HomeMy WebLinkAboutALPINE WOODS BLK 6 LT 5
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP231300 PID Number: 015-234-45
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
RICHARD & LYNDA STEPHENS
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
12220 KINLIEN CIRCLE, ANCHORAGE
❑ Other
Phone
Number o f 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
ALPINE WOODS 6 5
Fill added above original grade
Ft.
Gravel length
Ft.
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
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft2
Ft.
Well
200'+
--
25'+
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1250 Gal.
Surface Water
100'+
--
Material
HDPE
Number of compartments
2
Lot Line
10'+
__
NA
Foundation
10'+
-_
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks
Alarm location
Electrical installed by
Installer MIKE N ANDERSON (MNA)
PIPE MATERIAL House to tank 3034 Tank to dra afield 3034
Drainfield CO/MT 3034
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspdection 15` 10/02/23 2nd 10/02/23
Location and description
3rd 4th
TOP OF MAN HOLE
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
OF 4
-
Conditional Approval: Date
Q ' : t�,l�
_49 7H
Septic System
Approved -
Curtis Huffman
,�'•, •• /
Date
cc CE 128991 �`v
aw
2 � �slF�•. X10/09/23.. •F��..� w
`1lF�PROFESSI�NP�.A
Note: this approval does not include well permit requirements.
kmuv vo/UZ/ ion
EXISTING
4
B
R
HOUSE
LOT 5
LOT 4
LOT 6
PAVED DRI
V
E
W
A
Y
PID:015-234-45 PERMIT:OSP231300
FIRST WATER CONSULTING
ALPINE WOODS BLOCK 6, LOT 5
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP231300
Work Type: SepticTank Upgrade
Tax Code Number: 01523445000
Site Legal Address: ALPINE WOODS BLK 6 LT 5 G:2738
Site Mailing Address: 12220 KINLIEN CIR, Anchorage
Owner: STEPHENS RICHARD W & LYNDA L
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
mcnr S
'°
i
Departinent
9/11/2023
9/10/2024
35949
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received B r
y. S � % � w L Date:
J
Issued By: Date:
�
4
Development Services Department _ ` Phone: 907-343-7904
On-Site Water & Wastewater Section-- Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-234-45
Property owner(s) RICHARD & LYNDA STEPHENS Day phone
Mailing address 12220 KINLIEN CIRCLE, ANCHORAGE, AK 99516
Site address 12220 KINLIEN CIRCLE, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) ALPINE WOODS BLOCK 6, LOT 5
Legal description (Township, Range & Section)
Lot Size 35,949 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) El
(w/wo ADU)
Septic Tank
Qpg
de
U ra X ❑
EJ
(D)
Holding Tank
1-1Renewal
ElDuplex
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: z Z � Waiver Fees: _
Date of Payment: g I 51 2.023 Date of Payment:
Receipt Number: �� S o y5 Receipt Number:
Permit No. �} S (' Z -� 13 cvy Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
!!
September 11, 2023
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: ALPINE WOODS BLOCK 6, LOT 5
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank for current
functionality and future flexibility per the attached design to serve the existing 4-bedroom
residence. No groundwater was noted in the MOA on-site file, but if groundwater is encountered
during installation an epoxy coated steel septic tank may be required. The lot and area are served
by public water. The design will not impact any of the neighboring properties. Please contact us
if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231300, Curtis Townsend, 09/11/23
FIRST WATER CONSULTING
NO WELLS WITHIN
200' OF PROPOSED
SEPTIC TANK
ALPINE WOODS BLOCK 6, LOT 5
DESIGN DETAILS:
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231300, Curtis Townsend, 09/11/23
i~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMEN'I'AL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME IPHONE I ~NEW
John Hagmeier Company 1338-6336
I-]UPGRADE
'1399 West 34th , Anchorage, Alaska 99503
LEGAL DESCRIPTION
Lot 5, Block 6, Alpine Woods Subdivision
LOCATION NO. OF BEDROOMS
Section: 23 Township: 12N Range 3W 4
I Well AbsorPtion area Dwelling PERMIT NO.
