The URL can be used to link to this page

Home My WebLink AboutSOUTHPARK #2 BLK 1 LT 18 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .~l~/CJq04// PID Number: dj Name: , Wastewater System: [] New ,~]gUpgrade Address: ABSORPTION FIELD .Phc, cc: NO. of Bedsores: /:~X)C~O/--~,,,~--I ,~/~. ~,c)'.~-/~,~ ~DeepTrench O Shallow Trench DBed DMound OOther LEGAL DESCRIPTION soi,.~ti.,: ~.~GPD/Sq. Ft. Total Depth from original grade: Lot: Block: Subdiv~ion: Depth to pipe boEom from original grade: Gravel depth beneath p~pe /~ / ~p~ ~/D ~ ~F~. ~Ft. Township: Range: Section: Fill added above original grade: ~ Gravel length: ~- ~t. /IZ Ft. WELL: ~ New ~ Upgrade Gravelwidth: ~ Ft. Numberoflines:~ Distancebe~eenlines;/d/~ Ft. Classification (Private, A,B,C): ~/¢~. Total Depth: Cased To: Total absorption area: Pipe materi~l: ~/~ Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: Pump Set at: Ft. Casing Height Above Ground: SEPARATION DISTANCES ~,~i~,~ ~.o,~in~ as:~.~.~. TO ~eptic AbsorptiO~ Lift HoJdi.g ~ubliclPrivate MaRufacturer: Capacity i~ gallo~s: From Tank Field Statio. Tank ~ewer Lines ~/~ WelY ~ *W ~ /~ ~ ~ ~ Material: ~E~ Number°fC°mpadments: Sudace /+ ,. LIFT STATION Water /dd /~d ~ Lot Line ~/ /~/ "Pump on" level ~t: -Pump~ ~ High water alarm at Foundation /~ / /0 ~ Cu~ain . ~/~ ~D~ Pump Make & Model Electricallnspectionspedormedby: Drain] Remarks: BENCH MARK Location and Description: 170~ Eagle River Loop Eead, No. 204 Inspections performed by: E,~I~. River, Alaska 995~ Dates: 1st~z/_~ ~ e~ices approyali Department of Hea um Reviewed and approved by' ~~ ~?~ Dato: ~?~/~ -~' 72-013 (Rev. 9/91) MOA 25 Permit No. SWg,m014 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: SOUTHPARK SUBDIVISION ¢/2, BLOCK 1, LOT18 PIDNo.:02005218 LOT SCALE 1" = 40! CO ¢01 EXIST. 1250 GAL 92.6' S.T. 18 4 BDRM HOUSE ~-NEW TRENCH / / C03 MT1 97.2' 9~.3~O5MT2 86.7' 86.7'J 79.7' NO WATER FOUND A B C D E F 701 -- -- : 9.5 8,0 ~02 i6~0 46 0 203 49.0 19.~' ~04 24.0 71,C 305 -- -- 31.5 17.~ ~iT1 22.0 18.C ~T2 -- -- 27.5 ~1.~ SEPTIC TANK (INTEGRITY VERIFIED) KD(BOX 72~013 A (2/91] MOA 25 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~ - ~ ~ ' / [ L..-~'~- ' I ~)Township Range, Section: LEGAL DESCRIPTION~ .~_~/~.-t~---~ ! ) , ' 5 6- 7- 8- 9- 10- 11~ 12 13 14 15 16 17 '~.~, ~?¢~ 18 19- SLOPE 20- WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT '--"--- ~) DEPTH? . P E Depth to Water Alter Monitoring? Date; SITE PLAN PERCOLATION RATE '~ ~ {minutes/inch) PERC HOLE DIAMETER Gross Net Depth to Net Reading Date Time Time Water Drop , ~,~l~r ~:,~o~ ~-~,~j' ~" ~,, PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940014 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MENDEZ SIXTO R & MARIANA C OWNER ADDRESS:15640 SOUTHPARK LP ANCHORAGE, AK 99516-4847 DATE ISSUED: 1/26/94 EXPIRATION DATE: 1/26/95 PARCEL ID:02005218 LEGAL DESCRIPTION: SOUTHPARK ADDN 2 BLK 1 LT 1 8 LOT SIZE: 27471 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: Ao OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. 