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Home My WebLink AboutSOUTHPARK #2 BLK 1 LT 11 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~"~O JO '7 PID Number: O~O- O ~q-.~ I O Name: F P-F-~ ~TO ~ ~tc~ o ~ ~ Wastewater System: D New ~ Upgrade Address: I~ '~c~oo~ ~A~ ABSORPTION FIELD Phone: INo. of~rooms: ~DeepTrench ~ShallowTrench ~Bed ~Mound ~Other LEGAL DESCRIPTION so, Rating: / ~ GPD/Sq. Ft. Total Depth from~,od~al grade: Township: ~ Range: ~ Section: Fill added above original grade: Gravel length: I I ~- Ft. ~ Ft. WELL: D New ~ Upgrade Gravelwidth: Numberoflines: IDis~ance~lweenlines: ~ ~ Ft. ~I ~ Ft, F~. F~. /o ~ SO. Fh ~ ~ F~ Driller: Date Drilled: Slatic Water Level:Ft. Installer:~ ~/~ Oate~ Yield: I Pump Set at: I Casing Height Above Gr0und: GPM Ft. Ft. TANK SEPARATION DISTANCES u Septic ~ Holding a S,T.E.P. Well N~ ~/~ ~ Material: Number of Compartments: Surface Water 2 /*¢ >/~ ~¢~ LIFT STATION Remarks: BENCH ~ARK Inspections performed by: ~¢ Dates: lst~ ~ Department of H~ Ith and vices approval Reviewed and approved y:/ ~ ate: f / ~! \ A /~ PilTN[TI~R AAI~ SAPiPL[N~ ~/ELL TOBBEN SPURKLAND P.E. 205 W 15TH. AVENUE ANCH. AK. 99501 LOT 11, BLOCK 1 SOUTH PAR/( f5959 TERRACEWOOD LANE WILLARD BUUCK II SEPTIC SYSTEM AS BUILT DATE: JULY 50, 1995 SHEET: 2/5 GRID: 3256 25 42 ~ A I -1/4 PVC wBh I/8" holes o! $2" ~ A 6" Nalfpip¢ 1-1/4 PVC Holes Pointing Up 8" Sewer Rock 1-I/4" DisBbuBon Pipe Idirafi i40 32' L4KE OTIS GRAVEL 1" AIR DISTRIBUTION GRID $ Ft. of Cover 4" Topsoil 97.52 94.2 92.2 90,6 1-I/4" Discharge CW 0 89.2 June 20, 1995 EXISTING 1500 BAL STEP AIR DISTRIBUNON GRID I-INCH PVC W/TN I/8" HOLES AT 24 INCHES 5 RUNS AT 5 FEET 1500 go/ STEP lank BENCH MARKL: CAU TRANSF£IdER PEDESTAL TOP CONCRETE ASSUMED ELEVATION IO0. OOFT TOBBEN SPURKLAND P.E. ~ OT 205 ~/ 15TH. AVENUE AK. 99501 11 BLOCK i SOUTH PARK //2[ I 15959 TERRACEWOOD LANE WILLARD BULICK SEPTIC SYSTEfd AS BUILT DATE: JULY 50, 1995 SHEET: 5/5 GRID: 5256 PAGE 1 OF 1 MUNICIPALITY OF ANCHOP~AGE DEPARTMENT OF HEALTH ia_ND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHOP~AGE, ALASKA 99519-6650 0N-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950107 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:FREESTONE NICHOLAS J & OWNER ADDRESS:15939 TERP~AWOOD LANE ANCHOP~AGE, AK DATE ISSUED: 6/12/95 EXPIP~ATION DATE: 6/12/96 PARCEL ID:02005210 LEGAL DESCRIPTION: SOUTHPARK ADDN 2 BLK 1 LT 11 LOT SIZE: 25095 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHOKAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (ISAAC?2) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS BED SHALL NOT BE INSTALLED CLOSER THAN 100 FT. FROM S R AC .WATER. a ISSUED BY: / DATE: T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 ]Fax (907)-276-6013 Municipality of Anchorage Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 May 26, 1995 Division of Subject: Septic System Upgrade Permit Lot 11 Block 1 South Park fu March 1995 the septic system on this lot was tested. During the test the system became surcharged aRer the addition of 450 gallons of water. The attached test report describes the test and the observations made. The system must be replaced, but there are no suitable location on the lot. In