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HomeMy WebLinkAboutPAULSON LT 65B t LL LL LL y LL C y LL L i ce) CID Q Ma) O a O' CLg� a) w C) 0 co m T- D El E � 3 c c 3 • • , . t cc co C a3 -0 a I c O r 1 rx °•� , fi� r O- .O -•' mLo y L a O a) L) .. ... rn i. - X4.:1-. ___ �...�. mcri. CD _y ,..o • N ❑ L pad v �, O :: -�' : ��t c ,. y UCL > m > � al J y m CL E v n fh O LL > > . � ' • s ��� a C7 C7 o o o as v = z (V c� as m w O e- ;',`:',•• LL L.L • ami ami m c �[ -O � o f • a .� Z5 0 W co❑ mc cu E Cl) E w O 0 m rn m z (f)Z = o Z LL LL 0o L� W❑ Q ¢ o a� 0 0 z n> m ca o f— Z Q Y 'a N o ULLJ -0 UJ H v 'o g ® z �- ^ h o F- a O O O °'0. cu s _ CL a cn z ¢�Z O � ❑ (a s = `° z:3 w Q w Z5 1-9 o w z � o ¢ ❑ ❑ ❑ J € cr Q w o LL c� � Pm 2� J� a a. fn 0 F— O >0.3i D W Q Cd Q U yC_ o LO c W a o N 3 m E ❑ �' w :n m J a) _X a c I-- 0)��¢ D Y� _� a = ❑ U w t a) LU,= T Z .�. CO O N I-- 0 �? !n U W W 'Q< c fn 0 ❑ _ J a CL O Q Z Z N z a o cn o Q 4 a \ T-- V o 9 � cW \ ° LL Wa- W CL c� ca Li _p Q Q ya m V to u) LL LL F- Q. co U _ Y -�- -�' 1 T �t� T Z Q Z Z! �% Q > t0 �. Q O �~ a cl) ca O Q O O O Z v Z O C ' L V Z cn O W r M W �� Q V/ CL \ o o -0 J CO W J O � Z Q ° uT Z �W O ��o Z a o U) c rn Z J.2 Q U) cx cv, Q ?� v D c y vm oa O ._ U Q E a�� Q d m �� 0 0 J o ns U y -p O- O - Q z m in a Jin U� ti O a c 0 U) Q Permit No. OSP241044 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PAULSON LT 65B MARK A B TCO2 26 33 / c01 28 37 CO2 28 381 PID No.: 018-261-24 \ BB F �a \NEH1=G OLD TANK R TOP OF MH PLASTIC TANK I TO DUMP ASBUILT / \ SCALE: 1"=5(Y \ SEPI SEcn0N N.T.S. F Al i i � 49 TH MICHAEL N. ANDERSON: ' No. CE 9469 40" W � I � ® \ BB F �a \NEH1=G OLD TANK R TOP OF MH PLASTIC TANK I TO DUMP ASBUILT / \ SCALE: 1"=5(Y \ SEPI SEcn0N N.T.S. F Al i i � 49 TH MICHAEL N. ANDERSON: ' No. CE 9469 40" W MUNICIPALITY OF ANCHORAGE rnt On -Site Water & Wastewater Program �0 PO Box 196650 4700 Elmore Road a Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite r llei)a1,tIII e11t On -Site Wastewater Disposal System Permit Permit Number: OSP241044 Effective Date: 4/5/2024 Work Type: SepticTank Upgrade Expiration Date: 4/5/2025 Tax Code Number: 01826124000 Site Legal Address: PAULSON LT 65B G:3035 Site Mailing Address: 14440 ELMORE RD, Anchorage Owner: BERLIN KENNETH H & SANDRA S Lot Size in Sq Ft: 48959 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 4 This permit is for the construction of: ❑ 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: tS� f� l it --Sri.✓ Date: Issued By: Date: S 2 U Z MUNICIPALITY OF ANCHORAGE ", 3 4 Development Services Department `� p p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 , ON -SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 018-261-24 Property owner(s) BERLIN Mailing address 14440 ELMORE RD ANCH AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) PAULSON LT 65B Legal description (Township, Range & Section) Lot Size 48,959 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 Septic Tank 0 Upgrade 0 (w/wo ADU) Holding Tank ElRenewal ElDuplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A 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: > Waiver Fees: Date of Payment: (41-Z-17cl Date of Payment: Receipt Number: 0Z,((2-7 Receipt Number: Permit No. 0-si2 `i � O L/Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc March 31, 2023 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic tank permit Legal: PAULSON LOT 65B To whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. The tank will be decommissioned per the Uniform Plumbing Code (UPC). Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241044, Curtis Townsend, 04/05/24 LOT 65A 1" = 50' 33 LOT 96A ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: PAU1,,SON SUBDIVISION 1) LOT 65B PLAT 83-356 SURVEY CERTIFICATE 1, John L. '3chuller, Have conducted a physical survey of this property as sh(")-,vn on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance sho-iL any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundar, lines. EXCLU'510N NOTES: It is the owners responsibility to determine the exist,-nce of any easements, coverants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDZR NUMBER: DATE- SCALE. E—MAIL, APRIL 2, 2024. 1 oil =50' schullerckOgmail.com 24-017 DRAWN BY; CHECKED E-,,Y-. MD NUMBER: BOOK/P_AC;E-,'_ I JLS SW3035 240118 FND MXMINUM MONUMENT /j CO) FND 518 " REBAR � N6XNI low SUP P AW OFj.1 1. Ilk NT D46 AW S �j 9TH ?A ?A ....................... L JOHN L. SCHU=R. 0 LS-10408 0 1831 Talkeetna Street j4. , Z': z4- - Anchorage, Alaska 99508 "0 f (907) 227-1455 office IXN�l essiono, (907) 274--4992 fax 1"=50' EXISTING HOUSE INSTALL NEW 1,250 GALLON PLASTIC SEPTIC TANK W/ 20" RISER, DOUBLE CO AFTER THE TANK. DECOM. OLD TANK PER UPC, MAINTAIN 5' FROM FIELD AND 10' FROM BLDG. SCALE: DJRDRAWN: DATE: PAULSON LT 65B Anchorage, Alaska KEN BERLIN 4/2/2024 SEPTIC ALL LEACH FIELD PIPES TO BE REPAIRED FOR FINAL COSA Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241044, Curtis Townsend, 04/05/24 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS LEGAL DESCRIPTION I LOCATION ~i ,O. OF BEDROOMS ~ we,, I Absorption area Dwelling PERMIT NO. ~ ~ DISTANCE TO: ~ Z Manufacturer Material_.__j ~ ~ ~C ~~, ~ ~ No. of compartments Liq..capacityj ~in gallons IF HOMEMADE: Inside length Width Liquid depth ~ ~ Well Dwelling ~ ~ Z DISTANCE TO: PERMIT NO. O ~ ~ Manufacturer ~ - ~ Material Liquid capacity in gallons ~Q ~ DISTANCE TO: Wel~ ~.~. ~ Foundation~.% / Nearest lot li~l~t~M~. .PERMIT NO. ~ ~ Lenqth of each line Total leogth ~f lines Trench width Distance ~ No. o~nes between~ ~OgO?lines ~ Top of tile tojinis~grade ' Material beneath tile Total effe ion area m Length Width Depth PERMIT N0. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ DISTANCE TO: Well Building foundation Nearest lot line ~ Clas~ ~/~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING REM~KS II'"1111..~.tl INI ~ C:: ][ IF:::" ~.'.~, II ...... ]E qf-'% .... ¢]]~ IF::' ~:.',.~ INI C:: IHI C) IF::;,". ~:::.1, C~]i IE: ~ '~ DE'I=:'(.~FRT'MEIq]" JIF HI.:£At_.TH AND E]',IV I ROI',IMENTAI .... F'I:~OTE::CT I [)N ,3.~:.~ L.. ,:~ t I",EI::. I ,, ANCHOF;:AGE, AK oo,= ,", .~ 264-4720 F:*F:T. Fi'M I T' NO .. *' C~ C**~,~ ,, D A T' E .