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Home My WebLink AboutPARADISE VALLEY BLK 6 LT 3Paradise Valley Block 6 Lot 3 #020-412-22 - --- Municipality of Anchorage r' � Development Services Department Building Safety Division e ="_ {� a On -Site Water & Wastewater Program, 4700 Bragaw St. , > r . -- P.O. Box 196650 Anchorage, AK 99519-&650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SWO80153 PID Number: 020-412-22 Name: Wastewater System: C1 New ❑ Upgrade ESTATE OF JOSEPH W. &RITA M. DOLD y Address: �p 18010 SWITZERLAND DRIVE 0 ANCHORAGE, AK ABSORP i`�� N FIELD Phone: No. of Bedrooms: C] O (907) 345-9344 4 Daep Trench Shclfow Trench O Bed Mound E3 Other Soa Rot.ng. LEGAL DESCRIPTION 5.0 Totol Ocplh from "I ml grodo: 1.0+ ® TOP OF SAND PL Block: Lot: Subdivision: Dopth to pipe bch— ham ortglrtW grodo: Crone! depth bonoath p:po: 6 3 PARADISE VALLEY SEE DWG. R. 0.5 M Township: Range: Section: — ll oddee Wbo.o original grvda: — — trona! h"qu': 25 SEE DWG. Ft rL GrwG star,: Number of i;;;: patanco botaeon tinea_ WELL: ❑ New ❑ Upgrade 5 rL 1 — FL Cloml,cot.00 (Prhrato, AD.0): Totol Dop ' Caood To: Told oboorptlon orae: 125 PIPe �Md: D 3034/ F-810/SCH 40 Ft Ft so. n. prWcr: Dolo Drilled: Stotic dater Level: lnatnllar: GREY CONSTRUCTION Dote Intoned, 8/11-12/2008 FL Ywia: Pump Set Al: Caekvg Hctght Above Ground: TAN aPtd FtFL SEPARATION DISTANCES (3 septic 0 Holding ❑ S.T.E.P. 0 Othero TO Soptic Absorption lift Holding ubrc/Prtvato ° GREER Copt' " ' 1500 From Tank Field Station Tank sopor unoa Weil 100'+ 100'+ 100' - — l5alor4d: 25'+ STEEL Humbtr Humber of compornontx: 2 Surface water 100'x- 100'+ 100'+ — LIFT STATION Lot tine 5'+ 10'+ 5,+ — S.Ia en Oa o= — 1500 Manufacturer. GREER QUANICS pump cn la+al at: amp off lord 04- High aaler Worm at Foundation 5'+ 10'+ 5'+ — — TIMER TIMER 1 44 Pump Mo.+' a h Wo": Ehctrical rnapoe om porformad by: Curtain Drain NONE KNOWN P -TE -30 -PLUS RISING SON �Y BENCH MARK Remark!fTHIS IS A QUAINCS AEROCELL SYSTEM Locot,on and Dcacrlptlorc THE OLD SEPTIC TANK AND ORIO.NFIELD WERE COMPLETELY BOTTOM OF SIDING AT NORTH SIDE OF HOUSE ABANDONED TO UPC CODE. Paavnwd E{e•wtfon: 121.80 F, ENGINEER'S SEAL Inspections performed by: GEG, Ltd. Dates: 1st 8/11/2008 Quo opp�4 � 0 2nd 8/11/2008 ,� 3rd 8/12/2008 Development Services Department Approval � � 4 ....:.�.�� 0 D Conditional approval: Date: .........� ey A. arness.r QB .b C-793 >0 Reviewed and approved by: L'J Date: ��©dprofesslonaoe ��0400Q�o (r+a,,. 4/06) W n h-pz 1 1 1 Yl Cti ( C 1�-L -}-� D. T �n L -`C (�A 11 t CJ, 5 4 n'l GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING June 30, 2020 quanics eroCehl . /aska Aut ;prized Deafer Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650 Anchorage, AK 99519-6650 (907) 343-7904 Ref: Paradise Valley SID; Block 6, Lot 3 18010 Norway Circle, Anchorage, AK) Memo concerning converting CAT III AWWTS to CAT 11 AWWTS septic system To whom it may concern: The permitted septic system was installed on the referenced property in 2008 and started up shortly after the installation. ARM Septic Services. LLC recently checked the monitoring tubes in the drainfield and found them to be dry. In order to simplify the operation and maintenance of the system, we are proposing that this unit be permanently configured as a CAT II system. Our justifications are as follows: The receiving soil has a percolation rate of <1 minute per inch. Given this percolation rate, a 6.0 gpd/sq.ft. application rate is required for a Cat III system. A 4.0 gpd/sq.ft. application rate would be required for a Cat II system. There is 4.86 feet of MOA filter sand below the drainrock in this drainfield. After the effluent passes through 2 feet of MOA filter sand, the effluent should meet Cat III effluent quality levels. The residence on this property has a total of 4 bedrooms, so 100 sq./ft. of absorption area is required for CAT III effluent (600 gpd / 6.0). The existing 2008 drainfield has 125 sq./ft. of absorption area. In short, the drainfield meets the Cat III sizing requirements. The Inspection report already shows a 5.0 gpd/sq.ft. application rate, so the Inspection Report does not need to be amended. At this time. we request that your department approve a CAT II configuration to be used at the referenced property. Upon your concurrence, we will have ARM Septic Service, LLC., go to the property, Mmove the actuator from the ball valve or leave the valve in the open position, d have thprp place a CAT II sticker on the control panel. 60, ess, P.E., M.S. 3701 East Tudor Road, Suite 101 x Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 i Fax: (907) 338-3246' Website: www.garnessengineering.com Municipality of Anchorage Development Services Department e= .r . Building Safety Division \ On -Site Water 8 Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ek.us (907) 343-7904 Page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SWO80153 PID Number: 020-412-22 Name ESTATE OF JOSEPH W. & RITA M. DOLD Wastewater System: ❑ New ■ Upgrade Y Address; 18010 SWITZERLAND DRIVE a ANCHORAGE, AK ABSORPTION FIELD Phone: No. of Bedrooms: (907) 345-9344 4 O Deep Trench ■ Shallow Trench a Bad OMound °Other LEGAL DESCRIPTION SON Rot": 5.0 cn/sa. In. Tota Depth from otglnol pods: 1.0+ ® TOP OF SAND n Block: Lot: Subdivision: Depth to Pipe bsaom hem erginal pad: paw depth bawath Pip•: 6 3 PARADISE VALLEY SEE DWG. n 0.5 In. Township: Range: Section: rM ddb oboes wginol padw. paw Ie. Vh: — — — SEE DWG. n 25 n WELL: ❑ New ❑ Upgrade paw wkAk. 5 Number M Mess: 1 D'wtanas bstwesn .nee: - In. In. Ckowmf Lan (P.Np Aa.0): Total Dv Caeb Te: ) Told absorption yep:Pips matedol: 125 D 3034/ F-810/SCH 40 R n so. n D.Wer. Dote DNIed: stout wales unw: bwlalhr. GREY CONSTRUCTION Dole Metoa.d' 8/11-12/2008 IL YwW:Pump sol AL Above pou Casty N"ht nd: TANK GPM n n SEPARATION DISTANCES 0Septic 0Holding 0S.T.E.P. ■Others To Septic Absorption Lift HoldingubSa/Prhvle MoMedwr. GREER C, Ay In palom: 1500 From Tank Field Station Tank Sewer Unee Well 100'+ 100'+ 100'+ - 25'+ MalerW: STEEL Number of eompa.lmente: 2 Surface water 100'+ 100'+ 100'+ - - LIFT STATION Lot Uns 5'+ 10'+ 5'+ - - SizeIn gwM : 1500 wnosn.w.r GREER OUANICS 5'+ 10'+ S'+ — _ p on iw ' a: %wnFoundation v off- le.wl m: High water obrm ot: TIMER TIMER 44 ►ump Mab a M : I EMctrkal kwpMw pert r br. Curtain Drain NONE KNOWN P -TE -30 -PLUS I RISING SON Remorke..THIS IS A OUAINCS AEROCELL SYSTEM BENCH MARK Laaobsn ons DswApt1w, THE OLD SEPTIC TANK AND DRIANFIELD WERE COMPLETELY BOTTOM OF SIDING AT NORTH SIDE OF HOUSE ABANDONED TO UPC CODE. McWrwd EMwtwn: 121.80 n GEG Ltd. Inspections performed by: Dates: 1st 8/11/2008 ENGINEER'. SEAL 000 oo4p� 0 2nd 8/11/2008 �.....�gsP0 3rd 8/12/2008 vo��. Development Services Department Approval?•: 4 T y° . Conditional approval: Date: O'p fry A. °roes..: O C -79,53 Ftp Profess, ON 4000��p00 Reviewed and approved by: `'J Date: 9-2,6-0 (Rev. 4Me) PERMIT NUMBER: PARCEL ID NUMBER: SW080153 AS -BUILT DRAWING 020-412-22 A EXISTING 3 BEDROOM k HOUSE SEPTIC SYSTEM IS SIZED FOR 4 BEDROOM GARNLSS ENGINEERING GROUP, Ltd. p? •+_- .... CONSULTANTS 3 GENERAL CON TRACTORS �.... ••• aro, L nna .ow. w 101 • AMOOL14L Ar anon . w IaYAP- 1" . nu Ibrl�.