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Home My WebLink AboutSOUTHPARK #2 BLK 3 LT 21kmuv Uaivu ion Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201210 PID Number: 020-502-19 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name MICHAEL &JILL GOULD ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 15621 JENSEN CIRCLE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SOUTHPARK #2 3 21 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line FtZ Ft. Well 200'+ -- 25'+ TANK lZ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Tank insulated & installed 5'+ to deck supports. Alarm location Electrical installed by Installer NORTHERN EXCAVATION PIPE MATERIAL House to tank 3034d a n k to 3034 Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspect ectioes: 1s 8/19/2020 2na 8/20/2020 Location and description 3r 4'h BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL \ lk Conditional Approval: Date r�Q••' .t�',f.� 00 " ' • ' • ' • ... • / ' • • Curtis Huffman Septic System Approved - q Date l ��2� 1 �'• • �. / F�, • CE 128991 ��slF�•. 8/24/202p.•�� ,1iF�PROFESSIONQAP -� Note: this approval does not include well permit requirements. �W� kmuv Uaivu ion PID:020-502-19 PERMIT:OSP201210 FIRST WATER CONSULTING SOUTHPARK #2 B3, L21 rtiPAap, DR/V Q) ---------- 10'x 20'T & E Easement 20 a 0 Cb 0 LOT 22 0(§) Cb LOT 21 Septic vent (typ) 2.2 OH 0 cp 0\ Manhole -6-1 2.0 OH QQ 61 cv Ret. wall 0 es t-010 U,� rile �~ �.; '. '�� 2 `�'` � • ) 0 lb': C? lee 0 CP Shed encroachess 1.8'± (51® ra Lot 23 CP 0CP V-3 T 9 0 0 "ek A r of Lot 20 RECERTIFIED 8-25-20M9�,_t6'� '%'0' AS -BUILT NO CORNERS SET THIS DATE 4411p I hereby certify that I have performed a Mortgagee's inspection (:)F A •in accordance with ASPLS Standards of the following described property: LOT 21, BLOCK 3, 4qth,&F SOUTHPARK SUBDIVISION ADDITION No. 2 00 a '10 0 alp 11! a 0 00 7 a 0 46 0 Elizabeth Walatka 0 a a00 0 go 8036 - LS §7 MV 0SSSIONAI- 4%, *.., %% % XXN:*4.- Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN le _e 0 .0 V MIS 11th day of JUNE 'e-ue- 0. THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON. BE907-248-1666 Engineers and Surveyors UNLESS OTHERWISE NOTED F13 20-3, pg 20-21 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. 7/10/2020 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020-502-19 Property owner(s) MICHAEL & JILL GOULD Day phone 9072423884 Mailing address 15621 JENSEN CIRCLE, ANCHORAGE, AK 99516 Site address 15621 JENSEN CIRCLE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) SOUTHPARK #2 133, L21 Legal description (Township, Range & Section) Lot Size 21336 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) X❑ (w/wo ADU) Septic Tank FX Upgrade FXDuplex (D) ElHolding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A 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: ZI NS' 7 5 Waiver Fees: Date of Payment: 0a D Date of Payment: Receipt Number: $-00 o Z Receipt Number: Permit No. ne adl aIo Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com July 1, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: SOUTHPARK #2 BLOCK 3, LOT 21 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1250-gallon HDPE tank o serve the existing 4-bedroom residence. The lot and area are served by public water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201210, Rebecca Carroll, 07/09/20 FIRST WATER CONSULTING SOUTHPARK #2 B3, L21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201210, Rebecca Carroll, 07/09/20 SOtJ HPqR , �L �o USF D R/ve � p 10'x 20'T & E Easement 20° �b O Q b �-iJ LOT 22 CIO maw LOT 21 t�� Septic vent (typ) q9 O a 2.2 OH 0 CP 2.0 OH 3O 6'2 T .O to 2 CSS d Ret. wall �''� y< 2 0 •a 00001. 