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HomeMy WebLinkAboutSOUTHPARK #2 BLK 1 LT 31(Nev uwuziiu) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201115 PID Number: 020-501-21 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name ZONA RAELSON ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 4811 SOUTHPARK BLUFF DRIVE, ANCH. ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SOUTHPARK #2 1 31 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 Ft2 Ft. Well 200'+ __ 25'+ TANK M Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Tank insulated. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer PCN Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1s' 7/10/2020 ed 8/18/2020 Location and description dates:Z 3`d 4'h DOOR SILL ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date •+ ..� .....•.. • • •:� Curtis Huffman Septic A provedstem Pp l 4� Date �0 � aC��0 �`�c�s� • CES 28991• • F� �l,st,Q 0 ti� . FO PROFESSOO Note: this approval does not include well permit requirements. (Nev uwuziiu) PID: 020-501-21 PERMIT: OSP201115 v Off, �Lo' LOT 32 D o. PLAY DCO C (n HOUSE E O CO MH h0 N SUMP EXISTING FOLD i -P FCO B J A 01. ER�sNo�sE � ,6 w 3g DECK / APPROX. N P PSD WATER LINE W D Iw LOC. LOT 31 00 15BLK 1 KEYBO SCALE 1" = 30 FCO � DCO A -C=33.4' co 491H8.03 FINAL GRADE B -C=35.2' A -D=33.1' 94.23 INSUL B -D=39.8' 93.65 1,000 -GALLON 3.46 A - E = 3 0 . 3 HDPE TANK EXISTING FIELD B -E=40.8' SEPTIC SECTION SCALE NTS SOUTHPARK#2 BLOCK 1, LOT 31 SUPPORT, SERVICES:F CS- F�\ PREPARED FOR: `��' ZONA RAELSON /�� TI 1� 4811 SOUTHPARK BLUFF DRIVE J r 9 ANCHORAGE, AK 99516 FIRST WATER CONSULTING DATE: 9/28/2020 /,rtis Huffman / SURVEY: JLS -,f 13030 SUES WAY DRAWN: FWCS 020 1 CE 128991 eek 9/28/2020 ANCHORAGE, AK 99516 SCALE: 1" = 30' ' \ pftnsslo'0' i' 907-350-9566 firstwaterAK®gmail. com �``'t MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201115 Work Type: SepticTank Upgrade Tax Code Number: 02050121000 Site Legal Address: SOUTHPARK#2 BLK 1 LT 31 G:3236 Site Mailing Address: 4811 SOUTHPARK BLUFF DR, Anchorage Owner: RAELSON ZONA F S Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date: 1nent U n 12 v Department Lot Size in Sq Ft Total Bedrooms: 5/26/2020 5/26/2021 21047 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: Z6 Z�J i 3 MUNICIPALITY OF ANCHORAGE Jr Development Services Department�: Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICMELL PERMIT APPLICATION Parcel I.D. 020-501-21 Property owner(s) ZONA RAELSON Day phone, 9072277592 Mailing address 4811 SOUTHPARK BLUFF DRIVE, ANCHORAGE, AK 99516 Site address 4811 SOUTHPARK BLUFF DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) SOUTHPARK #2 BLOCK 1, LOT 31 Legal description (Township, Range & Section) Lot Size 21047 Sq. Ft. Number of Bedrooms 3 i APPLICATION IS FOR: APPLICATION IS AN: t TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial EJ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade Z Duplex (D) ElHolding Tank ElRenewal 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: ��f ���• Waiver Fees: I Date of Payment: Date of Payment: Receipt Number: *5`6LlIQL% Receipt Number: Permit No. ® 5P 26 1115' Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc COVID-19 2570 DISCOUNT APP► mn 13030 Sues Way, Anchorage, AK 99516 907-350 -9566 / firstwaterAK@gmail.com May 13 , 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: SOUTHPARK #2 BLOCK 1, LOT 31 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 1000-gallon HDPE tank outside any deck supports to serve the existing 3-bedroom residence. The lot and area are served by a Class A water system. 