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//
Benjamin Schiller
CE 12592R
E
GISTEREDPROFE S S I O N A L E N GINEER
1"=30'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
MT1
PERMIT # OSP231291 PID # 020-491-47
SOUTHPARK #2, BLOCK 3 LOT 2
A B
FCO 36.3
MH1 63.3
MH2 67.4
MT1 66.2
MT2 55.1
14.1
50.0
53.8
65.0
75.6FEET
0 30 60
FCO
NOTE:
THIS PROPERTY AND ALL SURROUNDING LOTS ARE ON
VARIOUS COMMUNITY WATER SYSTEMS.
SO
U
T
H
P
A
R
K
B
L
U
F
F
D
R
I
V
E
4-BDRM HOME
PLAN AS-BUILT
8/6/24
30' UTILITY EASEMENT
(DOC. NO. 1984-000621-0)
DRIVEWAY
ENCROACHMENT
10' T&E EASEMENT
20' T&E EASEMENT
EXISTING ABSORPTION FIELD
TO REMAIN IN SERVICE
MT2
NEW 1,500 GAL
STEEL STEP TANK BY
ANCHORAGE TANK
WATER SERVICE ROUTING
(PER ON-SITE LOCATION
SERVICES)
MH1MH2
A
B
BM
PROFILE AS-BUILT
(NO SCALE)
91.0
84.7
91.6
96.0
FC
O
MH
1
1500 GAL
STEP TANK
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFE S S I O N A L E N GINEER
8/6/24
PERMIT # OSP231291 PID # 020-491-47
SOUTHPARK #2, BLOCK 3 LOT 2
MH
2
90.8
1
L3_0_0
' RLEC
' UTILITY & Lot 3
OM. EASEMENT
89.59'55"E 150.21'
DRIVEWAY I
I ENCROACHMENT
Lot 31
=THPAR 30' UTILITY EASEMENT
(Doc. No. 1984-000621-0)
Loop BALCONY
2.0'x5.7' CANT 14.2
POST &
14.1 I \
RAIL FENCE \
72.3' h {\
z N 4.0 I O
LJ O ' O 9so J \ `In
4.4' I�
o bo 5.6' D X 4 2'
0 Lot 2 �pLFii ^ 0 m w a DECK10
r.I Z 29,703 S.F. 9� —+ 0 z
641
'•o• z 10.0' to
DECK
W SEPTIC M \N
Y MANHOLESi I I Lot 32
Q � 34.3'
SEPTIC
2 PIPES WOODEN
:FENCE
N 8O.26',50 179.76'
r �I
Lot 1
I I
NOTE: THIS LOT IS SERVED BY 20' T&E EASEMENT I I Lot 33
A PUBLIC WATER SYSTEM. I I I I
PLOT PLAN AS BUILT _X SCALE _11-f: 40' _ GRID __!W___!2__36_
Project No J24-15ZZA1
P.O. Box 210005
Lang & Associates, i n C , Anchorage, Alaska 99521-0005 opOO�
(907) 522-6476
Professional Land Surveyors jonothanOlangsurvey.com O.F. A n�p
kenOlangsurvey.com DOP'� '7S1�oo
I hereby certify that I have surveyed the following described property: X25, H �QnO
LOT 2, BLOCK 3, SOUTHPARK SUBDIVISION —ADDITION N0. 2 (PLAT N0. 83-213) D V
Anchorage Recording District, Alaska, and that the improvements situated thereon are
"" "' """" ""' (,
within the property lines and do not encroach onto the property adjacent thereto, that a
no improvements on the property lying adjacent thereto encroach on the surveyed �•
premises and that there are no roadways, transmission lines or other visible O AN ............N:
easements on said property except as indicated hereon. N C�ZQ�
Dated this the ND Day of A u6 V OQ� •' .�S-9944.•
, at Anchorage, Alaska 4pOQR0�3SIONA� moo"
It is the responsibility of the owner to determine the existence of any easements, �Op00o��
covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP231291
Work Type: SepticTank Upgrade
Tax Code Number: 02049147000
Site Legal Address: SOUTHPARK #2 BLK 3 LT 2 G:3236
Site Mailing Address: 4550 SOUTHPARK BLUFF DR, Anchorage
Owner: ERBER GARY & SANDRA JOINT
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date:
INA enr
C P �h
O �
DeI)ai- tinellt