10 o Y) 00 r.3 Lot 23 s N37°22` 1311E 132.13 Lot 20 o� OF �► • • • • 0 6 '# o. '•'QS �, r Crj . 49th .y � lizabath L. Walatka ��,� • • 8036 - LS • • r • s �46" A• • •• s s • • �® A W �Essloo�NR� i SCALE: 1'"® 401 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 21, BLOCK 3, SOUTHPARK SUBDIVISION ADDITION No. 2 Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN this 11 th day of JUNE 12020. THOSE SHOWN ON THE RECORDED `' _ ',' 2,00V -HOS S O �FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON. BE Engineers and Surveyors UNLESS OTHERWISE NOTED FB 20-3, pg 20-21 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. · ~., MUNICIPALITY OF ANCHORAGE , · ~ ' DL ~TMENT OF HEALTH AND HUMAN SEE ,£S Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Na,.e DISTANCES Jo ~ ~ ~/~ ~ ~ "~ ~~ TO SEPTIC ABSORPTION WELL Address FROM ~ TANK FIELD Phone(s) Permit NO NO of~ om~ WELL Township, Range, Section ;C, ~ ~[/~ /~ ~--~--~ AS-BUILT DIAGRAM (Show locat,on of well, sepgcsystem, propertyhnes, loundat'on, driveway, water bodies, etcd TYPE OF SYSTEM ~TRENCH ~ BED ~ W. DRAIN ~ OTHER or,g,nal grade ~ ~ FI ~ Fl/ / /~ FdJ added above original gcade ~ Gravel depth beneath p~pe Installer Date Installed % ..... %~ ' WELLS ~~ ~ PRIVATE ~ OTHER (Identify) REMARKS: - :: 72 013 (3/85) O? ! :I. 0 ,/..~!:::'F~ L I C AII'4'i-: CON'I'¢:~C;T r"hLhq[S. J OHI',.! HAGME t EJ:;: 2204. CL..IFZVEJ_(~I'41] AVE]. 24.8--.A7S? OL:i:I::'TH -I'0 F:'iF'E: BDI"'I'CJM (F'I".) ':.-~. 0 A,, 0 5i. 0 ...... :'o'-' ..I 0 = [~ .->. 0 ~:,P:HL, iZ.L :0L., lh (F"I.) 4,," [ f'OTAL DIEF:'T'H (F'T.) 9. (::).. ~ A ,, ~"~ 8 ,, 0 GR(~VE:L.. I,,j ]Z ):)'f'l"'l (F:T.) 2.5 2.0 ,, 0 f5 ,, 0 E')R¢~VfE[,. I.ENGTH (Iz' 1'. ) A4,, 0 3fi?. 0 AO,, 0 E;RF~VEL VCJI_UPiE (CU. YDS. ) 2. A,, 7 ;?[% 9 38. ~? TFMtIK S ! Z E: ((3AL.S) X I, [:?.50 ,, 0 -x-.~4. ]., 2Z;0 ,, 0 ~-e 1,250 ,, 0 '?~' SC) IL. RF?I"ING (S(;).F"f'. /BR) 127 127 :1.~'7 -x-..'-s TAN,k: PfUST HP~VIZ Al' I_E¢~ST TWC) CCiMF'¢~RTMENTS {cra'Lb by the ML~n~c:iF:,a!:i.'Ly oF Ar~c:horage (MOA) and I'..l'l-~ State oF Alasl<a. i t.~J.;I.], irlst.~:~ll the) ~y~st:(~m ir'~ ¢~c:ccmd~:~nc~s, t,,,it.h ~/:~:1.:1. MOA C:OdE.:S ~:u'~d in ccxnp!is, nce v,~:it.h tt'm~ design c:l"it~-~r'~a c:,F this pe)PmJ, t.,, any (*>:,n:!)xrgc~m(~ent, ~*¢i].:t. i"(.:~qL.~ir'~) ~U'~ ?ach::i:i.'L:i. onal ]: F' f-'~ 'i'HEi]g I/J]ZLI.. 1~I[3)" BL::_' (4PF'I:H3VE) i!EL. IEETI-FR I C:FIL. NDI;RK S :t: E)NIED I.,]:F'T EN'AT]iO!xi IS !NSTAL. I,.E[D IN AFl AREA COVE'.'F4ED BY MOA BUILDING C[)DEES, (!) AN IE!.,.IECTRIE:,/-~L F:'tERMIT ¢iND I!'4SPI~%TIL]N ML',ST' BE OBTAINED; (2,) AS-.BUILTS W!THOL!T AN EL. ECTF:..'IC(>&_ :I:N.SF'E:CT'IC)i',I REPDI:Cf'; P-dqD (3) T'FfE ~Y A LICENSED IELE:CTFi'.IC]:(-~N. ] ..,-'t JL..t_ 'lx ¥' P.O. B~.~ 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES June 23, 1986 John Hagmeier 1399 West 34, Suite 103 Anchorage, Alaska 99503 Subject: Lot 21 Block 3 Southpark Addition #2 On-site Sewer Permit #860019 - Issued January 24, 1986 On May 20, 1986, The Anchorage Assembly approved a new ordinance regulating on-site wastewater disposal systems (septic systems). All septic systems constructed after the effective date of this ordinance are subject to the provisions of this ordinance. Our records show that you currently hold a permit for the installation of a septic system. We strongly