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HomeMy WebLinkAboutALPINE WOODS BLK 4 LT 4Alpine Wood Block 4 Lot 4 #015-234-54 Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSPl11294 01523454000 Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade Permit Effective Dates: October 24, 2011 to October 23, 2012 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: ALPINE WOODS Site Legal Address: ALPINE WOODS BLK 4 LT 4 G:2738 Owner/Address: MOORE JASON D & MAUREEN M 16321 NOBLE POINT DR ANCHORAGE AK 995167566 Site Mailing Address: 6101 ALPINE WOODS DR, Anchorage Lot Size in Sq Ft: 33075 Total Bedrooms: This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify, the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: The Inspection Report will not be approved until the required fill down-gradient of the field is in place. Date: Community Development Department Development Services Division On-Site Water & Wastewater Program MUNICIPALITY OF ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. O[_'~'-' ~.-~/---/- Property owner(s) '~'~_..~,,¢.,o /~.//d2.c--z~..,¢ ,,vf~O~.~. Day phone Mailing address ./(,,'~.1 /Vo,~/.~-- '~,~,,¢7 ~,~U~ ~ .,4,,,~bbC'.,"~- Site address f,,IO I /¢/-./'1.,¢~-- ~,05 Legal description (Sub'd., Block & Lot) ,~Zj~I.4,/~ ~)¢0/25¢ Legal description (Township, Range & Section) Lot Size ;~,~; ¢'/'.¢- Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: ([~ all that apply) Absorption Field Septic Tank Holding Tank Privy Private Well THIS APPLICATION IS AN: Initial [] Upgrade J~ Renewal [] Water Storage [] THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single F.~mily Dwelling and is in accordance with applicable Municipal Codes. · (Signa~td~e O~l~rop~Ct"Co~er or authorized agent) ( Permit/Rush Fees: ~----'-~(--.) '" Waiver Fees: Date of Payment: /O/I ¢/I/~ Date of Payment: Receipt Number: ~ ©/~ ~ (~ Receipt Number: ,-~ ';~ Waiver No. Permit No. ~7~¢ i\\'" ~' G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11 ) Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional En§ineer E-mail: steve@panengak corn October 12, 2011 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Alpine Woods, Block 4, Lot 4 Septic System Permit Upgrade Request Ladies and Gentlemen: I am writing to request a permit to construct an upgraded septic system be issued for this property. The proposed system will serve an existing three-bedroom house. Currently the lot is developed. The lot is served by a class 'A' well (PWSID 213598). The existing drain field is in failure and shall be re-used as a reserve. A new drain field will be installed southeast of the existing field and will be sized to handle a three- bedroom waste stream. The surrounding developed lots are served by the same class 'A' well. There are no wells within 200 feet of the proposed soil absorption system. 1. Soils. One test hole was excavated by Lee Reid in January of 1982. See the soil log attached. Ground water was monitored for seven days. No ground water was monitored after the monitoring period. Bedrock was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 1.2 gallons/day/square feet should be used, using a 1,000 gallon septic tank and deep trench type drain field. A perc test will be performed at the start of construction and current ground water monitoring. e Soil Absorption System Design. a. See Sheet 2 of the design package 3. Surface Water: There is no surface water within 100 feet of the proposed system. 