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PARADISE VALLEY BLK 4 LT 24
Onsite File Paradise Valley Block 4 Lot 24 #020-421-03 ii LL ii ° w ii N \ O LO LU CL o w z ,.yam co El m is a°i E > O o /mac iv - ';2 n cu o Q O zLn / N w L.. > > N -0 w c � /1 1 �• . z C C 7 C7 J ° c CO � cm ° O 0 6.�' ' W 0 L 0 o c ° 0 =1:3 L) z W �c c o � o .(0 J O �5 '�s lik � LL LL N p o rn o °' LLLI z za. w� o C; W a ❑❑ Q`� a c E iW- Q W w o E L1J LLIO LLJ LL LL i Z O lEl M c o c ® U' U)Y z cn J < o H o : c O~ CL X O f— LL i n w co c V W (n 1— ai CD �°, o s cn ® O O H Q = o a w U LU H Q m O d a) n m a= d w ~ U z Q c `° a) a.a Q� CO Z z ~ 0❑ 0 0 3 `° � Ye m m Q o o LL z W U Z O cu ) o❑ to Of w � m > z� Q' D E z° Q coo W � 3 a � Q o i H LL 2 .J W 2 a d m O �, + LO m H n m a co v c6 n , E ° J U) N z W — -0 W p o c a' ❑ mCN �N ° F- Q a) Q `o a) u) o H (c a W W w N� L z m�' .� N Q C Z p ❑ = � -' N L v O co U C/)o Z Q `) C) >, zLLI Q U o W CL Co z J O H LL a CL cu a U)i_� LL O U �'a. 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Q PCI Q M Q Pel — CD Q LL - Q Cn MUNICIPALITY OF ANCHORAGE l�zcnt 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 M Department On -Site Wastewater Disposal System Permit Permit Number: OSP241036 Effective Date: 3/27/2024 Work Type: SepticTank Upgrade Expiration Date: 3/27/2025 Tax Code Number: 02042103000 Site Legal Address: PARADISE VALLEY BLK 4 LT 24 G:3538 Site Mailing Address: 6422 ITALY CIR, Anchorage Owner: JOHNSON INGRID DIANE Lot Size in Sq Ft: 12715 Design Engineer: FIRST WATER CONSULTING Total Bedrooms: 2 This permit is for the construction of: ❑ 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: r✓J �— Date: Issued By: Date: ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020-421-03 Property owner(s) INGRID JOHNSON Day phone Mailing address 6422 ITALY CIRCLE, ANCHORAGE, AK, 99516 Site address 6422 ITALY CIRCLE, ANCHORAGE, AK, 99516 Legal description (Sub'd., Block & Lot) PARADISE VALLEY BLOCK 4, LOT 24 Legal description (Township, Range & Section) Lot Size 12,715 Sq. Ft. Number of Bedrooms 2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Septic Tank ® Upgrade (w/wo ADU) Holding Tank ❑ Renewal ❑ Duplex (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. (Signature of property owner or authorized agent) Permit/Rush Fees: 2 Z Waiver Fees: Date of Payment: Receipt Number: Permit No. 036a Y 103 C Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com ! !! March 21, 2024 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 24 The owner has requested that we obtain a septic permit to upgrade the existing aged steel STEP septic tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank per the attached design to serve the existing 2-bedroom residence. The recommended 1500-gallon HDPE STEP tank be installed for current functionality and future consideration or flexibility. No groundwater was noted in the MOA on-site file, but if groundwater is encountered during installation an epoxy coated steel septic tank may be required. The lot and area are served by private water and any encroaching wells, easements, existing field … must be staked prior to construction to verify separations. 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 OSP241036, Curtis Townsend, 03/27/24 FIRST WATER CONSULTING PARADISE VALLEY BLOCK 4, LOT 24 DESIGN DETAILS: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241036, Curtis Townsend, 03/27/24 Municipality of Anchorage .. Page I of ~-" DEPARTMENT OF HEALTH AND HUMAN SERVICES " ENVIRONMENTAL ~ERVICES DIVISION " P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~'~Jc~40~.~(~ PID Number: Name: Wastewater System: c New ~Upgrade Address: ABSORPTION FIELD n~ .... No. of Bedrooms: '~O~-., ~ ~/~ ~ ~ DeepTrench ~ Shallow Trench ~'Bed ~Mound ~ Other Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION ¢,~ GPD/Sq. Ft. Lot: Block: Subdiv~ion: Depth to pipe bosom from original grade: Gravet depth beneath pipe Township: I Range: - ' I Section: ~ Fill added aboveoriginaIz.~ grade:~ ~,~ Ft. Gravel length: ~/~ Ft. I I WELL: ~ New ~ Upgrade Gravelwidth: Number of lines: Distance between lines: /~ Ft. ~ ~'~ Ft. Classification (Private, A,B,C): ~/~ Total Depth: Cased To: Total absorption area: Pipe material: ~/V~ ~ Et, /?~ Ft. ~ SQ. Ft. Driller:~/ Date Drilled: Static Water Level: installer: Date installed: Yield: Pump Set a~ Casing Height Above Ground: ~ GPU ~11~ ,t. /, ~. TANK SEPARATION DISTANCES D septi~ ~ Holding AS.T.E.P. To Septic Absorption Lift Holding =ublic/Private Manufacturer: Capacityin gallons: From Tank Field Station Tank Sewer Lines ~C~O~ ~A Material: Number of Compa~ments: Su~e ,~ , ,~ LIFT STATION Water /~ /~ ~ /~ Lot ~ / ~ ~ Size in gallons: Manufacturer: Line ~ ~ ~ /~0 ~~ "Pump on" level at: "Pump off" level at; High water alarm at: Foundation ~ ~ ~ ~ / /~ ~ /~' ~ ~ ', Pump Make& Mbdei ~ Electrical Insp~{~s pedormed by: Cudain ~O~ E Drain - ~E/ ~ ~ ~' ~ BENCH MARK Remarks: ~/V~ ~ ~ ~7 Location and Description: Assumed Elevation: Inspections performed by: ..:~- m... ~;,~. ~ Dates: 1st/o - / - ~9 Department of Health ~n~Human S~ices approval Reviewed and approved ~- ~'~.~ ,~ ~r~.~... Date./~, 72-013 (Rev. 9/91) MOA25 Permit No.Sw940336 Page 2 of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description.ARADISE VALLEY, BLOCK 4, LOT 24 PID No.: 02042105 i;~ i 102 8' i i (~T~&--~ i/ ~io3.9' fl 1~1 7'~ ~ / f X ~ m~U~T~O~ ..................... N,.T-,S;- .......................................................................................... ~ .......................................... ~ .......................................... :::: .................................................................................... i 90.0' :: NO WATER FOUND · PR~SS~R~ DISTRIBUTIO~ 5'P/L 1250 GAy. S.T.E.P. WELL SCAL~ 1" = 40' i i LOT 24 ROBERT C. COWAI~ CE-8801 72-013A (1/93) 10/24/1994 10:16 907594121! S AND S ENGINEERING PAGE 02 /' ........ ~'n~ ~ .~.,.,.