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SOUTHPARK #2 BLK 3 LT 22
South Park #2 Block 3 Lot 22 #020-502-20 Municipality of Anchorage On -Site Water & Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number. OSP201199 PID Number. 020-502-20 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two single Family Project: ❑ New ® Upgrade Name: BRUCE GOUGH ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address: 15611 JENSEN CIRCLE "ANCHORAGE, AK 99516 ❑ Other Phone: No. of Bedrooms: Soil Rating: Total Depth from original grade: 907-240-6143 4 GPD/Sq. FL FL LEGAL DESCRIPTION Depth to pipe inven from original grade: FL Gravel depth beneath pipe: Ft. Subdivision: SOUTHPARK #2 Block: Lot: 3 22 Fill added above original grade: Grave glh: Ft. owns ilia: _Range: Section: Gravel widlh: �eds Fl- Number of lines: Distance between lines: Ft. SEPARATION DISTANCES Totalabsorption SC. FL umberofirenches: Dist. between trenches: FL To From Septic Tank Absorption Field Lift station Holding Tank Sewer Line Well N/A - 25'+ TANK ® Septic ❑ S.T.E. P. ❑Holding ❑ Other Manufacturer. Capacity: Surface Water 100'+ z N/A GREER 1250 Gal. Lot Line 5'+ rn X LLJ - - Material: HDPE Number of compartments: 2 Foundation 10'+ _ _ LIFT STATION Remarks: Manufacturer. capacity: Gal. OLD TANK WAS REMOVED AND DISPOSED OF OFF-SITE Alarm Location: Electrical Installed by: Installer PIPE MATERIAL NORTHERN EXCAVATION House to tank EXISTING Tank to dralnfield EXISTING/D3034 Inspector GEG, Ltd. Drainfield EXISTING CO/MT EXISTING/D3034 Inspection Dates: 1st 7/16/20 2nd BENCH MARK (Assumed elevation) 3rd - 4th 98.90 Ft. Location and Description: TOP OF MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date: ENGINEER'S SEAL OF�oQ�oo 'T ..... ........ a...... ..: ..................o Q f r/ Garn ,ss. Septic System: Approved: Date: o� I o�(J211 Note: this approval does not Include well permit requirements PP P q CE_ 795 ap(... �o�o` o0 LICENSE �� fess�aq #AECC884 Op;opo PERMIT NUMBER: OSP201199 AB PHONE NUMBER: FCO 43.6 4.9 907-240-6143 2 OF 3 MH 46.6 18.8 SOUTHPARK #2; BLOCK 3, LOT 22 ST 47.6 22.3 DATE: RECORD DRAWING DBL1 47.8 23.6 r DBL2 48.0 24.4 . RECORD DRAWING PARCEL ID NUMBER: 020-502-20 I SERVED BY PUBLIC WATER I — APPROXIMATE LOCATION OF WATER +. LINE PER AWWU RECORD DRAWINGS APPROXIMATE LOCATION OF WATER LINE PER AWWU RECORD DRAWINGS SO(/7NPgRK Q �R�VE 10'x 20'T & E Easement --k �' :r.:: e: •' `" -' . •' •_ EXISTING DRAINFIELD • DRIVEWAY•i.- d„ \ �d \ ST \ 0 v \ EXISTING 4 MH BEDROOM HOUSE FCO %Jn SOUTHPARK #2; \ BLOCK 3, LOT 16 \ SERVED BY PUBLIC WATER \ \ \ SOUTHPARK #2; \ BLOCK 3, LOT 17 \ %:: ENGINEERING ENGINEERING.. SALES CONSULTING„ . , ::.,..w.., 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 - PHONE (907) 337-6179- FAX (907) 33&3245' WEBSITE: w .gamesserdneenng.wm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: BRUCE GOUGH 907-240-6143 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: SOUTHPARK #2; BLOCK 3, LOT 22 P.N.B. TYPE OF WORK: DATE: RECORD DRAWING 7i?n/qn -CO & MT WERE NOT INSTALLED -NEW 1250 GALLON HDPE GREER TANK SOUTHPARK #2; BLOCK 3, LOT 21 GENERAL LOCATION OF WATERLINE. WAS PROFESSIONALLY LOCATED PER -APPROXIMATE KEYBOX LOCATION PER AWWU RECORD DRAWINGS (ATTACHED) PERMIT NUMBER: PARCEL ID NUMBER: OSP201199 RECORD DRAWING 020-502-20 TOP OF MANHOLE = 98.90 98.51-98.60 MH ST TOP OF TANK = 94.34 TOP OF TANK AT OUTLET = 94.33 INVERT OF BUNG AT INLET = 93.73 NEW 1250 GALLON H. D. P. E. INVERT OF BUNG AT OUTLET = 93.53 SEPTIC TANK .• y 0-1 ., Lt: ... .....• .... I.... -- - ENGINEERING�SALES�,C0NSULTING.w�, • 3707 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507 "PHONE (907) 337-6179' FAX (907) 338-3246" WEBSITE, ww.v gamessengineenng.com ••••• • w•.•... ••. ......•..u..� • ., PREPARED FOR: PHONE NUMBER: PAGE NUMBER: f A. arness : W a BRUCE GOUGH 907-240-6143 3 OF 3 fj�% ' C ' 4�s PROJECT/LEGAL DESCRIPTION: DRAWN BY:•�♦ •. �- ?•'� 4p SOUTHPARK #2; BLOCK 3, LOT 22 P.N.B. ♦ FQ•��p`•�•�. . TYPE OF WORK: DATE: ♦♦i p�FESS,�P RFCnRn nRAWINr 71gnrgn AI�EI.. ����IL's ►� MUNICIPALITY OF ANCHORAGE On -Site Water& Wastewater Program PO Box 196650 47OOElmore Road Anchorage, �(8O7>343790*Fax� Fax: (907) ' ' Permit Number: OSP201199 Work Type: SaoUoTankUpgnade ` Tax Code Number: 02850220000 Site Legal Address: 8DUTHPARK#2BLK 3 L 22 G:3236 Site Mailing Address: 15G11JENSENC|F|.Anchorage Owner: GOUBHALASKA ADVENTURES TRUST Design Engineer: GAFlNESSENGINEERING GROUP LTD This permit imfor the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 7/10/20 20 7/10/2021 171 Oiupuoo| FkaN 2 Septic Tank [] Holding Tank [] Privy [] Private Well 0 Water Storage M All construction shall be|naccordance with: i. 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 (18/V\C80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.G5. Provide notification bycalling (QO7)343-7SO4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall boeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated toprevent freezing Special Provisions: Please locate where the water line enters the house to ensure that the required separations are being met. Based on where the line enters the house, the water line may need to be located. Show the location on the Inspection Report. Received By Date: IssuedBy: �_ MUNICIPALITY OF ANCHORAGE s Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 020-502-20 Property owner(s) BRUCE GOUGH Mailing address 15611 JENSEN CIRCLE "ANCHORAGE, AK 99516 Site address 15611 JENSEN CIRCLE *ANCHORAGE, AK 99516 Legal description (Sub'd, Block & Lot) SOUTHPARK #2; BLOCK 3, LOT 22 Legal description (Township, Section & Range) Lot Size APPLICATION IS FOR: ( ® all that apply) Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Day