HomeMy WebLinkAboutPARADISE VALLEY BLK 1 LT 9Paradis
Valley
lock I
Lot 9
020-424
-29
Municipality of Anchorage ·
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: 0sP101211 PID Number: 020-424.~1~
Steven Strawn Wastewater System: [] New [] Upgrade
Address:
5930 Greece Circle Anchorage, AK 99516 ABSORPTION FIELD
4 [~ DeepTrench I--I Shallow Trench [] Bed [] Mound [] Other:
LEGAL DESCRIPTION Sol, Rating: Total Depth from odginal grade:
.6 GPD/Ft2 11 Ft.
Block: 1 Lot: 9 Subdivision: Depth to pipe bottom from odginal grade: Gravel depth beneath pipe:
Paradise Valley 6 Ft. 5 Ft.
Township: Range: Section: Fill added above odginal grade: Gravel Length:
0-1 Ft. 60 Ft.
Well: [] New [] Upgrade Gravel width: Number of lines: Dist .... bet .... Ii ....
4 Ft. 1 - Ft.
Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
Existing Ft, Ft. 600 Ft2 ASTM D3034 PVC
Ddller: Date Drilled: Static Water Level: installer: Date installed:
Ft. Glacier Excavating 10/8-12/2010
Yield: GPM Pump Set at: Casing Height Above Ground:
Ft. Ft, TANK
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
T~To Septic Absorption Lift Holding ~ublic/PrivateManufacturer: Capacity:
From%
Tank Field Station Tank Sewer Line Anchorage Tank 1,250 Gal.
Well N/A N/A N/A N/A >25' Steel Two (2)
surface water>100' >100' N/A N/A % / LIFT STATION
Lot Line >5' 5 .... N/A N/A Gal.
"Pump on" level at: "Pump off' level at: in. High water alarm at:
Foundation >5' > 10' N/A N/A in. in.
Curtain Drain None Noted / ~ Pump Make & Model Electrical Inspections performed by:
Remarks:
***See Lot Line Waiver. BENCH MARK
Existing Trench Connected With Flow Splitter Valve. West Entrance Door Threshold.
Existing Septic Tank Decommissioned in Accordance 100.0 Ft.
with Municipal Code. 11% ~..-/,,j (.,
~ ~ ~..&'--~__,-'~J ~1 ~ 3 f~. Erlg~Peer's Stamp,
Inspections performed by: A. Harala Dates: 1st 10/8-9/10
2nd 10/9, 11, 12/2010
'~ ~'0.' '~.,!~:~- '.'1-":,".
Development Services Department Approval
Conditional Approval Date:
Reviewed and approved by: .z/,U/~ ~o¢-~Date: _'~ .-/O-//
<.~,. ,,,/,,,,, ,,,...~7~..?';/. -/.~.
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
Permit Number: OSP101211
t
PARADISE VALLEY SUBDIVISION
LOT 9, BLOCK 1
LOT 8
NOTE:
Existing Septic Tank
Decommissioned in
Accordance with
Municipal Code.
16,126 S.F.
FCO
Four
Bedroom Asphalt
Home Dnvewoy
Page 2 of 3
PID No. 020-424-90
S l 5¢.5' 40B.9'
S2 64.4' I 41.7'
FSV 69.2' 43.3'
C4 68.0' 59.6'
M1 70.4' 58.9'
C5 104.9 67,1'
, ®
\ \ THS
LOT 1 8
C5
Alt.
Site
ALTERNATE SITE
Category III System and 15'
Long x 5' Wide x 8' Effective
Depth Absorption Trench.
LOT
17
LEGEND;
CO - Cleanout
SV - Septic Vent
TH - Test Hole
MT - Monitor Tube
FCO- Foundation Cleon Out
THS - Test Hole Spurklond
FSV -- Flow Splitter Valve
LOT 1 0
PLAN AS-BUILT
SCALE 1' = 40'
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 -343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP101211
Page 3 of 3
PID No. 020-424-29
Original
~11,250 Gall°n I%,
/ I SepticTa.k I\
~8.1--' I I ~7.9
3::
-
90.5 91.0
Original Ground ................