DISTANCE TO: 245 I 7 ' 10 I
8
50
211
I- Z Manufacturer Material No. of compartments
~ Greer Tank Steel 2
Liq. capacity in gallons Inside length Width Liquid depth
1250 ,/ IF HOMEMADE: ......
~ Z~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~ - ~ Manufacturer Material Liquid capacity in gallons
Q Well Foundation Nearest lot line PERMIT NO.
~ DISTANCE TO: 200-240' ~ 35' 40' 850211
~ ~~ No. of lines Length of each line Total length of lines Trench width Distance between lines
~ 1., 39 39 ' i~s
~ ~ ~ /T9p~f tile t¢ finisD~rade Material beneath tile Total effective absorp~n area
~ [ ~g~{~:~' ~.~'~ ~ 4.5' 120 inches 780 Pt
~ngth ~.~'~ Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
m Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class A ( Priva':_.~e~th .... Driller Distance to I~t~i~e~u~ i PERMIT NO.
~ DISTANCE TO: Building fo~ti~n Sewer line ---- Septic tank 2 4 5' Absorption area(s)
OTHER
PIPE MATERIALS
ASTM 3034, Cast Iron
181 Sq. Ft./ BR
INSTALLER
John Hagmeier Company
REMARKS
4" Cast Iron Pipe used to septic
tank
inlet
ASTM PVC 3034 used for remaining ~J ~'~~ ~-- /
- , ,
lines
%field~ '"
APPROVED DATE LEGAL
2~t[.: C ~'[~,~,__ ~/I~ Lot 5, Block 6, Alpine Woods SubSivis~n--
72-013 (Rev. 3/78)
L ,:: I' ,I ..~ T/"1 -=
'T'OT'FIL. [:'EPTH =
"Gl~'.f::fv'El .... DEF'TFI
GP. Ff',,'["L. '.,.'OL. UH[i~. =
TFII'.,II< E; I ZF' =
I)E:F'F:IF::TMENT :3. I...IIEI::'IL. TH f::lNI.], [3',I',,,'II-:.:FINMENTFIL t, .:OTECTI Lq'l'4 ':"-'
;..2 E; 4..... 4. 7' ;2 I;~', . l:l N (]:I .t [)F..: FI (3 E.'". :2; '.~ 4. '-;--" i '2: iL · E FI G L E 'F.'. I ',,,' E F.~
F:' E t:',;: i'"l I T ,~ ~ - !: >".' ± 0 9 E
LECiF¢... ~"'~"-' .... "'" -'~' ':" "' 'IVt:~ ' '
.... ~=,,...R.~. F' T II..,~, · :, ,_t [:, E., tF~N F'ILF' Z NE l.,.lOr"K) E;LOCI< 6 LOT · 5
]'_, 'r'OU [:,EE;IGNII"~Ei "r'- IE' =,EFTI_.
L. I S T E [:: ....
· ,_,, ,1.:, FI',," I:::11 L FI D L E: I N '- ' "
'~ r" -~-, -r-, U.JI~.
141 [:'TH = 2..~ F:'T.
/t_Ei',tCiTH = 70. 0 I=T.
TOTFIL. DEF'TH = .~.,.."~'" 0 FT.
..,".~,~:, DEF'TH = ,'. 0 F'T.
'TFiNt::: ::'E;.T. ZC =-" :I.., .5E~1:3. 0 EiFILLONS "TklO ': qMF'Fff~'THENT TI"3NI':::',
L. IZNGTH = !54. ~B FT.
TO]"F-iI_ E..~:.F ,il = 5. 0 F:'T.
5. E~ FT.
7. ~.-~ t:::'T.
3:. 8 F'T.
]'~.E.':. ',]', I"':U.