-.uw PREPARED FOR: ESTATE OF PHONE NUMBER: PAGE NUMBER:- �- JOSEPH W. & RITA M. DOLD 345-9344 2 OF 3 A.m ';Jel LEGAL DESCRIPTION: DRAWN BY: PARADISE VALLEY, LOT 3, BLOCK 6 K.D.M. TYPE OF WORK: DATE: AS—BUILT DRAWING 8/25/20 ..... ....... A. GO ess: TEST HOLES LOCATION ON DESIGN WERE INCORRECT. ACCURATE LOCATION 5 AS SHOWN NOW. 10' UTILITY EASEMENT _._a— ■—._a— �. A B ,ALTERNATE SITE DBL7 53.37 77.82P�\ V NEW 1500 GALLON/ MH S.T.E.P. TANK DBL2 53.33 78.81 STI 57.17 82.76 �'\ 650 POD �AEROCELL MH 66.45 92.29 J / I 8, CO DBL2 POD1 61.33 87.74 BLI POD2 61.94 86.871TH/1 1 MTI \ JANDY VALVE g �' JV 53.31 82.57 C01 60.82 103.98 I C01 NEW GRAINFIELD ` MT1 70.97 111.28 CO2 79.81 116.43 A EXISTING 3 BEDROOM k HOUSE SEPTIC SYSTEM IS SIZED FOR 4 BEDROOM GARNLSS ENGINEERING GROUP, Ltd. p? •+_- .... CONSULTANTS 3 GENERAL CON TRACTORS �.... ••• aro, L nna .ow. w 101 • AMOOL14L Ar anon . w IaYAP- 1" . nu Ibrl�.-.uw PREPARED FOR: ESTATE OF PHONE NUMBER: PAGE NUMBER:- �- JOSEPH W. & RITA M. DOLD 345-9344 2 OF 3 A.m ';Jel LEGAL DESCRIPTION: DRAWN BY: PARADISE VALLEY, LOT 3, BLOCK 6 K.D.M. TYPE OF WORK: DATE: AS—BUILT DRAWING 8/25/20 ..... ....... A. GO ess: PERMIT NUMBER: ASPARCEL DRAWING PARCEL ID NUMBER: SW080153 020-412-22 FINAL GRADE TOP OF MAN JANOY VALVE 830 OUANICS 115.50 HOLE -115.50 AEROCELL UNIT n n TOP OF TANK INLET - 110.23 INVERT OF BUNG ---------- INLET- 109.88 1500 GALLON S.T.E.P TANK GREER - 10GA. MOUND WAS TOPSOILS AND HAND SEEDED TOP OF SAND 105.94 INVERT OF 106.- UL 10.20 OF TANK 110.58 FABRIC ORIGINAL GRADE AT HIGHEST POINT - 104.94 \y \moi 10% SLOPE I BOTTOM OF SYSTEM WAS INADVERTENTLY OVER DUG BY THE EXCAVATOR - 101.08 RELATIVE ELEVATION OF BOTTOM OF TEST HOLE - 99.94 (NO H20)- �Qo TO GARNGSS ENGINEERING GROUP, Ltd. --•---�---- -�--•• CONSULTANTS 3 GENERAL CON�......•••••• .• •••••• ....... ml L ll. Myo l= 101 • Aw"DW . Wf NIDI I,IOK (W1J,111-SIT • 1" (Ml).1Y-]IN \DLR �w.r.�,Y�rYyow PREPARED FOR: IPHONE NUMBER: PACE NUMBER: •• .......... ...... JOSEPH W. do RITA M. DOLD 1 345-9344 3 OF 3 OQ a ''.J f y Gorne s: LEGAL DESCRIPTION: DRAWN BY: OO�PJ 7 ' `FOG PARADISE VALLEY, BLOCK 6, LOT 3 K.D.M. DDn�e �1�$ CfCA TYPE OF WORK: GATE: y�Qo'P�o lseslo�000 PRFILE DRAWING 8/25/2008 �4000��0 �RlY. V IMS Pannone Engineering Services, LLC P.O. Box 102954 Anchorage, AK99510-2954 Ph: (907) 272-8218 Fax. (907) 272-8211 July 1, 2008 Well Flow Test June 20, 2008 18010 Norway Circle, Anchorage, AK Lot 3 Block 6 Paradise Valley S/D Time Meter Gallons Total Flow Static 12:20 28001 36' 12:30 28031 30 30 3.0 50' 12:50 28081 50 80 2.5 71' 1:15 28144 63 143 2.5 78' 1:30 28174 30 173 2.0 86' 1:50 28234 60 233 3.0 90' 2:20 28324 90 323 3.0 106' 2:30 28354 30 353 3.0 106' Overall Well Flow Recovery During Test 2.72 gpm 106 -36 70' Drawdown X 1.5 gallons per foot =105 gallon drawdown 353 -105 248 gallons recovery during test 248/130 minutes=1.91gpm recovery during test. amour car uc nnu iv:ao MA yu0440Tru Hlnko's Dlmond Blvd 10002 O ' e � 51o�r 'r' '��;• are�v6 Z A Nou., Sgeplr� s X11 A ' 20 .,^cE OFA �Asmaul>� �i • It is the responsibility of the owner to determine-•u��':'•✓; C.�ic�i c • "•` �0i^•r Korl Duw:my T the existence of any easements, covenants,•or re- strictions Which do not appear on the recorded su ct f; �........•••'cy' • division plat. Under no circumstances should any0 E •a,-,. ,:w�,,.;.— , data hereon be used for construction or for estab- 'LAME TS OF RECORD. OTUER THAN THOSE lishing boundary or fence lines. The surveyor takes 'SHOWN ON THE RECORDED PLAT, ARE Nor responsibility for the initial• transaction only. SHOWH MEOH, LOT. BLOCKLECEND MAtt eAr memumenr' s5?t1c1! •? k :^" %�1 AT f 1 LNO. 146M nr'r I �• RCI AR►R0►r0R,►NO ANCHORAGE RECORDING DISTRICT a ►M 6 TAC9 ' /426 IIYDCfl STREET ANCHORAGE ALASKA 99501 DATE: MEXISION 1 DY: n SCALE: ,� wORKOriDER: f1EtnBOOK: CgID: MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 21, 2008 Expiration Date: Aug 21, 2009 Permit Number: SWO80153 Parcel ID: 020-412-22 Legal Description: PARADISE VALLEY BLK 6 LT 3 Design Engineer: 0855 GARNESS ENGINEERING GROUF Site Address: Owner Name: JOSEPH W. & RITA M. DOLD Lot Size: 24974 SO. FT. Owner Address: 517 W. 12TH AVE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99501 - This permit is for the construction of: ❑✓ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. A. This is a revised design. Received By: Issued By: Date: S Date: Municipality of Anchorage Development Services Department \, Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. =" (4la- ola Property owner(s) —_ JOSEPH W. k RITA M. DOLD Day phone 345-9344 Mailing address 6311 SWITZERLAND DRIVE * ANCHORAGE. AK 99516 Site address 18010 NORWAY CIRCLE. ANCHORAGE. AK Zip Code 99501 Legal description (Sub'd, Block & Lot) PARADISE VALLEY SUBDIVISION: LOT 3. BLOCK 6. Legal description (Township, Section & Range) N/A Lot Size a'y , q _3_4 —Sq. Ft. THIS APPLICATION IS FOR ( ®all that apply): Absorption Field ❑ Septic Tank 19 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. PermittRush Fees: "(4LOO I7 V' Waver Fees: Date of Payment: 1'19 Ink Date of Payment: Receipt Number. NbS 71 Receipt Number. (Rev. 11/05) GARNESS ENGINEERING GROUP, Ltd. .�. CONSULTANTS S GENERAL CONTRACTORS v I July 18, 2008 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic Upgrade for Paradise Vallcy S/D; Lot 3, Block 6, To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The septic system is in a state of failure and needs to be upgraded. Two test holes were excavated on the property. Due to the presence of shallow bedrock and the limited area for a septic system upgrade, we are proposing to utilize a Quanics Aerocell treatment system. We are proposing that a new 1500 gallon S.T.E.P. tank, A 650 gpd Quanics Aeroccll unit with a Jandy valve basin and a 5 -wide trench type drainfield be installed. The drainfield will be designed around the 30 foot radii of the two test holes. Per the request of the buyer, we have sized the drainfield for a 4 bedroom house and provided an alternate site which is shown on the site plan and design drawings. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drain6eld specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached topography site plan drawing, the average topography for the property ranges between 10 to 20 percent. The topography in the area of the proposed drainfield has changed since the aerial topo-map was developed. The area for the drainfrelds is now a 2 to 5 percent slope running from approximately southeast to northwest. The proposed drainfield will be installed parallel to the existing slopes. In short, there are no slope concerns. We are unaware ofadverse impacts this installation would have on adjacent wells or septic systems. If you have any quq sti ns, please contact us at 337-6179. Thank you for your assistance. incerelf, dcffreY ss, P. M.S. Presid NOT¢': Attached is a site plan drawing, a design drawing, two detail drawings, a topography site plan, and two soil logs, which are all part of the design package jar this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337-6179' Fax: (907) 338-3246' Websitc: www.gaznmenginecring.com / I I ► rP� 1 I 1 1 I � 1 STC I I I I I KENO HILLS / 6: I I ► / I BLOCK S. LOT 13KENO HILLS 15; 1 I I \\ BLOCK 6, LOT 6 / ALTERNATE SITE i i ISTING SEPTIC SYSTEM -- 1------TM+2 —Il J -- —-------------- =—J --� —�- ----------- `•SEPTIC PARAD15E VALLEY; 1 AREA I v Ii / BLOCK A LOT 4 PROPOSED SEPTIC UPGRADEI (SEE DESIGN. PACE 2 OF 411 I PARADISE VALLEY //, PARADISE VALLEY; BLOCK 6, LOT �;i — J P I BLOCK 6• LOT 5 1 \ PARAD I►\`��\ BLOCKISi LO^Tc2 ` XISTING 3 BEDROOM HOUSE 100 WELL US elp PARADISE VALLEY; BLOCK 6, LOT 6 i / PARADISE VALLEY: BLOCK 4, LOT 1 \ V 1 I \ \ PARADISE VALLEY; \ / I \\ BLOCK 4. LOT 2 PARADISE VALLEY; \ \ BLOCK 4, LOT 3 1' - 100' I GARNRSS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS p..... ... ....... ]AI L TAP1 Ib,O, 1111[ 101 . AKW4GC M 00]01 h6S (W7)M7- 1" • FM (Wl". " PREPARED FOR: PHONE NUMBER: PAGE NUMBER: •••••••. ....... JOSEPH W. & RITA M. DOLD 345-9344 1 OF 4 re A. G ness: O LEGAL DESCRIPTION: DRAWN BY: oO ° CE eQp PARADISE VALLEY; BLOCK 6, LOT 3 J.L.M. �� °e' •�J� OgyooQ TYPE OF WORK: DATE. sio QOO4 SITE PLAN FOR SEPTIC SYSTEM UPGRADE 7/18/2008 INN MM ALTERNATE SITE civ 1sE-6 10' UTILITY EASEMENT I I I I I I \ PROPOSED 1300 /I e e c• I civ 1sE-6 10' UTILITY EASEMENT \ PROPOSED 1300 \ GALLON S.T.E.P. TAN .p .•. �- INSTALL 630 CALL N CO J AEROCE /N TH/1 INSTALL e VALVE 00 I \ gN I \ NUMBER OF BEDROOMS: 4 GALLONS PER DAY (CPD): 600 PERCOLATION RATE/S: <1 ALLOWABLE APPLICATION RATE: 6.0 PROPOSED APPUCATION RATE: 5.0 MINIMUM GRAINFIELD SO.iT.: 120 DRAINFIELD DESIGN: MAXIMUM DEPTH: 3 FEET WIDTH: 5 FEET LENGTH: 25 FEET M.OA. APPROVED SAND FILTER: 4 FEET EFFECTIVE: 0.5 FEET ACTUAL SO.FT.: 125 PROPOSED DRAINFIELD D6s 16 tI I—— EXISTING 3 BEDROOM HOUSE \ SEPTIC SYSTEM IS SIZED FOR 4 BEDROOM CONTACT CEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION. THE ENGINEER. WELL DRILLER. CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND GARNESS ENGINEERING GROUP, Ltd. - -a '-•- -+ten CONSULTANTS & GENERAL CONTRACTORS --.•->..— ]A1 L 100011 VOID. WI[ 101 • M9CINl. m ee501 • M (10)).=) In a MI (P0�311-]SN a YpSR[: ew.p�.ptiwYysa.. PREPARED FOR: ESTATE OF I PHONE NUMBER: PAGE NUMBER: JOSEPH W. do RITA M. DOLD 345-9344 1 OF 1 LEGAL DESCRIPTION: DRAWN BY: PARADISE VALLEY. LOT 31 BLOCK 6 A.J.G. TYPE OF WORK: DATE: REVISED DESIGN DRAWING 9/9/200 (Rev. 0IN5) F, OF ...... . . . ..... ........ .p .•. ... G fflE53.: E-7953' d4' • ,?!g, p 25 FEET LONG 4• CLEANOUT 4' MONITORING �TUBE 4• CLEANOUT r ------ \ ----- - ]IFEWIDE 4 — — — — — — — — — — — — — — — J '—FROM AEROCELL UNIT/DANDY VALVE �—• Zn$LVC--oan9 P6. I &40,* -(FK-e- 4- MONITORING TUBES r4" CLEANOUT 0.5' OF I WIDE N!k GRADE _ f—I L w--4, , 4�,�'%L Iil ORIGINAL GRADE 3 FEET DECP MAXIMUM GARNESS ENGINEERING GROUP, Ltd. p°ppp CONSULTANTS S GENERAL CONTRACTORS fffA••••••• •••••••••••• 3M' L t QWA s 101 • rc�owa[. r w 7 • wiolt �>WF-SIT • FILL tsorA a-=" • � ....fie.. PREPARED FOR:PHONE NUMBER: PACE NUMBER: JOSEPH W. do RITA M. DOLD 345-9344 4 OF 4 LEGA. DESCRIPTION: DRAWN BY: PARADISE VALLEY S/D: LOT 3. BLOCK 6 J.L.M. TYPE OF WORK: DATE: DEISGN OF DRAINFIELD 7/18/2008 A. ar ess: ;E— 9 * * " e� B �b b�°joG 7 LV )OS J.L.M. V ........ �N:ess:E VALLEY S/D: LOT 3, BLOCK 6 GARNESS ENGINEERING GROUP, Ltd. 0 pG� CCNSULTANTS A GENERALCONTFACTOFS4co OF QUANICS AEROCELL SYSTEM p am a wro. m s/2 w�. �oorot a nm wa ro+l vey�w/n• roo a+• w • �mn:...�r.�+'+^ �44l0. pro I sssloo oma' PHONE NUMBER: P 3 OF 3 ��OODoo�� ).H.H.S. 343-7904 TIME (MINUTES) READING aooaopp00 7 10/08 1 12:15 — GARNESS — ENGINEERING GROUP Ltd. ��Q'�0 ��:• 2 12:17 CONSULTANTS& GENERAL CONTRACTORS '�0, �. 0' 6' ww. SW& Trot L noon 101 • u¢wrwz. w NW7 • nia[: T°r)W-Tln • ru: oo b • rcemc ��, �......... ...... .. .:.A. SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: PARADISE VALLEY; BLOCK 6, LOT 3 ^ P '•.Je fr A. Gar essr O PERFORMED FOR: JOSEPH W. & RITA M. DOLD DATE: 7 11 08 DEPTH Ur 12:32 — Q e°, � o (feet) TEST HOLE 1 ��000000�a� 1 »» ORGANICS 6' SOIL CLASSIFICATIONS 2 — KENO HILLS j 6; I I KENO HILLS /5; .o• GW ___= ORG BLOCK 6, LOT 1J I I BLOCK 6, LOT 6 ° 3 °o e o°o° . , ,... GP ML I I 7 •! -------------------- -- --'. `-----------'-- 3 000°00 GM CL ° -- --------- +i ^f-/ - ---- --- -------- - —- SW GC OL wI H�2 q °000o°°°o°o° n °e SW MH TH/�1 �lf //- °•�• 5 10 •• �• e tIi / SPCH 3 EDRO.0 OH i Iii 6 11 SC _ . — 6' 1 7 12 DEPTH TO ` DATE 3 0' GROUNDWATER 8 DRY 7/10/08 DRY 7/17/08 9 — \ 1 SCALE: 10 r 100' DATE READING CLOCK NET TIME WATER LEVEL NET DROP 11 12 13 3 12:29 — 6' — 14 15 16 17 18 19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 3 FT. AND 4 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ❑ NO SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: DAVID GARNESS COMMENTS: GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS P RF RMED IN ACCORDANCE PERFORMED BY WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: r 2 OB 8 TIME (MINUTES) READING (INCHES) 7 10/08 1 12:15 — 6' — 2 12:17 2 0' 6' 4 12:31 2 0" 6' 5 12:32 — 6' — 6 12:34 2 p' 6' 7 12:36 — 6• — 8 12:39 3 0' 6' 9 12:40 — 6" — 10 12:43 3 0' 6' 11 12:44 — 6' — 12 12:47 3 0' 6' 0 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS E GENERAL CONTRACTORS y 9 D 3701 L lilppl °OAU, fUOE 101 • AMCKIIII M. 901 • PWMC: Po) 1-{170 • III 00 33N • MLBS,fL ,o ••.ea" • • • • • '' • • • • • • • • • •Q SOIL LOG - PERCOLATION TEST Q LEGAL DESCRIPTION: PARADISE VALLEY; BLOCK 6, LOT 3 ,p ••. f G rness. PERFORMED FOR: JOSEPH W. do RITA M. DOLD DATE: 7 11 08 r E-7 53 DEPTH .• •'��.Q.�O•�'•f,�Aoo 4 °p (feet) oo�� °r °o __e_ ORGANICS TEST HOLE 2 ��oo�o °,o �,o° SOIL CLASSIFICATIONS ; 2 oe0°,o KENO HILLS / 6; I I KENO HILLS /5; °o°o°o° Sw -o;ao'. GW ORG BLOCK 6. LOT 13 ' ' BLOCK 6. LOT 6 3 :.a:.•s GP ML -- -----------------------•--------------- .�•' GM CL --- • e r4� , w;TH2 1-_______ 4 • ••,z GC OL •� •'r °e e0° o SW MH N ' ' �•ii�- SP OR GP ° •• • ' I TM/1 g ••z` •••• SP CH SM OH 6 SIC I:DROC 1 1 7 DEPTH TO DATE GROUNDWATER a I \\\\\ 8 DRY 7/10/08 DRY 7/17/08 9- 10— 10 / 1' 100 tt DATE READING CLOCK NET TIME WATER LEVEL NET DROP 12 13 14 15 16 17 10 1:36 1 0" 6" 18 19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 3 FT. AND 4 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES E NO SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: DAVID GARNESS COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE FO MED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: d TIME (MINUTES) READING (INCHES) 7 10/08 1 1:24 - 6• 2 1:25 1 p• 6• 3 1:26 - 6• _ 4 1:27 1 p" 6- 5 1:29 - 6• - 6 1:30 1 p• 6• 7 1:32 - 6• _ 8 1:33 1 0" 6" 9 1:35 - 6" 11 1:37 - 6" - 12 1:38 1 0• 6• 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?W WELL INSPECTION REPORT NAME K0�(� .ors IPHONE <V3-6Y9� Eyy ❑UPGRADE MAI LING ADDRE S ox' 3130 9: i_) 0 LEGAL DESCRIPTION La�3 �� `tea �� Va. II,e s jD LOCATIO C� ra se. Va I10_ NO. OF BEDROOMS 2y DISTANCE TO: Well /'08 sorption area Ab10 Dwelling PERMIT NO. 810707 j© pmVt +:l I 7 ., i Z LU Manufacturer /f�,eer (r Material Seel No. of compartments Liq. capacity in gallons /` IF HOMEMADE: Inside length Width Liquid depth 6W 10Z O: Well Dwelli ell PERMIT NO. 02 acturerMat ri Liquid capaci gallons 1.