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Home My WebLink AboutPARADISE VALLEY BLK 4 LT 3Paradise Valley Block 4 Lot 3 #020-411-11 . Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191199 PID Number: 020-411-11 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: NORMAN & CAROL PETTY ABSORPTION FIELD - EXISTING Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 6340 SWITZERLAND DR., ANCH., AK 99516 111 Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. PARADISE VALLEY 4 3 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches Tank Field Lift Station Tank Line Ft' From -- -- Ft. Well 100'+ NA NA NA NA TANK ® Septic ❑ S.T.E.P. Cl Holding ❑ Other Manufacturer Capacity Surface Water 100'+ NA NA NA IM-1060 INFILTRATOR 1094 Gal. Material Number of compartments Lot Line 5'+ NA NA NA PLASTIC 2 NA Foundation 10'+ NA I NA NA LIFT STATIONManufacturer Capacity Gal. Curtain Drain NA NA NA NA Pump on level at Pump off level at High water alarm at Remarks Existing septic tank decommissioned per code, new tank installed & connected to in. in. in. existing field. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tandank to 3034 o Installer NORTHERN EXCAVATION Drainfield CO/MT 3034 Inspector FWCS / MNA BENCH MARK (Assumed elevation) 100 ft Inspection 1" 6/11/19 2nd 6/12/2019 Location and description 3rd 4`" DOOR SILL COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL ��\ Ar Conditional Approval: Date or& '-'2 49TH 1\ * V /lM40,14)4*--OHY 4 .p •.MICHAEL Na. ANDERSON: / �`43� No. 9469 / L(1 4 6.119/19v$ Approve ,._ /� Date l0'2 (r ' q N. ssio0-, ... Inspection Report_9-1-12.doc PID: 020-411-11 PARADISE VALLEY B4, L3 PERMIT: OSP191199 y4/6 r NEW IM-1060 II INFILTRATOR "P O V SEPTIC TANK .> /P/i... O , CO3 DCS / •0O � ' MH AD <V/, �� AD AD to 6' NEWER Co yi el MT /} \ 8 DECK lin }/ FCC S?j 'SIN �" :r SINGLE _ N FAMILY * ON /+/ 8M4 HOUSE iy /1 N /-1- q L-_ rt_ 28_6' -../ WELL �; j SBS. } SCALE: 1' = 30' FCO c0 CO CO CO A—C=75.0' 00 GRADE_ B— C=56.9' 95.64 4 A—D=81,0' 91.84 B—D=63.3' — 91� 1.094-GALLON \2925 PLASTIC TANK 6.1-1060 EXISTING FIELD INFILTRATOR SEPTIC SECTION SCALE: NTS PARADISE VALLEY B4, L3 SUPPORTOSERVICES: =b�� OF 44,1&s, PREPARED FOR: F ig <S..* NORMAN & CAROL PETTY *49TH %\ 6340 SWITZERLAND DR., ANCH., AK 99516 �/g1�1/��J�`J%�� Michael N. Anderson, P.E. DATE: 6/21/2019 ` MICHAEL N. ANDERSON / 4661 Natrone Ave. 1No. CE 9489/ Anchorage, Alaska 99516 DRAWN: FWCS t 6/21/1s (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30' � ‘`�=_ Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 May 28, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: PARADISE VALLEY BLOCK 4, LOT 3 To whom it may concern: The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 3- bedroom house. The lot and area is served by a private water and will not impact any of the neighboring properties due to the lot layout. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191199, Deb Wockenfuss, 06/04/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191199, Deb Wockenfuss, 06/04/19 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAM V i2 lJ 1477-4!5_4./ PHONE EW UPGRADE MAILING ADDRESS LEGAL DESCRIPTION 1 m is C.— V LOCATION INO. OF BEDROOMS VY DISTANCE TO: Well 7004 r o- e.N� (, 6 g PE ANO Ofy wQ Man ufactu Mater' � „ / No. of cmppartments Liq.c pacity i gallons M IF HOMEMADE: Inside length Width Liquid depth J 0Z DISTANCE TO: Well Dwelling PERMIT NO. 2 z F Manufacturer Material Liquid capacity in gallons D LU DISTANCE TO:� Well Foundation ( Nearest to I(} T PERMIT J LL z Z w I" No. of lines Length of eac7Iine Total lengt of lin�s Trench idt inches Distance b e ryJ Ines 1* OC cc P: 0 Top of the to finish grade Material beneath the f Total effecti e sotpfie+t area LU Length Width Depth PERMIT NO. a aF- wa Type of crib Crib diameter Crib depth Total effective absorption area w ti DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MAT RIALS 114 !