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Home My WebLink AboutMCMAHON #2 BLK 5 LT 2McMahon Block 5 Lot 2 #0 .7-36:1. -36 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: 0SP231209 PID Number: 017-361-36 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name KENT GAMBLE ABSORPTION FIELD Site Address ❑ Deep Trench ❑ Wide Trench ❑ Bed ound 12901 NORAK PLACE *ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth original grade C/O CONTRACTOR - 317-9433 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original gradFt. Gravel depth beneath pipe Subdivision Block Lot MCMAHON #2; BLOCK 5, LOT 2 Ft. Fill added above original gr Gravel length Township Range Section Ft. Ft. SEPARATION DISTANCES Gravel width Ft. Beds: Number of LinesDistance I between lines Ft. To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line T�rpfion area Ft2 Number of trenches Dist. between trenches Ft. Well 100'+ 25'+ TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer INFILTRATOR Capacity 1530 Gal. Surface Water 100'+ Material HDPE Number of compartments 2 Lot Line 5'+ NA Foundation 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks PER CONTRACTOR OLD TANK WAS REMOVED Alarm location Electrical installed by PIPE MATERIAL House to tank Tank to Installer D3034 drainfield D3034 ARM SEPTIC SERVICES Drainfield D30341EXISTING CO/MTD3034 Inspector GEG BENCH MARK (Assumed elevation) 97.74 ft Inspect ectioes: 15` 9/29/2023 2"d - Location and description 3rd - 4th _ TOP OF MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp itional Approval: Septic System Approved ��- Note: this approval (Rev 05/02/18) Date Ai_ Date /o Z not include well permit requirements. oQo�00p�� 0 I� 4- Ti I.............. .....••••.... e f y A. Gorness: QQ�9. '• CE -79 3 coli Q4ed pro f e s sloes°ate #AECC884 PERMIT NUMBER:p n n p� + PARCEL ID NUMBER: OSP231209 RECORD DRAWING 017-361-36 B / MHt 1 27.2 1 49.3 / ST1 1 33.0 1 51.9 ID Ll 1 35.8 1 53.2 / DBL2 36.5 53.5 / I 100' WELL RADIUS I / MCMAHON #1; I / BLOCK 5, LOT 1 NEW IM -1530 INFILTRATOR SEPTIC TANK / m STI / m \ \ . 0 H1 \ Cb EXISTING \ I ( / HOUSE � 00�I\GARAGE\ -� �{ I'ire1j �'+/ / J " : ,. I \ •.;+1'...4.�'�• •S. t . I ' !.. o •r }.. ' .Y. •.:� j. 100' WELL RADIUS / •� • r DRIVEWAY I WELL RADIUS / / N \ / SCALE: 1^=40' ®v:w"V ®m11to ®gee ENGINEERINGGARNESS "••• 9 ni ENGINEERING e SALES = CONSULTING�.....:.}�.�.}� 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 • PHONE (907) 3378179 • FAX (907) 338-3216 • WEBSITE: w .Qar ssen9ineeen9.com% ..... .��i i ............. /"...........�. •• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 to {#�,y-A mess w C/O ARM SEPTIC SERVICES 907-688-9433 2 OF 3 °®�!'�' CE 7953 ° _AV LEGAL DESCRIPTION:# DRAWN BY: ' MCMAHON #2; BLOCK 5, LOT 2D.J.G. ®® ��F� • �,5/ �y..••'��s `` TYPE OF WORK: DATE: LICENSE®0�� ESS\C? ` SEPTIC TANK RECORD DRAWINGS 10/24/2023 #AECC884®�� PERMIT NUMBER: PARCEL NUMBER:OSP231209 RECORD DRAWING 017-361-36 TOP OF TANK AT INLET = 93.29 INVERT OF BUNG AT INLET = 92.68 MH TOP OF MANHOLE = 97.74 IM -1530 2 -COMPARTMENT NFILTRATOR SEPTIC TANK PER CONTRACTOR TANK IS INSULATED FINAL GRADE = 95.74-97.33 t ENGINEERING -SALES=CONSULTING ,_, . X.:4 ,r_....r,w>. 