HomeMy WebLinkAboutSOUTHPARK #3 BLK 1 LT 10 Municipality of Anchorage paga I of '--~
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Sile Wastewaler DiSposal System and/or Well Inspection Report
Permit Number: ~ ~'~ O ~)0 ~'~ ~ ~ PID Number: 0 ~"-0~--
'~": p~ Vij ~;~ Wastewaler Syslem: ONew ~Upgrade
Phone:-~,~,__ ~9 ~No.~fBedrooms:.~ ~DeepTrench ~ShallowTrench ~Bed ~Mound ~Other
LEGAL DESCRIPTION so,, .ating: 0' ?~PD/Sq. FL
Fill ~dded above original adc: Gravellenglh:
WELL: Q New ~ Upgrade Gravel width: I~ Ft. Number of~lines:, --10islanc~betweenlines:
~b .~.TANK
SEPARATION D ISTAN CES ~s~p~io u Holding ~ S.T.E.P.
TO Septic Absorption Lilt Holding ~ublic/PHva,~ ~ ~Ma.ufaclurer: Capacily in gallons:
Well i~t+ ~ ~ ~ ~ Material: ~ [ Number olComparlmenls:~
17034 Eagle River L~ep Read~ No, ~
Department of Heallh and Human Services approval I~,~ ~,: ..........
PERMIT NO. S~W000289
PAGE 2 OF 3
iViunicip~ ,Mi% o£ Anchor'o. ae
DEPARTHENT OF BBA~THAND HUMAN SERVICES
ENVJRONBBNTAL SERVICES D~VJS~ON
P.B. Box 396650 ~Ancho~ege. A[oske 99519 6650 ~ TeLephone: 343 4744
ON-SITE WASTEWATER D~SPOSAL SYSTEB AND/OR WELL ~NSPBCT~ON REPORT
LESAL LOT 10, BLOCK 1, SOUTHPARK #3 P.LD. NO. 020-052--97
~ 10' TELECOM & ELECTRIC EASEMENT
~ CO' ~ ~ o MT2 ~ CO1 ,A uRIV ,
~.. . , DV (DIVERTER VALVE) 2- ' SEPTIC TANK
'--. I /SUBSURFACE DRAIN SUBSURFACE ............ DRAIN
PERMIT NO 5W000289 PAGE 3 OF 3
Hunicip. oti-L oF Anchor~ee
DEPARTHENT OF HEA~THAND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,O, Box 196650 OAncho~-age, Alaska 99519 6650(~Tetephone~ 343 4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 10, BLOCK 1, $OUTHPARK #5
P.I.D. NO. 020--052--97
ST1
FINAL GRADE~ff'~
NEW 1000
GALLON
SEPTIC TANK
ST2/95.7'
~ 90.5'
91.8'~C03 MT1
A B
FCO 2.5' 55.0'
ST1 15.5' 49.5'
ST2 19.0' 51.0'
DBLI! 22.0' 52.5'
DBL2 24.0' 55.0'
DV 25.0' 55.5'
C01 22.0' 54.0'
MT1 87.5' 75.5'
C02 68.5' 86.0'
MT2 6,5.0' 82.0'
C03 73.5' 90.5'
MT3 46.0' 74.0'
C04 80.5' 67.0'
MT4 46.0' 38.0'
C05 42.5' 41.0'
,~c~:l N AL GRADE
02 MT2 C04 r92.2'
,,,-,.-, .... _-,,,%.
ORIGINAL
87.6' '87.5' GRADE
A
NO WATER FOUND
80.0' B.O.H.
