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HomeMy WebLinkAboutSOUTHPARK #2 BLK 1 LT 4MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES 0 2 0 0J - e Environmental Health Division v 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name /FFD ® C i4 8 7 -/2 E6 -TO DISTANCES FROM SEPTIC TANK ABSORPTION FIELD WELL Address /Z/dl 1C::DeE:1 AIDS CIE6itir- Phonets) Permit No. No. of Bedrooms 9801eq11 WELL —� LOT LINE 7-0 /D LEGAL DESCRIPTION Lot f Block' Subdivision S B UT PA R FOUNDATION Township, Range, Section SA T i�N K 3 Vr+ AS -BUILT DIAGRAM driveway, water bodies, (Show location of well, etc.) septic system. property lines, foundation, TANKS SEPTIC ❑ HOLDING Manufacturer 6RE"EP_ Capacity in gallons 1 1500 Material STEL No. of Compartments 2 Ts �[ I CIO, 3f TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade FT Total depth from original grade FT I 6 • iL ��• Fill added above original grade -- FT Gravel depth beneath pipe FT Gravel length 5e FT Gravel width Z FT Total absorption area 5170 SQ FT Distance between lines -- FT Number of lines Soil rating /2 SQ FT Pipe material PVC. Installer BI (�9—ao f/,4,4"iE.� A li--,r/e57 Date Installed WELLS ❑ PRIVATE >eOTHER (Identifv) Classification (A,B.C) Total Depth FT Casetl to FT Installer Date Installed: REMARKS: LU/J%/Y//li// Grl�i"E/Z 5 STEM Scale: Inspections Date:�a \Aj, /•v=&c" Performed Mme)-RT.�DF1.1 by: _ - _ y®"'11 AL �„'®� � NLry 4�ou®aaaaeesaeaA`"9 �t ®'BJq oo % o P '•1�6a(." OaO 9Bp Oig HBa OOBCOC ®B<BB�B�fO �g+, F a Michael E. Anderson o, .if 4381 -E �B v Y�•. e°ooacoaaaea �QJ y9 �%P +� ` �sv.` Z+I o y IAeNACL. C 4 AJO CR49certify [hat this inspection was performed according to all Municipal and State guidelines in effect on this date: y@`Ply, /� I? Date: Health Department Approval: �3 Date: 9 72-013 (3/85) M Ll N .1.C; 1: F' A L_ 1: I Y 1: F 1 IV G; Ii CI Ii A (ii liii: Department of Health & Human Services uz,.! L_ ;:, t.rc:. E. t, A!"t r_!"?c:7r ar,Ic. +•�.1 �-r..16. cr ,�J`�c.>1. .:; 1';i>-�Fo-k? 0 1\1 IS 1 1Ei. ;i; 1::: bJ Ei: f? f fei: F "I" T. C': (' A HI K l` L:: R M :L `E 'c?rfril'i.- Nuiriber,. BCD-) 104 _sst..tr,!:,i OV/cis?/E.38 f.rlgine?e=r DesigraA (;L..T.P:I'I:i1=D l_,RAI-�IFiO' Day Phcme. Addre7Bs. :1.;'10:1 FORE:L-ANDS Ch. 2Fit't •f�:•'9i3 APdOP1C1RA3L , Ak" S,I?5:1"S ,- Idi., rY''fy...r.,.-,. .0A I_c?l. 1._erclal. Subdivision,., Pi01..1'1'APARK #2 Lot' 4 Block:. 1 Section. Iownst7i.pii 11.1\1 Range. ';W Lust S:i. e 43,1.00 (sq. it.. or =acres) I°la;: Bedroc:r«?S. 11-11.3 Fc:?rmi.t. 11' Total Capacity., 4 2A_11IC "TANK.,, P'Iinim.Am total. ciu-{pt..i.t:.: t.:anF:: r.:<:apaci.t.y. 1, 2 It -5? c1a11.an<s. Each sept.i.c. ;',I:: m!.tst.. ha'vca at. lca<as't. :' compart.ments„ S)r_`tst.tr t.rs t(o)p of sc'alati.c. 't. an d.; (s) _:; L -0 I t_!e. k.. reclui. res ...I I,, f-l:l.iC9'L i. on oven' t..wlk(Ss). IHIS i=Ei'il`i7:T IS A RIE.IS`r.LIEi: OF I:'tc:RMI:1 48700:38. UH'31"AL-L. TRENCH FE:P F1Il('il:a fl:_i? L_IdC+1 tILl...i tf.+ DE i1E:)hl„ raiJ,ILICa-1' .l..ftil'.PICH LE- I\1C; `I1-1 'l0 L2,- RA1.1..M3„ NO`I Y DHI'IS P'Ftl'.OR M EhlC,'FJ INSFE"C"I-:11711., TI -17.,13 PERMIT.