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HomeMy WebLinkAboutSOUTHPARK #2 BLK 3 LT 10krcev uaivcu i a/ Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221031 PID Number: 020-502-08 Dwelling: ■❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade Name LIVESEY, CHRISTINA ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 4670 SOUTHPARK BLUFF DR, ANCHORAGE AK 99516 ❑ Other Phone 907-229-0804 Number of Bedrooms 3 l� Total depth from original grade GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe infrom original grade Ft. Gravel depth beneath pipe Ft. Subdivision SOUTHPARK #2 Block Lot 3 10 Fill added above original grade F Gravel length . Ft. Township Range Section Gravel width Ft. Beds: Number of Line istance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. betwee enches From Tank Field Tank Line Ft2 Well >100' N/A N/A NIA N/A TANK R1 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity GREER 1000 Gal. Surface water >100, N/A N/A N/A Material PLASTIC Number of compartments 2 Lot Line >rj` N/A' N/A N/A NA Foundation >i u N/A N/A N/A TATION Manufacturer Capacity Remarks Gal. Alarm location Electra tailed by Installer PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield NORTHERN EXCAVATING Drainfield N/A CO/MT NSA Inspector L.TIDWELL BENCH MARK (Assumed elevation) 100 ft Inspection 15` 3/2/22 3/2/22 Location and description 3`d 2�a 4,„ BOTTOM OF SIDING AT THE NW CORNER OF HOUSE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF A4 Conditional Approval: Date � • • �tP��� *: 49Aw TM •*� I •�-?i •1� • r Septic Syste ,� Appro ��E :3— 12Z • Benjant -, chiller �� �F�; • CE 12592 • ����� #o �srF9• Lv� Date�`� 3/9/22 , •��C�.� lkk, , PROFESSIO \- Note: this approval does not include well permit requirements. krcev uaivcu i a/ SOUTHPARK #2, BLOCK 3 LOT 10 PERMIT # OSP221031 PID # 020-502-08 \ \ LOT 133 / LOT 12 \ / WATER LINE ENTERS FROM FRONT OF PROPERTY LOCATION IS APPROXIMATE CNG 1 NEE RI NG ,d 1 �' 1 %�P�••� • Ali w:49- • ,,,,, Benja i Schiller Ir�Fc�JT� . CE2592 w9/22 .•����`�� �ti®`�PROFESSIONP�` NEW 1000 -GAL SEPTIC TANK W/ 20" MANWAY PLAN! AS -BUILT 0 40 80 FEET 111=40' 10' UTILITY EASEIVIENT LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEAN( FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LOT 8 GP / / A B MH1 35.9 16.0 / SV1 34.8 18.9 2C0 1 33.6 1 19.6 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEAN( FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE SOUTHPARK #2, BLOCK 3 LOT 10 PERMIT # OSP221031 excixeca�xc PID # 020-502-08 PROFILE AS -BUILT (NO SCALE) . ; �. .......... • ' • • • • • Benja' Schiller ' CEs 22 •'C��F`� t�1�®� PROFESSIONP��.`'d 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: OSP221031 Work Type: SepticTank Upgrade Tax Code Number: 02050208000 Site Legal Address: SOUTHPARK #2 BLK 3 LT 10 G:3236 Site Mailing Address: 4670 SOUTHPARK BLUFF DR, Anchorage Owner: LIVESEY CHRISTINA Design Engineer: FORGE ENGINEERING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date l�zent- G llepartment 2/11/2022 2/11/2023 Lot Size in Sq Ft: 26798 Total Bedrooms: 3 ❑ 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 Veronica Pope Received By: GE 2022.02.11 10:05:03 -09'00' Date: Issued By: Date: '0 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. 020-502-08 Property owner(s) Christina Livesey Revocable Trust Day phone 907-229-0804 Mailing address 4670 Southpark Bluff Drive, Anchorage, AK 99516 Site address Same Legal description (Sub'd., Block & Lot) Southpark #2, Block 3 Lot 10 Legal description (Township, Range & Section) Lot Size 26,798 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) IN (w/wo ADU) Septic Tank ❑X Upgrade FX -1. Duplex (D) ❑ Holding Tank. ❑ Renewal ❑ 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: -#22 Date of Payment: a 1 D 202,2 Receipt Number: 7 3� Permit No. 051 ZZ 10 - 1 Permit App_::- : Waiver Fees: Date of Payment: Receipt Number: Waiver No. February 8, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 