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PARADISE VALLEY BLK 4 LT 2
Onsite File Paradise Valley Block 4 Lot 2 #020-411-10 trcev u5/uz/ i b) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 2 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211105 PID Number: 020-411-10 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑® New ❑ Upgrade Name Kyle &Benjamin Westcott ABSORPTION FIELD ❑ Deep Trench El Wide Trench El Bed El Mound Site Address 6320 Switzerland Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Paradise Valley 4 2 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic p Absorption p Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field I I Tank Line . Ftz Fl. Well 100'+ N/A NA NA 125'+ TANK M Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1500 Gal. Surface Water 100'+ N/A NA NA Material Number of compartments Lot Line 15.0'+ N/A NA NA NA HDPE 2 Foundation 10.0'+ N/A NA NA LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer drainfield Dean Construction Drainfield cO/MT3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation)1016 ft Inspdection v, 5/24/2021 d 5/26/2021 Location and description 3"' 5/27/2021 2„ 41^ See Site Plan, Bottom of house trim ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: •"' • Date • •. TH •. n A. a ***i Septic LSyste "- CE 8149 Approv w Date • •,.•' Note: this approval does not include well permit requirements. trcev u5/uz/ i b) ��Wro-nomv-'D v m o _ICC) n cu N _ o � ' K C nm v-rm rrl r -x ;a m nor- 0mm>= m -'D 0 o z o= -i �i z0OM0 U p p m C O -r Wm zzo m na O� z r -m N X > r - p z n cm N O O O �D r Z ;o m "O NOTES: RECORD DRAWING DRAWN LJC SITE PLAN n p N = C7 M co N N N 01 (4 10 N D w N Ut 07 N - i 0) N N 41 N - W CO cnc Dz T 0 Om Z. f-9 o OD D �_ 0 0 -< N m rno�z rn -O O D N V) O rn =I 0 F l n � D C/") Z -7- C) n \b✓ / \ / / K � O cn rrt C m O o� `'mom \ z Ln 7. Lo ov�- - m ME 0-0 \ / / // ``\♦ P1. NNONE ENG SVC LL.0xc 1. 1088) "" ""i , REVISIONS DATE P.O SOX 1807 PALER, AIC _9645 PSE �F.,ACgs y06/08/2021 PHONE (07) 745--8200 FAX (907 5-8201 _=��.. fy , 06/16/2021 SCALE PARADISE VALLEY, BLOCK 4, LOT 2 - aeon P.I.D. NO 40 020-411-10 KYLE & BENJAMIN WESTCOTT i '.Sty R. ft-.. ' �= PERMIT No. SITE: 6320 SWITZERLAND DRIVE ',� .. = OSP211105 ANCHORAGE, AKessa°` SHEET ` �` 1 OF 9 Wit; �'�«rF�r u T;a,� �';::•_: y POSITION PA_.ED OA?•Yf.45URFvIEVTS TO T.YESIE SCU IPAR) :AND pTP1ER PROFERT 1'CD.?Pi ERS C�', 6 4 THE 2ifATi C;i 1122'07: is THE USE OE I.E:NUIUG TITU7iGUS �PECIFi CAVY " St101,' .:,Y ^TFL CTS OETV:EE', EY.IS. FSTRUCr Mc- `I lF PEnFis LC•i �I`t=_S .;7"v!CR .;727:' ;ib Ij 10 �E !!SEC F6R ?OS!?Tt7 til HG nOCI"?C. eL S7'nUC TJ'" :SPRO'fE '1iS k FEU IL 725 'Eli_ 75 OF RcCORD, OR `:Y LEGA E11T l T'Y, Ol HER 7RA1; 1 H 0 S e' AFr,.AR 1UG ON Th_ RECORD PLA 7:011 SHON`: HE RE Ott{ -SS i:7BIC A- 1; EUCEL I!IE5 714Ai AY( ^PE O;i .HIS .'. R; !t.• :,RE NOT TO EE USED TO DET'RMNE F- OPERTI' IE5 0R PO 5!T ION ADD! ONA IMP ROV Eft'UTA F-7tY Pf.V!NG S14 !l t;EREGN MA HE A,P eR 0XI MA iE DUe' Tyr E.;CESSZVE 5110W ANDiOR ICE. OF A C,�s�40 �.; 49 TH '* u L � O N SHANE A. HOLT �44P '•.. LS -691. gip 4a �' oa o Q�c°Jessiona\ _ao AS-BUILTSURVEY I" =301 NO CORNERS SET THIS DATE T HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT � 6LO:A'4, rar"r.'tDISs t%7LLE)'i FLATfii - IF.,t ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE L'IPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS .%STH DAY OF AYAr' , 2021 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211105 Work Type: SepticTank Upgrade Tax Code Number: 02041110000 Site Legal Address: PARADISE VALLEY BLK 4 LT 2 G:3538 Site Mailing Address: 6320 SWITZERLAND DR, Anchorage Owner: WESTCOTT KYLE S & BENJAMIN W Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 4/12/2021 4/12/2022 19938 ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: kL&Cii Date: 4111,q �� , 5 € �+mazr, �x-..