HomeMy WebLinkAboutSOUTHPARK #2 BLK 3 LT 13 Municipality of Anchorage Page 1 of. 5
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW990406 PID Number: 020--052--62
RICHARD NEAR WastewaterSystem: [] New · Upgrade
4710 SOUTHPARK BLUFF DR. ANCH. AK [WEST/EAST] ABSORPTION FIELD [WEST/EAST]
Ph°ne:(907) 565--7550/54-5--5724 No. of Bedrooms: [] Deep Trench · Shallow Trench [] Bed E] Mound []Other
LEGAL DESCRIPTION 0.45 oP~/Sq.
15 5 SOUTHPARK #2 5-5.77/4.95-5 ~ 5.0 r~,
- - - 0
WELL; [] New.,[] Upgrade 5.0 rt 2 15' n.
.. ~. 1054 s~, rL ASTM D-5054/F-810
n. EAGLE MTN. EXC. 11/11/99- 11/12/99
~Lr ,,,. TANK
SEPARATION DISTANCES · Septic [] Holding [] S,T,E.P.
From Tank Field SteUon Tank S.wor U.. ANCHORAGE TANK 1000
Well 200'+ 200'+ - - 25% STEEL 2
sun'ac,I LIFT S~
Water 100'+ 100'+ -- --
Foundation 5'+
10'+
~'"F I
Drain - NONE KNOWN
I I
~emorks: *SEE WAIVER BENCH MARK
GARAGE CONCRETE SLAB ON
NORTH EDGE.
1 00.00
Inspections performed by:. AWWC, iNC. Dates: 1st 11/11/99
2nd 11/12/99
3rd 11/15/99
Department of Health, nd H/u~lan~Services approval .. ...
Reviewed and approved by: L./~./'"~-~/ .V.,. 7~;(5L' Date://-22-¢¢
PEBM,TSW990406NUMBER: AS -- BUILT DRAWING PAROEL020_0 2_62
..~0~~' / ~ ~PROXI~TE LOCATION
/~ / ~ N OF K~ BOXES
-~ O~ AT BEGINNIN~ OF
N~ D ELDS
~MT3 _ - 12.2 _39.6
~-; ~ ~ ~ .o~E= OLO mE.CH W*S *.~DO.~
~ ~ ~ N ' IN P~CE BECAUSE IT WAS TOO CLOSE
~ ~ - ....... T~ THE WATER LINE, ~PROXI~TELY
~AS~ WA~R & WAS~WA~R CONS~T~S, ~C.~
PHONE: (907) 337-6179/F~: (907) 338-3246
SOOTHPARK SOBDIVISION ~2; LOT 13, BLOCK 3 :
AS-BUILT DRAWING Of SEPTIC SYSTEM UPGRADE
PREP~EO FOR: PHONE NUMBER: ~O~xY'J ~E-7~
RICHARD NEAR (907) 565-7550/545-5724 '"'
~,.'"..~ .......... ";~
11/16/99I K'D'W' 1 = 30' 2 OF 3
PERMITsw990406NUMBER: AS- BUILT DRAWING
5~ /
WEST TRENCH ~ST TRENCH
~AS~ WA~R & WAS~WA~R CONS~T~S, ~C.
~REP~EO FOR: PHONE NUMBER:
RICHARD NEAR (007) 5~5- 75S0 /345-572 4
WR~ WR990094
Date Received:
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
PID# 020-052-62 HA#
11-22-99
Legal Description: Southpark Addn#2? Block 3 Lot 13
Engineer: Alaska Water & Wastewater Consultants
Permit ~ SW990406
6901 DeBarr Rd, Suite 2B, Anch6rage~ AK 99504
Applicant: Richard Near
Wa%ver Requested:
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Waiver is Granted:
List Conditions or Reasons
Waiver is NOT Granted:
for above: 5~ ~G/'~F~F..Y L~
Date:
Rec $: #0544?
Amount:
By:
$ ~.o~
Name of Reviewer
Date Paid:
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 %" Street
P.O, Box 196650 Anchorage, Alaska 99519-6650
http://www.ci.anchorage ak.us
AK Water & Wastewater Consultants, inc.
ATTN: Jeffi'ey Garness, PE
6901 De Bart Road, Suite 2B
Anchorage, AK 99504-0000
November 22, 1999
Subject: Waiver Request forSOUTHPARK ADDN 2 BLK 3 LT 13
Waiver # WR990094 Lot Line Request for Parcel ID 020-052-62
Dear Engineer:
Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater
disposal system to the lot line has been approved. The approved separation distance is 5 feet.