[ IS 'SkJLJFO I' l.:IR Et >11`.Ii:iL E I Al'i:l:l Y i,E'SI))FhlCE (II\1I-..Y f`<fJD EXE'I:IiE.;.i :I'�t/.a I /08, I. l atm familiar c• -a :l.'t.I"f l:.I"1 G! PC i. i. I- i'7'l'.!u f0!^ 1XI-t3itt' cs mPrs {-rola we11.?Si ia'.E !i3et. forth by the MI-ti-li.ci.paai.:i.ty of Anchorage.- (MOA) and the-, E3tat.ca of A1a:us6i6:a„ =' l will. ir-s't.all LhE_) ,tc-,frf in accordance with all MOA ccxIes arfr..l rezrlE.tll=rt.i.c?ns -Ind i.r7 c:�r�pLi.a•rir:r:_ wi't.tY t',.tEz c:aca ic7r7 cri.t.c=rir, of this permit. wi.1.7. i:adi'lu're t.c:l i-t1a. MOA asci S't.atr_` of F±lasbc::; requirements fr_7r, the seat. 1:?aack di.e'at.anc'r•s from any t'.'.xistlnCj 4•Jra :l a. ,; w stewca'tem, v;Ystern or public. sye,tteff? tali"t t.h7.3 or -An ' dj:-il.ent, or nearby lot.. rt. _ndcv•stand 't.hmt. fitY,s 17E,+rint t is 'valid for a Maximum of bedrooms. I al<.cc7 t..irii:ac':ir;-i't.< r7rl c.hr=it t.t?i:_+ of the k_r.?'1'..,-%I. .:::Y==t.r?m J.m gid' L?f:idre?oms cincl any en:larc:iement.. E4i1.1 Fa It.tire an acid itiona:l. permit„ Ei�r.rf u1,. DAIE... I / � f.JwriE r) C I_.IE F ( CIiAIs1 EtE:E: l scst.Aed By. DATE: _..... -..... .__.................. -F Municipality of Anchorage January 12, 1988 P.O. BOX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 �dk�@lYc�4bt Tom Fink, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES C.L. Crabtree 12101 Forelands Circle Anchroage, Alaska 99515 Subject: Lot 4 Block 1 Southpark Subdivision'1#2 Permit #870038, On-site Sewer Permit A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1987. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. Effective January 1, 1988, a new fee schedule is in effect. When re -applying for a new permit, the new fees are; $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sinc l� , Robert W. Robinson Program Manager On-site Services RWR/ljw enc: Copy of Permit /� � 0-ILN1.1-141 _11� ![_:'; I F-evaL. 1: -0-10 CIE= ' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 8215 L STREET, ANCHORAGE, A|( 79501 264`4720 PERMIT NO: DATF ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEEAL DESCRlP: LOT SIZE: MAX BEDROOMS: 41 P Inu_TH; I -FEE E3 LE WA F" 370O3n 03/A1/;7 . C. L. CRA13TnFF 12101 FORELANDS CIRCLE ANCHORAGF, Au 99515 265-6298 SUBDIVISION: SOUTHPARK #2 SECTION: 3 TOWNSHIP: 11N 43100 (nQ.FT. OR ACRES) 4 LOT: 4 RANGE: 3W BLOCK: 1 Listed below are the options available to you in designing your septic system" Choose the option that best fits your site, -------.... --..... ----.... ----------.... ..... ..... ..... --~-..... -.... --..... ET FIE if hJ EA FZ Ch 31 09 DEPTH TO PIPE BOTTOM (FT,) 7,0 6"5 7,O GRAVEL DEPTH (FT.) 5.0 O.5 1.0 TUTAL DEPTH (F1',) 12.0 7.0 8"0 GRAVEL WlDTH (FT.) 2.5 19.0 5.0 GRAVEL LENGTH (FT.) 46^0 77.0 RI,0 ** GRAVEL VOLUME (CU.YDS.) 23.5 26"1 22.5 TANK SIZE (GALS) 1,250.0 ** 1,250`0 ** 1,250.0 ** SOIL RATING (3Q.7T"/13R) 115 115 105 ** GRAVEL. LENGTH > 75 FT. REQUIRES mULTIPL[E RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS _.... ..... ---- ___..... ... ... _____ I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska.. 2. 7 will install the system in accordance with all MOA codes and regulations,, and in compliance with the design criteria of this permit" 3. 