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Home My WebLink AboutALPINE WOODS BLK 5 LT 7Al pi ne Woods Lot 7 Block 5 #015-234-37 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251078 Work Type: SepticTank Upgrade Tax Code Number: 01523437000 Site Legal Address: ALPINE WOODS BLK 5 LT 7 G:2738 Site Mailing Address: 6000 ALPINE WOODS DR, Anchorage Owner: BOLLERUD DANIEL M & Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft Total Bedrooms: 4/9/2025 4/9/2026 31604 ❑ Disposal Field R1 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 5 Special Provisions: If the existing 1985 bed is to remain in service, letters of non -objection (LNOs) must be gathered from the utility companies addressing the encroachment into the easement along the east property line. Received B� Issued By: Date: 4/9/2Q25 Date: MUNICIPALITY OF ANCHORAGE Development Services DepartmentPhone: 907-343-7904 On -Site Water & Wastewater Section P_ ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-234-37 Property owner(s) DANIEL BOLLERUD & JAN DODDS Day phone Mailing address 6000 ALPINE WOODS DRIVE ANCHORAGE, ALASKA 99516 Site address 6000 ALPINE WOODS DRIVE ANCHORAGE, ALASKA 99516 Legal description ALPINE WOODS BLOCK 5 LOT 7 Number of Bedrooms 5 Engineering Firm FIRST WATER CONSULTING Building Permit Number Not Applicable FK APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Absorption Field ❑ Initial ❑ Septic Tank ® Upgrade Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: 225 Date of Payment: y 2 zS Permit No. L5P 5%070 Waiver Fees: Date of Payment: Waiver No. Distance: 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com March 31, 2025 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: ALPINE WOODS BLOCK 5, LOT 7 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install two 1000-gallon HDPE tanks per the attached design to serve the existing 5-bedroom residence. The baffle of the first tank will be removed and the effluent pump installed in the second compartment of the second tank. No groundwater was noted in the MOA on-site file, but if groundwater is encountered during installation an epoxy coated steel septic tank or other action may be required. The lot and adjacent lots are served by public water with private wells to the south that are 100’+ away from the proposed septic tanks. Any encroaching wells, easements, … must be staked prior to construction. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. 74.1' N 89°55'05''W 243.00' N 8 ° 0 8 ' 3 0 ' ' E 1 5 4 . 9 5 ' 30 . 0 30 . 0 74.1' L = 160.82 44.0 S 2 0 ° 1 2 ' 3 5 ' ' E 1 8 1 . 6 5 ' 28.0 20 . 2 FIRST WATER CONSULTING NO WELLS WITHIN 100' OF PROPOSED SEPTIC TANKS ALPINE WOODS BLOCK 5, LOT 7 DESIGN DETAILS: 11 DR�vE LP/n/c Alnnn.S OF A�q�;�p 49 TH* �� fiat 0 0 a SHANE A. HOLT LS -6914 44a a o \\"fessioW Loo N 89°55'05"W 243.00' THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT ARE NOT SHOWN HEREON, UNLESS NOTED. NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. ONLY VISIBLE IMPROVEMEMS ARE SHOWN HEREON R SYSTEM PIPE NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 7 BLOCK 5 ALPINE WOODS SUB. ANCHORAGERECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED DA LED ATANCHORAGEA LASKA THIS 25 TH DAY OF MARCH 2025 7179 77-53240-7 HOL T LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223-8615 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: ~'IAJ o~ ~O ~¢::~ I PID Number: O/_~' ~ N~m~:~ ~ ~~ ~ Wastewater System: ~ New ~' Upgrade ~d'~'~:~O0 ~~~OS O~. ABSORPTION FIELD ~~ ~~ ~eepTrench~ ~ Shallow Trench ~ Bed ~ Mound ~ Other ~)il~ating:~ LEGAL DESCRIPTION I~ ~ ~1 0t~ U~GPD/Sq. Ft. Total~Depth~from ~°'riginall0'grade: Subdiv~ion: Depth to pipe bosom from original grade: Gravel depth beneath p~e Township/ [Range: ~ ISec~ Fill added above original grade:~, ~'~ Ft. ~Gravel length:~ ~ ~U''4 : ~0 ~t. WELL: B New ~ Upgrad~ Gravel width:~ ~ Number of lines: I Distance be~eenlines: ~. ~ I ~'+ Classification (Private. A.B.C): /T°tal De~Ft. Cased To: Ft. Total absorpt~o~ ~ SO. Ft. Pipe materiaho~o.