HomeMy WebLinkAboutPARADISE VALLEY BLK 2 LT 12Paradis
Valley
Block ;2
Lot 12
#020-424-09
www.sullivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue
Parcel Identification Number:
Legal Description Property Owner Name & Address
Paradise Valley Block 2 Lot 12 Jason Hipszer
18700 France Circle Anchorage, AK 99516
Pump Installation Date:
5-19-21
Pump Intake Depth Below Top of Well Casing:
150 feet
Pump manufacturer’s Name:
F&W
Pump Model:
4F07P07301S
Pump Size:
3/4 hp
Pitless Adapter Burial Depth:
10 feet
Pitless Adapter Installer:
Unknown
Disinfected Upon Completion?
yes no
Method of Disinfection:
Chlorine 50 PPM
Comments:
Pitless Manufacturer: Unknown
Pump Installers Name:
Sullivan Water Wells
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
-'~ ~ Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES "
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage. Alaska 99519-6650 · Telephone: 343-4744
On-Site WastewMer Disposal System and/or Well Inspection Report
Permit Number:. ~ 14/ C~ I 0,~ ~7-- _ PID Number: O ;~ o - ~ .2. t/, o O, c~
.arno: L..~['5 -~ ~2~O~1'~ 144LLL~-- Wastewater System: ~.New [] Upgrade
Address:
~--[~ ~ [ IN°'°fB~"ms: ~eepTrench ~ Shallow Trench ~Bed ~Mound ~Other
LEGAL 'DESCRIPTION c,~ff o.~.
T~shlp: ~ ~nge: I S~tion: Fill add~ a~ve oflginal g~de: G~I length:
SEPARATION DISTANCES ~septic a Holding, a S.T.E.P.
Remarks: BENCH MARK
J ~um~ Elevation: ~ ~ (~ ~J,
ENGINEER'S S~L
Inspections pedormed by: ~ ~[~ Dates:lst~ ~,~ ~:49~
, ~.-f,~.~.;/..~ :,-.. ~
2nd ~ Z~.~ Z..[Z.~.
Depadment of Health and Human Se~lces approval
Permit No.
Page 3 of5
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650-Telephone .~43-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Descriplion: LOT 12, BLOCK 2 PARADISE VALLEY PID No.:
b_lllllll I1~
I~lJ/llll I1'~
I~l.l~,~'~I~:~l~ I
~ I - I---I~l~sl~ I
Permit
Page ~ of 5
Municipolity of ^nchoroge
DEPARTMENT OF: HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchoroge, Alosko 99519-6650- Telephone 34.3-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legol Description: LOT 12, BLOCK 2 PARADISE VALLEY
PID No.:
LOT 11
lC SYSTEM SPECIFICATIONS:
jlELD LINES SHALL BE 4' DIA. PERFORAIED PIPE.
PIPES lEVEL WITH PERFORATION HOLES DOWn.
5 FT MINIMUM SEPAEATION BE'~[EN [DC;[ OF
'/~D FOUNDATION.
~ BEEP TRENCH
~V MONITOR TUBE
ICAL TRENCH CLEAN OUT
qSTEUCTION SHALL BE IN ACCORDANCE WIIH 11-1[
[D;TION OF ~lE HEALI~I AND HUU~ ~R~S
UC~ ~[ClRCA~S F~ DEEP ~EN~ES
P~C lANK ~L BE ~ S[EL C~S~UC~ BY
APPRO~D UANUFAC~RER ~ WA~R ~T
~S ON INIE~ ANO ~[T.
LINE TO NEW DRNN RELD SHALL BE 4" OIAUE~R
IP[. ~[ ~R~ LINE I/4' PER FOOT MINIMUM.