2/8/22 Subject: Southpark #2, Block 3 Lot 10 – Southpark Bluff Drive Septic tank replacement Dear On-Site Services Engineer: The septic tank at the subject property has reached the end of its life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the new proposed tank location. No conflicts exist between this proposed septic tank and any other well or septic system, whether on this lot or adjacent lots. This lot and adjacent lots are served by a public water system. The new septic tank will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic field and property line. The water line is located greater than 10’ away. Please refer to the attached plan page 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 OSP221031, Rebecca Carroll, 02/11/22 Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=40' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND SOUTHPARK #2, BLOCK 3 LOT 10 FEET 0 40 80 NOTE: THIS LOT & SURROUNDING LOTS ARE SERVED BY A PUBLIC WATER SYSTEM. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. NO SURFACE WATER WITHIN 100' OF SEPTIC. SO U T H P A R K B L U F F DR I VE 3-BDRM HOME 2/8/2022 LOT 9 SEPTIC AREANEW 1000-GAL SEPTIC TANK w/ 20" MANWAY MAINTAIN 10' MIN FROM FOUNDATION & 5' MIN FROM PROPERTY LINE 2CO DECOMMISSION EXISTING SEPTIC TANK PER UPC EXISTING TRENCH TO REMAIN IN SERVICE 10' UTILITY EASEMENT WATER LINE ENTERS FROM FRONT OF PROPERTY LOCATION IS APPROXIMATE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221031, Rebecca Carroll, 02/11/22 JUN. 13. 1'993 9: 55AM 3 HASc L 'N;.,� �. 'N0. 3403 ?, 1 PaA 4 j r 'te,.key*,C � YY �s �Off* 149i.!► Asia � .. Kari tow W f.�r It is th onsibil y` '*he .owner to determine ' . .� n P',,, the existence of any easemto�tS p- 6yboants, or re- `t '' 144*0 p� w •....•..•moo stricticns whit do not appear on''tFie%recorded sub- �� saror+u. ,�•• 4-division plat. Un r no circumstances should any j. OTS • aH THOSE•' data hereon' -6' : 'used for construction or for es b- TS OF RECORD OTHER THAN lishing boundary or fence lines.. The surveyor takes SHOWN HMEo WN ON THE �t:coAdeo �+T, ARE Mor responsibility for the initial transaction only..%., . .• LE6EW_Q LOT BLOCK�/� ,9 MASS eAr MONUMENT 14011 PIPE ,�/�'T f''f-�C�✓ 1�,�i�( PLAT'M0. 0 �Aors ANCHORAGE RECORDING DISTRICT o M14 A TACK 1EPAmE0" ar. DOWUNG a ASSOCIATES 1426 HYDE%? STREET I t ANCHORAGE ALASKA 9/�9/5�/01 REVISION 8Y1 J / SCALE: / �7 M ��K.SLS^ GRi DS 7� /~X~X MUNICIPALITY OF ANCHORAGE /~, ~.~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~k ~Jll ~ '-~ ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE 0~© ~W ~re~ ~J C~l~ 5~ ~'~ ~ ~ ~ ~ UPGRADE MAILING ADDRESS '~oo w 3q~ A~ LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS Iw~g m Ab~o.p,ion4~. Dwelling PERMIT NO. DISTANCE TO: ~ ~ . ~ ~ ~O ~ ~ ¢~ ~ z Manufacturer ~ Material ~ No. of compartments ~ ~ Liq, capachy in gallons Inside iength Width Liquid depth [oO ~ IF HOME.DE: -- ~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ Manufacturer Material Liquid capacity in gallons Q Well Foundation Nearest lot line PERMIT NO. Length of each line Total length of lines Trench wMth Distance between lines No. of lines [ ~ ~--~ ~O'~ inches ~ ~ Top of tile to finish ~rade Material beneath til~ Total effective absorption area kenflth ~[dth Depth PfiBMIT ~0. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ 31ass Depth Driller Distance to lot Jine PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER I // ,j~O REMARKS -~/~~' ~ ~- ~ · ............ / S-/24/8~ ~v~p~dcgdd* 2 81o~1~ C~l~'~t,~ hl LZ:[)l'qT¢lr_':T! F"HEfi'qEi' ;_~!.x~-$'-".%.~.E. ::. T ] f t(';I< ',: I Fr rq 'i'.' I.!:!]',! MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 90B01 264-4720 SOILS LOG - PERCOLATION TEST ~ SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: 3 4 6 10 12 ~4 17 18 19 20- COMMENTS ~:~,,' [ '"~1 / PERFORMED BY: ~)~-r-~ 72-008 (6/79) SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) , FT AND __ FT ~..~.z ~.