[ c>,~ U E [, ,, 84()9()9 10/2?5/84 A F' F:' L.. I C A N T', A D D R E S S :: CONTAC;T' F:'HONIE: :: LEGAL DESCRIP:: L 0 T S I Z E: MAX BIEDROOMS:: SUBD I V I S I ON: F:'At. JI_SON SECT'ION: 33 TOWNSHIF': 1,25A (SI;!. I:="F. OR ACF:~ES) L i s t ecl b e (I. o w a r e 'L h e o p t i o n s a v a :i. ]. a b ]. e 'L o y o t.t i n cl e si :i. g n :L n g y o t..t r' s e p'L i c system,, Clnoose .,,,.,.~ opt. ior} that. best fits your si'Le. "T' ER: E:: P,.I C; ~"'~ 1::., E: .. 1~ L~',,~,,, ,,., ,....,,,. miC~ % IP'qt DE:.PTH "F'O I='IPE BO'I"T'OM (F=T.) GFi:AVI'ZL DEF:"I"H (FrT.) TC1TAI .... DEF"TH (FT'.) GFi'.AVIE:L WIDTH (F:'T,,) GF~AVEL.. L..I:7.1qGTH (F:'T.) GIRAVEI, VOI_UME (CLJ. YDS,, ) TAI'.JI< S I Zl:"'" (GALS) SOIl.... RATING (SQ,,FT',, /BR) 2. () ** 4. () .-:!; .. 0 () .. 5 5. O 4 .. 5 27.5 2(). 0 EI.q. ,, 0 ** 3 8.0 27... 3 28, 250.0 ~'~'* 125 :L25 4 ,, () 1.0 5.0 5.0 88,0 '*'~' 24..5 250 ,, 0 1 "~5 ** DEF:'TFI TO F::' I F:'E B[]'T"I"OM < 3.5 FT'. REQU I IRES I I',ISUL..AT t 01',1 '.~* DEF:'TH TO P I F:'E BOTTOM < 4,0 I:'"'1", ' PlAY RI.:.;[~L.I.T. IRE.': A L. I F"T' STAT I *'.* GRAVE~L LENGT'H > 75 F"T,, REQU:I:RES MUL]"IF:'LIE I:=dJIxlS (NOT EXCEEDII',IG 75 FT '."~".~' TANK MLJST HAVE ~'T' L. EAST TNO [.',DMPAF. N"MENTS I c e r' 'L i f' y 't:. h a t :: .1.,, ! am f'am:Lliar wit. t"~ the reqt..tirenJent.='~ f'or' on-s:i.'Le sewers and wells as set f,:)rtl"J by 'Llqe ldur~ic:ipality of' Ar~chor'a. ge (IdOA) and the Sta'Le of' Atasl.::a,, 2,, I will :i. ns'Lal], the system :i.n accordance v~i.'Lh all MO(..~ c:odes and regu].at:Lons, and in comp 1 lance wi'Lb 't:.he des:i, gn c'r J. ter ia of' tln :i.s l:~errn:i.'L, 3,, I w:i. ll adhere 't'..o all MOA and State of' Alasl<a r'equ:i, ren'~en'Ls for the,, set ba,::l< dJ..s'Larlces from any exis'J:.il]g we].]..., wEtstewa'L6.)r, d."LfSposa]..syst, 6..h'¢i or' pt..tb].:i.c sewerage system on th:i.s or any adjac:ent of ne.a~tby lot,, Z.l.,,I understand that 'Ll"lis pe:rn'iit :Ls val:i.d £or a ma;.,'imum o,.r 4 b.e:dr'oo~'ns arid a n yen I a r g emen t w i '1 1 r .'.s, qu :i. r e an a cl cl i 'L i orl a 1 'p e r m .i.t. IF: A L. IF'"T STATION IS INST~LI...IED .T. Ixl AN (~I:-;'.E~ COVERED BY I"ID~ BUIL. DING C:ODES., 'T'HI!EI',I (.1.) ~N EL.E:CTRIC;AL. I='E"RMIT ~1'4](:) INSF'ECTION MLJS'T' BE OBT'AINI:'i:'.D; C2.) AS-BUILTS NIL..I .... NOT BE! AF'PROVED NI'T'HOUT AN ELECTRICAL. II',ISF'Ii-ZCTION F;'.EF'O.R'T; AND (3) 'T'HE ELECTI:R I C.;AL. NC)RK MuEFr' DIE: DOI'.JE BY A I_ I CEI',ISED ELECT'I::.~ I C I AN, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [~""~ SO ILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE SITE PLAN 1 4 5 7tt'1 WAS GROUND WATER ENCOUNTERED? f~'~ 0 P IF YES, AT WHAT ~,0 lo-/r-~? E DEPTH? ~ Reading Date Gross Net Depth to Net Time Time Water Drop 72-008 (6/79) PERCOLATION RATE BETWEEN . ' FT AND ~ FT CERTIFIED B Y :~¢-~',~ (minutes/inch) /. o ,, ,,/' , Department 825 MUNICIPALITY OF ANCHORAGE f Health and Environmenta Protection ~ Street, Anchorage, AK. ~9501 264-4720 * * * HANDWRITTEN PERMIT * * * WELL AND-~ON-SITE SEWER PERMIT /~/~/~ Mailing Address: .~.~ '// Permit # ~ Location: Phone Number: Legal Description:~ _~. ~-- ~CX:~-~i~- ~.~ Lot Size: d)~ Type of Soil.