1 SPECIAL PROVISIONS: DURING CONSTRUCTION OF THE PRIMARY TRENCH, A SOIL TEST MUST BE TAKEN AND PERCED AT THE PROPOSED REPLACEMENT SITE, THE PERC RATE MUST BE LESS THAN 60 MIN/IN AT THE PROPOSED REPLACEMENT SITE. RECEIVED BY: ~-? ~-~ DATE: t ROBERT SHAFER, P.E. ROGER SHAFt=R, P.E. December 17, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUD[ES AND REPORTS WELL iNSPECTiON & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & Municipality of Anchorage DEPARTMENT OF HEAL TH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99519-6650 REFERENCE: Southpark Subdivision Addn. #2, Block 1, Lot 18 We request you issue a permit to upgrade the septic system serving the four bedroom house on the referenced property and issue a conditional Health Authority Approval. An adequacy test performed on the existing system for Health Authority Approval purposes found the absorption capacity of the existing system to be inadequate. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. The monitoring tube within the test hole has been checked and found to be dry. Attached it the proposed upgrade design. This property is served by a Community Water System. There are no protective well radii which encroach upon the property. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 r¢ LdLdO 0 Z Om~-o o o~.~: o NYqd 311SI Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PEREORMEO ~oR: LEGAL OESCR,"T'ON: L/CO: L~I., ~C~?~ ~ ~/D ~ 1 2 3 4 5 6 7 .8 9 10 11 12 13 14- 15- 16- 18- 19- 20- Township, Range, Section: SLOPE WASGROUND WATER ~,~ ENCOUNTERED? SITE PLAN IF YES, AT WHAT DEPTH? MonitorinD? ,.~'""' [ Date: Gross Net Depth to Net Reading Date Time Time Water Drop 8,:03 ,~ ~/v" PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER ~ z· TEST RU~ e,:TWEEN g.C~....ff~D z~' VT / pER,OR~D By~& s E/dGINE'RING ,~//~ LERTIFY THAT THIS TEST WA8 PERFORMED IN ACCORDANCE ~[~A~ ~IPAL GUIDELINE~ ~ ] - : 72-008 (Rev. 4/85) ~ ON-SITE WASTEWA TER DISPOSAl. SYSTEM CONSTRECTION PRACTICES a~d MATERIAL SPECIFICATIONS REFERENCE: Southpark Subdivision, Addn. #2, Block 1, Lot 18 GENERAL: 1. The scope of this project includes the installation of a leachfield trench to serve the four bedroom residence located on the referenced property and excavation of the existing 1250 gal septic tank to verify its integrity. If the integrity of the existing septic tank is poor the existing septic tank is to be excavated, pumped, crushed, and abandoned in place and a new 1250 gal septic tank installed. Construction shaft be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and aft applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shaft be responsible for final grading areas subsequently depressed from soft settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shaft include two 4" cleanouts for pumping access. The septic tank shaft be sufficiently bedded to prevent settling or shifting of the tank. 3. Aft standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page Two Southpark Subdivision, Addn. #2, Block 1, Lot 18 December 17, 1993 Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level, ff the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three Southpark Subdivision, Addn. #2, Block 1, Lot 18 December 17, 1993 MINIMUM MA TERIAL SPEClFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shaft be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shaft be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shaft be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Southpark Subdivision, Addn. #2, Block 1, Lot 18 December 17, 1993 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as