HomeMy WebLinkAboutPARADISE VALLEY BLK 2 LT 1Paradise Valley
Lot 1
Block 2
#020-424-20
Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SGy 98a°� 9S PID Number: O H y O
Name`
j NG
Wastewater System: iNew ❑ Upgrade
fi4j e-/ et/
Address: ,//
220 Cl c.ln.. fa%rc Zo/ Agcy Ak y9r/
ABSORPTION FIELD
Phone:
No. of Bedrooms:
Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
#e
Deep
LEGAL DESCRIPTION
Rating:
Total Depth from original grade:
/3
� GPD/S . Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
l ,2 a/aG�, -5e 114 //cy
710 Ft.
/ O. O Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
6-S_ Ft.
Ft.
WELL: t3 New ❑ Upgrade
Gravel width: 31
Numberf lines:
Distance lines:
Ft
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
1
Total absorption area:
Pipe material: �^
PRryAre
-2S'3 Ft.
as3 Ft.
i--a So. Ft.
?VC 303y
Driller:
ALPiNF
Date Drilled:
91-2`/157
I Static Water Level:
I /✓arIv.relFt.
Installer:
Nn mw ler CO,
Date installed:
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
6 GPM
U^ K Ft.
-�" / Ft.
SEPARATION
DISTANCES
Xseptic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Litt
HoldingPublic/Private
Manufacturer.
Capacity in gallons:
Capacity
Z.Sd
From
Tank
Field
Station
Tank
Sewer Lines
/r+
nck, Hh
Well
139'
(~JD`
NA
N14
(o!'
Material:
S7�e_!
Number of Compartments:
2
urfae
4000
+fact
F/ao'
LIFT STATIONWate
Lot/
��
'tee
5,
%S
Size in gallons:
Manufacturer: r�
Line
/0
Foundation
�,
/ 6 '
N'Q
"Pump on" level at: "Pump o� ff;'yvet'S%
High water alarm at:
Curtain.
--
- _-._-_.—
----.------•-
-------••-
Pump Make lmooe
Electrical inspections performed by:
Drain
�?
Remarks: S< < .T:o„ g'sT,o„«
BENCH MARK
/
Z ,7/,i,
Location and Description:
%
.
O'vt-• 7�TC �AH �i-Car of cr<{ Marlte �i
Assumed Elevation:
v .✓ Top X 7-13 r”
/00,047 rt
ENGINEER'S SEAL
OF q,Nj
Ilk-
*
Inspections performed by: E2t1 Dates: 1st �l`/sS 9
.Of
4..• ;�.•
2nd 9-/6-9g
...«..».......... .�.»
Department of Health and uman Servi es approval ss
A.
y®� •'m.•�°uC 4736
Date:
Reviewed and approved by:
72-013 (Rev. 9/91) MOA 25
Permit No. SW980295
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196659 Anchorage, Alaska 99519-6658 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Paradise Valley Lot 1 BLk 2 PID No.: 02042420
PUBLIC
WATER
SEPTIC
+100' TO
WELL
Large
Boulder
em�
LOT 1
1250 GAL
SEPTIC TANK
Mose
Q
QUO WELL +100' TO
ALL SEPTICS
A
HOUSE
/1OO
+100' TO /
ALL SEPTICS
Q
TN 1IN
/
TO
y ALL SEPTICS
Z
AND WELLS
M
YELEVATIONS �_ Top HUGE Boulder, Marked
(NOT TO SCALE) As« suMEo ELEv = 1ao.00
m
ORIGINAL
GROUND =
1 LEVEL AT: O
100.9
3'
m
I I 3 NO CWT
�f 81.9
TANK
102.6 02.3 97.9 97.9
\87.9
SWING TIES
A—C = 78.2'
B—C = 45.0'
A—D = 124.5'
B—D = 91.9'
TEST HOLE
MONITOR TUBE
SEWER CLEANOUT
WELL
LEACHFIELD
EASEMENT
SCALE I"=50'
11/12/98
FROM JOHN HAGMEIRE CO.
