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Home My WebLink AboutSOUTHWOOD PARK BLK 3 LT 25Southwood Block 3 Lot 25 #012-073-58 ,� Municipality of Anchorage Aw Department of Health and Human Services 825'L' Street P.O. Box 196650 Anchorage, Alaska 99519.6650 Rick Mystrom http Uwww.d.anchorege.ak.us Mayor Permit Number. #SW40 0178 Date of Issue: 6-10-04 Parcel Identification Number: 012-073-58 Date Started: 6-11-04 Date Completed: 6-13-04 Is well located at approved permit.location? ® Yes ❑ No Legal Description: Southwood Park Block 3 Lot 25 Property Owner Name & Address: Matt Mathews 2804 Non'hem Lights Anchorage, Alaska 99517 Borehole Data: Soil Type, Thickness 8r. Water Strata Depth (ft) From To Method of Drilling ® air rotary ❑ cable tool Casing type: steel Stick up 0 2 Wall Thickness:. 250 inches oranics & silt 2 12 Diameter: ¢ inches Depth: 4l feet silty sand silty gravelly sand sift gravelly silt 12 30 37 170 30 37 170 188 Liner Type: Diameter: inches : Depth: feet Casing stickup above ground: 2 feet static water level (from grotmd level): 32 feet Pumping level: 410 feet after silt 188 267 2 hours pumping 100+ gpm gravelly silt & H2O won? clear 267 310 Recovery Rate: 100+ + gpm Silt 310 334 Method of Testing: &LIff Well Intake Opening Typei clay 334 396 silty gravelly sand silly sandy gravel H2O 396 403 403 410 ® Open End ❑ Open Hole ❑ Screened StartFeet Stopped feet ❑ Perforations Start(feet Stopped feet Grout Type: bentonite 4 8 Volume: 2 Depth: StartQ feet Stopped Z feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: chlorine tablets Comments: Well Driller. Alpine Dn7ling & Enterprises PO Box 110496 Anchorage Alaska 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property . �.... .. �L....11 J: 11.. .4 .1/ ......J. �..// /.. /. �L. n..• .1f1../�L • i�_...... A. �..... �.f�l !.. /// J.... .1 .....1_/'.. • MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water B Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Jun 10, 2004 Expiration Date: Jun 10, 2005 Permit Number: SW040178 Parcel ID: 012-073-58 Legal Description, -Soul! nw Park'S/D Block 3 Lot 25:7 Design Engineer: 0836 Brian T. Harten Site Address: 2400 W 66th Ave Owner Name: Matt Mathews Lot Size: 7000 SO. FT. Owner Address: 2804 West Northern Lights Total Bedrooms: 3 Permit Bedrooms: 3 Anchorage , A 99517 - This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Q 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 (1BAAC72 ) 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. O Received By. Date: G � d �- Issued By. (1(( Date: 4 o v Municipality of Anchorage Development Services Department C Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 Parcel I.D. 01207358 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Number SW 23o-5ai9_- $wa+. Property owner(s) Matt Matthews, Six -M Cedar Homes Day phone 244-5270 Mailing address (1) 2604 West Northern Lights, Suite 6 Mailing address (2) Anchorage, Alaska Zip Code 99517 Legal description (Lot, Block & Sub'd.) Lot 25. Block 3, Southwood Park Subdivision Legal description (Section, Township 8 Range) Lot Size 7,140 Acre S .F Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. (Signature of property owner or authorized agent) Permit Fees: 3YOWaiverFees: Date of Payment: Jr- / q - O Date of Payment Receipt Number. S.Z 'D 6& Receipt Number. (Rev. 12/00) BTH CONSTRUCTION, LLC EXCAVATION & ENGINEERING P.O. Box 110358 • Anchorage, AK 99511-0358 PhonwFax:336-0447* E-mail: bth@gci.net May 14, 2004 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 RE: Proposed Private Water Wells Lots 23 and 25, Block 3 Southwood Park To Whom It May Concern: The proposed single-family homes on the subject lots will be served by public