I CERTIF'¢ THF:IT'
...... Z Ffl"1 FI"-~MIL. IFff:.: kI.T. TH THE P. EE.!UII~%MENTS FB'I;' ON-SITIE SIENEF.:S FIN[:, NELLS It.-'-',-- SET
2. I 1.,.I T L.L l N:STFtLL "r'l-lE !:;',."Z;TEH 1 t'.4 FIF:CO'F.:E:,F'INF:E t41 TH THE COE:,E:S FIN[:, I-.fl..:l',,,'E RECE I VED
F-I COF'"r~ OF - ~' -
=_,, . ,IN,. ~.., JF.t fl FITTFIC:HMENT'5 14HICH Iz, F'I:':IF.:T OF' THIb
F'E F.: H '" '"'
.'..":. I .... -..r - ~ .. , ,"h-IT
,_ I NCLUDEE HORE THFtN 5 E EE.,',.'.L _ f I'",.
PERM I T FIPF'L. I C:F:INT HFI"_-', THE t;:E2q::'Ol',tS I D I L l T"r' TO l NFORM F ER=,L, 4NEL DLIF.'. I NG
THE I NSTI"":IL. LFIT I L-tN l 1"4~Z,F'EL-:T I OIqS CIF I:::lN'r' I.,.IELLS Fir.':,..TRCENT TO TH l 6 "-,rz, F'",'-m'"',,
THE: NUMBER OF F..:E::51E.,- N_.E.:, THF. tT THE klELL 1.,41 LL SE:.F.:VE.
Il..'.' I::f LIFT :5'T'FITION I':T, IN:~i;TF:ILLED., FIN ELE.~.TF~CFIL F'EF.:MIT F]Nf':, IN'"-',F'Er":TIF~N tlUg.;T
THE E. LECTR I CI::IL I.,.IOF..:I< ML. 'ST' E:E DONE D"r' t":1 L I F:ENSED ELECTF.': I C I FIN.
S I G NE
I.tFt I. I _.HNT · '.STE',,.'E TFICI<ETT
I :.3SI_IE[:, E , ' [:,RTE '
t 2/t2,-."8Z'.':
Permit %
Applicant:
Location:
MUNICIPALITY OF ANCHORAGE
Department = Health and Environmenta~ ~rotection
825 ~ Street, Anchorage, AK. ~9501
264-4720
* * * HANDWRITTEN PERMIT * * *
W-~t't=~)/OR ON-SITE SEWER PERMIT
Phone Number: ~
Legal Description: Z_ ~ ~ ~ ~ ~6rO ~
Type of Soil ~orption System Is:
Trench: Drainfield: Seepage Bed:
Lot Size:
Maximum Number of Bedrooms:
Holding Tank:
Soil Rating(sq.ft/br) /~ ~'q%m_ ~-H'}
DEPTH
The Required Size of the Soil Absorption System Is:
LENGTH ~ GRAVEL DEPTH ~' WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(H(>EDt-NG) TANK SIZE = GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is, 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
~e ,~sidence is remodeled to include more that ~Tbedrooms.
S igne~//~/~ ~ ~, ~x/'~.~ Issued by:
~ Ap~l icant
Date: /
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
~5 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOl LS LOG
PERCOLATION
TEST
PERFORMED FOR: ~:lt ~fl~e 'S~'~
DATE PERFORMED:
LEGAL DESCRIPTION:
3
~-4
5
6
7
8'
9
I-.S
SLOPE
SITE PLAN
10
1,1'-
12
13
14
15
16
17'
18
19.-
20
Reid, Jr.
COMMENTS
WAS GROUND WATER S
ENCOUNTERED? ~ ~> L
O
P
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~'~ (minutes/inch)
~" t,'~ ~='~' , FT
TEST RUN BETWEEN FT AND,
~rl'//:, ~m ,-/' -h:, ,'. Sc:' "¢-7o,,-, ~' ~ ~e, r,-~ ,,,,-~...,,,mt~
PERFORMED BY: ' , '~' ~
CERTIFIED BY:
72-00,~ f6/79~
L/5-0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
S~~ -OG
PERCOLATION
TEST
PERFORMED FOR: ~':t~
DATE PERFORMED: ~- 30- g'~
LEGAL DESCRIPTION:
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
C. Reid, Jr.
No. 2251-E
SLOPE
SITE PLAN
WAS GROUND WATER S
ENCOUNTERED? f~ o L
O
P
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ! %'"- (minutes/inch)
TEST RUN BETWEEN '~'~1'~ ET AND (~ FT
PERFORMED BY: ~'~'*~ ~'c'l
CERTIFIED BY:
DATE:
72-008 (6/79) ,
EXISTING
HOUSE
LOT 5
LOT 4
LOT 6
TR. B
10/8/2023
SCALE
I" =
Zo.
~,~1' ~ - ~ ..~0.0.
~11' .'~
/ 5
/. ~ ~ ~ 0,0
/ / - ~'1 ~
PLOT PLAN I~
~F"' I~*~'',-,, 1~'~ LOT ~ , aLOC~ ~
~ I~°~'.~ I ~~8(~ ~'~'~ )
MUNICIPALITY OF ANCHORAGE
Development Services Department = Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 015-234-45
Certificate of On -Site Systems Approval
Expiration Date:
Legal description ALPINE WOODS BLK 6 LT 5
Site address 12220 KINLIEN CIR Anchorage AK
Current property owner(s) RICHARD
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 10/9/2023
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
MUNICIPALITY OF ANCHORAGE
C).
Development Services Department `
p p � Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION `
Parcel I.D. 015-234-45
Complete legal description ALPINE WOODS BLOCK 6, LOT 5
Location (site address) 12220 KINLIEN CIRCLE, ANCHORAGE, AK 99516
Current property owner(s) RICHARD & LYNDA STEPHENS Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ® Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass
Age 0 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ �SD Waiver Fee $
Date of Payment �l2 `Il ZD 2-'; Date of Payment
COSA # y> C Z 3 Z Waiver #
COSA Application.doc
COSA Checklist.docx
COSA Checklist
Legal Description: ALPINE WOODS BLOCK 6, LOT 5 Parcel ID: 015-234-45
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA - PUBLIC &/OR CLASS “A” WATER
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 NA 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
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank NA
Date of pumping NEW TANK
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 7/25/1985
ALL standpipes present per record drawing
Total measured depth from grade 7.8 ft (max)
Measured depth to pipe invert from grade 3.8 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective (ED).
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 8/30/2023
Results Pass
Fluid depth prior to test 5 in
Water added 800 gal
New fluid depth 24 in
Elapsed time 1300 min
Final fluid depth 4 in
Absorption rate 600 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 120 in (MOA 10’ ED)
Effective depth used 76 in (Missing ED & Final Fluid Depth)
Effective depth remaining 44 in
Comments/Deficiencies: Approximate total measured depths from existing grade. Per ED elevation measured shots &
visual observations it appears 6’ or 72” of ED is approximately missing.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA
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
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to 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
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 10/09/2023
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 or NO 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 First Water Consulting &
10/09/23
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
264-472O
Application Date
GENERAL INFORMATION
(a)
(b)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
t,.v t.,.t ct/e.
Applicant Name ~;),
Applicant Address
Telephone: Home ~--'/J~C~ Business
(c) Applicant is (check one): Lending Institution F-I; Owner/builder []; Buyer [] · Other [] (explain);
(d) Lending Institution ~~,~~-~__~
Address
Telephone
(e) Real Estate Company and Agent
Address
Telephone _
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single~Family,~ Multi-Family []
Number of Bedrooms ' ~'~
Other
WATER SUPPLY
Individual Well [] Community~~' Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
OnsitEx 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 (11/84)
ENGINEERING FIRM PROVIDINg. ,NSPECTIONS, TESTS, FILE SEARCH, DAI ~ AND INFORMATION ~
t
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
Address '
Date
Telephone
Seal
Approved for ;~-'~/J..,~ bedrooms by. ~ ' , ~' -z.¢/F--~---~'~f..--1c~
Approved ¢/X~ Disapprove. Condit~/al
Terms of Conditional Approval
Date
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)
Ao
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
CHECKLIST- FEBRUARY 1984
R EC '
Legal Des. cription: L~o'~- ~'~ .r~/...~ ~' ~,~,
WELL DATA
Well Classification
Well Log Present (Y/N)
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 _~_,~7~
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
If A, B, C, D.E.C. Approved (Y/N)
Date Completed Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
y.
