HomeMy WebLinkAboutPARK PLACE LT 7Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP231086
PID Number: 020-092-53
Page 1 of 3
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ■❑ Upgrade
Name
Andrew and Heather Beat
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
16440 St. James Cir, Anchorage, AK 99516
❑ Other
Phone
303-378-8881
Number of Bedrooms
4
Rating
Total depth from original grade
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pip�from al grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Park Place 7
Fill added above original grade
Gravel length
Township Range Section
F
. Ft.
Gravel width
Beds: Number of Line
istance between lines
SEPARATION DISTANCES
Ft.
Ft.
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area Number of trenches Dist. betwee enches
From
Tank
Field
Tank
Line
Ft2
Well
>100'
>100'
N/A
N/A
>25'
TANK •❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1250 Gal.
Surface Water
>1 00'
> 100'
N/A
N/A
Material
Plastic
Number of compartments
2
Lot Line
>5'
>10'
N/A
N/A
NA
Foundation>
10'
>10'
N/A
N/A
L ATION
Manufacturer
Capacity
Remarks Tank replacement only
Gal.
Alarm location Electric lied by
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfield
Installer
A. C. E. S.
Drainfield N/A CO/MT D3034
Inspector L.Tidwell
BENCH MARK (Assumed elevation) 100 ft
Inspection15 5/11/23 2�d 5/11/23
Location and description
3`d 4,h
Bottom of Siding @ Point A
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date
Septic SysteBenjarti(w5chiller
/
¢� �F�
Approved ate /y
D 'I Ti
CE 12592 • �`�,��
�J'l�c • . 1 /3/24 • •�C�_®'�
.
Note: this approval - es not include well permit requirements.
FESSIONP�
PARK PLACE, LOT 7
PERMIT # OSP231086 PID # 020-09-253
ST. JAMES CIRCLE
CONFIRMED WELL
LOCATION
i
5' GAS EASEMENT
EXISTING,WELL
----- Lot 8A
\ �XCODEN
FE�CE /
pRM NOME / u
B i
1250 -GAL
SEPTIC TANK ',�ov
MH
EXISTING FIELD
REMAINING IN SERVICE
10' T&E
EASEMENTS
ti GE Lot 7 \
ENGINEERING \
*, 4J TH
Benja i Schiller
���F� • CE 2592
1 �i1aza
PROFESSIONP
Lot 7
Lot 6
A B
MH 11.9 1 54.3
SV
16.5
58.3
2CO
19.4
60.3
CO
21.7
61.2
WELL IS GREATER THAN 1 00'FROM PROPERTY LINE
PLAN AS -BUILT
0 50 100
FEET
111=50'
Lot 8
LEGEND
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEAP
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
,mi, mi 111111, 111111 !16,
ENGINEERING
PID # 020-09-253
PROFILE AS -BUILT
(NO SCALE)
�or q®1�
.AW,P • • .s,���
: 49 TH •.
• ' . �--
..........
' • • • .
Benja ' Schiller
Ia�����F�•
CE 12592
C?04
04
N 89'58'45"E 107.86'
5' GAS EASEMENT
Lot 8A
10' T&E
EASEMENTS
L
:P.
10.5'x 16.0'
GREENHOUSE
`PEN
8.1'x8.1'
COOP
O
WELL
\� 6.0'x12.0'
WOOD SHED 23 5
w
5.0'x47.3'
PORCH $
d� 40.9'
00 00
� ,t ' �vs4Cs,- A7'
N �
�� N 2 SjOR� R N 23 c
O tPAD 6 9 �' }
WOODEN
FENCE ;
Z
MANHOLE
PIPES
1 • 6
R S
L 6.00,
r�
V/- 8.2'x 12.2'
/ SHED
WOODEN
FENCE
1.3'x1.8'
CANT s'
34.
• o
N
DECK O
1n
0.3'x27.5'
CANT
Lot 7
43,472 S.F.