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 OSP201115, Deb Wockenfuss, 05/26/20 DESIGN BASED ON DIGITIZED JKD 4/17/86 ASB JPEG IMAGE PROVIDED BY OWNER. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201115, Deb Wockenfuss, 05/26/20 '~'AME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 C)N-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPI-'CTION REPORT MAILING ADDRESS LEGAL D~SCRI PTION LOCATION DISTANCE TO: Manufacturer DISTANCE TO: Manufacturer DISTANCE TO: No. of lines Absorption area ~j~, I Dwe'~'' NO, OF BEDRO0.~ ~ "ERM,T NO~.~ 072 / Liquid depth Well Dwolling PERMIT NO. Liquid capacity in gallons Top of tile to finish grade.~:~ ~ /' Deptl~ Crib de~th Material Nearest lot lin! [Trench Length W r , I Lengt" °f eac~.?~' Width PERMIT Distance between li.,p~s Total effec..ti o p 'on rea PERMIT NO. Type of crib Crib diameter Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line /PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank IAbs°rpti°n area(s) OTHER PiPE MATERIALS APPROVED DATE LEGAL 72-013 (Rev. 3/78) Lo'} I)E:F'F:IRTI',IEI~,IT . HE:FILTFI RI'.JD EI'.,IV l ROi'.~MEF,ITRL OTEI::T I OIq 82:'5 :E¢ E IL-il EE R: F" E F: IFq Z "-IF' -.,F..I I 'J.-t-,_ ,~ L. OT .-:..:'L BLJ-::: i SOUTE.IlF'FIF4:I-.:: FiB,[::,:b2 LO]" SIZE ;45-.64.75 'T'¥F'Eil OF SOIl... RES::)I-E']"IOI'.,I S'.¢S]"EH Ii;: TRE[",IC:H i'lla',,',',If'lLIl'l NLIMBEI;~: OF E:EC, F~:OCd"I:~.:, =: S0ti_ [:~'.R'T]:NG (SQ FT/E,'R)= 1.85 'IFHE FIlEC!I..II~EE:, :-2;:[;:ZE OF TIE S0tL. 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I T"/ TO I i",IF'ORI"I TH I S B, EF'FIF;ffI"IEI",IT I)LIR I IslG TI-IE I I$.;rRLLR'i' I ON Z I'.,ISF'ECT Z OI'.,I:'E; 01:: I:ll',l'.,.' 1.4ELLS flD3'RCEi'qT 'TO TH t E; PROPERT"r' FINE:, THEIl i'4LII'ES'~: 0[: F.'.'E:S;IDENCIiE; THFIT THE P.IELL il'.lILL .................... T' il4 C:, ..... ~:." ::,, :E P .il .-.... II IE_ IL. ] Z L.I] ['-.il .=:. IFil [;;? E27 F.~: E: IC~ IL.II ."j[F-'" EE il": BFIC. I-:::F ]: LL Z NG OF FIN'¢ S't'S'I"EM I.,~ I TI-IOIJT F I I"dlqL I 1"4SPEL-.'T I ON I::tI'.~E:, F:IPPRO',,,'I:"IL [i:'T' "I'H I~5 [:.,EPF:IFYFI~IEI',I1' I.,.IILL [il:E :ilil]_lE:..TE(::"F "il'13 F'F;:OSECUTZOI',L I'IIi",I]:MUM [:,ISTFIlNC:E 13EI"I,EEN FI Il,.IELL. Eli',II:, Fli",!'-r' ON-'SITE SEI4FIGE DISF'OSIZlL. '.";"r'STEM IS :l. Eil FEE'T' F'L}R FI P[:~'.I',,,'F:ITE I.,iELL 0t:;'. l!!:';t~.l TO :;~00 FEET FI:~'.OM R F'UBLIC: [..ELL E:,EPEi'.,IE:,II',IG UPOIl',I THE I"'¢PIE OF f:tlE:LIC: I.,IFJ:I_L.. ..,E. IIEF~. [..].IIE I:~; HII'.,Ii'I',IUM [..].._,1 I,I...L F'F,~:OM i:il PIl:~:I',,,'FITE !.,4EL..L TO FI F'I:E',,,'FITE '=': .... ' .. F:'EEI" FIE:, TO f:l E:OI',Ii'qUI',IIT'.,.' :~El.q[..':.Fil LII'.,IE IS 7'5 FEET. OTHEF..' REQLI I F?.EI,IIEI',II':E; HI::I'.,.' i:::IF'F'L'./. '.~i;f:'E:: ]: F I (::FIT I Oi'4S; RI'q[) CONST~:,'.L.IE;'T'I 01',1 D :[ RGr;IlFII',IS RRE E/FIILFIE:L..E TO ):NSL.IFi:E: F'F~:OPIl;;:F;: iI'4STRL. LRTIOI',I. F::- EE If;E:: fl'-'l~ Z 'T IEEE I CER'T'IF~'r' "FFIFIT :1..: I il:']l'l FF:iI'III...ZIaR !*!I'T'H THE FEg!IjIF:IEi'ENTii FOR Oi'4'-SI'TE SEI-,IERS Fli",IE:, P.iEL. L.S RS SE'I' FO,~¥1'H B" TF'IE I'11..11",1 :[ E: I F'FII_. I T"," 01::' ;-2: :[ I,.I:[L.L :[I",I'.E;TI::fl... 