HomeMy WebLinkAboutALPINE WOODS BLK 4 LT 5Alpine Woods
Block 4
Lot 5
#015-234-53
�No""A"'Y\ MUNICIPALITY OF ANCHORAGE S.
• On-Site Water&Wastewater Program
PO Box 196650 4700 Elmore Road
'
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax: 907 343-7997
http:llwww muni.orglonsite `'�
Department
R''CNOR..E
On-Site Wastewater Disposal System Permit
Permit Number: OSP191429 Effective Date: 9/27/2019
Work Type: SepticTank Upgrade Expiration Date: 9/26/2020
Tax Code Number: 01523453000
Site Legal Address: ALPINE WOODS BLK 4 LT 5 G:2738
Site Mailing Address: 6151 ALPINE WOODS DR, Anchorage
Owner: LORENZ MARK & KELLY Lot Size in Sq Ft: 40975
Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field El Septic Tank 0 Holding Tank ❑ Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: , Date: , a
Issued By: � i,C4 rAliutire, Date: - 7 1 ?
MUNICIPALITY OF ANCHORAGE
i
Community Development Department Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On-Site Water & Wastewater Program
Mayor Dan Sullivan
On-Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 015-234-53
Property owner(s) MARK LORENZ Day phone 907-360-8980
Mailing address 6151 ALPINE WOODS DRIVE `ANCHORAGE,AK 99516
Site address 6151 ALPINE WOODS DRIVE*ANCHORAGE.AK 99516
Legal description (Sub'd, Block & Lot) ALPINE WOODS: BLOCK 4, LOT 5
Legal description (Township, Section & Range)
Lot Size Sq.Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING:
(®all that apply) Initial ❑ Single Family (SF)
Absorption Field ❑ ® (w/wo ADU)
Septic Tank ® Upgrade Duplex (D)
Renewal ❑
Holding Tank ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well I
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR:
N/A Distance: -
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: �aS Waiver Fees:
Date of Payment: a2 -- L1" Date of Payment:
Receipt Number: c031 aa Receipt Number:
Permit No. OS ` (O Waiver No.
(Rev.01/11)
t __ 11x11 ICS
GARNESS ENGINEERING GROUP, Ltd Dealer
ENGINEERING SALES CONSULTING
September 18th, 2019
Municipality of Anchorage
Development Service Department
On-Site Water& Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed Septic Tank Upgrade for Alpine Woods; Block 4, Lot 5
To whom it may concern:
The subject lot is served by public water (community well) and a private septic system. The
existing septic tank was installed pre-1988. Per the request of the owner we are proposing to
decommission the existing septic tank per UPC and install a new 1250-gallon Greer Tank HDPE
septic tank. See attached design drawings for tank location and other MOA requirements.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance. /
-rely,
Jeffre £ . ar -ss, P.; ., M.S.
Presit/-
3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259
Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com
1.
GEG,Ltd.HAS AN 8 PAGE SPECIFICATION LETTER
THAT PERTAINS TO THIS DESIGN.BY PROCEEDING ALL ADJACENT LOTS SERVED BY
FORWARD WITH THIS INSTALLATION,THE PUBLIC WELL AND PRIVATE SEPTIC
ENGINEER,WELL DRILLER,CONTRACTOR AND
PROPERTY OWNER AGREE THAT THEY HAVE
READ THESE SPECIFICATIONS AND AGREE TO
ACCEPT THE TERMS AND CONDITIONS OUTLINED.
w1
EY FINGH DRIVE
DW N PROPOSED 1250 GALLON GREER TANK RATED FOR 10'
O BURIAL;INSTALL DOUBLE CLEANOUT BEFORE AND AFTER
TANK;MAINTAIN 10'SEPARATION FROM BUILDING `
FOUNDATION AND 5 FEET FROM DECK PILES
APPROXIMATE LOCATION OF EXISTING SEPTIC
TANK TO BE DECOMMISSIONED PER UPC
APPROXIMATE LOCATION OF EXISTING
NOT SURVEYED ON ATTACHED SEWER LINE PER MOA RECORDS
SURVEY;APPROXIMATE LOCATION
PER SURVEY IN MOA RECORDS 44.
\
\\ EXISTING 4
\ BEDROOM HOUSE
'P
9 \
1, \\ •..•.\
•-••4•••••..';.*:.,. .1 .•.,•;../&-•
o�02) \\ y • DRIVEWAY •'4•`
\\\ + ` , , • •,..;\\ ASSUMED WATER LINE
,�\ .. = L. r' .�� AND KEYBOX E ATTACHED
•ALPINE WOODS;BLOCK \\ •• ';�.�,, . �.,•�
4,LOT 6 .0. ••+ \ [[
tiF \\
\
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ALPINE WOODS;BLOCK 9 \\ '4 ;.•;• • J•
4,LOT4 y0 \ �..•�:
S ALE: \\ •IP elii \
1"=40' Pte/
GARNESS ENGINEERING GROUP, Lt ; 4
ENGINEERING a SALES.CONSULTING • •
•
3701 E.TUDOR ROAD,SUITE 101'ANCHORAGE,AK 99507•PHONE(907)337.6179•FAX(907)3383246•WEBSITE:www.gemessengineel1ng.com �••�••• •• •• ••••••• ••••
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0'�? J y A. m S
MARK LORENZ 907-630-8980 1 OF 1 v.G� CE-7953 :'• �
PROJECT/LEGAL DESCRIPTION: DRAWN BY: e` ••
ALPINE WOODS; BLOCK 4, LOT 5 D.J.G. ., p'•/ .•l•,J.�•�•,•••••••('`''�•.�.�, .•
•TYPE OF WORK: DATE: LICENSE,,h 1 tLJ'J •
DESIGN OF SEPTIC TANK UPGRADE 9/18/2019 #AECC884
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DOWNEY FINCH DRIVE a
(SEE SHEET 3 OF 13) ;n
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m SEPTIC
m STANDPIPES
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CANT. N 19.0' . 12.0'
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C12 m �� LOT 5 rn o
m 40,975 sq. ft. M cvo
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AS-BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 5,BLOCK 4,ALPINE WOODS SUBDIVISION
EASEMENTS OF RECORD,OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT(83-210)ARE NOT SHOWN HEREON. ANCHORAGE RECORDING DISTRICT,ALASKA AND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY WITHIN THE PROPERTY LINES AND NO VISIBLE
AND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT ENCROACHMENTS EXIST EXCEPT AS INDICATED.
