The URL can be used to link to this page

Home My WebLink AboutMATHIESON LT 3Bmathi'seson Lot 3B #051-102-64 to fiberglass tank was left in place. Alarm location Electrical installed by Tank to PIPE MATERIAL House to tank Installer Jr's Septic Services drainfield — Drainfield CO/MT Inspector Pannone Engineering BENCH MARK (Assumed elevation) It Inspection ection V 9/25120 2,.dLocation and description 31d 4w ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date�� OF AL'k � 11 TH Steven Pcniiorie Septic System 1<91 • CE 8149 �Q Approved Date qD, 7U�SSIG�� Note: this approval does not include well permit requirements.��®�� (Rev 05/02/18) �� Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page I of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201331 PID Number: 051-102-64 Dwelling: R Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 10 Upgrade FName Cross ABSORPTION FIELD Rd ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Phone El Other Number �Bedroo`ms'Soil Rating Total depth from original grade 3 LEGAL DESCRIPTION GPD/SF Depth to pipe invert from original grade Ft Gravel depth beneath pipe Subdivision Block Lot Mathieson 3BFill Ft. Ft. Township Range Section added above original grade Gravel length Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES To Septic Tank Absorption Lift Station I Holding Sewer Ft. Total absorption area Number of trenches Ft. Dist. between trenches From Field Tank Line FtZ Ft. Well I I TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 1000 Gal. Material Number of compartments Lot Line I NA Fiberglass 2 Foundation I LIFT STATION Manufacturer Capacity Remarks Exposed tank for replacement, tank was found Gal. to fiberglass tank was left in place. Alarm location Electrical installed by Tank to PIPE MATERIAL House to tank Installer Jr's Septic Services drainfield — Drainfield CO/MT Inspector Pannone Engineering BENCH MARK (Assumed elevation) It Inspection ection V 9/25120 2,.dLocation and description 31d 4w ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date�� OF AL'k � 11 TH Steven Pcniiorie Septic System 1<91 • CE 8149 �Q Approved Date qD, 7U�SSIG�� Note: this approval does not include well permit requirements.��®�� (Rev 05/02/18) �� MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite Permit Number: OSP201331 Work Type: SepticTank Upgrade Tax Code Number: 05110264000 Site Legal Address: MATHIESON LT 3B G:1359 Site Mailing Address: 20727 OBERG RD, Chugiak Owner: CROSS THOMAS B & MARTHA J Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 031" t 1" a v. Departiiient 9/9/2020 9/9/2021 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 (18AAC72) and Drinking Water Regulations (18AAC80) 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: Date Issued By: Date 3 r MUNICIPALITY OF ANCHORAGE Community Development Department 4 Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-102-64 Property owner(s) Thomas & Martha Cross Mailing address 1400 N Golden Hills Drive, Palmer, AK Site address 20727 Oberg Rd Day phone Legal description (Sub'd., Block & Lot) Mathieson L313 Legal description (Township, Range & Section) Lot Size 40,808 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x Septic Tank 0 Upgrade Q (w/wo ADU) Holding Tank ❑ Renewal ❑ Duplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: 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: 6,3, ri 15 Waiver Fees: Date of Payment: 642 02 U Date of Payment: Receipt Number: 2 % 2c 1 Receipt Number: Permit No. 0 S f ;),o 133 1 Waiver No. Permit App__- :- : L. c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201331, Deb Wockenfuss, 09/09/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201331, Deb Wockenfuss, 09/09/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201331, Deb Wockenfuss, 09/09/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201331, Deb Wockenfuss, 09/09/20 Municipality of Anchorage ' ' ; ,•, Development Services Department Building Safety Division On-site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3 www.cl.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW070172 PID Number: 051.102.64 Name: Wastewater System: ❑ New ® Upgrade Addreea: —20 Box 671546 rhuglak AK'99567 Phone. ABSORPTION FIELD ® Deep Trenon O Shallow isnot O Bed O Mmand O Odea: Nurear of sed oot e: (907) AAR.IA62 LEGAL DESCRIPTION Sod Rating- Total Dro'""m ovna� Block: Lot. Subdidslcn: 36 1 De01" to NO Odlan"bn on nal PO�FI� P wade: 8.7 FI. cn a dem" be wm pipe: Twp. Mathei$Dn Rape: section: 3.7 FI. 5.0 FI Fig added above Wgrk,a, Wade: Gravel Length: -0- Ft. 40 FI. Well: ❑ New ❑ Upgrade G,"Maetr: Nuneera ones: Datance beN~ Ntaa: Clasadlmoon (glvale, A B. C): Tag Dem": Cased W: Exist Private Ft. Total abso"On arae: 1 -r FI RFe Mal": Ft. FI Drinan: Data Drilled. slAW Water Laval: 400 Fta lnFlaner 3034 PVC FI YiMd. Flinestone Excavatin Date Mwiea: 81712007 PtanC set M: Gyne NnWe Abpve GraaW: • GPM F,. Ft. TANK SEPARATION DISTANCES ® septic ❑ Holding ❑ S.T.E.P. ❑ Other. ToViseptlon Litt Front ld Station Holding WiUPrivale Tank Sewer Line E lstr wan7 ""° °` Nunber elSteel 2 Surface wale.