fellows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. ~'~' MUN C PAL TY OF ANCHORAGE DE JMENT OF HEALTH AND HUMAN SER% .S Environmental Health Division ~ ' 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT SEPTIC ABSORPTION Phone(s) ' Permit No. No of 8edro~m~ WELL ~ Lot t~ lBlock ~ Subdivision rX~, S~ ~ -- ~ ' -~AGRA~(Showlocationofwell septic system propertyl,nes ,o~ndat,on ¢~ TYPE OF SYSTEM ) ~vel length ~ FI Cravei w,dth ~, S ' ~T ~ , umber o hnes ~o I rat~ % j P, pe rome.al ~ _ . ~ O PRIVATE ~' OTHER (Idenlilv) ~ / REMARKS: Scale: ' Jly Ihat thi inspectJo a 72-013 (3/85) DEPARTMENT OF HEALTH AND EMVIRONMENTAL PROTECTION 8~.~ L S]REE] ~ AIIC,NOKAGE, AK 99501. 264-4720 PERMI 1" NO: DATE ISSUED: APPL I CANT: ADDRESS: CONTACT PHONE: I...E GAL DESCRIP: LOT SIZE: MAX BEDROOMS: 8 ~ o ...~ 67 06727/85 GREAT LAKE~ CONS]' 22¢: W. 34, SUITE 607 ANCNORAGE, AK 344-0880 ' ' SUBDIVISION: SOUTHPARK i LOT: SEC] ION ..... ]OWNSH~ lin RANSE: ~178L (SQ.FT. OR ACRES) BLOOK: 1 Listed beiow are the options available to you in designing your septic system. Choose the option that best £its your site. -FR~£i~C~ BED W. DRPl ][ N DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 GRAVEL DEPTH (FT.) 6;0/ 0.5 .-.~.5 Tel'AL DEF'TH (F:']".) 10.0~ ~ 4.5 7.5 GRAVEl.. WIDTH (FI'.) 2.5 ~z,.O 5.0 GRAVEL LENGTH (FT.) 58. ( 4o.,u 7~. 0 SRAVEL VOI_OME (CU. YDS. ) ._~. } ~ 55.6 lANK SIZE (GALS) 1,000.00~ 1~000.0 SOIL.. RATING (SQ.FT./BR) .~ TANK MUST HAVE AT LEAST TWO COMPARTHENTS I certi£y that: 1. I am familiar with. the requirements £or on-site sewers and wells as set £orth by the Municipality o£ Anchorage (MOA) and the State o£ Alaska. ~. I wi].], install the system in accordance with all MOA codes and regulations, and in compliance with the design cPiteria o£ this permit. 3. I will adhere to all MGA and State o( Alaska Pequirements {o~ t~e set back d.istances from any existing well, wastewater disposal s~stem or public sewe'rage system on this or any adj:acent o~ nearby lot. 4. I understand that this permit is valid ~or a maximum o~ 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUWT BE OBTAINED; (2) AS-.~IILTS WILL. NOT BE APPRSVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. AF'F'LICANT: GREAT~AKES CONST ' PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4 5 6 7 8 9- 10. 11 13 14 18 2O COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAl PROTECTION ~ ( LS LOG PERCOLATION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~)~' (.~5~:? DATE PERFORMED: )' SLOPE SITE PLAN WAS GROUND WATER m0 sE ENCOUNTERED? IF YES, AT WHAT ~ ~i DEPTH? Gross Net Depth to Net Reading D~te Time Time Water Drop PERCOLATION RATE c~/ (minutes/inch) TEST RUN BETWEEN ,_~,,/L~ FT AND . ¢/ FT PERFORMED BY: //~PwU~.~ ~- CERTIFIED BY: 72-008 16/79) 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 1. GENERAL INFORMATION Complete legal description Lot 18; Block I; Southp~k Subdivision ~2 Location (site address or directions) 15640 Sou~hpark Loop Property owner Mailing address Sixto and Mariana Mendez Day phone 15640 Southpark Loop Anchorage, AK 99516 345-6189 Lending agency Mailing address Day phone Agent Bonnie Mehner/Jack wh~ Co. Address 3201 "C" Street Suite #I00 Anchora~e~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: Day phone 762-3110 AK If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature DHHS SIGNATURE __ Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: '~ ff Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not respo,~sible for errors or omissions in the professional engineer's work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:-~d(~H?