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HomeMy WebLinkAboutBIRCHWOOD LOOP LT 1Onsite File #051-243-15 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ORI -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191377 PID Number: 051-243-15 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name Jason & Ryan Mathias ABSORPTION FIELD ❑ Deep Trench RE Wide Trench ❑Bed E] Mound Site Address 17610 S. Birchwood Loop Road ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade (907) 240 3982 4 5.0 GPD/SF1 1.75 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1.25 FL Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot Birchwood Loop 1 Fill added above original grade 2.5+/- Ft. Gravel length 25 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines n/a Distance between lines n/a Ft. SEPARATION DISTANCES To Septic I Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 125 Ft2 1 n/a Ft. Well 73.3 83.6 I / 62.6 TANK ❑ Septic ❑ S.T.E.P. ❑ Holding 9 Other Manufacturer Orenco/Advantex Capacity 1500 Gal. Surface water 100'+ 100'+ / / Material Number of compartments Lot Line 61.3 53.8 / i NA Fiberglass 2 Foundation 101+ 10'+ / / LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer _ __drainfield Groundbreakers Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 204.0 ft Inspdection 15t 10/25/19 12/17/19 Location and description 2nd 3m 4,n Top of foundation at foundation clean out ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF ALS Conditional Approval: DateZ� k `7�R� f�nnnon• k Septic System , / P Y Approved 'tiv i Date 5,�J� a�0,Q Note: this approval does not include well permit requirements.�ia (Rev 0wu2n 8) d A N N �-nmp0^^ t I co c <5, 10,00 Cc)rn 10 -1 T O O O x A m vz*za) -10 cn < c>_,(nzmD_ v _ DO(nomzz0:z v, 0 , -0 C) G), mQ WMz>z z O > CO * r --II z r m o cn m �m D r 0 Z n E m to \ I d I I � I I 1 I f I i f I I l fl I I 1 I S C7 K D 0 c r r O O N ? Dx Z� �1D rn A— C N N N N CD U> v D Ma. o" nD �o- 0 m cnU O� �� , 41 tJ Ln W W CII Cn W W N Is X O O m � D C n -P 6> OJ -r W O N I I I t i i I D07, Z 1 l I I (n ;o D `L N z O m � - \ Ln m oa x r / I i il� 0X / / gym/ IIV I IIS i / r• •� �' 0N0 Shop / >i ; ri v -Lr�o, 0X> c /� // .moo /IN N�00 / r� s I > —1 i Mon� .tom_ ---i�v'% I A t /N\ --7 r� z m m I / n O _. �C>x f u / Ln m m-im om >n / o /! ! O q ml \\ \\ \ I t I I t \ \ \\ \ \ m m �� \\ \^ I I ; i i \ • i NOTES PANNONE ENG SVC, LLC REVISIONS DATE RECORD DRAWING PHONE 907)X 1807 745-8200 PALMER, FAX 907) 745-8201 i�P� �FA`-!Yil REV 1: 1/3/2020 SCALE BIRCHW00D LOOP L1 k 9 r+� REV 2: 1/10/2020 1" = 60' SITE: 17610 S BIRCHWOOD LOOP RD 051 DRAWN ACP 'E';.'ponnoae' 243-15 �"$'teven� JASOPO BOX 1(108 8 RIAS ��t1�ol; O ?+ :/ SHEET-243-15 PERMIT NO. SITE PLAN ANCHORAGE, AK 99511 2 OF 2 -iNIC0D0v-iz-� m z�x0m >pXm D 0 c r r O r D c7 CO D un ? Dx Z� �1D rn A— C S G��X m ;0C» A =-D.N 2 lmO; (AD 0 tC 0M N0U� o Ma. o" nD �o- m cnU O� �� , z �r� �m o�Do�D o -oo�� U) z _ z � i}v p my U Is X O O m � D C n Wheaton Water Well, Inc. 1190 N. Wasilla-Fish hook Road Wasilla, AK 99654 19071376-2041 Name: Ryan Mathias Address: 13120 Lupine Rd City: Anchorage State: AK Zip Code: 99516 Well Site: Birch Woods Lot/Block: L1 Additional: Well Depth: 183 ft. From: To: Formation: 0 6 silt/topsoil Below Ground: 181 ft. 6 8 gravel Above Ground: 2 ft. 8 10 silt/fractured rock Gal/Min: 2 10 11 sandstone 11 15 coal Static Level: 0 ft. 15 112 