Lot Size in Sq Ft:
Total Bedrooms:
9/22/2023
9/21/2024
29703
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: 15 i� (Dg—( C
Issued By:
Date:
Date: 2 Z t 3
4
MUNICIPALITY OF ANCHORAGE
Community Development Departments 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. 020-491-47
Property owner(s) Sandy Erber Day phone 907.360.9046
Mailing address 4550 Southpark Bluff Drive, Anchorage, AK 99516
Site address 4550 Southpark Bluff Drive, Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) Southpark #2, Block 3 Lot 2
Legal description (Township, Range & Section)
Lot Size 29,703 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(2) all that apply)
Absorption Field ❑ Initial ❑
Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑X Upgrade
pg 0
(D) ❑
Holding Tank ElRenewal ElDuplex
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that
this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: Z Z S -
Date of Payment: (5�31,/2 - Z2
Receipt Number: rc�D%362D
y
Permit No.S P Z3 12-9i
Permit App_.:- ::'.. c
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
August 30, 23
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Southpark #2, Block 3 Lot 2 - Southpark Bluff Drive
Septic Tank Replacement
Dear On-Site Services Engineer:
The owner of the above lot has a STEP tank that has reached its end of useful life, so we are
submitting this permit application for its replacement. The attached site plan identifies the location
of the home and septic field. No conflicts exist between this proposed system and any other wells
or septic system, whether on this lot or adjacent lots. We are replacing the septic tank with a new
STEP tank sized for four bedrooms and have specified a steel tank due to groundwater noted in
the test hole logs.
The new septic tank will be a minimum of 100’ from all wells and surface water. Please refer to
the attached plan for the septic design. If this design is followed, there will be no adverse impacts
to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231291, Curtis Townsend, 09/22/23
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Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=30'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
MT
SOUTHPARK #2, BLOCK 3 LOT 2
FEET
0 30 60
FCO
NOTE:
THIS PROPERTY AND ALL SURROUNDING LOTS ARE ON
VARIOUS COMMUNITY WATER SYSTEMS.
SO
U
T
H
P
A
R
K
B
L
U
F
F
D
R
I
V
E
4-BDRM HOME
SEPTIC PLAN
8/29/23
30' UTILITY EASEMENT
(DOC. NO. 1984-000621-0)
DRIVEWAY
ENCROACHMENT
10' T&E EASEMENT
20' T&E EASEMENT
EXISTING ABSORPTION FIELD
TO REMAIN IN SERVICE
DECOMMISSION EXISTING
SEPTIC TANK PER UPC
MT
NEW 1,500 GAL
STEEL STEP TANK BY
ANCHORAGE TANK
MAINTAIN 10'
SEPARATION FROM
WATER LINE
WATER SERVICE ROUTING
(PER ON-SITE LOCATION
SERVICES)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231291, Curtis Townsend, 09/22/23
f
r
L.30.0,
1 j
l
THPAR
.� K
Loop _
1n
l �
O
4 r
+� a)
O
41 MANHOLE
qVIC 4 Lot 2
a 29,703 S.F.
�r
rr
NOTE: THIS LOT IS SERVED BY
A PUBLIC WATER SYSTEM.
