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Home My WebLink AboutALPINE WOODS BLK 4 LT 6Alpine Woods Block- 4 Lot 6 #015-234-58 Municipality of Anchorage ; '::i_`;., _ Development Services Department �: Building Safety Division On-Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT oi, Permit Number. _5yq60331 PID Number. OIS — 2'34– 513 Name G ar 6"110A. Wastewater System: ❑ New ❑ Upgrade (0000 Downey FAJ, Dr' £xis}in " ABSORPTION FIELD Pnar NW" a Sebodes ..r 4 ' D Deep T 0 D snallmv Tr*,Kh D get D Maas D 011w. LEGAL DESCRIPTION Sal Rr,rp Total Depth hom Witpewl pats GPorFt' Ft. elotic Lot stem.+aron 4 At iAC DWM b pipe eottan ham agnr Yate Gravel tepih benaam ppe WVWS Ft. FI Twnamp Rrge seawn Fa atter ahoy%aprW pate Gravel LoVh Ft. Fi. Well: Comm ❑ New ❑ Upgrade Gravel with Numpar of Ines Distance hereaen Ines Ft. Ft clasufnalm (Pwne. A e. C) Taal Dope, casat to Total abu rptan res M Pip rrlr FL Ft FP DnW ore DIdW SlmK Wat« Lsva Insulw �` Date Mahler -2 A Ar Home Sevvzcee, 10o:0 Y» t Pump sr r Carrq Nepht ApU .Gam TANK GPM Ft. FL SEPARATION DISTANCES a Septic ❑ Holding ❑ S T E P. ❑ Other. To Septic Absorption LA Holding ubllUPnvate W;U°a"« A Task wp ty From Tank Field Station Tank Sewer Line q Gr 12$0 Mr«w Nwro« a Lompenmaas well — rV1 surtau veal« LIFT STATION La Lm r I o –t– ,u euuw 'F _ Gal e 'Fury On' MvN r 'Pvp a! level st Hqn ql« rrm r In in in Cwtrn Non /VO. /V. 0. NOV Make a Motel Elect W napwa $ petamW by R~s BENCH MARK Ytl DOW�PIgrl sofloLpfalNn ,., S•'xt E Coring-c- Noose, mW wvalgn IOC) FI. Inspections performed by: L ars SDates: 1" �Fk�L OFA! ��E....... Development Services Department Approvaliii •49TH Conditional Approval Date: _ / j t •-LASS ES ;.'n'K:A%o n FES§9� Reviewed and approved by: CVV Date: I i �% me W%j Lot 1\� \, Lot 5 \,� Lot 6 \ \ \ \ ti.. D IS.3' JE.S\\\E 19.5' 2.1EE ?0 16\ 00 \ ` ` '► ♦ ABANDONED EXISTING INSTALLED NEW 1250 GALLON STEEL SEPTIC \ SEPTIC TANK PER CONNECT TO EXISTING TRENCH ♦ \`� \ MOA CODE / 11 ap Lot 2 `,r '� Lot 4 � \ dO ' 11 WOODS ACK 4 Lot X00010 �ALPINE \ 4+ FEET COVER DOUBLE \ CLEANOUTS R II 'I II FOUNDATION CLEANOUT ELM= 96' WG9:.' Ly I 49th CONNECTED TO , �( EXIST DRAINFI£LB 1250 gal. septic tank s s o J. NO. CE -11500••.Z^- 11111� 25 0 25 50 75 IOU 125 150 BENCH MARK BOTTOM SIDING SE CORNER HOUSE SCALES 1' = 50 FT ASSUMED ELEVATION 100 20.3 W 157H. AVENUE LNUINUMINU I I ALPINE WOODS BLOCK 4 LOT 6 I I SEPTIC SYSIFM ASBU/LT ANCH. AK. 99501 GARY BULLOCK DATE. DECEMBER 13, 1006 L907) 979-_i916 6000 DOWATY MCM DR/VF SHEET.• 1/1 GRID: 2738 PERMIT ✓t SVO60331 PID 0 015-234-58 ALPINEVOODB4L61.DVG MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 09, 2006 Expiration Date: Oct 09, 2007 Permit Number: SWO60331 Parcel ID: 015-234-58 Legal Description: ALPINE WOODS BLK 4 LT 6 Design Engineer: 0007 SPURKLAND ENGINEERING Site Address: 006000 DOWNEY FINCH DR Owner Name: GARY BULLOCK Lot Size: 36134 SQ. FT. Owner Address: 6000 DOWNEY FINCH DRIVE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516-2459 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. - EMERGENCY TANK LOCATED NO LESS T FIVE FEET FROM ANY PROPERTY LINE OR BUILDING NG FOUNDTANK AT ONN ENTIOYBE FEET FROM ANY WAT RAN SERVICE LINE; ONE HUNDRED FEET FROM ANY SURFACE WATER; AND ONE HUNDRED FEET FROM ANY PRIVATE WELL; AND THE SEPARATION DISTANCES REQUIRED BY 18AAC72 FROM WATER SUPPLY WELLS. Received By- Issued y Issued By. f 11. 1 Date: Date: to 9 v6 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. n I r1 - g_� o — 52� Property owner(s) G phone Mailing address Zip Code Site address %000 Nwgj F n f_� Drive Zip Code Legal description (Sub'd., Block & Lot) AIP!,,e Wooa S k `i Lof (o Legal description (township, Range & Section) Lot Size 3L ` 13LJi Sq. Ft. THIS APPLICATION IS FOR (® all that apply) Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of proArty owner or authorized agent) Permit/Rush Fees: #y(0 Waiver Fees: Date of Payment: 1_014106 Date of Payment: Receipt Number. 97155- Receipt Number. (Rev. 11105) Mau 12-�)puMand En&86TOORU Environmental Consulting and Design &M!