� DISTANCE TO: Well /®p Foun ®onIAI Nearest lot line �� PERMIT NO. R )p1 r L �'/ / (J No. of lines 1 Length of each lin �- Total lengt f lin Trench wi th Distance between lines Top of tile to finish gr a dSJ ' OM X -1-A) A Material beneath tile inches Total effective absorption are $ U.1 Length Width Depth PERMIT NO. Q F CL FL Type of cr' Crib diameter -Crib depth Total efte6tive absorption area y DISTANCE TO: Well Building foundation earlot line est J Class / p Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tan Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING Vi air pyt 9)4V rd OL to O P INSTALLER I40 6'soH V—J C huh '� XC�x-UGt. FI T REMARKS % Oh 1 � Qd wj W iA �9 1 1 1— __j APPROVED DATE LEGAL 72-013 (Rev. 3/78) ' '« � - �U r-4 1 17-" 2,\F-1 L_ �� 00 /l ~^ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ^ 825 'L' STREET, ANCHORAGE, HK 99501 264-4720 /^�� E.:.:- I- L_ F=� t-4 _F FE E-7- t4 FEE F;Z F=� F- FR r-1 I _r � PERMIT NO. ( 810707 ) APPLICANT KORD CONST PO BX3130 HNC 99510 2436490 LOCATION PHRH�� CE VALLEY LOT SIZE �4974 SQUARE FEET LEGHL L3 ��R��DI�E VALLEY � TYPE OF SOIL ffl.:,ORP7ION SYSTEM IS: DRHINFIELD , MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 90 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: a?, ��=X ��H- �� = �.. THE LENQTH DIMENSION IS THE LENGTH (IM FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). -T'" E=_ ��r��VA t4 I�� I�� . �� . THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F-Ro FF C,! U 1 FZ E-:--- #7-0 E- F=" 1 0 �n P-4 F--. ��I F7_ 0 0 0 0:3 n I_1- 0�� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TOTHIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. _r t j CH < :ao > I P-4!EF fz� K_= r__� _T_ 1 93 fq ES. f=:� F -"F:- ��I F,"E: E`m BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 F�ET FOR H PRIVATE WELL OR 150 TO 200FEET FROM PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ��E= FR M I -F ��4 r-" I F-0 F::!E� C�A U M F:) U�� Zg:::L - �L�; I <E ":: L I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR OM -SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]� I UNDERSTAND THAT THE ON --SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT' IF THE -'RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] S SIGNED ISSUED � -_~_._~_QHTE~~ it /SOI LS LOG MUNICIPALITY OF ANCHORAGE • ae DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 � SOILS LOG — PERCOLATION TEST ] PERFORMED FOR: h.�''�r h `�'vIr g� yl - DATE PERFORMED: LEGAL DESCRIPTION: �s I K :p ( S vet %e- DEPTH SLOPE I ` SITE PLAN (FEET r C CA a J 3 ®e Vi .a4 w 5 Lue j6 V •� � �8 7 0• �e 8 'a` � 9- 10- 11 1011 WAS GROUND WATER s,_ n L ENCOUNTERED? V O 12 P IF YES, AT WHAT E - DEPTH? 13- 14- 15- 16- 17 314151617 18- 19- Reading 819 20 COMM PERFORMED BY: 72-008 (6/79) Reading Date Gross Time Net Time Depth to Water Net Drop I- PERCOLATION RATE TEST RUN BETWEEN FT AND CERTIFIED B'S. (minutes/inch) FT DATE: rrr s well is producing '' `_� gall INVOICE ons of water per hour, Set pump 4 feet. IxvolcP. Via. ,. ;-- � t AAOON DRILL �� < ,., r,... r W' DATE SR BOX 668, BOGARD RD. YOUR P. O. NUMBER PALMER, ALASKA 99645' ' TERMS 'TELEPHONE 746-4071 RALPS AN tot Blk. Sub.- — I f rw=?>' VVCLL Lvu DEPTHDEPTH CABIN FORMATION CASIx FORMATION DEPTH IN FT. CABIN FORMATION IN FT.; IN FT. lot 2tl1 1 102 _ 14 202 2 '� 203_ 8_ 104 204 4 .... __ 206 lOg _.�._---° 206 6 107 207 "- 7 8 _ 1Q8 209 ! 9 —••—�— _110--210-- 11 --- 112 12 _113--_- - --- x213 114 "" 214 14v.. 116 216 is____ _ xyo• a1s __�..------1 ---;---�--• _ 117 — 217 17 119 219 t9 120 20—° 220-- _20 121 221 4_ 122 222 2s -"12a "223 — _23--_ iz4 224--__ 224 �_ 24 125--226 26 26___127- 126 226 27 127 227 18 128 228 29 129 2z9 so Iso a3o 231 1 131 _ 82 132 232 89 133 239 _234— ; 84234 ----- 134 34 B _34-23 86 136 s6 _ lss 236 "237 37 137 isa asa ss w„ 189 239 i 88 __140 240 141 241 41 4a —142 242 t ._.....e.,.��._. 48 148 - 243 a._.....".._�. 44 - __._..� ' 144 aa4 .� 46 46 146 246 47 147- 148 248 48 260 a9150 6®_ —. 260 61 ._" 161 261 62 162 262 68 163 268 ."�... 64 164— 264 '26b i 64 166 67 167 267 _ _ ®269 68 148 ®, -- 69 169 269 80 180 �� 'f 260 81 161 281 ,.�_�". 82 162 262 ; 68 168 268 _._.� 64 ^,°--•284 164 f 86 186 286 —. 88 166 _ 268 67 _ "Y67 '" 267 68 188 268 89 ..-.-,...-169 289 70 170 270 71 17Y 271- 72278 17a 73 74.... 174 274 76 _ 176 276 96 '®"`""_" 178 276 77 177I .�®. `277 78 ----,.,^ 178 t 276 79 --�...•� 178 279 80 S 180 280 82 "— 182 ".' a 282 i '?'`"""`�• 18 4 1$4 284 06 lab--¢ _ 286 , —lee—, 286 0a189 288 "a9 tag 289 90 190 —290-- 81 _____ 191 a 291 92192 293 93 — 198 298 B4 194 .294 n 96 - 196 296 96 - - 198 _ r --- 298 87 E ��' 197 i "" 297 9$ 99 199 zoo ��, soo PLEASE PAY FROM THIS INVOICE ne:toox AMOUNT 3rl tt— ".il 71 Municipality ofAnchorE p� On -Site Water &Wastewater Pro c r: (907) 343-7904 �� ,�p1CJ v3 Certificate of On—Site Approval Parcel I.D. 020-412-22 1. GENERAL INFORMATION Expiration Date: 1— 17— ^ L Complete legal description PARIDISE VALLEY;BLOCK 6 LOT 3 Location (site address) 18010 Norway Circle *Anchorage 99516 Current Property owner(s) Mailing address Real Estate Agent GuyAdema Day phone 317-2488 Barbra Ramsey Day phone 250-9651 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: EPEC/;l elMj;jga,.L A Individual Well Individual Water Storage Community Class_ Well Public Water System Received by:_t�4 COSA to be released to the COSA Fee $ S;_2&10. �U Date of Payment Receipt Numbber 3 COSA# &CI�yB� 4 by the engineer. Date: Waiver Fee $ _ Date of Paymen Receipt Number Waiver Distance: . TYPE OF WASTEWATER DISPOSAL: Individual On-site N ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ by the engineer. Date: Waiver Fee $ _ Date of Paymen Receipt Number Waiver Distance: . 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineefs Comments: in conducting Nu evaluation, GEGpmvidedan angineeNig evaluation offhe welt androrseptic systemin accodsma wAh Ma guidelines andmitufationsestainishedbyMe MunidpaWafAnchorageandMNsbypmcfms. fie rammedresuitsdosabefne conddianotihasystends on the datalsoMeovaluation. Separetiondisfances"mmeasuredto readilyidenfifiable leaWrex Mum darads aencrachmentsmayexistthat wee notIdenkhaddwing the maluatimThe ope2Garslfife ofall wagsand "Pik systems depend on a vanisydvadefusatncluding, butnotgmdedto, SO conditions, gmundwaluounis (ihatmayfiuctuaie during Meyear), qualrtyolcrostruction(mefedela andwadmanship), and Me waterusaga of the tams! "ng the sysleads. These wndtianscan vary and are outside the cmdrol of GEG. Sads/ad"festrasults dontguarames fuiurepedormema onhe systands; Mmakre, GEG makes no warranty(express aimptieeJ regardbg the Mae psdom etw oMe waft orsepliosystem. GEG makes norepresentagon whmlreran ademalim wdiasepticsystem on betnstaltedan meprepadyin the Mani eifheroflhe cumnf systems fad. The content ofthfsmportis forms sole benefitmgreponadpao whomtainedGEG. ReEmo upon the anyone otherMan the pareonrpady who paidbrddsrepod. 