HomeMy WebLinkAboutSOUTHPARK #2 BLK 3 LT 12outh P( r'k
lock
Lot 12
020- 5O2
-10
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP231118
Work Type: SepticTank Upgrade
Tax Code Number: 02050210000
Site Legal Address: SOUTHPARK #2 BLK 3 LT 12 G:3236
Site Mailing Address: 4690 SOUTHPARK BLUFF DR, Anchorage
Owner: JONES LAURA B
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
,'Il e ' -
S
Department
6/7/2023
6/6/2024
23936
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: S " 1<`— l�i 7-0 C-9- i- Date:
0 Issued By: Date: b 2 3
4
MUNICIPALITY NCH
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 020-502-10
Property owner(s) Laura Jones Day phone 907-306-9390
Mailing address 4690 Southpark Bluff Drive, Anchorage AK 99516
Site address 4690 Southpark Bluff Drive
Legal description (Sub'd., Block & Lot) Southpark #2 Block 3 Lot 12
Legal description (Township, Range & Section)
Lot Size 23,936 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) ❑X
Septic Tank
❑X
Upgrade ❑X
(w/wo AD U)
(D) E]
Holding Tank
❑
Renewal ElDuplex
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 22 S Waiver Fees:
Date of Payment: rI 10 L3 Date of Payment:
Receipt Number: (20 H Receipt Number:
Permit No.Waiver No.
Permit App_'- : . _..:c
May 30, 2023
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Southpark #2 Block 3 Lot 12 - 4690 Southpark Bluff Dr
Septic Tank Replacement
Dear On-Site Services Engineer:
The owner of the above lot has a septic tank that has reached its end of useful life, so we are
submitting this permit application for its replacement. The attached site plan identifies the location
of the home as well as the septic location. This lot and all surrounding lots are on a public water
system. We are replacing the septic tank with the same size designed for 4 bedrooms.
Please refer to the attached plan for the septic design. If this design is followed, there will be no
adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231118, Curtis Townsend, 06/07/23
/
/
/
/
// //
Benjamin Schiller
CE 12592REGISTEREDPROFE S S I O N A L E N GINEER 1"=50'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
SOUTHPARK #2, BLOCK 3 LOT 12
FEET
0 50 100
FCO
NOTE:
ALL SURROUNDING LOTS ARE ON A COMMUNITY WATER SYSTEM
SOU
T
H
P
A
R
K
BLU
F
F
D
R
I
V
E
SEPTIC PLAN
5/29/23
T&E EASEMENT
DRIVEWAY FOR L13
ENCROACHES
4-BDRM HOME
NEW 1250 SEPTIC TANK.
MAINTAIN 5' SEPARATION
FROM EXISTING FIELD
AND 10' SEPARATION
FROM HOUSE
DECOMMISSION
EXISTING 1250-GAL
SEPTIC TANK PER UPC
EXISTING 43' TRENCH TO
REMAIN IN SERVICE
2CO CO
CO
WATER LINE ROUTING PER RECORD DRAWINGS
MAINTAIN 10' SEPARATION
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231118, Curtis Townsend, 06/07/23
~,.~
' '- *" : MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
r-]UPGRADE
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
S.
Liq. capacity in gallons ~ I F HOMEMADE
DISTANCE TO: ! Well
DISTANCE TO; IWell ,~ (~ "~
Length o! each line
IAbsorpt:2 e~rea
Inside length
Dwelling
Total length of
Crib diameter
Well
Type of crib
NO. OF BEDROOMS
W[dthMaterial IO~
Liquid depth
PERMIT NO.
NearestIIOt ~line/ PERMIT~ ~
PERMIT NO.
Crib depth
Building foundation
Total effective absorption area
Nearest lot line
DISTANCE TO:
Sewer line
Building foundation
DISTANCE TO:
Septic tank
OTHER
PiPE MATERIALS
SOl L TEST RATING
INSTALLER
REMARKS
APPHOVED
DATE
LEGAL
72~13 IRev. 3/78}
MUNICIF'ALITY OF AN CHIOF~AGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET,~ANCHORAGE, AK 99501
264-4720
ON--S I TE SEWEI'~ PER.'~I I T
PERMIT NO:
DATE ISSUED:
850052
02/06/85
APPLICANT:
ADDRESS:
CONTACT PHONE:
GREAT LAJ.~ES CONSTR.
200N 54TH AVE. SUITE 607
ANCHORAOE~ AK 99503
544-0880
LEGAL DESCRIP: SUBDIVISION: SOUTH PARK ADD ~2 LOT: .12 BLOCK:
SECTION: 5 TOWNSHIP: 11N RANGE: 3W
LOT SIZE: ~-~ (SQ.FT. OR ACRES)
MAX BEDROOMS:
Listed below are the options available to you in designing your septic
system. Choose the option that best fits your site.
