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HomeMy WebLinkAboutALPINE WOODS BLK 6 LT 7
Municipality of Anchorage Page
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: "~OI J~)~ PID Number: ~ ~
Neme'~[:::::2Ot~L-'T) ~,4 VI¢~I~ ~ ~,Wastewater System: ~New ~pgrade
Address: ~
~~ ~~ ~t~ ~~ ABSORPTION FIELD
Phone: ~~_~~ I INO'OfBodrOOms:
~ Deep Trench ~ Shallow Trench ~ Bed ~Mound ~ Other
Total Depth from original grade:
LEGAL DESCRIPTION S°ilRating: ~.~ GPD/Sq. Ft.
Lot: ~ Block: ~ Subdivision:~} ~ ~ ~Depth to pipe bottom from original~grade:~ Ft. Gravel depth beneath pipe~.~ Ft.
Township: I Rango: [Sec,on: Fill addedaboveorigin~:d~ Ft. Gravel length: ~ ~( Ft.
WELL: ~ New ~ Upgrade Graveldc;t.~:~{l~ J~ ¢Et, Number of lines:~ ~lDistancebetweenlines:~/Ft.
Classification~~(Private,i ~A'B'C): Total Depth: Ft. Cased To: Ft. Total absorption area~ ~Q. Ft. '~(~ipe material:~~l~ ~.~
J Date Drilled: Static Water Level: Installer: Date installed:
Driller'.~~ Ft. ~~ ~~ ~ ~"~
Yield: I Pump Set at: I Casing Height Above Ground:
GPM, Ft.I Ft. ~l ~l ~ TAN'K ~
SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P.
To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~ ~~~ ~
Well ~ ~ ~ I~ __ ~ Material: ~~ Number of Compartments:
Surface
Water (O~ IOOg I~ -- -- LIFT STATION
Lot Size in gallons: I Man~turer:
Foundation j~4 lC f~ ~j,+ __ -- "Pump on" level at: J"Pump ofr' ,eve, at:' ' J High water alarm at:
Cu~ainDrain ~ ~,~ ~ ~ ..__ Pump Make & Model J Electrical Inspections pedormed by:
I
Remarks: J~~~~ ~d~ BENCH MARK
~ ~~~ ~~(O~ Location and Description~p ~ ~
ENG~~AL
Department of Health~ ~an S~ces approval 'lJ~:'.
Reviewed and approved by: Date: ~~/
72-013 (1/91) MOA 25
Permit No. ~--~J~O IC)~ Page ~' of ~
Municipality of Anchorage
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
Legal Description: ~([,~ll~l~_., ~,J~ '~1..,~. (~ I~ '~-
/
/ ~'r'l LI~ ~O4:>
72-013 A (2/gl)MOA25
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
/
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT ~ ~.~
PERMIT NUMBER:SW910205 DATE ISSUED: 7/17/91
DESIGN ENGINEER:S & S ENGINEERS EXPIRATION DATE: 7/17/92
OWNER NAME:KEEFER DONALD C & VICKIE T
OWNER ADDRESS:12231 KINLIEN CIR
ANCHORAGE, ALASKA 99516
PARCEL ID:01523448
LEGAL DESCRIPTION: ALPINE WOODS BLK 6 LT 7
LOT SIZE: 32216 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT:
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH
INSPECTION. THE SEPTIC TANK CAPACITY MUST BE INCREASED
FROM 1,000 GALLONS TO 1,250 GALLONS. USE OF THE LIFT
STATION VOLUME WILL NOT BE CONSIDERED AS SEPTIC TANK
CAPACITY. PRIOR TO CONSTRUCTION OF THE WASTEWATER SYSTEM,
THE ENGINEER MUST OBTAIN PERMISSION FROM PUBLIC WORKS AND
ADJACENT PROPERTY OWNERS TO PLACE FILL MATERIAL INTO
ADJACENT DITCHES AS A MEANS OF ELIMINATING PONDED SURFACE
WATER AND ENSURING THAT THE PROPOSED WASTEWATER SYSTEM DOES
NOT ENCROACH ON THE REQUIRED 100 FT. SEPARATION TO SURFACE
WATER.
RECEIVED BY:
ISSUED BY'
July 5, 1991
ROBERT SHAFER, P.E.
