The URL can be used to link to this page

Home My WebLink AboutALPINE WOODS BLK 2 LT 3Onsite File Alpine Woods Block 2 Lot 3 #015-234-10 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201142 PID Number: 015-234-10 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JIM & ANNETTE COLEMAN ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 6251 DOWNEY FINCH DRIVE, ANCHORAGE ❑ Other Phone 7�_M� f Bedrooms Soil Rating Total depth from original gradePhone 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot ALPINE WOODS 2 3 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 Ft' Ft. Well 200'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ -- Material Number of compartments Lot Line 10'+ -- NA HDPE 2 Foundation 10'+ -- LIFT STATION Manufacturer Capacity Remarks Waiver 3' field to tank. Gal. Alarm location Electrical installed by Installer A+ SERVICES PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection V1 10/28/20 2nd 10/29/20 Location and description 3`d 41 GARAGE SLAB ON-SITE WATER AND WASTEWATER SECTION APPROVAL'Now e CAF A Conditional Approval: Date i ASK TM .....�:*.err ••, •••• ••••�•% Septic System A r ved - pp Date � l Z �� Curtis Huffman �Fc • CE 128991 �� i��F�• ..t 1/23/20 Q-• ,.w AW 11)kFlopROFESION�' Note: this pproval does not include well permit requirements. /Dr nG/nOM ON eiS,�\11�' PID: 015-234-10 PERMIT: OSP201142 Lvl 14j§ 0 o lf� Q0 O z �7 OFCK .0� 4e� QST/�c�S \ /0�/SF �o' 28.9' 0 0. (O 20 0' ^� S' S CONC WALK LOT 3 BLK 2 FP CANT / CONC 2.0, WALK \ WATER LINE FP CAN STAKED AT p /CONST. 10'+ MAINTAINED 26 C TO NEW S.T. C D � KEYBOX CgNr3' MH CO E PAVED D/W COCK W, \L/(O6si 80 6' PR O , ST BEY F �N A—C=15.9' B—C=20.4' A—D=19.4' B—D=23.8' A—E=21.6' B—E=26.6' CO INSTALLED NEW / 1250 -GAL HDPE GREER TANK/ !- \ C� / \� o< CTIVE / \ Li COVER SCALE: 1' = 30 SEPTIC SECTION SCALE; NTS ALPINE WOODS BLOCK 2, LOT 3 5UF'F'UNI,StKVIULt): ' Idw00 OF \\\ PREPARED FOR: F C. s �� 1 JIM 8c ANNETTE COLEMAN LIVING TRUST /� '' 1 6251 DOWNEY FINCH DRIVE * 9 TH ANCHORAGE, AK 99516 FIRST WATER CONSULTING DATE: 11/23/2020 /, rtis Huffman / 13030 SUES WAY DRAWN: FWCS SURVEY: JLS020 1 f� CE 128991 �� A 1 11 /23/2021 � ANCHORAGE, AK 99516 SCALE: 1" = 30' ��ssto��'v � 907-350-9566 firstwaterAK@gmail.com FMA_ ANCHORAGE RECORDING DISTRICT, ALASKA. AS -BUILT OF: ALPINE WOODS SUBDIVISION LOT 3 BLOCK 2 PLAT 83-21 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DAM SCALE: E-MAIL: NOV 9, 2020 1 "=40' 20-083 DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAGE: JLS SW2738 200237 !"ANN,OF ® ANW `S •....,•�,� 49TH .� • ♦ . • • • s s • ♦ • . • . . s • . . . . • . . . ® % FA CD ••aJQHN L. SCHULLER.• o s� LS -10408 21 • t 1 • 1O \.ate aegis , fession&�.�a"W 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227--1455 office (907) 274--49+92 fax Municipality of Anchorage s 1I �_ 1)r.prcrment P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 a Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV201084 COSA#:OSC201639 Permit#:OSP201142 PID#: 015-234-10 Legal Description: Alpine Woods Blk 2 Lt 3 Engineer: First Water Consultinq Your request for a waiver of the required 5 feet horizontal separation from the septic tank to the absorption field has been approved. The approved separation distance is 3.0 feet. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: Z ZU Approved by: LZ_9 y �o Name of Revie er **** VARIAN C E/WAIVER REVIEW **** 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com November 23, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: ALPINE WOODS BLOCK 2, LOT 3 – FIELD TO TANK WAIVER Per visual observations at tank installation, it appeared that 5’ was maintained between the tank and existing field. However at final inspection and as-built survey, it appears the tank is approximately 4’ to the existing field. The field was never exposed or compromised at tank installation and the field integrity remains intact with no adverse effects. We therefore respectfully request a field to tank waiver of 3’ be granted at this time. Due to site constraints (field, foundation, waterline…), the existing tank was removed, properly decommissioned and the new tank installed in the same location. Backfilled material was per code, compacted and the previous tank to field had no known issues for 37 years. Granting of this waiver is justified with no known or future issues anticipated. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. 6/4/2020 MUNICIPALITY OF ANCHORAGE ii Development Services Department ` Phone: 907-343-7904 On -Site Water & Wastewater Section- """� Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-234-10 Property owner(s) JIM & ANNETTE COLEMAN LIVING TRUST Day phone 9073519441 Mailing address 10380 NIGH ROAD, ANCHORAGE, AK 99515 Site address 6251 DOWNEY FINCH DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) )WINE Wooer S g LK 2_LT S Legal description (Township, Range & Section) Lot Size 46,769 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 Septic Tank El Upgrade Q (w/wo AD U) Holding Tank ElRenewal ❑ Duplex (D) El ❑ Multiple Dwellings ElPrivy (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. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: /aQ Iaoad Date of Payment: Receipt Number: Qogalq Receipt Number: Permit No. n5 pQ6 i , wa Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc COVID-19 2570' DISCOUNT APPLIED 13030 Sues Way, Anchorage, AK 99516 907-350 -9566 / firstwaterAK@gmail.com May 26, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: ALPINE WOODS BLOCK 2, LOT 3 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1250-gallon HDPE tank to serve the existing 4-bedroom residence. The lot and area are served by public water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201142, Rebecca Carroll, 06/04/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201142, Rebecca Carroll, 06/04/20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ?ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME IPHONE _.J ~' NEW MAILING APDRESS LEGAL DESCRIPTION LOCATION ' F, . ' ,~ NO. OF BEDROOMS ~ Manufacturer ]~e,S/' Material ~._~ ~ ~. Liq. qa~{city in gal toqs Inside length Width Liquid depth / Z~' ,7 ~ if HOMEMADE: -- ~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ -- ¢ Manufacturer Material Liquid capacity in gallons ~ Well / Foundation ~ Nearest line ~ DISTANCE TO: %-~7 ¢' ~/.,~* ~'*, P/~C-~ lot , PERMITNO. ~ No. oflin.s ~ ken~thofoachline~- ¢ Totall.n.tk~f'lines(~,~, ,* Trench~idth_ ,~¢~, inches Dista.cebe~eenlines ;~ Top of tHe to finish graOe ~. 5C¢' Material beneathtile ,, TotaleffecCLvea~or~tio~area Length Width Bepth PERMIT NO. ~ ~ T~pe of crib 6rib diameter Crib depth Total effective absorption area ~ ~11 Building foundation Nearest lot e DISTANOE TO: ~ Class Depth Briller Bistance to lot line PER~IT NO, ~ ~uilding foundation Sewer lina Septic tank Absorption area(s} ~ BISTANCE TO: OTHER SOIL TEST RATING -- INSTALLER / i) r APPROVED DATE LEGAL 72-013 (Rev. 3/78) i;.,EF:'F: :;;'"i"i'iE.: ',i'T .... ~::' ... ::. :::_ .._ ... ::: ?',f "* F."i;,/.i: iq: Z f..ii' El'- 'T'S ._ F'i;.:OTEE. T' I I-d",i " ;i~!;,[~:~:.'7' ' L' ::::, ~f~:!:::.~.:. i., r!r.4L:rli..u-::t-iL~i::.., i:::li'::: :::.:.:,,.+-,~. ,' ,::.c., . ':",',,..~-¢...h,:.!--~ut:: ......... + ........... i. · E:~GLE F.-: :[ ',,,:EF.: ,.7:), ..r.'"