This waiver approval applies to the current on-site wastewater disposal system and lot line
separation only. Any future upgrade to the on-site wastewater disposal system and lot line will
require all separation distances to be met or another waiver approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office at
343-4744.
SincereJy,
Civil Engineer I!
On-Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
ON-81TE WASTEWATER DISPOSAL SYSTEM PE RMI'r I I - I / '~, <1 fl (.~
Upgrade
Date Issued: Nov 04, 1999
Expiration Date: Nov 03, 2000
Permit Number: SW990406
Legal Description: SOUTHPARKADDN 2 BLK 3 LT 13
Design Engineer: 0041 AK Water & Wastewater Consulta
Owner Name: Richard Near
Owner Address: 4710 SOUTHPARK BLUFF DRIVE
ANCHORAGE, AK 99516-4843
Parcel ID: 020-052.62
Site Address: 004710 SOUTHPARK BLUFF DR
Lot Size: 23592 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[~ Disposal Field E~ Septic'rank ~] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1, The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15,55 and 15,65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing,
Date: //"-
Date://- 4-
NOTE: Application must be filled out completely
Properly Owner Name
Mailing Address /-~"/~o
Legal Description
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
On-Site Sewer/Well Permit Application
SINGLE FAMILY DWELLING
Parcel Identification Number
Lot Brock Subdivision
LotSize '~t~h~'Acres/l~ Number of Bedrooms ~'~ ~-"~t~.~. ~"~-LA-~~%
Inspections well be conducted by: ~Approv'ed Engineering Firm [] Municipality (permit fee included)
Does your house contain any of the following: [] Hot Tub [] Swimming Pool [] Therapy Pool [] Jacuzzi [] Water Softener Unit
This application is for: [] Sewer Only [] Sewer and Well ~[Sewer Upgrade []Well Only [] Water Storage
I certify that the above information is correct. I further certify that
this application is being made for a Single Family Dwelling and
in accordance with applicable Municipal Codes.
Property Owner/We I Driller
72-012 (Rev. 4/98)*
Receipt#
Alaska Water & Wastewater Consultants, ][nc.
6901 Debarr Road, Sltite 2B ~ Anchorage ~ Alaska 99504
(907) 337-6179 N Fax (907) 338-3246
Consulting Engineers
October 26, 1999
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic System Upgrade Design for Lot 13, Block 3, Southpark Subdivision #2
To ~vhom it may concern:
The existing 3 bedroom house is served by a comnrunity water system and a private septic
system. The existing septic system consists of a 1000 gallon septic t,'mk and a deep trench type
drainfield. The existing drainfield will not pass an adequacy test and must be upgraded prior to
the sale of the house. Cue test hole was excavated west of the existing of the septic system.
Cmnments regarding the proposed design are summarized as follows:
1. SOILS: Attached is a log which shows the soil profile, and the percolation test results. The
soils below the organic layers are a GP material to a depth of 2 feet and then transitions to a
GW/SW material to a depth of 3 feet. At 3 feet there is a ML lense to a depth of 3.5 feet and then
transitions to a G,t~t~naterial to a depth of 15 feet (bottom of test hole). Groundwater was
encountered during the excavation of the test hole at 15 feet. A percolation test was performed
between the depth of 7.0 feet to 8.0 feet which had a pemolation rate of 53.3 minute/inch. It is
our opinion that due to the overall appearance of the soils, a application rate of 0.45
gallons/day/ft2 should be used.
2. TRENCIt DESIGN:
a. Percolation Rate: 53.3 minutes/inch
b. Allowable Application Rate: 0.45 gallons/day/ft2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorptio_n_~ax:a: 1000 ft2
f. Total Depth:)~f~et (~"----nax.5"~"% ~t~ _,
g. Effective Depth: 3 feet ~,
h. Width: 5 feet
i. Reduction Factor: 0.58
i. Minimum Length: 120 feet total length (2 ~ 60 feet long)
j Effective absorptiou area = 1034 ft2
OCT 1999
~NVIRONMENTAk 8~I~VICE$ DIVISION
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: As can bee seen on the attached topographical site plan, there are no slope
concerns. The trenches are to be installed parallel to slope contours
5. LOT LINE WAIVER: We request that a 5 tbot lot line waiver be granted fi'om the
proposed drainfields to the northwest lot line. We are unaware of any adverse effects on the
neighboring properties may have with the granting of this waiver.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact me at 33%6179, or 244-9612. Thank you
for your assistance.
Sincerel~
Jeffi'e3
Presid
NOTE: Attached is a site plan drawing, a design drawing, a soils log, a topographical site plan,
and a 4 page construction specification letter which are all part of the design package for this
septic system.
