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HomeMy WebLinkAboutSOUTHPARK #2 BLK 2 LT 13MUNICIPALITY 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: OSP241153 Work Type: SepticTank Upgrade Tax Code Number: 02050136000 Site Legal Address: SOUTHPARK #2 BLK 2 LT 13 G:3236 Site Mailing Address: 4681 SOUTHPARK BLUFF DR, Anchorage Owner: JENSEN MICHAEL LIVING TRUST Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: ❑ Disposal Field © Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: t)CI)artin lit 7/10/2024 7/10/2025 21142 ❑ 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: .` 5 `-`�.�'3 Issued By: Date: Date: ®` 4 MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON -SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-501-36 Property owner(s) Michael Jensen Mailing address Site address 4681 Southpark Bluff Drive Day phone Legal description (Sub'd., Block & Lot) Southpark #2, Block 2, Lot 13 Legal description (Township, Range & Section) Lot Size 21,142 _Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: (Z all that apply) Absorption Field Fj Septic Tank UR Holding Tank 0 Privy ❑ Private Well ❑ Water Storage D APPLICATION IS AN: Initial El Upgrade RX Renewal R TYPE OF DWELLING: Single Family (SF) RX (w/wo ADU) Duplex (D) R Multiple Dwellings R (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: -22 Date of Payment: Receipt Number: O�277c Permit No. 0 —'5 10 Waiver Fees: Date of Payment: Receipt Number: Waiver No. Permit App_-'- : - I Municipality of Anchorage Orrsite Water and Wastewater REVIEWED FOR CODE COMPLIANCE Pannone Engineering Se rvi ces uc OSP241153, Ctatis Townsend, 07110 Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska Subject: Southpark #2, Block 2, Lot 13 Septic Tank Upgrade Permit Request This is a design narrative for a permit to install a 1,250-gallon septic tank to replace an existing 1,250-gallon septic tank to be issued for this property. The existing tank is 35 years old and is likely perforated and leaking, it will be decommissioned per code. Currently the lot is developed. The proposed replacement will be connected to the existing drain field. This lot and the surrounding lots are served by public water. There are currently no wells within 200' of this upgrade. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5'+ from any property line. 5'+ from any deck/stair support. 10'+ from building foundation. 10'+ from any water line. 100'+ from any surface water. 100'+ from any private wells. 200'+ from any public wells. The proposed installation will not affect the future development of this or the surrounding lots. If you have any questions or concerns, please contact me at (907) 745-8200. Sincerely, Steven R. Pannone, PE, F. ASCE Owner/Civil Engineer 17 June 2024 Mailing: P.O. Box 1807 Palmer, AK 99645 Telephone: (907) 745-8200 FAX: (907) 745-8203 11 II WATER SERVICE AT FRONT OF HOUSE I J �0 g 4BR HOUSE (E) On -site Water and N REVIEWED FOR CODE OSP241153, Curtis Toi S �\ OG �y.O DRIVEWAY .OT 13 °p��� \ i 1,250g SEPTIC TANK (E) DECOMMISSION PER CODE AND INSTALL (MIN) 1,250g SEPTIC TANK (P) INSTALL DOUBLE CLEAN OUT AFTER p AND CONNECT TO FIELD (E) ;� / VERIFY FOUNDATION CLEAN OUT AND y INSTALL DOUBLE CLEAN OUT BEFORE TANK IF NO FCO PRESENT THE CONTRACTOR, AND OR THE PROPERTY OWNER RESPONSIBLE FOR THE INSTALLATION OF THE PROPOSED WASTEWATER TREATMENT SYSTEM SHALL NOTIFY PES A MINIMUM OF 24—HOURS IN ADVANCE MONDAY THROUGH FRIDAY OF THE REQUIRED PRE —CONSTRUCTION INSPECTION. AT THIS TIME A REPRESENTATIVE OF PES AND THE CONTRACTOR OR PROPERTY OWNER WILL 1. DISCUSS CONSTRUCTION PROCEDURES AND DESIGN REQUIREMENTS. 2. VERIFY SITE CONDITIONS CONFORM TO THE DESIGN PLANS AND PERMIT. 3. VERIFY THE PROJECT LAYOUT CONFORMS TO THE DESIGN PLANS AND PERMIT. (Ref: AMC 15.65) PLEASE REFER TO THE NOTES AND SPECIAL PROVISIONS PAGE FOR MORE INSPECTION INFORMATION. PES SHALL NOT BE HELD LIABLE FOR INSTALLATIONS NOT MEETING THE REQUIREMENTS OF 18 AAC 72 AND/OR AMC 15.65 AND THE SPECIAL PROVISIONS OF THIS PERMIT AS APPLICABLE IF THE CONTRACTOR AND OR PROPERTY OWNER FAIL TO GIVE PES PROPER NOTICE. PES WILL ATTEMPT TO DOCUMENT THE SYSTEM AND OBTAIN ANY NECESSARY WAIVERS AT THE CONTRACTOR AND OR PROPERTY OWNERS EXPENSE. PES MAKES NO GUARANTEES THAT ANY NEEDED SEPARATION DISTANCES WAIVERS WILL BE APPROVED BY AEDC OR THE MUNICIPALITY OF ANCHORAGE ONSITE DEPARTMENT STAFF. for construction PA1�INONE ENG SVC, ULC ( Date P.O. BOX 100217 ANCHORAGE, AK 99510 scot 1p'r"'• `' �2024 PHONE (907) 272-8218 FAX (907) 272-8211:'� �►� :* 1"=50' •• ••••••• P.I.D. NO DRAWN BY: DRM SOUTHPARK #2, BLOCK 2, LOT 13 •.ti020-501-36 MICHAEL JENSEN. ° c�r►no. PERMIT NO. 4681 SOUTHPARK BLUFF DRIVE CE 8149 .;� OSPXXXXXX PLAN ANCHORAGE, AK '• Sheet 1 OF 2 07/1CYe SPECIAL PROVISIONS TO SPECIFICATIONS On -site Water andVl REVIEWED FOR CODE 1. GENERAL NOTES: OSP241153, Curtis TOM71W 1, 07/1X 1.1. ANY MODIFICATIONS TO THE ATTACHED PLANS NEED TO BE APPROVED BY PES AND THE OWNER OF THE PROPERTY. 