-',,ii ......... ::!i:'!!;; ;:ii:: 'T E']!'; ::Ei;; iEE ii.,,.~i EE: ii:;;;': ii=:" EE: ti:';,7": il "! ][: 'T' F' F.E F;.': i' I )J T i'40. ;¢;;; .7. :.L,;':; ;?. ?. i::tF:'i::'L.. :i: L."} .................. F:q'.jT ' i'.i. ',i .i: '-":i:::' i i"4C. F' .-ii- NE' : :-.:. .......... -:..:.-.':,:=: r' ,-' A [., [., i:;? i..-:/'-.Z :F; · 7' ,:-i. ,:/~ :;7!, .:-'7 ...'::..: .~! T-"i !:::! i",! E. H 0 F:'F':! (3 E., F. i'C 9'.'Y 5 ~;5,4- i....,'T. GF!i .'T.., E; ::T, CF;:~:F:'T'T. Zi',. --'-:~i;i...iE;DZY:]::L::;.i:Ed'-,i' F~.LF'.T.i'-,iE i.,-i.'OAD'_-7BLACk:' 2 LAT' ...... ' .... ; '7 "'7 ;: 7 .7 T. - ......... "" ..... i'""' ~ - -' · · _ _ _ · i.. AT' :5~,:::..,':.::. ,:~'. :.:'-,~-"~-q ":,..! !-"! ¢..,¢4 ,..:,t-,it- -' F.:FINEJE - ':;FF:TTLqt'.,I - i"IR::.::iH h'l i'-if ',llZF'r:;;' Ar.':' ~:::,~..'::-r'-,,-.."; .'--' . ................ - .... ':'~ '.:S~;! t'-i ,.":E',F.:':' ................................ · ........... , :: ..... : ,4- '::;A :i: L.. i-;'F~ T' T big ::::; 'i .%:::'~ ;-.',.'"' ......... ' .... . . i._.]::E;TEE.' E',iZi....Qi4 ?iiT:.('~. THE: QF:'T]:Cfi",i:iE; FF'/F!Z,_t'-~t_Iz.-F' ..... ['0 '.¢r'_'ii_.i :I:t'.,t [.,E:.StGNtNG 'T'L-..IUF.: SEF:'TTC :.::.:?'r::::.qTE:;l'i. C "4 () Q ::'-:, E "."hiE; E ?::'".- '_r lC;; ~',i "i"h'.l'":Fl" 8Ei;:'T,T F:: :[ T::S ¥ _-ii j[;;: :5 :[ TF_. !4 ]: E'TH :::= ,~:. 5 F:'T. LEN6. TH = '4-3. G F:T. TQTfq. L. [::,i~;;i::'-i-i-4 .... :L:i.. G i..':iF:l::l:,,,'EL. F..u...'ZF'TH :::: 7. 0 F:'T. GF.:R:,/EL. VQi....Li!'tE :-' ,.:.'::E.,. ;~ ('}U. TFki'.Ji-::: :~'~.T. ~.E: := :i , .7'.=, 3. (~, GFd ..... Z ."!'_::_': ,.; Ti.,.iO E. Oi'It::'FIF.:THEI",i'i .... i'Fii",!i'::: .,!::::; ii::::::_ !1 ...... E. '-' ~?..-'. ;?_-:,"; .ii';: tL..-~!.~ ~'..,,~ i,.I Z E., T H = :.i..E;. 0Fr'T. L. Ei"4GTH = Z.Z:. ~..3F'T. TQTF!L. C'EF'TH = ..7.. ;?F'T. ~ i",iOTE ~ - 'F.:Ec.-':!LI:[F;:ES :[N:SLti_FITZOf',i Gi:';'F ',,' :t r~ r. ,"m - ................. :::.F ,r"! = ~'~ .... r-, F'T. ' ,N'Tr'E,.., _ ~ ..... HFI'T' R:EL-::!LtlF.:E L.TFT STFITZLqI',I C'iF~:Ft',,,'Ei .... 'VQL. U.PitE = 5.:E',._..c" .-: .... .... T E z,.'" TF:IN!':: '.'T, T Z[~ = J..., ;~:SG. O GFII_LI~ !',I::'"; C 'l-l.,-IQ ('; ".: i".F'F:tF.:TI".ENT TFtNK; .~..,,..i .7: ~:, ££: E::.." F: ?-'::~! .;~.F ~"'-,,~ ~ Z r.T. iE: ii__ E:, E'_':, ~.T..'..-'.-~: :'£ ,.5-~ Ih,4i i.,.i ]: D'TH = 5. 0 F: i...Ei'.,iGTH = 60. ~--_~ FT. TQTF!i .... DEF'?H = _7:. 0 FT. ! NOTE ~ ..... F;:EQLI;[F::ES ];I'-,tLZ, L.tLFtTIEd'.,I "~ -' I-, ',"F 1 :-,,:: I Gt:;:W,,,'EL [.i::.,-", .", :;L. ~-:"~ ,..,z.-,- .... · .. ~. I'aZFt"E: ~ - !"iFY'r' F,'I::'E,t 1:[ RE L ]: FT ~.~;TFiT T ON GF.:F¢,,/EL UQLL.I!'IE := ±6. 6; CU. TF!!",!k: L:.;TZE = :J..., :::?F':.3 ~:'"~ GF¢.! E?'JS ,::TWA COHF'FIF;':THEI"4T T'f:INK', T. E:.F.F.:T 7: F"." THFiT ' :L. .T. F~i'i FF~.i'i;[i....:.(F:~F.:: H.TTH T'HE F;:E:~7:.i..i:iTF~:E!'i~::i'-,i-t"5 FQi:::: Oi"4-:.:.'iiTE :SEi.,.iEF.:S Ffl'-,tF:, WELLS RS SET FQF. t'FH Eh, 'T'I-4F:' ......... HL.n'-,i.'[F _,~'F'FILZ"!."T: QF Fd'.4CHOF.'Fn3F ........... R.h![::, THE STF!TE OF ;.-T..:. .T. i.,.!T.i....i... :i: i'-,i :..:; T Fi i_.. L THE :.SYSTEI,i !:1'.,i FtE. COF~:[:.,F~i'-,iE:E W.T. TH THE COC, ES Ffl'.lE:, HFt',,,'E F.E_.Ei ,El: iR COF'Y' OF THE C.C'i":,E 'SiJi,ii,'!FiRY F~i-.¢:[::, C, ZP,:.'~F.:F~i". FFi"TF-~E. HHENTS WHIF:H ]::.5 F'FIF.:T QF THZE, PE F,::i,i .T.T. .7:'.. _T. Lii'.4i)E:F::STF!i,,ii.3, TFiFiT THE Oi'.,i-:.:.;]:TE 5Ei.,.iEF.: :E;'T'5'TEf-,i i'iFt'T' F.:EL:::UTF.:E ENLFtF.:GEHEI",IT iF THE F:ES.T.[::'ENCE Z5 F:Ei'iOC'EL. ED TQ :[.t',!CLLE'E i'IOF.:E TFiFihl 4 E',E£:'F.:OEd"I'_:;. F'EF.:I'! Z "i" FiF'F'L..i: L-..f'-1i",!T t'"itq.:~!; THE RE:SF'Ot"4S :[ E; I L..t: TY TO ]: I",!FL-~F.:i'i F'ERSEff',ii"IEEL £:'UF.: ]: NG 'THE Z H!"