BOUNDARY SURVEY MAY DISCLOSE.
DATED THIS 5th DAY OF AUGUST,2019,AT ANCHORAGE,
UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON ALASKA.
BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS,OR
FOR ESTABLISHING PROPERTY BOUNDARIES. FIXED HEIGHT, LLC
NO CORNERS SET THIS DATE SCALE 1"=40' Land Surveying Services 907.290.8949
WWW.FIXEDHEIGHT.COM
JOB 0 19141
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
A NCS __,,4Il K ___ TO SEPTIC ABSORPTION
FROM TANK FIELD WELL
Address per,
Phone(s) Permit No. No. of Bedrooms WELL
Z G l .> 1 CC LOT LINE r
LEGAL DESCRIPTION
Lot Block Subdrvlsion
F— .r 1 4 A --Ill cAD_ps FOUNDATION
(Township, Range. Section
AS -BUILT DIAGRAM (Show location of well septic system, property Ines, teundal
driveway, water bodies, etc.)
TAM 11 1 1
SEPTIC
`�`�'� ] HOLDING
Manu ac[urer
capacity in gallons
Material
No of compartments
C-_
Z_
TYPE OF SYSTEM
1 TRENCH C'
BED W. DRAIN ❑ OTHER
Dep[h to pipe bottom front
Total depth from original grace
origin.! grade i
FT
t
__A
- ----
Fill added above original grade
Gravel uepth beneath pipe
ter`
j I
FT
Gravel length
Gravel width
total absorption.rea
'�D,stance between lines
Z j C
Number of lir rs of ruing
SQ FT
-----i Pipe ma:ena!
2!L SQ FT&-7:s,l 1>3cc7
-
instaler
A-
0L � Date Installed
--�
FT
FT
FT
FT
WELLS
❑ PRIVATE,, r, ( r� OTHER (Identify)
classification r,r?�� Iota DepIF Cased to
r% rtJ\
FT FT
Inst 3I r ,„r"( Date It raleu.
I REMARKS:
0
Municipal and and Slate guidelines in eflect on this date: Z 0
Health Department Approval:
2-013 (185)
O ?`v
L � • i r+ SS t
icl vL l —
Scale:
Inspections Performed by.
Date
certify that this inspection was performed according to all
188
DateZ-2e —de
(EN-GINEER:I
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICE
-065G
825 "L" Street, Anchorage, Alaska 99502 4
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: AC CCA61�- J S -!L /LIS .-1 %IC _ DATE= PERFORMED: {rd
P/ 1U� Township, Range, Section:
LEGAL DESCRIPTIONAL
SLOPE SITE PLAN
12,,,,,=1
4
M L.
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Sm
/tai G,ecv J i � >
W4 Tom_
�I
G `
WAS GROUND WATER y ,
ENCOUNTERED
L
IF YES, AT WHAT OI I --
DEPTH' E
Oeplh to Water Atter
Monitoring? — Oate: _
Reading
Date Gross
Time
Net Depth to Net
Time Water Drop
I 1
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
u� j TEST RUN BETWEEN FT AND FT ` //
COMMENTS UefI�ICc 4n a) O C�! I , i n.x �Ot *S'± f'ct te'-Z -5 7b) —' �t -Ik +t"u cot 1-5,
�A� � Wd
>�r+-�C erA -� �.�� ���,I f�� a s /6 r t ac->ti4 /Iti c�,-a s /S_ ,ti1�„, b:- P,�,• (s s�,`�f � •�
p/ace {-a. ,�JZi loe//
PERFORMED BY: — I GN' L/ZCERTIFY THAT THIS TESTWASPERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. -71Z P/8"
72-008(Rev.4/85)
MUNICIPALITY OF ANCHORAGE
Department o{ Health & Human Services
825 L Street, Anchorage, Alaska 99501 343-472O
ON-SITE SEWER PERMIT
Permit Number: 880083
Date Issued: 06/13/88 Engineer Designed
Owner Name: ALLIANCE BANK Day Phone:
Owner Address: P.O. BOX 99003 522-1311
ANCHORAGE, AK 99509-9003
Parcel Id: 015-234-53
Lot Legal: Subdivision: ALPINE WOODS SUBD. Lot: 5 Block: 4
Section: 23 Township: 12N Range: 3W
Lot Size .94A (sq.{t. or acres}
Max Bedrooms: This Permit: 4 Total Capacity: 4
SEPTIi total septic tank capacity: 1,250 gallons. Each septic
tank must have at least 2 compartments. Depth to top of septic tank(s>
{eet requires insulation over tank(s).
INFURM D.H.H.S. PRIORTO 1ST & 2ND INSPECTIONS BY ENGINEER, IF
AFTER OFF[CE HOURS CALL 343-4681 AND LEAVE A MESSAGE
CONSTRUCT PER ENGINEERS A[[ACHED APPROVED PLANS
THIS PERMIT EXPIRES 12/31/88
THIS PERMIT VALID FOR A S1NGLE FAMILY RESIDENCE ONLY
I CERTIFy TH�T:
1. I am /amiljar withthe requirements <or on-site sewers and wells as set
Zorth bv the Municipality o[ Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria o{ this permit.
adhere to all MOA and State o{ Alaska requirements for the set back
distances from any existing well, wastewater dzsposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum o[ 4 bedrooms. I
also understand that the capacity of the total system is 4 bedrooms and
any enlargement will require an addition, ---t1 permit.
Signed: Dcewl
ATE:
-------------G��-�-~-----�� --- --r--�r--------
1ssued By: /� -^�' DATE: y~ 3
MUNICfQp,I.ITY OF ANCHO" 'E N
DEPT. OF HEALTH &
EWIROSMENTAL PROTECTION
jkp 101988 - i
REUN ED
lA���� �: Njq.r+• , I : n'o � �
C.
�N
TNpT tR To h ;'
�T Tt:p
10 BOG t?,ft. A o i dt FOR
i, Q
�VAILI, j,t G1i
REggVE.