ROGER SHAFER
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 7; Block 6; Alpine Woods Subdivision;
Request you issue a permit to drill a w~ll and install a septic system
serving the 4 bedroom house located on the referenced property.
On November 28, 1990 a permit was issued to install a 4 bedroom septic
system. However, there was an ~rror in the d~sign which went
undetected through the permitting and inspection process.
Consequently, the system installed was only adequate for a 3 bedroom
house. A Health Authority Approval was issued on December 20, 1990.
At this time we wish to add onto the existing l~achfi~ld increasing its
size to a 4 bedroom capacity. Attached is the revised design.
If you have any questions or req~re any additional information for
your rev~ contact us.
A. SHAFER, P.E.
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
SCALE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
TELEPHONE 264-4721
.o,,cE or v oL^, o. 4394
Please take notice that the undersigned authorized represen-
tative of the Director has reason 'to believe that on or about
~ . //~ ,19,~/ , at or near the following:
APPROXIMATE LOC;~,TION:
NAME: ' ~' j~
A I~ D-~E S~:- .......
- WiT~.I~'N-T~E'MUNIC-i~ALiT'Y ~1~ ANCHOJii~I[-GE DID UNLAWFULLY:
'-~hich is a separate v 0 it'on-of § _ ."/'~v
~_,,,fr?~; of the Anchorage Code of Ordi-
nances each and every day such condition exists.
A COPY OF THIS NOTICE HAS BEEN SERVED UPON:
NAME .
~ ..------- !~ THFF~LLOWING MANNER:
,fie~b~erson~
~mail
3~o~in~ this notic~ on or about tho location
horoin when suoh person cannot Be found affor diligent
effort to do
If the vie ation or vio~Lati0~s ref~l~ to her,~/have not been
,~,'/'~' ./z~ , lg~z, legal proceed-
corrected by ...... ,,
be initiated as/l~rovided by law.
ings
may
Dated this__~_dayof-- V~ .,.~, ,19_~.
70-004 (Rev. 5/78)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
TELEPHONE 264-4721
.eT.cE or 439
Please take notice that the undersigned authorized represen-
tative of the ,Director has reason to believe that on or about
~./~¢,/Z,Y' ~ ' ' lg~--~/ , at or near the following:
APPROXIMA'r~ LOCATION:
A b~R~SS: - '
WITHIN TH[MUN[CI~LITY-~F ANCHORAGE DID UNLAWFULLY:
which is a separate violation of §
of the Anchorage Code of Ordi-
nances each and every day such condition exists.
A COPY OF THIS NOTICE HAS BEEN SERVED UPON:
IN THE FOLLOWING MANNER:
1. by personal service
2. b~certified mail
3/~'~_~. by posting this notice on or about the location described'~
herein when such person cannot be found aft~
~_~ effort to do so.
Iftheviolationo~ns~edtoherein4/havenotbeen
corrected by _- . ,19~..~,legal proceed-
ings may be initiated as provided by law.
atedt ~ yo .- ,,-,- ,19
70-004 (Rev. 5178~ ®s
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
~ ~ ~0 SEPTIC ABSORPTION
Address TANK FIELD WELL
~ ~ , ~ ~ driveway,AS'BUILTwaterDIAGRAMbodies, etc.,(Sh°w location of well, septic system, properly lines, foundation,
Manufacturer Capacity in gallons
~aterial No. of Comp~ments
TYPE OF SYSTEM ~ -
Depth to pipe bottom from I Total depth from original grade
original grade ~ ~, CFI W ~ FT
Fill added above original grade Grave~ depth beneath pipe
~ FT O,~FT
Gravel length Gravel width
~ FT' ~FT
Total absorption area Distance between lines
~ ~ 80 FT ~ FT
Date Installed
WELLS
RIVATE ~THER (Identify}
Classification Total Depth I Cased to
Installer Date Installed:
REMARKS:
,,. · ~dify that this inspe~ion was pedormed according t0 all
Municipal ..u a~e~loelinu In efle~ on this date: /
72-013 (3/85)
SCALE
October 31, 1990
ROBERT SHAFER, P.E.
ROGER SHAFER
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOl L TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 7; Block 6; Alpine Woods Subdivision
PERI, lIT REQUEST NARRATIVE
The septic system serving the referenced property failed an adequacy
test October 15, 1990. A soils test and upgrade design have been
completed.
This property is served by a Community Water System. All properties
within 200 ft. of the proposed septic upgrade are undeveloped.