~orption System Is: Trench: V Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: _~__ Soil Rating(sq.ft/br) / ~ The Required Size of the Soil Absorption System Is: DEPTH ~ LENGTH &~ ,.. GRAVEL DEPTH ~/ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The The gravel depth is the minimum depth of gravel between the outfall Pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SiZE = /~OO GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this departme: will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fe, for a private well or 150 to 200 feet from a public well depending upon the type of public well~ Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that: (1) I am familiar with 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 codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more t~ bedroom~ S igne~ ~ ,~ ~ ~ by~x ~ ~ A~A~ ~ Date: ~/~-~/z~, - 3 SWP/024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST LOG PERCOLATION TEST PERFORMED FOR: DATE PERFORMED'. ~-/12 /8~ LEGAL DESCRIPTION: '1-'! ~ t',~ 1'~:' ~,,, i ,'c .. .... 2 3 4 7 I SLOPE SITE PLAN co~nCr S4a 10 12 ~ NO [~zC) 13 14 15 16 17 18 Reld, ,Ir..' 19 2O COMMENTS ~O~ ~ r ~rr~ ~ PERFORMED BY: ~ e,,/o, n $ WAS GROUND WATER ~ S ENCOUNTERED? ~£$ L O P E IF YES, AT WHAT , DEPTH? ~t Reading Date Gross Net Depth to Net Time Time Water Drop ~ Zo .3.:)- . 8~- - .50 - flc:t 2_.0 .zq .Zl q~ ~ zo ,2q , I~ PERCOLATION RATE I ~' t l~- (minutes/inch) TEST RUN BETWEEN . ~Z FT AND ')' '/~% FT CERTIFIED BY: DATE: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENV!RONMENTAL PROTECTION 825 L. Street, Anchorege, Aleska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 9 10 11 12 13 14 15 16 17 18 C. Reid, 2251.E COMMENTS ~i. ~ r~.'~ PERFORMED BY: SLOPE WAS GROUND WATER-/~-$ ENCOUNTERED? IF YES, AT WHAT DEPTH? DATE PERFORMED: ...~/~2/8~ ~o~ ~T 83 o2q~ SITE PLAN \ I Reading Date Gross Net Depth to Net Time Time Water Drop qo% 2o .zq .~1 PERCOLATION RATE I ~' ~l~ (minutes/inch) TEST RUN BETWEEN 7 ET AND "~ 'l~L ET CERTIFIED BY: DATE: 72-008 (6/79) ALASKA L,,JIROFIm6FITAL COFITROL InC. ~nq~n~rinq f., ~nuironm~nlal Studi~s Subdivision Supplemental Soils Information. >~ TITN ~L~Block '- LOT ~P~ LOT ~' LOT ~(:, LOT TH I TH Z TH ~ TH ~o~ I 'mmm 3111 4 4 5 5 6 6 7 7 8 - 8 9 9 10 10 11 11 12 12 !3 13 14 14 17 18 18 20 ~0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1200 UJesl 33rd Au~nu(. Suite I~ * Anchoroqt. Alosko 99503 · (907) 276.1361 WATER WELL RECORD STATE OF AL ASKA DEPAR'rMENT OF NATURAL RESOURES Division of Geological & Geophysical Surveys Drilling Permit No. �.:OCATIQN OF 'WWI-L. (PleCgs camD10fe either lc, Ib or lc.) A.U.L. No. !2. 6prpugh Su"divis!on + of � Block I itr1 gtrs Section Na. Township Range Meridian E of of ._ S yy��--•Il � u (c. DISTANCE. AND DIRECTION FROM ROAD INI ERSEC -1-A ?N5 3. OWNER OF WELL: ! f Address ` - - t Street AJdress and Area of Well Location rI- I� Feet Below 2. WT !_L LOG� � � 4 WELL DEPTH. f final l 5. DATE OF COMPLETION ^suraoc -I Imojo o! Type �FGR �. ru}+ _ ___.ft. l..�Cab4u«tool Rolary �.Drivan ( Dvg-� I I i L f u -,� Jetiea �Scrod � Uili - or 7,1!SF r{ Domestic Public Supply 1_ Industry I: riaatlon Rechorge a. Comme(!col fail Well L other: . 