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Aug 10, 2000
Expiration Date: Aug 10, 2001
Permit Number: SW000289
Legal Description: SOUTHPARK ADDN 3 BLK 1 LT 10
Design Engineer: 0003 S & S Engineering
Owner Name: Paul Hewitt
Owner Address: 16010 Terracewood Lane
Anchorage, AK 99516-4825
Parcel ID: 020-052-97
Site Address:
Lot Size: 26083 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[~ Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Date:
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPOR)'S
WELL INSPECTION
& FLOWTEST
SOIL TEST
STRUCTU~kL &
MECHANICAL
~NSPECTIONS
CEIVFD
AUG 0 1 000
MUNICIPALITY OF ANCHORAGE
July 21, 2000
ROBERT C. COWAN, P.E.
CIVILENGINEERS
(907)694-2979
FAX(g07)694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 10, Block 1, South Park #3 Subdivision
It is requested that you issue a permit to upgrade a septic system to serve the three
bedroom dwelling on the referenced property.
Two test holes were excavated and percolation tests performed on 7/16/00. The
approximate location of the test holes is located on the attached site plan. Ground water
was monitored and after seven days TH#1 was dry, and TH#2 was at 8 feet as shown on
the aftached soils logs.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
P. CC/bjj
Enclosure
17034 NORTH EAGLE RIVER LOOP ' SUIIE 204 · FAGLE RIVER, ALASKA 99577
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMEI
Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH? pO
E
Monitoring? D/'~ Y Date:
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PR~
7/1~/oo o .~ 5- ,, ._
" " ~ ~/~" ~0 ~ ~/~" '~ '/~"
. ~ ~/~" ~ 0 I 7 ~'/~" '~ '/~"
PERCOLATION RATE ~"]' r7 (minutes/inch) PERC HOLE DIAMETER ~n
TEST RUN SETWEEN °~//°~' FTAND 3 //3. ET
PERFORMED BY: S & S ENGINEERING ' ' CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 Eagle River Loop Road NO, 2 /
/
ACCORDANCE WIT~*S~vT~/~i~II~J~r- GuiDELINES IN EFFECT ON THIS DATE. DATE: -~ ~¢' (~ ~
0
72-008 (Rev. 4/85)
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: P/~ ~J L ~ ~u,// 7' '~'
LEGAL DESCRIPTION: ~¢,~Y~ /o,'}x{~: '~ 3
DATE PERFORME~ ~<C,
Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
g. O./-I.
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
eeplh to Waler After '
Monitoring? ~ Date:
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
7/1 ~/~ O -- ~ ~/,~ ....
3 0 30 m,,~ 5' %." ~/¥"
~0 ~ ~" --
o - "
~O 3o ~,~ ~'/~" ~t~"
PERCOLATION RATE ~ 0 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN J'/ FT AND ~ FT
PERFORMED BY: S & S EN6-Ildl¢l=g '~J6 I -. CERTIFY THAT rplS TES~ WAS PERFORMED
Eagle River, Alaska 99577
72-o08 (Rev. 4/~)
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, P.E.
SEWER&WA[ER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOWTEST
ROADDESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
REFERENCE: Lot 10, Block 1, South Park #3
July 21, 2000
GENERAL:
The scope o£this pr0iect inclgqlres the installation of ~minimum 1000 gallon
sepuc tan~ anuan aosorptzon oea m serve the exmtlng three bedroom
residence located on the referenced property.
Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit or ADEC Authority to Construct with any
special provisions or conditions, and all applicable State and Municipal
Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any necessary underground
utility locates.
Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil settling.
On all leachfield mound systems, the property owner shall be responsible
for ensuring a satisfactory vegetation growth over the mounded area.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department or ADEC if required, for system installations.
Owners installing their own systems must also receive prior approval from
the Municipal Health Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
17034 NORTH EAGLE RIVER LOOP · SUITE 204. EAGLE RIVER, ALASKA 99577
Page 2
Lot lO, Block I, South Park #3
July21, 2000
3. All standpipes on the septic tank shall extend a nfinimum of 12 inches above final grade.
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachfield there shall be two adjacent cleanouts. These
cleanouts shall be located on undisturbed soil not more than 10 fi. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield. The second cIeanout shall be to
clean toward the septic tank.
Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
LEACHFIELD BED INSTALLATION:
Excavate the proposed Bed Area to the depth shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the bottom of the excavation becomes
smeared, it must be raked or scratched (rafted-up) before gravel or sand placement.
If a sand layer is required, place sand over entire excavation to the required depth shown on
the design. The top of the sand layer must be within 2 inches of level.
Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution
pipe must be installed level with perforations down. Gravel depth below the perforated pipe
shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a
minimum of two (2) inches. The total gravel depth throughout the entire bed shall be a
minimum of twelve (12) inches.
The perforated distribution pipes must be no more than six feet apart. The distance between
the outermost perforated distribution pipes and the sidewall of the absorption bed must be
no more than three feet.
Silt battier material must be installed between the final gravel layer and the native soil
backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed at the locations shown on the
design, and extend a minimum of 12 inches above final grade. The portion of the
monitoring tube extending through the gravel depth shall be perforated six (6) inches below
the bottom of the horizontal distribution lines. The monitoring tube should not extend
below the bottom of the gravel surface.
Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation
must be installed when the backfill depth is less than thirty-six (36) inches. The finished
grade over the bed must be mounded to prevent the formation of a depression after settling.
8. A mound system is to have the upper six inches of top soil and be seeded for vegetation.
Page 3
Lot 10, Block t, South Park #3
July 21, 2000
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipally approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couphngs (Caulder, Femco, or
equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform to
current MOA or ADEC requirements.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
1. The first inspection must be conducted after the excavation of ditches, pits, trenches,
or beds and before the installation of any gravel. A septic tank may be set in place,
but may not be backfilled before this inspection.
2. The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
Page 4
Lot ~0, Block ~, South Park#3
July 21, 2000
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction
meeting will take place on-site. The inspecting engineer will not coordinate, direct or conlrol in
any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these specifications
and plans and in accordance with the attached MOA permit or ADEC Authority to Construct.
There will be no contractual arrangement existing between the contractor and S & S Engineering.
S & S Engineering shall be the owner's representative and wilt inspect the work as stated
above to document the contractors activities. Final acceptance of the contractors work rests
with the owner.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR / INSTALLER
~ ~,~-~ MUNICIPALITY OF ANCHORAGE
DE ITMENT OF HEALTH AND HUMAN SER~ -:S
Environmental Health Division
. 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~ar.e · DISTANCES
Address ' ~ TANK FIELD WELL
Phone(s) Permit NO NO of Bedrooms
LEGAL DESCRIPTION
Township, Range, Section
AS-BUILT DIAGRAM (Show Iocanon Of wel), septic system, property hnes, foundst~on,
~ SEPTIC ~ HOLDING
TYPE OF SYSTEM
~ TRENCH ~BED ~ W. DRAIN ~ OTHER L, ~ IO
or,ginal grade/,FT L, 0 FT
~ PRIVATE ~OTHER Jld~iif;f ./ ~
REMARKS:
i ' ,~- cedily Ihal Ibis inspection WaS pedGrmed ~cc0rdin9 t0 ail
72 013 (3/85)
DE;PARTMENT' OF' HEAL/TH AND ENVIRONMENT'AL. PROT'ECTION
825 GTREE1 ~, ANCHORAGIE, AK 9950
264'-".q. 720
F:'Ei:F~M I '1 big:
DATIE I-SSUED:
APPL. I CANT:
A i-)DRb, b~b~:
CONTAC'T PHONE:
1642" 81-. dAMES
I...EL4AL DE:SCRIP: SUBDIVISION: SOUTHPARK ADD ~ LGT: 10
SECTION: 3 T'OWNSHIF': t ~N RANGE: 3W
L.CYF SIZE: {~6083 (SQ.F]. OR ACRES)
MAX BEDIRGOMG: 4
BLOCK
I_isted below ai'(~ Lhe options a'v'a: lable t.o you zn designing yOLU* S~Dpt. iE
s~/slLem, Choose 'Lhe op'Lion that brest Fits yOL.tF site.
t}EPTH 'FO PIF'E B£]-F'f'GM (F']-.) 1..~- ~o
GF;:AVEL DEPTH (FT.)
