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ALPINE VILLAGE BLK 2 LT 12C
Alpine Village Block 2 Lot 12C #014-132-39 M -W Drilling, Inc. *P.O. Box 110378.Anchorogc. AK 99511• .907-345-4000 • 907-345-3287 Fnx• Job No.: 04-1c1 Panel No.: 014.132-39 PemihNo. SWO40218 Groundwater Well As -Built A Lop •Well Owner: Dalton. *Legal Descrlptlon: Alpine Village Sr • Nole Depth: 55' • Casing Size: • Drill /ynhod.• Air Rotary •VseofWCU. Domestic Construction 6- •Cased To: 51.31' •Materlab A 53 Steel PM • IT'ell Completinw- Open end X SereetrPerforated _ Herhod: rfo •Screen/Perotlotrdescrlpaon: None ♦Grout Nola: (1) Sad- No. 8 benronite granules • Notes: • Well De elaphnenr Merbod: Air surge Noyes: •Slade water Level (SWL) 43' (a"") (6elm.) top of eadm f (TOC). • 1liUgleld test at 10{ 1 k"rs with 10M. of drawdown (DD) from Stolle level (SITZ). •Method: —Airlift • Dare of eompledon. 02 July 2004 • Pump In cult: Depth In fat from top of"sin . Detaab of rorsaatbu etrated size of material,color and hardness. 0 TO 2 casi�_stickup� -------- 2 TO 34 Silt: brown. occasionaenvel 34 TO 36 Graven silt_ bra _ _� Water ravel �_ , - .- __.. --------.-•------ --- -- ___ _._• �.y-_—_..._- - 36 TO 52 TO _52 55 Gravely silt: dry TO- _- _ - _ - - - - _ - _ - ._ - . - - - - - -_..- - _---- TO _ - - TO— TO_ -_.----_ - - TO TO TO ---Wq�fNE e: �fcmi8Efi6 _ -- TO —PIIrldenL-M MY Vd-mm Ina_— -- TU _-- .—..—__. C�ortZraoEDf - TO - - �.--� - -- - - - _._HMNAC0"iW .._- oi�tua TO TO _ — 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 ONSITE WATER SUPPLY PERMIT Initial Permit Number: SWO40218 Legal Description: ALPINE VILLAGE BLOCK 2 LOTy?�i Design Engineer: 0000 None Required Owner Name: RONNY DALTON Owner Address: PO BOX 110802 ANCHORAGE, A 99511 - Date Issued: Jun 22, 2004 Expiration Date: Jun 22, 2005 Parcel ID: 014-132 Site Address: 7317 BERN ST Lot Size: 8450 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 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. 5. The following special provisions. -THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55. PLEASE SEE THE ATTACHED SHEET'PERMIT REOUIREMENTS FOR A DOMESTIC WATER SYSTEM'. IF THERE ARE ANY OUESTIIONS PLEASE CALL THE MUNICIPAL ON SITE WATER AND WASTEWATER PROGRAM AT 907-343-7904. -THIS PERMIT IS ONLY VALID FOR A WELL TO BE INSTALLED ON ALPINE VILLAGE BLOCK 2 LOT 12C CURRENTLY IN PLATTING PROCESS. Received gy Date: Issued By. f Date: 1-77- Agy ' \ Municipality of Anchorage • !y, N`'( 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.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING olK- r3z—Ti3�, Parcel I.D. p�tFY�J.6:Hh _ Permit Number SW Property owner(s) Vl v it 6 1 _ C ace 11V K% Day phone FW— 9O / lD Mailing address (1) & b csA G l l y ///Ct/ i 1'// 'r Mailing address (2) Zip Code 99's—/S_ Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size �'�%S-O Acres/Sq.Ft. THIS APPLICATION IS FOR: 6-, i l�zN ?,f cj v Number of Bedrooms :3'n e'tJ'r,0o4'k% Sewer Only ❑ Well Only X Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ at the above information is correct. I further certify that this application is being made for a Single F mily Dwelling and is in accordance with applicable Municipal Codes. of property owner or authorized agent) Permit Fees: /�S•'O Date of Payment: ��yloy Waiver Fees: Date of Payment: Receipt Number: S 37 f orf1•t Receipt Number: (Rev. 12/00) ��(% 9 E t i B fii� ROSEWOOD PARK ESTATES i D el • b. ,a r� uu� .�, RI —I rTr9—I :I��T� o tt fi I .l_1_L'�-_b I_LJ_1 J L�. jf-T.-r-IT: r :T-1 �� -m F ! � J LLLL1C�J 1-J it cn —f T —1— I = -F a T-1 ('liaIt'll T COa a j t co �?ifir WHIM ����fi';� gg r 93 I IT i ![Ila Q Vr CU • 4 } Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 014-132-39 Expiration Date: le C 1. GENERAL INFORMATION Complete legal description Alpine Village Block 2 Lot 12C Location (site address) 7325 Bern Street Anchorage AK 99507 Current Property owner(s) Mac Stevens Day phone Mailing address Real Estate Agent 7325 Bern Street Anchorage AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual ElIndividual Well 0 Holding Tank F-1Individual Water Storage ❑ Community ❑ Community Class Well ❑ Public Sewer Public Water System ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment 9 2 ZD 21 Receipt Number 002 3oU COSA#05C711 536 Waiver Fee $ Date of Payment Receipt Number Waiver # 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 ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date C-) 51 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future , occupants or can ArcTerra guarantee that no unseen p� encroachments, deficiencies or discrepancies exist. �. �,A QTR 6. DSD SIGNATURE �[ V/ System #1 Approved for -I bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: OFe � � W4 7ER 4 E ASTM-V!"A -- TER -. i�ERVICE`' 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheeL10-10.12.doc Legal Description: COSA Checklist Alpine Village Block 2 Lot 12C If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 7/2/2004 Total depth 55 ft Cased to 51 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 8/25/21 Static water level at beginning of test 31 ft. Comments TA Age of tank(s) Tank type/material Septic/Steel Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping SSORPTION FIELD DATA Which s tested (date installed) ❑ ALL standpipes ent per record drawing Total measured depth from I ft (max) Measured depth to pipe invert from gra ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Com ments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 014-132-39 of Structure served by this system Well production at time of test 6.5 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ® No N Coliform bacteria is Negative Nitrate mg/L Nj Nitrate less than MRL (ND) Arsenic 17.0 ug/L ❑ Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 8/25/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years tTFNeli-ALinn material Comments: Adequacy test date Results [—]Pass For bedrooms Fluid depth prior to test in Water added gal New depth in lapsed time min Final epth in Absorption rate gpd Any rejuvenation treatmen t 12 months) If yes, enter date 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' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No NA ft 23 Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Founda _ ❑ Yes if No ft Surface Water > 100' ❑Yes if No ft Property Line > 5' ❑ e ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Community 00' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway com low hsorption Field on Lot to: (Please enter distances if less than required) Building Foundatlo _ ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ 0 ft Wells on Adjacent Lots: Water Main > 10' ❑Yes if No Private Wells > 100' ❑Yes if No ft Water Service Line > 10' ❑ Yes if No ft COmmL !Is > 200' ❑Yes if No ft Surface Water > 100' E] Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION =41k (�`�e,�I certify that 1 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. CE 7116 ESS71!!� COSA Checklist yellow sheet �F MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Arsenic Advisory Certificate of On‐Site Systems Approval # OSC211536 Subdivision: Alpine Village, Block: 2, Lot: 12C A water sample revealed an arsenic concentration of 17.0 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On‐Site Water and Wastewater Program website (www.muni.org/onsite) or at 343‐7904. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. 678970 • 3 >> O rV •4 ' Municipality of Anchora On-Site Water and Wastewater Progra NOV 0 7 LU 1u .• ` " �'V (907) 343-7904 e 4 '� sarcTvA CERTIFICATE OF ON-SITE SYSTEMS A ; VA ,\� se Parcel I.D. 014-132-39 Expiration Date: R6 0° O 1 1 1. GENERAL INFORMATION Complete legal description ALPINE VILLAGE BLOCK 2, LOT 12C Location (site address) 7325 BERN STREET,ANCHORAGE,AK 99507 Current Property owner(s) NICHOLAS&KRISTIN LUBY Day phone Mailing address 7325 BERN STREET, ANCHORAGE,AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 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 WaiverNariance request for: Distance: Received by: Date: ii/ //fl COSA to be relea o th ,e gine�ss otherwise requested q by the engineer. COSA Fee $ 524, Waiver Fee $ Date of Payment 1 l f$i i' Date of Payment Receipt Number (35-3(42. Receipt Number COSA# 65C/7/537 Waiver# 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 10/30/2018 Engineer's Comments:This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface,changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen i- O ' AX encroachments,deficiencies or discrepancies exist. / �� z . 