Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
PARADISE VALLEY BLK 2 LT 3
rndise Valley Block 2 Lot 3 #020-424- 18 Municipality of Anchorage Page of b DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 a Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5 96 oZ-1'S PID Number: 0 b2LQ-LV Name: I CONN G I<� Wastewater System: A 0 ew ❑ Upgrade Address: G ABSORPTION FIELD Phone: No. of Bedrooms: Sep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: S Total Depth from original /�ep GPD/S . Ft. Lot: 3 Block: 7 ubdivision• Depth to pipe bottom from original grade: Gravel depth beneath pipe /c7 fl Ft. Ft. Township: Range: Section: Fill added above original grade: ¢. Gravel length: G S . a — Ft. Ft. WELL: New 11 Upgrade Gravel width: %,� Number of lines: / Distance between lines: Ft. 3 Ft. ___� Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: 4e�TM D -3a31; r -r ViT f't 2-4 Ft. I 24<O Ft. 136 0 SO. Ft. ?" /p Driller:. Date grilled- Static Water Level: Installer: Tp/4i;4_*r / — Date installed: 31-1- Z3i ///�/ :n -e, /O/Z, /o °.4�. Z/ Ft. I/,t-t/ IA4 Yield: Pump Set at: Casing Height Above Ground: 7 f� TANK /-S-�GPM C/'✓k/✓ Ft. Z • Ft. SEPARATION DISTANCES 16Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding /Private Manufacturer: L Capacity in gallons: / Z5 -e, From Tank Field Station Tank Sewer Linea Well, � /3 / / / � /oma Material: / Number of Compartments: Surface >/00, >/oo' /� / >/oma' LIFT STATION LotSize r / in gallons: Manufacturer: Line - Foundation /D / /r 7 / / "Pump on" level at: "Pu evat at: High water alarm at: Curtain�/� Pump Make S M Electrical Inspections performed by: Drain / Remarks: %yJe„;7orTNLt,s Tele—ir — e_..,.f BENCH MARK / Location and Description: �r01/t�c it 1AX Xzwl /te d c o - I'eS o — Assumed Elevation: /AD i Eli SEAL b 'a, r U, `es„ p�Q l 11 r I Inspections performed by Dates: is 2n yy a a�t�e�n h r Services ap ro al Department of HeaIR and Human Date: , Reviewed and approved by: 72-013 (Rev. 9/91) MOA 25 A. Permit No, 9& 0 273 Municipality of Anchorage Page Z of 3 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 tion: �t 3. 6Ak z l�a/� dzp¢z�i8 9 P PID No.: Permit No. 9�o O Z'7 3 Page 3 of 3 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: /--b f3, /k L, �ar�ec�iSc- ✓�/�s� POW.: � O 1 \ T T I *IV ---- T s g�Wy I I kr�. o ay W aEYc I V1. I r m 1 I 'ems T yTs 111�11'�11 j �\ \11. � �\1' • --- t Fe, I' r eve IT2brG 00 LOP- A dODo c '• � '1 � O v . 6. ° o e. a ° • e a m ° D,D °Det-—.D0-o�.. eo "10 .oc6O0 8ospaQo -- o N°—..-_—. of—ineOo-e+a-a°-'e•gpo0 -°-•o-�°°OpO_D � " 6 e 0°.Oa 0.0•o omDo Doo a-00 RECEIVED. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES J U L 18 1997 DIVISION OF MINING & WATER MGMT WATER WELL RECORD LOCATION OF WELL Municipality of Anchorage BOROUGH _.SUBDIVISIONT-;171 SECTIONOTR6 RECTION TOWNSHIP RANGE NgypIRN. P EIN CIE ire 1 1 ❑S ❑W PLEASE MAIL WHITE COPY OF LOG TO: ONR/DIVISION OF MINING & WATER MGMT 3601 C St. Suits 800 ANCHORAGE AK 99603-6936 Phone (9071269-8639. Fax (9071662. 