Scole I' - 40'
ROBIN AND LEWIS KELLER RESIDENCE
LOT 12, BLOCK 2, PARADL~E VALLEY
SEPTIC SYSTEM PLAN
ROBIN AND LEWIS KELLER RESIDENCE
· LOT ~ BLOCK 2, PARADISE VALLEY
LEACH FIELD SECTION
F*[~3~1 : I::~_Pli'~ DRILI..IHG F*l:~ HO. : 90? 345 I/~:~2 Rug. ~ L::'~I 10:0~::~1 P1
Borchole Data:
: Soil Ty~.,'l'hic, kness & Water Slrata
Municipality of Anchorage
Department of Health and Human Services
825 'L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
RiCk Mystrom htr p:l/www ct.anch~a~e.a~. US
Mayor '
Permit Number: #SW 010037 Date of/ssue: 3-21-01 Parcel Identification Number:. 120-020:09
Date Start~l: 6-~-01 Date Comp~ed: 6-9-0? Is well located at approved pcrmk location? [] Yes [] No
Legal Description: paradise V~lley Block 2 Lot 12
Property Owner Name & Addr~s: Lewis & Robin Keller
f131 West 53~
Anchorage, Alaska 99513
Depth (fl) Method of Drilling [] airrotary l--I cablctoo!
From To
Casing tyl~: .~teel
stick-up 0 2
cobbly gravelly silt 2 21
gravelly silt 21 108
silt t08 119
gravelly silt
gravelly sandy silt- wet 140 158
silty watersand & gravel 158 161
Wall Thickness: t025 inches
Diameter: _6 inches Depth: 161 feet
Liner Type:
D!ametcr: ~ inches Depth: feet
Casing sficknp above ground: 2 fcct
Static water level (fi'om groun~ level): 131 feet
Pumping level: 161 feet aftcr
2 hours pumping/5 gpm
Recovery Rate:/5 gpm
Method of Testing: air lift
Well Intake Opening Type:
[] Open ~ I-'l Open tlolc
[] Sereencd Start fcc't Stopp~l feet
I-]Perforations Start __ fe~t Stopped. f~t
Grout Type: ~entonite # 8 Volume: f b~,
Depth: Start 0 fc~t Stopped _+ feet
Pump: Intake Depth 'f ~'~G feet
l%~p size I~ Broad Name __
Well Disinfected Upon Completion'/. [] Yes [] No
Method of Disinfection: CIodne Tablets
Comments:
Well Driller:. Alpino Drilling & Enterprises
P 0 Box ~10496
Anchorage AK 99511
Attention: The well dr~ler slmll provide a well log to thc property owner w~h~ 30 days of completion ~nd the property
Municipality ,of Anchorage
George P. ll, uerch, Mayor
Building Sa/'ety Dix~sion
P.O. Box 19c~50 · 4700 S. Bragaw Street
Anchorage, Alaska 99519-6650 * (907) 32t3-8301
http://www.cl.anchoragc.ak.us
February 4, 2002
Public Works
Lewis & Robin Keller
1131 West 53rd Ave.
Anchorage AK 99513
Subject:
On-Site Water and/or Wastewater Permit.
Permit Number: SW010037
Legal Description: Paradise Valley Subdivision Block 2 Lot 12
Dear Lewis & Robin Keller:
An On-Site IVater/Wastewater Permit, number SW010037, issued by this office for a single-family
system, will expire on March 21,2002. This permit was valid for 365 calendar days.
If this was a well permit and the well has been drilled, a well log must be sent to this office for
documentation ofthe installation and to close the permit.
If this permit was for a wastewater disposal system, an original as-built inspection report must be sent to
this office for review, approval and documentation. This as-built inspection report must be signed by
the licensed Professional Engineer ~vho inspected the installation of the system. As-built inspection
reports are required to be submitted within 30 days of the completion of the system.
Ifno system ~vas installed under this permit, and you are still planning to install a well or ~vastewater
disposal system, a new permit must be obtained from this office. A new permit for a second year may
be issued for a fee of $100.00 if the renewal application is received on or before the expiration date of
the original permit.
When applying for a new permit, the fees are: $400.00 for a wastewater permit and $150.00 for a well
permit.
If you have any questions, please call this office at 343-7904.
Sincerely,
Dan Roth
Civil Engineer
On-Site Water and Wastewater Program
Ene: Copy of permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P~O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Mar 21, 2001
Expiration Date: Mar 21, 2002
Permit Number: SW010037 Parcel ID: 020-424-09
Legal Description:~lSE VALLEY SUBDIVI$i6N -~'L'-C~, ~"'LOT 12'T.