+ LIFT STATION Lor lana Sze Manulactu, Adm On•bvel al: WWn v2kralanal.ti. Pury Make S Model M In Elemnol l nepewas penonned by. Renwa: Tank ex osed &Ins ected. BENCH MARK Loaua ara DesrnWa: Back Deck Aswned Ebwuon: �'. '100.0 Ft. Inspections performed by: PANNONE ENG, SVC, LLC Dates: 1"1100 Engineer's Stamp 12007 Development Services Department App ova1 �4 '�F'�.•Cr'�� Conditional Approval * `• r` ♦♦ Date: 4 y ' �...: .................00 0 0...... . . ' .............. . r ♦teven P -vnnonpj Reviewed and approved by. c. u� Date: ♦ �,% N CE 8149 . .: ♦♦♦ (Rn 04%) �'Qn(••'' ��: ♦e+ei�, E5;1 ��• 1 3A -29-07 SWINGTIES CO A B C FCO 4.2 11.6 T1 12.8 17.1 DC 17.0 21.2 DV 18.8 22.6 Cl 38.1 13.5 C2 14.3 40.1 �2% M1 16.2 37.4 M2 30.4 16.5 3 D A -C 13.7 NEW UPGRADED FIELD 40LFx2.5'Wx5'ED, 9'TD TH1 i //_ 2% EXIST'G 10009 SEPTIC TANK VERIFIED INTEGRITY. INSTALLED DV 8 DCO'S AT TIE-IN W/EXIST'G TANK EXIST'G DRAINFIELD IN FAILURE. TO BE REUSED C PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 Lot 3B Mathieson Thomas and Martha Cross P.O. Box 671546 Chugiak, AK 99567 (907) 688-1062 08-21-07 Scale P.I.D. NO 51-102-6 PERMIT N0. SW070172 RECORD sheet PLAN 2 or 6 O4C RC d 'P 09d g n 00 o RECORD DRAWING --Q£ o , OF A�gS�11 9'*. -*ash+ ;01 c Sleven R. Pon one / '. CE 8149 .��/ ' 4s �1•'0$-29-47�'� g �Q\ \0FE -29-07 SWINGTIES CO A B C FCO 4.2 11.6 T1 12.8 17.1 DC 17.0 21.2 DV 18.8 22.6 Cl 38.1 13.5 C2 14.3 40.1 �2% M1 16.2 37.4 M2 30.4 16.5 3 D A -C 13.7 NEW UPGRADED FIELD 40LFx2.5'Wx5'ED, 9'TD TH1 i //_ 2% EXIST'G 10009 SEPTIC TANK VERIFIED INTEGRITY. INSTALLED DV 8 DCO'S AT TIE-IN W/EXIST'G TANK EXIST'G DRAINFIELD IN FAILURE. TO BE REUSED C PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 Lot 3B Mathieson Thomas and Martha Cross P.O. Box 671546 Chugiak, AK 99567 (907) 688-1062 08-21-07 Scale P.I.D. NO 51-102-6 PERMIT N0. SW070172 RECORD sheet PLAN 2 or 6 1110 NY= M3N lv 39x1NOvN Z C 9:ff:1:T.f: ; aN3 HO" IV 3 l/lo �319n0a .5' .rrlsr .0' V ]9'11 yOLNp1 M Tw llowm I (n Y lllo Nv3q m _ g LL E CLZ m v y C C7 1110 NY= M3N lv 39x1NOvN M M O_ t` O O a Q 00 oa 3 p RECORD DRAWING 08-29-07 TH i�?• v1 Steven ft.•Ponnone.j ogCE 29 4q7-' 64 I Z C 9:ff:1:T.f: ; aN3 HO" IV 3 l/lo �319n0a .5' .rrlsr .0' V ]9'11 yOLNp1 a Tw llowm I (n M M O_ t` O O a Q 00 oa 3 p RECORD DRAWING 08-29-07 TH i�?• v1 Steven ft.•Ponnone.j ogCE 29 4q7-' 64 I PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 Lot 3B Mathieson Thomas and Martha Cross P.O. Box 671546 Chugiak, AK 99567 (907) 688-1062 w w O a CL Dale 08-21-07 Scole NTS SW070172 RECORD Sheet DETAIL 1 3 of 6 ao l/lo �319n0a MWAN31N3N0 i ^ m lllo Nv3q m �Y C7 FF 1/10 Nv310 d X W LLl to Lq NV310 NalwNroi PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 Lot 3B Mathieson Thomas and Martha Cross P.O. Box 671546 Chugiak, AK 99567 (907) 688-1062 w w O a CL Dale 08-21-07 Scole NTS SW070172 RECORD Sheet DETAIL 1 3 of 6 MUNICIPALITY OFANCHORAGE Development Services Department Onsite Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 23, 2007 Expiration Date: Jul 22, 2008 Permit Number: SW070172 Parcel ID: 051-102-64 Legal Description: MATHIESON LT 3B Design Engineer: 0062 PANNONE ENGINEERING SERVI( Site Address: 020727 OBERG RD Owner Name: THOMAS & MARTHA CROSS Lot Size: 40808 SQ. FT. Owner Address: PO BOX 671546 Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK , AK 99567-1546 This permit is for the construction of: ❑V Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Date: 61--3'61 Issued By __ Date: Z y 07 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. 1)t-5I-Ioa-69 Property owner(s) Thomas & Martha Cross Day phone 688.1062 Mailing addressP.0. Box 671546, Chuglak, AK Zip Code 99567 Site address 20727 Obems Road Zip Code 99567 Legal description (Sub'd., Block & Lot) Mathieson SID, lot 3B Legal description (Township, Range & Section) Lot Size 40,808 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 3 THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. Pannone Engineering Services, LLC (Signature of property owner or authorized agent) Permit/Rush Fees:y(i0."V- Date of Payment: _7/6107 Receipt Number: 7—,fl (Rev. 11105) Waiver Fees: Date of Payment: Receipt Number: Pannone Engineering Services, LLC P.O. Box 102954 Consulting Engineers Anchorage, Alaska, 99510 (907) 272-8218 (907) 272-8211 Fax July 13,2007 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519 Subject: Mathieson S/D, Lot 313 Septic System Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new septic system be issued for this lot. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The well is located in the southern portion of the lot. The existing septic system is located along the eastern property line and is in failure. The surrounding lots are served by private water systems, which are over 100 feet from the proposed soil absorption system. The existing septic tank will be exposed and its integrity verified. A new 1,000 gallon septic tank will be installed outside the well radius if it is required. l: Soils. The soils were investigated during July of 2007. No ground water was monitored in the test holes to a depth of 15 feet below ground level. Bedrock was not encountered in the test holes. The native soils have sufficient sand component (greater than 51%passing the #4 sieve) as not to require a two foot (2') sand filter. It is my opinion that the overall soils appearance of the soils, an application rate of 1.2 gallons/day/square feet should be used using a standard treatment system. 2. Trench Design. a. Percolation Rate: b. Application Rate: c. Number of Bedrooms: d. Design Flow: e. Min. Absorption Area: f. Total depth: g. Effective Depth: h. Width: i. Minimum Length: j. Design Length: k. Effective Absorption Area: 1. Septic Tank Size: 2.3 Min Per Inch 1.2 gpdpsf 3 450 gallons per day 375 sf 9.0 feet 5.0 feet 2.5 to 3 feet 37.5 feet 40 feet 400 sf . 1,000 gallon if required 3. Surface Nater: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches containing water. Page 1 of 2 Page 2 of 2 4. Topography: Lot 3b slopes to the southwest at approximately 2 to 3 percent in the vicinity of the septic system. The lot is uniform in its slope. The proposed installation will be located in the northern portion of the lot, greater than 50 feet from slopes greater than 25%. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: C:\Work\Letters\3B tvtathieson.001.doc I 8A BASEBALL BALLFIELD NO WELLS OR SEPTICS '—WELL ; EXIST'G SEP C y� AREA EXIST'G SEPTIC \ � 3A I /-ZrAREA 4/ �r\ TH1 3D ``c T' , �� THIS PROpE RM Q� WELL F� AREA UNDEVELOPED NO WELLS OR SEPTICS I TRUCTIDN 7/19/07 PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 _ Lot 3B Mathieson Thomas and Martha Cross P.O. Box 671546 Chugiak, AK 99567 (907) 688-1062 l" EXIST'G rAREA XIST'G SEP 3C/ DESIGN PLAN 7/13/07 Scole 1'100' 'ERMIT NO. SW07xxxx sheet 1 OF 6 ISSUED FOR C01 P m r / Steven Ponnope d '• CE 8149 ggi /♦'4'•07-19-07" Ilk 3 ii RM Q� WELL F� AREA UNDEVELOPED NO WELLS OR SEPTICS I TRUCTIDN 7/19/07 PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 _ Lot 3B Mathieson Thomas and Martha Cross P.O. Box 671546 Chugiak, AK 99567 (907) 688-1062 l" EXIST'G rAREA XIST'G SEP 3C/ DESIGN PLAN 7/13/07 Scole 1'100' 'ERMIT NO. SW07xxxx sheet 1 OF 6 1'5% � 3A /• 13.9 THIS ° 27 0.0 \ n n n /rte �n 10.0 EXIST'G 3BR HOUS 140.7 �\ r �mo2% 2\. b` ` I5.5 I LL C 102.7 c � 1 I PROPOSED UPGRADE FIELD 40LFx2.5'Wx5'ED, 9'TD i .3 EXIST'G 10009 SEPTIC TANK VERIFY INTEGRITY. REPLACE 2%IF FOUND LEAKING, ItINSTALL DV & DCD'S AT TIE-IN W/EXIST'G TANK EXIST'G DRAINFIELD IN / FAILURE. TO BE REUSED ISSUED FOR CONSTRUCTION 7/19/07 , A��1% ��Q(�• "' • 9Sf�It J. ( *Y �••"•" / 7 G 5ieJen'R: 'a one j / og •. CE 8149 r/ 4`I' '•7/,1907.-* ' (laRS9tl=�� PANNONE ENG SVC, LLC LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 REVISED D7/13/07 Scale 1"-50' Lot 3B Mathieson Thomas and Martha Cross P.O. Box 671546 Chugiak, AK 99567 (907) 688-1062 P.I.D. NO 51-102-e PERMIT N0. Sw07xxxx DESIGN PLAN Sheet 2 or 6 • 1nO MY3,o oN3 W,1Y31Y 3en1 tlOLIgN }� 8 Us PP to .� Y tZ o 0 1 _p w 3.0' (� 3enlwunow '. LL 7 w uio-r�v3�a ..r.�: �' 0 4.0' t 5.0' e iq e qEo un NV= 31Bf10o a 53 a MWAWMVU a o lmM o q�Y F H Ino NY313 h a. w �w rn lno rcv3io Np1VJW10! ISSUED FOR CONSTRUCTION 7/19/07 0NVtX\ REVISED Dote / y�P�� OF A�qS��,+ PANNONE ENG SVC, LLC 7/13/07 P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 Soole *• r•*�/ NTS �10 � Lot 3B MathiesonP.I.D. z 6 Sieves 'dniAone j Thomas and Martha Cross PERMIT N0. 7/19/07.