Geotextile Fabdc
85.0- ~ Drainfield Rock
80.0--'
o 74'0
Groundwater
9/26/1 (3
60' (Trench Length)
O
87.6
79.4.--~
NEW TRENCH
94.0
Geotextile Fabdc
Drainfield Rock
36' (Trench Length)
EXISTING TRENCH
O
O
PROFILE AS-BUILT
No Scale
85.0
87.5
Permit Number:
Tax Code Number:
Work Type:
On-Site Wastewater Disposal System Permit
OSP101211
02042429000
Septic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
Permit Effective Dates: September 28, 2010 to September 28, 2011
Design Engineer: ANDERSON ENGINEERING
Subdivision: PARADISE VALLEY
Site Legal Address: PARADISE VALLEY BLK 1 LT 9 G:3538
Owner/Address: STRAWN STEVEN E
5930 GREECE DR ANCHORAGE AK 995160000
Site Mailing Address: 5930 GREECE DR, Anchorage
Lot Size in Sq Ft: 16126
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions:
The Engineer needs to do an additional soils investigation to verify separation to impermiable soils
layer and ground water prior to the construction of the septic field. Construction may proceed at
your own risk before the 7 day water monitoring is complete. Please submit stamped and signed
results with the As-built Inspection Report. If the results require a design change, construction of
the system will stop pending On-Site review and approval.
Received By:.
Issued By:
Date:
Date:
Municipality of Anchorage
P.O. Box 196650 ® 4700 Elmore Road
Anchorage, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997
http:llwww.muni,or,qlOnsite
Development Services Department
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
WaiverS: OSP101212 COSA#: Permit~: OSP101211
PID#: 020-424-29
Legal Description: Paradise Valley, Block I Lot 9
Engineer: Anderson Engineering
Applicant: Steven Strawn
'Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 5.0 feet.
This waiver approval applies to the proposed absorption field to property line separation only.
Any future upgrade to the on-site wastewater disposal system will require all separation
distances be met or another approval from this department.
Waiver is Granted: X Waiver is not Granted:
Date: ~'~,~.~ ~---~/~d~ Approved by: ",~,~/~~/~~
Name of Reviewe~
Rec~: 047029 Amount: $320.00 Date Paid: 9/27110
**** VARIANCE/WAIVER REVIEW ****
Municipality of Anchorage
Development Services Department
Building Safety DiviSion
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www. muni.org/onsite
(907) 343-7904
~ ~i' ON-SITE SEWER/WELL PERMIT APPLICATION
~/~,,,...,,,. (~9?/~l?.l'z- FORA SINGLE FAMILY DWELLING
Parcel I.D. 020-424-29
Property owner(s) Steven Strawn
Mailing address 5930 Greece Drive Anchorage, AK
Site address 5930 Greece Drive Anchorage, AK
Legal description (Sub'd., Block & Lot) Paradise Valley, Block 1, Lot 9
Legal description (Township, Range & Section)
Lot Size 16,126 Sq. Ft.
Day phone
Zip Code 99516
Zip Code 99516
Number of Bedrooms Four (4)
THIS APPLICATION IS FOR ([~ all that apply):
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
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.
(Signature of property owner or authodzed agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
September 26, 2010
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 9, Block 1, Paradise Valley Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owners of the subject lot are upgrading the house to 4 bedrooms. We are
therefore requesting a permit be issued for the upgrade of the septic system to
accommodate the four-bedroom home. The attached Site Plan and backup
documentation identify the location and configuration of the proposed septic system.
The existing septic tank will be decommissioned in accordance with Municipal Code.
The existing absorption trench will be abandoned in place. Also identified on the plans
are the locations of the existing well on the lot and those on adjacent lots. No conflicts
exist between the proposed septic system location and the wells on this or adjacent
lots. Drainage arrows are shown indicating the current drainage patterns. The
drainage patterns will be maintained after construction.
The test hole placed on the lot at the location of the existing absorption trench indicated
silty gravel with some sand (GM). The percolation rate was determined to be 25
minutes per inch. A recent test hole placed by Spurkland Engineering resulted in a
percolation rate of 4.2 minutes per inch. We have designed the system however for the
slower percolation rate. We are proposing to construct a 1,250 gallon septic tank and
construct a 63' long by 3' wide absorption trench with an 8' effective depth. The
distribution pipe in the trench will be placed at 4' below the surface with the total dePth
at 12'. The alternate site for the four bedroom home will be a Category III Nitrate
reducing system with an application rate of 3 gallons per square foot per day. The
trench will be a 15' long x 3' wide x 8' effective depth. A minimum of 3' of cover will be
placed over the trench and 4' over the tank.
The ground surface on the lot slopes slightly to the west. The trench will be placed
LOt 9, Block 1, Paradise Valley
September 26, 2010
Page Two
parallel to the contours of the ground as much as possible and in conformance with
design criteria. A minimum of 100' will be maintained between all components of the
septic system and the proposed well and from any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
o
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
ANDERSON ENGINEERING
P.O, BOX 240773
ANCHORAGE, AK 99524
522'7773 677-7766 (F~)
September 28, 2010
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject:
Lot 9, Block 1, Paradise Valley Subdivision
Separation Distance Waiver
Absorption Trench to Lot Line
Dear On Site Services Engineer:
Lot 9, Block 1, Paradise Valley Subdivision is a small lot with only 16,126 square feet of
surface area. The existing septic system has failed and must be replaced with a new
four bedroom system. Test holes recently placed at the southwest corner indicate silty
gravel soils which will support a new absorption system. This area, however,
encroaches into the 10' setback from the property line on the west side. Placement of
the absorption trench within 5' of the western lot line will not adversely affect
neighboring lots. The lots to the south have septic systems at the north end of the lots
with the wells to the south. We hereby recommend a lot line waiver be issued allowing
placement of the absorption system within 5' of the western lot line.
