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ALPINE WOODS BLK 4 LT 1
Alpine Woods Block 4 Lot 1 #015-234-57 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191132 PID Number: 015-234-57 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name ERIC &JENNIFER MAXON ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 5801 ALPINE WOODS DR. ANCH., AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot ALPINE WOODS 4 1 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width 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 Ft2 Ft. Well 200'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1250 Gal. Surface Water 100'+ -- Material STEEL Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Existing septic tank decommissioned / removed per code, new tank installed in same hole and 5'+ to Alarm location Electrical installed by existing fields. PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer A+ Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspdectionates: 151 5/9/19 11 /12/19 Location and description 2�d 3rd 4'h BOTTOM OF TRIM ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date •411�� Alw j *: 49 TM ••* �l Septic System / .. .. ........ r Approved - Cs ltn o Ci► Date .. . • • • ..vim.—. ... . I Curds Huffman Note: this approval does not include well permit requirements. CE 128991 �1 lF,�' • .. • �� , F�PROFESSION��-� (kev Ooiu2ii u) ALPINE WOODS B4, L1 LOT 1 NEW 1250—GAL SEPTIC TANK,,,,, CIO �E '�Go \ <pcgTFp R 441M, qT „ PI D: 015-234-57 PERMIT: OSP191132 R� 00 EGA P + ate, + EXISTING 1�9 4BR HOUSE �9 1 's. X42.16' )RIVE ' z9.z 2�15g n5+� SCALE 1' = 30' SEPTIC SECTION SCALE: NTS PREPARED FOR: '_� OF ERIC & JENNIFER MAXON �� -4Z4, 1 ALPINE WOODS B4, L1 9 TH 5801 ALPINE WOODS DRIVE, ANCHORAGE, AK 99516 * FIRST WATER CONSULTING DATE: 2/5/2020 I` rtis Huffman / 13030 SUES WAY 1 ifs CE 128991 ANCHORAGE, AK 99516 DRAWN: FWCS 1 OFBSSIo'ov AV 2/5/2020�� 907.350.9566 firstwaterAK©gmail. com SCALE: 1" = 30' ��_'� CO 00 FCO COCO("- A -C=16.7' B -C=30.8 98'15 98.09 GRADE A -D=16.5' 95.69/ INSULATION B -D=38. 2' A -E=15, 7' 95.11 1,250 GALLON 4'94 STEEL TANK EXISTING FIELD B - E = 4 0 , 6' A -F=15,1' B -F=40,0' SEPTIC SECTION SCALE: NTS PREPARED FOR: '_� OF ERIC & JENNIFER MAXON �� -4Z4, 1 ALPINE WOODS B4, L1 9 TH 5801 ALPINE WOODS DRIVE, ANCHORAGE, AK 99516 * FIRST WATER CONSULTING DATE: 2/5/2020 I` rtis Huffman / 13030 SUES WAY 1 ifs CE 128991 ANCHORAGE, AK 99516 DRAWN: FWCS 1 OFBSSIo'ov AV 2/5/2020�� 907.350.9566 firstwaterAK©gmail. com SCALE: 1" = 30' ��_'� MUNICIPALITY OF ANCHORAGE ,�»C On -Site Water & Wastewater Program �0 PO Box 196850 4700 Elmore Road " Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite r 1)epattmcltc On -Site Wastewater Disposal System Permit Permit Number: OSPI91132 Effective Date: 4/26/2019 Work Type: SepticTank Initial Expiration Date: 4/25/2020 Tax Code Number: 01523457000 Site Legal Address: ALPINE WOODS BLK 4 LT 1 G:2738 Site Mailing Address: 5801 ALPINE WOODS DR, Anchorage Owner: MAXON ERIC D & JENNIFER N Lot Size in Sq Ft: 39782 Design Engineer: MbEgSbt1 CO�lSTKUCT 10A 4- EtJGINER-146 Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 2 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, seated, and heated to prevent freezing Special Provisions: 1. The water line is to be located prior to placing the tank. If the required separation is not being met, a change order is required. 