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Home My WebLink AboutSOUTHPARK #1 BLK 2 LT 7 Municipality of Anchorage Development Services Department .-'-"= .-~"~o On-Site Water & Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of On-Site Wastewater Disposal System and/or Well Inspection Report Perm;t Number:. SW020039 PID Number:. 020--051--66 WARD KNOUS Wastewater System: [] New · Upgrade 4371 SOUTH PARK BLUFF DR~VE * ANCH, AK 99516 ABSORPTION FIELD (907) 345-0148 4 rlDeep Trench mShallow Trench ~Bed rlMound rlOther LEGAL DESCRIPTION ~' "~'~ 1.0 w/s. r~ ,o~ ~ ~., .w~,6.0 2 ': 7 r SOUTH PARK ~1 ' 3.0 MAX .. 3.0 - - - SEE DWG. r~ 70 (2 5.0 n. 2 15'+ SEPARATION DISTANCES =s,p~o =.oI~ a$.*.E.P. T~nk F~eld $toUon Tank s.... U~. ANCHORAGE TANK 1250 Su,a~, Wot,, ~00'+100'+ - - - LIFT STATION ~emarks: THE EXISTING SEPTIC TANK WAS BENCH MARK COMPLETELY ABANDONED BOTI'OM OF SIDING O POINT 104,83 Inspections performed by:. AWWC, INC. Dates: ,st 3/22/2002 ~;':. 'J. i.f~..//~ .! ..... 2nd-4th3/22-23/2oo2 , ! IV/'/ t~ '~e re] A, a~3rless,. DeYelopmont Serv[co$ Departmont A~proYal . I1~. ".. ........... A B C ST1 ;32.36 17.41 - 53'2 37.73 15.65 - DBL1 - 16.92 72.63 99L2 - 17.40 72.78 CO1 - 53.37 76.08 I MT1 - 55.04 89.81 C02 - 63.85 105.72 CO3 - 76.49 76.49 MT2 - 75.27 105.52 C04 - 7;3.24 90.07 ALASKA WATER & WASTEWATER c.J.O. CONSULTANTS. INC., sc.~_~ PREPARED FOR: PHONE NUMBER: P^GE NUMBER: WARD KNOUS (907) 545-0148 2 OF' LOT 7, BLOCK 2; SOUTH PARK SUBDIVISION ~1 AS-BUILT DRAWING OF' SEPTIC SYSTEM UPGRADE AS BUILT DRAWING SW020059 -- 020-051-66 rF1NAL GR~D£ - 105.2S (X~.) ~P OF T~K AT~ : / = ~TOP OF T~K AT IN~ = 99.54 ~~ ~ ~0~ = 99.55 /~ Nm ]250 gALLON X 'A~: 8~/~ SEPTIC T~K[' ~I~RT Or ~ O~ - 98.80 ~' ~,~ . ~SI~ ~TER & &5~STEWATER ~ , CONSULTANTS. INC. N.T.S. WARD KNOUS (907) 545-0148 5 OF 5 ~ h...:....~ SOUTH PARK SUBDIVISION ~1= LOT 7, BLOCK ~, PROFILE AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bregaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7004 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Mar 18, 2002 Expiration Date: Mar 18, 2003 Permit Number: SW020039 Legal Description: SOUTHPARK #1 BLK 2 LT 7 Design Engineer: 0041 AK Water & Wastewater Consultan' Owner Name: Ward Knous Owner Address: 4341 SOUTHPARK BLUFF DR Total Bedrooms: 4 ANCHORAGE, AK 99516-4820 Parcel ID: 020-051-66 Site Address: 004341 SOUTHPARK BLUFF DR Lot Size: 27330 SQ. FT. 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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. Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. ON-SITE SEWER/WELL PERMIT .&,PPLICATION FOR ,b, SINGLE FAHILY DWELLING 020-051-66 Permit Number Property owner(s) Mailing address (1) WARD KNOUS Day phone 43J~1 SOUTH PARK BLUFF DRIVE * ANCHORAGE. AK 345-O148 Mailing address (2) Zip Code 99516 Legal description (Lot, Block & Sub'd,) LOT 7. BLOCK 2: SOUTH PARK g 1 Legal description (Section, Township & Range) THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade · Number of Bedrooms Well Only Water Storage THIS PROPERTY CONTAINS: Hot Tub ~ Swimming Pool Therapy Pool. [~] Jacuzzi Water Softening Unit I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTSr INC, Permit Fees: ('8,~'~-,~, Date of Payment: Receipt Number:, Waiver Fees; Date of Payment: Receipt Number:., ALASKA WATER & WASTEWATER CONSULTANTS, INC. I March 12, 2002 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragraw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade Design for Lot 7, Block 2, South Park Subdivision #1 To whom it