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PARADISE VALLEY BLK 4 LT 10
Onsite File Paradise Valley Block 4 Lot 10 #020-411-18 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211396 PID Number: 020-411-18 ling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name RAYMOND & SHERRY WALL ABSORPTION FIELD - EXISTING ❑ Deep Trench El Wide Trench El Bed EJ Mound ❑ Other Site Address 18200 NORWAY DRIVE, ANCHORAGE Phone Phone 7�_M� f Bedrooms 3 Soil Rating GPD/SF JTotal depth from original grade Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot PARADISE VALLEY 4 10 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area Ft' Number of trenches Dist. between trenches Ft. Well 100,41 � -- 25'+ TANK N Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ -- GREER 1500 Gal. Material Number of compartments Lot Line 5'+ __ NA HDPE 2 Foundation 10'+ __ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer MIKE ANDERSON PIPE MATERIAL House toan tk 3034. Tank to 3034 drainfield Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspdection 1s` 9/28/21 2nd 10/15/21 Location and description 3`d 4'" TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date Adw "' *: 4s TM ....�:.*.err • • • • • • • • • •�^• Curtis Huffman �Fcis • CE 128991 • ����W ��� l��• 12/9/21 . •�r PROFESSOO 'P Septic System Approved -(� D 7.2 Date/2 ,Z % Note: this approval does not include well permit requirements. (Rev 05/02/18) PID: 020-411-18 PERMIT: OSP211396 EXISTING FIELD c0 MT 1 Fco OBSR. A MT CO LOT 10 *BM TOP 0I K 4 OF MH DECOMMISSIONED EXISTING S.T. & INSTALLED NEW 1500 -GAL HDPE SEPTIC TANK WITH NEW DCO. A—C=41.7' B—C=27,2' A—D=46.4' B—D=32.1' A—E=49.2' B—E=35.5' 40.9' B B C MH YO EXISTING CRIB r / J i to .Q STAKED 100' WELL RADIUS ON LOT 20 PRIOR TO CONST. / LOT 21A-1 O Z LOT 20 SEPTIC SECTION SCALE, NTS PARADISE VALLEY BLOCK 4, LOT 10 PREPARED FOR: RAY & SHERRY WALL 18200 NORWAY DRIVE ANCHORAGE, AK 99516 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK©gmoil.com �urr�K I�tKvl�t�: C * 9 TH DATE: 12/9/2021 SURVEY: JLS tis Huffman DRAWN: FWCS CE 128991 SCALE: 1" = 30' 12/9/21 e PAGE: 1 OF 1 r0� '0 PAF S-00 S/S b8 �3.0�lN { Ln O J Aol IIN 0 0 ' of 4 cN : x ` QzAo LLC co A�� w E.v_ �O cd CQ Q m�o�� OO /j, xp E" 0 �. . 0 p ad co U " Aol IIN 0 0 ' of 4 cN : x ` QzAo v ^c+ E.v_ �O .H W V 00 M Ii1 ^�. 1�1 it '� LS. i•. ° .D r >" C 7 �} F 1"^al ^ pp O O °❑ .ter ?_ w C O C CL y N 2 A G O 3 Z oh CG W NO9> LW > ^ W rM/ • Grr W o W ° o C ra K m (} Q O�`� r° Y ��yc.gc• 2O° � N 0iai O p 7^ m v ti :ri VI N Q o = „7. 4 ,.+ W e j ca o y a N ca M Q e� 0 Qin-+ra h G. U h v vc°a U ✓G W le 0 N cG. (leo MUNICIPALITY OF ANCHORAGE 0n -Site Nater & Wastewater Program PO Sax 198050 4700 Elrrrxe Road Anchorage, Ara%k$ 1$•$ Phone: (W) N3 -70M Far- (Wr) 9d9.-7"7 hdwJ1wmr.ffnuni.argq 0nsift On -Site Wastewater Disposal System Permit Pe rmit N wm6er: CSP211 N Work Type: SepticTarkk Upgrade Tax Code Number: 02041 11-6000 Site Legs I Address: PARADISE VALLEY BLK 4 LT 10 0.3538 Site Mailing Address: '18200 P40RVVAY DR, AnChgrage Own-er_ WALL RAYMOND C JR & SHERRY L Des I g n Eng I neer- F I RST WATER CONSULTI NO TFC is perm it is for th a constro ration of: Effective Date: Expiration Date; Id paL7trn4_'nr Lot Size In Sq Ft' Tol Bedrooms: 9Yl7!2021 9Yl72022 3469 ❑ Disposal Field Ef SepijG Tank ❑ Holding Tank ❑ Privy D Priva6eWal 1 ❑ Vater storage All construction shall be in accardance with. 1. The attached epproved design, 2. All. req tiIrements speOfl ed in Anchorage Mu ntppal code Chapters 15.65 and 15.65 $:n d the State Cf Alaska Wasiewater Disposal Regulations j18AAC72j and Drinking W2ter Regulations (1aAAC$0) 3. Tile wastewater code requires Inspections during the Instiatlatlon. The engineer sh2lt notlTy the Dovolopmortil Services Depa riment per AM C 10 6S. Provide notirmtion by ca Iling (g07) X43-7904 (2447)- 4. 