Sincerely,
Michael E. Anderson, P.E.
5
Well
~4
5
VACANT
19
2O
21
16
15
10
ExiMing
Well
11
ENGLAND AVENUE
AREA
MAP
SCALE 1' = 100'
PARADISE
LOT
LOT 8
NOTE:
Abandon Existing Septic Tank
in Accordance with Municipal
Code. Connect Existing
Absorption Trench with Flow
Splitter Valve. Total Capacity
of New System is 4.7
Bedrooms.
SYSTEM REQUIREMENTS:
1,250 Gallon Septic Tank and
60' Long x .9' Wide x 5'
Effective Depth Absorption
Trench.
LOT 1 8
LOT 1 7
NOTE;
No Slopes >25% Are Within
50' of the Proposed or
Existing Absorption Trenches.
VALLEY SUBDIVISION
9, BLOCK 1
16,126 S.F.
Well
~ur
Bedroom Asphelt
Home Dnvewey
Site
ALTERNATE SITE
Category III System and 15'
Long x 3' Wide x 8' Effective
Depth Absorption Trench.
Absorption Area with
4' of Drain Rock. Exoct
Limits Unknown. Remove
Absorption Moteriol ond 9' of
Existing Trench. Ploce Silt
Plug in Excavated Area. LOT 1 0
LEGEND:
CO - Cleanout
SV -- Septic Vent
TH - Test Hole
MT - Monitor Tulle
FCO- Foundation Clean Out
THS - Test Hole Spurklond
FSV - Flow Splitter Valve
SITE
PLAN
SCALE 1' = 40'
LOT 9, BLOCK 1,
PARADISE VALLEY SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home Deep Trench System
Perc. Rate: 2-25 Min./Inch 1,250 Gallon Septic Tank
Application Rate: .6 GPD/SF 5' Drainfield Rock
NOTE: Existing Trench Satisfies Requirements for Three Bedroom Home. See GEG Adequacy Test.
Reduce Trench Length to 37' with Silt Plug. Effective Remaining Area = 37/48 or .77
77 (3 Bedrooms) = 2.31 Bedrooms Remaining Area
1 Bedroom X 150 GPD/.6 GPD/SF (Application Rate) = 250 SF Absorption Area
2500 SF/10 SF/LF = 25 LF Trench Length
THEREFORE: Construct a 60' Long x 3' Wide x 5' Effective Depth Absorption Trench at the
Location Shown. Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth
to be 9' Below Existing Ground. Provide 4' Cover OVer Septic Tank and 3' Cover Over Absorption
Trench. Maintain 100' Separation from Wells in the Area.
NOTE: Trench Upgrade Provides Capacity for Additional 2.4 Bedrooms.
Total Effective Area Satisfies Requirements for 4.71 Bedrooms.
/"/~Natura~
Backfill
Geotextile
Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rock
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away. ~
M' ' ' ' ~
m~mum 6 Separation From Bedrock. ~,,,,j~ ..................... ~ ..... 2,~
Minimum 4' Separation From Groundwater.
M nimum 100' Separation From Wells in the Area ~'~'~'"~;;;~;'E';;~;;;~'"":'~
. . , ' ~ .
Minimum 100 Separation From Surface Water or Streams.' ~.~ No. c~.~
2-
3-
4-
7-
8-
9-
10-
11-i
12-
13-
14-
15-
16-
18-
19-
20-
Performed For:
Legal Description:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www. ci.anchoraqe,.ak us
(907) 343-7904
Soils Log - Percolation Test
Mike Blakeslee
Paradise Valley Block 1 Lot 9
Slope
WAS GROUND WATER
ENCOUNTERED? No
S
F YES, AT WHAT DEPTH9 ...... L
O
Depth to Water After p
Monitoring? ,//~Jo ~ ~ E
~' ,'-.'~" l~ ". 4-t'~
.. z9 ., ,/
l- ~" '~%~' ~
Date 7/~X~~
Pedormed:
Township, Range, Section:
Site Plan
COMMENTS presoaked
Reading Date Gross Time Net Time Depth to Water Net Drop
9/7/2010 10:45 am 0 min 11"
8.125 9/712010 10:55 am 10 min 10.875" 2.875"
8.625 9/7/2010 11:05 am 20 rain 10.875 2.25"
8.5 9/712010 11:15 am 30rain 11" 2.375"
8.375 9/7/2010 11:25 am 40 rain 11.125" 2.625"
8.625 9/712010 11:35 am 50 min 11" 2.5"
8.625 9f7/2010 11:45 am 60 rain 2.375"
PERCOLATION RATE 4.2 (minutes/inch) PERC HOLE DIAMETER 6"
TEST RUN BETWEEN 5 FT AND 6 FT
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNIC P L-GI::TfDE~'INES IN EFFECT ON THIS DATE. DATE: 917/2010
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: /Z////~"~/
,~,~,~,,, ,~/-.,"E'
LEGAL DESCRIPTION: ~- ~:;~'"'
Township, Range, Section:~//.)~
SLOPE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
!
