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Home My WebLink AboutSOUTHPARK #2 BLK 1 LT 21 ~, MUNICIPALITY OF ANCHORAGE /-% D£~ ~TMENT 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 Name J~l~,; t-l~-~h,~ ~ ~ C,~ DISTANCES SEPTIC ABSORPTIO~ Address ~,~ ~ ~ ~.~ .~ ~ ~ Z~ ~ ~ l o -Z ~[ ~ ~-o2. TANK FIELD WELL Phone(s) ~,~,~,, ~C~ ~ Permd NO.~_~O i~ ~-- NO ol Bedrooms ~ ~ WELL LEGAL DESCRIPTION LOT LINE J J Subdivision Lot ~ t ~ock I _%~'fg- )" ~iC 'fl ?- FOUNDATION Townshi.~: Range. Section ~ -~ "~ j~ ~ ~--~ ''~ ~ ~ ~ ~ --~' ~S-BUJLT DIAGRAM {Show Iocat,on o, weft. sepnc system, property lines. ,ouadat .... driveway, water bodies, etc TANKS U ~ SEPTIC ~ HOLDING Manul~u~er Capacdy in gallons Matedal No. ol Compadments '~// ...... TYPE OF SYSTEM ~ ~ TRENCH ~BED ~ W. DRAIN ~ OTHER ~ ~ ~ 6 I~ .3C JJ.e Fill added above original grade Gravel depth beneath p~pe ~ FT i~ FT T°~a'abs°rpn°n~rea ql O SOFT ~ FT J 0 J'~ SOFT ~<~ ~3~ ~ Installer ~ ~ ~ ~ ~ .)~j~ ,-~ Date Installed ~) ~ WELLS ~ PRIVATE ~ I ,:~. REMARKS: . . ,., , , ~ Scale: , L;t~~' ' ':' ( / I ~ ~ - ~ ce~ify thai Ihis inspection was pefl0rmed aG~ording to all ~nicipalandStat~guidelinesineflect0nlhisdate: /o - /& - ~ 72-013 (3/85),.~ ALASKA IiUIROI m'eF1TAL COF1TROL SeRuiCeS, IiqC. ~,~li,,ecri,~q 6 ~nuirame,lal $1udies SPECIFICATIONS FOR ELEVATED BED ALTERNATIVE WASTEWATER TII~ATMENT SYSTEM- LOT 21, BLOCK 1, SOUTH PARK ADD#2 SUBDIVISION ~NNICiPALiW OF A~,~HOkA~E,~ D~PK OF ~EAL~H & ~VIRON~NTAL PROTE~ION 1.1 ~ D~WINGS, SHEETS 1 THRU 4, SHALL BE A PART OF ~i~CTJo~, ,R i VD 1.2 ~L ~TERIALS ~D ~ORK~NSHIP SHALL ~ET ~E REQUIRE~NTS OF ANCHO~GE DEPART~NT OF HEALTH ~D ' ENVIRON~NTAL PROTECTION PER~IT. 1.3 ~L EXCAVATIONS AND DEPTHS ~E ADVISORY ~D ~E TO BE VERIFIED OR ~ODIFIED IN ~E FIELD BY THE ENGINEER. 1.4 IT IS THE ~SPONSIBILITY OF ~E O~NER TO OETAIN ALL NECESS~Y PER~ITS OR EASE~NTS, 2.0 THE LIFT STATION 2.1 THE STOCK MATERIAL FOR THE LIFT STATION SHALL BE EITHER GALVANIZED STEEL (ASTM A-4444-76), OR ALUMINUM CULVERT, CAPABLE OF BURIAL TO 10 FT. 2.2 THE 36" DIAMETER PIPE FOR THE LIFT STATION SHALL HAVE A WELDED WATER TIGHT BOTTOM OF THE SAME THICKNESS AND COMPOSITION AS THE CULVERT. 2.3 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WMLDED AND WATER TIGHT. ALL WELDS SHALL BE CLEANED OF SLAG. WELDS ON GALVANIZED STEEL WILL BE SPRAYED WITH ZINC RICH PAINT OR COATED WITH BITUMASTIC. 2.4 THE TOP CAP SHALL BE RAIN TIGHT AND SECURELY FASTENED WITH SCREWS. A TWO INCH LAYER OF POLYURETHANE FOAM SHALL BE GLUED TO THE INSIDE OF THE TOP CAP. 2.5 ALL ELECTRICAL FITTINGS AND CONNECTIONS IN THE LIFT STATION SHALL MEET THE REQUIREMENTS FOR A WATER TIGHT SERVICE. 2.6 THERE SHALL BE A HIGH LEVEL ALARM, PEABODY BARNES 6147 OR EQUAL SET AT THE LEVEL OF THE SOIL PIPE FROM THE SEPTIC TANK. THE BUZZER SHALL BE LOCATED NEAR THE ELECTRICAL CONTROL PANEL OR IN A LOCATION DESIGNATED BY THE HOMEOWNER. 