2447)_4, Frorn CPctcber 15 to April 15, a subsurface soil absorption system under construction during freezing Weather shalt t e either; a. Opened and Closed on the same bey, or h. Covered, sealed, and heated to prevent freezing Received By: Y Issued By: _&Ae mt// 9/1712021 Date: r r MUNICIPALITY Development Services Department On -Site Water & Wastewater Section Parcel I.D. 020-411-18 ON-SITE SEPTIC/WELL PERMIT APPLICATION Property owner(s) RAYMOND & SHERRY WALL Day phone Mailina address 18200 NORWAY DRIVE, ANCHORAGE, AK 99516 Site address 18200 NORWAY DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) PARADISE VALLEY 134, L10 Legal description (Township, Range & Section) Lot Size 39,459 Sq. Ft. Number of Bedrooms 3 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade El Duplex (D) El Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 22 5 Waiver Fees: Date of Payment:/ 5 020 ? i Date of Payment: Receipt Number: O 1 5 3 Receipt Number: --P-ermit-No. - Waiver -No-- --- - --- - GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com September 9, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: PARADISE VALLEY BLOCK 4, LOT 10 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211396, Rebecca Carroll, 09/17/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211396, Rebecca Carroll, 09/17/21 LOT 5 z It XT 11-1 " r% " 1&% " U 1% U %_1 " Ix " t I IN " "10 t F% it %-, a 0 xx AS -BUILT OF: PARADISE VALLEY SUBDIVISION LOT 10 BLOCK 4 PLAT 87-16 o.14M. .14, 0 po T 11 SURVEY CERTIFICATE: I., John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures,, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibiliq, to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE. SCALE- E-MAIL AUG 30, 2021 1 "=40' schullerOak.net 21-1,34 DRAWN BY. JOHECKED BY, GRID NUMBER: BOOK/PAGE: JLS SW3538 210310 FNND 5/8" REBAR 0 F A -s" L A IVI) AW ® �. 7 � 4 49TH '--4 d . . . �................. VA 4-1 ?A .......... PA <D JOHN L. SCHULLER: 0 , LS -10408 ew 1831 Talkeetna Street Anchorage, Alaska 99508 ,or®'� 0 f (907) 227-1455 office ession (907) 274-4992 fax ~ MUNICIPALITY OF ANCHORAGE D[ .RTMENT OF HEALTH AND HUMAN SER JES . Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Address/ ~ ~O ~1 b '~ TANK FIELD Phone(s) Permit No. ~ ~No. of B WELL 34~-33 Township, Range, Section ~ ~ ~ ¢ l [driveway.AS'BUILTwaterDIAGRAMbodies~ ~t'~.)(~Pew I'ObCf. Sh b, well. ~ptic.. system, property hoes. ,oundat.on. ~ SEPTIC ~ HOLDING ~ ~anufacturer Capacity in gallons '.: I TYPE OF SYSTEM / ~TRENCH ~ BED ~ W. DRAIN ~'~ OTHER / ~" ~i'h'to pipe bottom frOmorlgi.a, gr'aOe ~ FT Total depth from original grade/ 0 FT '~ ~" Filladdedabovsorlg,na, grad8e(avelGrAveldepthbeReath plpewidth '} ' ~~ ~, ~ Total absorption Ar Distanc~ between lines 4 ~:;~' WELLS[~ - Classdicat~on (A,8,C) Total Depth Cased to % REMARKS: Inspect ons Pedormed by. " 72-013 (3/85) ~325 L. S'f]::~:Ei]iiiJ!" !~ AN(i)HOF,'A(i~iE, AK 99501 ?:.'b.q. '-' 4. 720 F:' ,, El ,, BOX ANCHOR¢.:K3E ;3 .q. 9 - ,'::~ 6 6 6 BL, L}L,I'..' 4 1,, ! am familiar' w:i.t.l'"~ t. he pequ:i.r'emerYLs for' on...