13134 LOCATIONISKETCH: WELL OWNER: �(-t5C r DEPTHS MEASURED FROMPgasing top ❑ground surf,, Ce WELL DEPTH: DATE OF COMPLETION BOREHOLE DATA: Depth Depth of hole: 1624. It Depth of Casing: It -41-00100—/ :7 Material Type and Color From Tv 111 DEPT_ H FATIC WATER LEVEL: i ft below (estop of casing ❑ ground surface Date: 14/12 ., METHOD OF DRILLING: (lair rotary ❑ cable tool ❑ other USE OF WELL: 341omestic ❑ irrigation ❑ monitor y ❑ public supply ❑ Other. CASING STIft. Diem: in. t0 / Casing typeCK: In. to WELL IN AKE I E: Daelioe'ndf a bt reaned ' Elperforated ❑ open hole �. / Depths of openings: to it �- SCREEN TYPE: Dlam: in. ♦ Slot/Mesh Sire: Length; It GRAVEL PACK TYPE: Volume used: Depth to top: GROUT TYPE: .7 Depth: from It to It r DEVELOPMENT METHOD: W / Duration: d PUMPI1�i t�L6VE1. AND YIELD: it after` hrs pumping gpm PUMP INTAKE DEPTH: ft Horsepower: a►� ! s WELL DISINFECTED UPON COMPLETION) L9"fES ❑ NO CONTRACTOR INFORMATION: REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: ONR/DIVISION OF MINING & WATER MGMT 3601 C St. Suits 800 ANCHORAGE AK 99603-6936 Phone (9071269-8639. Fax (9071662. 13134 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960273 DATE ISSUED: 8/29/96 DESIGN ENGINEER:ANDERSON ENGINEERING EXPIRATION DATE: 8/29/97 OWNER NAME:TUBBS KATHRYN OWNER ADDRESS:804 P STREET #7 ANCHORABE, AK 99501-3251 PARCEL ID:02042418 LEGAL DESCRIPTION: PARADISE VALLEY BLK 2 LT 3 LOT SIZE: 47653 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: TOTAL DEPTH OF THE TRENCH MUST NOT EXCEED 12.0 FT. BELOW ORIGINAL>GROUND LEVEL. ALL PORTIONS OF THE TRENCH MUST MAINTAIN NOT LESS THAN 50 FT SETBACK FROM A SLOPE OF 25 PERCENT OR GREATER. % RECEIVED BY: L�"A DATE: ISSUED BY:��G�fE "� DATE- 2- 3 August 15, 1996 Municipality of Anchorage Department of Heath & Human Services MuNrcrp 825 "L" Street ENV'koNMF ll7yoFANC Anchorage, AK 99502-0650 ^��sERV,CESaVISON Subject: AUG Lot 3, Block 2, Paradise Valley Subdivision 751996 Septic System DesignC Ctr Impacts to Adjacent Properties C �/�D Dear On Site Services Engineer: We are hereby applying for a permit to construct a well and septic system on the subject lot. Three testholes were placed on the lot at the locations shown on the site plan. The percolation rate was determined to be 45 minutes per inch and no groundwater was noted. We are therefore proposing to place a deep absorption trench with 10' of effective depth. The distribution lateral will be placed 3' below the ground surface. At the north property line of the lot the ground surface drops dramatically at slopes approaching 70%. The trench location therefore is a minimum of 50' from the edge of the slope. The ground surface in the area of the trench, however, i s fairly flat and surface water will drain freely across the proposed location. The well will be placed in the western corner of the lot and will not conflict with any septic systems in the area. All lots surrounding this lot are currently undeveloped. The topography of the lot is shown on the attached site plan along with the locations of all the improvements to be made to the lot. If the system i s constructed as designed the following statements can be made: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no 'adverse impact on Lot ,3, Block 2, Paradise Valley August 15, 1996 Page Two reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, a<z Michael E. Anderson, P.E.' .fi,ro>ao�gaPamRosea o+aaaooc+q©o ana¢< s �, 6� g� Attachments t2yg9� a SV{ICPIMsti�I2`� /g Y^.,$tFYi`.b9i n l �u"' ¢l •���'IIA'vir���u � it r'Wf q�"�.'��n �.saro i� _ . __ w. • u•_ ...._ GltUbn�,n ruavm wnc 10002 /we/ Aereey aiev �/'',' ``• j�N Iwearing Aerea° ant and ent°rreable aga. BErEF?Y E5 By�;IAEW UGICK I SE EFS 1 I 3°3510811 FND. 21/2° AL. CAP r dt UIL G. ERG - 160.00 MON. ON 2112".:.•:.