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Home My WebLink AboutALPINE VILLAGE BLK 1 LT 3AAlp ine Village Block 1 Lot 3A #014-131-24 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. -? i ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99§01 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION IWell J Absorp~ Dwelling PERMIT NO. ~ DISTANCE TO: ~ ~h ~ ~ t ~ '~ ~C) a Well Foundation Nearest lot line ~-- PERMIT NO, ~ No. of lines ~ " (oX ~g inches ~ Top of tile to flnlsh grade ~)t O'? Material beneath tile ~9¢ inches ~ Well~ ~ ~O ~ Building foundation Nearest lot line ~ DISTANCE TO: Glass ~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER APPROV~ ;,1 ~-'. , DA"E ~ LEGAL 72-013 {Rev. 3/7g) r.._0n:5.I- UC' Ron F-5 "One -:Y is t ✓Y} c thcutund r.C:r.iarts" 2204 Cleveland_ Anchorage, Alaska 99503 JRA�l= (J 4r 5'i C L '1E P e r f o r m e d F o r Pastor Zerbe '(a b-1-e—T-Pu-th_Cesp�1S_h�.f� a P r e r f o r m e d 7-18-78 leeal Oescri nti on: Lot 3A B1 ocl:1 Subdivision Alpine Village Subdivision This Form Reports Soils Loq Yes Percolation Test_ Yes nenth Feet Soil Characteristics b-LacR Peat & Oranics 2 Kec f i sh Si d — Tan Fine Silty Sand 6 — 8- 10- 12- 14 0- 12-14 16— Bottom of Test Hole 4 18- 20— Was Ground Water Encountered? No If Yes, At what Depth? v ' 0 — P I Readinq Date 7-19-78 Gross Time P'et Time Depth to H2O t;et Dron' -- r 10 10 y' 911 20 30 10 10 9I18"' 13 _L4" 1 3 -/BL" 40 10 I151T _' 50 10 60 10 1 " 11211 I - Percolation Pate 1"/20 Minute Proposed Installation: Seer,ace Pit Drain Field Depth of Inlet Depth To Bottom Of Pit Or Trench — Cr-►•',t"ENTS: TiYfjate of exi-ting cTGtam_ per olatj'ap rate is 210 S.F. per bedroom per actual percolation test. Test Performed ByNeal HausamData Certified Q.y:_ CTL _ D a t e: 7-19-78 "O.e ~s~ is Ivo~h a lJ~o~$and o~nion$" Shee~ ~ of ~0, No, O~e~or~c~ C].ien~.Grac? Baptist Church Pro]ec~ Seepage P~ ~it for Home F3~J2T SYSYBM ] DATA ]£GEND Silty Sandy Grs~.el, moJsL. Grave]. 6 ? 9 '~4' Thin Layers ol.',silts· sand bottom of test hole.(SM)' Silty Sandy Gravel, moist (OW-SI4) -'~ 8O Bottom of Test Hole No bedrock or water table 4 f ;' below seepage pit, 200 sq. ft. drainage area required per bedroom Sand Clay Organic ~ontent Fros% WaSer Table ANCHORAGE AREA ~.~]I~I~J~ Department of Environmental Quality ' '~__-~'- 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~'P-/-MJ:T /~/~P~-/.~7- /~<z/cCf/MAILING ADDRESS PHONE SEPTIC TANK: DISTANCE FROM WELL MANUFACTURER INSIDE LENGTH INSIDE WIDTH ~-/-7¢/~ ¢ .~C'?"~-~'~]-A T E R i AL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY /g~-¢~ GALLONS. SEEPAGE PIT: NUMBER OF PITS / LINING MATERIAL BUILDING FOUNDATION__ ADDITIONAL ABSORPTION DIAMETER __ OR WIDTH CRIB SIZE: DIAMETER__ NEAREST LOT LINE__ LENGTH DEPTH DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) .SQ. FT. WELL: TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED. . DISAPPROVED. NEAREST SEWER LINE REMARKS DEPTH SEPTIC TANK DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PiPe MATERIAL: LOT SLOPE: REMARKS: 1~] s ~ovc~ Form NO, EQ-03~ DATE G.A,A,B, .x GREAT,:.,~ ANCHORAGE ARF=:A BOROUGH - -- SEWAGr- DISPOSAL. SYSTEM -- APPLICATION AND PERMIT 5 fro FOUNDATION TO S[:EPAG£ PIT. 20 ft, DRAIN FIELD .FypE~):gj~ICI'~_tl~sEEpAGE AREA SIZE SEEPAGE PiT 20 fi, D,AiN FIELD. 10 ALSO CONSIDER AREA WELLS. 50_ ft. SEPTIC TANK 'ro N~ARES= ~-o'r WELL TO SEPTIC TANK WATER MAIN TO SEPTIC TANK DRAIN F,~LD 10 ft. ~=,c TAN~. 