2. The IR is to show the location of the waterline. Received By: Issued By: Date:Z 7 Date: t 2� /��, EP(FtFV' MUNICIPALITY OF ANCHORAGE Development Services Department i Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-234-57 Property owner(s) ERIC & JENNIFER MAXON Day phone 9074404601 Mailing address 5801 ALPINE WOODS DRIVE, ANCHORAGE, AK 99516 Site address 5801 ALPINE WOODS DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) ALPINE WOODS BLOCK 4, LOT 1 Legal description (Township, Range & Section) Lot Size 39782 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (IE all that apply) Absorption Field J Initial _ Single Family (SF) (w/wo ADU) Septic Tank Upgrade Duplex (D) ❑ Holding Tank [ Renewal ❑ Multiple Dwellings Privy C (SF and/or D) Private Well Water Storage THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. FWCS - Brent Western (Signature of property owner or authorized agent) Permit/Rush Fees: ,��J� Waiver Fees: Date of Payment: L// LI/Jt Date of Payment: Receipt Number: C9 3 235D Receipt Number: Permit No. 0.5P19113 Waiver No. G\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 April 23, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic Tank Permit Legal: ALPINE WOODS B4, L1 The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 4- bedroom house. The lot and area is served by a class A water system and will not impact any of the neighboring properties due to the lot layout. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191132, Deb Wockenfuss, 04/26/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191132, Deb Wockenfuss, 04/26/19 �'� zc cf �rkl r6�p qtr 4 .•:. G§ r l l�.:ti§ uf. ',t,s 1ANMICWAUW OP A11CHOKA0t l NO MUSS Of MUT" • U MR011 MUN PMUCTIOM M1MIwNk*WAL tN01MtEA1 -801 olml �!f L SMW • Ani- AIwAr ''OM T410UM 3964:' O"TE UWAGE OWKML SVX M AMOlOM WELL IN04WTIOM REPORT Irar John Hagwei*r Ca"nY 1338-6336 1 Ourw�si MAIU" AOORE3>Z 1399 N. 34ths Anchors •. Alaska 99503 lEtiAL Ot>iCRIR10N _ , Alpine Woods* Lot -1, Block 4 LOCATION .. Section.- 230, Townships 129s, � 1. i Q ..,. ANN 9Z 17M 71 • �► 1 1 r ��1 1� �.�'1 !1111/.rinA■���!!l�MEN - - -. �www��.�����wwwww■ NNW A10,1114VAMMEMEMEM • _ • •, M■■G UNOWwr.M■■.■ .�r_� inIm©c3r"Tniww■ F.1, _ ^�� �ww����®www■ iww■ Lot 1, Block 4, Alpine W00900P ri'�(iF��i11T�IIY�V�Otad�i u f :� ��'��A*�>{ '��'a,�• . X10»' c 4 ° s„ '�' `q"'•F r ° ,� -;�y :yt4 �_�... 4 xb w^.{�;.� •t t:#• �., tf y Y 3r r aY.1 �''M y$ •T yp -i Cj.. 7 ir':,. q . i , 43„Z $""" S ,n Yt6$,�z'4�'lr�' A9i F F �l.r, :i ,r R C,. L}`•�` _ ti i • y r e r "fe " DEPARTME 0""km IWT Tr Wl C3 iii , •' �+4 ."..' r ��11r Wii.!'�i•. x? .s'ir +�-!� "vRcf:+ , :: a ii ...' , „^� , _ i} y ; •,� . : r n r+ tk, Y :�,a�,~v�,�y3!ri rt;...g• •.,pie r x a .i�_»p PERM I T NO a 850212 0ATE� ISSUED( 05/.21/83 4 aPPL I CANTS J OMH HAGME 1 ER ADDRESS( 13" W 34TH Aa` � � ° r r14,11 r �{ k « i /.u� /�� s ,-ate. �� ' `'r er� � .w k *N?,� »•:" ktrYr ,�, !i� .x ,`4 .5...*i .�.Atw .++ � < '•. r -. @' ' •' `.+ ANCHORAW'j A 0,,o VM3 ► '? e g i r $ F A 4 &s'�' Y t 1CDNTACT PHOtts1. -8-6336 Yx LEGAL DE3CRIPs SUM Xlrtl�t*"iN:,tt `SECT2ONs :(3 TiW NSHXPCI.12N:-I t Mt i 1�OT SIZES 39782 (80 " a IAX SEDROOMBi 4 14 fisted belott=are the opt1cfte",available to,,.You.,th, e*i #ei4 . r :asptic system. ChGose,tho option that best (iter °your �*# t*4 tj , r r .. .. r ' .i r r +. r �. «. r ii{ s4iltJ •► r .� iii w ;.. yr". iii: "ib^ �L"il� T�'tA lvw 1»._• ,.•w 's sy .".Fj < �a.t y'.r■.4. .. !y x .r�'�•r.n rr iii► �ir +Y. r it r r r err 0 DEPTH .TO PIPE ` BOTTOM (FT ? , b«Q tI d 4 .i a# r S +F v w x `" +;5 GRAVEL .FJ,+r i.n. as �•e= +.'.a:,i.• ^r''.` »-.+ems J' Y.k i.. GRAVEL DEPTH (F T.) + 7. 7 .TOTAL DEPTH= (FT.) �°°'13.4. 7.0 `*3RAVEL MfIDTH ''(FT 3 2. S ' ` 29, 0 'r �3•-O T. GRAVE. LENGTH,,(FC.tDS. W ,8 1. ib2.sGRAVE4 59.1'.4 . TANK 812E (SPAX-f iii 30.0 "+e i, i30� El e* d !, 2'3©.0 •ai s ` SOIL RATING ;t�'at�. FT'. /BR) 312 ` a. t; 264" 312 ;. ' , ..` ...r `'4k, ,•:..t.. 1 t:.: ,�,r,:?..ey,_ qri. ti+r ��-.� +sa GRAVEL LEtt3TH '7!5 xPt: At'WtRES MULTIPLE • RUNS``(NOT CXCEEDING 75 FT;- EAG`Nl *0 TANK K'JS V" HAVE AT LEAST - TW0 . COMPARTMENTS � .. �.. :.. w r. `.r r" a r r .+r r � ` qiw 4i• ; .� +� w•�..4+. fir; .. .w. r.. .fr • r ::� ... w d► }.� ` i t, �. .rYr �: r .r 'wM .r J .► I cert!^ r . mats •- y�r`, -} - `�' .. :.