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HomeMy WebLinkAboutALPINE VILLAGE BLK 2 LT 16 iSSLi • Municipality of Anchorage On -Site Water and Wastewater Program < (907) 343-7904 5 a E T Y Certificate of On -Site Systems Approval Parcel I.D. 014-132-34e_— 0 i-- 2 Expiration Date: 1. GENERAL INFORMATION: Complete legal description ALPINE VILLAGE; BLOCK 2, LOT 16 Location (site address) 7227 Bem Street *Anchorage 99507 Current Property owner(s) John Cotner Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer 9 WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 1 Waiver Fee $ Date of Payment ' J Z 2_ Date of Payment Receipt Number Receipt Number COSA # O S C a a o �I Waiver # QVI 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. - • - �LilIilIl�1r1��LRtling ?JIMEM11 • Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: ZI14'-z-? In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system In accordance with the guidelines and regulations established by the Municipality of Anchorage and �0000O pO Industry practices. The reported results describe the condition of the systems on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or o �C encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and l �t. ' �) workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and """"" .. ' are outside the control of GEG. Satisfacto test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of .... .• • . • • • • •/J the well or septic system. GEG makes no representation whether an alternative well or septic system G" .Je can be installed on the property in the event either of the current systems fail to perform adequately in ' the future. The content of this report is for the sole benefit of the person/party that retained GEG toi— .iO� � E perform the evaluation. Reliance upon the information provided in this report by any other person or �� r9r �'f 'f Z V party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatcnnvar #AECC884 6. DS SIGNATURE l kkk(V(((((( System #1 Approved for bedrooms \�QP �SY System #2 Approved for bedrooms \ ON-SITE Disapproved = g WATER AND R'' Conditional approval for bedrooms, with the following VW0IaWA Tr V"ATER Z J� PROGRAM Original Certificate Date: 2 r i � `-2 7 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other qJ COSA Checklist Legal Description: Alpine Village; Block 2, Lot 16 Parcel ID: 014-132-34 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 4.8+ gpm mate drilled P-1982' ' �aterstorage-tank--vofume-- gallons Total depth *87 ft Well disinfected for coliform test? ❑ Yes ❑■ No Cased to Unk ft [Coliform bacteria is Negative Q Sanitary seal is functioning correctly Nitrate mg/L Nitrate less than MRL (ND) Wires are properly protected Arsenic C � ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by GEG,LTD. Date of flow test for COSA 7/31/21 Date of Sample 211/22 Static water level at beginning of test 34.2 ft Comments *Per 1986 HAA 2022 RE -ISSUANCE B. TANK DATA Age of tank(s) years Tank type/material Me red operating fluid level in septic tank ❑ Standp s/foundation cleanout per record drawing Date of DumDina 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 Comments/Deficiencies: Public Sewer -2022RE-ISSUANCE COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑Pass For bedrooms Fluid depth prior to test in Water added gal New dbWh in Elapsed timemin Final fluid depth in Absorption rate g"' Any rejuvenation treatment (past If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) if No ft ❑ Yes Septic Tank/Lift Station on Lot > 100' NSA Community Sewer Manhole/Cleanout > 100' ❑ Yes [7Yes if No ft M Yes if No ft Neighboring Tank > 100' 21 Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No *unk ft Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields _>_f0 Animal Containment > 50O_Yes if o ft F-11 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Yes if No ft Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Fo ations > 10' ❑Yes if No ft Surface Water > 100' ❑Yes if No ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' ❑ Yes if No ft Water�Main > 10' ❑ Yes o ft - Community Wells > 200' ❑Yes if No ft Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less n required) Building Foundation > 10' Property Line > 10' Water Main > 10' Water Service Line > 10' Surface Water > 100' ❑ Yes if No ft ❑ Yes if No ft ❑ Yes if No ft ❑ Yes if No ft ❑ Yes if No ft If a Wells on field is under driveway comment below Private Wells > 100' Community Wells > 200' ❑ F. ENGINEER'S COMMENTS Public Sewer CA *Not able to locate FCO on property -2-c_;' ps�-,-9 2022 RE -ISSUANCE 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. COSA Checklist yellow sheet Yes if No ft No ft #AECC88A 1�e M U H CIPAL� T Y OF A HCH 0 RA GE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC221047 Subdivision: Alpine Village, Block 2, Lot 16 907-343-7904 Fax: 343-7997 _ _ A water sample revealed an arsenic concentration of 10.9 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 014-132-34 1. GENERAL INFORMATION: Complete legal description Alpine Village; Block 2, Lot 16 Location (site address) 7227 Bern Street *Anchorage, AK 99507 Current Property owner(s) Sharon Tucker Mailing address Real Estate Agent Expiration Date: _ If -?Y-2-1 7227 Bern Street 'Anchorage, AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 907-947-5756 Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer WaiverNariance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ a" Waiver Fee $ Date of Payment $ a0 a 0 2 % Date of Payment Receipt Number _021076 Receipt Number COSA # 0 S C a 1 1 rJ d 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systemis on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systemis; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with #AECC884 (op O/y_S�T o n ttf_Z: i, l�l�iQR m^ o OGS JJ , ---,J,i�)�sFRVICEs�.�� ) l,)))1 1� Original Certificate Date:_S-Z `t ^� 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc Legal Description: Alpine Village; Block 2, Lot 16 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Pret9927 Total depth *87 ft Cased to Unk ft ❑ Sanitary seal is functioning correctly OR Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 7/31/21 Static water level at beginning of test 34.2 ft. Comments *Per 1986 HAA B. TANK DATA Age of tank(s) years Tank type/material Me red operating fluid level in septic tank ❑ Standp s/foundation cleanout per record drawing Date of pumping 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 Comments/Deficiencies: Public Sewer COSA Checklist yellow sheet Parcel ID: 014-132-34 Structure served by this system 1 Well production at time of test 4.8+ gpm Water storage tank volume - gallons Well disinfected for coliform test? ❑ Yes Al No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic 9.61 ug/L ❑ Arsenic less than MRL (ND) Collected by GEG,LTD. Date of Sample $/2/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑Pass For bedrooms Fluid depth prior to test in Water added gal New h in Elapsed time min Final fluid depth in Absorption rate gp Any rejuvenation treatment (past onths) If yes, enter date 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' NSA Community Sewer Manhole/Cleanout > 100' ft Property Line > 10' ❑ Yes if No ft � Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No *unk ft Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft Fv� Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Yes if No ft Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Fo ations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes o ft Community Wells > 200' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if 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 n required} If absorp ' field is under driveway comment below Wells on Adjacent s: Private Wells > 100' Community Wells > 200' F. ENGINEER'S COMMENTS Public Sewer *Not able to locate FCO on property -z �5 '-- P6�-P- co. t? 4ap G. ENGINEER'S CERTIFICATION l certify that f 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. COSA Checklist yellow sheet Yes if No ft ❑ Ye if No ft J re Go ess., CE 79 3 `' a�4�e71. zE. �,_rofesslo�'c—o #AECC884 vJ U h- CY7 0 O?U3 c6 m w caco 0 ��' v( Q �= 00 -EP Q 'N a G d O m N CD Q m f oN w a� m v° 0� or - (a n c� .L.. m '� ..�.. 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Uao y o°N o m oo o�mo a U) U U U U U u - w L) co z�L) w>U1-c)zUNCO0 Co �(jJ ¢¢UUUUUUow522an.0 0) > 0 J Cn AT SE .rl- z 00 N SEWER INSPECTION REPORT m 0 m D Z m � m D ro - za 0- m i z0+ z a b -- i 0 I 0 r o m D -� z z u N C k D -Oi N � D -DI I� D f � o r o------------ r — r 0m z z� I� m o z< y pm { z z ur �x m m I IV r 0 -mi M0r0 ro Il 0 0 0 r o m D -� z z u N C k D -Oi N � D -DI m I C f � o r o------------ r — u } w J d w w N N D 0 z d w J U IN Uw J �eI Nz wd z J0 wa >z cc0 W �w m0 w Z w0 rn p d U 0 J 0 I U) 1a0d3a N01103dSNI 83M3S M 3 z f w� a } Z �o , (0 �} 0 I m o. w d 0 W W " W w z a N 0 0 V) m U U z w� i d' 60 Z z Q S � IL Q d � w 0 { ' 1a0d3a N01103dSNI 83M3S M 3 z f w� a } Z �o , (0 �} 0 I m o. w d 0 W W " W w z a N 0 0 V) m U U z w� i d' 60 Z z 1a0d3a N01103dSNI 83M3S M 3 z f w� a } Z �o , (0 �} 0 I m o. w d 0 W W " W w z a N 0 0 V) m U U z MUNICIPAL►T; OF ANCHORAGE SEWERQ/� �� ^ tif£RGSpwf CONNECT PERMIT Vi r f�. ��'•' �. U�r DATE OF APPLICATION 5-1 a -t34 tiC/� OR! of AdSCHEDULED COMPLETION DATE 5-19-84 WATER & WASTEWATER UTILITY L1 SINGLE FAMILY 3000 ARC C VARD PHONE (fi�Z 786-5557 C MULTIDWELLING yy No, APTS LOTITfiRyyR 1 C COMMERCIAL BLOCK 2 0INDUSTRIAL SUBDIVISION Alp.Ane Village TAX CODE 014-132731IGRiD 2133 DRAWING No. New BUILDING ADDRESS Bern OWNER ' �-�3-` It � p�,,_ r A' (11 iPNONE MAIL ADDRESS r r CONTRACTOR:DLW Cont, Inc. (License & Bond required) VON PROPERTY ONLY C. MAIN TAP—TO PROPERTY LINE ONLY (MOA or State ROW Permit Required) 0 MAIN TAP & ON PROPERTY CONNECT (MOA or State ROW Permit Required) ASSESSMENTS 0 Paid previously 0 Main extension agreement 0 Subdivision agreement 0 Extended connect agreement 0 Pending—AMOUNTS LID#135 CONNECTIONSIZE 4" CHARGES IPERTins INSPECTION FEE S 10.00 j1 PAID CASH PERMIT FEE S 5.00 / t CK✓i t REIMBURSIBLE INSPECTED BY: NUMBER DEPOSITS TOTAL $ 15.00 DATE:, f ncmnnrw: PERMITTEE (Please Print) DLII CONT, MAILADDR. 248-5083 PHONE_ I HAVE READ THE CONDITIONS AND REGULATIONS ON THE REVERSE SIDE OF THIS PERMIT AND AGREE TO COMPLY WITH THEM P,EAMITfEE SfGNATt1RE POST IN A CONSPICUOUS PLACE AT THE JOB SITE 821 npd2) r AnU INSPECTOR MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~(~v..'~ ~,~l-l~.~,~t~._.~ Telephone: Home Business Applicant Address "7'Z'~-''~ ~:~,¢~ ~, ~)~,~Jw~b.¢~-~ (~;:~---, ~L%'O? (c) Applicant is (check one): Lending Institution []; Owner/builder ~; Buyer []; Other [] (explain); (d) Lending Institution .~/t"L% "/" ~ //V[C/~ Address (e) Real Estate Company and Agent Address Telephone (f) MailtheHAAtothe~addrt~ ~[ic~c:~/.~_' TYPE OF RESIDENCE Single-Family [~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well,]~. Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [] Public J~ Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 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 tills ~ealt~ 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 o! 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. NameofFirm '~;;~.'¢-._~E.,'l~'~ '4~r'~:~)~'"~r-3 Telephone Address ~Z~ Date ~- ~ Engineer's Seal Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MO~.~ MUNICIPALITY OF ANCHOP. A4EiALTH AUTHORITY APPROVAL (HAA) DEPT, OF HEALTH & CHECKLIST- FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264'4720 gE EIVED MAY 2 ~? 1986 Legal Description: Well Classification ~ Well Log Present (Y/N) Total Depth ~'7/ Cased to Static Water Level Casing Height Above Ground ~ '~' ' Electrical Wiring in Conduit (Y/N) Separation Distances from Well: TO Septic/Holding Tank on Lot ~'-_/~ To Nearest Edge of Absorption Field on Lot If A, B, C, D.E.C. Approved (Y/N) ~,~P~.~-~ Date Completed (~ y.. I~ Yield' ~ Depth of Grouting Pump Set At ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead · On Adjoining Lots ~'~ ~.~[ ; On Adjoining Lots To Nearest Public Sewer Line ~>o k-l-- To Nearest Public Sewer Cleanout/Manhole ~ c>C>'-k- To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments Date Installed Standpipes (Y/N) De pression over Tank (Y/N) SEPTIC/HOLDING TANK DATA / Size No. of C~partments / Foundation Gieanout (Y/N) Air-tight Caps (Y/N) /~ , Pum ping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Hold~g Tank: To Water-Supply Well / To Property Line To Water Main/Service Li~ / Course Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026t11/84) .: C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System ~sign Date Installed Length of Field ,/' Width of Field Depth of Fi~_ Gravel Bed Thic/k'ness . Square Feet of Absorption Area __ St~dpipes/Present (Y/N) Depression over Field (Y/N) .~te of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field:~ To Water-Supply Well ~ To Property Line To Building Foundat on //' To Existing or Abandoned System on Lot ' // ;On Adjoining Lots To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D, LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments /Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA / ** Check Permitted/l~edroom Rating Against HAA Request ** / I certify that I ha¥(~ checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No. Receipt No. 5 ~'~/~;),~ ~" Date of Payment ,~/.~ Amount: $ Page 2 of 2 72.026 (11/84) BESS'-, EPP$ & POTTS 2220 FAST 88 AV~FJa ANCHC~AGE, AK 99507 (907) 349-645]. WATER I,lZLL TF_.ST Doc~on: Client's Name: Address: Initial Reading un Meter: pr~-h,ction Ratn: 5.\k GPM 24-Hour CapacitYt~7~C~l]ons SURVEYQR':~ CERTIFICATIQN' I HEREBY CERTIFY THAT I HAVE BURVEYED THE PROPERTY DESCRIBED ON THIS PLAT IMPROVEMENTS ~ITUATED LEGEND o LOT CORNERS FOUNDATION DRAINAGE ARROWS NOTES: I. IT SHALL BE THE RESPONSIBILITY OF THE BUILDER. OR OWNER TO VERIFY THAT BUILDING LOCATION SHOWN MEETS ALL SUBDIVISION COVENANTS AND ZONING ORDINANCES, IT IS THE RESPONSIBILITY OF THE BUILDER TO VERIFY ALL ELEVATIONS WITH RESPECY TO ALL UTILiTiES, THIS PLAT REPRESENTS THE PARCEL OF PROPERTY DESCRIBED BELOW TAKEN PROM THE RECORDED PLAT DESCRIBING THAT PARCEL. INSTRUMENTS RECORDED PRIOR TO OR AFTER THE FILING OF THE RECORDED PLAT ARE NOT SHOWN ON THIB PLAT. THE INFORMATION ON THIS PLAT 18 FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS ) THE PLAT IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCES. BESSE, EPPS POTTS 2220 E. 88th. AVE. 349-6452 ANCHORAGE, ALASKA 99507 349-6454 DRAWN BY~ ~.~', SCALE~ )~ = '-'/? C-C I DATE, 7 /': '; /.A'~-"-- FLD. BK. s NO.