25 TYPE G ~ ~ £xceva[ors 7326 Zurich Anchorage, Alaska 99507 ^~n: Gary Hunsaker Subject: Grace Baptist Cl~urch Parsonage Lo: 3A, ~lock~, Alpine ¥111age Subdivision As ~e discussed tn my office today, the se~er installation at subject property will ~ued a full inspection ny this The permit issued by ~his office dill be valid for ~y ,)uly 1, 1973, this Departr~nt ~tll require ~he following: I. 6vidence of a soil tes~ by a licensed soil tester. This test is to be run Just beyond the boundaries of the seep- age pit. If the soil test is greater :i)a~ :he the installation will be cbnverted Lo a holding .t~nk maly (minimum 20DO g. Upon sattsfac:o~ soil test ~sults, ~e ~ill roquire th~ installation b~ un~overid to s~o~ five (5) feet cfi b. 3, ~ will ~quire, at the ~lt~e of fir)al i)~spectto~)~ a signed State--n: fro~ you as ~o the ~tze of U~e pi~ and the lini~g ~)ank you for your cooperation In bringing t~is tns~llatio~ into confo~nce with existing ~o~ugh regulations. Sincerity, Susan £, Dtckerson Sanitarian mld cc: Grace Baptist Church 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 Parcel I.D. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FORA SINGLE FAMILY DWELLING 014-131-24 1. GENERAL INFORMATION Complete legal description Lot 3A, Block 1, Alpine Village Location (site address) 7226 O'Brien Street Anchorage, AK COSA31 Expiration Date: —� " / 2 Current Property owner(s) Patrick and Susan Fogarty Day phone 632-4597 Mailing address Lending agency Mailing address Real Estate Agent 205 E. Dimond Boulevard #500, Anchorage, AK 99515 Mailing Address Unless otherwise requested, COSA will be held by DSD For pickup. 2. NUMBER OF BEDROOMS: Four (4) Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well✓❑ Individual On-site ❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System n Public Sewer 0 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Phone 522-7773 Date 6/1912012 'oter..r 1,16f . % Of A. + ANDGWN 5. DSD SIGNATURE -0,so 41 �. C6*4381 t � Approved for bedrooms. •j�'f4• ..; ..•'� Disapproved. ,+MtiRi��S�� 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: IVOriginal Certificate Date: (Rev. 11105) Municipality of Anchorage e Development Services Department` Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 3A, Block 1, Alpine Village Subdivision Parcel ID: 014-131-24 A. WELL DATA Well type Private If A, B, or C provide PWSID # _ Well Log (YIN) Y Date completed 7/24178 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 107 ft. Cased to 107 ft. Casing height (above ground) >18 in. FROM WELL LOG AT INSPECTION Date of test 7/24178 8119/12 Static waterlevel 52 ft. 38 ft. Well production 20 9.p-m. 13 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate N/D mg/L Arsenic: 12.4 ug/I Date of sample: 8/8/12 Collected by: J. Berkram B. SEPTIC/HOLDING TANK DATA Tank Type/Material AWwU Sewer system Date installed Tank size gal. Number of Compartments_ Cleanouts (Y/N) Foundation cleanout (YIN) _ Depression over tank (Y/N) _ High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./fe or ftz/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring tube _ Depression over field _ Date of adequacy test Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test in. Water added_ gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at_ in. "Pump off" evel at_ in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot NIA On adjacent lots NIA Absorption field on lot NIA On adjacent lots NIA Public sewer main 4T Public sewer manhole/cleanout >low Sewer /septic service line >25' Holding tank N/A Animal containment areas >50' Manurelanimal excrete storage areas >100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line _ Absorption field Water main Water service line Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Surface water Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS: Lot is Served by AW WU Sewer System. Well was in Place Prior to Sewer Main Construction in 1982. See AW WU Sewer Main Record Drawing. _��1�i♦ . 