C(�'nn .., to n t'�r 'NQ`� P C� � ✓
SEWER SYSTEM LOCATION PLAN
a �VA�no Lot 5 Block: �-
�a dBSGC�QteB,inc• s,4 }. a e7ias ° Prepared for:
r �;�ConsaltMq Engin��n ^
�Ano�oroW►'A{aska
Date: � u � � f cC
CORWIN & ASSOCIATES, INC.
1000 E. Dimond Blvd. Suite 205
ANCHORAGE, ALASKA 99515
(907) 522-1311
JOB I i ' - J
SHEET NO
CALCULATED BY
CHECKED BY
SCALE
OF— r
DATE
DATE
PRODUCT2041 Inc., Groton, Mass. 01471.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES'
825 "L" Street, Anchorage, Alaska 99502-0650io
SOILS LOG —PERCOLATION TEST io
°:S Y:jLso • °°.earn ``
B ce . Corwin
/No. CE -5283
PERFORMED FOR:_A r r ;-� r' J'C r ?,1`. - �e ORN�_R •'I � �
C�
4 %,PR0FESS1
_ Township, Range, Section:
LEGAL DESCRIPTION: AL- �'' .4.(L (,tJc�c '� - .�1 � P, g
p SLOPE SITE PLAN A:"Pc .r, ll��
` NIL I T i \.
1
2
3
i
4
5
6 4jI
I�
7
8
9 Al
10
11
12 •I�
13
i
14
15
16 END
17
18
19
20
COMMENTS
SM
5,14 _...
ML
r M
m
WAS GROUND WATER A
ENCOUNTERED? Mr)
S
L G
O
P
E
3
IF YES, AT WHAT
DEPTH?
Depth to Water Ani
Monitoring? _J�_� Dale:
c
Reading
Date Gross
Time
Net Depth to
Time Water
Net
Drop
�I
N
I
Reading
Date Gross
Time
Net Depth to
Time Water
Net
Drop
PERCOLATION RAIEZ�•
_s�— (minutes/inch) PERC HOLE DIAMETER
1 1
TEST RUN BETWEEN FT AND FT
PERFORMED BY: `L't L r-`��` 1 — CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE*IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
w
January 10, 1986
TO: Permit Applicant
P,v. 3("'-/\ 66350
ANC"0RAGE. ALAS 99 ._ -
DEPARTMENT OF HEALTH & HUMAN SERVICES
Subject: Permit # 850527
Lot 5 Block 4 Alpine Woods Subdivision
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be obtained from this Department for any
well and/or on-site sewer system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to this
Department for documentation of the installation and to close the permit.
If a private engineer inspected the installation of the on-site sewer system
the original as -built inspection report(three part form) must be sent to
this office for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
(S -W�
Susan E. Oswalt
Program Manager
On-site Services
SEO/ljw
enc: Copy of Permit
1-11KTIAU11 ' A' C~h_ -1-0, 41) F=7 q0; INJ CIT 01C.J lot ank 13 FE!
DEPAT-EM! O� '1[�LTH AND ENVIRUNMENTAL PROTECTION
ET, ANCHORAGE, AK 99501
264-4720
t:101_0l-1 !n: 51 AYE L4 Ey! F? 00 411 1 1 j� -2
PERMIT NO: 850527
DATE ISSUED: 08/21/85
APPLICANT: J&D CONSTRUCTING
ADDRES3: % GEOLAB 1131 E. 76TH AVE.
ANCHORAGE, AK 99578
CONTACT PHONE: 344-8042
LEGAL DESCRIP: SUBDIVISION: ALPINE WOODS
LOT: 5 BLOCK: 4
RANGE: 3W
in designing your septic
site.
-.... -.... ..... -..... --..... ..... ....
-----
VJ .. 1-D, F Z 4:4 1:��
4.0 4.0
0.5' 3.5
4.5 7.5
30.0 5.0
57.0 151.0 **
63.4 111.9
1,250.0 ** 1,250.0 *x-
284
*284 349
** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
**
TANK MUST HAVE AT LEAST TWO COMPARTMENTS
----------------------------------------
I certify that:
1' I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2' I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
�. ] wzll adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on Lhis or any adjacent or nearby lot.
4' I understand that this permit is valid for a maximum of 4 bedrooms and
any enlargement will require an ~additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERID BY MOA BUILDING CODES,
lHFN (1, AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUlLTS
WILL NO[ BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WURK MUST BE DONE BY A LICENSED ELECTRICIAN.
SlGNED
!�SULD �i TE:
�
SECTION: 23
TOWNSHIP:
12N
LOT SIZE:
20000 (SQ.FT.
OR ACRES)
MAX BEDROOMS:
4
Listed
below are
the options
available to
you
system.
Choose
the option that best {its
your
DEPTH
TO PIPE
BOTTOM (FT.)
4.0
GRAVEL
DEPTH (FT.)
6.0
TOTAL
DEPTH (FT.)
10.0
GRAVEL
WIDTH (FT.)
2.5
GRAVEL
LENGTH
(FT.:
117.0 **
GRAVEL
VOLUME
(CU.YDS.)
70.5
TANK SIZE
(GALS)
1,250.0 **
SOIL RATING
(SQ.FT./BR)
349
LOT: 5 BLOCK: 4
RANGE: 3W
in designing your septic
site.
-.... -.... ..... -..... --..... ..... ....
-----
VJ .. 1-D, F Z 4:4 1:��
4.0 4.0
0.5' 3.5
4.5 7.5
30.0 5.0
57.0 151.0 **
63.4 111.9
1,250.0 ** 1,250.0 *x-
284
*284 349
** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
**
TANK MUST HAVE AT LEAST TWO COMPARTMENTS
----------------------------------------
I certify that:
1' I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2' I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
�. ] wzll adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on Lhis or any adjacent or nearby lot.
4' I understand that this permit is valid for a maximum of 4 bedrooms and
any enlargement will require an ~additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERID BY MOA BUILDING CODES,
lHFN (1, AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUlLTS
WILL NO[ BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WURK MUST BE DONE BY A LICENSED ELECTRICIAN.
SlGNED
!�SULD �i TE:
�
tno
1-1()L, . I T" 6111A;
ANOHOHA(,L, Ai
`)07j 26.," "1 1 1
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Permit #: 840952
January 31, 1985
TO: Permit Applicant
SUBJECT: Lot 5 Block 4 Alpine Woods Subdivision
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1984.
