Depth GREATER ANCHORAGE ARLA L'OROUG1. Department of Environmental Quality 3330 "C" Street Anchorage, Alaska 9%03 SOILS I,O(j - PEROLATION TEST Soils log x)%- 1 o_.t Tepx; 2 3 S' }1wk l�. }esFrf� 4 5 6 7 3 - �Z� l7 S;Jt ML :27S_ B 9 10 11 12 r 13 S�Ope Date Perforr,ied 41-75 rcolation test 14 [ _ IWas ground water encountered? �t0 If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Ji1165-- 14 [ _ IWas ground water encountered? �t0 If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rate minute. -Proposed installation: Seepage Pit _ Drain Field Depth of Inlet _ _ _ Depth tp bottom of pit Rr �trench COMMENTS -���_ ]� '�rcw" u�, ee ate: EQ -040 (6/74) Performed for Legal Description: This form reports: Depth Feet Pa 3 4 5 6 7 s GREATER ANCIIORAGE ARLA L'OROUGi, Department of Environmental Quality 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - PEROLATION T'E'ST tate Performed rj -Z$-7 _ �e-----�1Qs.�_f�—_J`___ �_M a�+o N ��, t3Q•---A._p� �.zs�el�4 S 1 og kxx _ Percolation test_ b-li�L Tapso�'� 5rrrave(ly sand CINa $4Mcl reeMy SW: Ilzso 'I- 1 $t— iii s1� Sa,..� �,�X SJ oN li - Ml : 27,5 12 13 14 Was ground water encountered? NO � If yes, at what depth? Reading Date U- Net Time ff Net Urop irsirm'! I III,`, .11, W -am 14 Was ground water encountered? NO � If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Urop Percolation rate m�nuLe. Proposed installation: Seepage Pit _ _ Drain Field Depth of Inlet _ _ , Depth to t,ottom of^pit or trench COMMENTS: Performed [3y:_ 'A - Certified By: EO -040 (6/74) ate: Municipality of Anchorage Development Services Department Building Safely Division On -Site Waters Wastewater Program lid/ / 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 ,r1 Parcel I.D. _ 1 / i g"301- f� COSA# 1. GENERAL INFORMATION Expiration Date: / (� Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MCMAHON SUBDIVISION #1, LOT 6. BLOCK 6 3960 DOROSHIN DRNE • ANCHORAGE. AK 99516 STEVE MARTIN Day phone 3960 DOROSHIN DRIVE • ANCHORAGE. AK 99516 Day phone 764-2419 Clair Ramsey w/Dynamic Properties Day phone 261-7553 3111 "C" STREET • ANCHORAGE. AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 6 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 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 samples. (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 riles 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 GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 337-6179 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 5 LE O - Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, and separation distances measured to readily Idonlifiablo features. The operational life of all wells and septic systems depend on the local sells condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system wail continue to moot the operational requirements of the ADEC or MOA DSD. The content of this report Is for the solo benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. S. DSD SIGNATURE. Approved for CO bedrooms. Disapproved. n .[CyV. uvrness.- o CCE -7( 3 e� 7 / o % I le Conditional approval for bedrooms, with the filowing stipulations: Attachments: L/ COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Reort Nitrate Advisory Other (Rw. tINS) ONSITE WATER AND WASTEWATER PROGRAM Original Certificate Date: 9 — 2, 1'07 Municipality of Anchorage • '� Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196850 Anchorage. AK 99519-6650 www.muni.org/oneRe (907)343-7914 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MCMAHON SUBDIVISION N1, LOT 6, BLOCK 6 Parcel ID:Q 17 -36 1- -_Z$ A. WELL DATA *BASED UPON SURROUNDING WELL LOGS Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 1975 Sanitary seal (Y/N) YES