NOTE; ALL PROPERTIES SHOWN ARE SERVED /
..... SERVED BY A COMMUNI'P¢ WATER SYSTEM AND ............................ /-'
PRIVATE_SEPTIC SYSTEMS, __ /
¢/ L~T 24, BLOOK~D~ / S(I~OT 27. BLOBK '
THPARK #2 S UTHPARK #2 S/O
~ / ~ ~ / / o~ ~ / SYSTEM / / 1
/ ~ // ,K~/ ".~%k ~ % S~U~PARK ~2 S/D / / LOT 15, BLOCK
/ ~ . ' ~ ~'~ V 3 BEDROOM J J '
_~ ~ / /
~ / SOUTHPXRK ~2 S/D % _ /// '
__/ ¢~ / % ~
PHONE: (907) 557-6179/F~: (907)
SOUTHPARK SUBDIVISION ,2; LOT 15, BLOCK ,
SITE PLAN FOR SEPTIC SYSTEM UPGRADE ~. :,~
~REPARED
RICHARD NEAR
I
J.L.U, 1 = 100' 1 OF 2
PROPOSE DRAINFIELD UPGRADE-J
EXCAV ]~ TWO TRENCHES 'rHAT'
TRENCHES PARALLEL TO CONTOURS.
NOTE: THE CONTRACTOR SHALL. HAVE THE
NORTHWEST PROPERTY LINE FLAGGED BY
A REGISTERED LAND SURVEYOR PRIOR TO % ~--'
ALASKA. WATER AND WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAD, SUITE 20. ANCHORAGE, AK, 99504
~:GAL DESCRIPTION; PHONE: (907) ~37-6179/FAX: (907) 3~8-3246
DESIGN OF SEPTIC SYSTEM UPGRADE
RICHARD NEAR (907> 565-7550/54.5-5724
J.L.M. 1 = 30' 2 Of 2
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
6901 DEOARR ROAD, SUITE 2B * ANCHORAGE, AK. 99504 PHONE (907) 337-6179 * FAX (907) 338-3246
{SOil LOG -. PERCOLATION TEST]
LEGAL DESCRIPTION: SOUTHPARK SUBDIVISION ~2; LOT 1,3, BLOCK .3,
PERFORMED FOR: RICHARD NF. AR
DATE PERFORMED: 10/19/99 _
ORG
GP
GW/SW
ML (LENSE)
[TEST HOLE #1
SOIL CLASSIFICATIONS
ML
~ CH
OH
GH
DEPTH TO
GROUNDWATEF DATE
15' 10/19/99
13.3' 10/~1/99
DATE
10/20/99
10/20/99
READING
- PRES(
CLOCK
TIME
AKED PERC
NET TIME
(MINUTES)
-lOLL FOR 4+
WATER LEVEL
READING
-~OURS PRIOR TO
8#
NET DROP
(INCHES)
TEST.
1 6:18 ---
3 6:50 -- 6"
4 7:20 30 MIN. 5-7/16" g/16"
5 7:21 -- 6"
6 7:51 30 MIN. 5-7/16# 9/16'"
PERCOLATION RATE 53.,.3 (MIN./INCH
TEST RUN BETWEEN 7.0
COMMENTS: (//~
PERFORMED BY ALASKA WATER & WASTEWATER I,_
THIS WAS P..E. RFORMED/IN/ACCORDANCE WITH ALL ST~E[~
.DATE. DATE.
PERC. HOLE DIA. 6" (INCITES)
8.0 FT.
, CERTIFY 'tHAT
GUIDELINES IN EFFECT ON THIS
" % MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-47Z0
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE ~NEW
NAME . ~.~.~_~ [] UPGRADE
MAILING ADDRESS
LEG^L DESC, T N
LOCATION
t Absorption area
DISTANCE TO: 't' [~ ~
Liq?~ gallons IF HOMEMADE: Insi.de length
Dwelling ~/i~) ·
JWidth
NO. O.~.~EDROOMS
PERM'T2%07 ?
Liquid de. pt h
DISTANCE TO:
Well Dwelling
Material
PERMIT NO.
Liquid capacity in gallons
~ ~.~ ~ Nearest lot line ! PERMIT
DISTANCE TO: Well
NOi o'~e~ Le..tho~,n; Z Trench wid,~ ~ inches
Top of tile to finish gra Material beneath tile ~ ~es ve~s~ area
Length Width Depth . PERMIT NO.
Type of crib Crib depth ctlve absorption ~
Building foundation Nearest lot line
DISTANCE TO:
Depth Driller Distance to lot llne
Building foundation Sewer line Septic tank
DISTANCE TO:
OTHER
PIPEM~,,..4../L.~D--7_' ,~/ ~
SOl L TEST RATING
INSTALLER ~
REMARKS
DATE LEGAL
Permit
Applicant: ~,
Location:
Department
825
MUNICIPALITY OF ANCHORAGE ',otection
Health and Environmenta?