Permits are issued on a calendar year basis by authority
of ^?unicipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent
to this Department for documentation of the installation
and to close the lDermit.
if a private engineer inspected the installation of the
on-site sewer system, the original as -built inspection report
and the yellow copy must be sent to this office for review
and approval, and for documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Keith E. Bandt, Supe visor
Environmental Engineering Program
KEB/ljw
enc: Copy of Permit
SWP/0 5 7
�PPLIC�!!T: J & D COj5TPUCTIO+!
ADCPE50 7125 OLB SEWARE KWY
nK[HOpoGE, A[ 9ona'....
n3NTACT PHOKE: TAG -6561
** GRA\'EL LENGTH > 75 FT. REQUIRES MULZIPLE ROME (NOT EXCEE0ING 75 7T. E77|{�
** TANK MUST HAVE AT LEAST TWO COMP�RrMEKTS
--- --------- --- ---- -- --`- - ---
I cerLi['' t�at�
'
1. I with ths requiramenLs 707 07-01L2 sswars 170 wol]L 22 sc�'
Forth Ky t'le Municipality of pnchcrage /MGA) a:d �hc 3tate uV Ala:.ia
2, I All, ins�all t�e s�stem i: a-cur��ncc w!^^ a`` MO� odes a��
- , � - - �
a:i ir oyliacce -ith Lm dasi�" .rKeria of thiH perxit.
3. I w111 adhcre to all MOA snd SL.ts fcr the sct
disOroo any uxistinq vell, wactewate, dinposal sjstom o- x�1i
sewerage s\sLex' on this ar h�y aQacent or :earby loY.
e. I ttat this �ermiL is ;alnv yor s mazimum of 4 Ladrcc'Tn
any erlargemenk will raquire aq aidiLional rerT?t.
S
& u.'GINEERS, INC. SOIL LOG
_SOIL LOG
V/PERCOLATION
TEST
7125 OLD SEWARD HIGHWAY PERCOLATION T EST 4—BEDROOMS
ANCHORAGE, ALASKA 99502
(907) 3496561
4
PERFORMED FOR: __ ?--_-l5��1��---- ---- DATE PERFORMED: __-_ l_NO �I _` 4'
LEGAL DESGRIPTION:_LPT_ �---�Lv-Cit---�----� -
SLOPE SITE PLAN S 'M.
0--1 r0 sru t�++rH oRcnu+cS OL.
6 J i rj! py' , 5yi c) ML -- - --
34 4�
,s- 3.5 Sff,"� -1 RIE C'I:NC"7i 1
-- - -
/' 3,5 - 14, 0' <� ISI ,, rr4 -
5 �I
V 5,0r �:Ye)b ;i
f�`.G TD
L
I
8
9
10
11
12
13
W
WAS GROUND WATERS
L
ENCOUNTERED? ____
O
P
E
IF YES, AT WHAT „�---
DEPTH?
1' J
''" (rn:nute5 inch)
Reading
Date
Gross
Time
Net Depth to Ne
Time Water Dro
' .FLET)
c
St {Oe
FT
TEST RUN BET':JEEN
3'23
5/b'' st
•S 'k'.� f''r
Ti
tls �1t !1 f�,. itt-��1"-� =?-i
0'r
_ '> CLQ!
1
L�+F D ,V.ED BY M 1�� ? '"1:) i P,
1,\j sf��
_ _ -
_. DATE:
_Il6'-
1' J
''" (rn:nute5 inch)
DEPTH
PERCOLATION RATE
' .FLET)
c
St {Oe
FT
TEST RUN BET':JEEN
-/ _ FT AND
7
•S 'k'.� f''r
Ti
tls �1t !1 f�,. itt-��1"-� =?-i
0'r
_ '> CLQ!
1
L�+F D ,V.ED BY M 1�� ? '"1:) i P,
CERT,FIED BY:.-.
_ _ -
_. DATE:
Municipality of Anchorage =. °
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I. D. 015-234-53
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
Expiration Date: V_ —'z O —LIE
CYNTHIA SHELBY Day phone
6151 DOWNEY FINCH DRIVE *ANCHORAGE, AK 99516
360-771-5298
BRETT HULL W/ REMAX—DYNAMIC Day phone 351-8047
N Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
E
Individual Water Storage
❑
Individual Holding tank
❑
Community Class A Well
0
Community On-site
❑
Public Water System
❑
Public Sewer
❑
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ �- I
Date of Payment 3 111 l e r
Receipt Number
COSA #
Date:�3
Waiver Fee $ _
Date of Paymen
Receipt Number
Waiver#
S. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, i verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. i further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 0t3
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted tVrovide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOAl Q F
DSD Guidelines & Regulations. The reported results described the performance of the Dov ,.. .' ..
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may ..... . • • .. ... ...........
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test ....... ..... ........ .. .
results do not guarantee future performance of the system, nor do they guarantee that QO f r A. Garness.:
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide (♦ m E-79¢3
any warranty or future estimate of how long the system will continue to meet the 04 sfo ?� g i� •'' �`p
operational requirements of the ADEC or MOA DSD. The content of this report is for o po\
the sole benefit of the owner listed above. Any reliance upon or use of this report by any ro fessW'o:
other person or party is not authorized, nor will it confer any legal right whatsoever. DD000
6. DSD SIGNATUREt0FAIV6
Z.�System
#1 Approved for bedrooms.
`= ON-SITE
System #2 Approved for bedrooms.
`�
WATER RNLI
Disapproved.
5 o WASTEWATER
AM
PROGRAM
Conditional approval for bedrooms, with the following stipulations:
4
The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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. ATTCHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
By: 0 Original Certificate Dater 3- I'V-13
(Rev. I V05)
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 5 Parcel ID: 015-234-53
A. WELL DATA
Well type "A"
Date completed
Total depth ft.
Date of test
Static water level
Well production
WATER SAMPLE
If A, B, or C provide PWSID# 213598 Well Log (Y/N)-
Sanitary seal(Y/N)_ Wires properly protected
Cased to ft. Casing height (abo> 6
FROM WELL LOG
AT
in.
Coliform colonies/100 ml. Nitrate mg./L. Collected by:
A Ic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed PRE -7/15/88
Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 3/8/13 Pumper ISAACS PUMPING SERVICE
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 7/15/68 Soil rating (g.p.d.lftbr �212 System type TRENCH
Length 55 ft. Width 3 ft. Gravel below pipe 11 ft.