- ug Box 671546 DESIGN Sw07.... Chu Iak, AK 99567 Street �� \ai`(907) 688-1062 DETAIL 3 of 6 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: 3 -BEDROOM HOUSE, NEW DRAIN FIELD, VERIFY EXIST'G SEPTIC TANK, INSTALL DIVERTER VALVE, REUSE EXIST'G FIELD, 4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE INFORMATION ABOVE 5 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 13 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. DESIGN PARAMETERS NO. BEDROOM: 3 TANK SIZE: 1,000 gallon PERC. RATE: 1-5 MPI SOIL RATING: 1.2 gpd/SF APPLICATION RATE: 125 SF/BR AREA ROD: 375 SF SYS. TYPE: DEEP TRENCH, 5' ED MIN LENGTH: 37.5 LF Ste: 40LFx5'ED. 9.0' TO TOTAL AREA: 400 SF ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN-OUT T# TANK CLEAN-OUT NO. CQ CLEAN-OUT NO. M# MONITOR TUBE NO. R.I. RIGID INSULATION DV DIVERTER VALVE DCO DOUBLE CLEAN-OUT ISSUED LEGEND w—w— WATER LINE/ WELL RADIUS — ss — ss — EXIST'G SEPTIC —ss —ss — NEW SEPTIC n 0 CHAINLINK FENCE FOR CONSTRUCTION 7/19/07 C�%Ikxx :oFAtg%y*i�/ A NOP.O. ENGINEERING S o C , LLCso 9 PHONE (907) 272-8218 FAX (907) 272-8211 TH Lot 3B Mathieson� rS ,46 Thomas and Martha Cross CE 8149 P.O. Box 671546 7(1..... Chugiak, AK 99567 I OFEs9a �= (907) 688-1062 7/13/07 Scab NTS 051-102-64 PERMIT NO. SW07xxxx DESIGN ShIlt NOTES 4 of 6 2 3 4 5 6 7 8 9 t0 t I2 13 14 15 16 17 18 19 20 TEST HOLE 1 OR IOrganics Cloy/Silts POORLY GRADED GP/GM IGRAVEL W/SILTS SLOPE GRAVELS W/FINE TEST GP GRAINED ND/ ISAND ER V/DEPTH i HOLE BOH WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? DEPTH TO WATER AFTER MONITORING? DRY DATE- 7/10/07 TEST HOLE READING CLUCK TIME NET TIME WATER LEVEL READING NET DROP 1 6:21 4.5' - 2 6:31 10 MIN 8 7/8' 4.38 3 6:32 4.5• - 4 6:42 10 MIN 8 15/16• 4.43 5 6:44 4.5' - 6 654 10 MIN 8 7/8' 4.38 11 PERCOLATION RATE 2.3.0 (min/inch) F TEST RUN BETWEEN 4 FT AND 5 FT DATE PERFORMED 07-03-07 COMMENTS: Test hole excavated by Flintstone Excavating. Test Hole was presoaked before perc test. Test ran for 1 hour- last 3 readings reported. PERFORMED BY: M. Wehr. I CERTIFY THAT THIS TEST WAS PERFnRMEn IN ArrnRT)ANrF_ -'OF A4 Xk PANNONE ENG SVC, LLC REVISED Dote qS �� P.O. BOX 102954 ANCHORAGE, AK 99510 i Co �y(� PHONE (907) 272-8218 FAX (907) 272-8211 stole i * TH * l� 1".50• ... •••• Lot 3B Mathieson P.I.D. NO lrvein�oUn� Thomas Cross 51-102-6 MIT NO. 8149 Ew P.O. Box 671546SW07xxxxf)(7/07Chugiak, AK 99567 TEST sheet (907) 688-1062 HOLE 1 5 of 6 �P� �ft�ilt��tn kCOTY CF ANCHOPAGC Iry DEPT. O' 1:-.,!T! I & ENNI.ION INTAL fSO._CTION DOC Co. tloa SULLIVAN WATER W ELLS J U N a 1979 P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 RECEIVED OWNER OF LAND 01 r 6 c G Y nJ I'I1 L7 ]' /-/ / E.j-'e,.J DEPTH OF WELL ADDRESS C7 O X �1 1 G STATIC LEVEL OF WATER FT. LEGAL DESCRIPTION /?L Jt 3 6 V' ATNltsniL)d:9 DRAW DOWN FT. DATE - Started { b " 17�)r Ended PERMIT NUMBER % `r D r) O S KIND OF FORMATION: From Ft. to t Ft. From Ft. to_7 Ft. S ^ G Kr? ✓t� From Ft. to Ft. 00 L) L 4 From —7 to I d lFFt. N 41<1210� From '13 Ft. to�_FL "'o G t✓"T' tL From Ft. to Ft. (C'AuEG From /41 Ft. tom 3 Ft. /71 '�'t5 Sk^J40 From 17 3 Ft. to 1 7;r Ft. .-19'`'A ! Cc r9 7 From i �'Ft. toITS Ft CL --1 i V r! er ✓c G From / � Ft. to 'Td Ft. FlnIc S ; —o Front—Ft. to Ft. �y 04 re; C From le'. -? Ft. to 1 Y L Ft. Sr} .j o 9 ✓e 4 -- From Ft. to Ft. w� T= From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: GALS. PER HR to r KIND OF CASING 17 From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. (� From Ft. to p Ft. From Ft. DRILLER'S NAME c -12 - I r -t �_� r-� x t� I F=� L1I T Y t_t F �1 P -a r H t1"•; � r=i t� E , I t DEPARTMENT OF .HEALTH HNC:' EtJVIF:ONMENTAL P�._TECTION 825 'L' STREET, ANCHORAGE, AI'. 99501 264-4720 LUS F-IELLL FAr-.1C• EDrAa - I TJ✓rE I -IC- F= F�FE- Er•T I T PERMIT NO. ( 75020; ) AFFLICANT MADELYNN MATHIESON BON 511 E. P. LOCATION GLENN%OCEPG RD. LEGAL L3B MATHIESON S:D TYPE OF SOIL AE:'=ORSTION SYSTEM IS: TRENCH / ;3U LIPS LOT SIZE 4 000 SOUARE FEET MA;IMUM NUMBER OF BEDROOMS = = SOIL RATING <.SO FT!ER)= 85 THE REOUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C•EF=^TH= LEr-dtmTH- -i ce 0F=_F-1' EL CHEF -r - THE LENGTH DIMEN_ION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIEL.D. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F E=C_ LJ I FREE• &>EF=`T I tY -rnr-4 - I `E_ �rtt=tt_t tar iLLr�t l= PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AP>Li THE NUMBER.. OF RESIDENCES THAT THE WELL MILL SERVE. --- T1-30 <;2 > I ta=•F='EtCT I ctr (= F=IEE F�Et t_t I EEC• --- BRCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. 'MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL: OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOG_ ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN <O DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATION= AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F EEr7 I T E.