Design Engineer: 0069 Douglas T. Kenley, PE Site Address: NHN FRANCE CIRCLE
Owner Name: LEWIS & ROBIN KELLER Lot Size: 20113 SQ. FT.
Owner Address: 1131 WEST 53RD AVENUE Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE, AK 99513-
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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 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.
Date: '2Z' 0 /
.07/18/01 13:11 F.~,I I 907 563 4220 P~ ~CHORAGE ~]004
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,07/18/01
13:11 FA/ 1 gO7 583 4220
~003
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.cLanchorage.ak.us
(907) 343-7904
ON-SITE SEWEPJVVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Permit Number SWOlO0~7
Mailing address (2)
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size ~-- O~ I ~ '~ Acres~[~
Propertyowner(s) L~-t~.)i5 ~ ~-~'~ k~Lf--Lt~,- Dayphone ~'~/-Io! I
Mailing address (1) I1~/ [~5+ ~3v~ ~,, ~C~/ ~ ~1~
Zip Code
Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
[] Well Only []
~] Water Storage []
Jacuzzi
Water Softening Unit
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev, 1~00)
Waiver Fees:
Date of Payment:
Receipt Number:
Douglas T. Kenley, P,E.
9960E. Puffin Ddve, Palmer, Alaska 99645
(907) 746-1073
March 2, 2001
Mr. Lewis J. and Robin W. Keller, Owner
221 West 22nd Avenue
Anchorage, Alaska 99503
Legal Description of Subject Property:
Lot 12, Block 2, Paradise Valley Subdivision
Anchorage, Alaska
PERCOLATION TEST RESULTS
AND
GENERAL SITE INVESTIGATION REPORT
On February 1,200 I, the above-referenced 0.46-acre site was inspected in support of this application for
approval to construct an on-site wastewater disposal system and private well. The inspection consisted
of a visual observation of the subject parcel for general conformance with regard to site drainage,
adjacent parcel development, and confirmation of separation distances from other wells and sewer
systems in the area. Soils percolation tests and subsurface observation was performed by others on June
20, 1998. The proposed design for this system is based upon the findings from that observation.
The site is located northwest ofthe intersection of Greece Drive and France Circle. The immediate area
that has been selected for the wastewater disposal system has an average slope of 6%. The site is
moderately treed with alders.
On-site observation and physical survey show that there are no water wells nor private wastewater
disposal systems within a 100' radius of the proposed system. No surface water was observed at the time
of the inspection, and it appears that there is no potential for contamination of adjacent water wells or
streams from known sources.
Previously collected data: On June 20, 1998 two tcstpits were dug on the parcel. Pertinent data was
recoreded as follows:
TIl#1
Silty gravel to bottom of hole (15.5 ft deep)
No ground water observed
Percolation rate = 30min./inch at 6.5 ft. deep.
Tt/#/
Silty gravel to bottom of hole (16.5 fl deep)
No ground water observed
Percolation rate = 24min./inch at 7.5 ft. deep.
Lot 12, Block 2 Paradise Valley Subdivision
Page -2-
3/20/01
Groundwater was not observed in either of the holes after the (7) seven day wait period.
Based upon these findings it appears that the parcel has suitable soil conditions to support the proposed
(3) bedroom residence.
The proposed system will have no measurable impact on additional reserve space, surface or subsurface
drainage or on drainage from adjacent lots nor will it preclude surrounding properties from developing
future septic systems or wells. Attached please find proposed design drawings for the replacement
system. If there should be any questions concerning the percolation rate or characteristics of the site,
please call me at (907) 746-1073 or 243-5372.
Sincerely,
Douglas ~.~.
PE#8176
AJ_ASKA WATER & 'WA'STEWATEF~
PHONE: (9O7) 337-6170 * FAX (907) 3.18-324a
I SOIL LOG - PERCOLATION T£STI
PERFORMED FOR: SUSAN FRITSCH
DATE PERFORMED: 6/20/98
%%1~1'::~:~ [TEST HOLE #1 I
,-~i
.1-- I: ' GM ~ GP ~ML
HARD DIGGING. GM CL
.... ,,.,, SW HH
5- ~ s~ ~/Z_~__~CH .