1 will adhere to all MOA and State of Alaska requirements for the set beck distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit. IF A iIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODFS, THEN (1) AN ELECTRICALpERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-DUILTJ WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST ME [,qNE BY A LICENSED ELECTRICIAN. SIGNED DATE: � APPLICANT: C.L. CRAB7REE. lGswuD 9Y ��, '��y ^ DATE:/~.���L ------------------ ---------------- LpDP S6utpAkrt dOQD k� �� d\ by SCALE a 7.94 - s.2q r ID SO i Propos y � ; .�g03E T _ Fro. c. - - �.. ' �.. •:'tee ee J. Corvn 707 NOTS .7he ctccu,roxc� vF loot+ion 1� i / o- oF eKis�-in9 proper+y d D cornenS//n1et�¢ and G t� 5y4- c 5qs+erns IMtca�e tx. 4 C� i5 not exacf, Dimetsia.s 43, �oaSF I�tca�ed Ina,�re-been . de{-ervwAkd jb�:cue- Clo11n 44e Yw! % `A ! %saecit : X26 Sei� tar =3 Zed>4+ 36 r ilk uJrYirL = Z s nRArNAOE ARROW 1' 3or Na+ura{ Gas N SPLIT sxwk- oF/ , 1 11��iE rnsrYl yd /2s� Soi(s /¢d` • Ti=si 1lct 11 ,¢.Yle islo f '126 9���P✓ IN SuOD1UtStDA% � Q y � . CNo We11S) ; NIX I -OT ¢ j54K3 ,Sov j!QL Z ZD'�Bi w �5 1 _ - X00550 S E WEE 1$ YSTCM L OCA'i• (O" ALA M ;- I ij to F L I'.. .. I iFq 1.-I)INK ,) 1 11..A-J 11i W..: PA H 1 I 11 Th i!.I KA 1 i5 Id I full. ,,II`!1 .1 1..1- I I0 I,I_011 IJtW, - i NOTE. 1 1 THE ACCURACY OF LOCATION OF EXISTING 1 — —_— PROPERTY CORNERS, WELLS, AND SEPTIC / N SYSTEMS INDICATED IS NOT EXACT. DIMENSIONS INDICATED HAVE BEEN DETER /Q MINED BY USE OF CLOTH TAPE AND NOT BY` SURVEYING TECHNIQUES. 6 efi, Wnt -/,000 Qrpa �snruec� C �G !; oriv�od bisposa j 1 5 rn . 8 uee J. Corwin iu o. CE -5283 1/3)X005)= ®®ROFESS��`a I30' /4a� I 11A$ t+ r !_OV111 LF-GENb zo.R x si� 5q 0$ Q Communt-ty gale," i7v .5uJ)J44K'J'cn SEWER SYSTEM LOCATION PLAN Jed( 0=4o Lot Block Prepared for; i .Dafen Corwin & associates,inc. Consulting Engineers 4790 Business Park Blvd. • Bldg. D • Suite One • Anchorage, Alaska 99503 • (907) 561-6151 /} SOILS -LOG PERFORMED FOR: 'I 6 ��w -- DATE: ZS fCi� LEGAL DESCRIPTION: 6a;A Ib rle Odd "Z1 t z 3 4 5 6 7 '8 9 10 it 12 13 14 15 16 17 18 19 20 ia�^Visna-��y ra`k-d oT. IIS%b�m. WAS GROUNDWATER ENCOUNTERED? NQ IF YES, AT WHAT DEPTH? �i as >• ' s_ ` '+ A9 A A e • •s s•oxc•••...,00 3.. B F ; -•B u e J. Corwin w G S �•a o. CE -5283 GM — sA q Pave rrvo COMMENTS: . 6&1S a1 i N I o1nd %_�-�zt OrY ijiwall,4 1 a d a lis ag. �f f& [1 car —oT 'howls No _ END PERFORMED BY: AL. CERTIFIED BY: / DATE: b` h'fiS 84� • '� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s Certificate of On -Site Systems Approval / Parcel I.D. 020-491-11 Expiration Date: 1. GENERAL INFORMATION Complete legal description Southpark #2, Block 1, Lot 4 Location (site address) 15810 Southpark LOOP Current Property owner(s) Michael Karpiak Day phone Mailing address 15810 Southpark Loop Real Estate Agent Marianne Grant Day phone 529-6602 2. TYPE OF DWELLING: i] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual F-1 Individual Water Storage ❑ Holding Tank ❑ Community Class A Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNadance request Received by: _ COSA to be released to unless otherwise requested by the engineer. COSA Fee $ 7 ,?6 - a) Date of Payment & A9//3 Receipt Number (EaSa6 COSA# Q scg aag Date: Waiver Fee $ _ Date of Payment Receipt Number. Waiver # 3 S. 