~ IOO MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-502-08 1. GENERAL INFORMATION Expiration Date: 2 5 "Z© z3 Complete legal description Southpark #2 B3 L10 Location (site address) 4670 Southpark Bluff Drive, Anchorage, AK 99516 Current property owner(s) Christina Livesay Revocable Trust Day phone 907-229-0804 Mailing address Real estate agent 4670 Southpark Bluff Drive 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ❑� Water Storage ❑ Holding Tank ❑ Community Well ❑■ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ S -G-0 Date of Payment 3 1 o ao D.2 Receipt Number 0S 9 11) 71) COSA # 05G 2,21( aO Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 3/10/22 i*•'•TM�:9��� 6. DSD SIGNATURE: �.: / . .. System #1 Approved for bedrooms �% Benjam'rvSchiller1292 / System #2 Approved for bedrooms r��T•. C310522 • ��,,� Disapproved �iF�PROFESS10Na���� Conditional approval for bedrooms, with the following stipulations: 0F (4 By: J Get Original Certificate Date: s The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Southpark #2 Block 3 Lot 10 Parcel ID: 020-502-08 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 "ELL DATA ❑ Well log ' ed 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 Class A Community Well B. TANK DATA Age of tank(s) <1 years Tank type/material Plastic Measured operating fluid level in septic tank New R Standpipes/foundation cleanout per record drawing Date of pumping <1 Year Old D. ABSORPTION FIELD DATA 5' Wide Trench Which system tested (date installed) 8/18/85 MR ALL standpipes present per record drawing Total measured depth from grade 7 ft (max) Measured depth to pipe invert from grade 5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 2' F0_1 Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet 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) Arse _ ug/L ❑ Arsenic less than MRL (ND) Collected by --- Date of Sample STATION ❑ Required aintenance completed Age of lift station ears Lift station material Comments: Adequacy test date 1/25/22 Results 21 Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 533 gal New depth 1 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date N/A E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes Community Sewer Manhole/Cleanout > 100' ft Q✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' F✓ Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100'✓Q Animal Containment > 50' ❑✓ Yes if No ft if No ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M Yes if No ft 0✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' R✓ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100'✓Q Yes if No ft Water Main. 10' . - I _ , . _E,(] Yes if No ft Community Wells > 200' r7l Yes if No ft Water Service Line > 10' �✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes it No ft If absorption field is under driveway comment below Property Line;?. 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ® • • A/ c,�- :49'M . Benjani r�chiller . �� �'Fc •. CE 12592 Amp' �� /�lF�•, 3/10/22 •�c�C\�®® Lot 13 \ � r Lot 12 s� �6• Lot 16 '°sem oo, \MANHOLE \ 10' T&E SEPTIC PIPES EASEMENTS heti � /i r Lot 11 �`o �� ° 4.0'x6.0' DECK r� o' 2.0'x10.7' CANT 3.7'x4.0' DECK \ / SEPTIC r-1 \\ x tKtj~ PIPE 5263 ! RDOG RUN \� 2.0'x4.6'CAN 7 0. C� 9 . 1.5' CANT 3.1'x3.5' DECK ry0 K \PNp�i DRIVEWAY tKLot 9 �0(/ �s L® 98 S.FF.. , 0 ,os \ n \ NOTES: 'r� \ 1) DUE TO SNOW & ICE COVER, SOME SURFACE LEVEL FEATURES ARE APPROXIMATE. \ 2) THE LOT IS SERVED BY A COMMUNITY WATER SYSTEM. PLOT PLAN --_ AS BUILT _X_ SCALE _1"__50__ GRID — SW 3236Project No. 22-114yR1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Long & Associatesinc. (907) 522-6476 Phone g (907) 522-4625 Fax OF ��0�� Professional Land Surveyors ken0langsurvey.com jonothan®langsurvey.com �'`� ' o P. ��S Op I hereby certify that I have surveyed the following described property: ©� •� LOT 10, BLOCK 3, SOUTHPARK SUBDIVISION — ADDITION No. 2 (PLAT No. 83-213) * 49TH �* �Q 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 LAN premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the p �f' LS— 202. • JQ Day of —_ LA—Lz l _, at Anchorage, Alaska 4O F�,o �o� - ------•--------� ----- 40oROFfSS10NAL 1A4 It is the responsibility of the owner to determine the existence of any easements, �Opggqa�' covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 Parcel I.D. # MUNICIPALITY OF ANCHORAGE' DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING NAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) owner'-. Day phone .... Lending agency.