sewer. Public water has not yet been extended to front the subject lots, therefore private water wells are required to provide water service. It was not possible to place the proposed well within the property boundaries of Lot 25 and still meet the 75 foot separation requirement from a private well to a sewer trunk. Therefore, we are obtaining a water well easement on Lot 24 to the east. This easement is shown on the attached site plan. A copy of the easement will be provided to your department as soon as it is recorded. The closest well to the subject properties is located on Lot 22, Block 3 Southwood Park. According to MOA records, this well is 257 feet deep. am unaware of any adverse impacts this installation would have on any existing adjacent wells or septic systems. If you have any questions or comments on this design, please feel free to contact me at 230- 3992. Regards, F Brian T. Harten, P.E., BTH Construction, LLC V 51+ :. C� TH 9 (' \ \ PROPOSPROPOSED / *; 49- '.* �/ \ `� PRVATEEWELL 15'X20' WATER/;': • •• ••/ \ / \ / EASEMENT / BRIAN T HARTE PROF S310N� \ 50.0 50. 0 5D.0 50.0 :.. W SI 67TH AVENU LOTS 23 AND 25, BLOCK 3 BTH CONSTRUCT/ON, LLC SOUTHWOOD PARK SUBDVISION P.O. BOX 110358 OVERALL SITE PLAN ANCHORAGE. ALASKA 99511 PHONE: 336-3447 SCALE: MOR. 1'-40' DATE: 05/10/04 GRIDS: SW2027 SHEET 1 - - --_ - VER. NTS OWNER; SIX -M CEDAR HOMES ONUM 100 . D_0 _50.0 ��- _,50. _, 1+ Yom. SSI:: �•C�t:: i � M1S LE: 1' 40' \m EXISTING / \ HOUSE. TYP. PPOPOSED' EXISTING SIN -FAMILY HOME] - PVT. WELL .5 I I I (257 FEET) / I II y V 51+ :. C� TH 9 (' \ \ PROPOSPROPOSED / *; 49- '.* �/ \ `� PRVATEEWELL 15'X20' WATER/;': • •• ••/ \ / \ / EASEMENT / BRIAN T HARTE PROF S310N� \ 50.0 50. 0 5D.0 50.0 :.. W SI 67TH AVENU LOTS 23 AND 25, BLOCK 3 BTH CONSTRUCT/ON, LLC SOUTHWOOD PARK SUBDVISION P.O. BOX 110358 OVERALL SITE PLAN ANCHORAGE. ALASKA 99511 PHONE: 336-3447 SCALE: MOR. 1'-40' DATE: 05/10/04 GRIDS: SW2027 SHEET 1 - - --_ - VER. NTS OWNER; SIX -M CEDAR HOMES P-279 SOUTHWOOD PARK SUBDIVISION LOT 25, BLOCK 3 7.140 S.F. WEST 66TH AVENUE 100 100 RELATIVE MEED ELEVATION ('P> °M N 89.33'00"E 51.00' 10' SIDEWALK ESMi. 8 A.C. DRIVE R h d ---per-- nI l x I R FlN. FLR. •' as EL 102' g g PROPOSED BUILDING 1 1 § I . 1 1 I n.a x I r F 1 8 L --------- 8 111=20' Municipality of Anchorage Development Services Department Building Safety Division On-Ske Water and Wastewater Program 4700 South Bragaw St. P.O. Box 198850 Anchorage, AK 995196850 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Brian Hagen Legal description: Southwood Park Block 3 Lot 25 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. _ ❑ Additional soils information needed. ❑ Water monitoring results inadequate. _ ❑ Discrepancy in information submitted. _ ❑ Topographic information missing or inadequate. ❑ Incomplete, missing _ ❑ Incomplete; missing _ ❑ Additional adequacy test information needed. _ ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. _ ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. ❑ Well log required. _ ❑ Omission in narrative. ❑ insufficient fill over tank or field.— ED Other. Need easement letter Name of reviewer: Joe Goodall Date: 5/20/2004 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK 2004-042235-0 Recording Dist: 301 - Anchorage A 6/9/2004 11:13 AM Pages: 1 of 2 L SK A WATER LINE SERVICE EASEMENT CG The GRANTOR, MAURICE K. MATTHEWS dba SIX—M CEDAR HOMES, hereby grants an easement in perpetuity over and across the following described tract of land: A strip of land 10.0 feet wide which lies within Lot 24, Block 3, Southwood Park Subdivision, per Plat No. P-279 as recorded in the Anchorage Recording District, Third Judicial District, and being more particularly