1.2. PES SHALL BE NOTIFIED A MINIMUM OF 48 HOURS IN ADVANCE BEFORE CONSTRUCTION OF THE PROPOSED WASTEWATER TREATMENT SYSTEM. 1.3. PES SHALL BE NOTIFIED A MINIMUM OF 24 HOURS IN ADVANCE TO PERFORM A MINIMUM OF FOLLOWING INSPECTIONS: 1.3.1. A PRE CONSTRUCTION MEETING IS REQUIRED BY STATE AND MUNICIPAL REGULATIONS BEFORE A ONSITE WASTEWATER TREATMENT SYSTEM MAY BE INSTALLED. 1.3.2. TOP OF SEPTIC AND OR HOLDING TANK (TANK IS SET IN PLACE LEVEL WITH ALL PIPING ATTACHED (CLEANOUTS, MANHOLES, INLET AND OUTLET PIPING). 1.3.3. BOTTOM OF EXCAVATION OF THE DRAIN FIELD/S. 1.3.4. AFTER PLACEMENT OF FILTER SAND (IF NEEDED). 1.3.5. AFTER INSTALLATION OF THE DRAIN ROCK WITH ALL ASSOCIATED PIPING IN PLACE INCLUDING DISTRIBUTION LINES CLEANOUTS AND MONITOR TUBES PRIOR TO INSTALLATION OF FILTER FABRIC AND INSULATION (IF NEEDED). 1.3.6. FINAL GRADE INSPECTION. ENTIRE SYSTEM IS INSTALLED AND BACKFILLED. 1.4. THE ENGINEER (PES) HAS NO CONTRACTUAL RELATIONSHIP WITH THE CONTRACTOR (THE INSTALLER OF THE SYSTEM) AND, THEREFORE, HAS NO AUTHORITY, CONTROL OR RESPONSIBILITY FOR THE CONTRACTOR'S EMPLOYEES, THE QUALITY OF WORK, THEIR COMPLIANCE WITH THE DESIGN DRAWINGS/SPECIFICATIONS OR THEIR MEANS/METHODS OF CONSTRUCTION. AT APPROPRIATE INTERVALS, THE ENGINEER WILL VISIT THE WORKSITE TO OBSERVE THE QUALITY OF THE CONSTRUCTION AND TO DETERMINE IN GENERAL IF THE CONSTRUCTION IS PROCEEDING IN ACCORDANCE WITH THE DESIGN DRAWINGS/SPECIFICATIONS.THE ENGINEER WILL NOTIFY THE OWNER IF DEFICIENCIES ARE OBSERVED; HOWEVER, THE FAILURE OF THE ENGINEER TO OBSERVE A DEFICIENCY WILL NOT RELIEVE THE CONTRACTOR OF THE RESPONSIBILITY FOR CORRECTING ANY SUCH DEFICIENCY. THE ENGINEER WILL PREPARE RECORD DRAWINGS AND SUBMIT THEM TO THE REGULATORY AGENCY HAVING JURISDICTION OVER THE WASTEWATER TREATMENT SYSTEM (ADEC OR MOA). FINAL APPROVAL OF THE WORK AND CORRECTION OF ANY DEFICIENCIES IS BETWEEN THE OWNER, THE CONTRACTOR, AND THE REGULATORY AGENCY HAVING JURISDICTION OVER THE WASTEWATER TREATMENT SYSTEM (ADEC OR MOA). 2. SCOPE AND SPECIFICATIONS: 2.1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MOA COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON -SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55. 2.2. CONTRACTED WORK WILL BE IN COMPLIANCE WITH MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) DIVISION 10 & DIVISION 20 AS APPROPRIATE. 2.3. SCOPE OF WORK: INSTALL SEPTIC TANK PER DESIGN 2.4. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF -NA- BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN -NA- BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 2.5. STRUCTURES DEPICTED ON THMITE PLAN ARE BASED UPON ONE OF THE FOLLOWING: CONCEPTUAL PLOT PLAN DEVELOPED BY OWNER; A PLOT PLAN DEVELOPED BY RLS; OR A SURVEY AS -BUILT. 3. CONSTRUCTION SPECIFICATIONS: 3.1. ALL EXCAVATION DEPTHS ARE ADVISORY. THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE ENGINEER IF ACTUAL FIELD CONDITIONS VARY FROM THOSE USED TO PREPARE THE DESIGN 3.2. EXCAVATE THE DRAIN FIELD. BOTTOM OF EXCAVATION SHALL BE LEVEL AND SCARIFIED. RECORD ELEVATIONS AT BEGINNING, MIDDLE AND END OF TRENCH BOTTOM. CONSTRUCTION EQUIPMENT SHALL NOT OPERATE ON THE FLOOR OF THE EXCAVATION. ANY MATERIAL COMPACTED BY THE OPERATION OF THE CONSTRUCTION EQUIPMENT SHALL BE REMOVED AND REPLACED WITH UNCOMPACTED MATERIAL. 3.3. PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK WITH NATIVE MATERIAL OR SPOILS FROM EXCAVATION. LEVEL ROCK SURFACE TO tI" PRIOR TO INSTALLING THE PERFORATED PIPE. 3.4. ALL PIPE SHALL BE PVC CONFORMING TO ASTM D3034 OR ENGINEER APPROVED EQUAL. MINIMUM SOIL COVER SHALL BE 3 FEET OVER THE PIPE AND 4 FEET OVER THE SEPTIC TANK. ONE INCH OF INSULATION MAY BE SUBSTITUTED FOR 1 FOOT OF SOIL COVER. 3.5. ALL INSULATION SHALL BE 2" THICK DOW HI-40 INSULBOARD OR ENGINEER APPROVED EQUAL. CENTER INSULBOARD WIDTH OVER SEPTIC TANK OR LINES. 3.6. GEOTEXTILE SHALL BE MIRAFI 140S OR ENGINEER APPROVED EQUAL. LAP ALL JOINTS 2 FEET MINIMUM. 3.7. COVER THE DISTRIBUTION PIPE WITH A MINIMUM OF 2" OF SEWER ROCK AND COVER WITH GEOTEXTILE BEFORE PLACING INSULATION AND BACKFILL. 3.8. MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS. 3.9. SLOPE ALL FILL MATERIAL TO DRAIN AT 2% MINIMUM SLOPE AND 3:1 MAXIMUM SLOPE AND IN SUCH A MANNER THAT PONDING AT OR NEAR THE DRAIN FIELD DOES NOT OCCUR. THE FILL SHALL BE LEFT AT 6" HIGHER THAN SHOWN TO ALLOW FOR SETTLEMENT. SEED SURFACE AFTER COMPLETING INSTALLATION AS PER MOA CODE. 3.10. RECORD THE FINISH GROUND ELEVATION OVER THE BEGINNING, MIDDLE AND END OF SYSTEM. 