4. Topography: The existing topography ranges from 20 to 45 percent on the downhill side of the drain field based on the survey information in the area of the septic system. This slope will be filled to a maximum of 25 percent to that there are no steep slopes within the vicinity of the proposed drain field at the time of installation. 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification Mailing: P~O~ Box 100217~ Anchorage~ AK 995tG-0217 Physical: 61,5 East 82® Ave Cuite B6, Anchorage, Al{ ee~nc~ Te ephone: (907} 272-8218 FAX: (907} 272,-8211 Page 2 of 2 that the review is complete and that there are no further comments is received from MoA On-Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells within 200 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: Maiting~ P,O~ Box 100227, Anchorages. Al( 995~[0-,~,. zi~" 0 '~ ~ ~/ Physical: 6i,.5 East 82® Ave, Su~e B6, Anchora{¢~ AK 99503 Telephone~ (907} 272-82L8 FAX: (907} 272~8~L CO :L ~ ~ / ...... , ......... ' ................................. ~ ~/~'~'~op~ ~4~ ~. ~&~ ~, 10/28/11 FOR CONSTRUCTIONS P.O. BOX 100217 ANCHORAGE, AK 99510 ~ ~,.,-.' -.-~:-i 1"=50' ALPINE WOODS, BLOCK 4, LOT 4 ~ .... ~ P.LD. NO ~~~ 015-2,4-S4 JASON ~ MAUREEN MOO~E . 6101 ALPINE WOODS DRIVE ¥~:~~9.d~ PERMITosP111294NO. 'i':~"- ."~ PLAN ANCHORAGE, AK 99517 l~o~{s(~ Sheet SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: INSTALL NEW 1250 GALLON SEPTIC TANK AND NEW SOIL ABSORPTION SYSTEM. 4. GROUNDWATER WAS NOT OBSERVED TO A DEPTH OF 15 FEET BELOW EXISTING GRADE DURING EXCAVATION OF THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 15 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. -1.0 OR 4.0 ML ~ ~ /- FILTER FABRIC -4.0 -- ~ , ~-4" 0 PERF PIPE 5.0 ' ~ NO GROUNDWATER OBSERVED GP ~ DRAIN ROCK 6.0  -- 3.0 · 10.0 5.0 -- z -15.0 O~ o o SECTION ~z PROFILE SEE SECTION & PA~METERS DESIGN ~ARAM ETERS PRiMARY/RESERVE SEPTIC SYSTEM A~ B R EVIATI 0 N S NO. BEDROOM: 4 (6OO gpd) TANK SIZE: 12509 CU COPPER SOIL RATING: 188 SF/BR DIP DUCTILE IRON PIPE AR~ RQD: 752 SF TH TEST HOLE SYS. ~PE: DEEP TRENCH 5' E.D. FC FOUNDATION CLEAN OUT ~lN LENOTH: 75.2 LF Tf TANK CLEAN OUT NO. Cf CLEAN OUT NO. LEGEND USE: M~ MONITOR TUBE NO. -- W ~ WATER LINE/ 80 LF X 5' WIDE, 5' E.D., 9' TD R.I. RIGID INSU~TION WELL RADIUS TOTAL AREA: 800 SF DCO DOUBLE CLaN OUT DV DIVERTER VALVE ~ SS ~ NEW SEPTIC FS FLOW SPLICER ~~. D a t e NOTSS: P~O~ ~G ~C, L~ ~.OP. GL-'R,~ '-' ~o/~8/:~ ~o~ OONS~o~oN P.O. BOX 1002:7 ANCHORAm AK 99S~0 ~-' ,ON[ ~:' ~~~ _..~.~~.. ~ ~.,.~. NO ALPINE WOODS, BLOCK 4, LOT 4 ~~d ~~'A6~&'~ 015-2~4-54 dASON ~ MAUREEN MOORE "~i~]- CE 8149 ...~ PER~IT NO. 6101 ALPINE WOODS DRIVE ~ ~.. .~ 0SP~]1294 DESIGN DETAILS ANCHORAGE, AK 99517 '~?d~h~;s;~"~'~a'~i~ Sheet L,, f 4" 0 PERF PIPE SLOPE SECTION TOPSOIL AND VEGETATE --~ F EL TO CREATE 4:1 .............. \ , 4'1 INklL/KA/IUN ~U -- D~IN FIELD. TOP WITH w ..... ~~ 6" TOPSOIL AND VEGETATION. / ~~ ~10.0 5 o REMOVfi ORG~IGS BEFORE P~CING FILL. REUSE ORGANICS OVER NEW FILL. ~~. D a t e CONSTRUCTIoNNOTES: P~O~p.o. ~G ~C, L~ ~,_OF~ ...... A~'~I,'" 1 o/28/11 FOR BOX 100217 ANCHORAGE, AK 99510 ~:' ' ":~ ~ Scale .." ".. P.I.D. NO JASON & MAUREEN MOORE r~ ~t~n ~'Ponno~e~ 6101 ALPINE WOODS DRIVE l, ff~'.. ,-~ 0SPl11294 SECTION ANCHORAGE, AK 99517 ,~ta~X~~ Sheet f /....~_~ MUNICIPALITY OF ANCHORAGE I'i/t,~-'~r~- ~110J ~'~ '~ t/ 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 MAI LING ADDRESS - LEGAL DESCRIPTION ¢ - LOCATION ,~ NO. OF~BEDROO~ DISTANCE TO: Iwelll ~ %>.q~.O,-~ Absor,tion area_ %'~t~"-- ' Dwelling~ . PERMIT NO.