6- ! , . , SM -X,7.: OH
L~ ; SC
7-- II, ',. C, ROLJNDWATER DATE
,- : S,.T.E_ .~p~.
~: ' ' "~:'k
tO--, , I'=
11 -- ' ' DATE READING CLOCK NET TIHE WATER LEVEL NET DROP
' ' , TINE (HINUTES) READING (INCHES)
12~ i ' 6/20/98 PERC. HO.E WAS PRESOAKED 4 HOUI~ PRIOR TO TE~nNG
15-- , i ; 1 9:55 6'
,.. 2 10:25 ;~0 5 1/16' 15/16
14m · i I',!' 3 10:2.5 6'
, i I ~l 4 10:55 ,30 5' 1
16 -- 6 11:25 50 5'
17--
18--
19- ' i~c~COLATION RATE .3._~0 .(MIN./INCH) _Pe~J.o~ DIA. 6 (INCHES)
PmroME~ ~' ^~ W^'~R ,- W~,S~-W^TE, .. L ~L,~ ~,~ ~ Y . c~, ~T
DATE. DATE $11,~101
/I
II
DEPTH TO
C, ROLJNDWATER DATE
DRY 6120/98
A.LASKA WATER &: WASTEWATER
[SOIL LOG - PERCO~TION TEST I
P~R~RM~ FOR: SU~ ~H ·
~ J~ ff
DA~ PERFORMED: 6/20/98 ~]~j
7-- J', ' ~ TO DATE
) ~ , TIHE (HI~ES) E~ING (IN.ES)
12-- I; ., . 6/20/98 P~C. HC~ W~ PRE ~ 4 HOU~ PRIOR TO
17-- 8 11:47 30 4 3/4' 1 I/4
DEPTH TO DATE
GROUNDWATE~
DRY 6/20/98
LOT 11
tlC SYSTEM SPECIFICATIONS:
ONSTEUC~ION SHALL BE IN ACCORDANCE ~I'IH THE
· T EDISON Of' THE HEALTH AND HUUAN S[RV1CES
TEucTION SP[CIFICA~ONS FOE DEEP 1RENCHES
· P~C TANK SHALL BE (~' ST[EL CONSTEUC'I1ON BY
3A APPROVED UANUFACTURER W1TH WATER 'I~I~-IT
.ERS ON INIFT AND OUTLET.
~E I. INE TO NEW DRAIN FIELD ,.S~I. ALL DE 4' DIAUET[R
PIPE. SLOPE S[RV1CE LINE 1/4 PER FOOT UINIMUM.
I FIELD LINES SHALL BE 4" DIA. PERFORATED PIPE,
PIPES LEVEL Wire PER~'ORA~ON HOLES DOWN.
5 FT UINI~U ~P~A~ BE~EN EO~ ~
,~/AND F~NDA~ON.
NTS
~;W DOUBLE CLaN-OUT
~PICAL LINE CL~NOUT (100 O.C.)
_
EW 4" DRAIN LINE
EW DEEP TRENCH
EW MONITOR TUBE
....
(PICAL TRENCH CLEAN OUT '
-- ~ ~/~ROPOSED
4O 0
ROBIN AND LEWIS KELLER RESIDENCE
LOT 12, BLOCK 2, PARADISE YAL/.EY
SEPTIC SYSTEM PLAN
UT-I/MT-2
DISPOSAL SYSTEU
83.31 Ft
FT IN LrNGI~
ROBIN AND LEWIS KELLER RESIDENCE
LOT 12, BLOCK 2, PARADISE VArY
LEACH FIELD SECTION
/
(41 BDRM.
RESIDENCE
!-M
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-424-09
1. GENERAL INFORMATION
Complete legal description
Expiration Date:
Paradise Valley S/D, Block 2, Lot 12
18700 France Circle, Anchorage, Alaska
Location (site address)
CUrrent Property owner(s) Arlanda Crail & Gregory Silvey
, ,Day phone 344-2823
Mailing address
Lending agency
Day phone
Mailing address
2~
Real Estate Agent Clair and Barbara Ramsey at Dynamic Properties Day phone
Mailing Address 3111 c Street, Anchorage, Alaska 99503
"unless' otherwise ~equested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 4
261-7553
=
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 On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to One year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 Douglas T. Kenley, P.E.