TOTAl_. OEP'I'll (F'T.)
[SRAVEL WIDTH (FT.)
GRAVEL. L_IENGTN (FI".)
3RAVE~ VOLUME (CU.YDS
%ANK S.[ZE (GAL. S)
SGII. RATING (SQ.FT. /BR)
~-.~( "FAI',IK qUS'F HAVE q-F I_EAG'"~ -[WO [~'ARTMENTS
c:er'i'_ify tklat:
forth bM I:.he quriicipaliT_y oF qr~chor'age (MOA) and the State of Alaska.
2.. I wi ZI.] instal] ERie systet~i in ac:cordanc:e with ali MGA codes and r'egu].ations,
arid in conT) liarice with the design cr'iteria of' 't. his pepmit,.
..::.,T wiI] adher'e t.o ~]l.] M~]A &~rid GtatG) o{' Ata~k&1 r'equiremer'rt'.s For' the set back
oistanc:es Ir'om any existil]g well~ wastE~wateP :Jispo[~al system of public
,-~ , LU"ld(:er's't:.and that this per'mit is raj. id fop a m~ximum o[' 4 I]edP~oms and
IF' A LIF'T S'T'ATION IS INSTAL_LED IN AN ARIEA COVERED BY MOA BUlL.DING CODES,
'THEIq (1). AN I:.L~.C]I~ICAL.. I:::'ERMIT AND INSF'ECTIGlll MUST BE OBTAIIqED; (2) AS-BUII_TS
W]:LL. I'qOT BE AI:::'F'ROVED W]:THOUT AN E]_ECTI'~ICAI_ INSF'ECTION REF'ORT; AND (3) THE
:.L.,:L, II-~ZC~L WORK I¥IUST BE DONE BY P~ L, IUENSED [::.I_E.E, TRZCZAN.
,'al-I"b.l,_-~-Ihl~ SOU'fHF:'ARI< DEV CO
SEWER SYSTEM LOCATION PLAN
PERFORMED FOR:
LEGAL DESCRIPTION:
3-
4-
5
7
8
9
10
14
15-
17-
18-
20-
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PEREORM D:
SLOPE SITE PLAN
S
IF YES, AT WHAT ~ ~
DEPTH? ~ p
E
Depth Io Water After /,~/
I~IOnftoring? / ~,,,~ Oale: /'2~'~5
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE
(minutes/inch) PERC HOLE DIAMETER __
PERFORMED BY: ///~'~'~/~ , //~/~ CERTIFYTHATTHISTESTWASPERFORMEDIN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFE~N THIS DATE. DATE:
• '-� Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 020-491-17 - - Expiration Date:
1. GENERAL INFORMATION:
Complete legal description Southpark #3: Block 1, Lot 10
Location (site address) 16010 Terracewood Lane *Anchorage AK
C,-(& -2 d Z k(
Current Property owner(s) Jim & Audrey Hasle Day phone
Mailing address 16010 Terracewood Lane *Anchorage, AK
Real Estate Agent Brian Broderick Day phone 7484900
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class A Well
❑
Community
❑
Public Water System
®
Public Sewer
❑
WaiverNariance request for:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550
Date of Payment 6 3012 012
Receipt Number
COSA# SSC ��13 li
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
7)
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.
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: I Z�
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
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
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
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.
6. DSD,.SIGNATURE `'�
System #1 Approved for -2 bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms, with the following
:1
#��G\PALITynn
AECC884 �
0N. y.-
qTF SiTF O .