(ENGINLEF~F~_SEAL)
I
DATE PER~
WAS GROUND WATER
ENCOUNTERED?
s
L
IF YES, AT WHAT O
DEPTH? P
E
Depth to Water After
Monitoring7 . Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
~.,~/~,~ ~/'..,'~,,A. ' ~ "
PERCOLATION RATE ~' 7 ' (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND ~"5'"~ FT
COMMENTS /~'-'~--~'~' ~"~//[*/ /~"~), C~~ ~~~ ~~
CERTIFY THAT THIS TEST WAS PERFORMED IN
PERFORMED BY: ~'~ ~/~///~/~ I <
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4185)
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
UPERFORMED FOR: ,,/~/.~' Z,. ~" ' DATE PERFORMED
J~)J LEGAL DESCRIPTION: Township, Range, Section: ,~E-C. // 7'/I/kl
Jl,~ ' SLOPE SITE PLAN
18
19
20
o,7//
WAS GROUND WATER
ENCOUNTERED? ,~--~
S
L
IF YES, AT WHAT O
DEPTH.;' p
E
Depth to Water Alter
Monitoring? ,,O'O~t/~' Date:.
Reading Date Gross Net Depth to Net
Time Time Water Drop
~ :-~o A .... 2'~'~# -
7 ~ q' o .4 ...~ '~i~'~
PERCOLATION RATE '~ *=~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN E~ETWEEN ,.~,.-~" FTAI~D ~""~) FT
PERFORMED BY: ~~ ~G/~/~ I~CERTIFY THAT THIS TEST WAS PERFORMED IN
72-008 (Rev. 4/85)
I Municipality of Anchorage Page __~_.~_of 7_.-
' DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~"/-*.-/~,~Z'~:~ ~'~4:) PID Number: O ~ ~
Name:
/~/~ ~ Wastewater System: ~New ~ Upgrade
Address;
~/o~ ~/~. o~ ?~ ABSORPTION FIELD
Phone: ~/--~,~ IN°'°fBed~ms: ~epTrench ~ Shallow Trench ~Bed ~Mound
LEGAL DESCRIPTION so, Rating: Total Depth from original grade:
~, ~ GPO/Sq. Ft.
Subdivision: Depth to pi~ bosom from original grade: Gravel depth beneath pipe
WE LL: ~New D Upg fade Gravel depth: Number of lines: Disance.~n lines:
Classification (Private, A,B.C): Total Depth: Cased To: Total absorption area: Pipe material:
~/~A~ ~G Ft. 2~ Ft. '~ SO. Ft.
Driller: Date Drilled: Static Water Level: Installer: Date installed;
Yield: Pump Set at: ~ ~sing H~ight Above Ground:
~ ~PM ~ Ft./ ~ .. ~ TANK
SEPARATION DISTANCES ~eptic U Holding D S.T.E.P.
TO ~ptlc Absorption Lift Holding Publi~Prlvate Manufacturer: CapaciW in gallons:
From T... F~.,U Sa.on ~... S.~..Un. ~ ~C~~ TA~
Number of Compa~ments:
Sudace
w=t~ ~ W~ ~ wR ~ LIFT STATION
LineL°t ~ ~ /~ / ~ ~ ~ / Size in gallons:~ Manufacturer:
Cu~ainDrain ~ ~ ~ ~ ~ Pump Make & M~el~ Electrical inspections pedormed by:
Remarks: ~~/~ ~ ~ ~~F~ BENCH MARK
Lo~tion and Description:
I A~um~ Elevation:
~ ~ T/4/~ ~~ , ~ ~,
Inspections pe~ormed by: ~, ~~ Dates: ls~~~"~~N%" ' ':;;'"~"""" " ....
.
Depa~ment of Hea Ith an( ~ ~e~ces approval ft~~ '~
Reviewed and approved b~,: ~. ~~ Date: ~?[/~ 'l~t:-~2~' I~.~i~,~
.