•. I �� FOMVIEWPOINT VE AL. POST w/W.P. PARTNERSHIP- F.W.O•G•IF.B.22,P°.17.201 11T$4y s Bos -B RV,a. 4s. `. g2•F 7R•: R Ne T 1fIA L3 a2 �` 1963 8 ,�'` GgFfNBfCr• � , BLOCK / 9 `�`� F4sfiM fNr .a° THIS PROJECT i s10/ aty TRACT' F-2 r ' 1 � '` sxa tJu i I I 9A8 20 12x t 3j a 1 24'COMM14 g f $ \/O " 1 441UTILITY /// ~`. ��`Y y' ACCESS ESM c ' ' 1 ESUT 1t ! ��� `��` W �• I `a Aa 14 wp li 3 17 T 11 1 2 I 24' COMMOR `111 r6a,� 1 ; ACCESS 1 1 IESMT 11.15 1• '^ 1 P 1 I it= I jL s y1 CIOUTILITY .� p t 1 • I a 44 UTY ESMT.- a£ .da\h �• 1 1%IQ�1316 i0 Q S 15995 R.)0 cP rd E \ V � ��B�F � e j1•f�. oris 'e e•°�/ �y�8 �� n �r IR i i �"ee 11, Y �\ ,W n I �'0• l ' 19 II Q 1 I rQ / / BO 0148100'2 �a ' + 13 �(f �.�. � •d. > 20 /qr e r z `.BLOCK j i I 1 de °° X031 `. 21 / f 20 3D moo TRACT E-1 200,766 S.F.?�s'°orOFJII 3c. 4.6! AC ° Ao ° l LOCATION MAP; N 1,, I ° I Ila 1 Iz i I I lft?om 5eP'!2•!'C' Ne •01 LOT 3, BLOCK 2, PARADISE 1 �M VALLEY �V� Pip 4. eq i �°,) o •,� Oreo 5 a • SITE PLAN �G ��o t 45 4 �; T z.3 SJil ° LJ•r•� +(w-^ i SCALE 1" = 30' i �•, 4„�t.. y it .,.. f r;/ - � i 'moi i332{� i I i LOT 3, BLOCK 2, PARADISE VALLEY SUB. DESIGN FACTORS: Four Bedroom Home Perc. Rate: 45 Min./Inch Application Rate: .45 GPD/SF SYSTEM REQUIREMENTS.: Deep Trench System 1,250 Gallon. Septic Tank 10' Gravel Beneath Dist. Line 4 Bedrooms X 150 GPD 600 Gallons Per Day 600 GPD/.45 GPD/SF = 1,334 SF / 20 SF/LF = 67 LF Total Length Therefore: Construct a Deep Trench System With One Lateral a Total Length of 671. Lateral to Be Placed at 3' Below Ground Surface. nla-rtmma�.. ; 8au�le,.t.. O 6worax-r1 Le FABFbL. 'bQA,aFi6W 120 CA4- TYPICAL DEEP TRENCH SECTION (NO SCALE) NOTE: Bottom of Trench to be 4' Above Groundwater. ww+& 1L Minimum 3' Cover Over Trench.1rsfi r, �i �• .'. <.,a £_� E Grade Area Over Trench to Drain Away. w'.sS '�� 4331 " ,. nyy ewe �ro v .. e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 '•L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST I� PERFORMED FOR: D�STy lLhs�L DATE PER FOI LEGAL DESCRIPTION:L3j )SZ� J Q'r%s'rSc— Township, Range, Section: NAiehaW G. Aadoran„ Net Time Depth to Water . 1 N 4 eAomoc�c��a//55���//yyn Or mmaoomoe, 2 ,TS uayi, 3C) ■■II!■ ■■III■ NOIRE ■■1■■ /Os27 11 5 io y� 6- 3 .(Mb le■■■■■■■I■■ 7 9 11■■■■■■■�■■ NAiehaW G. Aadoran„ Net Time Depth to Water Net Drop $ }'-� 4 eAomoc�c��a//55���//yyn Or mmaoomoe, o�pan •=., ... NAiehaW G. Aadoran„ 10- 11 0 11 12 Q, 13 14 15 ' 17 7r -dc C' ;�, 18 19- 20- WAS s 20 WAS GROUND WATER t / ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water After �tl ,6 Monitoring? N��% Date: Reading Date Gross Time Net Time Depth to Water Net Drop $ }'-� -SL 311- ,TS uayi, 3C) ■■II!■ ■■III■ NOIRE ■■1■■ /Os27 11 9.475 io y� i 3 .(Mb le■■■■■■■I■■ 11■■■■■■■�■■ ��■■■■■■■��® 1!��I■!f■■■■��■ 10- 11 0 11 12 Q, 13 14 15 ' 17 7r -dc C' ;�, 18 19- 20- WAS s 20 WAS GROUND WATER t / ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water After �tl ,6 Monitoring? N��% Date: Reading Date Gross Time Net Time Depth to Water Net Drop $ }'-� -SL 311- ,TS uayi, 3C) /Os27 11 9.475 io y� i 3 .(Mb PERCOLATION RATE � (minutes/inch), PERC HOLE DIAMETER 41 TEST RUN BETWEEN % FT AND $ ?/ FT COMMENTS vr� vrra►s %>ItESf:r'Eac� /otl:r �a r PERFORMED BY: Ii^�w re CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-006 (Rev. 4/85) (ENGINEER'S SEAL) v e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST��`�""�°""(' .4-• 4:;31 _ PERFORMED FOR: tiys- Y / DATE PER LEGAL DESCRIPTION: G3i AL/ ��✓� SY Township, Range, Section: DEPTH 1 SLOPE r �Y SNF (FEET) / T / 1 /m ENCOUNTERED? 2//; tlll9(0 S 341, L O DEPTH? P / 3• �'f E Depth to Waterr %O04E /q Monitoring? 