5
TRENCH . £~ED W. DRAIN
DEPTH TO PIPE BOTTOM (FT.~ 4.O't.~--- 4.0 4.0
GRAVEL DEPTH (PT.) ~.0~' 0.5 .5.5
TOTAL DEPTH (FT.) 9.0~-- 4.5 7.5'
GRAVEL WIDTH (PT.) 2.5 17.0 5.0
GRAVEL LENGTH (FT.) 59.01~-~ 54.0 42.0~--
GRAVEL VOLUME '(CU.YDS.) ~9.9 ~1.5 '51.2
TANK SIZE (GALS) 1,250.0 ** 1,250.0 ** 1,~50.0 **
SOIL RATING (SQ.FT./BR) 96 96 96
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
I certify that:
1. I am {amiliar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design c~iteria of this permit.
5. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid, for a ~aximum o~ 4 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE
ELECTRICAL WORK MUST BE DO~IE BY A LICENSED ELECTRICIAN. .
APPL IC~ANT:SIGNED.~ ..................... DATE: .
ISSUED BY ..... 7 --- ' .............
~11 LS L(~G
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L St~#to Anchm'lge, Ala~<a 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
SLOPE SITE PLAN
9
10
11
13.
14,
15.
WAS GROUND WATER SL
ENCOUNTERED '0
IF YES. AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Droo
FT
COMMENT~
PERFORMED BY: /~.-/? ~' CERTIFIED BY:. ~ DATE:
72-008 {6/79)
Municipality-of Anchorage *'
DeVelopment Services Department
Building safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A $1NGL ;'FAMILY DWELLING
Parcel I.D. 020-502-10
1. GENERAL INFORMATION
COSA# ('*~'C I
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
SOUTH PARK #2; BLOCK ,5, LOT 12
4690 SOUTHPARK BLUFF DRIVE * ANCHORAGE, AK * 99516
SIMON HARRISON Day phone 929-1445
10900 STROGANOFF DRIVE * ANCHORAGE, AK * 99507
Day phone
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well [] ~ Individual On-site ·
Individual Water Storage [] t Individual Holding tank []
Community Class A Well ·. Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems
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.
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 Certificate of Qn-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.
Phone 557-6179
Address 5701 -E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 .
Engineer's Printed Name. JEFFREY A. GARNESS, P.E. Date "/'/2-3/i0
Engineer's Comments:
In conducting this evaluation, GEG, LtD. 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. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. 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.
DSD SIGNATURE
.~"'/ Approved for /~'
Disapproved.
bedrooms.
Conditional approval for
~)t;%. "'1
~2 ON-SITE
~: WATER AND
t WASTEWATER :
bedrooms, with the fllowing stipulations:
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
NiLra~e Advisory
(Rev. 11105)
Arsenic Adviso,~'
Maintenance Agreements
Supplemental Engineer's Report'
Other
Original Certificate Date: '~- ¢,~ 7"" / 0
'Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 1.96650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON:SITE SYSTEIVlS ,PPROVAL
CHECKLIST
Legal Description: SOUTHPARK #2; BLOCK ;3, LOT 12
Parcel ID: (~)~.. O -..~'"Oc~-/O
A. WELL DATA ICOMMUNITY WELL
Well type CLASS "A"
IfA, B, or C provide PWSII~' 215475
Well Log (Y/N)
completed Sanitary seal (Y/N) .Wires properly protected ~/N~.~'~ .
Date
Total depth ft. Cased to ... ft. Casing he__round) in.
FROMWELL LOG AT I~biSPECTION
Date of test ~
Static water level .ft.~ ft.
Well production ,.--~ g.p.m, g.p.m.
WATER SAMPL~ ~~h~~'~
Coliform ~ colonies/100 mi. Nitrate mg./L. Other bacteria __ colonies/100 mi.
~ ug./L. Date of sample: Collected by:
B. SEPTICIHO[DtNG TANK DATA
Tank Type/Material
SEPTIC/STEEL
Date installed
5/24/1985
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES
Date
of
pumping
Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Pumper. DENALI SEWER AND DRAIN
I'BELOW EXISTING GRADEI
Date installed 5/24/1985 Soil rating (g.p.d./ft2o~. 85 System type TRENCH.
Length 43 ft. Width 5 .ft. Gravel below pipe 5 .ft.
Total depth *9,4 ft. Eft. absorption area 430 ft2 Monitoring tube YES Depression over field NO
7/12/2010 PASS For 4 bedrooms
Date of adequacy test
Results (Pass/Fail)
Fluid depth in absorption'field before test 0 in. Water added 1200gal. New depth ~0 in.
Elapsed Time: - min. Final fluid depth 0 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.
"PumP on" level at__ in.
Datum ~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
· Septic tank/lift station on lot
Size in gallons Manhole/Access (Y/.Y~N_) f
"Pump off" level__a.~~. High water alarm level at
Cycles tested, Meets alarm& circuit requirements~
On adjacent lots
ICOMMUNITY WELLI
Absorption field on lot On adjacent lots /
Public sewer main ......~eanout
Sewer/septic service line ..~.-~--"~ Holding hank
~s. Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
in.