phone 907-240-6143 Sq.Ft. Number of Bedrooms 4 APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: N/A TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature bf property owner or authorized agent) Permit/Rush Fees:����. �y Waiver Fees: Date of Payment: 6�6 Date of Payment: Receipt Number: Receipt Number: Permit No. -- - 05P00099 Waiver No. (Rev. 01/11) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201199, Deb Wockenfuss, 07/10/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201199, Deb Wockenfuss, 07/10/20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division� Y O �� 0 S__3 825 " L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT Name DISTANCES TI I M L N 5o" TO FROM SEPTIC TANK ABSORPTION FIELD WELL Atltlreas AddreisS(P i �S( G 1 Q Cl�� Phones) Permit Na. No. of Be ooms WELL _ �U LOT LINE -Z, PT10N LEGAL DESCRIPTION Lot Block 3Sub��ttivision �'' ! SO�t FOUNDATION , Township, Range, Section AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, driveway, water bodies, etc.) TANKS I Nc— SEPTIC ❑ HOLDING V Manufacturer Capacity in gallon s L "4610 J V ` Material No. of Compartm nts P� 71 J TYPE OF SYSTEMti(Z 7 g7 TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER V 60 71 Depth to pipe bottom from Total depth from4riginal grade original grade : 4.� FT FT iA rill added above original grade Gravel depth beneath pipe FT FT � 06, Gravel length r00, Gravel witllh °— met .s, to FT $� FT Total /absorption area J �r g�p'l amr- /fj SO FT Distance between lines FT Number of lines Soil rating Pipematerial SO FT - uG S 1 � In taller Date Installed WELLS ❑ PRIVATE OTHER (Identifvl Classification (A,B,C)Total Depth Cased to I FT FT Installer Date Installed: REMARKS: jj 6 �e m, Scale: ENGINET'S SEAL - 1`—, Inspections Performed by: Date: ! _ o - - �z � ^^Robot E. K of o> _f J I V, r j 1 �c C �..� certilV [hat this inspection was performed according to allF� No. 414 e c1 s °n r Municipal and Stale guidelines in effect on this dale: Health Department Approval: C Date: q/ 72-013 (3/85) PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910053 DATE ISSUED: 4/10/91 DESIGN ENGINEER:ROBERT KNIEFEL, P.E. EXPIRATION DATE: 4/10/92 OWNER NAME:RICHARDS BRIAN D & OWNER ADDRESS:15611 JENSEN CIR ANCHORAGE, ALASKA 99516 PARCEL ID:02005253 LEGAL DESCRIPTION: SOUTHPARK ADDN 2 BLK 3 LT 2 2 LOT SIZE: 21338 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 1 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE: �- �?-/I ISSUED BY: DATE: KEKNIEFEL ENGINEERING RECEIVED 8441 Miles Ct., Anchorage AK. 99504 APR 10 1991 (907) 337-1121 • Fax (907) 338-1874 lvurn:c! pCy _ �f a i�u�maant ePMces SYSTEM DESIGN GUIDELINES AND NARRATIVE Lot 22, Block 3, Southpark Add. #2 Subdivision ----------------------------------------------------- ----------- 1. System Design = 4 bedrooms x 85 sf/bed. = 340 sf 2. Five Wide Trench (three feet of sewer rock depth) Total Length = 4 bed x 85 sf/bed. / 5' x .58 39.5' length Existing length = 27.2 + (ends 1' x 2) = 29.2' This Addition = 10' of piped length, three feet of sewer rock below pipe bottom. 3. All materials, construction methods and required inspections to follow MOA rules and regulations. The contractor is responsible for notifying the Engineer and the MOA at least four hours in advance of all inspection needs. 4. Contractor will insure no additions or changes have been made to the location of wells and septic systems on the adjacent lots prior to the time of construction of this system. If any changes to those systems have occurred, the engineer should be immediately contacted for review and possible changes will be made as necessary. 5. A.n,y.. QR/.Ej...l 1 ... ..... m.a.ted,a..7....... W 11, ... ...,... be .re.mo ed........tQ t.h.e. .u.n.d.e.r1.y.i...ng 9.r..a.ye1 l..y....s.and.....m.a.terl..a.l.... grade..r....gny...pQ.rt.lQn......of . the ......tren.G.h._.a. ce..a..... 6. The lot is generally flat except for a roadway cutbank along the two streets. the cutbank is greater than fifty feet from the proposed extension. The installation of the system will have little or no effect on the surface drainage, ground water, or the adjacent systems in the area. 7. This project upgrades the existing system since the original field as -built was never found and the subsequent test hole at one end of the field led to the conclusion the field was not large enough for the four bedroom design. This design results from soils testing done April 4, 1991 as attached. This work will complete the requirements of the conditional Health Authority issued on January 9, 1991. OF Robert E. Knie No. 4149-E P,Q/rj(�r�e Ly -e 5 TIO oma �A&JC Ft�-� l SEwc� Z, r s IR C � , }_N� (� \ 0 tYh-y" v I rr. ii,.:.�eeaa .e. jyd• ,(baa a q "J e V u+ J4 aomeo• see++ .ueu n e Robart E. Kniefe @ 'tea++ No. 4149. 4o7 7 9( -veli ` SOcl OLi P/falC74 �s-1a /SZri JC,)St;;J Gly. p/1v --05`�- �3 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: /COI l t/V "-' V �L�i��! DATE PERFORMESN' LEGAL DESCRIPTION: L\ �L't 1/Township, Range, Section: 1 DI�l> Sv/(A'L��� �� •Z— SLOPE LSITE PLAN (FEET) �V" 2 M (� 2G 3 SfM D W Its S« i I f� 4 6 pp 7 �y 8 s 9 10 11 12 Q 13 15 4 15 16- 17- 18- 191 617 18 19 U 20 COMMENT ENCOUNTERED? S IF YES, AT WH L O DEPTH? P E Depth to Water Age Monitoring? Reading - Date Gross Net Time Time Depth to Net Water Drop O_fiD 4• g O !ate •— PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT �J IAJAA Pyt to Mh n N �.I..'t._ i rrr:4-UA-;)AvJ DT'- CO PERFORMED BY: Giv t.erLCL� I �N i,611'K'C� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: I V 72-008 (Rev. 4/85) ®f Anchorage POU' ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840325 January 31, 1985 T0: Permit Applicant SUBJECT: Lot 22 Block 3 South Park #2 Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. 