�.. �. � 1. I ase' familiar with the rdquirements `tor_ onsite- sewers and 4L41 IS aus> seet.' . forth by the Municipality of Anchorage (MOA) 'and•, the State of Alaska. ` 2. 1 will install the system "in accordance"'with "all MOA- codes. and r�eiqulatlons, and in compliance with thse deaign�'criterI& bf:�thiq peCmit. 3. I will adhere to all MCJA 'Amd State of Alaska Neequiremant,s, for the set, .back distance% from► any *x1*tiny'w011, wastewater disposal' system or public sewerage system on this or any"adjac+ent ornearby lot. 4. I understand that this permit,is valid fora maximum of 4 bedrooms and any enlargement will require an additional permits, IF A LIFT STATION IS INSTALLED IN AN AREA COVERED DY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND,INSPECTION MUST RE OBTAINED{ (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT- AN ELECTRICAL INSPECTION REPORTI.'AND,(3)"THE ELECTRICAL. K MUST BE DONE'HY A LICENSED ELECTRICIAN. SIGNED - DATE e � �.• 7_0000 ArPL I CANT s JOHN HAGME I ER ' CC1 DATE 1 SUED 6Y r . .y. ess, ...a,S.3��_.0 _..... ......a..�.., ,. :�c.z s.. ..:. Y,:. � ��.�,. ..:`�... ,_. .. ��.nt _-. !tsA.,; _,. .�';i �.b �-` "'b�� ,•�4„r"n r. ,i '�.n�.�.w« .. U.. .. . •-- - -_----- ..:. -,.., .-.jai. .. Aft MUML am,. •`, DOM 10"" RAM AON UMTAA PROTac" N � •EIIOOI At10N EEi L ftn% ASM' OAMM MW n&4m r &au m #%a �Mbo m AWMAM "d" PE11sonwo :011: eft y DATE /E11E0RWD: AIem Alfux�ods LEOAL oEECRI►'f10N: • . � TMW yM D" 1 8•Z9i 1 s ly . Q2 arcux� y 3. M wrns,n 4 genw� q 6 • lovkh•3'1 7 •OS #02OF 44. gINS IA�'ain6mmom • �W iQ 11 MGROkI MAT Af rD ER t1100k1NTERED? 12 1F YK AT WAT . 1>f Comilt f 4req ` 5 roll,ySil� MINEMMEMEN ■wwwwwwww■ ■w�wwwwww�w■ .'I "Row"m 1011 RATE - TELT ma KTNEEM .1k ftllfohMEo fY: OATS ?I-"$ (t/?f1 �» � TMW yM D" 1 8•Z9i q:4 1,4b ly . Q2 wrns,n 44? 4920 q • lovkh•3'1 •OS #02OF 44. .'I "Row"m 1011 RATE - TELT ma KTNEEM .1k ftllfohMEo fY: OATS ?I-"$ (t/?f1 e �.:, '� i �', ir.p�zR'Vkd h 7'' ck £ r�, M c-..,,�' �tjyp '+'"r _ ; ✓' Y� ' y - ,, - . � „� �r � � �07�, r ✓ '` h ���r � �a, :. �� +' i, �t�� i ! 3� hat y"� :�'�` '�^ , � � �;i n w g �r �: � 'R^ c r' a° y '�;. ' i �. w•^: sp a h ry i� rK r � �� x r Y+r f aF A t t� 34 ow CLMTM iar Or inn ,t "LtMraA•.....n.... R MIA« M "M MwWO&nn OF I= MOM " INw SMA at --Ad•wAlmd swm N MW "a Mom 1Ni1IM pop"" Clow *I*" som"Im soma"" mo J.�,LN,rr�wt�ar CM►arn r in" "on ,Mr "Mmom " wr OMMOMM •Mw 111 PUN MM RAT Mt um N► 9 ePG£ x'84• • Municipality ®f Anchorage On -Site Water and Wastewater Program (907) 343-7904 s r. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-234-57 1. GENERAL INFORMATION Complete legal description ALPINE WOODS BLOCK 4 LOT 1 Expiration Date: 5-- 10 —18 Location (site address) 5801 ALPINE WOODS DRIVE, ANCHORAGE AK 99516 Current Property owner(s) KEVIN & LAUREL DOW Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 5801 ALPINE WOODS DRIVE ANCHORAGE AK 99516 ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class A Well Public Water System ❑ WaiverNariance request for: Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: Date: COSA to be released to the a er, unless otherwise requested by the engineer. COSA Fee $ 11501-co— Date of Payment Cj ) 16 11(0 Receipt Number QqR—R) COSA# ospi('0 It 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 S(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 5/12/2016 Engineers 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 r OFA occupants or can ArcTerra guarantee that no unseen v L encroachments, deficiencies or discrepancies exist. , /*�4gTIi ��+, 6. DSD SIGNATURE /--' S+¢ KENNETH M. ,GFFV' 104 System #1 Approved for bedrooms. + ".. 