PHONE NO. : 2486434
Nov. 19 1998 02:36PM P1
.OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING & WATER MGMT
WATER WELL RECORD
CONTRACTOR INFORMATION: jj REMARKS
Regist6red Business Name �y PLEASE MAIL WHITE COPY OF LOG TO:
r -- '� f DyIVISION OF MININGs & WATER MGMT
SY§nature o�� E�
esp entative Date 3601 C St, Suit* 800
ANCHORAGE AK 99503 -SSSS
Phone (907)369-8639, Fox 1907)562-1384
BLOCK SECT"am
V
SECTION TOWlNQp
RANGE
MENOIAN
6On000N subvivi LOT
�(
2L
Os
❑W
LOCATIONISKf✓TCH: WELL OWNER:
DEPTHS MEASURED FROM casing top Oground surface WELL DEPTH: DATE OF COMPLETION
ft
Depth of hoie: �ge�
r ft 1 i is
SOREHOIE DATA: Depth Depth Of Casing: _l
Material Type and Color Ffom To
DEPTUTO STATIC WATER LEVEL:
Sept?
Gam,
� ft below 'R top of Casing 0 ground surface
Date:
METHOD OF DRILLING: '$1 air rotary ❑ cable toot
c other
j.
USE OF WELL• V domestic 0 Irrigation 0 monitor
At
❑public supply 0 other•
01
CASING ST)CK-UP: _ ft. Diaril: in. to __ft'
Casing type: �_ilt. to n'
WELL INTAKE OPENING TYPE: 0. open end 0 screened
0 perforated 0 open We.
of openings: to ft
R q ®
�'
REEN TYPE Diam: in
rputmhs
tNb Sial: ': Length: ft
A:'EL PACK TYPE:
NO.V j9
8
le used: De 3t to top:
Niunicipality of Ai
-norage
GROUT TYPE: ..�. _ .
ft
Dept. Health & Hum
n Servici
is
Depth: from ft to
DEVELOPMENT METHOD:
Duration: • '
PUMPING LEVEL AND YIELD:
ft atter hrs pumoing tiri Wm
PUMP INTAKE DF_PTH: ft Horsepower.
WELL DISINFECTED UPON COMPLETION? .AYES ONO .
CONTRACTOR INFORMATION: jj REMARKS
Regist6red Business Name �y PLEASE MAIL WHITE COPY OF LOG TO:
r -- '� f DyIVISION OF MININGs & WATER MGMT
SY§nature o�� E�
esp entative Date 3601 C St, Suit* 800
ANCHORAGE AK 99503 -SSSS
Phone (907)369-8639, Fox 1907)562-1384
• Municipality of Anchorage
Department of Health and Human Services
825 U' Street
Rick Mystrom, 9
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
http://www.ci.ancho rage. ak. us
December 3, 1998
Lou Butera, P.E.
Eagle River Engineering Services
PO Box 773294
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 1 Block 2 Paradise Valley Subdivision
Waiver Request #WR980095-
Parcel ID #020 242 20
SW980295
Dear Mr. Butera:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
5.0 feet. Thes waiver is for the SE property line to the absorption field.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Sin rely,
iV6(
Daniel J. Roth
Civil Engineer
On -Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR980095 PID # 020-424-20 HA# Permit # SW980295
Date Received: November 19, 1998
Legal Description: Lot 1 Block 2 Paradise Valley
Engineer: Lou Butera, P E , Eagle River Engineering Services
PO Box 773294, Eagle River, Alaska 99577
Applicant: John HaQmeier Company
Waiver Requested: Lot line waiver from the SE propertyline to the absorption
field of 5'.
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Waiver is Granted: X Waiver is NOT Granted:
List Conditions or Reasons for above: SEe EA161,VEE2 'S AiTrIcH E D
ET or _rwo-1 f /CHH-1yy
Date: 12 atfj By: l ,,Ml
Name of Reviewer
Rec #: 04621/7231 Amount: $ 115.00 Date Paid: 11-19-98
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
November 19, 1998
Jim Cross, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Paradise Valley Lot 1, Blk 2
Waiver of separation distance
Dear Mr. Cross:
C ( CL
NOV 19 1998
l U"'Cepalrry of Anchorage
t7"t, Health & "(1man Servlc ;
On behalf of our client, John Hagmier Co., we are requesting a waiver of separation distance
between the lotline and the subsurface leachfield on the subject lot. The system was
inadvertently constructed 5' from the actual lot line due to the road curve. We are making this
request as we turn in the asbuilt for the system. This will not affect the reserve area, or
surrounding lots reserve area. The soils in the area are excellent and the waiver is adjacent to the
60' right of way. Granting this wavier should cause no negative impacts on surrounding area.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
Qc__'�L
\1997\95-097-wnv
\ \ --v °1-0� (� �� k S' CU
I
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program ' u�
825 L Street, Room 502 _
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SW980295
Date Issued: Aug 11, 1998
Expiration Date: Aug 11, 1999
Parcel ID: 020-424-20
Legal Description: PARADISE VALLEY BLK 2 LT 1
Design Engineer: 24 Lot L F_0_�L �.nL, S)4 - Site Address:
Owner Name: John & Jennifer Randolph Lot Size: 23459 SQ. FT.