6. DSD SIGNATURE System #1 Approved for — L(— bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following Phone 337-6179 Date 14D (Z /b �tions:Y OFpfy�yo r!// ON-SITE WATERAND WASTEWATER ?` Original Certificate Date: The Municipality orAnchorage Develop,emt Services Division (DSD) issues Cedfilcates 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 ofAnchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory, Well Flow Advisory (Rev. 70111112) 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: A. WELL DATA PARIDISE VALLEY; BLOCK 6, LOT 3 "TO BEDROCK Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 8/7/81 Sanitary seal (YIN) YES Total depth 303 ft. Cased to "8 ft. FROM WELL LOG Date of test 817/81 Static water level UNKNOWN ft, Well production 1-0 -9-13-m- Parcel ID: 020412-22 Well Log (Y/N) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 9/27/16 38.5 ft, 1.8+ g.p.m. WATER SAMPLE RESULTS: 4 3.4q - Coliform 0 colonies1100 ml. Nitrate 0.432 mg./L. Collected by: GEG, Ltd. Arsenic: Slug./L. Date-ofsample:9128/16&9/30/16 B. SEPTIC/HOLDING TANK DATA 'QUANICS ADVANCED TREATMENT SYSTEM Tank Type/Material "S.T.E.P./STEEL Date installed 8/11-12/08 Tank size 1500 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (YIN)No High water alarm (YIN) YES Date of pumping AS REQUIRED Pumper AROUND THE CLOCK PUMPING C. ABSORPTION FIELD DATA BELOW EXISTINGGRADE "ADVANCED TREATMENT SYSTEM, . Date installed 8/11-12108 Soil rating (g.p.dMor !bdrm "*5.0 System type "SHALLOW TRENCH Length 25 ft. Width 5 ft. Gravel below pipe 0.5 ft. Total depth "3+ ft. Eff. absorption area 125 ft' Monitoring tube YES Depression over field NO Date of adequacy test 9/27/16 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test E in. Water added 908 gal. New depth 0 in. Elapsed Time: E min. Final fluid depth 2 in. Absorption rat@ >_ - 600 g,p.d, Any rejuvenation treatment (past 12 mo) (Y/N & type) NONE KNOWN If yes, give date DRAINFIELD IS INSULATED. 24" SOIL COVER ACHIEVED *SEE ATTACHED MAINTENANCE AGREEMENT "*PER 8/27/2008 ELECTRICAL INSPECTION ON FILE D. LIFT STATION IN MOA RECORDS Date installed 8111-12108 Size in gallons 1500 Manhole/Access (YIN) YES "Pump on" level at TIMER in. "Pump offlevel at TIMER n. High water alarm level at 44 in. Datum BOTTOM OF TANK Cycles tested Meets alarm & circuit requirements? "*YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on tot 1001+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 251+ On adjacent lots ***1001+ ( CAVEAT) On adjacent tots ***100'+ ( CAVEAT) Public sewer manhole/cleanout 109+ Holding tank 75'+ Animal containment areas 501+ Manure/animal excrete storage areas 1004 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Water main 104 Wells on adjacent lots 100'+ Property line 5'+ Absorption 5'+ Water service line 101+ Surface water 1004 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 104 Water service line 10'+ Surface water 109+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS ***UNABLE TO PHYSICALLY MEASURE TO SEPTIC SYSTEM ON LOT TO THE EAST BECAUSE WE WERE DENIED CONSENT TO BE ON PROPERTY BY CONSTRUCTION WORKERS WORKING ON THE HOUSE. Aq -Qu'tor Sva. y ae�i F«.E -"—& J'loA G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date tD t,2/(b (Rev. 10/12/12) ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND Amy S Maclean THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this ��Day of October of 201,6 by and between Amy S Maclean herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AW WTS), described as Quanics Septic System located at (legal description). Paradise Vallev L3 136 2. Definitions. Alteration. Any change to the design or function of an AW WTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On -Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AW WTS that were included in the original design which would allow the AW WTS to continue to perform as designed. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AW WTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AW WTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations, Installation and Removal of Additional Equipment. Prior to performing any alterations to an AW WTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AW WTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AW WTS service and maintenance provider approved by the municipality and the manufacturer of the AW WTS for the entire term of the AW WTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the AW WTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AW WTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AW WTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. H. Owner agrees that the AW WTS installation and maintenance requirements as provided by the AW WTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AW WTS. I. Owner agrees to provide and maintain a telephone connection to the AWWTS as required by the AW WTS approval. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: Amy S Maclean b. Municipality: Director, Community Development or designated authority C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER: (� nn nn �7 ', •, 11 By: V 09—Q—Q 9✓(/y� (signature) Date: 10 (0 Amy S Maclean (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this 19rddy of j b", , 2011,9, by 'Carel S, h--ClC LCLr'1 it OF ALASKA --- NOTARY PUBLIC FOR ALASKA My Commission expires: Cl .1 I. '&A)d1) MUNICIPALITY: T guy y: l..✓t F CJ (signature) name) NOTARY PUBLIC j Victoria L. Harrell I µy GyAwission E,0res C1.1 1. aUzD Date: Title: Municipality of Anchorage ° Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 UdUJw.muni.or g/olsiie (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-412-22 COSA# CSC ) i) ? 5 1. GENERAL INFORMATION Expiration Date: Z 0 t/ 1— // Complete legal description PARADISE VALLEY S/D; BLOCK 6, LOT 3 Location (site address) 18010 NORWAY CIRCLE * ANCHORAGE, AK * 99516 Current Property owner(s) DENNIS GEASAN & SUSAN LUESCHER Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing .address 18010 NORWAY CIRCLE * ANCHORAGE, AK * 99516 Day phone CAROLE MARVEL W/ REMAX Day phone 775-750-1619 884-8912 110 W. 38TH AVENUE, #110 * 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. STATEPa'IENT OF INSPECTION BY ENGHNEE.R, As certified by my seal affixed hereto and as of the validation date shown below, I 'vEIlly that ,;,y investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, t, / that { t my and/or wastewater disposal system is (are) safes functional ar7rd adatgUatc Sr!vvrS t!rat the on -Bice wGFcel S`u`p,.. for the number of bedrooms and type of structure indicated herein. l farther verify that based on the .stlgation and inspection theinitrrnaa:vn obtained from, acrc rvuniciparl�o,Fr1,rjc,h,-a 2 files and f":m,ty on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd, Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's 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 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 how 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 Approved for _ bedrooms. Disapproved. Phone 337-6179 Date 7 1/6 odQO� I fi4.T......g..