~ t )filler: ~ Date Drilled: Static Water Level: Installer: ~ Ft. ~ + ~ ~1~Date installed: '~~ I I TANK G',~~ Y~el Pump Set at: Casing Height Above Ground: PM Ft, Ft. SEPARATION DISTANCES ~ Septic ~ Holding ~S.T.E.P. TO Septic Absorption Lift Holding Public/Private Manu~e~ ~~ Capacity in gallons: From Tank Field Station Tank Sewer Lines ' . ~OO Wel~ ~j, ~l+ l~(~ ~ ~ Material:~~ Number~ompa~ments: Surface ~ i Water {~ [~ ~ ~ j~ [~ ~ LIFT STATION Lot Size in gallons: J Manufac~ Foundation j~l~ ~O ~ ~ ~' ~)~ ~ "Pump ~: I"Pump ~'~etat: I ~,arm at: Cu~aJ~ ~[~ Pump Make & Model J Ele~rical Inspections p~dormed by: Drain Remarks: ~ ~~~ ~~ BENCH MARK ~~0~~. ~~ j~[~~ Location and Description: ~ ~ O~ ~V ~ y~L~, J A,umed Elevation: 100~ Ft. Inspections pedormed by: ~~ Dates: 1st ?/1~? ~ 2.d Depadment of Health and Human Se~ices appr I '~:~;'.. ~'~' ."- '~ffOFESS~ a ,roved by: /o- 72-013 (Rev. 9/91) MOA 25 PERMIT NUMBER: AS :BUILT DRA' "ING PARCEL iD NUMBER: SW980291 ' 0'15-234-37 /--APPROXIMATE LOCATION OF' EXISTING KEY BOX ~,, ~ \ F-APPROXIMATE I.OC^TION ~ 'x \ \ ~ OF EXI,gTING WATER LINE ~ '~ \ \ ~-LOCAI'ION OF EXISTING BED IS 1} C ~ ', ,,, \ /~,7UNKNOWN. DRAWING IS ASSUMED. I ~~\ ',.S--~__.-¢¢:-~'\ ., ~', .~-.o'. ,~.~'""; ~g b BE~()OM J M~X ~ " -- 38,5' 52.7' 15' LJI'II,IIY AND EQ~JES'I'RIAN ~SEMEN]' '~~~,,? · ~ / / ~,,~ / ~:' ',U' ~ 5~ ~: 'J NORTH TRENCH SOUIH TRENCH ,L,I,Z WOODS. SU,mWSIO,, LOT AS-BUrnT OF SEPTIC SYSTE~ UPGRADE ':JA~ES' ' ~i'"~ PREPARED FOR: PHONE NUMBER: A B s'rl 52.0' 14,0' ST2 60.2' 25,9' MH 62.0' 27,9' MT1 44.2' 58,2' Mr2 B1.5' 71,7' MT:5 :~8.5' 52.7' MT4 62,0' 78.7' Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 DATE PERFORMED/ ' / ~ 9//' Township, Range, Section: 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? ~'Y Date: L E Reading Date Gross Net Depth to Net Time Time Water Drop ~ :~/~ - /~o~ ~" / - /~" ~ :~o('s~ ~ //~ ~,, /,~z~', z~" PERCOLATION RATE '~ (minutes/inch) PERC HOLE DIAMETER ~O ',~ 72-00B (Rev. 4/85~ALL ~A_` ~:: AND:UNZCIPAL;UID~L,: ~-EFFECT O~: TH[~DAT~Z:E~, ~;7'' MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 'I96650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 10, 1998 Expiration Date: Aug 10, 1999 Permit Number: SW980291 Parcel ID: 015-234-37 Legal Description: ALPINE WOODS BLK 5 LT 7 Design Engineer: 41 _~:~ ~,_~ ~ ~, LL~_~ite Address: 006000 ALPINE WOODS DR Owner Name: WILLIAM DOSS Lot Size: 31604 SQ. FT. Owner Address: 6000 ALPINE WOODS DR Total Bedrooms: 5 Permit Bedrooms: 5 ANCHORAGE , AK 99516-2467 This permit is for the construction of: [~ Disposal Field [~] Septic Tank I~ Holding Tank [~ Privy [] Private Well Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: ~ /,2. -F-~ Alaska Water & Wastewater 7320 East Chester Heights Circle ~ Anchorage ~ Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers July 28, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental. Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref.' Septic Upgrade Design for Lot 7, Block 5, Alpine Woods Subdivision. To whom it may co~ern: The existing 5 bedroom house is served by a private septic system and a community well. The existing bed will not pass an adequacy test and must be upgraded prior to the sale of the house. Two test holes were excavated to the west of the existing septic system and one test hole was excavated to the so~th of the existing septic system ~ ~Comments regarding' ~he propoSed upgrade design are summarized as follows: 1. SOILS: Attached are the 10gs which shows the soil profiles, and the percolation tests results. The proposed upgr~le is to be designed around a 30'feet radius 0ftesth01e #3. No groundwater was encountered during the excavation of the test hole. One soil percolation test was performed at 5.5 to 6.0 feet which perked . out .at a rate of <1 minute/inch. The insuti soils shouldact asa sand filter. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Appli0ationRate: 1.2gallon'/day/fi2 c. Number of Bedrooms: 5 d. Design Flow: 750 gallons per day e. Minimum Absorption Area: 625 f. Effective Depth: .4 feet h. Width: 2 feet i. Minimum Length: 2 ~ 40 feet long each (80 feet total length) j. Effective absorption area = 640'rtZ(5625 ~ft2 OK) k. Maximum depth = 8 feet (on uphill side) 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: Attached is a topography site plan. The trenches will be installed parallel to the contours, on o~lope of approximately 20% - 25%. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. Sincerely, jSHO PROP "'1 - ----"-- /,, ALPINE: WO0~ SU~IVISIO~. LOT 7. BLOCK 5 --. ~ _.~ . : -: '-' E. HUFFMAN ROAD I I ] I N 1/2, NW 1/4. NW 1/4, ~ I NW 1/4, SEC. 26, T12N, RlW ~ 5830 HUFF~ R~ ~ PRIVA~ WELL A SEPTIC ~ LOT 1, VICKE~ I PRNATE WELL · SEPTIC NOTE: AL.L PROPERTIES IN ALPINE WOODS * ~ I SUBDIVISION ARE SERVED BY COMMUNI~ ~ WATER AND PRIVATE SEPTIC;. ~ ' I I I , , I A_LAS WA R AND WAS WA R PHONE: ~907) 337-6179/F~: (907) ~8-3246 '" ' ...... LEGAL DESCRIPTION: ~PE OF WORK: PREPARED FOR: PHONE NUMBER: BILL DOSS (541) ~"~ '~ ~ Ci~7953 ..' ALPINE WOODS DRIVE .... - ......... ' .... ---~- ~XISTING BED SYSTEMS~ ' ' TO BE USED AS A ALTERNATE ~,\ ~--APPROXIMATE LO~llON RESERVE SEPTIC SITE. \X \ OF WATER KEY BOX \ \ EXISTIN(; SEPTIC TANKS--~--~ COMPLETEL ~ '\\ ~ \\ TO BE ABANDONED \ r--APPROXIMATE LOCATION ~ \ \ ', \ \ (SEE NOTES) 15' EQUSTRAIN & UTILITY EASEMENT NOTES: 1. THE CONTRACTOR IS RESPONSIBLE FOR HAVING THE EAST PROPERTY LINE FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. 2. THE CONTRACTOR IS RESPONSIBLE FDR CALLING IN UTILITY LOCATES. OUR SUGGESTION IS TO TEMPORARILY DISCONNECT SERVICE, INSTALL THE PROPOSED~-~_. HUFFMAN ROAD TRENCHES, AND THAN RECONNECT THE SERVICE LINE BY REROLJTING THE LINE AROUND THE NEW TRENCHES. ALASKA WATER AND WASTEWATER ,,~,~.,,, ,~,~,~,~,,~-,-,o,..,: ,:.,.,o,,,,.: ,,o-,, .:,_-,-,-,,.,.,,¥,:.,,.,: ,,,o,, ~-~, ~,.~.~ ALPINE WOODS SUBDIVISION= LOT 7, BLOCK 5, ,..~.[.....~:[~.-.f.;~.~......'~...i, / I ~.~.r ~J. ~ TYPE ~3F WORK: ,:,,_,,,,, !. PREPARED FOR: PHONE NUMBER: (541 )858-9697 BILL DOSS ~1~?,,~"-.. ..... .';'~.~ DATE:7.28.9B/! DRAWN BY: SCALE: PAGE: J.L.M, 1 = 30' 2 OF DETAIL D~WING P~OFILE D~W~G PREPARED BY: ALPINE WOODS SUBDIVISION; LOT 7, BLOCK 5, DETAIL AND PROFILE OF PRESUURIZED TRENCHES BILL DOSS (541)858-9697 J.L.M. N.T.S. 3 OF ALASKA WATER & WASTEWATER^~. ~.o~ .~..~ o~ ~.L_~ ~:o ~. ~.~ .~. ~,~o,. · ^~.o~.~, ,~r-..~ .......... [SOIL LOG - PERCOLATION TEST] ,~I ~""49 - LEGAL DESCRIPTION: ALPINE WOODS SUBDIVISION; LOT 7, BLOCK 5, F PERFORMED FOR: BILL DOSS ~ DATE PERFORMED: 7/22/98 '(//~ ;. NO. 9608 ,: //[}~. '-.. C.E. .." DEPTH I ' ............ FILL SOIL C~SSlFICATIONS [SITE PLAN ...... 2 :..~ ~,,, ~ ~ I r'= IOO, I :~ ~/' ORGANICS .?::..~~,, .............. ~ ~ / ..../ /.-... DEPTHTO a**= I k~ I Y X / ',X GROUNDWATER ~n'~ / ~~<~X/ / 9~ EXTREHELY DENSE E. HUFFMAN ROAD Il 1 ~ ] ~ I I II SiLT WITH SOHE SW Il llllll II HEAVY SME~IN6 12~i~tlllttl 7/22/98 1 3:50 7 -- 1~ *NO PREI;OAK REOU RED 14 B.O.H. 15 16 I 17 - lB 19 PERCO~TION ~TE >60+ (NIN,/INCH) PERC. HOLE DIA. 6" (INCHES) 2 TEST RUN BETWEEN 5.5 6.0 FT. COMMENTS: PERFOMED BY A~SKA WATER * WASTEWATER ../ ~ ~ /U~ . CERTI. THAT ~H,S WAS ...