HomeMy WebLinkAboutSOUTHPARK #2 BLK 2 LT 6outhpark #2
Block 2
Lot 6
#020-501-29
Municipality of Anchorage
Community Development Department Page 1 of 3
On -Site Water & Wastewater Program
4700 Elmore St. a P.O.
Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsita • (907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP121230
PID Number: 020-501-29 ❑ New ® Upgrade
Name:SHELLIE HELTON
ABSORPTION FIELD
S Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address:
15731 SOUTHPARK LP *ANCHORAGE, AK 99516
❑ Other
Phone:
(907) 306-7116
No. of Bedrooms:
4
Soil Rating:
0.8 GPD/sq. Ft.
Total Depth /ram original grade:
9.5 MAX Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade:
3.00 MAX Ft.
Gravel depth beneath pipe:
6.50 Ft.
Subdivision:
SOUTHPARK #2
Block: Lot:
2 6
Fill added above original grade:
SEE DWG. Ft.
Gravel length:
58 Ft.
awns ip: — anger —
ec Ion: —
Gravel width:
3.ds Number of linea
Distance between linea:
2.5 Ft.
I —
— Ft.
SEPARATION DISTANCES
Total absorption area:
754 So.R.
umber o trenches:
1
Dist. between trenches:
— Ft
TO
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
Public/Private
Sewer Lines
Well
N/A
N/A
N/A
—
N/A
TANK []Septic ® S.T.E.P. ElHolding El Other
Manufacturer.
Capacity:
Surface water
100'+
100'+
100'+
—
ANCHORAGE TANK
1500 Gal.
Lot Line
5'+
10'+
5'+
-
N/A
Material:
STEEL
Number of compartments:
2
Foundation
5'+
10'+
5'+
—
LIFT STATION
Curtain Drain
NONE KNOWN
Nanufucturea Capacity:
ANCHORAGE TANK 1500 cal.
Remarks: OLD TANK WAS DECOMMISSIONED PER UPC
Pump on' level at:
42"
Pump off ' level at:
42"
High water alarm at:
46"
OLD DRAINFIELD WAS ABANDONED IN PLACE
pump Make & Modei:
20 OSI 05 HHF
Elecbical Inspections performed by:
MOA
PIPE MATERIAL
House to tank D3034 Tank to SCH40
drainfield
Installer
NORTHERN
EXCAVATION
CO/MT
MT D3034 Drainfield D3034 CO
GEG, Ltd.
BENCHMARK (Assumed elevation)
100.00 Ft.
Inspection
Dates: 1st 8/9/12
2nd 8/10/12
Location and Description:
3rd 8/12/12
4th —
BOTTOM OF SIDING ® SE CORNER OF HOUSE
Community Development Department Approval
Conditional approval: Date:
ENGINEERISEItL
oo60�p0
Qo �� •......... 9S�0
p P.•• •.COQ
o* : 4 T -7 00
�............................
G ness;'
OQo9. CE -793 e��O
�OO0000�
Approved:
Date:rofesslon°oma
PERMIT NUMBER: PARCEL ID NUMBER:
OSP121230 AS -BUILT DRAWING 020-501-29
A I 6
FCO
19.07
39.58
ST1
17.20
45.78
ST2
11.61
44.25
MH
10.98
44.28
C01
33.19
56.98
MT1
32.93
57.25
CO2
51.10
29.53
MT2
50.71
28.52
OLD DRAINFlELD
ABANDONED IN PLACE.
SOUTHPARK #2;
BLOCK 2, LOT 7
NEW 1500 GALLON
STEP TANK
Col
MT
A
D \TH
EXISTING 4 \�
BEDROOM
HOUSE
9(ATI737:miTaK
RESERVE DRAINFlELD
WATER SEPTIC
/ LINE AREA
/ 1.ITI SCO 4" PVC
/ TRANSITION TO 4" PIPE AT
/ DRAINFlELD.
C
\
SOUTHPARK #2;
BLOCK 2, LOT 5
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS 8. GENERAL CONTRACTOI23
3'!01 L NOON FOOL, 9OOE 101 • "MME. M( 99501 • W W (907)33)-61)9 r FM (907)336-39 6 • N M- x,mA9maeon99wYn9.c9m
PREPARED FOR: PHONENUMBER: PAGE NUMBER:
SHELLIE HELTON 306-7116 2 OF 3
LEGAL DESCRIPTION: DRAWN BY:
SOUTHPARK #2; BLOCK 2, LOT 6 PNB
TYPE OF WORK: DATE:
AS—BUILT DRAWING 8/14/12
(Rev. 01105)
PERMIT NUMBER: PARCEL ID NUMBER:
OSP121230 AS -BUILT DRAWING 020-501-29
TOP OF TANK
AT INLET = 94.98
INVERT OF BUNG
AT INLET = 94.34
FINAL GRADE = 1
J/r FINAL GRADE = 98.98-100.13
ST1 / ST2 MH
EW 1500 GALL
S.T.E.P. TANK
RELATIVE ELEVATION OF BOTTOM OF TESTHOLE = 88.17 (DRY)
- TOP OF TANK
AT OUTLET = 94.96
JAL GRADE 0
POINT = 103.67
FILTER FABRIC
OF PIPE = 100.67
OF TRENCH = 94.17
GARNESS ENGINEERING GROUP, Ltd.TH
CONSULTANTS & GENERAL CCINTRACTORS p ... ... .. .. .. ................