general the lot is wet with several springs. One spring is directly under the mound. The presence of this spring required the vertical separation of the mound. On May 23 the bed was exposed. We found 11 inches of water. The rocks were coated with a black substance, which extended two inches into the underlaying sand. This black layer was impermeable. A percolation test was conducted on the sand 12 inches below the black layer. A percolation rate of 40 minutes to the inch was observed. A percolation test was also conducted on the native material approximately 20 feet from the bed. A percolation rate of 7 minutes per inch was observed after 24 hours of presoak. I propose to rebuild the existing bed by removing the cover, septic rock and 2 feet of the silty sand. 2 feet of Lake Otis gravel be imported, clean rock placed, and a pressure distribution network installed. The existing ptm~p control will be replaced with a programmable cona'oller, set to discharge every 30 minutes. Air wilI be supplied to the bottom ofthe Lake Otis Gravel. By supplying air, I hope to maintain an aerobic condition in the bed, thereby extending the useful life. Since the bed is torn apart and the liftstatinn disconnected, I request a speedy review of this application. We are pumping the septictank on a weekly schedule. Yours Tobban S~burkland P.E. ~ ~> L Lilt !4 \\ 50 250 300 TOBBEN SPURKLAND P.E. [[ II 205 W 15TH, AVENUE ANCH. AK. 99501 (907~ 279-5916 LOT 11, BLOCK 1 SOUTH PARK 15959 TE£RACEWOOD LANE ?/ILLARD BULICK SEPTIC SYSTEM DESIGN DATE: MANCH 2~ 1995 SHEET: I/4 GRID: 3236 ~ ~£XI \ S?IN6 MZ)UND 4£' X ~, \\~ £EPLA£E ~ ~ ~ ~ ~X A~B ONE FLOAT ANB ~EPLACE CENT~LXL PANEL TOBBEN SPURKLAND P.E. I I 205 W ISTH~ AVENUE kNCH. AK. 99501 (907/ 279-5916 LOT 11, BLOCK I SOUTH PARK 15939 TERRACEWOOD LANE !C/LLANO BULICK II SEPTIC SYSTEM DESIGN DATE: ,~tANCfl 20, 1995 SHEET: 2/$ GRID: 3258 25 Ir A -I/4 PVD wifh 1/8" holes ot $2" A EXISTING 1500 GAL STEP I-INCH PVC WITH 1/8" HOLES AT 24 INCHES 5 RUNS AT 5 FEET 8" Sewer Rock I-1/4" D/st&u/ion Pipe Mirefi 140 2' LAKE OTIS GRAVEL-- 1' AIR DISTRIBUTION ORID I-I/4" Discharge 1500 ga/ STEP tank BENCH MARKL: SOUTH WEST CORNER 0£ HOUSE BOTTOM SIDING ASSUMED ELEVATION IO0. OOFT TOBBEN SPURKLAND P.E. 205 W 15TH. AVENUE ANCH. AK. 99501 (90~) 279-5916 11 BLOCK1ZOUTH PARK ~2[ [ 15959 TERRACEWOOD LANE WILLARD BULICK SEPTIC SYSTEM DESIGN DATE: MARCH 20, 1995 SHEET: 5/5 GRID: 5256 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: 6 7 8 10- 11 13- 14- 15- 16- 17- 18- 19- 20- (ENGINEER'S SEAL DATE PERFORMED: ~,,/~ ~/~!'.~>~ Township, Range, Section: WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN S IF YES, AT WHAT ~) DEPTH? p E Depth to Water Alter I Monitoring?.~2.L~Dele:~O/~' Gross Net Depth to Net Reading Date Time ~I~["VJ Time ~'~ ~t Water Drop PERCOLATION RATE . COMMENTS TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER __ 72-008 (Rev. 4/85) · MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street. Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Nar. e DISTANCES ~'xL/~'/~£ ~-/~;~,~/0,~ / s- ~.S ~. ~ TO SEPTIC ABSORPTION WELL ~dd~FROM ~ TANK FIELD 16420 St James Place, Anch 99523 Phone(s) Pc,mit No. NO- of 8~rooms WELL ~0~ ~ LOT LINE ' LEGAL DESCRIPTION PA El4 ~ FOUNDATION Township. Range, Section AS-BUILT DIAGRAM (Show location of well, septic system, p¢opedy lines, foundation, ~ ~ ~//// ~ ~ ~/ driveway, water bodies, etc.) TANKS / N ~ SEPTIC ~ HOLDING ~ TRENCH ~ BED 0 W. DRAIN ~ OTHER ~ ~ Depth to pipe bottom fro~ Total depth fro~ original grade ~ 3. f-%~T / F~ Gravelle,gthabsorption area '~/FT Grave, width ~¢ '' / Total Distance between Ii.es Insta~er ~ I :~ ~ Date ~nstalled/~~ WELLS ~ PRIVATE ~ OTHER (Identify) ~O~ /~v FT REMARKS: s~.~e: /"=.~ · ~;~ ~G~ ~ %~ch~el E. Andersen Z ~'~ Municipal and State ,uidelin. in ei[ect on this date: /"/~" Health Depa.ment Approval: , ~ ~ Date: 72-013 (3/85) INSPECTION REPORT MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION 35C~EAST TUDOR ROAD INSPECTIONS (907) 563-3464 -~,% INFORMATION (907) 786-8211 FOOTING ~ ELEO. TEMP. ~ ~ PLBG. UNDER. ~ J FOUNDATION ~ ~ ELEC. SERVIOE ~. ~ PLB6..OU~H ~ ~ J ' BOND BEAM ~ ~ ELEO. ROUGH ~ ~ ~AS TEMP. ~ J FRAMING ~ ELEC. FINAL ~ ~ GAS ~ g J IN8ULATION_ ~ OTHE~ '~ MECHANICAL g J" SHEETBOCK __ ~ MECH, FINAL g J STRUCT. FINAL ~ FIRE FINAL ~ PLB~, FINAL ~ J . OTHER ~ ZONING ~ OTHER ' g J NO NONCOMPLIANCE OBSERVED ~ CORRECTIONS ESSENTIAL AS J ~P~INED BELOW . l' ~ D WILL ~EEXAMINE AT NE~ INSPECTION ~ DO NOT CONO~L UNTIL ~EiNsPEgTED ~J --% INSPECTOR VHEN CORRE~ONS ARE MADE, PLEASE CALL FOR INSPECTION DO NOT REMOVE THIS NOTICE (4 Balm){150 Soil)(t.5)= 900sq.ft. z' '~ ~e& e o~=~EEFFiPE Construct.. Bed 18' x 50' = 900sq.ft. Install 1,250,gallon septic ta~ i0,_'~ lift station M.O.A. Approved between ta~ ~d bed, ~d at each end of bed. . . ~T ~-/ ~-~-- Install L/S Ala~ in ~elling Install Clean-outs at ta~. · ~L CONSTRUCTION Insulate Bed if cover is less than 3'. ~T~I~S TO ~ET M.O.A. NOTE: SPECIFICATIONS Ail D~ensions ~d Locations Must Be Field Verified Prior To Construction .S5 5 SYSIS -LOGATION PLAN : . · ' Muaicipalily o/Anchoca§e DEPARTMENT OF I-I -EALTH & HIJMAN 825 L Street, Anchorag . SOILS LOG -- PERQOLATION 3- 5P 6- 7- g- t0 12 13 14 15 16 17- 1,8- 20- NE Township. Range. Section: SLOPE WAS GROUND WATER 6~COU~Cr~REO? ' SiTE PLAN $ L oEP¥.? I0' ~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519.6650 www.cl.anchorage.ak, us (9O7) 343-7904 CERTIFICATE OF HEALTH AUTHORITY. APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-052-10 1. GENERAL INFORMATION Expiration Date: Completelegaldescription , SOUTHPARK #2 LOT 11 BLOCK 1 Location (site address or directions) 15959 TERRACE WOOD LANE * ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address NICK FREESTONE Day phone 345-9858 15939 TERRACE WOOD LANE * ANCHORAGE, AK 99516 Day phone DAVID WINDSOR w/ REMAX PROPERTIES Dayphone 276-2761 2600 CORDOVA STREET * ANCHORAGE, AK 99503 Unless othen~fse requested, HAA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class 'A" Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of titJe (except between spouses) for properties served by a single family on-sita wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a pedod of up to one year with valid water samples.) Certificates ara 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. Note:Alaska Watar and Wastewater Consultants, Inc. shall be pald $7OO. OO at, or pdor to closing for the