~0.~ ~ ACCO.~A<. W,TH ~qS1~" ~NO .UN,C,.A~ .U~UN.S .N ~.~C~ ON TH,S Date. Date: i ~ &Ut ?~ [ / DEPTH TO DATE GROUNDWATER _DRy _ 7/2.2/98 ALASKA WATER & WASTEWATER ~o ~. ~.~ .~. o,~o,~ . ^.o.o.~, ~. ~o~ ~%..~:.~.~ ~. [SOIL LOG - PERCOLATION TEST] ~.: ............. '-~d'l/l':'"') LEGAL DESCRIPTION: ALPINE WOODS SUBDIVISION; LOT 7, BLOCK 5, PERFORMED FOR: BILL DOSS DATE PERFORMED: 7/22/98 .... .... [TEST HOLEm DEPTH ~ (f~et) ~ORGANICS FILL/ORG DEBRI SOIL C~SSIFICATIONS sITE PLA~ EXTRENELY DENSE 7-- I Ill IlVISU~LY RATED THE DEPTH TO DATE 9-- -~B.O.H. , .... E. HUFFMAN ROAD 10~ 11 -[ DATE READING CLOCK NET TINE WATER LEVEL I NET DROP TIHE (HINUTES) READING (INCHES) 14~ .... - ~o 18~ ' PERCO~TION ~TE >~0+ {~IN./INCH) PERC. HOLE DIA. ~" {INCHES) 19 ~0 TEST RUN BET~EE~ -- ~T,~D -- ~T. f CO~E~TS: PERFOMED BY A~SKA WATER & WASTEWATER I, j, ~ L J~ , CERTI~ THAT THIS WAS PERFORME~ IN~ ACCORDANCE WITH ALL~TE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: DEPTH TO DATE GROUNDWATER . DRY 7/22/98. ALAs WATER & WASTEWATER - - '7320 E. CHEER H~. CIRC~' * ~CHO~GE, AK. 99504 ff~..'"~ ...... I SOIL LOG - PERCOLATION TEST I { LEGAL DESCRIPTION: ALPINE WOODS SUBDIVISION; LOT 7, BLOCK 5, ~ { ~.~ E[/E~ ..... ~..': Y~.~'ff~ .... PERFORMED FOR: BILL DOSS '[? ~'~ES P. WILLIAMS: DATE PERFORMED: 7/22/98 ~qfi~ '.. NO. 9608 .: ,~ TEST HOLE ~3 '~%~' ....... DEPTH ~ (feet) ~ ORGANICS BONDED W/SILT SOIL C~SSIFICATIONS ~/~¢/ HL LENSE 6H CL ,o ~o*, SM OH 6 ~ o o% SC 7 ,~¢*,% SW I DEPTH TO DATE ~¢,¢,~ W/ GRAVEL GROUNDWATER 9 ~ ¢o% %%% ..... ~ .... ~.I~gE- E. HUFFMAN ROAD 11 ; SW/SH DATE READING CLOCK NET TIHE WATER LEVEL NET DROP TIHE (HINUTES) READING (INCHES) 12 7/22/98 - .WA~ER ~BSORBED A S F~T AS IT .V ~.. ADpEB% ........ 15 ............................................. 18 19 PERCO~TION ~TE <1 (HIN,/INCH) PERC, HOLE DIA, 6" (INCHES) 2 TEST RUN BETWEEN 5,5 AND 6.0 FT, /./(/. THIS WAS PERFORMED )N ACCORDANCE WITH ALL Sq ~E AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~8{~ DEPTH TO DATE GROUNDWATER DRY 7/22/98 ~-.~. ¢! ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME 'PHONE I []NEW /~ ~[~'~r~ ~7~,~> ~c~ ~r~c"~,'~,9 ~ ~I ~PGRADE MAILING ADDRESS / LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS J Well J AbsorPtionar~a Dwelling 2~ PERMITNO. DISTANCE TO: J ~)O~I ~ Z No. of compartments - --r~iq'~a~c~Y~~gallOns~ IF HOMEMADE: Insidelengt, Width Uquiddept, ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. 0 ~ Manufacturer Material ~ Liquid capacity in gallons ~ Well ~O~ Foundation ~ Nearest lot line/ '2 PERMITNO. ~ ~ DISTANCE TO: ~ No. oflines ~ Length of each line Total length of Jines Trench width Distance~et~een lines N Top of tiJe to finish grBde 4 MateriaJ beneath tile Total effective absorption area . ~ -- ~ inches Length Width Depth PER MIT '~o-- ~ ~ Type of crib Crib diameter Crib depth TotaJ effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth DrilJer Distance to lot line PERMIT NO. g DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER . PIP'MATERIALS SOl L TEST RATING /~ ~'/~ ,m ,~.~. o d,~,,~ ~,~.f ~,',.-4 .~'----/o' i-,~ ~"~-~s.?-- ~. y ~r~ _ APPROVED DATE LEGAL 72-013 (Rev. 3/78) DEPARI'MEIxlT OF HEALTH ANI) ENVIRONMENTAL PROTECTION 825 I... ,STREE]":, ANCHORAGE, AK 995£)1 264-472() F:'ERM 31 T NIl: · C~(.~[ .. . l) A'T' E I o,:~ J E D ,, AF'F'L. I CAIxI'T': ADDRESS CON1ACI PHOIxlE: I... E BLANKENSHIP CONS P 0 BOX. 770087 EAGLE RIVER, AK 99577 694-56'~8 .C.