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Home My WebLink AboutALPINE WOODS BLK 2 LT 10Alpine Wood Block Lot 10 #0! 5- 234- ! 7 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211464 PID Number: 015-234-17 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Lee P Holmes ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 6531 Downey Finch Dr, Anchorage, AK 99516 ❑ Other Phone 350-7386 Number of Bedrooms 4 Soil Rating Total depth from original grade 1.2 - EXISTING* GPD/SF 11.8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6.2 Ft. Gravel depth beneath pipe 5.6 Ft. Subdivision Block Lot Alpine Woods 2 10 Fill added above original grade 0.0 Ft. Gravel length 45 Ft. Township Range Section Gravel width 3.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 504 Ft2 Ft. Well >100, >100' N/A N/A >25' TANK ❑� Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water >100' >100' N/A N/A Material Plastic Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation I > 10' 1 >1 0' N/A I N/A LIFT STATION cturer Capacity Remarks 'Invert of existing field dropped 0.4' to allow for gravity flow Gal. to tank. Water line relocated to 10' min from septic tank and field. Alarm location installed by Installer PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Northern Excavation Drainfield D3034 CO/MTD3034 Inspector J. Millette / L. Tidwell BENCH MARK (Assumed elevation) 100 ft Inspdection 15` 12/7/21 12/9/21 Location and description 2 n Bottom of siding 3b 41h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp �C OF®,�\l Conditional Approval: Date . • ' ' ' . tS',�� y�Q'� Al TH stemQtm,,t Approved Be.n•1i11erSeptic CE 2592 Date 2/20/21 , •�c�� 1�,� pROFESSIO��.� Note: this approval does not include well permit requirements. \RCV VJ/VL/ 10) Benjamin Schiller CE 12592R E GISTEREDPROFE S S I O N A LENGINEER1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND CO1 PERMIT # OSP211464 PID # 015-234-17 ALPINE WOODS, BLOCK 2 LOT 10 A B FEET 0 50 100 DOWNEY FINCH DRIVE 4-BD R M H O M E 12/20/21 10' UTILITY EASEMENT SHED NEW 1250-GAL SEPTIC TANK w/ 20" MANWAY EXISTING TANK DISPOSED OF PER MOA CODE INVERT OF EXISTING FIELD DROPPED 0.4' TO ALLOW FOR FLOW FROM TANK CLEANOUTS ADDED TO EITHER END OF FIELD 2CO1 2CO2 MH SV CO2MT A B 2CO1 24.8 MH 28.7 SV 33.1 2CO2 35.4 CO1 53.3 MT1 48.5 CO2 50.0 19.9 18.3 15.6 15.2 17.6 46.9 49.8 PLAN AS-BUILT WATER SERVICE LINE RELOCATED TO GREATER THAN 10' FROM SEPTIC FIELD SEPARATION WAS CONFIRMED AT CONSTRUCTION PROFILE AS-BUILT (NO SCALE) 94.6 90.5 95.2 100.3FCOMH SV100.5 FINISH GRADE 45' EXISTING TRENCH 88.7 94.3 COCO94.3MT2CO94.4 12/20/21 PERMIT # OSP211464 PID # 015-234-17 ALPINE WOODS, BLOCK 2 LOT 10 ORIGINAL INVERT ELEVATION: 94.7 1250 GAL SEPTIC TANK LOT 12 15.5' 25.8' ��, '...3 6 ,� 11.9' 8.5' N 06 N 7.6' v 2 :9 1.4' 9.0' 'n` , 2.9' 8.0' ; 4.0' `-2.9' N 5.5' 5.1' 36.5' BUILDING DETAIL 1" = 30' 30.8' o, �(z) co � $(3) Co o LOT 11 d bio . o co (z) Co m O r 0 37.6, Z �� ice........... o� LOT 10 LOT 9 6opOOpp�O OFA�-9��4 .............- ................. o . o �co STEVEN CALLA HAN; 00 / ,��N H DRIVE LS— 120,34 Co NOTE: 40 00 ssiono& 0 1. THIS DRAWING SHALL NOT BE MODIFIED WITHOUT THE Op00 O EXPRESSED WRITTEN CONSENT OF LCG LANTECH. 2. SNOW AND ICE MAY CONCEAL MINOR SURFACE FEATURES. ORDERED BY: JAKE MILLETTE, FORGE CIVIL PARCEL #: 015-234-17-000 SURVEY CERTIFICATION: LCG LANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY OFTHE PROPERTYAS SHOWN ON THIS DRAWING AND CERTIFIES THATTHE IMPROVEMENTS LEGAL DESCRIPTION: ADDRESS: SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXIST AS -BUILT 6531 DOWNEY FINCH OTHER THAN NOTED OR SHOWN. DRIVE EXCLUSIONARY NOTE: IT IS THE OWNERS' RESPONSIBILITY TO DETERMINE THE EXISTENCE OF LOT 10, BLOCK 2, ANY EASEMENTS, COVENANTS, RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY ALPINE WOODS SUBDIVISION DATA HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTY LINES, OR FOR PLOT -PLAN PURPOSES. 