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, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, � Keith E. Bandt, Supe visor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 MUNICIPALITY OF ANCHORAGE PERMIT NO: GATE I=SUED: APPLICANT: ADDRESS: 'CONTACT PHONE LEGAL DESCRIP LOT SIZE: MAX BEDROOMS: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION • 25 L STREET, ANCHORAGE, AK 39501 264-4720 -e-i-= _:EL4E FR w[ -=L I F�E=F-rl _ _r 840325- 05/0g/84 A. M. C. INC PO BOX 4-2882 ANCHORAGE, ASC 345-5813 SUBDIVISION.: SECTION: 2000 (SQ, FT 4 99509. SOUTH PART: -` a TOWNSHIP: 11N OR ACRES) . LOT: 22 RANGE: 3W LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING SYSTEM. CHOOSE THE OPTION_ THAT BEST FITS YOUR SITE. DEPTH TO PIPE BOTTOM ''.FT.) 4.0 4.5 GRAVEL DEPTH (FT.) 6.0 0.5 TOTAL DEPTH (FT.) 10.0 5.0 GRAVEL WIDTH (FT.) 2.5 16.0 GRAVEL LENGTH (FT.) 29.0 32.0 GRAVEL VOLUME (CU. YD=,.) 1.7.4 18.9 TANK. SIZE (GAL'S) 1,250.Q �:�: 1,250.0 _OIL RATING (SQ. FT. /BR) /x ,t") /� 85 l` +:r TANS; MUST HAVE AT LEAST TWO COMPARTMENTS BLOCK: 3 YOUR. SEPTIC 4.0 3.5 7.5 5.0 3-7.0 27.4 1, 251. O + tis I CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNIU_IPALITY OF ANCHORAGE (NOR) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. _. I WILL ADHERE TO ALL NOR AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL, WASTEWATER, DISPOSAL SYSTEM OR PUBLIC: SEWERAGE SYSTEM ON THI=S OR ANY ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THI_ PERMIT IS VALID FOR A MAXIMUM OF 4 BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOR BUILDING THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED? (2) WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND ELECTRICAL WORK MUST BE DONE BYOA LICENSED ELECTRICIAN. SIGNED A/ D_ . D,. _ 1. _ / DATE: nrr�iI n. n. :. •regi,/ ISSUED B`r'GQ�y DATE : -- '/ CODES, AS -BUILT=• (3) THE. MUNICIPALITY OF ANCHORAGE ae DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST 1w SOILS LOG ❑ PERCOLATION TEST P /9�r PERFORMED FOR: L7/AAp ✓nhrlSu—DATE PERFORMED: LEGAL DESCRIPTION: '�v�tti ya/A O �DLl< 3 Aor 2— E T SLOPE SITE PLAN ■■■Y✓!■■■■■■ 0ET Gross Time Net Time Depth to Water Net Drop FT AND FT (AV¢ra f Ve 1 I 01, 111Rni'C. 54" 1 rave( ■■SE■Z'� ✓Y 2 I DATE: �dPNIF .���. 3 I MEM-NO■■N 4 MEN EREMIEM—N.■■, ■ill■■lr■■■■■ 5 ■ all S i �e5 VI 6) Sone sb+gz�t,� ;,, piaaes o 5 Q Merck bowl des rubbles $-rams cr GRee-n cue San `� 7 0 8� 9 0 Ices ofi P Lni IA yCr ■■■Y✓!■■■■■■ Date Gross Time Net Time Depth to Water Net Drop FT AND FT (AV¢ra f Ve ■■■�■�■■I�r■■■■ rave( ■■SE■Z'� ✓Y PERFORMED BY: Uarc7 f�I�r__��,,OME DATE: �dPNIF .���. mwjwM■■■■■' rA■� MEM-NO■■N MEN EREMIEM—N.■■, ■ill■■lr■■■■■ ■ ■■■ON■■■■ ■■■■■■■■■■ ■ ■■■■■■■■■ c � e 10 Gs 0/0 WAS GROUND WATERS L 11 ENCOUNTERED? N O G 5i1 p 12 E IF YES, AT WHAT DEPTH? 13 20 Reading Date Gross Time Net Time Depth to Water Net Drop FT AND FT (AV¢ra f Ve rave( ✓Y PERFORMED BY: Uarc7 /j't 6 rr} ST is 4t 02y CERTIFIED BY: DATE: 72-008 (6/79) PERCOLATION RATE (minutes/inch) /� COMMENTS SD''! "�Yvv7 TEST RUN BETWEEN 37T i0 /O' wSvq/1 Yu7 er1- FT AND FT (AV¢ra f Ve rave( ✓Y PERFORMED BY: Uarc7 /j't 6 rr} ST is 4t 02y CERTIFIED BY: DATE: 72-008 (6/79) �4 s • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I. D. 020-502-20 1. GENERAL INFORMATION: Complete legal description SOUTHPARK #2: BLOCK 3, LOT 22 Expiration Date: 4O- I S_- 20�_2__ Location (site address) 15611 JENSEN CIRCLE *ANCHORAGE, AK 99516 Current Property owner(s) BRUCE GOUGH Day phone 240-6143 Mailing address Real Estate Agent 15611 JENSEN CIRCLE *ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Waiver/Variance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 141o' 50 COVib-1`i Date of Payment qi [10-2:0 Receipt Number COSA # 05 C 201H Q9 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: c3 — J o In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system = in accordance with the guidelines and regulations established by the Municipality of Anchorage and <,= _ industry practices. The reported results describe the condition of the system/s on the date/s of the h'< evaluation. Separation distances were measured to readily Identifiable features. Hidden defects or _ �• Mfr l I ✓ (_ :. / encroachments may exist that were not identified during the evaluation. The operational life of all wells % ;f ' ` 1 ', and septic systems depend upon a variety of variables, including but not limited to, soil conditions, ,: '•""""""""`.. groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and .. . .............. ...... are outside the control of GEG. Satisfactory test results do not guarantee future performance of the ;�.. / (: 1r ,'IS. system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system -. can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedroomsOF,gA,�O�/ _ ON-SITE _ bedrooms, with the followiril stipuIWATER AND m WASTEWATER - �1 Original Certificate Date: Zn?