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HomeMy WebLinkAboutPARADISE VALLEY BLK 5 LT 11Paradis Vail Y Block 5 Lot 11 #020-412-05 Municipality of Anchorage Community Development Department Page 1 of 3 On-Site Water & Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 •http://www.muni.org/onsite •(907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191284 PID Number: 020-412-05 ❑ New ® Upgrade Name: GLENN &SHARON ILLSLEY ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bedound Address: 18211 NORWAY DRIVE *ANCHORAGE, AK ❑ Other Phone: No. of Bedrooms: Soil Rating: Total Depth from origina ade: (907) 632-4729 3 GPD/Sq. FL Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade: Grave pth beneath pipe: Ft. Subdivision: Block: Lot: Fill added above original grade: Gravel length: PARADISE VALLEY 5 11 ��� FL Ft Owns Ip: anger eC Ion: Gravel width:eds Number of lines: F7 Distance between lines: Ft. SEPARATION DISTANCES Total absorpr area: umber of trenches: Dist. between trenches: To Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines so. Ft. Ft. well 100'+ 25'+ TANK ■ Septic ❑ S.T.E.P. ❑Holding ❑ Other Manufacturer. GREER TANK Capacity: 1250 Surface Water 100'+ Gal. Material: Number of compartments: Lot Line 5'+ N/A HDPE 2 Foundation 10'+ _ LIFT STATION Curtain Drain NONE KNOWN Manufacturer. Ca Gal. Remarks: oLD TANK DECOMMISSIONED PER UPC PER CONTRACTOR "Pump on" level at: "Pump oft" level at: High water alarm at: Pump Make & Model, Electrical Inspections performed by: PIPE MATERIAL House to tank EXISTING/D3034 Tank to EXISTING/D3034 drainfield Installer ARM SERVICES Drainfield EXISTING CO/MT EXISTING/133034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 9892 Ft. Inspection Location and Description Dates: 1st 8/2/2019 2nd - 3rd - 4th TOP OF MH ENGINEER'S EAL Community Development Department Approval oo�o p� 0 0 Conditional approval: Date: 4 T , ..:.. . ..........::�..0� �... .. ... .................� QQ or ss: Q 9� E-7953 mmQ '-�.�; �4edpr Approve Date: LICENSE 0 ofess10 novo #AECC884 Inspection Report _1-1-12.doc PERMIT NUMBER: PARCEL ID NUMBER: OSP191284 RECORD DRAWING 020-412-05 PARADISE VALLEY; BLOCK 5, LOT 12 VACAN F i EXISTING i HOUSE i J � Q � U C /i 2v j j DRIVEWAY a' •'• .�'•, DBL1&2 i \ \ PARADISE VALLEY; BLOCK 5, LOT 10 \ 0 1 SUMP , / APPROXIMATE LOCATION OF UNKNOWN I PIPE; BELIEVED TO NOT BE ASSOCIATED \ WITH THE SEPTIC SYSTEM GARNESS ENGINEERING GROUP, Ltd -- -- - - :---- — ENGINEERING - SALES �CONSULTING i — 1 =4 _'w*\\\ .4WAV �P•••••..... �♦♦ AF 3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE, AK 99507 -PHONE (907) 3376179 -FAX (907) 338-3246' WEBSITE: vrvrn.gamessengineenng.com,• ........... ........... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: J y Garnessc• � 1 GLENN AND SHARON ILLSLEY 907-632-4729 2 OF 3 CE -79 •' _Aw LEGAL DESCRIPTION: DRAWN BY: ��� • ) 4W PARADISE VALLEY; BLOCK 5, LOT 11 p D.J.G. �j��c��•'•••�� I• • TYPE OF WORK: DATE: LICENSE 1�1;;"'.� • SEPTIC TANK RECORD DRAWING SITE PLAN 8/15/2019 #AECCs8a i \ A B C FCO 25.6 3.4 24.9 \ MH 36.5 20.6 24.9 \ ST 41.2 24.0 34.8 DBL1 42.4 24.9 34.9 \ DBL2 43.4 25.7 35.1 PARADISE VALLEY; BLOCK 5, LOT 2 & 3 \ \ TMT 34.8 21.7 36.1 \ PARADISE VALLEY; BLOCK 5, LOT 12 VACAN F i EXISTING i HOUSE i J � Q � U C /i 2v j j DRIVEWAY a' •'• .�'•, DBL1&2 i \ \ PARADISE VALLEY; BLOCK 5, LOT 10 \ 0 1 SUMP , / APPROXIMATE LOCATION OF UNKNOWN I PIPE; BELIEVED TO NOT BE ASSOCIATED \ WITH THE SEPTIC SYSTEM GARNESS ENGINEERING GROUP, Ltd -- -- - - :---- — ENGINEERING - SALES �CONSULTING i — 1 =4 _'w*\\\ .4WAV �P•••••..... �♦♦ AF 3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE, AK 99507 -PHONE (907) 3376179 -FAX (907) 338-3246' WEBSITE: vrvrn.gamessengineenng.com,• ........... ........... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: J y Garnessc• � 1 GLENN AND SHARON ILLSLEY 907-632-4729 2 OF 3 CE -79 •' _Aw LEGAL DESCRIPTION: DRAWN BY: ��� • ) 4W PARADISE VALLEY; BLOCK 5, LOT 11 p D.J.G. �j��c��•'•••�� I• • TYPE OF WORK: DATE: LICENSE 1�1;;"'.� • SEPTIC TANK RECORD DRAWING SITE PLAN 8/15/2019 #AECCs8a i PERMIT NUMBER: PARCEL ID NUMBER: OSP 191284 RECORD D RAW I N G 020-412-05 FINAL GRADE = 98.90-98.90 MH ST2 2" INSULATION TOP OF TANK AT INTLET = 94.9 TOP OF TANK AT OUTLET = 94.98 NEW 1250 INVERT OF BUNG AT INLET = 94.17 GALLON H. D. P. E. INVERT OF BUNG AT OUTLET = 94.00 SEPTIC TANK �F 1�1�♦ GARNLSS LNGINEE R ING GRM'UP Ltd 9 • • • ,, • ENGINEERING:SALES:, CONSULTING 3701 E. TUDOR ROAD. SUITE 101 'A NCHO RAGE, AK 99507 -PHONE (907)337-6179- FAX (907)338-3246 ' WEBSITE: vNnv.gamessengineenng.cam •.......... ....... ! PREPARED FOR: PHONE NUMBER: PAGE NUMBER: J ff ness 1-+./ GLENN AND SHARON ILLSLEY 907-632-4729 3 OF 3 # 6) CE -7953 ' Zv LEGAL DESCRIPTION: DRAWN BY: �� • I���.� PARADISE VALLEY; BLOCK 5, LOT 11 D.J.G. ®�j Q°° '°.�,•!` �s ° �, w� TYPE OF WORK: DATE: LICENSE /��'OROFESS` 01 1 SEPTIC TANK PROFILE 8/6/2019 #AECC884 ��so`"** 2019-0270e4-0 L Recording Dist: 301 - Anchorage S 8/1/2019 01:04 PM Pages: 1 of 4 1103-11C Grid 3538 EN 19021 020-412-05 This permit is between Chugach Electric Association, Inc., an Alaska non-profit electric cooperative (herein "Chugach"), whose address is P. O. Box 196300, Anchorage, Alaska 99519, and Glenn B. Illsley and Sharon A. S. Illsley (herein "Permittee"), whose address is P. O. Box 1569, Kenai, Alaska 99611. 