Roc' q TFR m;
ti
ul /iosFRVICES
Original Certificate Date: -Z d 2 Z
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 Advisor`�
Well Flow Advisory Other 54 ep �� �j L/
i OC
I . �-4-a�(.t�e C(
COSA blue sheet_10-10-12.doc
n.A
Legal Description: Southpark #3; Block 1, Lot 10
If more than 1 septic system on lot: COSA Checklist # of
Parcel ID: 020-491-17
Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached) Well production at time of test
Date drilled Water storage tank volume gallons
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 CO
Static water aeginning of test ft.
B. TANK DATA
Age of tank(s) 22 years
Tank type/material `"u"Ptle
Measured operating fluid level in septic tank 0
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 5/13/22
D. ABSORPTION FIELD DATA
Well
test? ❑ Yes ❑ No
❑ "W", bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station year
Lift station material
Which system tested (date installed) "2000
Adequacy test date 6/10/22
❑ ALL standpipes present per record drawing
Results [✓ Pass For 3 bedrooms
Total measured depth from grade 4.33 ft (max)
Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 2.75 ft (min)
Water added 1022 gal
❑ N/A — pressurized field
2
❑ Monitor tubes go to bottom of effective. If not, state
New depth in
120
depth into effective 4"
Elapsed time min
P
❑ Code -required soil cover over field
Final fluid depth 0 in
❑ System presoaked
Absorption rate 450+ 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
y n/a
If es, enter date
Comments/Deficiencies:"Tested 2000 bed only - 1986 bed appeared dry. See letter from owner regarding no freezing.
COSA Cheddist 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'
Community Sewer Manhole/Clean0
_
0 '
11Yes
if No
ft
Yes
if No fl
Neighboring Tank > 100'
❑ Yes
if No
ft
Private r 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
> 10 '
Animal Containment > 50' ❑ Yes
if No ft
Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Commu ' ewer Main > 75'
[1 Yes
if No
ft
❑ Yes
if No ft
From Septic/Bolding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No *5+
ft
Surface Water > 100' []✓ Yes
if No ft
Property Line > 5'
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100' Yes
if No ft
Water Main > 10'
0✓ Yes
if No
ft
Community Wells > 200' []✓ 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'
Q Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓Q
Yes
if No
ft
Private Wells > 100' Yes
if No ft
Water Service Line > 10'
Q Yes
if No
ft
Community Wells > 200' [] Yes
if No ft
Surface Water > 100'
Q Yes
if No
ft
F. ENGINEER'S COMMENTS f
*Met code at time of installation - There is a.deckpost 4.5' from st1 of septic tank.
Ca�yy ain drainoutfall pipe was dry on 6/15/22. **Immediately adjacent to deck.
r✓ r C/� A--0 � � f -% ��L- t ' it X l f ,,Gg 1P P...t 0q, —1 'C>
F of ` i� / ' z �a-P ✓�z- , v f 0,,-&L ice. s: -A ; c
Qo6�pp
G. ENGINEER'S CERTIFI ATION o� OF q 004
o S�
1 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. .... �D
'•J e Goess:
n�
� Q 9; '• 7953 �`p
el
COSA Checklist yellow sheet 44 d pro f e s sior°oma'
#AECC884
Q
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC 221319
Subdivision: Southpark #3 Block 1 Lot 10
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this COSA / property is 22 years old. A leaking septic tank may be a source of contamination to
the aquifer. Typical replacement costs range from $10,000 to $15,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of a 16 -year-old septic tank in failure and should be replaced.
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Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O P. O - ~'~ ~ ~ 7
1. GENERAL INFORMATION
Complete legal description Lot 10,
Expiration Date:
Block 1, Southpark Subdivision Addit~o,w ~3
'Location (site address or directions) 16010 Terracewood Lane
Current Proper[yowner(s) Paul & Sybil t{ewitt
Mailing address 16010 Terracewood Lane~
Lending agency
Day phone 345-6249
Anchorage~ AK 99516
Day phone
Mailing address
Real Estate Agent Bob Stanton/Vista
Day phone 240-2560
Mailing Address 4241 B Street, Anchorage, Ak 99503
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked uP bY: ~/~/'2~~''
NUMBER OF BEDROOMS: ~ ~/:z~/°~
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank []
~] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for the transfer of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHRS also issues HAAs upon request to home owners.