described as follows: Commencing at the Southeast Corner of said Lot 25, Block 3, Southwood Park Subdivison; Thence N 00°07'00"W 22.81 feet to the Point of Beginning; Thence S 89°53'00"W 18.06 feet to the end of said strip. The purpose and intent of this easement is to provide a corridor for a water line to service Lot 25, Block 3, Southwood Park Subdivision, This easement is shown graphicall on the attached Exhibit A. (Page 2) p vXCjt6 'Ay P-LWCCt:AT pi Sl-rc Dated this 014-t day of J71,16 2004. Maurice K. Matthews, Grantor SUBSCRIBED AND SWORN to before me this STATE OF ALASKA NOTARY PUBLIC e�:Van W. Eiben My Commission Expires February 8. 2008 vo.,, w - Uzi, Notary Public in and for Alaska My commision expires- 67-/06[zOO6 ! day of :1�-uh4 2004. RETURN TO: Gastaldi Land Surveying 4726 West 88th Avenue Anchorage, AK 99504 Page 1 of 2 :i (PLAT NO. P-279) SOUTHWOOD PARK SUBDIVISION LOT 24, BLOCK 3 7.000 S.F. (RECORD) WEST 66TH AVENUE 0 C4 N 69.53'00"E 50.00' Grid: 2026 Scale: 1"w40' Date: 6/7/2004 S 3 File No.: SPS2430 Checked By: JAG. PACE 2 OF 2 a o z z WATER UNE SERVICE ESNT. ra— I.—_ N 618.06,0"E 18.08' N N EXHIBIT A 10' SIDEWALK ESWT. 1 11=40' GASTALDI LAND SURVDING 4726 WEST 88TH AVE. ANCHORAGE. ALASKA 99502 Grid: 2026 Scale: 1"w40' Date: 6/7/2004 BK: 04-05 PC: 22-24 Drown: V.E. File No.: SPS2430 Checked By: JAG. PACE 2 OF 2 III II IIII�zof 2 I IIIIIIIIIIIII4I 2004-042286-0 SSSUN44 N � OFA. A t; 491m- 4tfory A. GastalA J o AlF a O . LS -8091 2e AV �. Sv . p1'tessloncl`eo ��• 0140lklk%** � �` Municipality of Anchorage Development Services Department � m"' On -Site Water and.WastewaterBP Division P.O. Box 796650 gnchoragrgK 995 9-66 Ogaw St. I. '% xi.anchoragge.ak.us (907)343-7904 Pag ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT a of Permit Number: Na PID Number: pt _:a Atldreae: Wastewater System: [I New g ❑Upgrade Phone: ABSORPTION FIELD Number of aedreoma: O Deep Trench O Shallow Trench t] Bed 13 Mound LEGAL DESCRIPTION Soil Rating: 13 Other Block; Lot: Total Dep m original grade: Subtliviaion: GPD/Ftr T Township: Depth to Pipe bottom from original pntle: vN depth P beneath pipe: Sacgon; Fig added above original glade:Gravel Length: Well: New Ft. ❑ Upgrade Gravel width: Clesuficetion (Private, A, B. C): Number o(linea: Dietanq behweer �— TOlal Depth; r ... .._. _. 4. FP FL TANK '��'m 0 Septic O Holding [] S.T.E,P. &WrlVate Manu Mule, ❑ Other: Sewer Line spact 4g ( Material: Gal. Number or Compan. LIFT STATION BENCH MARK Inspections performed by: '�o,d t Dates: Development ServicesDepartment A 2nd Reviewed and a pprOva1 (Rev. Ivoo) approved by: Date: Ft. lines: in. •�F 49sN eyy7yy`ao aM•y MNa••a•• aaaa� 1 r NR14M T. NARTiq : ± CE.ltlpbg • �r fe/2—H ,a�•f$�a4 pR��ESSIONp eee i (I 1 SEPARATION DIST To From Septic Tank Absorption Field Lift Station Holding Tank Wall NIR! N�h NiR N�/} Surface Water j IA N (h N �h N �/t• Lot Lin. N 1A, Foundation 'i k N A NIA N(A anain Dram N! (A M (A N �(A Remarks FP FL TANK '��'m 0 Septic O Holding [] S.T.E,P. &WrlVate Manu Mule, ❑ Other: Sewer Line spact 4g ( Material: Gal. Number or Compan. LIFT STATION BENCH MARK Inspections performed by: '�o,d t Dates: Development ServicesDepartment A 2nd Reviewed and a pprOva1 (Rev. Ivoo) approved by: Date: Ft. lines: in. •�F 49sN eyy7yy`ao aM•y MNa••a•• aaaa� 1 r NR14M T. NARTiq : ± CE.ltlpbg • �r fe/2—H ,a�•f$�a4 pR��ESSIONp eee i (I 1 FROM : ALPINE DRILLING FAX N0, : 907 345 0202 NOV. 17 2004 08:24PM PS Municipality of Anchorage Department of Health and Human Services 6 P.O, Box 196650 Anchorage. Alaska 99519.6650 hnP:Nwww.ef.anoh0"e.ak. uz Permit Number: #SW04Of78 Date of Issue: Dote Started: 8-1- Date Completed: -a _ Pared Iden tt>featioa Nuptber: 12 73 0 Legal