` -<:P I EEE• C•Er EtyE EFS ==i 1 •_+_Snll I CERTIFY THAT 1: I AM FAMILIAR HITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. -. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE I5-REMOOELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED APPLICANT rT!DELYNN IESON ISSUED B'T_ �- ---------------- DATF�� 2y _.--- V _ OSE Russel Oyster 69.2.2774 'Soils Er Foundations GEOTECHNI CAL .&I -DEVELOPMENT (_.ox 90• Davis St., Eagle River. Alaska 99577 - 6942774 or 688 2280 SOIL LOG CO. Ead Ells 6882280 Land Development Performed for: Name: ":i=Ss;_'tt S:;_�I'!_ o'r 7e1. No. Hailing Address: Legal Description: Lot'iA "�•.�icn `_,;; +,,. , Daoth fee:) Soil Characteristics 0 1 .a:. — "'Ut r.Cc S: i with :not:; 2 i 5- :a 1�... 2 Z J nn:iy 3.av-)l with cobbles to 12 in, ari toni:i:r.; n,, to g5 rt,/,,P 6-- 3 _^on,, l'•:.ry Cl_ -In A: --I 10039. y7 8 9. ---1•--; it` ter :,inning -Into pi; ^s3dily at It feat. 9 CjF -- of pit. \��'-,ery)) 13 rnt�?•' ,: M •� ,� I.—Wer �; 17 S�',<`�: Cama L. v �)`'�•,, Ni. 429Sc 1, d 16 ;a ' Ground Water Encountered: Yes rx _ No If yes, What depth Propos,ed Installation: Seepage Pit Drain Field Cor:nants:=r r'.�s=h^, i.^. b;a;. t'.. si'�; ct ^;t lob -moi Perfort::ed by: Date: ,1ari' 2>. 19.7? CA -L.,.- E MUNICIPALITY OF ANCHORAGE • Development Services Department one: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-102-64 1 Certificate of On -Site Systems Approval GENERAL INFORMATION Complete legal description Mathieson L313 Location (site address) 20727 Oberg Rd Expiration Date: Current property owner(s) Tom & Martha Cross Day phone Mailing address Real estate agent 1400 N Golden Hills Drive Palmer, AK 2. TYPE OF DWELLING: Fx_1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ $550 Waiver Fee $ Date of Payment 3--5--21 Date of Payment Receipt Number Vo99 7 C Receipt Number COSA 4 OSC211093 Waiver # 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, 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and 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 identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. DSD SIGNATURE _X_ System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date Z( ®2 -awe, OF A/TH ��'t ,r- t3... ...... Steven 'R.* *f'an crie CE 81a 01SSO� Conditional approval for bedrooms, with the following stipulations: OF,ii/i i i J ON-SITF WATER AND G �2 Z PROGRAM �o I'SERV\ Original Certificate Date: �S 2 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Mathieson L3B If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA H Well log is filed'with Onsite (or attached) Date drilled 5/79 Total depth 196 ft Cased to 196 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 81312020 Static water level at beginning of test 142 ft Comments B. TANK DATA Age of tank(s)(e4f49 years Tank type/material �°PftX°G Measured operating fluid level in septic tank 54 Standpipes/foundation cleanout per record drawing Date of pumping �?- (9( -" D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 8/7/2007 AM ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 5.0 ft (min) ❑ N/A - pressurized field 0_1 Monitor tubes go to bottom of effective. If not, state depth into effective OR Code -required soil cover over field ❑® System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 2000 gallons Comments/Deficiencies: COSA Checklist yellow sheet 311 Parcel ID: 051-102-64 Structure served by this system 1 Well production at time of test 7.5 gpm Water storage tank volume na gallons Well disinfected for coliform test? ❑ Yes ❑✓ No F Coliform bacteria is Negative Nitrate 1.4 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample 2/11/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 8/13/20 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 0/0 in Water added 450 gal New depth 11/0 in Elapsed time 100 min Final fluid depth 0/0 in Absorption rate X450 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes Community Sewer Manhole/Cleanout > 100' [✓ Yes if No ft Fv Yes if No ft Neighboring Tank > 100' ✓/] Yes if No ft Private Sewer/Septic Line > 25'7 Yes if No ft Absorption Field on Lot > 100' ✓� Yes if No ft Holding Tank > 100' Z✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ❑✓ Yes if No ft 0 Yes if No ft Yes if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' MYes if No ft P/ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' Fv Yes if No Water Main > 10'✓0 Water Main > 10' Yes if No ft Community Wells > 200'✓� Yes if No Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' El Yes if No ft If absorption field is under driveway comment below Property Line > 10' F,71 Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' U Yes if No Water Service Line > 10' F/� Yes if No ft Community Wells > 200' El Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION OF L, l certify that l have determined through field inspections and reviewc.