~EWE]R F'EF(I'"! I ]- LEGAl,,. DESCR IF': L, OT SIZE: L..O'T I,,.OCAT I ON: SUBDIVISION: ALPINE WOODS SECTION'. ,~..) TOWNSHIP: 12 lA (SQ.FT. OR ACRES) ALPINE WOODS DRIVE LOT: 7 BLOCI<: 5 RANGE: 5W I certify that: :1.,, I am familiar with the requir, ements for on-site sewers and wells as set. forth by the Municipality o~ Anchorage (MOA) and, the, State o~ Alaska. R. I will install the _~ystem in accordance with all MOA Codes and regulations, and in compliance with the design criteria o£ this permit. 3. I witl adhere to all MOA and State of Alaska requirements ~or the set. bacl.:: distances from any existing well, wastewater disposal system or public: sewerage system on this or any adjacent or.nearby lot. ~ IF A I....IFl" STA'T'ION IS INS'T'ALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN' (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUIL-TS WII....I .... NOT. BE AF'PROVED WITHOUT AN ELECTRICAL INSPECTION REPORT;. AND (3) THE EI....li":CTliICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. olGNED DATE: .~- ~ ~- ~ ~ APPLICANT: I .... E BLANKENSHIP CONS Permit No: Date Issued: Applicant: Address: MUNICIPALITY OF ANCHORAGF Departmen ~f Health and Environments Protection Pouch 6-650, Anchorage~ AK 99502 264-4720 On-site Sewer/Water Permit HANDWRITTEN Legal Description: S/D: ~/.~z~2~.(~~ ~ Section: ~1~ Township: Lot Size: /~ Lot Location: Max Bedrooms: (Sq. Ft. or Acres) Lot: ? Block: Range: Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. . ~ ~ ...................................... ................. TRENCH (J_~)_y. t~ ~ZED ~ ,W. DRAIN Depth to pipe bottom(ft.) Z-J, 0~ Gravel depth (ft.) Total depth (ft.) Gravel width (ft.) Gravel length (ft.) Tank size (gal.) Soil rating (sq. ft./br) ** Gravel length 75 feet requires mu l~t ip 1~ ** Tank must have at least two compartments runs (not exceeding 75 feet: each) I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage(MOA) and the State of Alaska. 2. I will install the system in accordance with ali. MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well.~ waste~ater disposal system or public sewerage system on this or any adjacent or nearby lot. 4o I understand that this permit is valid for the maximum number of bedrooms stated above, and any enlargement or modification wi1.1 require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAl, INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED: Applicant ISSUED BY: DATE: DATE: SWP/024 rev.1/85 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME IPHONE MAILING ADDRESS LEGAL DESCRIPTION NO. OF BEDROOMS J Well , ~ Absorption area Dwelling PERMIT NO. DISTANCE TO: ZOO ~I ~ ~ ~- ~,~- co ~ ~<~ Manufacturer ~,~ Material /~.~ f No. of compartments ~ ~ Liq. capacity in gallons Inside length Width Liquid depth /0 CO IF HOMEMADE: ~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ - ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest tot line ~-,~ PERMIT NO. ~_~ ~ No. of lines ~ Length of each lige Total length of ,tines Trench width Distance betwSen lines of tile finish / Material beneath tile Total effective Top to grade/ absorption 8rea Length ~ Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER ~,~ 5 PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL 72-013 (Rev, 3/78) D Iii!: F::' 'T' I"'I '1" C) F:' :I: F::' E,...,~:::' r';.., ",", "r', f'l... ,t,"t, ~,. 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'l:. ,, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST - DATE P ER FORM E D :/~U~,~ I SLOPE SITE PLAN lO WAS GROUND WATER ~0 ~ 11 ENCOUNTERED7 O P '12 IF YES, AT WHAT E DEPTH? 13 Gross Net Depth to Net Reading Date Time Time Water Drop 14 PERCOLATION RATE -. ' ~,~ ,' . ' ~; * r~' ~ '~' {r~i~uJes/inch) TEST RUN BETWEEN I . i~T AND ~ COMMENTS i .~ . <...~,t~,.~.'~.-: ........... . . 