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HomeMy WebLinkAboutSOUTHPARK #1 BLK 3 LT 19Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page / of Z ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191202 PID Number: 020-491-45 Dwelling: FN Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New W Upgrade Name Mark Selland ABSORPTION FIELD [:1 Deep Trench El Wide Trench ❑Bed ❑ and Site Address 4530 Southpark Bluff Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from iginal grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade t. vel depth beneath pipe Ft. Subdivision Block Lot Southpark #1 3 19 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorpluel6area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well n/a TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Infiltrator Capacity 1537 Gal. Surface Water 100'+ Material Number of compartments Lot Line 5'-I- I NA Plastic 2 Foundation LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 30311 Tank to drainfield 3034 Installer GLW Drainfield cO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 327.0 ft Inspdection 151 7/9/19 7/16/19 Location and description 2'd 3111 4,h Bottom Trim South Side of House ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: A/ Date of `r � ,��C� i F'anrio.ec Septic System( �_W en , .. Approved Date s 1� 20a2 t v0'rt Note: this approval does not include well permit requirements. kmev uoruZi ion -Ir, mmn-�-- -+ �-icnnO�� _� ( _ t1TtD O A� 07 .N �o�O> �� �rn W �1,m M IKP,(7 C OrnxAv m--1 I I D D m 'u (nmm Z D DrJ- �im0ZMmC)toz i7Z�Zb-1b� O-- -, 70 _ �.. >O'WOZZO=D y f OnmrO— pm -foci oma nD Wino c/) W oa'`{D m Z z *.rm O ..O o m X U, oo � ITI ----I D 0 r -, 2 z W CL v .. m 0 cm \ 1 y � c1r) o A LUFF /'Drive— / '<� — -! it o - (Cn / o z / mm Im W I rn- IU _ I w N / / � r'-*, o -, m iii'', _ •� / �� � i I IW-= CLEAN OUT N/ 0I� v I 1 I / D1> W mT N) oz. Irk D o I j� I I a 1 I � CLEAN OUT / IT�+ �' om J // I �l It CLEAN OUT CLEAN OUTIn / '0 I J mr i t / m�Z X, 1 / / / Ln Ji I I y (Tl In r _ O C\ -u `10 ?A' 1 an�A+ -u �<mK / I L — — ' rmf.J--- ��Z�m------ 10.0 tii Esme- % 0.,..�n / C7 N / ice' / m t O'p m m z / z z { C to / z m Om J co o y Y — — — — N / - r D o - — — — — — — z� — — cn _. CO =-- Z oo p CD / NOTES: N' PA NONE ENG SVC, LLC P.O. BOX 1807 PALMER. AK 99645 PHONE (907) 745-8200 FAX 907 745-8201 ��QFgCgSI� �P• ' 9�+� REVISIONS DATE 12/13/2019 RECORD DRAWING SCALE SOUTHPARK #1 B3 L19 MARK SELLAND & KATHERINE FARYNIAR 4530 KBLUFF �* *rj "Ste�e�'k:'�an onel 50' P.I.D. NO 020-491-45 DRAWN ACP �202 S EEP19PERMIT SITE PLAN ANCHORAGE, AK 99516 `;\, k\, 11 2OF2 f f x � -.. � � - • 3 r -1 Ems: /i! [ � i -� �`.. �; F .. Etas ;.. Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve(c)panengak.com July 15, 2019 Subject: Southpark #1 B3 L19 4530 Southpark Bluff Drive Drain Field Justification To Whom it May Concern On May 10, 2019 Pannone Engineering Performed a septic adequacy test on the above-mentioned property. The septic system was visually inspected and measured. Six hundred (600) gallons of water was added to the drain field at a rate of 2.9 gallons per minute. Water levels in the drain field rose one (1) inch throughout the duration of the adequacy test and returned to the beginning operating level at the conclusion of the test. An inspection report approved by the Municipality of Anchorage On-site department and dated 11/19/1982, states that the soil rating for the subject property was rated at 198 square feet per bedroom. A four (4) bedroom house would require 792 square feet of total effective absorption area. The above mentioned inspection report states the bed dimensions to be 45x20' for a total of 900 square feet of effective absorption area making it oversized for the approved soil rating. This soil absorption system has been in operation for 37 years without issue. If this system where to fail it would be removed per code and replaced to the original design specifications. If you have any questions or concerns, please contact me at 907.745.8200. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer GOLDENVIEW PARK PH. 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LLV))>ryC.) V)- Lv, J) 0 L L i V ao�m� F-0 <DC)LIJ o)moJcnoW LLJ 0 Q Ld LEJ M M V) 0 U� '—;7 CD C.) Lu z D a n > < cr )- Lf) _3 uj w < LIJ -r Lu F- 0 < z (D Li (D L ij F- 7: Z) -i CD y 0 Crr Ld r) > 0 Lu M 0 =M0 r x LLJ 1-- 0 z (/) 0 I 5- tr) ra 9 z 0 :3: M ci (D z rr) U) > Ld CD • C-4 CL < 0 M z < n - I V) FY Lij 5- z Yo w F -X z r -i `i a L) z <0 (La n < :3: < a: T M Ld (1) 00 0 z pr) a cn OF 0 z w • I NkNN: OF • [rr.lirh -4 MUNICIPALITY OF ANCHORAGE On-Site Water& Wastewater Program PO Box 196650 4700 Elmore Road �'�rte �� A: i Anchorage,Alaska 99519 6650 Phone; ! .5 /` (907)343-790= ',• y r` http://www.muni.or Fax (907)343-7997 g/onsite On-Siteg(11111' Wastewater DisposalDc•partrrrent System Permit Permit Number: OSP191202 Work Type: SepticTank U Effective Date: 6/7/2019 Upgrade Tax Code Number: 02049145000 Expiration Date: 6/6/2020 Site Legal Address: SOUTHPARK#1 BLK Site Mailing Address: 3 LT 19 G:3236 4530 SOUTHPARK BLUFF DR. Anchorage Owner: SELLAND MARK A & Design Engineer: PANNONE ENGINEERING SERVICES Lot Size in Sq Ft: 26803 This permit is for the construction of: Total Bedrooms: 4 0 Disposal Field � C1 Septic Tank 0 Holding Tank All construction shall be in accordance with: Privy 0 Private Well 1. The attached approvedWater Storage 2. All requirementpeC odo inr design. Municipal code Chapters Wastewater Disposal Regulations (18AAC72)and Drinking Water 15.55 Regulations 3. The wastewater code requires inspections during the installation. The engineer 15 65 and the State of Alaska Servicese acode per AMC 15Provide notification iion bye ons (18AACSQ) 4. all October 15 to April 15 a subsurface soil absorption system under g neer 9h4shall notify the Development shall be either: calling construction 343 (24/7).d a. Opened and Closed on the same da during freezingw b. Covered, sealed, and heated to prevent freezing Bather Special Provisions: The Engineer will perform a test hole and perc test at tank installation to confirm adequately sized for the 4 bedroom house. Please submit the soils with the As-built Inspection Report. that the existing field is log and a statement regarding the field size c/i) Received By: ` / 1 '' ti Issued By: 4 ." Date: / 7 I ��-dr Date: 6- 7/q EP ,ANS MUNICIPALITY OF ANCHORAGE ........._„,............,.. 6., Community Development Department ` Development Services Division Phone: 907-343-7904 On-Site Water& Wastewater Program Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-491-45 Property owner(s) _ Mark Selland & Katherine Faryniarz Mailing address 4530 Southpark Bluff Drive Anchorage, AK 99516y phone Site address Same Legal description (Sub'd., Block & Lot) Southpark #1 B3 L19 Legal description (Township, Range & Section) Lot Size 26,803 Sq. Ft. Number of Bedrooms 4 _ APPLICATION IS FOR: (®all that a APPLICATION IS AN: TYPE OF DWELLING: PP Y) Absorption Field Initial 0 Single Family (SF) 0 (w/wo ADU) Septic Tank Upgrade El Holding Tank Ell Renewal (D) El Renewal Privy Multiple Dwellings Private Well (SF