Certificates of Health Authority 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 Ii, ss than 30 days old. 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.
72 025 fRev
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 Health Authority Approval Guidelines for the Health Authority Approval
application show 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
S & S ENGINEERING
Name of Firm 17o34 ~g~,, R!¥er L~p4~ead No, '~04 Phone
Address Eagle River, Alaska ~¢~77
Engineer's Printed Name
Date? ~ / -~-
,,,
~'~ .¢'E:NGINEER
~' ' "'
S,..,
bedrooms, with the following stipulations.
DHHS SIGNATURE
~-/ Approved for '~ bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date:
Original Certificate Date: ~ - ~2. ,,~ - O o
Reissue Date:
Municipality of Anchorage ¢( J~ C E IV E D ~
Department of Health and Human Services
Division of Environmental Services AU(~ ~-5 ~000
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650 ,,',ur'~U~AUi~ O[' ANCHOP, AGE
www. ci.anchorage.ak.us ,'~)NMENTAL SERVICES DIV!e~~
(907) 343-4744
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type __
Date completed __
Total depth
Date of test
Static water level
Well production
WATER SAMP~:
Coliform J colonies/lO0 mi
D oa~f sample:.
B. SEPTIC/HOLDING TANK DATA
Ta?k~T~Pe/Material $ ~./~ T, ~ ~ -¢ T~. /._
,Date installed ~/~'~
, · o Tank size )0o0
C!~,n. outs ~'eJ Foundation cleanout
Date 0f pumping ~/,~ --
If A, B, or C provide PWSID # __ Well Log
Sanitary seal ___ W~protected
ft Cased to ft ~ight (above ground)
A .NS."O"ON
Nitrate mg/I Other bacteria__
Collected by:
colonies/100 mi
in.
gal Number of Compartments
Depression over tank ~v o High water alarm
Pumper
C. ;~.BSORPTION FIELD DATA
D~teinstalled ~'/~5//oo Soilrating ~rfl2/bdrm) 0. ~' Systemtype
Length ~ '7 ft Width 1 5" ft Gravel below pipe c), ~ ft
Total depth z~ ft Effective absorption areaTO3- ft2 Monitoring tube ¥~5' Depression over field ~ o
Date of adequacy test ~,/~ -,"~,,, Results (Pass/Fail) ~ For ~ bedrooms
Fluid depth in absorption field before test ~ added__ gal. New depth __ in.
Time:--~depth in Absorption rate >= __ g.p.d.
Elapsed
Any reju~t (past 12 mo.) (Y/N & type) If yes, give date __
72-026 (Rev. 01/00)*
D. LIFT STATION
Date installed Size in gallons Manhole/Access
"Pump on" level at --~~r ala--~m level at __ in
Datum~ ~ Cycles tested Meets alarm & circuit requirements
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot On ~--
Absorption field on lot ~ adjacent lots
Public sewer main ~ Public sewer manhole/cleanout
Sew.~ce line Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation lo Property line ~ '~ '
Water main /o Water service line ) o
Drainage ~//I Wells on adjacent lots ,v
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Jo *-/- Building foundation )~ ~