1. Easement. Chugach is the grantee or user of an easement for the construction and maintenance of electrical facilities, as follows: Described in that certain written instrument recorded on the 215' day of October 1980, at Book 537, Page 570, on file in the office of the District Recorder, Anchorage Recording District, Third Judicial District, Seward Meridian, Alaska, Described in that certain written instrument recorded on the 281h day of June 1982, at Book 747, Page 107, on file in the office of the District Recorder, Anchorage Recording District, Third Judicial District, Seward Meridian, Alaska, (herein "Easement") which pertains to the following described real property: The Westerly Ten Feet (W' ly 10') of Lot Eleven (11), Block Five (5), Paradise Valley Subdivision, according to Plat Number 87-16, filed on the 41h day of March 1987, on file in the Office of the District Recorder, Anchorage Recording District, Third Judicial District, Seward Meridian, Alaska. Permittee acknowledges the validity of the Easement. Permittee warrants and represents that Permittee is the owner of the fee simple interest in the land subject to the Easement and the following described real property to which the Easement is adjacent: Lot Eleven (11), Block Five (5), Paradise Valley Subdivision, according to Plat Number 87-16, filed on the 411 day of March 1987, on file in the Office of the District Recorder, Anchorage Recording District, Third Judicial District, Seward Meridian, Alaska, (herein "Parcel"). Encroachment Permit - Page 1 of 4 eRecorded Document 2. Encroachment. Permittee has constructed or purchased the following improvements on or within the real property subject to said Easement: A well that encroaches approximately Six Feet (6') into the easterly side of the Easement at a location approximately Seventeen Feet (17') from the southwest corner of the Parcel, for a distance of approximately One Foot (1') (herein "Encroachment" 3. Permit. Chugach hereby authorizes Permittee to continue the existence of the Encroachment in its existing location subject to the covenants set forth in this permit. 4. Indemnification. Permittee shall indemnify and hold Chugach harmless from any claims for personal injury, property damage or other loss arising in any way from the continuation of the Encroachment. 5. No Expansion or Increase. Permittee shall not in any way expand or increase the extent to which the Encroachment occupies any of the real property encumbered by the Easement without the prior written consent of Chugach. Chugach has no obligation to provide such consent. 6. No Interest in Real Estate Acquired. Permittee hereby acknowledges that the Encroachment and any additions thereto, even if in violation of this permit, has not and shall not in the future give rise to any interest or estate in the real property subject to the Easement or any other real property. Without in any way limiting the foregoing, Permittee acknowledges that the Encroachment is not adverse to any interest of Chugach and its continuation is entirely with the permission of Chugach for purposes of the common law doctrine of adverse possession. This permit creates no interest in the real property subject to the easement. 7. Modification of Utility Facilities. If the electric utility facilities located within the Easement are upgraded, added to, replaced or reconstructed, Permittee shall pay that portion of Chugach's total costs for such modification which is reasonably attributable to accommodating or preserving the Encroachment. If such payment is not made within thirty (30) days of written demand for same, Chugach may terminate this permit in accordance with paragraph 9, below. 8. Covenants Running with the Land. The obligations of the Permittee arising from this permit shall be covenants running with the land which shall burden the Parcel and the Permittee's interest in the land subject to the Easement and shall benefit the Easement. 9. Termination. Chugach may terminate this permit after the giving of thirty (30) days written notice of such termination if: a. The Encroachment is enlarged, increased or extended within the real property affected by the Easement. Encroachment Permit - Page 2 of 4 2of4 eRecorded Document 2019-027064-0 b. The Encroachment is damaged by any means to an extent of more than thirty percent (30%) of its replacement cost at the time of destruction. C. Permittee fails to make the payment described in paragraph 7, above. 10. Term. This permit shall, if not sooner terminated by Chugach, expire forty (40) years from the date hereof. 11. Entire Agreement. This written permit constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all other prior or contemporaneous agreements, oral or written, between the parties. No modifications, amendments, deletions, additions or alterations of the permit shall be effective unless in writing and signed by all of the parties hereto. CHUGACH ELECTRIC ASSOCIATION, INC. By: &1J-� Shelly Schmi enior Manager Distribution Engineering Date: 1 PERMITTEE By: Nl-- -t/; 6e�- Glenn B. Illsley c� Date:Zz3c)%l / By: Shar n A. S. Illsley Date: -77 Z 30 /19 Encroachment Permit - Page 3 of 4 3of4 eRecorded Document 2019-027064-0 STATE OF ALASKA ) ) ss: THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this SCS day of L,1- 14 2019, by Glenn B. Illsley. NOTARY PUBLIC CRAIG WALLS STATE OF ALASKA Notary Public in a e tate of Alaska COMMISSION EXPIRES May 08, 2021 My commission expires: 0 5/G "/ 6j 1 STATE OF ALASKA ) ) ss: THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this Ro day of JI, I LA 2019, by Sharon A. S. Illsley. NOTARY PUBLIC CRAIG WALLS STATE OF ALASKA Notary Public in an or t e State of Alaska COMMISSION EXPIRES May 08, 2021 My commission expires: 6.5 1Ok l Ao a, STATE OF ALASKA ss: THIRD JUDICIAL DISTRICT The foregoing instrument was acknowledged before me this S'� day of v6-05+ 2019, by e. l "-, 4-4. Senior Manager, Distribution Engineering of Ch ach Electric Association, Inc., an Alaska corporation, on behalf of the corporation. STATE OF ALASKA, NOTARY PUBLIC Stephen L. Howe My Commisalon Ekes 4 t Zp Return to: Chugach Electric Association, Inc. P.O. Box 196300 Anchorage, Alaska 99519-6300 Attn: Land Services Department eRecorded Document -v Notary Public in and for the State of Alaska My commission expires: 4� 1"702 0 Encroachment Permit - Page 4 of 4 4of4 2019-027064-0 " MUNICIPALITY OF ANCHORAGE i - \l On-Site Water&Wastewater Program N°,'', ��t .S( PO Box 196650 4700 Elmore Road ., Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 f, http://www.muni.org/onsite 4��HaRAOE Department On-Site Wastewater Disposal System Permit 'ermit Number: OSP191284 Effective Date: 7/11/2019 Nork Type: SepticTank Upgrade Expiration Date: 7/10/2020 'ax Code Number: 02041205000 site Legal Address: PARADISE VALLEY BLK 5 LT 11 G:3538 ;ite Mailing Address: 18211 NORWAY DR, Anchorage Miner: ILLSLEY SHARON A S & GLENN B Lot Size in Sq Ft: 20308 lesign Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 his permit is for the construction of: • ] Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage II construction shall be in accordance with: . The attached approved design. . 