~P--r--- s/~ /2/ ) /-/,?' Parcel I.D. A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If(~ B, or C, attach ADEC letter. ADEC water system number ~./A~ Date completed /~//4 Driller .~,/~ Cased to /W,//~ Casing height ~//9 ~ires properly protected (Y/N) /J/~- Date of test Static water level Well flow Pump level1 'FROM WELL L/ ./ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot zoo Public sewer main /u/,~l Sewer service line ~)/,~ g.p.m. WATER SAMPLE RESULTS: AT INSPECTION c~ ~,/~ g.p.m~,;! ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout ~/,4 Petroleum tank Coliform /,)/~- Date of sample: B. SEPTIC/~ DATA Date i'nstalled Cleanouts (~N) High water alarm (Y/N) Nitrate /J/4. Other bacteria Collected by: /~,/~ 7 / ~- Tank size /2E'O ~,~-. Compartments 2_ (uNc~P..,, .Depression (Y,~ /,3 y Foundation cleanout (~VN) Y ~--~- / h.)/~ Alarm tested (Y/N) ~J,/~ Date of pumping ti "',z.q -q~' Pumper ~+" SEPARATION DISTANCES FROM SEPTIC~ TANK TO: Well(s) on lot /J/~ On adjacent lots To property line ..~? ' Absorption field Surface water/drainage /o0 ~ ~- Foundation Z/~ '/ 2(o t Water main/service line /O ~ +- CONTINUED ON BACK PAGE 72-026 (3/93)* Front C. LIFT STATION l~6,-~ Manufacturer Size in gallons ~ Manhole/Access (Y/N).._ Vent (Y/N) "Pump o~ ~'P~ump off" Level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DICTATION TO: On adjacent lots Surface water Well on Iot.,....~ D. ABSORPTION FIELD DATA Date installed Length /iz' Width Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (YN~ /,..2/,¢~ After test "/ If yes, give date Soil rating (GPD/Ft2) O. ~' System type ~ Gravel thickness Ld Total depth Cleanout present I~N) y Depression over field (Y~ N Results (pass/fail) ¢,/¢'~,tJ' ff~//',~7~,~ for ~L Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~J/A To building foundation On adjacent lots -~O ' 4- Surface water ldo ' ~ Curtain drain /4//4 On adjacent lots ,l~o0 ~ 4-- Property line /0 ' To existing or abandoned system on lot Cutbank 6-o~ e Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in effect c Signature ?' Engineer's Name~ Lo_? R._ ¢.~. H.". ~04, Date C~/~--/~ ,, of this,in§pe, ction. HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Bctck ROBERT SHAFER, P.E. ROGER SHAFER, P.E. May 26, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 H F~,LTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Southpark Subdivision ~2: Lot 18; Block 1 RECEIVED JUN 1994 .. t;Ju: ~, ~.~i. Ey oral3 ~,.. c< ~Uman Services A Conditional Health Authority Approval (HAA) was issued on December 23, 1993 for the referenced property. All work required for the Conditional HAA has been completed. Attached is the On-Site Wastewater Disposal System and/or Well Inspection Report for your approval. We request you issue a Final Health Authority Approval for the referenced property. If you have any questions or require any additional information, please contact us. SiTE PLANS ROAD DESIGN SOIL TEST A. Shafer, P.E. ~/LSU/jk PERCOLATION TEST STRUCTURAL & ON SiTE WASTE WATER DISPOSAL SYSTEht DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 CONDITIONS OF APPROVAL FOR HA 930784 Health Authority Approval 930784 is being approved under the following conditions: 1. The existing on-site wastewater disposal system is inadequate and must be replaced. The existing system will be allowed to operate on a temporary basis providing that wastewater does not surface on the ground or back flow into the house. 