The existing septic system was designed for a three (3) bedroom house.
The owner is fi~~ basement and adding a bedroom. The upgrade
design is for ~ four ~)~bedroom septic system. There is sufficient
room on the pro~ty~an alternate four bedroom system. A soil test
and groundwater monitoring have been completed near the proposed
alternative site.
The slope is approximately I to 2% at both the primary and alternative
sites. The bed is designed 24 ft. long rather than 15 ft. because a
bed 15 ft. wide with 1000 sq.ft, would be 67 ft. long, which is greater
than 4 times the width. The primary bed site was chosen over the
alternative site because of aesthetics.
If you have any questions or require additional information, please
contact us. _
AFER, P.E.
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
= '"'f 0 '
SCALE
0
0
/
/
/
1
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCR,PT,ON:J_~ '~j ~ I~ ~ j A !p;~d~ I,Oo~-~-°wnship, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
s
L
o
P
E
Depth to Water Alter
Monitoring?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ~-~ ~ (minutes/inch) PERC HOLE DIAMETER
. -- . TEST RUN BETWEEN ~-.~ FTAND ~FT
COMMENTS ~'~'--~/~' 1,o,,, f~ ,,!~ ~ - ~-~t ~l~, ~o ~- ~ , ,~ ,,
~ ":/"r'"'~" '~ -- '- - - )
PERFORM~D~Y'. !Ta'.~leEiverkoo~oadN~.~n41 x':-~ ~
CERTIFY THAT THIS TEST WAS PERFORMED iN
.... Eaole Riwr, Alaska 99577', ~ /~ /~
AC~uHDANCE WITH~LL STATE AND MUNICIPAL GUIDELINE ON THIS DATE. DATE. ~
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE ~~f
PERFORMED:
LEGAL DESCRIPTION:~,O+ ~-~,J~ll~./O ~/~,~'~ ~.1)~ ~.~.~Township, Range, Section:
SLOPE
~oH
_ J
SITE PLAN
WAS GROUND WATER
ENCOUNTERED? ~
S
IF YES, AT WHAT I ~)
DEPTH? ~:~ p
Depth to Water Alter.,
Monitoring? /-/0 Date: ,/
1
2
3
4
5
6
7
8--
9
10
11
12
13
14
15
16
17
18
19
2O
Gross Net Depth to Net
Reading Date Time Time Water Drop
7
'7
PERCOLATION RATE ~__ O (minutes/inch) PERC HOLE DIAMETER
, TEST RUN BETWEEN _~,~::::t FT AND ~ FT
COMMENTS
PERFORMED BY:I
ACCORDANCE *~"^~"~f~'~'"Z~¢, ~f~',PA~ ~,DEL,N ~ECT ON T.,S DATE.
72-008 (Rev. 4/85)
~/.oU~IICIPALITY
INSpEcTIONS
DIVISIO
STREET ADDRE
LOT / ?
FOOTING
FOUNDATION
BOND BEAM
FRAMING
INSULATION
SHEETROCK ---
STRUCT. FINAL
OTHER
NONCOMPLIANCE OBSERVED
[] WILL REEXAMINE AT NEXT INSPECTION
[] =r=~ T= '~';: ....... ~/~' El",' PLBG.UNDGR
~.~,,.,. -~.MP.I~' - ~, _'",. ', , ' ·
[-I. ELEC. SERVI~~;' ~,'r:--PLBG: ROUGH
~ ELEo' ROUGH~" ~ :" *~ '*~GAS TEMP. "-
~ ELEC.' FINAL ~ ~GAS~ '?" ''
~ OTHER ,~ '~ ~ MECHANICAL
~ ~ ~ ~ ~ ~ ? MECH,~ ~[NAL
~ FIRE FINAL ~"'..' PLBG.'.:[I.NAL
~ ZONING ~ ~ ' OTHER:':':
~ CORRECTIONS ESSENTIAL AS
EXPLAINED BELOW .~;~';;~ .:;',?'~'
~ D~NOT CoNCEAL'U~TI~"~pEcTED
(Rev. 11/87)
MADE, PLEASE CALL FOR INSPECTION
REMOVE THIS NOTICE
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
N'AME
IPHONE
~-813'3 I-]UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
Well
DISTANCE TO: ] 2.c~o ~-
~-<~l-z-~ ~ Manufacturer
~ ~ Liq. capacity in ~allons
/ ~O~P ~ muIV~lVl~:
O Z ~ I Manufacturer
~ I Well
~ ~ ~ DISTANCE TO'. I
~ ~ ~ No, of lines / I Lengt~ of each line
~ ~ ~ Top of tile to finish grade
Length
/ Ty--~f crib
DISTANCE TO:
Width
IAbsorption area
7'
Dwelling
Material
Width
NO. OFBEDROOMS
PERMIT NO. ~_~ ~-O
No, of compartments
Material
Nearest lot line /! ·
Trench width
~- ~' ~--inches
Inside length Liquid depth
Dwelling PERMIT NO,
Liquid capacity in gallons
Foundation ~O ' PERMIT NO, ~ &--O ~-4
Total length of lines
Iq,~ /~'~
Material beneath ~ile
Depth
inches
Distance between lines
Total effective absorption area
PERMIT NO.