10' UTILITY & Lot 3
TELECOM. EASEMENT
S 89'59'55"E 150.21'
DRIVEWAY
ENCROACHMENT
–30' UTILITY EASEMENT
(Doc. NC. 1984-000621-0)
BALCONY
14.2'
2.0'x5.7' CANT
72.3'
y
v�
op"
v
s-
SEPTIC
I PIPES
t
DECK
Lot 1
20' T&E EASEMENT
7 —
Lot 31
d �
`l!'1
I�
:r7
I0
. I
Lot 32
WOODEN
FENCE
I Lot 33
I I I
PLOT PLAN AS BUILT X_ SCALE _1 - 40Y GRIDSW 3236__ Project No. ____23-3fi11A1 _
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone tel`\
ken®longsurvey.com 4� �N,
Professional Land Surveyors jonathan®langsurvey.com •s OF.!4C� k'kt
travis0langsurvey.com i '� tS
I hereby certify that I have surveyed the following described property: �.' '9
LOT 2, BLOCK 3, SOUTHPARK SUBDIVISION – ADDITION No. 2 (PLAT No. 83-213) *: 49TH
Anchorage Recording District, Alaska, and that the improvements situated thereon are • • • • • • • • • • • • • • • • •
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible �/ �•• KENNETH G. LAN 10,•
easements on said property except as indicated hereon. I{� 6'• No. 202 /
Dated this the Day of at Anchorage, Alaska FOp �p
FSSIOtIt~ �
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963
n POST &
114.1'
RAIL FENCE
N
4.0'
�
J
4.4'
0
os 56' O
.r7 ➢ X
1 ,8'
4.2'
6.0'
M"
N z DECK
C'
4
i
'o• CoM
110,
Z
n
N
N "7
A
O
m N
n
34.3'
6'50,
.
179-76'
DECK
Lot 1
20' T&E EASEMENT
7 —
Lot 31
d �
`l!'1
I�
:r7
I0
. I
Lot 32
WOODEN
FENCE
I Lot 33
I I I
PLOT PLAN AS BUILT X_ SCALE _1 - 40Y GRIDSW 3236__ Project No. ____23-3fi11A1 _
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone tel`\
ken®longsurvey.com 4� �N,
Professional Land Surveyors jonathan®langsurvey.com •s OF.!4C� k'kt
travis0langsurvey.com i '� tS
I hereby certify that I have surveyed the following described property: �.' '9
LOT 2, BLOCK 3, SOUTHPARK SUBDIVISION – ADDITION No. 2 (PLAT No. 83-213) *: 49TH
Anchorage Recording District, Alaska, and that the improvements situated thereon are • • • • • • • • • • • • • • • • •
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible �/ �•• KENNETH G. LAN 10,•
easements on said property except as indicated hereon. I{� 6'• No. 202 /
Dated this the Day of at Anchorage, Alaska FOp �p
FSSIOtIt~ �
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 %" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
GA[~,?I L , E?~'~I~-' ~,. ~ SEPTIC ADSORPTION
Address TANK FIELD WELL
Phone(s) Permit NO. No. o~ 8~oom~ WELL
~- [J~ ~-0~-- LOT LINE
LEGAL DESCRIPTION
Townsbip. Range. Section
AS-BUILT DIAGRAM tShow Iocabon ol well. septic system, pxoperty hnes. foundabon.
TANKS
~ SEPTIC ~ HOLDING
Uanulac[urer Capacity i~
Material NO of Compa~ments
TYPE OF SYSTEM
~TRENCH ~BED ~ W. DRAIN ~ OTHER /
Depth to p~pe bottom from ~otal depth from obgmal grade/
FIll added above original grade Gravel dept~ beneath p~pe
Gravel length ~ravel w,Otb ~/ ~ I
~ ~ FT ~ ~ FT I
Nur,,beroihnes Sollratlng / '" ~"~/'
. leer
wms I '
~ PRIVATE ¢ OTHER {,dentifvl / ~ .~L
O~ss,ncanon (A,B,C~ Tom Depth Cased to
RE~ARKS:
~ / ~1 ~ ~ ~ Inspections Pedormed by:
Cedlly that 1his Ins~on was peflormed accordm9 lo 8l[ ,,'
Heallh Department Approvah ~ Date:
72-013 (3/85)
I CE:I::/T I F: ¥
Tom Fink,
Mayor
Ntunicipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
December 15, 1988
Tobben Spurkland, P.E.