Total depth "185 ft. Cased to •40+ ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: ND ug./L. Nitrate 3.59 mgA. Well Log (Y/N) NO Wires properly protected (Y/N) YES Casing height (above ground) 12 in. AT INSPECTION 7/19/2007 148 ft. 4.74 g.p.m. Other bacteria 0 colonies/100 ml. Date of sample: 7/19/2007 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA TWO SYSTEMS ON THE LOT Tank Type/Material SEPTIC/STEEL Data installed _511975 & 12/1993 Tank size 1000/1250 gal. Number of Compartmerds 1&2 Cleanouts (Y/N) YES Foundation deanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 7/19/2007 Pumper McDONALD'S PUMPING C. ABSORPTION FIELD DATA 0 N Date installeds/tars & 12/+sssSoll rating .p.d rIfEio125 & 1.2 system type DEEP TRENCHES Length 49/210.5 / ft. Width 490 3/3 ft. Gravel below pipe 5/5 ft. Total depth *9.21 ft. Etf. absorption area 250 ft' Monitoring tube YES Depression over field NO Date of adequacy test 0*7/19/2007 Results (Pass/Fail) PASS For 4/2 bedrooms Fluid depth in absorption field before test 47/20 in. Water added 600/40 gal. New depth 61.5 36.5 in. Elapsed Time: 249/158 min. Final fluid depth 58.5/2-3 in. Absorption rate >= 600/300 g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date — "TESTED BOTH SYSTEMS D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons Manhole/Access "Pump ofrlevees ugh water alar level at in. Cycles tested Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation t0'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineers Printed Name JEFFREY A. GARNESS Date S114/0-7, COSA Fee $ Y30 • 01 0 Waiver Fee $ _ Date of Payment � 1107 Date of Payment Receipt Number a 37 V 7 Receipt Number (Rev. 11105) Municipality of Anchorage *A. Development Services Department Building Safety DivisionOn-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Jeff Gamess Legal description: McMahon #1 Block 6 Lot 6 ❑Permit ®C.O.S.A. ❑Inspection Report The attached paperwork has been reviewed and is being returned for the following reasons: 1. Pre -tank C. 0. must be located and in working order. Name of reviewer: Pggi Date: August 17, 2007 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK /23/2007 09:54 FAX 1 9U7 ZU1'lb.. I J 111= XAN.=% 1=Am DOROSHIN AVENUE G+ O N 88'05'00" W 135.00' 1-J°�. EXISTING HOUSE „ 0 33.8 ti 214 n. N - 249 O 5 cn (N�1 n _m Iwo, LOT 6 3h �S<1rp T ` 75 42,0 12 4" 1-39-29- o meco en CAROL BUTLER with RUMAX PROPERTIES LAND dL CONSINUCTION SUNVEYO 440 VEST BENSON BLVD. $ 103 ANCHORAGE. ALASKA 99503 w3RK ORULN hummk w6. va SEPT 12 2000 ' 2000 -L -607A ,,7,-- -'; y U b Is 49 118 . a.:.K a •,K eth L. •Dreyer.'•l y ' LS -8202 = ............. ..... _h o 7 No -- 123 4; EXCLUSION NOTES: It Is the ornas' respmsblty to dele✓••nins LEGEND: SET FND the edstence o/ my easements• cormmts, or restrlct;o s S/M w/CAPQ d/a' RO 0 +Hith 60 not VPOe an the rtCwdnd sobdl•rsion plat. NOTE: ya• ALMON.Q)MWIMNT ID Under no ciroenstmees mlm l any data here" be used (or lata st 7Ar)t (j emsWCtion ar IW sstoWishinq prooaty lines rptM- —X_ X — SURVEY CENIRICATION; tANTECN hos conducted o OCRHANC- physk0l surrey of paotttY as sho.n m lois MOOD DECKS- he enls situated Na cO - drowingWe and that Ne Ynty one ALT W, ae wilt the phan e& and no enVaom- m MAVEt,T- manle asset other loon +olad- atAVCt- -� _I NGINEERS AS—OUIL.T Or. LECALOESIOPTION: W"CSTANDMKS +A1TA WLL- 6626 562 5291 LOT 6, BLOCK 6, ' Asea -"' FIRST ADDITION TO McMAHON SUBD { 53 CN LO m t ! ) _ 2 | { } & ° 2 \ : _ \ rA \ / / § / \ \ : \ C,3 ELL I I I I SGS RCEM 1073566001 Client Name Gayness Engineering Group, Ltd. Project Name/R Lt 6 Blk 6 McMahon #I Client Sample ID Lt 6 Blk 6 McMahon #I Matrix Drinking Watcr P\\'SID 0 All Dates/fames are Alaska