may concern: The existing 4 bedroom house is served by a community water system and a private septic system. The existing septic system consists of a 1500 gallon septic tank and a bed type drain field. The drain field is in a state of failure and must be upgrade for the sale of the house. A test hole was excavated in the area for the proposed upgrade. The septic system will be designed around the 30 foot radius of this test hole. We are proposing that a new 1250 gallon septic tank and dual five foot wide drain fields 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 the insitu sandy soils should act as a sand filter and that an application rate of 1.0 gallons/day/fi2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: <I minutes/inch b. Allowable Application Rate: 1.0 gallons/day/ft2 c. NumberofBedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 600 ft~ f. Total Depth: 6.5 feet (max.) g. Effective Depth: 3 feet h. Width: 5 feet i. Reduction Factor: 0.58 j. Minimum Length: 70 feet total le~n~gth (2 ~ 35 feet long) k Effective absorption area -- 603 1~ 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Wcbsite: akwwc.com 3. SURFACE WATERS: There are some surface waters approximately 120+ feet south of the proposed drain fields. The drain fields will be installed 100+ feet from any surface water. 4. TOPOGRAPHY: Attached is a topography site plan; in short, there are no slope concerns. 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. ~ ~ilSincerelI P.E., M.S. NOTE: .4ttached 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 SO~ P~K S/O 13; I I ~ ~ ~.~ ~ ~ ~ I I ~ ~T 5, B~K 1. I I * ~ ~ J ~T 9, B~K 1. I I I ~ Jj %% ~h I I J ~ , · 1 ~ '~o~ / ~l I~, / ',X' ~--~~ ~~,,~,~,, / - ~, ,-~-' . x, . / ~ g~OPERTIES SHOWNSERVED '-- -' II PR~ATE S[PTIC ~EMS. ~ ~SI~ ~TER & WASTEWATER ~ ~,, :. ~q ~ eo,so~x, ms. ~e. = ~ ....... ]ll7~ ........... ' WARD KNOUS 545-0148 1 OF 2 V~"'"':~, ~~.' (~:""~' LOT 7, BLOCK 2; SOUTH PARK SUBDIVISION ~I ~,,a~ '.~ ti ..' ~,:,~,._--...~ ....... ~[ OF WORK: .~e~ SITE P~N FOR SEPTIC SYSTEM UPGRADE :':.' ' · ~ I~m ~ ':':.~.', ~ I ~ m ; '...' / NOTE: THE CONT~OTOR S~ ~VE THE ~,. ~ m ~ ." ~' / WATER $E~CE UNE PRO~SSIO~Y LOgiC ~~A~ ~' m R , .',?J / ~C~ED ~ A REG,~RED ~D SU~OR ~ .~ ~ · ': '"1 / PRIOR TO ~ CON~U~ON. ~ ~ _. ~%~.~o~" ~L ~/~ ~/~oo2 ~ nF ~ ~A~. A~S~ WATER ~ WASTEWATER ............. OO~SULTA~TS, I~O. 1" = 40' ~ '": ..... ~ .... : .... WARD KNOUS $45-0~ 48 SOUTH PARK SU~OlVISIOH ~1~ LOT 7, ~E OF WOR~ DESIGN OF SEPTIC SYSTEM UPGRADE Al .&SI{A WATER & WASTEWATER ..z ~ '...?.~{ JSOIL LOG - PERCOLATION TESTI' ~..~--:.;.z ,, :l~..x, ...... ! ........ LEC, AL DESCRIPTION: SOtrD-I PA~K SUBDM$1ON; LOT ?~ BLOCK 2 v~b.~.e.:['.. ~1 :--7953 ..'" PERFORMED FOR: ,¥*"0 ..0,$ D^~: 3/~/2002 ~;.,.'....,. ........ ..-;~,~ ~ ~"%'o " ~o~°~ ~ ~] ITEST HOLE ~lJ '~m~<%~~ 1~ ====: ORGANICS ~o~o%< ~ GP ~ ML I 4 4 -- ~% o~o', ~ GC OL ,.,.,., ., ,, ~% ~, SP CH ,,,..., / // 6 ~ ~ ~'o', SC ~'* o°o~' DEPTH TO 7 ~ ~o ~o%< GRAVEL DATE ~'o o'o', GROUNDWATER oo%o%c~'0 o'o~, ~ ~-~ 1 '=100' ~ 0 o o', NET TI~E LEVEL NET DROP *o~o'o< CLOCK WATER ~'o o'o'. DATE READING 11 ~ 0o~o,,~ TIME (MINUTES) READING (INCHES) 0°~o%~ 3/6/2002 1 3:02 - 6- - 12-- 0% o'o' 2 3:04 2 O" 6' oo,0%= 12.75 13-- B.O.II. 3 3:05 - 6- - 4 3:07 2 O' 6' 14-- 5 3:08 - 6- - 6 3:10 2 O' 6' 15-- 16-- 17-- 18- PERCOLATION RATE <1 (MIN./INCH) PERC. H~E DIA. 6 (INCHES) 19- TEST R~ BETWEEN 5.5 FT. ~D 6.0 FT. 20 ~ ~ A FOUR HO~ PRESO~ WAS PERFORMED: ~ YES ~ NO SOILS LOGGED BY: JE~ ~RNESS PERCOLATION TEST PERFUMED BY: ~EB ~LL COMMENTS: ~E INS~ ~DY SOI~ SHOULD A~ ~ A ~D RL~R. PERFORMED BY ~W.W.C., INC. I, JEFFK~ ~ G~NESS, CER~ ~T ~IS W~ ~RFORMED IN ACCORD~CE WffH ~ ~ATE AND MUNIClP~ GUlDEUNES IN E~CT ON ~IS DATE: ,--~, MUNICIPALITY OF ANCHORAGE DE ITMENT OF HEALTH AND HUMAN SER\ ~f · - Environmental Health Division ' 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT N~,ne DISTANCES Address ~ ~''""'" ~ TANK FIELD WELL Pbone{s,.zT~ ~¢Z Permd~ 7"°' No o, 8~oms WELL ~ 7~ ~/ LEGAL DESCRIPTION Township, Range, Seceon ~_ ~ , ~/ AS-BUILT .IAGRA" (Show Iooat,on o, well, septic system, property hne., ,ou.dat,on, dnvoway, water bodies, etc.} TANKS ~ Material ~o of Compadments FTI D~stance between lines wELLs ~ PRIVATE ~ OTHER (Identifv} Classdlcabon (A.B,C) Total Depth Cased to REUARKS: / I POI~TIO~ DC BtEb bg¢ ?O ~RO¢~f) )'8P~, InspectionsPedormedby: . ~.', I ~ C ~ '. ~ cedily "al 1his inspection was pedormcd according to all _ 72-013 (3/85) DEF:'ARTMEI\ OF HEALTH AND ENVIRONMEI"4T~ PRO]'EC-I'ION 825 L SEREE'T, ANCHORAGE, AK 99501 PERM I T NO = DATE J.,J,..dJED. AEE L. If_,AN ! ADDRESS CON]'ACT F:'HOI'4E: []/O ED SANDERSON ACREAGE SYSTEEMS 601 El. NE)R"I-HERN LIGHTS ANCHORAGE, At::: 99503 276-6552 LEGAL DESCRtF': L. O'T ,-~ .[ Z E:: MAX BEDROOMS: SUBDIVISION: SOUTHPARK ADD~ 1 LO]": 7 SECTION." 3 TOWNSHIP." ].IN RANGE: 3W 27336 (SC!.FT. DR ACRES) I. LOL, I L. isted below ~=]p(E) thE: c)p'E¢.ons available 'Eo you in design:i, ng yl:)up septic system~ Choose the [~,l:)tion that best fits your' site,, (F'T. DEPTH TO F'IPE BOTTOM GF;',AVEL.. DEF'TI'] (r::T.) TOTAL.. DE'.F'TH (F:T.) GI:~AVEI_.. WIDTH (FT.) GFd~VE:I.,. r. JENGTH (Fl'.) GRAVEl- VOLLIMIE (CU. YDS. ) TANr::: SIZE (GALS) SOIL.. RATING (SQ.F],, /BR) :L,O :'~ O. ,5 1.5 20.0 38.0 2S. 2 250.0 '~-'~' 125 ¢~.~'~DEF'TH T[) F']:I::'E BO'TTOM < 2.0 FT. REQUIRES ADD!'FIONAL GROUND COVER a~.,~-DEPTH TO F'IPE BO]']"OM ':::3.5 FT. REDLIIRES INSULATION ~-,x- DEF'TH TO I::'IPFZ BO]'TOM < 4.0 F"T. MAY REQUIRIE A LIFT STAT]:ON .~.~. 'FANI< MUS]' HAVE Al' LEAST 'TWO COMF'ARTMENI'S ]: c::el,tir'y that: :1.., I am f~]mi ]. with the r, equipements for' on-site sewer's and wells as set f'oPth by the Mun:Lc::il:)ality ot' Anchot'age (MOA) and the State of Alasl.::a. ~:~. I will install the) syst. em ir] accopdance with all MOA c:c~des and pegu].ati(Dns, and in compliar'~ce with the design cr'itepi8 of' this-permit,, 3,, I will adhepe to a].l IdOA and State c~f Alaska r, equipe~ents fop the sec back clist,.arlc:[es ~'Pom any ex:Esr, lng well, ~.tastewateP disposaZ system of public sewePage ~sy¢~'Lem on 'Ll'li,~ (:)p any adjaceflt op neEd'by ].at.. 4. Z undef'starld that this per'mit is va].id ¢op a maximL~m Q¢ 4 bedpooms and any enla]*gement t*.~i].l pequine an addiCiQnat penmit. IF: A THEN W!L_L rELECTRICAL WORK MUST BE I)ONE BY A LICENSEI) EI.,.IECTRICIAN. LiF:T STAI"ION ].c~ .[NS IAL_LE, D IN AN AREA COVERED BY MOA BLJILDINI.u CODES, (~.) AFl ELE[FT'RICAL.. F:'ERMIT AND .[NSFI:.C]ION MUST BE OBTAINED; (2) A~ EI. IILT~.~ NO'f' BE APPROVED WITHOLJT AN J...[.,TRICAL. .[NSFI:..] ION REEF'ORT; AND (3) THE .L ,JodED BY MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVI RONIVIENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: ~OlJ~Lk 5 6- 7- 8 SLOPE DATE PERFORMED: $l SITE PLAN 10- 11 13 14 15- 16 17, 18- 19- 20- WAS GROUND WATER SL ENCOUNTERED? ~0 pO E IF YES, AT WHAT DEPTH? P~'~I:-.