3701E. TUDOR ROAD, SUITE 101-ANCHORAGE.AK 99507 -PHONE (907)3376179 -FAX (907)336-3246•WEBSITE:w gunessenpneemgmm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: C/O ARM SEPTIC SERVICES 907-688-9433 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: MCMAHON #2; BLOCK 5, LOT 2 D.J.G. TYPE OF WORK: DATE: ASEPTIC SYSTEM RECORD DRAWINGS 10/9/2023 — TOP OF TANK AT OUTLET = 93.29 INVERT OF BUNG AT OUTLET = 92.44 ,_s®®1®1®� ., 4� _Tdf r ................I......t........�...:.....:..... 3="EE= # it : ' Je rey A. Garr ss f w A #��1 CE-79M='�4 X X OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OH U OH U OH U OH U OH U OH U OH U OH U OH U OH U MB MB T E W U7,/,7<($6(0(176 6 & 5 ( ( 1 , 1 * ) ( 1 & , 1 * ( $ 6 ( 0 ( 1 7 S89° 54' 00"W 225.00 S0 0 ° 0 6 ' 0 0 " E 1 6 5 . 0 0 N0 0 ° 0 6 ' 0 0 " W 1 6 5 . 0 0 N89° 54' 00"E 225.00 S G E &$5&O9(5('67O5$*(6H(' :OO'(1:$/.:$<6 3$9(''5,9(:$< *5$9(/ *5 $ 9 ( / 5O&.6 &O1&5(7(67(36 /RW%ORFN 0F0DKRQ$GGLWLRQ1R )W 1RUDN3ODFH 6WRU\:RRG)UDPHHRXVH /O7 /O7 /O7 ℄1O 5 $ . 3 / $ & ( ℄(/ 0 O 5 ( 5 O $ ' E E (' * ( O ) 3 $ 9 ( 0 ( 1 7 (' * ( O ) 3 $ 9 ( 0 ( 1 7 5O: 5(7$,1,1*:$//6 :(//5$',U6 5O: 3$ 9 ( ' 6 , ' ( : $ / . SSS S SS OFW R E GISTEREDPROFESSIO N A L L A N D S URVEYORPierre M. Stragier No. L.S. - 9812 Legend: Scale 1" = 50' PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3. All measurements/setbacks are to the visual/apparent building footprint. 4. All dimensions to property lines are plus/minus 0.1ft. Gas Meter Electric Meter/Outside Power G E Utility Pole Overhead Utility October 17Tth, 2023. Lot 2, Block 5 McMahon Subdivision Addition No. 2 ARM Septic Services 23-427 10/17/2023 72-87 2835 S T E W Telephone Ped.Electric Ped. Septic MB Boulard Mailbox Water Well Fire Hydrant Light Pole DeckSSSeptic Cover MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-79917 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231209 Work Type: SepticTank Upgrade Tax Code Number: 01736136000 Site Legal Address: MCMAHON #2 BLK 5 LT 2 G:2835 Site Mailing Address: 12901 NORAK PL, Anchorage Owner: GAMBLE KENT W & Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: C n t 0 De pa i- t ni e n t 7/24/2023 7/23/2024 37125 El Disposal Field Z Septic Tank El Holding Tank 0 Privy Private Well 0 Water Storage All construction shall 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 (1 8AAC72) and Drinking Water Regulations (1 8AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: 7 Date: Issued By: Date: 3 UMUP UTY F ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water &, Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-361-36 Property owner(s) KENT GAMBLE C/O ARM SEPTIC SERVICES Day phone 907-688-9433 Mailing address 12901 NORAK PLACE *ANCHORAGE, AK Site address 12901 NORAK PLACE *ANCHORAGE, AK Legal description (Sub'd., Block & Lot) MCMAHON #2; BLOCK 5, LOT 2 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Q Septic Tank Upgrade x❑ (w/wo AD U) Holding Tank F]Renewal F]Duplex (D) ❑ Privy El Multiple Multiple Dwellings ❑ and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: N/A I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: _k225 Waiver Fees: Date of Payment: 7/3323 Date of Payment: Receipt Number: 037�.5-6- Receipt Number: Permit No. Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231209, Curtis Townsend, 07/24/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231209, Curtis Townsend, 07/24/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231209, Curtis Townsend, 07/24/23 \EDGE OF PAVEMENT fELMOREROAD 9 410 c>:' E m w E 0 OZZ ILT4 � ,,Ogg CD uj CV) 2 0 CL 0 0 E (D c: �o .c 0 s- 0 0 0 IrD 'Oc C14, Z3C) cv E 0 5 0 `t c CL (1) 4) 4) 4) 6 CL 0 m co I z (A CV) I CV) )2 -1 1 - . 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"ER ANCHORAGE AREA BOr'-' 'tGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH INSIDE WIDTH MATERIAl LIQUID DEPTH_ NUMBER OF .~-:/"-~'2~ cOMPARTMENTS. LIQUID CAPACITY J~g'~]f~ GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER /~/~ ~R WIDTH ';- LENGTH ~ DEPTH ,~' '~/~ / LINING MATERIAL /~.--/~/~ CRIB SIZE: DIAMETER/~' DEPTH ~ DISTANCE FROM: WELL /~7~r~ ~,/~ TOTAL EFFECTIVE BUILDING FOUNDATION NEAREST LOT LINE ~'~'~ ABSORPTION AREA (WALL AREA) :~z~-~'~--~ SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE /~:~</~/~/~-~</~/-~ CONSTRUCTION BUILDING ~' ~'-~" NEAREST ~:. FOUNDATION/~-/~-~'~'' LOT LINE CESSPOOL //v/~/~/~'--, DEPTH DISTANCE FROM: NEAREST ~'~-Zb SEPTIC / SEEPAGE SEWER LINE-'~' TANK /~'~;'~, SYSTEM /./~, C~-- APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: ~-/'9~./~'/~ PIPE MATERIAL: LOT SLOPE: REMARKS: ~- ~-~ ~' Form No. EQ-031 DIAGRAM OF SYSTEM APPROVED G.A.A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. NAME OF APPLICANT ~ ~ -' !~ INSTALLATION OF: SEPTIC TANK ~ TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TESTRESULTS MAILING ADDRESS SEEPAGE PIT , DRAIN FIELD TO BE INSTALLED BY OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 2/[ HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE /0{~ TYPe SEEPAGE AREA SIZE TYPE DIAGRAM OF SYSTEM MINIMUM OISTANCES, REOUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION tO SEEPAGE PIT ~ SEPTIC TANK tO seePage Pit WALL SEPTIC TANK ., SEEPAGE WELL TO SEPTIC TANK / 0 0 DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD DRAIN FIELD DRAIN FielD SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAge PIT . /00 { /0o r SEPTIC TANK, 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 SEPTiG TANK AND SEEPAGE PIT FITTED With AIRTight REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING ~]~ALLATION. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF Greater ANCHORAGE ARea BOROUGH ORDINANCE NO. 28.68 aND THAT THE ABOVE DESCRIBED SYSTEM ES IN ACCORDANCE WITH SAID CODE. "One test is ~uorth a thousand opinions" Performed For ~/'~e,~/O ~/~/~.¢,-Y,/3¢4 ~ate Performed This Form Renorts Soils Loq ~4~ Percolation Test Peoth Feet Soil Characteristics Was Ground Water Encountered? I¢ Yes, At what Depth? Readinq Date Gross Time Net Time Depth to H20 Net Dron Percolation Rate Minute Ct% Proposed Installation: Seenaae Pit ~1~¢ Drain Field ' Deoth of Inlet _~ t~tt Depth~o Bottom Of/~it~r Trench cn~!~ENTS: /~ ~ '-~"/' m/~/~e~ ~'~ ~'~ / ~'~'~'//~ ' Te~-Pe/formed By t~~~v' Data Certified BY: f~.'