�'/ lit SOIL TEST RATI G_" INSTALL R 84 REMARKS 6 OVE DATE LEGAL Wly) 91 11 7 72-0'K3-Mev.3/78) / L/ RETURN T0: -Division of Geological and GeOP�-cal Surveys (DGGS) STATE Of ALASKA • 3001 Porcupine Drive (Te IePhc \1277-6615) DE PANTM riT OF NATURAL RESOURCES - Anchorage, Alaska 99501 W A T E R W E L L R E C 0 R 0 Drilling Company Name Ve rnll s Dry 12 n g ...... mnlere either la. Ib, or Ic. U.S.G.S. Local No. Drilling Permit No. A.D.L. No. lVl.nliVn Vr we t� Section No. Township N/S Range E/W Her iJ ivn la. Borough Anch Sutdivision Paradise C�[ fljock 1 4} Ib. Fraction , / , Ic. Distance and D°rection from Road Intersections Street Address and Area of Well Location j, OWNER OF WELL•. Al Blaze Address: 2. WELL LOC Material Type Top Feet Below Surface Bottom 4. WELL DEPTH: (completed) 2r7,q ft. f J2 ev Surface Elation Date of completion ave l y 5. ❑ Cable tool )M Rotary ❑ Oriven ❑ Dug ❑ Auger Jetted 0.ared Other: 11❑ co poseu cieurocit4U❑ gray - brown-- e roc 6. USE: Domestic ❑ Public Scpply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commercial []Test Well ❑ Other: ay- ace ro c seepage VU 1UU 7. CASING: ❑ Threaded �We lJed 6 In. to 50 ft. Depth Weight 17lbs/ft. in. to ft. Depth casing per ora cell above s qe ra u e a pr gallons 1er ay 6. FINISH OF WELL: Type: opeh end placate r. 61, Slot/Mesh Size: Length: Set between ft. and ft. Fittings: 9, STATIC WATER LEVEL: 5� ft. ❑ Above X�Below lana surface Type of Measurement: 10. PUMPING LEVEL below land surface ft. after hrs. pumping 9•p•m- ft, after hrs. pumping 9•P -m• miINICIPALITY OF AN DEPT. EN 11. WELL HEAD COhPLET10N: ❑ In Approved Pit 30 Pltless Adapter inches above grade 12. GROUTING: Wall Grouted: ❑ yas NO Materiel: ❑ Neat Cement ❑ Other: Ij. PUMP: (if available) HP Length of Drop Pipe 265 ft. capacity 9•P Type; X91 Saumerslble ��❑Rc.:iprocating ❑Jet t_J Omer: 14. REMARKS: Sub Guard installed above pump. Water Temperature: 15• WATER WELL CONTRACTOR'S CERTIFICATION: This �drilled under my Jurisdiction and this well was Vern' L-.sc-' l�r?l""Y'•Fr—&--Ent aeg�sc r.d Ju•s> N v Shn Address: ��'L�tj•:�111��L_ ,I�r . _ // / � s/!`e.e' report Is true to Anrh the best of my knowledge and belief; o n t ract um L+ a se er n 1 �t Q0516 --1 �, a a� T/,� (/(/ Date: - — / —. J � / -.47120 - z LE -19 -.4 - - jV-1c PPO ill 9::,,'1 Ill UHN NUVHBER i:..iF BEDF-Mils SOIL RATING (LICA FUEBR)....: 85 � 1 -FIE Sl. -2.1: OF' THE SOIL ABSOF.PTIO61 sysmlyl Koo FEE W -Y W-11 M== -1,� �� 1� � | THE LENGTH DIMENSION I5 THE LENGTH (IN FEET) OfTs TRENCH OR DRHIMFIELD. THE DEPTH OF H TRENCH OR' PIT IS THE DISTANCE BETWEEN THE SURFHCE CiF THEK GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES / � | THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL. PIPE AND THE BOTTOM OF THE EXCAVHTIQN (IN FEET). \ \ � Fit E=7 1.1 UN :1 FZ EE PED ��iC.' �F-"i P -J 2' EE ft. CIO 4`5 W F:.,g I.- L- qD�� ! PERMIT HPPLICHNT HAS THEE TO INFORM THIS DEPARTMENT �lJRING THE INS'TA LLATION INSPECTIQNS OF WNY WELLS ADJACENT TO THIS PROPEERT'? HN) THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. | 714 KD Q, E- -IF 1 F::W FZ-,*'-'E-:E ��1 F-'-" EHEE:::11 BHCKFILLING OF HNY STEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMQM DISTANCE BETWEEN H WELL AND HNY ON-SITE SEWHGEE DISPOSAL SYSTEM IS �00 FEETFOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPE-N0ING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE: FROM H PRIVATE WELL TO H PRIYHTE SEWER LINE IS 25 FIEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPARTMENT WITHIN OF THE WELL COMPLETION. ' ` OTHER REWIREMVIAL'ENTS VIAL'PAWLS', SPECIFICATIONS AND CONN �TRUCT��D�H�RHMS AR7� HVHILABLE TO INSURE PROPER INSTHLL�TION I CERTIFY THAT 1: I AM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTHLL THE SYSTEM IN �I�1-1 THE CODES. ]� I UNDERSTHND THAT THE ON-SITE SEWIER SYSTEM MHY REQUIRE.: IF THE RESIDEENCE IS REMODELEED TO :[PICLUDE MQRE THAN ] BEDROOM.v_ SIGNED [ �LH5E JR 7�� - ---- . _�` � /� /�� ' /�\/ ' ��_��_ V4,0 -' ^ f 1 SOILS LOG MUNICIPALITY OF ANCH119OW&ELITY OF ANCHORAGE El DEPARTMENT OF HEALTH AND ENVIRONMENeTPRb' W&ffi�EI PERCOLATION ENVI )NMENTA. PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TUR 19 196 PERFORMED FOR: AL BLASE RE�,��MED: '/�b'Cc Z. LEGAL DESCRIPTION: LOT 3 PAeADISM VALLE Y r SLOPE SITE PLAN aKfO A P1 1 C. 2 o ne COVeSE G eAVF-4 poo 3 e o AMP SAND 5 o 9.5 b o 6 � O 7 D rJ 8 a o 9-0 o 10 d 11 S WAS GROUND WATER � S ENCOUNTERED? L O P E •� ��NE IF YES, AT WHAT t`I G DEPTH? 