~ Street, Anchorage, AK. ~01
* * * HANDWRITTEN PERMIT * * *
WE-L--k-AND/OR ON'-'~ITE SEWER PERMIT
Mailing Address: /~ / ~, C/j mJ '~J~
,. C~[. ' Phone N~er:
..... Seepage Bedi Holding Tank:
Soil Rating(sq.ft/br) , :~/,
of the Soil Absorption System Is:
The
Legal Description: ~ ~ Z]/'~ ~C ~ ~Lot Size:
Type of Soil Absorption System Is:
Trench: ~ Drainfiela:
Maximum Number of Bedrooms: ~
The Required Size
DEPTH /~ _ LENGTH .CT/G':' GRAVEL DEPTH ~ WIDTH
The length dimension is tKg, length(in~feet) of the tren'ch or drainfield.
depth of a trench or pit ~is the distance between th~ surface of the ground and
the bottom of the excavation(in feet). There ~s no se~ width for trenches.
The gravel depth is the mi~fm~m,depth of ,grave]. between the outfall pipe and
the bottom of the excayation~n feet).
* * REQUIRED SEPTIC(HebD%~ TANK S,IZE =
Permit applicant has the responsibili~ty ~o inform
installation inspections of ~ny. wells adjacen~
of residences that the: well wJ_l~ serve.
//~r'~ GALLONS * *
this d~artmen~ during the
thi~ p~perty and the~ number
* * * TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any ~ystem w~thout final in~p'ection' a~d-approval
will be'subject to prosecutzon.
by this department
Minimum dmstance' between a~,well~ and any on-site sewages, disposal, system is 100 feet
for a private well or 150 [o 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well ~o a private sewer line
is 25 feet and to a community sewer line ms 75 feet.'~ Well logs are%required
and must be returned to this department.within 30 ~a'~s of th¢,wel~ c~mpletion.
Other requirements may apply. Specifications,,~n~onstruction' diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES D~CEMBER 31] 1 9_8 3 *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipa%:ity of Anchorage.
(2) I will ~nstall the system in accordance with codes.
(3) I understand that the onrsi[e sewer system may require enlargement if
the resid/~nce .is remodeled-to include more t~t 3 bedrooms.
"- /3
Applicant D ' '>/ ~
SWP/024(1/81) ,,
,L-
ALINICIPAL)TY OF ANCHORAGE
DEPARTM£NTOF HEALTH AND£NVIRONM£NTAL PRO~EC%ION
......................... SOIL~ 1.:OG ;:-PERCOLATION TEST --
2
3
' e':
•
• t Municipality of Anchorage °4 TG =8==`,
On-Site Water and Wastewater Program < 'jai
(907) 343-7904 s .1 F E -r
ge - t SSkkc &-
Certificate of On-Site Systems Approval
Parcel I.D. 020-052-62 Expiration Date: 114-2-(r- I 7
1. GENERAL INFORMATION:
Complete legal description Southpark#2; Block 3, Lot 13
Location (site address) 4710 Southpark Bluff Dr.
Current Property owner(s) Paula Inman Day phone 306-2885
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage El Holding Tank ❑
Community Class Well ❑ Community El
Public Water System ® Public Sewer El
WaiverNariance request for: Distance:
Received by: Date: �l�f q-
COSA to be relea to the e sneer,unless otherwise requested by the engineer.
COSA Fee $ 5 6Waiver Fee $
Date of Payment z/ 1 Date of Payment
Receipt Number e)S 3 7 6 Receipt Number
COSA# CSC'_ 1 c 10 6/ 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.
Name of Firm: Garness Engineering 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: 1f'1411 q
L 1
Qaoo�pp�
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o
OF A4, op%
in accordance with the guidelines and regulations established by the Municipality of Anchorage and .�,
industry practices. The reported results describe the condition of the system/s on the date/s of the �4 P.•' il_ ''):1--001n1
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or "'� U
encroachments may exist that were not identified during the evaluation. The operational life of all wells 9TH. I, \ •-7 Op
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, ' t
groundwater levels (that may fluctuate during the year), quality of construction (materials and , : 1
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and h
are outside the control of GEG. Satisfactorytest results do notguarantee futureperformance of the O Q
V ••.Je r; • A. G.rness;•
system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of / 0 •E_'•5 , 4/
the well or septic system. GEG makes no representation whether an alternative well or septic system 9 v. ' c-4
can be installed on the property in the event either of the current systems fail to perform adequately in Dafe,, '•L L, .F7c,,/
the future. The content of this report is for the sole benefit of the person/party that retained GEG to Q4 �Professlor,°\Q
perform the evaluation. Reliance upon the information provided in this report by any other person or �4a§::5QQ
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
7' System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the follQ '1'g stipulation s,:s,
J 0
ON-SjTE -i•
WMERAND
•m WAsrr;��,Ar
PROGRAM ER o
y
L�
By ...- �' t -( I Original Certificate Date: `-t f�� ! 17
l
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
COSA blue sheet_10.10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Southpark #2; Block 3, Lot 13 Parcel ID: 020-052-62
A. WELL DATA AWWU
Well type If A. B. or C provide PWSID# Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N
Total depth ft. Cased to ft. Casing height (abo - •round) in.