~~ Date: ~//~/'%~ _ ti ti O X W o� 'n o LL V � a O i U Z a IL � IJ c � U a) � U L L ns Z p3:M N U a) 06 U c E� Q 0— (D (D U) o c 7 A, N O N m N O7 a) 0 C O .Q X W 0 0 O co i r c� ti 0 N U m 0 - CO r V N Q J c0 LO o _c s U MJ c W Q J Z Y O � O O c N O r— n � U u) O � a) c0 � a) J CO LL LLJ Q J Q U) J L1J J 2 06 F- LU L11 J m Q CD O c O a) Q- 0 Q N 7 U N E O O 0 a) .O M r c O cu Q cn CD c 0 O a) ui 0 O 0 a) .o A N C) N N N OD N a) U a) U RS C 0) .e, N N d a a 0 U o`` 0 0 ^� if ^ ii aO ma 3 v u, '2 cn m L C m .tm CW 0 E O V i ai 0 O p � � .0 t/) C Q- d 0 CL (n > `o +(D+ ,U _ mU O > Q cnow Q v d N LL N a) U) p u) •C OO O CL C. 0- O 0-0 0 'a o N E Fj a) X «+ O = L O 4- N U) Ccn cn ' ,� E 'a O Q Z O E O_ o > o m 2 O O> O +' LL 70 Q O N p C L C)O c a) _ R Z O a) E as O ai O 2 = U Q f— O �j O N V Q V Q cn a N N d a a 0 U > U) (D c oo c 0 4— cu ca U Q Q Q ca O L Q Q Q) 4- U) a) CPc O 0 0 U N U z co O co Co c c o� LL O Z J Q w Z i w (7 a T - N M .4 El cn U E cm a) LL El () U c O ElU U cn m a N a) El LZ r U � p a a) w ¢ V/ 1.L Q) Lia) L U c H N U c m 0- 0 0 a a) m n Ll w LL Z LO r IL w cn m a a) U c ca I a) a) LL i c a� co IL O (D co a) I E!? a� a� LL ¢ 0 c >+ co IL 0 (1) co we U) 0 U *U, .D c O � c O �_ A• N 3W � � c rn E Eo c U CL N ❑ U) 0 c 0 a> > > CIO U 0 a = (D ❑ a� a) "O U U c i _> (n ) J O Elco _ c d w O ❑� ml U) E a? J L L a> O OLL ❑ El ElDn Y � o J U N d w a� - a Q O w w H a) U) a a 0 cn Q w LL LL O O a V5 w w a a j Z U O H H N M .4 El cn U E cm a) LL El () U c O ElU U cn m a N a) El LZ r U � p a a) w ¢ V/ 1.L Q) Lia) L U c H N U c m 0- 0 0 a a) m n Ll w LL Z LO r IL w cn m a a) U c ca I a) a) LL i c a� co IL O (D co a) I E!? a� a� LL ¢ 0 c >+ co IL 0 (1) co we U) 0 8.13 Forge Engineering 7/17/24 N/A N/A N/A Benjamin Schiller, P.E. (907) 522-7773 Irt N o0)M 0, M M X Q1 LL o W U QCU L M41 W 3 D W 4+ N VLn � 4J W O F' by z L L W }�0 m 'E a � � O4 E W i'n 3 0 0 3 0 J E � N E � 4A C cY I 00 E E R E vv In a) C v E to T N L v m 3 Y c -0 b-0 x v o M L M � M n Q +j 3 � =3 > m CU 4- M F v o N v Ln maL+ U 3 O Ln o 4- +, �, N m LL a i � 4 -Jt m z o 41 °� cn c O m u 4J Ln .� . y, Z� r -I d N U cn > O Q Q N 0 Ln 2 O !` m L O � � Q w >, QJ t 0 � . � Q L O \ w E 0 CL uJ c O +, mC L Ln 1ci t]A O _0 N to O 40 3 O Ln � m O _r_ CJ N ;. m +, en . 4- O �n N O m O E 4+ of Ln L,? 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L a) p 3 c a a E vCL u ai � a `t M o rLo c X_, v> v-0 ro 3 0 — c +, u C ,n a) N a C E C C 3 a) u `n +- a' M o LA L �= aJ ° � W a) 3 M> m + L a) m + m C Ln (p u ami L C > >- VI a) a) L 3 ami on C 'U N p v p m O �^ a C O C '� 0 L += a E m Z '3 L "� v +-� L C o - — L m a L Z o 0 3 p Z o O to L H O L.L '+� > z +' a) C Q ++ O L >- +—' C” +, L u L m -O 'o �_ L u (LO `J n+ W amj v— m 3 l7 0 a) o +' L c0 c- o N •U E c m - o Q) C L O Y {n U d4 c m tia u Q L a) = ,N — 3 H aL•, u a) ra C C •- E 'x p m a) t Ln ai s c o O O v'^i 0; x° o 3 E a`) o w a p E dA c0 in m o .� H c0 > �n o u H 4, H + Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. Current Property owner(s) Mailing address Lending agency cos^# Expiration Date:~./-~,/'~ GENERAL INFORMATION Complete legal description [~C.~'~3,~non '~ 6l~ 5 Lo{ 2 Lo~tion (site address) J~Oj ~ ~[~m,A~3~ , Ak ~U;~ K~n~ Day phone qq~ Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless othen~ise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well Individual Water.Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual-Holding -Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a pedod of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells er 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 vedfy that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Address ~,0.~ 5'tk 5¥~. ~., A ~'.. A~ Engineer's Pdnted Name Lptl"~ .