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HomeMy WebLinkAboutALPINE WOODS BLK 5 LT 6Alpine Woods Block 5 Lot 6 #015-234-36 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES rr�� 2 3 9 -3f� Environmental Health Division V 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON—SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES h//1 A T, O R Eti/ Address FROM TO SEPTIC ABSORPTION WELL TANK FIELD 720 Int/ go +h WELL Phone(s) Permit No. No. of Bedrooms C01n1 / fir// �/F4G 5-7 9,01.)2Z0 LEGAL DESCRIPTION LOT LINE q,5 1 d' Lot Block Subdivision 'O 1 5 1AI IA14ODS FOUNDATION 5' z3' Township, Range, Section Z AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, yj driveway, water_bodies, etc.) TANKS SEPTIC ❑ HOLDING Manufacturer Capacity in gallons leEE 2 12:90 Material No. of Compartments 5T EE L 2 - TYPE OF SYSTEM %TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade FT /O FT Fill added above original grade Gravel depth beneath pipe p - / FT FT Gravel length Gravel width -70 FT FT Total absorption area Distance between lines q O SQ FT FT Number of lines Soil rating Pipe material ZOO SOFT Installer � xC)o . � I I k Date installed �/f12TE,ULI WELLS ❑ PRIVATE �HER (Identifv) Classification (A,B,C) Total Depth Cased to m M tin I r FTJ FT Installer IDate Installed: REMARKS: ti =•A I] 41.0 I tz-Ul:t (alto) /018oroln OFF CAV T f u Scale: / _ O'�l;QmLSEAL Inspections Performed by: ,°(�» r`�4i''a'@ Irl/, %l9`FAD,0.-_ / � m '��) r?BQ�mW96QHR�W$bf TeX Date: c "Yi /.Z 9115' y 90 ,� �•' cm f�9FH`:,g3fl yyG'o u7 a OPvmMG`;,;s /'✓%rC,�lAtt�c�'7t�©►JWMfl M yPo �.AmnFl I certify that this inspection was performed according to all 4� , , p Municipal and State guidelines in effect on this date: f z T 0 D:_„ Q Health Department Approval: IS3�2Date: tz-Ul:t (alto) MUNlL1P�Ll{Y uF ANCHORAGE Department o[ Health & Human Services 825 L Street, Anchorage, A1aska 99501 343-4720 ON-SITE SEWER PERMIT Permit Number: 900220 Date Iss�/ed: o7/27/9; Eng1neer Designed Owner Name: WILLlAM J O'BRIEN Day Phone: Owner Address: 720 W 80TH 522-5247 ANCH, AK 99518 ParceI Id: 015-234-36 Lot Legal: Subdivision: �LPlNE WOODS Lot: 6 Block: 5 Section: 23 Township: 12N Range: 3W Lot Sjze 31610 (sq.{t. or acres/ Max Bedrooms: This Permit: 4 Total Capacity: 4 SEPTIC TANK: Minimum total septic tank capacity: 1,250 1. J. Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) {eet r'equires insulation over tank(s). THIS UP8RAD£ SYGTEM MUST BE INS[ALLED AS SHOWN ON THE ENGINEER'S DESIGN DATED 7/27/90 (REVI�ED) INSTALLATION OF A LIFT STATION REQUIREEi AN ELECTR[CAL INSPEi,TlON. NOTIFY DHHS BEFORE ALL INSP- ECTIONS. THlS PERMlT lS FOR A 4 BEDROOM SINGLE FAMILY RESTDENC� DNLY, AND EXPIRES ON 12/31/90. l CERlIF� �HAl: 1. I am /amiliar with the requirements for on-site seweps and wells as set /orth by the Municipality of Anchorage (MOA> and the State o� Alaska. 2. I will insta]l the system in accordance with all MOA codes and regulations, and in compliance w1th the design criteria o{ this permit. 3. I will adhere to aIl MOA and State o� Alaska requirements for the set back distances �rom any existing well, wastewater disposal system or public sewerage system on �his or any adjacent or nearby lot. 4. I understand t�hat this permit is valid {or a maximum of 4 bedrooms. l also understand that the capacity of the total systeIT. is 4 bedrooms and any 1 al permit. Signed: (Owner) WILLIAM J D'BRIEN ' Issued B� DATE: �� ����� -___ _���_��-�-l'_��-�� ^� � ^� r `ao tit, Municipality of Anchorage uP In 71�k°s , DEPARTMENT OF HEALTH & HUMAN.SERVICES /e „.•..°® ma ®m� �-�o•r�°� • , 825 -L" Street, Anchorage, Alaska 99502-0650 e,,..4"t E � SOILS LOG — PERCOLATION TEST Michael E. A„derson ar •'e� 4381 pO p�. _ PERFORMED FOR: DATE PERFORM! . R�WU6 - s . LEGAL DESCRIPTION: Q5l�Dn S Township, Range, Section: S Z %/ZN 2 3w SLOPE SITE PLAN DEPTH (FEET) 1 �. P Poorly Z 6,PAt2EU err .?.4dEL- 3 4 5 S /L 7- y C�2A 6 /V1a z 7� 8- 9- 10- 11 - 12- 13. 