72-013 (1/91) MOA 25
Permit No. '~'/--'V/,,~/-/4~::~'~<~ Page / of ~
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343~4744
On-Site Wastewater Disposal System and/or Well Inspection Report
72-013 A (2/91) MOA 25
07/27~95
07:34
ANMC RESIDENT ENGINEERS OFFICE ~ TSSC ALASKA
~-W DRILLING, Inc.
P. O. BOX 4.1224 * 1~1OC Intetnation~! Airport Road
(907) 274-461 l
ANCHORAGE, ALASKA 99509
N0.519 ~01
DRILLING LOG
Use o~ Well~DOMESTIC-
We]/O~er-~Le ~eiu TronQ
Location (address of: Township, Range, Section, if known; or distance main road
Block 1 Lot 9 Paradise Valley S/D
_ Anchnrn~_e Alaska
Sl~e of casing--6" Depth of Hole256~-~-----~eet Cased to~254' 83 feet
Static water level ~20 ~t. (a~l~) (below) land surface. 'Finish of well (check one) open end ( X );
Screen ( ); Ferforated ( )-
Describe screen or pe~oration~ N/A .
WeB pumping test a 3t-~3~gall°ns per (~ (minute) for--2 .~ou~s with_.. 30 ._ft.
of drawdown fltom static level,
DateO~completiOrL~ Ap~.$l 15~ ~9~5 ._
WE~L LOG
. . at~i~ ~o~J
Depth~n,e~rom ~~ o, m~,,~,~,~~ ''
uept. Health & Human Ser~ces
G~vel: Sand.)' with C. ob__bles -
_.Loose Sand ,'
._~_~~tv?~_mo. 0ccas+~nal Gravel Le~es_
j~,mwn ClaY: Damn~S~'tcky
Brown Cl aY_~: Gravell
Waterbearln,~ Gr~vel,
Bedrock
3s _
35 ~TO~35
_~38 .TO_. 44 _
44 TO 95
._~TO 205
245 ._TO_ 251
251 TO 256
~WWA-~61~tt~ed
Certific"te No's. BI4 & 973
1 -- cuSTOR
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HI/MAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW940400
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:LE HIEU TRONG
OWNER ADDRESS:4103 MINNESOTA DRIVE
ANCHORAGE, ALASKA 99503
PARCEL ID:02042429
LEGAL DESCRIPTION: PARADISE VALLEY BLK 1 LT 9
DATE ISSUED:10/17/94
EXPIRATION DATE:10/17/95
LOT SIZE: 16126 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
DATE
DAT*:
September 16, 1994
MOA DHHS
825 'L' Street
Anchorage, AK 99502
BATES ENGINEERING
4410CEANVIEW DRIVE
ANCHORAGE, AK 99515
(907) 345-0807
SubJ: Well and Septic System Design for Hieu Le
Re: L 9, B 1, Paradise Valley Subd.
The attached Site Plan shows the existing and potential wells and
septic system locations on the surrounding lots.
WELL IMPACT
The well location was selected based on a compatible location to
allow for practical locations for wells and septic systems on the
surrounding lots. It is difficult to predict what .impact the
total development of the area would have on the available aquifer
and beyond the scope of this report, however, because of the size
of the lots and density of the subdivision we would 'recommend
that some type of a public water be planned for the future.
SEPTIC SYSTEM IMPACT
The septic system should have little impact on the ground water.
The fairly slow perc rates of 27 min/inch thru dense GM material
will provide adequate treatment of the effluent. The monitoring
tube ( on lot 10) is dry to 12', monitoring tubes on lots 11 and
12 to 14'& 15' are also dry and a test hole drilled on lot 15 by
R&M in 1977 recorded no water to a depth of 19.5'. Records
reflect that no water was encountered on iota ? or 10 block 2 to
depths of 12 and 14 feet. No bedrock or impervious materials
were encountered in any of the test holes.
Based on this information and the limited space available for
septic systems we are requesting approval of a deep trench system
using an 8' deep absorption area. During construction we will
verify no water to at least 4' below the drain rock and install a
monitoring tube. If water is encountered we will immediately
notify your office and coordinate a redesign of the system.
RESERVE SYSTEM
There is adequate space for an alternate system on this lot aa
shown on the site plan. We would recommend that consideration be
given to a future public sewer system because of the small size
of the lots and density of the subdivsion.