-:,TFd....td'":IT .'r :: !'-,! .T N:.T:;F'E:CT T. ON':5 OF F:¢',!'T' ,i.'].Et._I_S FiDJFtCEi',tT TO TH ]: '-=, F'F.%~F'EF.:T"? FIND THE !",!LiHE;EF.: QF F::E'.E;;[I::'E'-.NCES THR. T THE W.ELL .b.t:i:Ll .... SEF-:'v'E. ZF F'~ I....]:FT S!"FiT~qI"~ ]7:'3 ]:N:.:.3TFiL..L..ED., i'3H EL..ECTF:ZCF~L F'EF.:i'IlT FiND ]:t",iSPEZ:TTFd"4 I"iL.tST E~E E~E~-FF~T_i",iED. F!:.':-:,-Ed...iZLT:E; CF'd",ii",iOT E;E: FiF'F'F;:Q","ED i.dZT'HELT Fd",l Eh_ECTF.':ZCFiL TNL:;F'EC-r'iFd'-4 F,."EF:'QF::T. THE Ei....ECTF.: ~ CF-IL. WOFH-::: HL 'E T .ELE DOI'.,!E E?T' .8 L ]: CEi'.4:SED ELEC.:TF.:.T C T FIN. i-,.i, i.,.~ ;[ 5E .. Z hiC %,.,.' [:,Fi T E ' i :.L ,.'" 2 L:h--" FhT. TOThL C~EPFH = LL. O'er. i-~[OFH = ~. ~ Fi~ FOR i'H ~ fI-t~ 1,11~ [ 0 [ PF~L l FY OF ~N~;~t~;~O~ ~ tHE S F~ F( OF ~L~KR. .............. ' /k ~.~ . · 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: ~,l[ '~,¢,~'~o,-, DATE PERFORMED: LEGAL DESCRIPTION: 423!iiI----Z-- 5 6 7 8 9 10 .11 12 13 14 15 · 16 - 17- 18- 19- 20 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? ~ o L~ O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop COMMENTS RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT ~o '~' ~,'-~.~ '~":..,0~ ~' ~'1~. :°;~ '~ ....... ;' ~-'~-' ~' r 2' -'-'~ PERFORMED BY: 72-008 (6/79) MUNICIPAUTY OF ANCHORAGE ff f -.:V Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 015-234-10 1. GENERAL INFORMATION Expiration Date: l0%1 &0Z k Complete legal description ALPINE WOODS BLOCK 2, LOT 3 Location (site address) 6251 DOWNEY FINCH DRIVE, ANCHORAGE, AK 99516 Current property owner(s) JIM & ANNETTE COLEMAN LIVING TRUST Day phone Mailing address Real estate agent 10380 NIGH ROAD, ANCHORAGE, AK 99515 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the.engineer. Date: COSA Fee $ L 1 S0 co 1/10 Waiver Fee $ / G. .5 CD U) r Date of Payment U Date of Payment 1 2y 20 0 Receipt Number. Receipt Number + y Z S Z COSA# OeG20163� Waiver# 0_!�:,V2010139 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 11/17/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to `�1�� these various and dynamic characteristics and are outside the control of the evaluator of the ,q/ t y well and septic system. Therefore, any estimate of how long a system will function satisfactory r�g�Q: • . • for current or future occupants or guarantee that no unseen encroachments, deficiencies or J . discrepancies exist can be given by First Water Consulting & FWES *' 9 TH •'* rr / ... .. ......... / .... .......~..- 6. DSD SIGNATURECurtis Huffman r/ System #1 Approved for ` bedrooms r�+t�Fc�s� . •CE 128991.11/171202 it F�PROFESSIO�P'~" System #2 Approved for bedrooms \\. Disapproved Conditional approval for bedrooms, with the following stipulations: OF `e ��. PR o� 9��p�?EiNT By: Gf% Original Certificate Date: / The Municipality of Anch age 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 Legal Description: ALPINE WOODS BLOCK 2, LOT 3 Parcel ID: 015-234-10 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA – CLASS A WATER SYSTEM Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft (INTO BEDROCK) 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) NEW 0 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW Standpipes/foundation cleanout per record drawing Date of pumping NA - NEW C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 12/5/1983 ALL standpipes present per record drawing Total measured depth from grade 6.8 ft (max) Measured depth to pipe invert from grade 4.4 ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective *2.4’ INTO THE 7’ ED 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 5/12/2020 Results Pass For 4 bedrooms Fluid depth prior to test 3 in Water added 900 gal New depth 11 in Elapsed time 1310 min Final fluid depth 1 in Absorption rate 600 gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies:. *PER INVERT / BOTTOM OF MT VISUAL MEASUREMENTS AT TIME OF TEST. 