3.11. MAINTAIN 5' SEPARATION BETWEEN PERCOLATION HOLE AND THE DRAIN FIELD TRENCH. 3.12. EXPOSE, PUMP AND FILL LOG DISPOSAL CRIB OR CONCRETE TANK WITH SOIL TO ABANDON IAW WITH MOA CODE IF NEEDED. 4. CONTRACTOR RESPONSIBILITIES: 4.1. THE CONTRACTOR SHALL FAMILIARIZE THEMSELVES WITH THE SITE CONDITIONS AND LOCATIONS OF ALL LOT LINES, EASEMENTS, WELLS (E & P), SEPTIC SYSTEMS (E & P) AND SHALL MEET MINIMUM SEPARATION DISTANCES OR AS NOTED. 4.2. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. 4.3. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED. 4.4. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. 4.5. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER. 4.6. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN. 4.7. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED -LINE AS -BUILT DRAWINGS TO THE ENGINEER. THE RED -LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. 4.8. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION, TOP OF PIPE WITH CLEAN -OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING. S. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WILL BE PERFORMED IN ACCORDANCE WITH THE APPROVED PERMIT, AND ANY AND ALL CHANGE ORDERS, AND THAT THE AS -BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. THE PARTIES HEREBY AGREE TO THE TERMS AND CONDITIONS SET FORTH IN ATTACHED DOCUMENTS. CLIENT: CONTRACTOR: NAME: NAME: SIGNATURE: SIGNATURE: DATE: DATE: for construction PANNONE ENG SVC, LLC Date P.O. BOX 100217 ANCHORAGE, AK 99510 �.��•.,,.. •• S/a e�2024 PHONE (907) 272-8218 FAX (907) 272-8211.'� NTS .... ....... P.I.D. NO SOLITHPARK #2, BLOCK 2, LOT 13 020-501-36 MICHAEL JENSEN. y� }e n e PERMIT NO. CE 4681 SOUTHPARK BLUFF DRIVE 8149 ; osPxxxxxx �#� DESIGN DETAILS ANCHORAGE, AK .���I7lGE�' sheet 2OF2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 %" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Nar.. DISTANCES ~.eC ~u~/o~ SEPTIC ABSORPTION Addre~ ~ TANK FIELD WELL Phone(s) Permg NO. Ne. of ooms WELL > ~o ( LEGAL DESCRIPTION TANKS ~ SEPTIC ~ HOLDING TYPE OF SYSTEM " ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER Deplh to pipe bot[om lrom ~j~ Total depth from original ~rade Gravel depth beneath pipe ~ ~ ~: .I Total absorption area Distance between lines Number of Soil rating Pi~e material WELLS~ ~'" FT PRIVATE Cla~ificalion (A.B,C)~ ~h FT Cased to ~ ~ - /3 ~ 7--~ Inst~ Date Installed: / / REMARKS: L~ ~ - ~C LL Inspections Pedormed by: ~0~¢ ' ' · I /' (~ t~ cedily that Ihis inspe.ion was performed according to all Health Depadment Approval: Date: 72-013 (3/85) T LIF;.' NEi]:;.' CONSTRUCTION BOX F"~-~L.Mk.r~, AK 99645 Day Phone: F:'a P c ~:'? ]. I d: 0;;:',0..-()52-87 Lot Le~]~].: Subdivision: SOLITHF:'ARK ADDN~ ~:1:2 I..,~t~ Sectic~n: 3 Townsl'~ip: llN Ranc]e: :SW Lcd:. S:i. ze 2.:1.142 (sq. ['L. oP acPes) Max B(.:adr'ocHIIs: This PePmit: 4 Total (]apacity: 4 ...."'cFI,IL, '"'IANr.,, .... Plin:imum total sept:Lc tank capacity,", :1.,25". . gal,:Lc)ns. Each septic 'fr. a~"~ ~C ~L.~ ~'[.. have a't, least [~:~ compartmen'Es. Dep'Lh 't.c~ top o~' sept:i.c tank(s) < 4.0 l'E!6~t p6,!qL,!iPes insu],at:i, on over' tar'd.,: (s) . INSTAL. I.. F:'EFt ENGZNEEEF~S AT'f'ACIqE)]) AF'PROVED F'I_..ANS, NOTIFY DHHS PRIOR TO ALL. INSF:'E.C"I'IOIqS BY ENGZNEER OR ANY NECESSARY CI'~AIqGE DE:S:[GN. t..:[FT S'I"A'TION MAY NEIED ELEC"I'R:I:CAI... PERMIT, VARIFY WITH PL[SL.I C WOI::~KS. ]'H IS FqE:RM ]:T IS :ISSUED FOR 'r'FIE F'LANNFN]) SINGEEL F:AM]:LY~ 4 BEDROOM DW!ELL. ING ONL..Y AND EXF'IRES [)N :1.2/3:t/89~ ]] am fami].iap ~:i.'U] 'Lh,'..:;~ PeqLtiPefiiE:,i"rLs ((:)P C:Hq-"site ~ewer's and ~c]rLh by the MLin:[cii)a!ity oF Anc:hol*age (MOA) and {he State of Alaska. I will :i. nsta].l the system in ac:coPdalqc:e (.)i'Ll"i all MOA cc}des ar'id Pegu]at;ic~rls, and J. rl c:ompliaric:e kd. th the cles:i.t]n (:r, itep:ia c){ t. his pel"mit= I will. adhePE, 'L(::l all MOA and S'LaCe (::)~' Alaska p~:~quipement?~ tom 'Lhe set back dis'Lanc::es [i"c:)m any 0~)xist:ing we].]., wastewaLc, P disposa], sys'Lem ~i' public s(:~ei, age sys'L(em on this oP any adjacent of neapl:)y :L c~'l'.. ,, ]: under'stand 'Lhat 'Lh:i.s per'mit i,s val:i.d Fop a maximum c,f 4 bed~-ooms. also:) unde~'s'Land {hat the c:apac::i.t.y o( the 'LcrLal sys'Lem is 4 bed~-c)oms~ and Torn Fink, Mayor v unicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 May 8, 1989 Leroy C. Reid Jr., P.E. 1412 West 33 Ave. Anchorage, AK. 99503 Subject: Lot 13 Blk. 2 South Park Subdivision Addn. #2 Dear Mr. Reid, The proposed design for the delivery pipe from the lift station to the absorption bed on the referenced property cannot be approved as submitted. Per AMC 15.65.075.B the absorption bed must be placed on native undisturbed soil.' Whereas