~. c, i46 Mater~al No. of c~mpartments ~ ~ iLiq, capacity in gallons Inside length W~--- Liquid d~nth I ~) IF HOME~DE: ~ ~ ~ DISTANCE TO: W~ Dwelling PERMIT NO. ~Z ......~ ~ 0 ~ ( Manufacturer ~ Material Liquid capacity in gallons ~--~ ~ DISTANCE TO: WellingS; ~"'~ ~ ~,. ~ .~ Foundation_~ / Nearest ~.1~ lin% PERMIT NO ~ ~o. oflines ~ ken~thof~a~line Totd len~thofHne, Trench~id,h DistanceBet~eonHnes _ .~' '~&." inches Material beneath ti[ - ~ Total effective absorpt~o~ area Iop of tile to finish ~'adfi Length Wi~' ,~ Depth ~'~)1~ ~ // ~ PERMIT NO.  Typeofcrib '' Uribdiam Cribde Total effective absorption area P~ ~ .~~ ¢ DIS~'~E TO: Well Building foundation Nearest lot line ~ Class Depth Driller Distance to lot line PERMIT NO, ~ BuiJding foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SO~TEST RATING - , INSTALLER~ ~ [~''~~ REMARKS , ',,;, % ~-oolo . ~ ~ ENVIRONMENTAL R )TECTIO,] ~ APPROVED D~¢¢ -- -- LEGAL ~ 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Ala.;ka 99501 264-4720 SOILS LOG - PERCOLATION TEST E~/'s° ILS.,_ '~G//C,; ,/ [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: SLOPE r 10 11. 12 13 /'~AS GROUND WATER ,/ENCOUNTERED? IF YES, AT WHAT DEPTH? DATE PERFORMED: / - .J ~ ~ '~'~'- SITE PLAN 14 15 16 17 18 19 2O Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) COMMENTS TEST RUN BETWEEN /~:,4;' FT AND ~ FT PERFORMED BY: Ci£R"i IFIED BY: 72.008 ,'6'79) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.munl.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL INFORMATION Complete legal description Alpine Woods, BIo(;k 4 Lot 4 Expiration Date: Location (site address) 6zo'~ Alpine Woods Drive, Anchorage, AK qq~;16- Current Property owner(s) David M. & ~o(;elyn Barker Day phone Mailing address 6~ol Alpine Woods Drive, Anchorage, AK Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class _A. Well Public Water System TYPE OF WASTEWATER DISPOSAL: Indi~dual On-site [] Individual Holding Tank Community On-site ~ Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval ere valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastawatar disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy 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. Pannone En§ineering Services, LLC Phone :~72-8228 Address P.O. Box ~o295/,, Anchorage. AK o9~;~o Engineer's Printed Name .Steven R. Pannone, P.E. Date q128loo Engineers Comments: In conducting an adequacy lest, I attcmpt to provide a thorough, consei~tJous engineering analysis of thc system in accordance with MOA DSD Guidelines & Regulations. The reported results dc'scribe thc performance of the system under the conditions encountered at the time of thc test, and separation distances measured to readily idcntifiablc features. Th~ ~perat~~nal ~~fc ~f a~~ w~~~s and septic systems dcp~nd ~n thc ~~ca~ s~il c~nditi~n~ ground wat~~ levels thai .may fluctuate during the year, and thc water usage of thc family bring served by thc system. These cond,dons are outside the control of the evaluator of thls sTstem. AIl systems event~ally i'ail and satisfactory test results do not guarantee future performance of the s,/stcm, nor do they euarantee that ~,~./ there are no h~ddcn defects or encroachments. PES can therefore not provide any warrant, for futun: ~rformanc¢ nor g~v¢ any estimate of how long the system wdl continue to meet thc opcmtiona requirements of the MOA DSD. The content of thls report is for the sole benefit of the owner listed ---'"~-~_~ ~ ;e n ~--~"3. ~,',~- shove, re.