Crib diameter Crib depth Total effective absorption rea
Well Building foundation Nearest lot line
Depth Driller Distance to lot line PERMIT NO.
Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
DATE
LEGAL
APPROVED
72-013 (Rev. 3/78)
! /
!:'3F:hqVllii] .... DE]:::"T'H (F::'T.
~ ~..~t~...t~ .... DF:i]::'T{". ,{' , ,, )
(:'~FR A V E! .... W I :i'.) T l'"l < F::"!". )
,'::':iF:;:AVEI .... LI!i:I',IG'I"H (F:"T'.)
GRAVEl .... VE)LUMI:!Z <CU,, YD!!i!;,, )
TANK
SO ]; { .... F:;.'A'i" I NG < !i!!;C! ,, F::"l" . .,' !i:iU::;.'. )
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
PERFORMED FOR:
DATE PERFORMED:
LEGAL DESCRIPTION:
2
4
5
8
9
10
11
12
13
SITE PLAN
SLOPE
WAS GROUND WATER S
ENCOUNTERED? ~ L
0
P
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
~ 3oo 3~ 2, ~l .3~
14
15
16
17
18
19 C. Reid, Jr.
No, 2251-E
20 ,,~
COMMENTS ~o,( -~+ t~a~/
PERFORMED BY: /~*~,~. r~
PERCOLATION RATE I ~ (minutes/inch)
TEST RUN BETWEEN ~ FT AND z/l ",Z.. , FT
.¢,.dV:,,,~, /,,,,.,,.,_ ,~/~..~ / y;.~ ,:r
2'% I~-' ,,, ...~ ~, ~?~,'/Z.
CERTIFIED BY:
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY '
APPROVAL FOR A SINGLE FAMILY DWELLING
~:~ I/'~-- ~'~44'~) NAA# ~'~ ~;::~c~ \ C~) c~ \ °~ ~
GENERAL INFORMATION
Complete legal description
=
Location (site address or directions) 1"~% ~ I ~_._~1 ~ L,-I ~/~J ~
Property owner ~OM&~ ~. ~¢~--. Day phone
Mailing address 1~%~ ~ _ ~ .
Lending agency ~1~ ~O¢-%~~ Day phone
Mailing address ~O~ ~[~ ~.H 1~; ~~¢~
Agent ~ ~ ~¢~¢/~k~/~'~ ~~yphone
Address ~¢~ ~~,~¢~i ~l'~% ~,' -~~
Unless otherwise requested; HAA will be held for pickup.
NUMBER OF BEDROOMS: ~
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA ~21
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 $ & $ I-'.G,.££RI.G Phone ~4' Zq'-~
17034 Eagle Ri~er Loop Road N~ 204
Address Eagle River, Alaska 09577
Engineer's signature
DHHS SIGNATURE
,/)('.__Approved for ,~/~'-~) bedrooms.
Disapproved.
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 order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA ~1
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ,/~l~::~t,,J~ k_~~~/~(~r"~r)'[~[.J/.~Parcel I.D.
A. WELL DATA
Well type A
Log present (Y/N)
If A, B, or C, attach ADEC letter.
Date completed
ADEC water system number
Driller
Total depth
Sanitary seal (Y/N)
Cased to
Casing height
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
g.p.m.
AT INSPECTION
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
S EP 1 6 1991
g.p.m,
RECEIVED
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ' ,'~,~ d~ ~ J--
Absorption field on lot '~d~ I~
; On adjacent lots
; On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Sewer service line
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA ,.,
Date installed --~/~'.