203 W. 15 Ave. "C" Suite 203
Anchorage, AK. 99501
Subject: Permit application for Lot 2 Blk.3 South Park.
Dear Tobben,
The permit application submitted on 12/12/88, for the subject
lot, will not be processed until additional water monitoring can
be completed. Past experience in this area suggests that water
levels can raise substantially in mid to late Spring.-
Per AMC 15.65.040.H.5, this office will require water monitoring
through May 31, 1989 or the high water cycle, should that occur
prior to May 31. Verification of water level subsidence will be
necessary prior to issuance of an on-site wastewater permit.
Should you wish to discuss this matter further please don't
hesitate to come by my office.
Sinc~ellz, ~/
Daniel lq. Bolles
On-site $orvices
cc: A1 Sundquist, P.E., Manager On-site/Water Quality
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PER FORMED FOR: ~'~-//
LEG^'- DESCR,ET,ON: /,
1
2
4
5
6
7
8
9
10
11
12
13
14
15
16
17,
18-
19-
20-
~ Ft-o ~4 0 F-
SLOPE SITE PLAN
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~)
DEPTH? p
E
Oeplh to Water Afler Date' [ ~/L'~ l
Mort tor nD? ~N, kO .
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN '~/~'[ ~FTC%AN~D __ FT
ACCORDANCE WITH AI~L STA~E AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DA~E; ~-~t~-~ ~, J ~ ~- t~l~'~
72-008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
8
9
10
11-
12
13
14
15-
17-
18-
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
BoTT'o ~ o ~
OF ANCHORAGE
pROTECTiON
~ 0 t988
SLOPE
(E~GiNEER:S, S~EAL)
Township, Range, Section: -[- i,I ~ ~ ~'~ C ~ ~
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
Monitoring?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN FT AND ----FT
COMMENT~EC ~ IV ID
/"'? %
PERFORMED BY: ~2~'~Z~'~W I ~-~''~~ CERTIFY THAT THIS TEST WAS PERFORMED IN
/ -
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFF~C~ ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Adchorage, Alaska 99519-6650
343-4744
January 9, 1989
Gary L. Erber
1125 Orca Street
Anchorage, Alaska
99501
Subject: Lot 2 Block 3 Southpark Subdivision
Permit #880270, PID #020-052-73
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of Decembe'r 31,
1988.
Permits are issued on a calendar year basis by authority of
Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system
not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this Department for documentation of the installation and to
close the permit.
If a private engineer inspected the installation of the
on-site sewer .system, ~tbe original as-built inspection report
(three-part .form) must be sent to this office for review and
approval, and for documentation.
When applying for a new permit, the fees are: $90.00 for
an on-site sewer permit; $50.00 for a well permit; $140.00
for a combined sewer and well permit.
If there are any further questions, please call this office
at 343-4744.