13 -� Gross Time 14 ^•-- Net Drop 15 '"` -^•• I SO 16 ZOTTo M o 17 WO LI ,.15%!� MIAN +•'.9 19- 0 9in i® Reading Date Gross Time Net Time Depth to Water Net Drop �!•�•�� • •00 0 PERCOLATION RATE (minutes/inch) P� �•.• JU COMMENT I® PERFORMED BY: 72-008 (6/79) .25-E TEST RUN BETWEEN FT AND FT CERTIFIED BY: 7i s DATE: 7'1 f'&Z Cce b la (4 CAxJtZ OZ( CL-t�W ff)-\qC� L( -ML C) �-�l � ------ -- -- --- 010 wo'L 1%600-'�v �7�:velo,;nient Services X1[7'". -Mi t�'/c:�t�.i (.t 1( C74tiiitYC'<FC:S- ]t=;r't��'ri Certificate of 4n -Site Systems Approval Parcel I.D. 020-411-11 Expiration Date: 1. GENERAL INFORMATION Complete legal description PARADISE VALLEY BLK 4 LT 3 Location (site address) 6340 SWITZERLAND DR, ANCH AK Current property owner(s) GLENN MARSHALL Mailing address -SAME Real estate agent 2. TYPE OF DWELLING: [� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System Waiver request for: Day phone Day phone Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. R COSA Fee $ V v v Waiver Fee $- Date of Payment Z y oZO�2 Date of Payment Receipt Number Q o� �0 6 _ Receipt Number- - - - - COSA # 0 S C a 1160 % Waiver # hone: 9K17• 3Ap j,.!'904 ax: 90,'7-34-3-7997 997 POSAL: TYPE OF WASTEWATER 0 Private Septic ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. R COSA Fee $ V v v Waiver Fee $- Date of Payment Z y oZO�2 Date of Payment Receipt Number Q o� �0 6 _ Receipt Number- - - - - COSA # 0 S C a 1160 % Waiver # hone: 9K17• 3Ap j,.!'904 ax: 90,'7-34-3-7997 997 POSAL: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify t on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this on-site water supply and/or wastewater disposal system is (are) safe, functional and a bedrooms and type of structure indicated herein. I further verify that based on the info Municipality of Anchorage files and from my investigation and inspection, the on-site wate disposal system is (are) in compliance with all applicable Municipal and State codes, ord effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify Name of Firm MIKE N ANDERSON, P.E. Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. &. DSD SIGNATURE System #1 Approved for 3 � bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for t my investigation, based )plication, shows that the quate for the number of cation obtained from the mpply and/or wastewater inces, and regulations in ' information submitted. Phone 72788864 Date 8-15 1 OF . 1 kj% 4. =H M!( iAEE N. ANDERSON : Q__ f �d J,•., CE - 946 t$��' .I. Z�• Com.-�` bedrooms, with the following stipulati 11��w�►''`� ,� � -may �•�, ON-sI ST` �VVATER o PROGFAM 4:?� Cn , FAIT 4 By: Original Certificate Date: L62yoZoa ) 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. T Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. i 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory X ntt,o� COSA Chocklist blue sheet COSA Checklist Legal Description: PARADISE VALLEY BLK 4 LT 3 Parcel l: 020-411-11 If more than 1 septic system on lot: COSA Checklist # _of Structure served by this system A. WELL DATA H Well log is filed with Onsite (or attached) Date drilled 7/4184 Total depth 275.5 ft Cased to 50 ft X Sanitary seal is functioning correctly ❑t Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 8/4/21 Well production at time of test u Water storage tank volume 900 Well disinfected for coliform test' H Coliform bacteria is Negative Nitrate 4.31 mg/L ❑ Nitrat Arsenic ug/L 9 Arser Collected by MNA Date of Sample 814/21 Static water level at beginning of test 217 ft. Comments Water storage system in the crawl space (3x300 -gallon tanks) B. TANK DATA Age of tank(s) 2 years Tank type/material Measured operating fluid level in septic tank 48_' 0 Standpipes/foundation cleanout per record drawing Date of pumping 8/4/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 10'27B1 0 ALL standpipes present per record drawing Total