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HomeMy WebLinkAboutALPINE WOODS BLK 1 LT 6Alpine Woods
Block 1
Lot 6
#015-234-07
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191418 PID Number: 015-234-07
Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade
Name:
WILLIAM & MARY JACOB
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
6001 DOWNEY FINCH DRIVE, ANCH., 99516
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Fill added above original grade
Ft.
Gravel length
Ft.
ALPINE WOODS 1 6
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area z
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft
--
-- Ft.
Well
200'+
NA
NA
NA
NA
TANK ® Septic ® S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1500 Gal.
Surface water
100'+
NA
NA
NA
Material
HDPE
Number of compartments
2
Lot Line
5'+
NA
NA
NA
NA
Foundation
10'+
NA
NA
NA
LIFT STATION
Manufacturer
ORENCO / GREER
Capacity
1500 Gal.
Curtain Drain
NA
NA
NA
NA
Remarks Existing septic tank decommissioned
Pump on level at
82 in.
FROM TOP OF MH
Pump off level at
92 in.
High water alarm at
80 in.
per code, new tank installed 5'+ from &
connected to existing fields w/ valves.
Pump make and model
Franklin 2445040117 — 1/2HP
Electrical Inspections performed by
MOA
nk to
PIPE MATERIAL House to tank 3034 3034
Installer DENALI EXCAVATING
d ain field
Drainfield CO/MT 3034
Inspector FWCS / MNA
BENCH MARK (Assumed elevation) 100 ft
Inspdection 110/28/19 10/29/19
Location and description
2nd
3`d 4'h
BOTTOM OF SIDING
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
oe®'kNk
Conditional Approval:
Date
� ••
s * � 49 TH� * f
/ � •/
%MICHAEL N. ANDERSON.-
Tr No. CE 9469�'�
Approved &Lau, ADate
inspection r<epon_a- i- iz.aoc
ALPINE WOODS BLOCK 1, LOT 6
PID: 015-234-07
PERMIT: OSP191418
A -C=38.0'
B -C=22.2'
A -D=41.7'
B -D=26.1'
A -E=46.6'
B -E=32.3'
A -F=43.2'
B -F=34.0'
/-VALVES
SEPTIC SECTION
SCALE: NTS
PREPARED FOR: SUPPORT®SERVICES:
BILL & MARY JACOB Ar��� �F AL��
ALPINE WOODS BLOCK 1, LOT 6[WES r. y
F *
6001 DOWNEY FINCH DR., ANCH., AK 99516 * 49 TH
4K�
Michael N. Anderson P. E.�t MICHAEL N. ANDERSON
DATE: 11/11/2019 Q, No. CE 9469
4661 Natrona Ave. DRAWN: FWCS� 11./11/19'�'~��
Af
Anchorage, Alaska 99516 40
(907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30' 'OPESS10,0
E
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9/25/19
MV UM OF A UTY OF AHC HORAGE
Development Services Department 7 Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTICM/ELL PERMIT APPLICATION
Parcel I.D. 015-234-07
Property owner(s) JACOB & MARY WILLIAM Day phone 9072236429
Mailing address 6001 DOWNEY FINCH DRIVE, ANCHORAGE, AK 99516
Site address 6001 DOWNEY FINCH DRIVE, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) ALPINE WOODS B1, L6
Legal description (Township, Range & Section)
Lot Size 67,181 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
(w/wo AD U)
Septic Tank
®
Upgrade ®
Duplex (D) ❑
Holding Tank
ElRenewal
El
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes. FW
,GS
(Signature of property owner or authorized agent)
Permit/Rush Fees: //Aa5
Date of Payment: �7 Iql17
Receipt Number: 17 C�
Permit No. 655 tq lLjlZ
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
Michael N. Anderson, P.E.
Civil/Structural Engineering and Construction
4661 Natrona Ave. Anchorage, Alaska 99516
Phone 345 -3377 / Fax 345 -1391
Support Services
Brent M. Western
907-440-4601
September 18, 2019
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: ALPINE WOODS BLOCK 1, LOT 6
To whom it may concern:
The owner has requested we proceed forward to obtain a septic permit to upgrade the
aged septic tank on the subject lot. The proposed upgrade will serve the existing 4-
bedroom house.
The lot and area are served by public water. The proposed design will not impact any of
the neighboring properties due to the lot layout. Please contact Brent M. Western or me if
you have any questions.
Sincerely,
Michael N. Anderson, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191418, Rebecca Carroll, 09/25/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191418, Rebecca Carroll, 09/25/19
Municipality of Anchorage Page —L_ot_
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL'SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SWg7 0..33 PID Number: 015 - ASY - O 7
Name: R-L(,i4AiZp
Wastewater System: ❑ New Upgrade
Address:
6&0/
ABSORPTION FIELD
Phone:
No. of Bed ooms:
❑ Deep Trench Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade
.48 GPD/Sq. Ft.
Gravel depth beneath pipe
Lot: / Block: Subdivision:
Depth to pipe bottom from original grade:
(�ALPIN E xl6iilivo
Ft.
Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
10 Ft.
_
5Z . =t
WELL: ❑ New ❑ Upgrade
Gravel width:!_
Number of lines:
1
Distance between lines
ti Ft.
Z
1.5 Ft.
Classification (Private. A,B.C):
Total Depth:
Cased To:
Total absorptir,f, area:
Pipe material:
Ft.
Ft.
7.�'D SC. Ft.
RZO P9 ' 3 0
Driller:
Date Drilled:
Static Water Level:
Installer:
�.
Date int 11 d:
97t -
Ft.
/i /91
Yield:
Pump Set at: 77t.
asing Height Above Ground:
TANK
GPM
Ft.
SEPARATION DISTANCES
❑ Septic ❑ Holding ❑ S. T. E. P.
Tci
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
Well
;L0'0
o f
Z" +
Material:
Number of Compartments:
Surface
Water
Mo +
100
t o o t
LIFT STATION
Lot
Line
b0 f"
O
Size in gallons:
Manufacturer:
AN Ghl 14
Foundation
!
`O �'
O
"Pump on" level at:
tI ll
"Pump off' level at: High water alarm at:
r ! I
O
1 V
OAS"
Curtain
Pump Make & Model
Electrical Inspections performed by:
Drain
Q ea
Remarks:
BENCH MARK
Location and Description:
•-15,ftwt,
oTi o 1tt S N
m
Assumed Elevation: 0 .
ENGINEER'S SEAL
Inspections s
performed by: —_ Dates: 1 s�.
2nd.
Department of Health and Human Services approval
t .