'Eli '.E;'¢S"I'EI'"] II",l FIlCCORE:'RhlCE Iq:[TH 1"HE COE:'ES. ::il.: I UI",IE.'EEIlTR Oi",I-~:SITE 2.;E!-,.IER fffE.:;TEH MR'¢ REg!UIRE E:t",ILFIF..'GL=:MENT IF' 1"HE RESiDEI'4CE II',iC:LUf)IE HOF;E 'il'HE:iN 3: BEI)RO01'I:~. $ilI GNED: .... I SSUEEE:' ',,,' 4, 0 MUNICIPAI. ITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 025 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ,SREO.MED POR: I-I LEGAL DESCRIPTION:__~' f-~l~, 2 3 OL 1 DATE PERFORMED: SLOPE SITE PLAN [~PERCO LATION TEST Lol: 10- 13- 14. 15- 16- 17- 18- 19- 20- COMMSNTS k- '1'~ : b iV,.% PEREORmDS',: 72-008 WAS GROUND WATER ENCOUNTERED? IE YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE /¢ (minutes/inch) TEST RUN BETWEEN i ~ iFTA~D ~=¢T DEPT. OF ENVIRONMENTAL CONSERVATION BILL SHEFFIELD, GOVERNOR ~l~hone: ~0~ 274-2533 Address: 437 E Street Suite 200 Anchorage AK 99501 June 8, 1983 Mr. Daniel Green Triad Engineering 6937 Old Seward Highway Anchorage, Alaska 99502 Dear Mr. Green: Subject: South Park, Addition #2, Water Improvements (8321-FA-329) We have reviewed the plans and specifications for the subject project. Enclosed with this letter is a "Certificate to Construct" for the drinking water system. The "Approval to Operate" section of the certificate must be completed by a representative of this Department prior to placing the system in operation. Sincerely, Environmental Engineer BEE/msm Enclosure CONSTRUCTION AND OPERATION CERTIFICATE AL.ASKA~ DEPARTMENT OF ENVIRONMENTAL CONSERVATION. PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of. b t) ~-~ l'¥1 ~' Kf,, V iR .public water system located , Alaska, submitted in accordance with 18 AAC 80.100 ~ ,'~ Jt~)¢t..'"(7,"J~} /*((: }¢ ..]~' /'~.i (':-:'__have been reviewed and are El' approved, , [] conditionally approved (se~ attached conditions). If construction has' no;[ started within two years of the approval date, this (;ertificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. Approved by Date DATE The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL 'ro OPERAT~ The construction of the _public water system was completed on_ (date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date, TITLE DATE As-built plans submitted during' the interim approval period, or an Inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. BY . ,' :i~iTLE DATE COSA Checklist Legal Description: SOUTHPARK #2 BLOCK 1, LOT 31 Parcel ID: 020-501-21 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 Age of tank(s) NEW 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 - NEW C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/26/1983 ALL standpipes present per record drawing Total measured depth from grade 9.4 ft (max) Measured depth to pipe invert from grade 3.1 ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective 6.3’ INTO THE 7’ ED* 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 11/1/2019 Results Pass For 3 bedrooms Fluid depth prior to test 39 in Water added 1200 gal New depth 68 in Elapsed time 1290 min Final fluid depth 47 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies:.*PER INVERT AT SUMP. E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community wel) – NA: PUBLIC WATER 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. 9/28/2020 .{~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailin. g address Agent. Address Day phone ,',',','~q'~'- ~'g 12.. Day phone .Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: -~ TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further v~rify 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. 'To/,¢~ ~4 ~-~,~' r-~,~l~cJ,,-~-~ '~, ~ Phone ~- ~ ~/~ Name of Firm Address ~o.~ ~I1~ ~ ~ ~ ~ ~ ( Engineers signature ~ ~~~ Date tO/ll]~¢ DHHS SIGNATURE / Approved for -T'/~ t~ fi' E Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICESOCT ~27. Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 ~' Health Authority~pproval Checklist LegalDescription: J-o"T",-~l,, '~l~t $od'F+l -~/-N,'F&I,4. ParcelI.D.: A. WELL DATA Well type IfA, B, orC, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Total depth Cased to Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N). FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: - Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Dateinstailed ~/.~/~7> Tanksize IOo-~ Number of Compartments ~ Cleanouts(Y/N)"// Foundation cleanout (Y/N) ~/' Depression (Y/N) i~/ High water alarm (y/N) Date of Pumping ~o/~¥/~_ ~ Pumper C. ABSORPTION FIELD DATA Date installed ~-X~/~ Length ~/~. Width . ~ Effective absorption area .~ ~ ~, Date of adequacy test ! D///!/~? Fluid depth in absorption field before test (in.); Fluid depth ~- (ins) Minutes later: /~/~ ~'~ Peroxide treatment (past 12 months) (y/N). Soil rating (g~r ft=/bdrm) Gravel thickness below pipe Monitoring Tube present (Y/N) ~ Results (Pass/Fail) Immediately after ~ gal. water added (in.): Absorption rate = ~ ~7/~"~) g.p.d. If yes, give date I~._~ System type -~,,~-~ c- ~ '7' Total depth ~._E, F/'~ · Depression over field (Y/N) ~ For --~ .bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line "Pump o~t~s ~ots J On adiacent lots Water main/service line "Pump off" level at* Public sewer manhole/cleanout Lift station / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation J-?-/ Property line ~C) 'it- Absorption field. Surfacewater/drainage ~"~/o Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation ~,2C~ ~ Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ~//-~ ENGINEER'S CERTIFICATION ..' I certify that l have determined thru field inspections and review of Municipal records;ih~tth~"ab~e?YS~s ~e in conformance with MOA HAA guidelines~in effect on this date. j:' ~".?, ? .~'~.'i :','r ,~,'., En~neer'sName I o~,e~ ,~ucV~[,~ ¥,~ ') ~ ,:,, Date lo/ti [~ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment. Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,Q. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 31; Block 1; Southpark Subdivision ~2 Location (site address ordirections) 4Rll SnnPhpa~k glt~ff Drive, Anchorage, Alaska Property owner Brenda Schwarz Day phone 338-7611 Mailing address 4915 Rollins Drive, Anchorage, Alaska 99508 Lending agency Mailing address Day phone Agent Day phone Address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 3 NOTE: 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual well Community well × ~ Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. Name of Firm Address Engineer's signature STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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. ~ & 5 EHGINEEEING Phone 17034 Eagle River Loop Roac( NO. 204 E~.3~ ~N,,'el' htaska 99577 Date DHHS SIGNATURE /.. Approved for . Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~; /,/~-- ~; ~-- Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. I/gl) Back MOA #21 Municipality of Anchorage /j~-~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~--~¢:~ '~1 '~::~L-~I4-- ( A. WELL DATA Well type '~ If A, 13, or C, attach ADEC letter. Parcel I.D. ADEC water system number Log present(Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG Al" INSPEC'I'ION g.p.m. SEPARATION DISTANCES FROM WELL. TO: Septic/holding tank on rot ~-- .-, .-----~--/~; un adjacent lots Absorption field on lot "~,.-'¢~ 4" ~O¢/--~-~ ~_ ; On adjacent lots Public sewer main _ Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform _ Date of sample: Nitrate Other bacteria Collected by: El, SEPTIC/HOLDING TANK DATA Date installed ~-~'~¢'--~¢-~)'~ '/ Tank size Cleanout~Si~l) "/ Foundation cleanout~) High water alarm (Y/N) Date of pumping ~-- ~ Compartments "Z._ ~ "/ Depression (Y,L'~ ~--J. Alarm tested (Y/N) ~ . Pumper / ~ -/'¢*"'"¢~5 SEPARATION DISTAN,CES FROM SEPTIC/HOLDING TANK TO: / Well(s) on lot /4 /~, On adjacent lots To property line \ O "~ Absorption field Surface water/drainage I ¢2~' J¢~ Foundation ,Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent(Y/N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacentlots Surface water D. ABSORPTION FIELD DATA Date installed '¢~ Length ~ ~' Width Total absorption area ~-~ ~::~'~7~ Depression ~)ver field (Y~S[P Results4~f. ail) Peroxide treatment (past 12 months) Gravel thickness Soil rating \~""~/"~¢'- F Systemtyp~ Total depth Cleanouts present ~R) Date of adequacy test for "~ ~'- ~---,~c>v.-~l...J if yes, give date SEPARATION DIST/~,NCE FROM ABSORPTION FIELD TO: Wellonlot I~ /45¢ On adjacent lots ~- Propertyline To building foundation "~-¢ ' ~ T~ e?sting or abandoned system on lot On adjacent lots ~t ~ Cutbenk ,/'~' Water main/service line Surface water ~ c::~.~ I..~¢~ Driveway, parking/vehicle storage area Curtain drain ~ c:>i-.~¢_~- bedrooms 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. ~ & 5 g'NGINE~.RING 17034 Eagle River Loop Road No, 204 Signature :~;;i,; z:¢lv4);.. Alaska Engineer's Name Date [~-~ No. 8 HAA Fee $ /~ Date of Payment ~/~ ~ '~""- Receipt Number ~--'-~/ 72-026 (Rev. 3/91 ) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number D~PT. 01~ ENVIRONMENTAL CONSERVATION ANCHORAGE r)ISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 September 3, 1992 WALTER J. HIOKEL, GOVERNOR (907) 349-7755 Jim Williams S & S Engineers SUBJECT: South Park Terrace Class "A" Public Water System, PWolD #213475 Dear Mr. Williams: I have completed a review of this office's files concerning the monitoring status of the above-referenced (:;lass "A" Public Water System and found the following: 1. The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on ~992. This does meet the provisions of 18 AAC 80.200(a) of the State Drinking Water Regulations. 2. 'rhe last inorganic Chemical Contaminants sample results were submitted to this Department on November 15, 199_1. This does meet the provisions of 18 AAC 80.200(a) State Drinking Water Regulations. '~---'-~3~---~:~as~ i~adioactive Contaminants Sample results were submitted to the Department on October 12, 1988. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. 