Sincerely,
Daniel J. Roth
Acting Program Manager
On-site Services Section
DJR/ljw
enc: Copy of Permit
..:.46 1
[:,'ar'c:,~.~] :lld: 0;.~:'.0.--052-?:3
Lot
Sec t :L on
Lc~t S:ize ;270()C~ (sq. PL,, or ac:r'es)
Flax B(.:,(,dr'ooms~ This [::'(~.p~J,'~.; z} 'Jotal Capacity~
'~ ' LL~.,::i sei::,Lic 'Lank capaci'Ly,~ I. ?,5~ qa].].on!s. Eac:h sep'Lic
ch.- i .~[., i'AiqK~ ffJii]imum ~'~"'
~., :~. ~ ~. ~' have at ](:~aS'L ~:~ comp~Ptn~ents. Dep'Lh 'Lo top o~' sep'LJ.c: 'Lank(s) '(
.l:Nisi~:fi i ['[:::R ENGINE[LRS DESIGN. NO'I"IFY DHHS PI::~]L:ii::,'. I'0 EACH
i fi',;',q ;:~ ;;~'; ~ ~:', F:'ERM]:T EXF:'IRES 1::?./3:i/88,, A NEW PERMIT W]:I....L BE
Id.b~UIRED AF'IER 'II'IF~'[ DAI'E Zl::~ SYSTEM ZS NO'f llqS'FAL. L.ED. OBTAZN
]. C'Ii}-:RT I F:Y 'I HAl ~I
For'th by the Municipality of Anchor'age (MOA) ~iiiiJ 'l;l'l~) Stat. e oF
2, :[ ~,,~:i].]. :i. nsts].l Ll"llc~ sy~'l:.~am ~n ac:caPdance ~,d.'Lh a]..I. MOA c;odes and
ar'id :i.n CiCiIiI? ]. J, ai3C~i ilJ.'~,13 tl"l(a CIc~s:ig]i"i c:r'ite)Pti, a of this per'mi'L,,
.5,, :[ ~.,xi.].]. adhere 'Lo ali MOA and Sta'l:.e o( Rlaska pe)[;jlr.tJ.l,eillerl'l:,~F~ t'C)t" t.l"l,:~] ~set. back
s(,:w,x.~?l'~ag(~ sy~iT, em chi 'Ll'iJ, sop aF/y acJ.jac:eryL (::ir' r'leal'by
L i..il'ld~}l"SL~lid '[.hat LliJ. s p Ed" fil J, 'L :LB valid F(Jm a max:imum of 4 bedm:)oms~,
aJs(::) ur'~d~l',~,'L, and tl'16~.t, Lhe c:aj:)ac:J.'l'.y o~ L[-iia~ 'Lo'La], ~ys'l:.(~m ~.~s 4 bedPooms and
SOUTHPARK
SUBDIVISION ADDN. NO. 2
I.(~
,5'Z .C
I
179.7G,
~ NSo° Z~' 60,,W
F
.J
PLOT PLAN
GASfAI D! LAND SURVEYIN6
lei'l' A. Oaskaldi,R.L.S.
13et. Lies Bay Loop
/\ncborage AJ. asi<a 97515
lei. 907-3h/I-h272
GR ID [)Al E
F, B. JOB NO,
hereby cerlify lbal I have surveyed
properly depicLed above and lhal
lbo proposed improvements and drain-
age pakleJ['ns are as sNown hereon.
J.s ll~e responsJbJ1~l.y o1' Lbo ov~ner~
r.tor Lo conslruclJ, on, lo ve~'iry the
)osed buildJ, ng locakion on
~rade and ulJlit:y connecl.tons and
Jelerlui. r]e Lbo exisLence or a.y ease-
IllellLS~ coVellSflLS; or res[l'].cl.[OllS
~ldch du nol appear on lbo recorded
subdiv~sJ on plaL.
//
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3-
4-
7-
8-
10
13-
14-
15-
16-
17
18
19
2O
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
O~GAN I
(ENGINEER'S SEAL
Township, Range, Section: I 11 ~.~, ~ ~ ~ ~c_~
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth Io Waler ADec' ~ f I
Monitoring? . ~ 9ale: 0 ~
Gross Net Depth to Net
Reading Date Time Time Water Drop
'/hUgo °
,5~ r>~ ~ / ~o
~p ,d' ?.~ .~. / o
PERCOLATION RATE -~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN .~ FTAND ;~/~- FT
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Benjamin Schiller, P.E.
(907) 522-7773
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. #
1. GENERAL INFORMATION (M~st be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Lo(' 2, I'?(o~l~ 3~ .5o,~ P,,,~- ~1~ ~ z
Location (address or directions)
(b) Property owner - [fl ~1~ [~~~X
Mailing Address [/~ ~r~
(c) Lending Institution ~ ~
Mailing Address lot ~,
Telephone: (home)
Telephone
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here [~, if hold for pick up.)
List contact person and day phone number below: ..
