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Home My WebLink AboutPARADISE VALLEY BLK 1 LT 6Paradis Vail Y Block I Lot 6 #020-424-26 Sep 09 22 09:43p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE Development Services Department 1 Phone: 907-343-7904 On -Site Water & Wastewater Section Pax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Date of Issue: Parcel Identification Number- 020 424 26 Legal Description PARADISE VALLEY Block 1 Lot 6 Property Owner Name & Address: GILBERT MARY E 50% & WANG GEORGE JR 50% 5900 GREECE DRIVE ANCHORAGE, AK 99516 Pump Installation Date: 09 _ OT _ 2022 260 Pump Intake Depth Below Top of Well Casing: feet BERKELEY Pump Manufacturer's Name: B7P4MS10231-02 Pump Model. Pump Size: .00 hp 14 Pitless Adapter Burial Depth: feet MARTINSEN Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Completion? X Yes ❑ No Method of Disinfection: PELLETS Comments: Pump Installer Name: _ ANCHORAGE WELL &PUMP SERVICE Company: 7640 KING STREET ANCHORAGE, AK 99518 Mailing Address: 907-243-0740 State: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. .-.(L 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 J of www ci.anchorage.ak, us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: _..~/,.,~ f~ q..~ 7 PID Number: "'~ ~i(~tA L~ Wastewater System: [~ New [-I Upgrade qt O g qq 50ct ABSORPTION FIELD Well: ~ New ~ Upgrade e..--.. "~'~ Ic"~e~ TANK SEPARATION DISTANCES ~Septic ~ Holding ~ STEP. ~ ~her: T~ Sept:c Abso~tior L~ Hold,rig 'ub~,~nvate ~.a~ ~ C~,,~ TankField Station Tank *~t~. ~eer I~ 5om~ pf~T P~ ~ ~ ~ue~ BENCH MARK S & S ENGINEERIN~ Engineers Stamp Development Se~ices Depa~ent Approval .. ..... ~ i// ../ ~- ~ / ~ ,~.-..~l~k~Cl' ,~vi~w~ ~ ~,~ow~ ~y: //~/~/~, / ~ D~t~: ~ ~/~lU~h:.'~'l~:~:r:t[~ PERMIT NO $W040457 PA~£ 2 OF 5 ...... Mun_icip. 9[i¢. y_o.F AnchoraQe DEPAN/MI:=N/ UP Hk::AL/H AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 eAnchorQge, Atasko 995i9-6650eTetephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 6, BLOCK 1, PARADISE VALLEY $/D P.I.D. NO. 020-424-26 \ :CO \~ TBM DBL1 & LOT 7 ~ \ I \ I \ ~ . STAMP UND[V[LOP[ LOT 18 UNDEVELOPE LOT PERMIT NO. SW040457 PAGE 5 OP 5 Municip. oH~c of' Anchor~aQe DEPARTMENT OF HE~.THAND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION · ema. Box 196650 ·Anchor'age, Alaska 995[9-6650 · Telephone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 6, BLOCK 1, PARADISE VALLEY S/D P.ImD. NO. 020-424-26 ST1 ST2 / 99.3' FINAL ULATION A~ ,,/I NEW 1500 I~ A~ ~- v~).~ ' I GALLON I~°'z J SEPT,C TANK J FINAL GRA~E/ MTI=90.O' J YT2=go,e' A B rco 18.5' 41.5' ST1 22.0' 47.5' ST2 28.5' 54.0' DBL1 51.0' 56.0' DBL2 55.5' 59.0' C01 27.5' 73.0' MT1 27.5' 69.5' C02 52.5' 55.0' MT2 50.0' 55.0' C01=100.9' 02=102.0' '. · NO WATER FOUND 82.0' B.O.H. ENGINEER STAMP 0G/30/2005 11:15 9072432081 I~E~ ~_A1'KA g ASSO PAGB 82 L~5 LOT 6 SCALE: 1~ 30' EASEMENTS OF RE[CORD. O'T~FER ~ 33.lOSE 8:HOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. F'o O5-S, pg 15-16 Well 0 8290K -( 10'¢ ?A.Oo Lot 18 ,A.~BUIL? NO CORNER, S SET THIS DATE I here~' ce~t~y I~t I ~ perfom~l. Id, ong~gee'~ k~rpeceo~ of the f'o~owlng deccdbod proped~. LOT $. BLOCK PARAD~E VALLEY SUbdiVISION Anchm'age Recording P ~.c~r,~ Abr&a, end ~at Ihe Improvements situated Ihemon are w~ln b~e ~ lines end do not ovolap ~ enc~oec~ on the pmf)e~' ymj adjacent I~le~to, ~et Ito impmveme~s ~ ~e i~ lyfwg Engram ~d ~ by DOC CO. d~ SULLIVAN WATER WELLS P.O, BOX 670272, CHUGIAK, ALASKA 99567 *TELEPHONE 68~2759 OWNER OF LAND: ~ I ~'f'~ /--~ BORE HOLE DATA DATE: *~/~ T~ IDE~OATION NUMBER: ~ ._ ~ - ~ Is well located at appmv~?~rmIt location? ~ Q NO Methocl of Drilling: {3-elrmtaxy :3 cable tool Depth of we,: ~,~q ~ Casing Type ,..