HomeMy WebLinkAboutPARADISE VALLEY BLK 4 LT 13Paradise Valley Block 4 Lot 13 #050-411-21 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231139 PID Number: 020-411-21 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name TODD & LAURA ATWOOD ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 18230 NORWAY DRIVE, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot PARADISE VALLEY 4 13 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 Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line FtZ Ft. Well 100, __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1500 Gal. Surface Water 100'+ -- Material Number of compartments Lot Line 10'+ __ NA EPDXY STEEL 2 Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Tank insulated. Alarm location Electrical installed by Installer J RS PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1" 7/24/23 dates: 2"d 7/25/23 Location and description 3rd 4th TOP OF MH RISER ON -SITE WATER AND WASTEWATER SECTION APPROVAL -.."�►,t�t Conditional Approval: Date AW TH • '•••! "`••••;•' Septic System Approved Curtis Huffman % - Date �� ' 2 y ��c • CE 128991 �`/'� r�s'1 .. ,12/01/23 Note: this approval does not include well permit requirements. 1RCv u:J/uL/ 10) LOT 12 r176 LOT 19 %:%1,N%'%N t % _.: oF,A� �! �''.. 49 th / SCALE: 1 "= 30' �� •Elizabeth L. Walatka 8036 - LS • �,,,, "D r-- LOT 14 8342C LOT 17 RECERTIFIED 11-15-23LL t AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property:_ LOT 13, BLOCK 4, PARADISE VALLEY 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 Improvements 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 �ESStgNAt" „R this list _day of JULY 2p09. EASEMENTS 4F RECORD, OTHER THAN I THOSE SHOWN ON THE RECORDED t\!�FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON FB 23-3, pg 44 t ! "C - ij BE Engineers and Surveyors UNLESS OTHERWISE NOTED. DOWL, FB 09-4 58 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not arnstitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure of other improvements. This drawing shalt only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L, Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered. the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. PID:020-411-21 PERMIT O .( Garde CLF < � LOT 13 J L❑T 12 OSP231139 e� drlve*a> �oocl Grav / ret, / / Wall 910 FCO BM: MH TOP 100' WELL RADIUS BagL� JRs STAKED PRIOR IU TO CONST. a, Q L❑T 14 DECOMMISSIONED EXISTING S.T. & INSTALLED NEW C C 1500-GAL EPDXY SEPTIC TANK WITH NEW DCO. VERIFIED 5' DCO ®ID TO EXISTING FIELD & E aL DECK SUPPORTS. APPROX. �PS�ME EXISTING I(`( STAKED ESMT. APPROX. 100' WELL FIELD v\ Z L 1 Q PRIOR TO CONST. RADI. VERIFIED AT 1� q q CONST. 1 6 4c��10"E �LOT' 19 `\ N7 LOT 18 A—C=14,2' B—C=22,1' A—D=20,5' FCO Nco BM 99.47 Ut.V 95.69 B—D=30,4' INSUL A—E=23,2' 95.11 1,500-GALLON 4,94 B — E = 3 2 6' EPDXY STEEL TANK EXISTING FIELD , 5'+ SEPARATION VERIFIED AT CONSTRUCTION. SEPTIC SECTION SCALE, NTS PARADISE VALLEY B4, L13 PREPARED FOR: TODD & LAURA ATWOOD 18230 NORWAY DRIVE ANCHORAGE, AK 99516 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK@gmail.com APPROX. 100' WELL RADII. VERIFIED PRIOR TO CONST. LOT 17 �Urrur< I®�trcvl�ta r._®® ®OFAL4® 1 � * 9 TH* DATE: 12 j01 /23 SURVEY: WALATKA rtis Huffman /0 DRAWN: FWCS , CE 128991 # SCALE: 1" = 30, 12/01/23 � PAGE: 1 OF 1 ,FEsslo� MUNICIPALITY OF ANCHORAGE ��„ �„ r On -Site Water & Wastewater Program �o� '' PO Box 196650 4700 Elmore Road r Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite `.r Department On -Site Wastewater Disposal System Permit Permit Number: OSP231139 Effective Date: 6/15/2023 Work Type: SepticTank Upgrade Expiration Date: 6/14/2024 Tax Code Number: 02041121000 Site Legal Address: PARADISE VALLEY BLK 4 LT 13 G:3538 Site Mailing Address: 18230 NORWAY DR, Anchorage Owner: ATWOOD TODD & LAURA Lot Size in Sq Ft: 15331 Design Engineer: FIRST WATER