and/or D) Water Storage 0 THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. '11°-. lik (Signature of property owner or authorized agent) Permit/Rush Fees: a a5- Waiver Fees: Date of Payment: $��Q /ej Date of Payment: Receipt Number:___________62gle 24 Receipt Number: Permit No. d S P/q/2U.a Waiver No. Permit App_ :. ::..,:c; MUNICIPALITY OF ANCHORAGE WATER CONNECTION — Location Record ACCT. NO. NAME ADDRESS 'LL7530 5,2aTipork Ski-CP .,-- LOT 19 BLOCK 3 ADDITION SIZE CONN, - ------- DATE MADE NEW CONN. REPLACEMENT CONN. LOCATION: ALLEY 0 STREET I1 TYPE OF MAIN I tpe, CORP STOP D.z I SHOW SKETCH ON REVERSE SIDE THAW PLATE PERMIT NO. CURB STOP C TO C KEARNY WIRE CONNECTOR I CURB STOP C TO 1 W. OTHER: CONN. CORP CONNECTOR INSP. COUPLING C TO I PERMIT X BRASS BUSHING TOTAL X GALVANIZED BUSHING COMMENTS: BROKEN MAIN,EXT.CONNECTION, EXTRA PIPE 2 PART UNION CASING.DELAYS,ETC. FT. to 3 PART UNION I,.. SERVICE CLAMP Xu�h �Q�n ��C��G SLOT PILA 0 PAID PREY. COPPER PIPE ►1•e i/l t , /� ❑ W•M # t 1/4"KEY BOX 1--- ���x�. w/ 2" KEY BOX ❑ PAID CASH ❑ SUB AGREEMENT THAW WIRE DISCONNECTS ALT. # TT�� LOCATION 1051 N 0.P llr1 vLI.JQy EXCAVATOR L.., IMP. DIST. APPOINTMENT TIME: TIME READY: 0 EXT.AGREEMENT CONNECTION MADE BY INSPECTED BY 31-058(12/77) • 5 _\\ , 6, YP 112)3 L19 KEY BOX AND SERVICE LINE LOCATION BY SKETCH INDICATE NORTH STREET ALLEY Q� j I x• i l DcJay 31.058 (12//i) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191202, Deb Wockenfuss, 06/07/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191202, Deb Wockenfuss, 06/07/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191202, Deb Wockenfuss, 06/07/19 ,~ ('~, MUNICIPALITY OF ANCHORAGE DEPAR'~MENT OF HEALTH & ENVIRONMENTAL PROTE'CTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street* Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~HONE [] NEW J~X~~X HIGHLAND DESIGN, INC. ~'-f74.3 []UP.RAOE MAILING ADDRESS LEGAL DESCRIPTION LOCAT,ON NO.O BEDROOMS c~;~ Manufacturer, Materia~f ¢~t No. of compartments ,~. ~< Greet Liq. capaqity in gallo~s Inside length Width Liquid depth /2~-O IF HOMEMADE: ~ ' ~: Well Dwelling PERMIT HQ. O ~ ~ Manufacturer Material Liquid capacity in gallons o We, Poondat~on , N.are,t lot ghee- PERMIT NO.~ MOO _ No. of,i,es4 Lengthofeach line~0! Total 'engthoflinTS~[a, TrenchwiOth¢~./X~.~?~i+m~es Distancebetweenlines..~-/ Total effective absorption area ~:- Top oftlietofinish gra0ez,,6V, V4 4'5o// Material beneath tile ~'~/',nches Length Width Depth PERMIT NO. ,~ :- Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: .j Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER P'PE MATER'ALS /2~'~ eht,'re bed w,'t d' :o/i X APPROVED/ DATE LEGAL 72-013 (Rev. 3/78) ,~MUNi.t:IPALITY OF,,ANCHORAGE ,~ DepartmentF~)Heatthand Environmenta? ~otection 825 ~ Street, Anchorage, AK. ~J501 ~264-4720 * * * HANDWRITTEN PERMIT * * * NELL AND/OR ON-SITE SEWER PERMIT V,o.¢ation: T~p:e of Soil' Ab-sorption:System Is: Trench: Drainfield: Maximum Number :of Bedrooms: ~ Seepage Bed: ~ Holding Tank: Soil Rating (sq. ft/br) , ~k, .-) The'Requi%ed Size of the Soil Absorption System Is: , L~ENGTH~© ~0 GRAVE~ DEPTH ~'~ ~/~x~,r .