Building foundation 5'+ Property line 5'+ Absorption field
Water main 10'+ Water service line '10'+' Surface water.
5'+
100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line **5'+ Building foundation. 10'+
Water service line * 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
Water main 10'+
Driveway, parking/vehicle storage 10'+
F. COMMENTS
*BASED ON PROFESSIONAL LOCATES AND INSPECTION. SEE GEG LETTER .DATED 3/5/2007. **#WR970051.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date
"' T.
·
.! ;' · .....
ness.-'
COSA Fee $ L~
Date of Payment-7/
Receipt Number
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
Municipality o.f Anchorage (~'~'"'- c'2,~[ri .%.
Development Services Department ~
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Sb'eet
P.O. Box 196650
Anchorage, AK 99519-6650
wvw.muni.org/onsite
(907) 343-7904
CERTIFICATE OF 0N-SITE SYSTEIVlS ,&,PPEOVAL
FOR ,b,' SINGLE FAHILY DWELLING
Parcel I.D.
1. GENERAL INFORMATION
Expiration Date: ~ - .,~ -' ~;) ,,~
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
SOUTH PARK SUBDMSION ~2, LOT 12, BLOCK 3,
4690 SOUTH PARK BLUFF DRIVE * ANCHORAGE;, AK 99516
ERLINOA PARTRIDGE Day phone 366-6776
4690 SOUTH PARK BLUFF DRIVE * ANCHORAGE~ AK 99516
Day phone
GINA DUNDAS w,/ PRUDENTIAL Day phone 565-5500
16635 CENTERPOINT DRIVE 1{/200 * ANCHORACE~ AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well []~
Individual Water Storage
Community Class "A" Well ~
Public Water System
U
TYPE OF WASTEWATER DISPOSAL:
Individual On-site E~
Individual Holding tank
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems
Approval ara 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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 vedfy 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 CARNESS ENGINEERING CROUP. Ltd.
Address 3701 E. TUDOR ROAD. SUITE 101 * ANCHORAGE, AK 99507
Engineer's Pdnted Name JEFFREY A. GARNESS. P.E.
Phone
337-6179
Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The ropo~ted rosuits desc~bed the performance of the
system under the conditions encountered at the time of the test, end separation
distances measurad to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate dudng the year, end the water usage of the family being sewed by the systero.
These conditions are outside the control oft he evaluator of the system. Satisfactory test
results do not guarantee futura performance of the system, nor do they guarantee that
there ara no hidden defects or encroachrnents. GEG, LTD. 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 ropert 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 authorfzed, nor will it confer any I~gal tight whatsoever.
DSD SIGNATURE
~ Approved for ~L
Disapproved.
Conditional approval for
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental EngineeFs Reort
Other
Original Certificate Date:
Municipality of Anchorage
Development Se ices Department
Buildtn9 Safel~ Division
On-Site Water & Wastewater Program
4700 Bragaw Sl~eet
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(~07) 343-?g04
CERTIFICATE OF ON-SITE SYSTEH$ APPROVAL ( HECKLIST
Legal Description: SOUTH PARK SUBDIVISION ~2, LOT 12, BLOCK 5~ Parcel ID:
A. WEt. I. DATA COMMUNITY WATER
Well type "A" ff A, B, or C provide PWSID# 215475~
Date completed ~ Wires pmparly p~tact~ (Y/N) _
Total depth . Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of taat ~
Static watar level ~ .ff.
Well g.p.m, g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mi. Nitrate mgJL.
Amenic: __ ugJL. Date of sample:.
SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Tank size 1250 gal. Number of Compartments 2,
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping 2/'20/2007 Pumper,
ABSORPTION FIELD DATA
Date installed 5/24,/leS5
Length 4.5 .ff.
pBELOW EXlStlNO C, RADE]
Soil rating (g.p.d.lft2o~ 85
Width ,5 ft.
Other bacteria
Collected by:
. colonies/100 mi.
Date installed 5/24./1985
Cleanouts (Y/N) YES
High water alarm (Y/N) NO
MCDONALD'S PUMPING
Total depth ~.4 fl. Eft. absorption ama 450 ft2 Monitoring tube YES
Date of adequacy test 2/20/2007 Results (Pass/Fail) PASS
Fluid depth in absorption field before test DRY in. Water added 879 gal.
Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN
System type TRENCH
Gravel below pipe 5 ff.
Depression over field. NO
For 4 bedrooms
New depth DRY in.
600+ g.p.d.
If yes. give date -
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N) .-~-~
"Pump on" level at m. "Pump Ofl'~level at .in.
~ Meets alarm & circuit requirements?