-s:it.e sewer's ar'id weli.;].~; as set. for'th by t. h6? Nuriic:i. pal:i.t.y c:)f Ar'~chor'age (MOA) arid the St. ate:, c:,f Alaska. 2. f ~,,,:i.:i.l inst. atl 'Lhe syst. em in acccmdance ~,*it'..h all MOA c:c:~(::ies arid o.r'ic:l :i.r'l i:::c,i~¥:} 1 ;i. ar'ic;(i}:, t.x~:i.t.l"l the:, design c:r' it. er' :i.a of 'Lb is per'm:i.t. 3,, I w:i.!] acll"iere t.o a].l MOA ar'id S'Lat. e (::){' Alaska r'eclu:i, pement~!i~ f(::n- t.l"le !iiiet. l:::,ac:!.:: {:J J. st.o.r]ce;,s f p on] .:!;:rTy' E,x i!i~;t, i ri9 WE, ! t, Mast 8wat. er' d :J. sposa i syst. em or' pub i i c A L.[F:'T S'FAT!ON iS ;[N:~5;'t¥>d....L. ED ll',I AN AREA COVERED B"f' MOA BUIL. DING CODES, I'i.-IEiN(:I.) AN IELEX];I"RIC(.~L.. i:::'EiTRNI]; AND INSI::'EC]*t(:)N MUS]' BE OBTAINIED; (2) AS'""EiLJIL]"S LL NOT BE AF'F'F;:OVE]) WITF'K.Z)UT AN EL..Ec'r'RtCAL INSPECTI:ON REF:'OR'T; AND (:5) 'THE EL.E:Xi;TR:!:CAL.: WORK Mt]S'I ii{dE DE}NE BY A L ICIE]q:DED IEL..IEC]T~iCIAN. GI',IED .:d:::'l:::'L I CPdq'f' :i B i L,L.N ,, I:::%CKETT ,:~..,d~:::.b .., L, ...* , ,:::.; ~ __ -- C o W S' T.,q u c T iv_/:_,= ,¢ £ t/ d /,,v R.,,¢ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchor.ge, Alaska 99501 264~1720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST 1 2 3 4- 5- 6- 7 8 9 10- 11 12 13 14 15 16 17 18 19 2O DATE PERFORMED: LO SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT PTH? Gross Net Depth to Net Time Time Water Drop ' //~1 - ~ FT AND 7 , FT .... TEST RUN BE~EEN · ~RFORMED BY: '~~. ~/~ C~Y~FmD BY:~ ~ ~ DATE: GRE" R ANCHORAGE AREA BO " JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /Q??L!''/' /~-~'~->:/'~ MAILING ADDRESS LOCATION ~/~/~?/~f /~z~~:~Z// ......./~¢~L////';' LEGAL DESCRIPTION /<,/: /~' ,~..~>~"~' SEPTIC TANK: DISTANCE FROM WELl,'r :~;-'~';'~/Z~' y MAN U FACTU RER NUMBER OF COMPARTMENTS INSIDE LENGTH ~ INSIDE WIDTH ~ LIQUID DEPTH LIQUID CAPACITY GALLONS. SEEPAGE PIT: NUMBER OF PITS · DIAMETER .... OR WIDTH , LENGTH ::)/ DEPTH // LINING MATERIAL , 'M:'d'/ CRIB SIZE: DIAMETER "' ~E'~TH DISTANCE FROM: WELL BUILDING FOUNDATION ~ /-/' TOTAL EFFECTIVE NEAREST LOT LINE ,'¢>'J '~ -, ABSORPTION AREA (WALL AREA) '~/?;%//,<'/~:' SQ FT. ADDITIONAL ABSORPTION WELL: TYPE ~':;/-;-/,: d://'/' ': / "¢/'¢ CONSTRUCTION BUILDING NEAREST FOUNDATION __ LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DEPTH NEAREST SEPTIC SEWER LINE TANK__ REMARKS DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: INSTALLED BY: PIPE MATERIAl - LOT SLOPE: REMARKS: Form No. EQ-031 DIAGRAM OF SYSTEM G.A.A.B. R&M Civi/ Engineers ENC..,qEERING & GEOLOGI . L CONSULTANTS 229 EAST 51st. AVE. - P.O. BOX 6087 - ANCHORAGE, ALASKA 99503 TELEPHONE 907--279--0483 TELEX 090--35419 Geologists Land Surveyors JAMES W. ROONEY. P. E. MALCOLM A. MENZIES. P.E., L.S. JAMES H. WE/LMAN, P.E. August 7, 1974 8 1974 GREATER ANCHORAGE AREA BOROUGH DEPT. OF I:? ENTAL QUALITY R & M No. 462054 RALPH R. MIGLIACClO Engineering Geologist Faulk Brothers Constructiom P.O. Box 1738D Star Route A Anchorage, Alaska 99507 Re: Test Hole and Soil Log Report for Sanitary System Lot 10 Block 4 Paradise Subdivision Dear Mr. Faulk: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of July 28, 1974, and those procedures outlined in a letter dated September 13,-1971 by Mr. Rolf Strickland of the Greater Anchorage. Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 10 area for the purpose of defining genemal subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor-mounted backhoe and the test hole was extended to a total depth 15.0 feat below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours,. R & M ENGINEERING & GEOLOGICAL CONSULTANTS, INC. ~oney' ~ JWR: kd xc: GAAB ANCHORAGE F~!,~BANKS JUNEAU GreaTer ANCHORAGE Area BorOUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 'C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. INSTALLATION LOCATION LEGAL DESCRIPTION ~'2 ~7-"-/~;'~,, INSTALLATION Of: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SEEPAGE PIT , DRAIN FIELD , OTHER TO BE INSTALLED BY SOIL TEST RESULTS ~---~/~' //J~Z-~-;7--/~:;~/ NOTE: THIS PERMIT IS NOT VALI.D WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED ~ FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE Pit ~) /* ~ · DRAIN FIELD SEPTIC TANK ~ / , SEEPAGE PIT ~ ( DRAIN FIELD ~ TO NEAREST LOT LINE. WELL TO SEPTIC TANK J~ ~) / , SEEPAGE Pit J~ ~ DRAin FIELD ALSO CONSIDER AREA WellS. WATER MAIN TO SEPTIC TANK . ~"~'~ / , SEEPAGE Pit ~ DRAIN FIELD SEPTIC TANK, ~./3 . SEEPAGE Pit i~ DRAIN FIELD TO RIVER, LAKE STREAm CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST irON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit FITTED WITH Airtight REMOVABLe CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2S-68 AND THAT THE ABOVE DATE APPLICANT'S SIGNATURE '~ TH-1 7-z8-74 0.01 ORGANICS ORGANIC SILT (ML) ] .51 3,Ot SANDY GRAVEL TRACE SILT (GW) NO WATER TABLE 15.O' NOTE: Test hole excavated with tractor-mounted backhoe. Engineering I~ Geological Consultants Inc, ANCHO~A~ ~AmBA.~S, ALASKA JunEau FAULK BROTHERS CONSTRUCTION LOG OF TEST EOLE A~CHORAGE, ALASKA FROM: TO: GREATER ANCHORAGE AREA BOROUGH DATE ANSWER DEPARTMENT: ~ ,~/././~.. .... REQUESTED RECEIVER: REQUESTED ACTION SCHEDULE FOR IMMEDIATE ACT ON ~ CALL ME BEFORE YOU ANSWER FOR YOUR CONSIDERATION L~ NEED YOUR RECOMMENDATION OTHER ~ ZIA ;~ 1405 West 15th Ave, achorage, Alaska 99501 DIV. ' CITY PHONE TIME WELL LOG DEPTH WELL LOG STATIC LEVEL ~/ GPM-YIEL~5~ MI_gN I C I '~1. I TY 0~" ,'~:Nc~ ~RAGE DEPARTMENT~' HEALTH AND ENVIRONMENTAL MROTECTION 82.5 '"L"' STREET., ANCHORAGE., AK. 264-47'20 &4ELL PERI4 I f PERMIT NO. APPLICANT BILL N PUCKETT LOCATION NORWAY DR. LEGAL SRA BOX 4008 LOT SIZE ~44-8081 4~560 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIMATE WELL OR 150 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 7'5 FEET. WELL LOGS ARE REQUIRED AND, MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS 'AND CONSTRUCTION DIAGRAMS ARE AYAILRBLE TO INSURE PROPER INSTALLATION. F"ERf4 I T E>~P I RES DECEMBER _~'--~l.. 1980 I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. V4. 0 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. 020-411-18 Expiration Date: Z G r2©Z 2 1. GENERAL INFORMATION Complete legal description PARADISE VALLEY BLOCK 4 LOT 10 Location (site address) 18200 NORWAY DRIVE, ANCHORAGE, AK 99516 Current property owner(s) RAYMOND & SHERRY WALL Mailing address Real estate agent Day phone 18200 NORWAY DRIVE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 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: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number 9 0 2 2.O ;L Date: Waiver Fee $ Date of Payment Receipt Number COSA # Z 1 17 3Q 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 12/21/2021 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 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 `_3 �n system and maintenance. The