~ ....... '*" '"'" ~z~o~ ~UNIC~PAL~y OE ANCHOrAGe, BLI~L~ING ~A~C~y B]:VI~ON ~500 ~',~ TUOO~ ROAD TN~PCC?ION~ (907)~G~-~464 IN~O~NATI~'N (907>"~" 7,,b~ 8,.,,1 ) AB~I~8~;: 6~2~ ITALY D~ PEI~MIF $; ' ........ , PHONE f: 563,-2~00 i,O~: 24 [~LOCK; ~ ~ll[:~:' PA~ADICE V~LL~Y BA:fII: COMNGN~: 34G-lSGO 4:00 OR AFTER CALL ABOVE TO CONPIEEM TYPE OP INCP~CTIOt~: ~L~CT~ICAL ROUGH 0 0 0 0 ~O NONCOHPLIANC~ OB~RVCD ~ ~ CO~CTION~ E~G~NTZAI. A~:; ........ PAGE 1 OF 1 DEPONENT OF HEALTH ~ H~ SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502~ ~CHO~GE, ALAS~ 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940336 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:LONG WILLIAM W & OWNER ADDRESS:6422 ITALY CIRCLE ANCHORAGE, AK 99516 DATE ISSUED: 9/06/94 EXPIRATION DATE: 9/06/95 PARCEL ID:02042103 LEGAL DESCRIPTION: PARADISE VALLEY BLK 4 LT 24 LOT SIZE: 12715 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4~ FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: WAIVER NO. WR940047 ISSUED 9/6/94 GRANTE A 80 FT WAIVES FROM THE DRAINFIELD ON LOT 24/~O THE WELL ON LOT 23, AND A 5 FT. LOT LINE WAIVER. / /. //, / l RECEIVED BY: I/~ 1~ DATE: / Rick Mystrorn, Mayor MtmiC pality of Anchorage Department of Health and Human Services 825 "L" Street P,O. Box 196650 Anchorage, Alaska 99519-6650 September 6, 1994 Robert A. Shafer, P.E. S & S Engineering 17034 North Eagle River Loop Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for: Lot 24; Block 4; Paradise Valley Subdivision Waiver Approval: #WR940046 Dear Mr. Shafer, Your request for waiver of the required 100 foot Horizontal separation of a septic system to a private well has been approved. The approved separation distance is 80 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Your additional request, for waiver of the required 10 foot separation between a septic system and a lot line, has been approved. The waived distance is five feet. This approval applies to the existing septic system lot line separation only..Any future upgrade to the septic system will require all separations to be met or another approval from this department. Robert W. Robinson Acting Program Manager On-site Services. Ijm:#6 ~ MUNICIPALITY OF ANCHORAG~ Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR%WR940047 PID# 020-421-03 HA% Date Received: 09-02-94 Legal Description: Lot 24; Block 4; Paradise Valley S/D Permit ~ ~0 ~ Engineer: Robert A. Shafer, P.E. S & S Engineering, 17034 North Eagle River Loop, Suite 204 Applicant: Long William W. & Lomax Doreen Ann Cri~e-~ia: 1. Geology: > A. Water Table (~4%1 Points: B. Soil Sorption ~,~ C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions, "7~' "-/~/~.¢{ ¢J'¢ Waiver is Granted: ~ Waiver is NOT Granted: List Conditions or Reasons for above: Date: Rec %: 00248 Amount: $ 920.00 Date Paid: 9-2-94 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOiL TEST PERCOLATION TEST STRUCTURAL & ,MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN August 17, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Municipality of Anchorage 825 L Street P.O. Bo× 196650 Anchorage, Alaska 99519-6650 REFERENCE: Paradise Valley Subdivision, Block We request you issue a waiver for the horizontal separation distance between the proposed leachfield located on the referenced property to the private well located on' the adjacent lot 23, block 4, Paradise Valley Subdivision at 80 feet. We believe the above stated waiver should be granted for the following reasons: The well log indicates there is confining bedrock from 224 feet to 368 feet. The bedrock will prevent a subsurface migration into the aquifer. The well log also indicates the well is 368 feet deep with a static water level at 242 feet. This is a deep aquifer with little chance of contamination from the proposed septic system. The land slopes frOm the well to the proposed septic system. This would prevent any surfacing effluent from reaching the well. We also request you issue a 5 ft. property line waiver. As can be seen on the site plan we feel this will have no affect on the adjoining lots. If we may be of further service, please contact us. t A. Shafer, P.E. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA99577 0 om~O F Z W ~l¥Og ,0c3 = ,,~ q -'IIVI3(]/NOIIO3S-X I LL~ O~-SITE WAST~WA'£~ DISPOSAL S~ST~ CONSTRUCTION PRACTICES and MA'£~:~eIAL SPECIFICATIONS REFERENCE: Paradise Valley Subdivision; Block 4; Lot 24 1. The scope of this project includes the installation of a 1250 gallon septic tank effluent pumping (S.T.E.P.) system and a pressurized absorption bed to serve the two bedroom residence located on the referenced property. The existing 1000 gallon septic tank is to be excavated, pumped, crushed, and abandoned in place. The existing leachfield is to be abandoned in place. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANKINSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page Two Paradise Valley Subdivision; Block 4; Lot 24 July 28, 1994 4o Septic tanks installed with less than 4' of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10' from the tank. The firstcleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. PR~q[~RIZEDM0[~]D~YSTEMINSTALLATIO~: 1. Any peat or organic matter must be removed from the elevated mound site. 2. The bottom of the basal bed area as well as the top of the sand filter is to be within two inches of level. 3. The distribution piping is to be of P¥C (ASTM D3034 or equal). All joints are to be solvent cemented. 4. The side slopes of the top layer of the mound system must not be steeper than 33% (3:1). 5. The top of the mound shall be covered with a minimum of 6 inches of topsoil and vegetated sufficiently to prevent erosion. 6. The distribution pipes are to be embedded in sewer rock. Care should be taken to backfill in such a way as to prevent damage to the piping system. 7. Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 8. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. MINIMUM MA'£~eCu%LSPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. Page Three Paradise Valley Subdivision; Block 4; Lot 24 July 28, 1994 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: e e Se Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the ~200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. Page Four Paradise Valley Subdivision; Block 4; Lot 24 July 28, 1994 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PER FORM E D FOR: ~ /...~-~t"* LEGAL DESCRIPTION:~:~3"{- ~1~ / ~L~I"//~')/,.~l~ ~AY.~Towns~ip, Range, Section: SLOPE 1 6~ 7 8 9- 10 WAS GROUND WATER ENCOUNTERED7 11 S L IF YES, AT WHAT ~ O DEPTH? p 12 E Depth to Water After 13 - Monitoring? Date: 14- 15- 16- 17- 18- SITE PLAN 19- Gross Net Depth to Net Reading Date Time Ti[ne Water Drop ; ~.:~ [ ,~ ,, e ~ " I" 20- PERCOLATION RATE tu (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN .~FT AND 3 FT 1703.4 Eagle River Loop Eea~ No.~ ,~ _ .~. ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN~~N THIS DATE. DATE: 72-008 (Rev. 4/~) ¢~ 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 ¥'~' ~ (-.~ ~'N EW NAME ~O.~'~-/~ ~ -- ~ ~ ~ ~--~ / ~ UPGRADE MAILING ADDRESS LOCATION NO. OF BEDROOMS DISTANCE/TO: Well~o~ J'Q Absorption area ~__ /~ ~ ~ Manufacturer No, of compartments ~ ~ Liq. capacity in gallons inside length Width Liquid depth / O~O IF HOMEMADE: Well Dwelling PERMIT NO. ~D~ DISTANCE TO: O ~ ~ Manufacturer Material Liquid capacity in gallons ~ DISTANCE TO: ~o'~ /"~ /O ~ --. No. o~ ~in.~ ~ L~g~h ~i ~,~i.~.. ~ Tot.~ ~..gth o~ ~m~ T~..~h ~idth Distant. b~tw~.~ ~ Z//~] ~/~" /~O ~Oinches T°tal effective~9~i°n a~a ~~ ~ ~ Top of tile to finish grade/ ~ - ~ / Material beneath tile 6 inches ~ Length Width Depth PERMIT NO. O ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ ;lass Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER SOILTESTRATING/ ~O ~f//~ pb INSTALLER J,! R EMAR KS Q 6~, L / Certified Well LOt 24, Bk. 4, ~aradise Valtay LocaQon(. ............ ....: :: ................................ ..._ ..................... - .................................. Date completed ....... :..i.J?~.~, ~.., ~ ~.... ].9..8..4... -- 2 2 4 Fee ~ MUNIC~PALITY Depth 0f Wel! ........... L_; ........................................................ DECT.,.OF..MEALTH &. ENV RONMENTAL ~ ~;.': :; "i~ .......... U: ....... ~ .............. Fe e.t PERMIT NO: DATE ISSUED: PIki~ I ,:: I ~ ~L I T~r' OF A~OH·. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 9950t 294-4'720 ,:~ l'-.i -- =-'=;.-. T TE SE~-IER .~: ~.JELL PER~I I T 8402_~.5 ENGINEERED DESIGN 05,.~04..-'84 APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: A. E. C. S.' 1200 W. ~ AVE, SUITE B ANCHORAGE., AK ~-q. 50:< 56i-5040 SECTION: ti .... TOWNSHIP: %27~5 (SQ. FT. OR RCRES) I CERTIFY THAT: t. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) 8ND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. ~. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY E~ISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUIL[:,ING CODES, THEN (i) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT RN ELECTRICAL INSPECTION REPORT.~ AND (-~) THE ELECTRICAL WURK MUST BE DONE BY A LICENSED ELEE. TRIUIAN SIGNED DATE: APPLICANT: A.E.C.'- I .... UED DATE: ' . ~JUNICIPALITY OF ANCHORAGE ~ Depa~tment.~' '~ Health and Environmenta.r ~rotection 825 h Street, Anchorage, AK. ~501 , , ' 264'4720 · * * * HANDWRITTEN PERMIT * * * Permit ~ ~ ON-SITE SEWER PERMIT Applicant: ~~ ~~ ~'~ Mailing Address: Location: ~~u~I ~/C' ~d ~ Phone Number: ~--~D . Legal Description: ~ (~$~~,~ ~//-~ Lot Size: Type of Soil Absorption System Is: ~ //;~' /T//~/ Trench: Drainfield: Seepage Bed': X Holding Tank: .--~---/-- . Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Size of the Soil AbsorPt~n System Is: ' DEPTH LENGTH _ ~' . GRAVEL DEP~'H ' WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = _/~d GALLONS * * 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. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * 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 disposal system is 100 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 a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ 1 9 8,m{-* * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the ~esi dense Ls r~modeled to include more that 3 bedrooms. signed: ////~.~,,J~//~/C/~. issued by :/~_~'/~-~ ~pp l~.t - ' Date: ~<'/~/~ SWP/024 (1/St) ALASKA ENVIRONI~_~/rAL CONTROL SERVICES, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-1361 Jos.,~ ~ ~ · SHEET NO. ~ CALCULATED BY -~ CHECKED BY SCALE DATE DATE ~.'~-...i..~~..~ ..... ~~"~....i..~'-~-~...i: ............ i ................. :...i .......... ! ........... i .......... ! .......... i ............. i ................... ~ ~~,.., = ~ ~~~ .... i' .......... ........ i ~ i i.._.: i ...... .......... .................. :::::::::::::::::::::::::::::::::::::::::::::::::::::::::: t~h~. ~. ~.~~,m~[ ........ ~ ~ ...... ~ .......... ~ ~ ~ :~ } ....... ~ ........ ~ ....... ~ ........ ~ ....... ~ ............. ~ ~ ~..~ ..... : ........ ~ ......... ~ ........... :.~:.~ ~ ~ ~ .......... : ........... ~..~..~.~ ......... ~...(~ ~ ~.~ }~ ~ ,......~ (~ ~.~~..~.5(~ .......... ~ ~.~.~ ................ .... ~ ¢ ~. ~.-: ....... ?.........~ ~.......~ .......... ~ .~ ~ ~ ..... ~ ........... ~ ~ ............. ~ ....................... ~ ........... ~ ............. ~ ......... ~' ALASKA ENVIRONIV, ~'AL · CONTROL SERVICES, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-1361 JOB o~ .~ OATE~ CHECKED BY DATE SCALE ALASKA ENVIRONM~ ,TAL · CONTROL SERVICES, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-1361 JOB SHEET NO. ~ CHECKED BY. DATE ALASKA ENVIRONI~,.. ,TAL · .CONTROL SERVICES, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-1361 JOB. CALCULATED BY . DATE CHECKED BY DATE SCALE ALASKA ENVIRONI~ iTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-1361 JOB SHEET NO CALCULATED S¥ C~ECKEO BY SCALE DATE ALASKA i IiUIROFlmI rITAL COFITROL $1 RuICI $, IRC. J~n§in¢¢rJn§ ~, ~nuironmcr~tal Stuclics SPECIFICATIONS FOR ELEVATED MOUND DRAINFIELD SYSTEM - LOT24 BLK 4, PARADISE VALLEY SUBDIVISION 1.0 GENERAL 1.1 THE DRAWINGS SHALL BE A PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE, THE CONDTIONS OF THE PERMIT, AND ALL APPLICABLE RULES AND REGULATIONS CURRENTLY IN EFFECT. 