�ff October 6, 2006 Municipality of Anchorage Development Services Department Building Services Division On-site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Subject: SEPTIC TANK PERMIT APPLICATION ALPINE WOODS BLOCK 4 LOT 6 We are submitting an application for the replacement of the septic tank for this lot. The submittal consists of one (1) drawing showing the present improvements on the lot and the proposed improvements of the lot, of which only the septic tank is subject to this permit application. The installation of this septic tank will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of the proposed septic tank location. The proposed septic tank will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or are in need of additional information please contact me at 279-3916. Sincerely, Lars Spurkland 203 West 15° Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 2704Q)3, SpufkiandEng(?,gci.net Lot 1 \\ \\ Lot 5 DpvNEy FIS 4 -.. Lot 6 / 00 ABANDON EX/ST/NS INSTALL NEW 1250 GALLON STEEL SEPTIC SEPTIC TANK PER CONNECT TO EXISTING TRENCH MOA CODE � � Lot 4 Lot 2 v Lot 3 A L PINE VL70DS BLOCK DOUBLE 4+ FEET COVER CLEANOUTS q I I FOUNDATION CLEANOUT CONNECTED TO EXIST DRAINFIELD 1250 gal. Septic tank eg 25 0 25 50 75 100 125 150 SCALES 1' = 50 FT 4L 49th ' LARS SPURKLAND NO. CE -11500 SPURKLAND ENGINEERING ALPINE WOODS BLOCK 4 LOT 6 SEPTIC SYSTEM DESIGN 203 W 157H. AVENUE GARY BULLOCK DATE.• OCT. 6, ?006 ANCH. AK. 99501 r n„�� nn,vc SHEET 1�1 GR/D: 2738 PERMIT ✓I SV060XXX PID # P)� MUNICIPALITY OF ANCHORAGE BGS ="Z-7 y— 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 C2 DISTANCES FROM SEPTIC TANK ABSORPTION FIELD WELL Address 37-3� 9 �}✓i:it g cJJ aB WELL 7 Zoo l > Phone(s) j j -r Permd No. 1 90 DO f 9,r No. of Bedrooms LOT LINE LEGAL DESCRIPTION Lot 16 Blocky :::::[ubdivision /7� / rrte 1.✓OO�j FOUNDATION q r Z/ r Township, Range, Section Pr b y r^�,JY �-p 1k /�.l J a 3 l.J 3 2 !J AS -BUILT DIAGRAM driveway, water bodies, (Show location of well, etc.) septic system, property lines, foundation, TANKS PK SEPTIC ❑ HOLDING 5 2 F .yZ C r Manufacturer c-kar Capacity in gallons z� 14 _ r Material No. of Compartments TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pile bottom from original grade r FT Total depth from original grade / ! FT Fill added above original grade Z — FT Gravel depth beneath pipe 6'5 FT Gravel length S o? • S FT Gravel width 3-S-1 -'S1 FT Total absorption area �Ogo2 SQ FT Distance between lines FT 40 O • Number of Imes Soil rating 166' SQ FT Pipe material r8"/0 Installer 9p_ Ip 2_ r Z iO".r Date Installed I f-/4,`•26/r/d WELLS COMMtln L✓2% ❑ PRIVATE ❑ O (ldentifv)1 Classification (A,B,C) Tvr5T DepthCased FT to FT � coInstaller Date Installed: REMARKS: / SYS c7-S��✓ta�e .Sai<s 5�-d �SP� N+�'� �� " pjsr�/t p jj0 16 yq • 411-+41 �rpa « Scale: Inspections Date. Performed L r by: 12C 'd COD 00 Z_ ENGINEER'S SEAL L.w ((�� / �Qf�c r� t%QQ 1010 T'✓t�L( D6lvf' r [?e— t" certify that this inspection was performed according to all Municipal and State guidelines in elfect on this date: '71Y19 D f 1 Health Department Approval: Date:, 72-013 (3/85) MUNICIPALITY OF ANCHORAGE ry Department of Health and Environmental Protection Pouch 6-650, Anchorage, AK 99502 S11 IL; 264- 4744 On-site SewerAMONWr Permit HANDWRITTEN Permit No: A� F.�` - _" y�� ''oo l�sU C�`S ,j t�'J�� Date Issued:/ Applicant: 6A10"i' Address: � a.5 % Legal Description: S/D ,/` 4,01nIG %/ODDS Lot: Block: 4 - Section: 'Z'3 Township: Z;;;Z/t-" — Range: Lot Size: or Acres) Lot Location: (�� l/[�lN�✓Cy �7� ��C Max Bedrooms: Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. ---------------------------------------------- TRENCH BED W. DRAIN Depth to pipe bottom(ft.) Gravel depth (ft.)6;7 �JitiS eLl Total depth (ft.) �rc� o% ��u d �61�� r im �y j AeJ ,OiY/7 f- c ric r IP / Gravel width (ft.) ,- 'a .i a��/� %es Gravel length (ft.) ; ice vr, / r1 c-'><�:. e�, 0,7 �rc, Ory/f t �mt�d f c �� Tank size (gal.)e�Sic=,4o��; Soil rating (sq. ft./br)Z ** Gravel length 75 feet requires multiple runs (not exceeding 75 feet 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. 3. I will 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 this or any adjacent or nearby lot. 4. I understand that this permit is valid for the maximum number of bedroom stated above, and any enlargement or modification will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY SOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE FT.FrTRTCAT. WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED: Applican ISSUED B SWP/024 rev.1/85 DATE DATE: EC ALASKA MUIROf1� nTRL COnTROL SNIC664,IC 1�G OFANCHORAC,9 ECS DEPT. OF HEALTH & Q engineerinq & Enuironmental Studies ENVIRONMENTAL PROTECTION P. 0. Box 240668 Anchorage, AK 99524-0668 (907) 279-5553 *** FAX (907) 276--8706 May 14, 1990 Municipality of Anchorage Department of Health & Human Services 825 L Street, Fifth Floor Anchorage, AK 99501 ATTR: Robbie Robinson RE: Lot 6, Block 4, Alpine Village Dear Robbie: MAY 141990 RECEIVED This is to state that the Telephone, Electric and Drainage Easement on the south side of this lot, in fact, does not act, nor never has acted, as a drainage channel. *.0"Kt%% F It LCR/sr • of ..