5 6- , /o• S �3 3. o :33%yS 7 7 8 /0.ZE //.63 9 10 11 12 13 14 15 1s 17 18 19 20 COMMENTS ' `'S 74 WAS GROUND WATER /m ENCOUNTERED? Net Drop tlll9(0 S IF YES, AT WHAT L O DEPTH? P / 3• �'f E Depth to Waterr %O04E /q Monitoring? Date: '5 Lyaa:11INt_w Reading Date Gross Time Net Time Depth to Water Net Drop tlll9(0 r 3 : L'L /?. / 3• �'f 9 /3: 3z� i' /o• S �3 3. o :33%yS /0.ZE //.63 Z �a PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN/ FT AND FT PERFORMED BY: I ' ' 'r` �" •'` `�" RT THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) a Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 " L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Du LEGAL DESCRIPTION:L 3i // P 11-4 FEES 1 2—/b 3 4 S e i 5 7 • O 9 (� 10 WAS GROUND WAT ENCOUNTERED? 11 �O s IF YES, AT WHAT L � .f O DEPTH? P 12 E e Depth to Water �Qey 13 Monitoring? No 7 Data: 14- 15— t? 16 0 =o. 17 a 18 19 eQe� S01F%' IL,ASEIL DATE PER /'�sr Ago& C Township, Range, Section: C..L_ SLOPE �F-I \,ull\I-411V V1s,�\L� Depth to Water Net Drop 0101. f'/7 l- /0'3 i r" 91's 38.3 Michoe l E. Ar dua a� e SITE PLAN l7 JI ReadingDate Gross Time Net Time Depth to Water Net Drop 0101. f'/7 l- /0'3 i r" 91's 38.3 9 ••s/B.s /c,3IS i9 ,z //.c7 20-L_ -7-�q PERCOLATION RATE �S (minutes/inch) PERC HOLE DIAMETER % PO �jTEST RUN BETWEEN r i FT AND e.i2--FT Y FT " COMMENTS f S /"'-'e_ S' c' z PERFORMED BY I 1 r """" (E ' et CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: $/ �s l -9b 72-008 (Rev. 4/85) ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: Lot 3, Block 2, Paradise Valley Subdivision GENERAL: 1. The scope of this project includes the procurement and placement of a new 1,250 gallon Septic Tank and the construction of a deep absorption trench with 10' of drainfield rock beneath the distribution pipe. A total length of 67 L.F. of trench is required 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. A new 1,250 gallon septic tank must be procured from an approved source and installed at the location shown on the Site Plan. Lot 3, Block 2, Paradise Valley Subdivision August 14, 1996 Page Two 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. Lot 3, Block 2, Paradise Valley Subdivision August 14, 1996 Page Three 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. Lot 3, Block 2, Paradise Valley Subdivision August 14, 1996 Page Four 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. 07 8 9--in . u it ArtlX •` Municipality of Anchorage DEC i ZOYpG e�"o On-Site Water and Wastewater Program 1. j u=,?,(), , +a (907) 343-7904 E T Y Ol 5 3 L Certificate of On-Site Systems Approval Parcel I.D. 020-424-18 Expiration Date: �r �� - IS 1. GENERAL INFORMATION Complete legal description Paradise Valley Block 2 Lot 3 Location (site address) 5905 Greece Cir. Current Property owner(s) Joseph Lederhos Day phone Mailing address 5905 Greece Cir. Anchoareg, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well C Individual CI Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received b . &JL / v Date: 12/4/19 COSA to be released to the engineer,unless otherwise requeste.the engineer. COSA Fee $ 1�U Waiver Fee $ Date of Payment 1 .1 111? Date of Payment Receipt Number 059216 Receipt Number COSA# d 5GP 11 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. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 11/30/2017 461%0F Aq‘kl 6. DSD SIGNATURE * AVittk •• System#1 Approved for L( bedrooms j •:Steven R.•15annone• e System#2 Approved for bedrooms �� c��,•• CE-8149•• Disapproved �N `�Ri'OFESS* Conditional approval for bedrooms, with the following stipulations: `,„,,,L\\cY OF ` f,, J=V O„, ON-SITE ��, _. WATERA WASTEWATER z . PROGRAM �= O 4SERVICES-•. ... ...