7116 X20 tL/t �^'OAw System #2 Approved for bedrooms. Fess,ohh� Disapproved. Conditional approval for bedrooms, with the following stipulations: 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 engineers work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue she "0-10-12.dx 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 WOODS BLOCK 4. LOT 1 Parcel ID: 015.234.57 A. WELL DATA — CLASS A Well type A Date completed Total depth ft. Date of test Static water level Well production If A, B, or C provide PWSID # 213598 Well Log (Y/N) Sanitary seal (Y/N) Y Wires properly protected (Y/N) Cased to _ft. Casing height (above ground) _in. FROM WELL LOG AT INSPECTION WATER SAMPLE RESULTS: ft. ft. g.p.m. g:p.m. Coliform _colonies/100 mL Nitrate _ mg/L Arsenic: _ ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC / STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (YIN) N Date of pumping 5/9116 Pumper A+ C. ABSORPTION FIELD DATA Date installed 8/26/1985 Soil rating (g.p.d.W o ftz/bd 312 Length 42 & 48 ft. Width 4 ft. Collected by: Date installed 8/26/1985 Cleanouts (Y/N) Y High water alarm (Y/N) N System type DEEP TRENCH Gravel below pipe 7 ft. Total depth 12.6 & 10.2 ft.(Measured 5-10-16) Eff. absorption area 1260 feMonitoring tube Y Depression over field N Date of adequacy test 5.10.2016 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 800 gal. New depth 21 in. Elapsed Time: 1320 min. Final fluid depth 0 in. Absorption rate >=.600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off" level at_ in. Cycles tested E. SEPARATION DISTANCES - PUBLIC WATER WELL ON LOT TO: Septic tankilift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas SEPTIC/HOLDING TANK ON LOT TO Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Building foundation 5'+ Property line 5'+ Absorption Feld 5'+ Water main 10'+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 2001+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 101+ Water main 10'+ Water Service line 101+ Surface water. 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 200'+ F. COMMENTS Tested south trench only. North trench had 61" of heavy sludge / fluid. 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 KENNETH.M. DUFFUS Date 5/1212016 COSA canary sheet -2-6-1 5.doc 9 I�NNET. TFV rii �w / i a Fsssio'O' .� Municipality of Anchorage-' �_ - Development Services Department ;. Building Safety Division / On -Site Water 8 Wastewater Program Q/ 4700 South Bragaw St. �� P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.sk.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-234-57 1. GENERAL INFORMATION Complete legal description Location (site address or direct Current Property owner(s) Mailing address Lending agency HAA#___LL5D-5nLt- Expiration Date: g — � CD LARRY do DEBRA WOLFSON Day phone 5801 ALPINE WOODS • ANCHORAGE, AK 99516 Day phone Mailing address 762-3111 BETH WEISER/PRUDENTIAL JACK WHITE Day phone Real Estate Agent 3201 'C' ST. SUITE 200 ' ANCHORAGE, AK 99503 Mailing address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: 3. TYPE OF WATER SUPPLY: 0 0Individual On-site Individual Well Storage Individual Holding tank O Individual Water Class .A" Well 9 Community On-site 0 Community 171 Public Sewer Public Water System of Anchorage Development ices rtment issues certificates of Healln Aumority App oval'(HAA) based only upon the representations onsgi en 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 le-famosal and/or of title (except between DSD also Issu es properties HAAs upon request ed by a to sing eow1iners. sCertificates ite aof Heter alth Authority water supplysystem. Approval are valid for 90 days from the date of Issue for properties served by a private or Class a wit an may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid year for properties served by Class A or B wells or a public water water samples.) Certificates are valid for one responsible for errors or omissions in the professional engineer's system. The Municipality of Anchorage is not 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 for the number of bedrooms and type of structu, functional and adequate re indicated herein. I further verify that based on the Information