Total depth *15.04 ft. Eff. absorption area 1210 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 2/28/13 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 690 gal. New depth 16.5 in.
Elapsed Time: 120 min. Final fluid depth E in. Absorption rate >= 600+ g_p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
*Pump on" level atn. "Pump off" level High water alarm level at in.
Datum Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
On adjacent lot:
On adjacent lots
manhole/cleanout
Sewer /septic sernce Ire Holding tank
Animal n areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Properly line 5'+ Absorption field 5'+
Water main 10'+ Water service line **10'+ Surface water 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation *7Water main 10'+
Water service line ** 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
*SEPARATION DISTANCE PREVIOUSLY APPROVED. **ASSUMED BASED UPON THE WATER SERVICE
KEYBOX LOCATION AND SEPTIC LOCATION.
G. ENGINEER'S CERTIFICATION a v�
I certify that I have determined through field inspections and 4 ! Y
review of Municipal records that the above systems are in "' ' ' """ """"
conformance with MOA COSA guidelines in effect on this a
date. QO '•,J f Gar ess.
Engineer's Printed Name JEFFREY A. GARNESS Q o CE -7
Date
(Rev. 11105)
/D 0wticy _ F I NCH DR(V45
\
F\ ll`+
r
V
i
M7
2.Zroa Y
FRAM0 •` • �Giws
No J1[
EASEMENTS OF RECORD, OTHER THAN
THOSE SHO'.,'N ON THE RECORDED
PIAT, ARE NOT SHOWN HEREON,
AI Bwh ... ..., _.
O
40,973 6-F.
0.4¢ Ac,
V
' v Ra
No Cormn Srt Tn.• On Boob NO. ►•0. No.
r.
I AO,•Cy C.rt,}y tAOt 1 AO+. Nnlry w! IM IOlgwin0 Oowitl•d P,O ITy. {At 5 sIOCY 4- C OF A� �1
AGF/hE YVO.^DJ `UG D. Anen0r•p• ncad.pOr.lrllfr Arlo, •m tn•1 �� P�••►•e•�•vs
IM I"I"m•nt, •4tY•I•d tnw•On w• wHnln in• D,OOvrty Imw •nd C0 MCI "1140 Or S(,� •�
•nCr0•Cn on IM Dropwly ivime 040".1 tMr•10. IMI M Im0,0'a"On t On P• n` / « 47
IvInS •d11Cw1I Inw•10 •nC,0•Ch On IIN O,•m,11• In CYNt4n •nd IA•t tnw• M 10 r0w.ey . /•. •Mu .w.w, .•.w ...
teommq..0n Ln•. Or CIAO, yiPt)I• NMm•n 11 On wd C,00.T/ OXC•C/ M IMO-Wod hw•On.
t�r..nll N.Ide,.•a ,,
ea
2z APR•
Anenor•O+. Au.••
,aFCEArrF1eD is JULY zoos ����`tu.oa�_a/t
O
Municipality of Anchorage .r4E gG,
• '� Development Services Department Y°
Building Safety Division
On -Site Water & Wastewater Program $A T
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: l4 dm WA, 61 K y 14 S Parcel ID: OI S - 2-3q- 53
A. WELL DATA
Well type Pw61 iG 'A"
Date completed —
Total depth — ft.
If A, B, or C provide PWSID # 2115% Well Log (Y/IN)
Sanitary seal (Y/N)
Cased to -- ft.
FROM WELL LOG
Wires properly protected (Y/N)
Casing height (above ground) — in.
AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. 9—
p.m-WATER SAMPLE RESULTS:
Coliform colonies/100 mLNitrate mg/L Collected by:
Arsenic: — ug/L date of sample: -`
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material -%.ck Date installed -7//5/s6 Pre
Tank size I150 gal. Number of Compartments 'L Cleanouts (Y/N) i'
Foundation cleanout (Y/N) i/ Depression over tank (Y/N) n/ High water alarm (Y/N) --
Date of pumping 201 _ Pumper 15aac s Purnui^a Serljc�*_
C. ABSORPTION FIELD DATA
Date installed /5 $ Soil rating (g.p.d./ft2 o ft /bdr )29L System type 17EEo !ru,+c.�►
Length 55 ft. Width 3 ft. Gravel below pipe
Total depth N14ft. Eff. absorption area 0210 ft2 Monitoring tube Y Depression over field N
Date of adequacy test Zai Results (Pass/Fail) 04�6 ForY bedrooms
Fluid depth in absorption field before test —0— in. Water added= gal. New depth 15 in.
Elapsed Time: 150 min. Final fluid depth _ in.,, // Absorption rate >= GCO g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) Y-0 If yes, give date --
D. LIFT STATION
Date installed Size in gallons anhole/Access (Y/N)
"Pump on" level a in. "Pump off' level at High water alarm level at in.
Datum Cycles tested Meets alarm & circuit require nts?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: FQU c WATC-cL
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
Animal containment areas —
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 5'4 -
Water main 10'.1 -
Wells on adjacent lots '200
Property line 5 a- Absorption field 5 /4-
Water service line Io { Surface water 100`+ (N, 03
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line I17�-►• Building foundation Water main 10 `+
� � 1
Water Service line 10 Surface water t00 + (Al. D.*) Driveway, parking/vehicle storage 25 +
Curtain drain Wells on adjacent lots 2&+
F. COMMENTS
4 r1._ 1.
E 01' At `%I
G. ENGINEER'S CERTIFICATION i ��• • • • • ' ' •'q�� I r
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. . i-; w .....