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? C q* u Waw Attar momttrin ? Ostt tvo SOMEONE Mummmm..Immmm ..�� MINNSmMENNEN � mom 0� S L O P E 20 � (od PERCOLATION RATE ZO Immutesincm PERC HOLE DIAMETER TEST RUN BETWEEN _._ / FT AND 5 FT COMMENTS f�E TZ) ?`U PERFORMED BY: Fes" 4 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 72-008 (Rev. w85) Ate _DOD SF _14)z4a7A //7:5 Ti4LL %O L F o � EE.� n,PAi.✓�iE F r � CCG905® OOo�000�O 00 ^O`+0�9W0009Ja •O WWO •e 0' CEJ /e cq , N.ichae! E. Anderson ` 4361 -E e.W <� ®vQ���C a®�M/H�e OI�'�TeQQ�®f��v�1i➢� „, g' '^ •,�.a. r. ; (E GIN �E'�. 'S SEAL) Vj f Municipality of Anchoragefii ¢ ':+ flf MENT OF HEALTH & HUMAN SERVICES �° "• ” ' •� YM�' �' ,. IL Street, Anchorage, Alaska 99502-0650 .. LS LOG — PERCOLATION TEST 'G:. a4 '4 ` ��' Corwin 1. 4 c _sxs 4C�`pRdF�S�S\qo���'�► PERI?ORMED FOR`' -C _C A G L`' VS 7-F-IJ4 GATE PERFbFiit7lEP:n/.+: 8 LEGAL DESCRIPTION: L a+ Township, Range, Section: —F17 lel tl--" 7 I. 1 C' 7 7 OE T) OMA L PWE 1,/00 D S (FEE1 2 y 5,acie� .-,,o �oo� � ,-4�•� 1 Lq' --t-,-c.GC O -P SQn 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 67 M $ i i +V 6 ro-vc, COMMENTS SLOPE WAS GROUND WATER �� Q ENCOUNTERED? S IF YES, AT WHAT L DEPTH? OP E Depth to Water he Monitoring? Dale: Z •' SITE PLAN D} - I A- e 11 Gross Time Depth to Water PERCOLATION RATE (minuteslinch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT G PERFORMED BY: J� �eFcs 1 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINY 72-008 (Rev. 4/85) A t TIFY THAT T IS TE T WAS PERFORMED IN THIS DATE. DATE: of A _���A ..� OF A'yYp �� � �iu'm®aC.PO.ynR��1t� ® A a°490 m 000 Q 00.066 Des* ....P. .....e.. • .............a. C,� Michael E. Anderson +" . tL 4381 - E e 6: ,60 op410 00 FE SSO��'�� ` �r •'���� //5J tel, / /1517, 7q r J I L/se Pro�case l�s��� /, Z50 9a/. Cao Fo6r'ic 6e6ver Pock Const�uc � /B' % I Parcel I.D. 015-234-36 Municipality of A. On -Site Water and Wastewa (907)343-7904 Certificate of On -Site Systems 1. GENERAL INFORMATION 15 A� 7015 Expiration Date: 6-1-/7 Complete legal description ALPINE WOODS; BLOCK 5, LOT 6 Location (site address) 5950 ALPINE WOODS DRIVE `ANCHORAGE, AK Current Property owner(s) DENNIS & LISA URBAN Day phone 529-6712 Mailing address 5950 ALPINE WOODS DRIVE `ANCHORAGE, AK Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class A Well ❑ Public Water System ❑ WaiverNariance request for: N/A TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: =®- _- Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $�J� Date of Payment �ilsrt5 Receipt Number 01400" W ul COSA# DSc1513(02 Waiver Fee $ Date of Payment Receipt Number Waiver # N/A '00 li: 5. STATEMENT OF I E Y 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. Name of Firm Garness Engineering Group, Ltd. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road, Suite 101, Anchorage AK, 99507-1259 Engineers Printed Name Jeffrey A. Garness In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry oractices. The reported results describe the condition of the systems on the dates of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and seofic systems deoend on a variety of variables including, but not limited to, soil conditions, groundwaterievels (that may fluctuate during the year), qualkyof construction (materials and workmanshio), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future oerformance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well orseptic system. GEG makes no representation whether an alternative well or septic system can be installed on the orooerty in the event either of the current systems fail. The content of this report is for the sole benefit of the oerson/party who retained GEG. Reliance noon the information provided in this report by any other person or party, including but not limited to subsequent prooerty purchasers, is not authorized. In short, GEG disavows any legal duly to anyone other than the oerson/oarty who oaid for this