Lot 6
N 89'58'50"W 161.65' — — — — — —
Lot 7 \ Lot 8
PLOT PLAN ___ AS BUILT _X_ SCALE _1" = 50' _ GRID _ SW 3337Project No. 23_123LA2___
j�
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & A S S o C (a f e S y inc. (907) 522-6476 Phone
ken0langsurvey.com
Professional Land Surveyors jonothanCilangsurvey.cam
OF• At 1Skk
travisdlangsurvey.com ,tet ''
I hereby certify that I have surveyed the following described property:
LOT 7, PARK PLACE SUBDIVISION (PLAT No. 78-73)
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the _�"<�� Da `' "` "_
y of ���+�`-� N_ at Anchorage, Alaska
T -
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
. ........ ...........
.......
KENNETH G. LAN c�
'. o
c ' No. V02 ' cv A
® oifss0uav�.
State of Alaska AECC963
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program Do
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 y
http://www.muni.org/onsite
1
D�partrn�nt
On -Site Wastewater Disposal System Permit
Permit Number: OSP231086 Effective Date: 5/10/2023
Work Type: SepticTank Upgrade Expiration Date: 5/9/2024
Tax Code Number: 02009253000
Site Legal Address: PARK PLACE LT 7 G:3337
Site Mailing Address: 16440 SAINT JAMES CIR, Anchorage
Owner: BEAT ANDREW T Lot Size in Sq Ft: 43472
Design Engineer: FORGE ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding -Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:( S
Issued By:
Date:
-Date: Sl t c>/ Zo-L 2...
1�t1�UH COPALffV OF HCH0FIA GE
F
Community Development Department _ Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWERIWELL PERMIT APPLICATION
Parcel I.D. 02 0-092-53
Property owner(s) Andrew & Heather Beat Day phone 303-378-8881
Mailing address 16440 St James Cir, Anchorage, AK 99516
Site address 16440 Saint James Cir
Legal description (Sub'd., Block & Lot) Park Place, Lot 7
Legal description (Township, Range & Section)
Lot Size 43,472 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(0 all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) ❑X
Septic Tank
MUpgrade
❑X
(w/wo AD U)
(D) El
Holding Tank
❑
RenewalDuplex
❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: --I 2-Z 5 Waiver Fees:
Date of Payment: 9151L Date of Payment:
Receipt Number: OY106D Receipt Number:
Permit No. OO P231 1) g 6 Waiver No.
Permit App_'-'- : ,-.,:c:
May 2, 2023
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Park Place Lot 7 – 16440 Saint James Cir
Septic tank replacement
Dear On-Site Services Engineer:
The owner of the above lot has a septic tank that has reached its end of useful life, we are submitting
this permit application for its replacement. The attached site plan identifies the location of the
home as well as the wells and septic location. No conflicts exist between this proposed system and
any other wells or septic system, whether on this lot or adjacent lots. We are replacing the septic
tank with a 1250-gallon tank, although the rest of the system is only sized for 3 bedrooms.
The new septic tank will be a minimum of 100’ fro m all wells and surface water. Please refer to
the attached plan for the septic design. If this design is followed, there will be no adverse impacts
to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231086, Curtis Townsend, 05/10/23
//
//
//
//
//
//
//
//
x
x
x
x
REMOVE EXISTING 1000-GAL
SEPTIC TANK OR DECOMISSION
PER UPC
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
1"=50'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
LEGEND
2CO
MT
WELL IS GREATER THAN 100' FROM PROPERTY LINE
PARK PLACE, LOT 7
FEET
0 50 100
CO
3-BDRM H
O
M
E
9/7/22
SEPTIC PLAN
ST. JAMES CIRCLE
NEW 1250-GAL SEPTIC TANK
INSTALL DOUBLE CLEANOUT AFTER
AND NEW CLEANOUT / MONITORING
TUBE AT CONNECTION WITH
EXISTING FIELD
EXISTING WELL
5' GAS EASEMENT
10' T&E
EASEMENTS
VISUALLY LOCATE
WELL AND ENSURE 100'
SEPARATION AT TIME
OF INSTALLATION
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231086, Curtis Townsend, 05/10/23
_ N
5' GAS EASEMENT /
I
Lot 8A
10' T&E
EASEMENTS
ST. JAMES CIRCLE
N 89'58'45"E 107.86' L=3fi•0�
• lq
10.5'x16.0'"
GREENHOUSE
PEN
8.1'x8.1' 1'•
COOP
FENCE
r 6.0'x 12.0'
W000 SHI
0 5.0'x47.3
POCF RCI
19•
O0 RESNOE
PIPES
CANT
Lot 7
43,472 S.F.