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 Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for 4 bedrooms System #2 Approved for _ bedrooms Disapproved Phone (907) 272-8218 Date 6/5/13 Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: Thenici dy ArrEt Drage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other OOSA blue sheet r'- I. c If more than 1 septic system is on the lot: COSAChecklist# + of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Southpark #2, Block 1, Lot 4 Parcel ID: 020-491-11 A. WELL DATA Well type Class 'A" If A, B, or C provide PWSID # 213475 Well Log (Y/N) Date completed Sanitary seal (Y/N) _ Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft• Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/ Steel Date installed 10/1/1988 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 5/30/2013 Pumper A -Plus Home Services, Inc C. ABSORPTION FIELD DATA Date installed 10/1/1988 soil ratio 125 sf/br Trench g (g.p.d./ft2 orftz/bdrm) System type Length 56 ft. Width.2 ft. Gravel below pipe 5 ft. Total depth 12 ft. Eff. absorption area 560 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/23/2013 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 638 gal. New depth 0 in. Elapsed Time: 80 min. Final fluid depth 0 in. Absorption rate >= 600+ d. 9•P• Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum in. E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot_ Public sewer main Size in gallons _ 'Pump off' level at Cycles tested _ in. Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 4 Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 200+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 7 Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 200+ Absorption field 2.& Surface water 100+ Water main 10+ Driveway, parking/vehicle storage110+ F. COMMENTS `�4 ' W ti `l. � � �� %Z i+n,"7'L� G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 6/5/2013 COSA brown sheet 10-10-12.doc in. (� 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.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE FOR A Parcell.D. 000 -L19/- U_ 1. GENERAL INFORMATION Complete legal description Location (site addressor direct Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address OF HEALTH AUTHORITY APPROVAL SINGLE FAMILY DWELLING HAA# 614050v' = Expiration Date: �1 —3,0 -06- GMAC GLOBAL RELOCATION Day phone (AGENT) 762-5863 15810 SOUTHPARK LOOP * ANCHORAGE AK 99516 Day phone SHARI BOYD W/ PRUDENTIAL JACK WHITE Day phone 762-5863 3201 C STREET SUITE 200 * ANCHORAGE AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well I ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System 0 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 4 by an independent professional civil engineer registered in the, State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT 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 Health Authority 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. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE I/ Approved for 4 bedrooms. Disapproved. 337-6179 v Date 51 6_3 D Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other ON-SITE WASTEWATER nonr�R6M i��J�OII,)111 By: i�t�0�� /� Original Certificate Date: (Rev. 12101) �01 ,,, WW w'.8X4�'e,n ft. WWW 9 P m. _., g.p:m. e5510n OYef ianK (T/IVJ=�� .. niyii vvdLai aidnn (inv) Pumper G gum ?:ayam'.sBnh�, .,iv's W FW ISTINO GRADE atuig (g p d /it2or /bdrm 125 System type E Gravel belOW DIDe' Resu s lts' (Pass/Faiq raaa __ For * oegrooms ein. a era a 04ga1 a�a New dept m. ,.a,,. n Pump off _in. High water alarm level at n. Cycles tested Meets alarm & circuit requirements? On adjacent lot u Public sewer manhole/cleanout line Holding tank Water service line i o + Surface water the above systems are in 0 defines in effect on this date Date of Payment_ Receipt Number_ 4 `.moi arnessr E-7953 .�a pre fPcslono��a .. 08/08/04 WED 17:17 FAX 8077627516 3C7 G.CAi.JA6r6 G 4/3 L/.u6 ES�+Y ` H I BOYD'S OFFICE Z002 ���` � xodsHoq,Fx LOOP N • 117 ` v s40 �—. •N _---- DE7A/L ' OETAiL I% • I hereby cor/I/y /Aal 04 acWIUle survey o/ top 1a/loolnp descrloed proper/y- LO.TSOtIT Wgdl' _N/o/c�gaE.3Sb3� 1B eY/,2�SB 4z�i✓ 36.00 � 1 '1 a•� � 1 N/%0627c✓ 94.39 � j .�/ %1'06 L.✓ ioso/� � i i 3C7 G.CAi.JA6r6 G 4/3 L/.u6 ES�+Y ` H I BOYD'S OFFICE Z002 ���` � xodsHoq,Fx LOOP N • 117 ` v s40 �—. •N _---- DE7A/L ' OETAiL I% • I hereby cor/I/y /Aal 04 acWIUle survey o/ top 1a/loolnp descrloed proper/y- LO.TSOtIT Wgdl' MUNICIPALITY OF ANCHORAGE • t DEPARTMENT OF HEALTH & HUMAN SERVICES M}� 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. # ��� -��� cA 1. GENERAL INFORMATION Complete legal description I-oT 4 SIIilDIVI SION Lo clL 1. , SOL -nN PAA.k- # 2 Location (site address or directions) 1 5 a 10 So L,—n4DAP_k. l-ooP Property.owner CLiFfo12D �-_j KA-rHE2YrJ C2hBiV-EE Day phone 345-- OoS& Mailing address. t50 t0 SoutZ1P°tZ1L uoop� A+4c-tiOY 464 1 ALM I3 A 9CY5-/(0 Lending agency Day phone �a Mailing address' N �A Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: F°UP, 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone R �Q NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. 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 921 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 ASV_A INATEP— 4 S&Zv+415'S Phone Address Engineer's signature 6. DHIAS SIGNATURE _I,./ Approved for &Js bedrooms. Disapproved. Conditional approval for Additional Comments _S�- En 337-6/71? 9 Yio¢ Date / Z5 �o�i`n@9�et z OF AL ta bedrooms, with the following stipulations: Date 2I 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 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. 