the proposed total depth of trench excavation is 6' below original grade, and the bed is proposed to be installed at a depth of 2' below the original grade, this cannot be permitted. Considering the total depth of the test holes for this installation it would be necessary for additional testing and water monitoring to be completed prior to consideration of any deeper installation. I believe your concern over disruption of the supply and distribution piping by the contractor is valid and that alternative design methods can help reduce damage. However any design submitted to this office must be in accordance with existing code. As such I must ask that you resubmit a design which is within our ability to permit. Since~rely~, Daniel N. Bolles On-site Services cc: Susan Oswalt, Manager On-site Services db/65 ALASKA COIqTROL SERUICE$, Inc, enUlROnmEnTAL o I~ntjineerin~ ~, I~nuironmental $lu~lics 1200 Wesl 33r,J Auenue. $ui1¢ ~. Anchoroqe, Alaska 99503.{907/ 561-5040 TO DATE .- ~ ~ ~ SUBJECT .-~/.i:il;:'.. 7.-:' ALASKA ENVIRONMENTAL : '_ -- : "-CONTROL SERVICES,' INC. - ": ' '~ 1200 West 33rd Avenue Suite B · ' :~ -ANCHORAGE, ALASKA 99503 - i (907) 561-5040 JOB SHEET NO, CHECKED BY " " " - DATE Ld [] Ld [] 0 Ld ~Z ti- Z © D Z 0 O~ o o Z OE o td H X · I1_ o ~ ALASKA eDUIROIhmeDTAL CODTROL SeRUICeS, Inc. I~nt~ineefi~l ~ ~nuironmenlo[ Slu~lics SPECIFICA"['IONS FOR BED WASTEWATER TREA'TMENT SYSTEM LEGAL DESCRiEP'I"i[ON: L. OT !3, BLOCK 2, SO[J]-H PAR"~ ADDI]'ION I~2 GENERAL The Drawings, sheets i through 4, shall be part of !fi'~is specification. All materials and worl<manship shall meet the requirements ef the Municipality of Anchorage, .',')epartment of Health & Human Services (DHHS), the conditians of the permit, and all applicable rules r'egulat.~ons currently in effect. 1.3 All excavations and dep'Ehs are advismry, and are to be verified or modified in the field by the Engineer or inspecting agency. 1.4 It is the responsibility of the owner or installer to adhere to approved design for the installation, to maintain the specified separation distances and to have the appropriate inspections. 1.5 It is the responsibility of the property owner or installer to report to the engineer any abserved c:c)ndi'~:ions which would put the system in violation of state or municipal r-egutatiorls. !.6 If the installatien is not inspected by an AECS engineer, AECS wall not be responsible for the installed system. An engineer at AECS should be consulted prior to construction, to determine the number of inspections that will be required and to explain what these inspections will involve. ar'id 2.0 SEPTIC TANK If there is an e;.(isting septic tank it may be used if it meets the capacity ¥'equiremer~t for the residence. The structural integrity of the tank must be verif:Led. 2.2 ]"he septic tank shall be a UPC-approved two-compartment tank, construe:ted of 12 gauge steel with bitumastic coating and set level on undisturbed soil. If the tank is buried at. a dept:h of 4 feet or less, it must be insulated with an overlying layer ef 2 inch burial type I:)olystyrene rigid board insulatien. The septic tank shall the house foundation~ the absorption area. be a minimum o'f 5 'feet from and a minimum of 5 feet from 2.4' 2.5 2.6 227 The septic tank and bed shall be a mir;imum of 100 'feet from any private well or body o'f ~;ater, 150 feet from Class "C" wells, and 200 feet from Class "A" or "B" wells, unless otherwise specified. Less th~n the required separation distance must have prior approval or waiver by DHHS or Alaska Department o9 Environmental Conservation (ADEC). Piping shall be 'fitted with a meclnanical watertight calder coupling oF~ the outlet and inlet of the septic tank. Piping shall be 4 inch solid PVC ASTM D-.-..3034 or cast. iron, sloped a minimum of 1/4 inch per lineal foot on the inlet side and 1/8 in~'h per foot oF~ the outlet side. If the piping is buried at a depth of 4 'feet or less, it must be insulated with an overlying layer of 2 inch burial type polystyrene rigid board insulation. Cleanouts shall be installed as designated and capped with air-tight rain caps (Jim Caps or equivalent), and extend a minimum of 1 fo)or above ground level. If a lift station is required it shall be a c()mbination ]l.i~t station septic tank per Anchorage Tank and Welding, Inc. design. Specifications and design drawings are on 'file with the municipality and the engic~eer'. 3.0 SEEPAGE BED The gr'avel for the screened rock with No. 200 sieve. All DHHS approval. bed shall be 0.5 to 225 inch, less than .3 percent passing the substitutes must have prior 3.2 The bottom o'f the e}.~'cavation shall be level and raked with the backhoe blade 'ko ensure that the bottom has not been compacted during excavation. 