2.7 THE SUMP PUMP SHALL BE CAPABLE OF DELIVERING 10 GPM AT A HEAD OF 20 FEET. 2.8 PROVIDE A CALDER COUPLING AT THE CONNECTION OF THE 4" SOLID PVC INFLUENT PIPE AND 4" STEEL NIPPLE. 2.9 THE PUMP SHALL BE CONTROLLED BY A DIFFERENTIAL MERCURY FLOAT SWITCH, ADJUSTED TO ALLOW A TWO FOOT SPAN BETWEEN 'ON' AND 'OFF', AS SHOWN IN THE DRAWING. ALL RELAYS AND ELECTRICAL CONTACTS SHOULD BE LOCATED OUTSIDE THE CHAMBER TO PROTECT THEM FROM CORROSION, PREFERRABLY IN A DRY LOCATION WITHIN THE HOME. 2.10 COAT THE INTERIOR OF THE CHAMBER WITH BITUMASIC PAINT OR TAR TO APROXIMATELY 3.5 FEET ABOVE THE BOTTOM. 1200 LUcsl 33r~ Aucnu¢, SuJl~ B. A~choreq¢, Alosk~ 99503.(907) 561-50/40 2.11 MOA BUILDING CODES: WHEN LIFT STATIONS ARE INSTALLED WITHIN THE MUNICIPALITY, AN ELECTRICAL PERMIT AND INSPECTION ARE REQUIRED. IN AREAS NOT COVERED BY MOA BUILDING CODES, THE SYSTEM SHALL BE INSPECTED BY A LICENSED ELECTRICIAN TO INSURE THAT THE ELECTRICAL INSTALLATION IS IN ACCORDANCE WITH APPLICABLE CODES AND REGULATIONS. 3.0 SEEPAGE BED 3.1 THE GRAVEL FOR THE BED SHALL BE SCREENED TO THE SIZES INDICATED. 3.2 THE SAND SHALL HAVE AN EFFECTIVE SIZE OF 0.4 TO 0.6 MM AND A UNIFORMITY COEFFICIENT OF NOT MORE THAN 4. 3.3 THE BERM AROUND THE SEEPAGE BED SHALL BE CONSTRUCTED OF IMPERMEABLE MATERIAL, AND ON A SLOPE OF 1 FOOT VERTICAL PER 3 FOOT HORIZONTAL. 3.4 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL BE PLUS OR MINUS 2". 3.5 TWO OBSERVATION PIPES SHALL BE PLACED AS SHOWN IN THE DRAWINGS. THEY SHALL BE RIGID PVC, ASTM 3033 D-3034. THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5" HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A SECTION OF PERFORATED SEWER PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL) SHALL BE PLACED ON THE TOP OF THE PIPE. 3.6 THE INSULATION REQUIRED SHALL BE DOW EXTRUDED BLUE STYROFOAM INSULATION BOARD OF THE THICKNESS SHOWN ON THE DRAWINGS. 3.7 THE TOP AND SIDES OF THE BED SHALL BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX. 4.0 INSPECTIONS 4.1 THIS BED WILL REQUIRE TWO INSPECTIONS. THE FIRST INSPECTION WILL BE OF THE OPEN EXCAVATION, TO ASSURE THAT THE SYSTEM IS INSTALLED IN PROPER STRATA AND DEPTH. 4.2 THE SECOND INSPECTION WILL BE AFTER PLACEMENT OF THE GRAVEL, MONITOR STANDPIPE(S) AND DISTRIBUTION PIPE TO VERIFY PROPER INSTALLATION AND MATERIALS PRIOR TO BACKFILL. MUNICIPALIYY OF ANCHORAGE DEPT, OF HEALTH & EI~IVIRONMENTAL PROTECTION OCT RECEIVED ~ ' ALASKA ENVIRON~:~ITAL S.EET,O. ~" DE · CONTROL SERVICL ,'INC. 1200 West 33rd Avenue, Suite B C^CCUL^TEO BY ~,)~" DATE ]~)' ~--~"~' · ANCHORAGE, ALASKA 99503 (907) 561-5040 CHECKED E~Y SCALE IIi;' ~0 DATE JoB .T~ ~/~::]~;..- C'~ ..' ' ALASKA ENVIRONly~'~TAL S.EET.o.. ~'~ CF ~/ CONTROL SERVICL . iNC. 1200 West 33rd Avenue, Suite B CALCULATECBY ~l~. DATE /~' ''~--~'- ANCHORAGE, ALASKA 99503 (907) 561-5040 CHECKED BY CATE MUNICIPALITY OF:ANCHORAGE - DEPT. OF HEALTH & - ENVIRONMENT~J, PROTECTION RECEIVED ALASKA ENVIRONrh~_TAL CONTROL SERVICL ,liNC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO, C^LCUL^TED EY ~ CHECKED BY- DATE ii,/)JNJc a,~J~ ~fi6~o:~G~-] ENVtIK;~d~HTAC RRO~TEC[K:)N~ ALASKA ENVIRONMENTAL CONTROL SERVICEr~-~NC. 1200 west 33rd Avenue~ ouite B ANCHORAGE. ALASKA 99503 (907} 561-5040 SHEET NO ~--~.. O= ~ CHECKED BY DATE SC^LE /iFf 5rATIOH GALVANIZED OR PAINTED EN C £ O SURE .