• *10, JR. •� • 1251 •e Sincerely yours, Leroy C. Reid, Jr. PhD, PE, DEE ) 279-5553 A E� ALASKA CnUIROWnTAL COnTROL SRICCS, InC. S e Engineerinq & Enuironmental Studies SPECIFICATIONS FOR A TRENCH -TYPE WASTEWATER DISPOSAL SYSTEM LEGAL DESCRIPTION: LOT 6, BLOCK ALPINE WOODS SUBDIVISION 1.0 GENERAL 1.1 The Drawings, sheets 1 thru 4, shall be a part of this specification. 1.2 All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Health & Human Services (DHHS), the conditions of the permit, and all applicable rules and regulations currently in effect. 1.3 All elevations and depths are advisory, and are to be verified or modified in the field by the engineer or inspecting agency. 1.4 It is the responsibility of the property owner or installer to adhere to approved designs for installation, maintain the specified separation distances, and have the appropriate inspections. 1.5 It is the responsibility of the property owner or installer to report to the engineer any observed conditions which would put the system in violation of state or Municipal regulations. 1.6 If the installation is not inspected by an AECS engineer, AECS will not be responsible for the installed system. An engineer at AECS should be consulted prior to construction to determine the number of inspections that will be required and to explain what these inspections will involve. 2.0 SEPTIC TANK 2.1 If there is an existing septic tank, it may be used it if meets the capacity requirement for the residence and the approval of the MOA. 2.2 The septic tank shall be a UPC -approved two-compartment tank, constructed of 12 gauge steel with bitumastic coating and set level on undisturbed soil. If the tank is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 inch burial type polystyrene rigid board insulation. 2.3 The septic tank and trench shall be a minimum of 100 feet from any private well or body of water, 150 feet from Class "C" wells, and 200 feet from Class "A" or "B" wells, unless otherwise specified. Less than the required separation distance must have prior approval or waiver by ADEC or MOA. 2.4 The septic tank shall be a minimum of 5 feet from the house foundation, and a minimum of 5 feet from the absorption area. 2.5 Piping shall be fitted with a mechanical watertight calder coupling on the outlet and inlet of the septic tank. Piping shall be 4 inch solid PVC ASTM D-3034 or cast iron, sloped a minimum of 1/4 inch per lineal foot. If the piping is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 inch burial type polystyrene rigid board insulation. 2.6 Cleanouts shall be installed as designated and capped with air -tight rain caps (Jim Caps or equivalent), and extended a minimum of 1 foot above ground level. 2.7 If a lift station is required it shall be a combination lift station septic tank per Anchorage Tank and Welding, Inc. design. Specifications and design drawings are on file with the Municipality and the engineer. 3.0 ABSORPTION AREA 3.1 The gravel for the trench shall be 0.5 to 2.5 inch, screened rock with less than 3 percent passing the No. 200 sieve. All substitutes must have prior DHHS approval. 3.2 The bottom and sides of the excavation shall be raked with the backhoe blade to ensure that it has not been compacted during excavation. The bottom elevation shall be level. 3.3 Monitor standpipe(s) shall be placed as shown in the drawings, and shall be 4 inch rigid PVC ASTM D-3034, or cast iron. The section shown with holes may be 0.5 inch holes drilled on 6 inch centers on opposing sides of the pipe, or a regular section of perforated sewer pipe clamped to a solid section with either a no hub coupling or a solvent joint. A rubber rain cap (Jim Cap or equivalent) shall be installed over the top of the pipe. 3.4 The distribution pipe shall be perforated 4 inch PVC with a minimum crush strength of 1500 pounds and shall meet the approval of DHHS for use as drainfield pipe. All distribution pipes shall be laid level. 3.5 Trenches may be paralleled, but must have a minimum separation distance between the trenches of 10 feet or 2 times the gravel depth (which ever is greater). 75 feet is the maximum allowed linear length of any trench. 3.6 If the final grade over the trench is less than 4 feet above gravel, insulation is required, using burial type polystyrene rigid board insulation. There shall be 1 inch of insulation for every foot of soil less than the required 4 feet of cover, but there must be at least 24 inches of soil cover even though insulation is used. The solid pipe extending from the septic tank to the drainfield shall also have a minimum of 4 feet of cover or an equivalent layer of insulation to prevent freezing of the line. 3.7 Filter fabric is required. 