Fr -
Engineer's Printed Name LABS Sar U..'I RK��O'
v 15 0 /
Date HI Zgt
l -Lo 1
COSA Fee $ q c) j Waiver Fee $
Date of Payment l I� Date of Payment
Receipt Number Receipt Number
(Rev. 4/10)
Tr \ mv�' RO It"1
Municipality of Anchorage
Development Services Department
Building Safety Division .�
On -Site Water and Wastewater Program `
3. 6T•
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015.234-53 COSA # Q03"
Expiration Date: % - oP • 7
1. GENERAL INFORMATION
Complete legal description Alpine Woods Blk 4 Lot 5
Location (site address) 6151 Downey Finch Drive, Anchorage
Current Property owner(s) Max D. Dawn E. Medema Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
6151 Alpine Woods Drive, Anchorage, AK 99516
Day phone
Brian Roit / Dynamic Properties Day phone 907-244-9581
3111 C Street, Suite 100, Anchorage, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
r❑
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class A Well
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information
obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Finn Watkins Engineering, Inc. Phone 907-349-1851
Address P.O. Box 110443, Anchorage, AK 99511-0443
Engineer's Printed Name CINDY W. ELLIS
5. DSD SIGNATURE
Date 7/20/2006
iii
1* W. Ellis
✓ Approved for bedrooms. '���•., CE-lasn ; `
Disapproved.09 ssiowicc a
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date:
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -She Water S Wastewater Program
4700 Bragaw Street
P.O. Box 196850
Anchorage, AK 99519-6850
www.muni.org/onsfte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Alpine Woods Bk 4 Lot 5 Parcel ID: 015-234-53
A. WELL DATA
Well type A
Date comfktedd
Total depth ,R,
Date of test
Static water level
Well production
If A. S. or C provide PWSID S 213598
Sanitary seal (Y/N) _
Cased to R.
WELL LOG
R.
9 -p.m -
WATER SAMPLE RESULTS:
Cobform NA colonies/100 mL
Arsenic: _ mg/I
B. SEPTIGHOLDING TANK DATA
Nitrate mg/L
Date of sample: _
Wen Log (YIN)
Wires property protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
n.
g.p.m.
Other bactL
eria colondes/100 m
Cobected by:
Tank Type/Material Steel Septic Tank Date installed 7/15188
Tank size I A50 gal, Number of Compartments 2 Cleanouts (Y" Yes
Foundation cleanout (Y/N) Yes Depression over tank (YM) No High water alarm (Y" N/A
Date of pumping 7r20/06 Pumper A► Home Services
C. ABSORPTION FIELD DATA
Date installed 7115188 Sob rating (g.p.dJ12 or R=/bdm) 212 System type Deep Trench
Length 55 R. Width 3 R. Gravel below pipe 11' R.
Total depth 14i R. Eff. absorption area 1210 R' Monkortog tube Yes Depression over geld No
Date of adequacy test 7/13/2008 Results (Pass/FaIQ PASS For A(LL bedrooms
Fluid depth in absorption geld before test 15.75 in. Water added 911 gal. New depth 35.25 in.
Elapsed Time: 90 min. Final fluid depth 25.25 In. Absorption rate » 600 g.p.d.
Any rejuvenation treatment (pest 12 mo.) (YM 6 type) No If yes, give date
D. LIFT STATION
Date installed NA
'Pump on" level at _ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
Cycles tested
at _. in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic
Absorption field on lot
Public sewer main
Manhole/Access (YM)
High water alarm level at
alarm d drewt recOremeras?
on lot NA On adjacent lots
Sewer /septic service line
Animal containment areas
On adjacent lots
Public sewer manhole/cleanout
Manure/anlmal excrete
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5 Property 1ne 10'+ Absorption field 15
Water main 40+ Water service line 50+ Surface water 100' +
Wells on adjacent lots 200+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 12 Building foundation r Water main 40+
Water Service line 25+ Surface water 100' + Driveway, parldnpMehide storage 30+
Curtain drain none known Welts on adjacent lots 2D0+
F. COMMENTS: FCO is under the deck. 'Separation of T from drainfield to foundation previously approved.
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections and _'
review of Munbpal records that the above systems are in
conformance with MOA COSH guidednes In off on dris date. �: _�lA W. EII1S
Engineer's Printed Name CINDY W. ELLIS p. CBt'isan
Date 7r20�3 ��aS10�� CIA
COSA Fees %' Waiver Fee $
Date of Payment q' 71 Date of Payment
Receipt Number Receipt Number
(Rev. 11 NS)
in
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 015-234-53
1. GENERAL INFORMATION
Complete legal description Alpine Woods Block 4, Lot 5
Location (site address or directions) 6151 Downey Finch Dr.
Current Property owner(s) Max & Dawn Medema
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
HAA# 65D3q�7
Expiration Date: 7—;. 5-- 0 G
Day phone
6151 Alpine Woods Dr., Anchorage, AK 99516
Day phone
Brian Royt /Dynamic Properties Day phone 244-9581
3111 C Street, Suite 100, Anchorage, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class A Well
B
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate forthe 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(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm Watkins Engineering, Inc. Phone 349.1851
Address P.O. Box 110443, Anchorage, AK 99511-0443
Engineer's Printed Name Cindy W. Ellis Date 7/20105
5. DSD SIGNATURE
Approved for
Disapproved.
4 bedrooms.
Conditional approval for
bedrooms, with the following
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: L/'G%//I _ i Original Certificate Date: 7— 2 .�' v✓�
(Ra DIM
Municipality of Anchorage .*••
• "' Development Services Department
Building Safety Division `
On-SRe Water & Wastewater Program
4700 South Bragew St.
P.O. Box 198850 Anchorage, AK 99519.8850
www.muni.org/onste
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Alpine Woods Bik 4 Lot 6 Parcel ID: 015.23453
A. WELL DATA
Web type A
Date completed
Total depth R.
Date of test
Static water level
Web production
If A, B, or C provide PWSID 0 21360
Sanitary seal (Y/N) _
Cased to ft.
FROM WELL LOG
ft.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate rtgd.
Arsenic: _ mgA. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Web Log (YM)
Wres property protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
ft.
g.P.m.
Other bacteria colonies/100 mi.
Collected by:
Tank Type/Materiel steel septic Date installed 7/1 Was
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YM) Yes
Foundation cleanout (YM) Yet Depression over tank (YM) No High water alarm (YM) N/A
Date of pumping 6/23/05 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed 7/15/88
Length 65 ft•
Total depth 14 ft.
Soil rating (g.p.d.M? or f?ftr t) 212 System type Deep Trench
Width 3 ft. Gravel below pipe 11 R.
Eff. absorption area 1210 if Monitoring tube Yes Depression over field No
Date of adequacy test 8/23105
Results (Pass/Faiq Pass For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 808 gal. New depth 12 in.
