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HomeMy WebLinkAboutSOUTHPARK #2 BLK 2 LT 1tmev uoiuti 1 a/ Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231037 PID Number: 020-501-24 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade Name John Hume A ORPTION FIELD El De Trench El Wide Trench El Bed El Mound Site Address 4601 Southpark Bluff Dr, Anchorage, AK 99516 other Phone Number of Bedrooms Soil RatingTotal depth from original grade 907-223-2305 4 /sF Ft. LEGAL DESCRIPTION Depth to pipe invert from original g de Gravel depth beneath pipe F . Ft. Subdivision Block Lot Southpark #2 2 1 Fill added above original grade Gr I length Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dist a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between t ches From Tank Field Tank Line Ft Well >100' N/A N/A N/A >25' TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water >100' N/A N/A N/A Material Plastic Number of compartments 2 Lot Line >5' N/A N/A N/A NA Foundation >10' N/A N/A N/A tKUTATION Manufacture Capacity Remarks Gal. Alarm location Elec r tailed by PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Installer A.C.E.S Drainfield N/A Co/MTD3034 Inspector M. Jakubisin BENCH MARK (Assumed elevation)100 ft Inspectiones: 15` 4/17/23 Location and description 2nd t Top of Deck 3rd 4 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF k Conditional Approval: Date A1W CO 49 TH I •K d r¢ Benjam(rySchiller Septic System Approved Date % z �``�i••. CE 12592 • �`�r� �� sl• _4/18/23 • •��v�� F�PROFESSI l,�ONP�..� OFESSI Note: this approval does not include well permit requiremen S. �� � tmev uoiuti 1 a/ // // // // // // // // // // // // // // // Benjamin Schiller CE 12592R E GISTEREDPROFE S S I O N A LENGINEER1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PERMIT # OSP231037 PID # 020-501-24 SOUTHPARK #2, BLOCK 2 LOT 1 FEET 0 50 100 SOUTH P A R K L O O P 4/18/23 10' T&E EASEMENTS PLAN AS-BUILT UTILITY & TELECOM EASEMENT SOUTHPARK BLUFF DRIVEWOODEN FENCE POST & RAIL FENCE 3- B D R M H O M E 1250-GALLON SEPTIC TANK WATER SERVICE LINE PER RECORD DRAWINGS A B MH1 35.9 SV1 40.1 2CO 42.6 16.4 18.6 20.2 A B EXISTING TRENCH BENCH MARK PROFILE AS-BUILT (NO SCALE) 90.2 85.2 90.8 97.2FCOMH1 SV11250 GAL SEPTIC TANK 2CO90.0 Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A LENGINEER4/18/23 PERMIT # OSP231037 PID # 020-501-24 SOUTHPARK #2, BLOCK 2 LOT 1 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231037 Work Type: SepticTank Upgrade Tax Code Number: 02050124000 Site Legal Address: SOUTHPARK #2 BLK 2 LT 1 G:3236 Site Mailing Address: 4601 SOUTHPARK BLUFF DR, Anchorage Owner: HUME JOHN D Design Engineer: FORGE ENGINEERING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy n ..t ; S :Jv � f Department Effective Date: 3/31/2023 Expiration Date: 3/30/2024 Lot Size in Sq Ft: 22001 Total Bedrooms: 4 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Ss V� �0�—C� Date: Issued By:Date: 3 �& Z- MUHMPALf f Y OF AHCHOR'--` GEF Community Development Department, Phone: 907-343-7904 Development Services Division `� Fax: -907=343=7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-501-24 Property owner(s) Jordan Anderson Day phone 907-223-2305 Mailing address 4601 Southpark Bluff Drive, Anchorage, AK 99516 Site address 4601 Southpark Bluff Drive, Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) Southpark #2, Block 2 Lot 1 Legal description (Township, Range & Section) Lot Size 29,372 