} WIDTH The length dimension is the length(in'feet) of the trench or drainfield. The ~depth of a trench or pit is the distance between the surface:of the ground and :the bottom of the!excavation(in feet). There is no set width for trenches. :The gravel depth is :the.minimum:depth Of gravel between the outfall ~ipe and the bottom of the excavation(:in feet). * * 'REQUIRED SEPTICGHet=~Ne) TANK SIZE= /[)F) 0 GALLONS * * Permit applicant has the responsibility to.inform this department during the installation inspections of any wells~adjacent :to th;is property and the number of: residences that the well will serv.e. *'* * TW0(2) INSPECTIONS ARE;REQUIRED * * '* Backfilling :~f any system without final:in~spection.and approval by this department wi'll be subject to prosecution. Mi'nimum distance b~tween a::well:.,and.:any on-'site sewage disposal system is 100 feet for a pri~ate ,well :or ~50 to 200 f:eet ~from:a pUblic :well depending upon the ~ype of public well. Minimum :dist,ance from a private well to.a private sewer line is :25 feet:and to .a community sewer line is 75 feet~ Well.logs are required and must be returned to 'this :department within ~30 days of the well completion. Other requirements may apply. Specifications .and construction diagrams are a~ailable to insure proper installation. * * * PERMIT EXRI:RES :DECEMBER.i~i, .1 9 8 2 * * * I certify that: (1) Z am familiar ~ith the requirements for on-site sewers and wells as set forth by the_Municipality Of Anchorage. (2) I.will install the System in,accordance with codes. (3) ~I understand that tke on-site sewer ,system may require enlargement if the residence is remodeled to include more that 3 bedrooms. . S ~gne~: Applicant Issued by:. / ~ /%,{,1"('.¢4 .¥-.t ,'. k, .'C Date: ~, ,, / J ¢~ SWP/024(1/81) ~ - ~e ~ ~L~a o~ the e~l '".. d~th o~ a ~r~n~ or ~t ~ ~ ~s~ce ~e~ the ~e of ~he g~ou~ ~ ~ R~Ul~ S~lC(~ TANK S[~ a~ musk ~ ret~ to th[~ d~r~t wi~in 30 ~ay~ ~f ~ .~orCh by ~t~ M~o~pal~ky of ~hora~. . (3) ~ u~tand that the on-site ~wer Oat~ · ~" '= ~ SOILS LOG -- PERCOLA'rlON TEST PERFORMED FOR: Z? ~';~.~ ~-~6¢/¢¢~ 7/,~f/~ DATE PERFORMED: /// -- ~¢ -- ~:-/ SLOPE SITE PLAN 2 ~1 // 3 7 8 9- 10- 11 12 13 WAS GROUND WATER IF YES, AT WIIAT DEPTH? ~'~ / 14 15 16 17 18 19 20- PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND __ FT DATE: /Z- -'//~ 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343~4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description I Location (site address or directions) L~S:~C~ ~-~¢_)dJ~k '-~¢~.,F\( ~. '~..,~ ~-~ Mailing address /'/~-%¢ %,:,,.' ~, "~./~, "'~c~I/(~( ~,~(~ Lending agency Mailing address Address Day phone Day phone Un/ess otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water g~' II~©AII4~NTAL $£'~VIcE.,S O/ViSioN OCT 09 1996 CEIVED NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (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. NameofFirm ['--"~.~d~q ~C2-~wrJ/',_i~l,,"c// 1~.~'-- Phone Address .../,~¢ r~ ~ / ~--~ ~ ~ ~ Engineer's signature ~ ,..~.~..4_..~z_.~,.-~-~ Date DHHS SIGNATURE /~ Approved for bedrooms. 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 i~ased only upon the representations given in paragraph 5 above by an independent professional en~iineer 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 r~ot conduct inspectio.ns or analyze data. before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev 1/91) Back MOA ~21 MUN~C~'^Lm' OF ^ NC.~ Municipality of Anchorage Nvl~o ~ DEPARTMENT OF HEALTH & HUMAN SERVlCE~ ~ N~ALS["Wl Environmental Services Division OCT 09 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist R E C E i V E D Legal Description: A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Total depth Cased to Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~!'iq~/¢~ Foundation cleanout (Y/N) Date of Pumping ~O/ll ~ k Tank size ],~ Number of Compartments ,,~ Cleanouts (Y/N) . ~/ Depression (Y/N) J~ High water alarm (Y/N) Pumper -/ C. ABSORPTION FIELD DATA Date installed I1- I q- Length ,~,..