FROM WELL LOG AT I • CTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESU :
Coliform colonies/100 ml. Nitrate mg./L. Collected by:
• _-nic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed_ 11/11-13/1999
Tank size 1000 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 4/11/2017 Pumper A+ Home Services
East
C. ABSORPTION FIELD DATA ...Below Existing Grade West
Date installed 11/11-131999 Soil rating kp.d. r ft/bdrm)0.45 System type Shallow Trench
60
Length 60 ft. Width 5 ft. Gravel below pipe 3 ft.
*8+
Total depth *7+ ft. Eff. absorption area 1034 ft" Monitoring tube Yes Depression over field NO
Date of adequacy test 4/21/2017 Results (Pass/Fail) Pass For 3 bedrooms
0 689 5
Fluid depth in absorption field before test 24 in. Water added 455 gal. New depth 30 in.
225 2
Elapsed Time: 130 min. Final fluid depth 29 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date —
AWWU
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 & C -•i requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM 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/sept -rvice line Holding tank
• al containment 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 * Surface water 100'+
Wells on adjacent lots 100'+ PVT & 200'+ PUBLIC
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line **5. Building foundation 10'+ Water main 10'+
Water service line * Surface water 100'+ Driveway, parking/vehicle storage 0'
Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PVT & 200'+ PUBLIC
F. COMMENTS
*NOT VERIFIED, BUT 10'+ SEPARATION PER 1999 WATER LINE LOCATION PROVIDED BY CONTRACTOR
**WR#990094
OF ♦
G. ENGINEER'S CERTIFICATION ..... • ♦♦j
1 certify that I have determined through field inspections and *:• 4' *
�� �� • •
review of Municipal records that the above systems are in j.: • •
conformance with MOA COSA guidelines in effect on this r � • •
date. ♦ f - • ness +.k
Engineer's Printed Name JEFFREY k GARNESS 0.1) ...•••. E��SL 1
Date I;��f 1 ♦♦' Q •.S �� •
1
LICENSE x.11. i,•r+ •
#AECC884
(Rev.10/12112)
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. Ct
CERTIFICATE OF HEALTH AUTFIORI'TY
APPROVAL FOR A SINGLE FAMILY DWEI. LING
o2o-o52-6 AA# 05 ¢L¢
GENERAL INFORMATION
Complete'legal description
Lot 13; Block'3; Southpark Subdivision #2
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailin. g address
4710 Southpark Drive
4710 Southpark Bluff Drive
A~choraget Alaska
Dayp~one _565-7550
Anchoraqe, AK 99516
Day phone
Agent
Address
Ken McKean/Remax Properties
Day phone 257-0128
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDFIOOMS: 3
TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well xx
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
XX
Individual on-site
Holding tank '
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Re¥.1/91) Front MOA#21
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
Name of Firm ~to~t~ ~t~nts, I~. Phone
/ ~9~/~B~r ~d, ~uite 2B
Address . ///~ / ' ~a///'" 9L504 /
Engineers signature Q. ~~~
Wastewater Consultan¢~ Inc.
Shall be PAID $ ~~
mt,
or prior to, closing for the
· Engineering Services Provided.
DHHS SIGNATURE
'~ Approved for ,~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with tffe following stipulations:
Additional Comments
Date
The Municipality of Anbhorage 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 DH HS does this as a courtesy to purchasers of homes
and their lending institutions in orderto 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.
r t: CI: I v l::b
Mu nicipality of Anchorage NOV l '?