~/m4~-~,~¢~ 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for Phone Date · ." ~." ' --' X?.-' . ~, '. '-', -'- , bedrooms, ri ~'~,',~'~,' .~ bedrooms, wKh the following stipulations: .-'.~: WATERAND ' ~: · ,. PROGRAM :---' Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 19C~50 Anchorage, AK 99519-6650 wvw. munLorglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ~ ~le,~g,~, a~ ~1~5 Lo¥ ~. Parcel ID: O / 7 "' A. WELL DATA wel~ type 'P Date completed ~ I'~'{-~ Total depth IO~) ft. IfA. B, otC provide PWSID# - Sanitary seal (Y/N) ¥ Cased to. ~ 4. ft.l~ FROM WELL LOG Date of test b q h~o~o~ Static water level ... t~ n ~-no~ 'ft. Well production ~,-~o~ ~ g.p.m. WATER SAMPLE RESULTS: Coliform (;~ coionies/100mL Nitrate ~.~ mg~ Arsenic: <5 ug/L dateofsample: z[/ll~olO B. SEPTIc/HOLDING TANK DATA Tank Type/Material ~'re,~./ 5{'~[ Tanksize IO00' gal. Number of Compartments ~ Foundation cleanout (Y/N) ~ ' Depression over tank (y/N) ~ We, Log (Y/N), A/ Wires properly protected (Y/N) ¥ Casing height (above ground) ,-I- AT INSPECTION gp.m. Jn Cleanouts (Y/N) High water alarm(Y/N) Date of pumpir~g .. A~o,;J Jst1 Pumper ~'5 ~3,c~,.,. ~r~ J');,~ C. ABSORPTION FIELD DATA Dateinstalied G/;JlllS~ff Soilratin~ (g.p.d.lft~o~ J~5 Systemtype Length J ~ ft. ' Width J ~ ft. Gravel below pipe Total depth cj ft. Eft. absorption area ~3~, ftz; Monitoring tube Date of adequacy test' ~llll~-~ ~0~C) Results (Pass/Fail) Fluid depth tn absorption field before test ~/ In. : Water added 510 gal. Elapsed Time: J.~ min. Final fluid depth ~;in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) .'~ JV'c~ ~,,,,c,~,~ ft. Depression over field For ~ bedrooms New depth ~'~n. H..~O g.p.d. If yes, give date ----- Other bacteria .. ~ ' colonies/100 mL Collected by: L~,.~ D. LIFT STATION Date installed ~ 'DPe~ummP on' ~~/in' J E. SEPARATION DISTANCES Size in gallons ,//' 'Pump off level at /,'""in. Cycles tested// Manhole/Access (Y/N) High water alarm level at / in. Meets alarm & circuit requireme~? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tan~ift station on lot 100~ Absorption field on lot [OO~ + Public sewer main ICC)'+ Sewer/septic service line ;~ .5 ~+ Animal containment areas ,~)o~ ~ On adjacent lots On adjacent lots tOO Public sewer manhole/cleanout Holding tank /V'/A. Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building loundafion 5 J-t- Property line S ~ Watermain )'~ I0J'l' Wat~rservice line Wells on adjacent lots ICC)+ {O Absorption field ~ 4- Surface water A/,O, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I0~'1' Water Service line. Curtain drain /V,O, Building foundation IO'4. Surfacewat~r hi.O, ('tc~ Wells on adjacent lots Water main )~10 + Drhteway, parkingNehide ,qorago" I0 ~' G, ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that tho above systems are in conformance wilh MOA COSA guidelines in effect on this date. Engineer's Printed Name Date COSA Fee $ /1/~0 Date of Payment ~o1~ Receipt Number (Rev. 11~5) Waiver Fee $ Date cf Payment, Receipt Number, Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # HAl00105 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 5, Lot 2 of McMahon #2 subdivision. This inspection revealed a nitrate concentration of 8.41 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. SG~ Re£# Client ~mc Project N~me/# ~lient Sample ID Matrix 1101357001 Spurkland Engineering McMahon #2 B5,L2 McMahon #2 BS,L2 Drinking Water Printed I)ale~fime Collected Date/Time Received Date/Time Technical Director 04/08/2010 I 1:32 04/01/2010 12:00 04/01/2010 12:20 Stephen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Arsenic 5.0O U 5.00 ug/L EP200.8 C (<10} 04,~05/10 04,1)7/10 NRB War. era De~ar~mon~. Total Nitmtc/Nitrilc-N 8.41 0.100 mg/L SM204500NO3.F B {<10) 04,92/10 AYC HXerobioloej~ Z.abora tor~ Total Colilbnn Negative I E. Coli Ncgative I 10omi, SM209223B A 04,1)1/10 DLC 10Omi, SM209223B A 04,~1/10 DLC Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-361-36 1. GENERAL INFORMATION Complete legal description Lot 2 Block 5 McMahon #2 Expiration Date: //- ~Q. ~- O 22_ Location (site address or directions) 12901 Norak Place. Anchorage, AK 99516 Current Property owner(s) Glenn Hardinq Day phone 345-3086 Mailing address 12901 Norak Place~ Anchora.qe~ AK 99516 Lending agency Day phone Mailing address Real Estate Agent Mailing Address Jerd Ann Strand / u~c---,j. ~,_-~,~(¢-V" Day phone 345-0023 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] Community On-site [-~ [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority 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 less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public wate, r S~stem. The Municipality of Anchorage is not responsible for errors or omissions in the professional erLqineer's w'Sf,r('i (Rev. 11/99) 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation based on procedures outlined in the Health Authority Approval Guidelines for 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 vedfy 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Enq. Svc. Phone 272-8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Pdnted Name Steven R. Pannone, P.E. Date Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis ofthe system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of ~-~, the test, and separation distances measured to readily tdentifiable features. The operational life of all ~ wells and septic systems delxmd on the local soft conditmn, ground water levels that may fluctuate ~ ~'~ duriag the year, and the water usage of the family being served by the system_ These condittons are ~,. outside the control of the evaluator of this system. All systems eventually fail and satisfactory test ~ "'~:~ results do not guarantee futare performance of the system, nor do they guarantee that there are no ~..~t~ ................. hidde, n defects o.r encroachments. PES can therefore not provide any warranty for future performance %?x~.~reve n nor gxve any esttmate of how long the system will continue to meet the operatioual requirements of the ~?.¢ '-,, ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any rehance upon or use of this report by any other person or party is not authorized nor will it confer any 6. DSD SIGNATURE ~ Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: , -((((((((( ~ ; WASTEw~z~ : Additional Comments By: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Expiration Date: (Rev. 11/99) X Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: 'r~ - Reissue Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 2 Block 5 McMahon S/D #2 A. WELL DATA Parcel I.D.: 017-361-36 Well type P If A, B, or C provide PWSID # .... Date completed ~'O~ (c[-~(,~ Sanitary seal Y Total depth 105 fl Cased to 92+ ff FROM WELL LOG Date of test Static water level I ff Well production g.p.m WATER SAMPLE RESULTS: Coliform ~) .colonies/100 mi Date of sample: 8112/2002 Well Log _N Wires propedy protected Y Casing height (above ground). 