'r CdSYNG. -r� threaded-1Velded P {' ! uio.r. In. to may_ It. Depth Weight lbs, fil ti 4Yt it, o w� ft. Depth Stickup 1 FI D aLLL: —^c�---�—._,__----------�-------•+-•-•--•---1 :+�� —_ _ v_ Diameter'--__.�__—� ! ! I Sic,/ Mesh Slie Length. ;T --- _.-,•�- _--- __ _._ 4 -- --_- Se! beitwesn ft. and ft, $ockflilfn j Sravel pock } '.l( i0. STATIC WAFER LEVEL �,. tl. f_. I i !3o c Above or Below lo4+d surtore t Equipment used jQ 'ld3a il. PUIOPiNG LEVEL below !and surface and YIELD H�N`d Ada r�'�� { fi. otter hrs pumping g.p.m. i tr after - hrs. pumping g.p-m- ---.--•� -- - — — iZ.GROUiING, Well Csrouled: [j Yes L No I :r_riaf Neat Clement C i Other- 3 Pump; (if ovallabis) HP Length of Drop Pipe ft. capacity g.p.m, in 1� SQbm F j Jet Gentrifical ❑ Other --- - -- - i 14. REMARKS 2 i I[. WATER WELT_ COINTR.ACTOft n CERTIFICATION: 15 Wo er Temperature ° o F C ' This well w�:r d4ii-le-rl under my )urisdic,fion and thls report ig tour to the heal of my hrrowte.tn� e+,J belief; at, Babmc— Noon" Co L4+,eri c jNi, m', s+. - �--•- ,., ,_.�,: :. � .:.. : "L. I. ,., C.a s:. et'� s; my40n,xar i. NTI- CD 0')T (7) AVI cy') co LJ 0 0 LL 0 (n /ISR a ca 20 N tl N p � D U L L CU CW a) cn i (1) 06 U) E O > Un C)O A LO N O N co N co 0 C O co Q X w CD CD CD 4 N r co N M W CD a) U co d r LO m m Q Q) m co L- 0 O U M � W Q L 0 cD � .~J W Z O O co J J W O �- Q rn U N N (1) 70 70 _0 c ^' CD A J Un T Q CO 06 W Z W z J /W W O O O Q. O Q c m L U 0 O O Q Q cu a) Ln i1 U) a) a) C O F- X Al N cc O N C E O A N O N d' ai 0 a) co U O U cu C I 0 0 0 (n /ISR a ca 20 N N � CU a) N t 0 t ~ UO O ~ a) a) U i 0 c 0 o Q V a) = N N a) C Q. N O Q. > U) o NO O - fn N E Q Q U Q ..�LL Cl) a) N _ a) —(') �_ O U) 0 = a) o O y z Q N > O Q cC a) C L O Q. Q Q E ❑. ai L U) v = O L = Q) L X ate) cu cB O v - A cu O W W 1 ,�/� N E -0 O Q Ll O a- O p (� N _ p 5. 0 0 ; Q V LL -0 Q 44 ca dy 0 r 0 C O o m IL) N O N F- Q— L 4_ �� W �• W L ' •2. vJ 0 CU U) Q F- O U= O t U co U) c 0 4- 0 Q - U) a)E U) CO C� 0 4— 0 a) -1-1 m (D IN N 0 WA CD a) LL CD E a) Q) 11, 0 CD U) a_ CL 0 CO 0) m (n Q CL 0 70 n U) N D 0- U) 0 a) CL 0) L- 0 El c C6 U 0) E .0 U) E U) 0- E Zt 0 U 0 w U) _0CL — El 0 C/) 0 (n E > 'E =3 E Foll u CL U)Q) 0) CL 0 U)❑ 0 El F a) a) C: 0 _0 (D Y LL + CY) a c cu (n 0) 0) cu (D (D 0 0 H � a) cu o U) U) 0 0 0 N El ami w a) 0) .> L- CL 0 C.) c c > ui a) (1) M 0 H El 0 CU -0 m L. CL 0 U) EI CL 0 M (D a) -0 El L- a > m (D < CL 0 — to (n L) * r- 0 C/) LO -;: 0 (n 7iD— E 0 ❑ cu a_ U- 0 >- RON < F uj -jE a-) N CL w 0 El 0 CL Ln _0 : 5 C/) U) U) > _0 6 4- 0 w m a) -j LU D >% 0 LU uj E] (D 0- U) cu cnQ Q z z 0 U 0 0 T) H LL 0 LL 0 Q) > U) w LU U z 0 a) -0 CL CL a. a) 0) (n L- L- a) :t-_ _0 0 uj U) < < M .> a) a) cu 0- x > C-li C -i d L6 t6 3: ul m 0 CD a) LL CD E a) Q) 11, COSA Checklist Legal Description: PAULSON LT 65B ParcellD: 018-261-24 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA K Well log is filed with Onsite (or attached) Date drilled 11/12/84 Total depth 154 ft Cased to 153 ft ❑� Sanitary seal is functioning correctly ❑� Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 3/28/24 Static water level at beginning of test 100 ft Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 12/10/84 © ALL standpipes