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 *3’+ 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 F. ENGINEER’S COMMENTS The absorption field is under the driveway and as noted in previous MOA record docs there appears to be adequate cover for frost protection and no known issues. *WAIVER. 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. 11/23/2020 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 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) /-3 B2 ,'q/. P/ /,,l e" Location (address or directions) 62._~1 ~owl,{~ y ~'~c/-/ (b) Property owner Mailing Address (c) Lending Institution Mailing Address CoLE PlAN Telephone · (home)3q~5'-,-~5-~ Business (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here rR, if hold for pick up.) List contact person and day phone number below: .. TYPE OF RESIDENCE Single-Family'/~ Number of bedrooms /"/ WATER SUPPLY Individual Well [] Community'l~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 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 legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. 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. Name of Firm F'L/~TTOP TE¢I-t. ~[/~ ~ Telephone .~ c(5'- 135'5' Address I ~ ~.~O ECl-lo ST, .70r~qC~, Date 6. DHHS APPROVAL Approved for ~ Approved ~ 'Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of H~alth and Human Services (DHHS) issues Health Authority Approval cerificated based only upon 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. 72-025 (Rev. 7/88) Back Page 2 of 2 WEE~IDAT*~c,~ '~' . C~'~ We, Log Pre /NI MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: L:~ ,, ~ 2 ,z:}LPINE ~w'oOb% Date Completed If A, B, C, D.E.C. Approved (Y/N) Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ;Date Water Sample Test Results Comments ~EC. /~ tc:P ~'OvA/.. ~_ EI~T I F ~CATE AT-{AC/-t~-b SEPTIC/HOLDING TANK DATA Date Installed 12/~/o°2 Size Standpipes (Y/N) ¥~-~ Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~. A, )2~o G No. of Compartments Air-tight Caps (Y/N) ~E-$ Foundation Cleanout (Y/N) ~' Date Last Pumped I~f~/~O ;for l'J ./~. Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field 7.~ * Feo¢l C.O. Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field /.So Type of System Design Length of Field Depth of Field 're¢~c d Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test ~o Gravel Bed Thickness 7 Statndpipes Present (Y/N) Date of Last Adequacy Test FoR SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~/~o ~ To Building Foundation 15.5' Lot ~, A, To Water Main/Service Line '31 ~ F~oh To Property Line To Existing or Abandoned System on ; On Adjoining Lots '~$~' ~'~yS'o~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area D. LIFT STATION 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 HAA ~e~ in effect on the date of this inspection. Signed ~ ~ ~ Company Fla~ ~ ~.~ ~-"' ~:~ ~;'~i ~ .............. . ....... :.T.~ Engineers Seal Date ~c~ /~/ I~0 ~a~..~.~' MOA NO. ~ - ~ I~ '~ ~TH~ODOrZE F. MOORE / ~ '. CE- 3539 ..' Receipt No. Date of Payment /0 ~// ~ ~ / Waiver Fee: $ Amount: $ / ~ ~ ~ Date of Payment 72-023 (R.v. 7/38) B~c~ Page 2 of 2 STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 October 3, 1990 563-6775 FOR: Annette Coleman PWSID: ~21359~ According to the records on file in this office, the Alpine Woods Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, EVnEv~r oE~mCen~Ia~ Special i st VEC:pf MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWERAND WATER FACILITY 264-4744 Application Date 9/16' ~'~' '7 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) (b) Location (address or directions) Property Owner Mailin9 Address (c) Lending Institution Mailing Address Telephone: Home ~ ~,.,z-- &"~ 5-.