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HomeMy WebLinkAboutALPINE WOODS BLK 5 LT 2Alpin Wood.s lock Lot 2 015-234 -32 Municipality of Anchorage Page / of 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 Name~ ~ ~ ~ ~11~ ~r ~ Wastewater System: ~ New ~ ,upgrade Address: ~zo ~1~,-~ ~~ ABSORPTION FIELD Phone:.~/~ ~ ] Zl~ ~ No. of aedrooms~ ~~. ~. a Deep Trench a Shallow Trench ~Bed ~Mound ~Other Total Depth from original grade: LEGAL DESCRIPTION SoilRating: , ~ GPD/Sq. Ft.. ~ ' Lot: Block: Subdivision: ~ Depth to pipe bottom from original,rode: Gravel depth ben'eath pipe Township: ~ ~ IRange: ,~ ~ I,ection: ~ ~ Filladdodaboveoriginalgrado:~ Ft. Graveliongth:' ~ Ft. Number of lines: ~Distance between WELL: ~ New D Upgrade Gravelwidth: ~ Ft. ~I ~,lines: Ft. ClassifiCation (Private. A.B.C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static W~',,~ Level: Installer: _ ~,¢ Date installed: Yield: GPM IPump Set at: Ft. ICasing Height Ab°ye Gr°und:Ft. " 'TANK SEPARATION DISTANCES ~ s.pt~c ~ Ho~d,n~ ~ S.~.~.,. TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Unes ~ A. ~/,.~ ~A Material: 0 Number of Compartments: Surface w~t~ Ioo+ 1oo* ~ - ~ LIFT STATION LOt~ + ~ -- Size in gallons: ~ Foundation ~& g~ ~ ~ ".ump on" Iovol at: ~~rm al: Curtain ~J Inspections performed by: D?in )OO+ ~O~ jO~ )~O~ Electrical Remarks: ~11 ~e~ A~ L~~' BENCH MARK Location and Description:  Assumod Bovation: Health a uman vices approval I. Department of ~ · ~ .-~. ,,~ Reviewed and approvod by: Dato:/ 72-013 (Rev. 9/91) MOA 25 Permit No. SW950256 1 of 5 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:345-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal DescripUon T. 12 N, R. 5 W, SEC 25 SM AK. PID No: 015-254-32 LOT 2, BLK 5 ALPINE WOODS COMMUNITY WATER SYSTEM o ~ ~ ~1~ ~ SYSTEM TO BE INSTALLED 10' FROM R-O-W 3 EAST P/L AND 11' FROM SOUTH P/L SITE MAP CONTROL DIAGRAM 1" = 100' 1" =50' SYSTEM ROTATED 90" FROM DESIGN ~ .. ~ '..~5 kI BM B B SE PROP COR,(FENCE)EL=IO0 BM A BM C ~. ...........................Jl~----~--~ ~-4 47.7' 48.0' .'" BM A DESTROYED DURING CONSTRUCTION NEW BM A SE HOUSE COR. Permit No. SW950256 s OF S Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:345-4744 On-Site Wastewoter Disposal S~vstem end Jar Well Inspection Reporf. Legal Description T. 12 N, R. 3 W, SEC ;25 SM AK. LOT 2, ELK 5 ALPINE WOODS PID No: 015-234-,.52 MONITORINO TUBE C.O. C.O. SURFACE -~. C.O. C.O. C.O. 4" ¢ PIPE SEPTIC SYSTEM PLAN VIEW TYPICAL HORIZ 1"=40' VERTICAL 1"=4' 6 LINES A -BU LT CLEANOUTS CO~, ASSUME EL. 100 S.E. PROP. COR. MONITORING IL TUBE ~ EXISTING EL=95 GRADE EL. 95 INTAIN B.O.P.88.5 ~ G' 89 30' ABSORPTION SYSTEM PROFILE HORIZ 1" =20' VERTICAL 1"=10' PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930256 DESIGN ENGINEER:ARCTIC SLOPE CONSULTING GROUP OWNER NAME:CORNERSTONE BUILDERS INC OWNER ADDRESS:17510 SNOWCREST LANE ANCHORAGE, AK 99516 DATE ISSUED: 7/27/93 EXPIRATION DATE: 7/27/94 PARCEL ID:01523432 LEGAL DESCRIPTION: ALPINE WOODS BLK 5 LT 2 LOT SIZE: 26358 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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 (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: /~ ISSUED BY: ~ DATE: DATE: July 19 1993 Mr. Dan Roth Municipality of Anchorage Dept. of Health and Human Services 825 L Street Anchorage, AK 99501 Re: Septic System Design Lot 2, Block 5, Alpine Woods Dear Mr. Roth: Attached is the permit application for installing a septic system on the above referenced lot. Below is a narrative of probable impacts to adjacent properties. Adjacent Wells - There are no existing wells within 100 feet of the proposed new septic system. This lot is on a Community Water System. (See attached letter from DEC) Adjacent Wastewater System - The proposed bed absorption system will not adversely effect the future sites on the surrounding lots. Reserved Space - The soil conditions on the lot meet EPA standards. There is enough room for a future system to the north of the proposed system. Drainage - Positive drainage away for the field will be maintained. No concentrated surface water will be directed toward the field and no existing streams are within 100 feet of the proposed field. The installation of this on-site system will have no probable impacts to adjacent well or septic systems. The proposed system's separation distance radius will include parts of adjacent lots, but will not interfere with the on-site systems on these lots. Very truly yours, Carey S. Meyer, P.E. Sr. Civil Engineer CSM:KL:CC: 11100026.DM System Calculations for LOT 2, BLK 5 ALPINE WOOD ASCG Calculations 17-Jul-93 Page 1 of 1 Tank Size 1250 GALLON TANK REQUIRED Absorption Field Sizing Using an acceptance rate of 0.5 gal/SF/day and a daily load for 4 bedrooms of 600 gal/day. Req'd Absorption Area = 600 gpd / 0.5 gpd per SF = 1200 SF System Dimensions 40.0' X 30.0' -- 1200.0 SF The laterals are to be spaced 6.0' apart and 3.0' from edge of the bed. Permit No. 1 of 3 Municipelit7 of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:5¥5-47¥4 On-Site Wastewater Disposal System (]nd/or Well Inspection Report Legal Description T. 12 N, R. 5 W, SEC 25 SM AK. PID No'~15' LOT 2, BLK 5 ALPINE WOODS COMMUNITY WATER SYSTEM ? LOT1 /25/a <~ LOT 2 SYSTEM TO BE INSTALLED 10' FROM R-O-W '-% EAST P/L AND 11' FROM SOUTH P/L SITE MAP CONTROL DIAGRAM 1" = 100' 1" =50' CONTRACTOR TO SET GRADE TO ASSURE MIN. GRADE FROM PROPOSED HOME TO SEPTIC TANK _.