_ 0 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc Wal Legal Description: SOUTHPARK #2; BLOCK 3, LOT 22 Parcel ID: 020-502-20 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground)) Date of flow test for COS�k'' Static water at beginning of test ft. �'aments PUBLIC WATER Well production at time of test g Water storage tank volume gallons ill disinfected fo orm test? ❑ Yes ❑ No Col' acteria is Negative ate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample B. TANK DATA C. LIFT STATION Age of tanks) NEW years ❑ Required maintenance completed Tank type/material """"°`E Age of lift station year Measured operating fluid level in septic tank NEW Lift station material ❑ Standpipes/foundation cleanout per record drawing Comment Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) 1984? Adequacy test date 6/15/20 X ALL standpipes present per record drawing Results QPass For 4 bedrooms Total measured depth from grade **8 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade ***4,9+ ft (min) Water added 607 gal ❑ N/A — pressurized field **** 8 New depth in ❑ Monitor tubes go to bottom of effective. If not, state 120 depth into effective 316 Elapsed time min ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced n/a gallons If y n/a es, enter date Comments/Deficiencies: *10' OF ADDITIONAL TRENCH WAS ADDED IN 1991 **MT @ WEST END OF TRENCH "'CO @ WEST END OF TRENCH ""FIRST 193 GALLONS CAUSED A RISE OF F IN MT @ WEST END OF TRENCH. COSA Checklist yellow sheet 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' R Community Sewer Manhole/Cie > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Priva er/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 1 Yes Animal Containment > 50' ❑ Yes if No ft Yes if No ft Water Main > 10' ft Yes if No Manure/Animal Excreta Storage > 100' Community Wells > 200' Comm ewer Main > 75' ❑ Yes if No ft ❑ 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' QQ Yes if No ft Property Line > 5' '✓ Yes if No ft Wells on Adjacent Lots: My Absorption Field > 5' 0 Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' ft Yes if No ft Community Wells > 200' 0 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' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' Qv Yes if No ft Wells on Adjacent Lots: Water Main > 10' My Yes if No ft Private Wells > 100' [j Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' R Yes if No ft Surface Water> 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that / 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 #AECC884 J f ey—A_._G�ss,•' 49, : • CE-7953Ile 40�,pLr'o`f e s sioo°oc� #AECC884 a-0N� N C r 0 Ca a m `G c n( a -T _ v (T3J O C N �Fv D N N y x0@ m < m o. O N � m � CD a o o wa�o� N (D (D 0 C m, p a � c v am� oow,� °0CD c a j m o m o c a ° m N ? m N 3 N N o N a O CL a o D� N CCD N ° CD T (D Q y N ? co .a CD c to ID T CD a m m9 ON N =- a d N (D O C -o Fr 3 o rcu (D OC N N ClO p) N (D Dxj C 7 � o N C N 0 <, o c 0 � N � C m n m a o E; c a =)o,Q- 3 0 c O N 2 CO ? N 7 as N = N m In o - m C=4 m Nn N co O O O N : m 14 7 cr CD to c in � n' m 0 � a3 OCD A' N N N N, j. � m C -0 --1 m r D 0 cn c/)Dm00 � pm=z 20Qcn M°zo *=oma zzm0 -IOmXo 0 oo�o om m� or D Z u6C .C" N .9 j S v O \� - o 786 CD • 17(T W m 30 j-0 r+t p "'A10 e� 2 CD c 77 Oy LlmF .L a.o � ° jV O . c OD W N CJI A O N Nom+ ac ° mmcr"ac�)0-a ° 0 o Conm S. mm o J° 0 � CD ID �. 0. ° � m m o 3co � o =ate n D cn � o.� m 03 3��moN� Doom o Cho ° o m N n �O o r �p I - (n °'°o ca CD ° 0 0 0)o � Sap m D co - �-c roD 3 (Dcn m � 00 0 � 5 C 0�-< z O o(D N W x No I m (2.m CL cnN 3_ _� cn CJN�� O �.� `® `� x f -t ° m = c' o 3 � D � N � 0 Z �yc,�`j3� tCD=D D < 3 a 3 o m( O W m ®off• °so 0 -Di s XEn3�(D zp°v 8"aa P •��c¢ 3 � n a m°7 M Dnp Ohm �( o' <b m m mD CL co wN��(Dm C1Wo� 2 ° 6 gyp° .O r- �1® ( °CD N a o p (!(D 2-0 om Z N tio.° > m P k CD ° N O m N 0 SL ° o '���i� • �r ya ° d Atw (- o R _Rf. ° F 'tea+ OD W N CJI A • Municipality of On -Site Water and Wast (907) 343-7 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 020-502-20 Expiration Date: 1 2 1. GENERAL INFORMATION Complete legal description Southpark #2 BIQ Lt22 Location (site address) 15611 Jensen Cir., Anchorage Ak. 99516 Current Property owner(s) Todd & Teresa Loudon Day phone Mailino address 15611 Jensen Cir., Anchorage Ak. 99516 Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ I -A l l Iu Waiver Fee $ _ Date of Payment 10 It lea r,6- Date of Payment Receipt Number 63'1�_1G Receipt Number COSA# —0 5C_ Id. q5 a 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 Certif icate of On -Site System s Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Phone 272-8218 Address P.O. Box 100217, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone Date l7®0( 6. DSD SIGNATURE System #1 Approved for. bedrooms. System #2 Approved for. bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: /0 "J — 12 The unicipal o�r a Drage Development Sery ices Division (DSD) issues Certificates of On -Site Sy stems 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-1-12.doc If more than 1 septic system is on the tot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Southpark #2 BIk3 U22 Parcel ID: 020-502-20 A. WELL DATA Well type Public Date completed Total depth ft. If A, B, or C provide PWSID # A Sanitary seal (Y/N) Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate Arsenic: _ ug/L date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Well Log (Y/N) Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION ft. g.p.m. mg/L Other bacteria colonies/100 mL Collected by: Date installed Unknown Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 9/27/12 Pumper Northland Pumping Services C. ABSORPTION FIELD DATA Date installed 4/16/91 Soil rating (g.p.d./fe or ftZ/bdrm) 85 sfrbd System type Trench Length 39 ft. Width 5 ft. Gravel below pipe 3 Total depth 9 ft. Eff. absorption area 1207 ftp Monitoring tube Y Depression over field N 9/28/12 P 4 ft. Date of adequacy test Results (Pass/Fail) aSS For _ bedrooms Fluid depth in absorption field before test 28 in. Water added 624 gal. New depth 33 in. Elapsed Time: 1440 min. Final fluid depth 28 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N Absorption rate >= 650+ g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at —in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal Size in gallons �� Manhole/Access (Y/N) at _ in. High water alarm level at in. tested Meets alarm & circuit requirements? On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 200+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line11 0+ Curtain drain 50+ Surface water 100+ Wells on adjacent lots 200+ Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ F. COMMENTS *This system has used 80% of its operational life. 