N 89'58'50"W 161.65'-
- —
Lot 7 \ Lot 8
\ NOTE: DUE TO SNOW &ICE COVER,
SOME SURFACE LEVEL
FEATURES ARE APPROXIMATE.
PLOT PLAN --- AS BUILT _X- SCALE _1" =_50__ GRID _ SW 3337-- Project No.
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, in c . (907) 522-6476 Phone
kenOlangsurvey.com
Professional Land Surveyors jonothanolongsurvey.com OF At. \
trovisOlongsurvey.com ull,
I hereby certify that I have surveyed the following described property:
LOT 7, PARK PLACE SUBDIVISION (PLAT No. 78-73)
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the —_ IO- _ Day of ' '_' ____-___, - LL'LL-, at Anchorage, Alaska
49TH *'
KENNETH G. LANG ,• e.
,e KENNETH
•'k;
o. 5
11 F9FDp� r0.20'�'aDSJi
II��ROFESS10I �P s
It is the responsibility of the owner to determine the existence of any easements, •�\\\�\��
covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963
8.2'x12.2'
I
SHED
N
WOODEN
FENCE
N/
N
/1.3'x1.8'
CA
/ NT
O Lot 6
_ 34.Q'
CANT
Lot 7
43,472 S.F.
N 89'58'50"W 161.65'-
- —
Lot 7 \ Lot 8
\ NOTE: DUE TO SNOW &ICE COVER,
SOME SURFACE LEVEL
FEATURES ARE APPROXIMATE.
PLOT PLAN --- AS BUILT _X- SCALE _1" =_50__ GRID _ SW 3337-- Project No.
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, in c . (907) 522-6476 Phone
kenOlangsurvey.com
Professional Land Surveyors jonothanolongsurvey.com OF At. \
trovisOlongsurvey.com ull,
I hereby certify that I have surveyed the following described property:
LOT 7, PARK PLACE SUBDIVISION (PLAT No. 78-73)
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the —_ IO- _ Day of ' '_' ____-___, - LL'LL-, at Anchorage, Alaska
49TH *'
KENNETH G. LANG ,• e.
,e KENNETH
•'k;
o. 5
11 F9FDp� r0.20'�'aDSJi
II��ROFESS10I �P s
It is the responsibility of the owner to determine the existence of any easements, •�\\\�\��
covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963
'- , MUNICIPALITY OF ANCHORAGE '~- '
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
· 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHON~ I ~NEW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION ~ NO. OF BEDROOMS
~ ~ DISTANCE TO: /~ ¢ Absorption area Dwelling/~/ PERMITT~ ¢¢/NO'
~ ~ Manufacturer Material No. of compartments
~ ~ Liq. capacity in gallons Inside length Width Liquid depth
/~O IF HOMEMADE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ ~ Manufacturer Material Liquid capacity in gallons
O Well Foundatio~,¢ Nearest lot line PERMIT NO.
~ · DISTANCE TO:
~ No. of lines Length of each I~ne Total length of lines Trench width Distance between lines
~~ ~ Top of tile to finish grade ' Material beneath the
~ ~ / ~ ~ inches Total effective absorption area
Length Width Depth PERMIT NO,
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest {ct line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building~ foundation~, Sewer line Sep~c ~ , Absorption area(s)
OTHER
PIPE MATERIALS
~fiM~HKS
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
Dece~ber 29, 3.978
~780441
Sandra Gibbens
3212 Muriel Place
~%chorage, Alaska
99503
Subject: Lot 7 Park Place Subdivision
A permit issued by this department for well and/or
sewer system has expired.
Permits are issued on a calendar year basis, as stated
on the permit, by authority of Municipal ordinance°
If you have drilled the well~ a well log should be
sent to this department to document the installation
date°
If there are any further questions~ please contact
this office at 264-4720°
Sincerely,
Les No Buchholz~ RoSo
Senior Environmental Specialist
~B/ljw
enc: copy of permit
PERMIT NO.