�_ ... ..,�.--,xm+o-�.oeo.,;<_c-+�,. ..�-z*=c�r;:s•.->. .-...;-. zne,'<",:.'x' �..�..�`� _614UMCIPALITY OF ANCHORAGE C2'�^"""=. „......,.,..^f,.rae-+-.ra-""rr--�.Js.--4^'T..x„tswua,�-.+'c3-- ••-3 Community Development Department. Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERIWELL PERMIT APPLICATION Parcel 1. D. 020-411-10 Property owner(s) Kyle & Benjamin Westcott Day phone Mailing address 6320 Switzerland Drive, Anchorage, AK 99516 Site address same Legal description (Sub'd., Block & Lot) Paradise Valley, Block 4, Lot 2 Legal description (Township, Range & Section) Lot Size 19938 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x Septic Tank ❑X Upgrade ❑x (w/wo ADU) Holding Tank ❑ Renewal ElDuplex (D) El Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: a 5 Waiver Fees: Date of Payment: —V 12 a02 I Date of Payment: Receipt Number: O 5 G 276 Receipt Number: Permit No. OS IP21110 5 Waiver No. Permit App_:- :- : .,:c ; Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211105, Rebecca Carroll, 04/12/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211105, Rebecca Carroll, 04/12/21 "'"~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE _J ~J~EW NAME MAI LING ADDRESS LEGAL DESCRIPTION LOCATION DISTANCE TO: Manufacturer DISTANCE TO: Manufacturer Well iF HOMEMADE: Well DISTANCE TO: Well No. of lines / Length of each ~,~/' Top of tile to finish grade i~ Length Width Absorption area Dwelling Material Width Inside length Dwelling Material Foundation /71 Nearest lot liner~ ! Total length of li.~/ Material beneath tile Depth ITrench widt~inches nches NO. OF BEDRO~S No. of compartments ~:~ Liquid depth PERMIT NO. Liquid capacity in gallons Distance between lines To t a I e f f e c t i vea b s~.~.c~e a~.~ ~,~ PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATE~)A~S~ C'T---. SOIL TEST RATING INSTALLER ~-~ D ' - ' REMARKS APPROVED 72-013 (Rev. 3/78) DATE LEGAL PERMIT N0. APPLICANT LOCATION LEGAL DEPARTMENT £ ~HEALTH 8ND ENVIRONMENTAL ~.ITECTION 825 "g STREET., ANCHORAGE., AK. 264=4720 ~qELL_ R~-~[) Cl~-~--S I TE ( 83:0203: ) DAVID J LOWE L204 PARADISE VALLEY SRA BOX 920 ANCHORAGE 99502 56~-~2~ LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEN IS: TRENCH BEDROOMS = ~ ~ SOIL RATING (SQ FT/BR)= MAXIMUM NUME:ER OF THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: i50 THE LENGTH D~MENS~ON ~S THE EENGTH (~N FEET) OF THE TREN~.H OR DR~NF~ELD. THE DEPTH OF ~ TRENCH OR P~T ~S THE DISTANCE BETWEEN THE ~URF~CE OF THE GROUND AND TH~ BOTTOM OF THE EXCaVaTiON (~N FEET.':,. THERE ~ NO SET W~DTH FOR TRENCHES. THE GR~VEL DEPTH ~S THE M~N~r, IUM DEPTH OF 8R~VEL BETWEEN THE OUTF~LL P~PE ~N[:, THE BOTTOM OF THE EXCaVaTION ,::IN FEET). F~E~g~IJ I RED. SEPT I C: TANK: S I ZE-- ~:~ ~3RLi, ,,~D~-~S PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TPIC~ (:;') I ~4SPFC:T'IC~4S i--I~F. RFL]!LII ~:E[:. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DtSPOSRL SYSTEM IS ±00 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO R 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. F'E~_"ffl I T E~-(F' T ~:ES [)EL-:Ef'IBEF-; -:-'1.. ::LL=~- 8F~-': i CERTIFY THAT t: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS 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 4 BEDROOMS. SIGNED: RPPLICRNT DAVID J LOWE V4. 0 o,qVl~O J LOWE FEET FI~ ~ PR[~ ~L OR iSG TO ~ FEET T~/PE ~ ~J~L[C AL ~ ~LL COP~ET[ON. [ CE_.RT[F'i THFIT : ~; [ FD1 FSt4IL[AR WITH T~ RE~J[~NT5 FOR ON--SIT/ ~ ~ ~ AS SET ~u~ch Fr an~-~ PERFORMED FOR: ~ R. '"'"' " MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 , ., SOILS LOG - ~ERCOLATION TEST DATE PERFORMED: SOILS LOG [] PERCOLATION TEST 5/27/82 LEGAL DESCRIPTION: Lot 2 ~ Block 4, I Overburden 2 3 5 6 7 Gravelly Sand w/ trace silt 8 (SP) 150 sf/br 9 Paradise Valley Subdivision SLOPE SITE PLAN 10 12 13 14 15 16 17 18 19- 20- COMMENTS PERFORMED BY 72-008 (6/79) Bottom WAS GROUND WATER S ENCOUNTERED? No g P E IF YES. AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN Kinnev R. Baxter. P.E. BO~ .].,~1(~9, STAR ROUTE A ANCHORAGE! ALASKA BIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 2~.