Elapsed Time: 20 min. Final fluid depth 0.5 in. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) If yes, give date
D. LIFT STATION
Date installed NA
'Pump on' level at _ in.
Datum
Size In gallons
Manhole/Access (YIN)
'Pump Or level at _ In.
High water alar level at
Cycles tested
Meets alarm 8 circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank4ifi station on lot NA On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/deanoul
Sewer /septic service line Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 Property line 45 Absorption field 15
Water main 40+ Water service line 50+ Surface water 100+
Wells on adjacent lits 200+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 12 Building foundation 7' Water main 40+
Water Service line 25+ Surface water Igo+ Driveway, pan6ngNaNde storage 30+
Curtain drain none known Wells on adjacent lots 200+
F. COMMENTS
FCO is under the deck. 'Separation of 7' from drainfleld to foundation orevioush amroved.
G. ENGINEER'S CERTIFICATION gyp.` -K ......4
I certify that I have detemdned through field inspections and
49-1
review of Municipal records that the above systems are In ?k
conb7nance with MOA HAA guldellnes in effect on this date.
Engineer's Printed Name Cindy W. Ellis W. Ellis
Date 7/20/05 CE.10M
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
in.
/ 1 r
FINCH DRIVE
�
�o
V
w.
7.3*oa Y
FRAHt ��� 7'x/1'
`� Cars
O
40, 975 S.F.
0.44- Ac,
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PIAT, ARE NOT SHOWN HEREON,
At Bv.tt
V 2S
No Corm" Sat TMs D� Book No. ►e0• No.
F
I ha'abY Ce,t,fy Thal 1 Neva \INeyad the fonowin0 dowibed wW
O,ty, lot 5 llh)ct `L
CLF/SLE WO, ^•D9 �,UG D, Ancnolp, wording Drdnat Auw, aro that
the rrnprOye Tan It sitYated thween Ora within IM property IinN en0 00 n0, "'1a0 or
OMFWCh On IM PIOOwN lyln0 adjae•-•t th.r010, that no ITPIoveTenla On PION'",
lying adjacent Ihwelo en Croaoh On tha Ora Tr Ha In oy»IOh wW that Nwe we n0 roadway,
trantrrossion ITN or other visible WNmen11 on H -d Or00e, Y eaWOI N 114-0910d hwaoh.
Anchoraa. Alaska ze APR. 1996
RE'CFRTIF/ED /S ,IDLY zoo -5
49It! iv
•• •M •NI M•N.NM�.N •••
.i ��NMN.}r.. •..w•w N• •w
}' Iranla N,Ide,.art ��
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Parcel I.D. #
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
�/tUNICIPALIiY Ur
tdVIRONMENTAL SERVICES DIVISIC :
Q�; r 1996
CERTIFICATE OF HEALTH AUTHORITY RECEIVED
APPROVAL FOR A SINGLE FAMILY DWELLING
E ( S_ �LIy - 5-3 1, HAA# '-\r_V'lU C�li��
1. GENERAL INFORMATION
Complete legal description Lot 5; Block 4; Alpine Woods Subdivision
Location (site address or directions) 6151 Alpine Woods Drive
Anchorage, AK
Property owner
Leroy
& Linda Nordstrom
Day
phone 345-8193
Mailing address
6151
Alpine Wood Drive
Anchorage,
AK 99516
Lending agency uay pnone
Mailing address
Agent Brian Roit/ Dynamic Properties Day phone 261-7652
Address 3111 "C" Street Suite 100 Anchorage, AK 99503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well
Community well XXX
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 XXX
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 MOP =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 5 & 5 ENGINEERING Phone (C) ti 7 61
17034 Eagle River loop Road No. 204
Address
Engineer's signature
6. DHHS SIGNATURE
X Approved for __ 4 — bedrooms.
Disapproved.
Conditional approval for
Additional Comments
By:
Date
;I/ IC/cE
bedrooms, with the following stipulations:
Date ¢ - 25- - F5 -
The
S
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.
72-025 (Rev. 1/91; Back YCA =21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES RECEIVE
Environmental Services Division
825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
6
APR 17 1996
Municipality s.t Anchorage
Health Authority Approval Checklist inept. Health & Human Services
Legal Description: L o i Parcel I.D.: C' r i - - S- 3
A. WELL DATA
Well type C 14- s ) 4 If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/1) Date completed
Total depth Cased to Casing hei (above ground)
Sanitary seal (YIN) W• property protected (Y/N)
FROM OG AT INSPECTION
Date of test
l
Static water level
Well production
WATER SAMF
g.p.m.
TS:
Nitrate
Dafe of sample:
B. 1SEPTI]HOLDING TANK DATA
Collected by:
Other bacteria
9—
p.m-
Date installed / I r -/ Tank size J )' S '� Number of Compartments 2 Cleanouts ice) y
Foundation cleanout (Y) Y 6 i Depression (Y" N L) High water alarm (Y1t� r'
Date of Pumping y /I i Pumper `
�i ,iAr�v'1 VwJi.t 1�r��` j �.L Tia cL CLky 0,;- '; rhgg,✓ :H.vK 4 %iCt•aN y 2si
C. ABSORPTION FIELD (DATA �t c " t s s L f , r ,� t v t
Date installed -7 'S / Soil rating (g.p.d./ft2 or z/b '— System type r %'z f ^'L t{
Length a ' Width 3 Gravel thickness below pipe 1 Total depth i
Effective absorption area Monitoring Tube present(�%N) YE s Depression over field (YO
Date of adequacy test �' `! L Results (Pass/Fail) �' `� s ' For `f bedrooms
Fluid depth in absorption field before test (in.); C Immediately after GGS gal. water added (in.):
Fluid depth 1 �` (ins.) Minutes later: 1 `1 Absorption rate = 6 c c: -f g•p•d•
Peroxide treatment (past 12 months) (Y/1) ^r = N i K,v `` '� If yes, give date
D. LIFT STATION
Date installed
Manhole/Access (Y/1)
High water alarm level at*
E. SEPARATION DISTANCES
Size in gallons
"Pump on:JCv*l-at*`` "Pump off' level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Se tic olding tank on lot ; On ad' et3t-16fs
Absorption field on lot? ; On adjacent lots
Public sewer main
Sewer /service line
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM LE HOLDING TANK ON LOT TO:
Building foundation `T Property line -)- S- 4 Absorption field
Water main/service line 1 f Surface water/drainage t `' Wells on adjacent lots a
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 7 Property Line / U 4- Water main/service line /
Surface water 1 �: Driveway, parking/vehicle storage area
Curtain drain `" �''� k �' ^"`� Wells on adjacent lots f
S -C•f, L TTi2 G',C iif l�51 1j ' .j f:,'F'r.ty vµ�NF S I 7N M.J.A. rlLrf- 1
F. ENGINEER'S CERTIFICATION r �. c .e g ,e L T / �- s E �� •+ 5 t� c
I certify that have determined thru field inspections and review of Municipal records that the. above sxstems are
in conformance with MOA HAA guideli s in effect on this date.