�P of Municipal records that the above systems are in conformance with 49T MOA COSA guidelines in effect on this date. • • • • • '• ' • • • `'' "� • • Steven 'R. l'annorie• CE 8149 )k, r1iis COSA Checklist yellow sheet ft ft ft ft c� I o CJ rte, 0 � C� rte;o ----------- --�--LO---------------------1------el - t - - - - - - o i.£&'68I H1f1OS) I- ~ L O N 0 Z bi Q O ,Z' -VZ r s,� �, O,S, ._ 04 O �fS CO 8s`� - - - - - - - - - - -�- 2 W w ' W (n rWco O 0 N V 1 J m � 00 00 o I- O I- 000 —1 O a u 00 W Z W r Z Of W D -a WN (n Z d =3til W� Z W oz W J LOf LJ J U Ld ~af O d U 0- U � W 2 OfW o¢ Z:)w W �di� 3xiRfS'Tw"r" iEd� \ O w � 00 Q = m �'froc) �P4�b mor to a o LO ��v _1 _u Z I N 0 04 =W MY) 1 N-: SEGWO o Z WUJ Y �� U ' LO 00 hD` t LA '' •' .O ,�-� a��d ovyr ra Z 0 P Q 00 U Q J Z � -i W '> U Ld U LLJ N `o O er tr W OU / cc� L N U ? O ov .ac or c ac c Gr N /, Q. •O L .c c� >. C > H V � •- CN2�o Q X x X O X u �Oj y - �•oo N O �oo•�o c '` •� C C O L N •N N O C o c c o L E O a C G cerin .-J o o s Z N O � � a) cn> w CL N -, O N N m Oca LO Q. o o.: n'a o o•� N� `o o v N O ^`> O y_ o y N y C L O •- O O C .N o o n c ..- o 2 .—Z o Q03 U Q z W .— U -G. E - ,- m TEL rutin Tu < v,v J�4� u ` Ld N C-0 C�-d >v W v"a LO O o��E�_G ti �`_ o o < N T O� t6 _ C.7 ZQ_ j O O_ a. �. c n o cuoi �� 0 �, o+-- 0 04 rn� L U < � / OS o „ in 2 W ' n. Q�..O 3.Ely ��ci u �a.o� O- F' p -v N -« O p s ap c ti o� oa-yam a oo 3 n. o E.o / (6 �m •n O C c �i U -C N f6 v.T..0 O E .-• v H o v vi a •a .- c A L fu OE L '� >, O O Q7 O o a o- v o n L. �- i0— •� U V p C N c: U L r N p r C O i- .... L L L 7 fy •+-t - N O L In C C iJ d d 0 o �o Lao a r u 0 0 0 -G� o u m O M N N 4J OL ` n C O C a% 4- L i E E y O v c >. Eo N i v N v> v In M U O 04- f6 O O O C v .� Z --c �-u O �cuom•-�� '-r.n�'E� O 3 m z 9 6 w � W Z W r Z Of W D -a WN (n Z d =3til W� Z W oz W J LOf LJ J U Ld ~af O d U 0- U � W 2 OfW o¢ Z:)w W �di� 3xiRfS'Tw"r" iEd� \ O w � 00 Q = m �'froc) �P4�b mor to a o LO ��v _1 _u Z I N 0 04 =W MY) 1 N-: SEGWO o Z WUJ Y �� U LO 00 hD` t LA '' •' .O w a" W tQ-- Z 0 P Q 00 U Q J Z � -i W \ LO U Ld U LLJ Q O tr W OU cc� . • . ' /, X x 1 x CN2�o Q X x X x X W Z W r Z Of W D -a WN (n Z d =3til W� Z W oz W J LOf LJ J U Ld ~af O d U 0- U � W 2 OfW o¢ Z:)w W �di� 3xiRfS'Tw"r" iEd� \ O w � 00 Q = m �'froc) �P4�b mor to a o LO ��v _1 _u Z I N 0 04 =W MY) 1 N-: SEGWO o Z WUJ Y �� U U -s0 MUNICIPALITY OFANCHORAGE • 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. H 05-1 — I oz—(P°' 1. GENERAL INFORMATION Complete legal description L -.>r 3 g , YI/le,-utcaoa 5u ec, Location (site address or directions) - e-,2 0 7Z7 03c2r .QFC �iLcc c .:aac Yt-A_. Property owner T .V. 4, tM+c1 t+a- Ce o ss Day phone (ag Llcd- Z - Mailing address 2-o7 27 Oma 20 CrFccat ar .4t 49Sro7 Lending agency Mailing address Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well _K Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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 (RM.1/%) Front MOA N21 S. 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 furtherverifythat 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 David R. Dayton P.E. Phone 696,--21117 20M 10 Lyohalar St Address Ch%ak, Alaska 9956 Engineer's signature 6. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments [tom Date ...'.t GF �fC1i'2 ] n Iw1 Y,•p.•p.a•�V��y t1•��• !�0. S: CSF. � Qn bedrooms, with the following stipulations: Date ✓-/8 - g% ".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 engineers work. TVM(A".1/91) Back MOA►21 Municipality of Anchorage AEM Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: tor- 35 Sae, Parcel I.D. OS'( - /oz- G V A. Well Data Well type 1Rtl -'wrC If A. B, or C, attach ADEC letter. ADEC water system number. Log present (YM) y Date completed ��2-6/79 Driller Succ, �+r n✓ Total depth 1 13C.0 Cased to t q Le Casing height Sanitary seal (Y/N) Y Wires property protected (Y/N) y Date of test Static water level Well flow Pump level FROM WELL LOG S/es/79 14a , AT INSPECTION 5'0 g.p.m. 6,�4 g.p.m. 17 !1K SEPARATION DISTANCES FROM WELL TO: Z o U M am Septic/holding tank on lot /`%l` ; On adjacent lots /o0 v- z Absorption field on lot /Z-->` ; On adjacent lots /o o r Public sewer main A114 Public sewer manhole/cleanout -%//IV Sewer service line /o o r Petroleum tank �! WATER SAMPLE RESULTS: Coliform o Nitrate 0-(-(- Other bacteria D Date of sample:lz/u/4!