CONSULTING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field Q 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: Date: 't✓ s -2, Z 3 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section '_ Fax: 907-343-7997 ON-SITE SEPTIC/VVELL PERMIT APPLICATION Parcel I.D. 020-411-21 Property owner(s) TODD & LAURA ATWOOD Day phone Mailing address 18230 NORWAY DRIVE, ANCHORAGE, AK 99516 Site address 18230 NORWAY DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) PARADISE VALLEY 134, L13 Legal description (Township, Range & Section) Lot Size 15,331 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 Septic Tank Q Upgrade M (w/wo ADU) Holding Tank E]Renewal ElDuplex (D) El Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ignature of property owner or authorized agent) Permit/Rush Fees: �_ Z 5 Waiver Fees: Date of Payment: Receipt Number: Permit No. 0 I e - Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! June 5, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: PARADISE VALLEY BLOCK 4, LOT 13 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. The existing steel tank is approximately 99-98’ to the existing well. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. We would recommend a 1500-gallon HDPE tank be installed for future consideration or flexibility. However, groundwater was noted in the MOA on-site file at 8’ and if groundwater is encountered during installation an epoxy coated steel septic tank may be required or an Infiltrator plastic tank to meet code requirements to groundwater and/or separations. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231139, Curtis Townsend, 06/15/23 FIRST WATER CONSULTING NOTE: VERIFY GROUNDWATER AT CONSTRUCTION & MAY REQUIRE A 1500-GAL EPOXY COATED STEELL SEPTIC TANK. MOA FILE SHOWS GROUNDWATER AT 8' PARADISE VALLEY B4, L13 DESIGN DETAILS: NOTE: VERIFY SEPARATIONS AT CONSTRUCTION & IF NEED BE INSTALL INFILTRATOR TANK, WAIVERS, ETC. INSTALL PER CODE. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231139, Curtis Townsend, 06/15/23 I (907)343-7904 Pump hsta 0aUan Log Well Drilling )Permit Number: SW Date of Issue: Marcel Identification Number:—220 -- `f i -� I Legal Description O V C. k_� L 1 Pump Installation Date: �L— Pump Intake Depth Below Top of Well Casing: �_ 0 feet Pump Manufacturer's Name: w j &C4 -cd Pump Model: `S,o C3 ( j ..._ % 512 Pump Size 1/.L hp Pitless Adapter Burial Depth: 16? feet Pitless Adapter Manufacturer's Name: Pitless adapter Installer: Well Disinfected Upon Completion? © Yes ❑ No Method of Disinfection: to Ifo, Comments: Property Owner Name & address: �.Ak/Z.4 47Z.J0016 VvI_ ANCHORAGE WELL & PUMP SERV. Pump Installer Name: 330 EAST 76THAVENUE ANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS.COM R Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. ®evelopmeni- Services ®epar$rnent Building Safely Division .1,1j On -Site Water adf Wastewater Program � rG :.../10 ' 4700 Elmore Road P.O. Box 196650 Mark Begich Anchorage, AK 99507 s a F T Y Mayor www.muni.org/onsite (907)343-7904 Pump hsta 0aUan Log Well Drilling )Permit Number: SW Date of Issue: Marcel Identification Number:—220 -- `f i -� I Legal Description O V C. k_� L 1 Pump Installation Date: �L— Pump Intake Depth Below Top of Well Casing: �_ 0 feet Pump Manufacturer's Name: w j &C4 -cd Pump Model: `S,o C3 ( j ..._ % 512 Pump Size 1/.L hp Pitless Adapter Burial Depth: 16? feet Pitless Adapter Manufacturer's Name: Pitless adapter Installer: Well Disinfected Upon Completion? © Yes ❑ No Method of Disinfection: to Ifo, Comments: Property Owner Name & address: �.Ak/Z.4 47Z.J0016 VvI_ ANCHORAGE WELL & PUMP SERV. Pump Installer Name: 330 EAST 76THAVENUE ANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS.COM R Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE w 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 NAME PHONEY NEW �/",p ..r _ / A-r -JJJ"' /.3 ❑ UPGRADE MAILING ADDRESS � � P/' LEGAL DESCRIPTION LOCATION NO. OF BED^R�OO�MS _J U DISTANCE TO: Well - Absorption area - Dwelling 10 PERMIT NO. ,50 1 o Y PZ Q ~ Manufacturer Mat�Pyri No. of corn art_ n0 P.v � rn Liq. caBpa,scity in gallons Inside length Width Liquid depth /' O r"cR IF HOMEMADE: � Y Well Dwelling PERMIT NO. J U Z DISTANCE TO: z Material Liquid capacity in gallons 2 h Manufacturer D w I DISTANCE TO: Well 110 Foundation Nearest lot line PERyyT NO. J w Z No. of lines Lengtho each I' Total length of lines Trench width Distance between lines F Z w /-, j0 inches a H Top of tile to finish rade Material beneath the n�p ' Total effective absorption area 0 _ ���� p'G inches Length Width Depth PERMIT NO. Lu a Q F- Type of crib Crib diameter Crib depth Total effective absorption area wa w w Well Building foundation Nearest lot line DISTANCE TO: J Class Depth F Distance to lot line PERMI W Building fo dation Sewer line_ Septic tank Absorption�rea(s) DISTANCE TO: I fl OTHER PIPE AMATERIALS t't .e-�-rI4 7> J ® SOIL TEST RATING [� 112.6 -P V- INSTALLE j A s p REMARKS OFe Aty�e©saS �V :4 ° s •e.pp j 1 es7 roT =5- y?a.ee e,eeuo c:>uo,eee ee• 7 e• a+. ee 4. ` 2225-E 1971 J NE 25, ��e.n.0 Y� <TTT <4 ae Ny Ax'O VgQ��#N.'t.VBA. H APPROVED �DDAATE LEGAL 4 ®� �,�; 7%z7 �� WELL LOG --1 Date Drilledr 6--10-55 Lot 13 Rzk. 4 paradis8 Valle}r STIM. Static Water Level 31 feet Gallons Per Minute 17 / Draw Down N/A feet Total Feet of Casing 67 Tyne Material Drilled: 0 feet Tito 35 Sand; dry <.rra.vol 3.5 feet to 40 i)an; sandy s;ravel. 40 fps-t to 60 Cl.ag 60 feet to 67 rr'avel. w/mater t0 to Hefty Drilling S.R.A. Box 1553 A `/G�j2 A�a��Ti°�qGF Anchorage, Alaska 'Pei 99507 v F/��C` 0� `\ / � PERMIT NO: DATE IGSUED: APPLICANT: ADDRESS: Poll ���A AIC C'"" :1 F"' L_ 311: Y �IF:7, Ith"11 11-1 1;!!::!!: !1:: IF DEPARTMENT OF HEALTH AND ENVIRONMENTAL 1 ROTEC1I8N 825 L GTRE�T; ANCHORAGE, AK �9501 264�4720 � ' 11 it -II- llmj�� ` 850100 ` 04/15/85 CONTACT PHONE: LEGAL DESi­ RIP: LOT SIZI:Z: MAX BEDROOMS: JEFFOREYFK Y` S 2246 f1AUOEST PLACE :IT -C ANCHORAGE, AK 99508 333-0913 ` ^ SUBDIVISION: VIALLEY SECTION: 11 TOWNSHIP: IN 15330 (SQ,FT" OR ACRES) LOT: 13 BLOCK: 4 RANGE: 3W Listed below are the op�ionsavailable to.yC)u J.r\ desi��ning your septic system. Choose�the option that best rits your site, . .... ..... ..... ..... ..... ������..... ..... ..... ��������... ..... ..... ..... ... ..... �..... .... �..... ���� DEPTH TO PIPE BOTTOM (FT"> 3,0 ** 2,0 ** ' . GRAVEL DEPTH (FT") O,5 2.0� TOTAL DEPTH (FT") 3`5' 4"0 . GRAVEL WIDTH (FT") 17"0 5.0 ' GRAVEL LENGTH (FT.) 34.� 53,0 GRAVEI VOLUME (CU"YDS,> 21,5 TANK SIZELS) 1,800"0 i::�OIL RATING (SQ`FT,/BR) 125 125 . ' ** DEPTH TO PIPE BOTTOM < 3"5 FT" REQUIRES INSULATION ** DEPTH TO PIPE BOTTQM < 40 FT. MAY REQUIRE A LIFT STATION ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ��_~�__��__�_~�~_~�__~��~~����_�--_.~ I certiT`y 1"� I am {amiliar !*ith the requirements �o� on~site sewers and wells �s set ` �orth by theMunicipality of Anchorage (MOA) and the State oJ Alaska" 2. I will iI tall the system in accordance with all MOA codes and regulations, and in ccmmpliance with the design criteria cif'this permit^ ' 3. I will adhere to all MOand State oF Alaska requir�ments ��r the�set back ' distances �rom any e:isting well� �astewater disposal system or public sewerage system on this or anyadjacent or nearby lot" 4. I un�erstand that this perm�t is valid ibra imum o| 3 bedrooms `nd any enlargement will requ�re an addit�[onal permit" ' IF A LIFT STATION I8 INSTALLED IN Al,,! AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PE�MIT AND I�SPECTION MUST BE OBTAINED; (2) AS~BUILTS WILL NOT BE APP�OVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND <3) THE ELECTRICAL ". SIGNED DATE: .���^ . _�_�_����~_�.