Standard Time Printed Datefrime 08/082007 13:28 Collected Date/time 07/192007 9:49 Recehed Datelrime 07/192007 16:05 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Metals Department Bardness as CaCO3 156 5.00 mg/L Sh120 2340B C 0727/07 07/31/07 hill Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 0727107 07/31/07 hill Waters Department Total Nitmte/Nitritc-N 3.59 0.100 mg/L Sh120 4500NO3-F B (<10) 08/01/07 3DS Microbiology Laboratory Total Coliform 0 COVIOOmL SN1209222B A (<I) 07/19/07 SDP Private Individual Analysis Aluminum ND 20.0 ug/L EP200.8 C 0727/07 07/31/07 hill Antimony ND 1.00 ug/L EP200.8 C (<6) 0727/07 07/31/07 hfll Barium 4.16 3.00 ug/L EP200.8 C (0000) 0727/07 07/31/07 hill Cadmium ND 0.500 ug/L EP200.8 C (<5) 0727/07 07/31/07 hill Calcium 48200 500 ug/L EP200.8 C 0727/07 07/31/07 hill Chromium 4.56 2.00 ug/L EP200.8 C (<I00) 0727/07 07/31/07 hill Copper 82.3 1.00 ug/L EP200.8 C (<1300) 0727/07 07/31/07 Nil Iron 2460 • 250 ug/L EP200.8 C (<300) 0727107 07/31/07 hill Lead 6.61 0.200 ug/L EP200.8 C (<15) 0727107 07/31/07 hill Magnesium 8510 50.0 ug/L EP200.8 C 0727/07 07/31/07 hill Manganese 24.6 1.00 ug/L EP200.8 C (<50) 0727/07 07/31/07 Mll Phosphorus ND 200 ugfL EP200.8 C 0727/07 07/31/07 hill SCS Rct# 1073566001 All Datcs/rimts are Alaska Standard Time Client Name Garness Engineering Group, Ltd. Printed Daldrimt 08/082007 13:28 Project Name/# Lt 6 Qlk 6 McMahon #1 Collected Date/Time 07/192007 9:49 Client Sample ID Lt 6 61k 6 McMahon #1 Received Date/Time 07/192007 16:05 Matrix Drinking Water Technical Director Stephen C. Ede PN'SID 0 Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Private Individual Analysis Potassium 1120 500 ug/L EP200.8 C 0727/07 07/31/07 hill Selenium ND 5.00 ug/L EP200.8 C (<50) 0727/07 07/31/07 Dill Sodium 5100 500 ug/L EP200.8 C (x50000) 0727/07 07/31/07 hill Silicon 6040 200 ug/L EP200.8 C 0727/07 07/31/07 hill Silver ND 1.00 ug/L EP200.8 C (<100) 0727/07 07/31107 hill Thallium ND 1.00 ug/L EP200.8 C (Q) 0727/07 07/31/07 hill Zinc 355 5.00 ug/L EP200.8 C (<5000) 0727/07 07/31/07 hili Nickel ND 2.00 ug/L EP200.8 C (<I00) 0727/07 07/31/07 hill SCS Rer.M 1073566002 All Dates/Times are Alaska Standard Time Client Name Garness Engineering Group, Ltd. Printed Date/rime 08/08/2007 13:28 Project Name/# Lt 6 Dlk 6 McMahon 111 Collected Date/rime 08/022007 8:20 Client Sample 11) Lt 6 Dik 6 McMahon kl Received Date/rime 08/022007 12:45 Matrix Drinking Water Technical Director Stephen C. Ede P%VSlD 0 Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Com aim lD Limits Date Date ]nit Private Individual Analysis Chloride 13.8 0.100 mg/L EPA 300.0 A (<250) 08/07/07 08/08/07 JDS Fluoride ND 0.100 mg/L EPA 300.0 A (Q) 08/07/07 08/08/07 JDS Sulfate 122 0.100 mg/L EPA 300.0 A (<250) 08/07/07 08/08/07 JDS Total Dissolved Solids 186 10.0 mg/L SM20 2540C D (<500) 08/03/07 CLS 11CO3 Alkalinity 105 10.0 mg/L SM20 2320D D 08/06/07 TRM CO3 Alkalinity ND 10.0 mg/L SM20 232011 D 08/06/07 TRM OI I Alkalinity ND 10.0 mg/L SM20 23206 D 08/06/07 TRM Conductivity 270 1.00 umhos/cm Sk120 2510D D 08/02/07 CLS PH 7.89 0.100 p11 units SM20 4500-11 D D (6.5.8.5) 08/02/07 CLS Alkalinity 105 10.0 mg/L SM20 2320D D 08/06/07 TRM I30S l3U0v SR'AIIL Utm-rn [%. E�:4CII®II2AGI�y E�LAt3ICA oID.;.o= =-1-77Il4- SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED AT THE RATE OF 818.00 PER FOOT. PROPERTY OWNER nt. Ed LOCATION OF WELL SITE ` Lt' / au" V sa&: /w DRILLER Beu>,te Cta" of Rampart 1kttttnq. lJo4k4. WELL LOG: 0----217 stt4 graved.. 20., aay.