operational life of all well and septic systems are subject to a� ����� these various and dynamic characteristics and are outside the control of the evaluator of the ..4 well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q; • • •zit •; 4 for current or future occupants or guarantee that no unseen encroachments, deficiencies or g•' discrepancies exist can be given by First Water Consulting & FWf.5 *' �•* / ...... ./- 6. DSD SIGNATURE Curtis Huffman N System #1 Approved for bedrooms rF��s•, cEtzss9t ��A. �ll�c�FOp OF/SSIQA,\��,�.- System #2 Approved for bedrooms 1���\"�`�,� Disapproved Conditional approval for bedrooms, with the following stipulations: KUTY oF"6tri� V�\��� B Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other Legal Description: PARADISE VALLEY BLOCK 4, LOT 10 Parcel ID: 020-411-18 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) Date drilled 5/12/1996 Total depth 104 ft Cased to 104 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 8/9/2021 Static water level at beginning of test 61 ft. Comments B. TANK DATA Age of tank(s) NA — NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NA Z.Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA Which system tested (date installed) 5/27/1987 ® ALL standpipes present per record drawing Well production at time of test 3 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 6.70 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by F Date of Sample 12/16/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 8/9/2021 Results 0 Pass For 3 bedrooms Total measured depth from grade *11.5 ft (max) Fluid depth prior to test 45 in Measured depth to pipe invert from grade *6_8 ft (min) Water added 450 gal ❑ N/A — pressurized field New depth 55 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 4.9' OF THE 5'ED** Elapsed time 1440 min ®Code -required soil cover over field Final fluid depth 40 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 Comments/Deficiencies: *AT MT & CO GRADE. **PER ELEVATION SHOTS TAKEN AT TESTING. FIELD OPERATING IN THE TOP THIRD OF THE ED. FRE 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' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes — if No ft ®Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells >' 100 _ ®Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® 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 Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION .,►�Z4„� h I certify that I have determined through field inspections and review � Qw: • ` - • • ' of Municipal records that the above systems are in conformance �g�•�"pr��� with MOA COSA guidelines in effect on this date. ` :. il•I • • ••: .'..• ....•....t...... • �.. Curtis Huffman .: 4 c'c •. CE 128991 �k�, OPROFESSO .,� ft ft ft ft ft ft ft ft Nitrate Advisory Certificate of On -Site Systems Approval # OSC 211730 Subdivision: Paradise Valley B 4 lot 10 A water sample revealed a nitrite concentration of 6.7 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address P O Oox 196650 *Anchorage, Alaska 99519 6650 *www muni org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. ;Mailing Address P O Box x:96650 *-Ancho"rage, Alaska 99519 6650 *www mur� org W MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, townsh~.., range) Location (address or directions) (b) Property Owner Mailing Address (c) Lending Institution -~2/,'/ /~'~ T~tephone: Home ~t-~---.~.