250 H Street Anchorage, Alaska 99501 LEGEND: .................. LOT LINE SEPTIC NH Overhang ADJ LOT LINE MANHOLE Wood Deck Concrete a CG WATER WELL @ UTILITY BOX L] SEPTIC STANDPIPE #CC). Survey Department DRAWN DATE: 1/19/2022 WORK ORDER: 21153 Phone 562-5291 Inc Mainline DRAWN BY: AP PLAT: 82-210 Phone 243-8985 CHECKED BY: SC GRID: SW2738 � AECC 668 SCALE: 1" = 50' FB/PG: 822/73 REF: 20014L38 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211464 Work Type: SepticTank Upgrade Tax Code Number: 01523417000 Site Legal Address: ALPINE WOODS BLK 2 LT 10 G:2738 Site Mailing Address: 6531 DOWNEY FINCH DR, Anchorage Owner: HOLMES LEE P Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: roent G O L llepartment 11/3/2021 11/3/2022 46752 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The water service line shall be located to the extent required to confirm minimum 10 ft l (separation from the septic system. -0 o � � t +� cr.U VZ . `i _ -fir ( o w Received By: Date: Issued By: Date: �,67Zt-,01 4 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I. D. 015-234-17 Property owner(s) Lee P Holmes Day phone 350-7386 Mailing address 6531 Downey Finch Dr, Anchorage, AK 99516 Site address Sante Legal description (Sub'd., Block & Lot) Alpine Woods, Block 2 Lot 10 Legal description (Township, Range & Section) Lot Size 46,752 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 Septic Tank Upgrade Q (w/wo ADU) Holding Tank ElRenewal ❑ Duplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: §"? � 5 Waiver Fees: Date of Payment: 1 f b1 a0 2 ( Date of Payment: Receipt Number: Receipt Number: Permit No. O SP� J �/ f y Waiver No. Permit App_'- :• October 28, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 10/28/21 Subject: Alpine Woods B2 L10 - 6531 Downey Finch Dr Septic system design Dear On-Site Services Engineer: The owner of the above lot has a 4-bedroom home on the property with a septic tank that has reached the end of its life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the existing septic location and proposed new tank site. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The subdivision is serviced by a community water system. The new septic tank will be a minimum of 100’ from surface water, and more than 5’ away from the existing field. Please refer to the attached plan page for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211464, Rebecca Carroll, 11/03/21 ALPINE WOODS, BLOCK 2 LOT 10 C"o� i ��,•� Tii '9'�1 Benja i Schiller I ®PF •• CE 2592 `moi 1218/21 1�\`_PROFESSI�NP .o 4STALED 1250 -GAL 'ANK W/ 20" MANWAY STING TANK DISPOSED OF MOA CODE ISTING FIELD TO REMAIN IN RVICE IS HIGHER IN ELEVATION IAN THE OUTFALL OF THE TANK. :OP INVERT OF FIELD NO MORE IAN 0.4' TO ALLOW FOR GRAVITY OW FROM TANK & ADD CO TO WEST D OF FIELD. EFFECTIVE SORPTION AREA TO BE NO LESS AN 500 SF. VNEY FINCH DRIVE NO SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC TANK NO EXISTING WELLS - PROPERTIES ARE ON COMMUNITY WATER SYSTEM 0 50 100 FEET 1 "=50' LEGEND CO -CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEAN( FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND ALPINE WOODS, BLOCK 2 LOT 10 FEET 0 50 100 NOTE: NO SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC TANK NO EXISTING WELLS - PROPERTIES ARE ON COMMUNITY WATER SYSTEM DOWNEY FINCH DRIVE October 28, 2021 10' UTILITY EASEMENT SHED NEW 1250-GAL SEPTIC TANK w/ 20" MANWAY INSTALL DOUBLE CLEANOUTS ON BOTH SIDES OF TANK REMOVE EXISTING TANK & DISPOSE OF PER MOA CODE EXISTING FIELD TO REMAIN IN SERVICE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211464, Rebecca Carroll, 11/03/21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME -- PHONE I ~NEW Robert Hills 349-9127I []UPGRADE MAILING ADDRESS 1161 Golden Dawn Circle #1, Anchorage, Alaska 99515 LEGAL DESCRIPTION Alpine Woods Subdivision, Lot 10, Block 2 LOCATION NO. OF BEDROOMS Section: 23 Township: 12N Range: 3W 4 l Well 500 ,' [Absorption area Dwelling PERMIT NO. DISTANCE TO: Community