2. An escrow account, sufficient to cover all costs associated with construction, inspection and approval of a new wastewater disposal system must be established. The escrow account must specify that funds will not be released until DHHS has issued final approval of the wastewater system. 3. Ail work, including a revised as built inspection report, must be completed prior to June 30, 1994. 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 AUTHORIT-Y_ APPROVAL FOR A SINGLE FAMILY DWELLING HAA # ¥~o~ 0'3 °~l GENERAL INFORMATION Complete legal description Lot 18; Block 1,;!.Southpark-Subdivision #2 Location (site address or directions 15640 Southpar~ Loop Property owner Mailing address Lending agency Mailing address Sixto and Mar~ana Mend~z 15640 Southpark Loop Anchorage. Day phone AK 99516 Day phone 345-6189 Agent Bon~e Mehner/JACK WHITE CO. Address 3201 "C" Street Sc~t~ #100 ::'::" ANCHORAGE Day phone Anchorage', :'/,K Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community weli XX× 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 ~4XX 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 n~y investigation of this Health Authority Approval application shows that the on-site wat?.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 inves!i_gation 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 Phone S & S ENGINEERING Address 17034 Ea_al~ Rlvn. Loop-R~ad~(~ Eagle River, Alaslca 9~577 Engineer's signature DHHS SIGNATURF Approved for bedrooms. Disapproved. ~ Conditional approval for 4 bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. Well Data Well type {/~/,/f//.~(JkJ/7'/c'' If~)B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) ~ Date completed ~ Driller Total depth ~/~ Cased to ~/t Casing height Sanita~ seal (Y/N) ~ Wires properly protected (WN) : FROM WELL LOG Date of test ~/'/~ Static water level /L/'/~;~ Well flow /L~//z~' g.p.m. Pump level1 ~//~ SEPARATION DISTANCES FROM WELL TO: Septic/hotding tank on lot ~OOt~ AT INSPECTION /'~? g.p.m. ; On adjacent lots ~./..~ ;On adjacent lots Absorption field on lot /,, Public sewer main ,~'~')(//7L Sewer service line Public sewer manhole/cl~%out Petroleum tank WATER SAMPLE RESULTS: Coliform ~AJ,,/,/~ Nitrate D~te of sample: ~//~ Other bacteria Collected by: ~ B. SEPTIC/HOLDING TANK DATA Date installed "' Cleanouts (~N) High water alarm (Y/{~ Date of pumping Tank size }~L,~(~ ~-/4X.._ Compal~ments Foundation cleanout ~N) y f~ Depression (Y/~)~ ./"J/,,Zb Alarm tested (Y/~ (~L~ I~/~ Pumper SEPARATION DISTANCES FROM SEPTIC/~ TANK TO: Well(s) on lot N/~'~ On adjacent lots To property line ~-("~ ' Absorption field Sudace water/drainage (O0 ~ Foundation Water main/service line lO 4 CONTINUED ON BACK PAGE 72-026 (3/93)* Front Date installed Manufacturer Size in gallons ~. Manh~ ec~ss (Y/N) Vent (Y/N) "Pump on" level at'"'""--~. ~ "Pump off" Level at High water alarm level ~884e_sted Meets MOA electrical codes (Y/N) ~ ~ SE-'PARATION DISTANC~ATION TO: _ ~ Well on lot ..