Reviewed and approved by: _— Date:
A
♦ ♦1250 GAL ST
B
/ To D
♦ u DIVERTER ZD 200
/ as
DRAIN FIELD ♦ H / 500 GAL S TEP
2 5X52 �T /��
3FTD c
2 FT ROCK '"000
to 0000
INSULATED go19
K ♦ 000000 � /
1 i
to / SWING TIES TO TANKS AND BED:
/ F / AC 31 FT
BC 32
B' AD 40
9D 40
�� • A� 44
• ..................�, ♦ BT 42
/ SWING TIES rO TRE CHES: ♦♦♦` •,,/1♦ Au 63
�.•• \ •0 9 ♦ BU 57
FG / 108 FT Al � \ ♦♦ AS 80
?`N 127 s 49th [ 't BS 75
FK 113 �.... .. .......... ................s f
FL 130 /
70BB SPURKLANDAF
♦ ✓ •. No, CE -2225 •�
Wiskisk
"6ii 1111"1111111111111 111111111
25 0 25 50 75 100 125 150
SCALE- 1' = 50 FT,
TOBBEN SPURKLAND P.E. ALPINE WOOD LT 6 BLK I SEPTIC SYSTEM AS BUILT
203 W 15TH. AVENUE 6001DOWNEY FINCH DRIVE DATE: AUG. 20, 1997
ANCH. AK. 99501 SHEET. • 2/3 GRID: 2738
(907) 279-3916 11 RICHARD MARTIN
PERMIT # SW970233 PID # 015-234-07 APW01062,DWG
52.5 FT
1-1/4 INCH DISCHARGE LINE PVC SGEDULE 40
4 -INCH MONITOR 3/16° HOLES 0 30 INCHES
1-1/4 INCH DISCHARGE LINE PVC SGEDULE 40
4 -INCH MONITOR 3116" HOLES @ 30 INCHES
STANDARD 5—WIDE
18 FT X 45 FT
02t
4--414--P. of Cover
2" INSULATION
99.00- 0-000-0-0-0- - O -O-
TRENCH J2 00 00000000000 0000 Oo
97.0 —�
ZD 200 DIVERTER VALVE
TO EXIST. D.F =�)—O
500 GAL STEP
WITH ORENCO PUMP
AND SANDFILTER
CONTROLL PANEL
4 -INCH MONITOR
TRENCH #1
4 -INCH MONITOR
TRENCH 12
MONITOR
99.5
TRENCH #1
- 97.5
24 Sewer Rock .��������I1
SILT BARRIER •���� OF q� �♦♦
.• P.•••••••.............9s♦i
9 49th
8
1250 ST.
97.0
,.4 ............. .... ../ 500 GAL ORENCO STEP
�% T❑ EN SPURKLAND �=
♦C '��
♦ ✓� •�No. CE -2225 •.� �Ar
.................• ASSUMED ELfV.' 100.00 FT
;
TOBBEN SPURKLAND P.E. ALPINE WOODS LT 6 RIK 1 SEPTIC SYSTEM SCHEMATIC
203 W 15TH. AVENUE 6001 DOWNEY FINCH DRIVE DATE: AUG. 20, 1997
2,90Z) 279—J916 INCH. AK. 99501 RICHARD MARTIN SHEET.- 3/3 GRID: 2738
PERMIT NO SW970233 PID APWO1063.DWG
1 3V/2t.197 14121 go
ll
7 KIT, ,� 4N
INSPL-'CI'ION REPORT
MUNICI LITY or ANCHORAGES BUILDING SAFETY [IVIS! 1N
1600 rMAT TUDOR ROAD
INSPEUTIUM. VOICE 683,3404 lNSPF;CllQN.' FAX(9a7)343-6236 lNro; ms.,9211
NAML vc-A m rf
JD
AbDRESS CAD I
#
DAt
4) �, O 77
BLOCK
AEMPECTION; YE
4-3,10NONCOMPLIANW-
I CORRECTIONt US514TIAL AS EXPLAINO DELOW
WILL RP -AA AT f Mlpr'f i0N i I DO NOT CONCEAL MiL REANSPECTE0
COMMEMS: (r -OR INSPhOTOR USF )NLY)
VOWN CURRU1,; f l()Nb AJIF MADE PLEASE CAI -1- PON Ti�-1148M,174
U() 140T llpmovp 7fjjl� Nollu,
lya* c apl
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW970233
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E.
OWNER NAME:MARTIN RICHARD L & KATHERINE E
OWNER ADDRESS:6001 DOWNEY FINCH DR
ANCHORAGE, ALASKA 99516
PARCEL ID:01523407
LEGAL DESCRIPTION:
ALPINE WOODS BLK 1 LT 6
LOT SIZE: 67181 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED: 7/31/97
EXPIRATION DATE: 7/31/98
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 DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: -
r
ISSUED BY:i% "z"z
DATE: (f l(( f -7
DATE: 7 2/ -9'7
TS)PURKLAWD) RJR,,
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
ALPINE WOODS LOT 6 BLOCK 1
RICHARD MARTIN
Municipality of Anchorage July 9, 1997
Department of Health and Social Services
820 I Street
Anchorage, Alaska 99501
We are submitting an application for the installation of a septic system upgrade for this lot. The
existing drainfield did not pass an adequacy inspection and must be replaced. Due to the
presence of groundwater at 9 feet adjacent to the existing drainfield, and topography that does
not permit another bed or 5 -wide at this location, the replacement drainfield has been located at
the location shown. The testhole at this location showed a plastic silt beginning at 7 feet and
extending to the bottom of the testhole. Groundwater has not been observed, but the soils were
moist and pliable indicating that the material was not impermeable, however visual evaluation
concluded that the percolation rate would be too slow to be utilized for soil absorption. Since
only the top 7 feet of the soilhorizon can be utilized, and recognizing that the percolation rate is
marginal at 5.5 feet, only a bed or a 5 -wide drainfield seems to be possible. A bed at 2 feet will
require an area of 1200 sq.ft. It is doubtful a level area of this size can be found; the other
alternative, a 5 -wide trench at 3 feet with 2 feet of rock requires a length of 105 feet. Two
individual trenches, 52.5 feet long, at different elevations, based on the local topography, will
be relatively easy to install. Because a lift station will be needed, a pressurized distribution with
frequent, low dosage will be utilized. Pressurized distribution with intermittent discharge will
prolong the life of this system. The existing bed will be left in place, isolated with a diverter
valve. The bottom of this bed is 5 feet above the observed groundwater, and is not in violation
of the required separation requirement.