Cleanout~,~N) y Foundation clea nout(;~--)N)
High water alarm (Y/N)
Date of pumping A
Compartments ~'~'~-
y ' Depression (Y/N)
Alarm tested (Y/N) Pumper II-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line
Surface water/drainage
On adjacent lots
Absorption field
¢-JF"' Foundation
Water main/service line ~z~ ~-f--
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed ~
Size in gallons
Ven~N) y
High water alarm level '"~-')~ (~
Meets MOA electrical codes/fYi.N)
"Pump on" level at
Y
Manufacturer A 1~)~3('~..~ -t-Ak! K_.
Manhole/Acces~/~N)
;:~.~ ~t "Pump off" level at ~ n
Cycles tested /~//~ ~
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot ~.j O I~___~ ~On adjacent lots
"~ ! ~ Surface water 100
D. ABSORPTION FIELD DATA
Date installed
Total absorption area
Depress:· on, :°var field. . :(Y~) JLJ
Peroxide treatment (past 12 months) (Y~
Soil rating
Gravel thickness ~ ~ /
· Total depth
Cleanouts preser~N) , , y "
Date of adequacy test J[J/~
for +
If yes, give date
System type
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot kJO. l
To building foundation
On adjacent lots ~
Surface water
Curtain drain
On adjacent lots ~ I"~ Property line
j ~ ~' ~ To existing or abandoned system on lot
Cutbank ~,,.[ 0 I~ _~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effectDa the date of this inspection.
S & S ENGINEERING
Signature 17034 Eagle Ri~er L~p Roa~ NO, ~ ~""
Eagle River, Alaska ~95~ ,~,
Engineer's Name
Date ~ [ 3
HAA Fee $ /-~ O..g-- Waiver Fee: $
Date of Payment L~/_/{~ -~/ Date of Payment
Receipt Number ~__~0 ~_~ -- ~/~ Receipt Number
72-026 (Rev. 3/91) Back MOA 21
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
3601 "C" STREET, SUITE 322
ANCHORAGE, AK 99503
WALTER J. HICKEL, GOVERNOR
PHONE: (907) 563-6775
September 12, 1991
S & S Engineering
17304 Eagle River Loop Rd,
Eagle River, AK 99577
Re: PWSID # 213598
Dear Sirs:
My review of the records on file in this office reveals that the Alpine Woods Subdivision
Class "A" Public Water System, is in compliance with the routine coliform bacteria samples
requirements listed in Table C, and with the inorganic sampling listed in Table B of 18 AAC
80.200.
Sincerely,
Keven K. Kleweno
Lead Engineer
KKK/cf
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
---- 5---- ~------------ ~----~
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
FAX: (907) 561-5301
ANALYSIS REPORT EY SAMPLE for WORKorder! 36041
Date Report Printed: AUG 7 91 @ 14:27
Client Sample ID:L7 E6 ALPINE WOODS
PWSID :UA
Collected JUL lO 91
Received JUL 10 91 @ 15:57 h~s.
Preserved with :AS REQUIRED
CORRECTED
Client Name :MOA*HEALTH & HUMAN SRV-H20 QUALITY
Client Acct :MOAMBPO
EPO ~ 04985 CEXP. 12/91) PO #
Req ~
Ordered By :DAN BOLLES/HEALTH & ~MAN SRV
Analy8is Completed :JUL 11 91 Send Reports to:
Laboratory Supezvlso~./~TEPHENC2,EDE I)MOA*HEALTH ~ HUMAN SRV-H20 QUALITY
Chemlab Ref #: 913295 Lab Smpl ID: I Matrix: WATER
Allowable
Parameter Tested Result U~ts Method Limit8
...............................................................................................................
Eecal Coliform 0 col/lOOml
Sample SABLE COLLECTED BY: D. BOLLES; WITNESSED BY J.W.S.
Remarks:
1 Tests Performed ' See Special In~tructions Above UA-Unavailable
ND- None Detected "See Sample Remarks Above
HA- Not Analyzed LT-Less Than, GT-Greater Than
~SGS Member of the SGS Group (SocidtO G~nbrale de Surveillance)
Parcel I.D. #
~ MUNICIPALITY OF ANCHORAGE ~ ~'~_ "~
/'~'~ Department of Health & Human Services //a~t~, . 4.44,. ?"~' -,,.