=ee . on ofth s any othe , on .ot.thoriz d w confer any legal r/~t whatsoever, e~.~,.~...... ~ Approved for , ~ bedrooms. Disapproved. Conditional approval for bedrooms, with lhe following sfipulaiions: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.munl.org/onsite (9O7) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Alplne Woods Bk ~ Lot;~, Parcel ID: A. WELL DATA Well type ~_ Date completed If A, B, or C provide PWSID # 2t'~n~8 Well Log (Y/N) Sanitary seal (Y/N) Wires propedy protected (Y/N) Total depth ft. Cased to __ FROM WELL LOG Casing height (above ground) AT INSPECTION in. Date of test Static water level ft. ft. Well production g.p.m. WATER SAMPLE RESULTS: i · Coliform coloniesll00 mL Nitrate : mg/L Arsenic: ug/I Date of sample: B. SEPTIC/HOLDING TANK DATA Other bacteria Collected by: g.p.m. coloniesll00 mL Tank Type/Material, Anchorage Tank ~;teel. Tank size aooo. gal. Foundation cleanout (Y/N)Y* Date of pumping C. ABSORPTION FIELD DATA Date installed 81~?1~8,- Number of Compartments ;~ Depression over tank (Y/N) N Pumper A'* H(~me Ser~i<;es Date Installed 8h?h. q8~ cleanouts (Y/N) Y High water alarm (Y/N) NIA Soil rating (g.p.d./ft~ or fttrodrm) ~.',,~ .. System type DeepTrench Length 3'{ Total depth ~.~.,3 ft. ft. Width '~ Eft. absorption area &6~ ft2 ft. Gravel below pipe Monitoring tube __. Depression over field N Date of adequacy test nl:zxJ:~ooq Results (Pass/Fail) ..pass** For 3 bedrooms Fluid depth in absorption field before test 95 in. Water added57<l gal. New depthq8 in. Elapsed Time: a.A~ min. Final fluid depth 95 In. Absorption rate >= &,.;o+ 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 E. SEPARATION DISTANCES Size in gallons 'Pump off" level at in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line Animal containment areas Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? Water main 5~* Wells on adjacent lots On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~.o. Property line _~.o+ Water service line SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~o+ · Building foundation Surface water Wells on adjacent lots, 500 Absorption field Surface water. Water main 2~;+ Driveway, parking/vehicle storage ~o~. Water Service line ~o. Curtain drain ,,, None Known F. COMMENTS In. Waiver Fee $ Date of Payment Receipt Number COSAFee $ ~ ~-~ Date of Payment (~ /~.~'~/~'~ ~ Receipt Number Ob (Rev. 11~5) *FCO in Crawlspace, **Althouoh it oassed the adecuacv test & Inscection. this septic field aooears to be *1- q~% use,'l a ccordin(] to condil;ion5 encountered q12.,. & q124;Ioq. Remaining lif~, ts undetermined' -~a~ ' G. ENGINEER'S CERTIFICATION I cedi~ that I have dete~ined though field Insect/one and review of Municipal taco.s that the above systems am In ='""~'~~'~'"~ .. ................ confo~ance with MOA COSA guidelines In effect on this date. Engineers Printed Name Steven R, Pannone. P.E, Date ql~81~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Septic System Advisory Certificate &On-Site Systems Approval # 090346 During a recent adequacy test on the septic system for Block 4, Lot 4 of Alpine Woods subdivision, 95 inches of standing water was observed in the absorption field. This indicates that approximately 97% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval ' '' 'Z~ '~ ~:/"' ' "'"~' '" ...... ~ .... ' ........ i~oo~d~t& Z;c , 57_~- ... "3 ......: ...... :-"ii . ...... .