Wat~er 20 ' l0 ' 850259 o_ ~, ' ' No. of compartments I- 2~ Manufacturer Greer Tank ~ Material Steel 2 ~ ~ Liq. ~P23~i~ in gallons iF HOMEMADE: inside lengt.h~ '_'_ Width ---- Liquid depth --- Well Dwelling PERMIT NO. ~ v DISTANCE TO: None . ...... -_~z o" ,~ Manufacturer · Material Liquid capacity in gallons · - ~ Community Water Q Well Foundation Nearest lot line PERMIT NO. ,,~,~ DISTANCE TO: 500~ 20'+ 10' 850259 ~ ~. ~ No. of lines Length of each line Total length of lines Trench width Distance between lines - ~ '" 1 4 5 ' 4 5 ' 3 6 inches ---- I- ~ i~' Top of tile to finish grade Material beneath tile Total effective absorption area ~ 4 · 5 ' - 5 ' 72 inches 540 Length Width Depth PERMIT NO. ~: I- Type of crib Crib diameter Crib depth Total effective absorption area '" Well Building foundation Nearest lot line (~ DISTANCE TO: ..j Class Depth Driller Distance to lot line PERMIT NO. ~ Comm. Water J '" Building foundation Sewer line Septic tank Absorption area(s) 1 ~ DISTANCE TO: OTHER I · PIPE MATERIALS PVC ASTM 3034, C.I.P. SOIL TEST RATING , 125 So. Ft. 1 BR I NSTALLEI~' Self REMARKS The lot is served by a community water system: Cast ~ron cleanout located 8'+ \ from bu±:[~-.~n~n.'".:';:4" per- , forated ,' Xwas ,L ~' --~..~-t:' ~-~,~ .. --~ ~-,~ ~.-~ ~_~ placed i ~ ~L,~I ~f i e .~... ,,~ ~-.e ,~.~W.*.~.'~"*'"';%"~ , APPROVED DATE LEGAL ~S~ .~~~ ~~ ~, ~. ?~/,~_Lot 10, Block 2, Alpine Wo 72-013 (Rev. 3/78) 'Ii ::; ,::! ,::... ? .::!. ;:; MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOl LS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS PERFORMED BY: /~c~ ~ bJoo~ Erg. SLOPE SITE PLAN s L 0 -.~ Gross Net Depth to Net Reading Date Time Time Water Drop / &/4 o o ~" ~ ~/¢ ~.'o~ o.'o¢ $" I" PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN ~ FT AND I~ '~ FT / CERTIFIED BY: ~- ~~O~ DATE: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 .11 12 13 14 15 16 17 18 19 2O COMMENTS _~o;! WAS GROUND WATER S ENCOUNTERED? /'v'/o L O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop ~,. _.-, ~': ~,../ ~ . ~-,./ I ~7'Zl ,~ . ~-o .oV PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN ' FT AND ~ FT PERFORMED BY: ~,~ v c ~-.; ~' CERTIFIED BY: DATE: / ! 72-008 (6.'79) 401 E. FIREWEED LANE ANCHORAGE, ALASKA 99503-2197 (907) 276-3770 CALCULATED BY ;,~'E CHECKED BY .~ SCALE 7/ 4~$~- MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel 1. D. 015-234-17 1. GENERAL INFORMATION Expiration Date: 0 C)� t 3, a oa 3 Complete legal description Alpine Woods, Block 2 Lot 10 Location (site address) 6531 Downey Finch Dr, Anchorage, AK 99516 Current property owner(s) Lee P Holmes Mailing address Same Day phone 350-7386 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: Private Well ❑ Private Septic ❑■ Water Storage ❑ Holding Tank ❑ Community Well t❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment 12 22 2021 Receipt Number 02 2 COSA # �05 02-1 17 31 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 12/20/21 .�, • OF A�gkTH 11 / / 6. DSD SIGNATURE � �' � � System #1 Approved for bedrooms I' % BentamlrtiSchlller / System #2 Approved for bedrooms ��s'• 1220/21 Disapproved Conditional approval for bedrooms, with the following stipulations: nwsk m wATE:. ,l 1ER o �o PR013 \A-\ J)V;))1111111 By: Original Certificate Date: 0/02 0,2a 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 Checklist blue sheet COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Alpine Woods, Block 2 Lot 10 015-234-17 1 Community water system <1 Septic/Plastic N/A ■ Installed on 12/7/21 Deep trench 7/28/85 10/13/21 ■4 11.8 0 *6.2 737 0 ■ ■ 60 0 >600 None N/A *Invert of existing field dropped 0.4' to allow for gravity flow to tank. Total absorption area is now 504 SF. ✔ 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’ Yes if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ 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 Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to:(Please enter distances if less than required) Building Foundation > 10’Yes if No ft Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’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. 