report. Date Y i5- llt(lif OFAn 6. DSD SIGNATURE ff 2 ON-SITE _System #1 Approved for 4bedrooms WATER AND System #2 Approved for bedrooms o WASTEWATER Disapproved 1 PROGRAM Conditional approval for bedrooms, with the following stipuiafa �5C �iiFNT SERA\ ) S\` A By: Original Certificate Date: Th4l2unpricipality o chorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_31-12.doc If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: ALPINE WOODS; BLOCK 5, LOT 6 Parcel ID: 015-234-36 A. WELL DATA Well type A If A, B, or C provide PWSID# 213596 Well Log (Y/N)- Date Y/N)_Date completed Sanitary seal (Y/N)_ Wires properly protected Total depth ft. Cased to ft. Casing height (abo> h FROM WELL LOG AT Date of test Static water level ft. Well production g.p.m. _ WATER SAMPLE RESUL . Coliform colonies/100 ml. Nitrate mg./L. Collected by: Ar c: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 8/24-25/90 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 6-A $ / S Pumper A * h M e- Sr; .zvl cr-- S C. ABSORPTION FIELD DATA in. Date installed 8/24-25/90 Soil rating (g.p.d.lftlbrjjbdrm 200 System type TRENCH Length 70 ft. Width 2 ft. Gravel below pipe 6 ft. Total depth *9:5 ft. Eff. absorption area 840 fe Monitoring.tube YES Depression over field NO Date of adequacy test 6/l/15 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 5 in. Water added 854 gal._ New depth 5 in. Elapsed Time: 5 min. Final fluid depth 5 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed Size in gallons Manhole(Acoess (YM "Pump on" level at in. "Pump ofr level at Hrah water alarm level Cycles tested Meets alarm $ circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAtft station on lot Absorption field on Public sewer main Sewer /septic service line On adjacent On adjacent lots manholeldeanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Surface water Water main 10'+ Water service line * Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line * Surface water 100'+ Driveway, paridng[vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS *10'+ PER MIKE ANDERSON P.E. 1990 INSPECTION REPORT AND AOR HAA DOCUMENTATION. SEE BOX NOTED ON AS—BUILT FOR G. ENGINEER'S CERTIFICATION I codify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines m et%cton this date. Engineer's Printed Name JEFFREY A. GARNESS Date 7It511f (Rev. 11/05) \ACRC�e i JEy® .A ZP pP EP 4 . Fp T OD TWO STORY FRAME HOUSE pv WALL T G' I n s r• yPC eT. wALL / lO' TELE. & ELEC. ESM4. 15' EQUESTRIAN 6 UTILITY ACOEES EBMT'. °� 4 .TH �} .............. I............... • SHANE A HOLT LS -6914 •r O°Oq . . • • _ goo oA �a c p Ls O S 89°55105"E 185.41' HUFFMAN ROAD 6 HE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN XISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL TRUCTURES OR FSNOELINES. ASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. (UNLESS INDICA OTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES R LOCATE STRUCTURES. NY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. - Q Z LEGEND S SEWER VENT AS4BUILTSURVEY NO CORNERS SET THIS DATE 1"e30 1 HEREBY CERTIFY THAT 1 HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 8, BLOCK 5, ALPINE WOODS SUB. ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS 22ND_ DAY OF DECEMBER 2(1(13 HOLT LAND SURVEYING 8650.FS100-31.i D6-] TEL. 345-5513 Municipality of Anchorage .• • i' Development Services Department e Building Safety Division „ Onsite Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-234-36 HAA#�4!''iZ%ss & 1. GENERAL INFORMATION Expiration Date: abs &T Complete legal description ALPINE WOODS, LOT 6. BLOCK 5 ❑ Individual On-site Location (site address or directions) 5950 ALPINE WOODS • ANCH. AK. 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CARMEN do GORDON HECHT Day phone 345-6125 5950 ALPINE WOODS • ANCHORAGE, AK 99516 Day phone BETH WEISER w/ PRUD. JACK WHITE Day phone 3201 "Co STREET. ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 762-3111 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well N Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal andlor water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 2B • ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 8 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, groundwater 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. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE v Approved for C� bedrooms. 337-6179 Date 4-7/0 0 Z Disapproved. �G�QQy-' •. 0�% Conditional approval for bedrooms, with the fllowing stipulati ON-SITE ^� ��: WATER AND Attachments: HAA Checklist Manitenance Agreements Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other By: r +" a Original Certificate Date: (Rev. 17/01)1/ Municipality of Anchorage , Development Services Department Building Safety Division ` On -Site Water b Wastewater Program 47W South Bragew St. P.O. Box 196650 An&oorage, AK 995196850 www.danchorage.sk.us (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ALPINE WOODS. LOT 6. BLOCK 5 Parcel ID: 015-234-36 A. WELL DATA PUBLIC WATER Well type commumTY WELL If A, B, or C provide PWSID# _ Well Log (YM) 213593 Date completed Sanitary seal (YIN)_ Wires sed to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production G.P.M. g.p.m. WATER SAMPLE RESULTS: Coliform oolontes/100 ml. Nitrate mg, l. Other Date of sample: Collected by: S. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date Installed 8/1990 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 6/20/2002 Pumper A+ C. ABSORPTION FIELD DATA Date Installed 8/1990 Soil rating 402NIX Mbdrm) 200 System type DEEP TR. Length 70' ft. Width 30 ft. Gravel below pipe 6.0 ft. Total depth 9.5 ft. Eft. absorption area 840 fe Monitoring tube YES Depression over field NO Date of adequacy test 6/28/2002 Results (Pass/Fall) PASS For 4 bedrooms Fluid depth in absorption field before test 30.5 In. Water added 706 gal. New depth 37 in. Elapsed Time: 184 min. Final fluid depth 31 In. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 6 type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed 'Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption Held on Public sewer main service line PUBLIC WATER On adjacent adjacent kris Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption Held 5'+ Water main 10'+ Water service line f.#42' . Surface water 100'+ Wells on adjacent lots 100'+ PVr. 200'+ CLASS A SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 100+ Water main t0'+ Water service line 0*21' Surface water 100'+ Driveway, parldnglvehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent kits 100'+ PVr.. 200'+CLASS A F. COMMENTS 44 PER: £NCINMR THAT PERFORMED: INSPECTIONS MID SEPTIC INSTALLATION. G. ENGINEER'S CERTIFICATION 1 car* that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Prin edzo ame JEFFREY A. GARNESS Date 777- HAA Fee $ 375 Data of Payment 7 -17 -OL Receipt Number_AAQ �� , (Rev. 12101) Waiver Fee $ oN Date of Payment Receipt Number pi. STA. 9*03.52' ALPINE WOODS DRIV Ak plNz Ma Uw W W -L O CLM LMT. C L016iL1AM O 0TLM A LMT. m s s' LEGEND S SEVER VENT Y T NIMYR W cOeau OCT T PAIL 1'-W 1 Mnor to1TRT T T 11MW RT010 A MORiGYQ1 M6TRT01 V M TOl1Yd01G LCSUDO RIVIMTY. LOT L M« 0. M/M 110®I i1 01 O[COW. OML TMAM TMIQ YRIMM 011 M RCWOm RAT. AR MOI 110M11 MTJ®M(IOldf L�}I��N 1O11�LaMQ. MNiA TOCQlO ONOM11 AOL WrA= ARAOO MY " M MOI 10 00 UM TO OORMA[ RMM'QR �PuOvi i'w11 WY O[ M100WI1L MR N L1R1 001MUR MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING :� .3 3 HAA #�l1`�1t t- ��1 Parcel I. D. # 1. GENERAL INFORMATION Complete legal description Lot 6; Block 5; Alpine Woods subdivision Location (site address or directions) 5950 Alpine Woods Drive Anchorage, AK Property owner Tatsuaki Hida Day phone Mailing address C/O Realty Center 8400 Hartzell Rd. Anchorage, AK 99507 Lending agency Mina Odell/ GMAC Mortgage Day phone 562-2181 Mailing address Agent Erika Boyd / Realty Center Day phone 277-0500 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well Community well XXX 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 written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 S. 