Address 9806 E. Northstar Circle, Palmer, AK 99645
Engineer's Printed Name
Douglas T. Kenley
DSD SIGNATURE
~ Approved for .. ~
Disapproved.
Conditional approval for
bedrooms.
Phone (907) 746-1073
Date. LOd.~ .~ ....
,... .OF
bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: / (~ ~ ~ / /
Municipality of Anchorage
Dev~t Services Department
Building Safety Di~ion
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Lega Description:
A. VI/EEL DATA
Paradise Valle~ S/D, Block 2, Lot 12
Parcel ID:
020-424-09
Well type Pr~ae If A, B, or C provide PWSID #...
Date completed 6/9/0~ Sanitary seal (Y/N).,Y,
Total depth 161 , f. Cased to ~6,1, ft.
FROM WELL LOG
Static water level 131
Well Log (Y/N) Y
W~res properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
9117111
136.3 ff.
Y
24 in.
Well production 15 g.p.m.
WATER SAMPLE RESULTS:
Coliform Negative colonies/100 mL Nitrate 3,41.. mg/L
,,e~ser~ic: ~ ug/L date of sample:cJ/14/11
3 g.p.m.
co~~ad by: Fred Kenley
B. SEPTIG/H~_DING TANK DATA
T~k T~I', SepticJSteel ; Date installed
Tank ~ 12~0 .. ~1,. Number of comp~'~ents.~- 2 Cleanouts (Y/N)
Foundation Cleaneu~ (~fN) Y * ' ' ' '
Depress~)n over tank (Y/N) ,,, N High water alarm (Y/N)
Length 84 fL Width 2.5 fL
Total depth ~"T~=fL Eft. absorption area 1344 ft~ Monitoring tube
Date of adequacy test 9/17111 Results (Pass/F.afl) Pass
Fluid depth in absorption field before test s7-1/2 in. Water added 684 gal.
Elapsed Time: 314, min. Final fluid depth _65_ in. Absorption rate >=
Any rejuvenalion treatment (past 12 mo.) (Y/N & type) N
8/28/01
Gravel ~ pipe · _ 8
Y Depre~don over flek~. N
For .4 bedroolTiS
New depth.r~-l/4~in.
6O0 g.p.d;
If yes, give date -"
Y
N/A
D. LIFT STATION
Date instelled
~Pump on" level at
Datum
in.
E. SEPARATION'DISTANCES
Size in gallons
'Pump off" level at..
Cycles tested
in.
High water alarm level at
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM ~VVELL ON LOT TO:
Septic tank/lift station on lot 100+ ft.
Absorption field on lot 100+ ft.
Public sewer main N/A
sewer Iseptic service line 25+ ft.
Animal containment areas 50+ ff.
On adjacem lots
on adjacent lots 100+ ft.
Publ~ ~s~,~ ~e? manhole/cleanout
N~A
Holding tank , ,
Manure/ariimM excrete,sto~age'amas
SEPARATION DISTANCES FROM sEPTIc/HOLDING TANK ON LOT TOc ..
Water main N/A wa~ service line 10+ ft. surface water
Wells on adjacent lots 100+ ft.
100+ ff.
N/A
100+ ft.
· 'i 5+ ff.
lOO+ fi_
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10 ft. Building foundation 20+ ft. Water main NtA
Water service'line lO+ff. Sur[ace water 100+ ft. -
Dr~-~ay.' parking~vehk~e s~ge 7o+ FT.
Curtain drain ~a~e ~ ~ e~ W~qls on adj~t I~ 100+ ft.
corecormance with MOA COSA gtSdetines in effect on this date.
Engineer's pri~tad Name, DO ".ug~ras m. Kenley P.E.