APPL I CANT
LOF:A T I ON
LEGAL
SANDR 1~ GIBBENS
LORETTA FLH_.E' -P
LO'[' ? PARK PLACE
~1~. MURIEL PLACE
'I"'YPE OF SOIL RBSORBTION ~"-
_~TEM IS: DRAINFIELD
LOT '-- ~ ~
-,I-'E 43500 S.'~JRRE FEET
MR;<IMLIH NUMBER. OF BEDROOMS = ~. SOIL RRTIN~'- F' .._'~K~.. FT,/E:R)=
]'HE RE~!UIRED -I~.E OF THE SOIL AB'~]ORPTION
[:"EF'~T~H= ? L EI'-JI] T'H= 4_~.-: GRR%-'EL [-" E F" T F-I = i~:
]'HE LENGTH DIMENSION IS THE LENGTH ('IN. FEET> OF THE TREN..H-' OR [:'F.'.RINF~EL[:,.
THE DEPTH OF IR TRENCH OR PIT IS THE DISTANCE BETNEEN THE SLIRFRC:E OF TFIE
GRCUND AND THE BOTT.gM OF THE EXC:R',/RTION (IN FEET).
THE TRENCH L-J ~ D-IFH I S ~=:- ~--~0~.3 FEET
THE GRAVEL DEPTH IS THE I"tlNIMUM r:,EPTH OF GRAVEL BETNEEN "['HE OUTF(gU... F'IPE
AND THE BOTTOM OF THE EXCAVFITION (IN FEET).
PERMIT FIPPLICANT HRS THE RESPONSlBILIT~r, TO INF'OF.'M. THIS DEPHR Ff1ENT' '" ' DI. F.'TNG. THE
INSTALLATION IN_~FECTIuN_, OF AN'z' WELLS ADJACENT TO THIS PR_PER] T AND THE
NUMBER OF RESlDENP. Es_ _ THAT THE WELL WILL c_,ER.,,/E.-
BR~KFILLYNG OF RN'~' Sg-'STEM WITHOLIT FINAL INSPECTION AND RPPRO'v'RL E;'Y THI:5
DEPARTt'IENT WILL BE SUBJEC'T TO PROSEOUTIOI'.,I,
MINIMUM DISTANCE BETWEEN A WELL AND RNY 9 '- -, c ,-~-- IS
LN-z, ITE SEHRGE [.I_,FJ:HL S'~'STEi','I
1OO FEET FOR R PRIVATE WELL~ OR
i50 TO 200 FEET FROM R PUBLIC NELL DEPENDING UPON THE TYPE OF PUBLIC NELL..
WELL LOGS RRE REts~UIRED RND ML=,TI'- BE RETURNED TO THE [:'EPRRTMENT WITHIN ~:A DRg"S
OF THE WELL COMPLETION. --
OTHER REQUIREMENTS; MRY RPPL~L SPECIFICRTIONS RND CON'.{;TRUCTION [:'IRGRRMS ARE
R',/RILRBLE TO IN_,URE PROPER INSTRLLRTION,
PERI'-1 ][ -r EXF- ]~ RES E:,EC:Ei~.IE:ER -----:~-- ::L ..-:.'L.-_--~."- -~-', .... ':"
I CERTIFY THAT
1: I RM FRMILIRR NITH THE REQUIREMENTS FOR ON-SITE SEWERS RND HELL.:;,, '- RS '-:,EF
FORTH BY THE MUNICiF'RLIT'~' OF RNCHORRGE.
2: I WILL INSTALL THE S'T'STEH IN H-.CORDHNCE'P ' ' - WITH THE CODES.