Owner Address: 6558 Cimarron Circle Total Bedrooms: 4 Permit Bedrooms: 4
Anchorage , AK 99504 -
This permit is for the construction of:
❑✓ Disposal Field ✓❑ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: / /02
Date: !i - 1 /' 678
r
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
August 3, 1998
Jim Cross, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Paradise Valley Lot 1 Blk 2
Narrative & Permit Application
Dear Mr. Cross:
The proposed well and septic system will have very limited impact on adjacent properties for the
following reasons:
1. The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate, due to absorption capacity.
4. Drainage will not be affected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\ 1997\98-053-NAR.Doc
SEPTIC
+100' TO
WELL
LOT 1
1250 GAL
PUBLIC a SEPTIC TANK
WATER O Z
w
0:
+100' TO
ALL SEPTICS
Q PROP
QUO WELL
PROP
HOUSE
moo
TO
ALL /
ALL SEPTICS
TH1LuLn
~
(n ® N
Li X
Li M
+100' TO
X10% ALL SEPTICS
/ AND WELLS
0 - TEST HOLE
• - MONITOR TUBE
0 - SEWER CLEANOUT
- WELL
/ - — - - EASEMENT
PROPOSED LEACHFIELD
EXISTING LEACHFIELD
NO SURFACE WATER
NO KNOWN CURTAIN DRAINS
W LL/SEPTIC SITE PLAN
LEGAL: PARADISE VALLEY LOT 1 BLK 2
OWNER: JOHN HAGMEIER
CONTRACTOR: N/A
JOB 97-053 DATE: 8/3/98 SCALE 1 " = 40'
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK 99577
(907) 694-5195 FAX.- (907) 694-329?
oo� OF qz-°Doo
P�••,.....,..'I. 000
■• LOUIS A. BUTERA •• 4Q
�O�,ry `,• CE -6736 •: o
�DDn�ESSIONa �o�o
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: Paradise Valley Lot 1 Blk 2
8/4/98
A. GENERAL
L The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health and State
Department of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet
Municipality of Anchorage, Department of Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any
adjacent multi -family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer
approval.
8. It is always recommended that a surveyor locate the nearest lot line position and the location of any
easements.
9. Any remaining open test hole excavations shall be filled.
B. SEPTIC TANK
Septic tank shall have a minimum capacity of 1250 gallons and be of MOA approved design.
C. TRENCH
1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 13' at any point.
4. The effluent line within the trench shall be laid level within 0.03'.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed
over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface water runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any
Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH= 13' GRAVEL DEPTH = 10' under pipe, 2" over pipe
TRENCH LENGTH= 25' TRENCH WIDTH= 3'
SOIL RATING= 1.2 GPD/ft5 BEDROOM CAPACITY= 4
SEPTIC TANK = 1250 gallons
Twenty-four (24) hours notice required for all inspections.
\1997\98-053-spec.doc
I
�-�—� •w,.�l
i •S7 9
Municipality of Anchorage 49U •i �
DEPARTMENT OF HEALTH & HUMAN SERVICES �•• • «•«••«•N••••
825 "L" Street, Anchorage, Alaska 99502-0650 •• ,,Woe •••• ••••••••j r
SOILS LOG — PERCOLATION TEST Louis A•autl:ra ;
f_ •1._ CE -6736a j
PERFORMED FOR:_fiA4���r
oi
DATE PERFORMED: '7�Q 1_ .'�►
LEGAL DESCRIPTION: 7arfta�fG 11w1ky L/ e2_ Township, Range, Section:
EFT) SLOPE SITE PLAN
FEE
2
3 `
t
4-
5 5
G7
6
7 1
8-
9-
10-
11
9 10 11 '
12
13
,1
14 %
0 '
15-
16-
17-
18
5 161718
19-1
20
COMMENTS
6�/ rviTl-/ SnN�
%fo7roy of r//
WAS GROUND WATER l'
ENCOUNTERED? /• U
S
IF YES, AT WHAT '/ L0
DEPTH? ry
P
E
Depth to Water After
Monitoring? F/ -,y Dale:
L°t12-
Reading Date
Gross
Time
Net
Time
Depth to
Water ,rah
Net
Drop
7Y /6
Z
r 2, i Z
1 a» ,
'7
3
J z: Z•/
71 Z/id
It
Z' 3Y
I,,
9//e
3 P//6
//i a
67Z
'yr
ie
PERCOLATION RATE Z'9 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 6 FT AND FT
PERFORMED BY: r6 E— �f- 1 =5—;;� CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 98-053
Calculated By: LB
Date: 8/3/98
Legal: PARADISE VALLEY LOT 1 BLK 2
Single Family 4 Bedroom Dwelling
Deep Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom =
Percolation rate =
Wastewater application rate =
Required absorption area =
Trench width (W) =
Gravel depth (D) _
TEST HOLE 1
600
gallons
2.9
minutes per inch
1.2
gallons per day per square foot
500
square feet
3
feet
10
feet
Required length = Required absorption area / 2 / D
Required length = 500 / 2 / 10
Required length = 25 feet
Total Excavation Depth = 13.0 feet
OF q �:
49 LH * '*
�'. LOUIS A. BUTERA .rte
0 S) •, CE -6736
W PROFESS10NPa='v
98-053-CAL.xis 10:35 AM8/3/98
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
020.424-20
1. GENERAL INFORMATION
Complete legal description Paradise Valley Blk 2 Lot 1
Location (site address) 5901 Greece Dr., anchorage, AK 99516
Current Property owner(s) Michael Koy
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
COSA # 6 $ Da41"!