72-025 (Rev. 1/91) Beck MOA N21 Municipality of Anchorage Department of Health & Human Services Mu TY OF ANCHORAGE HEALTH AUTHORITY APPROVAL CHECKLIS'�NYIR AL SERVICES DIVISION Legal Description: LOT 4 A i,LOC-Y, J. Parcel I.D. JAN 3 1 1992 A. WELL DATA DIVED Well type CoMMV Ntt'/ ;If A, B, or attach ADEC letter. ADEC water system number 7anitary esent (Y/N) Date completed Driller. ept Cased to Casing height seal (Y/N) Wires properly protected (Y/N) M WELL LOG AT INSPECT N f test Static water level Well flow 9.p. g.p.m. Y V Pump level SEPARATION DISTANCES FROM WELL Septic/holding tank on lot Absorption field on lot . Public sewer main Sewer service line WATERPLE RESULTS: Date of sample: B. SEPTIC/HOLDING TANK DATA ; On adjacent On adjacent lots _ Public sewer manhole/cleanout. Petroleum tank Nitrate. Other bacteria Collected by: Date installed 10 1 Jr e Tank size /SOU Compartments T W O Cleanouts (Y/N„ Foundation cleanout (Y/N) YES. Depression (Y/N) NO High afer alar 1�IN " h��f� Alarm tested (Y/N) N �'� 9 ";E' )+ f SlSr- A-rTaCt� P Date Fpumping 4e SES"/ST`�. � P�MPirl � Pumper SEPAA TION DISTANCES t= od A SEPTIC/HOLDING TANK TO: C�p aN d WaII(S) on,lot �% +� On adjacent lots N Foundation A ®-7 u� SPT .�K To propertyllne'G'c�® AbsorptionfieldK yo ,o Water main/service line TQE+rG�1 c o Surface water/drainage N �� Pe.0- WAA 72-026 (Rev. 7/91)Front © PFS tNSP�C%roN CONTINUED ON BACK PAGE '20, F t F LO M64SVQF.-ice ; t �26J/q Z oRibr�✓A<- p�51(y,rF.e. aF sv571ry+ C.�ATION Date in t ll�ed Size in gallons Vent(Y/N) — High water alarm level Meets MOA electrical codes (Y/N) SEPARATION D. ABSORPTION FIELD DATA — Manufacturer Manhole/Access(Y/N) on" level at�yclestested off' level at — LIFT STATION TO: — On adjacent lots Surface wa Date installed 1� �I A) Soil ratingj ':2. S G%} 2 r System type Length 5c ®oWidth 2 ' GravelthicknessS O Total depth IZ Fit' Total absorption area S60 © Cleanouts present (Y/N) Y7✓5, O� Depression over field (Y/N) N 0 Date of adequacy test Results (pass/fail) 104SS for FoU>Q, bedrooms Peroxide treatment (past 12 months) (Y/N) N�R If yes, give date N 1A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot NIA On adjacent lots N /�' Property line 10 FFA 00 I u To building foundation '"(;P � To existing or abandoned system on lot 1A On.adjacentlots 2� FF�TQ Cutbank N/A Water main/service line 4'Z FEET•' Surface water ►4 /A_ Driveway, parking/vehicle storage area Curtain drain N /A u pElL IaSpacrioa 2.EPoe-i"• I ( (gg E. ENGINEER'S CERTIFICATION2• PFJz• t=(ELD MF�4SUV7�J-1F�1' t 2 qZ pE12 NA,A - Z./zz/89 �7 Z16/NAL 64&,JP-R. of I S14 S. -CEM certify that 1 have checked, ver' of, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's N/am .� EFFf`/ AlS S Date t ( T.9- ? z I HAA Fee $ oo Waiver Fee: $ Date of Payment d Date of Payment Receipt Number Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Game" Alaska Water & Wastewater Services "Preserving the Last Frontier" January 25, 1992 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99516-6650 Ref_ Health Authority Approval (HAA) Application for lot 4, Block 1, Southpark #2 Subdivision To whom it may concern: The septic system for this lot was tested on 01/25/92. The liquid level was monitored in the existing monitoring tube and water was introduced into the clean-out at the end of trench, at a rate of 8.3 gpm, for a total of 98 minutes (810 gallons). This is 135% more than the required 600 gpd for a four bedroom house. The float in the monitoring tube rose 7 inches, which corresponds to 116 gallons per inch. The recovery