Water Service line
Curtain drain ~,.,~-
Absorption field 5-
Surface water / e
/ o v-- Surface water ) o o -)--
l~o~w Wells on adjacent lots
Water main
Driveway, parking/vehicle storage
~]0 +
F. 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 MQA HAA guidelines in effebt on this date.
Engineer's Printed Name ¢~8¢~'- ~. ~,¢,a
Date r¢ / ~ s'/O ~
HAA Fee $ ~TJ~ , ~'~
Date of Payment _-,-'~/?-5¢/z:~
ReceiptNumbe, ~ ~--~' ~//~'~,~'~'~
Waiver Fee $
Date of Payment
Receipt Number
72?26 (Rev. 01/00)*
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
Applicant Name-- ~ J'~¢'~'[~5o r', Telephone: Homo
Applicant Address ~'~' ~'-
(b) Business .~"6 ~.' ,.~ ~ '7¢~-'
(c) Applicant is (check one): Lending Institution []; Owner/builder [~-tflS'Cyer []; Other [] (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Companyand Agent
Address
Telephone
(f) Mail the HAA to the following address:
Single-Family rlrlrlrlrlrlrlrlrl~ Multi-Family [] Other
Number of Bedrooms ~
WATER SUPPLY
Individual Well [] Community [~ublic []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
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 (11z84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION -. · ·
As certified by my seal ~ffixed hereto a nd 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 insj~ection. ~ f
Name of Firm ~(~ ~"~'~: ~-~ ~'~' Telephone ~--~ [ -~0{~'~[
DHEPAPPROVAL
Approved for {z~..~ bedroomsby~ ~'~"~ ,~'~~-- ~te
Approved ' ,/~ i, Disapproved Conditional
Terms of Conditioh~al Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
' MUNICIPALITY OF ANCHORAGE
MUNIcIPALiTY OF ANCHOi~AHGI~ALTH AUTHORITY APPROVAL (HAA)
t~'~. os ~I,~¢,I.T. & CHECKLIST- FEBRUARY 1984
Legal Description:
b/o /
If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Ldt
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Date Completed Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed [~/~(J.¢¢.[: J(~2 Size l~
Standpipes (Y/N) fJ¢~ Air-tight Caps (Y/N)
Depression over Tank (Y/N) ~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~c ~.~O~I
To Property Line
To Water Main/Service Line
Course -I'/00 !
No. of Compartments
I¢ ~ Foundation Cleanout (Y/N)
Date Last Pumped /~/'/~
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field lO I
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed J..O
Width of Field o~c/I
).'~"O ~O,/.~-/~.~- Type of System Design ~
Square Feet of Absorption Area
Depression over Field (Y/N) ~.O
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation _ ~O
Lot
To Water Main/Service Line ~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Length of Field
Depth of Field
Gravel Bed Thickness 0,~'
Standpipes Present (Y/N)
Date of Last Adequacy Test
TO Property Line ~_.1.
To Existing or Abandoned System on
; On Adjoining Lots -/'" ~20
To Cutbank (if present)
+ lO0 t
Comments
D. LIFT STATION
Date Ir~alled Dimensions
Size in (~ons Manhole/Acce~ ~"~
"Pump On"%~at "Pump~.,.Of¢ Level at
High Water Alarm"bev. e.~
Tested for' ~ .~"~s,-
Vent
(Y/N)
Pumping Cycles during. Meets MOA
CommentsElectrical Codes (Y/N)
** Check PeSo/Be, ting Against HAA Request **
I certify t ha~'(/D '//~r/c~, ¢cke/v/"~ i~fied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection,
Compa~ ~)r~4~//~¢.~'cL~5 MOA NO ~'-'/~-~ Z//~
Receipt No. 2~;~:27/ ,¢)~/'-4~ ' '
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84}
'~pgineer's Seal
DEPT. OF ENVIRONMENTAL CONSERVATION /
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA g9501
RILL SHEFFIELD, GOVERNOR
Telephone:
Address:
274-2533
DATE: June 5, 1986
PWS I.D.~ 213475
To Whom it May Concern:
According to records on file in this office the
SOUTHPARK ~
SUBDIVISIQN
Water System is in compliance with the State Drinking
Water Regulations
Sincerely,
CORWIN & ASSOCIATES, INC.
4790 Business Par~vd.
Building D Suite 1
ANCHORAGE, ALASKA 99503
Phone 561-6151
JOB
SHEET NO. OF
CALCULATED BY DATE
CHECKED BY DATE
SCALE