~' ~/' Business ' · Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here [-I, if hold for pick up. List contact person and day phone number below. /¢zoo ,,¢., ,-%% TYPE OF RESIDENCE Single-Family~ Number of Bedrooms WATER SUPPLY Wel0~" Community [] Public [] Individual Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~' Public [] Community [] Holding 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 72-025 fRev 8/861 Front 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 regulations in effect on the date of this insp~ection.. ¢I Name of Firm Address ~'~ "7', -[~:::' /¢4..), Telephone ~" ~ /~ ~.'-./¢) 7 Date ~'/.~ / ,~' '7 DHHS APPROVAL Approved for? bedrooms by Approved ? Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 fRev 8/86} Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Desqription (include lot, block, subdivision, section, township, range) .. Location (address or directio, ns) (b) Property Owner "~/// Mailing Address (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here ~, if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single-Family~ Number of Bedrooms 3. WATER SUPPLY We~ Community [] Public [] Individual Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public r-I Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-075 fRev 8/861 Front 5. 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 Approvat 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 regulations in effect on the date of this inspection. Name of Firm~/~' ,'"'"~',~--// ~',~. ~'~---~"-~,~'~ Telephone . 0 Address ~ Date ~ '%'~"a ~T~ '%?~ *, Engineer's Seal Approved Disapproved Conditional Z~' TermsofConditionalApproval ~ ~'.,(~'CL/"I I$ CtI'~5I'~,~DEIP I~EI'~ ~/~g~5 ~/~ ~ ~/~ CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-o25 tRev 8/861 Back RECEIVED WELL DATA MuNiCIPALiTY OF ANCHORAGE ..... L SERVICES DtI~-~IiI,CIPALITY OF ANCHORAGE (MOA) ENViP-.ONM~Nt^ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MAY 1 4 1987 264-4744 d Well Classification c--~/~' c"/' V' t J~, If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N). Y~-"$ Date Completed '/~/////~'~ Yield '7' ~'~n4 ,~"'/./~/o~7 Total Depth 70 Cased to ~/"'/- Static Water Level ~ // Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Depth of Grouting Pump Set At ~ _~'/./z-[ ,~/~./~3 c(] ~ Sanitary Seal on Casing (Y/N) ~ ~ Depression Around Wellhead (Y/N) yo / To Septic/Holding Tank on Lot / :~-'(~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot //~./D ; On Adjoining Lots To Nearest Public Sewer Line /~/o/,/'~ To Nearest Public Sewer Cleanout/Manhole /vo/V,~ To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~///~'/7/-/ Size Standpipes (Y/N) ~"*~--~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well / 5-0 To Property Line To Water Main/Service Line --- Course NO. of Compartments //~/~',~/v~ ~.]/~', ~ ~ Foundation Cleanout (Y/N) ~"~- ~ Date Last Pumped -~/~/~7 /"~//~ ;for Temporary Holding Tank Permit (Y/N) /V/~ To Building Foundation ~'/ / To Disposal Field ~ / To Stream, Pond, Lake, or Major Drainage Commenfs Page I of 2 72-026 (Rev 8/861 Front C. AE~,SORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ? Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ~-~zY.~,,~./,~. Type of System Design Length of Field /~" Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test ~-/~/~ Separation Distance from Absorption Field: / To Water-Supply Welt j O0 ~ To Prope~y Line ~P~, To Building Foundation Lot To Existing or Abandoned System on ; On Adjoining Lots 7--- ~- / To Cutbank (if present) To Water Main/Service Line /CO ~ .