______________ Lit;c6. By: c kit"-... Original Certificate Date: 101 2_ i.J «: y-- t7 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 blue sheet i , c If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Paradise Valley Block 2 Lot 3 Parcel ID:020-424-18 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 10/27/1996 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 266 ft. Cased to 266 ft. Casing height(above ground) 12 in. FROM WELL LOG AT INSPECTION Date of test 10/27/1996 9/21/2016 Static water level 217 ft. 208 ft. Well production 15 g.p.m. 6.5+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 1 •01 mg/L Arsenic ND ug/L Date of sample: 11/17/2017 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 9/21/1996 Tank size 1,250gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N Date of pumping 9/29/2016 . Pumper A+ Home Services I4-00sca aks 1. e-e ' L." pr.---; . t N Ca -7/-„. C. ABSORPTION FIELD DATA Date installed 9/23/1996 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.45 SF/BR System type Deep Trench Length 68 ft. Width 3.5 ft. Gravel below pipe 10 ft. Total depth 15.5 ft. Eff. absorption area 1,360 ft2 Monitoring tube Y Depression over field N Date of adequacy test 9/21/2016 Results(Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 69 in. Water added 648 gal. New depth 79 in. Elapsed Time: 200 min. Final fluid depth 69 in. Absorption rate >= 600+ g.p.d. No Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES 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 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ 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+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on File G. ENGINEER'S CERTIFICATION . Al. k �� ,c OF. I certify that I have determined through field inspections and ;07:pV.•• �) ..:.*9#, review of Municipal records that the above systems are in 0*: , • )' •.* 9 conformance with MOA COSA guidelines in effect on this date. •• 0 Engineer's Printed Name Steven Pannone :S1everi•I2.•0anriorie:•'of, Date 11/30/2017 ��1:-.. CE-8149 so/ k1 APOFg —. COSA canary sheet_2-6-15.doc '''E TR"iCT GRFFN eFC T S R .SFR�F 65 Sg. C 158'4? 0 0 0 0 M W N i0 0 0 W I+ O N O C+ o m Z N 0 4.0 W O. Cl. i., . I 4. Ill Z c e. FR „ N'',,Nt Ai' , . N J ,iw,., PARKING?PG N, ,,. ` ` t0 UTIL11,ESt•tT. %. \ .,,L .r _ S B6 lg 10.E 7,5.. � `r 00\` .... . .21 . ,\ tcj. ._ v� GREECE CIRCLE Parcel LD. D. 020-424-18 Q to & 2 411%t Municipality of Anc On -Site Water and Wastewater (907) 343-7904 Certificate of On -Site Systems Ap 1. GENERAL INFORMATION OL1 7 2016 Expiration Date: I � 12 17 Complete legal description Paradise Valley, Block 2, Lot 3 Location (site address) 5905 Greece Cir. Current Property owner(s) Joseph Lederhos Day phone _ Mailing address 5905 Greece Cir. Anchoareg, AK 99516 Real Estate Agent Relocation Service 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone ET 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well' 0 Individual 0 Individual WaterStorage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for. COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 52-(, - Date of Payment IC) I tc) I So Receipt Number 071 J?Gi COSA # t`7sG lQ I LA 12, Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION PY,FNGINEER As certified by my seal ed*:herei� and as ofthp validation data shown below, I verify that my investigation, based on procedures outlined .,: . in the Certificate of On -Site $ytl s ApprovalGuidelinesfor 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. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for T bedrooms System #2 Approved for bedrooms Disapproved Date 9/26/2016 A(,�s�� l * ., y •SIever (5annarie. �g CE -8149 Conditional approval for bedrooms, with the following stipulations: •t Fl fllr, By: -- �, lr VV-_' Original Certificate Date: O -) 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheel E 1, c F If more than 1 septic systerrr is on the lot: COSA Checklist # + of + Structure served by this system + Certificate of On -Site Systems Approval Checklist Legal Description: Paradise Valley, Block 2, Lot 3 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 10/27/1996 Sanitary seal (YIN) Y Total depth 266 ft. Cased to 266 ft. FROM WELL LOG Date of test 10/27/1996 Static water level 217 ft. Well production 15 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate 2 mg/L Arsenic Aff ug/L < D a?te off sample: 9/21 /2011fi Parcel ID: 020-424-18 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 12 in. AT INSPECTION 9/21/2016 208 ft. 6.5+ 9 - p.m - Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 9/21/199.6 Tank size 1,250 .gal. Number of Compartments 2_ Cleanouts(Y/N) Y Foundation cleanouuI (Y/N) Y / Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping i Q Y? Pumper C. ABSORPTION FIELD DATA Date installed 9/2.311996 Soil rating (9•P.0./ftz or ff/bdrm) Y YP OA5 SF/BR System type Deep Trench Length 68 ft. Width 3.5 ft. Gravel below pipe 10 ft. Total depth 15.5 ft_. - Eft, absorption area 1,360 ftz Monitoring tube Y Depression over field N Date ofadequacytest 9/21/2016 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 69 in. Water added 648 gal. _ New depth 79 in. Elapsed Time: 200 min. Final fluid depth 69 in. Absorption rate , 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D.-WFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in: High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES _ 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 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5# Absorption field+ 10+ 10+ 100+ Water main Water service line Surface water Wells on adjacent -lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on File G. ENGINEER'S CERTIFICATION 1 certify that 1 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. Engineer's Printed Name Steven Pannone Date 9126/2016. COSA canary sheet 2-6-15.doc Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 020-424—x Expiration Date: /_; 1 1. GENERAL INFORMATION Complete legal description PARADISE VALLEY S/D; BLOCK 2 LOT 3 Location (site address) 5905 GREECE CIRCLE, ANCHORAGE, AK, 99516 Current Property owner(s) ANDREW KLISKEY, DAVID PFEIFFER & LILIAN ALI Day phone 351-1405 Mailing address 5905 GREECE CIRCLE, ANCHORAGE, AK, 99516 Real Estate Agent ROSIE CARTER W/ PRUDENTIAL Day phone 982-4141 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: _r' ''"' Date: � s COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ L\% I Waiver Fee $ Date of Payment 10 to 9J L\3 4v, Receipt Number b-1 W COSA # C)Sc. 1,5 \ 55�5- Date of Payment Receipt Number 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. 1 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 (ime of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 beat soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor ob they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long file system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE _AZ System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for M bedrooms. Phone 337-6179 Date o`�•.......