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. Engineer's Printed Name Steven R. Pannone Date / 2 /00S— COSA brown sheet 9-1-12.doc Municipality- of Anchorage Development Services Department _ Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. COSA # QSC, G / G Q ,9' Expiration Date: & — .0- S / 1. GENERAL INFORMATION Complete legal description Lo 22; Block 3; Southpark subdivision M2 Location (site address) 15611 Jensen C r. Anchorage, AK 99516 Current Property owner(s) ROW Monis Day phone 223-8188 Mailing address sart10 Lending agency Day phone Mailing address Real Estate Agent Day phone -'Mailing Address— Unless ddress— Unless otherwise requested, COSA will be held by DSD for pickup 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑Q TYPE OF WASTEWATER DISPOSAL: Individual On-site❑ Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm s a s Engineering Address 15861 S. Birchwood Loop Rd. Chuglak, AK 89567 Engineer's Printed Name Robert A. Shafer 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone M-2979 Date Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: W . / ✓f Original Certificate Date: n ' 5 (R« „IDS) Municipality of Anchorage • Development Services Department Building Safety Division • - -- / On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lcf-ZZ., ou{t\PNrk Z- Parcel ID: OZO-,S0 -?t7 A. WELL DATA i L (kSS Well type S(MJr\� F`� If A. B, or C provide PWSID # _Z3#Li7S Well Log (Y/N) Date completed _ Sanitary seal (Y/N) _ Wires properly protectf Total depth ft. Cased to ft. Casing heightSabdve ground) in. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESUL Coliform onies nic: _ mg/I 00 mL Nitrate mg/L ft. Other bacteria colonies/100 mL Date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA (� Tank Type/Material :5 ` C. I Tank size J2r0 gal. N tuber of Compartments '2 - Foundation Foundation cleanout (Y/N) Depression over tank (YIN) Date of pumping 1 O C. ABSORPTION FIELD DATA Date installed �i �/ *-Soil rating Date installed Wl k-na"Jrl Cleanouts (YIN) High water alarm (YM) Pumper A ler k 1kn d (g.p.d./ft2Cf ft2/bdrm Length 3e1 ft. Width 5— ft. Systemtype iSwiciw 4-C.1c� Gravel below pipe �_ ft. Total depth Q_ ft. Eff. ab orpti area 3416 fe Monitoring tube `I_ Depression over field __AL Date of adequacy test t / t) Results (Pass/Fail)—For bedrooms Fluid depth in absorption field before test 27 in. Water added W gal. New depthZI in. Elapsed Time: IS6 min. Final fluid depth Z S in. Absorption rate >= t; Oy g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) � A- If yes, give date D. LIFT STATION Date installed Size In gallons 'Pump on" level at —in. a at _ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on tot Absorption field on lot Public sewer main Sewer /septic High water alarm level at Meets alarm 6 circuit requirements? ?,JL (:,- On adjacent tots On Public sewer manholelcleanout _ Holding tank Anunercontainment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' f Property line =-t Absorption field S 'f Water main /A If Water service line to Pit Surface water /dd Wells on adjacent lots 'Z -00't SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line to i� Building foundation / O 'r Water main Water Service line d r ( Surface water CUO r -r Driveway, parking/vehicle storage O '� Curtain drain (i t/i.L kaww^ Wells on adjacent lots F. COMMENTS 1, X� (D y n P CJi k,A4tI k4PACA1 c JJeJ rn `l1 r f2c�.:�i1 4y -t, in. Itfz-tlwtr6 dc,"— is V✓tI�NOJh, G. ENGINEER'S CERTIFICATION 1 certify that I have determin th ugh field inspE review of Municipal record that a abo a syyyste conformance with MOA CO A g ' ines I eH1 )nI Engineer's Printed Name O Date to COSA Fee S i-4 q o Date of Payment C2 Receipt Number n S\� Gal (Rev. 11/05) in Waiver Fee $ _ Date of Payment Receipt Number W � M U c43zs-D s� 0 oy m oZ° °-Z+cmi �mp x I O = a I LO I a T *�.30 S ' 00 V•.�` . N NOb yi�� O w w f� qDq C F= m N zv Om 0 T 0 �m 0 yyN m� —I (7 N DN 30 co N w Ls Zii OLOZ-61-90 Z1:50:£l lA/a114M HJeflelluepnld SatrMs x I f a I m II a co N w Ls Zii OLOZ-61-90 Z1:50:£l lA/a114M HJeflelluepnld SatrMs Municipality of Anchorage • ^� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. COSAx_ 1 LL)gf- Expiration Date: O C? 1. GENERAL INFORMATION Complete legal description Lot 22; Block 3; Southpark Subdidslon Addition #2 Location (site address) 15611 Jensen C rde Anchorage. AK 99516 Current Property owner(s) Brian a Kathleen orchards Mailing address Lending agency Mailing address Real Estate Agent Darren Donald / Keller W4liams Mailing Address 10LY1,13ensontvdit-503Andorage.AK99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ID Day phone 345.2677 Day phone Day phone 865-6513 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B webs or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm s s s Engineering Address 15861 S. Birchwood Loo .0 4. Arc 567 Engineer's Printed Name 5. DSD SIGNATURE __C Approved for bedrooms. Phone 694.2979 Date Z D F3 JL shaLl unt Disapproved. Conditional approval for bedrooms, with the following Attachments: COSA Checklist _X Septic System Advisory Well Flow Advisory Nitrate Advisory —OKSITE PHUGRAM Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (R.,, „,W) 11 Original Certificate Date, 4' 3 ^ OR Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description:oT 