¢'" On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length <~O' Total absorption area Date of adequacy test Soil rating (GPD/F¢) System type Width ~ ~ Cleanout present~A~) Water level in absorption field before test ~-¢ ¢ ~ Peroxide treatment (past 12 months) (V/~_l~ ~'~0~ ENX3ed ~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: '77ZE~c'H To building foundation On adjacent lots Surface water Curtain drain Gravel thickness ,.~¢ Total depth ~'.~ Depression over field (Y/I~ ~'/'~ //--"'~ for'''~ ~ Bedrooms After test If yes, give date E. ENGINEER'S CERTIFICATION On adjacent lots c~OO ~¢' Property line To existing or abandoned system on lot Cutbank ~ ' 4- Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified,~er..conformed to all MOA and HAA guidelines in effect op,thedate of this inspection. bngmeers r'~m~....'¢· -.. / - ~'/'~-',,';:;,, _~ · ~u~,'~f~tv~%~o~ ~,d N.~. 204 / ,,,/~ ~, ~ ~ ~ ,':.,, ,: /: Date b:~¢~ River~,~Af~ska ~9~7 / ~/~/~ ~ , ~ ,~ / 1' .,, :,, .:' "~ Fee $ ~00. ~-- Waiver Fee $ Date of Payment /~ -~ ~ Date of Payment Receipt Number ~ ~/ ~5~ ~ Receipt Number 72-026 (3/93)* Back 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 Lqt lg; Block i; So~h Par~ Subdx'~vi.'Zon AddZtZon #2 Location (site address or directions) 15640 South Park Loop Property owner Mailing address Day phone Lending agency Mailing address Agent Address 3201 ¢ Street, Anchorag&, AK 99503 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. .2. NUMBER OF BEDROOMS: 4 '-~ 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well X Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site XXX 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. 1/91) Front MOA #21 'HJo/~ sj@@u!6ue I~uo!sse~oJd eq~ u! sue!ss!u Jo Jo sJoJJa JoJ alq!suodsaJ leu s! e6e~oqouv ~o &!l~d!o!un~ eqJ. 'penss! s! el~o!i!l~eO ~ eJo,taq 83~p eZ,~l~U8 ~o suo!~o@dsu! ~onpuoo leu op SHHO Jo seeAolduJ3 'slueuJ@J!nbeJ e;els pus i~Jepej u]e]Jeo ~s!;e9 o; JepJo u! suo!lnl!;su! 6u!puel J!eq; pu~ SeUUOLI ;O s~aseLlocnd o~ ~seM nee e eb s!q; seep SHHd eq.L 'e~Sel¥ jo e;~l$ eLI; u! peJe~s!OeJ Jeau!Oue leUO!SSe;O~d ;uapuedepu! ue ~q e^oqe 9 qdeJtieJed u! us^!0 suop, eluese~de~ eM1 uodn Aluo pesBq se],eo!;!]aeO I~^o~dd¥ Al!~oq;n¥ q;leeH sense! (SHHO) seo!~JeS u~uanH pus q;IBeH Jo ~ue~u]Jedeo eOe~oqou¥ ¢o/qH~d!o!untq aLI_L s~uewwoc) leUOR!pp¥ :suo!~elnd!~s 8uF~OllOJ sql q~l~ 'sLuooJpeq ~o~ le^oJdde leUO!~!puoo '9 euoqd e~n~euS!s speeuCuB l~0g 'ON p~o~l dool aO^l;:~ el~=l I;~;OZ L SgeJ PPV QNI~IB=tN~mN':; S -~_ $ ~u,q..4 ,tO eu~eN 'uo!loedsu! s!ql jo e],ep eq; uo lo@~e u! suop, elnlSe~ pus 'seoueuip¢o 'sepoo e;e;S pub ledio!unbN lie q~i~ eoue!ldLuoo u! s! Lue~s/~s lesods!p ~e~,et~e~set~ ~o/puB ~lddns Ja~et~ el!s-uo eq; 'uol;oedsu[ pus uo!;elS!~se^u! ALU LUOJJ pus Sel!¢ eOe~oqou¥ ~o/Sdled!o!unlAl eq~, ~uo~; peu!B;qo uo!;eLu¢oju! eq~, uo peseq leq; ,qpe^ ~eq]Jn~ I 'u!e~eq pe],eo!pu! e~n~on~;s ;o ed~; pus sLuoo~peq jo ~eqLunu eq), Jo~ e~enbep~ pus leUOp, ounJ 'e~Bs 8! LUe],S~S lesodsip ~e),~t~e;setvt ~o/pue /,lddns Je~et~ e~!s-uo eql ~,eq), st~oqs uo!;eo!ldde leAO~ddv X~lJoq~nv q~leeH Bfq; ~o uo!;elSl~BeAU! ALU ~,eq~ ,~pe^ I 't~oleq u~oqs e~ep uop, ep!le^ eq~ ~o se pus o~e]eq pex!J4e leas ,~tu ~q poglueo sV MB=INI!DNB AlE NOIJ. OBdSNI 40 .LN=IIAIBJ.V.LS "g Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Lega Descr pt on .Zo-~L/~)~/?