measured depth from grade 9.6 ft (max) Measured depth to pipe invert from grade 3.4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 62 0 Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 0 gallons !"nmmcnl�/nefiricnriec fluid levels include missina 1.8' effective det COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance com Age of lift station _ years Lift station material Comments: Adequacy test date 8/4/21 Results Q✓ Pass For 3 Fluid depth prior to test 25 Water added 450+ gal New depth 26 in Elapsed time 1440 min Final fluid depth 25 in Absorption rate 450+ gpd Any rejuvenation treatment (pa: If yes, enter date gallons ❑ Yes H No ass than MRL (ND) less than MRL (ND) 2 months) 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' Community Sewer Manhole/Clea out > 100' 0 Yes if No _ ft Yes if No _ ft Neighboring Tank > 100' 0 Yes if No _ ft Private Sewer/Septic Line > 25' Yes if No _ ft Absorption Field on Lot > 100' 0 Yes if No _ ft Holding Tank > 100' Yes if No _ It Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No _ ft ❑ Yes if No ft Manure/Animal Excreta Storage100' Community Sewer Main > 75' 0 Yes if No _ ft [Yes if No _ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No _ ft Surface Water > 100' Yes if No _ ft Property Line > 5' 0 Yes if No _ ft Wells on Adjacent Lots: �........... Absorption Field > 5' 0 Yes if No _ ft Private Wells > 100' Yes if No _ ft Water Main > 10'v❑ 0 Yes if No _ ft Community Wells > 200' Yes if No _ ft Water Service Line > 10' 0 Yes if NO_ ft If septic tank is under driveway c ment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No _ ft If absorption field is under drivew y comment below Property Line > 10' 0 Yes if No _ ft Wells on Adjacent Lots: �........... Water Main > 10' 0 Yes if No _ ft Private Wells > 100' Yes if No _ ft Water Service Line > 10' 0 Yes if No _ ft Community Wells > 200' Yes if No _ ft Surface Water > 100'✓Q Yes if No _ ft F. ENGINEER'S COMMENTS COSA Checklist yellow sheet • • G. ENGINEER'S CERTIFICATION �� •' , I certify that /have determined through field inspections and review Pit • 4 q'rH of Municipal records that the above systems are in conformance with �........... .......... MOA COSA guidelines in effect on this date. , , y ......... �n!. MI ANDERSON •, CE 46 a��rr COSA Checklist yellow sheet MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Well Water Advisory Certificate of On‐Site Systems Approval # OSC211506 Subdivision: Paradise Valley, Block: 4, Lot: 3 This well’s productivity was determined to be 0.22 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3‐bedroom residence is 0.31 gallons per minute or 150 gallons per day per bedroom. Although the well production does not meet this requirement, water storage has been provided to meet minimum code requirements. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. EPo9,i/S MUNICIPALITY OF ANCHORAGE Development Services Department ` � Phone: 907-343-7904 On-Site Water & Wastewater Section — Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 020-411-11 Expiration Date: (0-21- 2,0Z-V 1. GENERAL INFORMATION Complete legal description PARADISE VALLEY BLOCK 4, LOT 3 Location (site address) 6340 SWITZERLAND DRIVE,ANCHORAGE,AK 99516 Current property owner(s) NORMAN&CAROL PETTY - Day phone Mailing address 6340 SWITZERLAND DRIVE ANCHORAGELAK 99516 Real estate agent Day phone 2. TYPE OF DWELLING: (� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: __. Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 55D Waiver Fee $ Date of Payment 6117-119 Date of Payment Receipt Number - (fVegOgb -- Receipt Number COSA# 65C/q /gSY 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. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm ANDERSON CONSTRUCTION&ENGINEERING Phone 345-3377 Address 4661 SHOSHONI DRIVE,ANCHORAGE,AK 99516 Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 6/14/2019 Comments:This investigation was completed in compliance with MOA guidelines,regulations, �_ and best industry practices/methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested.The flow and absorption rates may change A% OF Az \ due to subsurface conditions that may not be observed from the surface,changes in land use, ••. ,, local soil characteristics,groundwater levels that may fluctuate during the year,quality of construction(workmanship&materials),the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to * 4 9TH * / these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore,any estimate of how long a system will function satisfactory ri for current or future occupants or guarantee that no unseen encroachments,deficiencies or discrepancies exist can be given by FWCS and Anderson Construction&Engineering. ; ..MICHAEL N. ANDERSON 1 y No. CE 948 6. DSD SIGNATURE kY y,-.• 6//1.411.9•'' 'Plitvessiotos" Air System #1 Approved for 3 bedrooms �111howq.: System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: q °N-S/T SATE E g WASTE�ANp m PRoGR4 RSERVICSS o= 11/)►e))1111N By. -- = Original Certificate Date: (7 1 l The Municipality of Anchorage Development Services Division (DSD)issues Certificates of On-Site Systems Approval (COSA)based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: PARADISE VALLEY BLOCK 4, LOT 3 Parcel ID: 020-411-11 If more than 1 septic system on lot: COSA Checklist# of_ Structure served by this system_ A. WELL DATA ® Well log is filed with Onsite (or attached) Water storage tank volume 900 gallons Date drilled 7/4/1984 Well disinfected for coliform test? ❑ Yes ® No Total depth 275.5 ft ® Coliform bacteria is Negative Cased to 50 ft Nitrate 3.69 mg/L❑ Nitrate less than MRL (ND) Z Sanitary seal is functioning correctly Arsenic ug/L Z Arsenic less than MRL (ND) ® Wires are properly protected FW'CS Casing height (above ground) 18+ in. Collected by Date of flow test for COSA 5/23/2019 Date of Sample 5/17/2019 Static water level at beginning of test 181 ft. Well production at time of test 0.22 gpm Comments Water storage system in crawl space (3 x 300-gallon tanks). B. TANK DATA—6/11/2019 -NEW IM-1060 INFILTRATOR C. LIFT STATION - NA Age of tank(s) 0 years ❑ Required maintenance completed Tank type/material SEPTIC I PLASTIC Age of lift station years Measured operating fluid level in septic tank Lift station material ® Standpipes/foundation cleanout per record drawing Comments: 1094 gal working capacity ST Date of pumping NA—NEW TANK D. ABSORPTION FIELD DATA— 17'L x 3'W x 8'ED—85 SF/BR= 272 SF Which system tested (date installed) 10/27/1981 Adequacy test date 5/23/2019 ® *ALL standpipes present per record drawing Results El Pass For 3 bedrooms Total measured depth from grade 9_6 ft (max) *Fluid depth prior to test 24 in Measured depth to pipe invert from grade 3.4 ft(min) Water added 600 gal ❑ N/A—pressurized field *New depth 27 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 960 min depth into effective 6_2 ® Code-required soil cover over field *Final fluid depth 24 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date t' Comments/Deficiencies: *Fluid levels include missing 1.8' effective depth. FWiCS COSA Checklist copy 2.docx 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' Community Sewer Manhole/Cleanout> 100' ® Yes if No ft ® Yes if No ft Neighboring Tank> 100' ® Yes if No ft Private Sewer/Septic Line >25' ® Yes if No ft Absorption Field on Lot> 100' Z Yes if No ft Holding Tank> 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® 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 Wells on Adjacent Lots: Property Line> 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Absorption Field > 5' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below Surface Water> 100' ® Yes if No ft 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' ® Yes if No _ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community,Wells> 200' ® Yes . if No ft Surface Water> 100' ® Yes if No ft F. ENGINEER'S COMMENTS AirAP-� A F . L4 � G. ENGINEER'S CERTIFICATION , \ ' '' .. .1-' 1 I certify that/have determined through field inspections and review 1 1*-49 49 TH * t� of Municipal records that the above systems are in conformance I with MOA COSA guidelines in effect on this date. MICHAEL N. ANDERSON: 1 i No. CE 9489 {v / ie COSA Checklist copy 2.docx ,\ .. 