Datum ~ Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
COMMUNITY WATER
On adjacent lots
Absorption field on lot On adjacent lots
Animal containment areas. Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Properly line 5'+ Absorption field
Water main 10'+ Water sen/ice line * 10'+ Surface water
5'4-
100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line **5' Building foundation 10"+
Water service line , * 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
Water main 10'+
Driveway, parking/vehicle atto'age
10'+
SEE AK WATER & WASTEWATER REPORT DATED 8/26/1977 IN MOA RECORDS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
D.te
**~/WR970051
COSA Fee ~
Date of Payment c~-
Receipt Number
(Rev, 11t05)
Waiver Fee $
Date of Payment
Receipt Number
GARNESS ENGINEERING GROUP, Ltd.
' · CONSULTANTS & GENERAL CONTRACTORS
March 5, 2007
Municipality of Anchorage
Development Service Department
On-Site Water 8,: Wastewater Program
4700 Bmgaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907) 343-7904
Ref.' Water Line Location for South Park Subdivision//2; Lot 12, Block 3,
To whom it may concern:
Per the request of your department the water line was located by AWWU. Per our field
measurements the water line locate marks are 10 feet from the edge of the sump at the end ofthe
drainfield and 16 feet from the cleanout at the beginning of the drainfield. If you have any
questions, please contact us at 337-6179. Thank you for your assistance.
Pre
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com
GARNESS ENGINEERING GROUP, Ltd. '~.~..""'].~
CONSULTANTS & GENERAL CONTRACTORS
ERLINOA PARTRIDGE I 336-6776 I 1 OF 1
(Rev. 01/05)
roo~
Parcel I.D. #
1.
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
FEB 26 1999
~'AUNICIPALllY OE AN~M~J~AGE
CERTIFICATE OF HEALTH AUTHORITY
-APPROVAL FOR A SINGLE FAMILY DWELLING
020-052-~3
GENERAL INFORMATION
Complete legal des~['iption
ENVIRONMENTAL SERVICES DIVISION
Southpark Subdivision Addn. ~2;
Lot 12, Block 3,
Location (site address or directions) 4690 Southpark Bluff Drive
e
Property owner
Mailing address
Neil and Libby Young
4690 Southpark Bluff Drive
Day p~one 348-8316
Anchorage, AK 99516
Lendingagency ' DayPhone
Mailiqgaddress '
Agent Barry Cassaday w/ Jack White R.E. Dayphone 563-5500
Address '3201C Street, Suite 200 Anchorager AK 99503
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
xX
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my.,
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
Engineer's signature
~ WATER & WASTEWATER
6901 DEBARR ROAD, SUITE 2B
ANCHORAUk, ,N.P~KA ~
Phone
Alaska Water &
Wastewater Consultants, Inc.
Shall be PAID s ~l~
~ p~ior to, closin~ for t~.
Eng,neering Se~,ces Prov,~.
-
6. DHHS SIGNATURE
~ A~.proved for
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The M~Jn'icipality of Anchorage Department of'Health and Human Services (DHHs) issues Health Authority
Approval Certificatasbased 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 thei?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.
DEPARTMENT OF HEALTH & HUMAN SERVICES
Municipality of Anchorage
1999
· I'~UNICit~ALtTI' OJ: ANCMoP. AG
Environmental Services Division E
825 L Street, Room 502. Anchorage, Alaska 99501 E*N(V~)~J~4~CES
Health Authority Approval Checklist
Well type IfA, B, or C, attach ADEC letter. ADEC water system number
~/N) Date completed
_ c__,o__
Date of test ~LOG~ AT INSPECTIO~. N
WATER S~P~E~ULTS:
SEPTIC/HOLDING TANK DATA
g.p.m.
Dat~ of Pumping ~//O/~
ABSORPTION FIELD DATA
El~ecav, absorption area.
Gm'vel thiclmes_~ below pipe ' ~ Total depth
Mon,~.~ T,,pe p~..~N)_~_~_~ ~.,~..ion ~,,, fi,id
Fluid depth in absorption field before test (In.); ~Y~ Immediately after/~O gal. water added (in.): ~'/
Fluid depth ~::)// (ins) Minutes later: ,~ Absorption rate = ~,~(~)(~ 'Jr" g.p.d.
Peroxide treatment (past 12 months) ('~ ~ If yes, give date - '
724)26 (Rev. 3/96)'
D. U~ON
Manhole/Access (Y/N) ~ 'Pump off level at'
E. SEPARATION DISTANCES ~d/~U~*~/~ ~ ~~
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot ~
.A~u :li°cr Pst~eflren~aJ(:; lot ~ Public sewer manhole/cteano'"'"'""~ On adjacent lots '--"~'
Se~e Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~' ~ Property line /~ '~' Absorption field
Water main/sonace line lC)* ~
!
Surtacewater/draJnage I0~ ¥'- Weliaonadjacemlota /~,"~ ¥-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~ ~- Building foundation /t~ "~ Water main/aenace line I0 ~
/
Surtace water /~)(~ ~ Driveway, parking/vehicle storage area .~' ~
· /
Curtain drain ~ Walls on adjacent lots /~:~) '~'
F
.)