~ ;~x'.f_. DRILLED AT ThE RaTE OF. ~:???.00 PER FOOT. :!22 ),( .?.T0 ?L om[m.. PrOPErTY OWNER ~:z,. /:'~,~. ,%~.~4zl, .Co~r~ .~.~-~ LOCATION OF WELL SITE DRILLER WELL LOG: MUNICIPALITY OF ANCl''IOI~GI~ DEPT. OF HEALTH & ENVIRONMENTAL PROTEC'rIO~ JAN 2 9 1987 RECEIVED COST INCLUDES ALL LABOR AND MATERIAl FOR COMPLETION O~ SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF , ,' · ' THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS SERVICE CHARGEOF 1~% PER MONTH WILL BE ASSESSED ON PAST DUEACCOUNT~. MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-411-10 Legal description PARADISE VALLEY BLK 4 LT 2 Site address 6320 SWITZERLAND DR Expiration Date: Current property owner(s) PISCOYA RYAN & RAIANNE R X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for Comments or advisories: 11/9/23 bedrooms, with the following stipulations: By:, &Ltl =„ Original Certificate Date: $/9/23 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory X Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department{ ' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 020-411-10 Complete legal description Paradise Valley Block 4 Lot 2 Location (site address) 6320 Switzerland Dr. Current property owner(s) Ryan & Raianne Piscoya 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: V Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel © Plastic ❑ Concrete ❑ Fiberglass Age 2 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed © Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment �/2 �%3 Date of Payment COSA # 0-5C 2 3 ► 25 3 Waiver # COSA Application—June 2022 COSA Checklist Legal Description: Paradise Valley Block 4 Lot 2 Parcel ID: 020-411-10 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA FV] Well log is filed with Onsite (or attached) Date drilled 5/3/1983 Total depth 255 ft Cased to 28 ft ❑✓ Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 7/14/23 Static water level at beginning of test 37 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 66.5" Date of pumping 7/17/23 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 5/25/1983 0 ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 5' ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Com ments/Deficiencies: *Per field measurements. COSA Checklist June 2022 Well production at time of test 0.83 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes kZ Nc Z Coliform bacteria is Negative Nitrate 2.35 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L © Arsenic less than MRL (N D) Collected by Arcterra Consulting Date 7/11/23 STATION ❑ Requirealraii`f Age of lift station . Lift station material Comments ce completed Adequacy test date Results Q Pass Fluid depth prior to test Water added 750 ga 7/14/23 New fluid depth 36 in 0 in Elapsed time 60 min Final fluid depth 0 in Absorption rate 750+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 84 in Effective depth used 24-" in Effective depth remaining 60+x in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) ❑✓ Yes Septic Tank/Lift Station on Lot > 100' ft Surface Water > 100'J❑ Community Sewer Manhole/Cleanout > 100' Tank to Property Line > 5' ✓❑ Yes if No ft ✓❑ Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' J❑ Yes if No ft Absorption Field on Lot > 100' ✓❑ Yes if No ft Holding Tank > 100' ✓❑ Yes if No ft Neighboring Absorption Fields > 100' © Yes if No ft Water Service Line > 10'✓❑ Animal Containment > 50' ❑✓ Yes if No ft ✓❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' F,_/1 Yes if No ft ❑✓ Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100'J❑ Yes if No ft Tank to Property Line > 