- 201 7eet. 21-48' Sand4 g3auet with 10p clay. bdndo-u • 48---99' Coatz4 and daode gsavet. Some mato beating matetiat at 100 .." Shaming a paaallale 1 1/2 VX mdth a 8 {act head. 99--128' SLLto cJt4 wVA 30% aand in ./au4tLoa- Stt#d4 met but na mateA V2ctd. 128-185' mel- wuh 15% ctaq. 185-201' Stt4 met dan4 clay. going Zn" a cte= mato beatinq guwet at 2b1 7e" II ...M FS Ag., at mato 4tanddn4 WZ& a Puduotlan of 7 ViL Tump 41aad.d be dnatatted I 4 7¢et 1. cg bottom. k v v 1 KW Nw sE ut: Sc� a8 TlLN , R 3W . Sa � 57 t? o p C, ,pspo p COST INCLUDES ALL -LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. D WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF 8361800 '> .'s THANK YOU VERY MUCH. BERNIE �US OF RAMPART DRILLING WORKS � DATE e 14ths 78 SERVICE CHARGE 0r IY,% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. RETURN Tot alwillN of Goal"and Casphyslcal surveys (OCC$) r�90 •d�U /;rSTATE OF AIASaa ro 3001 FempiN Self(Teloohenet 177-441$) O[FARTNENT OF NATURAL RESOURCES Anchorage, Alaska $TS01 ,...'.: . YAT9R W LL • -L Rt C 0 A 0 frill leg Soaps" Or P /n•.1 bru l .,. F-- 1 OCAi10I N KLL ..M." ceselate either Is. Q. O Z� ,ogc4A4o rNd.Z rasa, leo-a( e.s.C.f. Local ". Orliling Permit w. A.O.L. no. .....-........ a......-ava.o.-r Ia. f .A E 1071Af. & Lot sloca Sr, 5.4• s.t2$b. .. T,menaftlo /'�'"'ws A..;7 PV✓ gm MSlul�rQ • o b to. nsteaae W Olrectlee Fres Read latoreactlees •' SY W 8::.,;: go .7 G s_ r•�-�y� � •.s -9 -mss / Ltreat Address a" Area of KII Locatlon ..�: vela a nut /afar •._,w:,::.:- �z"�'" �G/ass Moo V040O&W A �y . WILL LOC ' Feet Selat ' rf • .r Materiel TTos btto. N ♦. WILL OEPTNt (aaa luted) swrate Clevetlw •• ft. "to of Completion , ld- A P \p \ 3' S. 14Ca►le "*I 1010tary ❑0r1ven ❑Mag ❑btt d 08.W ❑0thart 113Auger r .? i • .. h Will QOmestle ❑PublicsuNlr ❑ledestrr �� ❑Irrlgatlew ❑Aach ry. ❑Caaearom ef ❑Test veli [3 Others ...-: �•: •..7:CASING•., ❑ Thread".. Owald"'...: •. . .• '•fa_'ln. •te QQ_fe. Win. '.. Velghi_�iaJre. _to. to it.'wta . W N L ,r xim or wLLLt YTN,__ achew el*mtert ilet/wsh $1201 L"tht bet Yetueea ft. end 'ft. Fltttnfss - 1 . $. STATIC 4ATER Elms rY 7 ft. ❑Aaoes 9601W IoM swfeu . 'TTN of Neaswewmatt 10- PUAPIIK LEVEL belam shad sarface -••, • .- . • 4q4� ft. after , Are. P'plas I.P.O.' "ft. after • .. _hwe. P."leg -f•1aa . . • 'll. WILL NM COswiLrTI04s U to Approved fit ' ►I Class A44 car � looks. as. grad • IL CAWTFRCt -well oroot"f ❑ TN ®Is • , Matorlolt ❑NNt Caeent ❑ethers • 13. PUIPt (If ovellable) K Laagth of prop PIN uoscetT 5 g•p Trost }:f"rolNe ❑ANl;"tl.f mumu. jot ❑OM.n . It. IL. RENRANi: a 15. INTER WILL CONIRK704'3 CERTIFICATION: '.{� mT hl"ge a" beliefs Ln ` •This Mall ams drilled Wer aql Jwi"Ittien sed true, .M,t Is trto the MK ofna, Vern' )1 r; /�.�. t= �h7�cr�iisrs AA i3 z7 391. juUrN t.wata `iYfa • ar<ct <ant< .oaf Address: 4 J&0,rri 0 Istat�- ahor ,N rrefenut a f.w-af.tu rW wt...ta...r�. •• .....-........ a......-ava.o.-r 03 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES a Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage. Alaska 99519650 (907) 3434744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 017-361-28 HAA# �/Pr,r(,J;3z 1. GENERAL INFORMATION Complete legal description McMAHON S/D #}: LOT 6. PLOr K 6 Location (site address or directions) 3960 pogosHiN AvE. ANcHogArF. AK 99516 Property owner GREG COUTURFDay phone (907) 345-7764 Mailing address_ C/O CAROL RUTTIER Lending agency Mailing address Day phone Agent CAROL RUTTIER Dayphone (907) 000—0000 Address. RFMAX PROP RTI S. 2600 CORDOVA STRFFT ANCHORAGE AK 9950 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 6 NOTE: if community well system, provide written confirmatlon 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 ing to the legality and status of system. 72-025 (Rev. 1191) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid si-=0-0 at, or prior to closing for the engineering services provided. 