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 furtherverify 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 S & S ENGINEERING Phone `i'f ` `� -7 17034 Eagle River Loop Road No. 204 Address Eagle River, Alaska 99577 Engineer's signature Date / i l �` 3, > G Win: �"-1F•.,. • "�•.�^, ,��1�1 Ar.!' ,', tai; ?� 0'.LC i � •', 6. DHHS SIGNATURE Approved for bedrooms. '_•_ ��y Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 4UTIC 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 DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 - Anchorage, Alaska 99501 - (907) 343-4744 Health Authority Approval Checklist Legal Description: Lo7- Q `" " c K -5- At-oat,.e_ Parcel I.D.: C S' a 3 A. WELL DATA Well type C. L A 5 s Log present (Y/N) _ Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE Coliform DatV6f sample: _ A If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to FROM WELL LOG TS: a 13 S-'9 V, Nitrate Other bacteria Collected by: B.S IC HOLDING TANK DATA Date installed ��s ��� Tank size / as`c &4(Number of Compartments Cleanouts �i( N) Foundation cleanout ON) V X45 Depression (Y&) N a High water alarm (Y/& Date of Pumping /° /.2 ty °) 6 Pumper 4 4 -f-S C. ABSORPTION FIELD DATA Date installed (; / ;'S / °) 0 Soil rating (g.p.d.ff or ft2/bdrm System type T "' `' it Length 7 o Width a Gravel thickness below pipe G Total depth Effective absorption area f"40 17-l' z Monitoring Tube present (ON) '/'F1 Depression over field (YQ "V 0 Date of adequacy test 3 `� S_ Results(Pas Fail) For 3 bedrooms u Fluid depth in absorption field before test (in.); D4Y Immediately after? Gy gal. water added (in.): Fluid depth "*f 4 (ins) Minutes later: "��'� Absorption rate = C cc) ± g.p.d. * r_cgs_r_ D+u r✓ur Rrsf W r« t_AS )YS G..4L Pv3 rIV ry LiAr-,11 ir4.. d Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)' m asin fight (above ground) _ z 3 properly protected (Y/N) r°�'1 n AT INSPECTION m a � m O Mg.p.m. Nitrate Other bacteria Collected by: B.S IC HOLDING TANK DATA Date installed ��s ��� Tank size / as`c &4(Number of Compartments Cleanouts �i( N) Foundation cleanout ON) V X45 Depression (Y&) N a High water alarm (Y/& Date of Pumping /° /.2 ty °) 6 Pumper 4 4 -f-S C. ABSORPTION FIELD DATA Date installed (; / ;'S / °) 0 Soil rating (g.p.d.ff or ft2/bdrm System type T "' `' it Length 7 o Width a Gravel thickness below pipe G Total depth Effective absorption area f"40 17-l' z Monitoring Tube present (ON) '/'F1 Depression over field (YQ "V 0 Date of adequacy test 3 `� S_ Results(Pas Fail) For 3 bedrooms u Fluid depth in absorption field before test (in.); D4Y Immediately after? Gy gal. water added (in.): Fluid depth "*f 4 (ins) Minutes later: "��'� Absorption rate = C cc) ± g.p.d. * r_cgs_r_ D+u r✓ur Rrsf W r« t_AS )YS G..4L Pv3 rIV ry LiAr-,11 ir4.. d Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* s Cycles teste E. SEPARATION DISTANCES Size in gallons "Pump on" level SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main service line m On adjacent lots adjacent lots "Pump off" level at* Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM S PTI HOLDING TANK ON LOT TO: Foundation Property line Absorption field S Water main/service line /O �� Surface water/drainage 100 Wells on adjacent lots a 0 f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / ` / /_ Property line Building foundation 0 Water main/service line Surface water I o o Curtain drain N() N C K-1 o w ,J F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area —Wells on adjacent lots 1 certify that 1 have determined thru field inspections and review of Municipal records.thQ;o s are • in conformance wi h OA H guid Ines in effect on this date. `. •'` �„ ;5, �f� CIry 1 Signature t+ 3 6-4 Co w A� Engineer's Name O�l+t`rG/�., c�CE880 waN ti�� Date •J c 6 HAA Fee $ ®© Waiver Fee $ Date of Payment 40 Date of Payment Receipt Number % ` Receipt Number 72-026 (Rev. 3/96)* • t 4 a.,.. for pickup #� }� i} , 1•y 4, & t e J(X 0 Wr z Holding tank, ,+ sx t lx�="Community -on site PUbllc sewer a ,;: ` NOTE: if community wastewater system, provide writtE attesting to the legality and status of system. 