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HomeMy WebLinkAboutSOUTHPARK #1 BLK 3 LT 18  . 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 PHONE [~NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION ] NO. OF BEDROOMS ~,~c~o:I Absorption area Dwelling ~/ PERMITNO, [1 [O IF HOMEMADE: ~ ~ Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity Jn gallons D Well Foundation Nearest lot line PERMIT NO.  ~ i No. of lines Length of each line Total length of lines Trench width Distance between lines ~ Length~ ~ Width ~ Depth Cdbdiameter ~t~ Cr,bOe~l ~ DISTANCE TO: Well ~OO/~ ~ OTHER APPROVED ~S"~ DATE LEGAL ~12~ ~ ~' ~ ' · ~ i' ~, MUNiCiPALiTY, OF ANCHORAGE · DEPARTMENT OF HEALTH & ENVIRONNIENTAL PROTECTION ENVIRONIVIENI'AL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~ , ~ f.~ ./ , PHONE MAILING A~DR~ LEGAL DESCRIPTION ~ ~'/--~' LOCATION ~ NO, OF BEDROOMS area PER ITNO,  Manufacturer ~ ~:~t-- Material--:~e/ No. of compartments Z Liq. ap cit i allons Inside length IWidth Liquid depth ' ~ Well Dwelling PERMIT NO. ~OZ DISTANCE TO: · --~O z ~ Manufacturer Material Liquid capacity in gallons ~ No. of lines ~ ~)/~Length'°~ yac~ )ine ~ ~ ~"'' Total lengthza:of lin~s TrenF~. / ~' ~ [' wi~t~, , ~- ...... Distance between lines ~1 ~ Material b~neath tile ~ Top of tile to finish grade ~. /~ ~ inches~ Total~,{~effectlve abso?~on~." area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest Jot line ~ DISTANCE TO: ~ ;lass Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ~ INSTALLER = ~ / X -:_,.' ' ') ' 72-013 (Rev. 3/78) PERMIT NO. DEPARTMENT OF' HEALTH RND EI"JVIRONMENTAL PROTECTION 825 "L" STREET, ANCHORRGE.. BK. 9950± 264-4720 C~b4--S T TE '~--~E~.-JE~: PERE'I Z T 8Z:0486 ) APPLICANT LOCATION LEGAL HIGHLAND DESIGN INC C/O JIM ARMSTRONG LiB B~ SO. PARK TERR. TYPE OF SOIL ABSORPTION SYSTEM SRR BOX ~16~ ANCHORRGE 99502 ~44-574~ EST. ~± LOT SIZE 999999 SQURRE FEET IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT,'"BR)= 257 ]'HE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:'EPTH= 7 LEf'~I3TH= '-:~: ]: ~3R:R%-'EL [:,EF'TH= 4 THE LENGTH DIMENSION IS THE LENGTH <IN FEET:) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTBNCE BETWEEN THE SURFRCE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET;). THE] TE:Ef-~E:H 14 Z [)TH Z".L-~. 5. E~EIC~ FEET. THE GRAVEL DEPTH IS THE MINIMUId DEPTH OF GRAVE[. BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F-:E{;-.~ L[ Z F?:E[) '--~EF'T I C: -['F~ F$ f=:.' 5 Z ZE= iC4~-30 ~3RLLE{b~'-:=. PERMIT APPLICANT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ]- [--.~ C~ < 2: ::, :[ b.~c_~:;F'E~]:'t- Z C~-~'_=. RF.-:E FtEE.~L~ ~ F-:E[:, BRCKFILLING OF' ANY SYSTEM WITHOUT FINRL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS ±E~O FEET FOR A PRIVATE WELL OR ±50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM [)ISTRNCE FROM R PRIYATE WELL TO A PRI',,,'RTE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY RPPL. Y, SPECIFICATIONS RND CONSTRUCTION DtRGRRMS ARE A'v'RILABLE TO INSURE PROPER INSTALLATION. F' E F-:i"l Z T E~-:;F' ~ F-:E'_~:; [:,EC:EE-1E:EF-: ]:i.. I CERTIFY THRT ±: I BM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE, 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE COPES. ~: I UNDERSTAND THAT 'THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN Z BEDROOMS, Y4. 