Oateof Payment [ \ \
(Rev. 4110)
WaiVer Fee $
Date of Payment
RecelptNuilfoe~
~ 0°
L ~ 3,/. ~9
SURVEY ORDERED BY:
PATTY SEYMOUR
BARB RAMSEY
CLAIR RAMSEY
DYNAMIC PROPERTIES
AS-BUiLT SURVEY 1" : 30'
NO CORNERS SET THIS DATE
THE ZNFORMA]'[ON HEREON z5 FOR THE USE OF LEND,IN6 ZNST~TUT~ON5 5PECZF~CALLY TO 5HOW
CONFLICT5 BE~EEN E~5~NG S~UC~E5 ~Nb PL~ED LOT ~5 AND/~ EASEMENTS; AND
NOT TO gE USED FO~ POSI~O~NG ADbI~ON~L 5~U~URES, Z~EO~TS, O~ FEliNES,
EASEMENT5 ~ EEE~b, OTHE~ THAN THOSE MPPEA~ZNG ON THE ~EC~b PLAT, 4~E NOT SHOWN
H~EON ( UNLE55
NO~: FEN~LINE5 ~AT ~4Y ~EA~ ON ~5 DRA~N6 ARE NOT TO BE USED TO
PEOPEE~ LINE5 OE PO~ON ADDZ~ONAL [~OVE~ENTS.
ANY P~N6 SHOWN HE~EON ~AY ~ ~PPEO~4~ DUE TO EXCES~ 5NOW AND/OR
i HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLO~N6 DESCRIBED PROPERTY
LOT 12.~ BLOCK 2~ PARADISE VALLEY
ANCHORAGE RECORDING DTSTRICT, ALASKA~ AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE kr~THIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED,
DATED AT ANCHORAGE,ALASKA THIS 29TH DAY OF
__SEPTEMBER , 20~.Z. HOLT LAND SURVEY[NS
600 H~6HV[EW DI~VE
SGS Ref.# 1114454001
Client Name Douglas Kenley P.E.
Project Name/# 1 l 120
Client Sample ID Outside HoseBib ParadiseValley
Matrix Drinking Water
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
09/19/201 l 13:37
09/14/2011 13:15
09/14/2011 14:00
Steohen C. Ede
Sample Remarks:
S/D BK2, LOT 12
4500NO3-F ~ Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements.
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic
ND 5.00 ug/L EP200.8 C (<10) 09/15/11 09/19/ll NRB
Waters Department
Total Nitrate/Nitrite-N
3.41 0.100 mg/L SM20 4500NO3-F B (<10) 09/15/11 AYC
Microbiology Laboratory
E. Coli Nel~ative 1 100mL SM20 9223B A 09/14/11 CR
Total Coliform Negative I 100mL SM20 9223B A 09/14/11 CR
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. munl.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
ParcelI.D.O..~O- /-~-~,,/~L--O~
1.
COSA #
Expiration Date:
GENERAL INFORMATION
Complete legal description .
Current Property owner(s) ,Ze,,?~/~
Mailing address
Lending agency
Mailing address
Day phone,
Real Estate Agent
Mailing Address
Dayphone
U~essot~ise~queste~ COSAw~ heM~DSDf~pick~.
2. NUMBER OFBEDROOMS: .,.~-/
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 On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered In the State of Alaska, Certificates of On-Site Systems Approval are required for the transfer of
rifle (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeownem. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for proportJes served by a private or Class C well and may be reissued
with new water sample results. (Ce~ficates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms'and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and Inspection. the on-site water
supply and/or wastewater disposal system ts(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation·
NameofFirm O~,,..:,,-/n~, ~. /'/-~-,,'?/~?{ Phone ,C/~?-?"/~
Address ~0~ ~.t~'~/ ~/~' g/'~¢/~t /?'~-/"~("~ ~'~'
Engineer's Printed Name ~<~,'~'~/~6 ~/~,,~/~/ Date. t-
., .,2% ,~ ,
5. DSD S?NATURE ' '~''' D0gO~,ST. KEt;L-',:Y.
*/Approved for ~ bedrooms. ~'--~.:.J........,-'z~,~/.. '~.~:;,,,,,.
Disapproved. ~,
Conditional approval for .~ bedrooms, with the following stipulations:
By:.