urge that you contact this office prior to constructing your system. Any changes in the code that could impact the construction requirements of your septic system ~ill be identified and brought to your attention. Please contact the Environmental Services Division at 264-4720. Thank you for your cooperation° Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/SSM/ljw unicipalitYof P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-:~a~ 4744 TONYKNOWLES. MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES February 9, 1987 John Hagmeier 1399 West 34th Avenue, Suite 103 Anchorage, Alaska 99503 Subject: Lot 21 Block 3 Southpark Subdivisions#2 On-site Sewer Permit #860019 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of January 24, 1987. Your permit expired on the date of issue basis by authority of Municipal ordinance existing at that time. A new permit must be obtained from this Department for any well'and/or on-site sewer system not installed by the expiration date. The new permit will come under the calendar expiration date as per the new Waste- water Ordinance (effective May 20, 1986). 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 the original as-built inspection report (three part form) must be sent to this office for review and approval, and for documentation. If there are any further questions, plesae call this office at 264-4744. R.W. Robinson Program Manager On-site Services RWR/ljw enc: copy of permit DEF'ARTMEN]' OF: HEAL'FIq AND ENVIRDIxlMENTAL F-"RO'I"ECTIDN 8~5 L., STREET, ANCHORAGE, AK 9950 264 -.~,c72'.0 F:'ERM I "I" bio: EL 6 ')" 1. 9 ):}A"I"E I ,:~:~L~}:I.) 01./24/'8~ ' AF'F'L I C:ANT ~ JOHN HAGME I ER AD-~)RI'Z':SS: 1399 WEST 34TH SUITE 103 (alq CI'-'IOIRAGE~, AK 99503 338-,-63:Z;6 CONI"ACT ~ F ,])NE L. EGAL ):_lE~L,r~..f. LDT S! ZE: :SUBDIVISION: SDUTHPARK ADD t$2 SE[};-FI[]N." 3 TOWNSHIF": 1:tN 21:3:57 (SQ.FT. OR ACRES) 4 . LOT: ~.1. RANGE: 3W sys'L.,em., Chc~c, sc-'c, the op'L!.on t. ha% best f:i.'Ls yOLU' ~J.'l:.~:'-~. Lhe optiorls available) to you :i.n designing youh sept:i.c: DIEF:"T'FI "['(::i PIF:'E BE]T'TDM (F'I-.) 2.0 GRAVEL. DEF']'H (FT.) O. 5 'I-oTAL DEP'T'Fi (F'f'.) :Z. 5 GF~AVEL. WIDTH (FI-,,) 22. () GRAVEL. LENGTH (I:::'T'~) 42~ 0 GRAVZL., VDL. UfqE (CU.YD~) 34.3 ]-ANI< SZZE (GALS) :1.,~:50,,0 ~..~- SO]:I. RATING (SD.I:::'T. /BR) 152 · x--~- DI::::F:'TH .... TO PIPE BOTTOM < ...:,"", ,.~=' FT. ,,L(..UIRE.~Z':' 's " ' :~ IblSUL. ATIDN x-.x. DIEJF'TH TO F:']:PE L,D~IJI-I < 4,C> F'T. MAY RE(2t..!IRE A LIF']' STATION I-,.,.A,..,ITWO COMF'ARTMENTS '~"~ TANK MUST HAVE .AT I cer't:i.~:'y t I,=~t.~ I. I am famiiiap with the PeqLlil"Ez~lerl~LS lop Ol]'-sit6~ sewn}ms and wells as set for:th by the liul zc..Zl_~;.~zLy oF Ancnor=~ge (MC]A) and tine State of Alaska; 2%, Z ~¢i].]. ~nstaI]. 'Lhe system in ac:c::opdance NJ. th all I"10~ c:ocle~ and i',agLiJ, ations~ ,}11]{:J J.n C;Ofiip],:i.¢~riC6~ *~J.t.h the design cr'itepia of th:i.s perm:i.C. 3,, ]: will adi"~epe 'Ko ~].]. MOA and St.~'Le of AZa*ka r'ecluiPem~nts for' the set back d]..:~..~,c.~=,~, from any e>~:i.s'Eing well, wastewater disposal system or' publi(: set4epa~je system on 'Lh:L~ or a"y ad.jaEef'Yk or nearl::~y lot. z].,, ]: t..UqdE, r.s~t~&r'ld tJqat this j:)er'~Rit ;Ls va].id fop a fllaxil~L.t~l of 4 I:)edr'of3ills a'irld any en].arg(emcant ~i:l.], pecluir, e an adclJ;tic)nal pepm:J.t. "T'HEIxI' WILL. IxlE)'I- BB AF'F'ROVED WITHOUT AN EL. ECTRICAL INSPECTION RE£F'OR-F; Ei:L.EC"I'R !CAL. NORK i"iUSF[ BE DONE: DY (1 I.,..ICENSED ELEC'TRZC-T~I',I. S I GNE~:D I..]