~ ~ Width Effective absorption area ?~gl~ 7~ Monitoring Tube present (Y/N) ? Depression over field (Y/N) Date of adequacy tes, /0/¢/~, Results(Pass/Fail) '~) For ~'/ Soil rating (g.p.d./ft~orfF/bdrm) /~ ~ Systemtype ~)--~ Gravel thickness below pipe ~ i I Total depth ':~l"'FluJd-- depth ql//~a v~t~ f- in ~ before test (in.);' Fluid depth (ins) M..~tcc ~ater: Immediately aftero~gal, water added (in.): Absorption rate = y' ~ . g;p.d. Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* -~ ! 7~"/~ F ~ t, lO bedrooms /O If yes, give date LIFT STATION Date installed Manhole/Access (Y/N). High water alarm level at* Cycles tested SEPARATION DIsTANcES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Size in gallons "Pump on" level at* *Datum On adjacent Iot¢ On adjacent Iot~ Public sewer manhole/cleanout "Pump off" level at* Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation '7 ! Property line ~> /(,P I Absor [ion field Water main/service line .~.~,~ I Surface water/drainage I~/OWellsll on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ~ I I Building foundation ~ / O Waiter main/service line Surface water i"~[ f.~ Driveway, parking/vehicle storage area Curtain drain ~ l¢ Wells on adjacent Iot~ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records,that the above syst,,?ms are in conforman?e with MOA HAA guidelines/j~ effect on this date. Signature Engineers Name I o ,.,~-~.~ ~-"~p u Date HAA Fee $ ~/ Waiv,er Fee $ Date of Payment/1¢~/~/.~¢~¢' Receipt Nu m ber~~-~'- ~OC~¢-~,) 72-026 (Rev. 3/96)* Date of Paymeht Receipt Number 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ~' Mailing address Lending agency Mailing address Agent Address Day phone Day phone · Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72*025 (Rev. 1/91) Front MOA #21 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 Address Engineer's signature / Phone DHHS SIGNATURE /~ Approved for .~'¢ c~ A- C4L.) bedrooms. Date Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 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 e[.rors or omissions in the professional engineer's work. 72~Y25 (Rev, 1/91) Back MOA ~F21 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type ~2~ If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot .- ~ , ~ AT INSPECTION ; On adjacent lots Z Absorption field on lot ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed l I - I ~. o¢ ~_ Cleanouts (Y/N) ~ High water alarm (Y/N) Date of pumping Nitrate Other bacteria Collected by: Tank size /~- ~O Compartments Foundation cleanout (Y/N) "'/ Depression (Y/N) {"'//~ Alarm tested (Y/N) ~'~///~* ~7_/~--/~ ,~L Pumper /~ ~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot J"////~ TO propertyline ~/0 Surface water/drainage On adjacent lots h///'/~, Foundation ! O Absorption field ~ Water main/service line ~ ..2_~ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ,Z/Z ~- Width Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating / ¢L¢) System type Gravel thickness ~ ~ ~ Total depth Cleanouts present (Y/N) 'j~ O Date of adequacy test ¢~/:~-/// for // Total absorption area Depression over field (Y/N) If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I".///) On adjacent lots i'~//A' Property line ~ ~,~ To building foundation c~ c") ~ To existing or abandoned system on lot On adjacent lots ~- ~.F> ¢.p Cutbank '.~' ~') '-~-~ Water main/service line '~ J,- O Surface water /'/,/,~-\ Driveway, parking/vehicle storage area "~ ~.