of the system was to be monitored; however, the float in the monitoring tube dropped 7 inches in less three minutes. In short, the field recovered completely in this time period. The system is adequate for a four bedroom house. If all goes well, please contact Mr./Mrs. Crabtree (the homeowners), at 345-0058, for pick-up_ If you have any questions, please call me. Sincerely, Vey A. G7Trne r/Consultant crabtre2.wps JAG/jag , P. E. Telephone - Fax 338-3246 0 8471 Brookridge Drive 0 Anchorage, Alaska 99504 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 FOR: Alaska Water and Wastewater Services WALTER J. NICKEL, GOVERNOR A 63; 563-6775 January 21, 1992 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 samples requirements listed in Table C, and with the inorganic sampling listed in Table B of 18 AAC 80.200. Sincerely, Keven K. Kleweno Lead Engineer t19 printed on recycled paper b y G.O. . MUNICIPALITY OF ANCHORAGE Department of Health & Human Services M { DIVISION OF ENVIRONMENTAL SERVICES M} 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel l.D. # C),qC�' ''Sa -t^)0 HAA# t \ P\ q9 L._h l 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LOT y f360c14f J SOu7rr PAJL'L� #2 S3 % I/M 2 3t,/ Location (address or directions) (b) Property owner 0 It FF62D C RABTTCEE Telephone: (home) zi5 6298 Business Mailing Address IZIDI F0.!F_1_A 1D5 e311--e (c) Lending Institution 617.1/ //IO2TG 96E Telephone 0 700 Mailing Address 5165 V/ 34�7<11 SuirE /00 (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: C r)/ /J�o �TGAGE 4! 5 (n/ 3G fh :5v/TE Ice) A 00HORAGE) AK 99s03 - TTM: MARK IROS 2. TYPE OF RESIDENCE Single -Family X 3. WATER SUPPLY Number of bedrooms 4 Individual Well ❑ CommunityX Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site 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. 72-025 (Rev. 7/88) Page 1 of 2 Z to Z abed M098 WIL'�°HI 990-ZL •Naom s,aaaulbuo leuolssa;oad aql ul suolsslwoaomijejolelglsuodsaajou slabejogouVtoAilledlolunWagl,pansslslaleo!l!laaoaeAolagelepaz ineao suolloadsul lonpuoo lou op SHHO to saaAoldw3 -sluawaalnbai a;els pus leaapal ulelaao!idles of iepio ul suollnlllsul bulpual ilagl pue sawoq to siasegoind of Asolinoo a se slgl saop SHHO aql •eNSeIV ;o alelS oql ul paaalslbei aaaulbua leuolssaloid luapuadopul ue Aq anoge g gdejBwud ul uanlb suol;eluasaadaa aql uodn /Thio paseq poleoillpoo lenoaddy L(;laog;ny g11eaH senss! (SHHa) saolAaaS uewnH pue glleaH to luewlaedap abeaogouy to Alilediolunlrl aql NOI1nVO lenoaddy leuol;lpuoO to swial leuol;lpuoO panoaddeslO panoiddV AG swooapaqaol panoaddy IVAOUddV SHHa '9 °^ ° 0 rani °^ UO 10 '3 lanyoiW °� y E leas s,aaaulbu3i^/I d 6 a $ {4°pvas°. ve.•^rang R� 6v z2 z h2 Sd b �4/ v a;eO FLG 0>'�2 XO y Q .