--':~..?:....~ t ~.." '.'...%' ~ BM )~ 24"DIA. BIRCH EL=lO0 f~l ~ ~t~'^ '"" ............. "'"~ BM A BM B · ".: ..... MT 1 38' 58' ',,:.... ........ Permit No. Page 2 of 5 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description T. 12 N, R. 3 W, SEC 25 SM AK. PID No: 015-254-.52 LOT 2, ELK 5 ALPINE WOODS / 25 BM A BM B D-1 SEPTIC SYSTEM PLAN VIEW D-2 . 1" =50' P-3 D-4 NOTES DESCRIPTION 1, CONTRACTOR TO VERIFY MIN. SQ, FOOTAGE PRIOR TO PLACING TOPSOIL, BM A ~M A 2&"DIA. BIRCH EL=lO0 2. CAUTION SHALL BE TAKEN TO ~INIMIZE BM B~ B SE PROP COR,(FENCE) 1 REMOVAL OF EXISTING VEGETATION OUTSIDE DRASNS WITHIN 100 FT OF NEW A~SO~T~O~ S~ST~. ~ ~ .' ~ ". 5, SYSTEM TO BE INSTALLED A MINIMUM ~ :'~9(h ~ .... /. l .......... ~/~/~ ' ' ' t '~'- 7. CONTRACTOR TO VERI~ 100' MIR. SEPARATION ~ ~ ;. Meyer a. ~U~L~E~ TO VE~I~ ~S~ rLO0~ ~k~. IS S~T '~,~" " '~ ~'' .... .' SO PROPER SLOPE IS ~S~EB TO SEPTIO TANK, ,Permi~ No, .3 OF 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:5¥3-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description T. 12 N, R. 3 W, SEC 23 SM AK. LOT 2, BLK 5 ALPINE WOODS PID No: 015-234-32 SEPTIC SYSTEM PLAN VIEW TYPICAL HORIZ 1" =40' VERTICAL 1"=¢' LOCATION OF NEW 1250 GALLON SEPTIC TANK TO BE DETERMINED IN FIELD. ABSORPTION SYSTEM PROFILE HORIZ 1"=20' VERTICAL 1"=10' PROPOSED TOPSOIL COVER TO ASSURE POSITIVE DRAINAGE CO 'x~ ASSUME EL. SPIKE IN 24" DIA. BIRCH TUBE ~ EXISTING EL=95 GRADE EL. 95 B.O.P.89.5 ~ ~ ~ 90 40' ARCTIC SLOPE CONSULT[NG GROUP, INC. Engineers · Architects · Scientists - Surveyors 501 Donner Ave. ue ,&~chom(je, Naaka 99518-5055 TM%aborn,: (907) 34g-5148 rex: (gOT) .~49-4213 SO]IS LOG - PERCOLATION TEST 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- DEPTH 5W SLOPE WAS GROUND WATER ~ S ENCOUNTERED? d~) L -- O IF YES, AT WHAT DEPTH? p l~pth to Water After I SITE PLAN t N 13- 14- 15- 16- .' 17- 19- 20- Gwss Net Depth to Net Reading Dat~ ' Time Tim~ Water Drop PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER 5 ° ~T ~D 5~ ~r COMMENTS ACCORDANCE WITH ALL STATE AMD MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. CERTIFY THAT THIS TEST WAS PERFORMED IN ARCTIC SLOPE CONSULTING GROUP, INC. Engineers · Architects · Scientists · Surveyors Td~: (~7) 349-5148 Fox: (go7) 54g-42t5 SO~ LOG / M.-7'~. 2- 3- 4- 5- 5- 7- S- 9- 10- ll- t4- 17- 15- 20- DEPTH OL WAS GROUND W~ ENCOUNTERED? IF YE~, AT WI-IA1 D~p~h to Watcr Moniwring? __ :OLATION TEST FER DEPTH? I DATE PREFORMED: '~ /~/9~ __ Township. Ran~e, Sectlon: /~"~/ =~/'~J "-~/'~} I/4/"~-~'~------~=~ SITE PLAN SLOPE Dat~ N ,,ck "i"' · (minutes/inch) PERC HOLE DIAMETER pERCOLATION I~KTE rT' Z '7 TEST RUN BETWE£N ~ o~_ COMMENTS ~ . _ ACCO~CE ~H ALL STATE AND MUNIC~ GU~ELIN~ IN EFFE~ ON THIS DATE. DATE: ~ ~ Net Drop CERTIFY THAT THIS TEST WAS pEP.FORMED DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 July 16, 1993 WALTER J. HICKEL, GOVERNOR (907) 349-7755 Mr. Kevin I_iebner Arctic Slope Consulting Group SUBJECT: Lot 2, Block 5; Alpine Woods Subdivision Class "A" Public Water System, PWSID 213598 Dear Mr. Liebner: I have completed a review of this office's ties concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: 1. The last satisfactory Total Co~orm Bacteria Sample results was submitted to this Department on June 7, ~993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 2. The last inorganic Chemical Contaminants Sample results were submitted to this Department on July 28, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 3. The last Radioactive Contaminants Sample results were submitted to the Department on April 23, 1993. This does meet the .provisions of 18 AAC 80.200(a), State Drinking Water Regulations. 4. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Depa~ment on June 24, 1992. Based on analysis of the previous VOC samples results have been satisfactory. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. Unless otherwise noted, this letter is valid for 30 days and is for the specified legal description noted above only. _ July 16, 1993 Page 2 If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II ML/pf STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS PROPERTY DESCRIPTION Lot, Brock & Subdivision or U.S. Survey Lot 2, Block 5; Alpine Woods Subdivision PWSID no. 213598 Certificate Issued for Application No.: 9421-DW-194-003 This approval does not constitute a guarantee of any kind, explicit or implied, as to the performance of the water supply and wastewater disposal systems. WATER SUPPLY A recent water sample was tested and found to meet Department of Environmental Conservation drink- ing water standards for total coliform bacteria. Name r"'~nvironmental Da~uly 16,'93 ~ng. Asst. II WASTEWATER DISPOSAL The domestic wastewater system was: [] inspected by the Department of Environmental Conservation and found to be in compliance with applicable requirements of 18 AAC 72; [] inspected by a Professional Engineer who certifies that the system complies with applicable re- quirements of 18 AAC 72; [] installed by a Certified Installer who certifies that the system complies with applicable requirements of 18 AAC 72; or [] tested by a Professional Engineer who certifies that the performance of the system is satisfactory and that the system complies with the minimum separation distances specified in 18 AAC 72. This approval is valid for a [] single family [] multi-family unit with a total of bedrooms. Name Title Date 18-0404 (Rev. 8/85) DISTRIBUTION: WHITE--BANK/LENDING INSTITUTION; CANARY--APPLICANT; PINK--DEPARTMENT INVOICE # STATE OF ALASKA DOMESTIC WASTEWATER PLAN REVIEW FEE REMIT TO: BILLING NUMBER: 2/2/93 STATE OF ALASKA YEAR PROG. REG DIST SUB PLAN REVIEW NO. F FISCAL/REVENUE 9141316 I01~-I011 -Iw I.I I-Iq 14 12.11 I--ID I~/I-' II Iq 15/I-I C~lO I-~ R DEPT OF ENVIRONMENTAL CONSERVATION DEC CONTACT (TYPED OR PRINTED): o 410 WILLOUGHBY AVE, #105 ,/~c~/,,~'/_ L~ M JUNEAU, AK 99801-1795 PHONE: MAKE CHECK PAYABLE TO: STATE OF ALASKA .