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ALPINE TERRACE BLK 2 LT 1
Alpine Terrace Lot 1 Block 2 #015-243-01 Municipality of Anchorage Page 1 of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 54-5-4-74-4 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SWO00416 PID Number: 015--243--01 Nome: MATr LOEWE Wastewater System: [] New · Upgrode Addrese: 11920 NEBESNA DR. ANCH AK 99516 [NORm/SOUTH] ABSORPTION FIELD [NORTH/SOUTH] No. of Bedrooms: Ph°ne:,,907!f ~ 562--6464 [] Deep Trench · Shollow Trench [] Bed [] Mound [] Other LEGAL DESCRIPTION ,o, Roe.o:0.8 ePD/Sq. F, Toro, D.p~ ,~m o,0,.o,5.8/6.00~o: n. 1 2 ALPINE TERRACE 2.8/5.0 ~ 5.0/5.0 - - - 0- 1 FL 45/45 WELL: [] New [] Upgrad _~'~ Gm-,,el width: 5 FL Number of 2 lin°e:jlDi~tance10'+between lines:Ft. ~ FL 776 SQ. FL D 3034/ F-810 n. A+ HOME SERVICES 10/17/00-10/18/00 ~L ~ TANK SEPARATION DISTANCES · Sept~ [] .o,d~ng [] S.T.~.,. To Septic Absorptlon Uft Holding Publlc/Pdv=te Manufacturer. Capocity In galrona: From Tank FTeld Station Tank S.wor U.o~ ANCHORAGE TANK 1250 we~ 100'+ 100% - 25'+ STEEL 2 Sun%ce 100'+ 100'+ - LIFTS~'^'nm~ ~./ Woter Lot 5'+ *5' - Si.. i. ~o,,o..:II~ Line Foundation 5'+ 10'+ - - -- Drain NONE KNOWN I I ~.mo~: BENCH MARK · 5 FOOT WELL WAIVER GRANTED WITH ISSUANCE OF PERMIT. SONA-TUBE ON NORTH WEST SIDE OF SHED. WATER WAS 10'-5" BELOW GRADE IN TEST HOLE ON 100.00 Inspections performed b,:. AWWC, INC. Dates:Is, 10/17/2000 2nd 10/17/2000 ~.~'~.~'~ ~'[ ........ 3rd lO/18/2ooo lO/22/2ooo 0h_%:.J '-. (:-795,3 ..' ~ Department of Health and Human Services approval %~% ..... ..... ~,~ Reviewed and approved by:/).,,./.,~ ./'/~, ~,..~/" Date://'- ~ .- o t:3 PER,~ NUM~ER:sw0004~ 6 AS--BUILT DRAWING P^ROEL ,D04 5--2"43--0~NUM~ER: x ~s 7s.5 95.~ ~ / GRANTED WTH ISSUANCE ~GI MT1 95.6 ~0~.7 / x OF PERMIT 5 4 / X C02 11 .8 115. / co& ~/ / / _ ~04 /~/ ~ ~ ~ DOUBLE CL~NOUTS //// TO BE USED AS A RESERVE SITE~ / / D~WU ~:.-' ..~ · :.~.~¢. F.~ ...,...,~ ........ "¢~j... ..... ~....~.-';;~ A B ST1 59.4 56.7 ST2 63.5 64.5 FD 66.0 68.0 FS 78.5 95.6 C01 81.2 96,7 MT1 95.6 101.7 C02 115.8 115.4 MT2 109.1 125.5 C03 93.8 115,1 C04 127.4 134-.8 K.D,W. Al ASKA WATER & WASTEWATER CONSULTANTS, INC.~ ~' '~ 1" : ,.30' PREPAREO FOR: PHONE NUMBER: PAGE NUMBER: MATT LOEWE (907) 562-6464 2 OF 43 LEGAL DESCRIPTION: ALPINE TERRACE SUBDIVISION; LOT 1, BLOCK 2 IYPE OF WORK: AS-BUILT OF SEPTIC SYSTEM UPGRADE AS BUILT DRAWING P, CEL,D NUMBER: ~ERMFF NUMBER: SW000416 015-245-01 Af INker ~ 94,81 ~ AY O~f ~ 94.~2 Mf CO ~ ,~0 PlU~ ~ N (ATHI~STPOIm ~Nm~ NORTH TRENOH SOUTH TRENCH DATE: 10/25/2000 ~ ~ ~ ~. CONSULTANTS, lNG. 1" = 50' ......... 6901 DEBAR RO~, SU]T~ ZB * ~CHORAGE, ~ 9950~ ' PHONE (907~57-6179 * F~ (907)~8-52&6 'REPARED FOR: PHO~;~BER: PAGE NUMBER: .... MATT LOEWE 562-6464 5 OF 5 )~ ~J~(~:.~rnes~,' ALPINE TERRACE SUBDIVISION; LOT 1, BLOCK 2 ,~4_r~... ~ ....'¢~ ~PE OF WORK: rOfesmO~ AS-BUILT PROFILE Of SEPTIC SYSTEM UPGRADE MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box '196650, Anchorage, AK 995'19-6650 (907) 343-4744 ON.SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 04, 2000 Expiration Date: Oct 04, 2001 Permit Number: SW000416 Legal Description: ALPINE TERRACE BLK 2 LT 1 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: DAVID AND ARLEENE GIBBONS OwnerAddress: PO BOX 3074 SOLDOTNA , AK 99669- Parcel ID: 015-243-01 Site Address: 011920 NEBESNA DR Lot Size: 49200 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] 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. 5. The following special provisions. Rick Myslrom. Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box '196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us October 4, 2000 Jeffrey Garness Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-B Anchorage, AK 99504 Subject: Waiver Request for Alpine Terrace, Lot 1, Block 2 Waiver Request #WR000079 Parcel ID #015-243-01 SW000416 Dear Mr. Gamess: Your request for a waiver of the required 10 feet horizontal separation from the on-site wastewater disposal system to property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing on-sitewastewater disposal system to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, ~ey Poet~'''~ Engineering Technician On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Wa'iver Review Worksheet Permit Date Received: Legal Description: Engineer: ~ ]~k T£R R/~ c£ Co,,.¢ Waiver Requested: Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: List Conditions or Reasons for Waiver is NOT Granted: above: Date: N~/~'f Reviewer Rec %: Amount: $ //~.o ~ Date Paid: ALASIG WATEI' WASTEWATER September 13, 2000 RECEIVED Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 SEP % 2000 MUNICIPALITY OF ANCHORA(~E ENVIRONMENTAL SERVICES DIVISION Ref: Septic System Upgrade for Lot 1, Block 2, Alpine Ten'ace Subdivision To whom it may concern: The existing 4 bech'oom house is served by a private well and septic system. The existing system is in a state of failure and needs to be replaced. A test hole was excavated on the prope~y. We are proposing that a 1250 gallon septic tank and a five foot wide drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 0.8 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 8.6 minutes/inch b. Allowable Application Rate: 0.8 gallons/day/ft2 c. Number ofBech'ooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 750 ft2 f. Total Depth: 6.0 feet (max.) g. Effective Depth: 3' feet h. Width: 5 feet i. Reduction Factor: 0.58 i. Minimum Length: 90 feet (2 x 45~) j Effective absorption area = 776 ft~ 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average topography of this property is a 5 to 8 percent running from approximately southeast to northwest; in short, there are no slope concerns. The trench is to be installed parallel to slope contours. 5. LOT LINE WAIVER: We are proposing to place the new drainfields as close as 5 feet from the west property line. There are no platted easements in which to encroach. We are unaware of any adverse impacts associated with the requested waiver. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Jeffret Presi~l NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, a soils log, and a 7page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com ~, ' (SEE PA(~2 OF 2) ~%, // S~ CONSULTANTS, INC. MATT LOEWE (907) 562-6464 =EOAL DESCRIF/ION: ALPINE TERRACE SUBDIVISION; LOT 1 BLOCK SITE P~N FOR SEPTIC SYSTEM UPGRADE X WAIVER FRO~ LOT LINE ~ X ~~~ -~ ~"'/ ~/~k '~ :. CONSULTANTS, INC.' ,:~ ~,~,~o~ ~o,,~: ~,=~, ~= ~ ~~....., ..... ,..., MATT LOEWE (907) 562-6464 2 OF 2 DESIGN DRAWING FOR SEPTIC SYSTEM UPGRADE _AT.&SKA WATER & WASTEWATER CONSULTANTS~ INC. PHONE (907) 337-6179 * FAX (907) 338-3246 LEGAL DESCRIPTION: ALPINE TERRACE S/D; LOT 1, BLOCK 2, i .... PERFORMED FOR: MATt LOEWE ~/~ ~- .: DATE PERFORMED: 9/7/00 ~.l ". I [ ~ ?" "'~ "'"'~ DEPTH ~,~;~2~ 2 ~ SOIL C~SSIFIOATIONS [SITE PLAN' 4-- Oo ~ ' WELL n 2 L[L*~H ~ Iec 84 ~1SM/ML SEEP * 10.5' 9/7/00 ../~/ ~St:~1 ~--E ~E-D'NG CLOCK I NET TIME WATER LEVEL NET DROP l , q ~IGW/SM UA1 ~A , TIME I (HINUTES) READ,I, NG (INCHES) [ ~ 2 8:11 30 2" 1~ ~1 .... ~---- 8:11 ............................... ~';; --//' .... s:4 ....... // ~7 ........................ 19 PERCOLATION RATE 8.6 _(~IN./INC?/ PERC. HOLE DIA. _ 6" " (I~CHES) 20~ ~ TESI RUN BETWEEN 3.5 FT. Ah ~ 4.0 FT. COMMENTS: PERC HOLE PRE-SOAKED FOR 4+ HOUR~ ~/¢~[ ' DEPTH TO DATE GROUNDWATER SEEP © 10.5' 9/7/00 10.25' 9/14/00 GRE ,,'R ANCHORAGE AREA BOR,..GH Department of Enviro'nmental QualiW 3330 C St~'eet Anchorage, Alad~a 99503 INSPECTION / LOCATION '~) ~2,~ ,~ bi/'--" REPORT ON-SITE sF:WAGE DISPOSAL SYSTEM LEGAL DESCRiPTiC, N L I ~------------------~ ~'-, SEPTIC TANK: DISTANCE FROM WELL~'~__!~; MANUFACTURER INSIDE LENGTH INSIDE WIDTH MATERIAL Li~QU ID DEPTH DISTANCE FROM WELL /~) '7~FOUNDATION /~) NUMBER OF LINES / ABSORPTION AREA DEPTH: NUMBER OF COMPARTMENTS LIQUID C A PAC I TY/~L'h/"~G A L LONS. TOTAL LENGTH ...-.,---. NEAREST LOT LINE ,:~O ~7- OF LINES ~--//" / SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER TOP OF TILE TO FINISH GRADE ~'~,~TMATERIAL BENEATH TILE /~::~ IN. ABOVE TILE ~Z/ IN. WELL: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION__ LOT LINE__, SEWER LINE__, TANK SYSTEM CESSPOOL OTHER SOU ACES APPROVED __ DISAPPROVED .REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: DATE DIAGRAM OF SYSTEM Form EQ-032 F:'EF~:H ]: 1'* '1. :: :j:l 'l"Hl:.:i: L.E:NEiTH [:, ]: i~"tE:I'.,tE; 101'.,I 1:5 'T'HE I..EI'.,IEil"H ,:: I N F'EE:"I" ', OF:' TI-IE~: .'I"F~:E':t'.,IC:H CJI:;;: I:::,I:;;:I::1 :[ I'.,tF:":I; E:L.[:,. 't"HtE [:,EF:'TH Cfi: FI TREI'.~C:H OF.: F'I'T' .T.:E; THE E:,I'.:.i;I"FINCE E:ETHE:EI'.,t 'T'HE: :SUF~:I:::'I:::IE:IE OF: 'T'HIE (:iil:;i:l]ll...lt'.,l[:, fiN[:, THE E:OT'TEff'I OF I"HE E .... H, H II[)I'-,I ,' I I'-,I FIEE':I">. "I"HED.':E :[ :5 I'qO 'Z'~;EI" .H I [:,TH Fi'.')~: 'T'F;.:ENC:HE'.5. ' L F~..H, E.L. [>EF'TH :[~; THE: i"1 Z N ]:. HUH ,[:,~F'I"H F'F .,t(H, E.L EiF..Tt4E.F.:t'.,I THE' F TF.I:::IL.t .... F:' I:::II'.4E:, THE Ei OTTOH CIF THE EEXC:FI'v'Ft'T'I ON ,:: Z N FEET ::,. I1::~;:-.':: [E: ,:::.'::.". L.li ][ It~:: liE.=.: ![]::. .==. EE. IF- Jl ][ ,:::: "]"" I~:=tI I~-.tl !'-":::..'=."-"' I ~:-:. lEE == :..1.._ :L=.~.". ~=-" .......... It::::, C]~ t1:::~t L... IL..... ll::::::~ ~'..,,!i ::!ii!i!;; I'"t ].' Iq :1: I'"IL.tI'"I [::, I 'J-.'~;'I"FII'.K::E' BIF_'THEEI'.~ FI 1.4ELL I=INE:, FIN'/ ON-S-'.'; I 'TE :SEHRGE E:, :[ '_'-:.iPOL-E;I::IL. :.:.'i;"r"J;'l"EH :t: :ii!; ::i..E~E~ F:'Elii"T F:C.'IF.: I:::t PF.':]:'v'R"i"E: I-,.IIELI... OR ;;.'~:e~EI FEET FI.':.'IF..' R PUBLIC HELL. :iSt:::'IEC: :[ I=' ]: C:FI'T' :[ ON'J!!; FII",I[:, C:OI'.,tSTI-i:I..IC:T 1 O1'4 [:, I F:IGRRI'"IS FIRE F:I',,,'R I LF:IBL[:Z ]; t",i:iii; TF:IL..I_ F::I'T' ]: Eltq. :[ CEI.';i:'T' I F:"¢ "I"HWF :1.: ]: I:::11"1 F::'F:IHtL. iRF.: HITH THE Iq:EQUIR'EHENT:E; F'OIq: OI'.~-:'.:.;ITE S;EI.,.IER~!; RN[) I.,.IEL. I._:5 Fl:!i!; :ii!;ET F:'[)I:~::TH E:'.r' THE I','II...IN I O I F'FtL ]: T'T' OF::' F:INC:HOrq'.FIGI:E. ;.:2: :[ H :[ L.I .... I I'.,I::STFII....L. 'T'HEi: :5'T".."=';TE:H I N FICCE~I~:[::,FII'.,IOE I.,.I I TFt THE COE:,ELE;. ::ii:: t t...IN[':,EF:i:STI=Ii'.,II], THRT THE OI'.,t-:SI'TE :SEI.,.IEF?. S:'¢~'T'EH i"IlR'T' RE(;:!UIF.:E ENI._I:::IF~:r3EHE:I'.,IT IF:' 'l"HtiE I:;'.IE:.51 [:,[EI'.,ICE 12'!; F.':IEPIEIDEI....EE:, 'l"O I I'.,tC:L.U[>EE HORE THRN 4. GAAB-HD- I GR'~'/TER ANCHORAGE AREA BOROIJ'~ d G.r,,~RTMENT OF ENVIRONMENTAL 0.UALItv 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY GALLONS. MATERIAL ~-~'--~'~--~'--~-' NUMBER OF COMPARTMENTS INSIDE LENGTH ~ .INSIDE WIDTH LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PiT: NUMBER OF PITS ~ OUTSIDE DIAMETER LINING MATERIAL / NEAREST LOT LINE~/~~' -~d~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) OR W~DTH , LENGTH , DEPTH DISTANCE FROM WELL J~ / ~ BUILDING FOUNDATION SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AR~'~'~ SQ. ET. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE FOUNDATION ..~'UIS'J'~CE BETWEEN LINES TOTAL LENGTH NEAREST LOT LINE OF LINES ., CH WIDTH IN. TOTAL EFFECTIVE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: ~~/~-~ ~_,o/~_r~-~c,,~,~/~ TYP E ~/~:,'~'- DEPTH /~"~ ~ LOT LINE /~9 /~ NEAREST / SEPTIC SEWER LINE~~ ~'- ,TANK DISTANCE FROM , BUILDING FOUNDATION/~/~ i WATER . / -- ~ SAMPLE /ff~/t/~-: , NEAREST / SEEPAGE . OTHER "~'/~/5~¢'~ /~2~ , SYSTEM ./~ /~, CESSPOOL/g/~-/~~, SOURCE~/~/ DISTANCES: DIAGRAM OF SYSTEM I DATE APPROVED G.A.A.B. NAME OF APPLICANT GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE:, ALASKA 99503 TELEPHONE 274-4561 PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH COMPLETION DATE ANTICIPATED OTHER NOTE; THIS PERMIT IS NOT VALI'D WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. / / BEPT,C S, E Oo 7 ' TANK TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS DI AM OF SYSTEM FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE pit~'~ ~ DRAIN FIELD / , DRAIN FIELD. SEPTIC TANK , SEEPAGE PIT . TO NEAREST LOT LINe, / WELL TO SEPTIC TANK /~ 0 DRAIN FIELD SEEPAGE PIT / ALSO CONSIDER AREA WELLS. / WATER MAIN TO SEPTIC TANK ? DRAIN FIELD SEPTIC TANK, C~=~ , SEEPAGE PIT ~) , DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FIT~WlTH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. ~ G .A .A .B. //~ l. lC E.SE~ ESIG~//ER i CERTIFY THAT i AM FAMILIAR WITH THE REQUIREMENTS OF GRiEATER ANCHO~AG~ AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DATE .,,_,~ ~,....