72-o26 (Rev, 3~6)*
WR~ WR990016
Date Received:
Legal Description:
Engineer:
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Wa'iver Review Worksheet
PID~ 020-052-6~ HAY HA990074
Feb 26, 1999
Lot 12 Block 3 Southpark ~2
Permit
Jeff Garness, PE, Alaska Water & Wastewater Consultants, Ip~,
Applicant:
Wa%ver Requested:
property line.
6901 De Barr Road, Suite 2B~ Anchorage~ Alaska 99504
Neil& Libby Yp~ng
Lot line waiver of 5 feet from the leachfield to the north
Criteria:
o
1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Special Conditions:
Points:
3. Other:
Waiver is Granted: Waiver is NOT Granted:
List Conditions or Reasons for above:
Rec 9: 04705/1195 Amount:
Na~e of Reviewer
$ 115.00
Date Paid: Feb 26~ 1999
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2-B ~ Anchorage ~ Alaska 99504
Phone (907) 33%6179 ~ Fax (907) 338-3246
Consulting Engineers
February23,1999
Municipality of Anchorage
Department oftlealth &ttuman Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
FEB 26 1999
Municipality of Anchorage
Oept. Health & Human Services
Subject: Lot Line Waiver for Lot 12; Block 3; Southpark Subdivision #2
To whom it may concern:
Request you issue a property linc waiver on the subject property for the separation distance
between the leachfield and the north property line at five (5) feet. We do not anticipate any
adverse effects by issuance of this waiver, as the property line is adjacent to a road right-of-way,
(please sec attached asbuilt survey)
If you have any questions, p~ & contact
S° ' '/
ere~ideht [1
JAG/gd u
us at 337-6179, or 244-9612.
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTME,~JT 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
o 2_o- o z-63,
JNiCIPALITf OF ANCHORAG~
RONM[:N~'AL $~RV/CE$ DIVI2~CN
AUG 2 6 1927
RECEIVED
GENERAL INFORMATION
Complete legal description i.-O'~- I ~-j ~ ~-- ~
J
Location (site address or directions) ~-/0 c~ C
property owner ,..~a_.~ ~' {'~_..F'-.~---
Mailing address
Lending agency
Mailing address
L, ,.~-,'WT_.-~,_ Day phone ~4~'- ~c~6 ~-
~c_~c ~'~ m -~ ~ 4- - ':/-'~ '7_.
Day phone
Agent ~_~ ~'.Y--- L~~l~ ,'t.E. {~F~.,~.
Address 'l~.,--q'~ ~ ~_..,~
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Day phone '7~ - -.,2i~"Z
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
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.
5. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
.......................
Name of Firm ,,,-~zl~k-.a.~."a?~.~-~ /' Phone
Address
{7~//~,~ ~/~_ ~ Date ~/~'/~-7~'''
Engineer's signature "
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
AdditionalComments .?-~-~-' ~c~71v~_~' o~.~c,~G,.f-,~m~-,.v /__,~-.. ~
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.
Municipalib/of Anchorage /~UNICIPALW~ O~ ANCN~
DEPARTMENT OF H~L~ & HUM~ SERVIC~~°~NrA~ SE
E~mnmen~l Se~s Di~sion
825 L ~reet, R~m 502 · Anchorage, Alas~ 99501 · (~7) ~
6
.eal~ A~hori~ Approval Checklist ~ E C E i V E D
Sanita~ seal {Y/N) ~ W~,~.l;l~t~prot~ed ~/N) ~
FROMWEE~"~.~ ~ AT INSPECTION
Well production J g.p.m, g.p.m.
WATER SAM~.~: ~
C. ABSORPTION FIELD DATA
72-4)26 (Rev.
De
Size in gallons __..--
Manhole/Access (Y/N)~ "Pump off level at'
E. SEPARATION DISTANCES
SE~FROM WELL ON LOT TO:
Septic/holding tank on lot ~ On adjacent Iot~
Absorption field on lot nt lots
ur: station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation -tO Properly line IO
Water main/smvice line O~°'x~".Surface water/drainage [C~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Abso~tion field.
Wells on adjacent lots
Property line
Surface water I C)(J i "t"
Building foundation
Curtain drain
'Z.C~c3
Water rnaJn/se~ice llne U NI~J,3C/,.~ t,J
Driveway, parking/vehicle storage area ~' / ~-
Wells on adjacent lots '~3~C3/'~-
F. ENGINEER'S CERTIFICATION ,~
/ I /
I certify that I have detefr~n~ f~eld i~pectlons and review of Munic~ records t~l~lg~ are
Waiver Fee $
Date of Payment
Receipt Number
D-te of P~,ment ~
Receipt Number.