4. The last Organic Chemical Contaminants/Volatile Organic Chemicals were submitted to this Department on _November 6_6~1991. This ~does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. issuance of this letter doe',; not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Water Regulations. If you have any questions on the above informatk)n, please do not hesitate to contact this office at 349-7755. KKK/cf Sincerely, Keven K. Kleweno District Engineer 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 ¸1. GENERAL INFORMATION (a) Legal Description (include lot, biock, subdivision, section, township, range) Location (address or directions) (b) Applicant Name .]~/./)Pi ...CC. J-J~_~J~,,_ Telephone: Home ~ L//,~':~_~_~_ Business ........ Applicant Address ~J~ll ,.s'©Ur'/~/~.P,K-C/-/JF~F D/~_ /¢~4~/,~.~/~_._ (c) Applicant is (check one): Lending Institution []; Owner/builder ~I; Buyer []; Other [] (explain); I ~L,~_I~.~.,~\L>,% ;Telephone (d) Lending Institution ~)~C~'~g~3- ~ Address (e) Real Estate Company and Agent ~_1~ Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ~ Multi-Family [-I Number of Bedrooms Other WATER SUPPLY individual Well [] Community,[~ Public [] Note: If community well system, must have written conlirmation lrom the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If commumty well sys~'em, must have written conhrmat~on from the State Department ol Environmental Conservation attesting to the legality and status. 72 025 (I h84) Page 1 of 2 FNGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMA'[ION 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 tile information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply end/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 Telephone A p p roved ,o r _~'~,"~...4....,~.-' b e d r oo rn s b y '~' J~-'~ [~-.~, ......... ~' Date Approved __ ,(./~ Disapproved Conditional. Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Flealth Authority Approval certificates based solely upon the representations given in paragYaph 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 theJr 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 Jssued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 WELL DATA MUNICIPALrrY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL. (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: _-.-~O()T'f'J MUNICIPALI'fY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED Well Classification ~bNtN][,1/1] J~T/¢' _ If A, B, C, D.E.C, Approved (~N) we,,LogPrese.t(Y,N, DateComp,e,ed Y,e,d Total Depth_ ¢'t//~- Cased to __ ~[//~Z~_ Depth of Grouting Static Water Level ,/~///~ Casing Height Above Ground __ Electrical Wiring in Conduit (Y/N) . j~/./~- Separation Distances from Well: Pump Set At N,/Id¢ Sanitary Seal on Casing (Y/N) _ Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot __ -~ ZOO / To Nearest Edge of Absorption Field on Lot _+ ~O~) / To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results _ Comments ; On Adjoining Lots ; On Adjoining Lots ____ N~- To Nearest Public Sewer ~/,/~ To Nearest Sewer Service L. ine on Lot iV, ~/~//:) ;Dato __ _ ~/~ SEPTIC/HOLDING TANK DATA Date Installed 2~ ~EPI:~,~ Size Standpipes ~.)N) Air-tight Caps (~N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ___/~///:~ Separation Distances from Septic/Holding Tank: To Water-Supply Well 'lL ~d)O TO Property Line .2. 0 To Water Main/Service Line Course ~ /~)0 / No. of Compartments Foundation Cleanout lC)N) Date Last Pumped. 4-/J' ~'~ Temporary Holding Tank Permit (Y/N) To Building Foundation _ /,.'