?: I UNDERSTRND THRT THE ON-SITE SEWER ~"~ , -,-- -
-' . _t~TEH MRS' REQUIRE ENLREaEHENT IF THE
RESIDENCE I~; REMODELED TO INCLUDE MORE THAN~ ~
'= 1,3NED: ~L~/ _~~,~
PPL I ~:ANT SRNDR~ GIBBENS
4040 "B" STREET
ANCHORAGE, ALASKA 99503
(907) 278-1551
June 8, J978
Ms. Sandra Gibbens
c/o Baugh Construction & Engineering
P.O. Box 4-J515
Anchorage, AK 99509
Reference: Suitability for On-Site Sewage'Disposal System
Lot 7, Park Place SubdivisiOn
Dear Ms. Gibbens:
On December 22, J977, a test hole was placed on the above
referenced lot by our firm. A copy of that test hole log
and an accompanying report has already been transmitted to
Mr. Rolf Strickland at the Municipality of Anchorage. That
test hole 10g showed there to be NFS, brown gravelly sand
with the unified classification of SP/SM from 2 to 16 feet
on the site. A gradation was made of samples from this test
hole. Therefore, the classification was not visual, but
done by laboratory analysis. It showed the percent passing
the number 200 screen to be 6%.
This should be excellent material for construction of an on-
site sewage disposal system. Though we did not run a percu-
lation test in this soil, it is our experience that using a
perculation rate of 1.5 minutes per inch is con-servative
for soil of this type.
A free water level was detected in the test hole at 11 feet.
Though the water table will fluctuate with seasonal and
clamactic changes, we feel that this was probably a relatively
high water table for this area.
If there are any questions, please do not hesitate to contact
us.
Very sincerely,
ALASKA TESTLAB
Melvin R. Nichols, P.E.
Laboratory Manager
MRNIbj
cC: ~r. John. Berggren
POUCH. 6~..~0
ANCHORAGE, ALASKA 99502
(907) 279-2511
GEORGE M. SULLI VAIV.
MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
· ' (825 :'L" S~reet)
February 2, 1978
File No. :-~,~'~-'
Mr. John Berggren'
7301 Chad S't'reet
Anchorage, Alaska
99502
Dear Mr. Be.~ggren:
The Department of Health and Environmental Protection has reviewed the'
extensive soil testi.ng report on Subject property.of Park Place Subdivi-
Sion, a subdivision of Tract A Place Subdivision, and has discussed the
· matte~ at length with the Soils Lab concerned. ..,
· Our Findings are:
.1.
'4.
The proposed ll-Lot Subdivision'is. the latest revision from the
original 14-Lot Subdivision.
Lo'ts 1 thru 8 which lie in the'Eastern half of the property are
iacceptable for on-site sew.age disposal and water supply, as stated
.in Mr. Strickland's letter of February 1.
Lots 9, 10, and 11 which consist of the lots in the Western half
of the proposed subdivision are problem lots because of surface
water problems.
Additional testing ~ required to substantiate the proposed sub-
division of lots 9, 10, and ll.
It ii our recommendation that the Preliminary Plat of Park Place Sub-
'division be approved as submitted with the condition that soils on
Lots 9, 10, and 11 be resolved with the Department of Health and Environ-
mental Protection prior to filing of the' final plat. This action requires
additional soils tests to.verify the subdivision and failure to provide
additional ~oils tests will require that Lots 9, 10, and ll be replatted
o~ be recombined into two lots rather than three.
Sincerely~ '~,t:~
\J_~me~ W. Hostman
~vi ronmental. Engineer'
JWH: lmp.
: . CC:
Roll Strickland - DHEP; Bob Grier - DOWL Engineers;
Don Alspach - Munic. Anch. Platting Office';
'Mel Nichols - Alaska TESTLAB; John Lynn - DHEP
MUNICIPALITY OF ANCHORAGE
DEPT. Ci': i },!',LT:f &
ENVIRONviEN1,.'.i ;.. :2CTION
i'
EIV~D
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
02009253 '~[ HAA #
1. GENERAL INFORMATION
Complete legal description
Park Place, Lot 7
Location (site address or directions) 16440 Saint James Circle
Property owner Robin Ward Day phone 345-6955
Mailing address 16440 Saint James Circle, Anchorage, AK 99507
Lending agency
Mailing address
Day phone
Agent Owner 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:
3
x
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 X
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(Rev. 1191) 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 wastewaterdisposal system is safe, functional and adequate for the number of bedrooms
and typeofstructureindicated herein, lfurtherverifythatbasedontheinformationobtainedfrom
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 Mountain Enqineerinq
Phone 562-1500
Address 3868 Shannon ~.'rcle
Engineer's signature
DHHS SIGNATURE
~2~ Approved for
Date 10/26/92
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
__ ~.~, r-- -: -'--~e/.,~tli~l __ ,,,~
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 DH HS does th is as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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 engineeFs work.