~/ DIVISION OF ENVIRONMENTAL SERVICES ~~
~ 343-4744 t~, ,, ~~
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF~/~
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Lot 7; Block ~; Alpine Woods Subdivision
Location (address or directions)
12231 Kinlian Circle, Anchorage, Alaska
(b) Property owner
Mailing Address
Jim and Sue Barkeley Telephone' (home)
12231 Kinlian Circle,' Anchorage, Alaska.
345-2096 Business
(c) Lending Institution
Mailing Address
City Mortgage Telephone
405 West 36th Avenue, Anchorage, Alaska 99503
RFJ & ASSOCIATES/Becky Hannon
(d) Real Estate Company and Agent
Address 8300 Briarwood, Suite B; AnChorage, Alaska 99518
Telephone
349-3344
(e) Mail the HAA to the following address: (or check here IN,. if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING/694-2979 ..
.?
17034 Eagle River Loop Road, Suite 204
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms
3
3. WATER SUPPLY
Individual Well [] Community:~ Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site r~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
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s!ql ~o uo!~e§!~se^u! XuJ ~eq~ Xjpe^ I '~oleq u~oqs e~ep uo!lep!le^ eq~ jo se pue o~eJeq pex!jje leas XuJ Xq pe!jR]eo sV
NOI.L'¢INIdO:INI QN¥ Vi'I/(3 'HOM¥~$ -3'lid 'SIS-:]& 'SNOIJ. D-3dSN! 9NIQIAO~d Plaid 9NII:I~]~NIgN~] .cj
~ MUNICIPALITY OF ANCHORAGE (MOA)
(~.4~,1 Health Authority Approval (HAA)
,,,~,....~ ......... :~R^~I~IECKLIST - FEBRUARY 1984
ENV~R~NME"I~'~ SERVICES DIVISION 343-4744
DEC 1 9 1990,
A. R E C E I V
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 '~;~
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments ,,~2.~,~.~_ \~. ~
Legal Description:
Date Completed
Depth of Grouting
If A, B, C, D.E.C. Approved (Y/N)
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
;Date
B. SEPTIC/HOLDIN~ TANK DATA
Date Installed "~/~:~ Size
Standpipes ~)/N)'~ Air~tlg~t, Caps~fN) 7
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N))
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLD NG TANK:
To Water-Supply Well ~ I
To Property Line ~. c;, ·
To Water Main/Service Line
To Streamed, La.~ or Major Drainage Course
Comments, r/~-~'
No. of Compartments
Foundat~leanout(~, )
,l,~/~ateLastPumped~' -I/'"\_ ; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed \~"- ~:)
Width of Field '~¢2F'~
Square Feet of Absortion Area
Depression over Field.(Y~)
Results of Last Adequacy Test
(::~,'~ ~=~¢;>~ ~-"~/'/~- ~ Type of System Design
Length of Field ~::::~'Z-
Depth of Field
Gravel Bed Thickness
~,I::::::~:~ ~ Statndpipes Preser'~/N)
~ Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~ I~ /
To Cutback (if present) hi/_~
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm I~evel at . ~ ,
· e,,e ,or
Meets MOA Electrical Codes(~N)
Comments
Dimensions
M an hole/Access(~:~/N) x,/
"Pump Off" Level at
Vent ¢i'/N) y
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HA/~6jl~ji~144'~e,,s in effect
inspection.
,,?+.
Signed
Date
MOA No.
on the date of this
Engineer's Seal
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt ~o. '"" "
Waiver Fee: $
Date of Payment
f~ ~ c,,©c~ ~ O~"/'~Page
2
of
2
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
STEVE COWPER, GOVERNOR
563-6775
December 14, 1990
FOR: S & S Engineering
Attn~ Roger
PWSID: 9213598
My review of the records on ~ile in this office reveals that the
Alpine Woods Class A Public Water System is in compliance with the
provisions of 18 AAC 80.060, State of Alaska Drinking Water
Regulations.
Sincerely,
Keven K. Kleweno
Environmental Engineer
KKK:pf
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL - (~) / -~-
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
GENERAL INFORMATION ('MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property Owner' -J~.~"~ HANSOI'J Telephone: Home
Mailing Address
(c) Lending Institution
Telephone
Business
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e)
Mail the HAA to the followin(3 address: or: Check here'l~, if hold for pick up.