- .,. Ma!ling address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well ~ Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: X Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~)25[Rev. 1t91) Front MOA#21 5, STATEMENT OF INSPECTION BY ENGINEER As ceitified by my seal affixed hereto and as of the validation dat~ m ~'vn below. I verify that rriy investigation of this Heal.th AuthorKy Approval application shows th£t[ the on-site water supply and/or wastewater disposal system is safe. functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEEEIN6 Phone Gq/-/ Name of Firm ]7934 ~a~le-l~fwr Loop if, cad No. 304 Address Eagle River, Alaslca 99577 Engineer's signature "?~/ZT~~''~, / /h,¢ Date DHHS SIGNATURE Approved for "~-///'( EE Disapproved. Conditional approval for bedroor-, bedrooms, with the following stipulations: Additional Comments By: ~:~Z-" /,Z-", ~ ~(-"Tz' Date 7 ~ ,Z - ¢] ~' __ The Municipality of Anchorage Department of Health and Human Sendces (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent prefessional engineer registered in the State of Alaska. The D H HS 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. 1/91) Back MOA#21 RECEIVED Municipality of Anchorage III1~1 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ~UNICIPALI1¥ OF ANCHO~'~r~.I~) 825 L Street,, Room 502 · Anchorage, Alaska 99501 · (9(~1~;~J/~4'~14sERvIcES Health Authority Approval Checklist Legal Description: Lo7- Io ~.~c~ 5o,/r'///,,¢,~- ~-'c_ ParcelI.D.: 0;~O -- ~-{"~- - ~' A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number ~. ! ~ ~ 7 J'- Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production Date saet~mple: Date completed ~ Cased to Casing hei~ve gr~d) __~Wi~ly protected (Y/N) FROM WELL LOG ~ AT INSPECTION g.p.m. Nitrate Other bacteria g.p.m. Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 5"//;~'f/'~$~ Tanksize Foundat on p eaneut (~N) 'Y'f' $ Depression (Y/~) Date of PUmping r~. ¢/~' Pumper I C. ABsOR~TION ' ' ~: FIELD DAT~ D t II Soil rating (g.p.d./ff~ o . ~ ~ System ~pe 7 ~ Lengt?; ~:~ ' Wiath '," ~ Gravel thickness below pipe ~ TOtal depth Effective:ak~Orption ar~-~ - ~ ~r Monitoring Tube present'N) ~J Depression over field (Y~ ~ O Date of adequacy test G/~/<~ ~ Results(Pass/Fail) P'~'f-f For Fluid depth in absorption field before test (in.); ~ Immediately after ~ gal. water added (in.): Fluid depth ~ ,/~u (ins) Minutes later: A O Absorption rate = 1y ~0 W .g.p.d. bedrooms Number of Compartments ;A C ean0uts(~/N). High water alarm (Y/~). ~v Peroxide treatment (past 12 months) (Y/N) r 72-026 (Rev. 3/96)* If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) ~ High w~ *Datum Cg~ff-tested E. SEPARATION DISTANCES Size in gallons , "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewe~~ Lift station SE'[CARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ,5" 'P Property line ~' 'P' Absorption field Water main/service line I 0 '-~ Surface water/drainage / o 0 -/~ Wells on adjacent lots On adjacent lots __.---------"~ic sewer manhole/cleanout SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line /O 4- Building foundation /O ',/ Water main/service line Surface water / o 0 4- Driveway, parking/vehicle storage area Curtain drain N o ,v~. K' ,vd ~ ,¢ Wells on adjacent lots /0 F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal record._sC~f.