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
· Other
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
LegalDescription: ~/~"f/~,,~//~¢~"~, ,~/,~/-~//~'L,//_~I/~.,,,/ 5~/~ ParcellD: O ~..O-
A. WELL DATA
Well type
Date completed .&/?,/~/
Toteldepth /~/ ff.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform .D .colonias/100 mL
Arsenic: ,~- J~ ~ mg/I
B.' SEPTIC/HOLDING TANK DATA
IfA, B, or C provide PWSID #.
Sanitary seal (Y/N)
Cased to /~'/ ft.
FROM WELL LOG
r'-~/ ft.
/.d" g.p.m.
Well Log (Y/N) ~v
Wires properly protected (Y/N)
Casing height (above ground).
AT INSPECTION
g.p.m.
in.
Nitrate ~ ~,~ mg/L
Date of sample:
Other bacteria ~ colonies/100 mL
Tank Type/Material
Tank size
J
Foundation cleanout (Y/N)
Date of p mpi
ABSORPTION FIELD DATA
__ gal. Number of Compartments ~.
Depression over tank (Y/N) ~ High water alarm (Y/N)
Pumper /')~,~ .,~// "~ '
Date installed ~'~/~ ~'~"/
Cleenouts (Y/N)
System type /~-~,,,~,
Gravel below pipe ~ ft.
Depression over field ,~/
· ~ bedrooms
New depth 7~/~in.
Absorption rate >= ~.~' gp.d.
If yes, give date
Date inslallod .~/~.~/z~/ Soil rating (g.p.d.lft~ or ~/bdrm) ~'.
Length ? ~ ft. Width ,,~, J- ft.
Total depth/~'-/1~, ft. Eft. absorption area/~ Sy~ff2 Monitoring tube
Date of adequacy test ~////f.'F Results (Pass/Fail) ~ For ,
Fluid depth in absorption field before test ~$~ in. Water added
Elapsed Time: ~..'?oe min. Final fluid depth ~f in.
Any rejuvenation treatment (past 12 mo.) (YIN & type)
D. LIFT STATION
Date instelled Size in gallons
'Pump on' level at in. 'Pump off" level at
Datum --~
Manhole/Access (Y/N) _,
in._.._...---- High water alarr~ k~v~at, in.
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot /' ~'~ '~ r~7~
Absorption field on lot /
Public sewer main ~//,/~'
Sewer/septic service line
Animal containment areas
On adjacent lots /~'
On adjacent lots / t ~ ,+ /'/
Public sewer manhole/cleanout
Holding tank ,4//.,'d/
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ,-~'~ ,"
Water main
Wells on adjacent lots /~'~ -'" ~/'"
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ?~ ~-/'/ Building foundation ~c~/-/'~. Water main
Water Service line ,-~
Curtain drain ~",~ ~'/'~,"'
Propen*y li~e x~"/2~'/~/' Absorption field
Water sefvloe line ,~"'~/'7' Sudace water
/~%.//
Surface water /<~,~/, /'~. D~mway. parking/vehicle storage 7~ ,'/'-~'
Wells on adjacent lots /<~,P /- /'/'.
F. COMMENTS
G, ENGINEER'S CERTIFICATION
· ,~.: . I
mv~w ~ Mun~l ~s that the a~ve sysm~
-
cos Fea $
Date of Payment
Receipt Number -'~ ~-'~ ~_-0 tA~,,,c~c,,,
(~. 11~)
Waiver Fee $
Date of Payment
Receipt Number
SGS Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
1060339001
Douglas Kenley P.E.
Lot 12 Block 2 Paradise Valley
Lot 12 Block 2 Paradise Valley
Dfinklng Water
All Dates/Times are Alaska Standard Time
Printed Date/Time 01/26/2006 14:50
Collected Date/Time 01/20/2006 14:20
Received Date/Time 01/20/2006 15:10
Technical Director Stephen C. Ede
PWSID 0
Sample Remarks:
Allowable Prep Analysis
Parameter Results POL Units Method Container ID Limits Da~ Date Init
l'4at:als by XCP/~
Arsenic $.00 U 5.00 ug/L EP200.8 A 01/23/06 01/25/06 WAW
SC.S Ref.#
Client Name
Projecl Name/#
Clienl Sample ID
~latrix
1060299001
Douglas Kenley P.E.