DEPARTMENT OF HEALTH & HUMAN SERVICE~uN~c~P×UrY
Environmental Services Division ENVIRONMENTAL SERVICES
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-47zt,~
Health Authority Approval Checklist
Lega Description: SOUTHPARK S/~2, LOT 13, BLOCK 3, Parcel I.D.:
020-052-62
A. WELL DATA
We type CLAS.~ "A" If A, B, or C, attach ADEC letter. ADEC water system numoer 21,3475
Log present (Y/N) Date completed
Total depth Cased to_._~ .~_.----~"-'-~as~ng height (aeove ground)
Sanitary s_..o_aLCY4~-~'~---"--' Wires properly protected (Y/N'}
FROM WELL LOG
AT INSPECTION
Date of test
Static water level .~/" ,'
Wel productior
WATER SAMPLE RESULTS:
g. D.rT
Coliform Nitrate Other bacteria
Date of sample:
Collected Dy:
B. SEPTIC/HOLDING TANK DATA
Date installed ~11 - 12/99_ Tank size 1000 Number of Corr, oarrments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Deoression (Y/NI NO High water alarm (Y/N) N/A
Date of Pumeing NEW Pumper
C. ABSORPTION FIELD DATA
Date nstalled 11/11-12/'99 _ Soil rating (g.p.d./ft2 or fl~/hdrm} _- 0,45 _ System type SHALl_OW TRENCH
Length1_20' (2 ~) 60')Nidth
5' Gravel thickness De,ow p~pe__ 3' Total depth 8'-8,75'
Effective aDsorotion area 1034 SO,IT, Monitoring Tube Dresent (Y/N) YES Depression over field (Y/N) NO
Date of adeauacy rest NEW
Results (Pass/Faill - For bedrooms
Fluid death in absorption field befere tes~ (in,); - Immediately after gal. water added (in.): _19.5"
Fluid depth (ins) Minutes later: - Absorption rate = - .g.p.d.
Peroxide treatment (past 12 rnonths) fY/N)
-- If yes, give date
72-026 [Rev. 3/96)'
D, LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Size in gallo~~
"Pum~ "Pump off" level at*
*Datum
E. SEPARATION DISTANCES
Septic/holding tank on lot
Absorption field on lot
Public sewer main
SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY WATE~
On adjacent lots ~
~nt lots
~'~'~Public sewer manhole/cleanout
S~ Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ,5'+ Property line 5'+ Absorption field
51
Water main/service line 10' Surface water/drainage 100'+ Wells on adjacent lots
200'4-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '5'
Building foundation
1 O' Water main/service line
10'+
Surface water 100'+
Driveway, parking/vehicle storage area
2'+
Curtain drain
N~NF KNOWN
Wells on adjacent lots
F. ENGINEER'S CERTIFICATION , /~
I certify that ~'~et~n~;
in conform~
Signature -.....
Engineer's Name' ," J I
Date ~
*SEE WAIVER LETrER
td inspections and review of Municipal reco
nos in effect on this date.
HAA Fee $_
Date of Payment
Receipt Number
72-026 (Rev. 3/~6)
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.G. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ~'"~C~Ch - ¢h~,.q -In::::), HAA# I'~C~ q ~)--~C'~L'/
1. GENERAL INFORMATION
Complete legal description
Lot 13~ Block 3~ Sou~hpark Subdivision Addition
Location (site address or directions) 4710 Southpark Bluff Drive, Anchorage, Alaska
Property owner
Mailing address
Lending agency
Mailing address
Dr. and Mrs. Birch
Day phone.
4710 Southpark Bluff Drive, Anchorage, Alaska
345-5453 hm
561-~F¢00 wk
Day phone
',Agent Lori Gibbons & Mik~ Kelly/VISTA REAL ESTATEDay phone. 562-6464
Address 300~ C ~o~; A~n~g~ A£z~;'a 9q503
Unless otherwise requested, HAA willbe held for pickup.
NUMBER OF BEr)ROOMS:
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:
XXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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 s & $ ENGINEERING Phone _
17034 Eagle River Loop Road No, 204
Address EagJe p. iver, Alaska 99577
Engineer's signature Date
DHHS SIGNATURE ..
~_ Approved for //~ edrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Date
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.
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHOFIITY APPROVAl. CHECKLIST
Legal Description:~OT /%,, ~LJC~. ...~o14-r,uD¢4~ ApD?.,2 Parcel I.D.
A. WELL DATA
Well type ~..(J,4/14/lcf/vFf?
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
/u//~ Date completed ////'il Driller
~ .Cased to ~/,,~ Casing height_
/~J/~ Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELl. LOG
- g.p.m.