1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE VERIFIED OR MODIFIED IN THE FIELD BY THE ENGINEER. 1.4 IT IS THE RESPONSIBILITY OF THE OWNER OR INSTALLER TO OBTAIN ALL NECESSARY PERMITS, EASEMENTS, OR WAIVERS REQUIRED FOR INSTALLATION OF THE SYSTEM. 1.5 SOIL CONTINUITY: DIG ADDITIONAL SHALLOW TEST HOLES PRIOR TO EXCAVATION OF THE BED TO ENSURE CONTINUITY OF THE 2 FOOT GRAVEL SEAM INTO WHICH THE SYSTEM IS TO BE PLACED. THIS IS STRICTLY PRECAUTIONARY, TO ENSURE THAT THE SYSTEM CAN INDEED OPERATE PROPERLY AND TO AVOID UNNECESSARY EXCAVATING EXPENSES SHOULD THE AREA PROVE UNSUITABLE. 2.0 SEPTIC SYSTEM 2.1 THE SEPTIC TANK SHALL BE A UPC APPROVED TWO COMPARTMENT TANK, SET LEVEL, AND INSULATED WITH AN OVERLYING LAYER OF 2" BURIAL TYPE POLYSTYRENE. THE SEPTIC TANK SHALL REST ON UNDISTURBED SOIL. 2.2 INLET AND OUTLET PIPING SHALL BE FITTED WITH WATER- TIGHT CALDER COUPLINGS. PIPING SHALL BE 4" SOLID PVC SLOPED A MINIMUM OF 1/4" PER FOOT, WITH A MINIMUM OF 4 FEET OF COVER. IF LESS THAN 4 FEET, USE 1" OF POLY- STYRENE FOR EACH FOOT OF COVER LESS THAN 4 FEET. 2.3 CLEANOUTS SHALL BE INSTALLED WITH CALDER COUPLINGS, CAPPPED WITH AIR-TIGHT JIM-CAPS (OR EQUIVALENT), AND EXTEND A MINIMUM OF 3 FEET ABOVE GROUND LEVEL. 2.4 THE SEPTIC TANK SHALL BE A MINIMUM OF 5 FEET FROM THE HOUSE FOUNDATION, AND HAVE A MINIMUM OF 5 FEET BETWEEN THE LIFT STATION AND THE DRAINFIELD. 3.0 DRAINFIELD SYSTEM 3.1 THE GRAVEL FOR THE BED SHALL BE SIZED BETWEEN 0.5 TO 2.5 INCH AND FREE FROM SILT OR SAND. 3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL BE PLUS OR MINUS 2" WITHIN LEVEL. 3.3 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL. 3.4 TWO OBSERVATION PIPES SHALL BE PLACED AS SHOWN IN THE DRAWINGS. IT SHALL BE RIGID PVC, ASTM 3033 D-3034. THE SECTION BELOW GROUND LEVEL MAY BE EITHER DRILLED 0.5" 1200 LUcst 33rcJ Au¢,u¢, Suil¢ E~ · Anchorcl§¢, Alaska 99503 · [907) 276-1361 HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A REGULAR SECTION OF PERFORATED DISTRIBUTION PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL) SHALL BE PLACED ON THE TOP THE PIPE. 3.5 THE GRAVEL SHALL BE COVERED WITH A LAYER OF UNTREATED BUILDING PAPER OR A NONWOVEN FABRIC (SUCH AS MIRAFAR FIBRETEX 200 GRADE, POLY-FILTER X, OR EQUAL.) 3.6 IF INSULATION IS U~ED RATHER THAN MOUNDED BACKFILL, THE INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM BOARD OR ARCO GEOFOAM EMBANKMENT INSULATION BOARD OF THE REQUIRED THICKNESS (1" PER FOOT OF SOIL LESS THAN 4 FEET OVERLYING THE BED). 3.7 THE TOP OF THE BED SHOULD BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX, OR BLUEGRASS. 3.8 IT IS CRUCIAL THAT CARE BE TAKEN IN CONSTRUCTION OF THE BED TO ENSURE PLACEMENT INTO THE PROPER SOIL STRATUM FOR PROPER OPERATION OF THE SYSTEM. ALASKA e[IUIROnmellTAL COF1TROL $1 RUICt $, IIqC. SPECIFICATIONS FOR LIFT STATION: Lot 24 Block 4, Paradise Valley Subdivision 1.0 THE LIFT STATION 1.1 THE STOCK MATERIAL FOR THE LIFT STATION SHALL BE EITHER GALVANIZED STEEL (ASTM A-4444-76), OR ALUMINUM CULVERT, CAPABLE OF BURIAL TO 10 FT. 1.2 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WELDED AND WATER TIGHT. ALL WELDS SHALL BE CLEANED OF SLAG. WELDS ON GALVANIZED STEEL WILL BE SPRAYED WITH ZINC RICH PAINT OR COATED WITH BITUMASTIC. 1.3 A MANHOLE ALLOWING ACCESS TO THE LIFT STATION AND ITS COMPONENTS SHALL BE PROVIDED. THE TOP CAP SHALL BE RAIN TIGHT AND SECURELY FASTENED WITH SCREWS. A TWO INCH LAYER OF POLYURETHANE FOAM SHALL BE GLUED TO THE INSIDE OF THE TOP CAP. 1.4 ALL ELECTRICAL FITTINGS AND CONNECTIONS IN THE LIFT STATION SHALL MEET THE REQUIREMENTS FOR A WATER TIGHT SERVICE. 1.5 THERE SHALL BE A HIGH LEVEL ALARM,PEABODY BARNES 6147 OR EQUAL SET AT THE LEVEL OF THE SOIL PIPE FROM THE SEPTIC TANK. THE BUZZER SHALL BE LOCATED NEAR THE ELECTRICAL CONTROL PANEL OR IN A LOCATION DESIGNATED BY THE HOMEOWNER. 1.6 THE SUMP PUMP SHALL BE CAPABLE OF DELIVERING 10 GPM AT A HEAD OF 20 FEET. 1.7 PROVIDE A CALDER COUPLING AT ALL CONNECTIONS TO THE LIFT STATION. 1.8 THE PUMP SHALL BE CONTROLLED BY A DIFFERENTIAL MERCURY FLOAT SWITCH, ADJUSTED TO ALLOW A TWO FOOT SPAN BETWEEN 'ON' AND 'OFF', AS SHOWN IN THE DRAWING. ALL RELAYS AND ELECTRICAL CONTACTS SHOULD BE LOCATED OUTSIDE THE CHAMBER TO PROTECT THEM FROM CORROSION, PREFERHABLY IN A DRY LOCATION WITHIN THE HOME. 1.9 MOA BUILDING CODES: WHEN LIFT STATIONS ARE INSTALLED WITHIN THE MUNICIPALITY, AN ELECTRICAL PERMIT AND INSPECTION ARE REQUIRED. IN AREAS NOT COVERED BY MOA BUILDING CODES, THE SYSTEM SHALL BE INSPECTED BY A LICENSED ELECTRICIAN TO INSURE THAT THE ELECTRICAL INSTALLATION IS IN ACCORDANCE WITH APPLICABLE CODES AND REGULATIONS. 1200 LUcsl 33rd Aucnue, Suite ~ · Anchordq¢, AlaskQ 99503 · {907) 276-1361 MUNICIPALITY OF DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION' 825 L Street, Anchorage, Alaska 99501 264-47~' SOILS LOG - PERCOLATION TEST~ PERCOLA~IO~ TEST PERFORMED FOR: · _ . ~lr~ DATE PERFORMED: -- NJ- SLOPE !1 III II1~ I!I : I// Vt Ii 1 2 3 4 5 6 7 8 9 10- 11- 12 13 14 15 16 17 18 19- 20- Gros~ [ Net Depth to ~ Nat. Reading Date Time I~Gt vt. Water Drop Time [ O WAS ~ROU.D WATER ENCOUNTERED? ~O E IF YES, AT WHAT DEPTH? r~L ~lc,_~ , han:t PERCOLATION RATE . ~ , ~ , Iminutes/inch} TEST RUN BE'rWEEN AND ~'* ¢'~'''" PERFORMED BY: [/~ I"~..~ ~ CE PERFORMED FOR: LEGAL DESCRIPTION: 3 4 5- 6 7 8 9 MUNICIPALITY OF ANCHORAGE ~..e u,,iI('~PALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVI RONI~IFD~.A~p°I~,,'[F:rC[ION 825 L, Street, Anchorage, Alaska 99~/(RC~-~~-~L PROJECTION' SOILS LOG - PERCOLATION ~T ~ 0 ~ CLAY, '~Lu ~., SOILS LOG PERCOLATION TEST SLOPE SITE PLAN / 10- 11 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: WAS GROUND WATER S ENCOUNTERED? ~ P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop /,z~ ~/,~/~ - ,~ '/~ PERCOLATION RATE ~' ~) (minutes/inch) /~. 