72-026 (Rev. 3/g6)'
825 "L" Street
FtickMystrom, P.O. BOX 196650 Anchorage, Alaska 99519-6650
Mayor
September 5, 1997
Jeff Garness,
Alaska Water & Wastewater Services
8471~Srookridge Drive
Anchorage, Alaska 99504
Subject: Waiver Request for Lot 12 Block 3 Southpark ~2
Waiver Request ~WR970051, , PID ;020-052-63, ~A970391
Dear Mr. Garness:
'Your request for a waiver of the required 10 foot separation
between an on-site wastewater disposal system and a lot line has
been approved. The waived distance is 5 feet from the absorption
field to the property llne.
This approval applies to the existing on-site wastewater disposal
system lot line separation only. Any future upgrade to the on-site
wastewater disposal system will require all separations be met or
another approval from this department.
If there any further questions or concerns regarding this waiver,
please call our office at 343-4744.
Sincerely,
Joseph H. Barvinrhak
On-site Services
lJw ~7
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR#~ PID% 020-052-63
Date Received: August 26, 1997
HA# ~q~k'%~ Permit
Legal Description: Lot 12 Block 3 Southpark ~2
Engineer: Jeff Garness~ P.E.~ Alaska Water & Wastewater
8471 BrookridKe Drive, Anchorage, Alaska 99504
Applicant: Jan & ERic Luttral
Waiver Requested: Lot line waiver of 5 feet from the leachfield to ~ot l~ne
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
Points:
3. Other:
Waiver is Granted: ~ Waiver is NOT Granted:
List Conditions or Reasons for above: .~- ~.,.~ o~ ~ /~!
·
Date:
By: ~e Of Reviewer
Rec #: ~03159/2559
Amount: $115.00
Date Paid: August 26, 1997
I,,~,UNICIPALITY OF ANCHORAGE
AJask Wa ter & Wastewa s. mc s mS ON
8471 Brookridge Drive ~ Anchorage ~ Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
AUG ? 6 1991
RECEIVED
August 2~, 1997
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Subject: HAA for Private Septic System. Lot 12, Bk 3, Southpark S/D.
To whom it may concern:
The subject lot has a 4 bedroom house on it which is served by a private septic system. The
results of the field investigation and adequacy tests are summarized as follows:
A. SEPTIC TANK: The existing septic tank was installed in May of 1985 (approx. 12 years
old). According to the M.O.A records, it is 1250 gallons, has two compartments and is made of
steel. Most tanks of this type typically have a structural life of approximately 20 years. No
warrantee is made regarding the future life of the septic tank.
B. SEPTIC SYSTEM ADEQUACY TEST: The drainfield is a 5 foot wide trench, which is 43
feet long, and has an effective depth of 5 feet (per the 1985 inspection report). On the day of the
inspection (8/13/97), the monitoring tube was dry. Seven-hundred & thirty-three (733) gallons
was introduced over a period of 224 minutes, and the water level rose to 16 inches. Nine minutes
later the monitoring tube was dry, indicating that all ofthe water had been absorbed. Based upon
this data, it was determined that the absorption rate of the trench exceeds 600 gallons per day, as
required for a 4 bedroom house.
NOTE: The adequacy of a septic system is #ffluenced by numerous factors, inchtding, but not
limited to, seavonal surface water #t. filtration, grotmdwater variations, septic system
maintenance Oerequency of septic tank pumphlg, usage of biological additives), condition of
drain pipe and pipe johtts (which can be damaged by seismic activi(y and deteriorate with age),
Ope of substances deposited itt septic system (cigarette butts, sanitary napMns, misc. objects),
and the amotttlI of water being introduced on a cotlt#tual bctvis. Cottseqttetttly, the restdts of this
adequacy test are only valid for the spec~c day of the test. Furthermore, because of thc, limited
nature of this investigation, it is pox~ible that there are bidden defects which may not have been
detected No warrantee is made regarding the fttture performance of this septic system
C. SEPARATION DISTANCE FROM ABSORPTION SYSTEM TO TIlE PROPERTY
LINE: According to the 1985 inspection report, the separation distance from the trench to the
property line is 10 feet. Attached is a copy ofthe most recent as-built survey, which indicates that
the sump (at the end ofthe trench) is approximately 8.5 feet from the lot line. Since the trench is
5 feet wide, the edge ofit is only about 6 feet from the lot line. To be conservative, I am going to
assume that the trench is 5 feet from the lot line. There are no wells, or septic systems, in the
vicinity which would be affected by this encroachment. We are requesting that the subject
separation distance be waived to 5 feet. The $115.00 waiver fee was submitted with this package.
D. SEPARATION DISTANCE TO WATER SERVICE LINE iS UNKNOWN: According
to the initial inspection report (5/85), it is 16 feet from the sump to the water service key box.
The inspection report did show the routing of the water line from the key box to the house. In
short, since the location of' the water line is unknown, it is not possible to determine the actual
separation distance to the septic tank and absorption field. If deemed necessary by your
department (DHtlS) we can have the water llne professionally located.
If you have any questions, please contact me at 337-6179, 244-9612, or on my digital pager at
1-800-481-1162. Thank you for your assistance.