~7~'~. Wall ~ick~ ' ~ ~hes ~i~ Stic~p ~e G~: ~ ~ ' feet S~t~t~el:, ~ J ~ f~t R~ ~te: ~ ,gpm ~et~ ofT~t~: ~ Well Intake Op~ng T~ ~d ~ o~ ho~e Q ~; S~. f~ Stop~d. ~t Q P~mt~s S~.. f~_~top~d ~ f~t GmutT~= ~ I~ ~ Depth: from. 0 feet. to ~k ~ '"~ feet Well Disinfected Upon Completion? ~ 3 No MethoclofDisint'ectlon: ¢-:./,/4bZ ,~i~ ".'~/~/¢1 Comments: DEPTH Ddller"s Name KrfEHTION: It Is ~e responsibility of the prOperty ownec to sub'it a copy of the well log to the propel authority. Municipality =f Ancho~g=: Department of Health & Human Secvlce$ and/or Department of Environmental Con$ecvation..MatSu Borough: Department of Environmental Conservation. r{OBER[ C. COW/~. fiE. rlOBERT A. S! IAFEI~ RE. CIVIL ENGINEEI'E~ Dater (907) 694-2979 FAX(907)694-1211 Hunicipality of Anchorage DEPARTHENT OF IIEALTI1 AND IlUHAN SERVICES 82§ L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 The septic igspegtions for t~te x;eferenced property were performed on ~I~OY- and ~/~0~. Prior to submitt~ng the On-site Waste~ater DtsposallSys%em and/pr Wel~ITIspectton Report we are waiting for the~O-~,~/~}~/~ILr,/~<~o be completed. -- '/ -- If we may be of further service, please contact us. Sincerely, $ 7034 NORTII EAGLE RIVER LOOP & SUIIE 204 · EAGLE 131VE R. ALASKA 99§?7 MUNICIPALIT~ OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7g04 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Oct 18, 2004 Expiration Date: Oct 18, 2005 Permit Number: SW040437 Parcel ID: 020-424-26 Legal Description:~PARADISE VALLEY SUBDIVISION BLOCK 1 LOT 6" Design Engineer: 0003 S & S Engineering Site Address: 5900 GREECE DRIVE Owner Name: JAMES KORPI Lot Size: 20257 SQ. FT. Owner Address: 5900 GREECE DRIVE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99509- This permit is for the construction of: [] 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: Issued Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 ON-SITE SEWEPJVVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Permit Number SW Prope~y owner(s)_ Mailing address (1) P Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Siz~ ~ ~5'~ Acre~ Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade Well Only Water Storage THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool [] Jacuzzi [] [] Water Softening Unit [] I 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. 17034 Eagle River Loop Road No. 2G4 (Signature of property owner or authorized agent) Permit Fees!~' ~ ~,, Date of Payment: Receipt Number: (Rev. '12/00) Waiver Fees: Date of Payment: '~ ~-~m~ Receipt Number: October 1 I, 2004 ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907) eg4-297g FAX (907) 694-1211 soe_ TEST MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 6, Block 1, Paradise Valley Subdivision It is requested that you issue a permit to install a well and a septic system to serve the proposed four bedroom dwelling on the referenced properD'. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 10/5/04, no water was found. After monitoring, ground water was not found. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The cons~'uction of this system will not prevent any future development on any of the adjacent properties. Ifyou require additional information, please contact us. Sincerely, Ro~ C~. Cowan, P.E. RCC~j] Enclosure t70~4 NORTH EAGLE R~VER LOOP "SUITE 204 · EAGLE Rr~ER. N.A~KA 99577 1" = DESIGN SITE-PLAN ~,3ll3~ Il '-' Il >~o DESIGN SITE-PLAN '\ \ \ / /' / / ~ !0 Legal Desc~'lptlon: 2- 3- 4- 5- 6- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17-~ 18- 19- 20- ~ Development Services Department //.__.,~,__~ Building Safely Dlvls]o~ /'[ ~--~..