+ _~^�~-_�__�~'_ APPLICA ISSUED ` ` ' ' DATE: ' ^ ` SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Je# 50- c �j DATE PERFORMED: 3 LEGAL DESCRIPTION: Pdlr(A ltSe VOL& O �UGL 1� Lty" 13 11 /1 g3 S�-iI �� I I SLOPE SITE PLAN 1 � 1lCy v I I 2 0 •' �' ('y�i`iy W) t.Q,zun San � t �rr`�l) O 4 5 L 6. a 7 0 8 G on 3121' �5 zxnJ 3/29195 9- 10 - WAS 10WAS GROUND WATERS 11 ENCOUNTERED? L O C1 P 12 IF YES, AT WHAT 13 DEPTH? dtfxl 3 Z8 FJ 14- 15- 16- 17 4151617 18- 19- T 819 T ZSLY C, G S`c/o Reading Date Gross Time Net Time Depth to Water Ne D PERCOLATION RATE (minutes/inch) CC ) �r7,m ,. '-JD TEST RUN BETWEEN g Sy`,(w-41(Y FT AND �-7 FT IZS Q'Ik. Pec-m/h'-nJ k?,= COMMENTS J6 rZ V ) Y, fk e k 6 t-Ls4jy,1 u Of re AuAi n l ^ l ay S e �iik a7 � PERFORMED v wuo (�,- 1 S`ra'i c2� CERTIFIED BY: DATE: 20 �� S PERCOLATION RATE (minutes/inch) CC ) �r7,m ,. '-JD TEST RUN BETWEEN g Sy`,(w-41(Y FT AND �-7 FT IZS Q'Ik. Pec-m/h'-nJ k?,= COMMENTS J6 rZ 6�� ) Y, fk e k 6 t-Ls4jy,1 u Of re AuAi n l ^ l ay S e �iik a7 � PERFORMED v wuo (�,- 1 S`ra'i c2� CERTIFIED BY: DATE: 72-008 (6/79) 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 FOR A SINGLE FAMILY DWELLING ciao-�(l(-al Parcel I.D. 050-411-21 COSA# 0,S t D Date: %- l 1. GENERAL INFORMATION Expiration c Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address PARADISE VALLEY S/D• BLOCK 4 LOT 13 18230 NORWAY DRIVE * ANCHORAGE, AK * 99516 JAMES & ANN SOUTHAM Day phone 770-6779 18230 NORWAY DRIVE * ANCHORAGE, AK * 99516 Day phone DONNA ORR W/ REMAX Day phone 240-7493 110 W 38TH AVE #100 * ANCHORAGE AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well E Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site E 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, t 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. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD, can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _(,z Approved for 3 bedrooms. Phone 337-6179 Date WATER AND Conditional approval for - bedrooms, with the following stipulations: WASTEWATER Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By. % r% Original Certificate Date: (Rev. 11105) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program c s 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 S/D; BLOCK 4, LOT 13 Parcel ID: 050-411-21 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N A Date completed 6/10/1985 Sanitary seal (Y/N) YES Total depth 62 ft. Date of test Static water level Cased to 62 ft. FROM WELL LOG 6/10/1985 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 6/11/2012 is Well production 12 g.p.m. 2.92+ g.p,m. WATER SAMPLE RESULTS: Coliform T colonies/100 ml. Nitrate 73 mg./L. Collected by: GEG, Ltd. Arsenic: A30 ug./L. Date of sample: 6/7/2012 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date installed 6/27/1985 Cleanouts High water alarm (Y/N) N/A Date of pumping 7/19/2011 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 6/27/1985 Soil rating (g.p.d./ft`or %drm125 System type TRENCH Length 56 ft. Width 5 ft. Gravel below pipe 2 ft. Total depth *6.1 ft. Eff. absorption area 400 ft2 Monitoring tube **YES Depression over field NO Date of adequacy test 6/11/2012 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 4 in. Water added 450 gal. New depth 19 in. Elapsed Time: 135 min. Final fluid depth 14 in. Absorption rate >= 450+ g.p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date **SUMP REPLACED WITH A CLEANOUT AND MONITORING TUBE. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot *99 On adjacent Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ 100' On adjacent lots **90'+ Public sewer manhole/cleanout N/A Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ ' Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS n �L *wR.4n9nn47_ **OFF ATTACHED WAIVER REQUEST. G. ENGINEER'S CERTIFICATION. i certify that t have determined through field inspections and* J. 4 review of Municipal records that the above systems are in •' • " conformance with MOA COSA guidelines in effect on this date. J 1 Engineer's Printed Name JEFFREY A. GARNESS 00�9s r Date 2 COSA Fee $ 646 Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Receipt Number Municipality of Anchorage 4 E s t ,o Community Development Department Development Services Division Er 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 Advisory Certificate of On -Site Systems Approval # 121238 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 13 of Paradise Valley subdivision. This inspection revealed a nitrate concentration of 5.73 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. NOR�P� APPROXIMATE CONFIGURATION \ \ OF DRAINFIELA PER ORIGINAL INSPECTION REPORT 90' WALNED RPON5 . HOUSE 100' WELL RADIUS P� qEC AP" 1� CLEANOUT DISTANCE FROM WELL TO CLEANOUT = 112.38', SHOT BY GEG. LTD W/ TOTAL STATION s/0� PB-pCK A Lj GARNESS ENGINEERING GROUP, Ltd p * : 4 T m -CONSULTANTS &GENERAL CONTRACTORS -ea...;:, .-gym, .:. .... ...... 3701 E 1000R RW, SME 101 a MCHOR40E. W( 99507 a PHONE (907)337-0119 • FM (907)338-3246 • KE n g meueng flngxem PREPARED FOR: PHONE NUMBER: PAGE NUMBER. •f i . . . . . . • • . ; .... JAMES SOUTHAM 907-770-6779 1 OF 1 Q f A. Gorn�ss: LEGAL DESCRIPTION: DRAWN BY: IJOe C 7 53 c�G PARADISE VALLEY S/D; BLOCK 4, LOT 13 A.J.G. O4fe '' TYPE OF WORK: DATE: 4�QOp fess% Qom WAIVER DRAWING 6/12/2012 O��JE 0p .� all/ / \ r � \> d ay / N O Oryvet &WJ (P.Garden N J A a+ ood ret, wall J O� � / m J A �' 23 4rGf'rigs d�a� ¢t m Bd�yo, � Wd m LOT 13 Ca LOT 12 LOT 19 ` IA -7A4 N7g°49'10 E LOT 18 OF A (,4s111 t♦I 49TH* 9 7e: LVaia;ka r Fa' NO. 3255-S ,: � _i \ E$$IOtL�� V1 ;71 7 -7.7-07 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. DOWL, FS 094, pg SB BE 8342C LOT 14 SCALE: 1"= 30' LOT 17 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's Inspection of the following described property: (OT 13. BLOCK 4. PARADISE VALY SUBDIVISION i7Cnchorage Recording Precinct, Alaska, and that the Improvements situated thereon are within the property lines and do not overlap or encroach on the property tying adjacent thereto, that no Improvements 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 21st day of JULY .2009 FRED WALATKA 6 ASSOCIATES Engineers and Surveyors (907.248-1666) 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.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. - 020 -`ill- 21 COSA # 0 q 0,i Expiration Date: a! - 0 q 1. GENERAL INFORMATION Complete legal descriptionFaraUistyc,4 91C__ Iz 9 Co} 13 Location (site address) (6230 Ahr�;;g Drive_ . Anc4xirnge, Ak 9951(o Current Property owner(s)-ellety)-Zi,n, fAMaCN - Day phone _ SYS-2619— Mailing address Jame — Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well K Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ L 15, 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 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. Name of Address Engineer's Printed Name Lis S�_jVuX'%A 5. DSD SIGNATURE V Approved for 3 bedrooms. Disapproved. Phone 179.3510, Date -7/Z4017 SOF ��ay, g7� 1 v IrJ % '•�L�•SPUR � jz5� Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Row 11105) Municipality of Anchorage Development Services Department Building Safety Division z On -Site Water & Wastewater Program '" "• 4700 Elmore 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: Paro lso VckN4 F&A Loi 13 Parcel ID: 020-4 II — 21 A. WELL DATA Well typeP�i�4c If A, B, or C provide PWSID # = Well Log (Y/N) Y Date completed =�=1 Sanitary seal (Y/N) Wires properly protected (YIN) Y— Total depth UL . ft. Cased to LI ft. Casing height (above ground) + 10 in. FROM WELL LOG Date of test 10 hies Static water level 31 ft. Well production la g.p.m. WATER SAMPLE RESULTS: Coliform _,01—colonies/100 mL Nitrate 5,9 mg/L Arsenic: NO ug/L date of sample:l5 0, B. SEPTICIHOLDING TANK DATA Tank Type/Material _b eeA bel Tank