present per record drawing Total measured depth from grade 4.0 ft (max) Measured depth to pipe invert from grade 3.0 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) _ If yes, enter date Comm ents/Deficiencies: COSA Checklist—June 2022 Well production at time of test 6+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes No ❑M Coliform bacteria is Negative Nitrate 0.742 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L WE Arsenic less than MRL (ND) Collected by Date 3/28/24 MNA C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 3/28/24 Results 0 Pass Fluid depth prior to test 2 in Wateradded 600 gal New fluid depth 2 in Elapsed time 1440 min Final fluid depth 2 in Absorption rate 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 112 in Effective depth used 2 in Effective depth remaining 12 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' ❑a Yes if No _ ft Neighboring Tank > 100' Q Yes if No _ It Absorption Field on Lot > 100' [j] Yes if No _ ft Community Sewer Manhole/Cleanout > 100' QYes ifNo_ft Private Sewer/Septic Line > 25' Q Yes if No _ ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No _ ft ❑i Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' nYes if No _ ft Ri Yes if No _ It ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑O Yes if No _ ft Surface Water > 100' 9 Yes if No _ ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS QYes ifNoft M Yes if No _ ft M Yes if No _ ft 0 Yes if No _ ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' El Yes if No _ ft Yes if No _ ft If tank or field is under driveway comment below G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Y� a t( Qrr d eahnrn et Phone 727-8864 Engineer's Printed Name Gjwr,�., . Date 1 /15-/2 `( q`c OF AP°� ^� �t lt-317V'; COSA Checklist June 2022 LOT 65A 1 50 LOT 96A ANCHORAGE RECORDING (DISTRICT, ALASKA AS -BUILT OF: PAUL SON SUBDIVIS10-11,; LOT 65B PLAT 83-356 SURVE)r CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance sho-ul( any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, cover -ants, or restrictions which do not appear on the recorded subdivision plat, WORK ORDER NUMBER: DATE: SCALE; E-MAIL, APRIL 9, 2024 1 =50 schullerakOgmailxom 24-017-2 DRAWN BY, ICHECKED BY. GRID NUMBER: BOK /PAGE: JLS SW3035 240129 FND ALUMINUM MONTUTMENT FND 5/48" REBAR 2 33 LO LO 0 00 a_ Li � W 0 V) Uj L_Lj cr- 0 Lj A10W 0 F AW 0� 0 49TH ;4A ............ U_Z ? a2 .. I ........... JOHN L. SCHULLER.-* 4 LS -104C8 1831 Talkeetna, Street '4 Anchorage, Alaska 99508 0 f MW AIW (907) 227-1455 office ession(3� (907) 274-4992 fax (a) Legal Descripti~on (include lot, block, subdivision, section, township, range) Location (address or directions) Applicants Address ~.C, ~o~ Z//~ ~F~JD_~_~_., ~~ (c) Applicant is (check one) Lending Institution ~-~ ~ Owner/builder ~ (d) Lending Institution ~ ~ Telephone Address (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: 2. Type of Residence Single-Family~-~7~ Number of Bedrooms 3. Water Supply Individual Well~ Multi-Family Other (describe) 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 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. Engineerin~ Firm Providing Inspections~ Tests~ File Search~ Data a~nd~.