0 ALASKA.eiiLIIROFlmdlTAL COI TROL $1 RuICI $, ~§in~fi~9 $ ~ui~omcml November 7, 198~ ML;NiCI?AIJI'Y OF Ai'4CI-IO'2AGL~ Department of Health and Environmental Control Services 825 L Street/Fourth Floor Anchorage, Alaska 99503 Re: South Park Addition #1, Block 3 - Lot 18 Attached are the corrected soils log and inspection report for the subject property. The syst~mwas installed in December of 1983, with Jim Green of AECS performing the inspections. Jim had logged different soils in half of the bed; changing the rating from the perc of 257 sq ft/bedroom to a visual rating of 125 sq ft/bedroom. Apparently DHEP was notified of the design change and the new soils, for a note about the redesign is attached to the 1983 permit (#g300g6); however, it appears the new soils log was not received by The bed design has sufficient absorption area for the 3 bedroom residence. Since the bed is placed in two different soils ratings, the calculation is unusual: 257 sq ft/bedroomX 1.5 (bed factor X 1.5 (1/2 # bedrooms) = 578.25 sq ft. 125 sq ft/bedroomX 1.5 (bed factor X 1.5 (1/2 # bedrooms) = 281.25 sq ft. 281.25 + 578.25 = 859.5 sq ft. required. Bed designed and instailed: 23 ft (width X 00 ft (length) = 920 sq. ft effective. The original inspection report (December 12, 1983) is in error in several places. It reflects the width as 21 feet; however~ actual spacing of pipes are 2 + 6 + 6 + 6 + 3 = 23 feet. The use of 21 feet as the width gives rise to a decreased effective absorption area, presented in the report as gOO sq ft. 1200 ~¢s! 33rd ~vcnu¢, $ui1¢ [~'~ Anchm'(l§e, los o 99503.{907) 561-5040 The calculation on the inspection report, under the remarks section, implies one bedroom established in 257 sq ft. soils and two bedrooms established in the 125 sq ft. strata. Functionally the 125 sq ft strata (closest to the septic tank) probably dissipates the effluent more effectively. Technically since the bed is established half in each strata, the design should reflect half the number of bedrooms (i.e. 1.5 bedrooms) in each strata. The inspection report states the legal as South Park Terrace, Block 3, Lot lg. The permit (#830486) reflects a legal of Lot 18, Block 3 South Park Terrace #1. Unfortunately, the legal on the soils log, used to obtain the permit, is Lot 18, Block 3, South Park. The (permit) soils test was performed December 23, 1981, and included the perc which rated the soils at 257 sq ft/bedroom. On November 2, 1984, this office remeasured the swing-ties to the standpipes for Lot 18, Block 3 South Park Terrace #1. The measurements were in agreement~ with the exception of the monitor standpipe in the bed. These appear to have been switched on the 1983 inspection report. The corrected inspection report reflects the existing system as observed and measured on November 2, 1984. Hopefully, this clarifies the discrepancies on this particular property. If this office can be of further assistance, please contact us at 561-5040. Sincerely, Larry Montgcmery t~- Engineering Technician Approved by: IVIUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST · EGA' DESCR,PT,O.: i (OOJC 2 SLOPE SITE PLAN 10 11 13- 14- 15- 16- 17- 18- 20- WASGROUNDWATER ~O S ENCOUNTERED? L O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND .-- FT MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST L~SOILS LOG [~'/<P E RCO LATIO N TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 4 5 6 ,-3 8 9 10 11 12 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS SLOPE DATE PERFORMED: /F~ -,~. -~- ~6 z) SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop .... ~ ~ I .~ PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) DATE: 72-008 (6/79] 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot i:'~; ~o6~i',.