61'2 1. 19. #v FESSIO.140' MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 1 • r t"''� 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Well Water Advisory Certificate of On-Site Systems Approval # OSC191238 Subdivision: Paradise Valley , Block: 4, Lot: 3 This well's productivity was determined to be .22 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3-bedroom residence is .31 gallons per minute or 150 gallons per day per bedroom, the production capacity can fluctuate. 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GENERAL INFORMATION Complete legal description Am�p� arc eo. Expiration Date: Paradise Valley, Block 4, Lot 3 Location (site address) 6340 Switzerland Drive Current Property owner(.) Jonathan & Margaret Wright Mailing address Real Estate Agent Day phone 6340 Switzerland Drive, Anchorage, AK 99516 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well I] Individual ll Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ '52� 940 Date of Payment 512�eMe Receipt Number 632580 COSA# 0S5ue tlq?) Waiver Fee $ 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,fundfibiial 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 /1P v r 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date 05/25/2016 Conditional approval for bedrooms, with the following stipulations: VvnI L,.I �•- Original Certificate Date:—S 3 % 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 COSA blue sheet ' _, If more than 1 septic system is on the lot: COSA ChedkligMl of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Paradise Valley, Block 4 Lot 3 Parcel 113: 020-411-11 A. WELL DATA Well type Private. If A, B, or C provide PWSID # Date completed 07/04/1984 Sanitary seal (Y/N) Y Total depth 27515 ft. Cased to 50 ftr' FROM WELL LOG Date of test 07/04/1984 Static water level 51 ft Well production 0.3 g.p.m. WATER SAMPLE RESULTS: Coliform Jerolonies/100 mL Nitrate _ mg/L Arsenic ug/L Date of sample: S �l 0�� l d Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION 05/10/2016 29 ft. 0.3 -M- Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/ Steel Date installed 09/17/1982 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 5 (A(, !'tel �o Pumper A-' /V o S40/11O`c-eS C. ABSORPTION FIELUVATA - Date installed 09/1711982 Soil rating (g.p.d./ftz or f?/bdrm) 85 SF/BR System type Deep Trench Length 17 ft. Width 3 ft, Gravel below pipe 8 ft. � I Total depth Eff. absorption area 272 fe Monitoring tube Y— Depression over field N Date of adequacy test 5/10/2016 Results (Pass/Fail) PASS For' 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 508 gal. New depth 0 in. Elapsed Time: 80 min. Final fluid depth 0 in. Absorption rate >= 450* g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N 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 Datum Cycles tested Meets alarm & circuit requirements? E SEPARATION DI TAN - 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-j- Public sewer manhole/cleanout 100+ Sewer /septic service line 45+ 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+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION_ FIELD ON LO_ T TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehiclestorage_10+ Surveyonfile �� G. ENGINEER'S CERTIFICATION I certify that I 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 05/25/2016 COSA canary sheet 2-6.15.doc Municipality of Anchorageo ,<, Development Services Department Building Safety Division $qf ETY Q On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC161193 During a recent COSA on-site inspection and test of the potable water supply well on Block 4, Lot 3 of Paradise Valley subdivision, the well's productivity was determined to be .3 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 01 Parcel I.D. 020-411-11 NOVSUBMITTA" 1 0 014 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: ;_3 15-- Complete legal description PARADISE VALLEY BLOCK 4 LOT 3 Location (site address) 6340 SWITZERLAND DR., ANCORAGE, AK 99516 Current Properly owner(s) MARYARMITAGE