~- ~.A,/~, q,~. Gross- Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE minutes/inch) PERFORMED 72-008 (6/79) SEWER SYSTEM LOCATION PLAN Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P,O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. O20-051-66 1. GENERAL INFORMATION HAA . Expiration Date: Completelegaldescription ' LOT 7~ BLOCK 2; SOUTH PARK SUBDMSION #1 Location (site address or directions) 4371 SOUTH PARK BLUFF DRIVE * ANCHORAGE, AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address WARD KNOUS Day phone 345-0148 4371 SOUTH PARK BLUFF DRIVE * ANCHORAGE, AK 99516 Day phone PEGGY 60NZALE$ w/ DYNAMIC PROPER~E$ Day phone 3111 "C" STREET * ANCHORAGE, AK 99503 261-7618 Unlessotherwise ~queste~ HAAwillbeheldbyDSD ~rp~k~. 2. NUMBER OFBEDROOMS: 4 3. TYPE OFWATER SUPPLY: Individual Well Individual Water Storage Community Class "A" Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. 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 and/or 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. ahall be paid $~t, or prior to closing for the engineering services provided. I 4. 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 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 furfher vedfy that based on the information obtained from the Municipality of Anchorage tiles and from my investigation and inspection, the on-site water supply and/or wastewater disposal systero is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUR'E 2B * ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Date 357-6179 Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of 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. Satisfactot7 test results do not guarantee future performance of the system, nor do they guarantee ~hat there are no hidden defects or encroachments. AWWC. 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 ~' Approved for J'~ bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the ~owing stipulations: ..... .... , ..... Manitenance Agreements Supplemental Engineer's Rec~ Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Olvtslon On. Ire Wst~ & Wastewater Program 4700 SoUth Bragaw St. P.O. Box 196650 Anchorage, AK g9519-6650 www.ct.enc~xxege.sk.us HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descttptlon: LOT 71 BLOCK 2, SOUTH PARK SUBDMSION i~1; Parcel ID: 020-051-66 A. WELL DATA Well typeCOUu~l~ If A, B, or C provide PWSID# 21347~~ ~ ~ ~roperly protected (Y/N) _ T . Cased to .ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Data of test Static water level Weld pnxtuctlon ,.J g.p.m. WATER SAMPLE RESULTS: .J g.p.m. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tanksize 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping NEW Pumper Date installed 3//22-23/'2002 Cteanouts (Y/N) YES High watar alarm (Y/N). NO C. ABSORPTION FIELD OATA ~ Data installed 3/22-23/2oo2 Soil rating ~13r ft;/Ixirm) 1.0 System type TRENCH Length 70 (:2 O 35')ff. Width 5 ff. Gmvst below pipe 3.0 ft. Total depth *-/.5-e.5 ft. Eft. absorption area 603 ff~ Monitoring.tube 'YES Depression over field NO Data of adequacy test NEW Results (Pass/Fall) - For 4 bedrooms Fluid depth in absorption field before test - in. Water added - gal. · New depth - in. Elapsed Time: - min. Final fiuid depth - in. Absorptlonmta>= - g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) - If yes, give date - LIFT STATION Date Installed Size in gallons · ~ 'Pump on' level at in. 'Pump orr n, High water alarm level at ~ .in. Da.