engineering sen4ces provid~cl. ' 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authodty Approval Guidelines for this application, shows that the on-site water supp~ and/or wastewatar disposal system is(are) safe, fun~'onal and adequate for the number of bedrooms and ~e of structure indicated herein. I further verily that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supp¥ and/or wastewater disposal system is(are) In cornpllanca with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address - 6901DEBARR-ROAD, SUffE 2B * ANCHORACE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 337-6179 Engineer"s Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious eeglneerfng analysis of the system In accordance wfth ADEC and MOA DSD Guidelines & Regulations. The reported results described the pedormance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operetional life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate dudng the year, and the water usage of the fareily being sen/ed by Re system. These condilions are outside the control of the evaluater of the system. Satisfactory test results do not guarantee future Fedotrnance of the system, nor do they guarantee that Inere are no hidden defects or encroachments. AWWC, Inc. can therefore not provfde any warranty or future estimate of how long the system ~11 continue to rn~et the operational requirements of ~he ADEC or MOA DSD. The content of Inls report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other pe~on or party is not authorized, nor mil It confer any legal dght wha~scever. 5. DSD SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for __ bedrooms, with the fllowlng stipulations: ~ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original CerfJficate Date: "~ - ~/- o / Municipality of Anchorage Development Sen/ices Department Or-,-E~te Water & W~tewater Program 4700 ~ Bragaw ~ P.O. Box lg6650 An~xage, AK 99519-~850 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descrlp§on: SOUTHPARK S/D 1~2; LOT 11r BLOCK ParcellD: 020-052-10 A. WELLDATA Well type '^" If A, B, or C pmvkle PWSID~ 213475 Data completed Sanlta~/~eal (Y/N)Wires~ Total deplh lt. Cased ta ft. ~ height (abev~ gn~md) Date of test FROM ~ AT INSPECTION well Log (Y/N) StaUc .~reductton g.p.m, g.p.m. WATER SAMPLE RESULTS: ~ Coliform __ ~lonl 1~ Other ~cta~ colones/100 mi. B. SEPTIC/HOLDING TANK DATA Tink Type/Material STEEL Tank size 1500 gal. Number of Compartments Foundation deanout (Y/N) YES Data of pumping 6/28/01 Oata Installed 9/19/90 2 Cleanouta (Y/N) YES Depression over tank (Y/N) NO High watar alarm (Y/N) YES Pumper A+ CJ ABSORPTION FIELD DATA Data Installed e/23/gs Soil rating ~ It'/lxlrm) 150 System ~ MOUND Length 42 ft. Wklth 25 .ft. Grawl below pipe 0.5 Totaldepth ,3.g+/- It. Eff. absorpflonareal050 It= Monltodngtube YES Depmsalonoverflald NO Data of adequacy tast 7/21/01 Results(Pass/Fall). PASS For 4 bedrooms Flulddeplhina13~orptionflaldbeforetas~*8.25in. Wataradded 700 gal. Newdepth 15 in. E]apsedTIme: 251 min. Final fluld depth 7.5 In. Absorptlon rate >- 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & I~tpe) NONE KNOWN *FROM FINAL GRADE TO TOP OF' SAND ~ *,BOTI'OM OF MT IS O 92.89'. BOTI'OM OF' SAND IS 95.7 PER T.S. If ye~, give data - UFT STATION Dete Instelied 9/15/90 'Pump on' level et 29" In. Datum BOTTOM Size In gallons 1500 "Pump off" level at 50" ir1. Cycles tested MULTIPLE Manhole/Access (Y/N). Y High water alarm level at Meets alarm & circuit requlremente? YES E. SEPARATION DISTANCES . ~ SEPARATION DISTANCES FROM WELL ON LOT TO. ~ Sepitc tenl~ staUon on lot __ __ ~ Abeerption field on lot. __ ~,..,~..