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SOUTHPARK #2 BLK 1 LT 12
Sol...I.thp rk #2 Block 1 Lot 12 #020-501-02 .ter' S• � ��+��� -s I -- /jO is6.. '• � . `° '•��� =,- I /Q 0 (Dcn ���� 0 5�D CIT 3- 221, E \ i �1` ��•r o0 7 42.85' l ro w . k _ o Q M o a o oAll Q c DID -� ID S 48'40 W 12B.86 '28» �-, r -r oo0- �Z 1 �— a�<rt� �� O CIZ 'O Ort 0- O O= / C Co X O O :: / /cu (D D- n O rD N 0 < �^ w/ O �L O (p O /� (� h N G DDD '<")I ZZZ n 0 0 n _ (D rD CL CJS - �x ti. I— 00 V VJ loo, Y �l rD �J mD ^ 5 D / (� o ago m O _ 3 O a Do c 3 H Q ID _n• �l SIDQ El IW I ti X co ti �mO O 1` 2 3.01 (n m G(n Cb [� 00 o w o O ^ b I; O UD QUO o o D <t<n G O N I I m W C I �a Z3 nw o p N �< CD c m m m (D I O rn W O (D w o cz r V ocn I N ^ r I a T N �0 710 c �. .. m W I D '< 0 G) �F - I i N of m O I O c Z� m v a n rlD 051 n C Z' X -o a 00 I`Q -� ° m ° C N m °' 00 v I P'F' W V oc O ^o CD 3 on m o I CA F+ o I O)O Q O 3� m O N W v W Z -. �. v c cn a o D 04 o nl I m77 Ql I \ rD (Dcn ���� 0 5�D CIT 3- o0 ^ a ro w _ o Q M o a o Q c DID -� ID S 48'40 W 12B.86 '28» �-, r -r oo0- �Z 1 �— a�<rt� �� W N CIZ 'O Ort 0- O O= / C Co X O O :: / /cu (D D- n O rD N 0 < _ d- 7 (o !D Q -" n _ (D rD CL CJS (D N n_ CD go 3 ^ 5 D / o ago m O _ 3 O a Do c 3 H Q ID _n• El El 0 (D (n m G(n -n [� = m c n I 03 o O ^ b UD QUO o o �a Z3 n 2 a c / m m (D (�D a (D o N v,' 0 n <rD X Z C Q /) rrDD (D O CL Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191405 PID Number: 020-501-02 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name JEBBADIAH ADKINS ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ound Site Address 15730 SOUTHPARK LOOP *ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth original grade 907-313-7966 (AGENT) 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SOUTHPARK #2; BLOCK 1, LOT 12 Fill added above original gr a Ft. Gravel length Ft. Township Range Section - Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well NSA TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1250 Gal. Surface Water 100,+ ;04 Material Number of compartments Lot Line 51+ NA HDPE 2 Foundation 10'+ LIFT STATION Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC Gal. PER CONTRACTOR Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Installer ARM SERVICES Drainfield D30341EXISTING CO/MTD3034 inspector TIM ECKLUND AND DAVID GARNESS BENCH MARK (Assumed elevation) 100.82 ft Inspectiones: 15` 9/12/2019 - Location and description nd 2 TOP OF MANHOLE 3rd - 4m - ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's tamp 60 Conditional Approval: Date o.:.. ....... ...........� .... .. .. ..................� Septic System Approved �-,, Date Z �a3 ^� e CE 7 Garne s:' �OQO �4��Pre ;'tel \ '''� l l.�i too Note: this approval does not include well permit requirements.#aecc ���D�0000 G (Rev 05/02/18) PERMIT NUMBER: PARCEL ID NUMBER: OSP191405 RECORD DRAWING 020-501-02 A B FCO 2.2 30.8 MH 13.5 34.5 ST1 17.2 35.4 DBL1 18.5 36.2 DBI -2 19.6 36.1 C01 86.5 95.5 SOUTHPARK #2;BLOCK 1,LOT 13 NEW 1250 GALLON HDPE GREER TANK RATED FOR 10' BURIAL \ SUBJECT LOT AND \ ADJACENT LOTS ARE qn \\ SERVED BY A PUBLIC \ 0 WATER SYSTEM \ V SOUTHPARK#2; \\ y BLOCK 2, LOT 6 EXISTING 4 BEDROOM HOUSE SOUTHPARK #2; BLOCK 1, LOT 11 PER MOA RECORDS \ IU \ 7- \ 4: ,A I ' DRIVEWAY \ 'e • . \ \ \ SOUTHPARK #2; \ BLOCK 2,LOT 5 u0 \ o. \ 9 \ v \ 20 \ 29c \\ GARNESS ENGINEERING GROUP - -- ---- — --- — = ENGINEERING -SALES CONSULTING =--- - =_ 3701 E. TUDOR ROAD. SUITE 101 *ANCHORAGE. AK 99507' PHONE 19071337-6179 • FAX 19071338-3246' WEBSITE: yr namessenaineenna.com PREPARED FOR: JEBEDIAH ADKINS LEGAL DESCRIPTION: SOUTH PARK #2; BLOCK 1, LOT 12 TYPE OF WORK: � SEPTIC TANK RECORD DRAWINGS PHONE NUMBER: PAGE NUMBER: 907-313-7966 (AGENT) 1 2 OF 3 APPROXIMATE LOCATION N OF EXISTING DRAINFIELD / SCALE: V=40' SOUTHPARK #2; BLOCK 1, LOT 6A Ltd DRAWN BY: D.J.G. DATE: 9/19/2019 \ ISL \`111 ®C�•�� ........... IF ........; i s .... .. . . . .................. .........� 0 r^ ' e r . Garness 8-7 A LICENSE PROF SS1 �A11's`e`w�� #AECC884 / PERMIT NUMBER: PARCEL ID NUMBER: OSP191405 RECORD DRAWING 020-501-02 FINAL GRADE = 100.19-100.40 MH ST2 2" INSULATION PER CONTRACTOR TOP OF TANK AT INTLET = 96.85 TOP OF TANK AT OUTLET = 96.90 NEW 1250 INVERT OF BUNG AT INLET= 96.05 GALLON H. D. P. E. INVERT OF BUNG AT OUTLET = 95.94 SEPTIC TANK VALIkil .41,P� ,,.... �1�♦. GARNESS ENGINEERING GROUP Ltd AV " * �'. ...., -- — — — 1 ENGINEERING o SALES :,CONSULTING - _- __ ___- _ -_ _- 10 0 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 -PHONE (907) 337.6179- FAX (907) 338-3246' WEBSITE: x gamessengineenng.com •,.,,,,,,, „ ., / PREPARED FOR: 7PHONE NUMBER: PAGE NUMBER: ♦ �•; ey Games ............. . .:• jw JEBBADIA ADKINS 907-313-7966 3 OF 3�#� _7 :r Q LEGAL DESCRIPTION: DRAWN BY: #A, SOUTHPARK#2; BLOCK 1, LOT 12 D.J.G. # 'p t •♦�♦ �� cep••• • • .�9 pNN *, TYPE OF WORK: DATE: LICENSEE1 P FES P SEPTIC TANK PROFILE 9/19/2019 #AECC884 1��►I%k11a ♦ ?/lZ//7 Tit.,ic N‘ SVALrTY MUNICIPALITY OF ANCHORAGE ,;:, -moo moment. On-Site Water&Wastewater Program .° `50, ,,, -N„e':, PO Box 196650 4700 Elmore Road a" _ Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 n �, ,t. n http://www.muni.orgionsite N. Department 44 -0;1,6 On-Site Wastewater Disposal System Permit Permit Number: OSP191405 Effective Date: 9/10/2019 Work Type: SepticTank Upgrade Expiration Date: 9/9/2020 Tax Code Number: 02050102000 Site Legal Address: SOUTHPARK#2 BLK 1 LT 12 G:3236 Site Mailing Address: 15730 SOUTHPARK LOOP, Anchorage Owner: ADKINS JEBBADIAH ALLEN & Lot Size in Sq Ft: 28078 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 2 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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 Special Provisions: ** Prior to tank installation, locate the end of the field to ensure tank-to-field separation is met. Install a cleanout to delineate the end of the field. Received By: .