.z
AT INSPECTION ~, _O
g.p.m,~ ~ m-
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
~O0 "~
,-'XO 0 '¢-
; On adjacent lots /L//'~
; On adjacent lots A/'/~
Public sewer manhole/cieanout /V/'~
Petroleum tank /'¢'/~
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed __ /0 -~-/- ~ ~' _Tank size__ /~f~(~ ~¢~- _Compartments_
Cleanouts ~/N) T-~ Foundation cleanout ~/N) ~,~r g..~E, Depressio~ (Y/~))
High water alarm (Y/~ /U/,4 Alarm tested (Y/~_}
Date of pumpir~g ~ - ~.~- ~' ~-~ Pumper ,~
SEPARATION DISTANCES FROM SEPTIC/~TANK TO:
Well (s) on lot A.//~ .On adjacent lots
To property line_ ~O r.p _Absorption field_
Surface water/drainage /(¢0 -/-
Foundation
Water main/service line__
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
Date installed % Manufacturer
Size in gallons ~ Manhole/Access
Vent(Y/N) "P~at _ ~u 'mp off' level at
' ~ Cycles tested
High water alarm level
Meets MOA electrical codes (Y/N) .-~
SEPARATION DISTANC~E.FR~OM LIFT STATION TO:
Well on lot J On adjacent lots
D. ABSORPTION FIELD DATA
Date installed
Length .~
Total absorption area
Depression over field (Y/Q)
Results
Width
Peroxide treatment (past 12 months) (Y/N)
Soil rating /8? S/=/~/7. System type
Gravel thickness _ Total depth
Cleanouts present (~/N) ._~t~p (~
Date of adequacy test
for .~ ~'"L
~,u~ If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots ¢'/0.00 ¢/- Property line
~L.0 ~4- To existing or abandoned system on
Cutbank /(~d '¢- Water main/service line
/'00 '-h Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or c~nformed to all MoA and HAA
of this inspection,
Signature
Engineer's Name
Date
$ & $ ENGINEERING
17034 Eagle River Loop Roacl NO. 204
Date of Payment
Receipt Number
72-026 (Rev. 3/91 ) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCFIORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
September 3, '1992
WALTER J. HICKEL, G~OVE'RNOR
(907) 349-7755
Jim Williams
S & S Engineers
SUBJECT: South Park Terrace
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:
The Fast satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on .August 10, 1,99~2. 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 15, 1991. This does meet the provisions
of 18 AAC 80.200(a) State Drinking Water Regulations.
The last Radioactive Contaminants Sample results were submitted to the
Department on October 12, 1988. This does meet the provisions of 18 AAC
80.200(a), State Drinking Water Regulations.
The last Organic Chemical Contaminants/Volatile Organic Chemicals were
submitted to this Department on November 6, 1991. 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 Water Regulations.
If you have any questions on the above information, please do not hesitate to contact this
office at 34.9-7755.
KKK/cf
Sincerely,
Keven K. Kleweno
District Engineer
DEPq[~OF ENVIRONMENTAL CONSERVATION
ANCHORA'~GI~ DISTRICT OFFICE
3601 C STREET, SUIT[-' 322
ANCHORAGE, x~t~Sl~ 99503
October 25, 1991
FOR: S & S Engineering
'\
WALTER J. HICKEL, G~OVERNOR
563-6775
PWSID #213475
My review of the records on
Subdivision Class "A" Public Water
18 AAC 80.200, State of Alaska
this office reveals that the South Park Terrace
is in compliance with the provisions of
Water Regulations.
Sincerely,
Byron Floys
Environmental Engineer
MUNICIPALITY OF ANCHORAGE
DMSION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION .FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
].. Gene~,al Info~l~tion Application Date ~/~/._/~..
(a) Legal Desc~iption)(include.,lot, b~lo~, subdivision, section, tc~;nship, range)
Location (a/ddazess or dkections)
/ / ,"/? £' --:?'
(b) Applicants Nar0e /-/"</?:;~, /,(?/:,/(.,'..
/
Applicants Address .-.'
(c)Applicant is ( heck o._9_~) Lendlng Institution ~; Own;er/builder
Buyer ~; Other ~ (explain);
. ///:,,,. ,:.../, /~
(d) Lending Institution//'/I' /f : :~_~" / : ~.?(~'(. Telephone
Telephone z,, ~ ':' ' .-' ,.