-$'; SoU'f:h Park Su~divsion 4¢~ Location (site address or directions) 4500 South Park Bluff Drive = Property owner Mailing address Lending agency Mailing address Mark Wilkerson 4500 South Park Bluff Day phone Anchoraqe, AK Day phone 345-4491 Agent Tamara K~l£y/ Haritage Re~ Estate Day phOne Address 323a "C" Street Anchorage, AK 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: 562-1222 Individual well Community well. Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. XXX 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. 72-025 (Rev, 1/91) Front MOA #21 '~tJOM s~eeu!Bue I~uo!ssojoJd eH1 u! SUO!SS!LUO JO S,IOJJ~) JOJ elq!suodseJ ~OU $! eDeJoqou¥ Jo ~l!l~d!o!un!Al eql 'penss! s! e~o!J!lJeo e eJo~eq e~ep ez~ieue Jo suo!~oedsu! ~onpuoo ~ou op SHHQ Jo see~olduJ=1 .s~ueLueJmbeJ e~els pu~ teJepeJ umlJeo/gsq~s o~ JepJo ut suo ~n~ lsu 5u puel J~eql pue setuoq lo sJaseqoJnd oi Ase~noo ~ s~ slql s@op SHHO eq/ miS~lV ~Lo el~lS @ql ul peJejsIJ~eJ JOeUiJ~U@ BUO~SSe~.oJd luepuedapu[ u8 Aq eAoqe g qdeJ§eJed u! ue^!6 suo!]~luesgJd@J eql uodn ~luo peseq selgo!J!peC) leAoAddv /qpoqlnv qiJeeH senss! (SHHO) SeO!AJeS ueuJnH pub qllBeH Jo ~uetup~deQ el~joqouv 1o Al!l~d!o!un~ eqJ. muewwoo I~uoR.!PPV :suo.~elndqs 6U!MOIIOJ eql q:J!M '$WOOJpeq JO; leAoJdd~ leUOp,!puoo 'pe^o~ddes!O 'SLUOOJp@q ~"' ~OJ peAoJddV ~ =II:IrlJ.¥NOlS SHHa ; ""'" ~.t'L5? t 'oN ~? ~) eJn~8uf~!s s,Jeeu!6u::] ~ d~ ~ ~ ' ouoqd ~ / eNla~aNlON~ S ~ S ~Ji~ ~o e~N · uoi~oedsul s!q~ jo e~Bp eq~ uo ~oejje ui suoi~lnbeJ pu8 'seouBu]pJo 'sepoo e~S pus led!o!un~ I1~ ql~ eoUe!ld~OO u! si ~e~s~s I~sods!p Je~e~e~s~ Jo/puB ~lddns J9]B~ e]~s-uo 9q~ 'uo~oedsu[ pub UO~B~SeAU~ ~ ~OJJ pUB Sgl!j ebeJoqouv Jo ~l~l~d!o~un~ eq~ ~oJj peu!e~qo uo!~8~Joju! eq~ uo peseq ~q~ ~J~JeA J~q~n~ I 'U~gJeq pe~o!pul eJn~onJ~s jo ed~ pue s~ooJpeq jo jeq~nu eq~ Joj e~enbepe pue i~uo~ounJ 'ejBs 9~ ~e~s~s lesOds!p je~e~e~s~ Jo/pu~ Aiddns Je~e~ 9~9-uo eq~ ~eq~ s~oq9 uo~oildde IeAoJddV ~poq~n~ q~i~eH s!q~ jo ~ ~Bq~ ~J~JeA I '~oleq u~oqs e~ep uo~sp!l~A eq~ ~o se puc o~eJeq pex!JJ~ lees ~ ~q pe~j~eo sV ~3~NION3 Ag NOI~O~dSNI dO '9 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /-.cT /~' /~,C ~ ,~'~?,~,-z~ 5~..~ Parcel I.D. A. WELL DATA Well type /~ Log present (Y/N). Total depth Sanitary seal (Y/N) If A~B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height ,.6 FROM WELL LOG Date of test ~.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/,~m,l~4ank on I.ot ~ Oo fO- ; On adjacent lots Absorption field on lot ~Oc~r ~ ; On adjacent lots ~ %~bwlie~ ::~w~(re~ien '. , Public sewe~°ut -- WATER SAMPLE RESULTS~~~ %~ ~ Nitrate Collecte-~'~ by--7. Other bacteria B. SEPTIC/H~OLDING TANK DATA Date installed /'~-//7--/~Z Cleanouts (~N)~.-~- High water alarm (YN~ ~ Date of pumping Tank size /2-¢0 ~/4f-L-c~'J.-t Compartments Foundation cleanout(~)'N) (('6'.,¢ Depression (Y~_~ Alarm tested (Y/N)' ~;~,~ '! SEPARATION DISTANCES FROM SEPTIC/;:CLD:::C TANK TO: On adjacentlots ~.oo'~-' Foundation Absorption field /~ / Water main/service line Well(s) on lot To property line Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION ,/~h.~/C/~ /¢~/'~ -------------------~-~'¢--~0"'- ~  _ Manufacturer .~ Size in gallons ~ Manh~ Vent (Y/N) ~evel at / "Pump off" level at High water alarm level Cycles tested Meets MOAe~ S~ DISTANCE FROM LIFT STATION TO: ~.--Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date insta,ed Length fO ~ Width Total absorption area ~'© Depression over field (Y,~ R es ult s(~[:i~a il) ,~"'/;1- 3"1/ Peroxide treatment (past 12 months) (Y/N) Soilrating /¢~'/~5'7~2~" Systemtype Gravel thickness/¢ Total depth Cleanouts present(~4) Date of adequacy test for '~/f'~-'J/'"'J If yes, give date bedrooms ;7~ ~¢~ /,¢..U~'o~-,.o/,J /~e.Oxif:~..?