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. // II Name of Finn Phone. X907) 337-6179 Address 6901 D BARR RUAUblill [t¢Arvcn rwuc r+v+ rv. aaovv Engineer's Signature i Date in conducting this evaluation, AWWC, Iry . Ate ted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and OA D HS Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water 000�pp usage of the family being served by the system. These conditions are outside the control of OF A � / the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do theyguarantee that there are no hidden defects or encroachments. pd %i • /f AWWC, Inc. can therefore not provide any warranty for Arturo estimate of how long the _ �* system will continue to meet the operational requirements of the ADEC or MOA DHHS. iF9ly� The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authodzed, 0 .... tfr A. Gayness? nor will It confer any legal right whatsoever. QA ��' . �F-7953 . • o z' 6. DHHS SIGNATURE Approved for bedrooms Disapproved Conditional approval for Additional Comments 0 Poor bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1191) Back MOA 921 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 "L" Street, Rm 502 Anchorage. Alaska 99501 (907) 943-4744 Health Authority Approval Checklist Legal Description: McMAHON S/D Il: LOT 6. BLOCK 6 Parcel I.D.: 017-361-28 A. WELL DATA Well Type PRIVATE If A, B, or C. attach ADEC letter. ADEC water system number N/A Log present (YIN) NO Date completed • 1975 Total depth • t 83'+ Cased to 40"+ Casing height (above ground) 18" Sanitary seal (YIN) YES Wires properly protected (YM) YES FROM WELL LOG Data of test N/A Stele water level N/A Well production N/A 9.p -m. AT INSPECTION 8/24/2000 152 4.6 O.P.M. WATER SAMPLE RESULTS: Coliform 'tR Nitrate 2 7'Z Other bacteria _81 Date of sample: 9/5/2000 Collected by. A.W.W.C.. INC. S. SEPTICIHOLDING TANK DATA TWO SEPTIC SYSTEMS ON LOT (1 FOR 2 BEDROOMS & 1 FOR 4 BEDROOMS). Date krstailed 12-93/5-75 Tank size 1000/1250 Number of Compartments 2/1 Clearwuts (YM) YES Foundation cleanout (Y/N) YES Depression (YIN) NO High water alarm (YM) _ N/A Date of Pumping _ 8/24/2000 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA :PER MOA RECORDS *PER AWWC INSPECTION Date Installed 12-93/5-75 Soil ratIng (g.p.dAt2 or fl2lbdrm) 1.2/125 System type TRENCHES Length 25'/49' Width 2'/3' Gravel thickness below pipe 5'/5' Total depth 10.1'+/9.3's* Effective absorption area 250/490 Monitoring Tube present (YIN) YES Depression over field (YM) NO Data of adequacy test 8-24-00/8-31-00 Results (pass/Fan) PASS For 2/4 Bedrooms Fluid depth In absorption fleid before test (In.); 0753" immediately aRer9l0/6389W water added 0n.f?5.5"/65" Fluid depth 39'/55" () Minutes later _ 90/1140 Absorption rate = 300+/600+ GPD Perwdde treabnent (past 12 months) (YIN) NONE KNOWN 9 yes, give date ----- 72-M(Rrv.3MTCwVut rVwWm D. UFT STATION Data installed Stzm Manhole/Access High water alarm E. SEPARATION DISTANCES leveler 'Pump otr leveler *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: SepUdholding tank on lot 100'+ On adjacent kris 100'+ Absorption field on lot 100'+ On adjacent kris 100'+ Public sewer main N/A Public sewer manhole/deanout_ N/A Sewer/sepOc service One 2 is"+ 64 M.S Lift station N/A SEPARATION DISTANCES FROM SEPTICfHOLDING TANK ON LOT TO: Foundation 5'+ Property One 5'+ Absorption field 5'+ Water main/service line 25'+ Surface wateddrainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water mairdservice One 9-%'4- Surface s'+ Surface water 100'+ Driveway, parldngMehide storage area 10'+ Curtain drain NONE KNOWN Wells on adjacent kris 100'+ F. ENGINEER'S I cerin Nat I i of Munldpat n with