; 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 ~ Size~ No. of Compartments
Standpipes (Y/Ni' \¢"/'""~y (~-) Air-tight Caps (Y/N) y Foundation Cleanout (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
Date Last Pumped
/~.,~,//~. 'for
Temporary Holding Tank Permit (Y/N)
Y
To Water-Supply Well
To Property Line----/7~_,
To Water Main/Service Line
Course
.>/0
To Building Foundation
To Disposal Field ,_~"-/
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 7/~. ,.~,4~
Width of Field / /~-~-'
/ v
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Fi, eld:
To Water-Supply Well ~-/Z0/
To Building Foundation ~I~~1' /
,ot
To Water Main/Se~i~e Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
/
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line '~ /
To Existing or Abandoned System on
;On Adjoining Lots ~,,~..'~_(~ /
To Cutbank (if present) ,~/~.
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified~r conformed to ali, MOA and HAA guidelines in effect on the date of this inspection.
Signed ~r~.~ Date
MOA No.
!
Company
?
Receipt No. '
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
Engineer's Seal
MUNICIPALITY OF ANCHORAGE
DEPAR'FMEN1- OF HEALTH AND ENVIRONMENTAL PROTECTION
DIViSiON OF ENVIRONMENTAL HEALTH
Ct:R'i IFICA1 [~ ()1- INSPECTION FOR HEALTH AUTHORITY APPROVAL
OI- ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 5-Block 6 Alpine Woods Subdivision
Location (address or directions)'
12220 Kinlien Circle
(b) Applicant Name Jz)_bn..~[agmeieLC_~
Applicant Address
(c) Applicant is (check one): !,ending Institution E]; Owr~er~buildo;'
(d) Lending Institution A!asNa_ S~,.a~:e,_.BanJ<_ .............. 'Telephone .........
Address 3I 0_W esI_.N o ~t h_e.i:: n_.Li ghts __B l_v..d
(e) Real E;state C0mp~mv and Agent .... Eo. rt~e~o~Jtt~s
Address
562-7653
Telephone
(f) Mail the HAA to the following addruss:
.? . / ,
-/~7L-:~ ...... :; ...... _ _:,, ....... [
TYPE OF RESIDENCE
Single-Family [] Multi_Family [-I O~her
Number o~ Bedroorns_ !], __ .
WATER SUPPLY
Individual Well [] Comrnu,-~t
attesting to the h?[ialcty and
SEWAGE DISPOSAL
Onsite)~ Public, [] Communily L'-] Holding Tank [] -
Note: If commL,'nity well systcm. !~ ,LF/.'. iqOV(? Wr tten confirmation from the State Department of Er~v~rol1~'lM ~:~'lservaBon
. :!
attesting to the legality and status, i- .
Page 1 of 2
ENGINEERING FIRi~I PROVIDING INSPECTIONS, TESTS, FiLE SEARCH, DATA AND INFORMATION
As certifiod by ray seat affixed h(;reto and as of the validation date sl~own below, I verify that my investigation of this Health
Authority Approval shows that the on-sit~-; water supply and/or wastewater disposal system is safe, functional and adequate
for' the number of bedrooms and type of structu~'e indicated herein. I further verify that based on the inforrnation obtained
from the Municipality of Anchorago files and fronn 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 ....
Address _~Z_~_/
Telephone
/4, :,,/(:
ZT/;.. :.:7?0
..