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. Engineer's Printed Name Michael E. Anderson, P.E. Date 6/19/2012 COSA Fee $ LLb:: /1 Date of Payment �D`f 11 -, Receipt Number (JQ Tta 9 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 49m i f8fE55tt Municipality of Anchorage ez Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 121231 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 3A of Alpine Village Subdivision. This inspection revealed an arsenic concentration of 12.4 micrograms per liter (ug/L) for the property's well water sample. 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. 4 fi PL t --PZA. N...- -- �OF A ( � . PRQSd4T SGwB�y49f0� y'�*f � ti T — Uf►'Ft. FCaaR.-._ -soR1. uE°WNo7° T QAs/3 of FLEVRT/oNs Na 91YS-3 ij`k S, tee; COAMER MUMED S'OOJZ Nck, fQfV/SBO // S-tST ADDED Wzaj AS'T BIRT t tFNCor ot S'MW. L.B. 1112112 s.wn.r rr �.•�•+� 4k11O,?AGC ACD, VI*Sr hi E[ wG7' � ....�►�� .COT -9A, SLOGK 1 Gnvwfil• /N. �a AGP/NE viccACE Su4o. Municipality of Anchorage P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program Department **** VARIANCE/WAIVER REVIEW **** Waiver#: OSPI21156 COSA#: Permit#: PID#: 014-131-24 Legal Description: Alpine Village, Block 1, Lot 3A Engineer: Anderson Engineering Applicant: Current Owner Your request for a waiver of the required 50 feet horizontal separation from the public sewer trunk to the private well has been approved. The approved separation distance is 42.0 feet. This waiver approval applies to the existing public sewer trunk only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ..............................................................................I Waiver is Granted: X Waiver is not Granted: Date: (Old .2 /01 Approved b Name of Reviewer ....................... e...............a .. ...................... a........... Rec#: NIA Amount: $0.00 Date Paid: NIA **** VARIANCE/WAIVER REVIEW **** ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 June 22, 2012 �sf /021 I S(p �d C kA yf Municipality of Anchorage ---a - Development Services Department On -Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Attention: On Site Services Engineer Subject: Lot 3A, Block 1, Alpine Village Subdivision Separation Distance Waiver Well to Sewer Main Dear On Site Services Engineer: The existing well on Lot 3A, Block 1, Alpine Village Subdivision is 42' from the sewer main fronting the property. The well, constructed in 1978 was in place when the sewer main was constructed in 1982. A waiver should have been obtained by AWWU when the main was constructed. No waiver is apparently currently in place. We are therefore requesting the waiver be issued to allow the well to remain in its current location. The well on Lot 3A is 107' deep with casing the entire depth. The well is drilled through what appears to be silty sand material with silty clay lenses at 64' to 105'. The static water level was found at 52' below the surface. The sewer main is constructed of ductile iron pipe with no evidence of leakage or deterioration. The original ground surface on the lot slopes from the well and toward the sewer main at an approximate 2% slope. We assume the water gradient slopes away from the well at a slope similar the original ground surface. A recent water quality test taken from the well indicated no detection of nitrate content. The absence of nitrates would indicate no contamination of the well water from sewage effluent from the main. No coliform or bacteria was found in the water further indicating contamination is not present in the well. Lot 3A, Block 1, Alpine Village Subdivision June 22, 2012 Page 2 of 2 Attached are the well log, water quality results and other drawings showing the proximity of the existing sewer main to the well. We hereby request the waiver be issued and the Certificate of On Site System Approval (COSA) be approved. Sincerely, (2c, l Michael E. Anderson, P.E. Attachments �P•• 49th _••°.