5' v/ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑✓ Yes if No ft Private Wells > 100'✓❑ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' © Yes if No ft Water Service Line > 10'✓❑ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Arcterra Co Engineer's Printed Name Kenneth Duffus Engineer's Comments: This investigation was completed in compliance with ADEC and V10A regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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 well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. COSA Checklist June 2022 Phone (907)-696-6111 Date OF ~ 4L 49 Iti * •*I KENNETH M 5 41 CE 11� www.muni.org/onsite Well Water advisory Certificate of On -Site Systems Approval # OSC231253 Subdivision: Paradise Valley, Block: 4, Lot: 2 This well's productivity was determined to be 0.83 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 5 -bedroom residence is 0.52 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate and may be insufficient to meet your needs. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Ma�lmg Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org � RAUMCPALITY(OF Ar CH C)RAGE Development Services Department \ Phone. 907-343-7904 On -Site Water 2 Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 020-411-10 1. GENERAL INFORMATION Complete legal description Paradise Valley 134 L2 Location (site address) 6320 Switzerland Drive Expiration Date: T / Z/ Current property owner(s) Kyle and Benjamin Westcott Mailing address Real estate agent 2. TYPE OF DWELLING: F Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic F 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 $ 550 Date of Payment Receipt Number 076566 COSA # 21 13 V� Waiver Fee $ Date of Payment Receipt Number Waiver # .- J 1 h 11_IVICIV I yr IIVJrC4 I IIJIV 0 T CIVh11VCCK As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. DSD SIGNATURE System #1 Approved for 5 bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date 20210608 Conditional approval for bedrooms, with the following stipulations: fil(((l!! OF,q�!ii�� ON -s � o ATER AND m ^ - i, ER r Pa o SERVIG ���• VV I ` Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the Slate of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory_ Other COSA Checklist blue sheet COSA Checklist Legal Description: Paradise Valley B4 L2 Parcel ID: 020-411-10 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA © Well log is filed with Onsite (or attached) Date drilled 1/1/1983 Total depth 255 ft Cased to 28 ft Sanitary seal is functioning correctly RMI Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA - `" Static water level at beginning of test 40.9 ft. Comments B. TANK DATA Age of tank(s) <1 years Tank type/material "'7"' Measured operating fluid level in septic tank lLa W Standpipes/foundation cleanout per record drawing Date of, pumping N/A D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) "y"" W ALL standpipes present per record drawing Total measured depth from grade 11.0 ft (max) Measured depth to pipe invert from grade L/ ft (min) ❑ N/A - pressurized field © Monitor tubes go to bottom of effective. If not, state depth into effective ❑® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 0.83 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑✓ No ❑® Coliform bacteria is Negative Nitrate mg/L 0 Nitrate less than MRL (ND) Arsenic ug/L ❑O- Arsenic less than MRL (ND) Collected by PES Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date "° "' Results F, -/]Pass For 5 bedrooms Fluid depth prior to test 0 in Water added 750 gal New depth 41 in Elapsed time 180 min Final fluid depth 0 in Absorption rate 750+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' 0 Yes Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ✓❑ Yes if No Neighboring Tank > 100' El Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 0 Yes if No ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main ? 