72-00~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O, Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 1. GENERAL INFORMATION Complete legal description ALPINE WOODS S/D: LOT 7. BLOCK 5 Location (site address or directions) 6000 ALPINE WOODS DR. ANCHORAGE. AK 99516 Property owner Mailing address Lending agency Mailing address ~)EFFREY AND CYNTHIA REED 6000 ALPINE WOODS DR. ANCHORAGE. AK Day phone 99516 Day phone (907/ 545-6148 (907) 261-7600 Agent KAREN FOSTER w? DYNAMIC PROPERTIES Day phone Address 3111 "c" STREET ANCHORAGE. AK 99505 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual well Community well xxx Public water NOTE: If community well system, provide wdtten confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding Tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC lng to the legality and status of system. 72-025 (Rev. 1/91 ) Front MOA ¢Y21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $450.00 at, or prior to, closing for the engineering services provided. 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 a~i State codes, ordinances, and regulations in effect on the date of this inspection. /~///._ ,I Name of Firm ALASKA WATER& WASTEV~ER CONSULTANTS, INC. Phone (907) 337-6179 /_ II i Address 6901 DEBARR ROAD, ~U(T/./E'/2B/,~NCHORAGE, ALASKA 99504 . / Engineer's Signature t..~...~'.~ ~ Date ~"~ ff./(::~ I, conducting this evaluation, AWWO, Inc//at~br~'~i~ed-- '---' to p~'rovide a thorough, conscientious enginee'ring /analysis of the system in accordance w/th ADEC and MOA bHq~'~' Guidelines & Regulations. The reported results described the performance of the system under the conditions '~ncountered at the time of the test, and separation distances measured to readily identifiable features. The operational lifo of all wells and septic systems depend on the Iocal solls condition, greund water levels that may fluctuate during the year, and the water ~,.~..~_~.,~ ,, ~ usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfacto~y test results do not guarantee future performance % OF A of the system, nor do they guarantee that there are no hidden defects or encroachments. "~"~".~ AVVWC, Inc. can therefore not provide any warranty for future estimate of how long the ,~./~.~.//~..~....'1'"; .?. system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of the owner listed above. Any ~"~4~' '/~'~':://? //-'[~ reliance upon or use of this report by any other person or pady is not authorized, ~y,~.,,,?,,~ n ess..' ( 6E-7~53 ." ~ · .......... nor will it confer any legal right whatsoever. 6, DHHS SIGNATURE P'"'"' Approved for ,~'-' Disapproved Conditional approval for bedrooms 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 ¢Y21 Computer Version RECEIVED MAY 22 ~000 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICI~aP^u~ . ,, Environmental Services Division ~IVIRONMENTAI. SERVI(:~ 825 L Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 Health Authority Approval Checklist Legal Description: ALPINE WOODS S/D; LOT 7, BLOCK 5 Parcel I.D.: 015-234-'37 A. WELL DATA Well Type. COMMUNITY Log present(Y/N) Total depth Cased to Date of test Static water level Well production IfA, B, or C, attach ADEC letter~ ADEC water system number. Date completed ~ ~e ground) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: .__ B. SEPTIC/HOLDING TANK DATA Date installed 9/24-/98 Tank size Foundation cleanout (Y/N)~ YES Collected by: 2000 Number of Compartments 2 Cleanouts (Y/N) YES Depression (y/N) NO High water alarm (Y/N) YES Date of Pumping 5/18/2000 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA J *NEW SYSTEM, LESS THAN 2 YEARS OLD J Date installed 9/16/98 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 Length 80' (2 @ 40') Width_ 2.5' .Gravelthickness below pipe **UPPER TRENCH DRY 5/18/2000 LOWER TRENCH 8" 5/18/2000 .System type TRENCH 7' Totaldepth 8.6' - 