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CO J > co (o N d 3: Om ❑ ❑ o LU Q w H N 1�1, 1.L w a H N M 14 a) (D LL a� C: m c� o a� a) LL U) O ca 0 a) U) o O co .W, IL ^W W IW^ _ m O O a� ❑ U C _L L O V U N a) U) .� C: -oo 0 E 0 ❑ Q - U cn co c ❑U .O a) c +-, Y U- ~ V LC ❑ L �^ f O (D O 'D N M N � O ❑ a) -a N 2 0 0 � > ❑ U m o L. : Q- o U O fn N a) r N EL (n + % O ❑ _ i>+ Q ❑ E ❑ d 75Lcn a� U) m -j aa) m ❑ a) w N " Y Z i L v QO 0 F- a ai cvo ow V O d w Q CO a > mi a ca- d in a > cri c� w m a) (D LL a� C: m c� o a� a) LL U) O ca 0 a) U) o O 1.98 Forge Engineering 8/5/24 NEW N/A N/A N/A NEW Epoxy Steel Benjamin Schiller, P.E. (907) 522-7773 / Lot 29 /Lot 30 PLOT PLAN AS BUILT _X_ SCALE _1__= 30' _ GRID SW 3538 Project No J24-1752 P.O. Box 210005 Lang & Associates, i n c Anchorage, Alaska 99521-0005 4000 (907) 522-6476 oQ� F COp�4 Professional Land Surveyors jonathanOlangsurvey.com v 4 ken®langsurvey.com I hereby certify that I have surveyed the following described property: LOT 24, BLOCK 4, PARADISE VALLEY SUBDIVISION (PLAT NO. 70-79) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. lL Dated this the _ Day ofA �G o ? TZ=Z_�, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. ..... ... r JO N C. LANG o OQ��F LS -994 C�JoG W?".ESSIONA- State of Alaska AECC963 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-.6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or o �,.• "' q�^�� encroachments may exist that were not identified during the evaluation. The operational life of all wells QQ and septic systems depend upon a variety of variables, 'including but not limited to, soil "conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and �g T Qv workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and"""' "' ""' """""'� are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of . • . . • • • • . • . • • • • . • • • • •� the well or septic system. GEG makes no representation whether an alternative well or septic system` �O '• f , A. Gorn ss: can be installed on the property in the event either of the current systems fail to perform adequately in Q �. ' . CE -79 the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in his report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right rofesslo" o whatsoever. #AECC884 6. DSD SIGNATURE r� System #1 Approved for aC bedrooms System #2 Approved for bedrooms 4FCh+©�i,.��r Disapproved Conditional approval for bedrooms, with the following# lIatigM:e?, NX4D = 3)3)) By '�fiaG_J A Original Certificate Dateq 1304?0 0 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. t(,nk COSA Checklist Legal Description: PARIDISE VALLEY; BLOCK 4, LOT 24 Parcel ID: 020-421-03 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑E Well log is filed with Onsite (or attached) Date drilled 7/1984 Total depth 224 ft Cased to UNKNOWN ft ■❑ Sanitary seal is functioning correctly ■❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 3/29/20 Static water level at beginning of test 200.2 ft. Comments B. TANK DATA Age of tank(s) 26 years Tank type/material STEPISTEEL Measured operating fluid level in septic tank 10"(ST11 Q Standpipes/foundation cleanout per record drawing Date of pumping 4/3/20 D. ABSORPTION FIELD DATA Which system tested (date installed) 10/14/94 Q ALL standpipes present per record drawing Total measured depth from grade 5 ft (max) Measured depth to pipe invert from grade ft (min) ❑■ N/A — pressurized field ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective A Code -required soil cover over field ❑N System presoaked (Required if vacant for greater than 30 days prior to date of test) 2008 Gallons introduced gallons Comments/Deficiencies: DRAINFIELD PRE-SOAKED ON 3/29/20 COSA Checklist yellow sheet Well production at time of test 2.9+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑■ Nc ❑■ Coliform bacteria is Negative Nitrate 2.21 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L X Arsenic less than MRL (ND) Collected by GEG, LTD Date of Sample 3/30/20 C. LIFT STATION ❑■ Required maintenance completed Age of lift station 26 years Lift station material STEEL Comments: S.T.E.P TANK IS APPROACHING THE END OF ITS USEFUL LIFE Adequacy test date 3/30/20 Results E Pass For 2 bedrooms Fluid depth prior to test 1 in Water added 327 gal New depth 2 in Elapsed time 45 min Final fluid depth 1 in Absorption rate 300+ gpd Any rejuvenation treatment (past 12 months) NONE If yes, enter date N/A E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes if No Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft ❑✓ Yes if No Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25'✓❑ Yes if No Absorption Field on Lot > 100'✓❑ Yes if No ft Holding Tank > 100'✓❑ Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ✓0 Yes Animal Containment > 50' ✓❑ Yes if No ✓❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft E] Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ft ft ft ft ft ❑✓ 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 _ Water Main > 10' ✓❑ Yes if No ft Community Wells > 200'✓❑ Yes if No _ Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10'✓❑ Yes if No ft If absorption field is under driveway comment below F. ENGINEER'S COMMENTS *WR#940046 G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet ft ft ❑ Yes if No *80 ft ❑✓ Yes if No ft r A ELM rscev #AECC884 *5 Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No ft Private Wells > 100' Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Surface Water > 100' ✓0 Yes if No ft F. ENGINEER'S COMMENTS *WR#940046 G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet ft ft ❑ Yes if No *80 ft ❑✓ Yes if No ft r A ELM rscev #AECC884 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Septic Tank Advisory Certificate of On‐Site Systems Approval # OSC201166 Subdivision: Paradise Valley Block:4, Lot: 24 The septic tank for this property is 26 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $7,000 to $11,000. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. SEPTIC PIPES +2',8.1' snm«n -4 2 STORY ' RESIDENCE Lot ?3 / L H 0/ -- -- �~ -�lDECK WELL-` \ � \ | 3�20'm 98.B7 10' UTILITY Lot 29 / Lot 30 � PLOT PLAN AS BUILT —2�— SCALE 1 30' GRID SW 3538 Project No. 20-159/Al---- 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Long & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fox Professional Land Surveyors ken0langsurvey.com C) F A I hereby certify that I have surveyed the following described property. - LOT 24, BLOCK 4, PARADISE VALLEY SUBDIVISION (PLAT No. 70-79) 49TH .... Anchorage Recording District, Alaska, and that the Improvements situated thereon are .......... ... within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated this the Day of --- 61 4 P at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963 / / \ t „l7y'o2,5y"E, 97-i8 /.SOF r' 00 :• •••:l9�1 &v Qt r ... a• •• ... •• •••••.•.0 Shone A. Hoh o / / r (j , �`r�` ••• IS 6914 S 0 001 f , % 0"Esslow. LP i ti • � aye• d balk 3 v � y2.7 I� 0 �L "i 4j 7.9 o �, o f moo) 1" * 20, o Za.D AS-BUILT SURVEY (NO CORNERS SET THIS DATE) Y` _ J I hereby certify that I have performed a Mortgagees inspectlon of the following described property: ILOT 24, BLOCK 4, PARADISE VALLEY SUB. fF ( Anchorage Recording District, 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 property lying adjacent 1 thereto encroach on the premises in question and that t ce- no ro ays, j transmission s, or other9 THE INFORMATI HEREON IS FOR THE USE OF LENDING easements said property except as INSTITUTIONS PECIFICALLY TO SHOW ANY CONFLICTS EASEMENTS OF RECORD, OTHER indica hereon, Dated at Anchf�ragey' BETWEEN EXI ING STRUCTURES AND PIATIED LOT L1NES THAN THOSE SNOWN ON THE Alas this �_ day of S4 OR EASEME S AND IS NOT TO BE USED FOR POSITIONING RECORDED PLAT, ARE NOT 14 �"B $'„T_S1 ADDITION STRUCTURES OR FENCELINES SHOWN HEREON HO T AND ASSOCIATES LAND SUR�'fO S ® � y yy Jeff Garness From: Sonja Blewett Sent: Friday, April 24, 2020 5:31 PM To: Jeff Garness Subject: Fwd: Survey for 6422 Italy Circle Sent from my Whone Begin forwarded message: From: Kevin Taylor <kevint@alaska.net> Date: April 24, 2020 at 5:29:13 PM AKDT To: Sonja Blewett <Sonja@garnessenginee ring.com> Subject: Survey for 6422 Italy Circle Hi Sonja, Email below from the surveyor saying the well is not in the easement. Let me know if you need more detailed confirmation. Thank you. Kevin Taylor, CRS Associate Broker RE/MAX Dynamic Properties 3350 Midtown Place Anchorage, AK 99503 Cell/Text 907 244-7437 Fro Kenneth : Kenneth Lanng�[ �ilto:ken@langsurvey.com] Sent: Friday, pri 21 4, 202012:46 PM To: Kevin Taylor Subject: Re: Survey for 6422 Italy Circle Kevin - The well is not in the easement but is right up against the edge of it.. Ken On Fri, Apr 24, 2020 at 11:56 AM Kevin Taylor <kevint@alaska.net> wrote: Hi Ken, Garness Engineering is asking if the well is outside of the utility easement. I'm looking at it saying it isn't. Can you verify? 1 y, statiompump Vault u Owner— -Pumping ..., � -Sludge level inches -pumping, y -pump basket N-O*z�!,Efflueslt fiftef clewproo� -o_ float rm emtion sal* . cu � . 3 visual alp . inside d ' �^ -jAtqTJr, system open x . .Ground water intus1on at fisef tO t3 *V\k"e,t _f AItom'= nn c�;. around, 7 ; ## ,- nUAsir p , ° and ���� s '� Technici!arx Cmn y Date of tragi e� 6� BID& La DATE DESCMPTION 04-03- 20., A + HOME SERVICES INC. 50 1 E". I "'00i Avenue Anchorage, Alaskzi 99516 CUSTOMER tL Anchorage, AK INVOI;CE Blcc;� Lot DATE DESCRIPTION AMOUNT 04 14- y Grde S2%. 00 0- red t Fri k TOTAL 1Z REMARKS Gallons Septic Leach Area, HoldingTank tan dpipas PROBLEM AREA ~~ CALL FOR MORE INFORMATION NEEDS TO BE DONE AGAIN IN 6 MONTHS Good Shape Sludge buildLIP on bottom 144oater on top Jim cap missing or Cut standpipe to 1ave ground Noeds Septictrine needs replacing Erik Widger From: Beverly Blakeslee <aplus@gci.net> Sent: Monday, April 27, 2020 10:35 AM To: Erik Widger Subject: 6422 Italy Circle I have confirmed with our technician, that yes - the lid for the lift station at the address above had indeed been secured (with extra screws) and meets all requirements at this time. Thankyou A+ Home Services, Inc. Bev '~ ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 0 'dO ~ ~, J O3 1. GENERAL INFORMATION · Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Lot 24; Block 4; Paradis~ V'allcy Location (site address or directions) Property owner Mailing address Lending agency Mailing address 6422 Italy Circle A~¢horage. AK 99516 Dor~en Long Day phone 5531E.:112th ..... ~-' Anchor~¢~ AK 99516 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: ~, Individual well XXX NOTE: Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4, TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public ~ewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority'Approval application shows that the on-site wate,r supply and/or wastewater disposal System is Safe, functional and adeqUate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance .with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING , ,,, ~ .*.... t~ .., .- '.~ Name of Firm ~7G$.;-'.U:~ .......r ............. Elglt Rivor, Alaska 9~577 Address /~Z ~ Engineer's signature ~. _ Phone DHHS SIGNATURE' Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain feaeral and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued::~The Municipality of Anchorage is not responsible for errors or Omissions in the professional engineer's work.. 72-025 (Rev. 1~1) Back MOA~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~;~,~C>fS'E [/'~/._~.ey ,~'4 Z2_c/ Parcel I.D. A. Well Data Well type Log present {~N) Total depth Sanitary seal {~N) 22~' If A, B, or C, attach ADEC letter. ADEC water system number ¥~$ Date completed ~l~. ~q?