~__~m Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES COUUUNITY WATER SYSTEU SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot Absorption field on lit Public sewer main On adjacent lots Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain. NONE KNOWN Building foundation 10'+ Surface water 100'+ Wells on adjacent lots 200'+ Water main 10'+ Driveway, parking/vehicle storage 5'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systema ere in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name o.te · JEFFREY A. GARNESS Receipt Number (~v. 12/ol) Waiver Fee $ Date of Payment Receipt Number 11~-28-2002 THU 11:42 ~ FAX HO. P. 02 M~,R-28-2002 Ti,:U 11:30 ~ L.~rTECH/SLAF. A F~ I, iO. 5616828 P. 02 ~ ! / / ! j~., . · ® / i i,o.oi · /.~ '""~'"""~ ":~ ""'" SOUTHPARK ADD. NO.1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION o,v,s,o. OFE.V'.O"ME"TA'"EA'T" CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date / /Y'J,~,-y) GENERAL INFORMATION (a) (b) Legal Description (include lot, block, subdivision, section, township, range) (wtL' I '7, TlIN Location (address or directions) Applicant Name ~L')~,¢''C~ UD Applicant Address (c) Applicant is (check one): Lending Institution f-I; Owner/builder ;[~Buyer []; Other [] (explain); (d) (e) Lending Institution A ~ ~S Real Estate Company and Agent Address '~ Telephone (f) Mail the HAA to the following address: Single-Family[~r Multi-Family [] Other 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. 4. SEWAG__E./,~SFOSAL Onsite ~ Public[] Community[] Holding Tank[] Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11,84) ENGINEERING FIRM 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. ~ NameofFirm ~¢'~,~f'~~/A~~,~, Telephone Date / ~) /¢87 ' ~?,/ .... . ¢.~¢ Engineer's Seal DHEP APPROVAL Approved for Approved. bedrooms by ~~ Y ~ate Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solety upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 Eiv.'MUNICtPALi~-, ~ r MUNICIPALITY OF ANCHORAGE (MO~-v 'vt/IRONM£NTArI.~FANOfo~,. HEALTH AUTHORITY APPROVAL (HAA) °e;VIcEs~GE CHECKLIST - FEBRUARY 1984 ~l," '~ION 264-4720 ' ] ]~e7 Legal Description' ~L~ WELL DATA Well Classification Cj':~/'rl~ rl~j~ L if~ A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~atJCompleted Yield Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date installed "~/~'/~)~ Size I ~ (~(~ "X- No. of Compartments o'xq Standpipes (Y/N) ~-,~ Air-tight Caps (Y/N) ~£-~ Foundation Cleanout (Y/N) Date Last Pumped Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) AJ ' A Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line -~'--~ To Water Main/Service Line Course ,~-~' fl,^. ;,or Temporary Holding Tank Permit (Y/N) N' ~ To Building Foundation ~ To Disposal Field ~ ~ To Stream, Pond, Lake, or Major Drainage Comments U Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/c:~(~/~ ~ Width of Field Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ,/~ Separation Distance from Absorption Field: To Water-Supply Well ~-0'0(~ To Building Foundation ~)(~ Lot N To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Standpipes Present (Y/N) Date of. Last Adequacy Test To Property Line /~ To Existing or Abandoned System on ; On Adjoining Lots ~' TO Cutbank (if present) Comments LIFT STATION Date Installe~fl Size in GalloL~s "Pump On" Le~(~el at Dimensions Manhole/Access (Y/N) ,.-. -.~. __ "Pump Off"~..cvei~{ High Water Alar%nl~Level at .--'~ent (Y/N) .-¢./ Tested for -""'~-. ~ Pumping Cycles durin¢'~,dequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check P~,.r~tt~ed, Bedr?m~ Rating Against "AA Request ** I certify t h~¢¢¢~,eck¢~ified, or conformed to a, ~A~nd HAA guidelines in effect on the date of this inspection. Amount: $ ~~ Engineer's Seal Page 2 of 2 )'~-- 72-026 (11/84)