MOA HA Engineers Id Inspections end review stems are In conlbrmance this date. HAA Fee S 6p©• 00 Waiver Fee $ Date of Payment 9 g -©o Date of Payment Recelpt Number/� ���P 5'�, Receipt Number nose lwv neer CmP dw Vff" e y Aarnsaa' low •. CE -7953 R VMfi�_ ' ..... '� cs, n MUNICIPALITY OF ANCHORAGE �• Department of Health & Human Services M}j \ DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # C�ll — �n t -21 Ca, HAA # �A Q T� Z--) 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LOT 6; BLOCK 6; McMAHON ''�j Location (address or directions) 3960 (b) Property owner Sheyti. Sinceai)t Telephone : (home) 345-0854 Business Mailing Address 3960 Dcjcoskin, Anchwtage, A2a3ka 99516 (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here j], if hold for pick up.) List contact person and day phone number below: S L 5 ENGINEERING 17034 Eagle River Loop Read No 204 Eagle River, Alaska (9577 2. TYPE OF RESIDENCE Single -Family j7 Number of bedrooms 3. WATER SUPPLY Individual Well 5� Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site g Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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 Telephone S & 5 ENGINEERING Address 17034 Eagle River Loop Road No. 204 Eagle River, AlaSKe v �^ Date •4 +0 'y sir 6. DHHS APPROVAL Approved for bedrooms---flate Approved - Disapproved Conditional Terms of Conditional Approval /���^it/L= CAUTIONa '< . The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 rr� t MUNICIPALITY OF ANCHORAGE (MOA) • � Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984- 343-4744 r� �= g `` Legal Description:(o- - A. WELL DATA r � Well Classifications\.I �OJbrl_, If A, B, C, D.E.C. Approved (Y/N) Well Log Present �`(Yam Date Completed "� S " Yield ,.. � Total Depth" h� Cased to �r Depth of Grouting , Static Water Level / SS Pump Set At JX_ rr Casing Height Above Ground 12 4- - Sanitary Seal on CasingQY N) y Electrical Wiring in Conduitq�??N) `f Depression Around Wellhead (YQ4 SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot �� �'f On Adjoining Lots /00 14 - To Nearest Edge of Absorption Field qn of / pa y� ; On Adjoining Lots To Nearest Public Sewer Line N A To Nearest Public Sewer Cleanout/Manhole f-) A To Nearest Sewer Service Line on Lot 14 Water Sample Collected by `J S C1- z 1^sS /moi ; Date I-/`"- E57 Water Sample Test Results b' Comments B. SEPTIC/HOLDING T NJ( 9ATA Date Installed S S Size o No. of Compartments i Standpipeso/N) Air-tight Caps¢?/N) Foundation Cleanoutc9/N) Depression over Tank (Y0) /" Date Last Pumped Pumping/Maintenance Contact on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Na SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Building Foundation �7 To Property Line 14) r To Disposal Field To Water Main/Service Line /a To Stream, Pond, Lake or Major Drainage Course t 00 Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Str to Z� �t Type of System Design Date Installed %s s �'� ' Length of Field Width of Field Square Feet of Absortion Area Depression over Field (YkED_ Results of Last Adequacy Test Depth of Field 1 Gravel Bed Thickness a Statndpipes Present�RN) Date of Last Adequacy Test - �5_ B% SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well ! bo l� To Property Line To Building Foundation Lot To Water Main/Service Line To Existing or Abandoned System on On Adjoining Lots o I4 - To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course / oo -F To Driveway, Parking Area, or Vehicle Storage Area �o 0 Comments D. LIFT STATION /A - stalled Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) . "Pump Off" Level at i' ---Vent (Y/N) "'Check Permitted Bedroom Rating Against HAA Request" Pum -j ingSycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & S ENGINEERING 17034 Engle River LOOP Hoad No. 204 Company real, River Alaska 99577 Date MOA No. C' Y Receipt No. /l i/S,`1)7J1� Date of Payment 9 /5— _- JT Amount: $ / 0 � ()b i; (gin' r G^ oraea�:. 