~ \~ O~Slte Water and Wastewater Program [k ~B'Y_ Jl) 470o s~ sreg~w s~ ~ ~ll~l~,~,/J P.O. Sox 19~650 Anchorage, AK 995196650 ~ (907} 343.7904 Soils Log - Percolation Test Pedormed For: /'-/t9 t ~' ~--~-~ Date Pe : %/'~cc~/ . , ' Slope ENCOUNTERED? COMMENTS Site Plan Reading Date Gross Time Net Time Depth Io Water Net Drop PERCOLATION RATE ~ · '~ mk~u~e,~o~) PERC HOLE DIAMETER TEST RUN BEIV~EN ~ FT AND ~ FT PERFORMEDS¥: W~'~6~ ~,~ ! ~"~2/~ CERTIFYTHATTHISTE.ST~NAS/ PERFORMED IN ACCORDANCE WITH ALI. STATE AND MUNICIPAL GUI[~EI[INES I1~ EFFECT ON THIS DATE. DATE: Hieu T. Le P.O. Box 91059 Anchorage, Alaska 99509 September 22, 2005 Municipality of Anchorage Health and Human Services 825 L Street Anchorage, Alaska 99501 Ref: On-Site Wastewater Disposal System Permit Permit Number SW 040437 Paradise Valley Subdivision - Block 1, Lot 6 5900 Grece Drive To Whom It May Concern: I Hieu Le, owner of the above property, intend to install the septic system myself. I am a civil engineer and am capable of operating the excavating equipment. Also, my friend Max Bolin, a retired operator/installer by profession, volunteered to help me on this project. Max Bolin was a certified installer with the Municipality of Anchorage before his retirement 4-years ago. I intend to occupy this home as my permanent residence. Sincerely, Hieu T. Lo HI.Jss ST FIUCTIJR~ & ROBERT C. COWAN, P.E. CML ENGINEERS (90~) 694-2979 FAX (907) 694-I 21 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 6, Block I, Paradise Valley Subdivision October 11, 2004 GENERAL: The scope of this project includes the installation of a 1300 gallon HDPE septic tank and septic trenches to serve the proposed four bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground · utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing ~tastewater disposal systems must be certified by the Munidpal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: I. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE I:~/ER. ALASKA 99577 Page 2 LotG, BIock 1, Paradise Valley Subdivision October11,2004 All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 fi. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCII/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (rafted-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced do~mward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 6, Block 1, Paradise Valley Subdivision October tt, 2004 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic rank proposed for inslallatiun must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials arc approved for use in septic system installations in the Municipalit~ of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use ora type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caul&r, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.$"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. Page 4 Lot 6, Black t~ Paradise Valley Subdivision October tl, 2004 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, grovel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading ofthe property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR / INSTALLER 4678 S 2,0 �, • • 7 .. Gi::._:B Municipality of Anchor. e On-Site Water and Wastewater Progr SEP 0 6 2017 )s -gait (907) 343-7904 S A E T Y �6 ) Certificate of On- .te ystems • rz 5 8 L Parcel I.D. 020-424-26 .2Expiration Date: 1 2 - 7 ! F V 1. GENERAL INFORMATION: Complete legal description Paradise Valley; Block 1, Lot 6 Location (site address) 5900 Greece Drive *Anchorage,AK 99516 Current Property owner(s) Travis Schreiner Day phone 398-0595 Mailing address Real Estate Agent Lori Seward Day phone 632-3661 6 s 9 Ip 7 2. TYPE OF DWELLING: ‘;) ® Single Family (w/wo ADU) r RUSH' ❑ Duplex SEP 0 7 201? �I ❑ Multiple Dwellings (Single Family and/or Duplex) 11:oa0rn ti 3. NUMBER OF BEDROOMS: 4 C! gcl.