This submittal consists of three (3) drawings showing the present improvements on the lot and
the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the
septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic
system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed.
The septic system design is based on the following :
No Ground Water or Impervious Layer to 16 ft.
No Percable Soil Below 7 ft
Soil Rating. @ 2.5 ft 7.5 min/in = 0.8 gal per sq.ft/day
Soil Rating. @ 5.5 ft 60 min/in = 0.45 gal per sq.ft/day
No. of Bedrooms 4
Use Soil from 1 to 3 feet
Required Area per Bedroom: 150/.8 = 187.5 sq.ft.
Total area required: 187.5 x 4 = 750 sq.ft
Use 5 -wide with 2 feet of rock
Reduction factor .7
Bottom area required: 750 x .7 = 525 sq.ft
Total length required: 525 / 5 = 105 ft
Use two trenches 52.5 feet long
Insulate trenches
Place one foot of additional fill
500 gal STEP with four foot riser
ZD 200 Diverter Valve
The installation of this septic system will not prevent wells from being installed on the adjacent
lots. There are no developed or natural surface / sub surface drainage courses on this or the
adjacent lots. The proposed septic system will not change the general slope of the area. Ponding
and/or concentration of surface runoff will not result from this installation.
I
(ENGINEER'S SEAL)
,1 Municipality of Anchorage
.� DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: RICA AP -D %4A 1 IN DATE PERFORMED: (047
LEGAL DESCRIPTION: ALPINE iX 000 Township, Range, Section:
E H Lo �p �jK.l SLOPE SITE PLAN
D
1
2
OP-4A1J l L-
Q"L-% '_t
S► t-4
3
3
�o0.L �.
s M
4
11.1 1
i 14
5
6oU-�
7
8
9 - 11 -4 e
10 Uri f / „ Q WA; GROUND WATER
I�r�t sd-�'� � ENCOUNTERED? �
11
12
13-
14-
15-
16-
17
314151617
18-
19
20
COMMENTS - 17 WD
S
IF YE'S, AT WHAT L
DEPTH? e,QPg 0
�- P
E
Depth to Water Alter
Monitoring? 9 Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
PEr.COLATION RATE (minutes/inch) PERC HOLE DIAMETER
TESL RUN =.5
f FT AND Z��c4
—IV-IU 4' -t-k c� e, t ti i'► w t t� s
PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage
t DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGINEER'S SEAL)
PERFORMED FOR: ZVl -14AC'sD HAeT 1 N _ DATE PERFORMED; /C? %
LEGAL DESCRIPTION:_AL- P &E Lebo DS Township, Range, Section:
Lc) i ( SLOPE SITE PLAN
1 ' F OfrL7 �F`�41�1 I i S
�vL 2 I - N
3 so -,"d -/ �;i" /-
4 NV , !ig It- 4 .)l 1 a/r
4t HS 0-
6-
7
6
7
$ S'
9
10
11
12
13
14
15
16
VYl O '1 '/,
d -1:0 2 L ENCOUNTERED?
(VI,5vAL)
&77o x4
O F=
17
NOL1=
W
m
20
Depth to Water Alter
Monitoring?
IF YES, AT WHAT
DEPTH?
�a
S
L
O
P
E
Date: _
Reading Date Grass Net Depth to Net
XIA'k Time Time Water Drop
• 2 1 rti "rl 7' L 3
71/x
PERCOLATION RATE �_ (minutesiinch) PERC HOLE DIAMETER
u
i
TEST RUN BETWEEN � FT AND � 2- F7
DISCLAIMFR� Gr�undwat r .conditions indi atad are for h date shown only.
Past and future presence and/or depth of groundwater can not be predicted
rom these o se�rv�a tons.
PERFORMED BY: I -_ �/ � •
CERTIFY THAT THIS TEST WAS PERFORMED IN
0
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: / 1 1
1199
r
3
72-008 (Rev. 4/85) 1
x-12- c ONLY
e Municipality of Anchorage
DEPARTMENT OF !-HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGINEER'S SEAL)
j� t /� l , /� ,� 1 t
PERFORMED FOR:_ 4Qf � 4Al2� 1`�`A(2,f—tN DATE PERFORh/YED:
LEGAL DESCRIPTION:_ /`9"tiLPl/yE 0e)e)p e
Township, Range, Section:
(F`�1, L. 6 SLOPE SITE PLAN
EET)
1
1
2
3
4
5
6
7
8
9
10
WAS GROUND WATER
ENCOUNTERED?
11
IF YES, AT WHAT
12
DEPTH?
13
Depth to Water Alter
Monitoring?
14
15
16
17
18
19
20
S
L
O
E
Date:
l�
PERCOLATION RATE 75— (minlitesiinch) FERC HOLE DIAMETER
TEST RUN BETWEEN _a_ FT AHD Z FT
DISCLAIMER Grnundwatar conditions indiratp,i are for the datPa Shown only.
Past and future presence and/or depth of groundwater can not be predicted
from these2 o �erva tons.
PERFORMED BY: s I - �� _ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:J,&49 rgg7
72-008 (Rev. 4/85) 1
--
--
l�
PERCOLATION RATE 75— (minlitesiinch) FERC HOLE DIAMETER
TEST RUN BETWEEN _a_ FT AHD Z FT
DISCLAIMER Grnundwatar conditions indiratp,i are for the datPa Shown only.
Past and future presence and/or depth of groundwater can not be predicted
from these2 o �erva tons.
PERFORMED BY: s I - �� _ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:J,&49 rgg7
72-008 (Rev. 4/85) 1
Lot 5
\ \ LOT 9
50 0 0 100 ,(50 200 250 300
SCALE- 1 " = 180 F
Well
Parcel 5
•••�ET I
OF 4441 ❑ i Q , , BL 2
..
49th •� W .. ' rN syn — � w���� � ►•� � � 1
1
.. .. .......... . .
�'�•.
TO B N SPURKLAND••�•=
fes••. O CE -2225 .•' / C
00
FES P /� D O W n
l�rra��� • / /, Lot 5
� Ik
Lot 6
Lot 4
TOBBEN SPURKLAND P.E. ALPINE WOOD LT 6 BLIP 1 SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE 6001 DOWNEY FINCH DRIVE DATE: JULY 9, 1997
ANCH. AK. 99501 SHEET: 1 3 GRID: 2738
907 279-3916 RICHARD MARTIN
PERMIT # PID # 015-234-07 APW01061,DWG
a
PROP, DRAIN FI4.
2 5 X 52.k FT
EXIST., f250 GAL ST
/xisI
i
♦ i I �— 500 GAL STEP ;*
.. '`' .