DRAINAGE
The lot generally slopes at
banks or other problem areas.
about 10% to
the west with
no cut
BA7'~'S ENGINEERING
n Design o Construction 0 Resource Development
441 OCEANVIEW DRIVE
ANCHORAGE, ALASKA 99515
Telephone (907) 345-0807
CHECKED BY DATE
'3~] PERFORMED FOR:
I~ LEGAL DESCRIPTION:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
18-
19-
20-
COMMENTS
#*.-'4,m".*'
DATE P E R FO R M E D:~ ~ ~ ~n~t~
Township, Range, Section: ~ // ~//~ ~~
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT
DEPTH? p
E
Depth to Water After
Monitoring? ,,~/0,~ Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
~ :~o A ;~/2~'/ .
7~ ~ ~ ~ ~1~'~
PERCOLATION RATE '~ ~'' (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN -~%~'~"-~ FTAND ~'~ FT
z~/~ ~,~z'~- ,~/~' ~,,,~' /~//~/9.d.
PERFORMED BY' '~"~-/"'~'~" ~"'~,,/G/~'~'~"~,/~4,,~_~ I~CERTIFY THAT THIS TEST WAS
· _ PERFORMED IN
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
,~.,~
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
DATE PERF~
Township, Range, Section:~,
SLOPE ~SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~)
DEPTH? P
E
Depth to Water After
Monitoring7 Date:.
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ ~ ' (minutes/inch) PERC HOLE DIAMETER ~//
TEST RUN BETWEEN ,,~ ¢FT AND '~'5'~' FT
PERFORMED BY: .~',,~/X'"~".~ ~;,?~/~/'/4./~'~."~//f,.'/,¢~ I ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; ~',~,~/~¢~'
72-008 (Rev. 4/85)
B,~ ~'"~-,~ ENGINEERING
Design ~ Construction [] Resource Development
441 OCEANVIEW DRIVE
ANCHORAGE, ALASKA 99515
Telephone (907) 345-0807
CHECKED BY DATE
M U N M P L 17Y F
Development Services Department
On -Site Water & Wastewater Section
Certificate of On -Site Systems Approval
Phone: 907-343-7904
Fax: 907-343-7997
Parcel I.D. 020-424-29 Expiration Date:
1. GENERAL INFORMATION
Complete legal description PARADISE VALLEY BLOCK 1, LOT 9
Location (site address) 5930 GREECE DRIVE, ANCHORAGE, AK 99516
Current property owner(s) ZHIQING GU
Mailing address
Real estate agent
321 E 45TH STREET. ANCHORAGE. AK 99503
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise
requested by the engineer.
COSA Fee $ 55 b Waiver Fee $
Date of Payment 5 ID/ d, da 1 Date of Payment
Receipt Number Receipt Number
COSA # O S C z 1 1 a 2 q 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 5/7/2021
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
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the Pi � • •�!`I��l
well and septic system. Therefore, any estimate of how long a system will function satisfactory �rg�•.' • •�1
for current or future occupants or guarantee that no unseen encroachments, deficiencies or ;t" fr
discrepancies exist can be given by First Water Consulting & FWI.S *• ' ...49 ......•..
6. DSD SIGNATURE r Curtis Huffman /
_ System #1 Approved for bedrooms �%T . CE 128991
lF�FD SSI�N-�'�'
System #2 Approved for bedrooms >(1��PROFESSOP�'�
Disapproved
Conditional approval for bedrooms, with the following stipulations:
SOF <<((�16
ON-SITE t—':_a
g WATER AND m
J WASTt=VATER Z
J`T PKUVF~HM
SER��G��
By: Original Certificate Date: S// Z
The Municipality of An e Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given i aragraph 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.
I/�Sr��G�y:�1�1��►���i
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist
Legal Description: PARADISE VALLEY BLOCK 1, LOT 9 Parcel ID: 020-424-29
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 4/15/1995
Total depth 256 ft
Cased to 255 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 24+ in.
Date of flow test for COSA 5/6/2021
Static water level at beginning of test 232 ft.
Well production at time of test 4.6 gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 1.38 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date of Sample 4/21/2021
Comments __________________________________________________________________________________
B. TANK DATA
Age of tank(s) 10 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 49”
Standpipes/foundation cleanout per record drawing
Date of pumping 4/17/2021
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 10/12/2010
ALL standpipes present per record drawing
Total measured depth from grade 9.5 ft (max)
Measured depth to pipe invert from grade 4.7 ft (min)
N/A – pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective 4.8’ OF THE 5’ ED
Code-required soil cover over field
System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Adequacy test date 5/6/2021 (TESTED LOWER TRENCH)
Results Pass For 4 bedrooms
Fluid depth prior to test 27 in
Water added 600 gal
New depth 36 in
Elapsed time 1195 min
Final fluid depth 27 in
Absorption rate 600 gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Comments/Deficiencies: Per our observations and the 2011 IR there are only COs in the original trench. A monitoring
tube will need to be installed in the future in the upper trench to conduct an adequacy test.