2. TYPE OF RESIDENCE
Single-Family [] Number of bedrooms q'
3. WATER SUPPLY
Individual Well [] Community [S~ Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
5. 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 th is'
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 compliande with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
NameofFirm I~[~zh/-~f 7~c~,~'t¢~/ _Cc, c._c Telephone
Address /
Date
6; DHHS APPROVAL
Approved for ~ bedrooms by
Approved ~, Disapproved
Terms of Conditional Approval
Conditional
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work,
72-025 (Rev. 7/88} 8ack Page 2 of 2
~ ?RAUGI~ICIPALITY OF ANCHORAGE (MOA)
ici p ~ ~.i,,ID~..~CHO R ~.
~uH ,r;-,m~.v ,, . ,,upRllh Authority Approval (HAA)
~Nvt~ONM~iCES P v ~ECKLiST. FEBRUARY 1984
- .EP 27 1989
RECEIVED
A. WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
343-4744
Legal Description: ~,¢' ~ ~//':'~,
Date Completed
Depth of Grouting
If A, B, C, D.E.C. Approved (Y/N) T
Yield
pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (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
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments p ~==(~ (~ ~-~¢r oJC ,5~/,~ / ~.~¢¢
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date
B. SEPTIC/HOLDING TANK DATA
Datelnstalled '¥/¥,/<~:~ Size 15'¢'~',,~ No. of Compartments
Standpipes (Y/N) ~' Air-tight Caps (Y/N)
Depression ove~' Tank (Y/N) J"/
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-We:ter Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
Foundation Cleanout (Y/N)
Date Last Pumped
N, ~. ; for
N, ~ Temporary Holding Tank Permit (Y/N)
TO Water-Supply Well ~ '8~,6"
To Property Line ~ ~ '
To Water Main/Service Line ~ '~''
To Stream, Pond, Lake or Major Drainage Course~ ~ 4o~, '
Comments ~'~,~' r_~,~,~-~ u(,,,4g~t'~'" ~,~,..Co~-,~/'~ ,P~¢~ ~4~
To Building Foundation ~C'O '
To Disposal Field ~ (o '
/~1,
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~/q { 6'9
Width of Field
Square Feet of Absortion Area ,¢ ~fC
Depression over Field (Y/N) /Y
Results of Last Adequacy Test /~, ~.
C~'/~¢(r~-, Type of System Design
Length of Field 5' -~
Depth of Field fi' '
Gravel Bed Thickness '
Standpipes Present (Y/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well .~ ~c.'~"
To Building Foundation Nd '
Lot /~,
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Property Line /o '
To Existing or Abandoned System on
; On Adjoining Lots '~ .7o '
To Cutback (if present) ,~,A.
To Driveway, Parking Area, or Vehicle Storage Area > ¢-'
D, MFT 8TATIO~
Date Installed q/Y {~ Dimensions
Size in Gallons I¢¢ ~/ ~( ~ Manhole/Access (Y/N)
"Pump On" Level at ~ (~ EY "Pump Off" Level
HighWaterAlarmLevelat ~ F~t¢/;h~~ ~4 Vent(Y/N)
Tested for N,A-. ( n
Meets MOA Electrical Codes (Y/N)
Comments 6zCr'~teOf o10
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA .g&¢¢~i~ in effect on the date of this
inspection.
Signed ~~ ¢ ~
~ ................. ~, ........ ¢ Engineer's Seal
=o, '"'"'""'
Receipt No, ~/~ 5 g 3 /~ Receipt No
Date of Payment 9~- ~
Waiver Fee: $
Amount: $ / ~.0~ Date of Payment
72-026 (Rev. H88) Back Page 2 of 2
ANCHORAGE/WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
563-6775
DATE: Se t 2
PWSID: 213475
Requested By: Mr. Moore
According to the records on file in this office, the South Park
Terrace S/D Water System is in compliance with the
State of Alaska Drinking Water Regulations.
Sincerely,
Cindy Thomas
Environmental Engineer