~/~- Applicant name, address and phone number: IMPORTANT T /'j'..~'/(~ .5',,/,~C~.~'~ Z,~-. 1. Please reference invoice number on your check. o ,4~c~'a~-, A/L 2. Submit part two of this form with your payment, Facility ! Project name: L~- '7.__ C'~_ ~- (7~{~i-~,~ (_Ob~(~ .~ ~'~.~-~ FEE REGS. SUB- DESCRIPTION / FEE BASIS Fee Amount Amount for REFERENCE CATEG. plan review 72.212 DOMESTIC WASTEWATER PLAN REVIEW (a)(1) WA Based on Peak Design Flow of 0-500 gpd $100 (a) (2) WB 501-2,500 gpd $150 (a) (3) WC 2,501-20,000 gpd $450 (a)(4) WD 20,001-50,000 gpd $700 (a)(5) WE 50,001-250,000 gpd $1,000 (a) (6) WF 250,001-750,000 gpd $1,400 (a)(7) WG More than 750,000 gpd $1,800 (a)(8) WH Modifications <20%: 20 percent of fee in (a)(1) to (7) Modifications 20% to 50%: equivalent %age of fee in (a)(1) to (7) Modifications >50%: 100% of fee in (a)(1) to (7) (a)(9) WI For sewer replacement, or extension of <200 ft. $200 200 ft.-I,000 ff. $500 > 1,000 ft. $1,000 (b) ~ On-lot sewer system with bank loan certification $250 (d) WK Fee reduction of 10% if simultaneous submittal of 18 AAC 80 plans < > PAID: -- ~ASH or ~ /~ Note: Payment due upon Total Amount of Fee $ -'-/'CHECK # "~'----~'~"'~ receipt of invoice. To legally construct, install, modify, or operate any part of a domestic wastewater facility in Alaska, owners/operators are required to pay a plan review fee pursuant to AS 44.46.025. Please check the information on this form for accuracy and remit the correct plan review fee to the address above, with a copy of this form. Signature of DEC contac~~ If there are any questions regarding this form, please contact your local ADEC office, ' ;O8 WHITE - APPLICANT, YELLOW- REMITTANCE COPY, PINK - FISCAL, GOLD - FILE COPY ~) printed on recycled paper by ~. EPLF3AJS • • G6• $4 Municipality of Anchorage a• On-Site Water and Wastewater Program < l fn< (907)343-7904 SA E T T Certificate of On-Site Systems Approval Parcel LD. 015-234-32 Expiration Date: I . ,3 2 ozo 1. GENERAL INFORMATION: Complete legal description ALPINE WOODS;BLOCK 5,LOT 2 Location (site address) 5820 Alpine Woods Drive*Anchorage,AK 99516 Current Property owner(s) Eric&Jennifer Murphy Day phone 242-2591 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual Eg Individual Water Storage 0 Holding Tank ❑ Community Class A Well ® Community 0 Public Water System 0 Public Sewer 0 WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 556 Waiver Fee $ Date of Payment l 1'1/9 Date of Payment Receipt Number (333/!0 Receipt Number COSA# 6.5civoo5 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal andState ordinances, and regulations in effect at the time of installation. Name of Firm: Gamess Engineering Group,Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road,Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: / /c-/19 00000�•�O In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o Or 4 �pQ in accordance with the guidelines and regulations established by the Municipality of Anchorage and • S O o .� 4 industry practices. The reported results describe the condition of the system/s on the date/s of the OO P,• 1 evaluation. Separation distances were measured to readily identifiable features. Hidden defects or A �` 1417 . = 00 encroachments may_exist that were not identified during the evaluation. The operational life of all wells and septic systems depend variabes, donditions, -- - groundwater levels (that may fluctuate during the year), quality of construction (materials and 2 workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and /• V are outside the control of GEG. Satisfactory test results do not guarantee future performance of the / i f r- A. Garness.: system/s: therefore, GEG makes no warranty(express or implied) regarding the future performance of QOCE �;O the well or septic system. GEG makes no representation whether an alternative well or septic system 0 lJ /, cec can be installed on the property in the event either of the current systems fail to perform adequately in � P� ..... the future. The content of this report is for the sole benefit of the person/party that retained GEG to \IRP0re$50` on0\„ perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for Li bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: yNATER AND \NASSEw�`�ER yROGRp'M By: g- •/ Original Certificate Date: I— 7" / The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet io-ia-12.doc COSA Checklist Legal Description: ALPINE WOODS; BLOCK 5, LOT 2 Parcel ID: 015-234-32 If more than 1 septic system on lot: COSA Checklist# 1 of 1 Structure served by this system 1 A. WELL DATA ❑Well log is filed with Onsite (or attached) Well production at time of test gpm Date drilled Water storage tank volume gallons Total depth ft Well disinfected for