Approved for _~.~_~_/'~.~/)beOrooms~
Approved ....... ............. Disapproved"%~
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. 'The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECI~,LIST - FEBRUARY 1984
264,4¥20'..
Well Classification /Y} V ~ ~ T~ ~/J~'3,(_ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) Date Completed Yield
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 Field on Lot
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
,Depression Around Wellhead (Y/N)
· On Adjoining Lots
· On Adjoining Lots
To Nearest Public Sewer Line
Cleanout/Man hole
Water Sample Collected by
Water Sample Test Results
TO. Nearest, Public Sewer
To Nearest Sewer Service Line on Lot
'Date
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) /
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-G~p~(',/~*,'~',~ ~.. x?/~- ~/~
To Property Line '~,~'
To Water Main/Service Line
Course /'Jo ~ ~"-'
Comments ~/4.. /$
Size/.Z'~__ ~_/~"~-_ NO. of Compartments
Air-tight Caps (Y/N) ~/~ Foundation Cleanout (Y/N)
Date Last Pumped /~
Jk~t ; for
Temporary Holding Tank Permit (Y/N)
Page 1 of 2
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
72-026(11/84)
Co
ABSORPTION FIELD DATA
Soils Rating in Absorption S. trata.
Date Installed
Width of Field ~i .~. /
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-~ C~YVltst~dAl
To Building Foundation
Lot /~)(9~,,.~ ~-
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~ e--l-'/'/' $
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
FT~ ~,L Standpipes Present (Y/N)
Date of Last Adequacy Test
Y
~J ~1~ ("~To ~operty Li ne
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
D, LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
**. Check Permitted Bedroom Rating Against HAA Request **
Signed"certify t.~).a; e.,,.~ c ~e ~_~,d~,~.~i ~ c"v" ~-'r-x,4,~,~"~ D a t e?r' .c.0.n_f or m ed to all MOA,~/~a'pd/,~'""H/~A guidelines in effect on the date of this inspection.
Company (~. l~/~//~. '~//Z~. MOANo. ~,~' ~'~'~ /~'
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
BILL SHEFFIELD, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA qg501
Telephone: (907)
Address:
274-~533
DATE: July 17~ 1986
PWS I.D.# 213598
To Whom it May Concern:
According to records on file in this office the Alpine Woods
Water System is in compliance with the State Drinking
Water Regulations
Sincerely,
CONSULTING ENGINEER
203 W, 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
SEPTIC SYSTEM ADEQUACY TEST
LEGAL:
LOT 5, BLOCK 6, ALPINE WOODS
LOCATION:
12220 KINLIEN CIRCLE
OWNER:
J. WILLIAMS
RESIDENCE:
SINGLE FAMILY, FOUR BEDROOMS
SEPTIC SYSTEM:
FROM MUNICIPAL RECORDS:
TANK: GREER STEEL, TWO COMP. 1250 GAL.
ABSORPTION SYSTEM: TRENCH
ABSORPTION AREA: 780 SQ. FT.
SOIL RATING: 181
INSTALLATION DATE: JULY 25, 1985
DATE OF PUMPING:
NOT APPLICABLE, NEW SYSTEM
DATE OF INSPECTION: JULY 17, 1986
TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND
WITH 4.5 FEET OF COVER. TRENCH HAS 4.5 FEET OF
COVER. NO LIQUID WAS OBSERVED IN SUMP.
THIS SYSTEM HAS BEEN IN OPERATION LESS THAN ONE YEAR.
OF SYSTEM IS REQUIRED.
NO TESTING
TEST RESULT:
THIS SYSTEM MEETS THE CODE REQUIREMENTS OF
THE MUNICIPALITY OF ANCHORAGE.
The operational life of all septic systems depends on the local
soil conditions, groundwater levels that may fluctuate during the
year, and the water usage of the family being served by the
system. These conditions are outside the control of the evaluator
of this septic system. We can therefore not give any estimate of
how long the system will continue to meet the operational requi-
rements of the Municipality and State.