� MICHAEL E. ANDERSON No CE -4381 SGS SGS Ref.# 1122166001 Client Name Anderson Engineering Project Name/9 7226 O'Brien St. Client Sample ID 7226 O'Brien St. Matrix Drinking Water Printed DatefTime 06/18/2012 14:41 Collected Datefl'ime 06/08/2012 15:52 Received Date/Time 06/08/2012 16:20 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Units Date Date hat Metals by ICP/MS Arsenic 12.4 x 5.00 ug/L EP200.8 C (d0) 06/14/12 06/15/12 NRB Waters Department 'Total Nitrate/Nitrite-N ND 0.100 mg/L SM21 4500NO3-F B (<10) 06/13/12 AYC Microbiology Laboratory E. Coli Negative I Mail- SM21 9223B A 06/08/12 DLC Total Coliform Negative 1 IOOmL SM21 9223B A 06/08/12 DLC MUNMWAUTY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 014-131-24 1. GENERAL INFORMATION ExpirationDate: Complete legal description ALPINE VILLAGE BLOCK 1, LOT 3A Location (site address) 7226 O'BRIEN STREET, ANCHORAGE, AK 99507 Current property owner(s) WILLIAM L. STRINGHAM Mailing address Real estate agent Day phone 7226 O'BRIEN STREET, ANCHORAGE, AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 2160 Date of Payment a Receipt Number % 13 20 V Date: Waiver Fee $ Date of Payment Receipt Number COSA # OS C 2 I 109 2 Waiver # Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 2/22/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to , +` OFAsll1 these various and dynamic characteristics and are outside the control of the evaluator of the - well and septic system. Therefore, any estimate of how long a system will function satisfactory g�P• • . 'F,9,�r for current or future occupants or guarantee that no unseen encroachments, deficiencies or f J 49 discrepancies exist can be given by First Water Consulting & FWr.S- *TH 6. DSD SIGNATURE �r •. Curtis Huffman System #1 Approved for bedrooms %O�� •, CE 128991 •,�� iTFR/22 System #2 Approved for bedrooms 1��\\\ESSO�� Disapproved Conditional approval for bedrooms, with the following stipulations: `SY `ll��l (�f (6, A. Vc y0i_ � -SJTE WATEJ? A dam m WAS Tr:V ATER z rtNUGRAM s o, SFR\JIG�� • By:1111, F" Original Certificate Date: 3" 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 SA Checklist Legal Description: ALPINE VILLAGE BLOCK 1, LOT 3A Parcel ID: 014-131-24 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 7/24/1978 Total depth 107 ft Cased to 107 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 2/24/21 Static water level at beginning of test 49 ft. Well production at time of test 6+ gpm Comments B. TANK DATA - NA Age of tank(s) _years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA - NA 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: Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic 7.76 ug/L ❑ Arsenic less than MRL (ND) Collected by F Date of Sample 2/24/2021 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 depth _ in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Fl;1�; 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 Community Sewer Manhole/Cleanout > 100' ❑ Yes if No NA ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ❑ Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No *42 ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ft ft ft ft ft ❑ 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 Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No 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 than required) Building Foundation > 10' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No —ft Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS *SEE MOA RECORD DOCS —1978 WELL IN PLACE PRIOR TO 1982 SEWER MAIN. G. ENGINEER'S CERTIFICATION 1 certify that 1 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. 