Description; ", Is well located at approved permit location? ® yes No Property Owner Name & Address: Mahaim rir B 2804 Northam Liohts Borehole Data: Soil Type, Th;dmeas A WaterStrata "..na (O From TO "O'r Method of Drilling ® air rotary ] cable of Stick up Casing type: steel orenks & sut 0 2 Wall Thickness: , Z60 inches siKy sand 2 12 Diameter: I inches Vg Depth: feet 12 30 Liner 311tY gravelly sand 30 37 Diameter: inches Depth: fact silt 37 170 Casing stickup above ground: ,2 feet gravelly silt 170 A88 smite water level (froth ground level): Meet am 1� Pumping level; 4i0 feet at}er gravelly ar7t d H2O wont clear 267 267 Pumping 100+ BPm silt 310 Recovery state: ]� gpm c%y 3i0 334 Method of Testing: �!clii silty gravelly sand 334 396 Well Intake Opening Type; 396 403 ® Open End [] Open }[ole silty sandy gravel H2O 403 410 D Screened Start Yeet Stopped feet ❑ Perforations Start feet StoPPcd fent Grout Type: t nice # 8 Volume: Depth: Start Q feet Stopped I feet Pump: Intake Depth feet Well Disinfected Upon Completion? ® yes ❑ No Method of Disinfection: ohlonnn j hrej. Comments: --- WeU Driller. Alpine Drilling 6 Enterprises PO Box 110496 Anchorage Alaska 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the Property ` MUN/C/PALITYOFANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Sheet P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Permit Number: SW040133 Legal Description: l5pQthwaod park`,S/C7 Bfoek.« Design Engineer: 0836 Brian T. Harten Owner Name: Matt Matthews Owner Address: 2804 West Northern Lights, Ste 6 Anchorage , A 99517 - Date Issued: May 20, 2004 Expiration Date: May 20, 2005 Parcel ID: 012-073-56 Site Address: 2416 W'66th Lot Size: 7000 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of. ❑ Disposal Field 0 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. Received By: Issued By: Date: ti 9 O Date: —1420 0 Municipality of Anchorage • Development Services Department Building Safety Division OnSke Water and Wastewater Program 4700 South Bragaw SL $ A { 1 • ° P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWERNVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel 11.13, 01207356 Permit Number SW Property owr er(s) Matt Matthews, Six -M Cedar Homes 2 7 C - 3 9 -12- fs Day phone 244-5270 Mailing address (1) 2604 West Northam Lights. Suite 6 Mailing address (2) Anchorage, Alaska Zip Code 99517 Legal description (Lot, Block & Sub'd.) Lot 23, Block 3, Southwood Park Subdivision Legal description (Section, Township & Range) Lot Size 7,000 ,- Mr Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only El Sewer and Well ❑ Water Storage ElSewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub (] Jacuzzi Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. (Signature of property owner or authorized agent) Permit Fees: t i 5' ti I p 'waiver Fees: Date of Payment 14 - Q Ll' Date of Payment Receipt Number. Z 14 Q (Rev. 14/00) JYVReceipt Number: S P-279 SOUTHWOOD PARK SUBDIVISION LOT 23, BLOCK 3 7,000 S.F. WEST 66TH AVENUE a 100' N 100' ASSAUMMEED DATUM (7 'PATION ) OM N 89483'00"E 60.00' — — — — — --10' SIDEWALK ESMT. A.C. DRIVE 8 1- - 1 30.a a.0' w1 � l xl 1 1 � 1 J 1 r- 1 FIN. F1R. i as as EL - 102. 