Expiration Date: /6-30-0
PMB 417, PO Box 7399, Breckenridge, CO 60424
Day phone
Day phone
Mary Tutterow/Dynamic Properties Day phone=
3111 C Street. Suite 100, Anchorage. AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well❑
✓❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
✓❑
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on -she wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite 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 Onsite 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 Finn Watkins Engineering. Inc.
Address PO Box 110449, Anchorage. AK 99511-0449
Phone 907-549-1851
Engineer's Printed Name Gndyw. Ens Date .1 29-09
49 TH
6. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X Arsenic Advisory —
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: Original Certificate Date: Z— 30-0s
(Rw +,As)
\ 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/onske
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Paradise Valley Block 2 Lot 1 1
Parcel ID: 020-424-20
A. WELL DATA
Well type Pri If A, B, or C provide PWSID #
Date completed 9129/98 Sanitary seat (Y/N) Yes
Total depth 253 ft. Cased to 253 ft.
FROM WELL LOG
Date of test 9/29/1998
Static water level 215 ft.
Well production 6 g.p.m.
WATER SAMPLE RESULTS:
Coliform o colonies/100 mL Nitrate 0.905 mg/L
Arsenic: 0 mgA Date of sample: 7/10/08
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N) Yes
Wires properly protected (Y/N) Yes
Casing height (above ground) 24 in.
AT INSPECTION
7/1 M008
211 R
2.5 9 -
p.m -
Other bacteria 0 colonies/100 mL
Collected by: Rocky Trainor / WaWns Engr
Tank Type/Material Steel Septic Tank Date Installed 911611998
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Yes
Foundation cleanout (Y/N) Yes Depression over tank (YM) No High water alarm (YM) NIA
Date of pumping 7/16/2008
C. ABSORPTION FIELD DATA
Pumper A+ Home Services
Date installed 9/16198 Soil rating (g.p.d.At= or ft=/bdrn)1.2 System type Deep Trench
Length 25 ft. Width 3 ft. Gravel below pipe 10 ft.
Total depth 14.5 ft. Eff. absorption area 500 ft2 Monitoring tube Yes Depression over field No
Date of adequacy test 7/16/2008 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 85.5 in. Water added641-7gal. ' New depth 118.5 in.
Elapsed Time: 108 min. Final fluid depth 113.5 in.
Any rejuvenation treatment (past 12 mo.) (YIN &type)
Absorption rate >= 600 g.p.d.
_ If yes, give date
D. LIFT STATION
Date installed Nn Size in gallons Manhole/Access (Y/N)
'Pump on' level at _ in. 'Pump off" level at _ in. High water alar level at in.
Datum Cycles tested Meets alarm 8 circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 136' On adjacent lots 100'+
Absorption field on lot 168' On adjacent lots 100'+
Public sewer main 100'+
Sewer /septic service line 100'+
Public sewer manhole/cleanout 100'+
Holding tank N/A
Animal containment areas 100'+ Manure/animal excrete storage areas 1004+
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 43' Property line18_ Absorption field 22'
Water main 100'+ Water service line 73' Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 6' Building foundation 77' Water main 100'+
Water Service line 105' Surface water 100'+ Driveway, parkingtvehicle storage 20'+
Curtain drain N/A Wells on adjacent lots 100'+
F. COMMENTS:
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections andP>
p';
49 TM��
review of Municipal records that the above systems are in
+
conformance with MOA COSA guidelines in effect on this date.
j..::.... w. ew
Engineer's Printed Name Cindy W. Ems
n; •., . Im"
Ia
Date 29-- 09
`v.
a1 ,...,.,.