List contact person and d.ay phone number below.
TYPE OF RESIDENCE
Single-Family~i~
Number of Bedrooms
WATER SUPPLY
[] Community~r Public []
Individual
Well
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite~. 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 (Rev 8/86~ Front
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Date [0 ~tl" ~
DHHS APPROVAL
Approved for ,~,~ (/.7) bedrooms by
Approved ,~ Disapproved
Terms of Conditional Approval
Conditional
Date
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
certificates based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in
order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data
before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
Page 2 of 2 72-025 cRev 8/861 Back
WELL DATA
iRO NMENT AL ~,Eg.V.[CES DIVI~IO~
E~ - MUNICIPALITY OF ANCHORAGE (MOA)
HE~T~AUTHORITY APPROVAL (HAA)
~,.,;~V [ ~ J~CKLIST- FEBRUARY 1984
264-4744
RECEIVED Legal Description:
Well Classification
Well Log Present (Y/N)
Total Depth
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
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
L OoO5
OI4MONITy' 5,¢¢TeyY)
If A, B, C, D.E.C. Approved (Y/N)
Date Completed Yield
Cased to 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
To Nearest Sewer Service Line on Lot
; Date
B. SEPTIC/HOLDING TANK DATA
'7//8s'
Date Installed
Standpipes (Y/N) ~'~ Air-tight Ca0ps (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-Supply Well
To Property Line
To Water Main/Service Line
Course .4- ~
Size lO00 ~ No. of Compartments ~Z-
Foundation Cleanout (Y/N)
Date Last Pumped -~' "'"7 ' ~'
· for
Temporary Holding Tank Permit (Y/N) '"-
To Building Foundation
To Disposal Field ""~
i
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026 fRev 8/861 Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~ /
Width of Field ~ ~ !
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
/40
-~AT 1,5 F/~ ¢,:.,T0¢-',./ Fo¢-
Separation Distance from Absorption Field:
I
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line .4- I OI
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field ~r-~-i
Depth of Field 4-!
Gravel Bed Thickness ~ II
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots -t-IOi
To Cutbank (if present) .-1-'~' 1
..~ ,'Z.o 0~
Co m ments
LIFT,~ATION
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 J;~ve checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~f)~{.~ Date JO tY~¥ ~
Company ~;;~J2~C_J¢_/~,,~l/'~ ~OO'~ MOA No
'- Il
Receipt No.
Date of Payment
Amount:
Page 2 of 2
72-026 fRev 8/86~ Back
' STEVE COWPER, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
3601 "C" STREET. SUITE 1334
ANCHORAGE. ALASKA 99503
._5~63-6775
DATE:
PWSIO #:
To Whom It May Concern:
Accordin,, to the records on rile in this of`rice, the
~:~J_~_~_~_-J' .:~//3 Water System is in compliance with the
State of' Alaska Drinking Water Regulations,
Sincerely,
Environmental Field Of'f'icer
IXDC. ATION:
Client's Name:
Address:
I~SE, EPPS & IKDTTS
2220 F2%ST 88 AV}2ang
&N<IK3RAGR, AK 99507
¢907) 349-6451
WATER wl~r.r. TEST
DRAW GALLONS ~L~NS
FIET.n METER
DOWN TIME ~PM . -~ VOLUME TOTAL MONITOR LEVEL. READING
,
I
C
~ ~; GPM
P.~duc..on Rate: 24-Hour Capacicf Gallcna
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
December
Application Date
GENERAL INFORMATION
(a)
(b)
Legal Description (include lot, block, subdivision, section, township, range)
. Lot 7 Block 6 A[.uLne Woods
Location (address or directions)
_ ]2231 Kinlein Circ]e~ Anchorage AK 99510
ApplicantNameJerrold Hansen Telephone: Home 345 .3874
Applicant Address
4, 1985
· ~'8
Buslness,~6 8135
(c) Applicant is (check one): Lending Institution [] ' Owner/builder [] · Buyer [] · Other [] (explain);
(d) Lending Institution Home Savings & Loan
Address 'F~enson Blvd Anchorage AK
(e) Real Estate Company and Agent ;':/A
Address
TeLephone 276 1451
Telephone
(f)
Mail the HAA to the following address:
will pick up
TYPE OF RESIDENCE
Single-Family~]~ Multi-Family []
Number of Bedrooms 3
Other
WATER SUPPLY
Individual Well [] Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite:~ Public [] 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 PROVIDh,,.~ INSPECTIONS, TESTS, FILE SEARCH, D~,A AND INFORMATION . - ~.v.