12/20/21 ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Municipslity of Anchorage Development Services Department CERTIFICATE FOR A Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.Oi Box 196650 ,,/~ Anchorage, AK 99519-6650 ~"~~/,~,~,~/ www.muni.org/onsite (907) 343-7904 , OF 0N-SITE SYSTEMS APPROV A L/ SINOLE FAMILY DWELLIN0 Parcel I.D. 015-234-17 1. GENERAL INFORMATION COSA# O E~.) ~--- l I I OOT.- Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address ALPINE WOODS; BLOCK 2, LOT 10 6551 DOWNEY FINCH DRIVE *ANCHORAGE, AK TONIA GILKEY Day phone 6551 DOWNEY FINCH DRIVE *ANCHORAGE, AK Day phone 610-438-5001 Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class A Well · Community On-site [] Public Water System [] 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATE~'~ENT OF !NSPECTION BY ENGINEER As certified by my sea/affixed hereto and as of the validation date shown below, I ....v~,,y=" ,J~'~ ~' my' investig.ation, 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 dicposa! ~tem is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on t,Se ,n~u,,,,~,,on o~,~i, ,~o from the Municipality ,, ,-,n~h,,, oge fries and f,m,m, my in',ootfg~*5''. ...... and ;, .... ,st. .... ~on, the on-site water supply and/or wastewater disposal system is(are) in compliance with afl appficable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 357-6179 Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidefines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of afl wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this repOrt is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal rig,~t whatsoever. 5, DSD SIGNATURE //" Approved for f'"J bedrooms. By: Disapproved. Conditional approval for bedrooms, with the following stipula~r~F ACe,;,,, .... ,~ ~ .' . ~'~. COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisow Arsenic Adv so-y Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 11/05) Municipality of Anchorage Development Services Depa ment 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 ,PPROVAL Legal Description: ALPINE WOODS; BLOCK 2, LOT 10 CHECKLIST Parcel ID: 015-2.34-17 Elapsed Time: 125 min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) **SUMP ONLY EXTENDS 49" 'BELOW INVERT. · Absorption rate >= 600+ NONE KNOWN If yes, give date 12 in. g.p.d. A. WELL DATA Well type COMMUNITY "A" If A, B, or C provide PWSID# 21,3598 Well Log (Y/N) Date corn plated Sanitary seal (Y/N) Wires properly protected (Y/N)_,,-'/ Total depth ft. Cased to ft. Casing heig~ in. FROM WELL LOG AT INS~5'~TION Date of test Static water level fl~.~..-'"'"'~ ' ft. Well production '. ..--'"~ g. p . m . g.p.m. WATER SAMPLE RESORT ~ Coliform ,~olonies/100 mi. Nitrate mg./L. Other bacteria colonies/100 mi, A~e ' .~:"/'~ug./L. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 7/28/1985 Tank size 1250 gal. ,Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping ~//,--~//O Pumper. AROUND THE CLOCK PUMPING C. ABSORPTION FIELD DATA [*BELOW EXISTING CRADEI Date installed 7/28/1985 Soil rating (g.p.d./ft2o~ 125 System type TRENCH Length 45 .ft. Width ,3 ft. Gravel below pipe 6 ft. Total depth .7.41 ft. Eft. absorption area 540 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 11/1 6/2010 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 2 in. Water added 630 gal. New depth D. LIFT STATION Date installed "Pump on" level at__ in. Size in gallons Manhole/Access ~ ~ "Pump off" leveLa~-------in~----- High water alarm level at ,in. Cycles tested. Meets alarm & circuit requirements? SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY WELL Septic tank/lift station on lot On adjacent lots Absorption field on lot Public sewer main Sewer/septic service line areas On adjacent lots ~nout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main 10'+ Water service line *UNKNOWN Wells on adjacent lots 200'+ Absorption field 5'+ Surface water. '100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water service line *UNKNOWN Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots, 200'+ Water main N/A Driveway, parking/vehicle storage 10'+ F. COMMENTS *SEE PREVIOUS LETTER SUBMITTED TO MOA. 