� ssaappy 9s —LSF. auogdalal flu - I (v� rom--, Nv Luald;oau)LN uoiloodsul slq; to alep eql uo loa;la ul suollelnbaa pue'seoueulpio'sepoo MIS pue edlolunlA lie g;lm aoualldwoo ui sl wals/`s lesodslp aalemalsem ao/pue Alddns aalem al!s-uo agl'uolloodsul PUB uol;ebllsanul Aw Luoal pue salll abeaogouV to Allledioiunw aq1 woa; poulelgo uopeLwolul aq1 uo paseq ;eql AllaaA aaglanl I •ulaiag palenlpul ain;ona;s to ad (l pue swooapaq;o aagwnu aql aol alenbape pue leuol;ounl 'ales sl walsAs lesodslp aa;ema;sem jo/pue Alddns aalem ails-uo aql ;egl smogs lenoaddy (;laoylny LMUGH slgl to uollebllsanui AW legl L(llaaA l'molaq umogs elep uollepllen aql to se pue olaJaq paillle leas /,Lu Aq pallpm sy NOIlVWHOdNI aNV V1VO `HOHV3S 3-Ild `S1S31 `SNO11OUSNl ONIOIAOHd WHId ONIH33NIJN3 '9 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) lAUNIgPALIiY of - ce CHECKLIST - FEBRUARY 19E IWE ENVI':WV,/ NTAL SE,E �VIGICN 343-4744 ,} r Legal Description: GoT 9 BGoe E / SO0T14 PA21C Z A. WELL DATA Well Classification C0 M m u n t Ty If A, B, C, D.E.C. Approved (Y/N) — Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Date Completed Electrical Wiring in Conduit (Y/N) Depth of Grouting 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 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 Water Sample Test Results Comments Cominon/�y We//- See 4171A6P/ED B. SEPTIC/HOLDING TANK DATA Date Installed /O-/- 88 Size /500 No. of Compartments Standpipes (Y/N) Y Air -tight Caps (Y/N) _ Depression over Tank (Y/N) N Pumping/Maintenance Contact on File (Y/N) Date Foundation Cleanout (Y/N) _ y_ Date Last Pumped NEW 00n57_9UC710N ;for Oornsreucrl"J Holding Tank High -Water Alarm (Y/N) &�f Temporary Holding Tank Permit (Y/N) _N1__4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well ZdO� f To Building Foundation To Property Line To Water Main/Service Line To Disposal Field To Stream, Pond, Lake or Major Drainage Course NOn/e 112 AQEA Comments 5V51erz %5 �90E�y 47E 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /Z 5 Type of System Design Ti? ENCFI Date Installed /0'/ - $8 Length of Field 56 Width of Field 36" Depth of Field /Z Gravel Bed Thickness Square Feet of Absortion Area SGD Statndpipes Present (Y/N) j Depression over Field (Y/N) N Date of Last Adequacy Test N Ew Consr2ucTronr Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well Z60' t To Property Line To Building Foundation i5 To Existing or Abandoned System on Lot A/0MF- o AJ Lo T- ; On Adjoining Lots 65, To Water Main/Service Line `/2 To Cutback (if present) MbA(E .QneSen T" To Stream, Pond, Lake, or Major Drainage Course NO N E f N A 2EA To Driveway, Parking Area, or Vehicle Storage Area e 7 Comments 42SOP-pi-i0kJ Fl e L1�> Is An ecj2 VATE IFT STATION Date In d 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) **Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guldeliine4s5 in effect on the date of this inspection,/�t�/ .�jjj'n�'a� Signed . ^E 'tUn 'en U°� Company AA-meakioJ 6AI,IAJ(.-CrUA) ,b sYA' L` ✓ r° / ec 'R Engineer's Seal Date Lz� MOA No. Receipt No. 0-5��a97a Receipt No. Date of Payment o� 'ao2 - Waiver Fee: $ — Amount: $ %�-��� Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 Michael U'. A,a ir.-r,an n, E �ti E or aus Na STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 316 ANCHORAGE, ALASKA 99503 DATE: February 17, 1989 PWSID: 213475 To Whom It May Concern: According to the records on file in this office, the SOUTH PARK S/D 42 is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, ALS , 4 VERA E. CRAIG Environmental Field Officer