4.0 INSPECTIONS 4.1. A minimum of two inspections are required for the installation of the trench. The first inspection will be of the open excavation to assure that the system is installed in the proper soil strata, correct depth and meet minimum specified design parameters. 4.2 The second inspection will be after placement of the gravel, monitor standpipe and distribution pipe to verify proper installation and position prior to backfill. 4.3 The inspection of the septic tank installation can be incorporated with any one of the above listed inspections. 4.4 The lift station will require either an MOA electrical inspection or certification by a licensed electrician, depending on whether the building code applies to this part of the city. ALASKA ENVIRONMENTAL TROL SERV a �y-ssr3 JOB /- " SHEET NO. CALCULATED BY— CHECKED Y—CHECKED BY SCALE t l I 14 4 /,Jc" c/ c5,i E� )I CGri OF T DATE— DATE— �. AK 0-e %r PRO= 2041� Inc., Gmmn, Mm 01471. q`!�►LPi NE •' •`• T 4 p � r q . iEROY C. REID, JR.i�r ` 9 CE - 2251Ar WOODS SUBDIVISION 6 BLOCK 4 4' ,49 0 to 30�? ��pr�t�ssio�� a boy o� �Ktu E \ MIX > _H7 ,94 1" 50 •t0' yRatNAbF- g 5 F1910Y175E1p '3 D\> c 1J Cy J �y Ar L n gyp' -rf-ue. , Etc. TRAtNAGE E'er PLOT PLAN GASTALDI LAND SURVEYING Jeff A. Gastaldi,R.L,`?. 3030 Bettles Bay Ln p Anchorage Alaska Tel. 907--3W -4272 RID DATE F.B. JOB N0. Caa _ � I hel-(A)y certify that. J have s,_Irveyed the property depiuLed ahove acid that the proposed improvements and drain -- age pattern; are as Shovin hereon. It is the responsibility of t -he owner, prier to coriSt.rurtian, to vFrify the prupused building lor2tiun on lot, grade? ar)d [it 1lit.y rnr er.t.ions .1nd to det.ermint the eyisl.ence ,` any ease- ments, covenants, of restrictions which do nut appear un the recurded 5Ut d1 Y - s 10n peat . UE n. aQ QC1F to H H z J O 00 o Q H H z (A IL Q H ttt U HHJ Q a Q U m til 4 FIL to -i H O wICH sA z til O FL H to k- 0 lu F z O H IPA z ��A • ' � w Ap G:7 •.• i :••ee L%aP��.�k 1 i :WC (L CN o�� t9 • j :rw �� z o . L s to • �� Z 1 l�•� a •• • t�Q,.� � � * • e s H � a Fl 0 O O i•- t-- z .m Q H Q � 0 U U ` a 'Q a �a Q U U 7 -1 j r3-- FAR 2 to --ice U JU F— H �o z . W (o G W 0 ZU W �• � O OHt—mm HQo❑� >W C@ Q ?tl V Z N ti m to H z W W D a, a w J z U) O �� F QOz} Q aH z MCC ,.mm : a H W . m M" QZJUY QOU(nU❑J 000 r x z OrQ i to O " O 4- a: "w o� xF C H W F- M LU D El O O 1- Z H Q Z W O J :E: U a H IL tL G m ►0 a Vv H Z O >v F 0 vi LOG • " t t = : � >x,, ■ J. AGE . 74 1Z_ -MUNICIPALITY OF ANCHOR ❑ PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOJ.ATION TEST PERFORMED FOR: ` A )lam I DATE PERFORM D LEGAL DESCRIPTION:y ! 1 5-.•`3 SLOPE SITE PLAN 1 S.n 2 ...]red st �-�'� ' s ' I i f G'' y • vl r L{moi C s•••s•••. •.1 Inr G oss g e-2 Ar 'r... �� r r ✓ 04 ;10 E• -19 Date Professlc�►` Time WAS GROUND WATER �_Lp, ENCOUNTERED? gYe1 / r IF YES, AT WHAT - Spb�fw+ DEPTH? 11" elIC..-r. PEfG. 11v .COLI Et TFS, PERFORMED BY:�i 72-008 (6/79) r•� Spy G oss _08 'r... �� r r ✓ 04 ;10 E• -19 Date Time Time Water Drop S 30 / r .COLI Et TFS, PERFORMED BY:�i 72-008 (6/79) r•� G oss Net Depth to Net Reaying Date Time Time Water Drop 30 cl: IV 3.c 0 : 0'7 3.05 Z 10:30 - 3 4 Nz 0 10 : 30 3:05 3 0'. 12-w 11 1 i'll 2.2y f+z o f 1 1 '• 12- ;, : 1 0 t( PERCOLATION RATE / 1 (minutes/inch) Gi" J TEST RUN BETWEEN ^✓ FT AND 2- FT I m I:w 4-(,k-cf >, Z' C, 1,r I D. 5 i r MUNICIPALITY F Development Services Department `- On -Site Water & Wastewater Section - Certificate of On -Site Systems Approval Parcel I.D. 015-234-58 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: Complete legal description Alpine Woods Sub, Block 4 Lot 6 Location (Site address) 6000 Downey Finch Dr, Anchorage, AK 99516 Current property owners) Andrew & Lindsay Cobb Day phone Mailing address Real estate agent 6000 Downey Finch Dr, Anchorage, AK 99516 Cody Keim 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone (907)250-9558 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -550-. Waiver Fee $ Date of Payment 7o 3 Date of Payment Receipt Number. 0 3 3'D 1 D Receipt Number COSA # 1q2-7-.) Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. 6. DSD SIGNATURE V/ System #1 Approved for 4 System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms Date 7/21/21 TH Benjamin,Schiller CE 12592 \ .