5 Receipt No. aRr., Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. Am TELEPHONE (907) 5622343 5633 B Street n Anchorage, Alaska 99518 44 .v �^•ro^°• Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER II TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D.# h th' W t SAMPLE to be: P4 -PRIVATE WATER SYSTEM Name S & S ENGINEERING Phone No. 17034 Eagle River Leep Read Me.2�4 Mailing AUgk River, Alaska 99577 City State Zip Code `t—` SAMPLE DATE: 0 Em r_ Mo. Day Year SAMPLE TYPE: & Routine El Check Sample (for routine sample with lab ref. no. ) El Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By READ INSTRUCTIONS RFFnRF COLLECTING SAMPLE Anal M sis s ows is a er Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received D o 1 Time Received 1 510 Analytical Method: Membrane Filter No. of colonies/100 ml. Lab Ref. No. Result* Analyst `7ri1D^ �.� m I� m U m U m BACTERIOLOGICAL WATER ANALYSIS RECORD /`�— �' VV y . SP7 U Membrane Filter: Direct Count d Coliform/100ml Verification: LTB BGB Final Membrane Filter Results ��� IOI Coliform/100ml Reported By5�,, �s�• Date Time: a.m. p.m. TNTC = Too Numberous To Count OB = Other Bacteria CHEMICAL & GEOLOGICEIL LABORATORIES OF ALASKA, INC. r -% 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 FEDERAL TAX ID # 92.0040440 IPBORPTO RIE$ ANALYSIS REPORT BY SAMPLE for Work Order # 16292 Date Report Printed: SEP 13 89 @ 15:58 Client Sample ID:L6 B6 MCMATON PWSID :UA Collected @ his. Received SEP 1 89 @ 15:00 his. Preserved with :AS REQUIRED Analysis Completed :SEP 1 89 Laboratory Supexvispp x �;STEPHEN C. EDE Released By Special Instruct: Chemlab Ref #: 7310 Parameter Tested ------------------ NITRATE-N Sample Remarks: Lab Smpl ID: 3 Matrix: WATER Result/Units ------------------------------- 0.79 mg/l Client Name 3 & S ENGR Client Acct SNSENGP P.O.# NONE RECEIVED Req # Ordered By : R SCHAFER Send Reports to: 1)3 & S ENGR 2) Allowable Method Limits -------------------------------- EPA 353.2 10 =1 Tests Performed See Special Instructions Above UA=Unavailable ND= None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than c MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL�14/__` un OF ON-SITE SEWER AND WATER FACILITY APPROVAL" cc�yU' 264-4720 Application Date ,2 143 t26 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) �,zt (b) Applicant Name �1yki-Telefhho_ne: Home SteBusiness Applicant Address"j (c) Applicant is (check one): Lending Institution 13; Owner/builder zQJ Buyer[]; Other ❑ (explain); (d) Lending Institution Y Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the H to the following address: c 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Welp Community ❑ 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 Onsite 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 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION M As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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 e_ -1-j _� ern-¢-'mak( - `.