72-M (Rev. 1/91) Front MOA 021 41. nation from State ^.+ til, A1 ,dI a §rftYj tty YVie. .. k 5950 Atpine''Wobdz D u.ve Locatidrr (site address or directions) 'r Community well, Anchanage, -°.AK 3 T 4i :�..II w �' B1u.en " ' ' 34 5 ` �W Property, owner .c,?,li Day phoneL. L ,Mailing address/0 PRUDENTIAL RELOVATION a 2500 C,rtr Wo -At 8-fud_ 411 Houaon; TEXAS 77042 Ig N Lending agency w Day phone L, Mailing address a upAgen �,� Day phone rt n hS•.vrk'L' Address a.,.. for pickup #� }� i} , 1•y 4, & t e J(X 0 Wr z Holding tank, ,+ sx t lx�="Community -on site PUbllc sewer a ,;: ` NOTE: if community wastewater system, provide writtE attesting to the legality and status of system. 72-M (Rev. 1/91) Front MOA 021 41. nation from State ^.+ til, A1 ,dI a §rftYj tty YVie. .. IndMdual;well 'r Community well, a.,.. for pickup #� }� i} , 1•y 4, & t e J(X 0 Wr z Holding tank, ,+ sx t lx�="Community -on site PUbllc sewer a ,;: ` NOTE: if community wastewater system, provide writtE attesting to the legality and status of system. 72-M (Rev. 1/91) Front MOA 021 41. nation from State ^.+ til, A1 ,dI a §rftYj tty S. STATEMENT ENGINEER OF INSPECTION BY , 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. If urther verify that based on the information obtained from r' . r the Municipality of Anchorage;files and from my investigation wateration and inspection, supply and/or wastewater disposal system is in compliance with all Municipal and State codes, r ordinances, and regulations in'effect on the'date of this inspection. F� 5yyyrrrr�iit _ •ak . Name of Firm& `a S & S ENGINEERING Phone y - { aa7 17034 Eagle River Loop R G a _ - .. r . •- }r, sH',; ^t �'' i7 a ,v fr -kc Address Engineer's signature Date`s s F k -K 1 i 4 n N ik ri a �`' aS �r r+k�•4, < 1 f 1 1A `1� ;hf Pfi4�Tl f1 ! - P� ••1•••11, ������\ y. �•7��},,. a •h.�'S" 4rvtm x.srn9'r�rr .Hir?!^ y�.r •• .: y : �. z.. - 0.7 •. x a7_. ' } - k gid. ;S 1'iz•. WK ,-s � .. 5 �p�^ n ky. R+. p '�y� s u..� .l. i� a } • ` e r i t 3 ti a s uv3�„& V ` 1 F ��a• •• ,. -�f� t �t e i' � 3`it.-. apa z ej i� r E r) ! ROBERT C. COWAN xr t <y u tE 8801 % 6 DHHS SIGNATURE " �� "'` f i v t�� z zr ..; }� '. - �caTt + z- •...x - ��Li r .�'�ir4 =far t � t ksrs : - T �� q4 + _ �w rt�ae .`'.. ;.� tea" �"3�,-Y��k. "�st'E'• �,.�`��►.'s."�.. 'S� r` v. x kv�¢.rvry.,. s 4•: ..AeernvedLfor bedrooms. t Y t� t k t i E3y'�'lt . APprovaa F�ardrir I conduct -'I responsi6 LIM wnvwmg -. -. '"'a`i i...nk. 1 y S '-�''�z��. � ,., f.,�t'' t .� S , '5: � jai ,•- ti±iygt�h .•s'avo a. ..t; 7%fi4kk�G'�a may,:_.;, orage Department of Health and Human Services (DHHS) issues Health Authority ed only upon the' representations given in paragraph 5.above by:an independent ;tered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes If x is in orderto satisfy certain federal and state requirements. Employees of DHHS do not nalyze Clata. before a certificate.is issued, The Municipality of Anchorage is not j,',- missions missions in'the professional engineer's work. , t 724M (Rw.1/91) Back MOA #21 , •i tl%1 ?'fa.4.. �i. 4 u � Ly� R• c Date' may,:_.;, orage Department of Health and Human Services (DHHS) issues Health Authority ed only upon the' representations given in paragraph 5.above by:an independent ;tered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes If x is in orderto satisfy certain federal and state requirements. Employees of DHHS do not nalyze Clata. before a certificate.is issued, The Municipality of Anchorage is not j,',- missions missions in'the professional engineer's work. , t 724M (Rw.1/91) Back MOA #21 , Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: (,-c�T 6 < &,<5� k&xParcel I.D. 015 a39 3c A. Well Data Well type O!iImuor 14 Log present (Y/N) Total depth Sanitary seal (Y/N) or C, attach ADEC letter. ADEC ater system number 9%y%8 Date completed Driller Cased to 1 Casing height Wires properly protected (Y/N) FROM WE L LOG AT INSPECTION oz Date of test �i n Static water level rri cz� Well flow g.p.m. g.p.m. M --J m T Pump levell SEPARATION DISTANCES FROM WELL TO: Septic/holding-tank on lot (7kob r� ; On adjacent lots P4 z Absorption field on lot (9�C6 ; On adjacent lots r Public sewer main i'�%�} Public sewer manhole/cleanout /V Sewer service line 4(/�A Petroleum tank /00 - WATER SAMPLE RESUL S. Coliform 4�%� Nitrate Other bacteria A,4 Date of sample: 0 " Collected by: B. SEPTIC/hTANK DATA Date installed �5"q� Tank size Q,�>6 Compartments 2 Cleanouts (tN) X> -5 Foundation cleanout (Y/N) %s Depression (Y/) �d High water alarm (YA% NO Alarm tested (Y/61 An Date of pumping Al 1,� 1 Clq Pumper At E- SEPARATION DISTANCES FROM SEPTIC/TANK TO: Well(s) on lot 01A On adjacent lots -, XW 4- Foundation To,17perty line 10'+ Absorption field 19 Water main/service line Surface water/drainage S� 101k 72-026(3=)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed AJIA Manufacturer Size in gallons 4 Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump o High water alarm level Cycles tested Meets MOA electrical codes (Y/N) !U SEPARATION DISTANCE FROM LIFT STATION TO: t /�1 Well on lot r�4 On adjacent lots Surface water 01/ D. ABSORPTION FIELD DATA Date installed g oZS `ib Soil rating (GPD/Ft) a0c) Sr�13�Z System type Length -,t6 Width -I Gravel thickness Total depth Total absorption area 8y6Sr Cleanout present (,VN) Date of adequacy testoZ,93 '9S Results (pass/fail) REFNC f f 16 YDS Depression over field (Y/P4 A30 S for Bedrooms Water level in absorption field before testAfter test Peroxide treatment (past 12 months) (YIKJ NOT J�Nowg­, If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: / "j Well on lot /A On adjacent lots 0-00 44 Property line 10, To building foundation 10'4- To existing or abandoned system on lot 1JIA On adjacent lots aS�� Cutbank )J% Water main/service line Surface water r'06 1+ Driveway, parking/vehicle storage area Curtain drain Nc 4. Now o-) . E. ENGINEER'S CERTIFICATION 1 certify that! have checked, verified, or conformed to all MOA and HAA guidelines in effec %�� p Qf this inspection. .acv" "• Fi 01 � iA 41, Signature Engineer's Name / ` 0& 4 T C . Ca w As✓ 'i+i :r �+ Rb�Ezi' c: `c6'NA11 CE .8801 Date ; HAA Fee $ Date of Payment 7 Receipt Numberd S�r�fS�s 3 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number - MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services M} i DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # � �— ��� �1� HAA # 0 A t o n\ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LoT Zo SL s A L pi,vg 1n/ooD5 5 Z3 T l2 AJ R3W Location (address or directions) V S 9.5 O lAleesS DSP (b) Property owner t�/i!/�An� �' OT3Tz�EN Telephone: (home) Business 5-Zz-52417 Mailing Address (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here 0,if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family 1! 3. WATER SUPPLY Number of bedrooms'1 Individual Well ❑ Community [�" Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGEDIS OSAL Or site Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 e ;o Z abed N099 (88/L 'ney) BZO-ZL 'NioM s,aaaulbua leuolssajoad eqj uI suolsslwo ao siong ioj elglsuodsai jou sl abeaoyouy jo AilledlolunW ayl'panssl sl al.eollgiao a aaojeq Bjup azAleue ao suol;oadsul jonpuoo jou op SHHa 10 saa/(oldw3 'sluawaalnbei a}els pug lejapal ule;aao Alsi4n o} aapio ul suol;njljsul 6ulpual alagl pug sawoy jo siaseyoind of Asalinoo a se s1g1 saop SHHa ayl Te Isgly P 91BIS 941 ul paa91sl6aa aaaul6ua leuolsseloid;uepuedepul ue Aq anoge g ydeiBeied uI uaA16 suolje}uesaadai ayj uodn Aluo pasgg pajeollijeo Ieno.iddV Al!joy;ny yligaH senssl (SHHa) saolAaas uewnH pug yllgaH;o juawliedea 96eaoyouy jo Aj!IedlolunlN a41 NOI1nVo leuol}IpuOO lenoaddy leuol}lpuoO jo swaal panoiddeslp panoaddy 17 a;eQ wooapaq Pr"7'L-- uosiapuy 3 laey:)iyy •B�d �� e _ a_ • O�• RDR6 paR° leag S aaaUlbU3 o ••o• °•o• o•.