Mailing address Real Estate Agent BOB BAER 2. TYPE OF DWELLING: ❑x Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Waiver/Variance request for: NONE Received by: Day phone Day phone 727-6025 TYPE OF WASTEWATER DISPOSAL: Individual (] Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: 2;to ! COSA Fee $ 5" — / Waiver Fee $ Date of Payment Ill 1 ag 1 `' l Date of Payment Receipt Number 6 0 Receipt Number COSA# JkAb 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 time of installation. Name of Firm SPURKLAND ENGINEERING Address 203 W. 15TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE System #1 Approved forc� bedrooms System #2 Approved for _ bedrooms Disapproved Phone 279-3916 Date 11/17/14 i H r SPURKLAIN' % 11100 Conditional approval for bedrooms, with the following &1d M Original Certificate Date: U s - of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Appro al (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 COSA Nuesheei f , - 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 4 LOT 3 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID #- Date completed /4/1984 Sanitary seal (YIN) Y Total depth 275.5 ft. Cased to >40 ft. FROM WELL LOG Date of test 7/4/84 Static water level 51 Well production 0.3 WATER SAMPLE RESULTS: Coliform NEG cofonies/100 mL Arsenic ND ug/L Date of Parcel ID- 020-411-11 Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) 12+ in. AT INSPECTION 5/29/14 ft. 30 0.30 g.p.m. _ a.os m'Ig/L 'rrtef+•r f g/ / Colle a Rer �. S ft. :e�!djja by: ANSON MOXNESS B. SEPTICIHOLDING TANK DATA Tank Type/Material GREER/ STEEL Date installed 9/17/82 Tank size 1000 gal. Number of Compartments Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping 9/16/14 Pumper ISAAC'S PUMPING SERVICE C. ABSORPTION FIELD DATA Date installed 9/17/82 Soil rating (g.p.d./fe or ftz/bdrm) 85 System type TRENCH Length 17 ft. Width 3 ft. Gravel below pipe 8.0 ft. Total depth 9'3• ft. Eff. absorption area 255 ftz Monitoring tube Y Depression over field N Date of adequacy -test 8/7/14 Results (Pass/Fail) PASS For bedrooms Fluid depth in absorption field before test 0 in. Water added 330 gal. New depth 3 in. Elapsed Time: 110 min. Final fluid depth 1 in. Absorption rate >= 300 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons _ "Pump on" level at in. "Pump off' level at _ Datum Cycles tested _ E. SEPARATION DISTANCES WELL ON LOTTO: Septic tank/lift station on lot 1001+ Absorption field on lot 100+ Public sewer main NA Sewer /septic service line 25'+ Animal containment areas 50'+ Manhole/Access (Y/N) in. High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots100 + Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5'+ Water main NA Water service line 10'+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10'+ Water Service line 10+ Surface water 100'+(N.O.) Curtain drain 50+ (N.D.) Wells on adjacent lots 100'+ Absorption field 51+ Surface water 100+ Water main NA Driveway, parking/vehicle storage 10' F. COMMENTS P APP S TO BE BLOCK BEFORE BOTTOM OF TRENCH WL . G. ENGINEER'S CERTIFICATION I certify that i 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 LARS SPURKLAND Date 11/17/14 COSA bmm sheet 10-10-12.doc F. AtA\s, l �c� �•9tl i TH10 E. SPU^nKLAND; ems/, 0 ES Municipality of Anchorage su, Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci. anchorage. ak. us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC 141603 During a recent COSA on-site inspection and test of the potable water supply well on Block 4, Lot 3 of Paradise Valley subdivision, the well's productivity was determined to be 0.3 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 2 -bedroom residence is 0.22 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 'SHANE A. H0LT�4, 10444 •'•,LS-6914.•'•��4 o �o 0 ��°Fesslorw- Qo THE INFORMATION HEREON I5 FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS -BUILT SURVEY 1" = 20' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 3, BLOCK 4, PARADISE VALLEY ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _6TH DAY OF _AUGUST 2014. 