3 FT DFAOr�--�-
2 FT 17 R00
OK —�
go to
1
to
�j 5 -FOOT BANK
OF
AV
/ ..... .......a
• s
'o -...........NPS
I���DFESSI: �i
25 0 25 50 75 100 125 150
SCALE- I' = 50 FT,
TOBBEN SPURKLAND P.E. ALPINE WOOD LT 6 BLIP I SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE 6001 DOWNEY FINCH DRIVE DATE: JUNE 20, 1997
ANCH. AK. 99501 SHEET 2 3 GRID: 2738
/an 7) 9 7a— 3A I R1(. 4AR17 MARTIN
PERMIT # PID # 015-234-07 APW01062,DWG
52.5 FT
1-1/4 INCH DISCHARGE LINE PVC SGEDULE 40
4 -INCH MONITOR 3/16" HOLES @ 30 INCHES
1-1/4 INCH DISCHARGE LINE PVC SGEDULE 40
4 -INCH MONITOR J116- HOLES @ 30 INCHES
STANDARD 5—WIDE
2 Ft. of Cover
7 //— Topsoil
INSTALL ZD 200 DIVERTER VALVi
TO EXIST. D.F
INSTALL
500 GAL STEP
WITH ORENCO PUMP
AND SANDFILTER
CONTROL[ PANEL
4 -INCH MONITOR
4 -INCH MONITOR
MONITOR
n
l� ' X!JSfL((J1'Llltll ml
• ILII • hI • ISI • UI • I•I • ■ • 14
• • • • • •
•tea • •�• • • 1 •�• •�•�•�
24" Sewer Rock
SILT BARRIER
.�����aaa��1 f
♦ � �F q f
��. P.E,,..........�
,. .,
W;�
4 4th r9
TNBBIN SPURKLAND\r'i
✓ '• No. CE -2225
s .
�1j pRQFESSION?���
500 GAL ORENCO STEP
TOBBEN SPURKLAND P.E. ALPINE WOODS LT 6 RIK 1 SEPTIC SYSTEM SCHEMATIC
A203 W 15TH. A VENUE 6001 DOWNEY FINCH DRIVE DATE: JULY 9, 1997
/an 7 f 97a_95� 1 RICHARD MARTIN SHEET,. 3/3 GRID: 2738
PERMIT NO SW970XXX PID # 015-234-07 APW01063.DWG
ke
72-013 (Rev. 3/78)
P
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL
ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501
Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
NAME
�j
SC' -D' t!Jkr�
PHONE
341Y CJS)
W� 77
❑UPGRADE
MAILING ADDRESS i j
6 � I 1�� )oan/�
/!C kt7(a
LEGAL DESCRIPTION
A I p► iur ��"ov�Q S %.a d
T I z.t,J
LOCATION f��
NO. OF BEDROOMS
DISTANCE TO:
Well
2_00_ i--
Absorption area
Dwellin
PERMIT NO.
CJS—ZL4 '�
UY
a
wQ
Manufacturer /' r
Material S .
No. of compartments
�
ti
Liq. capacity in gallons
12-50,
IF HOMEMADE:
Inside length
Width
Liquid depth
DISTANCE TO:
Well
Dwelling
PERMIT NO.
_jOZ
O z F
Manufacturer
Material
Liquid capacity in gallons
D
DISTANCE TO:
Well
It
Foundation
Nearest lot line
PERMIT NO.
w=
W Uj z
No. of lines /
Len h 4 each line
Total length of lin
Trench width 0
Distance between lines .�
Z W
f�
(7
j`
`R
2 ©inches
ac
ll
Top of tile to finish gradeMaterial
beneath the
Total effective absoon area
O
5 ra
inches
9 4)06)--
Length
Width
Depth
PERMIT NO.
W
0
< H
Type of crib
Crib diameter
Crib depth
Total effective absorption area
CL
W d
N
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
T
�V
PIPE MATERIALS
Z:' -1- 3 z
SOIL TEST RATING
f 43 a lam/,ems fr-sd- tvo
INSTALLER r Awu 1��tt
1
i'
REMARKS
s'
6
,
�+ /^
7fy a �-o/ra �' ' ' n
6011 7�L S
APPROVED
DATE LEGAL
iyp
72-013 (Rev. 3/78)
P
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIPx
LOT SIZE:
MAX BEDROOMS:
`
A t%-1 C:� ���.N "3��
DEPARTMENT HEALTH AND ENVIRONMENTAL .nOTECTION
825 L STREET, ANCHORAGE, AK 99501 ``-------'
264-4720
850362
LESLIE C. BURR
661 HIGHLANDER
ANCHORAGE, AK 99516
344-0501
SUBDIVISION: ALPINE WOODS
SECTION: 23 TOWNSHIP: 12N
1.50A (GQ.FT. OR ACRES)
LOT: 6 BLOCK: l
RANGE: 3W
Listed below are the options available to you in designing your septic
system. Choose tie option that best fits your site.
,
i-FREwP4K1U-8
'F—:"n
K*J ~ ][�F=Z ][ N
DEPTH TO PIPE BOTTOM (FT,)
4.0
\ 4.0
/
4.0
GRAVEL DEPTH (FT.)
12.0
0.5
3.5
TOTAL DEPTH (FT.)
16.0
4.5
7.5
GRAVEL WIDTH (FT.)
2.5
26.0
5.0
GRAVEL LENGTH (FT.)
37.0
49.0
95.0 **
GRAVEL VOLUME (CU.YDS.)
42.9
47.2
, 70^4 '
TANK SIZE (GALS)
1,250.0 **�/
1,250.0 **^�
1,250.0 **
SOIL RATING (SQ.FT./BR)
'220
209
220
** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS'(NOT EXCEEDING 75 FT. EACH)
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
- - - - - - - - - - - - - - - - - - - - - - - - - -- -- -- -- -- -- - - - - - - - - --
I certify that: '
I. 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 a maximum of 4 bedrooms and
any enlargement will require an additional permit.
.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA 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
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED ^
DATE:
_________________________-_______ -------------------
APPLICANT:
______________APPLICANT: LESLIE C. BURR
%SSUED BY§Jyj;y__DATE_-
---------------------------------
A�t
�____
['-1 LJ t%J I C:� :1 L_ 1 T''Y' C) F" A N C_�: " (-I Fz onk U E-1.