size 100 gal. Number of Compartments AT INSPECTION b fS 2co i I ft. g.p.m. Other bacteria —0—colonies/100 mL Collected by: _Lnos Sa42i?Inr� Date Installed 6 2T 85 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) At High water alarm (YIN) A/o Date of pumping 6 2 ?D01 Pumper TS� Puglnu S; V i e. C. ABSORPTION FIELD DATA Date installed 6 25 8 Soil rating (g.p.ddft2 o fP?bdrm 12`� System type SaIIaw Tunck Length Sb ft. Width 5 ft. Gravel below pipe Total depth .5 ft. Eff. absorption area eft' Monitoring tube Depression over field Date of adequacy test Iq '100 Results (Pass/Fail) P055 For i bedrooms Fluid depth in absorption field before test O in. Water added 500 gal. New depth_j_ in. Elapsed Time: k5 Final fluid depth in. r' Absorption rate >= 959 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) None Known If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) 'Pump on' level a in. -Pump oft' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & cir requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 94 1 Absorption field on lot ICOr+ Public sewer main N/A Sewer /septic service tine 25 + Animal containment areas MO, On adjacent lots 1W f- 1 On adjacent lots I OO it - Public sewer manhole/cleanout N Holding tank NSA Manure/animal excrete storage areas /V, 0. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I Building foundation 5 t+ Property line 5 + Absorption field 5 Water main 10+ Water service tine 10+ Surface water N,O, 1 Wells on adjacent lots 100 t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1 a Property line 10 1+ Building foundation 10 + Water main IJV A r Water Service line 2%1 t Surface water NO. Driveway, parkingtvehicle storage I D t r Curtain drain IVA Wells on adjacent lots 1,00 + F. COMMENTS G. ENGINEER'S CERTIFICATION �` 4, .,p QF A�qs 111 r A, I certify that I have determined through field inspections and review of Municipal records that the above systems are in 49H�os s. conformance with MOA COSA guidelines in effect on this date. Engineers CA ¢ I�.LARSERKLAhD.� g 1, �'• 't�tsa . � i Date COSA Fee $ Lf % O Waiver Fee $ /0 FID Date of Payment �— C%� `t Date of Payment %" 2-2 — 0� Receipt Number i g S 3 Receipt Number V (Rev. 11105) Municipality of Anchorage • Development Services Department j' 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 Advisory Certificate of On -Site Systems Approval # 90245 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 13 of Paradise Valley subdivision. This inspection revealed a nitrate concentration of 5.9 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. 00 / N66°'821"� ell OG�yve1 dfir ay Garden ,a ¢' cod reL �? / wall / >? � / m / / A (P ryp0 o tP � a O O O d O SAO %N 2. m Oaf cF _ ere m a LOT 13 Co LOT 12 i LOT 19 \ -4 SEM N76°49'10"E IA -7A4 LOT 18 OF At,, 11 l r CO11 '49TH .9 Fred lWalatka ISL}F . No. 3255.5 (� r 7-7-7-01 EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. DOWL, FB 094, pg 58 BE 8342C LOT 14 SCALE: 1"= 30' \ LOT 17 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagoe's inspection of the following described property:_ LOT 13, BLOCK 4. PARADISE VALLEY SUBDIVISION il(nchorago 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 Improvements 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 21st day of JULY .2009 FRED WALATKA 6 ASSOCIATES Engineers and Surveyors (907-248.1666) SPUTMand Engonc gong Environmental Consulting and Design July 29, 2009 Municipality of Anchorage Development Services Department Building Safety Division On Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519 Subject: WAVIER REQUEST PARADISE VALLEY BLOCK 4 LOT 13 18230 NORWAY DRIVE Ladies and Gentlemen: With this submittal we arc applying for a waiver of the 100 foot separation distance required between the septic tank and a private well. During the COSA review process it was discovered that the existing well to