~ POWER AND PUMP CONTRO£ £INES I~"OIA PU£L-PIPE CONNECTE~ TO COVER ~" URETHAN£ FOAM ~£UED TO COVE~ ~ CONDUI~ PUMP I AROUNO PIPE PITI E$S ADAPTER FOR PUMP REMOVAL GROUND STEEL PIPE PUMP .P~LESS ADAPTER COU L 'MIN '/ ~" SO£1D PE OR, /.TO ABSAORPRETAION ~ H£A T TAPE 4" D/A SOLID PVC PIPE ALARM CORD FROM SEPTIC TANK CLAMP GALVANIZED STEEL OR ALUMINUM CU£VERT E VEL PUMP PUMP /NS/DE OF PIT I ~E COATED WITH '-- ~ITUMINOU$ PAINT O~ T~R = ~ ~A~VANIZEO OR MUNICIPALITY INSPECTIONS (987) 56~464 IN~,~CTION'REPORT OF ANCHORAGE, BUILDING ~AFETY DIVISION ~5~0 EAST TUDOR ROAD ADMINI£TRATION (9~?) NAME: YELLOW ELEC., CHG. STREET ADDRE$£;.$OUTHPARK LEGAL: $OUTHPARK ~2 COMMENT: LIFT STATION 786~82~ F'ERMIT NO: 85-.1234 LOOP PHONE: 268-~e73 LOT 2~ BL. OCK t * INSPECTION~ REgUE3'TED: ELECTRICAL * 2J ELEC ','~O?J-Pr~ * COMMENT~. .~,~. * I NO NONgO~~q~ERVE I I DATE: ERRORS: ~UNICIPALITY OF ANCHOP, AGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT RECEIVED * I I WILL REEXAMINE AT NEXT * INSPECTION * I I FINAL INSPECTION APPROVED * I I APPROVED-CONDItIONAL FOR ..... DAYS * * FINA~ * FINISH TIME: FINI£H MILEAGE: * START TIME: START MILEAGE: * WORK-UNITS: . . TOTAL DISTANCE: * WHEN CORRECTIONS ~RE MADE~ P~EASE CALL FOR INSPECTION~ * * DO NOT REMOVE THIS NOTICE * I CORRECTIONS ESSENTIAL AS EXPLAINED ABOVE I DO NOT CONCEAL UNTIL REINSPECTED DEPARTMEN] HEALTN AND ENVIRONMENTAL OTECTION $,.-:,~; I_ STREET., ANCHORAGE, AK 99~JL 1 264..-/-F72 ] F'I_:;Rf~ I T NO: DATE I,.~UED. APP1. I [,Al II . ADDRESS: [,E. NI AC ] PHONE: JDNN NAGMEIER CO. 1399 WES]- 34, ~¢J. 03 ANCHORAGE, AK 995023 338-6,];36 L, EGAL DESCRIP: SUBDIVISION~ SOUTHPARK ~2 LOT: 21 SECTION: 3 TOWNSHIP: 11N RANGE: 3W LOT SIZE: 27154 (SQ. FT. OR ACRES) MAX BEDROOMS: 4 BLOCI<: I. L. isted below are the options available to you in des:Lgning your septic system. Choose the opti()n that best Fits your site. DEPTH TO PIF:'E BOTTGM (FT,) ~ 4.0 / 4.0 4.0 GRAVEl_ DIEF'TFI (FT.) ~ 2.~2.~' 0.5 1.5 TOTAL DEPTH (FT.) ~ 6" 4.5 5,5 GRAVEL WIDTN (FT.) ~ 5'.5 24.0 5,0 ?.,, . bRACEL LENGTH (F']-.) ~'~ 47.0 GRAVEL VOLUME: (L,U. YD,.>,, ) .0 41.8 4:3.4 'l"Alql< SIZE (GALS) SOIL RATING (SQ.F'T. /BR) L88 188 / '~"~" GRAVEL LENGTH,,":' 75 F:T. RE'QUIRES NU~L'FIF'LE_ - RUNS (NOT EXCEEDING 75 F'T. EACH) · ~' ]'AN}::: MUST ~AVE AT L. EAS'I' TWO COMPARTMENTS certify that.: 1. I am Camiliar with the requinements f,or on-site sewens and wells as set £or"Lh by the Municipality oF Anchorage (MOA) arid '[.he ,State of Alaska. 2. I will install the system in accoPdance with all MOA codes and Pegulatisns, and in compliance with the design cPiteria oF th:is pepmit. 