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. Engineer's Printed Name JEFFREY A. GARNESS Date I~/~/IO COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services De partment 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 FAIVlLY DWELLING Parcel I.D. 015-234.-17 1. GENERAL INFORMATION Expiration Date: ~:~ - ¢,~, O -¢ ~ Complete legaldescription ALPINE WOODS SUBDIVISION; LOT 10~ BLOCK 2 Location (site address or directions) 6531 DOWNEY FINCH DRIVE * ANCHORAGE~ AK 99516 Current Properly owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address KIRK & BEVERLY KIRKBRIDE Day phone 34.8-0607 6531 DOWNEY FINCH DRIVE * ANCHORAGE~ AK 99516 Day phone BETH WEISER W/ PRUDENTIAL JACK WHITE Day phone. 762-5111 3201 C STREE'f~ SUITE 200 * ANCHORAGE~ AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site [] Individual Water Storage [] Individual Holding tank [] Community Class A Well [] Community On-site [] Public Water System [] Public Sewer [] The MuniciPality of Anchorage Development ServiCes Department (DSD) Issues Certificates of Health AUthOrity Approval (HA,&) based only upon the representations given in paragraph 4 by an independent Professional civil engineer registered in the State of Alaska. Certificates of Health AUthority APproval are required for the transfer of title (except between spouses) for properties SerVed by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this repot~ by any other person or pady is not authorized, nor will it confer any legal right whatsoever. Phone 537-6179 Date ~ /3'27/0 ~/'' DSD SIGNATURE ~ Approved for L~ bedrooms. Disapproved. Conditional approval for __ bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flew Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: (~ - ~. 0 -- 0 Z~- ohs Cycles teSted, High water alarm level at in. Meets alarm & circuit requirements? Bewer maln ; line Public sewer manhole/cleanout Holding tank Property line b'+ Absorption field Water service line *UNKNOWN SurfaCe water surface Water Wells on Water main. Driveway, parking/vehicle storage Waiver Fee $ Receipt Number GARNESS EN INEERIN R0'UP, Lt& CONSULTANTS & GENERAL CONTRACTORS ~~'~r~ August 25, 2004 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 Kef: Field verification of water line This is concerning the property Alpine woods lot 10, block 2. Initially there was concern that the water line might be to, close to the septic system. Upon investigation of files in your office, it was found that a key box was located on the same side of the property as the septic system. No documentation was found concerning the route of the water line and where it entered the house. Upon request fi.om your office a field technician was sent to the property to verify where the water line enters the house. The field technician found that the water line entered into the side of the house opposite fi.om the septic system. The actual location of the water line is un-known. If 'ou have ,a~ ~tions, Please contact us at 337-6179. Thank you for your assistance. Pre '~£ mes~, P.E., M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 Fax: (907) 338-3246 Website: garnesseng/neering.com Sep 15 04 04:54p Martin & Beth Weiser (90?)248-?23? LOT 1 2 LOT 1 5 LOT 9 EX[S'RNG HOUSE LOT 11 LOT 10 DRIVE DRIVE [2] with PRdDENTIAL J&CK WHIrE EXCLUSION NOTES: It is the owners' responsibility to determine the existence of any ecJsements, coYenon[$, or restrictions which do not oppeor on the recorded subdivision plat, NOTE; Under no circumsJances should any data hereon be used for ¢onstructicn or for establishing property lines. LAND &: CONSTRUCTION SURVEYORS-PLANNERS-ENGINEERS 440 WEST BENSON BLVD. # 103 (fox) 561-6626 ANCHORAGE, ALASKA 99503 (907) 562-5291 2758 Ref: 89L460 SURVEY CERTIFICATION: LANTECH hos conducted 0 physical survey of this property as shown on this merits exist other then noted. LEGEND: SET FND 5/~'RB W/CAP<~ 5/8" Re 0 3.