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) . 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). . 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 Special Provisions: Letter(s)of non-objection for existing well located in Electrical Easement shall be submitted to Onsite prior to inspection report approval. Received By: 7t._ z1(1 '07//z Date: Issued By: ,/ A%'44 avz_e-el7 Date: 11, ? uc"6 8 9 70 >> MUNICIPALITY OF ANCHO �� • !( a JUL. 3 2919 Community Development Department " ' zQ Pho Development Services _ @r 07-343-79046' On-Site Water & Wastewater Program Fax. -7g,9 6 8 Ly Mayor Dan Sullivan On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 020-412-05 Property owner(s) GLENN & SHARON ILLSLEY Day phone 632-729 Mailing address 18211 NORWAY DRIVE *ANCHORAGE, AK 99516 Site address 18211 NORWAY DRIVE *ANCHORAGE, AK 99516 Legal description (Sub'd, Block & Lot) PARADISE VALLEY; BLOCK 5. LOT 11 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (Nall that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Ej Upgrade ® (w/wo ADU) Septic Tank ® Duplex (D) ❑ Renewal Holding Tank ❑ Multiple Dwellings ❑ Privy (SF and/or D) Private Well ❑ Water Storage ( I THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees CS O Waiver Fees: Date of Payment: 7/ Date of Payment: Receipt Number: I ORS! Receipt Number: Permit No. OS PI CL(c?S Waiver No. (Rev.01/11) GARNESS ENGINEERING GROUP Ltd ENGINEERING SALES CONSULTING July 2, 2019 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for Paradise Valley; Block 5, Lot 11 To whom it may concern: The existing 3-bedroom house is served by private septic system and well. The existing steel septic tank is 38 years old and assumed to be in a state of failure. We are proposing to decommission the existing 1,250-gallon steel septic tank per UPC and install a new IM- 1530 Infiltrator septic tank. We are unaware of any adverse impacts this installation would have on adjacent wells or septic system . If you have any questions, please contact us at 337-6179. Thank you for your as- .tance. .incerely, Je e, . . nes-, P.E., M.S. -resit ' t 3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com \ ‘11 ilLIV ill PP:17- N M V Opp -� 12� �� -/ / S. / ` _ _ 0 q. PARADISE'\VALLE �' .. / ROx/ALTF BLOCK S, .OT /� ..• l F<q 1 / •\ PARADISE VALLEY; 10 /sp / \\ BLOCK 5,LOT 4 I I Ij •pp \ 1\ 14/€4 .-17tt. �� ---I ---,VACANT I / I // I ♦\ / / I \ 411/ I / I / / \�. PARADISE VALLEY. 4°C R p / \1 BLOCK S,LOT 2 8 3 1 WF4q 7/04,8 #/ ` I • /• ii 1 \\ I /�S PARADISE VALLEY; BLOCK 5,LOTI9 � \ 1 —��/ / -' . PARADISE VALLEY, \ / \BLOCK 5.LOT 13 \\ i / S. / S. \ // \ \ / qA. \ ---- \\ // . / 1 1' /,y/• \ PARADISE-VALLEY, ` 'N �!�_ __ I • 0 /Ot 1 BACK 5,LOT 12 (� \ PARADISE VALLEY; I 1 / BLOCK 5,LQY O .. / VACANT / I ---I —_ �' / . /� I .\ � / i \ \ / S. . 66.` '1.. / \ / / \ 1 / P, I 708/ \/' 1 \\\\ /I / / NO �� `\ • 1 I •/ / \ 'ARADISE VALLE /. \ x-6'0 ..\\// I r �.�/ \\ I / BLOCK 4.LO� I /1 �<<Rg' 1..' j ---} — 0I, 00. \\i // M\\ 1 0g O0•/ PARADISE`/ALLEY: FARAD' VALL:Y, j .� ��/ \ I // BLOCK 4,ILOT 11 BLO•K 4,LOT 12 �AR'ADISS-GALLEY; I \\. 1 �// BLOCK 4,LOT 13 ---A, ----- 0=11 / \ j ,4 A 1 PARADISE VALLEY, I /\ / BLOCK 4,LOT 9 \\ / \\ �// '` A \\ / N. \ " OPARADISE VALLEY; O rr. , BLOCK 4,LOT 10 10 40 .•'\tG OF .I ,f. GARNESS ENGINEERING GROUP, Ltd it/ 9".t.,� 0 Seim immmel ENGINEERING SALES CONSULTING • 1, • 3701 E.TUDOR ROAD SUITE 101•ANCHORAGE,AK 99507•PH0PE(907)337-6179'FAX(907)336-3246•WEBSITE vmw.gamessengneenng.corn •..i..i 1 • • 2EPARED FOR: PHONE NUMBER: PAGE NUMBER 0 VO % 'e ' - A. Gar -ss r�. GLENN & SHARON ILLSLEY 632-4729 1 OF 2 ♦j G% C - • , �" 2OJECT/LEGAL DESCRIPTION DRAWN BY •aP '.•• ' PARADISE VALLEY; BLOCK 5, LOT 11 PNB •,,c�p�•'' 2 I 1,, • • 'PE OF WORK DATE: LICENSE•, 4 `vr ESS :P•4• SEPTIC TANK DESIGN UPGRADE 7/2/19 #AECCB84 1 ������• • #GEG,Ltd.HAS AN 8 PAGE SPECIFICATION LETTER PARADISE VALLEY;BLOCK 5,LOT 2&3 THAT PERTAINS TO THIS DESIGN.BY PROCEEDING FORWARD WITH THIS INSTALLATION,THE ENGINEER,WELL DRILLER,CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO NOTE:CONTRACTOR MUST HAVE ALL 100'WELL ACCEPT THE TERMS AND CONDITIONS OUTLINED. RADII SHOWN AND THE EAST LOT LINE,FLAGGED BY A PROFESSIONAL LAND SURVEYOR PRIOR TO \-3 CONSTRUCTION AND ENGINEERS LAYOUT. 10'UTILITY EASEMENT J r / / PARADISE VALLEY;BLOCK 5,LOT 10 / VACANT / / / / \ APPROXIMATE OCATION OF EXISTING SEPTIC / TANK;TO BE DECOMMISSIONED PER UPC SHED \ •ROPO ED IM 1530 INFILTRATOR SEPTIC TANK e / (2-COMPARTMENT) 4r / Z / MH T INSTALL PARADISE VALLEY;BLOCK 5,LOT 10 Q \\' 'MSC DOUBLE CO Oo J / 3 / acs" Ue i EXISTING + EXISTING p HOUSE c/o,. / fDEXI TING / S ii l \ / \ – 7/ I.I..'• -: DRIVEWAY .:• *'• ‘' r....- ..... ��� \ / / v1P�OR �.. �� N CURRENTLY OBTAINING LETTERS — i — ___� ��' �, OF NON-OBJECTION FOR \ EXISTING WELL IN EASEMENT ------ IV / \ / _ S ALE: ADIS ALLEY;BLOCK 4,L'IT 10 1 - / PARADISE VALLEY;BLOCK 4,LOT 12 \ ♦.001\\_\ 11 4.4 ARNESS ENGINEERING GROUP, Ltd • - 4' I. - • • 3701 E. sETUDOR ENGINEERING SALES�,CONSULTING -• —•�---u-0 • ! 4 N8914'40'E85.62 10'UTILITY EASEMENT 4 '� O 0 yW Wy? ^nnv I. / 0 1 Ill-, Z #14114/0` S 1/ la cs - • w 0 44, .,-,1. =- CG r� a m / ' 1/ Ir 1 I Op000004 t 4- L = 15000 ovP'�.. 1et)no f 49 m ' .77*QQ i7 0 SAF..4� h661 0 '�/ pRIVE� 007 o0 N�RW.4 j/ 007-; SHANE A.HOLT .' :1 v01%Q P LS-6914 y� ,4 0,. �a o ,of4ssional\..:L.'