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
ft
Neighboring Tank > 100’ Yes if No
ft
Absorption Field on Lot > 100’ Yes if No
ft
Neighboring Absorption Fields > 100’
Yes if No
ft
Community Sewer Main > 75’ Yes if No
ft
Community Sewer Manhole/Cleanout > 100’
Yes if No
ft
Private Sewer/Septic Line > 25’ Yes if No
ft
Holding Tank > 100’ Yes if No
ft
Animal Containment > 50’ Yes if No
ft
Manure/Animal Excreta Storage > 100’
Yes if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Property Line > 5’ Yes if No
ft
Absorption Field > 5’ Yes if No
ft
Water Main > 10’ Yes if No
ft
Water Service Line > 10’ Yes if No
ft
Surface Water > 100’ Yes if No
ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No
ft
Community Wells > 200’ 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
Property Line > 10’ Yes if No *5 ft
Water Main > 10’ Yes if No
ft
Water Service Line > 10’ Yes if No
ft
Surface Water > 100’ Yes if No
ft
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No
F. ENGINEER’S COMMENTS
*EXISTING MOA WAIVER.
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.
5/7/21
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-424-29
GENERAL INFORMATION
Complete legal description
Location (site address)
COSA#
Expiration Date:
Lot 9, Block 1, Paradise Valley Subdivision
5930 Greece Drive Anchorage, AK 99516
Current Property owner(s) Steven Strawn
Mailing address 5930 Greece Drive Anchorage, AK 99516
Day phone
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Un/ess otherwise requested; COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: Four (4)
TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class ~ Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding Tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 (am) 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(am) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
DSD SIGNATURE
~,,,.,."/ Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone 522-7773
Date 3/10/2011
bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Municipality of Anchorage
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 Subdivision, Block 1, Lot 9
A. WELL DATA
Parcel ID: 020-424-90
Well type Private
Date completed 4/15/95
Total depth 256 ft.
IfA, B, or C provide PWSID #~
Sanitary seal (Y/N) Y
Cased to 255 ft.
FROM WELL LOG
Date of test 4/15/95
Static water level 220
Well production 3
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL
Arsenic: N/D mg/I
SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,250 gal.
Foundation cleanout (Y/N) Y
Date of pumping New Construction
ABSORPTION FIELD DATA
g.p.m.
Nitrate 1.21 mg/L
Date of samp~le: 8/2/10
Number of Compartments Two
Depression over tank (Y/N)
Pumper
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
8/3/10
235
5.34 g.p.m.
Other bacteda o
Collected by: GEG, Ltd.
colonies/100 mL
Date installed ~o/~2/~o & ~o/~9/~4 Soil rating (g.p.d./ft~ or ~lbdrm) .6 GPD/SF
Length 60' & 36' ft. Width 4' and 3' ft.
Total depth 11-12 ft. Eft. absorption area 1,176 ft2 Monitoring tube
Date of adequacy test New Const. Results (Pass/Fail)
Fluid depth in absorption field before test in. Water added
Elapsed Time: ~ min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
System type Deep Trench
Gravel below pipe 5' & 8' 'ft.
Y Depression over field N
For bedrooms
~ gal. New de[~th in.
in. Absorption rate >= g.p.d.
N If yes, give date
Y
>24 in.
Date installed 10/8/2011
Cleanouts (Y/N) Y
N High water alarm (Y/N) N
LIFT STATION
Date' installed
"Pump on' level at __
Datum
in.
E. SEPAI~ATION DISTANCES
Size in gallons
'Pump off' level at~
Cycles tested
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main NIA
Sewer/septic service line >25'
Animal containment areas >50'
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots >1oo'
On adjacent lots >1oo'
Public sewer manholelcleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
>100'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5'
Water main N/A
Wells on adjacent lots >100'
Property line >5'
Water service line
>10'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field >s'
Surface water >1oo'
Property line 5 ....
Water Service line >1o"
Curtain drain None Noted
Building foundation >1o'
Surface water >1oo'
Wells on adjacent lots >1oo'
Water main >1o'
· Driveway, parking/vehicle storage
F. COMMENTS: Existing Absorption Trench Constructed in 1994 Remains in Service and is Connected to Recently Constructedc
Absorption Trench With a Flow SplitterValve.
***See Lot Line Waiver.
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 Michael E. Anderson, P.E.
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
GAR. N ESS ENGINEER. IN G GROUp. Ltd.