~;~ Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on thecdate of this inspection. HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91 ) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 20: ~EST 15TH, AVENUE SUITE 205 AN~HORAGE~ ALASKA 99501 Murd. cipal:i, ty o~: Anchmrage DJvisiot'~ o~: Env:i. ronmental Health Department o.~ Heal'Lin and Social Services 820 I Street February 2'7~ 1992 )ubjE_L: HAA 4~ 9200r34 L.ot 19, B].ock 3 South F'ark $~:[ On February 16, 1992 we hand dL.~(:~ a test hole into tine nor'th-E*.asi: C:01"£1(~.~r 0~: the [:)¢ecJ at SLd:)j(~¢=t properi:y. We ¢:c, und one o¥ the perCmrat(~d dJ. st. ribution pipes, 1--.1/5" conduit to the bottom (:)4: the sewer rocks-:. 4" o-¢ water was measured in this pipe. and inserted a Ap p r o:.', i matel y ']"l'-~e various e].evat:Jor~s are shown on the sketch below,, This inw~,sti.qatiorl ind:Lcates that the system is not submerged arid 'Llnat it is still operating as designed. Please :i. ssue the HAA ~or" this pl"opert, y. Tobber-~ Spurkland P.E. SEPTIC SYSTEM ADEQUACY TEST LEGAL: 15, Block ~' SoL, th Park LOCATION: 4530 South Park B1L~f~ Road OWNER: l)avi d Jensen RESIDENCE: Single Fami].y~ 4 Bedrooms WELL: Community Water System PWSID 213475 SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: 4 Bedroom System TANK: Greer Steel 1250 Gal. Two Cemparts. ABSORF'T I ON SYSTEM: Bed ABSORF'TION AREA: 900 Sq. Ft. SOIL RATING: 198 1NSTAI_I_AT I ON DA"FE: 11-19-'82 DATE OF LAST PUMPING: Isaacs-:. Feb 5~ 1992 DATE OF TEST: Feb 5 1992 TEST PROCEDURE: System was inspected and measured. Tank was ¥(~und with 3 feet o~ cever and with a liquid level o~ 48 inches. Bed monitor tube was 4.5 deep with 10 inches o~ water. 630 gallons of clean water' was added to the bed at a constant rate of 6.4 gpm while the water' levels in the tank and the moni- tor tube were moni'Lzored. The water levels did not change. No evidence o~ discharge to the ground sur'~ace was observed. TEST RESULT: This system meets the code requirements o~ the Health and Social Services Department o~ the Municipality o~ Anchorage. NOTE The eperational life of all septic systems depends on the local soil cenditions~ groundwater levels that may fluctuate during the year', and the water' usage ef the ~amily being served by the system. These conditions are outside the control of the evaluator o~~ this septic system. We can therefore not give any estimate e~: how long this system will function satisfactory ~or current or ~uture occup~nts. ~ .... ,, , , ,,~tf ,/,'it DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 WALTER J. HIOKEL, GOVERNOR (907) 349-7755 Februaw 6,1992 FOR: Tobben Spurkland PWSID # 213475 My review of the records on file in this office reveals that the South Park Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineer BR/cr MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) 50UTH ?/~t~K~ t3_~ I_ ! ?' lin ~ ~d ,5~c .~ Location (address or directions) qs~ ~OUFd P~K ~LUFF DR~U~ Applicant Name_ 5~1]~ ~S ~ Telephone: Home ~Y-~¢7 .us~.~ 2 Applicant is (check one): Leading Institution D; Owner/builde¢ ~ Buyer D; Other ~ (explain); (d) Lending Institution ~l ~ Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ~' Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well [] Community ~ Public [] Note: If comm unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4, SEWAGE DISPOSAL Onsite,l~ Public [] Community [] Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm J~-~-~'"~.~ [/V'("~ ,,' Telephone Address [~00 ~ ~~ ~1/(~ ~ DHEP APPROVAL Approved for Approved bedroom ~ Date Disappt~,ed Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOAI HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: ~.