� 7/21/21 � pROFESSOO -Z" bedrooms, with the following stipulations: VV/ -HI r— r-% M1'4U PROGRAM �)))))))m)))1 By: �J��r1/� Original Certificate Date: tF`f 2,0,2, The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Alpine Woods Sub, Block 4 Lot 6 015-234-58 Community Well PWSID 213598 14 Septic/Steel 48 ■ A+ Home Services 9/22/20 Deep Trench 9/4/1990 7/21/21 ■4 11.4 0 5.4 647 0 ■ ■ 1440 0 >600 ✔ COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to:(Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’Yes if No ft Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to:(Please enter distances if less than required) Building Foundation > 10’Yes if No ft Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 7/21/21 >5*✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ * Met municipal code at time of install. • Municipality of Anchorage On -Site Water and Wastewater Program 'oma (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-234-58 Expiration Date: % � -, - /Jr 1. GENERAL INFORMATION Complete legal description ALPINE WOODS BLOCK 4, LOT 6 Location (site address) 6000 DOWNEY FINCH DRIVE, ANCHORAGE, AK 99516 Current Property owner(s) JOSEPH & RICHELLE JUNGWIRTH Day phone Mailing address Real Estate Agent 6000 DOWNEY FINCH DRIVE, ANCHORAGE AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone NMI 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A Well ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Received by: '-,;�, - Ldi jou — Date: -12_-&-i3 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ q,16 r Date of Payment Receipt Number 6�i5�iai3 COSA# 05o3 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS 11/22/13 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen �' � �F `�L� \, encroachments, deficiencies or discrepancies exist. �'7 6. DSD SIGNATURE r KEXFETH V. DLEEiJ / System #1 Approved for bedrooms. '�� r �/ ,e` / System #2 Approved for bedrooms. eG,10 `btu Disapproved. Conditional approval for bedrooms, with the following stipulations: 0 The Original Certificate 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 blue sheat 10-10.12.tl c 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 6 Parcel ID: 015.234.58 A. WELL DATA — CLASS A Well type A If A, B, or C provide PWSID # 213598 Well Log (Y/N) Date completed Sanitary seal (Y/N) Y Wires properly protected (Y/N) Total depth _ft. Cased to _ft. Casing height (above ground) _in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g. p. M. WATER SAMPLE RESULTS: Coliform —colonies/100 mL Nitrate _ mg/L Arsenic: _ ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Date installed 1012712006 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 1112112013 Pumper AROUND THE CLOCK C. ABSORPTION FIELD DATA Date installed 6126/1990 Soil rating (g.p.d./f:2 or ft2/bdrm) 168 System type TRENCH Length 52.5 ft. Width 4 ft. Gravel below pipe 6.5 ft. Total depth 11.5 ft. (Measured 11122/13) Eff. absorption area 682 ft2 Monitoring tube Y Depression over field N Date of adequacy test 1112212013 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 3 in. Elapsed Time: 140 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off level at _ in. Cycles tested E. SEPARATION DISTANCES - CLASS A WATER SYSTEM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas SEPTIC/HOLDING TANK ON LOT TO Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Building foundation 5'+ Property line 5'+ Absorption field 54 Water main 104 Water service line 104 Surface water 1004 Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 104 Water Service line 10'+ Surface water. 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NONEKNOWN) Wells on adjacent lots 2004 F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of determined through field inspections and review of Municipal records that inspections and review of Municipal records that the above systems are in Municipal records that the above systems are in conformance with MOA above systems are in conformance with MOA COSA guidelines in effect on conformance with MOA COSA guidelines in effect on this date. COSA guidelines in effect on this date. on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 1112212013 COSA brown sheet_10-10-12.doc 0 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 pt RV f CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-234-58 COSA Expiration Date: 1. GENERAL INFORMATION Complete legal description ALPINEWOODS BLOCK 4 LOT 6 Location (site address) 6000 DOWNEY FINCH DR., ANCHORAGE, AK 99516 Current Property owner(s) GARY BILLOCK Mailing address SAME Lending agency Mailing address Day phone 345-7115 Day phone Real Estate Agent FSOB Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding Tank ❑ Community Class A Well E 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 Firm Spurkland Enginneering Phone 279-3916 Address 203 W. 15th Ave., Ste 202, Anchorage, AK 99501 Engineer's Printed Name Lars Spurkland 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Date JUNE 21, 2012 of A.