3. I w~ll adhePe t.o ail MOA and State oF Alaska nequinements for the set back dist. ances £r'en~ any ex:i. st.:ing well~, wastewate~ disposal system or' public sewerage system on this o~ any adjacent or' neaPby lot. 4. ]: under'stand that {his p~pmit is valid fop a maximum oF 4 bedrooms and any enlangement, will. pequzpe an addit, ional permit. IF A LIF'T STATION IS INSTALLED IN AN AREA COVERED BY MOA BUICDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSF'ECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NO] BE APPROVED WITHOU]' AN ELECTRICAl_ INSPECTION REF'ORT; AND (3) THE EI_ECTRICAL biOFd<: MUST BE DONE BY A LICENSED ELECTRICIAN. .......... , ........... ..... ................................. AF'PLICANT: JOHN HAGMEIER CO.. ISSIJE-D BY ~~ ~~ DATE, POU /6-650 ANCHORAGE. ALASKA 99502-0650 (907) 264..4111 /anuary 31, 1985 lO: Permit Applicant .... JECT. Lot 21 Block 1 Southpark Subdivision ~2 A permit issued by this Department for an individual well ar,d/or on-site sewer system has expired as of December 31, l~ 84. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from tNis 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 and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Keith E. Bandt, SupeYvisor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/O 57 DEPARTMENT OF HEAL. TH AND ENVIRONMENTAL PROTECTIOI/I 8:25 L STREET, ANCHORAGE, AK 99501 264-4720 F'ERM t T NO: 84o7.=7 DATE I~SUED. ~ 8, ~.7/84 AF'PL I CAN]': ADDRESS: CONTACT PHONE: LANDMARK-VENTURE LTD P 0 BOX 112.654 ANCHORAGE~ AK 9¢511 345-4807 LEGAL DE~.[,RIF. LOT SIZE. MAX BEDROOMS~ SUBDIVISION: SOUTH PARK :~2 LOT: 21 SECTION: 3 TOWNSHIP: :[1N RANGE: 3W 27154 (SQ.FT. OR ACRES) 4 DEPTFI TO PIPE BOTTOM GRAVEl_ DEPTH (FT.) TOTAL DEPTN (FT.) GRAVEL WIDTH (F'T.) GRAVEL LENGTH · (FT.) GRAVEL VOLUME (CU. YDS,) TANK SIZE (GALS) SOIL RATING (SQ. FT. /BR) Listed belew are the Options available to you in designing your septic syste~. Choose {he option that best fits your site. (FT.) 4.0 4, 0 ~' 0 ~ 2.5 0.5 .~.~ 4.5 5.5 2. ~ 24.0 5.0 I '~' 47.0 96 ~ ~ 188 ~88 ~ DEPTH TO PIPE BOTTOM " · . .~.5 FT. REQUIRES INSULATION ~e DEI='TH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION · ~-GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDIIIG 75 FT. EACH) ~ TANK MUST HAVE AT LEAST TWO CGMPARTMENTS I certify that: 1. I am familiar with 2. 3. IF A THEN WILL .ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. , .......................... r.!ATE: ApF'L I CANTt ~Ny~K-'~ENTURE LTD the requirements for on-site sewers and wells as set f~rth by the Municipality o¢ Anchenage (MOA) and the State of Alaska. I will install the system in accondance wi'Lh all MOA cedes and regulations, and in compl~.ance with the design criteria e¢ this permit. I wi].], adhere to all MOA and State of Alaska requirements eom the set back distances 'fnom any existing well, wastewate~ disposal 'system ep public sewerage system on this e~ any adjacent er nearby lot.. I undens{and that this permit is valid for a maximum of 4 bedneems and any enlargement will requi~e an additie~aI perm&t. LIFe STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES~ (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS NOT BE..' APPROVED WITHOUT AN ELECTRICAL INSPECT'ION REPORT; AND (~) THE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGIi ~S SEAL) j LEGAL DESCRIPTION: ~.O~'~ ~[/ ~2/O¢~' (r.~,~.//~.~ Townsh,p, Range, Section: /"/'/~/r D % / SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 ./ WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~) DEPTH? p E Depth Io Water Alter Monitoring? Oate: 13 14 15 16 17 18 19 20- COMMENTS PERFORMED.V: Gross Net Depth to Net Reading Date Time Time Water Drop I~UNi ~iPALiT~ O~ ^ PERCOLATION RATE ~ES~f RUN BE~V~EEJ~ (minutes/inch) PERC HOLE DIAMETER __ FT AND FT CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION; 2 3 9- 10- 11 13- 14- 15- 16- ~'~ ~UNIC DEPARTMENT OF HE PALITY OF ANCHOR,~,. .LTH AND ENVIRONMENTAL PROTECTION Anchorage, A~aska 99501 264-4720 )G - PERCOLATION TEST SLOPE COMMENTS SOILS LOG . PERCOLATION TEST SITE PLAN PERFORMED BY:_ 72-008 (6/79) WAS, ODND ^ ER [ ENCO NTERED? - 0 DEPTI . [ Gross Net Depth to Net Re; ling Date Time Time Water Drop ~r~ ~:o$ z~ /.~q , ~ PERC( TEST ~/9 c~r LATION RATE /}'/~/ (minutes/inch) ~UN BETWEEN C~?¢? FT AND ~ FT CERTIFIED BY: 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 CERT!FICATE OF HEALTH AUTHORITY 1. GENERAL INFORMATION Complete legal description Location Property owner Mailing address Day phone ?¥,S¢-'~ S-~' 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. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of sys~'em. ;r2-025 (Rev. 1/9!) 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. S & S ENGINEERING Name of Firm 1793dE:,~!cr,,:...., .............. Phone Eagle River, AlasEa ~29577 Address .... Engineers signature '~',~/:~ ~-~-'"~-- Date ~ /l /~-7 DHHS SIGNATURE ~ Approved for Disapproved. Conditional approval for bedrooms. ~ ~ ~ ROBERt C. COWAN / ~ 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 eng bee r 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, MUNtOpALIIY OI: ANCHORAGE ENVIRONMENTAL SERVICES DIVtSION MunicipalitY °fAnch°rage "n~ 1997 ~ DEPARTMENT OF HEALTH & HUMAN SERV~ Environmental Se~ices D vision 825 L Street, Room 502 · Anchorage, Alaska 99501 Health Authority Approval Checklist LegalDescription: i-eT 3J gL~¢ i .~0~r~''~'4/~'~ "~ '~- ParcelI.D.: 0'~'° A. WELL DATA Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEc letter. ADEC water system number ~ I ~ g '7 ~ Date completed Cased to __ _ Casi~ve ground) ~- Wy0Perly protected (Y/N) FROM WELL LOG ~ AT INspEcTION Date of test Static water level Well Production / g.p.m, g.p.m. WATER SAMPk~ ~~: Coliform ~ Nitrate Other bacteria Dar o~ sample: Collected by: B.