~ 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 To Nearest Public Cleanout/Manhole Water Sample Cofiected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved ~)N)I~0'1~ Date Completed Yield Depth of Grouting Pump Set At __ Sanitary Seal on (Y/N) Depression Wellhead (Y/N) ; On Adjoining Lots On Adjoining Lots __ To Nearest Public Sewer __ To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed il/!q/ Z Size Standpipes ~N) Air-tight Caps Depression over Tank (Y,~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: TO Water-Supply Well --.~ll~Jr"~ TO Prgpert~ine 2. To Water M'aid/Service Line j,,.~"- Course : :.h /00 NO. of Compartments ~- Foundation Cleanout ~N) _ Date Last Pumped -~/3J/~ N//Of' ; for ~ Temporary Holding Tank Permit (Y/N) To Building Foundation 7 / To Disposal Field ,_~"' To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72 026{11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed II ~ I ~:~ ~'- Width of Field ~---~)" Square Feet of Absorption Area Depression over Field (Y/.~ Results of Last Adequacy Test Type of System Design Length of Field ~_~- / Depth of Field ¢7//~ Gravel Bed Thickness ~ /'/ Standpipes Present (~N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well / 20o tO. / To Property Line , ~ To Existing or Abandoned System on To Building Foundation / '7 Lot To Water Main/Service Line / ¢2 · To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ~' ; On Adjoining Lots / 0 ""'~ Comments D, LIFT STATION Date Installed Dimensions Size in Gallons / Manhole/Acce. ss ~ "Pump On" Level at ,y, ///y~ "Pum~vel at High Water Alarm Level at ! /; j ~ Vent (Y/N) Tested for ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** i certify that i hav~e,c~e,ck ,ed~.verified, or conformed to all MOA end HAA guidelines in effect on the date of this inspection. . Signed C~ ~/,¢/~/~/' Date ~ot/,2~/~:~ 6 Company__.~'//~./.~'2,~-. _ /~(dC-r MOA No, Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) ALASKA i,dlROFImeFITAL COFITROL se, lCe$, InC. ~nclineerin~ 6 ~nuironmental StuJics DAVE JENSEN 4530 SOUTH PARK BLUFF DRIVE ANCHORAGE ALASKA 99516 SELLER-SAME JUNE 1 1986 DAVE JENSEN 4530 SOUTH PARK BLUFF DRIVE ANCHORAGE ALASKA 99516 60251 LEGAL:SOUTH PARK #1 BLOCK 3 LOT 19 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-MAY 29 1986 THE TYPE OF ABSORPTION SYSTEM IS A BED WITH AN AREA OF 900 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY 0F THE SYSTEM IS 929 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME 0E 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 5/31/86 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. ~200 [[]est 33rJ Auenue, Suite E~, Anchoraqe, Alaska 99503"(907) 561-50/40 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-~533 p~s t.~.# .~/$ '-/'7.5' To Whom it May Concern: According to records on file in this office the ~ /~,_ ~ ~4ater System is in compliance with the State Drinking Water Regulations Sincerely, ALASKA ENVIRONMENTAL CONTROL SERVIC~'~! INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 CALCULATED BY ~ / " ' DATE CHECKEO DY / / / / / / / / / / / / / / / ,,,, TU~>E I ~ APPLI( NT FILLS UPPE~R/HA[~"ONI~Y' Time Time J Time Time Date Date Date Date Ins ector . Inspector Inspector Inspector ~ · ~U;,/Ci~ALITY OF ANCHORAGE Field Notes: '1F~>¢~ DEPT. OF HEALTH ~ , ENVIRONMENTAL PROTECTION .RECEIVED ( ~ APPROVED BEDROOMS ,~ *CONDITION8 OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE ~-~(.o - k ~ ~(~ ~ SOilS Rating Date Sewer Installed -~'/'~'~' Well To Absorption Area Well Log Received \ ~(~: il- ~_ (~'~, Well ,o Tank Septic Tank Size