_??. ~o,~'/P.q¢~ /~.'-~-~Parcel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Date completed Driller Total depth Cased to Cas ng height Sanitary seal (Y/N) Wires properly protected (Y/N) Date of test Static water level Well flow Absorption field on lot Public sewer main Sewer service line FROM WELL LOG AT INSPECTION MUNICIPALITY OF ANCHORAGE ~NVIRONMENTAL SERVICES DIVISION Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 2_¢~O ¢ ; On adjacent lots ~. OO/'/' ; On adjacent lots ,,..)/FI Public sewer manhole/cleanout /~/~ Petroleum tank WATER SAMPLE RESULTS: .~:,~'C ~ ~C_. oct 2 8 1991 g.p.m. RECEIVED Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~ - _~ ~-- Cleanouts (Y/N) ~ High water alarm (Y/N) Date of pu~ping Tanksize /2 ~ 0 ~ ¢¢ [ Compartments ~--- Foundation cleanout (Y/N) t.~ Depression (Y/N) Alarm tested (Y/N) (¢ - ~ - ~/ Pumper -~-5, ~ ~Ci % SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~O~ To property line ,~(O Absorption field Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed ~ Size in gallons % Vent (Y/N) %~ump on" level at High water alarm level ,'%-, ~ Meets MOA electrical code~/N)')'~. SE:PARAI'ION DISTANCE FROM LIFT STOLON TO: Well on lot On adjace~ots D. ABSORPTION FIELD DATA ~ Date installed ~ - "---~ '-~ Soil rating Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water System type Length [PX2 '~b'~¢~ I Width Total absorption area Depression over field (Y/N) _ Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) ,~) / JA Gravel thickness ~. ~" Total depth Cleanouts present (Y/N) Date of adequacy test for '¢"'/- bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: I Well on lot To building foundation On adjacent lots ~ (~ / '~' Surface water Curtain drain On adjacent lots ,~ ~Po -/ Propertyline , "~ 2. ~ To existing or abandoned system on lot Cutbank ~,¢~0 ¢- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect of this inspection. $ & S ENGINEERING Signature _ 17~34 Ea~le Rib, er Loop Roa~ No. 204 l~gle River, Alaska 995~/ Engineer's Name HAA Fee $ Date of Payment Receipt Number 72-028 (Rev 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 October 25, 1991 WALTER J. HICKEL, GOVERNOR 563-6775 FOR: S & S Engineering PWSID #213475 My review of the records on file in this office reveals that the South Park Terrace Subdivision Class "A" Public Water System, is in compliance with the provisions of 18 AAC 80.200, State of Alaska Drinking Water Regulations. Sincerely, Byron Roys Environmental Engineer "'~" MUNICIPALITY OF ANCHORAGE DEPARTMEN ~' OF HEALTH AND ENVIRONMENTAL PR~ (ECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Apphcation Date GENERAL INFORMATION (a) Legal Description (include lot. block, subdivision, section, township~ range) Lo, /t, TIIN; _ocation (address or direcbons) (b) Applicant Name ~r*~ ~,~*~O~ Telephone:Home ~K-~9 ~ Business ,~6~'ql~ ' (c) Applicant is (check one): Lending Institution ~ Owner/builder ~; Buyer ~; Other ~ (explain); (d) Lending Institution ~,/A Teleehone Address ' "i .(e) Real Estate Company and Agent ;i':!i,7 '~.' ·Address Telephone · ,:-' ,, (f) Mail the HAA to the following address: :'-2. ': TYPE OF RESIDENCE :_ Single-Family~ Multi-Family [] ~, .