- v -~ APPLICANT'S SIGNATURE , ~ , v~'? ~ FORM NO, EQ-01 6 ~ Performed For "One tes~ is worth a thousand opinions" B1~29 TUDOR ROAD, ANCHORAOE, ALAIKA 9950'I · TELEPHONE 333-84'12 Mr. Ron Schaefers 0ate Performed March 21~ 1973 Leaal r)escrintion: Lot 1 Block 2 Subdivision Alpine Terrace- Anchorage This term Reports Soils Leo yes Percolation Test r)enth Feet Soil Characteristics Organic Silty Gravel overbu]:.den Silty Sandy Gravel, moJs~ occassional cobbles Cie as~ Gr ay ~.~ 4 x I00 : ,_~.()C' Was Ground Water Encr, ~nt;e,-ed? ~' IF Yes, At what Dent. ho iReadinq Time r.'~enr, t:r' H2Q iiet Dfc Percolation Rate ~linute Proposed Installation' SeeDaoe Pit yes Drain Field Deeth of.Inlet Depth To Bottom Of Pit Or Trench .CAMMENTS: 17~ square foe5 drainage area mrequired per bedroom ., .no bedrock or water table ~ feet below bo/~tom of seepage pit Test Performed By J~mes O. M~ak __ Lab Manager Data Certified By: Const. Test Lab Date: 3-21 -73 MUNICIPALITY OF DEl)T, OF HEALTH & ENVIRONMENTAL PROTECTION DEC 1 6 1988 WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysicol Surveys LOCATION OF WELL (Pleoee complete either IO,~'~I~,.$,,IV'L~'~ A.D.L. No. Io.I]Borough Subdivilion Lot Block Ib~.I I/4qtrl. Section No. TownshiPN[~ Range E[-'] Meridian '~.'errace 1 2 __of__of__of -- s [] w[] Ic.JJDIsTANCE AND DIRECTION FROM ROAD INTERSECTIONS $. OWNER OF WELL: Atlatna & Nebesn~ Address:Vist~ Real Es~.te Street Address and Area of Well Location ~Ve 2. WELL LOG Feet Belo~ 4. WELL DEPTH: (final) 5. DATE OF COMPLETION Su.ao, 203 ~t. [[ -- 27 - 88 Material Type Top Bottom ~ ~ 0 ~ 6. ~Cable tool ~Rotar~ ~Driven ~Dug .~~ . ~ 8 7. USE: ~ Dome,tlc ~ Public Supply ~ Indu,trv C~vellySilt 8 20 ~ Irrigation ~ Recharge ~ Commerlcal G~velIy sandy sil~ H20 20 28 ~ z.,, w,,, ~ o,~,r: Wa~r ~nd & C~vell 8 gpm 28 32 e.c.s,,s, ~ ~h~.=~.~ ~ W.,~.e Cemented ~velly silt 32 ~ ~.. 6" ~.. ,o 53 ,,. o.,,~ w.*,,, 17 ?~ctured rock ~ 53 ~o=. ~.. to__ft. Depth Sti~,., 2 . ,t. Ha~ rock 53 203 ,. ~,,,s, OF WELL: Type: o~e~ e~d Diameter: w~ter 53-60 s,ot/a,,h S,=,: 127-131 s.t ~.,.... .. =.~ f,. ~o. s~.~,c w*~z, ~EVEL= 2~ .. 1~7~8 Date ~ Above or ~ Below land surface Equipment used: I1. PUMPING LEVEL below lend surfoce end YIELD ft. after ~hrs. pumping 12.GROUTING Well Grouted: ~ Yes ~ No Material: ~ Neet Cement ~ Other: I~. PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. 14. REMARKS: 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Wofer Temperature ~o ~ F ~ C This well wes drilled under my jurisdiction end this report is true to the best of my knowledge end belief; A,l~ine Dri!lin~ & Ente~rises Registered Business Nam~ ..:?~*- Contract License Number ~a,....: ?. ~. Bo~ ll~96,~c~ora~;[~Alas~ 99511 Aufhorlzed Repres~afive Form OZ-WWR (11/81) Copy Disfribution; WHITE-Store DGG~ PINK-Driller~ CANARY-Customer Depar"t'..ment ,:::)~' I...lea],th & I.,.lurrx,s'~n Ser'v:i. ces 825 1 .... S't..r'eet, Anchor'age:, Alasl.::a 99501 0 N ..... S Z 1' E W E I .... L P lei; R M ]: T Up g r' ad e I.Zng :i. neet' De.~?~ .~, gned t3wner' Name: ALASKA HC]USING F:'II'qANCE CORPORA]"IC)N :;;:~.,,.,i"i,...:~ ,'.'~.:,¢ :'. ¢', .. · :; ":;':'. :5 ::::~ i:::a:::; f' 8]'H AVf.-'.i;NUE ANCHORAGE:, Al< 995(>1 Day I:::'hol"~e ,. 276.,...','] 599 Lo'l: ~..,.'.*d.~,! ,,':::h. ibdivis:i,c~n~ ALPINE TERRACE;' ,~UBD. Lo'l:.: :1. Sect. ion: 24 Town.sh.i.p: :I, 2N Range: 3W L. crt.. ,S:ize 45000 (sq,, ft..,, of acr'es) Bedr'ooms: ]'his Per'mit.,: () "f'c~,tat C, apar,::i.t..y~ 4 B l,[:'Jcl<: 2 ~.411i!;I...I...~: I.,,.o(:.:j taus't:, be subm'i'l:.'Le, cl 'Lo Mur'~:i.c::i. pali'Ly (:)~ Anchor'age Depar'tmerrL o{' l,.,leal'Ll'~ .,?.~,d ~L,~mar'~ Ser'v:i. ce~ ¥-,~:i.'Lhin 30 r.:lays of well completion. C!:::t,'( ,i,i-'( iidAt: 1, I am ~'am:i.t:i. ar. with 'Lh~.¢., r'eclu:i.~'ement:~.~ .l'of or~.....site sewer's and wells as set ~:or"Lh by 't',,he Mun:i.c:i, pal:i.f;.y ~::~ Anch,:::mage (MC)A> and 'Lhe St, at.e ;~:'.,, I w:i.L] ~::.;¢ /.':t].]. the sy!~i'L(~.;~rfl :i.r] ac(:::~2r'.dar'H:::e wi'(.h ali. M[]A c:ocles~ and r'egulatic)r'~s~ and in cc)mpl:i, ance w:i. th the c:le~i((~n cr'iter'ia o¢ this per'mi'L,, 5,, i will. adher'e '1:.(::~ .all MOA and State of' Alaska r'eqLt:i.i"emer"r(,s ~'cH .... L. he set, bac:k d:LsL,::u~c:es ~'r'c::,m any existir'~g we].1, ~,~as'Lewater' disposal system or' pul:::,]:i,c s(,.'.~t,~er'age~ ~y~'L6?m Qn th;i.~i~ of' any acljaC;el]t (::)r' near'by lot, 4,, I under'st, arid 'Lhat 'Lh:i.s per, m~.'t:. ~.s valid ~of a maximum of 0 bedr'ooms, also uncler'star'~d 't:.ha't'.. the capac:i.'Ly o~ the t.o'Lal system i.?i!i 4 bec;lPc:xDfli!!!~ ancl any er'l].al-gemet"it w:J,]..I, f'(~qLt;J,~'e an additional l::~ePmit, (O~/a'"~,.:',:i") ALASI<A HOUS I NG F:' I NANCE CEIRI:::'ORAI" I ON /-*' ~ no i~l~r~um.~3nces .hould any da a ~ [. · ,/ ~ hercon I~, ,used for conshuctlon or for ~ [ I , ,. ",,,' J , ~ ~.- ,, ,., . ~ ~ ' * ' ' " ' l, ~,~ ~+~ , ~ ~'[. -X -' .... ,,, _A ~...;.~.~...,..:~ . · ~ t· z~ ~. ~ -,. ~'~ I0~ U?~?Y ESOT ~ ~ ........ ~, ~ 8~°~'W ~5.03 MUHMP UTY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-243-01 1. GENERAL INFORMATION Expiration Date: —Z. - 3--2022 Complete legal description Alpine Terrace Sub, Block 2, Lot 1 Location (site address) 11920 Nebesna Drive Current property owner(s) Matt Loewe Day phone (907)250-8446 Mailing address 11920 Nebesna Drive, Anchorage, AK 99507 Real estate agent Lindsay Sizemore Day phone (907) 727-8445 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: Date: TYPE OF WASTEWATER DISPOSAL: Private Well FP1 Private Septic R Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA # 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 and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 6/28/21 DSD SIGNATURE System #1 Approved for _1( bedrooms System #2 Approved for bedrooms Disapproved OF Akq�11 ��P49 _ .TH •*r Benjamt. -Schiller CE 12592 _ •`c���� Conditional approval for bedrooms, with the following stipulations: B • �'`^' Z ^� Original Certificate Date: 7—7�Z% 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory II Well Flow Advisory _ 0 _ Other .Si-eep �a� 4012 COSA Checklist blue sheet Ao(o St o !