72q:)25 (Rev 1/91) 8ack MOA
Municipality of Anchorage .~..%~
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: T,nt-. 7 r Park Place
Parcel I.D. 02009253
A. WELL DATA
Well type Private
Log present (Y/N) Y
Total depth 180'
Sanitary seal (Y/N) Y
If A, B, or C, attach ADEC letter, ADEC water system number
Date completed 6/22/?8 Driller Syren
Not available-
Casedto d~p~pr -I-.bran qR ,Casing height 1.5'
Wires properly protected (Y/N) Y
BROS.
Date of test
Static water level
Well flow
Pump level
FROM WELLLOG ATINSPECTION
6/22/78 10/11/92
15.5' 26'
3 2.4
g.p.m.
Not Stated 166'
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 120 '
Absorption field on lot 125 '
Public sewer main N/A
Sewer service line N/A
g.p.m. ~
; On adjacent lots GT 200 '
; On adjacent lots GT 200 '
Public sewer manhole/cleanout N/A
Petroleum tank N/A
WATER SAMPLE RESULTS:
0
Coliform
Date of sample: 10/13/92
N it rate
ND
Collected by:
Other bacteria 0
Mountain Enqineer inq
B. SEPTIC/HOLDING TANK DATA
Exact date unknown
Date installed 1978
Cleanouts (Y/N) Y
High water alarm (Y/N) N
Date of pumping 10/23/92
Tank size 1,000 gal Compartments 2
Foundation cleanout (Y/N) N Depression (Y/N) N/A
Alarm tested (Y/N) N/A
Pumper Isaacs
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 1 20,
To property line 10'
Surface water/drainage N/A
Onadjacentlots 180'
Absorption field. 5 '
Foundation 9
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed None
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Exact date
Date installed 1978
Length 43' Width 3'
Total absorption area 258 SE
Depression over field (Y/N) N
Results (pass/fail) Passed
Peroxide treatment (past 12 months) (Y/N)
unknown
Soil rating
85 SF/BR
1.5 re±n/inch System typeTrench
Gravelthickness 3 ' Total depth 7 '
Cieanouts present (Y/N) Y
Date of adequacy test 10/11/92
for 3
If yes, give date N/A
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot 125'
To building foundation
On adjacent lots
Surface water N/A
Curtain drain N/A
17'
Onadjacentlots 180' Propertyline 10'
To existing or abandoned system on lot
Cutbank N/A Water main/service line
Driveway, parking/vehicle storage area 50 '
± through house
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name Mark Pearson
Date 10/26/92
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI0~ ' ,r~-T~.~x~,~4~_, ':, L! TION
EN..,.ONME.TAL ENC,.EE.,NC D'"'S'ONTe, epho.e C E 1 V
REQUEST FOR APPROVAL OF INDIVIDUAL ~ATER AND SE~ER FACILITIES
DIRECTIONS: Complete all parts on page ]. Incomplete requests will not be processed, Please allow ten {]0) days for processing. ~-~ '~ ~
PHONE
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS
3, LENDINGIN~TITUTIO~ 1 ~ PHONE
I
MAI LING ADDRESS
4, REALTOR/AGENT ~ PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
t_oiz~ ~\- ~..t::.
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four
[~. SINGLE FAMILY [~ Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
't~' INDIVIDUAL~
[] COMMUNITY
[] PUBLIC UTILITY
~\'~ ~'~L--~* ATTACH WELL LOG. Awell log is requ'ired for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE~*
[] PUBLIC UTILITY
**If individual/on-site, give installation date i(;~ "i~"
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FiVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[~ INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING --
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
Absorption Area to nearest Lot Line
5. COMMENTS
~]"'~PPROV ED FOR ..~'~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Title)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)