~ Nu nnber of Bedrooms - 3. WATER SUPPLY Other ndividual Well [] CommunityJ~, Public [] , . Note: If community' well system, must have written confirmation from the State Department of Environmental Conservation attesting to tl~e legality and status. 4. SEWAGE DISPOSAL Onsite,J~ Public [] Community [] Holding Tank [] Note: If community well system, must nave written confirmation from the State Department of Enwronmental Conservation attesting ~o the legality and status. 72-025 (11/84) Page 1 of 2 E.O,.EE.,.G r,.M P.OV'Oh '%"ECT'O"S. TESTS. r,'E SEA.°". As ce~ified by my seal affixed hereto and as of the vaJidation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, fu Octio~a~ and adequate for the number of bedrooms and type of structure indicated herein. I fudher 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 alt Municipal and State codes, ordinances, and [e~ul~ti~n~.in effect on the date of this inspection. NameofFirm Am/~T ~(.~l~(~ Telephone Date 3 - I ~ ~ ~ ~ Engineer's Seal DHEP APPROVAL Approved for Approved _ bedrooms by//~ Disapproved _ Conditional. Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health aha 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) MUNICIPALITY OF ANCHORAGE 61 'ENVIP, ONMENTAL SERVICES DIVISION ' MUNICIPALITY OF ANOHOBAGE (MO~i HEALTH AUTHOFIITY APPROVAL (HAA) MAR 1 6 1987 CHECKLIST- FEBRUARY 1984 264-4720 RECEIVED WELL DATA Well Classification Legal Description: .~'~. T'ItN(, C?~,/,. ~.r-~ If A, B, C, D.E.C. Approved (Y/N) 'N(/ Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ~_~ A. T-r ~,r Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. ~OLDING TANK DATA Date Installed Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) I~ ,//% Separation Distances from Septic/Holding Tank: To Water-Supply Well 9 Of')",~ TO Property Line ~ ""(0 To Water Main/Service Line ~ ~)/4- Course ~ 00/4' Size I'~ .~'O~p(~. No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ~ "t ~- ; for Temporary Holding Tank Permit (Y/N) To Building Foundation J (") ~'~- To Disposal Field '" ~ z 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 '7 ~ ~ ~' Width of Field ~ ()¢ ¢-._~,--.'r Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ~,~'[ ~ s.. F-AC-'"Cr/,(L,'[ - Separation Distance from Absorption Field: To Water-Supply Well __ O. CO /-J,- TO Building Foundation ,'-' Lot To Water Main/Service Line __ ~"O To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field 4:~ 07J Depth of Field_ ,~,',~'z~ ' [ O · Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~O To Cutbank (if present) ~ O ·4- ")_ O,O z.+ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments "* Check Permitted Bedroom Rating Against HAA Request ** I certify that I bare checke~:~v, erifJe~, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~//.~, "~ Date ,"~ ~'/,('~ 7 Company MOA No. Receipt No. ~ ~ ¢ O O ~ ~ Date of Payment ~ ~/6 - ~ ~ Amount: $ / O ~. ¢~ Engineer's Seal Page 2 of 2 72-026 n ~/84) Municipality of Anchorage MEMORANDUM DATE: .~/1~'/~" TO: ~,'/~ ~ FROM: SUBJECT: DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA gg501 gl'EVE COWPER, GOVERNOR Telephone: (907) Address: 274-2533 DATE: 3-16-87 PWS I.D.# 213475 To Whom it May Concern: According to records on file in this office the SOUTH PARK TERRACE Water System is in compliance with the State Drinking Water Regulations Sincerely, en, RS ~ Regional Sanitarian Supervisor