75' M Yes if No ft P] Yes if No ft ft ft ft ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200'✓❑ Yes if No ft Water Service Line > 10' ✓[D Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / 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. 20210608 COSA Checklist yellow sheet Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC211319 During a recent COSA on-site inspection and test of the potable water supply well on Block 4, Lot 2 of Paradise Valley subdivision, the well's productivity was determined to be .83 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 5 -bedroom residence is .52 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. c, 8 i i7Q, •tom Municipality of Anchorage `; On-Site Water and Wastewater Program tan ' (907) 343-7904 E SEP -•S 211i Certificate of On-Site Systems Approval � �` �A` 016 : L ' Parcel I.D. 020-411-10 Expiration Date: 1. GENERAL INFORMATION Complete legal description Paradise Valley Block 4 Lot 2 Location (site address) 6320 Switzerland Dr. Current Property owner(s) Residential Fund Mortgage Day phone Mailing address 1661 Worthington Rd #100 West Palm Beach, FL 33409 Real Estate Agent Day phone 2. TYPE OF DWELLING: O Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 • 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: 1 Received b • O4L&4 'I i 1111' )_ Date: [o j�414 Ir N. - COSA to be released to the engineer, unless otherwise requested I he engineer. COSA Fee $ Jia.( Waiver Fee $ Date of Payment q long f l�- Date of Payment Receipt Number 03/$54 Receipt Number COSA# ObGRILICa Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 9/27/2017 OF 4&4 k rrc0Q 1+� • j*: , •- 1\ •.* / 6. DSD SIGNATURE .. ... "' ")' System #1 Approved for L( bedrooms • Steven fit. Pannone �� . CE-8149 '/� System #2 Approved for bedrooms 4/4)3', ., , Disapproved t OFES`\��� \`\ Conditional approval for bedrooms, with the following stipulations: rr vIA P -A 0 4'(t-P S ti‘7 AA: OF 1'27 AQP ��F 0" AERAN0 z W NJ o: N2 W'S CRAM coo ��o= By: I. t'�'�- Original Certificate Date: ld -t f - 17 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory " Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheeL t - If more than 1 septic system is on the lot: COSA Checklist# 1 of Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Paradise Valley Block 4 Lot 2 Parcel ID: 020-411-10 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 5/3/1983 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 255 ft Cased to 28 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 5/3/1983 9/15/2017 Static water level 45 ft 'OD - 2 ft Well production 5.2 g.p m. • v`-f5 g p.m. WATER SAMPLE RESULTS Coliform N 'q colonies/100 mL Nitrate (.,Q•C1C1 mg/L Arsenic H ) ug/L Date of sample: 10121 rCollected by `-'1tD-1- v tC r- \WS B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 5/25/1 983 Tank size 1 500 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 9/25/2017 Pumper Northland Pumping _ C. ABSORPTION FIELD DATA Date installed 5/25/1983 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 SF/BDRM System type Deep Trench Length 54 ft. Width 3.5 ft Gravel below pipe 7.0 ft. Total depth 10-11 ft. Eff. absorption area 756 ft2 Monitoring tube Y Depression over field N Date of adequacy test 9/15/2017 Results (Pass/Fail) PASS* For 4 bedrooms Fluid depth in absorption field before test 60 in Water added 650 gal. New depth 72 in. Elapsed Time- 1 80 min. Final fluid depth 60 in. Absorption rate >= 600+ g.p.d. N Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements'? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS *System presoaked per engineer's bulletin. G. ENGINEER'S CERTIFICATION , �� 11 q� l I certify that I have determined through field inspections and �'0'�P • '9:42.9, review of Municipal records that the above systems are in # . • \ '. fo conformance with MOA COSA guidelines in effect on this date. •••••• ••- • r g Steven Pannone / • Engineer's Printed Name /r ▪.Steven R.