Sineerel!~
~. Garness, P.E., M.S.
c.c. Jack White Real Estate, Clair Ramsey
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
AUG 2 6
RECEIVED
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcell. O.# O~-,-~:~ --'¢~ ~'~--" ~-~,~ HAA#
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner ~ ~--..t.4. ['t.~.'t,~,J~ Telephone: (home)
Mailing Address ~"ff'~ ¢[~ ~O ~"~ ~'~ ~/at~ ~' I-'~ ¥~'=
Business
(c) Lending Institution
Mailing ~~
(d) Real Estate Company and Agent
Address
(e) Mail the HAA to the following address: (or check here,~l~ If hold for pick up.)
List contact person and day phone number below;
V.. J 33'7-
2. TYPE OF RESIDENCE
Single-Family'S( Number of bedrooms
3. WATER SUPPLY
Individual Well i'-] 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. SEWAGE DISPOSAL
On-siteX Public r-I 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.
~2-o~s (..,. 7/ss) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional end adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
Date
Engineer's Seal
Approved for /-// bedrooms by _ Date
Approved ,~'~ Disapproved Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
Page 2 of 2
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)'
Health Authority Approval (HAA)
CHECKLIST -,FEBRUARY 1984
343-4744
Log Present (WN)
Total
Static
Casing Heig'
Electrical Wiring in Conduit
Legal Description: ~' I'~.'= ~ ~ ~
If A, B, C, D.E.C. Approved (Y/N) Y
Date Completed Yield
pth of Grouting
Pump Set At '
, Sanitary Seal on Casing (Y/N)
Depression Around
SEPARATION DISTANCES FROM
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on
To Nearest Public Sewer Line
; I Lots
; On Adjoining Lots
~blic Sewer CleanouVManhole
To Nearest Sewer Service
Water Sample Collected ~
Water Sample Te~s
B. SEPTIC/HOLDING TANK DATA·
Date Installed ~7/_.~_~t_Size ?-';~,,~ No. of Compartments
Standpipes (Y/N) Y Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) ~'
Depression over Tank (Y/N) ~ ~:) Date Last Pumped % ~;~,,S ~ ' I~'-~O
PFmping/Uaintenance Contact on.Fil.e (Y/N) ~ IA, ; for __~
Holding Tank High-Water Alarm (Y/N) ~ Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well i~J'/A To Building Foundation
To Property Line ~ "~ [ 0 I To Disposal Field,
To Water Main/Service Line ~' ~. O #
TO Stream, Pond. Lake or Major Drainage Course
Comments
Page I of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~
Width of Field ~
Type of System Design
Depth of Field '~'
Gravel Bed Thickness
n ,
Stat dp'pes Present (Y/N)
~&____, D..ate of La. st Adequacy Test
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM A[~SORPTION FIELD:
To Water-Supply Well !'~ ~ ~{~ To Property Line
To Building Foundation ~'
Lot I',J' I .A, ; On Adjoining Lots
To Water Main/Service Line '~ I. ~ t To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course i/~/~
To Driveway, Parking Area, or Vehicle Storage Area ~, #
Comments
To Existing ~or Abandoned System on
Ioo
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pum~
High Water Alarm Level at ~ Vent (Y/N) __ _
Tested for ~ Pumping Cycles during Adequacy Test.
Meets MOA Electrical Cod~ _
Comment~
**Check Permitted Bedroom Rating Against HAA Request'*
I certify that I have checked, ver. jfied, or c~ltformed to all MOA and HAA
inspectio~ / '~ ^--,/".. IJ -
Date ~-"'/1 ~ ~ ~ __ _ ~; .....
RecelptNo. ~/~? (~/g?) Receipt No. ~
Date of Payment ~-~/--p a Waiver Fee: $
Amount: $ / Date of Payment
12~ (.~. 7~) Sack Page 2 of 2
alines in effect on'the date of this
Engineer's Seal
' laf 1j' KNIEFEL ENGINEERING
8441 Miles Ct,, Anchorage AK. 99504
(907) 337-1121 · Fax (907) 338-1874
HEALTH AUTHORITY RESULTS AND ANALYSIS
Date of Testing: August 31, 1990
Legal Description: Lot 12, Block 3, Southpark
Street Address: 4690 Southpark Bluff
Number of Bedrooms: Four (4l
Wel! Flow Test: No f!ow test, Community
Results of Water Qua!ity Analysis:
No Water Quality Analysis since Community Well
Results cf Septic System Adequacy: System adeq~ate for 4 bedroom~
Total Gallons Into si/stem: 602 gallons in 65 minutes
Comments:
The house was occupied at the time of testing. The system
includes a tank and trench system. The septic system Js adequate
for a four bedroom house. The well is a com~tn'ity well approved
by ADEC. The system was tested in accordance with MOA policy ar, d
regu!a%ions in force at the time of this test.