3.3 Sand, for leveling, shall have a size distribution which meets the requirements of MOA code 15.65.077. The distribution pipe shall be perforated 4 inch rigid PVC w.it_l"l a minimum cr'ush strer~g'Eh of :L50() pounds and shall meet the approval of DHHS for' use as drainfield pipe. All pipes shall be laid level, and spaced according to the drawings. 3.5 Monit(:~r standpipes shall be placed as shewn in the drawings. They shall be 4 inch rigid PVC ASTM ~3-3C'~34, or cast iron~ The section sho~n ~ith holes may be either drilled 0.5 inch holes on 6 3~7 3.8 ir]ch centers ori opposing sides o'l: the pipe, or a section of regular perforated sewer pipe may be clamped to the selid section with a no-hub coupling or solvent joint. The perforated section ef the menitor tube shall be located in gravel only~ The portion of pipe above the sewer rock shall be solid. A rubber raincap (Jim Cap ~)r" equivalent) shall be placed over' the top o9 the pipe ~ Insulation is required, using burial type polystyrene rigid board insulati!~n. There shall be i inch of insulation for every 'foot of soil less than the r'equired 4 feet of cover", but there must be at least 24 inches of soil even thougl'~ insulation is used~ The solid pipe extending from the septic tank to the drainfield shall alse have a minimum of 4 'feet of cover er an equivalent layer e'f insulation combined with soil. The side slope of the mound shall be slope i 9eot vertical to :3 feet horizontal. The bed shall be planted with a white clover and red fesc:ue mix, or' with bluegrass. 4.0 INSPECTIONS 1"his bed will require a minimum of three inspectiens. The first inspectien will be o'~ the open excavation, to assure that the system is installed in tine proper soil strata, correct depth and meet minimum specified design parameters. 4~2 The second inspection ~ill be after placement of gravel, monitor standpipes, and distribution pipe, to verify proper' installation and position o'f pipes prior to backfill. The third inspectien will be after final backfill grading and seeding to ensure that adequate soil cover has been provided over the bed~ 4~4 The inspection of the septic tank or lift statien installation can be incorporated with any one of tine above listed inspections. The lift station will r-equire either- an MOA electrical inspection or certification by a licensed electr"ician depending en whether the building code applies to this part of the city. ALASKA ENVIRONMENTAL · CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B · ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEETNO. / OF. CALCULATED BY !' '~' J DATE CHECKED BY DATE SCALE. ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 E.EET .O. ~- OF ~ ~,~ CALCULATED eY DATE CHECKED BY DATF PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 8 10 12 13 ~14 - 17- 18- 20- COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, SLOPE SITE PLAN / A WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT OL ,,DEPTH;' PE Depth lo Water After ~' I~oniloring? ~ ~"'~ Oate: ~//~ ~/~? L'/ R""~ad'n 9L~ Gross Net Depth to Net Date Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER -- TEST RUN BETWEEN __ FY AND __ FT ~J~ ~o./~ ~ ,'.~z~9~d' >~'f: ~.,/,4,,.. ~'/~J .~/-z'~Z ~ PERFORMED BY: /' f~'-,,~ I J~' /~z ~J CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) .PI~O T. PLAN K.I~NN~TH. G LANG~ L.§. AS BUILT SCALE· 1731 GEORGE BELL CIRCLE, ANCHORAGE, ALASKA 995Z5 fi=ab' (907) 345-6476 I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED ' PROPERTY: LOT I'~ , BLOCK ~ , ~u~ ~,~- ~,x~>~q~ , *aqc~ RECORDING DISTRICT, ALASKA, AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND DO NOT ENCROACH ONTO THE PROPERTY ADJACENT THERETO, THAT NO IMPROVEMENTS ON THE PR0;PERTY LYING ADJACENT THERETO ENCROACH ON THE SURVEYED PREMISES ~AND THAT THERE ARE NO ROADWAYS~ TRANS- MISSION LINES OR 0THER VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT AS INDICATED HEREON. DATED THIS THE I%~ DAY OF /~zac.' , 't9 ~>'), AT ANCHORAGE, ALASKA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-.4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel LD. # 020-052-87 HAA# 0 0 1. GENERAL INFORMATION Complete legal description $0UTHPARK ~2 LOT 1.5. BLOCK 2 Location (site address or directions) 4681 SOUTHPARK BLUFF Property owner Mailing address Lending agency Mailing address Agent CAROL BUTLER Address BOB SCHUTZIUS 4681 SOUTHPARK BI UFF Day phone Day phone (907) 265-6025 RE/MAX PROPERTIES 26OO CORDOVA Day phone (907~ 257-0116 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well Community well XXX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding Tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC lng to the legality and status of system. 