!F:T STA'I-]:ON IS INSTAL.LED IN AIq. ARI:ZA C[).~:.nED"' k/'-~''''- BY MOA BUILDING CODES, (1) AN ......... C,FC[LAL PERM:IT AND lI,Io. Ft::.L, lION MUST L.~: .LI~..IA.I.N[:D~ C2.) h,:r [UIL. F,.: ISSUED BY PERFORMED FOR: .JoAn Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: (ENGINE~ SEAL) DATE PERFORMED: 2~- ~4~ /~Sg Township, Range, Section: SLOPE S'ITE PLAN DEPTH? Depth Io Wal~ I¥1onitorieD? WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT '%' __G~o~E ~ Net Depth to Net Reading "'"~Ba~ Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN FT AND __ FT COMMENTS ~.~o, I ~bt>/ ,~- 7~0 ~ ,"S ~/,3~.z//? /--~.¢¢~ 4:Y¢- I/~5'-~'/,~' PERFORMED BY: /¢ -~'~'~ S'F 2 ~; O ;Z¢- I _~¢-~-¢-/~'~¢¢-¢'"'~~ ' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT/~ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH'&. HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: ~ ~'/~ (ENGINEER'S SEAL) ,~ /-.2( Township, Range, Section:~c $ 4 5 6 7 8 9 10 11 12 13 14 15 16- 17- 18- 19- 20- COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~) DEPTH? p E Oeplh to Water After Monitoring? Dale: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN __ FT AND FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT/ON THIS DATE. DATE: ,~ '~ ~¢'? ~'J'~' /~/~;~' 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: (ENGINEER'S SEAL) LEGAL DESCRIPTION: 1 0t-. o5~, ~,~ ~'c 2 4 7- 8- 9- 10--- 11 /bL 13- 14- 15- 16- 17- 18- 19- 20- Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross ~Net Depth to Net Reading ~ _~im~ Time Water Drop ~lq ~o I 3I COMMENTS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: '~ '~- A ~/t~"J J ? E,~ ~ Mumcipalit~~ of Anchorage DEPARTMENT OF HEALTH. & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: (ENGINEER'S SEAL) LEGAL.DESCRIPTION: /--r~,~/ ~'~'~ ,~4'~ ~'k "E='? T°wnship' Range' SectiOn:sLOPE 1 6- 7 8- 9- 10- 11 13- 14- 15 16- 17- 18- 19- 20- SITE P~_AN [ WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 0eplh to Water After Monitoring? _ Date: Gross Net Depth to Net Heading Date Time Time Water Drop I +~>o I-I~ ~'.i~ ,.~ o.~-o ~ ~.p~ ~ ~ ,~ , PERCOLATION RATE '7- ~ (minutes/inch) PERC HOLE DIAMETER ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: f -iG'~G / 72-008 (Rev. 4/85) MUNICWAUTY Oil" ANCHORAGE Development Services DepartmentPhone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-502-19 Expiration Date: Jt�Ae 1 , 019 1. GENERAL INFORMATION Complete legal description SOUTHPARK #2 BLOCK 3, LOT 21 Location (site address) 15621 JENSEN CIRCLE, ANCHORAGE, AK 99516 Current property owner(s) MICHAEL & JILL GOULD Mailing address Real estate agent Day phone 15621 JENSEN CIRCLE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Private Well ❑ Water Storage ❑ Community Well ❑ Public Water System Public Sewer Day phone TYPE OF WASTEWATER DISPOSAL: Private Septic Holding Tank ❑ Community ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ q 1-Z 5b (CoV I h -1 Date of Payment Receipt Number Z S 2 n/ COSA# 0 5 C "15( 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN PE Date 8/24/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject toOF A -Slli these various and dynamic characteristics and are outside the control of the evaluator of the � li well and septic system. Therefore, any estimate of how long a system will function satisfactory ��®��Q: • • • • �„� �� for current or future occupants or guarantee that no unseen encroachments, deficiencies or . discrepancies exist can be given by First Water Consulting & F{;S . , TH • :. ` ••: P � ...::�.. i� 6. DSD/SIGNATURE Curtis Huffman 1 V System #1 Approved for bedrooms CE 128991 System #2 Approved for bedrooms ��F��'ROFESSI40kv � .