~ / To Disposal Field ~¢~ / To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026(11/84) ~3 / ~ ! 5,,u'r///,¢,¢ az- C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata / ~,,~'~ ~ Datelnstalled 26 -~F~°~' ~P~ Width of Field 3 ¢' Type of System Design Length of Field f3f~.- / Depth of Field Gravel Bed Thickness 7 Standpipes Present 0~'N) Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test ~~-~ ·-5 ~: Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ~-~ / Lot To Water Main/Service Line "/' ,~0 / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line J ~ / To Existing or Abandoned System on ; On Adjoining Lots 1~ ,_~0 To Cutbank (if present) *1- lDO/ -t- I0/ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at __ Tested for Electrical Codes (Y/N) Dimensions Manhol~ (YC~/N) _,,. yp Off" Level at / Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA Comments "* Check Permitted Bedroom Rating Against HAA Request ** I certify that I h ¢~ch eC~ed, ve/~i f ied, or conformed to alI.MOA, and, HAA g uidelines in effect on the date of this inspection. Signed ~'~ Date_ Company ~ E~.~ I~¢., MOA No. Date of Payment 'q - / /~-~l~ ~;..' ' ~,' ~En~r~ ,¢ Seal Amount: $ ~ ~ Page 2 of 2 ~*~'. CE -225] ~.~ ALASKA B iUIRO[1Ffi F1TAL COIqTROL BRENDA SCI~AP, Z l~gll SOUTHPAP. K BLUFF DRIVE ANC. ggRAGg ALASKA 99516 SELLP}~.- 5Rv~ Sgl tJlCg$, I[lC. APRIL 15 1986 WILL PICK UP FRCM CUR OFFIE 601¢9 LEGAL:.SCOTH PARK SUBD/BLCCK 1/LOT 31 ADE(~JACY TEST i:IOR SE~"iR SYSTEM ADECJJACY 1EST DATE-APP. IL 10 1986 THE TYPE OF ABSClqPTIC~q SYSTEM IS A TRENCH WI'IH AN ?,REA CF 588 S~. THE SYSTEM 1S CAPABLE OF /UCEPTING #50 CAL~S CF WATER PER DAY. THE SURGE CJLPACITY CF THE SYSTEM IS 690 GALLONS. BASED UFON THE TEST DATA THE SYSTEM IS ,NSOEPTABLE FOR A 3 BEDRCCM HDYE. SEPTIC TAix~3EQ1J,NSY THE EXISTING SEPTIC TANK VOLIAW~ CF 1000 IS ADEQUATE THIS 3 BEDROZM u' T~E SEPTIC TAFN/PA(~ PLANT WAS PLgvPEB ON APRIL 11 1996 1200 LU~sl 33rd Aucnu¢, Suite B o Anchoraq¢, Aloska 99503,,(907) 561-$0~i0 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the "~o~A// . ~/-p~ Water System is in compliance with the State Drinking Water Regulations Sincerely, ALASKA ENVIRONMENTAL CONTROL SERVI' v,, INC. 1200 West 33rd Avenu¢ SuRe B ANCHORAGE, ALASKA 99503 Phone 561-5040 APPLIC ~IT FILLS OUT UPPER HAl ONLY Mailing Address ~ ./' - . ///.'~,,-.., Buyer Address Zip Cod? ." .: - . Zip Code Address ' '' ~'' / i '~ / ' . Address z~p Code ;;' :. ¢>/" Zip Code Phone Phone Legal Description ) " ' , ' /.,~( // ~ ~,./: ,, ,. : Type of Residence ' ~ Multiplel:amily No. of Bedrooms .,. , [] Other Water Supply [] Individual .~ Community · Public Utility ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available). Sewer Disposal E]~ Individual [~ Public Utility [] Holding 'rank Year Individual Installed: ~F ; ~ ¢ When Connected to Public Utill,t NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN SE INITIATED. Time Inspector Time ()ate Time Date Inspector Inspector Insp r Field Notes; RECEIVED (~>) APPROVED BEDROOMS DISAPPROVED CON DITIOh)~L APPROVAL* *CONDITIONS OF APPROVAL Soils Rating IWell 1'o Absorption Area Well to Tank Well Log Received Septic Tank Size o~ 274-25~ 43? g. StrEet ._~--/"~ Suite 200 ~ _// Anchorage, AK 99501 ~ep~ember 6, 198~ 'fo Whom it ~.my Comcu~n: .. Addition dl [~ater ~ystem is l[~ compliance with the ~tate Dr-~ W~er R~gulation~. Bruce E. Ericg~om ~nvAromnen[al ~itsy Lawi~orn AW .'[J