-' /~d AA, O, /A, /:'~-~-~'. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots ~.c.~ Surface water Curtain drain //('~(~ On adjacent lots ~.c~o '¢-- Property line To existing or abandoned system on lot /(/b Cutbank ..4/¢A.,~' /¢~j6-.-7.J~Watermain/serviceline //f~ Driveway, parking/vehicle storage area -~ E. ENGINEER'S CERTIFICATION I certify that lhave checked~v~, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signature 17034 E~4~le River Loop Road No. 204 Engineer's Name,. , ..4. HAA Fee $ / ~'(~'P' --/ · -., Date of Payment ,'~'/// Receipt Number Waiver Fee: $ Date of Payment Receipt Number WALTER J. HICKEL, GOVERNOR D~PT. 01~ ~NVJRONMENTAL ~ONSER¥/~TION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 Mr. Scott Swenor S & S Engineering May 13, 1993 (907) 349-7755 SUBJECT: Lot 18, Block 3; South Park Terrace Subdivision Class "A" Public Water System, PWSlD 213475 Dear Mr. Swenor: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on April 1, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on November 5, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. [ The last Radioactive Contaminants Sample results were submitted to the Department on December 10, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on November 6, 1991. Based on analysis of the previous VOC samples results have been satisfactory. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. Unless otherwise noted, this letter is valid for 30 days and is for the specified legal description noted above only. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. ~Sincerely' ~ Environmental Eng. Asst. II STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS PROPERTY DESCRIPTION Lot, Block & Subdivision or U.S. Survey Lot 18, Block PWSID 213475 3; South Park Terrace Subdivision, Addn. ~1 This approval does not constitute a guarantee of any kind, explicit or implied, as to the performance of the water supply and wastewater disposal systems. WATER SUPPLY A recent water sample was tested and found to meet Department of Environmental Conservation drink- ing water standards for total coliform bacteria. TitleEnvironmenta1 Date 19~3 En~. Asst. II May 12, WASTEWAT ER DISPOSAL The domestic waste~ater system was: [] inspected by the De"'~pp rtment of Environmental~onservation and found to be in compliance with applicable requir~..~8 AAC 72; / [] inspected by a Professional"F.,.ngineer/Cho certifies that the system complies with applicable re- quirements of 18 AAC 72; ~' [] installed by a Certified Instal/I,e? who c~tifies that the system compiles with applicable requirements of l8 AAC 72; or / ~ [] tested by a ProfessiOnal Engineer who certif~e~ that the performance of the system is satisfactory andthatthes,~,te'mcomp~i s ,_e w'ht themin~im~eparationdistancesspecifiedin18AAC72.' This app.~s valid for a bl single family I~ multi-% unit wi_th a total of bedrooms. 18-0404 (Rev. 8/85) DISTRIBUTION: WHITE--BANI~/LENDING INSTITUTION; CANARY--APPLICAN~ PINK--DEPARTMENT MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) (b) (c) Legal Description (include 10t, block, subdivision, section, township, range) Location (addres§ er d irebtibns) . . . ..~..~,,~ '~ ~- Lending InsbtutLog ;- . - Telephone Business (d) (e) Mailing Address Real Estate Company and Agent Address Telephone ~--7& -~.~7~ ! Mail the HAA to the following address: (or check here~[, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family~i[. Number of bedrooms 3. WATER SUPPLY Individual Well [] Community,S.. 