19.5 AT INSPECTION 8/12/2002 79 ff 3.0+ g.p.m Nitrate /~ mg/I Other bacteda Collected by: Laura Pannone in. (~ colonies/100 mi B. SEPTIC/HOLDING TANK DATA Tank Type/Material Greer Steel Date installed 6/2111974 Tank size 1000 gal Number of Compartments 1 Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm .N/A Date of pumping 71812002 Pumper Anchora,qe Cesspool ABSORPTION FIELD DATA Date installed 612111974 Soil rating (g.p.d./ff2 or ft2/bdrm) !25 System type ..Pit Length ...,18 ff Width. 18 ff Gravel below pipe ...6. ff Total depth 9 ft Effective absorption area 432 ft2 Monitoring tube _Y Depression over field N__ Date of adequacy test 8/12/2002 Results (Pass/Fail). Pass For _3 bedrooms Fluid depth in absorption field before test 4...~6 in Water added.450 gal. New depth51 in. Elapsed Time: ..1.440 rain Final fluid depth 46 in Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date (Rev. 11/cJ9) D. LIFT STATION Date installed Size in gallons "Pump on" level at in"Pump off" level ~ SEPARATION DISTANCES FROM WELL ON LOT TO: Septictank/lift station on lot 114+ Absorption field on lot 118+ Public sewer main 100+ Sewer/septic service line 10t~- in Building foundation Water main 50+ Drainage 100+ Property line 20+ Water Service line Curtain drain 100+ COMMENTS Manhole/Access High water alarm level at in Meets alarm & circuit requirements? On adjacent I~)ts :100+ On adjacent lots 100+ Public sewer manhole/cleanout Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 28' 3" Property line, 12+ Water service line 50+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 50+ 50+ Surface water 100+ Wells on adjacent lots 100+ 100+ Absorption field 29 Surface water 100+ Water main 50+ Driveway, parking/vehicle storage 50+ I ce~ eat I have datelined through field ins~cfions and rev~w of Munici~l records that the a~ve sy~ems are in confo~ance wEh MOA H~ guidelines in e~ct on this date ~~ ..~ EngineeCs Pdnted Name S~ven R. Pennons, P.E. ::re of Payment ~/~/~ Date of Payment ~iptNumber ~~ ~ ~, (Rev. ~ ~ ~) 1~___ CT&EEnvl~onmen~l 8ervlee~ Inn. 9075515301 T-823 P.OZ,"02 Mat~ ~g Order~ By ~m 0 Sample Ali D&tt~/Tlmes nre Alaslo~ Standard 3'line Printed Da~trttme 0S/l 5~002 11:45 CoBected Date/Time 0g/12~002 14:00 Rete|ved Oate. efhlle 08,'12;2002 16:00 TechnlcaJ Director $lepben C'. F. de puru~eler Rmm~lU PQL AIIO~IMc Pre~ Amflyril Lin~m t:~te l~te Init ~k~-N 4.~2 0.200 ~g~L F. PA300.0 (<10) 08/13!02 JD'I' Total co~/I 0~n~, SMIS 9222B (<1) 08/12/02 JO.J: 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 Parcel I.D. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ~/~vt,.~ ~r4,'.'~ Day phone Mailing address ~ ~ ~ o ! N~ V~ ~ L. Lending agency d"¢7 ~,~,, ~l ~,Day phone Mailing address Agent Day phone Address 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) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm 'T'-eL~-~I ~1~¢¢~'-.