obtained from the Municipality ofAnchorage (les and from my investigation and inspection, the on-site watersupply and/or wastewater disposal system is(aro) 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 8 Regulations. The reported results described the performance orthe 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, groundwatorlevels 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 evaluatorofthe system. Satisfactofest ry results do not guarantee future performance of the syslem, 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 confor any legal right whatsoever. S. DSD SIGNATURE �L Approved for 4_ bedrooms. Disapproved. Phone 337-6179 Date o� Conditional approval for bedrooms, with the following stipulations: 4 WATER AND •: PROGRAM Attachments: c2. •.,, HAA Checklist _� Maintenance Agreements 0 Septic System Advisory 9 Supplemental Engineer's Report Well Flow Advisory Other By.a Original Certificate Date: 7 •' .Q — t7 (Ft".1201) Municipality of Anchorage • -r Development Services Department Building Safety Division s • • `• On -Site Water 8 Wastewater Program 4700 South Brsgew St. P.O. Box 196M Anchorage, AK 89519.6650 www.ci.anchorege.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST ALPINE WOODS SUBDIVISION LOT 1 BLOCK 4 Parcel ID: 015-234-57 Legal Description: A. WELL COMMUNITY WATER well tYP• If A, B, or C provide PWSID# 213598 Well Log (YIN Date completed Sanitary seal"'fires properly protected (YIN) T...al a Cased tD ft. Casing height (above ground) in. FROM WELL LOG Date of test Static water level R. Well production g'P'm' WATER SAMPLE RESULTS: Coliform colonies1100 ml. S. SEPTICIHOLDING TANK DATA AT INSPECTION Nitrate •'"" Date of sample: Co6ected by: Tank TypelMaterial STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (YIN) YES Depression over tank (YIN) NO Pumper McDONALD'S PUMPING n. g.p.m. .colonies/100 mi. Date installed 8/26/1985 Cleanouts (YIN) YES High water alarm (YIN) N/A Date of pumping66/16�— C. ABSORPTION FIELD DATA Date installed atly,985 Soil rating (g.p•d-/Wo r^ 312 Length42�/ 48 R. Total depth •6 10.1 n. Eff. absor0on area 1�26U R' 12. Width 4 R. Date of adequacy test '6/16/2005 Systemtype DUAL TRENCH Gravel below pipe ---Z--ft- Date 7ft. Monitoring lube YES Results (PasslFad) PASS Fluid depth in absorption field before test 10/4!3 in. Elapsed Time: 135 min. Water added 977 gal. Final fluid depth 20/461n. Depression over field NO For 4 bedrooms New depth39/46in. Absorption rate >= 600+g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN if yes, give date — *TESTED SOUTH TRENCH ONLY D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High Water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent Absorption field on lot Public Sewer /septic service line Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line S'+ Absorption field 50+ Water main 10'+ Water service line 70'+ Surface Water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, rkin Y Pa g/vehide storage 10'+ Curtain drain NONE --KNOWN Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I car* that I have determined through field inspecdons and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed N%� me JEFFREY A. GARNESS Date -7�CZSI - HAA Fee $ Waiver Fee $ _ Date of Payment Date of Payment Receipt Number Receipt Number (.I w r' r r tiet d �. 3snoH .......�1 ONl1SIX3 0 LO 1110 o; L 10-1 T00ln saluToossY v aaapaK BS m IL08 YY3 6C:80 S00 �O O\� IaO 1V,mVNv L 31 1 M �Q7 oN N ,9l'Z4l=� •off w r' r r tiet d �. 3snoH .......�1 ONl1SIX3 0 LO 1110 o; L 10-1 T00ln saluToossY v aaapaK BS m IL08 YY3 6C:80 S00 aBnS Sa00M 3NId-IV `-b >iom e ` l 10-1 —40oonus eu —2434 000A a ro:n :_40 1-1Ine—SV c slwu Jduh 041 1 0o (Vndold s!Y1 10 ,04 H0311V1 :NOLM 4e —194 x --x---..