521"2421P -PS f}D6 Parcel ID: _CU.:), A. WELL DATA 1-)UQL�C Well type _- • . x / _ If A, B, or C provide PWSID # _ Date completed Sanitary seat (Y/N) ._ Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water levet ft. Well production g. p.m. WATER SAMPLE RESULTS• Well Log (in Wires properly protected (Y/N) Casing height (above grou in. AT INSPECTI 11111111111i'� Coliform nies/100 mL Nitrate mg/L Other bacteria colonies/100 mL Arseni 'g/L date of sample: _ Collected by. B. SEPTIC/HOLDING TANK DATA TankType/Material S ris STEEL Date installed 00PA) tcOAD Tank size lagal. Number of Compartments a y ' Cleanout T/t) VC -S Foundation cleanmio) �$ Depression over tank ` V _00 High water alarm(1 I�t A -)O Date of pumping a Pumper- 1%_6Ti'LMOL) _P0s4iPJAX,, C. ABSORPTION FI LD DATA Date installed, 5 Soil rating (g.p.d./ft2ft2/bdmn g5 System type Z?XIA7 u Length 3� ft. Width S fL Gravel below pipe 3- ft. Total depth liI ft F Eff. absorption areaftt Monitoring tube Depression over field Date of adequacy test oZ /N O Results Pas / ail)_1_Li�� For � bedrooms �' n Fluid depth in absorption field before test,—23 In. Water added gal. New depth, j3 in. Elapsed Time:min.' Final fluid depth p �in. rt � Absorption rate >= (000 -t g.p,d, Any rejuvenation treatment (past 12 mo.) (type) If yes, give date D. LIFT STATION -k)//i Date installed Size in gallons 'Pump on' level at_ in. 'Pump off level at _, in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service Manhole/Access (YIN) High water alarm levet at in. Meets alarm 8 circuit requirements? On adjacent lots Public sewer manhole/cleanout Holding tank Animal nment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r r 5 1 Absorption field S / Building foundation �_ Property line � r P � Water main 1>4 Water service line /D d Surface water /00 r Wells on adjacent lots �2(20+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r r .4 Property line oi0 Building foundation �S Water main �D r Water Service line II D "f Surface water /UCi Driveway, parking/vehicle storage r Curtain drainti7011- - YJ�u7d)Welis on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determir review of Municipal records conformance with MOA COS/ Engineer's Printed Date COSA Fee $ Q Date of Payment �U Receipt Number oss 20 (Rev. 77105) h field inspections and the hove syste are in 3li sin affect o4hf4 date. Waiver Fee $ Date of Payment Receipt Number •, F , • 9 r .rcP' • A 4,A , 83ZS'.D 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. # � Z� — � SZ S 3 HAA # �� �— � l 6 0 0 y ua tl cl 1 oov4- 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) (_u i 2� C3cIL 3 Sv�1l�k Location (address or directions) (b) Property owner � I "ti P) N S C/>� Telephone : (home) Business Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone fNjc4✓ 6(4_c .L Telephone (e) Mail the HAA to the following address: (or check herexif hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 3. WATER SUPPLY Individual Well ❑ Community Public ❑ Note:..lf 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 this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm N i 1fL2 L�(i-in�•'t:-2'+1Lt Telephone � � 7—(o Z,, C — Address V QK4-fl I uta C 11 Date 14AA US 5 Eu -j& /y�j 5, t eaeeom°oep 5-w r is °c'.. 0 4. LSS1lL� �b�,✓(—^,D (,(p !Ae no. eoeo eoo° ° S i S yti� I p � Engineer's Seal ^�,A A3 C� rae Robert E. Kni W 1"l""' l%T No. 4149 6. DHHS APPROVAL Approved for a"t edrooms by "'-" ` Date y Approved X Disapproved Conditional Terms of Conditional Approval • 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rm 7/ee) Back Page 2 of 2 KEKNIEFEL ENGINEERING 8441 Miles Ct., Anchorage AK. 99504 (907) 337-1121 • Fax (907) 338-1874 sao!AjaS ue April 5, 1991 ekloyouy1d All «;j 04.jd_ Mr. John Smith, Manager 1661 On -Site Services Program ddb Department of Health and Human Services Q ��'� Municipality of Anchorage ) ] d 825 "L" Street -+ Anchorage, Alaska 99501 SUBJECT: LOT 22, BLOCK 3, SOUTHPARK ADDN. #2 CONDITIONAL HAA COMPLETION Dear Mr. Smith: Based upon the conditional Health Authority issued on January 9, 1991 for the above property, we have proceeded to complete the required work to prove up the system. Kniefel Engineering was retained by Mr. Ed Walsh of Scott Wetzel and Associates to complete the necessary work to bring the system into compliance with your regulations. On April 4, 1991, we completed a test hole at the south end CO of the existing field. The following information was gathered and is displayed on the attached drawing: The current drain field consists of 4" perforated PVC pipe The pipe has 6" of sewer rock over the pipe and 3' of sewer rock below the pipe The bottom of pipe is approximately 4.5' below grade The sewer rock width at the south CO was 4.2' The inside of the field pipe measured 27.2' in length between the two cleanouts The accepting soils at the bottom of gravel level were visually rated and then percolated resulting in an 85 sf per bedroom rating. This would require a total of (4 x 85 sf/bed) 340 sf of absorption area. This information was used to determine the size and adequacy of the field. The field is of trench design and we checked for both a five wide and normal trench design to see if the required length is present. Lot 22, Block 3, Southpark System Design April 5, 1991 page two F..i..Ye.......W..i..d .e. 4 bedrooms x 85 sf/bedroom / 5' x .58 correction coefficient = 39.5 foot required length, existing is 27' - 29' No.rma.J......T..r..e.n. :�.h For a trench we have 4 bedrooms x 85 sf/bedroom / (2 x 3' sewer rock depth) = 56.7' required length, existing is 27' - 29' The existing bed is 27.2' plus at least one foot on each end of the pipe length for absorption area which totals 