COSA Fee $ ` L -:R n
Date of Payment %— V-9 — n qC
Receipt Number
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
SCS ReEB
1083334001
Client Name
Watkins Engineering
Project Name/a
Paradise Valley 11211
Client Sample ID
Paradise Valley B2,LI
Statria
Drinking Water
PWSID
0
Sample Remarks:
All Dates/Times ars Alaska Standard Time
Printed Date fime 07/24/2008 13:59
Collected Dattf ime 07/102008 15:45
Received Date/time 07/102008 16:12
Technical Director Stephen C. Ede
Allowable Prep Analysis
Parameter Results PQL Units Method Coommer ID Limits Date Date Inst
Metals by ICY/M3
Arsenic ND 5.00 ug/l. EP200.8 C (<10) 07/15/08 07/18/08 NRB
Waters Department
Total Nitrate Nitritc-N 0.905 0.100
Microbiology Laboratory
Colony Count 0
Total Coliform 0
Fecal Coliform 0
mg/l. SM204500NO3-F D (<10)
col/100mL SM209222B
coV100mL SM209222B
eoU100mL SM20922211
A (<200)
A (<I)
A (<I)
0722/08 JDZ
07/10/08 DLC
07/10/08 DLC
07/10/08 DLC
87-16
PARADISE VALLEY SUBDIVISION
LOT 2S. 459 B SOCK 2
0
n
OF 4
ery A. Gaetaldi o` _
. � LS-6091AV
•. �e1♦
#J�°� •••. 71 �0
. eo,p••�6��•V• c�y.1
rol'3sIonol Lo
GASTALDI LAND
SURVEYING, LLC
JEFF A. GASTALDI, R.L.S.
ZDDO E. DOWUNG RD., SUITE 8
ANCHORAGE, ALASKA 99507
PHONE 248-5454
GRID DATE
3538 7/16/2008
F.B. JOB NO.
98-20 1 PVS12
111=30'
Y CERTIFY THAT 1 HAVE SURVEYED THE
PROPERTY DEPICTED ABOVE AND THAT NO
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
IT IS THE RESPONSIBILITY OF THE OWNER TO
DETERMINE THE EXISTENCE OF ANY EASEMENTS,,
COVENANTS OR RESTRICTIONS WHICH DO NOT
APPEAR ON THE RECORDED SUBDMSION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT, ALASKA
NOTE. NO CORNERS SET THIS DATE
Municipality of Anchorage
Development Services Department
e� Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 020-424-20 HAA# CQ 03671
1. GENERAL INFORMATION Expiration Date:p�y
Complete legal description PARADISE VALLEY S/D: LOT 1, BLOCK 2
Location (site address or directions) 5901 GREECE CIRCLE * ANCHORAGE, AK 99516
Current Property owner(s) STEVEN & CHARLA JONES Day phone 344-1456
Mailing address 5901 GREECE CIRCLE * ANCHORAGE AK 99516
Lending agency Day phone
Mailing address
Real Estate Agent PEGGY YOUNG W/DYNAMIC PROPERTIES Day phone 261-7600
Mailing address 3111 "C" STREET * ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water 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, 1 verify that my
investigation, based on procedures outlined in the Health Authority 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. 1 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,
Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 x ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date r n
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for _�L— bedrooms.
Disapproved.
Conditional approval for bedrooms, with the fllowing
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
QP��tYtOF(q�c'y0'��
ON -SITE -0
WATER AND_ . r"
PROGRAM
_10cc\
n �
By: L l_,_QxJ[ ip ��Yw Original Certificate Date:
—4 1 1
(Rev. 12101)
Mul
Develo
;norage
?rogram'
g "
vco. ._t.®
"I'll �• using, neignt (above ground) _ aZ- in.
v ..
7/ 3/2004 'ba � x
4 r
9 9 1 9
., , ..