sandstone 112 128 shale Casing: 44' of 6" steel casing 128 129 coal129 183 sandstone Liner Pipe: 140 ft. Screened: N/A Perforated: N/A Grouted: YES Depth: N/A WATEER QUALITY TESTING Develop. Method: Air f,oiiform bb scn+ Go1/100rnL Mtrates < m Pzt_ b1°: -L L Use of Well: Residential Arsonic Drilling Method: Rotary Misc: Other: well disinfected with chlorine 50 ppm The well was pumped 5' off the bottom with 100% draw down for 2 hours and recovered at 2. Date Drilled: 9/10/2019 Driller: Ben Mattson (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW OSP191377 Date Of Issue: 08/29!2019 Parcel Identification Number: 051-243-15 Legal Description Property Owner Name & Address: Birchwood Loop L1 Ryan & Jason Mathias 13120 Lupine Rd Anchorage, AK 99516 Pump Installation Date: 03/27/2020 Pump Intake Depth Below Top of Well Casing: 145 feet Pump Manufacturer's Name: Meyers Pump Model: 3NFL72-8-P4-01 Pump Size 3/4 hp Pitless Adapter Burial Depth: 12.6 feet Pitless Adapter Installer: unknown Well Disinfected Upon Completion? ❑✓ Yes ❑ No Method of Disinfection: Sterilene Comments: Pump Installer Name: Wheaton Water Well, Inc. 1190 N. Wasilla-Fishhook Road Wasilla, AK 99654 Attention: The pump installer shall provide a pump installation log to the DSD within 30 clays of pump installation. Development Services Department Building Safety Division � p On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Mark Begich Anchorage, AK 99507 Mayor www.muni.orq/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW OSP191377 Date Of Issue: 08/29!2019 Parcel Identification Number: 051-243-15 Legal Description Property Owner Name & Address: Birchwood Loop L1 Ryan & Jason Mathias 13120 Lupine Rd Anchorage, AK 99516 Pump Installation Date: 03/27/2020 Pump Intake Depth Below Top of Well Casing: 145 feet Pump Manufacturer's Name: Meyers Pump Model: 3NFL72-8-P4-01 Pump Size 3/4 hp Pitless Adapter Burial Depth: 12.6 feet Pitless Adapter Installer: unknown Well Disinfected Upon Completion? ❑✓ Yes ❑ No Method of Disinfection: Sterilene Comments: Pump Installer Name: Wheaton Water Well, Inc. 1190 N. Wasilla-Fishhook Road Wasilla, AK 99654 Attention: The pump installer shall provide a pump installation log to the DSD within 30 clays of pump installation. AVbXilWLand SXUYe\ingLand DeYelRSmenW CRnVXlWanWVSXbdiYiViRn SSecialiVWVCRnVWUXcWiRn SXUYe\ingGURXSTRP H DUe\eU, P.L.S.124 E 7Wh AYeQXeAQchRUage, AOaVNa 99501(907) 306-8104PaiO@S4AK.cRPBiUchZood LooS SXbdLoW 1Legend 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://wvvw.muni.org/onsite Permit Number: OSP191377 Work Type: WellSeptic Initial Tax Code Number: 05124315000 Site Legal Address: BIRCHWOOD LOOP LT 1 G:0954 Site Mailing Address: Owner: MATHIAS JASON 50% & Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms 8/29/2019 8/28/2020 87171 Q Disposal Field © Septic Tank ❑ Holding Tank ❑ Privy Q 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 B Issued By: Y Date: G(/ Date: g �_ 0 ON-SITE SEWERMELL PERMIT APPLICATION Parcel I.D. 051-243-15 Property owner(s) RYAN & JASON MATHIAS Mailing address PO BOX 110818 Site address NHN BIRCHWOOD LOOP Legal description (Sub'd., Block & Lot) BIRCHWOOD LOOP Ll Day phone Legal description (Township, Range & Section) Lot Size 87,171 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (0 all that apply) Absorption Field Initial r_X1 Single Family (SF) Septic Tank nUpgrade El (w/wo ADU) Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings El Privy ❑ (SF and/or D) Private Well nX Water Storage 1:1 THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Permit/Rush Fees: 45�96 +2-264 2-26 8Waiver Fees: Date of Payment: ('k2-311" 2'0 Date of Payment: Receipt Number 0 25 (4 L I CA Receipt Number: Permit No. 0�e)i0i� 131-1 Waiver No. Permit App_'-'- :• :—'.,:c ; 10unicipa!ity of Anchorage Cn-site Water and Wastewater REVIEWED FOR CODE COMPUAN( Pannonen 9 n e e r i n e ry i c e S LSC CSP191377 Gib Vibckerrfuss 080 Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com Subject: BIRCHWOOD LOOP L1 21 August 2019 Initial Septic System Permit Request Design Narrative This is a design narrative to issue a permit to install an initial septic system for this property. The system will serve a proposed four (4) bedroom house. The system will utilize a new 1500g ADVANTEX tank w/ AX -20 Pod and a conventional gravity fed drain field. This lot will be and the lots to the Northeast are served by private wells. The lots to the southwest and south are currently undeveloped. There are no wells within 100' of the proposed septic system. i. Soils. One test hole was performed on the property in the area of the proposed system by Garness in December 2016. Ground water was not observed to a depth of 3.75' below the surface after water monitoring in GEG TH42. Bedrock was not encountered in the test hole to 12.0. Based on the results of the percolation test and overall soils appearance, an application rate of 5.0 GPD/SF was used for a CATIII AWWTS wastewater system in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 50 feet of the proposed septic tank and drain field (AWWTS). 4. Topography: The existing topography on the lot generally slopes from southeast to the northwest. The proposed field is to be installed in a slope of 7%-10% and there are no steep slopes in the area of the proposed system. 5. Drawing Markings: The Drawings are marked "For MoA Review Only'. When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of this or the surrounding lots. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Nlailing: P.O. Box 1807, Palmer, Al; 99645 elephone: (,9107) 715-8200 FAX (907) 745-8201 NOTES: FOR CONSTRUCTION DRAWN I JR. I SITE PLAN -r'i to 0 Orn "a •ter 0 o - CD -' N C O a �v� 'S fn A (n -D v Z 7J Z < O rn p �rn -! N V-(� O co Dor'.-' — to m r z to A n ,mom — ;-. m _(jV( A EVUBE3 2: ;u Z FCf�OODC9tr -sem Qm c fl o o ' C r Ax z cn z <�Axl_nm< Oma �{ Iv m AX �— �^� (nm � crOSP19 7 �o 'x om cmn —� r �o �OOm m O is QC1100 O N0 O� p CmmzZ G I NO 0(n 0 Np O per' O O c00 ? �mO pm(n0c00^nmLn m C) c)) (!1 - 0 � -rt SpA Z O0 m ma r- "trn Q rIm -u �A 0 Z 0-00� Tim rm -0 0 1Z 0-00 m ;uS Lo m Z.O O Lo S Ln Z-0 D r -. -7 a o -n Z Q O n cm �� �' cn m" cn x Ln cn x m 0 > 0 m 0 A pl- P/ANNONE ENG SVC LLC P.O. BOX 1807 PALMER, AK 9645 PHONE (907) 745-8200 FAX (907) 745-! BIRCHWOOD LOOP L1 - '= SITE: NHN S BIRCHWOOD LOOP RD eta, JASON & RYAN MATHIAS CE8149 PO BOX 110818 ANCHORAGE, AK 99511 REVISIONS UAIE 08/29/2019 08/21/2019 SCALE 1"=60' P.I.D. NO 051-243-15 OSP191377 1 OF 2 (D;;te Water and tAbstemter 2 > -'o 0 p OHM EOAEVVED FOR CODE COMP -0 �O COO 2> >LnoKoo KOO> :;70> 'z > > T M 0 > > ZM0 oox�uo-MUmpxmxmomz pa bX5 mom mo, > > -ozlcFlm->nm>mn6- m 0" oss, '- �;! i� E �: 0 MR o c v- Mm'M > � 3: C) 0 0 M, > M X -0 z M 0 0O ;0 �m zzoc:oo�o M FA ;0 C m ;UM50 z > M ZMMO' C) Z;<o Z z > z --o �Umn mVOZ ;u 0. z K'T-za-mo :z M - 00, '>oozm;;)� 0 Cc,, 9 - o >- Z' u ->0 * Z 0 Z' 2 �8 T� R ;p f2 2 v! '?. 