~fe ~f~Dt~e ~ are in conformance with MOA H~ guidelines in effect on this date. Signature ~~ ~ c- . HAA Fee $. ~ (~ ~)'' O~ Date of Payment g/~ ~/~ ~" 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY 264-4720 Application Date >,y£4-//d 7 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) q 7o ,, P -Z (b) Applicant Name /~'~/4.,-~z4~"~z Telephone: Home Applicant Address Business (c) Applicant is (check one): Lending Institution []; Owner/bui~der.,~; Buyer []; Other [] (explain); (d) Lending Institution Address ~ ~.¢-~ ~'¢ (e) Real Estate Company and Agent Address Telephone (f) Mai[ the HAA to the following address: TYPE OF RESIDENCE Single-Family~[~ Multi-F~y. [] Number of Bedrooms ,~.~) Other WATER SUPPLY Individual Well [] Communi{~/J~ Public [] Note f commun ty we I system, must have Wr ti~n confirmation from the State attesting to the legality and status.. Department of Environmental Conservation 4. SEWAGE DISPOSAL ' ' ~ /. , Onsite/J~( Public [] Community [] H~)lUing Tank [] /.. Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA i-A AND INFORMATION ,,i: - As certified by my seal affixed hereto and as of the varidation 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 in,.Spection. ~.~. _ .,~ Name of Firm '"~--'~&.~_.~,~ ~7~- ~ ~ Telephone Address / ~ ~ ~ ] ~ ~ Date 0 ~ ~/t ] ~ ~ Engineer's Seal Approved ~ Disapprove~' Conditional~ Terms of Coh~dittonal Approval .,.li:t :. ,~ , CAUTION The Muncipality of Anchorage Department of Health and Environmental protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in p~ra~aph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a c0urtbsy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: /-or WELL DATA 1~gCg~~g~l~ Well Classification ~_.}-~N-~''--~ ,'~ Well Log Present (Y/N) If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) 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 ~,,;,'~ o To Nearest Edge of Absorption Field on Lot ~",2,¢ ~ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Size 1¢A-¢,~ No. of Compartments ~"'~t~O Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) ~ Date Last Pumped 10/'~.'1/op-~:~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: TO Water-Supply Well To Property Line ~-~ To Water Main/Service Line ;for Temporary Holding Tank Permit (Y/N) . To Building Foundation To Disposal Field Course Comments To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72 026(11/84} ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date taste,ed Width of Field 5 Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field / Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot 1~ (~ ~/L~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (il present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that ha~ecked, verified, ~conformed to all MO,~ and,HAA guidelines in effect on the date of this inspection. Signed "'~7-~~~ Date / Company MOA No. Receipt No. /OC.~ Date of Payment Amounts ' ~'~ Page 2 of 2 72-026 (11/84) Engiaeer's Seal · ~ CONSULTING ENGINEEP,. i'ELEPHOtTE: {907) 279-391 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOT 10, BLOCK 3, SOUTH PARK #2 LOCATION: OWNER: 4670 SOUTH PARK BLUFF DRIVE EGGERT RESIDENCE: WELL: SINGLE FAMILY, THREE BEDROOMS COMMUNITY, CLASS A SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP. 1000 GAL. ABSORPTION SYSTEM: WIDE TRENCH ABSORPTION AREA: 260 SQ. FT. SOIL RATING: 85 INSTALLATION DATE: MAY 24, 1985 OCTOBER 21, 1986. ISSACS NOT TESTED. SYSTEM LESS THAN 2 YEARS OLD TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH FOUR FEET OF COVER AND WITH 47 INCHES OF LIQUID. CLEAN OUT TO TRENCH WAS SEVEN FEET DEEP AND DRY. SUMP WAS NINE FEET DEEP AND DRY. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not 'give any estimate of how' long the system will continue to meet the operational requi- rements of the Municipality and. State. . oF. 4,,_ MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTmeNT OF HEALTH AND ENVIRONMB~rfAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name~p~-~ l~.