<q Ali TH ...X, E. S5U KLAND0.i Ilk Conditional approval for bedrooms, with the following stipulations: Attachments COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: / ZZ/ (/ Original Certificate Date: Z " 2 (Rev. 11105) Municipality of Anchorage q , • Development Services Department Building Safety Division On -Site Water & Wastewater Program a 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: ALPINE Woom Calk K LOT (o Parcel ID: 015-234- Sg A. WELL DATA Well type g If A, B, or C provide PWSID # 21357$ Well Log (YIN) Date completed = Sanitary seal (Y/N)= Wires properly protected (Y/N) - Total depth _ ft. Cased to ft. Casing height (above ground) _ in. FROM WELL LOG AT INSPECTION Date of test — Static water level Well production — g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform _ colonies/100 mL Nitrate — mg/L Collected by: Arsenic: ug/L date of sample: = B. SEPTICIHOLDING TANK DATA Tank Type/Material AncNoR E IAkSTOLL Date installed ( 240t0 Tank size 250 gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) _�L Depression over tank (Y/N) /J High water alarm (Y/N) A/ Date of pumping 10131 ti, Pumper A4 &TIE .SCVUtLe.S C. ABSORPTION FIELD DATA Date installed 6 26 40 Soil rating (g.p.d.hY o ftz/bdrm16�5 System type 'Q69Gt1 Length 575 ft. Width q ft. Gravel below pipe G.5 ft. Total depth I I ft. Eff. absorption area (09Z ft' Monitoring tube Y Depression over field f1/ Date of adequacy test 441-Z Results (Pass/Fail) PA53 For 4 bedrooms Fluid depth in absorption field before test _ in. Water added 6O gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth __0_ in. Absorption rate >_ (000 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at n. High water alarm level at in. Datum Cycles tested Meets alarm & circuit uirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOTTO: Commuoit,/ Weil Septic tank/lift station on lot On adjacent lots Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas On adjacent Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 10 1+ Absorption field 5 tF Water main 101'- Water service line 10�+ Surface water lob m+ Wells on adjacent lots 2001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line iOm+ Building foundation 101+ Water main i0 t Water Service line 10'+ Surface water (()D'+ Driveway, parkingivehicle storage 25 Curtain drain 56'+ 011a) Wells on adjacent lots '2C0'+ F. COMMENTS G. ENGINEER'S CERTIFICATION e 1 certify that I have determined through field inspections and _,4 . `49 � ' review of Municipal records that the above systems are in . :�.'^.. . . conformance with MOA COSA guidelines in effect on this date. : "� .. . .. , . . Engineer's Printed Name LAR5 SPURKLAND SPURKLAND.A�z' ( 11590 iA Date 61u'1Z ((11 °R6r .. P� = COSA Fee $ (M Date of Payment Receipt Number (Rev. 4110) Waiver Fee $ Date of Receipt Number PLOT PLAN _ ASBUILT Y- SCALE L q o GRID 1-151 Long & Associates, Inc. (1150))0 Daryl Avenue, Anchorage, —6476 Registered Land Surveyors (9077') 522-4625 Faxne en y certify that I have surveyed the following described property. 4 NtLPSNr- Woov-> �7w;o'rzw\'0100 _ Anchoraoi Recording District, Alaska, and that the Improvements *Hunted thereon an within the properly lines and do not encroach onto the property adjacent thereto. that no Improvements on the property lying adjacent thereto encroach an the surveyed premises and that then aro no roadways, transmission lines or other visible easements on sold property except as Indicated hereon. Dated this the Zn,," Day of 20 12 at Anchoraos, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Project No. X2.05`1) Alaska 99515 :KENNETH 6. LAND.' ., LS -5202 P �4t�cFessroNa. � 0 - - I-- oowN�Y F/wcN r✓�i v� _ n�� ror/ oB , rr h '1 �w o + ,gym I� o iIF-"3 �\ re�ica !` 'p Z � \ SL�Pftc. cW-p��- 51,5 11e,35HlsD , 0 o. aY, \ n (07,1Z \ C CwI 2ro�cpµT IZ8 `I 3.8 Drsc.� `tl h �\ Lor & 1, S Z;osu�¢"T-/-- Cot = \ GOT4 PLOT PLAN _ ASBUILT Y- SCALE L q o GRID 1-151 Long & Associates, Inc. (1150))0 Daryl Avenue, Anchorage, —6476 Registered Land Surveyors (9077') 522-4625 Faxne en y certify that I have surveyed the following described property. 