septic tank separation distance (measure from the well to septic tank standpipe) was 99.8 feet. According to the well driller's log, the well was drilled in June of 1985 and has a total depth of 62 feet, a static water level of 31 feet below the top of the casing, and a yield of 12 gpm. On June I V% 2009 the static water level was observed at 31 feet below the top of the well casing. Steady pumping of 500 gallons of water from the well at a maximum out put of 6.5 gpm caused a draw down of 7 feet. Water samples collected from the exterior hose faucet on lune 151h, 2009. Water quality analysis for bacteria, nitrate and arsenic showed 0 coliform or other bacteria per 100 ml, 5.9 mg/1 of nitrate -nitrogen, and below the detection limit for Arsenic. The existing septic system was installed in June of 1985. It consists of a 1000 gallon steel septic tank and a 56 foot long subsurface shallow absorption trench with 2 feet (effective depth) of sewer rock. A monitor tube extends only about 5 feet below existing grade. During an adequacy test, 500 gallons was added to the septic system. Prior to the start of the test, the fluid depth in the trench monitor was 0 inches and the maximum depth reached was 3 inches. After the flow was water was stopped, the fluid level dropped two inches in 95 minutes. Soil logs indicate the following site conditions: a layer of organics; clean sand, gravel and cobbles to a depth of 8 feet, with a clay scam from 4.5 to 4.8 feet deep. Ground water was observed at a depth of 8 feet on March 21 K 28, 1985. The well log records sand and gravel to a depth of 40 feet, clay from 40 to 60 feet, and water bearing gravel at 60 to 62 feet. 203 Nest 15'h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gei.net Environmental Consulting and Design Mitigating Factors: The well head is located up gradient from the septic tank. If the septic tank were to overflow, it would drain away from the well head, making surface Flow contamination from the septic system impossible. The water hearing strata is at a depth of 60 feet, beneath a 20 foot thick layer of clay. It appears that the water hearing aquifer is confined by this clay layer. The clay layer should protect the aquifer from subsurface contamination from the septic system. The existing tank was in place for 24 years and water quality samples collected on lune 15'h, 2009 meet minimum drinking water standards. Total coli form and other bacteria were not detected in the water sample collected from the well on the subject lot. A nitrate result of less than 5.9 mg/I was reported. Waiver Request: 99 feet from septic tank to well. Included for your review is a surveyed asbuilt showing the location of the existing drain field, the septic tank and the well, soils logs conducted in 1985, the well log, and water quality result from water samples collected on June 151h, 2009. If you have any questions or are in need of additional information, please contact me at 279-3916. Sincerely, Le"OSQ L�— Lars SpBrkland 203 %Vest 15'h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gci.net t Municipality of Anchorage 0 _Development Services Department On -Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW WR#: 090047 HAM 090245 Permit#: PID#: 020-411-21 Legal Description: Paradise Valley. Block 4. Lot 13 Engineer. Sourkland Engineering Applicant: Cheryl Zimmerman tent �0 ^n 4 Q n w t)CpJrtment Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 99 feet. This waiver approval applies to the existing septic tank to private well 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:/8 5/2009 Approved by < , 1 , Name of Reviewer ............................................................................... Rec#: 046853 Amount $1.050.00 Date Paid: 7/29/09 **** VARIANCEMAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 1 Application Date 152– at GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) G?9,Xz Va.Plt•c /ocl< 4- is-T%5Zw— Location (address or directions) 1\16r c a (b) Applicant Name ��' f /2 tis Telephone: Home 3 `iY Business 3o Applicant Address "2 0 No c,f _y r<')re , �,. G,w�h)'= J? /•; i Y/ h (c) Applicant is (check one): Lending Institution ❑ Owner/builder Buyer ❑ ; Other ❑ (explain); n e (d) Lending Institution t'�}� u t l�}, _ �J TelephoneC61 Address (e) Real Estate Company and Agent IN t KI Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Famil Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Wel Community 13 Public 11Note: If com unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: f community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 o _J 5. ENGINEERING FIRM PROVIDIN%x INSPECTIONS, TESTS, FILE SEARCH, Dr. jl AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional,pd adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm C C Telephone Address Date /o ~ 2- I 6. DHEP APPROVAL /n �� Approved for '3 edrooms by (yl Date Approved X Disapproved Conditional Terms of Conditional Approval Seal CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCH0000 %1 DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MO.y ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) 7 1 1985' CHECKLIST - FEBRUARY 1984 284-4720 t� Legal Description: � A. WELL DATA Well Classification o„'yes fit ^^ If A, B, C, D.E.C. Approved (Y/N) Well Log Present) Date Completed /r'> ) Y Yield C ' - Total Depth 6 1P_ Cased to Depth of Grouting —' Static Water Level 3 1 Pump Set At Casing Height Above Ground % Y2- Sanitary Seal on Casingf V) Electrical Wiring in Conduit) Depression Around Wellhead (Y/t Separation Distances from Well: To Septic/Holding Tank on Lot /oC> ; On Adjoining Lots G' i /00 j 9 To Nearest Edge of Absorption Field on Lot /1 b ; On Adjoining Lots ' T /0 D To Nearest Public Sewer Line _ To Nearest Public Sewer Cleanout/Manhole "—” To Nearest Sewer Service Line on Lot Water Sample Collected by 2Qr` ! ; Date 0- iel _8 s' Water Sample Test Results 4 Comments _-/' f'v r� ��a f � - �a ,� �7- l� •r� f a( ve.-, • c. B. SEPTIC/HOLDING TANK DATA Date Installed b"^ 't s'S Size /� No. of Compartments � Standpipes 6A) Air -tight Caps( ), Foundation Cleanout ON) Depression over Tank (Y16 Pumping/Maintenance Contract on File (Y/N) Date Last Pumped for Holding Tank High -Water Alarm (Y/N) Temporary moiomg IanK rermit (Tirv/ Separation Distances from Septic/Holding Tank: To Water -Supply Well L a To Building Foundation To Property Line /t> Su( -FA To Disposal Field !� To Water Main/Service Line Cz r f To Stream, Pond, Lake, or Major Drainage Course C t` LD C) Comments Ir JelVe;, f �^nom. ° refor7 Pagel of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata lkxf &S- 1 Type of System Design 60 Date Installed 6 - Z S Length of Field G Width of Field 6 Depth of Field 3 fir- 64 --If Gravel Bed Thickness Square Feet of Absorption Area Standpipes Presentd9N) Depression over Field (Y/R Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well A/C Yr To Property Line 13 To Building Foundation !S 4K To Existing or Abandoned System on Lot N H ; On Adjoining Lots C -,T 30 To Water Main/Service Line T (c7 To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course G T ro o To Driveway, Parking Area, or Vehicle Storage Area E7T.. S-0 Comments -r 4"0'46:�g _/6 D. LIFT STATION led Size in Gallons "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 - (Y/N) �`` RuWing Cycles during Adequacy Test. Meets MOA "' Check Permitted Bedroom Rating Against HAA Request'" I certify that a checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed a �?-��'`z'— = Date 149 Company f�r MOA No. S 1 Receipt No. J 512 lQ O of A4.����� Date of Payment 10- a l " A�••••••N•••0•'•0••9,0 Amount: $ i¢ b pft tn'r s Se'h. �, !e C. Reid, Jr. Page 2 of 2 sT••• ,IN*. 2251.1 72-026 (11 /84) 1LR HG i is J'it