~ .-,.~ ;....' .: ~,~"- .~. ' : l: Y~':?,? ?~'L,~'~ '* / - I . . . : ...... I. : .. '..:,.~,~ I '~~~: ~ :'- :1:: :~='4~5'. ',L=' ,, :~1 .. : ~ I '. · '- : . . .~'..~'.2 ~ . ~2 ~ ......... ;. . ~/: · · : ~ ~l~x~ .... I he~ e~y .~t I have ~om~ n ~lor~g~e's .~- ~ .... --~ ~F' '~ -~ .... ~ ...... ' ' ~ · · A'/ ' ' '~.~ ' ~'~;~ ' ~*[~'~, '" I: ~ ~ * ~, ~ ~,-~.,,,.~.,~.~ ~ ~ ~ ~chora~e Reeo~tng P~c~ ~k~ end that '~e lmp~e- ~/~ ' ....: ~ ~/. :~ f/ ~*.. ~ meats ~tua~d thereon n~e ~2t~ ~e p~per~ Unes and do /~/ ~ . . d ~ ~'.~ , . Z ( P~/~ notover~por, en~cho~the~e~y~mgndj~cent~- ~/~ ...... : ..... ~ ~. %- - ~*/-: ~'a~ *- ~.~.~ enoch mn *~e preml~e~. In ~uestlon and ~at ~ are no / ~ ...... ~ '%~ ~.. · .~,,'$r ~ . ~id pr~y ex~ as Indi~ her~n. ' ~ j~. ~ . ~ t~ -,. . - ,~ Datedat~chorage ~2s~a. P~T ARE NOT $~ .HEREON,i ~'~'- ~ * .~ : . ,[ - ~,- ; ................. ~ ~ineom mad ~eyors 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 4; Block 4; Alpine Woods Subdivision; Location (site address or directions) 6101 Alpine Woods Drive Property owner Mailing address 741i Brown Day phone FozriCge Way Anchorage, Acao~a 99515 Lending agency Mailing address Day phone Agent Barry Cassaday JACK WHITE COMPANY Day phone Address 3201 C Stre~_L #I00 Anchoraqe, Alaska 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: 563-5500 Individual well XX Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. XX TYPE OF WASTEWATER DISPOSAL: Individual on-site 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. 72025 (Rev ]/91) Front f¥~OA ~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 ray 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 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 Address 1:/034 £agle River Loop Road N~ ~ Eagle River, Alaska ~.~.-_//~ Engineer's signature DHHS SIGNATURE ../~. Approved for Phone bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: , Date 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 n0t_, responsible for errors or omissions in the professional engineer's work. 72 02.5 {F~e,/. 1'91) 8ack MOA #2! Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:Z~'TL~ ~ L:Z,/~,-'_K' ~ t ~1~i~. L~ 9,-~'~'~. Parcel I.D. - - ' ) ~'- ' I ' ' I A. WELL DATA Well type ~_,~/,~orat If A. B, or C. attach ADEC letter. Log present (Y/N) Total depth Sanitary seal (Y/N) Date completed Cased to _,~! ~ Casing height Wires properly protected (Y/N) ADEC water system number Driller Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION MUNICIPALITY .OF ANCHOI~OE ENVIRONMENTAL SERVICES DIVISION ~CT ~ 1 1991 g.p.m. RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 2_.00 Absorption field on lot Public sewer main Sewer service line ( WATER SAMPLE RESULTS: Coliform ~ / Date of sample: Nitrate ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout .~)/.~ Petroleum tank .~J~ ~_ ~ Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~ / I ~ / ~4, Tank size l ~O~ ?~ /~- Compartments ~ . ~ Depression (Y/N) Cleanouts (Y/N) L~ Foundation cleanout (Y/N) '~ A) / / High water alarm (Y/N) k~/~ Alarm tested (Y/N) ~/ Date of pumping / 0 - ~ - ~- I Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot A~] I? On adjacent lots '~. C)C) ~- Foundation ~ ~' To property line d -'~ Absorption field .~ ~ Water main/service line 2~_-~ ff- / ioo Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installe'~ Manufacturer Size in gallons '~, Manhole/Access (Y/N) (Y/N) ~ ~"Pump on" level at "Pump off" level at Vent High water alarm level '~ Cycles tested Meets MOA electrical codes (Y/N~.