MOA CE 90-030
DEPT. OF ENVIRONMENTAL CONSERVATION
A~CIIORAGE WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHOPJ%GE, ALASKA 99503
September 21, 1990
STEVE COWPER, GOVERNOR
563-6775
FOR: Bob Kniefel
PWSID: ~213475
According to the records on file in this office, the South Park
Subdivision, Addition ~2 Water System is in compliance with the
State of Alaska Drinking ~'~ater Regulations.
Sincerely,
VEP~ E. CFC%IG
Environmental Spe ist
VEC:pf
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
1. GENERAL INFORMATION .
(a) Legal Description (include lot, block, subdivision, section, township, range)
_~',-.,.,?H P~v. '~,.Z Bt.oc.v- 3 LOT' 1,~- ~ .,? 'T-IS ~ P.,'~,..,.,
Location (address or directions}
(b) Applicant Name C', "¢"~" L.,,.~-e$ (~o",~elephone: Home Business
Applicant Address ~o0 ~,d ~"J '~ ~ ~,,'t~ ~O~- A ,., cl~ ~IK
(c) Applicant is (check one}: Lending Institution []; Owner/builder~; Buyer []; Other [] (explain);
Lending Institution t~ L,Ln'~..~,c[ ~ ~_t,-('- ~t~l<,J.~c~Telephono
(d)
Address ~2_ ~.~ ~ ¥~ <~, "~ ~,'t ¥-~
(e) Rea~ompanya~ Agent
Address ~ · ~,
Telephone ~q'~ -
(f) Mail the HAA to the following address:
'
TYPE OF RESIDENCE
Singte-Family~.~ Multi-Family []
Number of Bedrooms z~_
Other
WATER SUPPLY
r'l Communit~ Public[]
Individual
Well
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite[~ Public[] Community[] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and Item 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 /n, E¢,~ Telephone 44 I .~c.4. O
Address I~oO YJ :~-4 . ~n¢~n,-,.~ A ~ flq '~-o t
Date ~,~ ?.i&..~,,-~ ~ e ,- ~'- j ~
DHEP APPROVAL y~ ~
Approved for ~.-~,~-~, bedrooms b
Approved ~ Disapproved Conditi n~
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely 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
MUNICIPALITY OF ANCHORAGE (MO~;
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-472O
Legal Description: ~o
O V 26 tg85'
RECEIVED
A. WELL DATA
/Nion If A, B, C, D.F-C. Approved (Y/N)
) Date Completed Yield
· .'Total Depth "~ Cased to ~ Depth of Grouting
Static Water Level ~ Pump Set At
Casing Height Above Ground-'"""~_ Sanitary Seal on Casing (Y/~
Electrical Wiring in Conduit (Y/N) "'"'"~_ Depression Around~A~head (Y/N)
Separation Distances from Well: ~ ~ '
To Septic/Holding Tank on Lot ~...'"'~___..;.~On Adjoining Lots __
To Nearest Edge of Absorption Field on Lot /.,.-~ ; On ~Lots __
To Nearest Public Sewer Line / To N~arest/ub~
CleanoutJManhole / To Nearest Sewer Service L'~
Sample Collected by~~ ;
Water
Date
Water Sample..~.t~Rl~sults~
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes ~q)
Depression over Tank (Y/~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ;ZOO "~
To Property Line 4 ~
To Water Main/~e~vi~ Line
Size /~ 5'-O No. of Compartments ~"
Air-tight Caps ~,l') Foundation Cleanout~N)
Date Last Pumped ~
~ ; lot
~' Temporary Holding Tank Permit (Y/N)
Course /o~ ~ '
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-O26(11/84)
C. ABSORPTtON FIELD DATA
,"~ Soi!s Rating in Absorption Strata
· Date Installed .5- - 2.,~ -~..~-"
Width of Field
Square Feet of Absorption Area ~.~'O
Depression over Field (Y/~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~oo
TO Building Foundation ,2.,:~
Lot ·
TO Water Main/Service Line /g yo ~7
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field ~ .'~
Depth of Field
Gravel Bed Thickness 5'"'
Standpipes Present ~N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ,'70
~'"~' To Cutbank (if present)
/
Date Installed ~ Dimensions
Size in Gal, l, ons ~ Manhole/Access(Y/N)
"Pump On Level at -"~'~ "Pump Off" Level at
High Water Alarm Level at ~'*""-~~ __.
Tested for ~ ~during Adequacy Test. Meets MOA
Electrical Codes (Y/N) ~ ~
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection·
Signed ~"~-'"~'~.__/~'~ ' Date /0=? '~ 's'
Receipt No. '"~
Date of Payment !
Amount: $ (,~
Page 2 of 2
DEPT. OF ENVIRONMENTAL CONSERVATION
437 "£" STREET. SUITE
ANCHORAGE, ALASKA g9501
BILL SHEFFIELD, GOVERNOR
Telephone:
Addre~:
274-2533
According to records on file in this office the
~ Water System is in compliance with the St~e Drinking
Water Regulations
Sincerely,