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-site'~ 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. 72~25(Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is 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 ,"'¢~'~'""¢ Telephone Date 6. DHHS APPROVAL, Approved for ~ bedrooms by Approved ~ ~_ Disapproved Terms of Conditional Approval Conditional ~:l'JIiL'Ji The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7;88) Back Page 2 of 2 ~ MUNICIPALITY OF ANCHORAGE (MOA) (~k"%~ O~. It'lealth Authority Approval (HAA) /~.~, ~,~:"'~i_~J. xo'~-~ L\O'¢CHECKLIST- FEBRUARY 1984 ~.~ .?¢.~.~,.~¢.-,txC Legal Description: /~/~¢' ~'~ p.'¢,~?-'// ,,,Z/,,,¢,~' '~/ esent (Y/~) Date Completed Yield Cased to Dopth of Grouting _ __ ~ Pump Set At __ Casing Height Above G'7o~m~_ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N'p..: Depression Around Wellhead (Y/N) ~,,,,. SEPARATION DISTANCES FROM WELL,~..... To Septic/Holding Tank'(~n Lot- %~..~ ; On Adjoining Lots __ To Nearest Edge of Absorption Field on Lot '"'"'"-...%.. ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Pu'6fickSewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed /~-'-/Z.--~'~ Size /Z-5-a No, of Compartments Standpipesl~/N) Air-tight Caps Y~N) Foundation Cleanout~N) Depression over Tank (Y~ Date Last Pumped ~"~-~' Pumping/Maintenance Contact on File (Y/N) A'/,,4 ;for HoldiJ3g¢l~a~.~ I~,~i-",~ater Alarm (Y/N) ~'/,g Temporary Holding Tank Permit (Y/N) S FROM SEPTIC/HOLDING~ "~*" ~'* " · '. · . · ¢C~ ~ / ~ater-~l~'~.,~.~(~lJ '~,'.'- , ~ '/"- TO Building Foundation ~To Property Line /~ To Disposal Field Drainage Course 72-026 Rev. 7/88i Fronl Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field /~-¢"~;//~-,~'"~?)~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present ~N) Date of Last Adequacy Test Square Feet of Absortion Area Depression over Field (Ye Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation ~'~"' Lot ,g//4 To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~- //¢~ ~ /~ To Property Line To Existing or Abandoned System on ; On Adjoining Lots /~ 'f'- To Cutback (if present) D. LIFT STATION led "Pump On" Level at-"-'--~.~ High Water Alarm Level at "~'~'"'--~ % Tested for ~ Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ~[r~.E ~ date of this inspection. ,¢~Z-~/-~'-- Signed Date of Payment ~ -~ ~ ~ Waiver Fee: $ Amount:$ /.~¢~ ¢ O Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHOP~AGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, AK 99503 STEVE COWPER, GOVERNOR 563-6775 FOR: ALAN/AECS DATE: ~ay 24, ~989 PWSID: 21347,5 To Whom It May Concern: According to the records on file in this office, the South Park Terrace S/D Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Environmental Field Officer VEC:kk MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL ttEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ~/~ /Cz Legal Description (include lot, block, subdivision, ~section, ,township, range) (a) (b) Location (address or directions) -5>~,~7'A ~.~.~ ~Z,~,::- r~...?iu~: Applicants Name ~<~/, Applicants Address' TM ~' ' Telephone - Home Business 3~?-- ~-.~1 (c) Applicant is (check One) Lending Institution ~--~; Owner/build~r~[~ ; (d) Lending Inst'ituti9~~, Telephone Address Real Estate CO. & Agent. ~ ' ~ (e) Address Telephone , ~-- /~ (f) Mail the HAA to the following address: 2. Type of Residence Single-Family~ Number of Bedrooms Water Supply~ Individual Well~' Multi-Family~--~ Other (describe) Community~ Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewage Disposal 0nsite ~ Public ~ Community ~-~ Holding Tank ~-~ Note: If community well system, must have written confirmation from the State Department of EnMironmental Conservation attesting to the legality and status. [Page 1 of 2~] Enginenring 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 regula- tions in effect on the date of this inspection. Name of Firm ~'t ~-~ ~ ~ ~ . Telephone ~/-~f~ Address ~',? ~,,~ (~ ~. :~ , >c~ t~: .