�- .a ,• ..� ,-
a k�4
.2 ft 217'
colonies/100 mL Nitrate 4 7f'mg /L. Other bactera' _colonies/100 ml
For 4
W-W49a"44
"
New de
ICH
w
nxnunnvrv..kewi.'Xw.uery maSna¢w+arRwrw,'R`r+xMxwwauiWwaa+urrw'mnwP.xaw-I.anms.u+Mti\ rrrvw.nwse Y
100'+
100'+On adjacent lots
N/A Public sever manholelcleanout N/A .M
S FROM SEPTICIHOLDING TX�NK ON LOTTO � ��
5'+ Property line � + Absorption field _�„ ,� , „�„
Water service line s10'+' Surface water 100 +
KROM ABSOF22PTION1ELDxON Lot TO ,x..
Building foundation' =6'.L Water main
a
+ Surface water 100 + bnvewayparking/vehicle storyg e 10,+
�2<due-. .., `w`.. a$�Sk�ia`�ts4��`.�JA:3.w �3`�'J�Fe'etts.',�"., :.,., �. . .iA �a id;'L'�k �2 St*�.ni, � � � �':?.S,.0 ✓ � �x
irds that the above systems are in
HAA quidetines in effect on this d.
.............. v�
......................:.....00
Garn ss:
140IPA
s E ..53
�4oa ro esso %O
0
V Waiver Fee $
ts�✓...;"I�ai^mFvufsA*.e9.i>ai�YN�o�M.'hR.t; mnnwh:«:-.aA,M..uti;YrA•.�h`23N�SkFd ^..'�w7+;4 1:..rw�..m.rth�Fa«*.;u,sai� a ..+k a�.�. ,c> a mh% r:
Date of Payment
O to 2 Receipt Number w. ,x
Jul 02 04 09:31a Steve and Charla Jones
As Built Survey
(907)344-1476 p.2
1 87-18
PARAMSE VALLEY SUBDIVISION
LOT 1�A1459 B SOCK 2
i Ir Irm- ESNT.
/w4c ,
p FINAL STRUCTURE AS—BUILT
AS, B U I I_ T 1 b.r.h. 4.rnfr Ibw1 I I.........r.x Inv
GxflLLP 1 pr ppo 11 4►IQLA .b... .wa \b.l we
LVIP ItURVGV INP .ncr.ac..�nl. ..b1 .m.p. N I..IC.I.J.
4.11 A. Ewa lql wl• R.1 .f. 11 1. rM /..pwm in 11111 s1 Ib. ..... ..
Mcbo ap.. Al x.�u P0000 we..n.wl. .r L.V 1AIIOR..blcn .. ..1
%IQIE 340-0.04 wnpvor M M. 1.Awrn.. 4vbPlv),I.w pov,
u00%r ne esr.0 l..... .6..14 n.. 4,
IP UA1F
bfroon .404 Par
SO II/lu/011 41.001/blgq b-"4
4r<fwn.41
lrwI.cwr . l.
F.P. . Ac$OA"RfcO0Rc bl>1RIcI.,Rf�i2 q aIovwrtiorna.w
r.
ROTA: Ya eORNQRx zEl TNIz wlc•.
07-14-04 02:58PM FROM-CT&E ESI, SGS ENV SERVICES
9075615301 T-065 P.02/03 F-177
Laboratory Analysis Report
All Dates/Times are Alaska Standard Time
Printed Date/Time
07/13/2004 11:20
Collected Date/Time
07/08/2004 9:20
SGS Ref.#
1043971001
Client Name
gineering Group, Ltd.
Project Name/#
$lock 2, aradise Valley
Client Sample ID
Block 2 aradise Valley
Matrix
g Water
9075615301 T-065 P.02/03 F-177
Laboratory Analysis Report
All Dates/Times are Alaska Standard Time
Printed Date/Time
07/13/2004 11:20
Collected Date/Time
07/08/2004 9:20
Received Date/Time
07/08/2004 16:00
Technical Director
Step)ftn C. Ede
Sample Remarks:
Parameter ResultsAllowable Prep Analysis
PQL [!nits Method ContainerlD Limits Date Date Init
Waters Departtaent
Nitrate -N 0.709 0.100 mg/L EPA 300.0 B (<=10) 07/08/04 JIB
Microbiology Laboratory
TotalColiforrn 0 w1/100mL SM209222B A (<=I) 07/08/04 DKC
.I. -aboramry Division 200 West Potter 0l i_ve,_Anclt_ulag_e, AK 99519-16.05 _ t_I9071_562__2.243_ f(907)5815301 vMV.Sgsenvi[Onmen[AI
Me,nper ut [no SGS Grnup rsnga[e Gone,aIu 0 Smveillxnul
ll:ia
m
) I
1
0j
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907) 343-1744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILL/Y DWELLING
Parcel I.D. # 020-424-20 HAA #
1. GENERAL INFORMATION
Complete legaldescription PAR_Da RD •N •
Location (site address or directions) Font GREECE CIRCLE ANCHORAGE AK 99516
Property owner JENNIFER & .JOHN RANDOLPH Day phone(- 345-3528
Mailing address 5901 GREECE CIRCLE ANCHORAGE AK 99516
Lending agency
Day phone
Mailing address
Agent PEGGY GONZALE5 W/ DYNAMIQ PRQPERTIES Day phone( -207) 261-7618
Address 3111 "C" SIBEFT ANCHORAGE AK 99503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site xxx
Holding Tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
ing to the legality and status of system.