~ Driller Cased to I 'TZ~' Casing height ¥~--~ Wires properly protected (~_.)N) FROM WELL LOG Date of test Static water level /F~ ' Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: SepticJlaeidi~g tank on lot Absorption field on lot Public sewer main 2 Sewer service line /C~' g.p.m. AT INSPECTION ?.7 ; On adjacent lots ; On adjacent lots /~d Public sewer manhole/cleanout ~-~ Petroleum tank ~/~ WATER SAMPLE RESULTS: Coliform (~ //~ ~ Date of sample: Nitrate (D. o~ ~' .,~ ~/.~ Other bacteria O B. SEPTIC/I~I~I~ERRG TANK DATA Date installed Cleanouts ~1) High water alarm ~N) Date of pumping /,J~ 7'-,~- Tank size / 250 Compartments Foundation cleanout (~) "/~[ Depression (Y~) Alarm tested ~N) Pumper /~,/,~- SEPARATION DISTANCES FROM SEPTI~ TANK TO: Well(s) on lot /~2_' To property line Sudace water/drainage On adjacent lots Absorption field '-/- Foundation /~ Water main/service line ~ CONTINUED ON BACK PAGE 72-026 (3/g3)* Front C. LIFT STATION Date installed Size in gallons / 2. Vent (Y~) High water alarm level Meets MOA electrical codes (~/N) "Pump on" level at Manufacturer ,z~/,,y_/./o'~,~-~' Manhole/Access~N) /-/2 ~' "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot /~2Z On adjacent lots [~Z. ' Sudace water /~c~ 9-- D. ABSORPTION FIELD DATA Date installed /(~ _/~/_ c/c/ Length z/d' ' Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) ~, ? Width ~ ' Gravel thickness ~0 ~ Cleanout present (Y/~ /Jo /J/~- ~E~ ~¥~T~w Results (pass/fail) System type /~ Totaldepth ,' 5'.9 ' Depression over field ('~) A Jo for /u/,~. Bedrooms After test W'//',~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /g 2 ' To building foundation On adjacent lots 50 ' ~- On adjacent lots ~ ' Property line ~'O ~ To existing or abandoned system on lot Cutbank ~ ' + Water main/service line Surface water Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I cern'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in ~ Engineer's Name R~/3~v{~ C. ~o~ Date )o /[ [¢/ ~/ ~/ HAA Fee $ ,~ Date of Payment Receipt Number ~ e~ date of this inspection. ,~, .... .*..~...~ ~...:.: .... ~. ~ ~'~=.~.~ !~ ~ ~ ROBERT C COWAN * ~ Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back Commercial Testing & Engineering Co, Environmental Laboratory Services iFjl,~i~B~e~r~e'~J~W'~~J'J~ LABORATORY ANALYSIS REPORT CT&E Ref.{4 94.5291-1 C£1m~t sample ID L24 BLK4 PAKAD~SE VALLEY 8/[I client Name 6 & $ SNGINEERING WORK Order 10113 ~roj~ub# RaCelVe~ Da%e 10/~4/94 $ 16~00 RWBID UA 9ample Remark~ ROUTing ~;~4gL~ COLLECTED BY: BOB. C~ QC Allowabl~ gxC. Ana~ Param®ter Results Qual Units M~thod Li.~$ 5ate 'Date Ini~ Ni~rate-N 0.98 mg/L EPA 3~.2/300.0 10 10/17/94 CMR See Sal~lpl~ Red, arks Above NA - NcC ~alyzed Unde~.e0ted, RepoTted value is ~he practical ~an~ifica~ion limit. LT - Le~s Than secondary d/luciDa%. GT - Greater 5633 8 Street, Anchorage, AK 99~18-1600 --- Tel', {907) 582-2343 Fax: (907) 561.6301 ~NVIRON~ENTAL FACILITIES IN A~SKA, COLORADO, FLORIDA, ILLINOIS, M~RYLANO, NEW ,JERSEY, OHIO, UTAH, WESTVIRGIN~A EgE'ON ~P69L~6 ~ SB3IA~BS 8~] ]~INBNNC~h']N~ B~I3 6P:PI CT&EReL# Client Sample ID Matrix Commercial Testing & Engineering Co. Environmental Laboratory Services ~~'~e'~'.~e'~'J4r~'~'~'~w'~'.a~ LABORATORY ANALYSIS REPORT 94.3124-1 LOT24 BLK4 PARADISE VALLEY S/D WATER ClientName S 8: S ENGINEERING WORK Order 79744 Ordered By R. SHAFER Printed Date 06/27/94 ~ 13:32 hrs. ProjectName CollectedDate 06/23/94 @09:35 hrs. Project# Received Date 06/23/94 ~ 10:00 hrs. PWSID UA Technical Director STEPHEN C. EDE Sample Remarks: ROUTINE SAMPLE COLLECTED BY: SS. Parameter QC Allowable Ext. Results Qual Units Method Limits Date Anal Date Nitrate-N 1.1 mg/L EPA 353.2/300.0 10 06/24/94 DJS * See Special Instructions Above * * See Sample Remarks Above U = Undetected, Reported value is the practical quantification limit. D = Secondary O~lution. UA = Unavailable NA = Not Analyzed LT= Less lhan Gl' = C~eater Than 5633 B Street, Anchorage, AK 99518-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA !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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (addresS or directions) (b) Applicant Name //¢'~'~ ' ~--/2~'-¢¢z42~- Teiephone: Home ~¢~-'-//'~/¢- Business 5--~f' (c) Applicant is (check one): Lending Institution []; Owner/builder,.-~ Buyer []; Other [] (explain); (d) Lending Institution ~.~Ci.~\~c...~.. ~%'-~_'~._~-~kO.T~lephone Address (e) Real Estate Company and Agent ] !~.. Address (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Singte-Family,~]/' Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Well"~ Community [] Public [] Individual Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWA~DISPOSAL ~ Onsitc'iNI Public [] Community [] Holding Tank [] Note:( ~lf 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 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA ANEt INFORMATION ' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or was~tewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Date ,, DHEP APPROVAL Approved for ~';'.~o ('z) bedrooms by Approved /~ __ Disapproved Terms of Conditional 'Approval Conditional Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) ssues 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 ~ati~fy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the Professional engineer's work. Page? 2 of 2 72~025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) ~,NVII~ONJVlIiNTAL PROTEcTIoN HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 NOV 264-4720 LegalDescription: ~--ojr' ~/, ~__~'~_~..~¢~_~ WELL DATA Well Classification ¢f/'1~c~ ,, A. B, C. D.E.C. Approved (Y/N) Well Log Presen(~)N) Date Completed 7-_,-~~~47/ Yield Total Depth _..¢ ~c/ Cased to (' 7c// Depth of Grouting ~¢-.