�rannone Date 9/27/2017 ��• '• CE-8149 4j ski Vi PR r COSA canary sheet_2-6-15.doc • Municipality of Anchorage II , j_ Development Services Department : f:= Building Safety Division ' , On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Adv isory Certificate of On-Site Systems Approval # OSC 171462 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 4, Lot 2 of Paradise Valley subdivision. This inspection revealed a nitrate concentration of 6.99 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. Municipality Of Anchorage Development Services Department Building Safety Division . . On-Site Water_and.Wastewater Program 4700 SOuth Bragaw St." Box 1'96650 Anchorage, AK 99519-6650 www. ci.anchorag e.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERa. L' !NFORMAT!ON Location .(site address O~ directions) Cur~'eh't Prc~p&rty owner(s)':~' ~--~4. ,~ Mailin'g address ~,'~"Z o Day phone Lending agency. .. Mailing address " : , "' Day phone Real Estate Agent "· Mailing Address 'Unless otherwise, requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: ~ Day phone. 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 · .'I'-I · Community On-site r'-i Public Sewer [] The Municipality of Anchorage De~,elopment Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 .~re 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 vahdabon date shown below, I ven,fy that my investigation, based on procedures outhned m the Health Authonty Approval Gmdehnes for th~s apphcation, shows that the on- ' . site water, supply and/or wastewater disposal system is(are) safe, functional and adequ'ate for the number of ·bedrooms a~.d,.~p.e of structure indicated herein. I further verify that based on.the information obta'ined from the Municipality ~f~chorage files and from my investigation and inspection, the on-site water 'St. ip'~]y and/or · waste.~te~X';di~l~osal system is(are) in compliance with all applicable Municipal and State codesi'.~iinances, ~.nd ,r~g.uFat:i~)ns in effect at the time of installation. · ' '~;Na~eofFirm. /~'/¢,-~ ,,~ ,?',.(./~,Ic[.~v~or't ~,,'~-::,; .'. .Phone ~-~3~. DSD SIGNATURE /^pp ow or . Disapproved.,· . Conditional ·approval for bedrooms. Additional Comments Attachments: HAA Checklist Sel~tic System AdviSo~ Well Flow Advisory. (Rev. 01/02) X Maintenance Agreements Supplemental Engineer, s RepOrt Other Odginal Certificate Date:: ,~'-- I ~ -~:)/-/- Ad ';:Legal Description: Munigipality of Anchorage evelopment Services 'Department '~ ~.. 'Building Safety Division . . ! ' '! OniSit~ Water & WasteWate'rPr0gram ,.470OSouth BragawSt.- ,.. . i · P.O. Box 196650 Anchorage, AK 99519-6650 i : '~ www.~:i.anchorage.ak.us i (907) 343-7904 HEALTH AUTHORITY,APPROVAL CHECKLIST WELL DATA D~te completed -5'-/'>/~. ~' iTotal depth If Al B,.or C provide'PWSID # ~ ':Sanitary seal (Y/N) Y' Cased to 2-- °o ft. F~OM WELL LOG Date of test ' Static water level ft. Well production g.p.m. WATER SAMPLE RESUI .TS: Coliform (~ colorJies/100 mi. Arsenic: ~ mg./l~ SEPTiC/HOLDING TANK DATA .,Tank Type/Material . ~ J,--.-~ ~ Nitrate (-.P, ~ mD.II. Date of sa np e: ,,Tank size t ~o gal. FoUndation cleanout (Y/N)' ,..~_: Depression over tank (WN) /'%( 'ABSORPTION FIELD i::)ATA Length '~' ~ ft! Width -z~, ~ ff. Total depth/d'~f(' ft. Eff.~ absorption area ?~-C, ft= Monitoring tube . Date of adequacy test. '7//'~/O '~, Results (Pass/Fail) Fluid depth in absorption field before test C~ in. Elapsed Time:/X/'N'0 min. 'Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) 'z.~: in. Well Log (Y/N))"~' ~' Wires properly protected (YIN') Casing height (above groundl g.p.m. ; Other bacteria . ~/ c~lonie~/lO0 mi. Collected by: hl't ~' 'c' '.