coliform test? ❑ Yes El No Cased to ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL(ND) ❑Wires are properly protected Arsenic ug/L ❑Arsenic less than MRL(ND) Casing height(above ground) in. Collected by Date of flow test for COSA Date of Sample Static water level at beginning of test ft. Comments CLASS "A"WELL-ADEC#213598 B. TANK DATA C. LIFT STATION Age of tank(s) 25 years ❑Required maintenance completed Tank type/material 'STEEL. Age of lift station years El Standpipes/foundation cleanout per record drawing Lift station material Date of pumping 12/12/18 Comments: *50 INCH LIQUID DEPTH ON 1/3/19 D. ABSORPTION FIELD DATA Which system tested (date installed) 8/9/93 Adequacy test date 1/3/19 ❑ALL standpipes present per record drawing Results E Pass For 4 bedrooms Total measured depth from grade 8'+ ft(max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 6.6+ ft(min) Water added 607 gal ❑ N/A—pressurized field New depth 2 in 0 Monitor tubes go to bottom of drainfield. If not, state Elapsed time 35 min depth into effective ❑t Code-required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) NONE date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies:SOUTH WEST MT NOT FOUND COSA Checklist yellow sheet • E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100' 0 Yes if No ft ID Yes if No ft Neighboring Tank> 100' ['Yes if No ft Private Sewer/Septic Line>25' ['Yes if No ft Absorption Field on Lot > 100' [1]Yes if No ft Holding Tank> 100' ['Yes if No ft Neighboring Absorption Fields> 100' Animal Containment> 50' ❑Yes if No ft El Yes if No ft Manure/Animal Excreta Storage> 100' Community Sewer Main> 75' El Yes if No ft illYes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations> 10' Yes if No * ft Surface Water> 100' ['Yes if No ft Property Line> 5' ['Yes if No ft Driveway/Parking>0' [1]Yes if No,comment Absorption Field > 5' ['Yes if No ft Wells on Adjacent Lots: Water Main> 10' ['Yes if No ft Private Wells> 100' EYes if No ft Water Service Line> 10' Yes if No ft Community Wells>200' ['Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ['Yes if No ft Driveway/Parking > 0' ['Yes if No,comment ** Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells> 100' ['Yes if No ft *** Water Service Line > 10' LI Yes if No ft Community Wells>200' [j Yes if No ft Surface Water> 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *EDGE OF ST1 TO EDGE OF FOUNDATION IS 5.58 FEET **ASSUMED ***UNKNOWN .� 1—'IEw61 jrt-'- t eft 0 r ka7 CLASS "A" WELL - ADEC# 213598 1 ' L-o -7-,Q..' oo60pppp G. ENGINEER'S CERTIFICATION �� . ..j:q•CA\\%‘ l certify that/have determined through field inspections and review O' • • , �';- '.-1 Q0 of Municipal records that the above systems are in conformance with e* 491 �`� �O MOA COSA guidelines in effect on this date. Q Q V Q /, •.J' jy A. Go ness. Q . —795 .‘:'GI' Q4T • ;coO p1•,.P• •••.....• ��C� COSA Checklist yellow sheet P�oress�c�oc� y #AECC884 'N'ppp is lSin o..,--. _ e-'pU aeE SHEET INCH�FDRIVE 13) s" TEE byo'. / / 6" TEE SIA• 14.0 E8-ME �� 1 ' GVBVB . `� sp Q S"-6‘10.15-SW— it O'I0.15-SW— �, �y�i� ' fA 3.5528-SE - :R. -1/3°BEND / , 1/4° BEND 1J 9938 I 3 1 , N , ',''.ty, . •h .,` BL K 4 �" i \ \ P.C. STA. 4+78 87 '2° BEND �' 9s % ,.s - 2 56 'vo 2 7,Jt . / " / ' 6 P.T. STA. 9+03.53 . �B9 /7 / /: t 4,../.,)-i (F •� / h'y C°j QJ ALPINE WOODS DRIVE ` �` H PIPE SHALL BE CLASS 62. I / '� '000 _ F OHS ARE TO BOTTOM OF PIPE. 6 o A CONNECTS SHALL BE 3/4" TYPE K / i ,.ESS OTHERWISE NOTED. ro- ASH) asa) 'i-vAsi qt. GRO I RT It. GRO.- - LS R. GRO:— (11;i. O F 1N1SH c. QF I Ir - . . • ti c.i c9 a • • N Frontier Surveys,LLC Project No:18-462 Date:12/27/2018 0 Ordered By: Michelle Webb Plat:83-210 Grid: N/A sole 1•s 40' ---,-yi •I I LOT1 7 x w I a i1w 1 C) 2Id V Q a T a : Nor 12'30'E X72 IP. Z mI o tt -".-.n • 'V • -7 00.a tUo1-----------.. i •�111.17 GRAVEL - ' m DETACHED Fr o a 0 • s SHOP wO I O Sly 94 20.1 PAVED 0 • X0.6 nn do U • DRIVEWAY a g i - J 21.1 2.0 I 1 10.5 ass•st 2 Lot 2,Block 5 Alpine Woods - a�hr, as h Subdivision I r` Ill 26,358 Sq.Ft.+/- 6 9.0 IStory Woo•Woods Or w jl r $ •.1111111111 Raw\\73\2Stwy Wood 3 Car Irv,• ouse wan AnaUu%l3.v nempr.6 Detached Shop mQI • • •• 22332• 1---iaso S2 yso.5y Vl .0.W. 1/ 1— Z ,,1 i A I LOT3 I I • I I .Legend:. ... ..,-......... . .. _... eEy Electric Meter/Outside Power •O.,Telephone Pole As Tel.Ped. nGas Meter Deck -o- Fence cE.,Elea.Ped. 'S;Septic Q Water Valve `Qj Mailbox -se-Overhead Utility Conceal Nnlos, 0 20 40 E:: 1.Ti•s document is created to lila purpose of a single properly transaction and is subject to Federal Copyright Laws. 2 Eaceplalg IA y oss rbgligemue,aro Latslily tar ahiu.wvey shall not Monad ire Lust of Nepwiry mi.survey. 3 All nleasurnmonarsabacks aro MSc..sunIapperenl building I°olpmt. SCCIe In Feet 4,w dimensions to properly lines are plustrNm,9 0.111. ``\,,,s,lns‘1i111 This survey compiles with the ASPLS Mortgage Location Standards.The sunny represents visible lmproacrnanis and e OF 4 11 t co:ibens at ion time 0101u surrey.TO*document docs not conslitule a boundary Yarvoy and is subject to any ..---.4.y....`..^." � '•.. .•.•4 `I/g inaccuracies that a suo00quant baandely survey may,West.It is Iia responsioikty of 1110 Qaner to determine are , "/ /a esatcncn al any nnsyrrnna,covenants.a rnsldtenn which do no napes on Urn loran pial.tlndm nn r.'rclmslnncet c5.,• . 