-rW3J WtM, JIAdold 6u4sYVolss »I Jo uopoMsuoo A 44 7hs1 V SnK Jo) pasn p ww,Ll plop Aw p1^o4s s00uolsur . ou uaDuA P IK•WWnQ 'Ndmr ,SZ'G :310N Vid uolslNipQK p.Dloo01 0Y1 w J ddo 109 op Ya!W+ Be .p/S Qd'n/M QNp/4 suolUNlat A 'olwus�oo Ylusuwsos Am ;e suwlOpa = ow *lip o1 A116VIsuodssl uwo 041 $1 11 331ON NOS=X3 ._. CNJ 135 CN30 'NVId 101d V SV 3sn b0! 03ulcori 38 01 ION SI ONVAVbO SIHI -31ON Cti fin drSY,V 1-1-5002 aLIHM )j:)v IVLLN3Oflbd 411^ `J--1NH3V'4 :31NNOS MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. # C�1S - �3'l- S`1 HAA # 1. GENERAL INFORMATION Complete legal description A121 -2a 11,'20ds, kl--d'•-7 4 IC" - Location C - Location (site address or directions) 5801 Alpine woods Dr. off Huffman and Birch Roads Property owner Margo Eldridge Day phone 345-5811 Mailing address 5801' Aloihb hoods Dr. Lending agency Day phone Mailing address Agent Bonnie Mehne� Dayp hone ' 563-5500''- AddressAngie. A7< Unless otherwise requested, HAA will be held for pickup. 2. - NUMBER OF SEDROOMS.:FT - ... _.._,__.... 3.-; -TYPE OF WATER SUPPLY: Individual well .. _.... :, well .....,:. X Public water.. NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Envi. Address 206 E. F Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments Phone (907)272-9336 AK 9950 Date �v —7 CL — bedrooms. Date i -Vo CAUTION :'The Muni-,ipality, 6V'An6horage Department of Health and Human Services (DHHS) issues Health Authority Approval Certifies.6ased only upon the representations given in paragraph 5 above by an independent pr&e 6ional 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 engineers work. 72-025 (Hev.1/91) Back MOA N21 Municipality of Anchorage Aak Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Alpine Woods Bl;: 4 lot 1 Parcel I.D. A. Well Data Well type A If A, B, or C, attach ADEC letter. ADEC water system number 'X Q-5 4 1 - Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell Date completed Driller Cased to FROM WELL LOG SEPARATION DISTANCES FROM WELL TO Septictholding tank on lot Absorption field on lot Public sewer main Sewer service line Casing height Wires properly protected (Y/N) AT INSPECTION e� � x m. g•p#� g'p 'r � q' r C D r mr" Community wellc Cn Ln C71G On adjacent lots Z On adjacent lots WATER SAMPLE RESULTS: Not applicable Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed Nitrate Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria 7/85 Tank size 1250 gal. Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) High water alarm (Y/N) N Alarm tested (Y/N) N/A Date of pumping Seotember 29 1994 Pumper Isaacs Puincj ng Spru",1•p SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: N Well(s) on lot N/A On adjacent lots 200+ ft. Foundation 10 ft To property line 40+ ft- _ Absorption field 11 ft. Water main/service line 11 ft. Surface water/drainage None observed CONTINUED ON BACK PAGE 72-026 (3193)' Front C. LIFT STATION Not applicable Date installed Size in gallons Vent (YIN) High water alarm level "Pump on" level at Meets MOP electric"des (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots anufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Date installed 7/85 Soil rating (GPD/Ft) 312 ft2/bedrocxnSystem type trench Length 90 ft. Width 4. ft- Gravel thickness 72 inches Total depth 148 inches Total absorption area 1260 ft. 2 Cleanout present (Y/N) v Depression over field (Y/N) N Date of adequacy test 6/2/95 Results (pass/fail) Pass for 4 Bedrooms Water level in absorption field before test 5 inches Peroxide treatment (past 12 months) (Y/N) N SEPARATION DISTANCE FROM ABSORPTION FIELD TO: After test 19.5 inches yes, give date Well on lot N/A On adjacent lots 250+ ft. Property line '10 ft _ To building foundation 10 ft. To existing or abandoned system on lot N/A On adjacent lots 84 ft. Cutbank igone o,�_qervec? Water main/service line 25 ft. Surface water None observed Driveway, parking/vehicle storage area 40+ ft Curtain drain None observed E. ENGINEER'S CERTIFICATION 1 cer* that i have checked, verified, or conformed to all