� Disapproved Conditional approval for bedrooms, with the following stipulations: �ll(ttf- A.l(( 1% Ori -SITE G� 1�7 Z5r SNATMATER o PIROGRAM By: CLrU` Original Certificate Date: I 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 Legal Description: SOUTHPARK #2 BLOCK 3, LOT 21 Parcel ID: 020-502-19 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA – PUBLIC WATER Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA – NEW TANK PENDING INSTALL Age of tank(s) 0 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW Standpipes/foundation cleanout per record drawing Date of pumping NA C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/17/1986 ALL standpipes present per record drawing Total measured depth from grade 7.3 ft (max) Measured depth to pipe invert from grade 3.3 ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date 6/19/2020 Results Pass For 4 bedrooms Fluid depth prior to test 13 in Water added 700 gal New depth 22 in Elapsed time 1350 min Final fluid depth 12 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies: 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 if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 if No ft Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I 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. 8/24/2020 ~ MUNICIPALITY:~F ANCHORAGE' , , (~l~) DE~ARTMEN71' OF HEAI-TH & ~,UMAN SERVICES ~ ' '". Divisiori. of Enyir0nment~l;S~'viee$ On-S te Serv ces Sect On P;O. Box,196650 Anchorage, AlaSka; 99519-6650 - . 343-4744 ' -' - CERTIFICATE OF HEAL?H AU'[HOREFY APPROVAL F~R ,~ SINGLE F~MjEY DWEL~LING .~l I.D. # ~)--'-'-'-'-'-'-'-'-'~-~'~ - I~ S ~q "' GENERAL INFORMATION ' Z. I, '6. ~'..;:.- ~o~/~?~'/~ Comp. le~te legal description -T'IIN'', & ~W. ' ..... :--'"':"' ' ' ""' "' Location (site address or directions) Property'o'wner. Mailing Lending;:~:en~/ Day phone Day phone Mailing address Agent ~¢-JF' '~-~ I Address ~,2-0/ '¢__.' '~-/'~-~-{' Day phone Unless otherwise requested, HAA will be held for pickuR: .~ ... , NUMBER OF BEDROOMS: z~ "V, 3, TYPE OF WATER SUPPLY: · ndividual well Community, well Publicwate~ ' -· -' NOTE: If community well System, provide written confirmation from State ADEC attest- ,, /ng,to the legality'and status.of system...' 4. TYPE OF WASTEWATER DISPOSAL: · ., '.- , '" .. ' ' L .:-: · ~, '- : ~. : ,, ' ~-,¢..,. . ~:;- I~.~&.;. ._~, ;:: :' :. · Hodngtank.'. : ' - ' Public'seW¢[-'. ' : ' ' · ,, . ' ~'~:~ NOTE ' If communit~'wastelwate~?.ystem '~rovide w~'itten confirmation ~rom State ADEC sTATEMENT OF INSPECTION. BY ENGINEER ' h'" ':i' As certified by my s'eal affixed hereto ,and as of the validation dar6 shown b~10w, I verify that my investigation of this Health Authority ~pproval application shows that the on-site water supply and/or wastewater disposal system is safe, functional andadequate 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 Municipa~ and State codes, ordinances, and regulations in effect.o~'th~ d~.i6' Of ibis inspe(~i'0n. Address Engineer's signature ~~ Date DHHS SIGNATURE APproved fo~' : bed~;0brh'§; ' " Dis&pproved ' '~ ":" ' ' Conditional approvaPfor "'~:' b~dr/5oms; w~th the following sbpulat~ons: Additional Comments '" Date ~'he Mu~i~ip~tiity of An~)rage Department of Health and Human Services (DHHSI issues Health Authority Approval C~.,:iificates based only upon