9 y' should this document be used err conslrucbon Or Ice establishing a boundary°,fend line, *. 49T—Nib • ` y •.* i As-Bullt Survey of: —7....„12'''''.2...t.,.>• + Lot 2,Block 5 Alpine Woods Subdivision X11 nxoasSWasea _' I,Frederic Wagner,hereby certify that this Mortgage Inspection Survey was performed by me,or yrj si% AA��,,,,1��/7/2019 .• under my direct supervision on December 21st,2018. y//,EOt 1i�aFss...•• �`— Frontier Surveys,LLC FRONTIER, 1taSSiON." 650 W.58th Ave.Suite E Anchorage,Alaska 99518 Starve 5•-, 907.460.1686-info@frontiersurveys.com PROFESSIONAL SEAL www.frontiersurveys.com MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 41E!---1-" ' 907-343-7904 On-Site Water and Wastewater Section ` i Fax: 343-7997 www.muni.org/onsite �—/ Septic Tank Advisory Certificate of On-Site Systems Approval # 0SC191005 Subdivision: Alpine Woods Block:5, Lot: 2 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 25 years old. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. , a ": Mme,- I r J / 3 � � ' A s": • .11*.„--;,,,. y,, . ...„1..... Iwo itv- °`'i.._,. ,, , . i.,..tx;f4. ..,,,,t . ,. -,,. , - '4, -,4, .2-.r SI" ':04 dkiN2 ' Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www,muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-234-32 Expiration Date: GENERAL INFORMATION Complete legal description ALPINEWOODS BLOCK 5 LOT 2 Location (site address) 5820 ALPINE WOODS DR. ANCHORAGE, AK 99516 Current Property owner(s) DANA GRIFFIN Mailing address Lending agency Mailing address . Day phone 704-728-9772 Day phone Real Estate Agent Mailing Address Unless Otherwise requested, COSA will be held by DSD for piCkup. NUMBER OF BEDROOMS: 4 Day phone TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site, [] [] Individual Holding Tank [] [] CommunityOmsite, '~' ~'i~''' ..... [] [] Public Sewer ~ [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners, Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a priVate or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a pedod of up to one year with ,valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a pUblic water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shOWn below, I vedfy that my investigation, based on' procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy that based on the information obtained from the Municipality of Anchorage .files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Spurkland Enginneedng Phone 279-3916 Address 203 W. 15th Ave., Ste 202, Anchorage, AK 99501 Engineer's Printed Name Lars Spurkland DSD SIGNATURE Y'"' Approved for J'3L Disapproved. Conditional approval for bedrooms. Date 8/11/2011 bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) Arsenic Advisory Maintenance 'Agreements Supplemental Engineer's Report Other Original Certificate Date: ? 0 -;ZT-// Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST LegalDescription: ,/~lpJ~ ~oc~5 ~lk 5 Lc)-~ '~. ParcellD: A. WELL DATA ~u~3~[c Well type ,~ Date completed ~ Total depth .-.- f. IfA, B. or C provide PWSID # Well Log (Y/N) Sanitary seal (Y/N) , Cased to --- ft. FROM WELL LOG o)5- Z=J~- ~Z. Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: g.p.m. g.p.m. Coliform -, colonies/100 mL Nitrate w mg/L Arsenic: -- uglL date of sample: -' B. SEPTIC/HOLDING TANK DATA Tank Type/Material )~fl~O~'a~ Tank size ~'7.50 gal. Foundation cleanout (Y/N) Date ofipumping C. ABSORPTION FIELD DATA Date installed,,, .~.':lli~l~/,~ Soil rating (~'~ or~/bdrm)'' 0,5 Length t~ ft. Width ~ ft. Collected by: Date installed 8/~! Fl°~, Number of Compartments '~. Cleanouts (Y/N) '~' Depression over tank (Y/N) /V' High water alarm (Y/N) Pumper , / System type Gravel below pipe Total depth "~) ft. Eft. absorption ama 17~ ft2 Monitoring tube ¥ Date of adequacy test 10~7/2olo Results (PasS/Fail) J)o,5~ Fluid depth in absorption field before test {~ in. Water added,(=00 gal. Elapsed Time: ~ min. Final fluid de,!~h' .~ in. Any rejuvenation treatment (past 12 mo.) (YIN & type). Depression over field /V~ For ~ bedrooms New depth ~ in. Absorption rate >= ~o0~ g.p.d. /~, If yes, give date" D. LIFT STATION. Date installed.~. ,,,/ Size in gallons "Pump on" level at/in. "Pump off' level at ~ in. Datum/-- Cycles tested / E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (Y/N) High water alarm level at n. alarm & circuit requirem/s? Septic tank/lift station on lot ~ On adjacent lots Absorption field on lot Public sewer main On adjacent lots --" Public sewer manhole/cleanout Sewer/septic service line --- Animal containment areas Holding tank Manure/animal excrete storage areas -"' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation .5 ~ ~- Property line 5 ~- Absorption field Water main JO's' Water service line IO ~ Surface water Wells on adjacent lots oo'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line IO '~+- Water Service line ~0 4,- Curtain drain ~'Olf Building foundation lot+ Surface water [0o ~ I Wells on adjacent lots ZOO 1~ Water main Io ~4. Driveway, parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Date ~ ~(~JJ ' COSA Fee $ Date of Payment ~ Receipt Number (Rev. 4/10) io/2?/// Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O~% ?:...-~3~i, 3~. 