~HOLDING TANK DATA Date installed lO / I, / ~ ~ Tank size I~o Number of Compadments Foundation c eah~u~ ~N) ~ Depression (Y~ Date Of ~:umping3 /Iq/9;'7 Pumper I ~A ~ ~ C. ABSORPTION FIELD DATA .' Date installed Io/i,/~..:: Soil rating (g.p.d./ff2or~ Length~~ ~ ]E Width ~ I~ Gravel thiokness below pipe 0,~ Totaldepth ~ ~ ~'/~ Effeotive absorption area ~ 4o ~ ~ Monitoring Tube present ~N) Ye~ Depression over field (Y~ ~ 0 Date of adequacy test 3/31 - [9 7 Results(Pass/Fail) ~A~ For ~ bedrooms Fluid depth in absorption field before test (in.); ~ '/~" ' Immediately after~/~ gal. water added 0n.): Fluid depth '7 '/~" ~ (ins) Minutes later: ~ O Absorption rate = _g.p.d. Peroxide treatment (past 12 months) (WN) ;;. ' ~ ~o~v~ If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed Size in gallons Manhole/AccessDN) ~,¢v- /-)~ /-/C/,,~' "Pump on"level at* Jl/ O ,9(,'-/ "Pump off" level at* h' ¢o High water alarm level at* Cycles tested ~ -/~ SEPARATION DISTANCES /o o *Datum T0/~ ~,~ /,-~,~ ~,~ y SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sew.~er-d eff~ptic service line Lift station SEPARATION DISTANCES FRO~HOLDING TANK ON LOT TO: Foundation I ~ Property line / O 4- Absorption field Water main/service line /0 + On adjacent lots Public sewer manhole/cleanout Surface water/drainage /o0 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain Building foundation /'~ Water main/service line Driveway, parking/vehicle storage area ~vo ~., ~ Wells on adjacent lots ~. o o +- F. ENGINEER'S CERTIFICATION I certify that I have determined thru field/nspechons and review of Mumc/pal recor~ a~oi ,~s are in conformance withMOA ~A guidelines in effect on this date. ~ ~ / ~ ~":~ ~ Y Signature Engineer's Name Date ' [ ~ / ~ 7 '~,~??.. .,,,'"~ HAAFee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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 legat description Location (site address or directions) 1,5'd'/O 5oCH~./~cc'/'t /,,oof~ Property owner Mailing address Lending agency Mailing address Agent /~./L Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If communitY wasteWater system, provide written confirmation from State ADEC ~ttesting 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, l 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 ~'/~/"]~f~ '7~c-~4't'~/ -~er'~'~¢~_/ Phone Address Iq~O ~o ~/~ ~nC~ ~ ~/~ Engineer's signature ,~~ ~ ~ Date ~/~/~ DHHS SIGNATURE ~,~ Approved for Disapproved. Conditional approval for 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 ~vork.. , .. 72-025(Rev, I/91) Back MOAff21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST MUNICIPALITY OF ANCHORAGE ENV~NT~- SERVICES8 ]~}~)2 DIVISION Legal Description: '~ I// ~ocr~/?~tc/~ -c/D ./¢ ~-- Parcel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter.~ADEC water system number ~ ! :3 ¥ 7,5- 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 AT INSPECTION Date of test Static water level Well flow Pump level g.p.m. RECEIVED Municipality of Anchorage Dept. Health & Human Services SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ; On adjacent lots Absorption field on lot Public sewer main Sewer service line ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed o lo /g Tanksize 12,,.c~' ~.