DEPARTMENT [ HEALTH AND ENVIRONMENTAL ]TECTION
825 LSTREET ANCHORAGE� AK 99501
'
264-4720
�r.4—�i -*,r* EE E3 E-_ w ra i=z F> E=- F� m x -T, ~ U
PERMIT NO: 850362
DATE ISSUED: 06/26/85
'
APPLICANT: LESLIE C. BURR
ADDRESS: 661 HIGHLANDER
ANCHORAGE, AK 99516
CONTACT PHONE: 344-0501
LEGAL DESCRIP: SUBDIVISION:
ALPINE WOODS Nj LOTQ6
BLOM 1
SECTION: 23
TOWNSHIP: NE1
3
SIZE: 1,50A (SQ.FT.
OR.ACRES)
MAX BEDROOMS: 4
Listed below are the options
available to u
in de igning
your
septic
system.LOT
Choose the option
---
---~----~------
F_= 13
W~
1.3F;:ICA l[Kq
DEPTH TO PIPE BOTTOM
\ ` 4.0
4.0
GRAVEL DEPTH (FT.) "—
`/
TOTAL DEPTH (FT.)7.5
GRAVEL WIDTH (FT.)
2.5
76
GRAVEL LENGTH (FT.)
`
.
49 0
95 **
GRAVEL VOLUME (CU. YDS.
\
47 2
TANK SIZE (8ALS)
100 0 **
1, **
O
0.0 **In
** GRAVEL LENGTH > 75 FT. REQUJRES MULTIPLE R 8 (NOT EX 7 FT. EACH)
** TANK MUST HAVE AT LEAST _ TWO\COMPARTMENTS / N \J� /
� / /,
_ _` _'_ _ _ +- _
I. I a& Imiliar with the requi ements for M -site 4w)l
forth b the Municipality of Anchorage MOA) and,kthe StIte of Alaska.
2. 1 will nstall the system i accordant with ll'MOA c des and regulations,
and in c mpliance with the esign cri ria of t -is pe mit.
t he
°. ^ will ~°AWN ~^~ .. .^~�.~ .��.^.� �..^� for,the ~e^ ~~^.
distances from any e> well, wastewa er dispos I system or public
4. 1 understa c that this rmit is va.'d or a maximum of 4 bedrooms and
en t
IF A LIFT STATION IS INSTALLED IN AN AREA 'RED BY MOAQUILDINS CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECT MUST BE OBTAINED; (2) AS7BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL I SPECTION REPORT; AND (3) THE
ELECTRICAL WORK .USELECTRICIAN.�
SIGNEDA§QATE.",
APPLICANT
ISSUED BY ATE:
(ENGINEER§ SEAL)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:�LF� , DATE PERFORMED:
LEGAL DESCRIPTION: Re C�9�a��' � � +' � Township, Range, Section: � te r_ 2- °S'r °'rI o o
Ep SLOPE SITE PLAN
1 P V ?e -1-t_
15
r
16-
17
6 17
18
Bps
be"A- Vj ck -y
WAS GROUND WATER
ENCOUNTERED?_
IF YES, AT WHAT
DEPTH?
Depth to Water After
Monitoring? Date:
MEMMMMMMIN
2
`q
C't'��i��
3
4-
5
5
r
6
r
7
.a�<
r
8-
9-
MRSOMR-661
10-
1011
.■'E^MEN■EMEMI-rawmaRomg'
11
12-
213
c �
131
`
14
A
15
r
16-
17
6 17
18
Bps
be"A- Vj ck -y
WAS GROUND WATER
ENCOUNTERED?_
IF YES, AT WHAT
DEPTH?
Depth to Water After
Monitoring? Date:
MEMMMMMMIN
MRSOMR-661
.■'E^MEN■EMEMI-rawmaRomg'
MMUMEN,.��ffin
NERNMENON
■MO■M■M►'�■
■EN■■■ENN■
r'r L
Reading Date Gross Net Depth to Net
Time Time Water Drop
20
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
1 TEST RUN BETWEEN FT AND FT
`.
COMMENTS `�0 �' �' i� i a « "Z7Vx1rIcam /'� y ra_"7C�! f� 12-5
�7 7�,�
PERFORMED BY: 116 CS i nC%�5� I� 0G` �^ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: q.� Z -v
72-008 (Rev. 4/85)
a,
0 -<--SOILS LOG a
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0� PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 2644720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Mr'y L4 4 ",, - DATE PERFORMED: 17 LS
LEGAL DESCRIPTION: A I I-,. LJwr/ p ( L b �:<t 7e 1 f Imo' I4
SLOPE SITE PLAN
( ! _
1 jj G7�
iM 6414y S jravl
Io4S� _ �'r!!J
6K 614"-Y Sa-n� 1wei
arra '2z,%_5 Nl:s coca s --,bac.
`V0j00001b�Q0���1 U'
' t 0000jr
y C. Reid, Jr. ;
No. 2251.E
WAS GROUND WATER
ENCOUNTERED? ab
IF YES, AT WHAT
DEPTH?
rt
6 AkQ tWflk-"0---
Reading
Date
Gross
Net
Depth to
Net
Time
Time
Water
Drop
f
� Y
f 4.
r
PERCOLATION
TEST RUN BEI
(minutes/inch)
FT AND FT
COMMENTS -SID -11 L� lat' CC) 093 3 A'//i ffm / . � t>, > Pe raft owndlJ44.A
41i I" d/ 4wn ,_s Setwef w ,,kximAli<r04 _ter ¢ud s'erke .s, i�
PERFORMED BY: '� I / /;/' 7 ^ } �'_CERTIFIED BY: DATE:
fh, ks� Jas c1omt �echiuse fl\ey
72-008 (6/7911�C a eft Ate- / i
j
MUNICIPALITY OF ANCHORAGE PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION / TEST
825 L. Street, Anchorage, Alaska 99501 2644720
SOILS LOG —PERCOLATION TEST bS06�
�or
',( k 1�1 f e' ',� q CD
PERFORMED FOR: �' A DATE PERFORMED: -- /3b 18
LEGAL DESCRIPTION: L 4 MoA ST SLOPE SITE PLAN
(IF7T
OL
2
3 -
4 - t'r
5
6-
7
8-
9-
18
OF AJ.411
•
*4
19 No, 2251 -E
)'190FESSO'
9o.
9%,.W !��/DCOLATION RATE 1 (minutes/inch)
TEST RUN BETWEEN y FT AND FT
COMMENTS
kf e
WAS GROUND WATER S
ENCOUNTERED? L
0
P
IF YES, AT WHAT -7
DEPTH?
8" d,jz P e, r tio\c
Reading
Date
Gross
Net
Depth to
Net
Time
Time
Water
Drop
q
Liq
10
PERFORMED BY: It CERTIFIED BY:
72-008 (6/79)
DATE:
ALASKA ENVIRONMENTAL
CONTROL SERVICE", INC.