4 NtLPSNr- Woov-> �7w;o'rzw\'0100 _ Anchoraoi Recording District, Alaska, and that the Improvements *Hunted thereon an within the properly lines and do not encroach onto the property adjacent thereto. that no Improvements on the property lying adjacent thereto encroach an the surveyed premises and that then aro no roadways, transmission lines or other visible easements on sold property except as Indicated hereon. Dated this the Zn,," Day of 20 12 at Anchoraos, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Project No. X2.05`1) Alaska 99515 :KENNETH 6. LAND.' ., LS -5202 P �4t�cFessroNa. � MUNICIPALIT,' OF ANOHOisAGE ' DEPARTMENT OF HEALTH & HUMAN SERVICES l T Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH A,.-;-. HORITY APPROVAL FOR A SINGLE FAMI'_`` DWELLING Parcel I.D. # O 1 S — 2,3 Ll— c5 eq 1. GENERAL INFORMATION HAA # i_A gk sj ) n1 1-\ �) Complete legal description �a— K_,_ Location (site address or directions) 000 W -VI t AC Property owner a—rtii� j L- o �k— Day phone 395; — 71 IS - Mailing � Mailing address h 00 o Lending agency Day phone Mailing address Agent s�a`8-c�► �'�"� a �c- Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well ✓ v 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 Holding tank Community on-site Public sewer _.. NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status ,_,f system. 72-025 (Rev. 1191) Front MOA 021 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 / 0 0 ktga Phone �7� 3Q'dla Address ca)_03 /5-/-4 Engineer's signature 6. DHHS SIGNATURE Approved for —— bedrooms. Disapproved. Conditional approval for Additional Comments Date 3`ab L F3 bedrooms, with the following stipulations: Date I/ 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 MOA 421 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.L�� K Ll ' ° 1��,14 ""v g Parcel 1. D. b 15 — �3�— S A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. ADEC water system number Ift"t D Date completed Cased to FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Driller Casing height Wires properly protected (Y/N) ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria Date installed size Compartments -Z Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) N High water alarm (Y/N) N/'4 Alarm tested (Y/N) r-�!A, Date of pumping s�� Yl l I I Z— Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 11/4 On adjacent lots '� Foundation 9 To property line f, D Absorption field S Water main/service line 7Z5 Surface water/drainage NIC) 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE z AT INSPECTION %i7 n T' `?! n J Ci rI1 T ca �' g.p.m. g.p•rn O Z ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria Date installed size Compartments -Z Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) N High water alarm (Y/N) N/'4 Alarm tested (Y/N) r-�!A, Date of pumping s�� Yl l I I Z— Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 11/4 On adjacent lots '� Foundation 9 To property line f, D Absorption field S Water main/service line 7Z5 Surface water/drainage NIC) 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level . "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA "Pump off" level at Cycles tested Surface water _ Date installed �6 2` 40 Soil rating %` 8 System type A_a,,tc-4 Length Width 3 Gravel thickness. b Total depth I Total absorption area g 2 Cleanouts present (Y/N) y Depression over field (Y/N) �� Date of adequacy test 3/x.5 G q3 Results (pass/fail) for V bedrooms Peroxide treatment (Past 12 months) (Y/N) NO If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO:// Well on lot N/^ On adjacent lots N/4 Property line g To building foundation To existing or abandoned system on lot NIA On adjacent lots 5 D Cutbank Water main/service line Surface water Driveway, parking/vehicle storage area Curtain drain t4l O 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. Signature Engineer's Name Date 14� v2b t �Q3 HAA Fee $ 17 C , Crf) Date of Payment 22 l� Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 March 24, 1993 Mr. Tobben Spurkland SUBJECT: Alpine Woods Subdivision Class "A" Public Water System, PWSID 213598 Dear Mr. Spurkland: (907) 349-7755 I have completed a review of this office's files concerning the monitoring status of the above -referenced Class "A" Public Water System and found the following: 1. The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on March 17, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 2. The last inorganic Chemical Contaminants Sample results were submitted to this Department on July 28, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 3. The last Radioactive Contaminants Sample results were submitted to the Department on February 16, 1993. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. 4. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on June 24, 1992. Based on analysis of the previous VOC samples results have been satisfactory. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above -referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, G�� ttd4� Michael Lu Environmental Eng. Asst. 11 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 Parcel I.D. # OJT— 123 y 'Sr HAA # 4�y 5,6 j 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or.directions) , (b) Property owner Telephone: (home) Business Mailing Address 37l 3 /V�� -Z moire (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here F; if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family IX Number of bedrooms 3. WATER SUPPLY Individual Well ❑ CommunityX Public ❑ Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site. Public ❑ Community ❑ Holding Tank ❑ Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm A FGS LCL Telephone :52-2 7 Address Date t0 j� • °a i * i 1 � � Y C. REtD, 1R.go / ems Sale' 6. DHHS APPROVAL . ;t� � y Approved for bedrooms byZe2Date �_ Approved _—_X___ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health 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 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. 7/88) Back Page 2 Of 2 MUNICIPALITY OF ANCHORAGE (MOA) • g I)h#rity Approval (HAA) '�'N�L`�Y r C!C EBRUARY 1984 .Rory:n�r�r;�343 4744 6 �•� � ?o'C1 Legal Description: ,C � � .��/�GJo owls ° ;, E C �E V E [) A. WELL DATA If A, B, C, D.E.C. Approved &) , 2GZ°`l Well Classification Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouti Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring i nduit (Y/N) Depression Around Wellhead (Y/N) — SEPARATION DISTANCES FROM WELL: i To Septic/Holding Tank on LotZO; 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 OhoSiD a B. SEPTIC/HOLDING TANK DATA Date Installed 6 Z/ a Size 1ZJT No. of Compartments Z Standpipes ®/N) Air -tight Caps I) Foundation Cleanout ON) Depression over Tank (Y6) Date Last Pumped /t)a,,i Pumping/Maintenance Contact on File (Y/N) / JCA ; for �1/� N/ Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well Zoe To Building Foundation U To Property Line To Disposal Field r' To Water Main/Service Line r To Stream, Pond, Lake or Major Drainage Course �O Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed .Alzg0 Width of Field .3--5- Type of System Design. Length of Field So7'S'� Depth of Field // Gravel Bed Thickness ry Square Feet of Absortion Area Statndpipes Present (9N) Depression over Field (Y/) Date of Last Adequacy Test Results of Last Adequacy Test l✓/� SEPARATION DISTANCE FROM ABSORPTION FIELD: 7F -e-, �- New /f Yd To Water -Supply Well 2_ To Property Line `3 To Building Foundation Z/ To Existing or Abandoned System on Lot /JIA ; On Adjoining Lots i 30 To Water Main/Service Line To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course > /a0 i To Driveway, Parking Area, or Vehicle Storage Area ZS' Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Co (Y/N) Comments Dimensions Manhole/AcoesS-(Y/N) p 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 guidelinee�,iaq0 log the date of this inspection. 52 . Signed ,f Company Date/Y/g °°°'�°• n� is Seal MOA No. �� 1 U — O Z I % ROY C. REID, R, / CE -2251 i Receipt No. �o2 % p & 7 Receipt No. Date of Payment / ("' je�? Amount: $ % Z11" 0-6-1 Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION 7*773TER'.11 r)IF)TRI-T OrFICE 3601 C STREET, SUITE 322 ALAS:"A 99503 'F07: ABCs '%ttn: Sabra STEVE COWPER, GOVERNOR T,ugust 30, 1990 ?-,*7SID: :i!,'21359,:, 563-5775 �ccordin- to theL offth records on file in this ice, e Alpine 7-7oo�ls 1- L �2 T-7ater SySte;-p. iS in compliance ith the State of Alaska Drin".,Ln- 1.,7 a t e r ?,,e g u I a t I o n s Sincerely, Ll VTI,TaA 17. RZA I C 7nviron-iaontal Spe(c'-list V 17,C STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE A. APPROVAL TO CONSTRUCT for PUBLIC WATER SYSTEMS Plans for the construction or modification of RL I`F1 1) e AJ 00 0 S UJ A I -E public water system located in ;t 1V C 14 io IZ d -r , Alaska, submitted in accordance with 18 AAC 80.100 by / 9 %(c IC N Y Mhave been reviewed and are ❑ approved. �( conditionally approved (see attached conditions). Additional pump tests be oned o wells 113 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 "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. p(�US a� 3 S The construction of the RL PI NV 14) 0,0D 9 4014 % Eft I'M P public water system was completed on FCb 1, wet ry 1 , / q ?' 7 (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 s stem was constructed according to the approved plans. The system is hereby granted final approval to op te. 4 L Q'.. B TITLE DATE DISTRIBUTION: t. WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEER/MUNI-BOROUGH (Complete Section C)