1 r 1 1 1 1 1 z 1 PROPOSED BUILDING Er4 .. va-aa avc au.vu- 101' 101, 1 =20' R x BTH CONSTRUCTION, LLC EXCAVATION & ENGINEERING P.O. BOX 110358 • Anchorage, AK 99511-0358 Ph0nWFex:338-3447 a E-mail: bth@gci.net May 14, 2004 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 RE: Proposed Private Water Wells Lots 23 and 25, Block 3 Southwood Park To Whom It May Concern: The proposed single-family homes on the subject lots will be served by public sewer. Public water has not yet been extended to front the subject lots, therefore private water wells are required to provide water service. It was not possible to place the proposed well within the property boundaries of Lot 25 and still meet the '75 foot separation requirement from a private well to a sewer trunk. Therefore, we are obtaining a water well easement on Lot 24 to the east. This easement is shown on the attached site plan. A copy of the easement will be provided to your department as soon as it is recorded. The closest well to the subject properties is located on Lot 22, Block 3 Southwood Park. According to MOA records, this well is 257 feet deep. I am unaware of any adverse impacts this installation would have on any existing adjacent wells or septic systems. If you have any questions or comments on this design, please feel free to contact me at 230- 3992. Regards, Brian T. Harten, P.E., BTH Construction, LLC Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. /►_ P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.sk.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. #__0Q t4' O C Expiration Date: 1. GENERAL INFORMATION Complete legal description Ler 26' &i 6eu: p Location (site add`r'ess'or'dltections) CurrentPr'opWty;owner(s�, _ ueiri+a..s Day phone 244-Siq-o Mailing address 2-gb4 LA. � " Ale q4n-2. Lending agency Day phone Mailing address Real Estate Agent- Day phone Mailing Address UnlesS otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ Individual Water Storage , ❑ Individual Holding tank ❑ Community Class Well ❑ 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 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below,/ 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 We number of bedrooms and type of structure indicated herein. I further verify that based on the information c hed,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, ordirfa.". es, and regulations in effect at the time of installation. R' Name of Firm 09" 1�' 3_�'; �cr_ Phone Y96- 344 Address d?o 8eY 11e1155C 4cjA i 0°4a1 Engineer's Printed Name nen ' + i�,�« I Date- 12.-u- 64 5. DSD SIGNATURE ��. Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: p -P Original Certificate Date: 2 (Pe .01roz) 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 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lor 2 3 11CF11Jeoo'PA-O.. Parcel ID: erz-a}3-Sg A. WELL DATA Well type-ZAA If A, B, or C provide PWSID # _ Well Log (Y/N) _YES Date completed _ Sanitary seal (Y/N)_(&S. Wires properly protected (Y/N) Yes Total depth -41LO ft. Cased to LQ ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test 4-13—o4 Static water level 3.2 ft. ft. Well production to a t g.p.m. fy g.p.m. WATER SAMPLE RESULTS: Coliform —A—colonies/1 00 mi. Nitrate 45 mg./I. Other bacteria _� colonies/100 ml. Arsenic: Klr7 mg.A. Date of sample: j -.f -04 Collected by: b2vw "ACT" i B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed Tank size gal. Number of Compartments snouts (Y/N) Foundation cieanout(Y/N) ion over tank (Y/N) High water alarm (Y/N) mping Pumper C. ABSORPTION PI)=LD ATA Date installed Soil rating (g.p.d./ftz or ftz/bdrm) System type Length ft. Width ft. Gravel b ipe ft. Total depth _ ft. Eff. absorption area ftZ Monitorin Depression over field _ Date of adequacy test Resul s/Fail) For _bedrooms Fluid depth in absorption field befor _ in. Water added_ gal. New depth_ in. =Z�;=nt Final fluid depth _ in. Absorption rate >= g.p.d. (past 12 mo.) (Y/N & type) If yes, give date E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift Station on lot NIA On adjacent lots nN 1A Absorption field on lot NIA On adjacent lots r4 1A - Public sewer main 4 Public sewer manhole/cleanout > tQa Sewer /septic service line 4n Holding tank