1. GENERAL INFORMATION ComPlete legal d~scriPtion' Location (site address) Current. Property owner(s) Mailing ~ddress ., Expiration Date: /! Day phone Lending agency Day phone Mailing address Real Estate Agent Mailing Address Day phone Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROoM'S: ~ 3. TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class m Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public SeWer I I I The Municipality of Anchorage Development Services Department (DSD) iSsues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional .civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or class c well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in theprofessional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER .5. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my. investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm 3~c'l~o, nj ~n~z4h,,~/ Phone Address' ~0~ ~, ~5~,Av'e, 5~-¢, Zoo, ~c'~"~.,..~,~L, .A i~ E.gineer's Printed Name DSD SIGNATURE Approved for ~/- Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well .Flow Advisory Nitrate Advisory 1/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: .-I '3 '-/ 0 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type '~A" Date completed ~ Total depth --' Date of test Parcel ID: ors- ,33W- 32. IfA, B, crC provide PWSID # :2t35,1~ Sanitary seal (Y/N)... -- Cased to m ft. FROM WELL LOG Well Log (Y/N) Wires properly protected (Y/N) casing height (above ground) AT INSPECTION Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform -- colonies/100 mL Nitrate -- mg/L · Arsenic: -- ug/L' ·date of sample: -- B, SEPTIC/HOLDING TANK DATA TankType/Material ~ncl~°e~uTm~:~/fCSo~[rt s Tank size 12.50 g. r . p ment 2. Foundation cleanout (Y/N)' ~ ..* Depression over tank (Y/N) ./V' · Date of pumping. ~/Z/ZolO Pumper C. ABSORPTION FIELD DATA Date installed J~9 ~ Soil rating r ft%drm) O. 5 Length /~, ft. Width 30 ft. Total depth 3-,3 ft. Date installed 0/ Cleanouts (Y/N) "/ High water alarm (Y/N) Gravel below pipe Eff..abs0~ption area 13,1,0ft2 Monitoring tube y tO[*["LolO Results(Pass/Fail) P~,,5 Depression over field ~ For L[ bedrooms New depth ~ in. (~O0 g.p.d. If yes, give date ~ Date of adequacy test Fluid depth in absorption field before test ~ in. Water added ~,00 gal. Elapsed Time: ¢o'~0. min. Final fluid depth ~ in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) /~/'o System type ~e D g.p.m. Other bacteria '--' 'colonies/lO0 mL Collected by: - ' D. EIFT STATION Date installed ,,.,'"' "Pump on" level a/t,,~, in. Datum J E. SEPARATION DISTANCES Size in gallons "Pump off" level a .t./n. Cycles tested. ,/ SEPARATION DISTANCES FROM WELL ON LOT TO: [2,.,Io{ ;c Manhole/Access (Y/N) ~in High water alarm level at . Meets alarm & cimuit requirer~s? Septic tank/lift station on lot Absorption field on lot On adjacent lots '-'"- On adjacent lots Public sewer manhole/cleanout · Public sewer main Sewer/septic service line ~ Holding tank Animal containment areas ----' Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation c~ -I- Property line. $ 4- Absorption field Water main I o ' -{' Water service line I O ~ + Surface water *Wells on adjacent lots ?..0o '-t- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ! Property line [0 '+ Building foundation I o -I- · Water Service line l O ! + Surface water IOo' t' Curtain drain A/~,e J4,~o,cv~ Wells on adjacent lots ~O ~ I. Water main [ o -t- Driveway, parking/vehicle storage. F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name L^~s .¢/,,r LL,J Date '¢~1 ?-o,o COSA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. 015-234-52 1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Expiration Date: Completelegaldescription ALPINE WOODS SUBDIVISION; LOT 2, BLOCK 5 Location (site address or directions) 5820 ALPINE WOODS DRIVE * ANCHORAGE, AK, 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BARRY TANNER Day phone 274-9924 1166 GAMBELL STREET.* ANCHORAOE, AK, 99501 Day phone HEIDI TIDLER W/ DYNAMIC PROPERTIES Day phone 3111 C ST. * ANCHORAGE, AK, 99503 346-4495 Un~ssotherwise~queste~ HAAwillbeheldbyDSD ~rp~kup. 2. NUMBEROFBEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~] Individual Holding tank Community On-site [~ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Cedificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon req[Jest to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authodty Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Date 337-6179 Engineer's Comments: In conducb'ng this evaluation, AKWWC, /nc. attempted to provide a thorough, conscientious engineerfng analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of ail we/Is and septic systems depend on the local soils condition, groundwater leve/s 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 the system, Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there ara no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system wi//continue to meet the operational requirements of the ADEC or MOA DSD, The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any · otherperson orparty is not authorized, nor wi/lit confer any legal right whatsoever. o DSD SIGNATURE ~ Approved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: ~.'" ~-o' ' ' '. '"0 ~' ~[ WATERAN~D,. :. · -, OGRAM -, .., . PR ._..., ...- Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other (Rev. 12/01) Odginal Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On.Site Water & Wastewater Program 4700 South Bmgaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (~7) HEALTH AUTHORITY APPROVAL CHECKLIST Legal Oescflpflon: ALPINE WOODS SUBDMSIONi LOT 2, BLOCK 5 Parcel ID: A. WELL DATA 015-2_~4-52 Wall type~:)UmJNrrf Date completed. , If A, B. or C provide PVVSID~ 21~598 Well Log (Y/N), ,, Sanita~ seal (Y/N pmpedy protected (Y/N) Cased to __ff. Casing height (above ground) FROM WELL LOG Date of test StatJ° water level WATER: SAMPLE RESULTS: AT INSPECTION g.p.m, g.p.m. in. 2 Depression over tank (Y/N) ,NO Pumper SEPTIC/HOLDING TANK DATA Tank Type/Material .... STEEL Tank size ,,1250, gal. Number of Compartments Foundation cleanout (Y/N) ,YE5 Date of pumpJng .. :7/30/2003 ABSORPTION FIELD DATA l'BELOW fiNAL Date installed 8/9/1993 Soil rating ~r ff~:)drm) 0.5 Length 42 fl. Width 30 fL Total depth 6 ft. Eft. absorption ama 1260 fi= Monitoring tube YES Date of adequacy test , 7/30/2003 Results (Pass/Fail) PASS Fluid depth in absorption field before test ,,5 in. Water added 953 gal. Elapsed Time: 155 min. Final flutd depth 3 · in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Absorption rate >= NONE: KNOWN System type BED Gravel below pipe ,, 0.5 ft. Depression over field, NO For ¢ bedrooms New depth 5.5 in. 600+ g.p.d. If yes, give date - Date installed ...... 8/9/1993 Cleanoute (Y/N) YES High water alarm (Y/N) N/A CHUGACH PUMPING Coliform ~ colonies/100 mL Nitrate ~mgJL. Other ba . · · . Date of sample: ~ Collected by: ~ Do LIFT STATION Date installed Size in gallons ~ "Pump on~ Iovol at ~ High water alanm level at .in. ~ ~ Cycles tested Meets alarm & cimuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY WATER Septic tank/lift station on lot Absorption field on lot Public sewer main On adjacent lots Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line Water main 10'+ Water service line Wells on adjacent lots 100'+ 5'+ Absorption field 5'+ ~0/'1'' ~ Surface water, 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line I (~' '~ Surface water 100'+ Driveway, parking/vehicle storage -'-'-~I~ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the ebove systems are in conformance with MOA HAA guidelines in effect on this date. JEFFREY A. GARNESS Engineer's Printed Narpe Waiver Fee $ Date of Payment Receipt Number Wednesday, July 30, 2003 3:05 PM Gina Dundas 907-245-1729 p.02 Parcel I.D. # 1. 015-234-3~~ GENERALINFORMATION COmPlete'legal description 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Lot 2; Block ~; Alpine Woods Location (site address or directions) 5820 ·Alpine Woods Drive ~:!;' ... : ': Anchorage~ AK p[0Pe~yowne~ Tom & Jean Belding Dayp~one 345-9123 UallingaddreS0: 5820 Alpine Woods Drive Anchorage, AK 99516 Lending agency . Day phone ,., ,,,.~ ,.,,.,~a;,;;~,~'a,~,~ress ~ -. Age R~-h SlmDs~D/Dvnam~ c Properties Address ~. Day phone Unless otherwise requested, HAA will be hel'd for pickup. NUMBER OF BEDROOMS:·` 4 '%.',. *-/. .:-'. i TYPE OF WATER SUPPLY: Individual well NOTE: Community well ×× Public water - If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF wASTEWATER DISPOSAL: Individual on-site XX 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. 5. STATEMENT OF INSPECTION BY ENGINEER Se 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 verifythat 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 c_ompliance with all Municipal and State codes, ordinances, and regulations in ef~/~atl~u~ ~f this inspection. Name of Firm Address Wastewater Consultants, tnc, ~ Phone Anchore~e ~K 99504 Engineer's'signature Date DHHS SIGNATURE [,/"' Approved for F ~) ~/~ bedrooms. Disapproved. Conditional approval for b_~ed~ooms with.the following stipulations: Additional Comments Date '¢- ~-~' 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 enginee r registered in the State of Alaska. The DH HS does this as a courtesy to pumhasers of ho mas and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage ~-~% DEPARTMENT OF HEALTH & HUMAN SERVIC~'~-°~ Enwronmental Services D~v~s~on 825 L Street, ROom 502 · Anchorage, Alaska 99501 · (907) Health Authority Approval Checklist Legal Description: ALPINE WOODS S/D; LOT 2, BLOCK 5 015-234--52 Parcel I.D.: A. WELL DATA Well type CLASS "A" Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production B. SEPTIC/HOLDING TANK DATA 213598 If A, B, or C, attach ADEC letter. ADE© water system number Date completed ~ Cased to __ Casing height (a~d) __ Wires pm~cted (Y/N) FROM WELL LOG/~,TINSPECTI~ ~ g.p.m, g.p.m. Nitrate Other bacteria Collected by: Date installed 8/10/93 Tank size 1250 Number of Compartments __ Foundation cleanout (Y/N) Date of Pumping 8/25/99 2 Cleanouts (Y/N).__ NO YES Depression (Y/N) NO High water alarm (Y/N) YES Pumper McDONALD'S C. ABSORPTION FIELD DATA Date installed 8/g/93 BED Soil rating (g~p.d./ft~ or ft2/bdrm) 0.5 System type 0.5' 7.25' Length 42' Width 50' Gravel thickness below pipe Total depth Effective absorption area 1260 SQ FTMonitodng Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test 8/25/99 Results (Pass/Fail) PASS For 4 bedrooms 4.5"/4.5" Fluid depth in absorption field before test (in.); 2'5"/DRYImmediately after 1052gal' water added (in.): Fluid depth 2.5" DRY (ins) Minutes later: 1140 Absorption rate = 600+ g,p.d. PerOXide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date - 72-026 (Rev. 3/96)* D. LIFT STATION .. Date installed Manhole/Access (Y/N) ~~'~t* "Pump off" level at* ~ wate~ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: c~en~3~9~ Septic/holding tank on lot On adja Absorption field on lot ....