~1 Cleanouts (Y/N) Y' Foundation cleanout (Y/N) Y' High water alarm (Y/N) iN,A, Alarm tested (Y/N) Date of pumping I /' '~5' / ? Z ' Pumper ' Ro/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To propertyline Surface water/drainage On adjacentlots -> 2oo' Absorption field ~ ~ ' "~ ~OO' Other bacteria Compartments Depression (Y/N) Foundation Water main/service line 72-026 (Rev. 7/91)Front ! ~:~ ,~ , ~ cONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Eo¢¢r' no~' Vent (Y~) ¢~ic-/'~h/' "Pump on" level at High water alarm level ~' ' Meets MOA electrical codes ~)N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: "Pump off" level at Cycles tested Surface water Well on lot N./I , On adjacent lots ~ ~oo ' D. ABSORPTION FIELD DATA Date installed to /~'o / Length ~O~ ~¢ ~.4-' Width Total absorption area ?(¢2 Depression over field (Y/N) N Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot N, To building foundation I¢' Onadjacentlots ';> ;~O' Surface water ~> ~oo ~ Curtain drain Ncne seen Soil rating 1~.5- ~'/Z~r,,~ System type Gravel thickness o"' &¢Nco/¢,.p~, Total depth Cleanouts present (Y/N) Date of adequacy test ¢-~' ~ 7 for ~'/ bedrooms No,~ ~no~ ,~.¢' If yes, give date /~, ,4-. Onadjacentlots '~ °~°o' Propertyline To existing or abandoned system on lot t,/, ,~, Cutbank t~.~, Water main/serviceline ':~ Io ' Driveway, parking/vehicle storage area ! o ~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date ~-~ ~ HAA Fee $ Date of Payment Receipt Number 72~026 (Rev. 3/91 ) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 WALTER J. HICKEL, GOVERNOR (907) 349-7755 Februaw 27,1992 FOR: Ted Moore 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 Engineering Assistant BR/of 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 Application Date GENERAL INFORMATION (a) Legal Description (include lot. block, subdivision, section, township, range} ~'~,~4 ?...,-.~ .~ /~-./ /...e / ~c~,.. %7 /~/,)1-~3''-)'~ (b) (c) Location (address or directions) Applicant Name ,./'o,'~,-, ,/"J ~,/',C,;-' Telephone: Home Applicant is (check one): Lending Institution- ~; Owner/builder~;" ¢ Buyer D; Other ~ (explain); Business (d) Lending lnstitut onX~'~(-/~'~-6' ~::~'~r~ ~L.~J~_ Telephone Address ~) O ~' X)~f ~ U~ (e) Real Estate Company and Agent ~%%~, ~,~ ?~L~ Address (f) Telephone ..~ g ~-- - '~-(~-'~'~'::~-----~"~'~%~ ~ /-, ~' -~., 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 community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite'%[~ 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 (11/84) Page 1 of 2 5.. E,NGINEERING FIRM PROVIDING INSPECTIONS, TEST~, FILE ~EARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Aulhority 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 verity 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. /"*~ ~ 2; /r~ ¢ Telephone -~--~ ~ Address / 2. ~ ~'.~ !-J 5 ·,/ir ~"~ ,"-'n c,,- o~..) .