~5' A~.,UON. ~ UO~UUE~T ~ LOT 10, BLOCK 2, ALPINE WOODS SUBDIVISION MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Location (address or directions) (b) Pre)pert/owner Mai~ing Address /-¢~,'~ ~'~x ~,~.~' ~'c~O N Telephone' (home) iOOf ~'. Business 8 ?6- / (c) Lending Institution Mailing Address IOO ! (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here r~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Number of bedrooms Single-Family [] 3. WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) ' Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION _ As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the .on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm ~'/o{-/-o/a 7-ec/nn~cc~f ~r'u"~¢a~' Telephone Address 1"/5'.3~ ~¢'~ 5/~ ~nc/~o/-ct~"~ /~ Date ,/~0 u 2__. ~ /~.¢ ~/¢"~ % ~~ngineor's Seal & % THEODORE F. ~AOORE ~ 6. DHHS APPROVAL Approved for 4 bedrooms by Approved _,~ : Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based onlyupon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-02,5 (Rev. 7/88) Back Page 2 of 2 · - ~ MUNICIPALITY OF ANCHORAGE (MOA) . t ~'~', i[e--~ :r . Health Authority Approval (HAA) I~'~'"i.'~-.,'~,_i~,~'.;~J~r_~]":~':~'r~ CHECKLIST - FEBRUARY 1984 ,..:, Well Classification 343-4744 Legal Description: L.o If A, B, C, D.E.C. Approved (Y/N) Y' Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed 7/~/'8,5' Size Standpipes (Y/N) ~' Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) Air-tight Caps (Y/N) No. of Compartments ~' Foundation Cleanout (Y/N) Date Last Pumped II/ /U~. ; for N,~. bt,/~. Temporary Holding Tank Permit (Y/N) ^h SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~, ~oo' To Property Line ? to' To Water Main/Service Line ~, ES ' To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation To Disposal Field /30 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7 /' Width of Field Type of System Design Length of Field Depth of Field I/' T'ro~c6 Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Gravel Bed Thickness 5' ¥O Statndpipes Present (Y/N) /V Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation ~, To ' Lot To Water Main/Service Line ~ ~J" To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~ a tl To Property Line /5' ' To Existing or Abandoned System on ; On Adjoining Lots .':> .,3'~ ' To Cutback (if present) /%-~. ~ (0o ' D. LIFT STATION J~[,4, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and inspection. Signed Company f::/'~/' 7"~c~',cc~[ Date /~O v MOA No. Receipt NO. ~ / _~'/ / g ~ ~ 0 Date of Payment //' Amount: $ / ~, 72-026 (Rev. 7/88) Back H~A,~.,~i~,j~.~i,~ll~ect on the date of this .%?...". · ·; · ::.?$._% ,. Sea, THEODORE F ~'AOORE · jr "Oo CE-3~89 .""~' ~'~,~ .. ....~ m Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ISAACS PUMPING SERVICE (Norm Tibbetts, Owner) 6218 Quinhagak Street ANCHORAGE, ALASKA 99507 Phone 563-3300 I claims and returned goods MUST be by this bill. ~a.~/~gj~ DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE / 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 November 22, 1989 STEVE COWPER, GOVERNOR 563-6775 FOR: ALPINE WOODS HO~4EOWNERS ASSOCIATION PWSID: ~213598 According to the records on file in this office, the Alpine Woods Water System is in compliance with the State of Alaska Drinking Water Regulations. Thank you, Cindy Thomas Environmental Engineer CT:bas A MUNICIPALITY OF ANCHORAGE DEPARTMEN, OF HEALTH AND ENVIRONMENTAL PRO, ECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date (~/~ GENERAL INFORMATION (a) Legal Description (include tot, block, subdivision, section, township, range) Alpine Woods Subdivision, Lot 10, Block 2 