--/- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area D. LIFT STATION Dimensions Manhole/Access (Y/N) "Pump Off" Level at Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, v. erifi¢,¢, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Sign ~"1-~. ---~/~'~--~¢~--~-~ at e ~' - - '/4-- '%- o ' Company .~--~ z~:/,/~-,,~, MOA No. Z~ ~ ~- /~ Date of Payment Amount: $ /d) Page 2 of 2 72 026 fRev 81861 Back 440 W. Ben,,on Blvd. ~,~ May 12, 1987 Municipality of Anchorage Public Health Department On-site Water ar~ Sewer 825 L Street, 5th Floor Anchorage, Alaska 99501 Attn: Susan Oswald RE: Lot 10 Block 4 Paradise Valley Subdivision Adequacy Test Dear Ms. Oswald: At the request of the owner, ~. Bill Puckett, I have performed an adequacy test on the existing seepage pit installed in 197& and connected to the new home built on-site in 1980. The system was found to be inadequate for a three bedroom home as ir~icated in the test results herein: Date Time Tank Pit Rate Quantity 5/4 0 rain 4.O' 4.5' 0 0 Before p~mping 0 4.5" 4.3' 0 0 After pumping lO 4.5" 5.3' ? gpm 70 12 6.0" 5.3' 7 84 gal+running back in tank 19 6.0" 5.3' 0 84 stopped flow 30 6.O" 5.3' 0 84 5/5 0 15.0" 47.0" 0 0 15 15.5" 47.0" 7gl~ 105 20 17.0" 63.5" 7 140 30 18.5" 63.5" 7 210 60 26.0" 63.5" 7 350 65 28.0" 63.5" 7 450 gal ga}~ rtmning back in tank The seepage pit was four~ to absorb only 140 gallons prior to backing up steadily into the septic tank. The well was tested and delivered an adequate 450 gallons in just over one hour and it was considered acceptable. A? test hole was dug on May 8, 1987, with the soils log prepared and enclosed for your review in the area of recommended expansion. The soils cor~itions are very good but the system had to be axter~ed from the septic tank back towards the house with solid pipe in order to maintain adequate separation from the bluff as indicated on the attached site plan. Please let me know ~hen a pern~t to modify the system may be acquired. Sincerely, Wayne ~enderson, P.E. cc: Bill Puckett L;AB IN~TRUCTt ON$ Report Printed: MAY 13 87 ~ 09509 (40RKORDER # 447 CHEMLAB ~F #56! 78 DATE RECEIVED: HAY 8 87 CLIED~T: PENINSULA ENGINEER8 B ILL INO ADDRE.~$1 440 W B~ 8TE ~0~ ~CHO~GE, AK 99503 C~ACT PERS~: ATTN AOCT~ PAYABLE PURC~SE ORDER M ~R~L PR~ISED: ~Y 18 87 ~ RE~I~D~Y ~ 87 SPECIAL IN~TRUCTI~ ORDER OATEIMAY 13 87 VIAl-HAND DELIVERED AC~NO~ PENINSP - (907) (907) REQ# ORDEREDBYI UNKNOWN S~mDte # $~mp~e Description Matrix To Te~t Method un~ Re~u~ Time '~ Time Date Date Date Inspector Inspector Inspector Comments Conditional Approval Date Sewer Installed Permit No. Septic Tank Size ~::~, ~ ~ Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Mailing Address ~ ~Y Buyer ~ Address Lending Institution ~/~ ~ ~ ~5/~ ~ Phone Address ~zvc~, ~ Realty Co. & Agent ~ Phone Address 8tract Loo~tion Typ~ ~f Residenoe ~ 8ingle Y~mily ' D Multiple Family No. of Bedrooms ~ ' ~ Other :' Wat~Supply -~: ~ Individual A~ACH WELL LOG. A well log is required for all ~ells drilled since June D Community 1975. For wells drilled prior to that date, give w~, depth (attach Iog~if, ~ Public Utilit~ available.) Sew~e Disposal ~lndividual Year Individual Installed: ~ D Public Utility When Connected to Public Utility:. D Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY' EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.