72-025 (Rev. 1191) Front MOA #21 Computer version
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1000.00 at,
or prior to, closing for the engineering services provided.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply and/or
wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of
structure indicated herein. I further verify that based on the information obtained from the Municipality of
Anchorage files and from my investigation and inspecVon, the on-site water supply and/or wastewater
disposal system is in compliance with all Municipal 2rM State codes, ordinances, and regulations in effect
on the date of this inspection. , v 'k t
Name of Firm
Address
Engineer's Signature
Phone (907) 337-6179
Date
In conducting this evaluation, AWWC, fnc. ttpmp d to provide a thorough, conscientious engineering analysis of the
system in accordance with ADEC and M A DHH 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, ground water levels that may fluctuate during the year, and the
usage of the family being served by the system. These conditions are outside the control o
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.
AWWC, Inc. can therefore not provide any warranty for future estimate of how long the
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
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.
6. DHHS SIGNATURE
Approvedfor_bedrooms
Disapproved
Conditional approval for
Additional Comm
0
bedrooms, with the following stipulations:
Date -�D'-2,S-6D
�.
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of
homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of
DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1191) Back MOA tt21 Computer Version
Municipality of Anchorage OCT 2 0 2000
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division MUNICIPALITY OFANCHORAG
825 "L" Street, Rm 502 Anchorage, Alaska 9950f:tWtW8N9P"ERVICES DIVIS
Health Authority Approval Checklist
Legal Description: PARADISE VALLEY S/D; LOT 1, BLOCK 2, Parcel I.D.: 020-424-20
A. WELL DATA
Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A
Log present (Y/N) YES Date completed 9/29/98
Total depth 253' Cased to 253' Casing height (above ground) 24"
Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
FROM WELL LOG
Date of test 9/29/98
Static water level 215'
Well production 6.0 g.p.m.
WATER SAMPLE RESULTS:
AT INSPECTION
10/11/00
Coliform 0 Nitrate 0.809 mg/L Other bacteria 0
Date of sample: 10/11/00 Collected by: A.W.W.C., INC.
B. SEPTIC/HOLDING TANK DATA
1
Date installed 9/16/98 Tank size 1250 Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression (Y/N) NO High water alarm (Y/N) N/A
Date of Pumping 10/13/00 Pumper McDONALDS PUMPING
C. ABSORPTION FIELD DATA
*MEASURED IN FIELD
Date installed 9/16/98 Soil rating .p.d./ or ft2/bdrm) 1.2 System type TRENCH
Length 25' Width 3.0' Gravel thickness below pipe 10' Total depth *14.5'
Effective absorption area 500 SQ.FT. Monitoring Tube present (Y/N) YES Depression overfield (Y/N) NO
Date of adequacy test 10/11/00 Results (Pass/Fail) PASSED For 4 Bedrooms
Fluid depth in absorption field before test (in.); 43.75" Immediately after 880 gal. water added (in.): 97.75"
Fluid depth 53.25' (ins) Minutes later: 1407 Absorption rate = 600'+
Peroxide treatment (past 12 months) (Y/N) N/A If yes, give
72-026 (Rev. 3196p Computer Version
D. LIFT STATION
Date installed
Manhole/Access (Y/N)_
High water alarm level at*
Hyde s ed
E. SEPARATION DISTANCES
"Pump on"
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
in
"Pump off' level at*
Septic/holding tank on lot 100'+ On adjacent lots 100'+
Absorption field on lot_ 100'+ On adjacent lots 100'+
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer/septic service line
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+ Absorption field 5'+
Water main/service line. 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line
Building foundation 10'
*WAVIER #WR980095
Water main/service line 10'+
Surface water 100'+ Driveway, parking/vehicle storage area 10'+
Curtain drain
F. ENGINEER'S
I certify that I I
of Municipal n
with MOA HA,
Engineer's
HAA Fee � ? " , a�
I[/,LN49ki1
field inspections and review
systems are in conformance
on this date.