�\N t. oOd P J • J y . a ass:`G CE -79 3 m ` �4 ofessio^°o �4O�000�a ,s ec-4 OF, bedrooms, with the following stipulations: ON-SITE WATER AND WASTEWATER pROGRAM Original Certificate Date: _/ (� "� % - The Mdnicipafifyr ffchoiage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11105) Nitrate Advisory Arsenic Advisory Other 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 S/D; BLOCK 2, LOT 3 Parcel ID: 020-424-18 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 10/27/1996 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 266 ft. Cased to 266 ft. Casing height (above ground) 12+ in. Date of test Static water level FROM WELL LOG 10/27/1996 217 Well production 15 WATER SAMPLE RESULTS: Coliform n colonies/100 ml. Arsenic: A) (D ug./L. M.T9111-DIR lei TPIr,4ITA AT INSPECTION 10/11/2013 203 g,p.m. 6.26+ Nitrate 1, yO mg./L. Date of sample:1 0/11/2013 Collected by: GEG, Ltd. Tank Type/Material SEPTIC/STEEL Date installed 9/21-23/1996 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping Pumper Or) e S / L c 5 C. ABSORPTION FIELD DATA "BELOW EXISTING GRADE Date installed 9/21-23/1996 Soil rating QBr ft'/bdrm) 0.45 System type DEEP TRENCH Length 68 ft. Width 3.5 ft. Gravel below pipe 10 ft. Total depth *15.6 ft. Eff. absorption area 1,360 ft' Monitoring tube YES Depression over field NO Date of adequacy test 10/11/2013 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before et 101 in. Water added 730 gal. New depth 111 in. Elapsed Time: 120 min. Final fluid depth11 07 in. Absorption rate >= 600+ g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date aF IL+" Qf,-t-OL,� yNv'e JySTCJ'r 6$`. r-L4L_ D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump ofr' level at wa er alarm level at 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 lot: Absorption field on lot 100'+ On adjacent lots 100'+ 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A 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 N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A 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 certify that 1 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. Engineer's Printed Name JEFFREY A. GARNESS Date f 0'z.3//3 (Rev. 11/05) .......................... A. Gar ess.: m . CE— 53 w� "-i z 4�nd p+'of essio��oo Municipality Of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road F.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. 020-424-18 COSA# C D- 1. GENERAL INFORMATION Expiration Date: Complete legal description PARADISE VALLEY S/D; BLOCK 2, LOT 3 Location (site address) 5905 GREECE CIRCLE * ANCHORAGE, AK * 99516 Current Property owner(s) DUSTY & CONNIE KASER Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing address 5905 GREECE CIRCLE * ANCHORAGE, AK * 99516 Day phone 345-3947 TAMMY GILLS W/ DYNAMIC PROPERTIES Day phone 727-8115 3111 C STREET * ANCHORAGE, AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 samples. (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 WSPECTMI BY ENGINEER As certified by my seal amxed hereto and as of the validation date shown below, I verily ti",at my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, ' nn.ai PgrP! gL?tehv%vS that the on-site water SuApp an /or wastewater d7sposI cy te"n JS (are) Safe, unCfl_i for the number of bedrooms and type of structure indicated herein. l further verify that based on the Int'oniration Obiained riOtie the °viiJnJCi a{ii of /I Is Ora E fJIES and f'om m in�.e�ctinati-on a -d ins ec�fon the p y g y y.,., p on-site water supply and/or wasteivater 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. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation. GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of hour long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Phone 337-6179 Date qb4A ✓� Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: gg qq��ppt, , p j �a Atter llIl�s:eb. //�J to IV1s" 1` COSA Checklist � ArCEE'iity rttliiiC��irV Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Ni 'r 6 Adviv ry / Other /,� Original Certificate Date: V r � �f (Rev. 11105) Municipality of Anchorage U���}��U��� ��uK�y^���� ������ntm�m�n»t Development _-�_'_-- Buildhng8afetyDivision - On -Site Water & Wastewater Program 47OOBragmwStreet PD.Box 1Q6850 Anchorage, AKQ0510'8G5D vmww.muninrg/onoih» (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEms APPROVAL CHECKLIST Legal : Parcel ID: 020-424-18 A. WELL DATA Well type PRIVATE- Kf\B.orC provide PVVG|D#NZv� Well Log (Y/N) YES Date completed Sanitary seal (Y/N) YES VVinym properly protected (YYN) YES Total depth 266 ft. Cased to 266 ft. Casing height (above ground) 1 in. FROM WELL LOG AT INSPECTION Date of test 10/27/1996 4/14/2011 Static water level 2 Well production 1 0.p.m. 8.p.m. WATER SAMPLE RESULTS: Coif/nn , cdoniem/100 mi Nitrate mg./L. Collected by: Arsenic: uQ./L. Date ofsample: /2Vl'L B. SEPTIC/HOLDING TANK DATA TankType/Material Date installed 9/21-23/1996 Tank size 1250 gal. Number ofCompartments 2 C|eonouteMYN\ YES Foundation cleanout OYN\ YES Depression over tank (MN) NO High water alarm MYN\ YES Date ofpumping Pumper C. ABSORPTION FIELD DATA Date installed Soil natingrft2/bdnn\O.45 System type ___-~ DEEP TRENCH Length 68 ft. Width 3.5 ft. Gravel below pipe 1/0ft. Total depth _*15.6L_ft. Ef[absorption area 13GO ftc Monitoring tube YES Depression over field NO Date ofadequacy test Remu|to(Pmss/Fmi|) PASS For 4 bedrooms Fluid depth inabsorption field before test 98 in. Water added GODgal. New depth 1O8in. Elapsed Time: 130 min. Final fluid depth 105 in. Absorption rate >= 8.p.d. Any rejuvenationtreatment (past 12nlo.)(Y/N0ktype) NONE KNOWN |fyes, give date ___—___ D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High water alarm level at 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'+ Public sewer main N/A On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A 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 N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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. Engineer's PnLnt d Na a JEFFREY A. GARNESS Date T �� COSA Fee S 1 J 4 — Date of Payment Ll (a' 1 I 1 Receipt Number Ol -7 05- (Rev. s(Rev. 11/05) Driveway, parking/vehicle storage 10'+ Waiver Fee $ Date of Payment Receipt Number PIAT PLAN ASBUILT X SCALE 1"= 4,0' GRID $w V Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, Registered Land Surveyors �9071 522-4625 Fax"° I hereby certify that I have surveyed the following described property: S VN -L - L., , } r (Pl./x� I -? t(0 Anchorage Recording District. Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto. that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways. transmission lines or other visible easements on said property except as indicated hereon. Dated this the e Day of _ AC;cL «. �4 2", k 1 - at Anchorage. Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. Project No. _ - m - Alaska 99515 OF ACv°;k, 495+ '•: v ............ KENNETH G' LANO.' �'• LS -5202 ..i l� • g A