~;VELL FLOW TEST DATA
STREET ADDRESS:
CLIENT: PHONE NUMBER;
N[YMBER OF BEDROOM: '~ GALLONS PER DAY N
WELL ' ~SEE C 0 S A SITE VI ': ~ ' CHECK iST* ~ ~
1. Casing Height ~c :Ground): 7~~,~ ~'~
2~ Sanit~y S~]ffYESfi/NNO (if ~Oa. dcsc~be in Comments)
4~ Water S~ples N~ed: ~¢ ~ N~if "YES'", ~te taken'
5, Depression ~ound Well: YES /~if NO'~ descri~in. Co~ems)
6. D0c~ Wall ~d Four Hour Flow 'Test (FHA}: YES / ~)
SCALE: 1"= 30'
LOT 8 o~~'
LOT 18
\
\
\
LOT 17
2.0~
2,0
LoT9
8352~
(h '
LOT 10
,,~' ~ .' ~ '..
9[~ ~ Fred Wal~tka .;~,~
.
EASEMENTS OF RECORD, OTHER T~N
THOSE SHOWN ON THE RECORDED
PLAT A~ NOT SHO~ HEREON.
Bumeff
BE
RECERTIFIED 3-09-1
AS-BUILT NO CORNE~'S SET THIS DATE
I hereby certify that I have performed a Mortgagee's inspection
of the following described propeity: LOT-g~BEO(~--'J~-------
,, pARADISE VA~ EY SUBDIVISION
.Anchorage Recording Precinct, Alaska, and that the
Improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvemenls on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 5th _day of AUGUST .,2010
FRED WALATKA & ASSOCIATES
(907-248-1666) Engineers and Surveyom
· '"~ ' ~ MUNICIPALITY OF ANCHORAGE
, ~ ....... ~ HEALTH & HUMAN SERViCEs~ ~
'attesting to the legality and statuS Of system~ ' ::-.-!';: ::-~' ~ :::: .......
5. STATEMENT OF INSPECTION BY ENGINEER
Ascertified by my seal affixed hereto and as of the validation date shown below, I verify that my
;application shows that the on'site water supply
in E
:,.~ Disapproved ....
..... '""~ w,,,=~, the following stipulations:'
: '~" ~Conditional approval for b~droofiaS,' '
Additional 'Comments
Department of Hea th and Human Service~iDHHS) ~ssues Health Authonty
on v upon the representations given n paragraph
istered in the state Of Alaska. The DHHS doi~s this ~:~:COU'rtesy t6'purchasers
o!:h..0mes
)rder to satisfy fiertain fedemland state requ'i~:~nts. Employees of DHHS d~'not
~ns or analyze data before a certificate is issued, The Municipality of Anchorage is not
responsible for errors or omissions in the profess onal engineer's work:. ':-,:~.:;~,~'
72.025{Rev. 1/91) Back MOA~I
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: /--- ~:~ ~/~/:-~"~:)~':~~ Parcel I.D.
A. Well Data
Well type
Log present (Y/N)
Total depth ~ / Cased to
Sanitary seal (Y/N)
FROM WELL LOG
Date of teet ~z///
Static water level
Well flow
Pump level1
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~Tz./,y?/~._.<'' Driller
-~.~'o~ / Casing height
Wires properly protected (Y/N)
g.p.m.
AT INSPECTION
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot /'~ /
Absorption field on lot
Public sewer main
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform /~ Nitrate
Date of sample: '7 //7-~ /~,~'~ .
~ ~' Other bacteria
Collected by:
B. SEPTIC/~ TANK DATA
Date installed~ / :/'/~'~'~' Tank size /,~: ~: - Compartments
Cleanouts (Y/N) k/ Foundation cleanout (Y/N) \/~ Depression (Y/N)
High water alarm (Y/N) /~/,/~ Alarm tested (Y/N)
Date of pumping ~//.~ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ./~2 /
To property line ~-~' /
Surface water/drainage
On adjacent lots
Absorption field
Foundation r-~ 7 /
~service line ~- x~.
72-026 (3/93)' Front CONTINUED ON BACK PAGE
C. LIFT STATION ./c//.z~.
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length
Width
soil rating (GPD/FF)
Gravel thickness
Cleanout present (Y/N)
Results (pass/fail)
Total absorption area
Date of adequacy test /f/~
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
System type ..~C~.J ?~'¢¢~¢//~
Total depth ~¢', ~ 4~¢/
~ Depressbn over field (Y/N) ~/
~/~ for ~ Bedr~ms
After test ~' ~
.If yes, gbe date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
/
Well on lot //
To building foundation ~4"-2 /
On adjacent lots
Surface water
Curtain drain /~.///~
On adjacent lots '~ /0 o / Property line
To existing or abandoned system on lot
Cutbank /f/',//,.z). Wc, tcr ,main/service line
Driveway, parking/vehicle storage area ¢¢r.¢ /
Lot /.- , ¢' I
E. ENGINEER'S CERTIFICATION
I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effe,,.~c4,~~is inspection.
~,~.' ,~ .. 4..-{.
-
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/9~)* Back