-- SEPARATION DISTANCE FROM LIFT~TATION TO: Well on lot On a%cent lots Surface water D. ABSORPTION FIELD DATA Date installed ~ - / ~ - ~_2 z_/ Soil rating / Z ~ 4~//~ System type Longth ~ - Width ~ G ~ Gravolthicknoss~. ~ Total absorption area ~ ~ & 2 ~ -- Cleanouts present (Y/N) Depression over field (Y/N) /~ Date of adequacy test Results (pass/fail) iP ~ ~ -~> - for Peroxide treatment (past 12 months) (Y/N) /,0 / ~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: bedrooms / Well on lot /~L// F3r- TO building foundation On adjacent lots ~ tO Surface water /J/~ Curtain drain k..) ! If yes, give date AJ //~ ! On adjacent lots 2c¢ '(- Property line ! ~ ~ To existing or abandoned system on lot "7c Cutbank ~)/~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERING Signature ~/u;~4 E. agie ~iYer L~p Engineer's NameEagle River, Alaska ~577 Date 1~,~- t ~ - ~1 HAA Fee $ ./~'-~) Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 DEPT. OF ENVIRONMENTAL CONSERVATION WALTER J. HICKEL, GOVERNOR ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 563-6775 October 8, 1991 FOR: Rodney S & S Engineeriang PWSID 213598 My review of the records on file in this office reveals that the Alpine Woods Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria samples requirements listed in Table C, and with the inorganic sampling listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineer ~JNICIPALITY OF 3~NCHORAGE DIVISION OF ENVIRONMENTAL HEAL%~. DEPARTMENT OF HEA~LTH AND ENVIROh?IENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdi~.ision, s~ction~ township, range) Location (address or directions) (b) Appli ame,, ' ....... , , Telephone - ttome Business cants N ~ ~ ~ , .. , ,~ ~,, ~ . Applicants Address (c) Applicant is (check one) Lending Institution ~ ; Owner/builder Buyer ~ ; Other .~. (explain); (d) Lending institution Telei~hone .............. Address (e) Real Estate Co. & Agent .... I ---- '~ r ~ Address Telephone (f) Mail the HAA to the following address: 2. TTpe of Residence Single-Family ~ Number of Bedrooms Other (describe) 3. Water Supply Individual Well.~. Community ~ Public ~---~ Note: If commanity well system, must have written coafirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewa~_~ Disposal Onsite ~.~ Public ~--~ Community i ' '] 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 2i 5. Engineering Firm Providin~ Inspections, Tests, File Search, Data and Information e As certified by my seal affixed hereto and as of the validation date showm be!ow, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, function,~l and adequate for the aumber 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. Name of Firm (ENGINEER SEAL) DEEP Approval Approved for ~,Z~z/~,) bedrooms Approved /~ Disapproved Conditional Terms of Cenditional Approval CAUT ION THE FCJNICIPALITY OF ANCHORAGE DEPAR'i~E.NT OF HEALTH /,aMD ENVIRONFLENTAL PROT'{CTi'3N (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESEN~f- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTER£i) IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COL'P, TESY TO PURC!btSERS OF HOMES THEIR. LENDING INSTITUTIONS IN ORDER TO SATISFY CF, RTA!N FEDERAL >~;D STAYE REQUIRE- MENTS. F~MPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR >:NALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF .~;CHC)RAGE IS MOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL ) RR4/ej/D18 [Page 2 of 2] 7-1 9-:::4 A® Well Classification f_~ %.,%,~x.