/ A +f C®SAChe'cMist .. Legal Description: Alpine Terrance Sub, Block 2, Lot 1 Parcel ID: 015-243-01 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 11/27/88 Total depth 203 ft Cased to 53 ft © Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) +16 in. Date of flow test for COSA 6/21/2021 Static water level at beginning of test 27.8 ft Comments B. TANK DATA Age of tank(s) 21 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 51 © Standpipes/foundation cleanout per record drawing Date of pumping 10/8/20 A+ Home Services D. ABSORPTION FIELD DATA Shallow Trench Which system tested (date installed) 7/29/1976 0 ALL standpipes present per record drawing Total measured depth from grade 7.9 ft (max) Measured depth to pipe invert from grade 7.3 ft (min) ❑ NIA - pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective "o.s' ® Code -required soil cover over field Well production at time of test 0.6 gprn Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes (] No nm Coliform bacteria is Negative Nitrate ❑ Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample C. LIFT STATION 6/02/2021 dZ� Il -?-Z maintenance completed Age of lift sta I years Lift station material Comments: Adequacy test date 6/21/2021 Results O Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 611 gal New depth 0 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate '600 El System presoaked tion P � gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons if yes, enter date Comments/Deficiencies: "Monitoring tube/sump was part of the original installation and may have been filled with dirt or debris 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' L�J Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft 7 Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' ✓J Yes if No ft Absorption Field on Lot > 100' ✓[] Yes if No ft Holding Tank > 100' V Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ❑✓ Yes if No ft . [✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [�✓ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' El Yes if No ft Surface Water > 100' ® Yes if No ft P roperty Llne > 5 L�J Yes if No ft Wells on Adjacent Lots: Absorption Field > 5'(�]✓ ft Private Wells > 100' Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' [✓ Yes Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10'[]✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 2✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Water Service Line > 10' [] Yes if No ft Community Wells > 200' Surface Water > 100' [✓ Yes if No ft F. ENGINEER'S COMMENTS *WR# 000079 G. ENGINEER'S CERTIFICATION l certify that 1 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. COSA Checklist yellow sheet �✓ Yes if No ft ❑✓ Yes if No ft Q oC . TH, .moi �. Benjam r chiller � ��� •. CE 125926/28/21 A=,. MUNICIPALITY OF ANCHORAGE Development Services Department =' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-243-01 1. GENERAL INFORMATION Expiration Date: fl- - 7 — 2 - Complete legal description Alpine Terrace Sub, Block 2, Lot 1 Location (site address) 11920 Nebesna Drive Current property owner(s) Matt Loewe Day phone (907)250-8446 Mailing address Real estate agent 11920 Nebesna Drive, Anchorage, AK 99507 Lindsay Sizemore 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone (907) 727-8445 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic ❑■ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA # 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 and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 6/28/21 A(g5`'�l� TM ,lam • * / 6. DSD SIGNATURE ;101s.1-3..... System #1 Approved for bedrooms �� enja `iNSchiuer -- j System #2 Approved for bedrooms CE 12592ir Disapproved li��\ PROFESS1* Conditional approval for bedrooms, with the following stipulations: kvvk��% rTY nc<I;" �9 _'vi1SERVIC,i:: ``. Original Certificate Date: 1-7-21 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Other S4 -e2 t 4-a.,K1C COSA Checklist Legal Description: Alpine Terrance Sub, Block 2, Lot 1 Parcel ID: 015-243-01 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 11/27/88 Total depth 203 ft Cased to 53 ft FE -1 Sanitary seal is functioning correctly FE -1 Wires are properly protected Casing height (above ground) +16 in Date of flow test for COSA 6/21/2021 Static water level at beginning of test 27.8 ft. Comments B. TANK DATA Age of tank(s) 21 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 51 W Standpipes/foundation cleanout per record drawing Date of pumping 10/8/20 A+ Home Services D. ABSORPTION FIELD DATA Shallow Trench Well production at time of test 0.6 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑® Coliform bacteria is Negative Nitrate 2.31 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 6/02/2021 C. LIFT STATION uired maintenance completed Age of lift stal-bq,, years Lift station material Comments: Which system tested (date installed) 7/29/1976 Adequacy test date 6/21/2021 0 ALL standpipes present per record drawing Results R] Pass For 4 bedrooms Total measured depth from grade 7.9 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 7.3 ft (min) Water added 611 gal ❑ N/A — pressurized field 0 New depth in ❑ Monitor tubes go to bottom of effective. If not, state "0 Elapsed time 1440 min depth into effective ❑® Code -required soil cover over field Final fluid depth 0 in F71 System presoaked Absorption rate '600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: "Monitoring tube/sump was part of the original installation and may have been filled with dirt or debris 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' ❑ Yes Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' F,71 Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' F71 Yes if No ft Holding Tank > 100' El Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10'✓❑ Animal Containment > 50' P/1 Yes if No ft F,71 Yes if No ft ✓❑ Yes if No ft Water Service Line > 10' ❑✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' ❑ Yes if No ft F,71 