*PG ••. �ef�• . ♦A. Gar ess:• CE— `e�G 4�Pr Conditional approval for bedrooms, with the following stipulations Attachme: its: C OSA Checklist Hrcenir Ar,4Vi Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate A Vllsory Other OpooSO ff r l/ .to () J : ON-SITE Z : WATER AND WASTEWATER PROGRAM Q JJJJ�J�� c 7VTS0��I.� By:— ", Original Certificate Date: (Rev.11/05) Municipality of Anchorage • Development Services Department Building Safety Division ` 0. •: 4 T I On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: PARADISE VALLEY S/D; BLOCK 6, LOT 3 Parcel ID: A. WELL DATA *TO BEDROCK. 020-412-22 Well type PRIVATE If A, B, or C provide PWSID# N A Well Log (Y/N) YES Date completed 8/7/1981 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 303 ft. Cased to *8 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 8/7/1981 6/24/2011 Static water level UNKNOWN ft, 39 ft, Well production 1.0 g,p,m. 1.86+ g,p,m, WATER SAM LE RESULTS: N Q GEG, Ltd. Coliform colonies/100 ml. Nitrate mg./L. Collected by: Arsenic:Q "ug. /L Date of sample: 6/23/2011 B. SEPTIC/HOLDING TANK DATA *QUANICS ADVANCED TREATMENT SYSTEM. Tank Type/Material *S.T.E.P./STEEL Date installed 8/11-12/2008 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping - Pumper AROUND THE CLOCK PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE **ADVANCED TREATMENT SYSTEM Date installed 8/11-12/08 Soil rating p.d./ rft2/bdrm)**5.0 System type *SHALLOW TRENCH Length 25 ft. Width 5 ft. Gravel below pipe 0.5 ft. Total depth *3.3 ft. Eff. absorption area 125 ftZ Monitoring tube YES Depression over field NO Date of adequacy test 6/24/2011 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 0 in. Elapsed Time: - min. Final fluid depth 0 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - NOTE: DRAINFIELD IS INSULATED. 24" SOIL COVER ACHIEVED. D. LIFT STATION *SEE ATTACHED SERVICE INSPECTION REPORT. Date installed 8/11-12/08 Size in gallons 1500 Manhole/Access (Y/N) YES "Pump on" level at TIMER in. "Pump off' level at TIMER in. High water alarm level at 44 in. Datum BOTTOM OF TANK E. SEPARATION DISTANCES Cycles tested * Meets alarm & circuit requirements? YES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A 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 main N/A Water service line 10'+ Surface water 100'+ 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 o� �•H • ��0 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. t7o ' .J f A. arness• Q Engineer's Printed Name JEFFREY A. GARNESS QO�' E-79 �c4` Date i / gofessio� \ : O000©� COSA Fee $ ! qo — Date of Payment —"" q6 — � i Receipt Numbers t q i (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SGS Ref.# 1112705001 Client Name Garness Engineering Group, Ltd Project Name/# ParadiseValley B6, L3 Client Sample ID Paradise Valley B6, L3 Matrix Drinking Water Printed Date/Time 06/28/2011 13:42 Collected Date/Time 06/23/2011 10:15 Received Date/Time 06/23/2011 11:45 Technical Director Stephen C. Ede Sample Remarks: 450ONO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements. Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 Waters Department Total Nitrate/Nitrite-N ND 0.100 Microbiology Laboratory E. Coli Negative I Total Coliform Negative 1 ug/L EP200.8 C (<10) 06/23/11 06/24/11 NRB mg/L SM20 450ONO3-F B (<10) 06/23/11 AYC 100mL SM20 9223B A 100ml- SM20 9223B A 06/23/11 ACF 06/23/11 ACF JUINEW-2011 04:04 AN 41* UNIT # 45 Legal Description: Paradise Valley; 86, L3 Street Address: 18010 Norway Cir Owner Narre: Dennis Geasen Billing Address: 18010 Norway Cir Phone #1 775750-16191 Phone #2 336-1575 Phone #.III ... ........ 2 Start up date: 9/2/2008 Contract End mate: 5390 Dates of service (,,, - Timer - Off 10 Override - On 1:30 ff .. .. ...... Timer On 1 .,50 ... ........ 2 Pum Run Time N + � b 5390 1_0W Level COL.int 31 High Level Count Ics 9 Orfice clogged (Y/N) n OME6 Maned (Y/N) ok Phone Line Checked (Y/N y Tank Levels Checked (Y/N) ok Pumping Needed (Y/N n Floats Checked (Y/N) ok Monitoring Tubes All dry Filter Plates Cleaned (Y/N) ok Filter Cleaned (Y/N). ok -Pressure All Lids Secured (Y/N) 'Y Door Hanger Left (Y/N) ,-7,,, y Notes: 5,'IG;0� - Jandy yaws vorking. photos: 2417.2419 Filter cleaning plate left in basket. Pulled and adjusted timesrs. Check latr P.02 1 J1-2011 04:05 AM • Karol, Around the Clock Pumpingg 5700 Whispering Spruce Drive Anchorage Alaska 99516 907-34541.26 18010 Norway Circle, paradise valley subdivision 136,1.3 was pumped and the Quanics system was serviced January 29, 2011. The property Is owned by Dennis Geason on our records and there is an existing service agreement on the Quanics system that is prepaid until 9/15/11. Thanks Andy Thickstun Owner Around the Clock Pumping P. 03 EMOUN-30-2011 04:04 AN ■ ■ -eAA_J P.01 UZ, � '} �, p i t�-s -fes , Municipality of Anchorage • t�"� Development Services Department Building Safety Division / .. On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsfte 343-7 onsite (907) 343 7904 ; % +� CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. I oW-g1A-0?A COSA# 1. GENERAL INFORMATION Expiration Date: a %" O A Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address PARADISE VALLEY BLOCK 6, LOT 3 18010 NORWAY CIRCLE ' ANCHORAGE. AK 99501 ESTATE OF JOSEPH W. & RITA M. DOLD Day phone 345-9344 6311 SWIZERLAND DRIVE • ANCHORAGE. AK 99516 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the Stale 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 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with alt applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 . ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date (;/z5 -/0i3 Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering anaWs of the system in accordance with ADEC and MOA DSD Guidelines Q 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 readly identifiable features. The operational fife of all wells and septic systems depend on Me kcal sols 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 Me control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee Mat there are no hiddon defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how 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. S. DSD SIGNATURE Approved for __�L bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing stipulations: Attachments: COSA Checklist v Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Reort Nitrate Advisory Other 0 • • ONSITE • '• WATER AND •; WASTEWATER PROGRAM ' By: a. Original Certificate Date:— g 4, Municipality of Anchorage • -tel Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: PARADISE VALLEY, BLOCK 6, LOT 3 Parcel lD:O vZO A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N/A Date completed 8/7/1981 Sanitary seal (YIN) YES Total depth 303 ft. Cased to 8 ft. BEDROCK FROM WELL LOG Date of test 8/7/1981 Static water level UKN ft, Well Log (Y/N) YES Wires property protected (Y/N) YES Casing height (above ground) �� In. AT