72~25 (Rev. 1/91 ) Front MOA 1~21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $800.00 at, or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verity 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 verity 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 Munici~,~ and State codes, ordinances, and regulations in effect on the date of this inspection~ Name of Firm ALASKAW S~EWATEP, CONSULTANTS, INC. Phone (907) 337-6179 Address 6901 DEEARR R~OAD/S~I~E ~¢,~(~HORAGE, ALASKA 99504 Engineer's Signature~ Date In conducting this evaluation, AI,1/WC~ a thorough, conscientious engineering analysis of the system in accordance with ADEC and ~OA DH~¢ Guidelines & Regulations. The reported results described the ~d at the time of the test performance of the system under the conditions ; and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continua to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or parly is not authorized, nor will it confer any legal right whatsoever. 6. DHHS SIGNATURE J--'"' Approved for L/- 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. 72-025 (Rev. 1/91) Back MOA #21 Computer Version RECEIVED Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICF~p 1.~"2000 Environmental Services Division 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SEI~VlCES DIVISION Health Authority Approval Checklist Legal Description: SOUTHPARK ~2 LOT 13, BLOCK 2 Parcel I.D.: A. WELL DATA Well Type Log present (Y/N) Total depth Sanitary seal (Y/N) A If A, B, or C, attach ADEC letter. ADEC water system number 2134575 Date completed Cased ~~'~~- __Casing height (above ground) FROM WELL LOG Well production WATER SAMPLE RESULTS: Coliform Date of sample: AT INSPECTION g.p.m. Nitrate Other bac-te~a Collected by: ~ ~ B. SEPTIC/HOLDING TANK DATA Date installed 6-20-89 Tank size Foundation cleanout (Y/N). YES 1250 Number of Compartments 2 Cleanouts (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) Date of Pumping 6-9-00 Pumper NORTHLAND C. ABSORPTION FIELD DATA Date installed 6-20-89 Soil rating (g.p.d./ff2 or ff2/bdrm) 15O System type. BED Length 59' Width 16' Gravel thickness below pipe 6" Total depth 59" Effective absorption area Date of adequacy test Fluid depth in absorption field before test (in.); Fluid depth 3.5 (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72~926 (Rev. 3/96)* Computer Version 6-9-00 Results (Pass/Fail), PASS For 3.75" Immediately after 925 231 Absorption rate = NONE KNOWN If yes, give date 944 Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO 4 Bedrooms gal. water added (in.): 5.5" 600+ GPD D. LIFT STATION Date installed Manhole/Access (Y/N) ~on" level at* "Pump off' level at*  _ *Datum. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TOi Septic/holding tank on lot Absorption field on lot Public sewer main ~ On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property Fine 5'+ Absorption field 5'+ Water main/service line 10% Surface water/drainage. 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Surface water Curtain drain F. ENGINEER'S CERTIFIC.~ I certify that l h.~a ~rr~ of Municlpal r~coMs ~a~t S~gnature (~ ~ Engineers Name. Building foundation 100'+ NONE KNOWN Driveway, parking/vehicle storage area JEFFREY A. GARNESS field inspections and review systems are in conformance ~this date. 10'+ Water main/service line 10'+ 10'+. Wells on adjacent lots .......... HAA Fee $ ~ 09 ,- F-J Date Of Payment Receipt Number 72-028 (Rev. 8/g8)* Oompuler Version .) Waiver Fee $ Date of Payment Receipt Number_ Parcel I.D. # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending a~ rmy Mailing address Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS:- 3. ' TYPE OF WATER SUPPLY: Individual well ~mmunity well Public water NOTE: 4. TYPE OF WASTEWATER DISPOSAL:' lng to the legality and status of system. Individual on-site /~ · · Holding tank ' · -- ' Community on-site . Public sewer NOTE: If community well system, provide written confirmation from State ADEC attest- 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 STATEMENT OF INSPECTION BY ENGINEER As certified b~ my seal affixed hereto and as of the validation date shown below, I verify that my investigationof 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 fro~ 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 data of this inspection. Name of Firm /~,4/~ ,~'~-~/'~ ~¢-,"~'~' Phone (~ ¢{~ ~/~ / / / .:_Address eq O~z / /P~ ~ ~-,~4 / ~.~,,.~ ,~/~-,¢/, Engineer's signature ~ KND Engineering 20441 Ptarmigan B~vd. Eagle River, AK gg577-8736 DHHS SIGNATURE '_?~ Approved for --~ 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 requirernents. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errom or omissions in the professional engineer's work. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501e (907) 343-4744 Legal Description: A. WELL DATA Well type Health Authority Approval Checklist 2~t~or_..~__ ~ ,,~¢t~-/~ Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Date completed Casing height (above ground) Well production g.p.m. WATER SAMPLE RESLrL~ Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date iostalled /~ -,70- o° ~' Tank size Foundation cleanout (Y/N) y Depression (Y/N) Dateofeumping [t9-~ ~ ~' Pumper c. A SORmON DAXA Number of Compartanents oL Cleanouts (Y/N) y High water alarm (Y/N) /~t4 Fluid depth in absorption field before test (in.); Fluid depth ,~ ~/r~ Minutc~ later: ~ ,t Peroxide treatment (past 12 months) (Y/N) Date installed ~o-,,=~9'-- 8~} Soilrating (g.p.d./fi2orfi2/bdrm) /~O~2~/Z"Systemtype ~-~,- Length ~,~/ Width /Gt Gravel thickness below pipe ~ // Total depth ,~ ~}*' Effective absorption area ~Sz,t-/~ Monitoring Tube present(Y/N) [f Depression over field (Y/N) / Date of adequacy test / 47- ~. c~..~ Results (Pass/Fail) ~70--$$ For ~/( bedrooms ~ '/ lmmediatelyafteroCt~Ogal, wateradded (in.): (in.) Absorption rate = g Oo '/- .g.p.d. ff yes, give date D. LIIWI' STATION Date installed Size iii gallons (Y/N) ~f off, level at* Manhole/Access High water ularm level at* ~ *Datum Cycles tesd~'~/ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank ou lot Absorption field on lot Public sewer nnfin Sewer/se~service line ; On adjace~ ~nt lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundatiou /g2_. 7" Property line -~' ' Absorptiou field ~, Water maiiu'service line /O / /' Surface water/drainage /0o/~' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Buildiug fouudatiou ~ 17 r Surface water /~O / ~- Curtain drain / 6~ O /~: Water maixu'service line / 0 / W Driveway, parking/vehicle storage area .~o / /- Wells ou adjacent lots 7_. ~' O / ~'' F. ENGINEER'S CERTIFICATION 1 certify that 1 have determined thrufield inspections and ,'eview of Municipal rec~_d~.'~,~d~o; ¢~}a ems are in conformance with MOA HAA guidelines in efJbct on this date. ~&~..'" ~'%,. ~t~~ }~ . , ~:" ~ '..75,~ , ' ~ ~ . .,~ ............................... ' .............................................................. ~t4~4~= - HAA Fee $ ~ ' ~ Waiver Fee $ Date of Payment /0~~~ Date of Paymeut Receipt Number/~ ~(~F//) Receipt Nmnber Rev. 8/95 OSS: haa.wk.doc 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 1. GENERAL INFORMATION Complete legal description Lot 13; Block 2; South Park Subdivision Addition ~2 Location (site address or directions) 4681 Southpark Bluff Drive, Anchorage, Alaska Property owner Mailing address Lending agency Mailing address r,¢nn*~s c~rule Day phone 4681 Southpark Bluff Drive, Anchorage, Alaska 99516 Day phone Agent Address Day phone Unless otherwise NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: requested, HAA will be held for pickup. 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, 72~25 (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 verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature ~ ,~ ~ I~IGJi~iEEEiNG 77034 Ea~le River Loop Road No. 204 ~Je Rivm', Alaska 99577 Phone DHHS SIGNATURE Approved for ~' 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage /~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description' ~---c,~' [~'~ ~.~z.- ~ ~'~'~'~'~'~'~'~'~'~"~0~'~ / Parcel I.D. A, WELL DATA Well type If A, B, or C, attach ADEC letter. 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 g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main AT INSPECTION Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Lc -'-/~ ~'¢'1 Tank size ~"Z-~O (,¢~/~.-- Compartments Cleanouts I~/N) ~' Foundation cleanout ~'N) ',¢ Depression (Y~ High water alarm (Y~ ~ Alarm tested (Y/N) Date of pumping '%~' ~ Well(s) on lot To property line ~,~ ~ Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: "¢~ '~ ~ ~- On adjacent lots "~,~- Foundation Absorption field ~'~ ~ Water main/service line 72-026 (Rev. 7/91) Front , ' ' CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA ~!ectri~ SEPARATIO. O.O.O.O.O.O.O.O.O~ANCE FROM LIFT STATION TO: W~ On adjacent lots Manufacturer Manhole/Access (Y/N) ~ "Pump on" level at ~vel at .~'~Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed ~J~'" '?"~ ~' S Length '~'¢~ Width IL~I Total absorption area ¢) ~¢f' Depression over field (Y,(~ Results4~..~fail) Peroxide treatment (past 12 months) (YI~ Soil rating [~"~ ¢~/~,¢, System type Gravel thickness 0.