-,-"~On adjacent Iots~ Public sewer main Public ~wer manhole/cieenout ~FROM SEPTIC~IOLDING HTAI~I:nOgNtanL:T TO: Bulidlng foundalJon '§' Properly line 5'+ Water main 10'+ Water ssrvloe line. 10'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water eer%'lce line 10'+ Surface water 100'+ Cuflaln drain NONE KNOWN Wells on adjacent lote 200'+ F, COMMENTS *PER 1995 INSPECTION REPORT Absorption field. 5'+ Surface water 100'+ Water main. 1 o'+ Dffveway, paddng/vehlcio etorago 5'+ G. ENGINEER'S CERTIFICATION I cerZtfy ghat I have determined 6~mugh 88eld inspections and review of Municipal records ~hat ~he above sy~ems ere in conformance wlgh MOA HAA guidelines In effect on this date. EnglneeCs Printed Na~o Date _~_~_.~_~ o / JEFFREY A. GARNESS Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY Of ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorsge, Alaska 99519-6650 343-4744 Parcel I,D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address ~'iL~. I:---- %~-o h-I t.~-, f'--~ Day phone Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: V TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4, TYPE OF WASTEWATER DISPOSAL: NOTE: 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. 724)25 (Rev. 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 on the date of this inspection. Name of Firm -% IlL, Engineer's signature ~ .- .r.,.,-¢~g,.c~% Date /1¢/Cz) DHHS SIGNATURE !"~. Approved for L~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 p~'ofessional engineer's work. 72-025 (Rev. 1/91) Bsck MOA~21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Health Authority Approval Checklist LegalDescription: LoTtlt~k'x.I: ~ooo/~v-~r~.ldf__ Parcell. D.: Oeq. o-- O~:37-.~ I ' A. WELL DATA Welltype I//3~~t IfA, B. orC, attach ADEC letter. ADEC water system number o~,/~ ~z/7~ Log present (Y/N) Total depth Sauitary seal (Y/N) Date of test Static water level Well productioo Date completed Cased to FROM WELL LOG g.p.m. Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION g.p.m. ~ n~ WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed c1/15/~]t..9 Tanksize /,~ot.;> Number of Compart~nents ,~ Clemtonts(Y/N) ~'/ Foundation cleanout (y/N) 7 Depression (Y/N) I~ High water alarm (Y/N) Date of Pumping ~'/~t//~'0" Pumper iI,.bt~te C. ABSORPTION FIELD DATA Date installed /~///~t0/.,ga" Soilrating (g.p.d./fl2orft2?odrm)/F~r~-~ Systemtype Length ~/~- width ~2.~ Gravel thickness below pipe ~ , c Total depth Effective absorption area /~'~ Monitoring Tube present(Y/N) 7 Depression over field (Y/N) Date of adequacy test /"t'//.~ Results (Pass/Fail) ~ For ~// bedrooms Fluid deptb in absorption field before test (in.); Fluid depth t~///& (ins.) Minutes later: Peroxide treatment (past 12 months) (Y/Iff) ~xl O Immediately after gal. water added (in.): Absorption rate = ,t~/~..