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ALPINE 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 · >porn s,Jeeu!tliua leUO!SSa~oJd aql u! SUO!SS!LUO JO s]oaJa Jot elq!suodsaJ leu s! e~eJoqou¥ to/il!led!o!un~ eq.L 'panss! s! aleo!t!lJeo e e]oteq elep @ZileU~ ao suo!loedsu! lonpuoo leu op SLING ~o see/foldgu::l 'slu@guej!nbeJ 8u!puel ~!eql pue SaUJOLI ~O s~eseglo~nd el Xsel~noo e se S!LI~ seop SHH(] aqj. 'e>tSel¥ ~o ale,S atp, u! pa~e~s!l~e] Jaeu!~ue leUO!SSa~o]d ~uepuedepu! ue teAoJdd¥ ilpoqlnv q~leeH senss! (SHHQ) sOO!AJe. 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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)