(e)
Real Estate Co. & Agent
Address
~elephone
2o Type of Resideno~
Single-Family ~
Numbe~ of Redro~s
3 o Wate~ Su_pp_~
Individual Well
Multi-Family
O~e~ (~s~i~)
Conmunity ~ Public L~
Note: If corarunity well system, must have %~itten confirmation frc~ the State
Department of Envirorarental Conservation attesting to the legality and status°
Is the well adequate fo= the number of bedrocks specified in this HAA~Y/~)
4. Sewage Dis._f~sal
O~site~ Public F---[ Community ~-~ Holding Tark F-~
Is the wastewate~ disposal system adequate for the taung~r of bedrocras . )
[Page 1 of 2]
2-15-84
5o ~ Firm Providinq Inspections, Tests, Data and Information
I c~rtify that I have c~cked~ verified, or conformed to all MOA HAA Guidelines in
effect on %he date of this inspection°
Nar~ of Firm ~' ~/ __
Add~ess~~tC/Q
Signed by
Date
(ENGINEER SEAL)
DHEP
6. app_r ova ±
, -J"- '~ ' ~C~-Date
for
Appro~d ~ msap~o~d
I
%he Municipality of Anchorage Department of Health and Envirorm~ntal P~otection d~es
not guarantee th~ continued satisfactory performance of the watem supply and/Or the
wastewate~ disposal system° This approval indicates that, as of the validation date
sh~n above, based on the data and information furnished by an engineer registered in
the State of Alaska, the wate~ supply ~%d wastewater disposal system is safe and func-
tional for the numbe~ of badrccras and type of structure indicated.
( DHEP SEAL)
7. Mail
KB2/d5/s
the ~ to ,the following address:
[Page 2 of 2]
2-15-84
Ac
MUNICIPALITY OF ANCHORAGE (MOA)
HEAnTH AUI'HORITY APPROVAL (HAA)
CHECKLIg~ - FEBRUARY 1984
WE]iL Ii%TA
Legal_ Descri. pt~on,:,
Well Classification
Well Log P~essnt (Y/N)
Total Depth ~7/~ Cased to
Static Water I~vel
Casing Height Above Ground ~//~
Electrical. Wiring in Conduit (Y/N) ~//~
Separation Distances f~cm Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewe~ Line
Clesnout/Manhole
Water Sample Collected By
Water Sample'Test P~sults
; On Adjoining nots
;%//~ ; On Adjoining Lots
TO Nearest Public Sewer
To Nearest Sewe~ Service, Line on Lot
B. SEPTIC/HOLDING TANK DATA
Date Tnstalled tO/g, 3 Size l OS co No. of Cc, lDa~tn~-nts
5oundat~on Cleanout
Standpipe ~) A'.[~-tight Caps ~) '/' '
~p~ession o~= Ta~ ~)~ ~te ~st P~d_ ~3/~ .
Pu~ing~intenan~ ~n~ract ~ File (Y~)~ ._; for
Holding Tank HiGh-Wate~ Ala~ .(Y~) ~ ~a~y Holdi~ Tank ~t (Y~)
Separation Distances f~om Septic/Holding Tank:
To Water-Supply Well ~/~ ~_.
To P~ope~t¥ Line ~o~
To Water Main/Service Li~e. ~)~_
Course A3/~
!
To Building Foundation ~O
To Disposal Field .c~,,, /
TO Stream, Pond, Lake, o~ Major D~aina~e
[Page, 1 of 2]
2-15-84
C. ABSORPTION FIELD E~kTA
Soils Rating in Absorption Strata
Date Installed /O/~..~
Width of Field %~/
Square Feet of Absorption ~ea
Depression over Field (Y~
Results of Last Adequacy Test
Date of Lash Adequacy Test
Type of System Design
Length of Field ~5-~
Depth of Field .
Gravel Bed Thickness
Standpipes P~esent ~N)
Separation Distance f~omAbsorption Field:
To ~ate~-SupplyWell
To Building F6undation
Lot %Y/~
To Water Main/Service Line
To Stream/Pond/Lake/c~ Major Drainage Coarse
To Driveway, Parking Area, o~ Vehicle Storage Area
Comments
/
aY/M To Property Line
~ k~~ To Existing or Abandoned System on
; On Adjoining Lots >3o /
~d3/ To Cutbank(if present) ~/~
D. LIFT STATION
Date Installed A//M
Size in Gallons ~/~
"Pump On" Level at ~/c
High ~ter Alarm Level at ~3/~
Tested for
Electrical Codes(Y/N)
Dirmnsions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
~ets MOA
Cor~uents
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, o~ confor~d to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed ~.~J[~/~, Dete ~T-/j-/~ ~
Company /~ff3~ MOA No. ~u/
[Page 2 of 2]
2-15-84
DEPT. OF ENVIRONMENTAL CONSERVATION
S@UTHCENTRAL REGIONAL OFFICE
437 "E" STP&ET, SUITE 200
ANCHORAGE, ALASKA 99501
BILL SHEFFIELD, GOVERNOR
Telephone: (907]
Address;
274-2533
DATE: 5~'~
FWS I.D.
To Whom It May Concern:
According tO ~ecqrds on file in this office the
(~ I~,~/~" Water System is in compliance with the State Drinkidg
Water Regulations.
Sincerely,