29.2 feet. Based upon the above information it appears the bed is 10' short of meeting the required length for a five wide bed. Recommendation: Based upon the above information we recommend the addition of 10' of five wide bed construction with a three foot depth of sewer rock. This will bring the total length over the required when the additional foot on the end of the field beyond the final cleanout is counted. Attached is the design submittal for the additional ten feet of system. We would appreciate your prompt consideration of this permit. With the completion of this work the field will meet MOA requirements and the conditions as noted on the conditional HAA and be ready for final HAA approval. We appreciate your consideration of this matter. Please call if you have any questions or comments. Respectfully Submitted, Kniefel Engineering ® ccc��� � �YB�b�00V00y Robert Knie , P.E. 0 "°49 Robert E. Knie No. 4149•E MUNICIPALITY OF ANCHORAGE �aF � Department of Health &Human Services �} DIVISION OF ENVIRONMENTAL SERVICES 343-4744 r §' TIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF Otl.,g]XE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # r,� - C - 3 HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) 5l✓ l l .� Com;" Sc --:.J C� IZL�� (b) Property owner J Telephone: (home) Business 33 ^ 1 1 Z Mailing Address I (c) Lending Institution - Mailing Address (d) Real Estate Company and Agent Telephone Address J+i Telephone (e) Mail the HAA to the following address: (or check here O,if hold for pick up) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family Y1 3. WATER SUPPLY Number of bedrooms `r— ., Individual Well ❑ Community /&'L 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. ]2-025(Rw. 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 verifythat my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. L"'i CN 6' 1IJ IC t�✓(r Telephone 3 3 7 -r I z - Name of Firm P Address /A t 5 Li Date [ �_ / Z-- -,rT/ CY D ��e0� •� Ea?.�,9�� SSTH X s Robert E. Kniefn( ! .� No. 4749-E .�, ® AV is�PRCFESSt�N� 6. DHHS APPROVAL Co,1111177�wa// , / Approved fo� y bedrooms by Date Approved—Oisapp avert/ 4+ /JConditional Terms of Conditional Approval: ��y�._ j/�A' �Ot del' o�rtol7iav[ /Va7G! / d� 7lc 4-1�1,S/4Y/�i/os2 Yiz!/�iaLi //6 �lOt/SiZeu eevicGr/y k+2 k�gykdZ Of r�� SySY2�+c UJiG�dC lYqui`Y!( !?D «iTaY %�GdvI 4n..e `S z:; CAUTION The Municipalityof Anchorage Departmentof Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above byan independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 C) -Z-0 --()sy-S3 MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) a spa CHECKLIST - FEBRUARY 1984 �5 343-4744 Legal Description: �� ZZ� t3 (--g L IL 3 V H A. WELL D/{T$ ��� <C� l5(.0 i( JZS✓-. cll��� Well Classification Li f') ry If A, B, C, D.E.C..Approved (Y/N) L 5 Well Log Present Date Completed Yield -� Total Depth Cased to Depth of Grouting Static Water Level Casing Height ring 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 To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Nearest On Adjoining Lots On Date B. SEPTIC/HOLDING TANK DATA Date Installed R0140wJ Size z No. of Compartments Z Standpipes (Y/N) X Air -tight Caps (Y/N) Foundation Cleanout (Y/N) i Depression over Tank (Y/N) N Date Last Pumped ZZ- Z 2- yFi Pumping/Maintenance Contact on File (Y/N) YJO ; for I�JIA Holding Tank High -Water Alarm (Y/N) nJ / A Temporary Holding Tank Permit (Y/N) h A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well _7 To Building Foundation r To Property Line Z� To Disposal Field To Water. MaihjServiceLine / To Stream, Pond, Lake or Major Drainage Course r Comments 72-026 (Rev. 7188( Front Page 1 of 2 (2- Legal L i C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design 7TZ CH Date Installed Wo IL Length of Field (,AN1C Width of Field (A Depth of Field CA rJ Gravel Bed Thickness IA t - Square Feet of Absortion Area U " (L Statndpipes Present (Y/N) ya,S Depression over Field (Y/N) N 0 Date of Last Adequacy Test Z ). L CIO Results of Last Adequacy Test S•-� 5h SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 7 5-0 0 To Property Line To Building Foundation Lot /�J /A On Adjoining Lots r To Water Main/Service Line To Cutback To Stream, Pond, Lake, or Major Drainage Course N To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y. Comments i Dimensions To Existing or Abandoned System on foo present) Manhole/Access (Y/N) . "Check Permitted Bedroom Rating Against HAA Request" "Pump Off' Level at Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection �` 1 1 Cid d;� Signed �: ���•; 4 xso�eli Lti Company / f� L LiV61.vCZ721•VGtr /L ¢ j u Aga°'.Yj ear's Seal Date /z /�a tao> vac y� xa raa yea MOA No. GG" 61 "1 Receipt No. � a "-//i ( _ I 4el5`yi Date of Payment /— 3-9Y Amount: $ Receipt No. Waiver Fee: $ Date of Payment 72.026 (Rev. 7/88) Back Page 2 of 2 KEKNIEFEL ENGINEERING 8441 Miles Ct., Anchorage AK. 99504 (907) 337-1121 • Fax (907) 338-1874 H.EA,LTH,..AUTHoR,Z.TY .R.E,�.S.ULTS.....AND ANA.L.Y.S..1.5. Date of Testing: December 21, 1990 Legal Description: Lot 22, Block 3, Southpark #2 Street Address: 15611 Jensen Circle Number of Bedrooms: 4 Well Flow Test: Community Well ----------------------------------------------------------------- Results of Septic System Adequacy: Satisfactory Total Gallons into system: 600 gallons in 90 minutes ----------------------------------------------------------------- c.o.m. me.n. ts... The well is a community well and the ADEC letter is attached. The septic system absorbed the 600 gallons within the 24 hour period. The system was tested in accordance with MOA policy and regulations in force at the time of this test. DEPT. OF ENVIRONMENTAL