INSPECTION 6/20/08 36' Well production 1.0 g.p.m. '2.72 g.p.m. •PANNONE 'ENGINEERING WATER SAMPLE RESULTS: Coliform _0 colonies/100 ml. Nitrate 1.84 mg./L. Other bacteria _0 colonies/100 mi Arsenic: N/D ug./L. Date of sample: 7/1/2008 Collected by: PANNONE B. SEPTICIHOLDING TANK DATA •AEROCELL SYSTEM Tank Type/Material •S.T.E.P./STEEL Date installed 8/11-12/2008 Tank size 1500 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) YES Date of pumping NEW Pumper C. ABSORPTION FIELD DATA eE�ow viral cRAOE Date installed 9/11-12/2008 Soil rating .p.d.fl or ft'/bdrm) 5_0 System type 5—WIDE Length 25 ft. Width 5 ft. Gravel below pipe 0.5 ft. Total depth +3.72 ft. Eff. absorption area 1125 ft' Monitoring tube YES _ 'Depression over field NO Date of adequacy test NEW Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test= in. Water added=gal. New depth =In. Elapsed Time: = min. Final fluid depth= in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed 8/11-12/08 Size in gallons 1500 "Pump on" level at TIMER in. "Pump off" level atTIMER in, Manhole/Access (Y/N) YES High water alarm level at 44 In. Datum BOTTOM OF TANK Cycles tested NEW Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent tots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ Public sewer manhole/cleanout N/A Holding tank N/A 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 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 JEFFREY A. GARNESS Date le/2S&IR COSA Fee S 4 7-�O I— ' elDate of Payment �� Receipt Number 4 555 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number FROM : P ENG SVC SCS Re4N 1082899001 Client Name Pannone Eng. Srv. ProlatNametx L3 136 Panuli$t Vallcy Client Sample 10 L3 ti6 Paradise Valley Matrix DrinkinRNater PWSID 0 Sample Remarlo PHONE NO. : 9072728211 Aug. 04 2008 02:20PM P3 Ad DatesiT mes are Aloka Sarndard Time printed Date/Time 07/01/1008 1339 Collated Date/time (X+/20/2008 )3:30 Receirrd Date/Time 06120/2008 14:35 Techaical Diralor Stephen C.kde AlloaaNto Pmp Analysis Pentland Results PQL Units Method Container ID Limns Date Date Inn Hetals by ICP/ALS Arsenic ND 5.00 Watars DepaztmAnt Total Nitrazt;Nitrite-N 1.84 0.100 ug/L EP200.8 C (<I01 mp,1. SM20450ONO3•F B (<101 Microbiology Laboratory Colony Count 0 wl/100ml. SM2092228 Total Coliform 0 wl/IOOmL Sh120 92228 FeealColiform 0 wl/IOOmL SM20922213 06,127/08 06/30/08 NRB 06!27108 JDZ 06120108 DLC 0620/08 DLC 06/20/08 DLC i ■n�6 27 2008 8:02nM Risin6 Son Electric, Inc. 907-622-6777 August 27, 2008 Grey's Construction Doug Grey 2320 N. River Circle Eagle River, AK 99577 RisingSon Qlectric, Inc. \�/ 14Q16 ooci1anJ Drive gagle River, AK 99 77 (907) 622-6777 Re: Lot 3 Block 6 Paradise Valley - 18010 Norway Circle - Anchorage, AK Dear Doug: p.I The lift station at the above referenced property has been wired in accordance with NEC and State/Local codes. Thank you. Sincerely, Kevin S. Hornbuckle, Owner Administrator License Number 1284 Specialty Contractor License Number 27285 cc: file Gamess Engineering Group MUNICIPALITY OF ANCHORAGE�� • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # LvIa -- as HAA# AM 1. GENERAL INFORMATION Complete legal description C a lyco,�-��Cl �' {'— V a W zE � Location (site address or directions) Z lU Cf' 161,9 IL r� Property owner 114P ✓J O(f_- �C12f� Day phone Mailing address Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water _1:�3 14 Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site_ Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 of this Health Authority Approval application 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 ofthis inspection. / Name of Firnf all -C-- 21 4 I Si�ifl�/r1 25C:2C _ Phone �� < 2 - Address Address Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments 0 WTIC M Date l z `— 5 James F. Sizer # 1517 E bedrooms, with the following stipulations: Date �a— 2 L— 2 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. 72-025 (Rev. 1/91) Beck MOA#21 Municipality of Anchorage Department of Health & Human Service's M}t+ HEALTH AUTHORITY APPROVAL CHECKLIST �j5(L�' Legal Description: % 8(a ��a�I f�G �al""� Parcel I.D. A. WELL DATA Well type �e If A, B, or C, attach ADEC letter. �4DEC water system number Log present (Y/N) — Date completed ' `� Total depth Cased to 4 `� (4 Casing height Sanitary seal (Y/N) /Y Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG 8 7-9\/ f 3 , 5 g.p.m. -,rpoC AT INSPECTION .� —1C2- �>3 3©o rn 0 w m 10 SEPARATION DISTANCES FROM WELL TO: / Z Septic/holding tank on lot I I, 1 ® ; On adjacent lots l Absorption field on lotc // On adjacent lots ,n O OO Public sewer main `y 017 ?"fl Public sewer manhole/cleanout /V�1sv Sewer service line WATER SAMPLE RESULTS: P Coliform N Petroleum tank N ®// C_ - Nitrate 0 & )091�� Other bacteria /Vo1-�2 6 `` - 2 � Collected by: Date of sample: ��" B. SEPTIC/HOLDING TANK DATA Date installed 8! j2 Tank size / Z �So Compartments Z Cleanouts (Y/N) /Y Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) �/ Alarm tested (Y/N)�%� Date of pumping�ff,�!/!/1 �� I � � f2 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: / Well(s) on lot On adjacent lots > ! �� ( Fc, dation f To property line t A Absorption field to -Water main/s, rvice line Surface water/drainage 72-026 (Rev. nst) Front CONTINUED ON BACK PAGE C. LIFT STATION J� Date installed � JZA Manufacture Size in gallons ` Manhole/ ss Vent(Y/N) High water alarm level "Pump Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots r _ (Y/N) _'Pump off' level at Cycles tested Surface water r Date installed "6 " 3 / Soil rating 2—,7 P 0 / System type G Length Width Gravel thickness 12— Total depth Z Total absorption area 70/, j Cleanouts present (Y/N) Depression over field (Y/N) G v Date of adequac test — 162 T Results (pass/fail) Po � �� for bedrooms Peroxide treatment (past 12 months) (Y/N)y If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot .1 / a / On adjacent lots 10>/00 Property line To building foundation To existing or abandoned system on lot .42 012 On adjacent lots Cutbank Zy Ob �'2 -r Water main/service line { /(1�) 1 Surface water All (0�2 e Driveway, parking/vehicle storage area 50' Curtain drain �) ©)v ff E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. 4,0 s o Signature Engineers Name A Date 1n � t` r, HAA Fee $ 170 Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 • FAX 274-9645 Sizemore & Associates 6410 Switzerland Drive Anchorage AK 99516 Attn: James Sizemore Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: Lab Number Method A124066 Paradise Valley L3, B6 Water Parameter A124066 EPA 353.3 Nitrate -N : p C Reported By: Susan C. 