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BOX 102954 ANCHORAGE, ICK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 BIRCHWOOD LOOP Ll SITE: NHN S BIRCHWOOD LOOP RD JASON & RYAN MATHIAS PO BOX 110818 ANCHORAGE, AK 99511 n 0 z REVISIONS UAIL Q c4 08 --i�EV. 08/2-9/2019 SCA/21/2019LE TH .... .. . .... P.I.D. NO ... 051-243-15 CE 8149 OSPI91377 2 OF 2 ROM GARNESS ENGINEERINGROUP Ltd CIVIL & ENVIRONMENTAL ENGINEERS 9 : a� 3701 C.TUDOR ROM. SUITE 10f • NILHOMG£. Rx 43507 • FlSONE {907J 777fi174 • FAX ([AlJ 1]511+8 • Ytc 0.5RE: ++ww.ywnC.scn�navlM.con � f Wnicipality of Anchorage On-site Water and Wastewater v � .(...... .3 ..4a 411 ............................. 0 J I'TreyrA-Gamess SOIL LOG - PERCOLATION TEST �$c�, CEr79 LEGAL DESCRIPTION: T1 5N, R1 W, SECTION 19, LOT 4 - PROPOSED MATHIAS SUBDIVISION PERFORMED FOR: RYAN MATHIAS DATE: 12/6/2016 ft���fjP� dQ DEPTH — LICENSE Rguviuu (feet) ORGANICS AEccasa TEST HOLE #2 1 LOAM (SM) 2 3 4 5 6 7 8 9 10 11CL OR ML VISUALLY RATED IMPERMEABLE 12 B.O.H. 13 14 15 16 17 18 GM&ML DEPTH TO GROUNDWATER DATE SEEPS @ 11' 12/6/2016 8' 12/13/2016 3.75' 11lilllif 6" - 2 4:42 30 r%/,.i 2-3/4" NIIl1 4:42 - 6" Iltl1l111 4 5:12 30 3-1/4" 2-3/4" 5 5:12 - 6" - 6 5:42 30 DEPTH TO GROUNDWATER DATE SEEPS @ 11' 12/6/2016 8' 12/13/2016 3.75' 5/11/2017 6" - DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 12/6/2016 1 4:12 6" - 2 4:42 30 3-1/4" 2-3/4" 3 4:42 - 6" - 4 5:12 30 3-1/4" 2-3/4" 5 5:12 - 6" - 6 5:42 30 3-1/4" 2-3/4" 19 • _� •...,ter. � .... • 11— — lwo%. ""., " ,� l 1/ r—F—M . MULE VIA. O UNI,Htbj TEST RUN BETWEEN 3 FT. AND 4 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: FE YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH. PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERF DRMED 1N ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 711 i MUNICIPALITY OF ANCHORAGE ra Community Development Department 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. 051-243-15 Property owner(s) RYAN & JASON MATHIAS Day phone Mailing address PO BOX 110818 Site address NHN BIRCHWOOD LOOP Legal description (Sub'd., Block& Lot) BIRCHWOOD LOOP L1 Legal description (Township, Range & Section) Lot Size 87,171 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (E)all that apply) Absorption Field ❑X Initial 0 Single Family (SF) El (w/wo ADU) Septic Tank Q Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well 0 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: S16 4-225=no Waiver Fees: Date of Payment: `22A $\ C Date of Payment: Receipt Number: O 2jy0 Gx Receipt Number: Permit No. CrDQlCii \311 Waiver No. Permit App_2- :•: .,:t Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191377, Deb Wockenfuss, 08/29/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191377, Deb Wockenfuss, 08/29/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191377, Deb Wockenfuss, 08/29/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191377, Deb Wockenfuss, 08/29/19 • • MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT,herein the "AGREEMENT" made and ered into as of this OADay of ./4L O r.ptiy of 20 ,by and between GL/l AA At , herein the"OWNER," and the Municipality of Anchorage, herein the"MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein,the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Wastewater1Treatment System(AWWTS), / described as Ad vad �.2c4,tM¢4 - Sy,stzvvt located at(legal description) /r / ��r 1. c0 L0,10 zoo. k-1 / 1 ,A_ 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. pi" It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). (r. Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. (" Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 • pp, Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. 12,h Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. 124n Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. PlIA Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. RAI Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. 1�-'V` Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver.of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By: r `` ''"t (signature) Date: ak / -( • f_ (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this;r9 day of 20lq, by ky /3 n/ al*TH-1 ft-.S Ouumu«r J.MO *.''i'��i //U/V4AVneelei_h_ NO • Y PUBL FOR ALA KA `S �OTAR My Commission expires: a = PUMG qF'Al'P```� MUNICIPALITY: By: (d� / (signature) Date: aAA//9 (print name) Title: (rev. 05/18/2018) Page 3 of 3 MUMMA 31 m a 0 0 °-C: wo 0 LL cu Z ii vZ E W 0 a () 0 -a 0 0 4721 WR L4 Alm mi 0 Q (j) cu ffS ca ry 06 c 0 Co Q) 0 0- 0 CL r1w (D "a M RS a) a C: E cu 0 a)a) Da) r) .a r-,- C16 )-6- -Az) 0 76 .0 cu a. < c .0 cu E x LU >1 C/) CL ED D❑R 0 0 0 0 C: a) m a 0 0 °-C: wo 0 LL cu Z ii vZ E W 0 a () 0 -a 0 0 4721 WR L4 Alm mi 0 Q (j) cu ffS ca ry 06 c 0 Co Q) 0 0- 0 CL r1w (D "a M RS a) a 1�1 6 I L� �o LL C: E cu 0 a)a) Da) r) .a r-,- 0 a. ED D❑R C: a) cu Z;, LL a) — cu 0) a m CO E -0 —0 E uj a. m 0 U CL CD CL n 0 -0 cu❑El f ❑ ca LL (D < 0) . r_ 0 C0 0) .E; 0 0 CL = E z LL Lij m WU) " Ul LL 0 < 3: 0 a cn 0: LU LL 0 0) U—) = E ca LL 0 ED D El uj a- M '" a- w 3� E 0 o LLI >. d - CL z 1�1 6 I L� �o LL C: E cu 0 a)a) Da) r) .a r-,- I ll as U- 0 0 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, 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 ofbedrooms 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 Phone (907) 745-8200 Engineer's Printed Name Steven R. Pannone P.E. Date OF A4., ��?• r1• .. 6. DSD SIGNATURE✓ System #1 Approved for bedrooms ".'teveii R. fann.ne CE 8149 System #2 Approved for bedrooms¢ cl c��� • , . Disapproved tij �'ofE�sio� Conditional approval for bedrooms, with the following stipulations: t t ll flr.. __ ', WASTEWATER JJ By: PROGRAM ice\ Original Certificate;Date: 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other Legal Description: Birchwood Loop L1 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 9/1o/19 Total depth 183 ft Cased to 44 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 9/10/19 Static water level at beginning of test 0 ft. Comments B. TANK DATA Age of tank(s) ")2"" years Tank type/material Adv ­/Ft , Measured operating fluid level in septic tank n/a ❑ Standpipes/foundation cleanout per record drawing Date of pumping n/a D. ABSORPTION FIELD DATA Wide Trench Which system tested (date installed) lor25119 0 ALL standpipes present per record drawing Total measured depth from grade 4.25 ft (max) Measured depth to pipe invert from grade 3.75 ft (min) ❑ NIA — pressurized field On Monitor tubes go to bottom of effective. If not, state depth into effective X Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 051-243-15 Structure served by this system 1 Well production at time of test 2 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? 