~ DHEP Approval Approved for ~-~ bedrooms ApproVedcon~d~ Disapproved Terms of ional Approval (ENGINEER SEAL) Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCRASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQULRE- MENTS. 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. (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7~-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHoRITy APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: Well Classification ¢o/4~ u~;~ ~ MUNICIPALITy OF ANCHORA~ DEPT. OF H,~ALTII & gF'IVIRONMENTAL PROTECTION NOV 1 D84 R.FC iVED If A, B, Or C, D,E.C. Approved~N) Well Log P~esent (Y/N) ~J,}~r = Date Completed Total Depth /bJ/)ot Caseu to Static Water Level AJ/J~ Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances f~om Well: To Septic/Holding Tank on Lot .-<3,//~ Yield Depth of Grouting Sanitary Seal on Casing (Y/N) Depression A~ound Wellhead (Y/N)~//f4 ; On Adjoining Lots ~ q~Oo¢"); On Adjoining Lots To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer' Line A)//¢ To Nearest Public Sewer Cleanout/Manhole /~//~ ' To Nearest Sewer Service Line on Lot Water Sample Collected By ~) ~ ; Date Water Sample Test Results -~£~/~4¢~ S~-,~- z L~rr~,C B. SEPTIC/HOLDING TANK DATA Date Installed I ~//%/~ Size 1~L%'-~-3 No. of Compartments Standpi~es~N) ' z Ai~-tight Caps ~) Foundation Cleanout~) ~p~ession ove~ Ta~ (Y~ Date ~st P~d A ) /~ .... P~ing~aintenan~ Con~act on File (Y~//~ ; for Holding Ta~ High-Water Ala~ (Y~)~/i~ ~ra~y Holdi~ Tank Permit (Y~)~/~ Sep~ation Distan~s ~ ~ptic~olding Ta~: To Water-Supply ~11 ~ ~OO ~ 1'~ To ~i].ding Foundation To ~o~rty Li~ ~ To Dis~sal Field [0 TO ~ter Main/Servi~ Line 1,~' ~ 7~" ~eY Wo~(J~5To S~e~, Pond, ~e, ~ Major ~aina~ [Page 1 of 2] Receipt Date Paidj~ Amount: 2-15-84 C. ABSORPTION FIELD DATA De Soils Rating in Absorption Strata Date Installed. /~r//~/~ Width of Field ~.~, D.) Square Feet of Absorption Area Depression over Field (__Y~.~ Results of last Adequacy Test Zzo-?r3' Type of System Design Length of Field Z~O' Depth of Field ~, ~ ' Gravel ~d Thickness , ~ ~ . ~te of ~st A~qua~ ~st ~//~ Separation Distance from Absorption Field: To Water-Supply Well ? ~OQ ~ 1.5 To P~operty Line ~ / [ To Building Foundation ~.~ ~ /,) To Existing or Abandqned System Lot A~//~- ; On Adjoining Lots > 30 ~ To Water Main/Service Line I,~ _~7' 'r(~l~e~ ~L"%0.~, TO .CutbarJ~(if present) To Stream/Pond/Lake/or Major Drainage Course z%~/ I~ To Driveway, .Parking Area, c~ Vehicle Storage Area _~% ! LIFT STATION ~ Si~ in Gallons ~ M~cess (Y~) "~mp ~" ~vel at ~ ~'~ ~f" ~vel at__ High Water Alum ~vel at ~~ Vent (Y/N~_ Tested fo~ /~i~ycles d~in~ Adequa~ Test. ~ets ~A Electrical Codes (Y/N/ Co~ts / ~ ** Check Permitted Bedroom Rating Against HAA ?equest I certify that I have checked, verified, or conforrc~d to all MOA ~ Guidelines ~in effect on the date of this inspection. Date MOA NO. [Pa~ 2 of 2] KB1/dL/s 2-15-84 DEPT. OF ENVIRONMENTAL CONSER%?kTiON ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 ·ILL .~IEFFIELD~ ~OVERNOR T~ephone: f~07) 274-2533 To Whom it May Concern: According to records on file in this office thef '~~ Water System is in compliance-with the State Drinking Water Regulations