.�L���
Signature
Engineer's Name 4'� Vt '> c 9 "' En' Q eal er
Date ? :. (7:-,, . ,!
,
HAA Fee $ C' •? Waiver Fee $
Date of Payment �r / 7 / ��� Date of Payment
Receipt Number l �, 6 1} 7) Receipt Number
Rev. 8/95 OSS: haa.wk.doc
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES M
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 I.D. # 111 �3 HAA #
1. GENERAL INFORMATION
Complete legal description LOT 51 gt.D +1 ALp1.'Je WaOlps
sug�� v t Staff
Location (site address or directions) 115 1 A --PooE WOODS D21UE ,
4_oC VeAr&f_, ¢ h1. Ka 9 C1 5-i` to
Property owner UF'a 00" TI20H Day phone 34+5'(033
Mailinq address �i A-LPPNjf WOODS Pp- ') A1Giy . , A� X19,516
IP
3.
4.
Lending agency Day phone
Mailing address /\/ /A-
/,(1,A-
AgentPq
�Day phone I LA
Address N�
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
4--
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
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.
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.
p,l14SKA WA -re -P- wArs1�WR-r-`�JZ
Name of Firm Seey1c-46-1S Phone '33-7-617?/23G-324
Address
E544`7l Ea0CK.4a406F_j0,P—, i Ar k. • 99SO4-
Engineer's signature
6. DHHS SIGNATURE
By:
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date 6- fid_. /11
o'��•
OF
41,
qS
ess
.•'�1 �
AO
nUFES5W' w
bedrooms, with the following stipulations:
Date 7 /L,:� — / /
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 orderto 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. 1/91) Back MOA #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
LCT5 BOK 4- Aupin��
Legal Description: � Parcel I.D. (��� —G-..3�i-5 3
WOO sv DIv(S10
A. WELL DATA
Well type COMMUNW-1 If A, B, or C, attach ADEC letter ADEC water system number 2 1 3 9178
Log present (Y/N) !Y /� Date completed � Driller 911,4
Total depth N 1A- Cased to H JA- Casing height
Sanitary seal (Y/N) N I - Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
H /a
N �A-
g.P.m.
AT INSPECTION
/V g.p.m.
/V
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot N 1A- ; On adjacent lots
Absorption field on lot N 4 A ; On adjacent lots IV 1A
Public sewer main N Public sewer manhole/cleanout IV /,A
Public sewer service line N /A" Petroleum tank N /14.
WATER SAMPLE RESULTS:
Coliform Nitrate py A Other bacteria /A
Date of sample: 1A Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed (S' S Tank size ZSD Compartments %VJO
Cleanouts (Y/N) Y� S Foundation cleanout (Y/N) YE Depression (Y/N) /V D
High water alarm (Y/N) N /& Alarm tested (Y/N) N fi4
Date of pumping
t3 6QF✓R- R),M PeD 'SYS716J'7 LVA S /^J S7nUZ0 MJ J u LY /'7013 J
►-ro+�►E was Na -r t occupiAD UN T! L sp4JVA%21e OF 19 q I 1 Ac. PEJZ
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: 1�°rvw
COMM 1'� �/a /1� /� 7 r
Well(s) on lot On adjacent lots / Foundation %0.
To property line » 10 I ' '" 70` Absorption field 22 �2' Water main/service line » 10 r@ OePOSIT-
' 1 /^ S1 of S OF " fwwsr—
Surface water/drainage /y J"�
72-026(Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT TION i`i
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on"
Meets MOA electrical codes (Y/
Manufacturer
Manhole/Access
SEPARATION DI5TANCE FROM LIFT STATION TO:
Well o
D. ABSORPTION FIELD DATA /N
On adjacent lots
"Pump off" level at
Cycles tested
Surface water
Date installed 7 1Z a /5Soil ratingZ s� ��
21 Bs��H System type 3D?gNGu
Length Width 3 -O Gravel thickness 0 Total depth 14' 0
Total ( absorption area 2.1 O Pr'
P Cleanouts present (Y/N) yE S
Depression over field (Y/N) Na Date of adequacy test / L3v�q'�
Results (pass/fail) Y G S for E -OU K/I bedrooms
MPeroxide treatment (past 12 months) (Y/N) If yes, give date (�
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Y� + LA Well on lot N/A (Ca"MV017_On adjacent lotsProperty line
/ a +
To building foundation 7 O To existing or abandoned system on lot A
- FiEW maosuaw »10l@ oppose£ stiD0S
On adjacent lots >- Ito FELT Cutbank ^ 51 FEIC--T- Water main/service line of- T►- Hvu-V-
Surface water N 1A Driveway, parking/vehicle storage area 37
Curtain drain 4/,4
,4
E. ENGINEER'S CERTIFICATION
I certify that I have checked,
Signature
or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
.._r OF 4 ��.
Engineer's Ndm6-�I'r�'�'1
Date
144,U P b"" -.Mr
HAA Fee $ �Q. G" Waiver Fee: $
Date of Payment
Receipt Number I'
72-026 (Rev. 3/91) Back MOA 21
Date of Payment
Receipt Number
Alaska Water ge Wastewater Services
"Preserving the Last Frontier"
Telephone - Fax 338-3246 0 8471 Brookridge Drive 0 Anchorage, Alaska 99504
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
FOR: AWWS
Lisa
July 1, 1991
PWSID 213598
WALTER J. HICKEL, GOVERNOR
563-6775
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 provisions of 18 AAC 80.060, State
of Alaska Drinking Water Regulations.
Sincerely,
/"'4
Keven K. Kleweno
Lead Engineer