¥ g.p.d. If yes, give date D. LIFT STATION Dato installed Manhole/Access (Y/N) Size in gafions "Pump on" level at* 4/5 *r atu., High water alarm level at* Cycles tested ~ SEPARATION DISTANCES "Pulnp ofF' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: ~ Absorption field on lot ~otss ~ Public sewer main ~'~Public sewer manhole/cleanout Sewer/septic service__ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation . ~ Property line r~O Absorption field Water mairdservice line ~0 ~ Surfaco water/draiaage ,~/O-O Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation /7//3 Sarface water Curtain dram ..3 Water mafi~/service line > ~ (-~ Driveway, parking/vehicle storage area ~ 7..~ Wells on adjaceat lots ~//~ Proper~ line I0 F. ENGINEER'S CERTIFICATION I certify that i have determined thrufield inspections andreview of Municipal record~ in conJbrmance with MOA [1~ guidelines ia effect on thi.v date. Signature ~ ~ Cfi-2225 HAA Fee $ ~-~OC~) , ~/~ Date of Payment ~,//~5~/~,X''~''~ Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: T. SPURKLAND P.E. 203 WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99502-3904 (907) 279-3916 F~x (907)-276-6013 SEPTIC SYSTEM ADEQUACY TEST Lot 11, Block 1, South Park #2 15939 Terracewood Lane Willard Bulick Single Family, 4 Bedrooms Community Water System. PWSID # 213475 FROM MUNICIPAL RECORDS: 4 Bedroom System TANK: Anchorage Tank 1500 Gal. Two Comparts.STEP ABSORPTION SYSTEM: Bed ABSORPTION AREA: 1050 Sq. Ft. SOIL RATING: 150 INSTD_LLATION DATE: 9/13/90 WAIVERS GP~%NTED: None Required DATE OF LAST PUMPING: Isaacs March 12, 1995 DATE OF TEST: March 13, 1995 TEST PROCEDURE: System was inspected and measured. Tank was found with 6 feet of cover and with a liquid level of 11 inches. Bed clean out was 5 feet deep and dry. Bed monitor tube was 4.5 feet deep with 10 inches of water. 440 gallons of clean water was added to the bed while the water levels in the tank and the monitor tube were monitored. The flow of water was stopped when water started to flow into the tank. The water level in the bed rose 6 inches as a result of adding the 440 gallons. The water level dropped 1 inch during the next two hours and an additional 1.5 inch during the night. Based on the observed water level drops it was determined that the system absorbed 200 gallons in 17 hours, or 280 gallons per 24 hours. TEST RESULT: This system does not meet the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE: The operational life of all septic systems depends on the local soil conditions, 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 this septic system. We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. All septic systems ultimately fail. Some systems last 15-20 years, others fail after less than 5 years. TOBBEN SPURKLAND P.E. I 20.5 W 15TH. AVENUE I ANCH. AK. 99501 LOT J1, BLOCK i SOUTH PARK 15939 TENRACEWOOD LANE FtlZ£A£D BUUCK SEPTIC SYSTEM AS BUILT DATE: JULY 30, 1995 SHEET: 2/3 GRID: 5256 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ~_~'/,/'~-,~"~/-- ~uT-H )oArc/d ~L~.