the representations given in paragraph 5 above by an independent erofessional enginee!' registered in the State of Alaska. The DHHS does this as a courtesy zo purchasers of homes and'their lendingin§titdtions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct ihspections or analyze data before a certificate is Issued. The Municipality of Anchorage.is no! responsible for errors or om'ss~ons in the professional engineer's,work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: '/--o'/L ~-I, BI~__, 3, ~l~o,r'~-7~..Parcel I.D. A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing h e~,~ / Wires properly protected (Y/N) / / FROM WELL LOG AT INSPECTI/~ / MUNICIPALITY OF ANCHOP~AGE ENVIRONMENTAL SERVICES DIVISION Well flow ' g.p.m. / Pump level1 .. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot / ; On adjacent lots Absorption field on lot / ; On adjacent lots Public sewer main / Public sewer manhole/cieanout Sewer service line WATER SAMPLE RESETS: Coliform Date of s/ B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) g.p;'n~.R 0 8 1994 RECEIVED High water alarm (Y/N) Petroleum tank Nitrate Other bacteria Collected by: Tank size / .~ ~0 Foundation cleanout (Y/N) Date of pumping ~-~J. Compartments 2. '"i/ Depression (Y/N) Alarm tested (Y/N) -- Pumper ~T"~/~_~ ~' SEPARATION D STANCES FROM SEPTiC/HOLDING TANK TO: Well(s) on lot -- To property line '~' / Surface water/drainage On adjacent lots 2~0¥' 'J~ C.~t~,~.~ w~,//Foundation ~" 5" Absorption field Water main/service line 72-020 (3~3)' Front CONTINUED ON BACK PAGE C, LIFT STATION Date installed Size in gallons Vent (Y/N) - High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer -- Manhole/Access (Y/N). -- "Pump off" Level at - .Cycles tested -- SEPARATION DISTANCE FROM LIFT STATION TO: Wellon lot ~ On adjacent lots -- Surface water-- D, ABSORPTION FIELD DATA Date installed Length ~/g ~'7-' Width Total absorption area ~.~ Date of adequacy test Soil rating (GPD/Ft2) /~'~ ~7-~ """~- - '~ ~ Gravel thickness ,.~ ~'" Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Cleanout present (Y/N) Results (pass/fail) System type ~-f' Total depth ~ c// "~. Depression over field (Y/N) ~,Ars S for z~ Bedrooms /~"~ Aftertest 12, 5# ~ Il yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot -- To building foundation On adjacent lots Sudace water ~ On adjacent lots ~ -I- F'T:'. Property line /O / To existing or abandoned system on lot - Cutbank '-' Water main/service line Driveway, parking/vehicle storage area ~'~ / Cudain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ Date of Payment Receipt Number ..~'.~,~.'. ooo , 'o ',~,9.~ ~.~ ~.%-~ ~ A %%G'~ ~ 9h ~,b~., "% o~' 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 .~¢ '-- ¢ ~'~" GENERAL INFORMATION {a) Legal Description (include lot, block, subdivision, section, township, range) Location (address 9r directions) (b) Ap'plicant Name ,/,~ 'Y~,~,'~z~-,',-- Telephone: Home Applicant Address ~ Zo~ C/ev~,/~,.,~¢f /'¢~'.e.~..~ (c) Applicant i's (che~;k'~ne): Lending Institution []; Owner/builder//~ Buyer (e) (f) Address Real Estate Company and Agent Address Business ,,~- i,. ; Other [] (explain); Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Sing~e-Family,,J~ Multi~yI-I Number of Bedrooms Other WATER SUPPLY ~) Individual Well [] Communit 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:/If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72~025 (11/84) Page 1 of 2 ,5. ENGINEERING FIRM PROVIDh-,,.