~' /=,;,¢4 .~ lr~c~r~ Cq,~-/ ~" Business (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here [], if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family [~ Number of Bedrooms q WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] 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. Page 1 of 2 72-025 (Rev 8/86~ Fronl .5. 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. Name of Firm J~'[~/--/-~o 7'~c~_c~[ _C~'~'~¢~- Telephone Address I ~ ~ ~) ~c~or~q~ . ~ Date ~ //~/~ 7 Engineer's Seal DHHS APPROVAL Approved for ~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional Date CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon 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. Page 2 of 2 72-025 IRev 8/861 Back MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 /, o '/' Legal Description: WELL DATA Well Classification '~/" Well Log Present (Y/N) Total Depth 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 If A, B, C, D.E.C. Approved (Y/N) Date completed Yield Cased to 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 Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ! ~-/~-/ Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~ ~oo ' To Property Line Size 19-5z~"~1 No. of Compartments Air-tight Caps (Y/N) )" Foundation Cleanout (Y/N) Date Last Pumped /I,/¢ · 'for N,,~. N,/1-, Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ir- To Water Main/Service Line Course To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026 fRev 8/86~ Front MUNICIPALITY OF AN(3-1OIb~31~ DEPT. OF HEALTH & ENV!RON.MEHT.% PROT. -r'CT. !C'?! SEP 1 6 1987 RECEIVED C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ! ~/,5- / Width of Field ~'6/' 15'0 Square Feet of Absorption Area ~'/ Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot /~, To Water Main/Service Line 'f8,~,¢~-~ Type of System Design Length of Field .,C'~' / Depth of Field I '~ / Gravel Bed Thickness '7 l Standpipes Present (Y/N) Date of Last Adequacy Test To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line ~--~- To Existing or Abandoned System on ; On Adjoining Lots ~ ~o, ~¢,x~o~ To Cutbank (if present) N,~, D. LIFT STATION N./~. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~_~'-~ ~. ~ Date Company t~l~z~f 7~c~n,~l~ MOA No. Receipt No. ~'~--') Date of Payment Amount:, Page 2 of 2 72-026 IRev 8/86~ Back Engineer's Seal DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE / 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: To Whom It May Concern: According to records on 9ile in this og~ice, the ..... 8L~ .... _WOOO~ .......... Water System is in compliance uith the State Orinking Water Regulations. Sincerely, Michael P. Leuis Environmental Engineer MUNICIPALITY Of: ANO'IOR,,A~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION SEP ~. 