'ti-fental Microbiology Supervisor Report Date: 06/16/93 Date Arrived: 06/11/93 Date Sampled: 06/11/93 Time Sampled: 1100 Collected By: JS * Definitions * B = Below Regulatory Min. H = Above Regulatory Max. E = Estimated Value M = Matrix Interference D = Lost to Dilution MDL = Method Detection Limit Units Result * MDL mg/l 0.6 0.1 Date Date Prepared Analyzed ----------------- 06/15/93 MUNICIPALITY OF ANCHORAGE• DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 1 ,1 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) /9,oly NoaOAY e�2c � gQ51� (b) Applicant Name :foe >/W Telephone: Home 3 a X72! `J Business .'Zl� 3-3101 y Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent No NE Address - Telephone Telephone (f) Mail the HAA to the following address: t ! O tt L) \ 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well Community ❑ 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 I� 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 72-02e (11/84) .. 5. ~ENGINEERING FIRM PROVIDIN, ASPECTIONS, TESTS, FILE SEARCH, DA 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 inspection. e Name of Firm i ��t.t.��i�G�:N�G� Telephone AL7? Address ow A �1w-- Date it+7 ..` ��. C F, lit fro ;P 49TH 2225-E ,.��+ Engineer's Seal Q� 1 • 1 .JE 25 1971 �,i d� •• - - J - - -- ,a %w-�-�• o Approved for fti'` ¢ bedrooms by —� Date Approved ✓ — Disa>p�(Qved Con onal Terms of Conditional Approval CAUTION / - ZS - 8(0 The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an 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 requirements. 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 work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF&WRbTHORITY APPROVAL (HAA) DEPT. OF H ENVIRONMENTAL PROTE IRMLIST - FEBRUARY 1984 264-4720 JAN 2 4 1986 Legal Description: LOT 5 gub RECEIVED I?AP-Aa► A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) ��!t Well Log Present (Y/N) Date Completed g- _7' F1 Yield 3 • a 4 �► o,T +^� Total Depth &03 Cased to �O + Depth of Grouting N o N a Static Water Level q-7 Pump Set At -5, Casing -Height Above Ground a✓' to Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ! Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 1 b 3 On Adjoining Lots No N L=' i/ 0 ; On Ad' N O w t To Nearest Edge of Absorption Field on Lot Joining Lots i To Nearest Public Sewer Line No�hEl. To Nearest Public Sewer Cleanout/Manhole N To Nearest Sewer Service Line on Lot / Water Sample Collected by ! S ; Date �a%/ p� Water Sample Test Results ��G Comments B. SEPTIC/HOLDING TANK DATA Date Installed g t �� Size No. of Compartments 7(00 Standpipes (Y/N) z Air -tight Caps (Y/N) Foundation Cleanout (Y/N) y Depression over Tank (Y/N) N Date Last Pumped Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) WIA Separation Distances from Septic/Holding Tank: To Water -Supply Well C�.S To Building Foundation ✓f8 To Property Line 8 To Disposal Field 1d To Water Main/Service Line 7! To Stream, Pond, Lake, or Major Drainage Course 0�� Comments Page 1 of 2 y 72-026(11/84) - C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design $F- y Date Installed Length of Field 417 Width of Field Depth of Field �+ �� << SNt Gravel Bed Thickness Square Feet of Absorption Area 2© Standpipes Present (Y/N) Depression over Field (Y/N) �y Date of Last Adequacy Test Results of Last Adequacy Test i^ r 4-1tL� Separation Distance from Absorption Field: To Water -Supply Well //0 To Property Line iG To Building Foundation `"f U To Existing or Abandoned System on Lot o N j= ; On Adjoining Lots 0 �_ To Water Main/Service Line To Cutbank (if present) No N ILE To Stream/Pond/Lake/or Major Drainage Course N O)V L To Driveway, Parking Area, or VehicleJStorage Area `ted f Comments 4 D. LIFT STATION Date Installed _ Size in Gallons Nod "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that have checked, verified, conformed to all O'A/aa9dd HAA guidelines in effect on the date of this inspection Signed Date �o�7L a �O �-r- Company � � ,MOA No. Receipt p /'- 8 `' ' Date of Payment c2 u - h.• - �iP //�: G'S't o ma•q ?Tti °Y `t Engineer's Seal Amount: $ ' ��•'. 2225-E yr' 26. t971 Page 2 of 2 P9;1^, • :: 72-026 (11/84) No. � � � �•�• ��•� ;��?�, "')20ANCHORAGE, W. 15th AVE "C" SUITE 203 ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 S E P T I C S Y S T E M A D E Q U A C Y T E S T LEGAL: LOT 3, BLOCK 6, PARADIZE VALLEY LOCATION: 18010 NORWAY CIRCLE OWNER: JOESEPH DOLD RESIDENCE: SINGLE FAMILY, THREE BEDROOMS WATER SYSTEM: ON SITE WELL SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: GREER STEEL, STEEL, TWO COMP. 1250 GAL. ABSORPTION SYSTEM: 5 FOOT BED, 47 FT LONG ABSORPTION AREA: 270 SQ.FT. SOIL RATING: 90 INSTALLATION DATE: AUGUST 1981 DATE OF PUMPING: JULY 1985, ROTA ROOTER - DATE OF TEST: JANUARY 24, 1986 TtST,P.ROCEDURE: SYSTEM WAS INSPECTED. WATER DEPTH IN TANK WAS O'` 48 INCHES. BOTTOM OF MONITOR TUBE FOR BED WAS 35 INCHES BELOW GROUND LEVEL. WATER DEPTH IN TUBE WAS 4.5 INCHES. 230 GALLONS OF WATER WAS ADDED TO THE BED AT A STEADY RATE OF 6.6 GALLONS PER MINUTE. Q,'r? • J N'. 2,, t a WATER LEVEL CAME UP 7 INCHES. IN THE NEXT 30 MINUTES THE WATER LEVEL DROPPED 3.75 INCHES. APPROXIMATELY 165 GALLONS WERE ABSORBED IN 30 ~�} MINUTES. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, 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 this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. 1 3 W. 15th AVE "C" SUITE 203 � � �p QadQ��9 Poco ^`20ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 R E S I D E N T I A L W E L L I N S P E C T I O N LEGAL: LOCATION: OWNER: TYPE OF WELL: LOT 3, BLOCK 6, PARADIZE VALLEY 18010 NORWAY CIRCLE JOESEPH DOLD SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: WELL YIELD FROM TEST PUMP YIELD: DATE OF INSPECTION: 3.5 GPM+ 6.6 GALLONS PER MINUTE JANUARY 24, 1986 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6.6 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACCOUSTIC PROBE. STATIC WATER LEVEL WAS FOUND TO 47 FEET BELOW TOP OF CASING. AFTER 30 MINUTES OF PUMPING THE WATER LEVEL WAS 122 FEET. WELL RECOVERED TO 68 FEET WITHIN 39 MINUTES. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON JANUARY 21, 1986. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. t; 5. LEGAL DESCRIPTION -Z Z-0 DATE PECEIVED j INSPECTION APPOINTMENTS Snbw TIME TIME TIME NUMBER OF,BEDROOMS ❑ One ID Four ❑ Other SATE DATE � DATE; INSPECTOR INSPECTO p. INSPECT MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCAO0,1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT, OF HEAUJ ` 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P': f CTION` • ENVIRONMENTAL SANITATION DIVISION OCT 1 6 1981 Telephone 264-4720 DDCC ee cc REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEp�HAGBOil D DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE�� 172 INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER >•. PHONE + ;; MAILING ADDRESS - 3. LENDING INSTITUTION ZA PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS - 5. LEGAL DESCRIPTION -Z Z-0 STREET LOCIf ATI � � � 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ID Four ❑ Other SINGLE FAMILY ❑ Iwo ❑ Five ❑ MULTIPLE FAMILY Imo' Three ❑ Six 7. WATER SlLltpkr INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISP1- SYSTEM 172 INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED M 1 - 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED f3 INSTALLER ❑Sep is Tank or ❑ Holding Tank Size:If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS LT'APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 72-010 (Rev. 6/79)