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank ❑x Upgrade ❑X (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees:2 2 S Date of Payment: 3/2 Sr 12 3 Receipt Number: O q / 9 3 � Permit No. 0_9P 2 3/n37 Permit App_'- : ..:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. March 24, 2023 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Southpark #2 Block 2 Lot 1 - 4601 Southpark Bluff Dr Septic system design Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots, considering this property and all surrounding properties are on a community water system. We are replacing the septic tank with the same size designed for 4 bedrooms. The new septic tank will be a minimum of 100’ from all wells and surface water. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231037, Curtis Townsend, 03/31/23 // // // // // // // // // // // // // // //Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND SOUTHPARK #2, BLOCK 2 LOT 1 FEET 0 50 100 NOTE: NO EXISTING WELLS - PROPERTIES ARE ON COMMUNITY WATER SYSTEM SOUTH P A R K L O O P 3/20/23 10' T&E EASEMENTS SEPTIC PLAN UTILITY & TELECOM EASEMENT SOUTHPARK BLUFF DRIVEWOODEN FENCE POST & RAIL FENCE 3- B D R M H O M E ENSURE ALL PIPES EXTEND ABOVE GRADE AND FIX AS NECESSARY NEW 1250-GALLON SEPTIC TANK DECOMMISSION EXISTING 1250-GALLON SEPTIC TANK WATER SERVICE LINE PER RECORD DRAWINGS Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231037, Curtis Townsend, 03/31/23 '' MUNICIPALITY OF ANCHORAGE "' DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264~4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~.me DISTANCES Addre~ TANK FIELD WELL ~/,y Pho.e(s)7~~' ~'~ Permd NO.~ NO. ol BeSoms LOT UNE ~ ' LEGAL DESCRIPTION [ownsbip, Range, Section Z3 J ~ driveway,AS'BUILt DIAGRAM {Showl°cati°n°fwe'l septic system' " °pe"ylines f°unda6°n'water bodies, etc.) TANKS ~ SEPTIC ~ HOLDING Ma~ulsctu[~r Capacdy i~ gallons Ma[erial No. of Compsdmenls TYPE OF SYSTE~ ~TRENCH g BED ~ W. DRAIN ~ OTHER original grade FT // FT V Fill added above original 9rade Gr~vel depth beneath pipe FT G[avel length Gravel width L Total absorption area Distance between lines ' - Number Ol lines Soil rating Pipe material d Installer D PRIVATE ~ OTHER fldentifv) '~'~ ~ / '7 Classification(A,B,C) TotaIDepth Casedto . ~ ~ ~ ~ ~: Instaner Da,e Ins,ailed: ~ REMARKS: Ins ections PeHormed by: I ceflily that Ihis inspe~ion was peflormed according to'ag Municipal and Stale guidelines in ellecl on this dale: ~ 72-013 (3/85) M U N I C I P A ~ I T Y 0 F A N C H 0 R A G EE Department cH~ [-lealth & Human Services 825 L Street, Anchorage, Alaska 99501 L']43-4720 (] N - ,:~ I T E S E W E R P E R M I T F:'ermit Number: Date Issued: Owner Address: 88 .)0~ ~. . ~ I~...,.,, ./SU Engineer I TURNE!R CONSTRUCTION P.O,, BOX 3489 F'ALMER, AK 99645 Designed Day Phone: 74~~ 8._o4 F'ar'ce ]. t d." 020-052'-75 Lot Legal: Subdivisiorl: SOUTHPARK ADDN ~2 L. ot: Sectien: 3 Township: llN Range: 3W Lot Size 22001 (sq.~t.. or acres) Max Bcedr'oom~ 'this Permit: tal L,~pac. zt,/~ ~ i B Ioc k: eel liE., 'TAN[.'.]: Minimttm total septic tank capacity: 1,0Cx} gallone. · Lank must. have at least 2 c:ompart, ments, Depth to top of' sepi'.ic Feet r(~qL~ires insLllat, J.o~ over ~.a['il.:: (s) . Eac:h sept. i(::: tank (s) ".. 4.0 INFORIq D.I-I.H.~),, [:'RIOR TO 1S1' .:,,. 2]ND INSPECTIONS BY ENOIN[:.E..h~ AFTE~R OF:FICE HOURS CALl_ 343-4681 AND LEAVE A ME:.~SAGE C[!NSTI::~LJCT' F~ER ENGINEERS AF:'F'ROVED ATTACHED DE,=ISN I F:' I CEi:R'['IF'Y THAT: 1. I am familiar with t. he requirement, s for' on-.site sewers and wel:Le as set ~orCh by the Municipality oE Anchorage (MOA) and the State oF Alaska. 2. I will install the system in accordance wit. h all MOA codes and regulatioos, and in compliance with the design criteria o[ this permit'. 3. I will adhere to all MOA and State o{' Alaska requirements for the set back distances [rom any existing well, wastewater disposal system or public sewerage system on this or aoy adjacent or nearby lot. zJ.. I ur~derstanc:l t. hat this permit is valid For a maximum o~ 3 bedrooms, l also understand t. hat. the capacity ~{' 'the total system is 3 bedrooms and /1.3.14. PLOT AS BUILT ~ENNETH G. LANG~ L.S. // SCALE 1731 GEORGE BELL CIRCLE ANCHORAGE, ALASKA 99515 (907) 345-6476 I HEREBY CERTIFY THAT I HAVE SURVEyED. THE FOLLOWING DESCRIBED PROPERTY:. LOT. I , BLOCK ~ , ' ~f&~:-. "~. ~:;~ ~Z , ~0~'' RECOPJDING DISTRICT, ALASKA, AND THAT THE IMPROVE- MENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND DO NOT ENCROACH ONTO THE PROPERTY A~.JACENT THERETO, THAT NO IMPROVEMENTS OM THE PROPER~Y LYING ADJACENT THERETO ENCROACH ON THE SURVEYED PREMISES AND THAT THERE ARE NO ROADWAYS~ TRANSMISSION LINES OR OTHER VISIBLE E~SEMENTS ON SAID PROPERTY EXCEPT AS INDICATED HEREON. DATED ~HiS THE ~ff~ DAY OF ~l~ , 198~, AT ANCHORAGE, ALASKA. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4- 6 m 1 '11 12 17- 18 19 20 C. Reld, Jr, 2251-E COMMENTS DATE PERFORMED: SLOPE SITE PLAN WAS GROUND WATER / · ENCOUNTERED? )~L~ SL E IF YES, AT WHAT DEPTH? (o' d PERCOLATION RATE ' t<~ (minutes/inch) TEST RUN BETWEEN ~7/r~ FT AND d FT PERFORMED BY: ~,~/~'9~ CERTIFIED BY: DATE: 72-008 (6/79} ALASKA ENVIRON~M~E. NTAL CONTROL SERVIC 1INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 ~.E~.o. --~ oF 5'- CALCULATED BY '~' I~'~"ff/ DATE- CHECKED BY DATE i---Il n T II. Z 0 I- 0 Z o H I- U [~ .3 °°1 O0 0 O0 ALASKA ENVIRONMENTAL CONTROL SERVICE 6, NC. 1200 west 33rd Avenue. ouite B ANCHORAGE. ALASKA 99503 (907) 561-5040 ~HEET NO. C~LCULATEO BY Z./~,~ O~T~r//~/~ CHECKED ~Y OATE ALASKA nuIBo[lm nTAL conTROL ~nclineerinq 8' ~nuironmen/er Stucljes InC. SPECIFICATIONS FOR A TRENCII-TYPE WASTE[~TATER DISPOSAL SYSTEM SOUTH PARK SUBDIVISION, BLOCK g, LOT 1 GENERAl, 1.1 The drawings, sheets 1 through 5, shall be a part of 'this specification. 1.2 All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Health & Human Services (DHHS), the conditions of the permit, and all applicable rules and regulations currently in effect. 1.3 All elevations and depths are advisory, and are to be verified or modified in the field by an DHHS approved inspector. 1.4 It is the responsibility of the installer '~o adhere to approved designs for installation, maintain the specified separation distances, and have the appropriate inspections. 1.5 If the installation is not inspected by an AECS engineer, AECS will not be responsible for the design. An engineer at AECS should be consulted prior to construction, to determine the number of inspections that will be required and to explain what 'these inspections will involve. 2.0 SEPTIC TANK -- SEE ANCHORAGE TANK LIFT STATION/TANK SPECIFICATIONS 2.1 If there is an existing septic tank it may be used if it meets the capacity requirement for the residence and the approval of 'the MOA. 2.2 The septic tank shall be a UPC-Approved two-compartment tank, constructed of 12-gauge steel with bitumastic coating and set level on undisturbed soil. If tile tank is buried at a depth of 4 feet or ]ess, it may be insulated with an overlying layer of 2 inch burial type polystrene rigid board insulation. 2.3 The septic tank and bed shall be a minimum of 100 feet from any private well or body of water, 150 feet from Class C wells, and 200 feet from Class A or B wells, unless otherwise specified. Less than tile required separation distance must have prior approval or waiver by ADEC or MOA. 2.4 The septic tank shall be a minimum of 5 feet from the house foundation, and a minimum of 10 feet from the absorption area. 2.5 Piping shall be fitted with a mechanical watertight calder coupling on the outlet and inlet of the septic tank. Pipimg shall be 4-inch solid PVC ASTM D3084 or cast iron, sloped a minimum of I/4 inch per lineal foot. If the piping is buried at a depth of 4 feet or less, 1200 LUcst 33rd ~uCnu~. 5uii~ B,Anchoroq¢. ~l~)s):~) 99503,(907) 56t-5040 2.6 2.7 it must be insulated with an overlying layer of 2 inch burial type polystrene rigid board, Cleanouts shall be installed as designated and capped with air-tight rain caps (Jim caps or equivalent), and extended a minimum of 1 foot above gronnd level. If a lift station is required it shall be combination lift station septic tank per Anchorage Tank and Welding, Inc. design. Specifications are attached. Absorption Area The gravel for the trench shall be 0.5 to 2.5 inch, screened rock with less than 32 passing #200 sieve residual. All substitutes must have prior DHHS approval. 3.2 The bottom and sides of the excavation shall be raked with the backhoe blade to insure that it has not been compacted during excavation. The bottom elevation shall be level, 3.8 8.4 3.5 3.6 3.7 Monitor standpipe(s) shall be placed as shown in the drawings, and shall he rigid RVC ASTM D8034, or 4 inch cast iron. Tile section shown with ho]es may be 0.5 inch holes drilled on 6-inch centers on opposite sides of tile pipe, or a regular section of perforated sewer pipe, clamped to a solid section, with either a no hub coupling or a solvent joint. A rubber rain cap (Jim cap or equivalent) shall be installed over the top of the pipe. The distribution pipe shall be 4 inch rigid PVC with a minimum crush strength of 1500 lbs. All distribution pipes shall be laid level. Trenches may be paralleled, but must have a minimum separation distance between the trenches of 6 feet or 2 times the gravel depth (whichever is greater). 75 feet is tile maximum allowed linear length of any trench. If 'the final grade over the trench is less than 4 feet above gravel, insulation is required, using the burial type po]ystyrene rigid. There shall be t inch of insulation for every foot of soil less than the required 4 feet of cover, but there must be at least 24 inches of soil cover even though insulation is used. The solid pipe extending from the septic tank to the drainfield shall also have 4 feet of cover or an equivalent layer of insulation to prevent freezing of tile line. If insnlatJon is not necessary, the gravel sha]l be covered with a layer of nonwoven Oeotextile fabric. 4.0 INSPECTIONS 4.1 4.2 A minimum of two inspections are required for the installa'tion of the trench. The first inspection will be of the excavation to verify that installation will be ia the proper soil. The second inspection will be after placement of the gravel, monitor standpipe and distribution pipe to verify proper installation before backfill. Certificate of On -Site Svstems Approval Parcel I.D. 020-501-24 Legal description SOUTHPARK #2 BLK 2 LT 1 Site address 4601 Southpark Bluff Drive Anchorage Current property owner(s) John Hume ' 2 Expiration Date: `f X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: 0 Original Certificate Date: 4/20/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Absorption Field Advisory Tank Age Advisory _ Other Well Flow Advisory Nitrate Advisory Arsenic Advisory COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 020-501-24 Complete legal description Southpark #2 Block 2 Lot 1 Location (site address) 4601 Southpark Bluff Drive, Anchorage, AK 99516 Current property owner(s) John Hume 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone (907) 240-2376 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units A Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel X Plastic ❑ Concrete ❑ Fiberglass Age < 1 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed A Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: 0 Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $_ Y-0 Waiver Fee $ Date of Payment Gi y z Z 3 Date of Payment COSA # _ 01� C 2 3 j Waiver # COSA Application—June 2022 Southpark #2 Block 2 Lot 1 020-501-24 N/A N/A New Installation 6/15/88 12.4 5.6 3/20/23 19 760 43 1440 19 > 600 19 Benjamin Schiller, P.E.4/18/23 (907) 522-7773 Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING MUNi,,.JPALITY OF ANCHL~KA~I: ENVIRONMENTAL SERVICES DIVISION OCT 1 7 1997 RECEIVED GENERAL INFORMATION Complete legal description L..o ~T- I3 Location (site address or directiOns) Property owner Mailing address ~' Lending agency Mailing address Agent '~ A~_.~/_-- L~J~rT'~- {~-~:-.¢¢¢-- ------------------~/ ~,,.,~P_._~z~,~5~-.~/,Day phone Day phone..~-."71' H,-~ 3't)~'- Wb~'-O Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~-~ '~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~21 "STATEMENT OF INSPECTION BY ENGINEER. As certified by my' sea[ 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 At~skr~We. ter .&~ /~ Phone Wast::water ~.~.31vl,,es //'J Address / ¢~/~F/f,,~0//;,~ EngineeCs signature ~~(~ Dato bedrooms. 6. 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 courtesyto 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 ~uN~!~^uw o~ ~;. ~.~- - -- E6R'At- SEE DEPARTMENT OF HEALTH & HUMAN SERV~q~°t'~ Environmental Services Division ,~T 17 1991 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist R E C E I V LegalDescriptJon: L.o"~ t.) O~l~j ~o~-rH-'~"~c~'ZParcelI.D.: ~)2.0- A. WELL DATA  , or C, attach ADEC letter. ADEC water system number Log present (Y/I~.... . Date completed Total depth ~.. Cased to Casing height (above ground) Sanitary seal (Y/N) ~"~" - Wires properly protected (Y/N) Date of test FROM WELL Static water level Well production ~ g.p.m. WATER SAMPLE ~ Coliform ~ Nitrate oD~f sample: Collected by: ~ g.p.m. Oiher~. B. SEPTIC/HOLDING TANK DATA Date installed (~/,~/~)c~ Tanksize Foundation cleanout (Y/N) 7 / ~.~-'-O Number of Compartments ' 2. Cleanoute (Y/N) _ Depression (Y/N) /V O High water alarm (Y/N) fJ/~¥ Date of Pumping /0/-(-/~--~ Pumper C, ABSORPTION FIELD DATA Date installed Length ~"'~' / Width Soil rating (~T~'~or ff~/bdrm) /..~----O System type ~ ..,--,o¢=. ~,--~4 ~ ,~-----~--,~ I / Gravelthickness below pipe ~' ~ / Totaldepth /7_. ~-' Effective absorption area Monitoring T?be present (Y/N) y /©/~/~/c=/~ Results (Pass/Fail) f:)~:~ '~ Date of adequacy test Fluid depth in absorption field before test (in.); ~)' !' ~ i/mmediately after (¢' ?~gal. water added (in.): Fluiddepth ~2'z~'~'# (ins) Minutes later: 4/~'' Absorption rate = ~'(~ ~ .g.p.d. Peroxide treatment (past 12 months) (Y/N) iVOYJ'~--- J~'Jo C'-//V/ If yes, give date ' /J//~-.- ' . Depression over f e d (Y/N). For ~- j~..¢ o,~ ~ '~-~,~ bedrooms 72-026 (Rev. 3/96)* Date installed Size in gallons ~ Manhole/Access (Y/N) , ~__"Pump~ ._ % off" level at* Fligh water~~ *Daturn__ ~ C o ted PROM WELLON'OT TO: Septic/holding tank on Iot~ On adjacent Io~.~~-~ Absorption field on lot ~lots ....~"~'-~-~ ~eh;la~anout Public sewer main Public sewer ~~e Lift station ~~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation / ~' ~ I ~ Properly line ~ I ~ Absorption field ~/¢' Water main/se~ice line. /O ~ Sudace water/drainage /OO/~ Wells on adjacent lots ~ / ~ SEPARATION DISTANCE FROMASSORPTION FIELD ON LOTTO: Property line ~O .~ ~ Building foundation J~ /~ Water main/service line Surface water ¢,~C)O t.¢_ Driveway, parking/vehicle storage area Curtain drain /'40~ -¢~ ~~d O L-~-J ¢v) Wells on adjacent lots ¢~,-O O ENGINEER'S CERTIFICATION/ I certify that I ha.~ve d~rmine~,d~t/~ru field inspections and review in c°nf°rmaTde ~th~j~A ~Rl~%nes in effect °n this date' Signature t, Engineer's Name ~,l~ /¢' Date /O//_q--,/~ ~- HAA Fee $. ~ ~ Date of Payment Receipt Number ~ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Reccpt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # GENERAL INFORMATION Complete legal description Lot I; Bloc~ 2; Sou~ Pa~k Subdivision Add. No. 2 Location (site address or directions) 4601 South Parr BluJ~ Driv~ Property owner - Edgar P' ~ Ko~h.~.6¢n A.Van ClVv6 _Dayphone 345-3440 Mailir~g address __460! South Par~z ~Driv¢, A~choraqe, Ak. 99516 .... D~ Phdne _ Lending agency Mailing address_ A~ent Lo~ Gibbo~ or MiE~ K~y VISTA/BETTER HOME~a~ phone_ 344-9603 ~ ~ENS Address _621 W~t.D~ond Blvd. Anchoraq~Ak. 99515 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: _ 3 3. TYPE OF WATER SUPPLY: NOTE: individual well Communi(y well XX Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of System. 72~25 (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 ,~ & $ ENGINEERING Address 1'7~134 ~le Ri,vet' Loop I~oa~ %t~'!b River, Alaska 99577 Engineer's signature DHHS SIGNATURE X Approved for"~'~'oJ=:-'~ ~//~.) bedrooms. Phone 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 work. 724)25 (Rev. 1/91) Back MOA Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:~--o~ \ ~;~-.-.-.-.-.-.-.-~z_'Z-- ~'~c>,w~. ~?.-¢- Parcel I.D. A. WELL DATA Well type /~ Log present(Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Total depth Sanitary seal (Y/N) Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~-c~ ' ~' Absorption field on lot "7.-,. c~ ~ ~'' Public sewer main Sewer service line WATER SAMPLE RESULTS: g.p.m. AT INSPECTION ~ONIcIpALtTY OF ANCHOP, AG~ ENVIRONMSNTAL SERVICES DIVISION g.l~m.0 9 1991 RI CEIVED :; On adjacent lots On adjacent lots Public sewer manhole/cleanout Petroleum tank Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed L~- ~ ~<5~, Tank size ['7~--~ C) Compartments Cieanouts (~/N) ~ Foundation cleanout {~/N) ',/ Depression (Y/~ High water alarm (Y/(~) ~ Alarm tested (Y/N) Date of pumping {~-.~ -- c'~ L Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot '?,-,~ c~ ~ ~ On adjacent lots fl/A Foundation t'~ To propertyline '~'Z-'~ Absorption field L~, ~ ' Water main/service line Surface water/drainage I C~ ~ ~' 72-026 (Rev. 7/91)Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electr~ SEPARATIO~bIA91STANCE FROM LIFT STATION TO: ~=flf~on lot On adjacent lots Manhole/Access (Y/N) ~s tested Surface water D. ABSORPTION FIELD DATA Soil rating t ,~ O ¢¢/6,?... System type Gravelthickness L,, ,~'- ~ Cleanouts present (~) Date of adequacy test for -r'cia ma If yes, give date Date installed Length ~""/-' ~ Width Total absorption area [0'-/U, ~' Depression over field (Y~i) /'~ Resu Its,~=~Tfail)_ Peroxide treatment (past 12 months) (Y~) / SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot %'~- f'~ ~ ~ On adjacent lots Property Pine To building foundation On adjacent lots "¢.;~:::' ~ ¢¢ Surface water ~. c>o ~'- Curtain drain ¢J/,A- Cutbank To existing or abandoned system on lot 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 Signature Engineer's Name Date ENGINEERING ;7024 Eagle Rive]- Loop ~:oad J~o, 2(74 P.'ver, Alaska 99577 HAA Fee $ / /~ ~ Date of Payment ?~- ~;'- ,~' Receipt Number c~.~ '-~'..-~ ~ 72-026 (Rev. 3/91 ) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number I [ DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 / / WALTER J. HIOKEL, GOVERNOR (907) 563-6775 December 6, 1991 FOR: S & S Engineering PWSID #213475 My review of the records on file in this office reveals that the South Park Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineer BR/pf MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # O~-'~) ~,~- (~4 HAA# (~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (adBr~e~¢ or directions)', ). 5 (b) Property ~¢~er"2'~'~ Ma ngAdd/'eg$' ,~o~t (c) Lending Institution- Telephone: (home) Business .?V~' ~';1]V 'Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here ,[D~if hold for pick up.) List contact person and day phone number below: ' 2. TYPE OF RESIDENCE ./ Single-Family~ Number of bedrooms Z/ 3. WATER SUPPLY Individual Well [] Community)i~ 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'Ji~ 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 ':~JOM s,JeeuJbue IPUO!SSejoJd eqi u! sue!es!we JO sJoJJe JOJ elq lsuodseJ leu s! eapJoqouv ,Lo ,~l!lPd [o! u n V~ aW1 'penes! s! elpow1Jeo p eJojeq plep eZ/~lpUp Jo suop, oedsu! lonpuoo ],ou op SHHC] jo see~oldLU3 's~ueuJeJ!nbeJ elpls pup IpJepeJ u!plJ@o X~s!jps el JepJo u! suo!~m,!lsu! 6u!puel J!eql pup sewoq )o sJespqoJnd el Xs@lJnoo p sp s!ql seep SHHQ eq.L 'P~SPlV ,to elPlS etll u! peJm, SlaeJ Jeau!Sue leUO!SSe)o~d ~uepu@depu! up Xq e^oqp ~ qdp~§pJpd u! ue^i6 euo!~p~ueseJde~ eq~ uodn/~lUO pespq pe~po!,tpee Ip^oJddv,qpoqinv qHPeH sense! (SHHQ) seo!^~es upwnH pup q~lPeH ,LO luew~edeQ eJ~pJoqou'v ~o ~l!lPd!o!un~ eq.L IpAoJddv IpUO!l!puoo 1o sw~el ipuo!l!puoo peAoJddes!c]~ ~. Pe^°Jddv f "l~AO~dd¥ SHHO '9 A. WELL DATA Well Classification M U N I C Ip~L~,¥,~'~%~A~i~;'I-I O R A G E (MOA) Approval (.AA) ~FEBRUARY 1984 ~al Description: ~ If A, B, C, D.E.C. Approved ON) hg Present (Y/N) Date Completed Yield __Cased to Depth of Grouting _ __ Static Wat'~ __ -- __ Pump Set At _ __ Casing Height Ab-~und __ Sanitary Seal on Casing (Y/N) ~~l'nDgl~n~CA~ncd~s%M~ _ Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results To Septic/Holding Tank on Lot ~"~-~- ; On Adjoining Lots '~-~ ; On Adjoining Lots To N;~ blic Sewer Cleanout/Manhole ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~'-/~"g~( Size Standpipes ~N) Air-tight Capsi~N) Depression over Tank (Y/i~ Pumping/Maintenance Contact on File (Y/N) No. of Compartments ~ Foundation Cleanout~'N) Date Last Pumped ,,J/~F Holding Tank High~Water Alarm (Y/N) SEPARATION DIST~J~0~. FI~OM SEPTIC/HOLDING TANK: TO Water-Supply Well . To Property Lih~ ! To Water ~ain/Servige L n.e . ond¢ Lake 0rj /~"~ TO Stream,'.? Majdi: D~:ainage Course Comments ; for , Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y~ Results of Last Adequacy Test Type of System Design Length of Field -~ Depth of Field // Gravel Bed Thickness ~"-~ Statndpipes Present CN) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line 'to Stream, Pond, Lake, or Major Drainage Course 'to Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line ,~z,~o ¢" _ To Existing or Abandoned System on ; On Adjoining Lots /O To Cutback (if present) D. I. IFT STATION Size in Gallo-71'~---.-._.~.~ "Pump On" Level at High Water Alarm Level at - --~. Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this Signed Company MOA No. ¢~ Receipt No. Date of Payment Amount: $ 72-026 (Rev 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 Seal DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: August 31, 1988 PWSIB: 213475 To Whom It May Concern: According to the records on ?ile in this o??ice, TERRACE SUBDIVISION Water System is in compliance o¢ Alaska Drinking Water Regulations. the SOUTH PARK with the State MPL:pkk Sincerely, Michael P. Lewis, PE Environmental Engineer I Lot 18 I _ I 30.0, S 86'09'56"E 113.14- 10 1 13.14'10' T&E EASEMENTS \ Lot 1 '\ ^ 22,001 S.F. toWOODEN FENCE) j � W Lot 2 ow 31.8 N A o I a o M J o A - O m 50 O 2 3.0'x8.3' CANT 3,0 13 3 v N PORCH. O 'p_ 2.0' CANT I 2.0' CANT P n 6.0' 26.1' 8•x24' DECK SEPTIC PIPE MANHOLE 30.0 POST & RAIL FENCE PIPES I o N v' V I O� C14N 78-10 35 "W 90.00' y LryO� I L, Lp — UTILITY & TELECOM. Rm EASEMENT SolyTHPARK Loo _ P 1 NOTE: THIS LOT IS SERVED BY A COMMUNITY WATER SYSTEM. I PLOT PLAN ___ AS BUILT _x_ SCALE40__ GRID _ SW 3236Project No. __—_23=0741R2____ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone kenOlongsurvey.com Professional Land Surveyors jonathanOlongsurvey.com �OFA�q\ 4 travisOlongsurvey.com rAQ'�,• '�•,5u,1'. I hereby certify that I have surveyed the following described property: LOT 1, BLOCK 2, SOUTHPARK SUBDIVISION — ADDITION No. 2 (PLAT No. 83-213) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the—11���__ Day of at Anchorage, Alaska UZ, It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. *. a49TH M ...:* KKENNETH G. LANG No. 5202 .' State of Alaska AECC963 Lot 18 _ 3��_� — — S 86'09'56"E 113.14' - - -J >\ I 10T&E EASEMENTS \ Lot 1 22,001 S.F. WOODEN FENCE- ^ I c p y: rn 1.38 0 q= Lot 2 0 31g w O I O 50 O Z 3.0'x8.3' CANT -;3� N \ PORCH. 2.0' CANT 3 p 2.0' CANT I p n 6.0 26.1' a 8'x24' DECK o_ SEPTIC 0 }0 4 POST & RAIL FENCE PIPES 14 C1i d. O N N 28 10'35" W 90.00' 3tiryp� I UTILITY & TELECOM. ------ — EASEMENT R� SOV THPARK Loo P I NOTE: THIS LOT IS SERVED BY A COMMUNITY WATER SYSTEM. I Pi nT Pi AM Ac of w T X ecAi r 1" = 40' ram SW 3236 P,].,t tin. 11500 Daryl Avenue, Anchorage, Alaska Lang & Associates, inc. (907) 522-6476 Phone kenOlongsurvey.com Professional Land Surveyors jonothanOlangsurvey.com frovisOlongsurvey.com I hereby certify that I have surveyed the following described property: LOT 1, BLOCK 2, SOUTHPARK SUBDIVISION — ADDITION No. 2 (PLAT No. 83-213) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated this the ___1__ Day of ___ at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 99515-3049 *; ¢8TH T� •,* y , KENNETH G. LAN e 0 acs •, No 5202 .' 1 -�"OOFESION � State of Alaska AECC963