12649, FB 167-55 HOLT LAND SURVEYING 600 HIGHVIEW DRIVE ANCHORAGEAK 99515 345-5513 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1® General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) A -4- .� n r.. _ /- i f' ,t, _ e . J. a - > /)i/ . _ -r-ai .4 � ./ ,, 7 (11� // Location (address or directions) ? 7 -0,3 71 (b) Applicants NamBusiness Applicants Address (c) Applicant is (check one) Lending Institution ; Ooner/builder ; Buyer ; Other (explain); -- (d) Lending Institution Telephone _ Address (e) Real Estate Co. & Agent's V Address Telephone42 ��' (f) Mail the HAA to the following address: „� .ter➢ �� f f- L.< t,.� �1 �� I 2. Tie of Residence Single -Family Multi�Family Number of Bedrooms 3. Water Su221X Individual Well Community Other (describe) Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite = Public Community 1=1Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] ki Ja Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, i verify that my investigation of this Health Authority Approval shows that the on�-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from 'My investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Address r �.— Date (ENGINEER SEAL) 6. DEEP Approval Approved for ! bedrooms By Approved Disapproved Terms of Conditional Approval Conditional Telephone o aOF �A1'4ha .o Jtz' -4 y C, need, Jr, Y j No. 2251-E =, CAUTION THE 14UNICIP_ALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY .AX INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE— MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S TOORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 't, 7-19-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 8's-4 Type of System Design Date Installed 1//7/,6Z. Length of Field /7' Width of Field 3 Depth of Field /V Gravel Bed Thickness Square Feet of Absorption Area SS/.t�� Standpipes Present 6?IN) Depression over Field (YA. Date of Last Adequacy Test Results of Last Adequacy 'lest Separation Distance from A8sorptio Field:/ To Water -Supply Well /.2Z* ® To Property Line /d, To Building Foundation 's To Existing cr'Abandoned System cn Lot O(Ar On Adjoining Lots To Water Main/Service Line A) I A- To Cutbank (if present) VIA To Stream/Pond/take% Major Drainage Course _ To Driveway, Parking Area, cr Vehicle Storage Area Cann ents 7C'�J 8�CG,p�Ka�sid _ �7a�� 2sSA1 �P�nn rn as -bmf c k �c�aK�Gnc..iuus- D. LIFT STATION Date Installed 01A, Dimensions '01A Size in Gallons Manhole/Access (Y/N) N/k "Pump On" Level at "Pump Off" Level at 1�31h High Water Alarm Level at Vent (Y/N) -1AJ64 Tested for OtAr Pumping Cycles during Adequacy 'lest. Meets MDA Electrical Codes(Y/N) A)(A- Comnents ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Gu on the date of this inspection. w4� Signed .. Date �!�'�r• i Company .��Ct� MOA No. — IaS_ ir..f.4sr KB1/d5/s ,A /(Page 2 of 21 Yv dines in effect qo�o ..11 2-15-84 Time APPLIC- NT FILLS OUT UPPER HAr"` ONLY ` %r- ,PropirtyOwn� er`G/_%/< _�/`r� ._ Phone �jJL/, Date Date Date Mailing Address i / Zip Code Buyer Address f �T � Zip Code 6; Lending Institution ��, yy1 qG• uy , (3 L/.j/9.A/ _ Phone Address YrY Inspector t� Zip Code " Realty Co. & Agent Phone Address Zip Code Legal Description DEPT. OF IJElIT: I R, r J/ Street Location' ENVIROk&1041A._ i ..0,ECTION Type of Residence Single Family RECEIVED ( ) APPROVED BEDROOMS ❑ Multiple Family No. of Bedrooms ( ) DISAPPROVED ❑ Other ( ) CONDITIONAL APPROVAL' Water Supply -9 Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community DATE For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Soils Rating Sewer Disposal Well To Absorption Area 6 Well Log Received afE,.e X Individual w / w Year Individual Installed` ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time,01 , Date Date Date Date � 3 Inspector Inspector Inspector Inspector t� — Field Notes: MUNICIPALITY OF ANCHORAGE DEPT. OF IJElIT: I R, r J/ ENVIROk&1041A._ i ..0,ECTION RECEIVED ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY:. " Soils Rating Date Sewer Installed Well To Absorption Area 6 Well Log Received afE,.e w / w Well to Tank ' Septic Tank Size?