10' Effective absorption area 1120 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N). NO Date of adequacy test *NEW Results (Pass/Fail) For ~ Fluid depth in absorption field before test (i~added (in.): Fluid depth ~ Absorption rate = ~12 months) (y/N) If yes, give date 72-026 (Rev. 3/96)* Computer Version D. LIFT sTATION Date installed Manhole/Access (Y/N) YES High water alarm level at* 44" Cycles tested N/A 9/24/98 Size in gallons 2000 "Pump on" level at* 40" "Pump off" level at* *Datum BO'FI'OM OF TANK 40" E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic~holding tank on lot Absorption field on lot Public sewer main On adjacent lots ~Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation. 5'+ Property line 5'+ Absorption field 5'+ Water main/sen/ice line. 10'+ Surface water/drainage 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main/service line 10'+ Surface water Curtain drain F. ENGINEER'S CERTIF I certify that Ih~e~l( of Municipal r~cord~ i with MOA H~A gui~ Signature ',.-~' Engineer's NaJ/j Date 100'+ Driveway, parking/vehicle storage area 10'+ NONE KNOWN u field inspections and review 'e systems are in conformance t on ihia date. JEFFREY A. GARNESS Wells on adjacent lots 20g'+ HAA Fee $ Date of Payment ~2L-(/~-- '-~'"~- -- ~' D Receipt Number /J~'z'c'D~ 7/'1'''~/- .'~-) 72-026 (Rev, 3/06)* Computer Version 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 01 5-234-37 HAA # 1. GENERAL INFORMATION Complete legal description Lot 7; Block 5; Alpine Woods Subdivision Location(siteaddressordirections) Anchorage, 6000 Alpine Woods Drive Prope~y owner William Doss Mailing address C/O Jack White Real Estate AK Day phone Anchorage, AK Lending agency Mailing address.. Day phone Agent Sallie Nickerson/Jack White Real Est. Day phone Address '3201 "C" Street Suite 200 Anchoraqet 'AK 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 563-5500 5 XX 72-025(Rev. 1/91) Front MOA#21 NOTE: XX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm A]ask~, Water & Wa_st~ rater Consut~ant~,_[~/~ Address . 7,?,20 ircle Engineers signature ~o ~~ )~ ALASKA WATER & WASTEWATER CONSULTANTS IS TO BE PAID $1150.00 FROM THE ESCROW ACCOUNT #10-64628 FOR ENGINEERING SERVICES PERFORMED. DHHS SIGNATURE I'/' Approved for bedrooms. Date ~ ~ r~ Disapproved. Conditional approval for bedrooms, with the following stipulati(.,?~ Additional Comments By: /¢,'/ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #'21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERV, I~E.~ ~ Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Legal Description: Health Authority Approval Checklist (,~,.~O~ L"~'~, ~P,-~ Parcel I.D.: WELL DATA Well If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Total depth ~ed to Casing he ground) Sanitary seal (Y/N) y protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water leve g.p.m. Coliform ~ ~ -~ mple: Collected by: SEPTICI~ TANK DATA Date installed Foundation cleanouti~N) J;~Xt$?,~&. Depression (Y/~. Date of pUmping N/~j/~ Pumper ABSORPTION FIELD ~ATA Date installed ~ l/~/~ ~ Length~ ~,e ~0 ~ ~idth Effective absorption area //~0 ~ Date of adequacy test ~ Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (Y/~ Other bacteria Number of Compartments ~;~ Cleanouts {~N) 'YE~' High water alarm (~N) Soil rating r.ftqbdrm) 0,~ VlSu,~-~.. System type 5 '% Gravel thickness below pipe .~ I Total depth Monitoring Tube present~YN) y Results (Pass/Fail) "~ · Depression over field (Y~ For ~11 Immediately after gal. water added (in.): Absorption rate = '""' g.p.d. If yes, give date bedrooms 72-026 '(Rev. 3/96)* D. LIFT STATION Date installed c~/~.~ Size in gallons Manhole/Access ~fll) Y/~.~ "Pump on" level at* /~0" High water alarm level at~; !