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10'✓❑ ❑ Yes Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: ft Absorption Field > 5'✓Q Surface Water > 100' Yes if No ft Private Wells > 100'✓� Yes if No ft Water Main > 10'✓❑ Yes if No ft Community Wells > 200' ✓❑ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' E✓ Yes if No ft If absorption field is under driveway comment below 5* Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑✓ Yes if No ft Private Wells > 100' R Yes if No ft Water Service Line > 10' F71 Yes if No ft Community Wells > 200' R Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *WR# 000079 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. COSA Checklist yellow sheet Asw ®F At'lose q���� a *..49TH �� �•. Benjarrnchiller �� •. CE 12592 • �`� 6/28/21 , • \% Ar, ����� pROFESSIONR..' HOUSE DETAIL Scale: 1_30 's 'a. 2.0' CANT O ti \ \ \ 120 "j9� �`,S\O vCj�� � •a t'J RSO \ 1.2'x3.0' ^ / CANT Lot G Cr.� 1 8.CONNEX p \/ SHED 8.0'X20.3' SHED % — — — — 8.1'x20.3 / 10.2'x20.2' SHED SHED \% (� i �®� � j WELL CP �. 50,476 S.F. Q w WOODEN FENCE \ Z a O' O I \ o GRAVEL- 0 DRIVEWAY O /.. .. LOT 6 \ WOODEN /tf FENCE P i S 3.0' O� 1 F -SEPTIC 11.1'x23.9' SHED 11.2'x24.3' S 0002 00 W 10' UTILITY EASEMENT I SHED 158.24' rr %�, u i 'L O o N 89'5800'W 175.03' ti M WOODEN FENCE . ALATNA AVENUE MORTGAGE SURVEY _X_ SCALE _ _= 60__ GRID __SW 2740 _ Project No. 21-379/&l_____ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & A S S d C i a t e S inc. (907) 522-6476 Phone 9 (907) 522-4625 Fax Professional Land Surveyors ken0longsurvey.com v OF jonothan0langsurvey.com I hereby certify that I have surveyed the following described property: LOT 1, BLOCK 2, ALPINE TERRACE SUBDIVISION (PLAT No. 64-63) p * 49!-H**' 9 —H -Y D� Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a "�LA6' """"" o ............... representation of the conditions that were found on the date the survey was performed. This survey does not constitute a boundary survey and is subject to any inaccuracies Q Q that a subsequent boundary survey may disclose. The information contained hereon shall KENNETH o not be used to establish any fence, structure, or other improvements. 44F��o . .�S 5202. 'S Dated this the _?__ Day of � 'L� zl at Anchorage, Alaska 04 a '-. �0 r> G OQROFFSSIONAG aQ It is the responsibility of the owner to determine the existence of any easements, �4Oopvod covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 Can -Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC211364 Subdivision: Alpine Terrace Sub, Block 2 lot 1 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 21 years old. Typical replacement costs range from $8,000 to $11,000 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. 1} `'" j -„m, f'- "" s '`Y✓T ^;`` f i -'P `� '�N k N... F'y77, Mai�mg Address , P O Box 196650 *Anchorage, Alaska' 99519 6650 *ww ' mum org �.,:»,...� s �a �F.-,m_... •n,?��; .�,r_b..,, ss, .:32.v..�' �_,.-a� �.�.,�a.' <�.#� w�sr.. �.a�.�,'s:+u w �. s�.^..�.,�,a`:�uw�. „'-r ass?�- . �;i,'� � , 4: .,.s � .> « ,� � �a�s.w�fi�,� � �:,.av� Municipality ®f Anchorage R ... ® Development Services Department `� .. Building Safety Division K > A F E On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) 4 OSC211364 During a recent COSA on-site inspection and test of the potable water supply well on Block 2, Lot 1 of Alpine Terrace Sub subdivision, the well's productivity was determined to be .6 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is .41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. August 11, 2021 PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677.7766 (FAX) FORGECIVIL.COM MOA Development Services, On -Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Alpine Terrace Sub, Block 2 Lot 1-11920 Nebesna Dr Low -Flow Well Dear On -Site Services Engineer: Benla In Schiller ' •. CE 12592 • �`� iiz�. st) u2) , . •�' �'ROFES510NP�' Forge Engineering was asked to provide the testing and certification for the well and septic system at this property. This property had two wells, one of which was not in use and left open to possible contaminants. This well was decommissioned during the testing process. We performed a flow test on the remaining well, monitoring the static water level of the well as we adjusted the flow rate. We ran the well for several hours and we were ableto stabilize the static water level at approximately 0.60 GPM. This is sufficient for the home, and we were able to obtain a COSA. Afterward, correspondence revealed that there .was a 250 -gallon holding tank in the garage. This did not affect the testing in any way. The homeowner explained to us that they had this storage installed_ around the time that they stopped using the second well. They had someproblems with the equipment controlling both wells, and installing the water storage was the simplest solution. Since that time, they lived in the home with 6 children and rarely had problems with water supply issues. The additional storage no doubt was the reason for that. However, a prospective buyer hired a well driller to perform an alternate test. The well driller pumped the well dry, let it recover for 60 minutes, and pumped it dry again, measuring the total amount of water pumped. They calculated a recovery rate of 0.25 GPM. While this is a relatively small difference in results, it is significant in that it is less than what would be required for the home. Per AMC 15.55.070.C.4, a well that produces 150 gallons per day but less than the minimum needed for the home is required to have a water storage tank with a minimum capacity of 500 gallons. For this 4 -bedroom home, 600 gallons are required per day. A well producing 150 gallons with a 500 -gallon storage tank would equal 650 gallons, and would take over 3 days without use to recover the storage. At this property, the well produces over 360 gallons per day, has an existing water storage tank of 250 gallons, and holds an additional 175 gallons of storage in the well itself. This is a total of 785 gallons, and the storage would recover in 28 hours. We request that this be considered as sufficient to meet code, and the COSA be amended with this information. Sincerely, Benjamin Schiller, PE 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.ci. anchorage. ak. us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC211364 During a recent COSA on-site inspection and test of the potable water supply well on Block 2, Lot 1 of Alpine Terrace Sub subdivision, the well's productivity was determined to be .25 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom. residence is .41 gallons per minute. Currently this well does not meet this requirement. Additional storage may be necessary to meet homeowner needs depending on demand and variable well flow rates. All parties are advised that the production capacity of the well may also fluctuate seasonally. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Parcel I.D. # 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 015-243-01 1. GENERAL INFORMATION Completelegaldescription ALPINE TERRACE SUBDIVISION: LOT 1. BLOCK 2 Location (site address or directions) 11920 NEBESNA DRIVE. ANCHORAGE AK. 99516 Property owner MATt LOEWE c/o SHARON BEEN OF DYNAMIC Day phone Mailing address 3111 "C" STREET, ANCHORAGE AK 9950,3 Lending agency Day phone Mailing address (907~ 261-7676 (907) 261-7676 Agent ~HARON BEEN w/ DYNAMIC PROPERTIES Day phone Address 3111 "C" STREET. ANCHORAGE AK 9950,5 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well xx× 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: Individual on-site xxx Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide wrftten confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1/91 ) Front MOA #21 Computer Version Note: Alaska Water and Westewater Consultants, Inc. shall be paid $-I-~0:'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 vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation and ins,@ection, the on-site water supply and/or wastewater disposal system is in compliance with all MunicjB~|and State codes, ordinances, and regulations in effect on the date of this inspection. ~ .~ .//'/ ~ / NameofFirm ALASKAVCATEt~8~WA~ZT~NATERCONSULTANTS, INC. Phone (907)337-6179 Address 6901DEBARR/ROAD,/,~0~2JB*'ANCJHORAGE, ALASKA 99504 . / Engineer's Signature ~, -~//~""J~"-- Date 1//2-/0o In conducting this evaluation, AVCWC,~Ir/~. ~tte~pted tek'pre',idea thorough, conscientious engineering/analysis of tho system in accordance with ADEC and ~OA Dt~S 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 all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the famlly 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 are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the 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 reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DHHS SIGNATURE ~ Approved for InL 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 Municipalib/of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Computer Version NOV 0 3 2000 M u n ' c ' pl~ ~ A~L~fHA~ ~hl~l~aAgl~l S UUN[CIP&UTY OF ANCHORAe~, DEPARTMENT OF A ~L~TAL SEBVICES D,~ Environmental Services Division 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 Health Authority Approval Checklist Legal Description: ALPINE TERRACE; LOT 1, BLOCK 2 Parcel I.D.: 015-243-01 A. WELLDATA IWELL ~1 IS BEHIND HOUSEI Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A (TWO WELLS) Log present (y/N) #1: NO #2: YES Datecompletad #1: PRIOR TO 5/19/75 #2:11/28/88 Totaldepth ~:1 101'+ #2: 203' Casedto#1: 40'+ #2: 5,3' Casing height (above ground) #l : 19" #2: 29" Sanitary seal (Y/N) YES Wires propedy protected (Y/N) YES Date of test #1: Static water level FROM WELL LOG AT INSPECTION N/A #2 : 11/28/88 /~1: 8/24/00 #2:8/24/00 N/A 24' 4' 22' Well production N/A 1.25 g.p.m. 1.1 0.08 g.p.m. WATER SAMPLE RESULT~.~ Coliform '7- Nitrate Date of sample: ~o/5o/2ooo [' ~/~'~ /w/'-,~I(~ Other bacteria Collected by: A,W.W.C., INC. B. SEPTIC/HOLDING TANK DATA Date installed Foundation cleanout (Y/N) Date of Pumping NEW C. ABSORPTION FIELD DATA 10/17/2000 Tanksize. 1250 Numberof Compartments 2 Cleanouts (Y/N) YES YES Depression (Y/N) NO High water alarm (y/N) N/A .: Pumper - [*BE~'Ow FINAL GRADE] 0.8 System type TRENCH Gravel thickness below pipe 3.0/3.0' Total depth 6' Date installed 10/17/00-10/18/00 Soil rating (g.p.d./ft2 or ft2/bdrm) Length 90' (2 © 45') Width 5' Effective absorption area 776 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test NEW Results (PaSs/Fail) For ~-------15~edrooms ded (in.): Fluid depth in absorption field before test (in.); . -- Fluid depth (ins) Mingling. Abso~tion rate = ~onths) (Y/N) If yes, give date 72-026 (Rev. 3/96)* Computer Vemion D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level.~ evel at* "Pump off' level at*, *Datum SepticJholding tank on lot Absorption field on lot Public sewer main Sewer/septic service line Property line Surface water. Curtain drain E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ 100'+ N/A 25'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5% Property line Water main/service line 10% Surface water/drainage 100% SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: *5' Building foundation 1 100'+ NONE KNOWN F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inepections and review of Municipal records that the abo~/.e systems are in conformance Signature Engineer's.N/~am[ i/ ///RE'~ A. GARNESS Date ~.~---~ ~'/ ~) HAA Fee $ '-~ C'r~ ' Date of Payment ///~ '~/ Receipt Number ~/-/~ (/7'/~-~'"~.> 72-028 (Rev, 3/98) ComputerVemlon On adjacent lots 100'+ On adjacent lots 1 oo'+ Public sewer manhole/cleanout N/A. Lift station N/A __ Absorption field 5'+ Wells on adjacent lots __ 100'+ · 5 FOOT WAIVER GRANTED WTH SSUANCE OF PERMT Water main/service line 1 O% Driveway, parking/vehicle storage area 10% Wells on adjacent lots 100'+ O.F., '. ........... " Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Location,(ad. dress or d_ireCtions). (b) Property owner ~ '/OfT~/c'~--" Telephone' (home) Mailing Address Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address ~'/ ~- ~/n~ Telephone ~' ¢~ (e) Mail the HAA to the following address: (or check here~: if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family'~ Number of bedrooms 3. WATER SUPPLY Well~ Community [] Public [] Individual Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site'~ Public [] Community [] Holding Tank [] Note: If community welt system, must have written confirmation from the State Department of Environmental Conservation attesting, to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 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 /~'~/~ Telephone Address /~-~ Z.