~ INSPECTIONS, TESTS, FILE SEARCH, D~,, A 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 an d/or wastewater disposal system is safe, fu nctioaal 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 Address /2~oo Date /' o/¢~/I~'~ . Telephone DHEP APPROVA~,~~ ApProved for Approved _~ Terms of Conditional Approval CAUTION The 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4726 Legal Description: WELL DATA Well Classification (~c"~ ~ ~q ~ ~,- I~ A, B, C, D.E.C. Approved ~J) 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 J Water Sample Collected b.y.,--~~ Water Sample T~e~ults/ ~',~ ~'~/"~c ~/ Comm~ Depth of Grouting Pump Set At Sanitary Seal on~s' g~(Y/N) Depression~r~und Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date SEPTIC/HOLDING TANK DATA Date Installed ~'-/~ Size / ~ 5"-~) No. of Compartments Standpipes ~) Air-tight Caps ~) Foundation Cleanout ~N) Depression over Tank (Y/~,'~_ Date Last Pumped ,4/~ Pumping/Maintenance Contract on File (Y/N) /t/'/~ ; for /v~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~. C) C~ --/- To Property Line ~ ~ F To Water Main/Service Line ~ Cour~se ~,~z- Temporary Holding Tank Permit (Y/N) To Building Foundation ~2. To Disposal Field $~' To Stream, Pond, Lake, or Major Drainage Comments page I of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata ' Date Installed 9- /d' Width of Field 3 - 4// Square Feet of Absorption Area Depression over Field (Y/,~J'F Results of Last Adequacy Test V Separation Distance from Absorption Field: To Water-Supply Well 6; F To Building Foundation A~-/' Lot / Type of System Design ~""~- ~,?~ Length of Field Depth of Field _ Gravel Bed Thickness y Standpipes Present Date of Last Adequacy Test /v' To Water Main/Service Line ¢'/- ~-~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line /~? To Existing or Abandoned System on ; On Adjoining Lots ~7" .~o To Cutbank (if present) ./v' ~ 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 ,,'"' Manh? esC~s (Y IN) Jump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA Check Permitted Bedroom Rating Against HAA Request ** I certify that~._..¢l have checked, v_erified, or co?formed to all MOA and HAA guidelines in effect on the date of this inspection. Signed' ~,.~'-~y ~,~,'~"~'"~~, Date Company MOA No. Receipt No. ,~/ ~ OC,)I O 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 BILL SHEFFIELD, GOVERNOR 7'elephone: Address: 274L2533 DATE: October 8, 1986 PWS I.D.# 213475 To Whom it May Concern: According to records on file in this office the SOUTH PARK Water System is in compliance with the State Drinking Water Regulations Sincerely, ~Regional Sanitarian Supervisor ALASKA ENVIRONMENTAL CONTROL SERVICi'"'*'"INC. 1200 West 33rd Avenue, Suite B · ANCHORAGE, ALASKA 99503 (907) 561-5040 DATE ALASKA ENVIRON ~NIE~NTAL CONTROL SERVIC ?INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SCALE OF. OATE DATE ALASKA ENVIRONmeNTAL JoB ~/~.~;,r ~o '. ,' CONTROL SERVC ~ INC. ~.~ET.O '~'~ I Or ~ 1200 West 33rd Avenue Suite B ~ ~ ANCHORAGE, ALASKA 99503 CALCULAfED BY Phone 561-5040 CHECKED BY DATE ~ 22 21 25 O¢~Ac. 40 \ \ 0. $8Ac. 39 0. 56 Ac. \ ' ~ 38 25,3~/ SF ~ ~ b-$ Ac. ~ 68 Ac. ~ 192.13' 110. 0~' 18 0.$$ Ac. z~, 459 Sp O. 08Ac. 5 ~89°~0'3q,,6 33~31' · 24 ~ 20 z~,8~, s~ ~ 24 759 SF 0.$BA~. 0, $0 AC. /9 IO'ToI~. ~ ~1~. 28, 000 PF 0. GC Ac. 27 P. 74 Ac, 25 889 SF ~$ A C. 2~q. 13' 30 ~ 31 8~,, 000 SF 31, ,997 SF ~ 0.OO Ac. 0, 72Ac. 3 7,4~7 Sp ~.~$~c. ~ 150. 00' 25Z 09' 3b PS,, 8~3 SF 0.$9Ac. $87 °2p'Io~''IV pp, 080 SF 0. $I AC. 25, 050 $F I I 32 21, bb6 SF