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 ©uadra Engineering Inc Telephone 276 3770
Address 401 E Fireweed Lane
Date
December 4 1985
Engineer's Seal
DHEP APPROVAL
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)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MO,-v
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: Lot
Subdivision
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
uEC 06
RECEIVED
7 Block 6 Alpine Woods
Well Classification Ccaxnunity Water Syst6m If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) Date Completed Yield
Total Depth Cased to Depth of Grouting
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
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/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed ~_~,~ize ~ No. of Compartments
Standpipes (Y/N) ¥ Air-tight Caps (Y/N) Y
Depression over Tank (Y/N) N
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) n/a
Separation Distances from Septic/Holding Tank:
To Water-Supply Well 200 Fc plus
To Property Line 30 ft
To Water Main/Service Line 12 ft; to
Course 200 ft plus
Comments
2
Foundation Cleanout (Y/N)
Y
Date Last Pumped New Installation
N ; for
Temporary Holding Tank Permit (Y/N) n/a
To Building Foundation
To Disposal Field
15 Pt
7 ft
service line
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
. SO,ils Rating in Absorption Strata
Date Installed July 16, 1985
Width of Field 21 ft
143 sq.
Square Feet of Absorption Area 882 sq.
Depression over Field (Y/N) N
Results of Last Adequacy Test n/a
Separation Distance from Absorption Field:
To Water-Supply Well 200 ft plus
To Building Foundation 22 ft
Lot 5, Block 6 100 ft Plus
ft/bdr. Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
ft Standpipes Present (Y/N)
Date of Last Adequacy Test
To Water Main/Service Line 20 ft tO service line To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course 200 f~-_ plus
To Driveway, Parking Area. or Vehicle Storage Area 20 ft to driveway
Comments
42 ft
6 inches
Y
To Property Line 11 ft
To Existing or Abandoned System on
; On Adjoining Lots none on lots 6 & 8
n/a
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~~_ ec~. v~ifi,~r/~ onformed to all MOA and HAA guidelines in effect on the date of this inspection·
Signed .'~~-,~~ate December 4,~ 1985
Company /Ouac:~a En~i~eerinc[ '.i. ~ MOA No. ST 85-199
Receipt No. ~
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
,/~,~/~- ~, STATE OF ALASKA
/~"~.~'-'4~--~¢'~ DEPARTMENT OF ENVIRONMENTAL CONSERVATION MUNICIPALiTy
CONSTRUCTION AND OPERA N CERTIFICA O N c
for *,, 0
PUBLIC WATER SYS~~o~
A. APPROVAL TO CONSTRUCT ~Cf~/__ --~
Plans for the construction or modification of ~ ~ ~~OO ~ ~ ~ ~ r~ ~
~3~ ~ --F ~- ~ ~ ~ C[.~ ~ ~ public water system located
~D C ~ ~ ~ ~ , Alaska, submitted in accordance with 18 AAC 80.100
have been reviewed and are
[] approved.
conditionally approved (see attached conditions). Add±t±onal pump tests
~on~e'ted o~f wells #3 and #4 to show draw down and recovery rate.
TITLE DATE
If construction has not started within two years of the approval date, this certificate is void and new plans and
specifications must be submitted for review and approval before construction.
B. APPROVED CHANGE ORDERS
Change (contract order no. or descrtl~tlve reference)
Approved by Date
C.. APPROVAL TO OPERATE
Thais made"APPROVALavailableTOto theOPERATE"public, section must be completed and signed by the Departmentp~lj ~'bef°re~ 4::~jany ,~a~~
The construction of the .j~L P_Ti~,'~- ~ COD ~ .z~/~ .T~J~ .~-~fvJ ~r~ public
water system was completed on J~'C__~ ~'ula ~'w ~ /~¢ ~ ~'~ (date). The system is hereby
granted interim approval to operate for 90 days following the completion date.
BY TITLE DATE
As-built plans submitted during the interim approval period, or an inspection by the Department, has confirmed
the s~stem was constructed according to the approved plans. The system is hereby granted final approval to
DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C)
3. PINK · ENGINEER/MUNI-BOROUGH (Complete Section C)