� Date: ,/it5 G Issued By: �I, iiiv'AIM .. _ Date: /. ,// / / RUSI4 MUNICIPALITY OF ANCHOR +• 49 6 7 9 . ,1, °• � Community Development Department \\� _ Phone: 907-343- •I Development Services - F-x: 907- 343-7997 On-Site Water & Wastewater Program Mayor Dan Sullivan 6 8 L 9 y„ On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 020-501-02 Property owner(s) JEBBADIAH ADKINS Day phone 0/ Mailing address 15730 SOUTHPARK LOOP"ANCHORAGE,AK 99516 Site address 15730 SOUTHPARK LOOP ANCHORAGE.AK 99516 Legal description (Sub'd, Block& Lot) SOUTHPARK#2; BLOCK 1, LOT 12 Legal description (Township, Section & Range) �1 Lot Size Sq.Ft. Number of Bedrooms /31l APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial ❑ Single Family (SF) Absorption Field ❑ Upgrade (w/wo ADU) Septic Tank ® Duplex (D) ❑ Renewal ❑ Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP. Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: pZa5 n±(85 Waiver Fees: Date of Payment: q PO{I'1 D of Payment: Receipt Number: of 756/b4"Receipt Number: Permit No. 05P/q ILIO Waiver No. (Rev 01(11) Asa (FARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING September 3, 2019 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for Southpark#2; Block 1, Lot 12 To whom it may concern: The subject lot is served by AWWU water and a private septic system. The existing septic tank is steel and was installed in 1987. Per MOA memorandum, a steel septic tank over 30+ years old must be inspected and/or replaced. Based upon this fact, we are proposing to replace the existing septic tank. We are proposing to decommission the existing 1250-gallon steel septic tank and install a new 1250-gallon HDPE Greer tank rated for 10' burial. See attached design drawings for tank location and other MOA requirements. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. :rely, .- e,, A e_r -ss, ".E., M.S. Presi P-n 3701 East Tudor Road. Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com GEG,Ltd.HAS AN 8 PAGE SPECIFICATION LETTER \ \ THAT PERTAINS TO THIS DESIGN.BY PROCEEDING FORWARD WITH THIS INSTALLATION,THE SUBJECT LOT AND ENGINEER,WELL DRILLER,CONTRACTOR AND ADJACENT LOTS ARE VO PROPERTY OWNER AGREE THAT THEY HAVE SERVED BY A PUBLIC \ READ THESE SPECIFICATIONS AND AGREE TO WATER SYSTEM ACCEPT THE TERMS AND CONDITIONS OUTLINED. SOUTHPARK#2; �i BLOCK 2,LOT 6 KEYBOX PER MOA RECORDS \ SOUTHPARK#2;BLOCK 1,LOT 13 \Tp \r 0 0 ,.., . !° • \ 131 • \ •. \�_,— i DRIVEWAY • • \\ r.. 4011 t • • \ I • 41 \( \/ . : • EXISTING 4 \ SOUTHPARK#2; DECK BEDROOM 1 BLOCK 2,LOT 5 \s, HOUSE \ PROPOSED 1250 GALLON HDPE \ GREER TANK RATED FOR 10'BURIAL \ APPROXIMATE LOCATION OF EXISTING SEPTIC \\ s•\ 1 \\ TANK;DECOMMISSION PER UPC \ \ • d \ \ BEGI ING OF DRAINFIELD TO BE \\ :` CO EXPOSE TO CONFIRM SEPARATION \\ oCO DISTANCE WITH SEPTIC TANK \\ %$\ \\\: \\ 10'OFFSETFROM HOUSE\ \\\ \\ 0\ \ \ \ \\ APPROXIMATE LOCATION \ OF EXISTING DRAINFIELD \ \ \ SCALE: \ 1"=40' SOUTHPARK#2:BLOCK 1,LOT 11 \ \ SOUTH PARK#2;BLOCK 1,LOT 6A r \ /^\ ♦.♦♦�\\\•\\t, 44• � � Li% ' • GARNESS ENGINEERING GROUP, Ltd • 4' '• * '• ENGINEERING•SALES•CONSULTING0 3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE.AK 99507•PHONE(907)337-6179•FAX(907)338-3246•WEBSITE:www.gamessengineering.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: .I /J= , 'y ' Gam=-S JEBB ADKINS 313-7966 (AGENT) 2 OF 2 ti,• ..••r CE-7•- r PROJECT/LEGAL DESCRIPTION: DRAWN BY: .'..1, . ••.•• SOUTHPARK#2; BLOCK 1, LOT 12 D.J.G. .. ♦ 0\, ♦• TYPE OF WORK: DATE: LICENSE,, ESS1a♦♦♦ DESIGN OF SEPTIC TANK UPGRADE _ 9/6/2019 #AECC884 ������ J S ou / '•\ ..................................\......„..„,...... ,,.....,..,,.7.r. N thPark Loo_ - _ ! _ N � N 20'4447„ W — — �/ `~ p�, — N 20.44'47,. W 80 0p• — ------ --- R-2 6g 1' ate. Uivert // o ...\ ' t Edge of Aspho/t_ =5 7 .13' 0�1�e L= 113 .0 3' _ s@tbpCk- - — Ikikil"--- ) _ _ 30" Gosline and Oroinoga Easement — q' N I .. I cfl �A ct.d~y N T •• i 1 t4 00,e N P. = yO�se o Lot 12 ,N C7 ` Zj6. \(r) O t /;, Deck X18' /N 'Q8'` 1`" 'cA NOTES Z ,O I O \ 9_ N 1. Bearings and distances are record k/ aper referenced plat unless otherwise noted. /L �^ X 2. Sufficient boundary evidence was � _ --c---- subject 20' Rear Setback Ul recovered to establish the subject parcel on the ground. 10' T & E Easement Not all controlling evidence is — — .,,. shown hereon. ;•• T S 30'26'34" E 249.23' -~�`oF At _ • fa rpoi nt Land Services , LLC .LEGE . •1s�� Monument e��,`Q►,•'• `' �-�,� SURVEYING, MAPPING, LAND PLANNING, GIS • Septic Vent * . 49TH /\ �r L• 1131 E. 76th Ave., Suite 101 Anchorage, Alaska 99518 . , ;, ,/,/, ,/,/�.� , FarpointAK.com • (907) 522-7770 • survey@farpointak.com / iG%Z • ASBUl1.T SURVEY OF: SURVEY CERTIFICATION:FARPOINT has conducted a physical Lot 12, Block 1, Southpark Subdivision, survey of the subject property,the improvements situated 0•• MICH' J.HORNE,• , thereon are within the property lines as shown. ��' ��/ Add n. No 2, Plat No 83-213 TO-v)c9�co•• LS-718 718 •lc'a��� Anchorage, Alaska EXCLUSION NOTES:It is the owners responsibility to determine PREPARED FOR: in0F COV;0441:'�� �, the existence of any easements,covenants,or restrictions which Jebb Adkins �`� fS qN" .`: WORK ORDER No. DATE: SCALE: ZONING: do not appear on the Plat used forthis survey. NOTE:Under no������� Sept. 1,2019 1"=40' R7 15730 Southpark Loop 19131 DRAWN:CHECKED: GRID No: FB BOOK/PAGE: circumstances should any data hereon be used for construction Anchorage,AK 99516 JLA MJH SW3236 J1/1 or for the establishing of property lines. 30 144n. . 6 e .‘,17-.. -- ..