~,~ .¥7- Well Log P~esent (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances ~c~ Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line C leancut/Manhole Water Sample Collected By Water Sample Test Results MUNICIPALITY OF ANCHOY-~ DEPT. OF HEALTH & '~ ENVIRONMENTAL PROTECTION OCT RECEIVED MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: Iof A, B, c~ C, D.E.C. Approved(Y/N) h;'L~'~ Date Cc~pleted 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 To Nearest Se~er Service Line on Lot ; Date Be S , IC/HO I G raTA Date Installed ~ ~ i~--C''r~> C~q~- NO. ~ C~~nts ~ Stan~i~s (Y~) ~ z ~ ~ Aid-tight Caps (Y~) 'l ~ Foundation Cleanout (Y~) ~'C~ ~' ~pression o~ Ta~ (Y~)~ ~te ~st P~d ~ P~ing~intenan~ ~n~a~ ~ File (Y~)~/~ ; fo~ Holding Ta~ High-Wate~ Ala~ (Y~) ~/~ ~ra~y Holdi~ Tank ~t (Y~) ~/i~ ~p~ation Distan~s ~ ~ptic~olding Tank: To Water-Supply ~11 ~.~ ~-~ To '~ilding F~ndation ~ TO P~operty Line ~,-> To Water Main/Service Line course ~O/~ Coranents~- C ~ ~ ~. ¢.~' ~ % To Disposal Field -~.~ ' To Stream, Pond, Lake, c~ Major Drainage [Page i of 2] 2-15-84 C. ABSORPTION FIELD E~TA Soils Rating in Absorption Strata }~-~--A //~%'- Type of System Design Date Installed ~/I 7/~i~ Length of Field Width of Fiel~ {~ ~" ,'-'~.~ ~'~ '~D~__ ~ of Field ~'_._ S~e Feet ~f ~s~ption ~ession o~ Field (Y~) ~ ~te of ~st A~a~ Test Results of ~st ~a~ ~st ~.~ ~p~ation Distan~ f~ ~sorption Field: To ~te~-Supply ~11 ~..,,w~ .~, To ~o~rty Li~ ~ / To Building Foun~tion ~ I ~ To Existing or ~ndo~d Sys~m Lot ~/~ ; ~ ~joining ~ts i~C, ~ To Wate~ Main/~vi~ Line ~f- I TO ~t~(if pre~nt) To St~e~ond~ke/~ ~jo~ ~aina~ ~ ~ /~ To ~i~way, Pa~ki~ ~ea, ~ Vehicle St~a~ ~ea ~ / Cc~rents D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at ,/'~ Tested for / Electrical Codes (Y~/N) ~/~ Dimensions ___---~-- ~E~e/~ss (Y/N) //~Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Conmlents , ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect on the date of thi~inspection. Signed '~.~.~ Date i Cc~lpany MOA No. KB1/d5/s [Page 2 of 2] 2-15-84 STATE Of ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE for PUBLIC WATER SYSTEMS APPROVAL TO CONSTRUCT Plans for the construction or modification of RL NE  [ I public water system located Alaska, submitted in accordance with 18 AAC 80.100 ?'~'_~' have been reviewed and are [] approved. conditionally approved (see attached conditions). Additional pump tests be ~on~be~ted o~ wells #3 and #4 to show draw down and recovery rate. TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. B. APPROVED CHANGE ORDERS Change (contract order no, or descriptive reference) Approved by Date C. APPROVAL TO OPERATE The"APPROVALis made availableTO OPERATE" section must be completed and signed by the Department before any ,~a~~to the public. The construction of the ~'~L P_T/1)~- ~ CO J~ ~ ~ ~ .T ~J~ ~')~ ~ public water system was completed on ,K'C-~ ~t4a rw I , I~ [~" ~' (date). The system is hereby granted interim approval to operate for 90 days following the completion date. BY TITLE DATE As-built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the ~stem was constructed according to the approved plans. The system is hereby granted final approval to .... TITLE DATE t8-0407 (Rev. 11/83) DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Cornplete Section C) 3. PINK - ENGINEER/MUNI-SOROUGH (Complete Section C) 4. GOLDENROD - MUNI-BOROUGH (Complete Section A)