0 Yes ❑ No Coliform bacteria is Negative Nitrate 0.200 mg/L ❑ Nitrate less than MRL (ND) Arsenic 1.00 ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date n/a Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate '600 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' 73.3 Community Sewer Manhole/Cleanout > 100' El Yes if No ft M Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' [71 Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No 83.6 ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' Yes Animal Containment > 50' n Yes if No ft 0 Yes if No ft Water Main > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' Community Wells > 200' Community Sewer Main > 75' M Yes if No ft n 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' 0 Yes if No ft Property Line > 5' ✓v Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' (./ Yes if No ft Private Wells > 100' M✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' ✓� Yes if No ft Water Service Line > 10' M✓ 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' Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓Q Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Q✓ Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet OF A - TH yi Ste�•en��'anno`i�- CE 8149 wi �4w 1POEESSI`� FBF' est Lab, LLC Mat=Su T Midtown Community Business Park 9131 East Frontage Road, Suite 15 Palmer, Alaska 99645 Phone: 745-3005 1 Fax: 745-3010 Website: www-tziatsutestlab.coni E -Mail: riiatsutestk-ib.officeZ�grnaiicom Legal Description of Property: 17.3 rc h C7 Sample Site Locatiow. 04_iLs,"d lo, — Deliverer Initials: (I.E.: bathroom sink, outside hose bib) Date Sampled: Time Sampled: / 7 -_' 3 c, Sampler Initials: Circle One: Health Guard Test This Section to Be Completed by Lab B200961 Analysis Results: Lab ID # MSatisfactory M Unsatisfactory F]Sample Rejected - Reason: H Total Coliform Present (P)/Absent (A) ( Yellow / Nq(Cojlo` E. Coli Present (P)/Absent (A) ( Fluorescence / No Flu(resCence Incubator# I Received LU0 By: I Started : APR 3 01 12020 1 V5'� By: _� I Finished J Ft, L, -0, By: JtV' ab, tmsu Test = Name: Pannone Engineering LLC ti%Iailing Address: P.O. Box 1807 Palmer, AK 99645 Legal Description: Birchwood Loop Lot 1 Sample Site Location: Outside Hose Bib Lab ID##: M200301 Date Sampled: 04/13/2020 Time Sampled: 1000 Sampled By: ACP Date Received: 04/14/2020 Time Received: 1004 Parameter Method Result Unit ' MRL MCL Date Total Coliforms Colilert SM 9223E P --- --_ -_- 04/15/2020 F coli Colilert (SM 922313 A --- --- 04/15/2020 Total Nitrate - N TNTplus 835/836 (Hach 10206 < MRL tng/L 0.200 10.0 04/16/2020 Arsenic Metals by ICP/MS EPA 200.8 < MRL µg/L 1.00 10 04/ 15/2020 A9ethod Reporting Linrit (AIRL): the lowest concentration that can be reported reliably Almvinuun Confuminant Level (IbICL): highest acceptable level in public water systems as set by GPA mg/L: milligrams per liter: 1/1000"ol'a gram ,ug/L: micrograms per liter; 1/1,000,0001"of a gram Absent (A): none of this type of bacteria was detected Present (P): one or more bacterial cells of this type were detected Results Reported By: Patience Lynch Laboratory Analyst Reviewed By: Signature: `�eeIdI1gWl,r Jen VJ0Ilii, nt. G;pr 22. 2:20) Email: matsutestlab.office@gmail.com