CONSERVATION ANCHOP CE WESTERN DISTRICT OFFICE 3601 _ SoInEE P, SUITE 37.2 ANCHORAGE, LAS -A 99503 FOR: Bob Kniefel P"MID: #2213475 A WALTER J. NICKEL, GOVERNOR 563-6775 ,7anuary 9, 1991 ;:9y reviow of the records on file in this office reveals that the South Park Subdivision Claus A Public W!ater System is in compliance with the provisions of 18 AAC 30.060, State of Alaska Drinking Water Regulations. Sincerely, Timothy A. P.arnowski Environmental Engineer t::, K �K�c pooled on recycled VaP;;r b y (l MUNICIPALITY OF ANCHORAGE a 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 1. GENERAL INFORMATION (a) Legal Location lot, block, subdivision, or directions) Application Date /(0 1986 township, (b) Applicant Nameftl Mq_ &&4lephone: Home usme sc2S t1 % ® Applicant Address Aff iC�l Jr� ��®®3 IfJacnlP 1zL� (c) Applicant is (check one): Lending Institution; Owner/builder ❑ ;Buyer O ;Other ❑ (explain);" (d) Lending Institution A'ASKA %1l C UAL Y --Telephone Ogg_ r Yq'o Address Tr ak_(/ d m-1`7 - (e) Real Estate Company and Agent Address (f) Telephone 2. TYPE OF RESIDENCE Single -Family Multi-Fam'ly ❑ Other Number of Bedrooms - 3. WATER SUPPLY 71 Individual Well 1:1 Community I� 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 POSAL . Onsite Public ❑ - Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 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 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 ins faction.. /� Name of Firm � � ('ra QS. Telephone Address.(�i!gi(FT�rnY.'s=LaL"/3rG��/1��'L1 {I��!•.1�hiur7s��►-J—rari�l� Date i , 198 6. DHEP APPROVAL 0 Approved for C9caF�' bedrooms b7Y, _ Approved 74 Disapproved Terms of Conditional Approval O n Vol .cone Vic. �i Fc ru J. Corwin° C s°oo o. CE -5283 8 a 0 Conditional CAUTION Engineer's Seal 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 »-Mn n vnm B. SEPTIC/HOLDING TANK DATA � �^ * Date Installed SdLLLNL Size 1;W0 No. of Compartments Z Standpipes (Y/N) Y,0 Air -tight Caps (Y/N) — Foundation Cleanout (Y/N)-- Depression over Tank (Y/N) N0 Date Last Pumped Pumping/Maintenance Contract on File (Y/N) 1q1A ; for Holding Tank High -Water Alarm (Y/N) —N I hr Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: , To Water -Supply Well S®� / To Building Foundation �2'S To Property Line 2 / To Disposal Field le To Water Main/Service Line 5-0ToStream, Pond, Lake, or Major Drainage Course '..ACL —, --I- ' _ inn J"I '-- '1;M.1 At rM.S Q.110_ RN T40!10 Comments Page 1 of 2 72-026(11/84) MUNICIPALITY OF ANCHORAGE (MO. ) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHORAGE CHECKLIST - FEBRUARY 1984 DEPT. OF HEALTH & ENVIRONMENTAL PROTECiIOtj 264-4720 •7�I�r JUL 1 i�t;o �� Legal Des npt'oJ' i rn: h1a 3 A. WELL DATA R C E I V E D Well Classification / If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to - Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/ Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA � �^ * Date Installed SdLLLNL Size 1;W0 No. of Compartments Z Standpipes (Y/N) Y,0 Air -tight Caps (Y/N) — Foundation Cleanout (Y/N)-- Depression over Tank (Y/N) N0 Date Last Pumped Pumping/Maintenance Contract on File (Y/N) 1q1A ; for Holding Tank High -Water Alarm (Y/N) —N I hr Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: , To Water -Supply Well S®� / To Building Foundation �2'S To Property Line 2 / To Disposal Field le To Water Main/Service Line 5-0ToStream, Pond, Lake, or Major Drainage Course '..ACL —, --I- ' _ inn J"I '-- '1;M.1 At rM.S Q.110_ RN T40!10 Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Ratingin Absorption Strata kma f y Ip,� - uM � Type of System Design -� Date Installed ._l��✓t2(1(J n "' Length of Field um kYIowyl Width of Field UIVi k/na%Wnt '* Depth of Field t 7 I9 Gravel Bed Thickness fb Noup'1 � Square Feet of Absorption Area (AM kYlat � Standpipes Present (Y/N) N 25 Depression over Field (Y/N) Da�te�of La�st/F��d�@\qu cy Test �-3�lMtpt >' 9�� Results of Last Adequacy Test Q(�u�lr( I�Y7 OYYYI `14 Av Q Separation Distance from Absorption Field: v To Water -Supply Well :J ©0r 4- To Property Line /J r To Building Foundation To Existing or Abandoned System on Lot - NJ(A On Adjoining Lots /001 To Water Main/Service Line 5d To Cutbank (if present) — To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vlehicle Storage Ar Comments it e&n /107 vn6ae4r6 6 [ole .qui( D. LIFT STATION Date �q�gra�� Field in7(�G�r Is umab� � c�¢+�rmwti-2 0(tauf 461 tJA no ,'on, �ndeaqfs 4:"el ; Vd&n , W19M 0� ✓ry ek 6ys" aeCFp4d 900 gaMona 0 lilaslur- dcl rvh y IMLfd'C'Q Cf rlae t.l s. �djar'p�•'U/Sro,(is :5,6LJ5 Dimensions NO L,)a`(-r Size in G41ons Manhole/Access (YY/N) "Pump On" Le at "Pump " evtt t"el at High Water Alarm Leve '` Vent (Y/N) Tested for l� Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (,Y/N)� Comments " Check P. milted Be room Rating Against HAA Request " I certify th c d, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed e Date lea Tunl-el /486 Comp y MOA No. �! Receipt No, t/ 729'L 1 u Date of Payment 1- )C_�,- Amount: $ LOS C)C Page 2 of 2 72-026 (11/84) ngineer's Seal UF L S9 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE: June 13, 1986 PWS I.D.# 213475 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the SOUTHPARK TERRACE SUBDIVISION Water System is in compliance with the State Drinking Water Regulations Sincerely, C � Steven W. Eng, PE District Engineer CORWIN & ASSOCIA'�, INC. 4790 Business Park arid. Building D Suite 1 e ANCHORAGE, ALASKA 99503 Phone 561.6151 ADB -JouT`i pM ,' SUPiY� AgDN No 2 , 3CX. 3�LT Z2- SHEET ZSHEET NO. OF CALCULATED BY Y%SM DATE IG —BG CHECKED BY DATE ar.Ai E _ 1" = 3o'-0" t N770 v 'So, DRIVEWAY d 6 *AI`, C.O. _ °S. P. P� P. S {ioUSE c.o. s