-9--4-14-T- — — T _T ( _ - ___ r – 41-1 1 witli 10?° , - __ - - 6 I � � , � __ __ Uzi - r \. ! r r ---•-• ve `'N .4_,,E1,3yoeri/ a \ o v irL 114.',1.*.•.0.°6#64.6..1 r 4 L-7-- Te7/ A CO - 1 • �� -1~�- \ I , —A-, % t ZIP f i I 6a:- : -- S74• ..rf r- (Ass) ‘ f 13 (Ass) ' 1` .a H N 'ti a"xa " raw w/ s•TA 4. 7. 7/ - 1a S v ?V ---.,, i5-4 4e-' - - fir a MeA/s STA TA- at 4 e0• e e (45$) . 47 ,-. r 4 Jf: / AS -- B I LT 1983 KEY BOX AND SERVICE LINE LOCATION BY SKETCH INDICATE C ;� • , NORTH '! C 3 t/ STREET eJ AL EY S ( I 0.,1 t l 31-058(Rev.10/97)Back 1 MUNICIPALITY OF ANCHORAGE DE ITMENT OF HEALTH AND HUMAN SER r- ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON—SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name I') tthAl c DISTANCES FROM TO SEPTIC TANK ABSORPTION FIELD WELL AddfeSs / 57 3G SvL.c.n+pq-12K L,�cP y57 WELL .,_. �.-.. Phones) ,9 34-5. 45'g4— Perpmit No. z v'J al4:o ':� No of Bedrooms 4 LOT LINE --'7 -Z f LEGAL DESCRIPTION Lot 1p. Block 1 Subdivision 50, ri+prhtK A9 e� FOUNDATION Township, Range. Section ^n�_��� (f iV �j W S �G 3 r �, t� 6..17i IS-BUILT DIAGRAM (Show location of well, septic system, property lines, loundahoq driveway, water bodies, etc.) TANKS t X SEPTIC ❑ HOLDING Manufacturer` n�.inKf010Am, Capacity in gallons 1?-50 *rl Material -' No. of Compartments TYPE OF SYSTEM ❑ TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade /{- FT Total depth from original grade ' 3FT 6 Ilk a G FIII added above original grade o FT Gravel depth beneath pipe / FT Gravel length 179, FT Gravel width ,7 FT Total absorption area �i C" SQ FT Distance between lines (7 FT Number of ;as Soil rating GY O SQ FT Pipe material jjlC A 6 ✓�: G Installer A4,4144 I Date Instance , �7::2 WELLS ❑ PRIVATE Idl OTHER (Identiiv) ` � Classification (A, B,C) 6;-minKfvf/ Total Depth FT Cased to FT Installer Date Installed. REMARKS: S I roc �T �G7v�q a Scale: jft'l�pf Inspections Performed by. E AL "OF Q® ®�o °1113 eo `off ®00000001111.0.9.090 ...... o �•• �® Robert D. Schilling "� °•' CE - 1411 �000e_ �a-!/Sai7S /L iS JsC eai//S/Z Date . 1 rr�sTa Udi aotl5 ot I kd=� J)" ��� te''`a certify that this inspection was performed according to all.° r �-�-� Date: ,SAL Municipal and State guidelines in effect on this date: / Health Department Approval: 72-013 (3/85) ' ~ ` P, L.3 ilh:: 5 :11- El ::T: 1", Sh H.. 1: 0- "r, !I::::: �11 1!- � E�l !F';:! E:'�� 14 ` 0.5 TOTAL DEPTH (FT.) 2.0 ** 1"0 GRAVEL WIDTH (FT.) PROTECTION DEPARTMENT (FT.) OF HEALTH AND ENVIRONMENTAL 325 L STREETv ANCHORAGE, AK 19501 1,250,C ** SOIL RATING (SQ.FT./BR) ** 150 150 264-4720 Ef PQ --- ED 1: if" !E�: �����FI: ���If- 1, � \ PERMIT ND: DATE ISSUED: APPLICANT: ADDRESS. CONTACT PHONE: LEGAL gESCRrP: LOT SIZE: MAX BEDROOMS; Listed below are system, Choose 05/01/05 ' WM C NEIL COMPANY C/O GEOLA9 1131 E 76TH 0101 ANCHORAGE, AK 99502 344-n042 SUBDIVISION: SOUTH PARK 02 SECTION: 3 TOWNSHIP: 11N 28073 (SQ.FT. OR ACRES) / 4 / the options available to the option +i that best fits p on a es s .... --..... --------- E31EZ13 DEPTH TO PIPE BOTTOM (FT.) 2"5 ** GRAVEL DEPTH (FT.) in rz 64 ` 0.5 TOTAL DEPTH (FT.) 2.0 ** 1"0 GRAVEL WIDTH (FT.) 22707 GRAVEL LENGTH (FT.) 41"0 GRAVEL VOLUME (CU.YDS,) 105.0 33,5 TANK SIZE (GALS) 2%2 1,250,C ** SOIL RATING (SQ.FT./BR) ** 150 LOT: 12 RANGE: 3W you in designing your site:: si~ in rz 64 x nii 2.0 ** 1"0 3.� 105.0 ** 2%2 1,25(),0 ** 150 BLOCK: J. your septic ** DEPT; TO PIPE BOTTOM < 3.5 FT. REDUIRES INSULATIhm ** DEPTH TO PIPE BOTTOM < 4^0 FT. MAY REQUIRE A LIFT STATION **GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNSMOT EXCEEDING 75 FT. EACH) ** TANI*,: MUJT HAVE AT LEAST TWO COMPARTMENTS _ _ _ _ _ _ _ _ _ _ ' 1 certify that: � 1. I am familiar with the requirements for nn -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 criteria o[.this permit. . 3. I will adhere to all MOA and State of Alaska requirements for the met back distances from any existing well, wastewater disposal system or p"�lic sewerage system on this or any adjacent or nearby lot. � �^ 4. I understand that this permit is valid for a maximum of 4 bedrooms a�d any enlargement will require an additional permit, IF A LIFT STATION IS INSTALLED IN Fi.EA COVERED BY MOA BUILDING CODES.- TEEN [)DES,TuEN (1) AN ELECTRICAL PEARMIT AND INSPECTION MUST BE OBTAINED; (2) AS -GUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL"104K MUST RE DONI BY LICENSED ELECTRICIAN.. ' SIGNFD t'�}-__ APPLICANT: WV1 C NE�L C-1�P�NY C/0 GE3L�3 /� � ISSUED BY DATE: ~ �/,~ _______________ ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANC�F HEALTH & I NTAL PROTECTI • +� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ON 1-1 pEO CATION PERCRC 825 L. Street, Anchorage, Alaska 99501 20J���Va 2 J 1AR7 GG r {� �7 teSOILS LOG - PERCOLATIONkESC L I'VE 1,E U �- PERFORMED FOR: Z2zr" ��i�//✓[_.� �� DATE PERFORMED: LEGAL DESCR IPTION: L©3` /.Z �LIJG,e DEPTH SLOPE SITE PLAN (FEET) I I-1 1 2 3 4 5 6 7 8 9 10 1 n/O/NrOX' 72,1.5z511 ro r 7'15 Oel)-1/ 12 13 14 15 Date ' ('y(„ '(I V lw EMENNEENNE Depth to X41 16 ,•"o Door o,o0 4; r,. Time Water Drop �o 0000ooe, 18 4 s Robert D. Schilling _ 19- _ t� CE -1411 MENOMONEE `a 20 WAS GROUND WATER S ENCOUNTERED? L O P IF YES, AT WHAT E DEPTH? ■■■■■■■■■■ Date Gross EMENNEENNE Depth to Net Time Time Water Drop MENOMONEE ■■■■■■■.■■ Reading Date Gross Net Depth to Net Time Time Water Drop i PERCOLATION RATE (minutes/inch) PERFORMED 72-008 (6/79) DATE: 7 SOIL Lo '� v • PERCOLATION "GE-OLAB SOIL LOG TEST 1131 EAST 76TH AVE. SUITE 101 ANCHORAGE, AK 99502 (907)3448042 PERCOLATION TEST BEDROOMS JOB NUMBER: pvt DATE PERFORMED: PERFORMED LEGAL DESCRIPTION: SLOPE SITE PLAN 7 8 10 — 11 12 j 2- ( 13— 7-0. 14- 15- Z 16— 0 0 17— 0 0, 18- • 19- 3 4 5 6 /5- VG''a% Ie" DEPTH (FEET) ]j 7 8 10 — 11 12 PERFORMED BY 12-009,9831 ;TH ...... .. .... 