~.cc~ '~1~-- Phone ~-~/ ~ Address ~ ~ [~--~ Engineer's signature ~ '~ DHHS SIGNATURE ~ X Approved for''7''/J'f'~' bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 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 engineeCs work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: L~,'-~ ~.,f~' J~.,J~o~c~[ ~"ParcelI.D. A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Y If A, B, or C, attach ADEC letter. ADEC water system number Date completed I~1 ~ Driller ~ I ~.. Cased to '~ ~ 7-- Casing height ( ~ Wires properly protected (Y/N) .~' Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ') /(..~:~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank g'P-~ _~ ~ > ~ 0 WATER SAMPLE RESULTS: Oo,,,or ¢ Date of sample: Nitrate .-~ I~///~ Other bacteria ¢ Collected by: '7-7 B. SEPTIC/HOLDING TANK DATA Date installed ~ /2. l /') ~ Cleanouts (Y/N) y High water alarm (Y/N)~ Date of pumping &'/ Tank size I ~ Compartments Foundation cleanout (Y/N) y Depression (Y/N) /~/"/~ Alarm tested (Y/N) t~//'~ Pumper Well(s) on lot 1 I..~ To property line /.~' Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: On adjacent lots I~ A ~.~):)~o n fie. d ~ Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots I). ABSORPTION FIELD DATA Date installed (" /.2-1/? ~! Soil rating ,~,~o ¢.' ~.~ { Length I ~ Width / ~ Gravel thickness Total absorption area ['¢' ~ Depression over field (Y/N) Results (pass/fail) for Peroxide treatment (past 12 months) (Y/N) Surface water Cleanouts present (Y/N) Date of adequacy test System type Total depth /,,, If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot / To building foundation On adjacent lots Surface water Curtain drain On adjacentlots I I C~) Propertyline To existing or abandoned system on lot Cutbank h.[,¢ ~t ~ 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 effect on the date of this inspection. Signature Name ,-CD HAA Fee $ Date of Payment ~ - 7_2- --~.~_. Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. ~' 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS g~SUl,?S for INVOICE S 54g52 Chemlab Re~.S 92.2807 Sample ~ 1 ~tatzix: WATER Client Sample ID : 2/5 }~C1,B_IION P~t$ID : UA Coliectad : JUN 15 92 ~ 12:45 Received : JUN 1,5 92 ~ 13:10 Preserved with : AS REOUI~ED Client l~l~e :TOBBEN SPURKLAND, P.E. Client kect :TOBBENS BPOS : POS :NONE RECEIVED 0zdered By :TOBBEM SPIIggLAND, P.E. Analysis Cmapleted : JUN 17 92 Send Reports to: Labe~a%oxy Supe~¥iso~ : STEFNEN C. EDE i)TOBB~N gpURKL~,ND, P.E. Paramet ez Rnsu]gs~ U~/~ I~oghod 3,1lowablo Limits 7-77% NITRAT~_N { ~.o ~ mE/1 ~P~ 353.2 10 Sample ROUTINE SEMPLE CO[,LECTED BY: T,S. NO TAG FOR YHIS SAI,~LE. ! Testa Performed * See Special Instructton~ Above UA~Unavailable ND'. Non~ Detected ~ See Sample Remarks Above NA= Not Aualyzed LT~Less Then, GT=Greater Than ~SGS Member of the SGS Group (SociCt¢ G~n6rate de Surveillance) I I N ~_/~~~s situated thereon ore wilhin the property lines :nd do not ~rlop or encmoch on the property lying adjaCent thereto, that no Improvements on the property lying adjacent therefo en~ch on the premises in quest ~ and thet there are no ro~d~oys~ transmission lines or other visible easements on s~id pro~rty ex.pt es indicated hereon. Anchorage, Alaska, this Z~-fla~ of ~ ~,19 PREPARED FOR: AS-BUILT DWN, IDATE C4~ID ~L~ ~0. m~': ' KARABEL NIKOFF SURVEYING