3701 E T MR RO SW 101 • M1CR0RA4Y. M: 00507 • PRONE (W])3S/-B1J9 • FM( (907)339-3218 WE991E: wwx arra ginnfingsam p
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: . •. ••••••........••••
SHELLIE HELTON 306-7116 3 OF 3 Q fr y G nesS:
LEGAL DESCRIPTION: DRAWN BY: Q4 CE -7 3�
SOUTHPARK #2; BLOCK 2, LOT 6 PNB 4pX®tee'ty�!T ��aoo
TYPE OF WORK: DATE: �44d p" fl,
PROFILE AS—BUILT DRAWING 8/14/12
(HeV. U1Nb)
Municipality of Anchorage
Community Development Department - Development Services Division
P.O. Box 196650 - Anchorage, Alaska 99519-6650 - 4700 Elmore Road
Info and Help: (907) 343-8211
INSPECTION: Voice: (907) 343-8300 Fax (907) 249-7777
Inspection Report - Electrical
APPLICATION NO. RETROE121405
Permit
Permit Type: Electrical Res
Preference:AM
Address of Project: 15731 SOUTHPARK LOOP Inspec#: 199835
Parcel: 0205tion0129D00
�W�W iNuun yr VVOM Inman power and control for lift station - BWP
Contacts
ontractor (907)622-3607 POWER. LIGHTING AND CONTROL, LLC 13841 SAVAGE DR
Owner HELTON ERNEST H & SHELLIE M
Inspector Comments:
III:
Inspector:
6L1jFP SLs -
(/ t
•Z. ,iC-- A,.% Date:
x
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
OSP121230
Tax Code Number:
02050129000
Work Type:
Septic Initial
Permit Effective Dates: August 07, 2012 to August 07, 2013
Design Engineer:
GARNESS ENGINEERING GROUP LTD
Subdivision:
SOUTHPARK#2
Site Legal Address: SOUTHPARK #2 BLK 2 LT 6 G:3236
Owner/Address: HELTON ERNEST H & SHELLIE M
15731 SOUTHPARK LOOP ANCHORAGE AK 995164850
Site Mailing Address: 15731 SOUTHPARK LOOP, Anchorage
This permit is for the construction of:
Lot Size in Sq Ft: 23076
Total Bedrooms: 4
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
:ssued By: J1 plly ,. G...
/-Z_
MUNICIPALITY OF ANCHORAGE
Community Development Department • Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On -Site WaIW& Wastewater Program
SHG , Mayor Dan Sullivan �` �A�
(' On -Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. oa b " /-a9
Property owner(s) SHELLIE HELTON Day phone 306-7116
Mailing address 15731 SOUTHPARK LOOP *ANCHORAGE, AK
Site address 15731 SOUTHPARK LOOP *ANCHORAGE, AK
Legal description (Sub'd, Block & Lot) SOUTHPARK #2; BLOCK 2, LOT 6
Legal description (Township, Section & Range)
Lot Size
Sq. Ft.
Number of Bedrooms
4
THIS APPLICATION IS FOR:
THIS APPLICATION IS AN:
(E all that apply)
Initial
Absorption Field
®
Septic Tank
IK
Upgrade
❑
Renewal
❑
❑
Holding Tank
Privy
❑
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: `$ 5.36'- Waiver Fees:
Date of Payment: ?P2.1 /a Date of Payment:
Receipt Number: Receipt Number:
Permit No. (33 10l2La3n Waiver No.
Rush $31 tb (Rev. 01/11)
()76926,
OSP )2l'Z3 0
August 1, 2012
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Proposed Septic System Upgrade for Southpark #2; Block 2, Lot 6
To whom it may concern:
The existing 3 bedroom home (recently been converted to 4 bedrooms) is served by public water and a
private septic system. The septic system is in a state of failure and needs to be upgraded. We are
proposing to install a 1500 gallon S.T.E.P. tank and a deep trench type drainfield. Attached are a site plan
and a design drawing showing the proposed septic system. One test hole was excavated on the property.
The primary drainfield and a reserve site will be designed around the 30 foot radius of this test hole.
Comments regarding the design are summarized as follows:
1. SOILS: See the attached logs which show the soil classifications, groundwater monitoring, and the
percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications
3. SURFACE WATERS: There are no surface water concerns.
4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography is 10-15%
running northeast to southwest. In, short, there are no slope concerns. .
We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
If you have any questions, please contact us at 337-6179. Thank you for your assistance.
4.S.
NOTE: Attached is a site plan drawing, a design drawing, and one soil log, which are all part of the
design package far this septic system. (Contact G.E. G. Ltd for 7 page construction specification letter.)
3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengincering.com
\
SOUTHPARK #2; )
BLOCK 2, LOT 9
SOUTHPARK #2;
\\BLOCK 2, LOT 13
SOUTHPARK #2; \
\ BLOCK 2, LOT 8 /
ARETAC
i
EPRC
ARS
\\ 1
\
SOUTHPARK #2;
BLOCK 2, LOT 7
SOUTHPARK #2;
BLOCK 1, LOT 13
\ \
\ \\
\
\\
\ \
\ \....
\\
SOUTHPARK #2;\\
SOUTHPARK #2\\
BLOCK 1, LOT 12 \\
BLOCK 1, LOT 11 \
\ \\
ALL LOTS SERVED BY
PUBLIC WATER.
SOUTHPARK #3;
BLOCK 1, LOT 7 I I
I I
N
SCALE: I
SOUTHPARK #2;
\\BLOCK 2, LOT 14
:r-' u 'N
SOUTHPARK #2;
BLOCK 2, LOT 15
AREA
SOUTHPARK #2;
BLOCK 2, LOT 5
\\\ \
\\
SOUTHPARK #2; \ \
BLOCK 1, LOT 6A
\ \ SOUTHPARK #2;
\ BLOCK 2, LOT 16
SOUTHPARK #2;
BLOCK 2, LOT 4
/\ \ \
`y �1SARK #2;
OUTHP
SOUTHPARK #12,
9LOCK 1, LOT 4
BLOCK 1, LOT1 1
\ SOUTHPARK #2;
\ < BLOCK 2, LOT 18
1 r ------
r(
1 (
SOUTH
+ 1
r (
1 (
+r
r
#2: ( +
BLOCKLOCK 2,, L LOT 3 SOUTHPARK #2;
( r BLOCK 2, LOT 2
r(
SOUTHPARK #2;\ \ SOUTHPARK #2;
BLOCK 1, LOT 3 \ \ BLOCK 1, LOT 2
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & OENER,5 CONTRACTORS.
3701 E. MOOR R . SUITE 101 • INCMWE, & 99507 • PHONE (901)337-81]8 • FM (907)339-3248 • WE9 -. wwwAamm gln 6n9•aan
PREPARED FOR: PHONENUMBER: PAGE NUMBER:
SHELLIE HELTON 306-7116 1 OF 2
LEGAL DESCRIPTION: DRAWN BY:
SOUTHPARK #2; BLOCK 2, LOT 6 PNB
TYPE OF WORK: DATE:
SITE PLAN 7/27/12
VMNOTE: THE CONTRACTOR
NUMBER OFBEDROOMS: 4 \
GALLONS PER DAY MS: soo SHALL HAVE ALL WELL RADII
FLAGGED BY A REGISTERED
PERCOLATION RATE/S: 8.57 \ \
PROPOSED APPLICATION RATE: 0.8 LAND SURVEYOR PRIOR TO
MINIMUM DRAINFIELD SQ.FT.: 750 CONSTRUCTION.
DRAINFIELD DESIGN: \ \
MAXIMUM DEPTH: 9.5' \
M.O.A. APPROVED SAND FILTER: N/A \ \
REQUCTIO FACTOR: N/A \ \
s
LEG, Ltd. HAS A 7 PAGE SPECIFICATION \ \
LETHAT PERTAINS TO THIS DESIGN.
TO SOUTHPARK #2;
TO OBTAIN A COPY OF THE LBLOCK 2, LOT 7
CONTACT GEG. BY PROCEEDING FORWARD
WITH THIS INSTALLATION, THE ENGINEER, \
WELL DRILLER, CONTRACTOR AND
PROPERTY OWNER AGREE THAT THEY PROPOSED 1500 GALLON
HAVE READ THESE SPECIFICATIONS AND STEP TANK \
AGREE TO ACCEPT THE TERMS AND
CONDITIONS OUTLINED. r
EXISTING GALLON
CO1 MTI `PROPOSED DRAINFIELD
SEPTIC TANK
/ \
TO BE �
O DECOMMISSIONED PER UPC ,r'/ MST
GZ\ FC \\ Tm#1 1 °
MISTING DRAINFIELD TO BE ° EXISTING 4
ABANDONED IN PLACE. 4 BEDROOM
HOUSE CO T2
.�
;.::.;..::��.':. 1� RESERVE DRAINFIELD
/
/
/ WATER SEPTIC
/ LINE 125" SCO 40 PVC J ARE
/ TRANSITION TO PIPE AT
\ /
DRAINFIELD.
SOUTHPARK #2;
BLOCK 2, LOT 5
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
3701 E. 10001t ROAD, SUITE 101 - MMOPAOE, M 99507 • PHONE (907)337-61'!9 - FM (907)338 O • NE X—. www.99msuwllnw�in9com
PREPARED FOR: IPHONE NUMBER: PAGE NUMBER:
SHELLIE HELTON 1 306-7116 1 2 OF 2
LEGAL DESCRIPTION:
SOUTHPARK #2; BLOCK 2, LOT 6
TYPE OF WORK:
SEPTIC SYSTEM UPGRADE DESIGN
(Row. otros)
PNB
8/1/2012
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
SOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION: SOUTHPARK #2; BLOCK 2, LOT 6
PERFORMED FOR: SHELLIE HELTON
DEPTH____
(feet ORGANICS TEST HOLE #1
1
2
N
SEE ATTACAHED SITE PLAN
7—
8
9
10
11
12
13
14
15
16
17-
718
18-
19—
----
GM
SOIL
CLASSIFICATIONS
SCALE:
i' = ioo'
DRY 7/31/12
2
_ _
RED LOAM
DATE READING CLOCK
TIME
NET TIME WATER LEVEL
(MINUTES) READING
NET DROP
(INCHES)
7/31/12 1 2:10
- 6.00"
-
GW
30 2.50"
ORG
3 2:40
- 6.00"
-
;*.
G P
3.50"
M L
3
-
6 3:40
30 2.50"
3.50"
GM
CL
4
GC
OL
0000s,
SW
MH
5
• :
SP
CH
/
SM
OH
6
SC
2
N
SEE ATTACAHED SITE PLAN
7—
8
9
10
11
12
13
14
15
16
17-
718
18-
19—
B.O.H.
GM
DEPTH
OGROUNDWATER DATE
SCALE:
i' = ioo'
DRY 7/31/12
8/7/12
DATE READING CLOCK
TIME
NET TIME WATER LEVEL
(MINUTES) READING
NET DROP
(INCHES)
7/31/12 1 2:10
- 6.00"
-
2 2:40
30 2.50"
3.50"
3 2:40
- 6.00"
-
4 3:10
30 2.50"
3.50"
5 3:10
- 6.00"
-
6 3:40
30 2.50"
3.50"
19 PERCOLATION RATE 8.57 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 5.5 FT. AND 6.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ® YES ❑ NO
SOILS LOGGED BY: ANDREW GRAY PERCOLATION TEST PERFORMED BY: ANDREW GRAY
COMMENTS: PERCOLATION RESULTS ARE WITHIN 1/16TH OF AN INCH.
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PEVFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: a✓ 7 l7.
/ / \
MUNICIPALITY OF ANCHORAGE
- DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME rf /
Jedr n /� %fir � yr n
PHONE /_�
J p �l�
NEW
❑ UPGRADE
MAILING ADDRESS
3 .3Y''' tt 3
LEGAL DESCRIPTION
13 tZ
LOCATION
L.ao
NO. OF BEDROOMS
c�
5oc,; N A�r/<:-
Well
Absorption area
Dwelling
PERMIT NO
U
DISTANCE TO:
•7
Y
z
P2
Manufacturer
Material 1 _
No, of comport MX
F
e,
j re
dam•
w
Liq. capacity in gallons
�
IF HOMEMADE:
Inside length
Width
Liquid depth
(7 z
DISTANCE TO:
Well
Dwelling
PERMIT NO.
0z<
zF
Manufacturer
Material
Liquid capacity in gallons
Well
Foundationq
Nearest lot line
Z
PERMIT N
wT
DISTANCE TO:
/
w Mz wO
No. of lines
Length of each figr
Total length of line
Trench widt
Distance between lines
inches
HTop
finish
Material beneath tile
Total effective absorption area /
of tile to grade
p
inches
Length
Width
Depth
PERMIT NO.
w
QF
Type of crib
Crib diameter
Crib depth
Total effective absorption area
w�
LJ
Well
Building foundation
Nearest lot line
DISTANCE TO:
ClassDISTANCE
Depth
Driller
Distance to lot line
PERMIT NO.
J
`u
�
TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS C /
p 1!C
SOIL TEST RATING
172—
cl .rn ou'
INSTALLER
John Lam EX64- lel •
REMARKS
C&l - f-nve� G�%r jIn iNe 6a�. Q�•f0
2" IKCe�
VIUNN ON MTr OF- IM
aver
O GE
DEP . Of HE ,LTH
&
Gl
vt f
ENV .ON TEN A.L , ROT
.CTI U
J J11.
s
e
!mss e - a(
SIO /�- S TSY O Z
APPROVED DATE LEGAL
C C
✓ I)e I/ J Ou th p¢r/� � Z !J �J C�L 2-
p i
72-013 (Rev. 3/78)
Uq U r-4 I e_ I F= FA @_ I IF *-0 ED F✓ FIR A C VA ED F. F! C3 E
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
=:25 L STREET, ANCHORAGE, AK 99501
264-4720
CA 14— co I "FE co EOP IEFt F„E41fr@ I T'
PERMIT NO: 840361
[NATE ISSUED: 05/21/84
APPLICANT:JOHN HAGMEIER COMPANY
ADDRESS: 1=99 W. 34TH #103
ANCHORAGE, AK 99503
CONTACT PHONE: 338-633
LEGAL DESCRIP: SUBDIVISION: SOUTH PARK #2
SECTION: 3 TOWNSHIP: iiN
LOT SIZE: 2307E (SO. FT. OR ACRES)
LOT LOCATION: Si_UTHPARK LOOP
MAX BEDROOMS: s
LOT: 6 BLOCK`. 2
RANGE: fW
LISTED BELOW ARE THE OPTION'S AVAILABLE TO
YOU IN DESIGNING
YOUR SEPTIC:
SYSTEM. CHOOSE THE OPTION
THAT BEST FIT-
YOUR SITE.
------------------------------------------
DEPTH TO PIPE BOTTOM (FT.:?
k0
4.0
4.0
GRAVEL DEPTH (FT.)
3.5
TOTAL DEPTH, (FT.)
8.0
4.5
7.
5
GRAVEL WIDTH (FT.)
2. 5"
20:0
5.0
GRAVEL LENGTH (FT.)
65.0
39.0
56.0
GRAVEL VOLUME (CU. YDS.)
27.0
28.8
41.4
TANK SIZE ( GALS)
1.000.0
1,000.0
W W
1,000.0
W*
SOIL RATING < SG. FT. /BR)
172
172
172
:+* TANK MUST HAVE AT LEAST TWO COMPARTMENTS
I CERTIFY THAT:
1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITr' OF ANCHORAGE (MOA) AND THE STATE OF ALASKA._
2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS,
AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
3. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENT'_ FOR THE SET BACK
DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF 3 BEDROOMS AND
ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODE=,
THEM (1) AN.ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) A`_=,-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED DATE:
APPLICANT: JOHN HAGMEIER COMPANY
ISSUED BY DATE:
r
SOILS LOG /
MUNICIPALITY OF ANCHORAGE X�v
• +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: She— ;e- `A7 'C. I -F/('O�� Al nn II1 DAT.E7 PERFORMED: 5 1 S�BY
LEGAL DESCRIPTION: Pr+R NL )T(I.7l c2
SL PE SITE PLAN
t PT J Paa t
IMLI Goavellty 1_:chit
z 13ru-0n,
moist
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
CGrY+ )
QraoP,l-
)_ Ghi tVl�u/Oru
"t're 500.12ecL
WAS GROUND WATER n, L
ENCOUNTERED? +lJ
P
IF YES, AT WHAT E
DEPTH?
n -/ d
Reading
Date
Gross
Net
Depth to
Net
Time
Time
Water
Drop
++aJ
IQ.,
1
�-Irb-�v
ItoS
1O
,51
,al
71
It
1,15
3
I:as
Ia
,ss
� Is
1:37
10
5(0
5
li
.5
I.qp1
s
al
µ
_ 1:5,5
PERCOLATION RATE 't l l I (minutes/inch)
TEST RUN BETWEEN FT AND 5- FT 99
?/Ciu4 pfn o la Ftl ,(I ,
PERFORMED BY:(SfpQvk) I MCt J rCw\ja .J'rt. m�r. CERTIFIED BY:
mor3,st 8a-va�j
72-008 (6/79)
DA
0
t
-0 SOILS LOG
MUNICIPALITY OF ANCHORAGE
11
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: -,�; � P,II •P f4P L-I'n✓1) YY11 DATE PERFORMED:
LEGAL DESCRIPTION: QnU±k rQ r'1 02 U r9 L
ffIEPTH)rP -{-{3SLOPE SITE PLAN
l' C)rau¢,ll�
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
(Gm) S. Li (3moeL7
Brow,
=====JSPJ S gntd a ')
WAS GROUND WATER S
ENCOUNTERED? A)(D LO
P
E
IF YES, AT WHAT
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN
PERFORMED BY: Cn RCPrI)/ MARE rnan9 CERTIFIED BY:
72-008 (6/79)
(minutes/inch)
FT AND FT
A
1
N
MUNICIPALITY OF ANCHORAGE
Development Services Department T Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 020-501-29-000
Legal description SOUTHPARK #2 BLK 2 LT 6
Expiration Date: 11/28/2024
Site address 15731 SOUTHPARK LOOP Anchorage AK 99516
Current property owner(s) STRONG TRUSTSTRONG ALEXANDER H/TRUSTEE
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Z
Original Certificate Date: 12/8/2023
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 Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approva"une 2022
MUNICIPALITY OF ANCHORAGE
!
Development Services Department '
P P �.�-� 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. 02050129000
Complete legal description SOUTHPARK #2BLK 2 LT 6
Location (site address) 15731 SOUTHPARK LOOP
Current property owner(s) STRONG TRUST
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone 907-229-5200
3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units 0 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: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 11 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑■ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
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 $_ ,�� 0 Waiver Fee $
Date of Payment � I / 2-3 Date of Payment
COSA # 0S C 2 3 % L� Waiver #
COSA Application—June 2022
COSA Checklist
Legal Description: SOUTHPARK #2BLK 2 LT 6 Parcel ID: 02050129000
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments Public Water
B. TANK DATA
Measured operating fluid level in septic tank na*
Date of pumping 11/28/23
❑■ Required maintenance completed, if AWWTS
Comments: *STEP tank
D. ABSORPTION FIELD DATA
Which system tested (date installed) 8/10/12
❑■ ALL standpipes present per record drawing
Total measured depth from grade 10 ft (max)
Measured depth to pipe invert from grade 3.5 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑■ Monitor tubes go to bottom of effective.
If not, state depth into effective
❑■ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced 2000 gallons 10/16/23 date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficienci
COSA Checklist June 2022
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑■ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date
C. LIFT STATION
❑■ Required maintenance completed
Age of lift station 11 years
Lift station material Steel
Comments:
Adequacy test date 10/17/23
Results g Pass
Fluid depth prior to test 12 in
Water added 600 gal
New fluid depth 15 in
Elapsed time 30 min
Final fluid depth 12 in
Absorption rate 600 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 78
Effective depth used 12 in
Effective depth remaining 66 in
in
E. SEPARATION DISTANCES
From. Private Well on Lot to: {Please enter distances it less than required or I community well on lat)
Septic TankiLitt Station on Lot > 100' Community Sewer Ma n hol e1C leanou t > 100'
F1 Yes if No ft ❑Yes if No ft
Neighboring Tank> 100' ❑Yes if No ft Private Sewer/Septic Line> 25' ❑Yes if No ft
Absorption Field on Lot> 100' El Yes if No ft Holding Tank > 100' El Yes if No ft
Neighboring Absorption Fields a 100' Animal Containment >!50' ❑ Yes if No ft
[3 Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑Yes if No � ft ❑ Yes if No ft
❑ NJA — Served by Community Well {not on lot} or Public Water
From Septic/Holding Tank and Absorpt#on Fields) on Lot to: (Please enter distances if less than required )
building Foundations> 10' F] Yes if No 5+ ft Surface Nater a 100' ■❑Yes if No
Tank to Property Line > 5'
❑■ Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
❑■ Yes
if No
ft
Private Wells > 100' aJ Yes if No
Water Main > 10'
❑■ Yes
if No
ft
Community Wells > 200' ■❑ Yes if No
Water Service Line > 10'
❑■ Yes
if No
ft
If tank or field is ender driveway comr-hent below
F. ENGINEER'S COMMENTS
ft
ft
ft
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm NorthRim Engineering Phone 694-7028
Engineer's Printed Namc Steve Eng
G05A Checklist June 2022
Date 12/1123
OF, AC
i���``
qtr .49 TH
� I
i
Steve Eng . ` /
,,y GE -6256 ? 0
Ns12�'•1%2�
MUNICIPALITY OF ANCHORAGE
-
Phone:907343-7904
Development Services Department Fax:907-343-7997
On -Site Water & Wastewater Section
Lift Station/PUMP Vault
1111150Ti I
Owner Street Address
Septic Tank:
-Sludge level 15inches, -Pumping: required rve-s) no -pumping completed yga—no
_
Lift _Station.
-pump basket cleaned je-no -Effluent filter cleaned e no
-Control floats cleaned Qno -Proper float settings confirmed Q§�no
-Operation satisfactory (y—M no
Alarm System:
-Dedicated electrical alarm circuit Q'6N no -Audible and visual alarm inside dwelling js2__Q,!,%t
-Alarm system operation
Manhole Riser
-Ground water intrusion at riser to tank connection yes_no le functional a no
*Ground water intrusion around pipe penetrations yes_ & -Weep ho
no Property Secured e
�no
.5 �
-Manhole lid: Functional (& no Insulated <jC
Other
-All manufacturer required inspections and maintenance completed Qe no
comments,,
Qualified Maintenance Provider:
Technician Date of maintenance -
Company
Signature Date 23
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL r
FOR A SINGLE FAMILY DWELLING R1W/SH1
' 1
Parcell.D. 020-501-29 COSA#
1. GENERAL INFORMATION Expiration Date: e I
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
SOUTHPARK #2• BLOCK 2 LOT 6
15731 SOUTHPARK LOOP *ANCHORAGE, AK 99516
SHELLIE HELTON Day phone 306-7116
15731 SOUTHPARK LOOP *ANCHORAGE. AK 99516
Day phone
MARIANNE GRANT W/ PRUDENTIAL Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
E
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
'Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 45lda,
Engineer's Comments
In conducting this evaluation, GEG, LiD. attempted to provide a thorough,
in ADEC MOA
0oo6o0p0�4
conscientious engineering analysis of the system accordance with and
DSD Guidelines & Regulations. The reported results described the performance of the
�O 4
`
P' SV�oi
system unde.- the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
.,7*
septic systems depend on the local soils condition, groundwater levels that may
. . . . . . . . . . . .. . . • • • . • . . • • • .
fluctuate during the year, and the water usage of the family being served by the system.
Q
These conditions are outside the control of the evaluator of the system. Satisfactory test
. . _ . . . . . . . . . . . . . . . . .
results do not guarantee future performance of the system, nor do they guarantee that
J r A. G rness:
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
CE am
Q4 ra '., la�tµ (2•'
cqd�
operational requirements of the ADEC or MOA DSD. The content of this report is for
��"ar'rof
00
the sole benefit of the owner listed above. Any reliance upon or use of this reportby any
00
04000 0
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.Z=ZpN-SITE?
=Z WATER AND
Conditional approval for bedrooms, with the following stipulation WASTEWATER
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Nitrate Advisory Other
By
(Rev. 11105)
Original Certificate Date: 9 -1 q y
Municipality of Anchorage
' Development Services Department e c
Building Safety Division
On—Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: SOUTHPARK #2; BLOCK 2, LOT 6 Parcel ID: 020-501-29
A. WELL DATA
Well type
Date completed
Total depth ft.
Date of test
Static water level
PUBLIC WATER
If A, B, or C provide PWSID# _
_ Sanitary seal (YIN)_
Cased to ft.
FROM WELL LOG
Well production g. P. M.
WATER SAMPLE RESU
Coliform colonies/100 ml. Nitrate mg./L.
A cg. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP/STEEL
Tank size 1500 gal. Number of Compartments 2
Foundation cleanout (YIN) YES Depression over tank (YIN) NO
Date of pumping NEW Pumper —
C. ABSORPTION FIELD DATA I *BELOW FINAL GRADE
Well Log (YIN) _
Wires properly protected
Casing height (abo r<
AT
ft.
-elm
Collected by:
Date installed 8/9-12/12
Cleanouts (YIN) YES
High water alarm (YIN) YES
n.
Date installed 8/9-12/12 Soil rating (g.p.d./ftorMbdrm).0.8 System type TRENCH
Length 58 ft. Width 2.5 ft. Gravel below pipe 6.50 ft.
Total depth *10.02 ft. Eff. absorption area 754 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test — in. Water added =gal. New depth =in.
Elapsed Time: = min. Final fluid depth = in. Absorption rate >= 600+ g,p,d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date —
D. LIFT STATION
Date installed 8/9-12/12 Size in gallons 1500 Manhole/Access (Y/N) YES
"Pump on" level at 42 in. "Pump ofP level at 42 in. High water alarm level at 46 in.
Datum BOTTOM OF TANK Cycles tested NEW Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAtfl station on lot On adjacent
Absorption field on lot On adjacent lots
Public sewer main
Sewer /septic service line
areas
manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Properly line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parkingtvehicie storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
oo600pp4O
G. ENGINEER'S CERTIFICATION o
I certify that I have determined through field inspections and 4 T
review of Municipal records that the above systems are in ' • • • .... .. ' .. • "" • • • "" •
conformance with MOA COSH guidelines in effect on this
date. Q .y A..•• ness,..
Engineer's Printed Name JEFFREY A. GARNESS QQ s� CE -79$3 m�
Date CAh4G e •.6.�!!f 1 Eoda
���ifrofesswI10\
COSA Fee $ l400 1 ()6
Date of Payment 01 al 17
Receipt Number. 6iii 6660(r
(Rev. 11105)
Waiver Fee $
Date of
Receipt Number
7
f T
0.
'A
CO.$
M.H.
EXISTING
HOUSE
........... ..... . 0
'p
........... .. .. ..
O ND
Y
O5
UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES,
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LJ Lor 9RWY SURVEY TYPE
SYMBOLS
Lj FWNDArN AS -MLT
SET REBARASPHALT
M W DRAINAGE
El pm STRUCTURE AS -WILT
o FOUND REBAR
❑ PLOT PILM -'dll=�T' TOPOCI
e a a WOOD FENCE CONCRETE
_.lI'LT �IiTL& T=171-FidATION AS -BUILT ... NO �NMS MTp0
n ASSUMED ELEV.-X--N--,E METAL FENCE WOOD DECK
PLOT PLANS & LOT SURVEYS
NOTE:
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS,
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCA1CN. ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURVEY CERTIFICATION
Prepared by
PLOT PLAN
OF 14 %*
Robert E. Johns, Jr. & Assoc.
...........
4PC,3
Professional Land Surveyors
1700 Brink Drive.
AV %
a .. .
ANCHORAGE. ALASKA 99504
AV
•Scale:_
Aw _49th
V 40'
Rec. Lot S.F.Red.
Plot Fle No.
FOUNDATION AS -BUILT
Date Surveyed:
8/13/12
rown by.
D REJ
Checked b
JMK
1,
== R 0
l.t . .1 N.
'8
MFwR.
R
Date Drawn:
8/13112
Grid:
3236
W.0
1'2-117/12
21
-331
FINAL STRUCTURE AS -BUILT
mt a
........
Legal Description:
Lot 6 Block 2
fess
SOUTHPARK#2
. . .
........
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date n r
(a) Legal Legal Description (include lot, block, subdivision, section, township, range)
il?L.l '2n�h �?�r'➢LSE t' T/1 /U J 31.E St`; '. _3
Location (address or directions)
(b) Applicants
Name ti1
/➢Aj
% s,Aic.
Telephone
- Home6C;`-V.%q7siness
Applicants
Address
(c) Applicant is (check one) Lending Institution
Buyer E:] ; Other [::::I (explain);
(d) Lending Institution,
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. Type of Residence
Single -Family
Number of Bedrooms
3. Water Supply
Individual Well.
Multi -Family
Community EZI
1= ; Owner/builder 10 ;
Other (describ
Public
Tel
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 F-1 Community M Holding Tank
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and statue.
[Page 1 of 2]
5
6
L 6 a_
b
Engineering Firm Providing Inspections, Tests, File Search, Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein. I further verify that,
based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm /-�L-c < J. -r Telephone
Address
Date�z,',/�cf_
DHEP Approval
Approved for
Approved _ X
Terms of Conditional
,^c!
(ENGINEER SEAL)
bedrooms By
Disapproved
proval> %AL' "
CAUTION
P�
G0�O os
4 ee.c
9
Conditional
OpoG 'Ei,r•::14
rJ�
t
)y C. Raid, !i! _..;
NQ. 2251 c
ctL e-- >z_a-t
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY_ UPON THE REPRESENT-
ATIONS 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 REQUIR-
MENTS. 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 21
7-19-84
A.
f muwicIPALITY OF ANCHORAGE
DEPT. OF HEALTH & -
' ENVIRONMENTAL PROTECTIOR
MUNICIPALITY OF ANCHORAGE (MOA) IAUG Z 9 1gR4
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984 . RECBV- -ED.
Legal Description: 1-6 a.�2 x;fG P�uvc 2
MEL DATA g&J
Ge UMM oN+ Y
Well Classification If A, B, or C, D.E.C. Approve(�Y/N)
Well Log Present (Y/N) 64Zp-) Date Conpleted ��ya Yield_
Total Depth �Y� Cased to Depth of Grouting OUB
Static Water Level A) 14 Pump Set At Al /1A
Casing Height Above Ground A./4* Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N_ ) ot�� Depression Around Wellhead (Y/N)
Separation Distances frau Well:
To Septic/Holding Tank on Lot , 2 on, On Adjoining Lots AJIyA
To Nearest Edge of Absorption Field on Lot(7j° On Adjoining Lots
To Nearest Public Sewer Line �q To Nearest Public Seder /
Cleancut/Manhole w/14- To Nearest Sever Service Line on Lot _ _AJ hi
Water Sample Collected By Vd SAM.. g - bate A)
Water Sample Test Results
Camments
B. SEPTIC/HOLDING TANK DATA
Date Installed )� / Size Y- / o o G� No. of Ccmpartmments Y a
Standpipes 4% N) Air -tight Caps N) Foundation Cleanout Y )
Depression over Tank (Y Date Last Pumped AJJJA
Pumping/Maintenanoe Contract on File (Y/N) for A /Vi
Holding Tank High -Water Alarm (YM)Ail
a Temporary Holding.Tank Permit (Y/N) A 24
Separation Distances from Septic/Holding Tank:
To Water -Supply Wkll > Q()` To Building Foundation � % d _
1'
To Property Line 2,7 =--- To Disposal Field
K f
To Water Main/Service Line a `F•rp oto`. To Stream, Pond, Lake, or Major Drainage
Course A) 0V
Comments x FtzorA As -nn -,Lc -
[Page 1 of 21
2-15-84
C. ABSORPTION FIELD DATA
I "Y'
Soils Rating in Absorption Strata 1'7 2 Type of System Design b ENc:l1
Date Installed X-*(, //181* Length of Field X%. 63
Width of Field x 31 Depth of Field. 7 '
Gravel Bed Thickness °
1
Square Feet of Absorption Area ma_ s-ao'' Standpipes Present N)
Depression over Field (Y49 Date of Last Adequacy Test Aq a
Results of Last Adequacy Test A44
�T'
Separation Distance from Absorption Field:
To Water -Supply TAbll i 2 on' To Property Line 2. i-)
To Building Foundation )o ' To Existing or Abandoned System on
Lot /J/4 ; On Adjoining Lots > 30'
/
To Water Main/Service Line 9 7'ro , To Cutbank(if present)
To Stream/Pond/Lake/or Major Drainage Course A)/A
To Driveway, Parking Area, or Vehicle Storage Area--*
Comments•k DRATMF;ELu u"ns°H PARKiNcs AREM, 4-'1//USU4.ATi0/J 130AAD
AND ° BAG/f F;LL aUE,R '7/?F_NCH y% F2Gm 45-13„r(I.
D. LIFT STATION
Date Installed AJ )A Dimensions .:J )J4
Size in Gallons —,[U _ Manhole/Access (YM)
"Pump On" Level at / "Pump Off" Level at �11
High Water Alarm Level at _A) q- Vent (YIN) IU
Tested fon. Pumping Cycles during Adequacy Test. Nbets MOA
Electrical Codes(YM) A)1A
Comments T
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inspection. .�
Signed ��Date 8 zS �.••° °`°,° A.0
Company�l/tcs ;,u,- MOA No.94-St Oc�y ���t"4 iR� RS Oaall
y=. .a nu..�a➢aie.. .0 +e
KB1/d5/s
4 etoy C. Reid,
No. 2251•R
[Page 2 of 21
2-15-84
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