2248-E d 91" u- 4 U/�w JtA _1 , L/'//WAS GROUND WATER S ENCOUNTERED? L 0 P E IF YES, AT WHAT DEPTH? _'01 Gross Time Depth to Net i Reading Date Time Ime Water Drop PERCOLATION RATE ---.I,) 64--f (minuteslinch) TEST RUN BETWEEN FT AND FT CERTIFIED BY: DATE: E I j 2- ( 13— 7-0. 14- 15- 16— 0 0 17— 0 0, 18- • 19- 20— DEPTH (FEET) ]j PERFORMED BY 12-009,9831 ;TH ...... .. .... 2248-E d 91" u- 4 U/�w JtA _1 , L/'//WAS GROUND WATER S ENCOUNTERED? L 0 P E IF YES, AT WHAT DEPTH? _'01 Gross Time Depth to Net i Reading Date Time Ime Water Drop PERCOLATION RATE ---.I,) 64--f (minuteslinch) TEST RUN BETWEEN FT AND FT CERTIFIED BY: DATE: E I Y GE 8` ®Municipality ®f Ac®rage _._`� On-Site Water and Wastewater Program (907) 343-7904 S F E T Y Certificate of On-Site Systems Approval Parcel I.D.020-501-02 Expiration Date: 1. GENERAL INFORMATION: Complete legal description SOUTHPARK #2; BLOCK 1 LOT 12 Location (site address) 15730 SOUTH PARK LOOP *ANCHORAGE AK 99516 Current Property owner(s) JEBBADIAH ADKINS Day phone Mailing address Real Estate Agent GARY BECKER �. Day phone 907-313-7966 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex)r�� 3. NUMBER OF BEDROOMS: 4® V It lel 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: 5. STAYgMENT 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 On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineerinq Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and 0000� industry practices. The reported results describe the condition of the system/s on the date/s of the o �F X044 evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells groundwater levels uconditions, l ..T(fluctuate ilincluding olcn* workmanship), and the water usage the family utilizing the ystemThst not e conditions can and ......... , . ...... I' are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Q system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of """" "' the well or septic system. GEG makes no representation whether an alternative well or septic system A. ss:' can be installed on the property in the event either of the current systems fail to perform adequately in OQ 9. CE 795 e�G the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or Q�PrPap o\�oo party (including subsequent property purchasers) is not authorized, nor will it confer any legal right N1 Prof whatsoever. #AECC884 6. DSQ SIGNATURE )' System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, `Q�Py1Ty OF'�(r��ni�(/s `` �G Z O� J ON - with the following3tipulat SATES ru WASTER ANp m WAIFIQ PROGRAM r� Original Certificate Date: 7 �J The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other 64, Legal Description: SOUTHPARK #2; BLOCK 1, LOT 12 Parcel ID: 020-501-02 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system PUBLIC WATER A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ ji es are properly protected Caheight (above ground) in. Daf flow test forCO Stawater le t beginning of test ft. Cois B. TANK DATA Age of tank(s) NEW years Tank type/material HDPE Measured operating fluid level in septic tank N/A ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 6/2611981 ❑ ALL standpipes present per record drawing Total measured depth from grade 4.6+ ft (max) Measured depth to pipe invert from grade 3.5+ ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COVER OVER FIELD WAS DETERMINED AT SUMP COSA Checklist yellow sheet Well production at time of to gpm Water storage tan me gallons Well disi ed for coliform test? ❑ Yes ❑ No oliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance compl Age of lift station rs Lift station materi Commen Adequacy test date 9/5/19 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 1274 gal New depth 2 in Elapsed time 15 min Final fluid depth 0 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date N/A N/A E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑✓ Community Sewer Manhole/Cleanout > if No ❑ Yes if No ft es if No ft Neighboring Tank > 100' ❑ Yes if No ft Private eptic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > if No Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft ✓❑ Yes if No ft Manure/Animal Excreta Storage > 100' ❑✓ Yes if No ft ity Sewer Main > 75' ❑ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' U Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10' ✓❑ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet #AECC884 t o � v � � v v�a aoL m o. 0 r z NQ ❑ I a r -I -4-� • ti �� c p I V Z v p iz O>- 19 7 �o e O h w n] LL I a W i s o.. C O O o u :� •OZF . 1 I to cxz Z N. mlu _ wolS. o .oa N CO ,Ol r.0lr .Sg•z�i 3 ,.ZZ ap O X "t. JI P'rG��-P� , a1 bp'�'���� J w . 7s ` N tr • ( I ) C Ro pN tl� I 2 a.� sz ' r ,sa t o � v � � v v�a aoL m o. 0 r z NQ ❑ I a r -I -4-� • ti �� c p I V Z v p iz O>- 19 7 �o e O h w n] LL I a W i s o.. C O O o u :� •OZF . 1 I to cxz Z N. mlu _ wolS. o .oa N CO ,Ol r.0lr .Sg•z�i 3 ,.ZZ ap O X "t. JI P'rG��-P� , a1 bp'�'���� J w . 