Date of Payment JZ�I 6 D
Receipt Number%
72.028 (Rev. 3/88)* Computer Verslon
Wells on E
Waiver Fee $
Date of Payment
Receipt Number
10-18-00 09:28 FROM -CTE ENVIRONMENTAL
A44■■CUE Environmental Services Inc.
. —irvrr----
CT&E Ref.#
1006391001
AK Water & Wastewater Consultants Inc.
Client Name
Project Name/#
Paradise Valley Ll, B2
Client Sample ID
Paradise Valley Lt, B2
Matrix
Drinking Water
Ordered By
PWS1D
0
Sample Remarks:
Parameter
5615301 T-609 P.02/03 F-607
Client POP
Printed Date/Time
Collected Date/Time
Received Date/time
Technical Director
for I
Released By Ij
Results PQL Units Method
Waters Department
Nitrate -N 0.809
Microbiology Laboratory
Total Coliform 0
0.500 mg/l, EPA 300.0
col/100nd, SM18 9222B
10117/2000 15:21
10/11/2000 15:00
10/12/2000 15:50
Stephen C. Ede
Allowable Prep Analysis Init
Limits Date Date
10 max 10/12100 SCL
10/12/00 IDT
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section CMD
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # d� q,)- 41 '�_) I HAA # ��
1. GENERAL INFORMATION
Complete legal description ✓���� 5 �- r%Nl�z y L� r 1 /3��_
Location (site address or directions) "/ 6%''e_e_c e C,%
loru Ef '11
Property owner T 1�H Day phone �� ? - 2__ 1/ 9'
Mailing address z� 0�! C �r �� /�,>�/ Su, r�- �2 vl ' 17
Lending agency
Mailing address.
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: I
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Day phone
Day phone
Public water
NOTE: If community well system, provide written confirmation from State ADEC,attest-
ing, to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
I
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA N21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify 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 re�laiior in eff t on the date of this inspection.
age a 'ver 3 inee
6� ring Services
Name of Firm P.O. Box 773294, Eagle Rio -1 , aK 99577 3294 Phone
Address
Engineer's signature Date
.e
Louis A. Butera
6. DHHS SIGNATURE 4 '`y, CE -6736 �.
X Approved for �- bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By:
Date 2-2(-7?
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-M (RW. 1/91) Back MOA a21
D. LIFT STATION �,iVX -
Date installed
Manhole/Access (Y/N)
High water alarm
E. SEPARATION DISTANCES
*Datum
Size in gallons
at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 13c On adjacent lots
i
Absorption field on loth On adjacent lots
"Pump off" level at*
I- l a49
11
Public sewer main + / O 67 Public sewer manhole/cleanout -( 00
'
Sewer /septic service line Lift station -1411A^-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation K2- Property line -4-0 � Absorption field
Water main/service line _Surface water/drainage froo Wells on adjacent lots + loo
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line rCwA �) Building foundation �76 r Water main/service line
i-Il'e�, "
Surface water + tae Driveway, parking/vehicle storage area �� d s
Curtain drain —/V4 - Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal
in conformance with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name Z Z� 0
Date al— /k-425
HAA Fee $ 2oy ,(DO Waiver Fee $
Date of Payment a -
Receipt Number 0
72-026 (Rev. 3/96)*
Date of Payment
Receipt Number
are
FEB -24-09 16:62 FROi-CTE ENVIROMTAL
Y CME Environmental Services Inc.
CT&E Rcf.p
Client Name
Pcmjeet wame1#
Client Sample M
Mateix
Ordered By
Pwsw
990604001
Pagk River ftineering
l.ot 1 silk 2 Paradise vaAey
Loi 1 BW 2 Paradise Valley
prinking Water
■
6616301 T-664 P.02/03 F-263
Client FM
lrt inted lbtteirtme 02123199 11:52
Collected Vagi i ue 02117/99 15:15
Beeeired Date(fime 02/17/99 15:45
Teebeical Director. Stephen C. Ede
8 amend By rI I. _ r 1 A Aj,
Attowebte Prep AnaLrsix
Parameter Resutcs PmL units 1lotlro4 Limits pate _ Dace snit
8.100 u
0.100 a9t4
EPA 300.0
10 max 02/16/99 82/18/49 SCE
Nitrate -N
Totat Coliform
0
cnt1100ml-
51+18 92228
02/17/99 KAP