4�OF AW / ......... .. • • . .... .. • .. • • .. . Curtis Huffman �� °F�•, CE 128991AM • �� i }�1\:-ROFESSIDNA—�— ft ft i Lot 7 10' UTILITY '1___rEASEMENTS Lot 5A CHAIN-LINK FENCE --L .2' ^y. S ,, yFo A Ili ::fl 1 18,012 S.F. CP O O 25.4' i Lot 2 I 30.0' '. N 89'59'E 120.00' r.'. O ' v 2 rri 01 °�• 5.0'x21.4' O 1 CONCRETE PORCH O a�STp� No eT F T 6.3'x13.4' DECK am S 89'59'W 120.0 CHAIN-LINK FENCE Unsubdivided NOTE: DRIVEWAY LOCATION APPROXIMATE DUE TO SNOW & ICE COVER. 20.2' 2.0'x5.7\ CANT +\ /—WELL I AN PLOT PLAN _—_ AS BUILT _X_ SCALE _1___ 30__ GRID _ SW 2133Project No. 21-097/1_ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associatesinc. (907) 522-6476 Phone 9(907) 522-4625 Fax 0 F �oo�� Professional Land Surveyors ken®longsurvey.com v p Jonathan®langsurvey.com I hereby certify that I have surveyed the following described property: �11"K 'V LOT 3A, BLOCK 1, ALPINE VILLAGE SUBDIVISION (PLAT No. 72-130) p 49TH . .............. Anchorage Recording District, Alaska, and that the improvements situated thereon are �•'� within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed �' KENNET G premises and that there are no roadways, transmission lines or other visible �Q �`�, easements on said property except as indicated hereon. 's�. ZS 2( •.L —5202. SJ�� Dated this the _ Z5Day of P_v2�r�+� --_--, 202_, at Anchorage, Alaska 0 0 T 4QORop'- 0NA4 �6c� It is the responsibility of the owner to determine the existence of any easements, 044SION4 covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 •. J N O ' v 2 rri 01 °�• 5.0'x21.4' O 1 CONCRETE PORCH O a�STp� No eT F T 6.3'x13.4' DECK am S 89'59'W 120.0 CHAIN-LINK FENCE Unsubdivided NOTE: DRIVEWAY LOCATION APPROXIMATE DUE TO SNOW & ICE COVER. 20.2' 2.0'x5.7\ CANT +\ /—WELL I AN PLOT PLAN _—_ AS BUILT _X_ SCALE _1___ 30__ GRID _ SW 2133Project No. 21-097/1_ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associatesinc. (907) 522-6476 Phone 9(907) 522-4625 Fax 0 F �oo�� Professional Land Surveyors ken®longsurvey.com v p Jonathan®langsurvey.com I hereby certify that I have surveyed the following described property: �11"K 'V LOT 3A, BLOCK 1, ALPINE VILLAGE SUBDIVISION (PLAT No. 72-130) p 49TH . .............. Anchorage Recording District, Alaska, and that the improvements situated thereon are �•'� within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed �' KENNET G premises and that there are no roadways, transmission lines or other visible �Q �`�, easements on said property except as indicated hereon. 's�. ZS 2( •.L —5202. SJ�� Dated this the _ Z5Day of P_v2�r�+� --_--, 202_, at Anchorage, Alaska 0 0 T 4QORop'- 0NA4 �6c� It is the responsibility of the owner to determine the existence of any easements, 044SION4 covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 •N'' 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) i Location (address or directions) (b) Applicant Name Telephone: Home Nu Jc Business sP�Nlr- ?�l l�f� i +� Applicant Address -, � –o— Q/ (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder O ; Buyer ❑ ; Other ❑ (explain); - (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address 'r ° '� `xj" Telephone (f) Mail the HAA to the following address: 2. TYPE OF RES,/ I.D,ENCE Single -Family kd Multi -Family ❑ Other Number of Bedrooms 4 — 3. WATER SUPPLY Individual Well Q'/ Community El 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 13 Public Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025(11,84) Page 1 of 2 5. ENGINEERING FIRM PROVIDING ..4SPECTIONS, TESTS, FILE SEARCH, DA), AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of thin I I«Filtll Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adet I) (Fite for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtrllIled from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply alld/ur wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effo(;l on the date of this inspection. Name of Firm 1W1i:iiH - Telephone8"Ya low" �' V57? <'�E' AAA race Date---?nr gi� Ab66 r•�;'oA�,% R e p^may R • P •• n••°.te A. Sh�iot i cW i �. 