� Collected by: nF-a B. SEPTICIHOLDING TANK DATA Date installed Tank size / CkDn Compartments Z Cleanouts (Y/N) Y Foundation cleanout (YM) N Depression (Y/N) Al High water alarm (YM) A✓/a Alarm tested (YM) A✓/A Date of pumping� Pumper ✓ ''S Liu ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots /a Q � Foundation /D To property line /071- Absorption field Water main/service line 2Sf- Surface water/drainage /o O t 72-026 (3M3)- Fmt 72 -026(3'93) -Font CONTINUED ON BACK PAGE oz L� T D rn_ � Cn o C m Z o U M am Septic/holding tank on lot /`%l` ; On adjacent lots /o0 v- z Absorption field on lot /Z-->` ; On adjacent lots /o o r Public sewer main A114 Public sewer manhole/cleanout -%//IV Sewer service line /o o r Petroleum tank �! WATER SAMPLE RESULTS: Coliform o Nitrate 0-(-(- Other bacteria D Date of sample:lz/u/4!� Collected by: nF-a B. SEPTICIHOLDING TANK DATA Date installed Tank size / CkDn Compartments Z Cleanouts (Y/N) Y Foundation cleanout (YM) N Depression (Y/N) Al High water alarm (YM) A✓/a Alarm tested (YM) A✓/A Date of pumping� Pumper ✓ ''S Liu ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots /a Q � Foundation /D To property line /071- Absorption field Water main/service line 2Sf- Surface water/drainage /o O t 72-026 (3M3)- Fmt 72 -026(3'93) -Font CONTINUED ON BACK PAGE C. LIFT STATION Date installed '`)/'4t Manufacturer Size in gallons Manhole/Access (YIN) Vent (Y/N) 'Pump on" level at 'Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 5'/x/72 Soil rating (GPD/Ftz) scfh System type Length Width 31 Gravel thickness 3 Total depth 7 Total absorption area 2-sy Cleanout present (YIN) Y Depression over field (Y/N) Date of adequacy test r 3 Results (pass/fail)5 for 3 Bedrooms Water level in absorption field before test 0.40 After test 0- -5,? ' -AG. -,(,5 Peroxide treatment (past 12 months) (Y/N) Al If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots /0071- Property line io e - To building foundation 1!5— To existing or abandoned system on lot Nc hr. On adjacent lots Z S'/- Cutbank A6,✓ , Water main/service line L 5-1�- Surface water /oo/" Driveway, parking/vehicle storage area .ia d-' Curtain drain /yoN 4 Al I'V a J 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. David R. Dayton P.E. 20210 Donalar St. I �' Alaska Signature Chvgiak, c ' Engineer's Name Jl Date v v HAA Fee $ a Date of Payment Receipt Number 72-028 (3,93)' Back Waiver Fee $ Date of Payment Receipt Number 20210 Donalar 696-2417 January 3, 1994 Legal Description: Lot 3B, Mathieson Subdivision Date of Test: December 31' 1993 Well Depth: 196' Static Water Level: 142 ft. Requirements: 3 Bedroom - 450 gallons per day Test: The well was tested with the existing pump through an outside hose bib. Volume and drawdown were measured at regular intervals. After pumping was stopped, the recovery was measured. Results: The well produced 475 gallons in 74 minutes with a maximum drawdown of 3 ft. The drawdown was fully recovered within 5 minutes. The well is currently producing adequately for a 3 BR hone. L �t'�+�•• No. 2=O E o�Y_PRAcrcr.,�NP, D! Chugiak, Alaska 99567 1907MMMM 20210 Donalar 696-2417 January 3, 1994 ADEQUACY TEST Legal Description: Lot 3B, Mathieson Subdivision Date of Test: December 310 1993 Septic Tank: 1000 gallon, 2 compartment, steel tank (DIM Records) Absorption System: 3' wide x 3' deep, x 44' long trench (DHHS Records) Soils Rating: 85 Sq. ft. per bedroom (DHHS Records) Requirements: 3 Br - 450 gallons per day Test: Water was pumped into the trench while measuring volume, time and water level rise. After pumping was sropped, the water level drop was measured at timed intervals. . The results were plotted on a graph of time and gallons absorbed and the extrapolated to 24 hrs. Results: The absorption system is currently functioning adequately for a 3 BR hone. ;E OF At ;ti I. ...................0 David R. Doytrn i.. •. 140. 9£01! !'9Fn .......... MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIROMIENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ?OCT, I F 'Y (a) Legal Description (include lot, block, subdivision, section, township, range) /0.7 gyp, (S1oc4-.c/ n147F17rsr:J SU12 Location (address or directions) �=lErJiJ f OD.cQC- COai� G F? -.23 us (b) Applicants Name /i1AdFu /h ►.ywtiiltic1u�J Telephone - IIome Business Applicants Addressor fog 7 7- 004 O f_ A(.j F 7--t JFti 4K gnt"1 j (c) Applicantelis-(check one) Lending Institution Owneribuiider Buyer , Other (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. 6 Agent !