1200 West 33rd Aven6— Suite B
ANCHORAGE, ALASKA 99503
(9071591-5040
JOB 61 L 6 AL- PIAIE WOODS _
SHEET NO
Of
CALCULATED BY 'j -rj< DATE_ -
� Kalls
MUNICIPALITY OF ANCHORAGE
°': Ir,
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. 015-234-07
1. GENERAL INFORMATION
Complete legal description ALPINE WOODS BLOCK 1, LOT 6
Expiration Date: 1N0'q a -7 l of ()� C)
Location (site address) 6001 DOWNEY FINCH DRIVE, ANCHORAGE, AK 99516
Current property owner(s) WILLIAM & MARY JACOB Day phone
Mailing address
Real estate agent
6001 DOWNEY FINCH DRIVE, ANCHORAGE, AK 99516
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Private Well
❑
Water Storage
❑
Community Well
Community
Public Water System
❑
Waiver request for:
Received by:
4
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 65D
Date of Payment 1—?— 14
[
Receipt Number i�� y is
COSA # 0 01163 5
Day phone
TYPE OF WASTEWATER DISPOSAL:
Private Septic
Holding Tank
❑
Community
❑
Public Sewer
❑
Date:
Waiver Fee $
Date of Payment
Receipt Number
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 ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377
Address 4661 NATRONA DRIVE, ANCHORAGE, AK 99516
Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 11/7/2019
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
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
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by FWCS and Anderson Construction & Engineering.
6. DSD SIGNATURE
System #1 Approved for q bedrooms
�OF��\
,`S
��
*.4TH9
I/0 I
MICHAEL N. ANDERSON:
1 No. CE 9489`7/
1
. p.1� /_7/19 .. +'
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
OF XI /I
nAl elTe
WATER AND
By:Original Certificate Date: 1 1 I I
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 DRAFT.docx
DRAFT COSA Checklist
Legal Description: ALPINE WOODS BLOCK 1, LOT 6 Parcel ID: 015-234-07
If more than 1 septic system on lot: COSA Checklist #
of
Structure served by this system
A. WELL DATA – CLASS A (PWS ID 213598)
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 – 10/28/2019 1500-GAL
Age of tank(s) NEW years
Tank type/material STEP / HDPE
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 NEW years
Lift station material
Comments:
D. ABSORPTION FIELD DATA – TWO 52.5’L x 5’W x 2’ED – 0.8 GPD/SF = 750SF
Which system tested (date installed) 8/1997
ALL standpipes present per record drawing
Total measured depth from grade 5 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 6/7/2019
Results Pass For 4 bedrooms
Fluid depth prior to test 0 / 0 in
Water added 650 gal
New depth 2 / 1 in
Elapsed time <5 min
Final fluid depth 0 / 0 in
Absorption rate 600+ gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Comments/Deficiencies
COSA Checklist DRAFT.docx
E. SEPARATION DISTANCES – NA CLASS A WELL
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.
11/12/19
G£ BU
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904 5•,ETY
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcell.D. 015-234-07-000
1. GENERAL INFORMATION
Expiration Date: "la '5 -
Complete
5 -
Complete legal description ALPINE WOODS BLK 1 LT 6
Location (site address) 6001 DOWNEY FINCH DRIVE
Current Property owner(s) ROBERT & CHRISTINE WATKINS Day phone
Mailing address
Real Estate Agent
6001 DOWNEY FINCH DR., ANCHORAGE 99516
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
❑
WaiverNariance request for: Distance:
Received by: '4"e711
�"
COSA to be released to the engineer, unless
COSA Fee $490.00 - 021 rar 4
Date of Payment '54
Receipt Number 16- 6%)_�3
cosA# 0,S r- /3 /30`1)
Date:
by the engineer.
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
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 Blk 1 Lt 6 Parcel ID: 015-234-07
A. WELL DATA
Well type Pub
Date completed
Total depth ft.
If A, B, or C provide PWSID #
Sanitary seal (Y/N) _
Cased to _ft.
FROM WELL LOG
Date of test NA
Static water level ft.
Well production g.p.m.
WATER SAMPLE RESULTS: PUBLIC WATER
Coliform colonies/100 mL
Arsenic: _ ug/L
Nitrate _mg/L
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC / STEEL
Tank size 1250 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Date of pumping 6/10/2013 Pumper A+
C. ABSORPTION FIELD DATA
Well Log (Y/N) Y
Wires properly protected (Y/N) _
Casing height (above ground) in.
AT INSPECTION
NA
ft.
Collected by:
Date installed 7122/1985
Cleanouts (Y/N) Y
High water alarm (Y/N) Y
Date installed 8197 Soil rating (g.p.d./f:2 or ftz/bdrm) 0.8 System type TRENCH
Length 52.5 X 2 Trenches ft. Width 5.0 ft. Gravel below pipe 2.0 ft.
Total depth 5_0 ft. (Measured 6/1o/i3) Eff. absorption area 750 ftz Monitoring tube Y Depression over field N
Date of adequacy test 06110/2013 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0_0 in. Water added 600 gal. New depth 1 in.
Elapsed Time: 10 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 08/12/1997 Size in gallons 500 Manhole/Access (Y/N) Y
"Pump on" level at 21 in. "Pump off' level at 23 in. High water alarm level at 14 in.
Datum top of tank Cycles tested 3 Meets alarm & circuit requirements? Y
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot N/A On adjacent lots N/A
Absorption field on lot N/A
Public sewer main NIA
Sewer /septic service line NIA
Animal containment areas NIA
SEPTIC/HOLDING TANK ON LOT TO:
On adjacent lots NIA
Public sewer manhole/cleanout NIA
Holding tank NIA
Manurelanimal excrete storage areas NIA
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 1004
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 101+ Surface water. 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+
F. 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.
Engineer's Printed Name KENNETH M. DUFFUS
Date 07/29/2013
COSA brown sheet_10-10-12.doc
OF ALS �t
r4 C) TH*
A KENNETH M. DUF /
p 7116
Wi FES510N AW
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015- 234- 0-4-
1. GENERAL INFORMATION
COSA # I N i 0 �J
Expiration Date: �2 —-%T=/a
Complete legal description
V1/6od5
Blk 1
L.V w
Location (site address) _
(�QO�
Dow ncv
Fi n c�
Drive.