14574 'x;��p P1Are4�.�V�rp i� ms ante N �F Ahr 6. DHEP APPROVAL Approved for )Su& 19( bedrooms by Date a, ' Approved X Disapproved Conditional e- 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) iiI11t"CIPAUlY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF iHMIH & HEALTH AUTHORITY APPROVAL (HAA) EhIVtNOtENTK PROTECTION CHECKLIST - FEBRUARY 1984 NOV 0 4 264-4720 Legal Description: L 3A 6� D iA�Ln W. A. WELL DATA Well Classification SE. If A, B, C, D.E.C. Approved (Y/N) "'lA Well Log Present (PN) Date Completed Yield r Total Depth Cased to IC�l Depth of Grouting Static Water Level Z Pump Set At r., H Casing Height Above Ground �� Sanitary Seal on Casingd!bN) Electrical Wiring in Conduit&/N) Depression Around Wellhead (YZgE) Separation Distances from Well: To SapUG46@4 ing-Tank on Lot N P ; On Adjoining Lots p To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots / To Nearest Public Sewer Line SS '�` To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot S+_ Water Sample Collected by s " S ��Ut�� ; Date Water Sale Test Results.4r^T'1 SJ'� Comments �E�� L,,4"� as-N3yf1 i 14162 e' WrOV _16� -rft�s•� -st T� YLE�i� VZ�S L DSP. SS OCG Cavi B. SEPTIC/HOLDING TANK DATA Date Installed Size No -of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Water Main/Service Line To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Course Comments �.. � 1I.`�'T72 L'�x sg5!4,�_ �hr21 1�iA-tee• ) Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date ;Installed Width of Field Type of System Design Length of Field Depth of Field G av I Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) Depression over Field (Y/N) ate of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) To Driveway, Parking Area, or Vehicle Storage Area Comments Ccs' T`O �7�G-✓`-- D. LIFT STATION Date Installed Dimensions - Size in Gallons anhole/Access (Y/N) "Pump On" Level at 'Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked rif' r conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed I Date //-/-SJ Company PH.' 174 MOA No. 00 Receipt No. 2� e1. :, Date of Payment cam- • "' Amount: $ * Robarr A. 1457-F a Page 2 of 2 Q 3"*�® •"�G'th"" 72-026 (11/84) B~HmlnlPALITY OF ANCHORAGE MUNICIPALITg OF ANCHORAGE ........ Tie DEPT OF HEALTH & DEPABTMENT OF HEALTH & ENVIRONMENTAL PROTEg 825 L Street - Anchorage, Alaska ~9501 ~NVIRONM~NTAL P~OTE~ION ENVIRONMENTAL ENOlNEE ING DIVISION JAN Telephone 264-4720 ,.D,v. DuAL W TE. U DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER MAILING ADDRESS PROPERTY RESIDENT (if different from above) PHONE PHONE PHONE 2. BUYER PHONE 3. LENDING INSTITUTION ~ ~ ~ ~ PHONE MAILING ADDRESS ~ -- ~ , ~ '5~'~~ I PHONE MAILING ADD~ESS ~ - E. STREET LOCATION " "' 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One J~ Four [] Two [~], Five [] Three [] Six [] Other 7. WATER SUPPLY J~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June lg75, For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM J~ INDIVIDUAL/ON-SITE*~ [] PUBLIC UTILITY **If individual/on-site, give nsta at on dateC;~-~- (.~.~c.~z(-- If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72~)10(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LtTY Connection Varified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [~APP ROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY(~e) LEGAL DESCRIPTION -I 72-0l) Rev. 3/78