-' ~'J .~ ,~' 6. DHHS APPROVAL Approved for '~ Approved ~' bedrooms by /~~/ ~Date /,~ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 ~;.:.i~(:,~IUNICIPALITY Of ANCHORAGE (MOA) Health Authority Approval (BAA) CHECKLIST- FEBRUARY 1984 Legal Descr pt on ~ Well Classification ~I:',~,y'.4-?"E' - ~. &JE't./. ~/~r~z. #, ~,,j, I~f,~A~ B.C.Yiel~:~II''~I'D'E~C' Approvedo,5.~.D./ Well Log Pres~nt~) ____ Datp ~ompleted ~ ~ ~ //-~7-~ ~ Total Depth~-~ased to~- ~' Depth of Grouting ~ Static Water Level ~ - /~/ ~- ~ Pump Set At ~ Casing Height Above Ground ~. / '~ Sanitary Seal on CasingS) Electrical Wiring in Conduit~N) Depression Around Wellhead (Y~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~_.~. /~o ~-- To Nearest Edge of Absorption Field on Lot ¢,~. To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot ~-~/'~ Water Sample Collected by Water Sample Test Results Comments' (~b ?W'£cz. ~ "'re/" //*¢-~'~' ~ ~z.z. '~/o ;On Adjoining Lots /¢rO .~- f ; On Adjoining Lots /¢.,v ~- ,,O/,~-- To Nearest Public Sewer Cleanout/Manhole ~/,,,¢ B. SEPTIC/HOLDING TANK DATA Date Installed 7-~-~' Size Standpipes~N) Depression over Tank (Y~t Pumping/Maintenance Contact on File (Y/N) / Holding Tank High-Watbr~ Alarm (Y/N) /J/~ SEPARA~.I'0N"iDISTANOES 'FROM SEPTIC/HOLDING TANK: To Water-suPply We'll To ProPerty) Ei'h~ ~ To Water Main/Serv'ice l'ine To Streaml Pond, Lake or M~jor Drainage Course /~'~'~ No. of Compartments Air-tight Caps ~N) / Foundation Cleanout (Y(~ Date Last Pumped ~ ~z.--J~' / /J//4- ;for ¢/4- ,/ Temporary Holding Tank Permit (Y/N) To Building Foundation ~//~ / To Disposal Field /¢ / Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area /~> Depression over Field (Ye 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 ~--~/~ Depth of Field Gravel Bed Thickness Statndpipes Present ~N) Date of Last Adequacy Test /~0 ~-f-' To Property Line ; On Adjoining Lots To Water Main/Service Line To Existing or Abandoned System on I To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ! /o -r Comments D. LIFT STATION / Dimensions 1! Size in Gallons Manhole/Access (Y/N) "Pump On Level at ~".~~ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) _ Tested for ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. ~ Receipt No. c~¢0 ~~ Date of Payment Amount: $ /.~) Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL} (a) Legal Des~c~iption, !~nc!.ude lot, block, subdivision, section, township, range) Lo~at~'r~ '(a(;~l~ or dike~t~s) (b) Telephone: Home (c) (d) (e) Business Tele ~hone Real Estate Company and Agent ,V~'~/'?~?- Address ?~,,,~---~- / ~/~ Telephone Mail the HAA to the followina address: or: Check here ~ hold for pick up. List contact perso9 and day p~e number b~low. TYPE OF RESIDENCE Single-Family'. Number of Bedrooms. 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 fRev 8186~ Front 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 ,/~-'~_..5 Telephone Address /'¢~'/~'" /~ 3;3"'~' /,~u/'4~, ,~ Date DHHS APPROVAL Approved for ./~/.~."Z'z/~ bedrooms by Approved ~/~ Disapproved Terms of Conditional Approval Conditional Date CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional, engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the prof, essional engineer's work. Page 2 of 2 72-025 IRev 8/86) Back WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCId~I~(~ETM AUTHORITY APPROVAL (HAA) ENVIRONMENTAL SERVICES DiVlSC/t~cKLIST ' FEBRUARY 1984 264-4720 AUG 2 ~ 1988 Legal Description: If A, B, C, D.E.C. Approved (Y/N) Date Completed ~/~J'"/' //~ Yield ~1~ ~'~ Depth of Grouting '~'l/~4', Pump .Set At 4')/4 Sanitary Seal on Casing{~N) Depression Around Wellhead (Y(~ RECEIVED Well Classification Well Log Present (Y~, Total Depth /~"~1 / Cased to Static Water Level ~ /3,~' · Casing Height Above Ground ! Electrical Wiring in Conduit(~N) Separation Distances from Well: ! To Septic/Holding Tank on Lot ~/~ 73' To Nearest Edge of Absorption Field on Lot ~?'~JJt/'~E' ; On Adjoining Lots /4rr_) /-f" ; On Adjoining Lots To Nearest Public Sewer Line /-)/~' To Nearest Public Sewer Cleanout/Manhole ,/J/!~ To Nearest Sewer Service Line on Lot Water Sample Collected by /'~'~ /4-, /~J/~/' ; Date Water Sample Test Results ~-r'- -,~ /V/'/~'~'' Comments ~ /.,J~F...~ ~ ~ ~"-:'//"~' B. SEPTIC/HOLDING TANK DATA Date Installed//'~''~''~'~'~''~' Standpiper~) Depression over Tank (Yi~) Size /~..:~"0 No. of Compartments / Air-tight Caps (Y~I) Foundation Cleanout (Y~) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~//o¢ ; for ,~J/,~ Holding Tank High-Water Alarm (Y/N) ,4//,/4- Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-SupPly Well To Property Line To Water Main/Service Line ~7.-~'/-/.'- Course /~'o To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7'~¢~/ 7-~'~)-7~/~I~ Width of Field ~ ~'~//C,~ ,~,~o~.~ ~ Io Square Feet of Absorption Area Depression over Field (Y(~) Results of Last Adequacy Test Type of System Design Length of Field '7~ Depth of Field "T~--~/ /~'/ Gravel Bed Thickness -r Standpipes Present~) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /~'O To Building Foundation ! Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on · On Adjoining Lots ~ To Cutbank (if present) /,~o ~-f-- /0 Comments D. LIFT STATION Installed Size in "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N), Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ~,~h~d,~ve~ed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'~'--'~-~ ~'~J'~ Date Company ~ MOA No. Receipt NO. ,~o¢/2~/ ~) ~" ,C~ (..)