6 1987 RECEIVED MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 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 lot, block, subdivision, section, township, range) Lot 3 Block 2 Alpine Woods Subdivision (T12N R3W Section 23) Location (address or directions) Downy Finch Drive (b) Applicant Name Winter Wise Inc. Telephone: Home 33 3-58 77 Business Applicant Address 7400 East 20th Avenue, Anchorage 99504 333-5877 (c) Applicant is (check one): Lending Institution [] · Owner/builder ~ Buyer [] · Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: Call: De Winter Const, 333-5877 TYPE OF RESIDENCE Single-Family Jik Multi-Family [] Other Number of Bedrooms three (3) WATER SUPPLY Individual Well [] Community~k Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4, SEWAGE DISPOSAL Onsite [~]x 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 (11/84) Page I 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 flies 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 Telephone Address Date Engineer's Seal Re-issued at request of requirement. Residence Original approval dated applicant due to lending institution first occupied during March, 1985. October 29, 198~. Approved for ,th_tee (3~bedrooms by w Approved xx× ' Disapproved Conditional Terms of Conditional Approval Date April 12, 1985 CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 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. Page 2 of 2 72-025 (11/84} MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HZALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information ~Application Date~_~/~~_~ (a) Legal Description (include lot, block, subdivision, sgction, township, ~ange) Location (address or directions) (b) Applicants Name~L)z~z~g f~),~-~ .~j ¢ Telephone - Home~B~ ~t-O1Business Applicant's.,~ . ..'~d~,~' .. ,~,~0° ~ ~O~ ~(~o~,q~. , ~/~ ~ ~/ (c) Applfcant''i'~ ~ch;~l~) Lending Institution ~ ; ~er/builder ~ BuY~r:~ ~.'~0~~( expla in); . ~ ...,~...,,~-- '~ (d) Leading' ~nstitut,~m ,Jf3~ Telephone (e) Real Estate'Co~ & ~ent Address Telephone (f) Mail the HAA to the following address: ~ 3 3 -L,-F-2 .x'7 2. Type of Residence Single-Family~ Number of Bedrooms 3. Water Supply Individual Well[---'-I ~ult i-Family ~--~ Community~ Other (describe) Public~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite ~ 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. Page 1 of 2] 5. En~ineerin~ Firm Providin~ Inspections~ Tests~ File Search; Data and Information e 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 regula- tions in effect on the date of this inspection. Approved for ~ bedrooms' B Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 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 R~QUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/DI8 [Page 2 of 2] 7-19-84 aJ j"~ P T r) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification ~/~ rz- f3 Well Log P~esent (Y/N) Total Depth /L//~ Cased to Static Water ievel Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances f~cm Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot Nearest Public Sewer Line To . ~-- Date Campleted ~/~ Pump Set At Cleancut/Manhole ~(~///+ To Nearest Sewer Service Line on Lot Water Sample Collected BY ,c~/~ ; Date Water Sample Test Results ~; '. . ,-,~ ..... ."'~ ; On Adjoining Lots ~//~ ~ ZOo~ ; On Adjoining Lots To Nearest Public Sewer B. SEPTIC/HOLDING TANK E~kTA Standpipes ~N) Air-tight Caps ~.,~1) Foundation Cleanout~N) Depression over Tank (Y__~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N)/~./O~ ; for Holding Tank High-Water Alarm (Y/N) ~j/Fg Temporary Holding Tank Permit (Y/N) Separation Distances frcm Septic/Holding Tank: - To Water-Supply Well ~ ~CPd> ' To Building Foundation '-~,5 / To Property Line ~' To Disposal Field To Wate~ Main/Service Line ~)~' 'r°~~To Stream, Pond, Lake, or Major Drainage course [Page 1 of 2] 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCENT~AL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: AccQrding to records on file in this ~_~//~S ~'/~// Water System is Water Regulations. in compliance ~ith the State Drinking Sincerely,