~'~- t~, Telephone: (home) Business Mailing Address (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here ~for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family[~ Number of bedrooms 3. WATER SUPPLY Individual Well [] Community~c [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISP. P.P.P.P.P.P.P.P.P~OSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-o25 (Rev. 7/88) Page 1 of 2 leAoJdd¥ leUO!]!puoo Jo s~Ja± leuo!~!puoo peAoJdd8s!a ,/,)(.. pe^oJddv .~,~,..~---~'"'z..,~ --'-',-~,'~/ Aqs~ooJpe~Jo, p@^oJddv ~AO~d~V 9HHa '9 lees s,Jeeu!bu3 · uoRoedsu! s!~l ~o elep eql uo ~aeile u! suoRelnSaJ pub 'seaueulpJo 'sepoo e~elS pub led!o!un~ lie ~liM eoue!ldmoo u! s! me~gXs lesodslp Je~eMe~SeM Jo/puB Alddns Je~eM el!e-uo e~ 'uo!joadsu] pub uo!le~!~seAu! Xm moJ~ pub Sel!¢ eSeJoqouv Jo ~]led!o!un~ e~l ~oJ¢ peu!elqo uo!lemJo~u! e~ uo peseq leal ~tlJeA JeqlJnl I 'u!eJeq pe~eo!pu! eJn~on~ls io ad~ pub smooJpeq ¢o Jeq~nu e~j Jo¢ alenbepe puB' leUO!loun¢ 'ajes s! ~e~sAs i~sodslp Jei~MS~SBM Jo/puB Xlddns JeJeM 81ls-uo eq~ ~eqi SMOqS leAoJddv ~lpoqlnv qlleeH s! q~ jo uoReD!~seAui Xm leql ~jpeA I 'MO leq UMOqS elep UoRBp!IeA eq~ ¢0 Se pUB oleJeq pex!j1~ I~es ~m Xq pe!~!lJeo sV NOI~V~OJNI aNY vzva 'HO~S t11~ 'S~St~ 'SNOI~O~dSNI 9NlalAO~d ~alJ DNI~NIDN~ 'g A. WELL DAT~)¢ Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level 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 To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments SEE.. MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Date Completed Depth of Grouting Legal Description: If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA /5'd~ ~ Date Installed ?-/$- P~ Size ~ No. of Compartments Standpipes (Y/N) y Air-tight Caps (Y/N) Depression over Tank (Y/N) ,,~ Pumping/Maintenance Contact on File (Y/N) FoUndation Cleanout (Y/N) Date Last Pumped /(/~'/-4/ ; for HettY,9 Ta~k High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well //~o~ '=.' To Property Line 2. ~r To Water Main/Service Line ..5"Z ' To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation To Disposal Field Temporary Holding Tank Permit (Y/N) 72-026 (Rev. 7/88) Front page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field 2. 150 Square Feet of Absortion Area /¢S¢ Depression over Field (Y/N) /'/ Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well // To Building Foundation ,.CZ-/ Lot /t"~4,'~- ¢'/¢ ~/'~ ~' To Water Main/Service Line Type of System Design Length of Field Depth of Field Gravel Bed Thickness / Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line /o' To Existing or Abandoned System on ; On Adjoining Lots 7 7 To Cutback (if present) ~';¢ / To Stream, Pond, Lake, or Major Drainage Course A/',¢/,/,~ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) ~/$" oF'F ~o'r'~ "Pump Off" Level at ~ ~'" Vent (Y/N) /,4 · ~ Pumping Cycles during Y **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~1/~-~ Company Date /O/V/e§ ¢ ~, ~ ~ Engineer's Seal MOA No. Date of Payment 72-026 (Rev, 7/86) Bsck Receipt N( Waiver Fee: $ Date of Payment Page 2 of 2 ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 October 4, 1990 STEVE COWPER, GOVERNOR 563-6775 Attn: Wayne McFadden PWSID: I~213475 According to the records on file in this office, the South Park Subdivision Water System is in compliance with the State of Alaska Drinking Water RegulationS. Sincerely, VERA E. C__ VEC:pf