°a�Ocos r� sR'c� FtaGt. JOI panoaddy IVAOaddV SHHa '9 ? ebb 7i V -:11? V -v 0 ff-D 2.1_01-2 ssaippb' S9g -[.�� auoydalal �,r -��,9 ��S � rv�, Wald 10 aweN 'uoljoadsul sly3 �o elep eqj uo;oa4e ui suol}elnbaa pue 'saoueulpao 'sapoo eje;S pug ledlolunw Ile qj!m aouuildwoo ul sl welsAs lesodslp aa}emalseM ao/pue AIddns jejum 91!s-uo ay} 'uoljoadsul Pug uoljebljsanul Aw woij pug salla ebeaoyouy to A}lledlolunW eqj woal paulelgo uoI}ewaojul eqj uo paseq }eqj AjlaaA iayjan� I 'ulaaay paieolpul ain}onils jo ads l pug swooapaq �o aagwnu eqj aol ejunbape pug leuoljoun} 'ales sl welsAs lesodslp aa}ema}sem ao/pue Alddns aajem a}Is-uo eqj ;ey} smogs lenoaddy Allaoylny y1le9H slyj l,o uol}ebljsanul Aw }eqj ApJ9A I 'molaq umOLIS alep uoljepllgA ay};o se pug ojejay paxl j;e leas Aw Aq paipliao sy NOIIVWHO:INI aNV V1Va'HaaV3S 3l1d'S1S31'SNO11O3dSNl JNIaIAONd WHIR ONId33NION3 'S 'J� 0011 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST FEBRUARY 1984 343-4744 Legal Description: 407' 6 45Z 5 �9C ,o i.vE' lit/D0,0 S Well Classification (fommyu try If A, B, C, D.E.C. Approved (Y/N) -66elzf Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Date Completed Electrical Wiring in Conduit (Y/N) Depth of Grouting SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Comments SEE' A r7-AcHED CETrlE2 B. SEPTIC/HOLDING TANK DATA ; Date Date Installed Size /Z 5O No. of Compartments Z Standpipes (Y/N) Air -tight Caps (Y/N) V Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped AIEW ContsT. Pumping/Maintenance Contact on File (Y/N) ti1Eld ; for COAL ST, Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) V/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well Soo'+ To Building Foundation S To Property Line q 5, To Disposal Field 9 To Water Main/Service Line y Z To Stream, Pond, Lake or Major Drainage Course DSI O N E IN AREA Comments S E P7 -I C TANK Is A IpFE! ??o 4TE_ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 200 Type of System Design TREtiICN Date Installed Length of Field 70, Width of Field 2 Depth of Field /0 Gravel Bed Thickness Square Feet of Absortion Area 8 qD Statndpipes Present (Y/N) Depression over Field (Y/N) N Results of Last Adequacy Test PASSED Date of Last Adequacy Test 8I �90 AleW Co,25,, SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well Soo' + To Property Line /0 01 To Building Foundation 4.5 To Existing or Abandoned System on Lot NONE OA! La -r ; On Adjoining Lots r2y To Water Main/Service Line To Cutback (if present) Al 061,E PRE SE.fI7' To Stream, Pond, Lake, or Major Drainage Course NONE /M A K6 A To Driveway, Parking Area, or Vehicle Storage Area /7 Comments ABSo>z.�27l0&1 F")ELD 15 ApEau,4T"E =nsta Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) **Check Permitted Bedroom Rating Against HAA Request"* I certify that I have checked, verified, or conformed to all inspection. Signed Company�crl2-sa»� CnDG:�.lt—f`RaN� Date i Ll MOA No Receipt No. .1, a3 / (_ Date of Payment / , ^ If// 11, Amount: $ 7 A '06 "Pump Off" Level at nt (Y/N) Cycles during Adequacy Test. MOA ander J % in effect on the date of this �'.,�t%ofa tlGfG L`y4!@0 G`.°3ip Ip401I218 pZ0 •&Oo4p @9 O �. Engineer's Seal €�^ �a®U' mpN°np as nue4ee ea •m m4®oe 4a0 ma �'� 0, % - Michael E. Anderson 4381 - E Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev, 7/88) Back Page 2 of 2 STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASI:A 99503 December 18, 1990 Attn: Wayne McFadden PWSID: 4213598 563-6775 ily review of the records on file in this office reveals that the Alpine T'Toods Subdivision Class A Public Water System is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking ",,later Regulations. Sincerely, a4>4" P I.. A L;leweno Environmental Engineer IGRI::pf