~" Cleanouts present (~)/N) Date of adequacy test for (~f.) ~z:~ Ia- bedrooms //--~o ~,.J ~/ If yes, give date ~d'/,,~_ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Welion lot To building foundation On adjacent lots "Cs ~- Surface water Curtain drain On adjacent lots ~¢,- Property line To existing or abandoned system on lot Cutbank ~/~ Water main/service line \ ~ Driveway, parking/vehicle storage area 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. $ & $ ENGINEERING Signature _17034 Eagle River Loop Road No, 2_.04 E.~'~le htlver, Alaska 9~577 Engineer's ~ame Date ")'P - ~ ~' HAA Fee $ / 7~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72 026 (Rev, 3/91) Back MOA 21 DEPT. OF ENVIRONMENTAL CONSERVATION WALTER J. HIOKEL, GOVERNOR ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 563-6775 January21,1992 FOR: S & S Engineering PWSID 213475 My review of the records on file in this office reveals that the South Park Subdivision Class "A' Public Water System, is in compliance with the routine coliform bacteria samples requirements listed in Table C, and with the inorganic sampling listed in Table B of 18 AAC 80.200. Sincerely, Keven K. Kleweno Lead Engineer MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location ( a ~;O ~ d,~ e~t i o n"~,?dL~~ (b) Property ~¢¢~ Mailing Ad~~' ~~/~ (c) Lend,ng Inst,tuti~n Mailing Address Telephone: (home) ///c ¢¢,¢ Telel~hone Busin essS¢-~; ~ --,¢~'¢'/ (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here E~,if hold for pick up.) List con~act person and day phone number below: 2. TYPE OF RESIDENCE Single-Family,[~ Number of bedrooms 3. WATER SUPPLY Individual Well [] Community,~)' 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,j~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department o,f Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 ~ J.o ~ e§~d 'HJOM s,JeeulSue leUO!Sse~oJd aql u! suols9! LUO JO SJOJJ8 JOJ eiq!suodseJ :lOU s! eS~Joqouv ,[o ,~]!led!o! un ~1 eqJ. 'penss! s! e~eo!Jl]Jeo ~ eJojeq elep ezXieue Jo suo[loadsu! lonpuoo'lou op 9HHO ~.o sea,~oldUJ=t 'sluetueJ!nbe~ re, els pue leJepe~ ulelJGo ~JS!leS O1JepJO U! SUO!ln~I~SU! 8u!puel J!eql pue seuJoq jo s~eseqo~nd ol ,~sepnoo e se s!ql seop SHHQ eqJ. 'eNSel¥ ~o e~elS eql u! pe~e~s!Se~ Jeeu~Sue leUO!SSejo~d ~uepuedepu! ue,~q e^oqe ~; qde~§~ed u! ue^!8 suo!leluese~daJ eql uodn/[lUO peseq pel~O!~peo le^oJdd¥,~lpoqlnv qlleeH sense! (9HH(]) seo!^~es ueuJnH pu~ q~lUeH lo ~ueLul~deQ elSeJoqou¥ Jo ~l!l~d!o!unlAI eqJ. leUO!llpuoo le^oJddv leUO!llpuoo Jo SLUJe/ peAoJddes!C] ~ peAoJddv ~q smoolpe~¢¢lot peAoJddv 'lVAOblddV SHHQ '9 A. WELL DAT Well Class~i~?cation Well Log Present (Y/N) MUNICIPALITY OF ANCHORAGE (MOA) ~ Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ,,~/.-? ,~ '~'/~ ,D~,..,~..,¢ Z. Date completed If A, B, C, D.E.C. Approved ~gN) Yiel/d¢. Total Depth__ Cased to Depth of Grouting / /- Static Water Level Pump Se_,.t.A~__ Casing Height Above Ground Sanit~eal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) _.~e"pression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Fiel~Cn Lot To Nearest Public Sewer.~'" To Nearest S.,~r.4Cervice Line on Lot Water Samp~p~rected by Water S.a/~e Test Results Comments /¢/AC ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed (/,~o,/,~' ¢ Size J;~ $'~ No. of Compartments Standpipes ~)/N) Air-tight Caps ~'N) Foundation Cleanou~N) Depression over Tank (Y/~ Date Last Pumped Pumping/Maint~an~ ~tact on File (Y/N) . ; for Holding ~'n~.~gh~ ~ (Y/N) ~ Temporary Holding Tank Permit (Y/N) SEPACATION ~J~;E~:~ SEPTIC/HOLDING TANK: ,: . %%.. ,, / / To W~ter~Suppi~Weil ~ ~,.~ -~ ~o To Building Foundation TO Pl~epertybiRe,~. · ' '¢"~,kf~%' To W~te~Maln/Serwcl~ Line d To Strea~¢&e¢' L~eCq~'~j~r Drainage Course To Disposal Field 6'-/ / / 72-026 (Rev. 7/88) Front Page 1 of 2 . C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ,/~ Square Feet of Absortion Area Depression over Field (Y/(~) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ Z-GO To Building Foundation Lot ~ To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field 'J'-,¢ / Depth of Field Gravel Bed Thickness Statndpipes Present ~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~> ~...) To Cutback (if present) Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y-/N) "Pump On" Level at __ "Pu. mFq~ff" Level at High Water Alarm Level ^,) ~_~at ~ Vent (Y/N) Tested for ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidel Signed Company /¢'~-~'~"* -~' Date MOA No. Receipt No. 72-026 (Rev 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 Seal / DEPT. OF ENVIRONMENTAL CONSERVATION/ / ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 Dr. Leroy C. Reid, Jr. Alaska Environmental Control P.O. Box 240668 Anchorage, AK 99524-0668 er 9~ Services STEVE COWPER, GOVERNOR 563-6775 PWSID: # 213475 According to the records on file in this office, the South Park Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Vera E. Crai9 Envi ronmen t a 1 VEC:bas