~ ~ *Datum _~',~'7-/dA,~ oF- Cycles tested ~J/~ - ~//~/xtJ T,,~/VJ( "Pump off" le~/el at* '7'Fr~ r-,. E. SEPARATION DISTANCES Public sewer main ~ Se~ Lift station SEPARATION DISTANCES FROM SEPTIC~ TANK ON LOT TO: Foundation '~ ~ ' 1(- Property line ~' ~- Absorption field .Water main/service line /,0 '4- Surface water/drainage ,/(-~'~' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line .~. tO ~ ~ Building foundation Water main/service line Surface water ~ 00 ' + Driveway, parking/vehicle storage area ~ Curtain drain ~'~o~- ~1~, Wells on adjacent lots ~00t~ F. ENGINEER'S CERTIFICATION ~ ~ ~v~Oc~ IS ~ T/~ ~ ~1~) ~ Y~ ~- I ce~i~ that l ~ave determi~ thru field/inspectiOns and review of Municipal records that ~~~ are in conformance with MOA ~ ~ui~el~s in effect on this date. ~. ~. . Engineer' me ~~ ~ ~ I~/~ HAA Fee $ ' Waiver Fee $ Date of Payment J~ /~ lq ~' Date of Payment Receipt Number ~ ~. . ~Z ~ Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~..~._~;;?,¢~r~5~.¢~ _ Telephone: Home ,.~2.-~_ Business Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder,S" Buyer [] · Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-FamilyJ~ Multi-Family [] Number of Bedrooms __ Other WATER SUPPLY Individual Well [] Community~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL 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) 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. Name of Firm~C/~- Address _J,,~ Date .... ~.~ Seal DHEP AppROVAL Approved ~, Disapproved Terms of Conditional Approval Conditional Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the represent{~tions given in paragraph 5 above by an independent professional', engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72~025 {11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: Well Classification Well Log Present (Y/N) ,~y.~,. · Date Completed "~/,~ Yield Total Depth A,I/~ Cased to A//~. Depth of Grouting Static Water Level ~IJ/~4' Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot I1~t B, C, D.E.C. Approved~N) .~',~-.E-O( Sanitary Seal on Casing (Y/N) ,~"'~ Depression Around Wellhead (Y/N) ~ · _-~?~/4= ;On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date Comments SEPTIC/HOLDING TANK DATA Date Installed ~Size ~ No. of Compartments Standpipes ~'N) Air-tight Caps i~N) Foundation Cleanout (~N) Depression over Tank (Y,~ Date Last Pumped Pumping/Mair~tenance Contract on File (Y/N) eJ/,~.- ; for Holding Tank High-Water Alarm (Y/N) p~,l/~.... Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course ,~./oz~, To Building Foundation ./~V ~.~ To Disposal Field /0/4' 4~ To Stream, Pond, Lake, or Major Drainage Comments ~ ~ ~.~.:~.~:~ t~__~ (~. ~..~:~~ . Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ./G/ t~ -i. Square Feet of Absorption Area Depression over Field (Y/¢ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ~.,'~ Lot Type of System Design Length of Field ,_~ (.D '~ ~(~ Depth of Field ~ ~ ~ ~ Gravel Bed Thickness ~ · ~ ¢ ~ + /~O ~ ~ Standpipes Present~/N) Date of Last Adequacy Test 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 ,"~',~ To Cutbank (if present) D. LIFT STATION Date Installed ~4,)/~_ Size in Gallons "Pump On" Level at ~)/,4- 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 hCve checke~ verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed d~'_ ~/)~'~,~,/_~. ~Of-.~_~ Date Com pan:'~.~ ~'~':~. - MOA NO. Receipt No. '~C~'"~¢~1~ Date of Payment /~'~,~ '~-~ Amount: $ 4~,G .O'~ Page 2 of 2 72-026 (11/84) Engineer's Seal DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA gg501 BILL ~FFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the Water System is in compliance with the State Drinking Water Regulations Sincerely,