4,s k h *1 a 9 Tl I Al 6. DSD SIGNATURE riff::II System #1 Approved for I bedrooms. -a, System #2 Approved for bedrooms. �, *' 'OrEss1o'``' Disapproved. Ar ����� Conditional approval for bedrooms, with the following stipulations: ON-SITE Lx, WAVER AND `11.. WASTEWATER o PROGRAM By: LA J�;r-{, _Vc N Original Certificate Date: 0 V 09 j a O I $ 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. 1 7. ATTACHMENTS: '� ' c-, ; 10 COSA Checklist X Nitrate Advisory;t l• � Septic System Advisory Arsenic Advisory • Well Flow Advisory Other , : COSA blue sheet 10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist#_of Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: ALPINE VILLAGE BLOCK 2, LOT 12C Parcel ID: 014-132.39 A. WELL DATA Well type PRVT If A, B, or C provide PWSID#_ Well Log (Y/N)Y Date completed 7/2/2004 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth 55 ft. Cased to 51 ft. Casing height(above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 7/2/2004 10/26/2018 Static water level 43 ft. 32 ft. Well production 10 g.p.m. 6+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate Ail) mg/L Arsenic: /1. 6 ug/L Date of sample: 10/26/2018 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA—PUBLIC SEWER Tank Type/Material Date installed Tank size gal. Number of Compartments Cleanouts(Y/N) Foundation cleanout(Y/N) Depression over tank(Y/N) High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) _ System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring tube Depression over field Date of adequacy test Results(Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons _ Manhole/Access (Y/N) ._ "Pump on" level at_in. "Pump off" level at _ in. High water alarm level at _in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot NA On adjacent lots NA Absorption field on lot NA On adjacent lots NA Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank NA Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots ABSORPTION FIELD ON LOT TO: PUBLIC SEWER Property line Building foundation Water main Water Service line Surface water Driveway,parking/vehicle storage Curtain drain Wells on adjacent lots— F. COMMENTS ++_\\ * ‘1,i 4 G. ENGINEER'S CERTIFICATION *14 • 'rLt _ I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA # � KENNETH Aff COSA guidelines in effect on this date. + `% "'' ,alio l�L /.. °�/ Engineer's Printed Name KENNETH M.DUFFUSF�ss�o�a`. •lv ``'111:111°' Date 10/30/2018 COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT ; • if 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite __ Arsenic Advisory Certificate of On-Site Systems Approval # OSC181588 Subdivision: Alpine Village, Block: 2, Lot: 12C A water sample revealed an arsenic concentration of 11.1 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On-Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.0.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org Municipality of Anchorage M& Development Services Department .{ . Building Safety Division On -Site Water and Wastewater Program ` 4700 South Bragaw St. P.O. Box 196650 Anchcrage, AK 99519-6650 www.muni.orglonslte (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 014-132-39 1. GENERAL INFORMATION HAA # QSII� `J3 Expiration Date: Complete legal description Alpine Village Block 2 Lot 12C Location (site address or directions) 7325 Bern Street, Anchorage Current Property owner(s) Ronnie & Shelly Dalton Day phone Mailing address Lending agency Mailing address 161 Shelly Marie Cir., Anchorage, AK 99515 Day phone Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will behold by DSD for pickup. 2." NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer El The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 Watkins Engineering, Inc. Phone 349-1851 Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis Date 5. DSD SIGNATURE Vf Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following 10-Zq-o5 ^" "} E v 49TH` 1* W. Ellis CE -10577 NZ X � ^ Additional Comments `'�`; WATER AND ; r^= PROGRAM ////////1�1111111��••. Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: % " S` D.5� AI dl - (R« 01/04 Municipality of Anchorage ° • Development Services Department Building Safety Division On-Sfte Water & Wastewater Program ' • `• 4700 South Bregaw St. P.O. Box 190050 Anchorage, AK 99510.8850 www.muni.org/onsfte (907) 343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Alpine Whye Slit 2 Lot 12C Parcel ID: 014-132-39 A. WELL DATA Well typePe If A, B. or C provide PWSID of = Well Log (YM) Yes Date completed 7/0 m Sanitary seal (Y" Yes Wires property protected (Y/N) Yes Total depth rt. Cased to 51 rt. Casing height (above ground) 21 in, FROM WELL LOG AT INSPECTION Date of test 7r" 8114105 Static water level 43 rt. 35 ft. Well production 10 9.p -m. 5.9 9 -P.M. WATER SAMPLE RESULTS: Conform 0 colonkm/100 ml. Nitrate 40.1 mg.A. Other bacteria 0 colontes/100 ml. Arsenic: 0 mg.A. Date of sample: en4ms Collected by: Rocky S. SEPTIC/HOLDING TANK DATA Tank Type/Matedal Public Sewer/AW WU Date Installed Tank size gal. Number of Compartments _ Cleanouts (Y/N) Foundation cleanout (Y/1) _ Depression over tank (YIN) _ High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed NA Soil rating (g.p.d.Atz or fe/bdrrr>) _ System type Length ft. Width ft. Gravel below pipe ft. Total depth _ ft. Elf. absorption area ilz Monitoring tube Yes Depression over field Date of adequacy test Results (Pass/FatQ Pees For —bedrooms Fluid depth in absorption geld before test _ in. Water added 808 gal. New depth_ in. Elapsed Time: _min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YM 3 type) If yes, give date D. LIFT STATION Date installed NA 'Pump on' level at _in. Datum E. SEPARATION DISTANCES Size In gallons Manhole/Access (YM) 'Pump oW level at _ in. High water alarm level at in. Cycles tested Meets alarm b circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllifi station on lot NA Absorption field on lot NA Public sewer main 75'+ Sewer /septic service line 30'+ On adjacent lots NA On adjacent lots NA Public sewer manhole/deanout 10V+ Holding tank NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation NA Property line _ Water main Water service line Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line NA Water Service line Curtain drain _ F. COMMENTS G. ENGINEER'S CERTIFICATION Absorption field Surface water Building foundation Water main Surface water Wells on adjacent lots d certify that 1 have detenrdned through tleld inspectlons and review of Municipal records that the above systems are in conformarwe with MOA HAA guidellnes in effect on this date. Engineer's Printed Name Cindy W. Ellis Date 6/29/05 Driveway, parldngtveNcls storage HAA Fee $ 5q -6D Waiver Fee $ Date of Payment�yy,pODate of Payment Receipt Number7�/l0 AReceipt Number P4 (Ray.12A1) / "'r andir W. Ellis 4V-+bs7r '50! LOT /2B 1 /.30.07, OWELL eN U H4VE0 EX/STING 8 R �IwAYtd S7RUC7YlRE O v pp o to O mv: `/ �I\ EH7RY /Y-) CX)I �U? I LOT / l N 1 It , /O -30 -04 Lot _/2C ,Block 2 ne 1/i/toe Sulz�! Anchorage Recording Dist ct, Alaska LOT SURVEY CERTIFICATION I Powder 0vllfy that leave evrvsyed the Mdpvty shown and daeorlbed haraon. and that IM IaWr Mts sitWfod Invert We within Ph* pap. Nly xnee and N M/ an1100 N MsedOoh M Od laoMl popvly and that no 4npra" is M edlaosnt prop" a tap N Mareooh de IM procaine In "Pipe art IMI then We 00 roadways, atlilty line, ar other visible 000006040 an sold property *.dept N Indleated Pearson, Scale /it „^I Date X30 © CYC 22'04 Ret 2133 F. S. No. 47-33 I W 8450 S.F o -W 0.H. 1 C� O Eanleents of record other thou Phone shown on the plat of nosed are not shown harsen amass. otherwise noted. LEGEND 0 Bross or Aluminum Copped monument recovered O Iron pipe and/or rebor recovered. O 212 x2 hub 6 tack recovered O 5/8" x b0" rebor set this survey BAS/S OF V&77CAf�L� DATUM 1927 N & S. /972 AO✓u5r Prepared by. R. L. BUTTON Regis/erod Lord surveyor (907)279-6200 5/9 W. EighhhAvi Anchorage A Property of:90/72y? 2,, EI;Lnn /y allon 06/16/2005 16:33 5625427 AtA,U PAGE 01 DATE SCHEDULED TIME ?� INSPECTOR SUBDIVISION ALPINE VILLAGE BLOCKILOT/TRACTBLK 2 LT 12C INDICATE NORTH W T n— CF C> SUE MAIN: TYPE MAIN: DEPT AT MAIN: AT PROP. UNE: ! CONNECT LOCATION: ?JO' w COMMENTS: O SS t W4MA 30` C.0-. INSPECTED BY: C .lDATE: