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THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEYAND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. JOB # 22044 I NO CORNERS SET THIS DATE I SCALE 1 "= 30' N CP REBAR *..'49 T"........ *.% B u Sali : �o LS -14837 "tit tit � P4 254022. •' �5�,= rt t OFE S II AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT 11, BLOCK 2, SOUTHPARK SUBDIVISION ADDITION No. 2 ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT THE IMPROVEMENTS AS DEPICTED HEREON EXIST AS SHOWN IN RELATION TO THE PROPERTY LINES. DATED THIS 25th DAY OF APRIL, 2022, ATANCHORAGE, ALASKA. FIXED HEIGHT, LLC C.O.A. 122554 Land Surveying Services 907.290.8949 225 W 23rd Ave., Anchorage, AK 99503 WWW.FIXEDHEIGHTCOM a/�".`:-"- MUNICIPALITY OF ANCHORAGE enc �o On-Site Water&Wastewater Program `� SP^ PO Box 196650 4700 Elmore Road . F . Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite fDv part ('11 I *hC$ORRGt On-Site Wastewater Disposal System Permit Permit Number: OSP181013 Effective Date: 2/5/2018 Work Type: Septic Upgrade Expiration Date: 2/5/2019 Tax Code Number: 02050134000 Site Legal Address: SOUTH PARK#2 BLK 2 LT 11 G:3236 Site Mailing Address: 15621 SOUTHPARK LOOP, Anchorage Owner: SARANDRIA EMMANUELLE J 50% & Lot Size in Sq Ft: 22426 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 4 This permit is for the construction of: Q Disposal Field Q Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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: Date: Z �� Il I ©t 8 Issued By: • I Date: a MUNICIPALITY OF ANCHORAGE 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. 020-501-34 Emmanuelle Sarandria & Neil Shibe 907-250-0908 Property owner(s) Day phone Mailing address 15621 SOUTHPARK LOOP, ANCHORAGE, AK 99516 Site address 15621 SOUTHPARK LOOP, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) SOUTHPARK #2 BLOCK 2, LOT 11 Legal description (Township, Range & Section) Lot Size 22,426 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field U Initial Single Family (SF) Axl (w/wo ADU) Septic Tank �` Upgrade 1>1 Duplex (D) Holding Tank Renewal I Multiple Dwellings ❑ Privy (SF and/or D) Private Well n 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 dt'property owner or authorized agent) Permit/Rush Fees: 57a9 Waiver Fees: Date of Payment: 1/311/3 Date of Payment: Receipt Number: Ul6 -D Receipt Number: Permit No. £45Pt 3/O[3 Waiver No. Permit App_9-1-12.doc ts.ctCTER�y ARC T ERRA H / CONSULTING, INC fR.,9 s�TING• ,•�� 212 E.5151 Ave,Anchorage,AK.99503 .r.w5n- Office(907)868-3791,Fax(907)868-3793 January 30,2018 Municipality of Anchorage Development Services Department On-Site Water& Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade Sewer Permit- Southpark #2 Block 2, Lot 11 The owner has requested we proceed forward to obtain a septic permit to upgrade the septic system of the subject lot. The septic tank and lift station are in failure and need to be replaced immediately. Per below, the owner is considering upgrading the field as well. We have utilized a more conservative application rate than shown on the 1984 inspection report, which field seems to be functioning adequately. The design is based on existing soils data. An additional test hole will be conducted prior to field install to verify conditions and make appropriate design changes if needed. The general slope of this lot is flat over the septic area. The proposed upgrade will serve the existing 4-bedroom residence. We propose to install a pressurized bed. The property and adjacent lots are served by public water. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 868- 3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. 1111111k,170 Kenneth M. Duffus,W Attachments: On-Site Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test-MOA Record Docs 20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793 WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN S❑UTHPARK #2 BLOCK 2, LOT 11 1`-'93 R= `-- `'� Lot 11 Block 2 W Ae tti'i'•y PRIOR TO CONSTRUCTION Q Lot 12 : .._ Urs'9 a 6.2' 3 OPIUM :et d/ tea ` ` I- w rr7j��n ��= O�:nt�A�0 o o O t1. n. 3 iii ';X' 4-BR HOUSE 14.0' ` O o 3'.;d.1.ie t7 Ili :4,.< . 62.0' ■ RJ fe '',lel stil ti 5...:1r\ _0 Lot 10 li' v ,I, — DE a SS1ON EXIS MG q,_ S. I:15 L.S.AND INS ALL Li O. NEW 1500-GAL ST P N NO SLOPES>25X WW �� `\ w" � R I % 100'OF PROPOSED FIELD `,``. c N o. ``, AT s E 0 Flysl ti `0 \ TNte-t "a� Rl 0 C� W MTCI D \ ;; r�'w TNIMM E E 5 0 thih, V (si IV Tu m H- N (A v o FLAG PROPERTY LINES AREA SERVED BY scale: 1'= 50' & EASEMENTS PRI❑RPAGE 1 OF 2 PUBLIC WATER • TO CONSTRUCTION a N DESIGN DETAILS 4 BDRM X 150 GPD = 600 GPD m 600 GPD/0.45 GPD PER SQ. FT. = 1,333 SQ. FT CV (1333 / 5' W x 0.5RF (4' GRAVEL) = 134 FT. TRENCH I USE 2 TRENCHES - 67' (L) X 5' <W) X 4' (ED) TOTAL DEPTH OF SYSTEM IS 6' MAX FROM ORIGINAL GRADE % 0. L 0 \ NO PUBLIC WELLS WITHIN 200' OF o PROPOSED SYSTEM. NOTES: rn NO PRIVATE YELLS WITHIN 200' OF 21 PROPOSED SYSTEM EXCEPT AS NOTED. 1. INSTALL 1500 GAL STEP & INSULATE TANK IF <4' COVER. t PROPOSEDC WELL E1XC PT AS IOTEDF 2. INSULATE BED WITH 2' HD BURIAL FOAM IF < 3' OF FILL. a MIN. 2' FILL WITH INSULATI❑N, >3' COVER NO INSUL REQ. L- 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INT❑ SEPTIC TANK. I 4. CONTRACTOR WILL ENSURE ALL SEPARATI❑NS TO ADJACENT 1.o WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... .23 �(S'..... l��• �F 1Q. 4 PREPARED FOR: RCTER1i� . NEIL & EMMA SHIBE �� q o * �\ .'7 # 15621 SOUTHPARK LOOP °� l do Tr o Oat TH /� * ANCHORAGE, AK 99516 / \ �. m /. 20 ) % o U D y. S "Th FIELD BOOKS COMPUTED 5 a '1cno � ` X44; r BOUNDARY:BOUNDARY DRAWN: BMW z a"' �, 1 IN 4' # STAKING: STAKING CHES` KMD f`...0 � \ ^ q O ' _ AseulLr: FRONTIER DATE 2/5/18 F'c \ 0ti o FESSI DWG. FILE GRID: ! 1^ �� C �'l E � f SW3236 F oN 1� 4 Z `_' ACAD FILE: FILE .1DB No.: 18109 R/��A'SAI(99577"8136 WASTEWATER DISPOSAL SYSTEM DETAILS SOUTHPARK #2 BLOCK 2, LOT 11 LV l I I v Block 2 3 isim %act- >' c 'Y' •,..._ % = RE-CONFIRM WATERLINE' �: , t;;. 9 PRIOR TO CONSTRUCTION a : - Q L O t 12 ; ''y 6.2' v °,•- J` '.1▪: 2.5'N. 5 .,... ins --40,0 dam -7.:: o a 62.0o 70- ~-.!,. `-.N' 4-BR HOUSE O O -.-,. o , 14.0' �, 0 62.0' CU i:::• '�= I�I�I�I�I4I4I• �I� L , '•AesS,,•„•„•„• , \ Lot 1 O ;: t ,0��a�. .4b, l INSTALL FCO ""e •. s''<i. i.▪ •▪ •” .T DECOMMISSION EXIS ING 4.1 a. T co q-NEW 1500-GAL ST ALL NO SLOPES >25% W/IN 0,4 �5 ��' IS.DIVERTER.44 100' OF PROPOSED FIELD I m �o EXIST.BED cu N FLAT E ,� FLAT ` () . OJ co S TH18-1 .ee R 0 Z APPRROX.LOC. O ' O o �N) FLAT FLAT ,4 O J N TH 1984 \\ s %h: a M PRESSURIZED DISTRIBUTI❑N SYSTEM HOLE SPACING DESIGN 1. RESIDUAL HEAD = 5' m 2. HOLE SIZE = 3/16' = 1.00 GAL. PER HOLE @ 30 PSI 3, 30 GALS (PUMP DELIVERY)/1.00 GALS./HOLE = 30 HOLES 4. 134 LF LATERAL/30 HOLES = 4.5' SPACING PER HOLE 3 5. ALL HOLES SHALL HAVE CAPS INSTALLED PER MANUFACTURES SPECS. cz I Scale: 1'= 30' U w ��'�.\N PAGE 2 OF 2 / < v. OF W ,16 4 PREPARED FOR: gCTER /A�. ..1— 1 NEIL & EMMA SHIBE � s o /* . .J.- .7* A 15621 SOUTHPARK LOOP :461'7(jik �,•/ ; -` �ccTERQ� AII.CTE1212,1 ��r� OF' ALq \ CO\SUL1ING, INC ;, • a 212 E. 51St Ave,Anchorage,AK.99503 TII y 1I Office(907)868-3791,Fax(907)868-3793 / 4 (f m,.QY+u wNG•,�N*" , 5. KENN / sy— SOILS PERCOLATION TEST I '�� Jr' /� ���/ fT.rnsio-,a-• -- Performed Performed for: Neil & Emma Shibe Date Performed: 2/2/18 \`'qb-f Project: Southpark#2 B2,L11 TEST HOLE// TH 18-1 Depth (Feet) SEE ATTACHED SITE PLAN ";; ,:;i: FOR HOLE LOCATION 1-4= :F 111 Org/OL-ML i..-i! :4.1-.4 Was Ground water encountered? NO What depth? NA 2- ;;Vi, i •Via, * Depth to water after monitoring? Date? 3 �'�= t . 4°,-. �r 4- 1' Reading Date Gross Net Depth of Net 5 . ,.� Time Time Water Drop 4 6-,'- _ > ' I 2/2/18 1:00 - 6" - ''"'°t GM/sm 7-; 2 I:30 30 min 5 1/16" 15/16" F 'b. 8 ,.*- 3 * 1:31 - 6" - 9 ''�'•'',,,-I ' 4 2:01 30 min 5" I" . .1. 0 '. a_ 5 * 2:02 - 6" - 11 " 6 2:32 30 min 5 1/16" 15/16" 12- � : . 7 i"a 13- `egg m, 8 B.O.H. 14- 9 15- 10 16- II 17- 12 18- * Water Added 19 Percolation Rate 32 (min/in) Perc Hole Diameter 6" HOLE PRESOAKED 20- PRIOR TO TEST Test Run Between 6 feet and 7 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. NAME 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 PHONE [] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LoT- Il LOCATION NO, Of BEDROOM~ DISTANCE TO: I PERMI~' 0'~'~4~- I Absorption area Dwelling[ Width IF HOMEMADE: Well Dwelling DISTANCE TO: Manufacturer Material DISTANCE TO: line We]l / , · No. of lines Lengt h~h line de . --~4~-I~ Material Width Depth Top of tile to finish gn Length Type of crib Crib diameter ~ Well DISTANCE TO: Dlass Depth Building foundation ISewer line DISTANCE TO: OTHER width No. of compartments kiq u id.~de~J~. PERMIT NO. Liquid capacity in gallons inches Distance be~en inches T°tal ~abs°rpNl~& PERMIT NO, Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to tot line PERMIT NO. Septic tank Absorption_ area(s) PIPE MATERIALS SOl L TEST Ft/~TI NG REMARKS APPROVED 72-013 (Rev, 3/78) DATE LEGAL August 30, 1984 Susan ~swald Department of Health and Environmental Protection Nun~cipality of Anchorage Re: Lot 11 Blk.2 Southpark No.2 Your department issued a permit to Dave Meek to install a septic system on Lot 11 Blk.2 Southpark No.2 based on a soils test of 125 square feet per bedroom soils. The soils do not reflect those test results. Enclosed is a new soils report. I've redesigned a bed system and inspected it based on the soil conditions on site. The bed is shown in the el evation___b.~ ~ ,,, If any further information is required, please call 345-7007. Thom Fischer SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PERCOLATION TEST PERFORMED FOR:~ LEGAL DESCRIPTION: o~.CTA~ ~C.~ 1 3 5 7 8 DATE PERFORMED: SLOPE SITE PLAN 10: 11 12 13 14 15 16 17- 18- 19- 2O CE-3816 WAS GROUND WATER ~0 S ENCOUNTERED? ~ P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop ~ " ,,4', c:)~~ ~,,~ ~S ~' .__% " 4', o PERCOLATION RATE "-~ " {minutes/inch) ,~--~_ TEST RUN BETWEEN ~ '--~-F~T AND ~ FT COMMENTS PERFORMED BY: JH~)¥v~ "~g¢~,4'(-'*'¢~.- CERTIFIED BY: ~ MJ~I~J~... DATE: 72-008 (6/79) [:,EPFtRTMENT OF HEFILTH F~I"~D ENVIRONMENTRL PROTECTION 825 L S]'REE'T., ~NCHORFIGE., FIK 9'_'a50i 264-4720 L.~, ~ -d --' ,.:::;,, % T E.--2 ..... E_ fi- 4] ,,_ IF:~ F' E=i] E4;.,'. E-t' ]iL'_ T PERM I T NO: E 4E ;-724 [:,RTE ISSUE[:,: I;:34,.."20,.."L--:4 FIPF'LiCFINT: I_".,FIk,'ID E: MEEK RDDRES'S,: ~:±E'iO CHESRPERKE CIF.<CLE RNE:HORRGE., RK CONTRCT PHONE: 26]:'-42t5 [..EGFIL DESCRZP SUB[:,IVISION: SOUTH PRRK ~2 SEC:TiON: 3. TOWNSHIP: ±±N [...01' SIZE: 22426 (SE! FT (}R FiE:RES) f,IFfi,.< BEDF..'OOMS: Z.': LOT: RFINGE: 3:~4 BLOC:E: ~ LISTED BELOW FtE]E THE OPTIONS RVR!LRBLE TO "r'OLI IN DESIGNING "fOUR SEPTIC S"r'STEM CHOOSE THE OPTION THRT BEST FITS 'T'OUR SITE. ()EF:'TH TEl PIF'E BOTTOM (FT. > GRR'¢EL DEPTH (FT. 'TO]'F~L DEPTH <FT. G R FI",'"E L WIDTH GRFP,"EL LENGTH (FT. ORRVEL ","OL. UME (CU. ?DS. TRi',IK SIZE (GRL. S) SOIl... RRTING '::SI;L FT. 4. E4 4.0 4.0 8. E~ 8.5 ]:.5 :1.2. 0 4. 5¢ 7. 5 2. 5 &7.0 5. 0 24. E~ 3:4. 0 4i. E~ 18. 8 ~:~.. 4 3<0. ~ d.,., 000. 0 :+::-~: i., 000. 0 :+:$ i., 000. 0 :+::+: i25 ~.25 i25 :+=:+: TFINK MUST HR',,,'E FF[' L. EF!~;T 'rwo ,...uflFHB. IHEBtT_, I CER]:IF'T' THFIT: :~_. I BM F'RMILIRR 14ITH THE REQUIREMEWTS FOR ON-S, ITE SEWERS FiND WELLS RS SET FORTH E~'.¢ ]"HE MUNICIF'IqL. IT'¢ OF' FINCWORRGE ,::MOt~) FIND THE 2';TRTE OF FiLFISKFt. 2. I WIL.L INSTFtLL THE S'.¢STEI~! IN RC:CORI],RI'-,ICE I,tI'FH RLL. Mi3R CODES RND REGULRTIONS, RND IN COMPLIRNCE WITH ]'FIE [)ESIGI'.~. CRITERIFI OF TH!S; F'ERMIT. 2:. I WtL. L RDHERE TO RLL MOR RND STRTE OF R[_.RSKR REE~LIIREMENTS FOR THE SET BRCK DISTRNCES FROM RN"r' EXISTING P~EL[ .... WRSTEWRTER DISF'OSRL 5'¢STEId OR PLIBLIC SEi.4ER~GE %'¢%TEM ON THIS OR FIN'¢ RDJRCENT OR NEFtRB'¢ L. OT. 4. i UNDERSTFINO THAT THI:B PERMIT IS ',,,'RLID FOR A IdRXIMUM OF ~: BEDROOMS AND RN'¢ ENLFIRGEMENT WILL RE6!UIRE RN RDDITIONRL PERMIT. IF F! L. IFT --:,TPITItN iS IhiC;]'FIl_LE:[:, IN FiN FIREFI CO-VERE[:, E,T t',IOFi Ell'FI ~:,ING F:FI[:,E'--, THEN ,:;~.::, RN ELE3TF:ICFtL.. PERMIT RN[:' ll~_.~ E._.TI_N MUST E:E uETMINE.[ ...... ~... M_, E, UILT_, I.,.IiLL NOT 8E E~PF'RO',,,'ED WITHOUT RN EL. ECTRICFIL. iN:BF'E)]TION REF'ORT.~ RN[:, ,:]~:::, EL. ECTRICFIL. ~,.ll~,:] HUST E:E [:,ONE E:'-r' Fi L. ICENSE[:, EL. ECTRICIRN. . ' , - -T ..................................................... 7 ............................ I ' '] ........ RF'F'L. I Ii:FINT: I >];S U E [:, [:,FI',/! [:, E-:~ h'!EEK & ENGINEERS, INC. $ 7125 OLB SEWARD HIGHWAY · ANCHORAGE, ALASKA 99502 April 20, 1984 ~kmicipality of Anchorage Department of Health and Enviromnental Protection 825 "L" Street Anchorage, Alaska Re: South Park Subdivision Addr~2 Gentlemen: The attached Percolation test dated December 22, 1982 was incorrectly labeled as Addition #4. It is actually Addition ~f2, Very truly yours David Stanley C~ot echnical Y~nager DAS:ds WASILLA ANCHORAGE SOLDOTNA (907) 376-3770 (907) 349.6561 (907) 262-9534 & ' ENGINEERS, INC. · :~'~ 7125 OLD SEWARD H'WY. ANCHORAGE, ALASKA 99503 349 - 656l. SOI,LS LOG - PERCOLATION TEST I 2 5 6 7 8 9- lO- I! 12 13- 14 )UNO WATER TEREO? SWANSON YES, AT WHAT DEPTH) 15 16 !? % JOH~ E. SWANSON? P~OFES$10~ 2O COMMENTS ' PERCOLATION RATE _ \//5~,4L , (mlnu edinch) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-501-34 Expiration Date: ~;~ - (~' - / / GENERAL INFORMATION Complete legal description Lot 11, Block 2, Southpark Subdivision No. 2 Location (site address) 15621 Southpark Loop Anchorage, AK 99516 Current Property owner(s) James and Michele Halley Mailing address 15621 Southpark Loop Anchorage, AK 99516 Day phone Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: Four TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class__ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. DSD SIGNATURE ~/"~ Approved for ~ bedrooms. Disapproved. { ConditiOnal approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory By: (rev 11/05) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SiTE SYSTEMS APPROVAL CHECKLIST Lot 11, Block 2, Soulhpark Subdivision No. ~2 IfA, B, or C provide PWSID # Sanitary seal (Y/N) Cased to f. FROM WELL LOG Legal Description: A. WELL DATA Well type Date completed Total depth g.p.m. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform colonies/100 mL Arsenic: ug/I B. SEPTIC/HOLDING TANK 'DATA Tank Type/Material Septic~Stea Tank size 1,250 gal. Foundation cleanout (Y/N) Y Date of pumping 3/08/2010 C. ABSORPTION FIEED DATA Date installed 9/25/84 Length 40 ft. Total depth 3.5 ft. Nitrate mg/L Date of sample: Parcel ID: 020-501-34 Number of Compartments 2 Depression over tank (Y/N) Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION g.p.m. Pumper Isaac's Pumping Service Other bacteria Collected by: Soil rating (g.p.d./ft~ or ~/bdrm) 125 SF/BDRM W~lth 20 ft. Eft, absorption area 800 ~ Monitoring tube Date of adequacy test 7/21-22/10 Results (Pass/Fail) Pass Fluid depth in absorption field before test 2 in. Elapsed Time: 1,126 min. Final fluid depth 2 Any rejuvenation treatment (past 12 mo.) (YIN.& type) N in. colonies/100 mL Date installed 9/25/84 Cleanouts (y/N) Y High water alarm (Y/N) N System type Shallow Bed Gravel below pipe .5 Y Depression over field .N 3.25 For 4 bedrooms Water added e65 gal. New depth in. Absorption rate >= 600 If yes, give date in. g.p.d. D. LIFT STATION Date installed 5/85 "Pump on" level at 45.5 in. Datum Bottom of Tank E. SEPARATION DISTANCES Size in gallons 5oo "Pump off~ level at 41.5 in. Cycles tested 3 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line Animal containment areas Manhole/Access (Y/N) Y High water alarm level at 48 Meets alarm & circuit requirements? in. On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Absorption field Surface water Building foundation >5' Property line >5' Water main N/A Water service line >10' Wells on adjacent lots >200' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >1o' Building foundation >1o' Water Service line >1o' Surface water >lOO' Wells on adjacent lots ; ~,:3~ Curtain drain None Noted F. COMMENTS: >5' >100' Water main >10' Driveway, parking/vehicle storage. >50' review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Pdnted Name Michael E. Anderson, P.E. Date 7/27/2010 COSA Fee $ /-~ ~ 0 Waiver Fee $ Date of Payment 7 / ~ O, /[ O Date of Payment Receipt Number ~ ~ --~ ~ ~)'-~ Receipt Number (Rev. 11/05) 2764429 ....... RE/MAX Properties, Inc. RE/MAX Properties, Inc. 02:40:57 p.m. 07-29-2010 2/2 I UNDE~ NO OR~MST~S ~OU~ AN ~--~ILT ~ U~ ~ ~NS~UC~ ~ F~ ESTA~USHING B~ND~Y ~ ~N~ UNES. ~E ~R~OR TAKES R~BIU~ F~ ~E INI~ ~SAC~ ~LY ~D A~MES RN~CI~ M~IU~ ~LY FOR ~E C~T ~ ~E ~R~Y. US~ DISTilS PREVAIL O~ ~AUNG. REPR~UC~ MAY CAU~ ~R~S IN ~. ~ ~t ~ SURLY T~E S~BOLS ~ F~NDA~ ~T ~ ~TP~ ... ~-~LT... ~T~... T~Y O F~ND ~B~ ~ ~ - ~D ~N~ PLOT PLANS ~ LOT SUR~ N0~: IT IS ~E RE~ONSIBILI~ OF ~E BUlmER OR O~ER, PRIOR TO ONLY ~OSE IMPRO~MEN~ ABO~ GR~ND AND CONS~UC~ON. TO ~RIFY PROPOSED BUI~ING GRADE R/LA~ ~O~. ~CES, ~ [~ SEP~C ~OU~, SIDEWAYS, TO FINI~ED GRADE AND U~U~ CONNEC~S AND TO DE~RMINE ETC., ARE SHO~ IN ~EIR APPROXIMA~ L~A~. ONLY. ~OW ~E EXIS~NCE OF ANY EA~MEN~, CO~NAN~ OR RES~IC~ONS MAY ~E~NT S~E IMPRO~ ~ BEING SEEN AND L~A~D. ~ICH DO NOT APPEAR ON ~E RECEDED SUBDI~SION PLAT. ALL DISTANCES ARE RECORD UNLESS O~ER~E NOTED. SURLY CER~FICA~ON _~~ Prepared by ,, Robert E Johns Jr. Assoc. '~'~--'~'~ ~'e. Professionol Lond Surveyors ~~*~~ 842 E. : .... ; ~ ~~~ ~ale: 1" R~. Lot S.F. ;R~. Plot ~le No.. i.. . . =50'  ' ~eck~ b~ Do~, ~r.~: 6/29/10 D~a.. ~ REJ JMK / ~. 6/30/10 3236 1188 ~.?,...,~.~, ~ ~** LOT 11 BLOCK 2 SOUTHPARK ~2 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 GENERAL INFORMATION Complete legal description ~'~u.TZ./ /D~_ ,~, Z~. LocatjOr~(~slte address or directions) Mad~ng aaa[eg~,~, - ,, ' Agent Day phone Day phone 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. $/91) 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 flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compiiance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address ~¢) Engineer's signature Phone DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 724}25 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. ~ ~'~ ~) ~)5'~'7~ ~"~ A. WELL DATA Well type ,r~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~,/~ Driller Cased to /4J//~ 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 ~ ~oO / Absorption field on lot ~ ;~00 ~ Public sewer main /LJ~,4 Public sewer service line /4j~ g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ,4J/,~ Nitrate /1~,//:) Other bacteria ~//~ Collected by: Date of sample: . /', B. SEPTIC/HOLDING TANK DATA Date installed ¢~ /~ /¢¢~-. Tank size /Z- C'_zb Compartments '~ Cleanouts ~'~,? ~, .F0undat,on cleanou~/N) Depression (Y~ H gh water ~ ~; ;', ~ ~-,;~ Alarm tested (Y/N) ~/~ ate or pum[ai~'~,/~"~*"~*"aa~'e~- -- / SEPARATIO~,~C~E~'~TIC/HOLDI NG TANK TO: Well(s~ on lot ~~ On adjacent lots /, Foundation To property line ~ ~ Absorption field ~ Surface water/drainage /Oort~ ype~l - Water main/service line 72-0~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent Y~) "Pump on" level at High water alarm level / Meets MOA electrical codes~Y~N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot ~ 2~,~ / Manufacturer /z~ ~ ~'~ .~'2¢ .7'-~.,.~ Manhole/Access~'4) ~.0 /%0./¢~¢/¢.//' "Pump off" level at ~'~'?1~./: ¢'~/'"'¢~-/1 Cycles tested / /'/.~;/ /z/./¢¢~..~ On adjacent lots ~ ~,o Surface water D. ABSORPTION FIELD DATA Date installed ~ o ,4U.) ~" ~' Length 'cC'E) / Width__ °'~O Total absorption area /~O ./7 Depression over field (Y/~ Results (pass/fail) /-~¢~ Peroxide treatment (past 12 months) (YN~. Soil rating /ZJ-- System type Gravel thickness / Z ~/ Total depth -.~ Cleanouts present~N) Date of adequacy test for Y bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /~./~ On adjacent lots To building foundation On adjacent lots_ ~/2' / Property line / O ? To existing or abandoned system on lot Cutbank ,A/¢,Ic/Pc ~' Water main/service line Surface water ~ /o0 / Curtain drain Driveway, parldng/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in S,..tur; Engineers Name Date_ HAA Fee $ / 7¢ ¢"~E~ Date of Payment '--0-~ ~-/'- ~-~' Rs0ei.t N.mber /' Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Sack MOA 21 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 WALTER J. HICKEL, GOVERNOR (907) 349-7755 May 14, 1993 Mr. Lee Reid, AECS SUBJECT: Lot 11, Block 2, South Park Terrace Subdivision Class "A" Public Water System, PWSID 213475 Dear Mr. Reid: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on April 1, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on November 5, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last Radioactive Contaminants Sample results were submitted to the Department on December 10, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on November 6, 1992. Based on analysis of the previous VOC samples results have been satisfactory. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. Unless otherwise noted, this letter is valid for 30 days and is for the specified legal description noted above only. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, _ Michael Lu Environmental Eng. Asst. II STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPROVAL OF ON.SITE RESIDENTIAL WATER AND SEWER SYSTEMS PROPERTY DESCRIPTION ~t, Block & Subdivision or U.S. Su~ey Lot 11, Block 2 South Park Terrace Subdivision PWSID no. 213475 This approval does not constitute a guarantee of any kind, explicit or implied, as to the performance of the water supply and wastewater disposal systems. WATER SUPPLY A recent water sample was tested and found to meet Department of Environmental Conservation drink- ing water standards for total coliform bacteria. Tit~.Environmenta1 Oat~y 1QQq WASTEWAT ER DISPOSAL TE~eii~pme~ bWyalth~W~e~itYmSte%~o~Slvironmental Conservation and f d~to be in compliance with [] inspected by a Professionah~ngineer who certifies that.~J~ system complies with applicable re- quirements of 18 AAC 72; ~ J .... [] installed by a Cer~~les with applicable requirements of 18 AAC 72; or ~ ...... [] tested by a Profe~t the performance of the system is satisfactory and that the syst~ration distances ~p~cified in 18 AAC 72. This approval is val~ single family I I multi-fam'1~h atotal of bedrooms. 18-0404 (Rev. 8185) DISTRIBUTION: WHITE--BANK/LENDING INSTITUTION; CANARY--APPLICAN~ PINK--DEPARTMENT Alaska Water & Wastewater Services "Preserving the Last Frontger" FAX MEMO FAX DATE: · Lo'T' NUMBER OF (Including cover) ?,OM:......,.S~=~.?-~=~ ~--.~ TO; COMPAHY: SUBJECT: MESSAGE: 8471 .Brookrldge Drive, Anchorage, Alaska ~$o4 · Telephone: {g07) 337-8179. '1 ~ ~ Alaska Water & Wastewater Services "Preserving the Last Frontier" November 29, 1991 Realty Center 8400 Hartze[1 Road anchorage, alaska 99507 attn: Ms. Griggs Ref: Lot Il, Block 2, Southpark Subdivision #2. IS621, &outhpark LOOp. Health Authority Approval Omar Ms. Griggs: Rs per your request, a Septic system adequacy test and engineering evaIuation, as required for an HAA, was performed at the subject property. Based upon information obtained from records at the MO~ Department of Health and Human Services (DHHS), and during the site visit, it is apparent that there are some major discrepancies between the record drawings and the aotual installation. These discrepancies are noted as follows: I. The record drawings indicate that the .field is a "mound" type system instaIled approximately 2'-0" below grade. The site investigation revealed that there are pipes which extend 7' to 8' below grade. This wouid indicate that the system was eot installed at the same elevation as it was approved for. 2. The record drawings indicate that the lift station is iocatmd southeast of the existing septic tank- Field investigation revealed that there is an undocumented lift station located east of the existing septic tank. The size and manufaoturer of the lift station is unknown. I believe this lift station replaced the one which mas originally installed in september of 1984, but its installation was never approved by DHHS. Consequently, there was no electrtcat inspe~tion done. 3. The record drawings indicate that the leachfield mas to be 20' wide by 40' long (SOO fL2.). Field measurements indicate that the field is approximately 12.5' bY 27'(358 ftc.). In short, it is possible that the actual installation is significantly smaller than the approved design, Telephone - Fax $88-$246 · 8~t71 arookridge Drive m Anchorage, Alaska 9950~ 12~02/91 09:24 P,03 4. According to OHHS records, there appears to be some discrepancy as to Nhat the percolation rate is for the soil. DHHS will need to clarify this. At this point,since it is not possible to verify whether the system is designed in conformance Nigh MOA standards, it would be unethical to approve the sub3ect system. Consequently, it is my recommendation that the system be excavated, so as to expose the llft station and ail leaohfield piping, and the system inspected/documented by DHHS. Prior to any excavation work, DHHS should perform a site visit to confirm the findings of Alaska Nater and Wastowatsr Services. I have discussed the subject discrepancies With Susan Oswalt of the DHHS, and I believe she Nill support me on this decision. Upon documentation of the systeM, and correction of any deficiencies, we can then run an adequacy test. Since the records research portion of the HAA is complete, end a letter of compliance for the community well has been obtained from the Alaska Department of Environmental Conservation, the follow-up adequacy test will be performed at a reduced fee. If you have any questions please contact me. If you ~ould like to discuss this with Susan Oswalt, at OHHS, she can be reached at 907-343-5733. Thank you for your business. Eveleth.wps JAe/~ag cc. Susan Oswalt, DHHS 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 GENERAL INFORMATION (a) (b) Application ~ate ~ ~ ~ ~ ~ Legal Description (include lot, block, subdivision, section, township, range) South ?ark #2 Block 2~ Lot: 11, TI.I_N, B 3W, Sec 3 Location (address or directions) 15621..South Park Loop, Anchorage Appli0JntName Ron & Susan Kerr Telephone: Home 345-4654 App~iicant Address ,~ --above- Business (c) Applicant'i~, (check o~e): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution ' Homequity Address 1855 Gateway Blvd., Suite 950 (e) Real Estate Company and Agent Address Telephone 4!5-246-6526 Concord, 6A 94520 Telephone (f) Mailthe HAAtothefollowing address: % Dee High HIGH, PHUKAN & SORENSEN CONSULTING ENGINEERS 271T2 Gambeii, Suite ~03 Anchorage~ AK 99508 2. TYPE OF RESIDENCE Single-Family [~ Multi-Family [] (~,.O.~jer Number of Bedrooms ~.4" ~ WATER SUPPLY Individual Well [] Community;E~t Public [] Note: If corn m unity well system, must have written confirmation from the State Department of Environ mental 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. Page 1 of 2 72-025 (11..84) 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 regulations in effect on the date of this inspection. Name of Firm High, Phukan & Sorensen Telephone 272-7111 Consulting Engineers Address 2702 Gambell, Suite 103~ Anchora~e~ AK 99503 Date 7/05/89 6, DHEP APPROVAL Approved _ ,X, Disapproved Conditional Date Terms of Conditional Approval CAUTION Th~' Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a'certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72.025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 ~ Legal Description: South Park #2, B2, ~ 15621 South Park Loop WELL DATA Well Classification Community Class A If(~ B, C, D.E.C. Approved (~N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Yes Water Sample Test Results Comments SEPTIC/HOLDING TANK DATA Date Installed 2~8"'--~ ~%ize 1250 Gal.___ No. of Co~artments 2 Standpipes(~)v'~= f'~)Yes A~ightCaps(~/N) Yes~L&) FoundationCleanout~N) Depression over Tank {Y~ No Pumping/Maintenance Contract on File (Y/N) N/A Holding Tank High-Water Alarm (Y/N) N/A Separat on Distances f.r.,gm Septic/(l~lding Tank: ,- ~%,,::'~ '?-"~"L~200, v To Water-S0~ply Well -: - TO Pr0pert~ Eir;e "''~'~:' 4-7' ~ To Water Main/ServiceLin~i · lO~ 2~ +too, · Course Yes4--~ Date Last Pumped 29 June 1989 ; for Temporary Holding Tank Permit (Y/N) N/A To Building Foundation 13 ' ~ To Disposal Field -'~ 25' 2~ To Stream, Pond, Lake, or Major Drainage Comments · _~) Pe~"DHHS' Records on-site measurements as of 6/19/89 Page 1 of 2 72-026 fRev 81861 Fronl C. ABSORPTION FIELD DATA Soils Rating in Absor~i~nsS~,~a Date installed 2~4 12,3' Width of Field Square Feet of Absorption Area Depression over Field (YO Results of Last Adequacy Test 125~/Bedroom O 800-ft.2 -('~ No ~ Type of System Desi~..) Length of Field 26.7 ~ Depth of Field 3.5' Q Gravel Bed Thickness 1 i ~ Standpipes Present (~N) Date of Last Adequacy Test.w` Sat~isfactory for 4 Bedroom House Yes~) 19 June 1989~) Separation Distance from Absorptionf.~eld: To Water-Supply Well +200' '"-' To Building Foundation Lot N/A ~ Watcr ,Main~rvice ~ 39' ® 45' ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~ Per DHHS Records To Property Line 20' (~ To Existing or Abandoned System on ; On Adjoining Lots 75' to Field on Lot to the S.W,L, IJ N/A To C,,kC~ank (if present) +200I ~ 551 (~ Per on-site measurements LIFT STATION Date Installed May 1986 O 500 Gal ~ Size in Gallons "Pump On" Level at 45½" High Water Alarm Level at 481' Tested for 3 Electrical Codes(~) Yes Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent~N) 2' Diam.; 45½" to Pump On 41~" Yes Pumping Cycles during Adequacy Test. Meets MOA Comments This lift station replaces an older failed one. It is located near the SE corner of the back deck. The tank to lift station sewer line apparently Just een~s around <no clean-outs) to the north to the lilt station inlet, bitt ~ Check Permitted Bedroom Rating Against HAA Request ** station outflow line apparently has I certify th~'~'t't~h a~?e checked, verJfied,.o'~conformed to all MOA and ¢15~A guid~r~es ,~ ~ffeSc)t ( bed Signed Date Company HPS Consul,~i/ng Engin~(~A NO. Receipt No. Date of Payment Amounts Information from DHHS Files. Information gathered by HPS on-site. Page 2 of 2 72-026 fRev 8/861 Back PROJECT SUBJECT PAGE --OF-- MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION JUL 1 41989 RECEIVED ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 563-6775 DATE: PWSID: To Whom It May Concern: According to the records on file in this office, the ~t 7~ ~/y/3 Water System is in compliance with the State of Alaska Drinking Water Regulations. MPL:pkk Sincerely, E~Vironmental MUNICIPALITY OF ANCHORAGE DEPARTIV1ENT 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 1. GENERAL INFORMATI~)N - ~ ' " . ~ , Application (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~w~L~} ¢~, ~(E~. Telephone: Home (c) Applicant is (check one): Lending Institution ~; Owner/builde~]; Buyer ~; Other ~ (explain); (d) Lending Institution Address (e) (f) Telephone Real Estate Company and Agent Address Telephone 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: II community Well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 ENGINEER;NG FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AS certified by my seat affixed hereto add as of the validation date shown below, I verify that my investigation of this Health Authority ApprovaJ shows that the on-site water supply an d/or wastewater disposal system is safe, functional and adequate fc~ the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Mt~nJc~paJit~ of Anchorage files and from my investigation and inspection, the on-site water suppty and/or w~Stewate~ disposaJ system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of thLs ir~spection. Engineer's Seal DHEP APPROVAL Approved lc; Approwc~J ,.':~. bedrooms by _ Disapproved Conditional Approval CAUTION The MuncJpa]ity of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval cec, ificates b~ed solely upon the representations given in paragraph 5 above by an independent professional engineer reg's',erec ,n the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their Jending inst:tubons in order tO sattsfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze da:a be,%re a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the profess~onaJ eng~neecs work. Pa:~e 2 ol 2 r,, D~?,,. ~,r.~l F,t ~,~_0~ A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRLJARY 1984 264-4720 Legal Description: (.,,.,~'~- I I '~-~L Well Classification (:~.u..~'.,~ ¢/~,,~5",f' If A, B. C, D.E.C. Approved (WN) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date SE.T,C/HO'D,NG TA.K UATA Date Installed ~--~/~¢:~/~¢- Size ~"~ ~ No. of Compartments Standpipes (Y/N) "~'~_,_'~'-~ Air-tight Caps (Y/N) "~', ~,%-'%, Foundation Cleanout (Y/N) Depression over Tank (Y/N) 6--~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well I,--~; / ~ TO Property Line ~ / To Water Main/Service Line ~ .4- Course ~ ( Date Last Pumped ~-~,% :]-H'¢3~4 ~,,,'~-~Pr~_ ~,~, ;for Temporary Holding Tank Permit (Y/N) ~/ ~ ~ To Building Foundation I¢-~/ To Disposal Field ~"'?' / To Stream, Pond, Lake,'or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~; (~c~, ~-,/, Width of Field I .,. ,. . , Square Feet of Absorption Area Depression over Field (Y/N) ~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~ [ ~ TO Building Foundation ~1, 7 ! Lot ~ I ~--~/~,~I~'~- 'Type of System Design Length of Field ~' / Depth of Field IS I/ Gravel Bed Thickness ~ ~ Ii Standpipes Present (Y/N) Date of Last Adeqb'a~y Test To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~:~ ~L~ ~..~ / To Property Line I "7 To Existing or Abandoned System on ; On Adjoining Lots ~ To Cutbank (if present) D.' LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at .Vent ('~/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h~rve ch~ied, or conformed to all MO¢ and HAA guidelines in effect on the date of this inspection. Signed '""~4z~~ Date Company ~'~¥~-'~-'~'~"~¢'~ ~ {.t~r~.-r~., %_ ~-"~'~ ~- MOA No. Receipt NO. ~ "~'~] 4 ~ Date of Payment ~' '~ ~P) - Amount: $ 4~~) Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPAItTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR H~ALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 8/29/84 (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 11 Block 2 Southpark Subd. #2 Location (address or directions) off Southpark Bluff Drive (b) Applicants Name Dave Meek Telephone - Hom~45-415~usiness263-4215 Applicants Address 3100 Chesapeak Cicle, Anchorage, AK 99516 (c) Applicant is (check one) Lending Institution ~-~ ; Owner/builder~ ; Buyer ~--~ ; Other~--~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: 2. Type of Residence Single-Family~ Number of Bedrooms 3. Water Supply Multi-Family~ 4 Other (describe) Individual Well ~-~ Community ~ Public ~-~ Note: If community well system, must have written confirmation from the State Dep~rtment of Environmental Conservation attesting to the legality and status. 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. [Page 1 of 2] En~ineerin~ Firm Providin~ 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, ordinamces, and regula- tions in effect on the date of this inspection. Name of Firm Tectonics Telephone 349-2526 Address 1207 E. 74th, Anchorage, AK 99502 Date 8/30/84 (ENGINEER SEAL) Approved for fou3~ bedrooms B Date Approved X Disapproved -- Conditional __ Terms of Conditional Approval CAUTION 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 REGISTERKD IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES ~ND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- 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 SEA, L) RR4/ej/D18 [Page 2 of 2] 7-19-84 DIVISION OF ENVIRONMENTAL HEALTH ~_ ~J/ DEPARTMENT OF ~IEALTH AND ENVIRONMENTAL PROTECTION~ APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ~/~/~ (a) Legal Description (include lot, block, subdivision, section) to~.mship, range) Lo-r- II Location (address or directions) ~ Applicants Address ~JOO ~F+~~ ~~ ~, ~W~-/~>_ (c)Appliqant is (check one) Lending Institution ~ ; ~er/builder ~ ; Buyer J J ; Other ~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: e Type of Residence Single-FamilyJ~ Number of Bedrooms Multi-Family Other (describe) Wat&r S u_p_p l_J! Individual Well ~--~ Community ~ Public l Note: If community well system, must have written confim~ation from the Stste Department of Environmental Conservation attesting to the legality and. status. Sewage Disposal Onsite ~ Public ~--~ Community ~--~ Holding Tank [ Note: If community well system, mus~ have v~itten confirmation from the State Department of Environmental Conserva~i6n attes~ihg to the legality and status. [Page 1 of 2] En$ineering Firm Providin$ 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 w~stewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. T el epho n e ~2~ ~- Z~-~ Address / ZO 7 ~, '~4'/~ DHEP Approval Approved for Approved ~ bedrooms Disapproved __ Conditional Date Terms of Conditional Approval CAUTION THE bfUNICIPALITY OF ~NCHORAGE DE~AR~4EN~ OF HEALTH ~ND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATION$ GIVEN IN PARAGRAPH 5 ABOVE BY ~N INDEPENDENT PROFESSIONAL ENGINEER ~EGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY- CERTAIN FEDERAL AND STATE Rf~QUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~NALYZE 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/DI8 [Page 2 of 2] 7-19-84 ae Well Classification Well Log Present (Y/N) Total/ Depth Static Water Level MUNICIPALITY OF ANCHORAGE % HEALTH AUTHORITY APPROVAL (H~SmO~~LK_ CHECKLIST - FEBRUARY 1984 RECEIV..E,D If A, B, o~ C, D.E.C. ApproVed(Y/N) Date C(~',~3 le ted "" Yield Card to ~pth of/G~outin~[ ~ ~ ~t At Casing Height ~ Ground Sanit~y ~al on Casing (Y~) Elec~ical Wiring in ~nduit (Y~) ,.~p~ession ~ound ~l~ead (Y~) Sep~ation Distan~s f~ ~11: To ~ptic/Holding Ta~ cn ~t ; ~ ~joining Lots To ~)a~est Edge of ~so~tion Field on ~t ,' ; ~ Adjoining ~ts To Nearest Public ~r Lin~ '" TO ~a~est Public ~r Clean. t/Manhole ,~To ~est ~ ~rvice Li~ on ~t Water S~ple Collected By ; ~te Wate~ S~le Test ~sults / C~nts SEPTIC/HOLDING TANK DATA Date Installed ~./Zo/~[_ ~ Size Standpipes (Y/N) ~ Air-tight Caps (Y/N)~ Depression over Tank (Y/N)~313 Date Last Pumped_ No. of C~a~t~.~nts Foundation Cleanout (Y/N) ~(~ Pumping/Maintenanos Contract on File (Y/N) ~/~- ; for .... Holding Tank High-Water Alarm (Y/N) ~;/~ Temporary Holding Tank Permit (Y/N) Separation Distan~s from Septic/Holding Tank: / To Water-Supply Well ~J.//% To Building Foundation I ~ To Property Line ~?~'"~' ' To Disposal Field '~ / To Water Main/Service Line .~ ~Z~'- TO Stream, Pond, Lake, or Major Drainag~ [Page 1 of 2] 2-15-84 C. ABSOP~ION F~ELD D~TA Soils Rating in Absorption Strata Date Installed ~/~/~/;' Width of Field Square Feet of Absorption A~ea Depression over Field (Y/N) ~qD Results of Last Adequacy Test I~,~-- 7~' Type of System Design Length of Field ~ Depth of Field ~ ~" ~OCD~J~ravel~. Bed Thickness ~ Standpi~s P~esent (Y/N) Date of Last Adequacy Test Separation Distance frcm Absorption Field: To te. -sup ly To Li .e 1'7 To Building Foundation __~,~_~/ To Existing or ~ndo~d System Lot ~/~ ~ ~ Adjoining ~ts ~O '~ To Water Main/~rvi~ Line ~ ]~ To ~t~k(if pre~nt) ~ TO Stre~ond~ke/~ Majo= ~ainage C~se ~./~ To ~iveway, Parki~ ~ea~ o~ Vehicle St~a~ ~ea~ ~.~ ~ D. LIFT STATION Date Installed ~,Z~o/~P4[ Size in Gallons ~ ~ "~ o~" ~e~l at I~~' High Water ~ ~vel at ~ ~' Ma~ole/Access (Y/N) ~ Off" Level at i~~' ven~ (Y/~) ~ Tested for Electrical Codes(Y/N) . ** ~eck ~tted ~ ~ting ~ainst'F~ ~quest I ~rtify that I have~ed, verified, o~ ~nfor~d to all MOA ~ C~'l~lj~s in effect [Pa~ 2 of 2] ?draping Cycles duFing .a, dequacy Test, Meets MOA 2-15-84