~-z~O 7 Date of Payment ~/~/~ Amount: $ /~,~ Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALI~ DEPARTMEbr~ OF HEALTH AND F~NVIRONMENTAL PROTECTION APPLICATION FOR HEALTH ADTHORITY APPROVAL CERTIFICATE I. General Information Application Date (a) Leg,al D~scription (include lot, block, subdivision, section, tcwnshiD, range) Location (add~ess or directions) (b) Applicants Nan~ ..... -~ ,.:.,., ,, Applicants Address ,,×," ? ~ ~ (c) Applicant is (check one) Lending Institution ~-~; Owner/builder ~ ; Buyer ~-'~ ; Other i "I (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. a Agent Address 2. Type of N~sidence Single-Family ~'-' Number of Bedrooms Multi-Family ~--~ Other (describe) 3. Water Supply Individual Well ~ Con, unity ~-~ l~lblic Note: If conmunity well system, must ha~ ~itten ~nf~tion fr~ ~e State ~~nt of ~virc~ntal Con~rvation attesting to t~ legality ~d status. Is ~e ~11 adequate fo~ the n~r of ~~ s~cified in this 4. ~ Dis~sal Onsite ~" ~b!ic ~[~ ~nity ~ Holding Ta~ Is t~ ~stewater dis~sal system adequate f~ ~e /' I / ''~ [ 4? ~ ,:.:-' . ,, ~.: ...." .~ [Pa~ 1 of 2] ~ . :: .. :,.:, .... , ..... 2-15-84 5. Engineering Firm Providing Inspections, Tests, Data and Information I ce_~tify that I have checked, verified, c~ conformed to all MOA HAA Guidelines in effect on the date of this inspection. ~-2>' Signed _ ,.~.~//..-w~/:?w'''~ Date ( ENGINEER SEAL) Te lephone · '0,~ 1'4:3. 9~6-~ 6. DHEP Approval Approved for Approved .~.~,.,. K~droc~s ~sap~o~d~-~ ~ Date Conditional ~-~ C --' ' ' Terms of Conditional Approval The Municipality of Anchorage Depa~tmant of Health and Environmantal P~otection dces not guarantee the continued satisfactory peufotnnance of the water supply and/o~ the wastewater disposal system. This approval indicates that, as of the validaticn date shc~n above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional fo~ the pnmber of bedrocms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 21 2-15-84 ae Well Classification ,..-'~ Well Log PTesent (Y/N) Total Depth ~-~/~ ,~'-~ Cased to Static Water Level _~/ x_/ w Casing Height Above Ground , Electzical Wiring in Conduit (Y/N) Sepa~ation Distancss f=cm Well: · To Septic/Holding Tank on Lot MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNK~PAM1Y OF ANCHORAGE DEFr. OF HEALTH & CHECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECTION D Pump Set At ~//~o /~/X-- / Sanita=y Seal on Casing (Y/N) Dep=ession Around Wellhead ,(Y/N) ~/~ ? ; On Adjoining Lots > / ~ To Nearest Edge of Absc~tion Field On Lot > / ~ ~ / ; On Adjoining Lots >/o To Nearest Public Se~= Line ,/9/~/ To Nearest Public Sewer Cleanout/Manhole /9//~ To Nearest Sewe= Service Line on Lot3zJ~ o~ ,//,,/~ Water Sample Collected By ~/~7- ; Date , Wate= Sample Test Results SEPTIC/HOLDING~ TANK DATA Date Installed 4~-/~o~ Size /~<-73 No. cf Ccmparbnsnts Standpipes (y/N)/ £,~ Air-tight Caps (Y/N) ,/~9 Foundation Cleanout (Y/N) Depression over Tank (Y/N) /~,, Date Last Pumped ~/////~/ Pumping/Maintenance Contract On File (Y/N) /~; for Holding Tank High-Ware= Alarm (Y/N) ,W/~ Temporary Holding Tank Permit (Y/N) Separation Distances f~cm'Septic/Holding Tank: To Water-Supply Well /~ ~ To Building Foundation To Property Line -J' / ~ z To Disposal Field ~/O~w~ To Water Main/Service Line Course ~-~,,7,~ '~'~'~0 Stream, Pond, Lake c~ Majo= D=ainage ~' //.~ , Co~ments_~.. ,B"~ [Page 1 of 2] 2-15-84 ABSORPTION FIELD DATA ' Soils Rating ~in~Absorption St~ata~' /~-o j~,//~Type of System Date Installed ,C~ 7~ ~/? ~ Length of Field Square Feet of Absorption A~ea Depression over Field (Y/N) Depth of Field~ C ' Gravel Bed Thickness~,, ~ '~ Standpipes P~esent. (Y/N) /~, Date of Last Adequacy Test~C~/~/~/ Results of Last Adequacy Test Separation Distance f~om Absc~ption Field: To Water-Supply Wall ~ /~ / To P~operty Line~ ~ / To Building Foundation ~ /~9 y' ~- To,Existing or Abandoned. System cn / Lot ~ /D ; On Adjoining Lots ~ /~'~ / " ~., o 7,4,~'~ To Wate~ Main/Service Line a~<' ,,~/cW'¢ To Cutbank( if present) To St~eam/Pond/Lake/c~ Majo~ Draina~ Coarse / TO D~iveway, Parking A~ea, c~ Vehicle Stc~age A~ea ~ ~ ~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Cc~ments ** Check Permitted Bedrocm Ra~ing Against HAA Request ** /-// I certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed,, ~~'~~' Date Company ~-~-.~',--~ o/,.~:_c ~.:~/a/ MOA No. KB1/d5/s [Page 2 of 2] ENG ZNEERS SEAL 2-15.~84 FIELD PUMPING TEST DATA SHEET PROJECT: LOCATIO~I OF WELL (Legal Description): ~x~7-./ _/~/~.Li WELL DE?TH: ~,,/z, .... .z~ .... FT. CASING: 4<:,/(~ FT DATE DRILLIHG COMPLETED: ~-~,,/*.~*,~'~ DRILLER: STATIC WATER LEVEL (Top of Casing): ~<--/ '-~ ~/ FT C1 ock Time E)apseo Time Since Pumping Started/ Stopped, Min. 1 10 15 2O 25 3Q 35' 40 45 50 55 60 (! hour} 9O 120 (2 hours)! 150 )80 '(3 hours') 210 240 /" ~ hours RECOVERY 'Q 5 10 15 20 25 30 '35 45 50 55 : 6Q (1 hour) 9U i 1-./Ii t ~ f)Ot.~rS ) i Depth to Water, ft. Drawdown/ Recovery Pumping Rate, GPM 0 Remarks Start 1. Approval requested by: Mailing Address: 2. Property Owner: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received / Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR ~_______~.._.~, Phone Mailing Address: 3. Legal Description: 4. Location: 5. Type of facility to be inspected o. of bedrooms 6. Well Data: A. Type C. Construction 7. Sewage Disposal System: A. Installed /'~7~'~ B. Installer C. Septic Tank: 1. Size 2. Manufacturer B. Depth /-D~-O D. Bacterial Analysis D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines , Di stances: A. Well to: Septic tank , Absorption area , Sewer Lines Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: _CMRO 2. Property Owner: ~/~ ~7 Mai.ling Address: 3. Name of Buyer: VA FHA ..... Mailing Address: ~"~ , ~....~~ Day Phone Name of Lending Institution: , /~ Mailing Address: Phone Name of Realtor or.Agent: _~~ ~~'~ Mailing Address: ~0/ -- O~ ~A Phone Legal D escripti~: Z~ ~ ~ ~ Location: /~~' ~ '-- ~~ Type of Facility to be inspected: Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well /-~'~ , ~No. Bdrms.k--~'~ Sewage Disposal System Type of System: Public Utility Individual (on-site) .~ If Individual, date of installation / EQ-037 (~/74) Page 2 of two pages - Rec for Approval of Individual S ~, & Water Facilities Legal Description Comments . . Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)