~; AT INSPECTION · Date installed 5"/"Z Cleanouts (Y/N), ~ ', Gravel below pipe ' ~.r~,, ;~ Ift/ ~/ Depression over field For ~ b~droom$ Water added ~o '~1 New depth in. ~bsorption rate >= /~0 ~' ~.p20,' ~ ~, If ye{; give date ~. 'Z D. LIFT STATION ' i ! : '. i ;~ ' ' : . ~': Date ~nstalled '~ ]:!IS~ze ~n gallons -f .,~,..,~. ~ess (Y/N) ' . "Pump on" level at ~~evel at' I 'in,. ~High water alarm level at Datum~ " ';.i'"' ~' "' les i~' ~sted ~'iii' ~ , ~ · ~li ~ Meets;" ~ alarm &'circuit requirements? E. SEPARATION DISTANcES~i';;:' ~` =' . .; i SEPARATION DISTANCES FROM WELL ON LOT TO: ~ ' :' ' :.!! O,nadjacentlots '. ' /~o ' on adja,cent lots / oOr ./,. . i' Publ c'se~e~imanhole/cleanout Septic tank/~l;-~.atqen-on Absorption field on lot Public sewer main Sewer )septic service SEPARATION DISTANCES FROM SEP~TIC/~ TANK 'ON'LO,T,.TO: Building~'oundation.___~_.~'t. I~...-"1~; .'Propertyl,ne,~o,~ i.. i !"I;:1': Absorpt,on field ater ; ;ll;,~ I1. ~ '.Water service hne~ ~'O ~ :, ~...,. Surface water /°°l"f"'L'l..~ ..v!; ~ ,' . . : ' We~s on adjacent ~ots - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:,i" ". ',;.. ~-O I ~ !:;', ~ ..... '~ ' ' ,. i~ Water main . Property/line ~. Water Service line Curtain '.drain /'w' F. COMMENTS adjacent ets ' .eu.~ .Iv'To,,,~ .,~,,. "'t'u G. ~ENGINEER'$ CERTIFICATION ~ ,:i , ": , I certify'th'at,I have deterrnined through 'd inspections one ~ [evie~/ ~f.,Municipa/ records that ~e.above systems are in ~, Conform~ncd with MOA H'AA' 'in effbc~ orJ' this date:: Engine'er's Printed Name'! te.~,l~el(l~t~¢~/~/i/f ~l;; i t ,[ ~arking/vehicle storageI ' HAA Fee Date of Payment Receipt Nt)mber · tne~. 12/01 Waiver~Fee $, Date' of Pa, ~em R C~ ~tNu ~b~r EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED 'F'/~ PLAT ARE NOT SHOWN .HEREON. P~J. / AS-BUILT NO CORNERS SETTHIS DATE / I hereby certify that I have performed a Mortgagee's' inspection ~"~""_:~/~..OE'- ~.,{.. ;'~ of the following described property: z..o 'F' ~ ~ ,, ~ =.~:~...~. improvemen~ situated thereon are within the pmpe~ lines and '~,~ ~,~ ~ h~. , .~'~ ~ .,? ~?~':. ~..~' thereto, that no improvements on pmpe~ lying adjacent thereto ~-',~.;,.~,.%~% [~ ~'~.~, ~'~:..~'...~:' encroach on the premises in question and that there are no ~,k[~..~..~,..~ .,. ,t. roadways, transmission lines or other visible easements on said ,%~;.~t. x~,~ prope~ except as indicted hereon. ~k~3~>, ~ ~r Dated at Anchorage, Alaska this,. ~ day of ~A t/ 20 ~ ~ FRED WA~T~ & ASSOCIATES ~ (907) 248-1666 Engineem and Suweyors MUNICIPALITY OF ANCHORAGE DEPARTME.T OF HEALTH A.D E.VIRO.ME.TAL PROTECT'O. DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (incl~¢e lot, block, subdivision, section, township, range). Location (address or directions) (b) Applicant'Name a/CEE' Z.~t.,J~ Telephone: Home -~4-~'"~":¢'/ Business (c) ,Ap:pl~cant is (~heck on~): ~en~mg Institution D; Owner/builder~; Buyer D; Other D (explain); (d) Lending ,nstitution~/~ Address .~-,:(e) Real Estate Company and Agent "~ddress Telephone Telephone (f), ,.~ail the HAA to the followin, · TYPE OF RESIDENCE t~J~ Multi-Family [] Bedrooms" :~ ' '~ "- ::'!:' ~"~,"~'". ' -- .? JPPLY Other IndividUal'Well~ Community [] Public [] : '~.,.!i:,~,~':,:'-::, . Noiei If c~)mmunity well system, must have written confirmation from the State Department of Environmental Conser~ati'on attesting to the legality and status, ' ' ' : :'" - Page I of 2 SEWAGE DISPOSAL Onsitet~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department 6f Environmental Conservation attesting to the legality and status. 72-025 (11/84) '5. ENGINEERING FIRM PROVIDI[~'~NSPECTIONS, TESTS. FILE SEARCH, D, ~ AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below. I verity 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 indicatee herein, t further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and nspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal ano State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~ Telephone Address .I¢~"¢~ ~ "~"~'~ '"'¢/'~" ~/~ ~' ~ Date ~ ¢ ? DHEP APPROVAL Approved for ~'~'~- ~') bedrooms by ~2~-~ ~' ~/~'~ ~ate Approved ~ Disapproved ~/ Conditi~hal .Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations § rven in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH EP 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 responsib e for errors or omissions inthe professional engineer's work. Page 2 of 2 72-025 [ 11/84) --, O~' ~C-~O\'~\$~I~NICIPALITY OF ANCHORAGE (MOA) .',~O~~'- _~ CHECKLIST - FEBRUARY 1984 ~ _ ~ ~ ~ I 264-4720 ~~ ~ Legal Description:~~ WELL DATA Well Classification Well Log Presentl/~N) Total Depth .X-~_.¢ ~C.¢sed~ Static Water Level ~J) Casing Height Above Ground Electrical Wiring in Conduit(~N) Separation D~stances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole /d//~ Water Sam pie Collected by Water Sample Test Results Comments i~)~),¢7.~ ,~ ~'~rS?'- ¢-/q"~'7, If A, B C, D.E.C. Approved (Y/N) Pat~ompleted ~'""-~"~' Yield ~) -'~'~' ~'~/~ Depth of Grouting Pump Set At ' Sanitary Seal on Casing ) Depresmon Around Wellhead (Y(~) ,/O ; On Adjoining Lots / /,¢0 ' ; On Adjoining Lots /~"0 To Nearest Public Sewer To Nearest Sewer Service Line on Lot B. SEPTIC/HOLDING TANK DATA Date Installed --~"~-~¢"-~"~ Size StandpipesCN) Air-tight Caps(~N) Depression over Tank (YI~ Pumping/Mmntenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /°¢'f/' No. of Compartments Foundation Cleanout CN) Date Last Pum peal ~;-~'~ ~:~ ~ ,~,//~ ;for /U//~,¢ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field (~ To Stream, Pond, Lake, or Major Drainage · Pag~ I of 2 72-026t11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'-~Z~5-- ~'~ Width of Field -~. ~' /5-0 Square Feet of Absorption Area 7-~' Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field ~'"¢ ~ Depth of Field /0 ~ // Gravel Bed Thickness 7 Standpipes Present,N) Date of Last Adequacy lest To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) ~)//~ D. LIFT STATION "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 Vent (Y/N) g Adequacy Test. Meets MOA Page 2 of 2 72-026 (i 1/84) ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ha~e~hec~ed., ve)-ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed~-~'~-f~ -¢ ~-'(--'/,~ ' ~ Date Company ~ MOA NO. Dateof Payment ~'~ ~ ? Amount: $ /~ ~ WORKORDER # : 2423 CHE~lL~8 REF ~ : '/409 DATE PROMISED : AUG 25 87 CLiENI : AECS ~EPORTS TO ~i : ANCHORAGE, AK 99503 561-5040 ' ~ ACC'F NO WO DATE LAB INSTRUCTIONS VIA Reoort PrinteD: AUG 24 B7 @ 0~:00 PURCHASE ORDER #: VERBAL SAMPLES RECEIVED RED # : ORDEREDBY SPECIAL INS~RUC ION~ ROUFINE SAMPLE COLLECTED 8-20-7 BY AECS, Chemlab Cilen~ ;'arameter REPORTS TO #2/ / / : AUG 21 87 AUG '2~ 81 HAND DELIVERED Sample # Samoie Description Matrix 1'o Test MetOoo units i L2, 84 PA~AO~SE VALLEt 1 20153-NITRATE-N APPLI(~'NT FILLSOUT UPPER HA[~"~ONLY ~ ' Zip Code Buyer ~ ~'t/~ Addreas ." Zip?ode Lending Institution t~7 ~ .... >'~Y ~ / ~' '~ ~ '~ /? ~' >''' Address Zip Code ? Phone Rea.y Co. & Agent ,X~ "' <- Address Zip Code Type of Residence [~.-5'l'rTg I e Family [] Multiple Family No. of Bedrooms [] Other Water Supply ~vidual ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. [] Community ~ ~-<.r~ ~ r~)'-~C') For we Is drilled prior to that date, give well depth (attach log if available). [] Public Utility ~' Sewer Oiapoeal ~ddual Year Individual Installed: [] Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date (~ Inspector Inspector Inspector Inspector ( ~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL < )~.s....ow~ /~ ¢~ ~ ~ ~ ~ ~ ~o.~.~o.~v....ow~ ' ~Y ~'~'~ ~ ~'~~"~~ Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received ~'" 8' ~ Well to Tank Septic T~k Size 72.023 (31~2)