(~ ~' Static Water Level /~' Pump Set At Casing Height Above Ground ~0~5' ' Sanitary Seal on resin ((~N) Electrical Wiring m Conduit(~N) Depression Around Wellhead (Y~) Separation Distances from Well: / To Septic/Holding Tank on Lot /_r~3/ ; On Adjoining Lots ~ ~) To Nearest Edge of Xbsorption Field on Lot /~:~ n Adioining Lots ~ /6t9 To Nearest Public Sewer Line ..4'2/~ To Nearest Public Sewer Cleanout/Manhole ,4'./~- To Nearest Sewer Service Line on Lot Water Sam pie Collected by ,¢ _&~--~ ; Date /i~- ~/-~' Water Sam pie Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed /~-~--.~-~ S,ze 'f(~) NO. of Compartments Stand pipes~N) Air-tight Caps ~/N) Foundation Depression over Tank (Y(~) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) //v/~ ; for Holding Tank High-Water Alarm (Y/N) Separatiod Distances from Septic/Holding Tank: To Water-Supply Well /~ ( r / "~F~'¢''~/' To Property Line To Water Main/Service Line Course ~/~' Temporary Holding Tank Permit [Y/N) /- TO BUilding Foundation ¢'E:~ To Dis posal Field ~-- To Stream, Pond, Lake. or Major Drainage Comments Page~l of 2 72-026 11/841 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date installed ~ -2 ..~ -~'? Width of Field cO-C) .Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field:/ To Water-Supply Well /~)~' To Building Foundation Lot /'/'~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~7- TO Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions .~ Manhole/Accos~ "Purgrr"Off" Level at Cji Vent <Y/N) Pumping Cycles during Adequacy Test, Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 6_~ ~c,.~ Date /~-~/' ~ ~-- Company /6~/-~'~'~ --/"'-~ c MOA No. ~"-~Lff Receipt No. ~ ~"~ J 0 q Date of Payment ~ l1J~ 1~¢ I '! Amount: $ ~1~c''~ ineer's Seal Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH 1. General Information Application Date ///~//~ , (a) Legal Description (include lot, block, subd.i.v~ision, section, township, range) L~ ?~ ~ P,4..~A o,"~' U,~.~-~¥ -r,~d RF~-~ -.~c ~ ~ Location (address or directions) (b) Applicants NameC/~ ~ ~; $ ~' Telephone - Home Business Applica?t ~. Address (c) Applican~ tsL (check one) Lending Institution Buyer. ~'~ ,~ ~ther ~--~ (explain), (d). Lending Institution ' ; ..Address ..... . .' ~-~ ; Owner/builder~; Telephone (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: 2. Type of Residence Single-Family~ Number of Bedrooms 3. Water Supply Individual Well~ Multi-Family ~-~ .3 Other (describe) Community~-~ Public~--~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal 0nsite~. Public~ Community~--~ Holding Tank~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality am~ status. [Page 1 of 2] 5. Engineering Firm Providin- Ins. ections_ Tests Fi. le Data and tions in effect on the date of this inspection. Name of Firm /~. _/~'C ~ f/~;C . As certified by my seal affixed hereto and as of the validation date shown belov, verify that my investigation of this Eealth Authority Approval shows that the water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify based on the information obtained from the Municipality of Anchorage files and from investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- Address Date DHEP Approval Approved for App:oved Telephone bedrooms Disapproved (ENGINEER SEAL) Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DEEP) ISSUES h~/~ALTE AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPE 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DEEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQULRE- MENTS. 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. (DHEP SEAL) RR4Iej/D18 [Fage Z of 2] 7-19-84 ao MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICI?ALITM OF ANCHORAG] DEPT. OF HEAL'[ ENVIRONMENTA _ DEC RECEIVED Well Classification ~,~';u~e~- Well Log P~esent~N) Total Depth ~ ' Cased to Static Water Level I ~ ~ ~ Legal Description: .~ /~ ~ ~/v' ~ ce. I1_ ~If A, B, ~ C, D.E.C. App~oved(Y~} ~l~ Date ~leted ~/~/~ Yield ~ 17~' a,) ~pth of G~outing ~mK~ ·; ~ ~t At ~ ~0~ Casing Height Above Ground ~_, ~- Sanitary Seal on Casing ~N) Ei~'ctrical Wiring in Conduit~~ ~,,/?/~. ~ession ~ound ~l~ead (Y~ Sep~ation Distan~s f~ ~1~ To ~ptic/Holding Ta~ ~ ~t L) IO~ ~ ~'~ ; ~ ~joining Lots TO ~a~est ~ge of ~sorption Field on Lo~.) /O ~ '; ~ Adjoining ~ts To Nearest Public ~r Line ~/~ To Newest Public. Clean~t/Ma~ole Nz/~ ~ ~est~ ~r ~rvi~ Li~ on ~t ~)/~, Water, Sable Collected By ~'~ ~ ; ~te 11/7/~ ..' Water S~le Test ~sults B. SEPTIC/HOLDING TANK DATA Date Installed ~/Z~/~. Size ~No. of Cu~ga~tments ~__ Standpipes ~N) Air-tight Caps ~) Foundation Cleanout ~) ~p~ession o~ Ta~ (Y~ ~te ~st P~d ~/~ P~ing~aintenan~ Con~act ~ File (Y~)~/~ ; for ~3~ Holding Ta~ High-Wate~ Ala~ (Y~) ~/~ Te~ra~y Holding Tank Petit (Y~) ~/~ Sep~ation Distan~s ~ ~ptic~olding Tank: To Water-Supply Well 0 I Oil To Property Li~e I~ LI'~ TO Water Main/Service Line Course '~'4f9~ To Building Foundation To Disposal Field To Stream, Pond, Lake, c~ Major D~ainage Receipt ~ $1 .m'qD Date Paid: !~'ll-%g Amount: ~ ~---' [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/~. ~ ~ Width of Field ~O~ Square Feet of Absorption A~ea ~OD' . 7~b1~ Type of System Design Length of Field Depth of Field ~ Gravel Bed Thickness Standpipes Present ~) Depression over Field (Y~ ~ Date of last Adequacy Test Results of Last Adequacy Test_ Separation Distance frc~ Absorption Field: To Water-Supply ~11 /O8~ ~'~ To Property Line To Building Foundation ~O'~- To Existing or A~a~ ndoned System on Lot ~/~ ; On Adjoining Lots ~ 30 ! To Water Main/Service Line ,~/1~. To Cutba,~k(if present) To Stream/Pond/Lake/c~ Major Drainage Course To Driveway, Pa~king Area, or Vehicle Storage Area ~;) ~ %~ De Date Installed ~ ~. ns ions Size in Gallons ~ Manhole/~s (Y/N) "Pump On" Level at ~ "~Off" Level at Hig~ Water Alarm Level at __/p~,~nV~g c~du~Vent (Y/N) Tested for ing Ad-~quac~; Test. Electrical Codes(Y/N) Co~,~nts ~' Meets MOA ** Check Permitted Bectroom Rating Against HAA ~qequest I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. KB1/d5/s [Page 2 of 2] 2-15-84