~"~n adjacent lots Public sewer main ~ Public sewer manhole/cleanout line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 5'+ Foundation 5'+ Property line 5'+ Absorption field 200'+ Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 10'+ Building foundation 10'+ Property line Water main/service line Sur[ace water 100'+ Driveway, parking/vehicle storage area Curtain drain NONE KNOWN Wells on adjacent lots F. ENGINEER'S CERTIFICATIO~//~ I certify that I h~ d~rr~d t~ru field inspections and review Signature /~/~ Z~/'./4./Jy \~7-'.-- Engineer,s N~i~/~J/' J'E~FREY A. GARNESS Date 10'+ 5'+ 20O'+ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 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 1. GENERAL INFORMATION Complete legal description Location (site address or directions) ...~',~ ~- . · Property owner ~.¢r/¢ Mailing address Day phone Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Z/ 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. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm b~' ~.-~/ Address, ~ 0 t /~/-,.¢~'YCyc' Engineers signature Phone Date O.HS 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 #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:/_-,2. A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date completed Driller Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ,/~ K2 ¥' Absorption field on lot ,/~ O Public sewer main /~) ~ Sewer service line ! ~ AT INSPECTION g.p.m. .g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout [G~P '-/' Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ,~J~'/~ "~ ~ / Cleanouts (Y/N) Y High water alarm (Y/N) Date of pumping Tank size Foundation cleanout (Y/N) ~; ~ Compartments ~ Depression (Y/N) Alarm tested (Y/N) -'--- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /~) O To property line c~'/'' Sudace water/drainage On adjacent lots Absorption field ?o o Foundation Water main/service line 72-o26 (3/93)° Front CONTINUED ON BACK PAGE Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) Date of test Static water level Well flow Pump level1 FROM WELL LOG AT INSPECTION g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots .g.p.rr~,. ~' 3::o Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: ...~' ;/~.~'-~---- B. SEPTIC/HOLDING TANK DATA Date installed ~/~',/¢ ~ Cleanouts (Y/N) ~ High water alarm (Y/N) Date of pumping Tank size /~ ~ g2 Foundation cleanout (Y/N) Compartments Depression (Y/N) Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /O ~ '/' On adjacent lots /~ O '": To property line 2~ ~ '-/'' Absorption field /~_2 ''/'- Sudace water/drainage ,/~ Foundation /~<~ -/' ,./... Water main/service line /~ 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electdcal ~¢~~'~) SEPARATION DISTANCE FROM LIFT STATION TO: Man ~""~'~'"'~.. Manhole/Access (Y/N) "Pump on" lev~----_. "Pump off" Level at Cycles tested ~~ Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length z/O Width Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) ,, ..~ Gravel thickness Cleanout present (Y/N) ~ Results (pass/fail) System type ,Z~Z.~ ' Total depth r~ Depression over field (Y/N) ,,~ for ~ Bedrooms After test '-- If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots /~d~ Property line To existing or abandoned system on lot Cutbank /Q~ ''/-- 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 Engineer's N Date HAA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number 72-026 (3/93)' Back C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATION DISTAI',JCE-'F~M LIFT STATION TO: WeJLeml~t On adjacent lots Manufacturer Manhole/Access (Y/N) ~  " Level at ~ tested Surface water D. ABSORPTION FIELD DATA Date installed ~¢/'~/~ "~ / Length Z//-O Width Total absorption area / 2 ~O Cleanout present (Y/N) Date of adequacy test A/~,.) ._~,,~/¢-7/--~.~_ Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) · -~' Gravel thickness ,System type Total depth Depression over field (Y/N) /4,/ for r Bedrooms After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots ,/~ Surface water Curtain drain On adjacent lots /~ ~ Property line To existing or abandoned system on lot Cutbank /oD ~ Water main/service line Driveway, parking/vehicle storage area //~P E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on Signature Engineer, s Ne,me, ~-- Date inspection. HAA Fee $ ~cq~ Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 WALTER J. HICKEL, GOVERNOR (907) 349-7755 July 16, 1993 Mr. Kevin Liebner Arctic Slope Consulting GrouP SUBJECT: Lot 2, Block 5; Alpine Woods Subdivision Class "A" Public Water System, PWSID 213598 Dear Mr. Liebner: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on June 7, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. e The last inorganic Chemical Contaminants Sample results were submitted to this Department on July 28, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last Radioactive Contaminants Sample results were submitted to the Department on April 23, 1993. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on June 24, 1992. Based on analysis of the previous VOC samples results have been satisfactory. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. Unless otherwise noted, this letter is valid for 30 days and is for the specified legal description noted above only. July 16, 1993 Page 2 If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II ML/pf