-- . Date /0 ~' '~ ~ ~' DHEP APPROVAL Approvedfor- -C ) edroo s Y ' Approved /'~ ~ ~ Disapp~ed Conditional Terms of Conditional ApRroval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protect[on (DHEP) issues I~ealth 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 (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: --~'-~'#/~ ,~'~: ,5 ~/'- // A/ /d, LINICIPAU1Y OF ANCHORAGE DEPT. OF HEALTH & ENVIRONh~NTAL PROTECTION OCT 3 KI:L,I:I V I::U WELL DATA Well Classification /~/ If~A, B, C, D.E.C. Approved~l) ~ sent (Y/N) Date Completed Yield Cased to Depth of Grouting Static Water Lev~-'t~e -- Pump Set At Casing Height Abov~ ~ Sanitary Seal on C.~~,, Electrical Wiring in Conduit (Y/N)'~. Depression~ellhead (Y/N) Separation Distances from Well: ~ ~ To Septic/Holding Tank on Lot ~X~ ; On Adjoining Lots To Nearest Edge of Absorption Field on LOt / ;'OcL~.djoining Lots To Nearest Public Sewer Line J To Nearest P~e~ CleanouVManhole J To Nearest Sewer Service~oi~.on Lot Water Sample Collected~'''~/'~ Water Sample T..~'~ults ; Date B. SEPTIC/HOLDING TANK DATA Date Installed /~ - /.c, - ~ $' Size Standpipes ~,~) Air-tight Caps~.~N) 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 ~ ~ ;~o~ To Property Line ~'~ F- rO To Water Main/Service Line (-'~ '~ [¢~ Course ~z~)'- /00 /2. $ ,~ No. of Compartments Foundation Cleanout(C_~N) Date Last Pumped ------¢' ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ,/ ~7~ To Disposal Field '--'--'--'--'--'--'--'--'--'~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026{11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata .Date Installed /O - /o ~ ,¢, i , i. ~./ , Width Of Field ~ Square Feet of Absorption Area ~'?O Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well _¢_~T ZOO To Building Foundation /O ' Lot Type of System Design To Water Main/Service Line z'~ 7- /O To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Length of Field On{¢ .~'¢_~ Depth of Field Gravel Bed Thickness Standpipes Prese nt~Y~N) Date of Last Adequacy Test To Property Line /O ' To Existing or Abandoned System on ; On Adjoining Lots ~ 7'- ~O ' To Cutbank (if present) D. LIFT STATION IO~[O- $S" Dimensions I~' 8~cp cf~' ~.-. 2.~ c~L Manhole/Access CN) ~' ~" "Pump Off" Level at l'~ ~ ~" ¢ ' Vent (Y/¢ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes Comments Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certifyL------~.~. ~'~ ,.~,¢'''''~'--~that I b~_ve checked, verified, or conformed to all MOA and H~A~A g uideli nes in effect on the date of this inspection. S i g n e d ~'~'"~'¢~- ~¢-.-''r ~'' "~ '' Date_ Company ~ ~-- C. ~' MOA No, ST- 2'-~--O ~.~ Receipt No. ~.~ i~'~("~ 1ol " Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: ~ /~ According to records on file in this office the ~.~D~(~O_~ Water System is in compliance with the St~e Drinking Water Regulations Sincerely, ,J~UNICIPALI'i'Y OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT RE.¢EIVED