`3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: 1/0/14 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 1-3•(5 &61 Waiver Fee $ Date of Payment 9/q-i • Date of Payment Receipt Number d jcfg3C1 J #1- VW/1 Receipt Number COSA# QSC.: -1 L~E ( 1 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. Name of Firm: Garness Engineering Group, Ltd (GEG)... Phone: 907-337-6179 Address: 3701 East Tudor Road,Suite 101-Anchorage,Alaska•99507',: Engineer's Printed Name: Jeffrey A. Garness Date: �Qa000044� In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system oOF AIL in accordance with the guidelines and regulations established by the Municipality of Anchorage and 2 ...... industry practices. The reported results describe the condition of the system/s on the date/s of the p nn evaluation. Separation distances were measured to readily identifiable features. Hidden defects or UI) encroachments may exist that were not identified during the evaluation. The operational life of all wells '•• .*v0 and septic systems depend upon a variety of variables, including but not limited to, soil conditions, , groundwater levels (that may fluctuate during the year), quality of construction (materials and 4 workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the �V., ., y arm ess, Q system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of V0n0 11. / CE—179 3 the well or septic system. GEG makes no representation whether an alternative well or septic system U 9' ij �� / .ceQ can be installed on the property in the event either of the current systems fail to perform adequately in It P !{0 /.�� °\o the future. The content of this report is for the sole benefit of the person/party that retained GEG to Q� a p.0 I ss sioc`o� perform the evaluation. Reliance upon the information provided in this report by any other person or �Q��daa party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE r r tO System #1 Approved for Uf bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following)stipulations: \/'J TER AND c•r EIA;r,rr 7 (y��0 G iC FI't'JI By: cam•-�(� Original Certificate Date: L - 7 / 7 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheel_1 o-1 o-12.tloc If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Paradise Valley, Block 1, Lot 6 Parcel ID: 020-424-26 A. WELL DATA Well type Private If A. B. or C provide PWSID# N/A Well Log (YIN) Yes Date completed 9/22/2005 Sanitary seal (YIN) Yes Wires properly protected (Y/N) Yes Total depth 242 ft. Cased to 242 ft. Casing height(above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 9/22/2005 8/28/2017 Static water level 210 ft. 222.1 ft. Well production 8 g.p.m. 3+ g.p.m. WATER SAMPLE RESULTS: Coliform /..4a(-1-colonies/100 ml. Nitrate 1' 1 C2) mg./L. Collected by: GEG. Ltd. Arsenic: < S' ug./L. Date of sample: 8/28/2017 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 9/21-22/2005 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Yes Foundation cleanout (Y/N) Yes Depression over tank (YIN) No High water alarm (Y/N) N/A Date of pumping 8/29/2017 Pumper Around the Clock Pumping C. ABSORPTION FIELD DATA [•Below Existing Grade Date installed 9/21-22/2005 Soil rating k.p.d./fft or ft/bdrm) 1.2 System type Deep Trench Length 43 ft. Width 3 ft. Gravel below pipe 5-8 ft. Total depth *11.2+ ft. Eft. absorption area 498.8 ft Monitoring tube Yes Depression over field No Date of adequacy test 8/29/2017 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 3 in. Water added**76Q gal. New depth 32 in. Elapsed Time: 120 min. Final fluid depth 25 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date - Two-thousand thirty-one (2,031) gallons of water was introduced throughout the pre-soak on 8/28/2017. **It should be noted that although the home was vacant, there appeard to be a plumbing leak coming from the home on the day of the 2,000 gallon pre-soak on 8/28/2017, which continued until the day of the adequacy test on 8/29/2017, resulting in an unknown additional amount of water being introduced throughout the pre-soak and septic adequacy test. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at .. wa er alarm level at in. 1- •• Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100 + On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line t0'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain None Known Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION ,1 .OF.•A4 4% •...f oll I certify that i have determined through field inspections and4 � +" review of Municipal records that the above systems are in Q Q� conformance with MOA COSA guidelines in effect on this 6 / Q date. d '•,J- fr=. A. arness.= 4 Engineer's Printed Name JEFFREY A. GARNESS �vt,% E-793 t1-0� Date / Al. �, ....ci/6,03- ,,;<'-,,` 04 , fessio edR ,°oa #AECC884 (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-424-26 GENERAL INFORMATION Complete legal description Location (site address) COSA #~ Expiration Date: Lot 6, Block 1, Paradise Valley Subdivision 5900 Greece Drive Anchorage, AK 99516 Current Property owner(s) Hieu and Carol Le Mailing address P.O. Box 91059 Anchorage, AK 99509 Day phone 244-2302 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: Four (4) TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class ~ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of'On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER o 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. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engin~eer's P'rinted'Narfle Michael E. Anderson, P.E. DSD SIGNATURE /~ Approved for L~ Disapproved. Conditional approval for bedrooms. Phone 522-7773 Date 4/29/2011 ~,, ~.- · _-,,~, ... .._JL bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: (Rev. 11/05) Original Certificate Date: ~//.~///~// Municipafi of A chorage Dev e ' rvices Department Building Safety Division On-Site Water & Wastewater Program 4700 Br~aw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni:orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type Private Date completed 9/22/05 Total depth 242 ft. Paradise Valley Subdivisien; Block 1, Lot 6 Date of test Static water level ~21o Well production 8 WATER SAMPLE RESULTS: ,r Coliform o colonies/100 mL Arsenic: N/D mg/! B. SEPTiC/HO. LDIN{} TANK DATA Tank TyPe/Material Se~ptic/Stee~ Tank size 1,500 gal. Foundatien_ cleanout'(Y/N) Y -Date,Of pumping, 4~1.9J2011 C. ABSORPTION FIELD DATA · Date ~nstalied 9/2.2J,05 Length 43 ff. Total, depth 11-12 ft. Parcel ID: 020;424,26 IfA, B, orC provide PWSID # Sanitary seal (Y/N) Y Cased to 242 FROM WELL LOG ,9/22105 g.p.m. Nitrate .956 . mg/L Date. of sample: 4/19/11 Well Log (Y/N) - Y Wires properly protected (Y/N) 'Casing ~height (above ground) ~ AT INSPECTION 4/20/11 216.2 ft. 3.03 g.p.m. Y >24 in. Number of Compartments .TwO Depmssien over tank (Y/N) N Pumper A Plus Home Services Date ins~lled 9/22/o,5 Cleanouts '(Y/N) Y High water alarm (Y/N), ' Soil rating (g.p.d./ff2 or ~/bdrm) .~.2 GPD/SF Width 3 ft. Eft. absorption area 498.8 ft2 Monitoring tube __ System type .Deep',Tr~ch Grail below pipe 5.8 ft. Y Depression over field N Date of adequacy test 4/20/11 Results (Pass/Fail) Pass For 4 bedreoms Fluid depth in abserpfion f~ld :before test 19 in. Wateradded 613 ...gal.' Newdepth 23.6 Elapsed Time: 1,24~ min. Final fluid depth 19 in. AbsorptiOn rate >= Any rejuvenation treatment (past 12 mo.) (YIN & type) N if yes, give date in. g.p.d. wa~er.Fe~ Date of,:p~ment: Re~t.Number'