LI2 B2 Paradise Valley SD
LI2 B2 Paradise Valley SD
Drinking Waler
All Dates/Times are AlaNka Standard Time
Printed Date/Time 01/'20/2006 15:22
Collected Dar eKl'lme 01/18/2006 13:30
Received Date/Time 01/18/2006 15:28
Technical Director Stephen C, Ede
PI¥SID 0
Sample Remarks:
Allowable I~'ep Analysis
Paramelcr ResulLs POL Units Method Container ID Limits Date Date Inil
Waters Department
Nitmtc-N
2.96 0.100 mg/L EPA 300.0 B (<Gl0) 01118/06 DSII
Microbiology Labora tor~
TotalColil'orm 0 col/100mL SM209222B A (<=1) 01118/06 TLF
Dougla s~[~_en~l.¢y p60 E~P~-ffi. r~tr ¢__e~ lm~[,~_la_ ~k a 95~645 (9073~46-_10T~
September 23, 2005
Municipality of Anchorage
On-site Water and Wastewater
4700 Bragaw Street
Anchorage, Alaska 99507
Re: Lot'52, Block 2, Paradise Valley Subdivision, Anchorage, Alaska
In r"
p epatlng for the septic test, it was noted that there was 2 inches of water in one clean-
out and 3 inches of water in the other clean-out. The system is made up ora 2.5 ft. wide
x 8 ft. E.D. x 84 ft. septic trench. Before proceeding with the test, it was verified that the
water level in the monitoring tubes was well below the water in the clean-outs, indicating
that perhaps the clean-outs were dipping down on each end.
While running water into the system at approximately 3.2 GPM, there was an immediate
indication of a rise in the monitoring tubes (~ inch in a 10-minute period), with an
average rise throughout the test of the same amount. Each monitoring tube was located
within 1-2 feet of the clean-out, so it was easy to verify depths of the septic rock to the
bottom ofthe distribution pipe. Water did rise to a depth of 4-5 inches in the clean-outs
during the last 30 minutes of the test, at which time the water flow was at 5.5 GPM. Two
days after the initial test, the water in the clean-outs was back to 2 inches in one clean-out
and 3 inches in the other.
This is not a serious problem with the septic system, and it was determined that it passed
thc absorption requirements.
This test indicates the condition of the septic system on the date of testing. No
representation is made regarding the future life or performance of the system.
Many factors affect the life and performance of a septic system, including the quantity
and quality ofwastewater flow, frequency of septic tank pumping, and changes in
groundwater conditions.
If there is anylhing else you require, please contact me at (907) 746-1073.
Sincerely,
~~e location of the st- ~ro[s) ·
.. /
../ ,,,,- .BT
NOTES LEGEND
~. ~ D~[O~ A~ ~SEH~S SH~N ARE Q FO~ ~5
TArN FR~ PARAD[~ VArY ~. ~T NO.
87-t6. ( )~C~ D[~[~S
E. ~TE ~ A~ZLT S~V~ dAN. Et 2002. 0 d' ~PTZC VENT PZPES
3. NO ~ ~ ~ZS S~VEY ~ N~D ~CK
~. THZS ~VEY NAS ~T P~NED TO VER[FY ACREAGE
~ TO ~[~ ~S/TZON OF LOT C~.
SURVEYORS CERTIFICATE
~,.......
visit, ~ ~HE ~S ~.N ~ ~Cm~LLY }.~~~.~
EXIST AS ~S~I~D, AND ~A~ ALL D[~I~ A~ ~ ~.~ -Az
~........,
_ BATE ~G[ST~TION NO. ~ ~t ~N
DRAWN m ~P~at¢ovlch..or,n,... ~ ~,. ASBUILT SURVEY FB
C~D ~I ~E~gtnee~lng Consultant~ LOT t8 BLOCK 8 GRID 35~
DATE 2/~/02 · ~506 ~ST ~%H AV[~ PA~DI~ VA~ S~IVIS[~ ~Rj.
ANION. ALASKA ~503 PLAT ~. 87-~G os~