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Current Property .owner(s) A «re� Mey Day phone
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent _ &3LI Lowe �� Day phone 2,44- 5g8 j
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
y
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
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 in$
Address 203 V. I St`% AJC. , Ana►13CC%4AK 99 501
Engineer's Printed Name L ARS 5,214fz0 a�A
6. DSD SIGNATURE
_4Z Approved for bedrooms.
Disapproved.
Phone 211-31/6
Date Zhi l z o l l
OF
e `�IN
�C
LARS E. SruRKLAND.°'
/ 11500
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
:' • AL1►QTCIA AAT=
PROGRAM .:
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: JG�G✓� Original Certificate Date:
(Rev. 11105)
Municipality of Anchorage 0u,
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 WOOS BIK I Loi (v Parcel ID: 015 - 23Y- 07.
A. WELL DATA R,61<< Nz,0
Well type — If A, B, or C provide PWSID # 2t3518 Well Log (Y/N)
Date completed —
Total depth — ft.
Date of test
Sanitaryseal (Y/N) —
Cased to ft.
FROM WELL LOG
Static water level ft.
Well production _ 9.p -m.
WATER SAMPLE RESULTS:
Wires properly protected (Y/N)
Casing height (above ground) '-- in.
AT INSPECTION
Coliform colonies/100 mL Nitrate mg/L Collected by:
Arsenic: — ug/L date of sample: -`
B. SEPTIC/HOLDING TANK DATA
g.p.m.
Tank Type/MaterialG�eeo�/ sfe,- Date installed
Tank size 11SO gala Number of Compartments of Cleanouts (Y/N)
Foundation cleanout (Y/N) y Depression over tank (Y/N) /V High water alarm (YM) N
Date of pumping 1'Zy 2011 Pumper Isaac s PUM► 1 1 .Se�vi Le -
C. ABSORPTION FIELD DATA
Date installed Soil rating GiJftzor ft2/bdrm) 0System type s�a ��o w irenc
Length -4): 5Z.5 ft. Width 5 ft. Gravel below pipe Z ft.
Total depth 5511 ft. Eff. absorption area ' 5o ft2 Monitoring tube Y Depression over field //
Date of adequacy test 11774911 Results (Pass/Fail) t.ss For 9 bedrooms
Fluid depth in absorption field before test __�_ in. Water added 100 gal. New depth S in.
Elapsed Time: 1440 min. Final fluid depth 4— in. Absorption rate >_ (oQ0 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) /VVone Rnowr\ If yes, give date —
D. LIFT STATION
Date installed 4/12120 11 Size in gallons 500
"Pump on" level at 'L I in. "Pump off" level at M3 in.
Datum MH 91AA Cycles tested 3
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Manhole/Access (Y/N) Y
High water alarm level at I L% in.
Meets alarm & circuit requirements?
Septic tank/lift station on lot On adjacent lots
Absorption field on lot
Public sewer main
On adjacent lots
Public sewer manhole/cleanout
Sewer /septic service line Holding tank
Animal containment areas –"
Manure/animal excrete storage areas —
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 I4- Property line 5 + Absorption field 5 14'
Water main 10 `•I- Water service line lot+• Surface water I C0 t+
Wells on adjacent lots Zoo `-I-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+- Building foundation l +' Water main
Water Service line 10` 4- Surface water ton'+- Driveway, parking/vehicle storage 1014 -
Curtain
Di}Curtain drain 501 + OJ -0) Wells on adjacent lots -ZOO 1-
F. 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.
Engineer's Printed Name Lgas S %4r 6t aVNA
Date q Zo l 1
COSA Fee $
Date of Payment
Receipt Number 0751 _;5o ,
(Rev. 4/10)
Waiver Fee $
Date of Payment
Receipt Number
�tOFA(,gs11
000
•j'9TH i
00—
. �e • KLAND.'Zlaw
PARCEL 5
LOT 5
—
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D 460600.
OF At 'ep
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DATE e
�9®®
�. ee
r
ss° see ease •
e oaa .a ase •eooe .e®
♦ 9� * R. L. Button
Lot Block
_. t t 'F • LS -1192 .•' oe'`a
.s
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Y Y clocI bc.11v/s/V/ / /63^2/0 9�Q ipe•ae. OFESSIONNO�
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Anchorage Recording District, Alaska Easements of record other than those shown on 02-09-11
the plat of record are not shown hereon unless
otherwise noted.
LOT SURVEY CERTIFICATION LEGEND
I hereby certity that I have surveyed the property shown and described 0, Brass or Aluminum capped monument recovered
hereon, and that the improvements situated thereon are within the prop- O Iron pipe and/or rebor recovered,
erty lines and do not overlap or encroach on adjacent property and that O 2 x 2 hub & tack recovered
no improvements on adjacent property overlap or encroach on the premises • 5/8° x 30° rebar set this survey
in Question and that there are no roadways, utility lines, or other vielble
easements on said property except as indicated hereon.
Date Prepared by: R. L. BUTTON
R Registered Land Surveyor
Scale / /i o (907)279-6200 5/9 W. EyghthAve. Anchorage Ayaslra99501
IRef.273 Q I F. B. No. �,�J - �� I Property of: lgllChol-cl 114Q,l„
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services OF ANCHv�Gt
On -Site Services Section MUNI SEP\j10ES DIVISION
IRONM
P.O. Box 196650 Anchorage, Alaska 995119-45%V50
343-4744 AUG 2 5 1997
CERTIFICATE
FOR SINGLE EL
APPROVALTH AUTHORITY
FAMILY WELLING
Parcel I.D. # 015-1114n,07 \ HAA # AQS_) L N L+
1. GENERAL INFORMATION
Complete legal description ALPINE \X/ o D5
Location (site address or directions) 6 DO I Do\it/NFy FINCH Die IVL
Property owner 1` AZ 1 N , 21C+4AZ D Day phone
Mailing address
Lending agency
Mailing address
Agent
Address
Unless otherwise requested, HAA will b\e, held for pickup.
2. NUMBER OF BEDROOMS: � "
3. TYPE OF WATER SUPPLY:
Individual well
Community well I!5 2$
Public water
Day phone
Day phone
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 k1
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev.1/91) Front MOA#21
5. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I 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 l o 66" �g p v r kla.a L— Phone
Address
Engineer's signature
6. DHHS SIGNATURE
t# Zo 3
Approved for bedrooms.
Disapproved.