•. nn. Address Telephone 34)'-3g4+ j (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Multi -Family Number of Bedrooms 3 3. Water Supply Individual Well M, Community Q Other (describe) 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 [El_ Public M Community M 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[ 5. CT/3fy Al+7.4Tew11 r Engineering Firm Providing Inspections, Tests, File Search Data and 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 regula- tions in effect on the date of this inspection. Name of Firm AE'Cs Telephone Address /7cY> LJ A0f ANc14oC4& - 14L Ci9S"O-21 Date /C /i'Z- (ENGINEER SEAL) 14 ij DHEP Approval C01 Approved for ) U bedrooms By �9 C /r -I10 Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION C. Rad, . 2251•E THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MU11ICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIOMIL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A. WELL DATA ^ ^ MUN':CIPALI Y OF Ar:CHoRAGE !" DEPT. CF HEALTH 8 ENVIRONV4ENTAL P.,OTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 OCT 1 0 i-84 RECEIVED Legal Description: !1'3G, A444/,7csoAJ Well Classification \-_ -IA)P If A, B, or C, D.E.C. Approved(Y/N) oV4 Well Log Present &N) !es Date Ccupleted _,� S-22 79 Yield q•q/9P Total Depth 4-1%91 Cased to /95' Depth of Grouting uut Static Water Level /VO � Pump Set At u NK Casing Height Above Ground Sanitary Seal on Casirg Electrical Wiring in Conduit (Y/N) NP S Depression Around Wellhead (Y Nd Separation Distances from Well: To Septic/HG14iF@-Tafk on Lot7�xltiq,L ; On Adjoining Lots G-T/oo� To Nearest Edge of Absorption Field on Lots`* -l -z y' ; On Adjoining Lots &rio.T To Nearest Public Sewer Lire N To Nearest Public Sewer Clear.cut/Manhole ,J1 To Nearest Sewer Service Lire on Lot 44L- Water aWater Sample Collected By L' G Uro c., ; Date C/ o c 4 3 LJ Water Sample Test Results Jll'/1ST�Y Comments ' f✓o-- We\\ taj -X 'Y_-Frtg. SIAWD_ �r< B. SEPTIC/HOLDING TANK DATA Date Installleed 4 5--30--71 Size y/o o6 5.../ No. of Ccnpartnents r Z Standpipes &t) 2e-,9 Air -tight Caps )t Fcurdaticn Cleanout (Y XJ6 Depression over Tank (Y Date Last Pumped 3L-/ Pumping/Mainterance Contract on File (Y/N)VI-- for ,v4_ Holding Tank High -Water Alarm (Y/N) A.A- Temporary Holding Tank Permit (Y/N)W-f- Separation Distances from Septic/Holding Tank: To Water -Supply Well *17•-19, t- To Building Foundation 4'1- 041 To Property Line V- tiu' To Disposal Field -i S-" To Water.Main,/Service Lire u A- To Stream, Pond, Lake, o- Major Drainage Course b' ' Comnenl •4 4� Receipt # Date Paid: Amount: (Page 1 of 21 2-15-84 i1 (t 3(, ,14d4111F--` C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata' �S ljZ/!ice Type of System Design i ct.ucii Date Installed 5-30-77 Length of Field --'� tel' Width of Field Depth of Field -4c 7 Gravel Bed Thickness* 3-' Square Feet of Absorption Area -A- Z SS D'- Standpipes Present O/N)�elo Depression over Field (Y/0' I -t) Date of Last Adequacy ibst 0 f 8 Results of Last Adequacy 2bst If r Separation Distanoe from Absorption Field: To Water -Supply hb11 s/4 11.4 To Property Line 7� -4 /U To Building Foundation N- /U ' To Existing or Abandoned System on Lot U a- On Adjoining Lots w9 - To Water Main/Service Lire u a. To Cutbank(if present) ,v4 - To Stream/Pord/fake%x Major Drainage Course l. --r / u o ' To Driveway, Parking Area, or Vehicle Storage Area ,ry 5>' Comments V f.tv.� AS -6..'14 -Y V RIEM1Su.1F > rgrtu . sl�..r r". 2a S D. LIFT STATION Date Zr lled Dimensions Size in Gallons Manhole/Access (YM) "Pump On" Leval at �� "Pump Off" Level at High Water Alarm Level at nt (YIN) Tested for Pumping Cycles during Adeq st. Maets NDA Electrical Codes(Y/N) Caments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, cr conformed to all MOA HAA Guidelines in effect on the date o5, this linspection. Signed�`/ / 7�+C1 Date q 0 Company A Cc S MOA No. R y- KB1/d5/s [Page 2 of 21 2-15-R4 ALASKA cnUmonmCf h C000L SERUICCS, InC. Engineerinq & Enuironmental Studies OCTOBER 11 1984 MADELYN MATHEISON P 0 BOX 77-0511 EAGLE RIVER AK 99577 SELLER — LYNN BURNS BUYER — SUBDIVISION — MATHEISON BLOCK — LOT — 3B ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN UNKNOWN AREA. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 450 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOW. THE SEPTIC TANK WAS PUWED ON OCTOBER 2 1984 . FLOW TEST ON WELL THE WELL FLOW RATE WAS 9.41 GPM FOR 3 HOURS. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUW OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. 1200 West 33rd Autnue. Suitt B • Anchorage, Alaska 99503 • (907) 5615040