7s Parcel I.D. 020-501-02 pE E` Municipality of Anchorage On -Site Water and Wastewater Program <' (907) 343-7904 s ry Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date:. Complete legal description Southpark 42, Block 1, Lot 12 Location (site address) 15730 Southpark Loop Current Property owner(s) Joseph Obrochta Day phone Mailing address 15730 Southpark Loop Anchorage, AK Real Estate Agent 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 99516 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual F1 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System Public Sewer ❑ WaiverNariance request for: Received by� _� / Date: t co COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ GJ;)� " Date of Payment -/ P -;)J lS Receipt Number OLA 533G COSA # BSC�151(o 8' Z Waiver Fee $ Date of Payment _ Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance-, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE LSystem #1 Approved for � bedrooms System #2 Approved for bedrooms Disapproved Date 12/18/2015 OF At, WOO Seven f2. • f�aririorie � • • CE -8149= Conditional approval for bedrooms, with the following stipulations: By: � two = Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheet_< - ., If more than 1 septic system is on the lot: COSA Checklist # 'of 1 Structure served by this system I Certificate of.On-Site Systems Approval Checklist, Legal Description: Southpark #2, Block 1, Lot 12 Parcel ID: 020-501-02 A. WELL DATA Well type PublicIf A, B, or C provide PWSID # AWWU Well Log (YIN) Date completed Sanitary seal (YIN)— Wires properly protected (YIN) Total depth ft. Cased to ft. " Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m, 9— p.m-WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 10/1985 Tank size 1,250 ga . Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High-water alarm (Y/N) N Date of pumping 12/18/2015. Pumper A+ Homes Services C. ABSORPTION FIELD DATA 10/1985 z z 100SF/BR Shallow Trench Date installed Soil rating (g.p.d./ft or ft /bdrm) System type Length 90+ ft. Width 5 ft. Gravel below pipe 1 ft. Total de0th 4:6 ft..-. Eff. absorption area 630"kf Monitoring tube Y Depression over field N Date of adequacy test 12/18/2015 Results (Pass/Fail) PASS For 4— bedrooms Fluid depth in absorptiomfield before test 0 in. Water added 619 gal. New depth 3 in. Elapsed Time: 120 min. Final fluid depth 0n. Absorption rate >= 600+ g.p:d., No Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout` Sewer /septic service line Holding tank Animal containment areas _ Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main "10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 1200+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots/400+ F. COMMENTS Survey on File Water main 10+ Driveway, parking/vehicle storage 10+ G. ENGINEER'S CERTtMATION ,r+hPad IN I certify that l have determined through field inspections and "N V'1, review of Municipal records that the above'systems are in * iH conformance with MOA COSA guidelines in effect on this date. j Engineer's Printed Name Steven R. Pannone {even W.' annone .�,� CE -8149 Date 12/18/2015 i►`' COSA canary sheet 2-6-15.doc Municipality of anchorage ;I a �► Development Services Department =. Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 ? ,/z Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 5(D l -0a 1 �1 , l0 Parcel I.D. 020— COSA# Expiration Date: f ao %.� 1. GENERAL INFORMATION p Complete legal description SOUTH PARK ADDITION 2; BLOCK 1, LOT 12 Location (site address) 15730 SOUTHPARK LOOP *ANCHORAGE, AK Current Property owner(s) LARRY ROSS Mailing address Lending agency Mailing address Real Estate Agent Mailing address Day phone 345-7779 15730 SOUTHPARK LOOP *ANCHORAGE, AK Day phone MARIANNE GRANT W/ PRUDENTIAL Day phone 529-6602 3801 CENTERPOINT DRIVE #200 *ANCHORAGE, AK 99503 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 E 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 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 CSF !Ct!SPECT!ON BY ENGWEER As certified by my seal amxed hereto and as of the validation date shown below, I verily that my. investigation, based on procedures outlined in the Certificate of On -Site Systems .Approval Guidelines for this application, �,, bliat the �+°ice, t t� ,,/ •- r/!- to ew to disposal reeeto io la!^e cafe frrnctiona! and adequate J1/C/i�VJ !!fQ[ .11G vii-�]I(G �'v�Gc�.i .S��p,f ?ini,f/�ii VG..acv fva«.�i:,vp Jamal J�vi vl� ) , -j for the number of bedrooms and type of structure indicated herein. i further verify that Lased on the inforniation obtained fiord the Municipality of Ainchorage `'!es and from, try investigatlCn and insoectlon, the on-site water supply and/or wastewater disposa! 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. Address 3701 E. TUDOR, ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. 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. Phone 337-6179 Date ./r OF VA0 A..... r ess,- �° CE 79 3 .; � v44eyP�o o�\ o� rofessio 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulat�o,� �.F .` e -7o ``•- ,� : �IA�ER ANCA PRS -RAM NT C 0 S A Chece:iist �' rgarEir.Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report !vitrat /LrviSos yJ Other By°���l�l' 0 Original Certificate Date: (Rev. 11/05) Municipality of Anchorage • Development Services Department Building Safety Division ' On -Site Water & Wastewater Program A ` 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SOUTH PARK ADDITION 2; BLOCK 1, LOT 12 Parcel ID: 020-052-11 A. WELL DATA JAWWU WATER Well type If A, B, or C provide PWSID# Well Log (Y/N) Date completed Total depth ft. Date of test Sanitary seal (Y/N) Cased to ft. FROM WELL LOG Static water level ft. Well production g.p.m. WATER SAMPLE RES Coliform 00 ml. Nitrate Wires properly protected (Y/N' Casing height (abo round) AT INSPECTION mg./L. Collected by: ft. Ar c: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 10/85 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping' 4/26/2011 Pumper ISAACS PUMPING C. ABSORPTION FIELD DATA *BELOW ExiSTIW GRADE Date installed 10/85 Soil rating (g.p.d./Wo 2/bdr 100 System type TRENCH Length 90+ ft. Width 5 ft. Gravel below pipe 1 ft. Total depth *5.0 ft. Eff. absorption area 6302 Monitoring tube YES Depression over field NO Date of adequacy test 4/21 /11 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added 605 gal. New depth DRY in. Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) _ 4* Per ASI. NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line On adjacent On adjacent lots Holding tank JAWWU WATER manhole/cleanout Ani nment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 100'+ Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS 000�SOOp G. ENGINEER'S CERTIFICATION A=F OF . oS�4 certify that 1 have determined through field inspections and 0 (/).'49 review of Municipal records that the above systems are in"""' "" ' """"""""'� conformance with MOA COSA guidelines in effect on this Q Q date. ff A. Gar ess•- Q Engineer's Printed Name JEFFREY A. GARNESS OQ E 7 mkp� 4 Date 2L11 e y Prof essto"Go�' COSA Fee $ __ _ _ ' 1 10 Date of Payment �51 Receipt Number0115_�) (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number rINl%fm FLOOR 71 O (o-WME0) g; -\N I AssuP"No cmmm LOT 13 513 D9 a0 C. e. MINING OIL'IrWT e �aZ9� 00 y .� X22 $ 'o FpONT suKmO MTHACK \ \ . \ 7- 900 At"NO WMArK Yl REAR KMDM B@TBAOf( \ � •O ' � O ttn A° 5r EXISTING 2 HoUSE Na h \ �Y G°� LOT 11 GAS LINE & X DRAINAGE ESMT. \ (WIDTH VARIES) \ C=amLo \ Og \ 0 \ LOT 6 0 UNDER NO CIRCUMSTANCES SHOULD AN AS–BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES, THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY_ LISTED DISTANCES PREVAIL OVER SCALING_ REPRODUCTION MAY CAUSE ERRORS IN SCALE. LJ LOT smvEY SURVEY TYPE ❑ FOUNDATION AS–BUILT SYMBOLS a SET RESAR aRn•o� DRAINAGE ASPHALT ❑ FINAL STRUCTURE AS–BUILT O FOUND REBARp WOOD FENCE .,; CONCRETE ❑ PLOT PLAN ... AS–GUILT ... LVT SURVEY ... TOP6f7RAPHY 00 s ASSUMED ELEV, — METAL FENCE WOOD DECK TRI PLOT PLUITANS &c LOT SURVEYS NOTE, IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL IRE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS. SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED, WHICH 00 NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL OISTANCES ARE RECORD UNLESS OTHERWISE NOTED. Prepared by SURVEY CERTIFICATION �rr�rM�M� OF Robert E. Johns, Jr. & Assoc. .�` PLOT PLAN +� �..•.•..`� �. IAraby aartlty that 1 here phY•I.Ay frnelee P•:•• tRe 1-teren ane earonhad hraeA, me loaf 1 + •'•, Professional Land Surveyors 1700 Brink Drive. rj n teaed a, mgbhrh.d all of th. tot —amt• `j !hA Oe and to tR. Ir.t M my Ar # ANCHORAGE, ALASKA 99504 e.'a,Ae an w,e,Meep..we _ANn,A, an eMnw,nnn. ha.. arrn Air _ 4L �• 0 n,ae.urrtd t^.• And eefreet, w Scale: yf t 1 = 40 Rec. Lot S.F. Roc. Plot File No. FOUNDATION AS-9UILT M •% 1, Robert S. MINA4, Jf., he'MY wtify that 1 �•• •• • at RtnA art AI'91-11! .�r�.y of tRe Date Surveyed: 4/25/1 1 Drawn "Y RB J Checked . L p+r/erw,ae ° ..♦ ... .r.r. .... r.r ..0 leandetlen an thtA le! end nor s' ebtan.la,. bad Mfrrnetlon a. Ne.A haeett RO RT o, JR. an. tn,A ane ne enamae..,.hta arhe ar,... 4 0 At" Mh�lr. •� � • � Date Drawn: 4/26/11 orld:SW3236 W.D. 11-81 � 0 FINAL STRUCTURE AS–GUILT �: S�. •.,• •4 ,••.�• J�� LCQcI Descrlption- RoO;;fa�n�e YR^ ��°� R �ofc.........+• SOUTHPARK #2 Sat pa en d let and phot tll the ♦ p ot, dw Me.n ath..lr. ����w���� • BLOCK 1 LOT 12 . MUNICIPALITY OF ANCHORAGE} DEPARTMENT OF HEALTH & HUMAN SERVICES i Division of Environmental Services dtlh5 On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING q Parcel I.D.If �C,�-()�lq- 1\ HAA# W��3©0- ` P 3. 4. GENERAL INFORMATION Complete legal description LoT IZ BLK l SoUTHPARK 2 - Location (site address or directions) 15,730 SOUTH PARK LOOP ANCO Ak 99514o Property owner l RV 4 BETN 9055 Day phone 561- 7447 Mailing address Lending agency AK HOME MORTGAGE Day phone X61-3407 Mailing address BOX 196850 ANCH Al= 99519 Agent N A C Fic ;Pn anC6 Day phone Address 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 NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025)Ru.1/91) Front MOAM 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 FLA'LoP TECH SVCS Phone 345 - 13SS- Address Iq530 EC Ho ST A401 AK 9gS16 Engineer's signature —��~ �*�� �JG[W'� Date June 9, /993 s• •r 49 THEODORE F. MOORE ; CE - 3589 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments 0 111TIC bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-05(Ray.1/91) Back MOA421 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT 12 gck I, SoVTNPARii *2 Parcel LD A. WELL DATA Well type Log present(Y/N) Total depth Sanitary seal(Y/N) Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. ADEC water system number Date completed to FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot — Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Nitrate Driller Casing height Wires properly protected (Y/N) — AT INSPECTION MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION ;Iii 0 9 1993 g. p. m. 9 -P.M. DECEIVED On adjacent lots On adjacent lots Public sewer manhole/cleanout _Petroleum tank Other bacteria Date of sample: Collected by: DEC lei4-er ctHack—f B. SEPTIC/HOLDING TANK DATA Date installed 10/85- Tank size )2,5c) 6A L Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) y Depression (Y/N) N High water alarm (Y/N) .A• Alarm tested (Y/N) N.A Date of pumping 6 (7 193 Pumper TSace c r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot N.A. On adjacent lots N,A• Foundation % To property line 5O/ Absorption field S/ Water main/service line >257 Surface water/drainage > /o0 / 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access(Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed 10/85 / Length %D + Width On adjacent lots "Pump off" level at Cycles tested Surface water _ Soil rating loo t"ADRM Systemtype 5'WIDE DRAiAFtECD Gravel thickness Total absorption area 630 v3 P&R As 3LT Cleanouts present (Y/N) Depression over field (Y/N) Results (pass/fail) Total depth S Date of adequacy test 10 /3/93 for Peroxide treatment (pas( 12 months) (Y/N) "OKE kNDwN If yes, give date RA • SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot NA On adjacent lots N, A, Property Ii To building foundation 19 To existing or abandoned system on lot NSA On adjacent lots > 30 Cutbank W. A, Water main/service line > 29' Surface water > !Do Driveway, parking/vehicle storage area Curtain drain NONE 085E"00 E. ENGINEER'S CERTIFICATION > so' bedrooms I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. �� a•oeooa � 4i Signature t✓ A� Engineer's Name , ye -o Ao-L r Mooee aea°aaaoa Oche//•�o(/LL(�`fiy �b�>eees eeBaee�eyQ ejO� Date June /9 9, 93 4t, THEpDOfrE r. A,1e0RE ; CE -35&'9 tt �liiF Gi'eti"s �a*r ' O� HAA Fee $ / /6 Waiver Fee: $ — Date of Payment 6 3 Date of Payment Receipt Number 1 5- Receipt Number 72-026 (Rev. 3/91) Back MOA 21 WALTER J. NICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 May 25, 1993 Mr. Jim Williams S & S Engineering (907) 349-7755 SUBJECT: Lot 15, Block 3, (16221 Baugh Circle), Southpark Subdivision #1 Class "A" Public Water System, PWSID 213475 Dear Mr. Williams: 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: 1. 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. 2. The last inorganic Chemical Contaminants Sample results were submitted to this Department on May 6, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 3. The last Radioactive Contaminants Sample results were submitted to the Department on December 1, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. 4. 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.. Mr. Jim Williams May 25, 1993 Page 2 If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II 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.D.# r� ��-�{�'t� HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) G.o f 12 9/GcIT 1 SGu f4 et -k S/'D ), 2 Location (address or directions) 15730 ?affil- G.oc_-X5, (b) Property owner /I lar k4L u-Sr4 FeoCCr�lf Telephone: (home) Business 786-2750 GO Dred"rf GCnron Dl.ive e 44c 99303 Mailing Address � r /¢'16AOI-c---,7— (c) Lending Institution 4It Gsfi Telephone 766--2800 Mailing Address ` ood CCF-ecPef alno"2 01-«ey Amc4 /1k 995-03 (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here C9, if hold for pick up.) List contact person and day phone number below: erg f?oo�e 3YS-1sSS 2. TYPE OF RESIDENCE Single -Family 3. WATER SUPPLY Number of bedrooms L_ Individual Well ❑ Community N 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 CA Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Pagel 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 .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 F(af {6e %reh nr'a./ Ser'vtrvi Telephone 3 ys'-)3s5 Address l`153 6coo Sf,. .4,IC,ho�a�e Date 3 / 7 9y b1 •" ^a. t��kM1a� • ^� ���y o G'.'••�}g ••••n ineer'sSeal �HEUGUii�r. !dCC.".'c CE - 35C9 6. DHHS APPROVAL Approved for bedrooms bi�( Date Approved—Disapproved Conditional Terms of Conditional Approval _ o& 1i I CAUTION" 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. 7108) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) }��� • u Health Authority, Approval (HAA) CHECKLIST - FEBRUARY 1984 Ct-�'A'343-4744 ENVIg01.'PMENTAL SERVICES DIVISION Legal Description: A. WELL DATA 3 Well Classification c�as /� \�(�, Co� �antw If A, B, C, D.E.C. Approved (Y/N) 5' Well Log Present (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/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ;Date Water Sample Test Results Comments co no/lance crFl-eecti¢c-( B. SEPTIC/HOLDING TANK DATA Date Installed 10 /&S SizeZj SO17al No. of Compartments 2 Standpipes (Y/N) Y Air -tight Caps (Y/N) 1 Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped 3/13 /90 41K -ZkOacs f Pumping/Maintenance Contact on File (Y/N) X, A. ; for mH. Holding Tank High -Water Alarm (Y/N) M, h. Temporary Holding Tank Permit (Y/N) Al. A. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Building Foundation 7 To Property Line So' To Disposal Field �` l To Water Main/Service Line > Zc ' To Stream, Pond, Lake or Major Drainage Course > I oo, - Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata foo. !ter / ar.r Type of System Design S- wide drerrn p4to/ , Date Installed to /6,5" Length of Field 90 Width of Field 5 Depth of Field 5 Gravel Bed Thickness I helves le -.e Square Feet of Absortion Area 630 nee' as -guilt Statndpipes Present (Y/N) Y Depression over Field (Y/N) _ N Date of Last Adequacy Test 3 / /3 /9Q Results of Last Adequacy Test ff6(@e'lrra�r -6'v r Y 6 ecirooml SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well > 0001 To Property Line 2 0 To Building Foundation 19, To Existing or Abandoned System on Lot N.A. ; On Adjoining Lots > ?o ' To Water Main/Service Line ---> F -S " To Cutback (if present) N. A• To Stream, Pond, Lake, or Major Drainage Course > (00, To Driveway, Parking Area, or Vehicle Storage Area > S-0 ' Comments Sys—� jLem //�n•soat ro< w,h, 2000 9u//04s /fZo . Addrio�a //oo �' I(onr ado/toC % s tf-em du* -'n ferf w/o � nr�r�anF f(•-c�ai 6u(cfu� ",o Gr!2crnFe•(c( D. LIFT STATION hl. h. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "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 gX4etinesyq effect on the date of this inspection. r� Vin; Signed . Company F&(h- e Tec%e',r�u/ S¢vvr«r Date -5 ` r ry MOA No. 9U Receipt No. Date of Payment Amount: $ mr. "rrt `� °....;°••••°°•°............ tt Engineer's Seal Receipt No. -ve,K � Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back "Page 2 of 2 STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 FLATTOP TECHNICAL SERVICES Attn: Ted Moore March 16, 1990 PWSID: #213475 563-6775 According to the records on file in this office, the South Park Terrace Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VERA E. CRAIG Environmental Field Officer VEC:bas MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY H87-0060 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 12 Block 1 Southpark Subdivision #2 Location (address or directions) 15730 Southpark Loop Anchorage, Alaska 99516 (b) Property Owner Dan Boling Telephone: Home 345-4594 Business 274-5564 Mailing Address 15730 Southpark Loop Anchorage Alaska 99516 (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) 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 E Number of Bedrooms four (4 ) 3. WATER SUPPLY Individual Well ❑ Community ®x Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite C$x 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 (Rev 8/861 Front 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 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 Area Engineering Telephone 274-0512 Address PO Box 231182 Anchorage Alaska 99523 Date Engineer's Seal This department has received written confirmation from the engineer regarding the Conditional Approval of February 9, 1987. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipal standards and is now approved. 6. DHHS APPROVAL Approved for four (4) bedrooms by Date Approved XXXXXXXXXXX Disapproved Terms of Conditional Approval Conditional dhhs CAUTION June 26, 1987 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. Page 2 of 2 72-025 fiRev 8/861 Back MUNICIPALITY OF ANCHORAGE DEPARTML,+T OF HEALTH AND ENVIRONMENTAL PhuTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ��-colon OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1-2:7,-467 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L i 12, t3wc K i `�- o:,, -Z -t4 'DfhZY- N_ -2-- Location Location (address or directions) I573� Sow HPrfizc (-�—P .4ticif zi4co' l4K �(�516 (b) Applicant Name Dmf Telephone: Home "-? 4-S - 452 4- Business Z74- 55( - Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 0; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address Telephone 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 4— 3. WATER SUPPLY Individual Well ❑ Community �r Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 7°( 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. 72025 (11/84( 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 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 L:-�:: AJSTelephone Z -? - C', f Z Address n c i3 - -F 'L "3 t I P_ -2_- L4-t.r C N-�12- Date / - a- (51 - been .t ••, u. Gc.2i5_:�e.�(, iJ caner .'ate -sof, S j( y r•z....-�/ w r ma k/., 5 y sfe , `�l7ia ec�...•-� '% d 7� -�25.. ;T , .� j sd 7Ss'7� in 77 i y 'L�o.-k ....,.e •..c/r� Zvi- `%1�Iiu �-u.�i. � Engine .:&W oF Ai E .:....-.i..-. 6 .... ;y.A Robert D. Schilling • E CE -1411 ,• rdi E; o a���f�� 2�ov B. DHEP APPROVAL // Approved for !�% bedrooms by 'a", ' Date 411 Conditional Terms of Conditional Approval Fr 14 &r� rV Lar Pr 7-lue /i sa f ra /aYio� ri Q 1n/Ora u+t/� u c(/yaGeer 7 TU Y`Le` l4ari r F"i /cl. 7_/zz �ytCor/r/`>aov�1I f /,✓-?l! Srspu/wdlje lela�e-ee(/ ,r 17"/; LL�f�G�i upS/dpe TU a GC/, d �QfT r✓ �,,/� ��u/� sig/// 4/ %~/u' liIJU%�-C' �06tGC17i 0v2 .S'�t4 �/,CJS dhep CAUTION 63/2V�`C`Pr. ;W (a�Y Th2rt /✓Uit.L lJ�urZ 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 72-025 (11;84) t,� n r �O` MUNICIPALITY OF ANCHORAGE (MOA, HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description:�� A. WELL DATA Well Classification C -01w rutisTY &B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Total Depth Static Water Level Cased to Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Depth of Grouting - - Pump Set At Yield Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots On Adjoining Lots _ To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date Comments ajEG Gawci//�Kce /� •' 1afcc! / -Z,(-87 o71a_al-d B.SEPTI HOLDING TANK DATA Date Installed 69C -?'L �6� Size 1450 - No. of Compartments ?s Standpipes (Y/N) 1� Air -tight Caps (Y/N) Y' Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances fro Septi /Holding Tank: To Water -Supply Well Ot'wf Lc» To Building Foundation l3 To Property Line -5 To Water Main/Service Line r - Course Comments Page 1 of 2 72-026(11/84) To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Dr`L-r v7 Date Installed 0, c5 j Length of Field yo + Width of Field Depth of Field• c`7 Gravel Bed Thickness Square Feet of Absorption Area 6 3 Standpipes Present (Y/N) K Depression over Field (Y/N) Ar Date of Last Adequacy Test /Upc J Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well D✓er 2. r To Property Line Zi To Building Foundation To Existing or Abandoned System on Lot On Adjoining Lots To Water Main/Service Line — To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area A Comments 1��ra✓t� i 4i L/j &e5S1 77�C/ h.i� S/L •n�N/Jf !LJ �IaTN)/41 UY" iirG_i ✓. L7.dP l/ ��.. ./(.ilu.P/` G�Q� /U .S / .�Pr?w e.( w1'df' D. LIFT STATION A)/04 - Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at - Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA 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 /--2-7—%7 CompanMOA No. Receipt No. 0 (J 2 2 ®®®®®®® ®�� ®F AC`geS'®® Date of Payment °° ,°°°°•.,° Amount: $ Engineer's Seal Of 4 ®.. o°eeee°oe HeAeeeepioieee® Page 2 of 2 A OeRoben D. Schilling 4 CE - 1411 72-026111/841®�4 • ° eye,�°v °O° �` BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE: January 26, 1987 PWS I.D.# 213475 To Whom it May Concern: 274-2533 According to records on file in this office the SOUTHPARK TERRACE ADDITION #2 Water System is in compliance with the State Drinking Water Regulations Sincerely, James C. Allen, RS Regional Sanitarian Supervisor U C 10 u BIBVA1303Sl nooz�N a, a r 0 r mvm 93 �= oo 254 `m4«o r m c L�wE v muo c E � mES ism3 E� mY off: °mo o«C 0r� a to mq0 m � , my m oa E q ISM a v Z O f- a U w r U Q U TAI k m I O Q w w � w O ¢