Date
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-M(Rev.1/91) Back MOAN21
MUNICIPALITY OF ANCHO
Municipality of Anchorage ENVIRONMENTAL sERVICEs
DEPARTMENT OF HEALTH & HUMAN SERVICES
0*
Environmental Services Division AUG 2 5 1997
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343--474c4
Health Authority Approval Checklist C L E D
Legal Description: ALP)NE VlooDS Parcel I.D:: '015-' 234—O-7
A. WELL DATA
Well type 1 �� t If A, B, or C, attach ADEC letter. ADEC water system number A 35!1 b
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Date completed
Cased to
FROM WELL LOG
Static water level
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
Nitrate Other bacteria
Collected by:
Date installed 7-2-2---4r Tank size 4150 Number of Compartments 2 Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression (Y/N) N High water alarm (Y/N) _
Date of Pumping Y27/9- Pumper �� 4X q C-
C.
C. ABSORPTION FIELD DATA /
Date installed 8//2./97 Soil rating (g.p.d./ft2 or ft2/bdrm) System type
Length Width Gravel thickness below pipe Total depth 3 l
_ Z
Effective absorption area 90 Monitoring Tube present (Y/N)—y Depression over field (Y/N)
Date of adequacy test N/,4 Results (Pass/Fail) 7 For _bedrooms
Fluid depth in absorption field before test (in.); N1A- Immediately after2 gal. water added (in.):
Fluid depth ✓ (ins) Minutes later: Absorption rate = � g.p.d.
Peroxide treatment (past 12 months) (Y/N) If yes, give datey
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed g//L(9 Size in gallons
Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* �3
N�-
High water alarm level at* y *Datum I
Cycles tested N
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: N/A
Septic/holding tank on lot On adjacent lots
Absorption field on lot
Public sewer main
Sewer /septic service line
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: 51 40,
Foundation Aa Property line > 60 Absorption field Ito �
� II
Water main/service line _Surface water/drainage Wells on adjacent lots N/fes
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line >/0 Building foundation 160 f Water main/service line >.g5
Surface water 1 /H,e:> ' Driveway, parking/vehicle storage area ? ,2S
Curtain drain 1`110 Wells on adjacent lots NA.
HAA Fee $ c=' f Waiver Fee $ —
Date of Payment ! Date of Payment
Receipt Number Receipt Number
72-026 (Rev. 3/96)*
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 co l�� ��y1to
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
B I/ 9 A 1- P//VE W600S 12- 14 3 W 25C, 2
Location (address or directions)
(b) .Applicant Name F-5 ' .B URA Telephone: Home J x-56VI Business3yq-0550/
®
;.Applicant Address a qOO 14159r2CL-G 9A ANCW &k T7,507
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder C?'; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution fG�n�►nn1jG- Telephone
a
Address 1 a
(e) Real Estate Company and Agent APS $y/2AJ, -
Address
Telephone
(f) Mail the HAA to the following add re s:,
/ (L
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑ Other
Number of Bedrooms
3. WATER SUPPLY
Individual Well ❑ Community �(APublic ❑
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
OnsiteXl 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.
Page 1 of 2 72-025(11/94)
B 1 L 6 /9 G 1',ING- woo,05
5. ENGINEERING FIRM PROVID...0 INSPECTIONS, TESTS, FILE SEARCH, L„ rA 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 LE -7C S t MCTTelephone
Address 200 I ll 33 -L"j' At)C S 7-6 6 A&C
Date �(J a ! �3
NO A4
0-4
�..... ..... � . ...:.. rix,
i
: t k it tfoAR. : AP
I�` ,/
# ••.• -2251 0 i
1 ��professlon �;c�
6. DHEP APPROVAL
Approved for - bedrooms by Date
Approved Disapproved Conditional
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)
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984 J U N A 9 1
264-4720
Legal Description: 61 LC ALL D
3
I nt cu '5 X2.3
A. WELL DATA
Well Classification COMMO/y/7,7" If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) Date Completed
Total Depth 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
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by �.
Water Sample Test
Comments
M
_ Depth of Grouting
Yield
Pump Set At
Sanitary Seal on Casin )
Depression Aroun ellhead (Y/N)
On Adjoining Lots
On Adjoining Lots
_ To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Date
B. SEPTIC/HOLDING TANK DATA
Date Installed Z Size I ZS v No. of Compartments 2,
Standpipes 6( N) Air -tight Caps &N) Foundation Cleanout((' N)
Depression over Tank (Y4 Date Last Pumped Ak' N/A
Pumping/Maintenance Contract on File (Y/N)&- ; for NM
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) IV FZA
Separation Distances from Septic/Holding Tank:
To Water -Supply Well 00 To Building Foundation 20
i
To Property Line — 5(),+ To Disposal Field 15 -
To
To Water Main/Service Line 7 i� f To Stream, Pond, Lake, or Major Drainage
Course i 00 fi
Comments 4z-�5EE 'C'eK E ©F' occ u,�A/1lC Y
Page 1 of 2
72-026(11/84)
b 1 L 6 #6 PIn(6 W,000,5
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ' to Type of System Design BE 13
Date Installed 7-22— qS le
Length of Field �5
Width of Field 2- d 40 Depth of Field 2,5 - ,S; -
/ Gravel Bed Thickness 5
Square Feet of Absorption Area �� A V Standpipes Present QN)
Depression over Field (Y(Ij
Results of Last Adequacy Test X
Date of Last Adequacy Test X IV/ A
Separation Distance from Absorption Field:
To Water -Supply Well 200 To Property Line
i
To Building Foundation To Existing or Abandoned System on
Lot N �i ; On Adjoining Lots ,�o /
To Water Main/Service Line in To Cutbank (if present) 1. Z&
To Stream/Pond/Lake/or Major Drainage Course iDO /_�-
To Driveway, Parking Area, or Vehicle Storage Area �S
Comments ✓ sL(= CER /, OF Occup mr-V
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"
`* Check Permitted Bedroom Rating Against HAA Request'*
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
I certify that I ha echecke5dv ified, r conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed /� DateZ�b 6 ,
Company MOA No. b�S-02 C �,++ ��``1kit
A
Receipt No. -39 UR I �
Date of Payment ( — / q " R
Amount: $ (080 -s -
4
08O -s"'
4 %Mclime yrs "l c E raw of A-, r ,4
Z cER r OF oca/Aw"y
Page 2 of 2
$t_3 S1 r,1!F- 101-4AI
72-026 (11/84)
'Velt 1460
**04
. .p
y . REID, JR, i
CE 2251 : � ,i
��`sessioCfd��®
4TF ACHImewr ft�
BILL SHEFFIELD, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907)
Address:
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
DATE: June 9, 1986
PWS I.D.# 213598
To Whom it May Concern:
274-2533
According to records on file in this office the ALPINE WOODS
Water Regulations
Water System is in compliance with the State Drinking
Sincerely,
Steven W ng, PE
District Engineer
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