=' �ODODO�oo AS-BUILT SURVEY 1" = 30' SURVEY ORDERED BY: OAR WALDEN NO CORNERS SET THIS DATE nELLER WI(4MS I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT IT,BLOCKS PARADISE VALLEY(PLAT 87-16) THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ANCHORAGE PROVEMINT DIITUITE, ALASKA, AND THAT NHE CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN EXIST OTHER THAN NOTED. HEREON L UNLESS INDICATED) DATED AT ANCHORAGE,ALASKA THIS 7TH DAY OF NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE JUNE , 2019 PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. HOLT LAND SURVEYING 9309 GROVER DRIVE 14'66,FB 197-22 ANCHORAGE,AK 99507 345-5513  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 NAME PHONE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDH~MS DISTANCE TO: I ,~~ Absorption area ~' Manufacturer ~ ~ - of~partment ~ i M~t~ ,o. Liq. c~%t~n¢lrons. IF HOMEMADE: Inside length-- Width ~ Liquid ~h Dwelling / ~ PERMIT NO, ~ ~ ~ Ma~ / Material L;qu]~ u~p~ui[y in Q Well ~ ~ Foundation Nearest lot line PERMIT NO. ~ DISTANCE TO: ~~ ~ '~[~ f~e~ Distance betwee~lines ~~m~ Z No. of(~xlines Length of ea~i~ Total length o Trench~i~h¢ inches ~ ~ ~ Top of tile to finish grade / Material beneath tile Length ! Width Depth PERMIT NO, . N Ty~ C~meter ~ Total effective absorption a~ / ( ~ / ~ Building foundation m ~ DISTANCE TO: ~ (~~ Depth Driller Distance to ,o, line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER SOIL TEST RATING ~¢~' /~, ,,I a~ ', REMARKS * ~ ~ z ~-~ I~f 72-013 (Rev /78) BOX 1369, t~TAR I{OL'TE A ANCHORAGE, ALASKA 9950:8 3.C14-.??14 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF ~00 ~ea~o DRillED AT THE ratE of _ ~20o00 PER FOOT. 276-644~ PROPERTY OWNER ,~,Z.. g~ t~ 7742 D. 12~J~ ~ ~d~o~ 9950~ D~ILLE~ WELL LOG: 91---137' 137--149~ 149--300~ 245--248' Coo~*. of 2~6t.&¢: ~,20.00 pe~ fa. )C 300fee.6: ,,$~000.00 f~o C.~u~¢e for .~et~ u.p o,~ ~ed.l. SeaL. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLINg. ~ ' ~ 6000.00 WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF, THANK YOU VERY MUCH. bERNIE CLAUS OF RaMPaRT DRILLING WORKS DATE ..... l~ 2 ~ ' ~ ~ ~ ~ ~ SERVICE CHARGEOF 1~% PER MONTH WILL BE ASSESSED ON PAST DUEACGOUNT$. [:,EPRRTMENT ' ' HERLTH RNr) ENVIR. ONMENTRL, RGTECTION PERMIT NO. ,, ,.~_,=. ..... APF'L I CANT L DCRT I ON LEGAL L, t'-.I -- :. :[ TE SEI~-.IEF: PEFt-.I'-I ,I T' BR. IRN F'. MILLIS .i,'4~ NEST i2TH R,~EN.E _/~_~:]1-~1 L ~ B 5 FRRRDZ_,E YRLLEY ~ZD LOT _,Z~E ........ ~IIRRE FEET c-. ':"- IS: ,- r' TYPE OF _,uIL RBSORPTION _~r=,TEfl TREN..H MR,..,IMLIM NUME:ER OF E,E[.ROOM=, = 4 SOIL F.'.FITING ,"~Q FT,..E,F ..... Z40 THE REQUIRED SIZE OF 'THE SOIL PIBSORPTIUN :~r_-TEM IS: [::,EPTH= :1_ .-'!- I_ E I'-.t,3 T'H = 2~: ,Z~ F:': R %-' E L [:, EF"T'H = -_t. ~-Z1 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRtNFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND 8ND THE BOTTOM OF THE ENCRYR'FION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE E'.:,:',C:RVRTION (:IN FEET). REI::.t I I F.:EC. _ EFT T r': TRt-~F-':..: _ I ZE= i--- 5[3 ..~ .... PERMIT HPFLI_,RNT HRS THE RESF'ONSIBILITY TO INFORM THIS DEPRRTMENT DIIRING THE INSTRLLRTION INSPECTIONS OF 8NY WELLS RD..TBCENT TO THIS PROF'ERTY FIND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. BRCF..FILLING OF RNY :~r_TEM WITHOLtT FINRL INSPECTION RND RPPROVRL B'¢ THIS [:,EPRRTMENT WILL BE SUBJECT TO PROSECLITION. MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS i00 FEET FOR R PRIVRTE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC NELL. MINIMUM DISTANCE FROM R PRIVRTE WELL TO R PRIVATE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. NELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 30 DRYS OF THE WELL COMPLETION. OTFIER REQUIREMENTS MRY RPPLY, SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. I CERTIFY THRT ±: I BM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WEL. LS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE NITH THE CODES. ~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. S I GNED: RFFLIC4-~NT BRIRN P. MILLIS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: I 2 3 4 5 6 7 8 10 ~2 18 20- SLOPE t / / PLAN WAS GROUND WATER ENCOUNTERED? ~t~' SL IF YES, AT WHAT DEPTH? Gross Net Depth tO Net Reading Date Time Time Water Drop PERCOLATION RATE "~ · O [ (minutes/inch) CERTIFIED BY: ~~'"~"-~ ~' ~ 72-008 (6/79) /~?,, i~/%o ~'~,~ APPLICANT FILLS OUT UPPER HAt''~IONLY ~.ling~Address ///C) ~ /~ ~ ~ .~ ~/~ ~'~ ? ~ ~/Zip Code ~--~ 'Address ~- , ~ Zip Code ~'~'~ Lending Institution /~ ~/~ Address i ~ Zip gode ~'~g--C Realty Co. & A.nt ~ .... ~F>/x~ / :/~ ~// Phone Type of Resi~n~e " ....-~ . ~ '~ ' ~ Single Family g Multiple Family ' Nm-o~.Bedroo~ ~ Other ' Water Supply ~ ~. .~ Individual ~ ,. ~, A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ Community ' For wells drilled prior to that date, give well depth (attach log if available. ~ Public Utility- Sewer Disposal ~ ? ~lndividual Year Individual Installed: ~... ~ Public Utility When Connected to Public Utility: /// ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED, Time Time Time Date Date Date Date ~_~j~_ ~ ,~ Insp~tor Insp~tor Insp~t~ MuNICIPALI'rY OF ANCHO~GE DEPT. OF HfiALTH ENVIRONMENTAL pEo~ECTION MAY 1 ~ ~g83 ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* By:DATE Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received 5~ ~ Well to Tank Septic T~k Size 72-023 (3/82) NSPEOTOR " : ~P~OR · ~ I ,~R ~ '- · · . · ~ MUNICIPALITY OF ANCHORAGE MUNfC PAL TY ~F' ~NCHORAGE  DEPARTMENT OF HEALTH & E~ RONMENTAL PROTECTION ENvIRoNMENTAL SANITATION DIVISION ' Telephone ~64-4720 RmUEST FOR "D wDU [ S E DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proceS~d. Please allow ten (10) days for processing. 1. PROPERTY OWNER ~ MAILING ADDRESS ' ~q* ~* f ff re tflo}~g~e~n ~ "~ PHONE PROPERTY RES DENT I d' e b:' ) ~ P NE 2, BUYER ~ ~· HO MAI LING ADDRESS 3. LENDIN~ INSTITUTION ' ' PHONE MAILING ADDRE88 ' PHONE MAILING ADDRESS . 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE ~ NUMBER OF BEDROOMS ~]~ [] One [] Four SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six 7. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY [] Other * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM - NDIVIDUAL/ON-SITE~ [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79 ) Parcel I.D. 020-412-05 Certificate of On -Site Systems Approval Expiration Date: 3-15-2023 Legal description Paradise Valley Block 5 lot 11' Site address 18211 Norway Dr. Anchorage, AK.99516 Current property owner(s) Fidler X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory X Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNOPAUTY of ANCHORIA"k.GE rPA Dovelopment Servloes Depai`tlT ont I'17c�ni?: 907.343-7904 do-Sit0 Mater & Misitmater Sootion - 1-nx: 907.343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 020-412-05 Complete legal description Paradise Valley; Block 5, Lot 11 Location (site address) 18211 Norway Dr. *Anchorage, AK 99516 Current property owner(s) Josh & Becca Fidler 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 202-4651 3. TYPE OF WATER SUPPLY: V Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL:❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 3 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment C I �1 Date of Payment COSA # �S L� I�'� Waiver # COSA Apprieaton June 2022 Legal Description: Paradise Valley; Block 5, Lot 11 Parcel ICS: 020-412-05 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system Q Well log is filed with Onsite (or attached) Date drilled 5/26/81 Total depth 291 ft Cased to unknown ft R Sanitary seal is functioning correctly R Wires are properly protected Casing height (above ground) 12.1- in. Date of flow test for COSA 1/19/22 Static water level at beginning of test 179.2 ft. Comments B. TANK DATA Measured operating fluid level in septic tank *4811 Date of pumping 11/9/22 ❑ Required maintenance completed, if AWWTS Comments: *1/19/22 D. ABSORPTION FIELD DATA Which system tested (date installed) 5/11/81 0 ALL standpipes present per record drawing Total measured depth from grade 12.58 ft (max) Measured depth to pipe invert from grade 6.25 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 6.33` ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) No If yes, enter date Well production at time of test 7.0+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes No R Coliform bacteria is Negative Nitrate 57- 7Z mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 51-11 Arsenic less than MRL (ND) Collected by GEG, Ltd. Date 12/2/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station N/A years Lift station material N/A Comments: N/A Adequacy test date 1/19/22 Results g Pass Fluid depth prior to test 0 in Water added **619 gal New fluid depth 14 in Elapsed time 120 min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 120 in Effective depth used 76° in Effective depth remaining 44" in Comments/Deficiencies: **Nine (9) inches of water appeared in sump after introduction of first 207 gallons of liquid. COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' QYes if No ft M Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' 10 Yes if No ft Holding Tank > 100'Q Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft Fol Yes if No ft Community Sewer Main > 75' Yes if No ft Manure/Animal Excreta Storage > 100' 0 Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No *51+ ft Surface Water > 100' 0 Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS * 5'+ to deck. 0 Yes if No ft © Yes if No ft © Yes if No ft El Yes if No ft Tn-Y 19P-1 Wells on Adjacent Lots: Private Wells > 100' E Yes if No ft Community Wells > 200' [�] Yes if No If tank or field is under driveway comment below ft G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineering Group LTD. (GEG) Phone 907-337-6179 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 systems on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may o F 0 exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate �Q during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing BUJ:' the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not .. 9 . QQ guarantee future performance of the systemis; 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 can be installed on the property in the event either of the current systems fail to perform Q f A. Gorn s: adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG Q �' jr! p to perform the evaluation. Reliance upon the Information provided in this report by any other person or party QQ r6'•. CE -795 � chop (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSH Checklist June 2022 LICENSE �Grofess100\ #AECC884 �OO�QOoO Nitrate Advisory Certificate of On -Site Systems Approval # OSC 221567 Subdivision: Paradise Valley Block 5 lot 11 A water sample revealed a nitrate concentration of 5.72 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mad�ng Address P O Box 196650 *Anchorage, Alaska 995�.96650 *www muni org • '-° Municipality of Anchorage r �� On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 020-412-05 Expiration Date: -2 02' 2- 1. 1. GENERAL INFORMATION: Complete legal description PARADISE VALLEY: BLOCK 5, LOT 11 Location (site address) 18211 Norway Drive *Anchorage 99516 Current Property owner(s) Josh & Becca Fidler Day phone 202-4651 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3- 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNadance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 55 a Waiver Fee $ Date of Payment Receipt Number COSA # 0 S C a 2 1017 Date of Payment Receipt Number Waiver # 63 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: Gamess 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: l 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 systems on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells 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 an workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and/ are outside the contrat of GF -G. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an altemative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in 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 this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. _TSIGNATURE 2 l System #1 Approved for J bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, OF i 4 / CE -79.. G�1 prof3S30 : #AECC884 l<<<<ttrrrrrrrr i with the following`atiore- y0 WAT SITE < WAST'_ AM AS By: Original Certificate Date: (D —202 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 _ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: PARADISE VALLEY; BLOCK 5, LOT 11 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA * ❑ Well log is filed with Onsite (or attached) Date drilled 5126181 Total depth 291 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 1119122 Static water level at beginning of test 1792 ft. Comments Parcel ID: 020-412-05 Structure served by this system Well production at time of test 6.4+ gpm Water storage tank volume NIA gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 5.31 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 1/13122 B. TANK DATA C. LIFT STATION Age of tank(s) 2 years ❑ Required maintenance com d Tank type/material 5�"" °" Age of lift station ars Measured operating fluid level in septic tank 48" Lift station mate ❑ Standpipes/foundation cleanout per record drawing Comme Date of pumping 5/24/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 5111181 Adequacy test date 1119122 ❑ ALL standpipes present per record drawing Results Q Pass For 3 bedrooms Total measured depth from grade 12.58 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 625 ft (min) Water added 619 gal ❑ N/A — pressurized field 14 New depth in ❑ Monitor tubes go to bottom of effective. If not, state 120 depth into effective 6.33' Elapsed time min p ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO date of test) Gallons introduced N/A gallons If yes, enter date N/A Comments/Deficiencies: COSA Checklist yellow sheet 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' F1 Yes if No Community Sewer Manhole/Cleanout > 100' R Yes if No ft [7 Yes if No ft Neighboring Tank > 100' []✓ Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' P,1 Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' Animal Containment > 50' El Yes if No ft [I Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation> 10' Manure/Animal Excreta Storage > 100' if No Community Sewer Main > 75' RlYes if No ft n Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water > 100' ED Yes if No ft Property Line > 5' F1 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' 0 Yes if No It Water Main >� 10' -- u 'res _ if No ft Community Wells > 200' NO � Yes - if 114 Water Service Line > 10' S✓ 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' (D Yes if No ft If absorption field is under driveway comment below Property Line > 10' El Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' El Yes if No ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' Q Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS *TO FOUNDATION - 5'+ TO DECK G. ENGINEER'S CERTIFICATION / certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet e:1 #AECC884 www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC 221017 Subdivision: Paradise Valley B 5 Lot 11 A water--sarnp-ie-Teveaied a nitrate concentration of 5.31 -milligrams- per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address P O Box 196650,* Anchorage, Alaska 99519 6650 *www mu'"ni org Parcel I. D.020-412-05 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION: Complete legal description Paradise Valley; Block 5, Lot 11 X6'1 8 9 10 u 77 rV PG. V p S s 6' S Af ETY /u z w ZZ O[ 6 8 L9C�*\ Expiration Date: _� ( Location (site address) 18211 Norway Drive *Anchorage, AK 99516 Current Property owner(s) Glenn & Sharon Illsley Day phone 907-632-4729 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings. (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNariance request for: Received by: Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: 91 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 Engineerinq 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 �oo�p04O� 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 encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, levels (that may fluctuate during the of construction (materials and O Cl) : 49 H �� groundwater year), quality workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and • • • • • • . • • • • • • • • • . • • • •D 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 be installed the in the fail in Q f r y ess! Q DO can on property event either of the current systems to perform adequately the future. The content of this report is for the sole benefit of the person/party that retained GEG to CE -79 3 4 9 c�0 perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right 40ea/'rofess- 00\ OpOp�0000 whatsoever. 6. DSD SIGNATURE -d System #1 Approved for bedrooms ��'l�lt%C1pJJ System #2 Approved for bedrooms Disapproveda O 9 q�4<siTF � Conditional approval for bedrooms, with the foil � g uyD 0= 1 T '1bN By: Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other • Legal Description: PARADISE VALLEY; BLOCK 5, LOT 11 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 5/26/81 Total depth 291 ft Cased to UNK ft Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA 7/5/19 Static water level at beginning of test 185.4 ft Comments B. TANK DATA Age of tank(S) NEW years Tank type/material HDPE Measured operating fluid level in septic tank NIA ❑ Standpipes/foundation cleanout per record drawing Date of pumping N/A D. ABSORPTION FIELD DATA Which system tested (date installed). 5/11/81 ❑ ALL standpipes present per record drawing Total measured depth from grade 12.5+ft (max) Measured depth to pipe invert from grade *5.7+ ft (min) ❑ N/A — pressurized field . . ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 6.2+ Parcel ID: 020-412-05 Structure served by this system Well production at time of test 7.3+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 5.44 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG Date of Sample 6/28/19 C. LIFT STATION ❑ Required maintenance Age of lift station Lift station material Adequacy test date 7/5/19 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 804 gal New depth 10.5 in Elapsed time 10 min ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO date of test) "' If yes, enter date N/A Gallons introduced 2000 gallons Comments/Deficiencies: 'AT SUMP; "SYSTEM PRESOAKED ON 7/3/2019 COSA Checklist yellow sheet ME, 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 Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' [D Yes if No ft Private Sewer/Septic Line > 25'[Z] Yes if No ft Absorption Field on Lot > 100' 0✓ Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' ❑✓ Yes if No ft Water Main > 10'✓Q Animal Containment > 50' ❑✓ Yes if No ft ❑✓ Yes if No ft Yes if No ft Water Service Line > 10' Z✓ Yes if No Manure/Animal Excreta Storage > 100' —❑✓ If septic tank is under driveway comment below Community Sewer Main > 75' Yes if No ft Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: ✓0 Absorption Field > 5' if No Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10'✓Q ft Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' Z✓ 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' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓0 Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' Q✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' 0✓ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION i certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet #AECCS84 Nitrate Advisory Certificate of On -Site Systems Approval # OSC191415 Subdivision: Paradise Valley, Block: 5 , Lot: 11 A water sample revealed a nitrate concentration of 5.44 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. 0 081VE N SHANE A. HOLT: LS -5914 AS -BUILT SURVEY I" = 30' smvy o"",RGD BY: TO C"R­ __tr - IFI T —1 'I" I' 'I 'Ll TO I T 11— 11GE DISIRICT, 411S�A, AIM IT- 111E VlSleL& I ;PRrV;JK[`ETS 5111 ED TRRfO!l ARE 11.17-! G� - - '11EI I -:ZT '�E 1A FRT1 L;I;ES -D W1 -L� FTAC�IEAC­, I. ' TRE­'Rlrl I-- '.I III... "'AR 141SI OTIIER Tl�;, -Ell. TRIIII All I l ­1TAI I .A� — 1101 10 DE V- TO 11­1.�,, OR lATT 11 l.TS I., II—I 1R.R11 REIII, AI 1U AT I ."j110iO1 GE "I :'l 0 - AT Rj9 nFT O[ ID SnVEY:l.G 93 D9 GROVER DRIVE AXCHORAGE,AK 99507 Municipality of Anchorage Development Services Department 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 FAHILY DWELLING Parcel I.D. 020-412-05 1. GENERAL INFORMATION Expiration Date: Completelegaldescription PARADISE VALLEY SUBDIVISION; LOT 11, BLOCK 5, Location (site address or directions) 18211 NORWAY DRIVE * ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CATHY ANDERSON & JAMES CARE Dayphone 345-3801 P.O. BOX 240783 * ANCHORAGE, AK 99524 Day phone Day phone Unlessothetw~e mquested, HAA w#lbehe~byDSD ~rp~k~. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL.' Individual On-site r~ Individual Holding tank Community On-site B 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 pdvate 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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ 0 at, or pdor I to closing for the engineering services provided. I 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authorfty 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 furlher vedfy 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 ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address 6901 OEBARR ROAD, SUITE 2B * ANCHORACE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 537-6179 Engineer's Comments: In conducting this evaluation, AKWWC, thc. attempted to provide a thorough, DSD Guidelines & Regulations. The reported results described the performance of the systemunderthaconditionsancounteradatthetimaefthatast, andseparation /~,.~:~, 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 I These conditions ara 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 '(/~ ~ '.. J~'~ =r,~ -~ Corn ess**: theraareooh,d andafactsoren=,c mao,s. , .,nc, conthera rano, pmv,da any warranty or future est~nate 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 '~I~,Z~,~____..~_ ~ .'"i ~.<'~ the sola benefit of the owner listed above. Any reliance upon or uae of this report by any ether person or party is not authorized, nor wilt it confer any legal fight whatsoever. 5. DSD SIGNATURE Approved for Y Disapproved. Conditional approval for __ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Odginal Certificate Date: Municipality of Anchorage Development Services Department Building Safety DIvls~n On,Site Water & Westewater Program 4700 South Bragaw St. P.O. Box lg6650 Anc~a, AK g9519-6650 www.ci.arx:homge.ak.us (~07) 343-79O4 Legal Desc~'iption: A. WELL DATA 'C. HEALTH AUTHORITY APPROVAL CHECKLIST PARADISE VA~FY SUBDNISION; LOT 11, BLOCK 5, ParcellD: 020-a, 12-05 Well type pRIVAlt~ If A. B, or C provide PVVSII~t N/A Date completed 5/26/1981 Sanitary seal (Y/N) YES. Total depth 300 ff. Cased lo 40'+ ft. Date of test Static water level Well production WATER SAMPLE RESULTS: / Coliform C~ colonies/100 mi. Arsenic: ~' mg/L. SEPTIC/HOLDING TANK DATA FROM WELL LOG 5/26/2001 131 ft. 4.0 g.p.m. Nitrate 4'O'Tmg.lL. Date of sample: 07/29/02 Tank Type/Material STEEL Tank size 1250 gal, NumUer of Compartments Foundation cieanout (Y/N) YES, 2 Depression over tank (Y/N) NO, Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 2/15/2002 181 fl. 4.8 g.p.m. 12+ in. Other bacteria ~* colonies/100 mi. Collected by: AKWWC, INC. Data installed 5/11/81 Cleanouts (Y/N) YES High water alarm (Y/N) N/A Date of pumping 4/27/2002 Pumper AROUND THE CLOCK PUMPING ABSORPTION FIELD DATA Date installed 5/11/81 Length 29 ft. *MEASURED IN FIELD Soil rating (g.p.d./ft=or _(~-"~ 140, Width 3 ft. Total depth .12,78 ff. Eft. absorption area 580 ft~ Monitoring tube**YES Date of adequacy test 2/15/02 Results (Pass/Fail) PASS Fluid depth in absorption field before test 5 in. Water added 720 gal. Elapsed Time: 15 min. Final fluid depth 5 Any rejuvenation treatment (past 12 mo.) (Y/N & type) in. Absorption rate >= NONE KNOWN System type TRENCH Gravel below pipe 10 ft. Depression over field NO For 4 bedrooms New depth 29 in. 600+ g.p.d. If yes, give date - '~*MI' APPEARS TO EXTEND ONLY 78" BELOW INVERT. D. UFT STA'RON Date installed "Pump on' level at in. Datum - E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons 'Pump off' level et Cycles tested Septic tanklllft station on lot100'+ Absoqotlon field on lot 100'+ Public sewer main N/A Sewer/septic sewice line 25'+ in. ManholelAcce~ (Y/N) High water alarm level at Meets alarm & circuit requirements?. On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 10'+ Surface water 100'+ Wells on adjacent lots 100'+ Property line 10'+ Water service line 10'+ Curtain drain- NONE KNOWN F, COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systema are in conformance with MOA HAA guidelines in effect on this date. JEF~<EY A. GARNESS Engineer's Printed Name Date ~J/~'/o "Z Absoq3tion field 5'+ Surface water 100'+ Water main N/A Driveway, parking/vehicle storage 25'+ Waiver Fee $ Date of Payment Receipt Number in. Municipality of Anchorage Development Services Department 6uilding Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 w,,~w.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-412-05 1. GENERAL INFORMATION Expiration Date: Completelegaldescription PARADISE VALLEY SUBDMSION; LOT 11~ BLOCK 5~ · Location (site address or directions) 18211 NORWAY DRIVE '~ ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CATHY ANDERSON & JAMES CARR Dayphone 345-3801 P.O. BOX 240783 * ANCHORAGEt AK 99524 Day phone SKIP PENNr'BAKER w/ COLDWELL BANKER Day phone 2525 'C' STREET * ANCHORAGE, AK 99504 265-9143 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ~ Individual Water Storage Community Class Well ~D Public Water System II 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 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 pdvate 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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or pdor to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal afT/xed hereto and as of the validation date shown be/ow, I 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(am) safe, functional and adequate for the nurnber of bedmoros and type of structum indicated herein. I further vedfy that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, t~e on-site water supply and/or wastewater disposal system is(am) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUEE 2B * ANCHORAGE, AK 99504 · Engineer's Printed Name J£~i-~EY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reporfed results described the performance of the system under the conditions encountered at the time of the test, end separation distances measured to readily Identifiable features. The operational life of ali wells and - septicsyetemsdependonthelocalsoi/scondition, groundwaterleve/sthatmay fluctuate during the year, and the water usage of the family being sen/ed by the system. These conditions ara outside the control of the eva/uator of the system. Satisfactory test resutts do not guarantee future perfonwance of the system, nor do they guarantee that there ara no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or futura estimate of how long the system wilt 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 roport by any other person or parly is not authorized, nor will It confer any legal right whatsoever, 5: DSD SIGNATURE ~ Approved for ~ bedrooms. Date 337-6179 Disapproved. Conditional approval for __ bedrooms, with the f]lowing stipulations: . '.; ,¥ ~-.. -.-~ ~. ON-SITE ·. [ : WASTEWATER :' PROGRAM Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: ~-"" Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewatsr Program 4700 South Bragaw St. P,O. Box 196650 Anchorage, AK 99519-6650 www.ci.anc~orage~lcus (gO'Z) 343-79O4 Legal Description: A. WEII DATA Well type PRIVA~[ If A, B, or C provide PWSID~ N//A Date completed 5//26/1981 Sanitary seal (Y/N) YES Total depth 500 It. Cased to 40'+ ff. HEALTH AUTHORITY APPROVAL CHECKLIST PARADIS[ VA/II=Y SUSDNISlON; LOT 1 1, BLOCK .5~ Parcel ID: FROM WELL LOG 5/'26/2001 151 .ft. 4.0 g.p.m. Date of test Statk: water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: N//A mg./L.. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 2/15//2002 181 It. 4.8 g.p.m. Nitrate 4.08 mg./L. Other bacteria __ Date of sample: 2/15//2002 Collected by: 020-412-05 YES 12+ in. 0 colonies/100 mi. AWWC, INC. Date installed 5/11/81 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) Date of pumping 4/27/2002 Pumper AROUND THE CLOCK PUMPING G. ABSORPTION FIELD OATA *MEASURED IN REID Date installed 5/11/81 Soil rating (g.p.dJft~Or{~_~l~.~) 140 System type Length 29 It. Width 5 .It. Grovel below pipe Total depth .12.75 .ff. Eft. absorption area 580 It' Monitoring tube Date of adequa~ test 2/'15/'02 Results (Pass/Fell) PASS Fluid depth in absorption field before test ,5 in. Water added 720 gal. Elap~ed Time: 15 min. Final fluid depth 5 in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN TRENCH 10 ft. Depression over field NO For 4 bedrooms New depth 29 in. 600+ g.p.d. If yes, give date - **MT APPEARS TO EXTEND ONLY 78" BELOW INVERT. D. LIFT STATION Date installed Size in gallons M~ "Pump o~ water alarm level at in. ~ Cycles tested Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manholeJcleanout Holding tank N/A N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line §'+ Water main N,/A Water service line 10'+ Wells on adjacent lots 100'+ Absorption field ,5'+ Surface water. 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ Water main N/A Driveway, parking/vehicle storage 25'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections end rm4ew of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date HAA Fee $ Date of Payment (Rev. 12/01) Waiver Fee $ Data of Payment Receipt Number FEB-22-02 FRI 09:46 · 82/22/2682 !8:3~' 90727£7804 ./ .:: WaGE AMD HOUR ADMIN FAX NO. 0000000 ".ROBfRr .E.-,~HS ~ .. '.. /. - /£ P. OI/OI ... ~ LEGCND: hub ~ lacK-found O set iron ~ebor -tounO 0 ~t itoh ~pe -found 0 sol ~=~ cap -found ~ Glum. ~p ~ound ~ sol ]-NC.. Sca~. i 1": 30' Dr~m~: ; 9-z~-sR · 18-055