Location (address or directions)" Section 23, Township 12N, Range 3W (b) Applicant Name Robert Hillo Telephone: Home App~cantAddress 1161 Golden Dawn Circle (c) Applicant is (chec~ one): Lending Institution [] · Owner/builder [~ · Buyer [] ' Other [] 349 - 9127 Business NO. 1, Anchoraqe, AK (explain); 99515 Lending Institution Home Saving Telephone i001 Benson, Anchorage, AK 99503 Address 272-1451 (e) Real Estate Company and Agent Address N/A Telephone if) Ma~l the HAA to the following address: Home Savinqs Bank 1001 Benson Anchoraqe, AK 99503 2_ TYPE OF RESIDENCE S~ngte-Family [] MultJ-Family I-1 Number of Bedrooms 4 Other WATER SUPPLY Individual We}} [] Community[~ Public [] Note: if community well system, must have written confirmation from the State Department of Environmental Conservation a~esting to the legah~ and status. 4. SEWAGE DISPOSAL Or, site [] Publ:c [] Community [] Holding Tank [] Note. I1 commumty we;t system, must have written confirmation from the State Department of Environmental Conservation attest,rig to the :egahty and status. Page 1 o! 2 5. EIM3iB~EERIMG RRM PROVIDINg. ,NSPECTIONS, TESTS, FILE SEARCH, DA..~ AND INFORMATION by m3, seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Hem~, .~pro,,~ s.",ows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate r~mbe~ ol bedrooms and type of structure indicated herein. I further verify that based on the information obtained ~ of Anchorage.files and from my investigation and inspection, the on-site water supply and/or a~stea~al~r dzR3osat system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on QUADRA Enqineerinq, Inc. Telephone 276-3770 401 East Fireweed Lane, Anchorage, AK 99503 Auqust 27, 1985 Engineer's Seal Approve<: lc, ~rooms bye/ ~ _ Appro~e~ ,~ DisapproVed Conditional(~ Terrr~ ot' Creditor.,:1 Approval CAUTION Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority based so,ely upon the representations given in paragraph 5 above by an independent professional .n the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending :o sabsfy cerlain federal and state requirements. Employees of DHEP do not conduct inspections or a cerbficate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the ~-e~ s work. Facje 2 ~ 2 WELL DATA DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 /'~ ~ ~7 ~ 264-4720 Legal Description: ~ Alpine Woods Subdivision Well Classification Community Water If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed 6/10/85 Size 1250 Gal. No. of Compartments 2 Standpipes (Y/N) ¥ Air-tight Caps (Y/N) ¥ Foundation Cleanout (Y/N) ¥ Depression over Tank (Y/N) N Date Last Pumped New System Pumping/Maintenance Contract on File (Y/N) N/A · for N N/A Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: 500' To Water-Supply Well 60' To Property Line 100'+ To Water Main/Service Line 10' To Building Foundation 20' To Disposal Field To Stream, Pond, Lake, or Major Drainage Co u rse Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 6/'I 0/8 5 Width of Field 3 ' 125 Square Feet of Absorption Area 540 Ft2 Depression over Field (Y/N) N Results of Last Adequacy Test New Separation Distance from Absorption Field: 500' To Water-Supply Well 20' To Building Foundation Lot N/A 100'+ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area New System Comments Ft2/BDRM Type of System Design Length of Field 4 5 ' Depth of Field 6 ' Gravel Bed Thickness 6 ' Standpipes Present (Y/N) System Trench Date of Last Adequacy Test Y New System To Property Line 10' To Existing or Abandoned System on 200'+ ; On Adjoining Lots To Cutbank (if present) N/A D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** Signedl certify that ~¢¢'¢~ ¢..~1 have checked, ve~ed,c~.C~,l~f~eOr conformed to all M OA/and I~IAA~/Z~ 7//~ ~¢'guidelines in effect on the date of this inspection. Company C~d~/2¢} ~'-~J~/q ~-"rE~fr~ MOA No. ~'T'(f~'°z~-°/~.~ Receipt No. Date of Payment ~'j - .~ Amount: $ ~'~- -~---~ Engineer's Seal Page 2 of 2 72-026 (11/84)