~ ~t~: __~Telephone - Home~-----~-Business~-~_~2_~--~ Applicants Address ~oO Oo 3 _~J~ ~b~z3~f/ (c) Applicant ~is (check one) Lending Institution ~ ~ 0wrier/builder Buyer ~ ; Other ~ (explain); (d) Lending Institution ~O_~w~- ~f~D~% ¢~, ~Ciq/_~ Address ~~t_ ~ [~- d~-- (q) Real Estate Co. & Agent :C~ f~_~f\-L,~f~e ~ Address - ~00 ~ ' ~C~, ~ ~,-~ ~ O~ (f) Telephona_~_~q.-©~ Ch Mail the HAA to the following address: '2. ~ype of Residence Single-Family~ Number of Bedrooms 3o Water Individual Well~ e 'Multi-Family~ Other (describe) Community~ Public~S~ Note: If community well system, must have written confirmation from the State Department 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] Engineering Firm Providing Insp_ections~ Tests, File Search, Data and. Information As certified by my seal affixed hereto and as of the validation date sho~m below, I verify that my investigation of this Health Authority Approval shows that the on-site wa~er 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 ~,~th all b~nicipal and State codes~ ordinances, and regula~ ~ions in effect on the date of this inspection° Name of Firm~A~~~/~-~d~'~/'c~'~ Telephone ,3'~/-3-~z/'0 (ENGINEER SEAL) DHEP Ap_22~oval Approved for~__~bedrooms Approved _~. Disapproved Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF NEALTH AND ENVIRONMENTAL PROTECTION (DREP) ISSUES tlEALTR AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFES%IONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. TH~ DHEP DOES THIS AS-A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL ~ND STATE REQUIRE- MENTSo 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 2] 7-19-84 ]~DU.gglO~lcl 1V.[N:~WNO~IIAN~ '~ HIIV)H :10 A. ~'~ Well Classification Well Log Present (Y/N) ¢J/~'- Date C~ompleted ~/,4- Yield Total Depth f'~/~r Cased to MI,~' Depth of Grouting Static Water Level ~/~ Pump Set A~ : Casing Height Above Ground 4)/~r Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) /~//¢'~' Depression Around Wellhead (Y/N) Separa~tiQn Distances from Well: To Septic/Holding Tank on Lot '~,~¢0 ! ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot '~c3! - ; On Adjoining Lots TO Nearest Public Sewer Line v..J/,~. To Nearest Public Sewer Cleanout/Manhole /'g/~,- To Nearest Sewer Service Line on Lot Water Sample Collected by /~,]/r' ; Date Water Sample Test Results ¢'JfA~ ! Comments .~"E,n. J4~..-.,~ ~ ~/E~.~ ~ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal De.scription:. ~'?//I/X'~°'~'6~ IfaD, C, DEC. Approvedl~N) / SEPTIC/HOLDING TANK DATA Date Installed Standpipes~N) ' Depression over Tank (Y~ Size /¢c,o N~/of Compartments Air-tight Caps ~'4) Foundation CleanoutCN) Date Last Pumped ;for /'0/~' Temporary Holding Tank Permit (Y/N) ~J (,,4' To Building Fouhdation /~$ ~' To Disposal Field /43 / To Stream, Pond, Lake. or Major Drainage Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distance~ from Septic/Holding Tank: To Water-Supply Well To Property Line TO Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84} · C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata [)ate Installed · Width of Field Square Feet of Absorption Area Depression over Field (Y/~) Results of Last Adequacy Test Separation Distance from Absorption Field: 'Fo Water-Supply Well .t- "~oo z 're Building Foundation r~O'" Lot ~ ,~¢r- To Water Main/Service Line -/-.2.0 · 're Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ~.~'.;~ ~' Depth of Field ~ / Gravel Bed Thickness ~,"' Standpipes Present ~) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots q' To Cutbank (if present) +1oo/ Comments D. I.IFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for '/~"2//,'/¢ IElectrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~¢'~'~'~ 'Date Company ~L~_~ -- MOA NO. Receipt No. ¢~'~'~ Date of Payment ~\~.~ Amount: $ Page 2 of 2 72-026 (11/84) DEPT. OF ENVIRONMENTAL CONSERVATION / ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 RILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the ~/~[~ ~ Water System is in compliance with the State Drinking Water Regulations Sincerely,