m_JA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line orption field Water main er service line Surface water Weffg on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Surface w Driveway, parking/vehicle storage Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name�r Date 12— 7— Q4 HAA Fee $ K V S Date of Payment i� r< O Receipt Number 1-5- J 3 2— (Rev. (Rev. 12101) Waiver Fee $ _ Date of Payment Receipt Number Aw 9*--* 491 G NANM 10068 PHONE NO. : 9072489362 (PLAT NO. P-278) SOUTHWOOD PARK SUBDMSION LOT .a249 BLOCK 3 WEST GMM AVENUE k wm sm=� . u .Z_ 1 11=400 N QO"2 EXHIBIT A GASTALDI LAND SURVEYING 4726 WEST 88TH AYE. MOMORAGE. ALASKA 99502 pM: 2020 $oOM: 1'.40' DOtx V7/=4 OK: 06-00 PG: 22-24 OmMn: r.0 no No.: lr=4J9 I Chwk" By: JAA PAGE 2 0r 2 ��I{WII 2�of�eI�'d W� 20"2s" Dec. 09 2004 08:15M P2 f"M A GOMM �kasrond 4 �� z41 957 2004-042285-« Recording Dist: 301 - Anchorage A 6/9/2004 11:13 AM Pages: 1 of 2 K 911�IQIIQI�QIQIIQQIIQI�iQi�IIQIQIQIQ1�11gIQIala011�Q� A WATER UNE SERVICE EASEMENT CG The GRANTOR. MAURICE K GMAT � amass the following described tract h8mbYof land: an easement in perpetuity o =30,01n. strip of land 10.0 feet wide which Ices within tot 24, Block 3, Southwood Park Third i Judicial District. and being more particularly deer Plot No. P-279 as recorded In the scribed Anchorage Recording District, Commencing at the Southeast Comer of sold Lot 25, Block 3, Southwood Park Subdivison; Thence N 000071001W 22.51 feet to the Point of Beginning; Thence purpose and Intent ofthis ease06 fact ment Is to provide e end of sold a�corridor for a ter line o water line to service Lot 25, Block 3, Southwood Park Subdivision, This easement is shown grapb1cali on the attached Exhibit A. (Page 2) AAAr"`rr PR GsrA4'nO+ ON shn Dated this day of x,06 2004. Maurice K. Matthews. Grantor SUBSCRIBED AND SWORN to before me this -g — - day of v """ , 2004. STATE OF ALASKA NOTARY PUBLIC Van W. Elben 0 MY Comm mm, McOos Fscrosy 6.2006 Va.' W • 't -i'— Notary Public In and for Alas My commision expira� oZ%wcat.J2oo6 RETURN TO: Gaxtaldi Land Surveying 4726 West SSth Avenue Anchorage, AK 99504 Page 1 of 2 12- B-06; t2:59PM; SGS Rett 1047649001 Client Name BTH Construction Project NameM US 213 & L23 193 Southwood Client sample ID L25 B3 Southwood Matrix Drinking Water PWSID 0 :907 5615301 K 2/ 9 All DstesMmes are Alaska Standard Tithe PrintedDatell'ime 12/08/2004 HAS CollectedDate/Thne 11/19/200414:55 Received DateMine 11/19/20994 15:55 Technical Director j/ St 0112 . Ede Released Sample Remarks:- Pawmeter Results PQL Unie Mabod Container ID Albwable Peep Malysis Init omits nate Dw Metals by SCP/M$ Arsenio 5.00 U 5.00 ug/L EP200.8 C 11/06/04 12/07/04 Jib Waters Department Nitrate -N 0.100 U 0.100 mg/L EPA 300.0 B (<=10) 11/20/04 BJA Microbiology Laboratory TotalCDlironn 0 col/100mL SM2092228 A 11/19/04 DKC P-279 SOUTHWOOD PARK SUBDIVISION LOT 25, BLOCK 3 7,140 S.F+/-(REC) WEST 66TH AVENUE 0 N 51.76'(MEAS) 51.00'+/—(REC) N 89.53'00"E(REC & HELD) I LOT 24 I r - - - WATER UNE , SERVICE ESMT. �► I(2004-042286-0) L — — — I GASTALDI LAND SURVEYING JEFF A. GASTALDI, R.L.S. 4726 WEST BOTH AVENUE ANCHORAGE, ALASKA 99502 PHONE 248-5454 GRID I DATE 2027 1 9/30/2004 F.B. I JOB NO. 04-11 1 SWP253 GRAVEL DRNE r 30.0-b 11.4' b d EXISTING BUILDING LOT 25 WATER SERVICE PROVIDED FROM WELL ON LOT 24. BLOCK 3 N 89053'00"E 51.00'+/—(REC) 51.56'(MEAS) I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. R IS THE RESPONSIBIL T Y OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA NOTE: NO CORNERS SET THIS DATE. 10' SIDEWALK ESMT. 1 11=20' OF -` . ....... 44 #. ;' •., � .•'• 49TH .................... i' lary A. Gastaldl •gym ••�� LS -6091 ,i�AV . ^o0' p'•.......••' 6 411* -'0%3310n0% °c