~-~_~,,~r<._~. As certified by my seal affixed hereto and as of the validation date shown be!ow, Verify that my investigation of this Health Authority Approval sho~ that the water supply and/or ~stewater disposal system is safe, function~ and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the info~ation obtain~ from the ~nicipality of ~chorage files and from investigation and inspection, the on-site ~ter supply and/or ~stewater disposal system is in compliance ~th ~1 ~nicipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Fim.~~ ~ '' ~ ~Z'~Li~{~'~Z~f ~f~.~.-~ '~ Telephone. ~ (ENGI~ER S~) ~ ~ ~'~ ~ P~ 6. DHEP Approval n /7 ~ ~--f~~/~ ~' Approved / Dtsa~r .... ~ /I .... ~q~m~.~,~.~9~'~'.~' .~. Terms of Conditional Approval CAUTION 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. T~!E DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND TIiEIR 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 MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUI~ORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: 1985 Well Classification ~c~ Well Log Present ~{ Total Depth /~5-~' Cased to Static Water Level ~/ Casing Height Above Ground Electrical Wiring in Conduit ._~/N) Separation Distances f=cm Well: To Septic/Holding Tank on Lot To Nearest Edge of AbsoFption Field on Lot To Nearest Public Sewer Line Sanitary Seal on Casing ~/N) De~ession Around Wellhead (Y~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole A3//~ To Nearest Sewer Service Line on Lot Water samCe Collected Water S ie Suits B. SEPTIC/HOLDING TANK ,DATA Date Installed 12t/~o/l~,~ Size /',25'-o No. of Compartments 2_ Depression over Tank (Y~ Date Last pumped ~J//% Pumping/Maintenance Contract On File (Y/N) A)//~; for Holding Tank High-Water Alarm (Y/N) ~3//~ Temporary Holding Tank Permit (..Y/N) Separation Distances f~cm Septic/Holding Tank: To Water-Supply Well . To Property Line To Water Main/Service Line Course ~/~ / To Building Foundation~~¢/ To Disgosal Field 13,<g'" To St=earn, Pond, Lake, or Major Drainage Receipt 9 Date Paid: Amount: ~ [Page 1 of 2] 2-15-84 ABSORPTION FIELD DAT% soils Rating in Absorption Strata Date Installed ! 2//o/~'~ Width of Field °~' / Square Feet of Absorption A~ea Depress:Lon over Field (Y~ Results of Last Adequacy Test Separation Distance fu~ou A~sorption Field: To Water-Supply Well J / ~ / ~ --To Property Line To Building Foundation Lot Length of Field Depth of Field ~O" Gravel Bed Thickness / ~ate of Last Adequacy Test /t)/~ Type of System Design 33 / To Existing or Abandoned System au On Adjoining Lots ~D ~ To Water Main/Service Line · ~)(~c .. To Cutbank(if, ~esent) To Stream/Pond/Lake/c= Majo~ Drainage Course J> : - To Driveway, Parking A~ea, or Vehicle Storage A~ea /O~ , ~ I- _. _ ~...7./-: ~>~~dw~--~/8~- D% LIFT STATION Date Installed Manhole/Access (Y/N), /U/A. Size in Gallons AJ/A' - "Pump On" Level at , - High Water Alarm Level, at AJ/~ Vent (Y/N) ~J{/% ~ ' cycles ~ming Adequacy 'Test. Tested fo Electrical ¢cm~n~____ Meets MOA ** *'* Check permitted Bedrocm Rating Against HAA Raquest on the date of this inspection. ~B1/d5/s [Page 2 of 2] 2-15-84