�4Sj)jX Telephone Q `�� — g IA Address �w� C)6 C_Prt`4« Date _ - 1 A�y �• • THOM A. FISCHER CE -6793 E9 r4 DHEP APPROVAL t a, yn Approved fort = bedrooms by " " ' Date Approved Disapproved Conditional Terms of Conditional Approval, � r r 1 �l \1 CAUTION Engineer's Seal l 2 - /T-- f6 The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority 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 79_p95 111/841 f^) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description:"��° A -pot," 4=1 A. WELL DATA Well Classification FPx 1 Ll &1EIf A, B, C, D.E.C. Approved (Y/N)Well Log Present (Y/N) © Date Completed t9 TS Yield 4`7!5 CxPm- Phlls. I r Total Depth 1Ni44 Cases) to 40 Depth of Grouting �►� r Static Water Level's Pump Set At ' Casing Height Above Ground rr Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) N)4z) Separation Distances from Well: ( To Septic/Holding Tank on Lot } �� ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot r'� ; On Adjoining Lots To Nearest Public Sewer Line V's/tom' To Nearest Public Sewer be J Cleanout/Manhole V.4 To Nearest Sewer Service Line on Lot Water Sample Collected by ��, vVo�ItW7— ; Date Water Sample Test Results Fac -n17 �� Ow -04 Comments B. SEPTIC/HOLDING TANK DATA Date Installed � rzr Size `zs) No. of Compartments I Standpipes (Y/N) �(Cs Air -tight Caps (Y/N) �'(44S Foundation Cleanout /N) Depression over Tank (Y/N) t-�O Date Last Pumped Pumping/Maintenance Contract on File (Y/N) for N /14 Holding Tank High -Water Alarm (Y/N) N Temporary Holding Tank Permit (Y/N) — Separation Distances from Septic/Holding Tank: r To Water -Supply Well t o o To Building Foundation i To Property Line 4u To Disposal Field r To Water Main/Service Line Z `� '� To Stream, Pond, Lake, or Major Drainage t Course Comments M DEPT. OF HEALTH & ENVIRONMENTAL PROTtLHUN Page 1 of 2 72-026(11/84) DE r f j11986 RECEIVED C. ABSORPTION FIELD DATA Soils Rating in Absorption �,Strata - •� Type of System Design Date Installed L36 7', Length of Field - 47 Width of Field Depth of Field `TF' 11 ( rr Gravel Bed Thickness Square Feet of Absorption Area '��{ /4d' Standpipes Present (Y/N) 1'ig;s Depression over Field (Y/N) NL1 Date of Last Adequacy Test (� JZ_GXz'�- c, Results of Last Adequacy Test _ f� ��br "7'ayrin USS Separation Distance from Absorption Field: To Water -Supply Well r oO To Property Line 4 To Building Foundation Z ( wti F1[?f��'P0c To Existing or Abandoned System on Lot IV /V* On Adjoining Lots �� 16{" Tf To Water Main Service t•i To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course j t t� To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Levi Tested fXCos Electrica Comme . Dimensions nhole/Access (Y/Nj "Pump Off" Level at Vent (Y/N) Pumping C�sef during Adequacy Test. Meets MOA ** Check Permitted Bed m Rating Against HAA Request ** I certify that I ve ecked, verifi d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed SL Date _�10 bek4 Company I'iet" E• C 0 MOA No. Receipt No. ZB O / �`p Or �, Date of Payment l��C' •.v (9 �,�� 9TH Engineer's Seal Amount: $ 00" .. seer..... C (� ,�} •• 7FI0A1 A. PISCHE r:•.'• CE - 6793 x/ Page 2 of 2 ''•� 4 GREATER ANCHORAGE AREA BOROUGH '330 Department of Environmental Quality "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: / Mailing Address: Phone: 2. Property Owner: Phone: T Mailing Address: 3. Legal Description: G /C/o /Ae,;Ltf-� 4. Location: Addy7y � 5. Type of facility to be inspected No. of bedrooms 6. Well Data:7-..�-J A. Type B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal_ System: A. Installed .S� 30 -7S B. Installer i AO�, C. Septic Tank: 1. Size /.2. sd dnId. 2. Manufacturer D. Seepage P e Pit: 1. Absorption Areay 2. Material E. Disposal Field: Total length of lines A ..� 8. Distances: A. Well to: Septic tank Absorption area Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Ae '2 of two pages - Rei )for Approval o� Individual Water Facilities lb 41 Descri ption Comments (N Approved 'NL Disapproved Date lg Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM accurate representation of the subject sewer ano water raciiities ana Lnese raciiiLiea are operating satisfactorily. SIGNED Date EQ -034 (1/74)