MOA and HAA guidelines in effect p/ IF lL(?S.r"��a{t <VS9. Y�fIlY.1c':.:eas Signature Engineer's Name Date 1 �— HAA Fee $ Date of Payment Receipt Number 72-026 (3193)' Back Waiver Fee $ of this inspection. Date of Payment Receipt Number John �ir! ;im,oson j f AAI'M IROWFMAL %[ANAC;NIAT INCORPOR E -D June 6, 1995 Jim Cross Municipality of Anchorage (MOA) Department of Health and Human Services On -Site Services Anchorage, AK 99501 Re: Lot 1, Block 4 Alpine Woods S/D Mr. Cross, Attached please find a copy of the Construction and Operation Certificate issued by the Alaska Department of Environmental Conservation (ADEC) for Public Water System # 213598. A class "A" public water system. This is the water system currently serving the above mentioned property. Also for your reference is a letter dated October 12, 1994 from the ADEC, Anchorage District Office stating the water system is in compliance with the monitoring requirements under State Drinking Water Regulations (18 AAC 80.200) If there are any questions please call me at 272-9336. Respectfully, ENVIRONMEENNT`A�L NAGEMENT, INC. John Simpson, P.E. 206 E. FIREWEED LANE, SUITE 201 • ANCHORAGE, AK 99503-2703 CONSULTING (907) 272-9336 • FAX (907) 272-4159 • TRAINING (907) 272-8852 • FAX (907) 272-0319 rs+ddPP "ii � r �y����� q iq d 4 MI MI~ Of IliliLrl4 �lNf 1011BtiA'M. �1101lt:TtON � . " � �� '� i x , ZIA 0 DI1INlo1/ 4F 0ANIIOI�M'1'At� CEATIfICAT E of MVICflG1t row Mfltt.TH AUT"004" APPMNAL � of oN4nrE BSA AND WATER FAC Lmr `Y afy , .' } �� ,• a . >. Fes;, • iC. ,,�, a �{r - #+; . t.•._�as�taEt�AL Nt��fetw►tltkt „ }., . � � �� � � �' y s s, i#v 1 f Y Location (admmw or dwft-ftm) M ¢ F6 R+� APP m+' trace Joh Mae lN'_�"A�_ Tataphont Homs SUN ON •�:.� "` ' 13!! fast 3Kth� S�ta�14aa, �µ ADO�^t Adm " (c) Applicant is (ct� orwy Lwv* 0 W4#kMm 0 Owrwra,lla�r Is: Buyer O : 011w0 leowtw+): , # �� Alaska Stag Bank .... - � j.sast - - you (d) Landirq .. A ' 31fl Min Hatumm u0m IMlfd Real Eatata C&nP " Wid AqW. FOCIMIN C102CUMrr1 �rr1r �.^«.wfw Fi a•'S .. # +• fir.$,: ' ► y' Addraas ..+._...ate.."." TiNph" "S t ":k + AMM M tIM}IOMOwMq Udall r r x� �-�• $�+rd�s tom, .p n is t �.°4xta�`' k � Y a ,..acF w^>« z - �"�`�-+. 3 �.: i�`bi 1 t io #r a � � r wairlata,r watlO wr fx .. P40W NcommuMty wasp EnrNOINIMI 1 Cl attaa1N�p b dw homy bpd stabA. tE: 4. UWAM DISPOM ' Ons+ta O p11tlNI. O ONOWMINi 0 140M tank O trots: K CMjnW ty W" sy&" muss hm wflllan evowmation"we Bola Dspm~ of &wv0' mw" CofwwvG " a"" tt» "A" 0n0 "ur. pRop 1 nl 2 rt .' r N110�IDM10 III:PEC�IQN� TUU MIJ i2ARCK DATA AIM'S 1QANATt011 . " r IMtc+W~ hy my seal Nri,ad hweto and as of dw validation daft "wri below. I ve t!► WM nay N ora _ , Ai/norlgAppr¢vaI stnowa fled lheomalM waw w*pb►and/or wastawaftr disposal aystam M aaM, hr+ctlanai and aoeq� , aJP* a on -aft wa Mb k:f- .'. ' tortlw rKmew d bedrooms and typed sfatrctwe WdWalad harMn. ! h�M»r rerN!► Mat bare0 ort filte ktkxntatlon - , "1� Alas and frofn my investlptllon 1aQ� 1!M ter ndiron ti �4 4 r ., Dorn Ma #ft#tic+paflfy d Anohorape and $tall Dodos. pdMlMuf�aa` 1rQuiaMona h aANct of!t w ► ' ooMawaer disposal syd" is in wo as Mw4*W Mrd #0 date of Vris Wepacwk �A1t i�NL/�1�VG TMaphone ZTt •.�T 7O ; ` ." . Nrat d Fnn _ 0 • � i � Add,a X101 E Fi+h6'KJI�'s'� Lel c=' i4r�l f"/} . Arc. • �4S'D k �- R" Aver tr� /S 1985' Dasa O.A,— DNEI/ APPROVAL p� Apprwed fiorbedroom$ by o App vmd Disapproved Conditional Terms of Conditional Approval CAUTION S" The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based so" upon the representations given in paragraph S above by an Independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 :;� r w • _ � � ;.,ry. ,��,,.grty,�k''. ,_ .%, ,r««.�r.,,;,�. .!t'i .aiH ...:� .� ...Y., ..,• .>.,.,,r�.r+r��a.a�ic�c:c�rnlr.�rii�w4s��r — # ' • DST. OF KAU" • MtN1W11PALITY OF ANO ICA AOR (May ON1111011*49WAL H+ OTKno" HEALTH AUTHCRM APPROVAL MAAJ •", UG 14 10 CHECKLIST • FEBRUARY 1994 2"4M EallyED ,I#f___.___._ �� A. WELL DATA Well Ctassifrcatron la7M/rfJN f' l ry""If A. B. C. U.EC. Approvrd (Y/N) Well Log Present (Y/N) Dote Completed Yield Total Depth Cased to Depth of Gr3uting Static Water Levet Pump Set At Casing Height Move (around Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot ; On Adfol" Lob To Nearest Edge of Abwrption Field on Lot ; On Adjoining Lob To Nearest Public Sewer Line To Nearest Public Sewn{ Cleanout/Manhole To Nearest Sewer Service Une on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed S Size /ZSV r No. of Compartments Z Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) rNI Date Last Pumped -r K. Pumping/Maintenance Contract on File (Y/N) - ; for Holding Tank High -Water Alarm (Y/N) /J . Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well zoo 'e ' To Building Foundation To Pro ''♦ perty Lire GO f 7o Disposal Field To Water Main/Service Line �.a'0 f ro Stream, Pond, Lake. or Major Drainage Course Comments _ Al ned 5V4rt9A J:V ST /1•9,§tJrt� ,4S7*0�O 01 Page 1 of 2 ...: ....�. ..... ... _.....,....,.,.... �...1:..•�:-,.�...........d_......., .x..,�..,wvier... ::�+,.:.... _�a�wr�ase.`�;wa�. C. ABSORPTION FIELD DATA �Jpt�*Ofype Sods Rating rn Absorptwn StrataFr d syaten+ Design -?" Clf _ ._.. Date installed 7J- Length of Field 701 Width of Field Depth of Field 71 ,''_�f Gravel bed Thickness 7 Square Feet of Absorption Area �V---P Standpipe Present (YIN) . Depression over Field (YIN) q Date Of Last Adequacy Teat 1W SJ- Sr1PV1 Results of Last Adequacy Teal Mad Separation Distance from Absorption Fier To Water -Supply Wetl Z- -ice' To Property Line To Building Foundation To Existirp Abandoned System on Lot -_N A ; On Adjoining Lob To Water Main/Service Line .�_To Cutbank (if present) /v zi— To Stream/Pondilake/or Major Drainage Course To Driveway, Parking Area, or Vrrhkie Storage Area Comments . T_ME� SjST'>)tM WAS 0,44-V XAMi £7si7'L•1/ /A/VAU rO, D. LIFT STATION Date Installed — Dimensions Siza in Gallons _ Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments '• Check Perrnittert Bedroom Rating Against NAA Request '• Pumping Cycles during Adequacy Test. Meets MOA I certify that I iav checked, vcbrified, or conformed to all MO H guidelines in effect on the date of this inspection. Signed Mitt a,d 8 -; CompanyMOA No. Receipt No. Date of Payment • �r"� 1 Amount. $ 06 /jr* +�9 �� �► Engineer's Seal •....«n �•w r� go,Mwhaol EL Page 2 of 2 �� °fir % ;� n.* M �!< �pAUfES3�a TTP STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE A. APPROVAL TO CONSTRUCT for PUBLIC WATER SYSTEMS �r+s Plans for the construction or modification of 11_l,.Efr�� h�N 00 --12--Cf /QSS' � _ public water system totaled In �1 Jt[—� Q Alaska, submitted in accordance w1th 18 AAC 80.100 by_ T g y��_ have been reviewed and an ❑ approved. �i conditionally approved (see attached tonditlonsj. Additional pump testa be �on�ted wella rR3 and !4 to shoe dray dova and recoverp rate. j6A444r, o Tf If construction has not started within two years of the approval date, this certifi,-.ate Is void and new pians and sp-ucifications must be submitted for review and approval before construction. B. APPROVED CHANGE ORDERS Change k *~ ~ M. w I 1 -0l" M««roq C. APPROVAL TO OPERATE Approved by Date The "APPI. OVAL TO OPERA? E" section must be completed and signed by tts Department before any water Is is made ave l lable to the pubik.. Pw S J The construction of tfrq_1UP-t N 0 dam-- T�Q �M public water system was compisiod on ccty 1 6 _ (date). The system Is hereby granted Interim approval to operate for 90 days foltowing the completion date. e• TRLE �ATt As -built plans submitted during the Intowrim approval period, or an inspection by the Department, has confirmed it,e s stem was constructed according to the appro-ed plans. The System is herctly granted Wei approvni to op to. �2__ _�_� on,e