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Home My WebLink AboutSOUTHPARK #2 BLK 3 LT 25 MUNICIPALITY OF ANCHORAGE D~ RTMENT OF HEALTH AND HUMAN SEA ;ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ,~ ON-SrrE SEWA_GE__~S_POSAL SYSTFM AND/OR WELL INSPECTI()N REPORT -7-- "~d~-~¢'~C~*', ('~'~ ~Z.-~-~;~-~-~--- --- DISTANCES ~-~"~: "~ ' '~q~'~-~' ~ T[ SEPTIC ABSORPTION :ROM ~ A~.,~ ~ ~ ~ ~ ~ ~t~ TANK FIELD ~*~ ~scn,.T,O. LOT LINE ~ ~0 ' ~ ~ ' Lot 1 Block T I t_J::zL. .~ SEPTIC TANKS [] HOLDING Capacdy in gallons __ TYPE OF SYSTEM , ~.~RENCH/ [-'] BED ~] W. DRAIN [] OTHER Depth to pipe bottom from Total depth from original grade Fdl adaed above Orlglllal grade ............... Gravel WELL N,,/A, :OU~ ¥ ON , F WELLS [] PRIVATE ~ OTHER ddentilv) REMARKS: Inspections Pellormed hy: SEAL Municipal and 81ale guidelines in effect ~ ..... ceflily Ihal Ibis inspeclion was porlormed accerdigl] Io all date: ,~/~,~ ~Z~. _ Health Depflrlment Approval: 72 013 (3/85) DIEI:.:'AR'FI~EI:FF OF HI~iAI..T'H AND ENVIROI',IMEI~,FI]~:fl... F'I:~O'I".F.:CTI[]I',I 825 I.. STREETe. ANCH[II:RAGIE, Al< 9950 264-4720 AI:::'F'L,. I CANT ADDRESS." [;[]N]'r~-~ [;T F'Hf,)NE i: F:'E')NDA MCBRIDE 3511 HOOF)ER WAY AIqC, HORA(=]E, AK 995:1. 5 2~'72~.. 6964 L,EGAL DE,.CI,.[I ,, L.OT ~" ,.~ 1ZI .... MAX BE'iDF~[)[)I"tS: E L.O[,['. .... :, Listed I:)el~w are '[.h¢~ op'Liol'lS avaJlab].~ 'Lo you :i.n designing your' sep't',,ic system. Choose 'Ll'~e Ol:)tion tha'L best fits yOLtl' si'kE~. DEPTH "1'0 P]:PE BOT'rOM (FTo) 4.0 4,, 0 4,, 0 GI::~AVli;L., DEPTH (F:"T'.) 7. () 0,, 5 ;.'".;. TOTAl. DEF:"I'I'I (1::'].) 11. ] ' ~ 4,,5 7.5 GRAVEl., W,IDTH (FT,,) ": GRAVIEL VOLUME (CI,J. YDS. ) 6.;,. 2 o ~,, .: ,, I'ANK SIZE (GALS) 1,250.,0 '~"~' 1~250.0 *'~' J.~250,0 '~'* SOIL RATING (SQ.F"'T. /BR) '.::.;~.EI 267 3:L8 ,~..~4. GI:?¢WI!ii].., I,.EIqGI'H > 75 F:"I',, REQU:I:F~ES MI. fl~.I:I:F:'I,,E RUIxlS (Iq[)T EXI.,,EI::DIIIG 75 I='T, .~.4~ 'I'ANI{ HI,ISI HAVE AT LI=A,.:I TWO CI]I4F:'AR'I:IqENIS cer"Lify that: :1.,, I a~l ~'am.'ili~r* with f'or"LI-i by the Idurlicipal:i. ty c3f' Anchorage (MOA) and the St, a'L~ of' A~aska. I w:i,].l :Lns'Lall 'Lhe sys'Leli~ itl accordanc:e with a:l. 1 IdEIA [;odes and regu].a'l:.:Lons~ ancl in compliance with the cJes:i,g]'~ c:r'it, er:[a of t.h:i.s permit. ): will adhere 't:.o all MOA and State o¢ Alaska requirE~nerlts {(2~- tl'le t~et:, back d;i,s'LarlCeS t'['ofll any existing well, wastewater, dispo~al system of pLd21:i,c sewed'age sy~]tefll Ol] t. hiEi (]p any adjacent (;:m near, by lot.,, I i.tl'ldei-st:,a.r'ld '[.ha'L 'bhJ, s [)(~nnl~.'l:. J.S valid ¢o1' a max:Lmum of 4. bedr, ooms and any erl].apgC~mlel'rL will. t'equip~! al"t addit, ior]al i::)er'mi't'.,, IF A L, II:']' S'T'ATION 3.,:~ :[NSTAI.L,EI) IN AN Afd:A COVbJ.,ED BY M[)A LU.[I,_D.fN[: THEN (1) ~N ZI..EL, 1KZC~L t E,RM,I,I ~ND ,I.N,~I E[,t~ON MUST BE O~'I'AZNED~ (~,.) ~S-BI_III,,.TS NIL. L. NOT BE APF'ROVED NZ"I"I.-I[:)I.J'I' AN I,.,L,.EI.,fR.[C~I,.. INSPEC'I"Z[]N REF'ORT~ AND (..,~) 'T'HE E:.I,,.I=CII~.I.C~L NORI::: MUST BE DDNE BY (,~ I..,..[CEN,:~ED I:.I~.E.I,.,II..~Z(.,~I~. FERFORMED FOR: LEGAl. DESCRIPTION: 1 2 3 4 6 7 8 9 10 12 13 14 15 16 17 18 20 COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Ane, horage, Alaska 99S01 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST SLOPE DATE PERFORMED SITE PLAN WAS GROUND WATER I"JU ENCOUNTERED? IF YES, AT WHAT DEPTH? . Reid, Jr, 225~.E Readin9 Date Gross Net Depth to Net Time Time W.~ter Drop ~ ,'~. ~ II '~ 7. ,'~ . /~. ~ I l, t~' PERCOLATION RATE V~-~ (minutes/inch) PERFORMED CERTIFIED BY: DATE: 72,008 (6179) Parcel I.D. 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING JUL 20 1999 1. GENERAL. INFORMATION CompleteJegaldescription T,rH- ?~... Rlnr~r '~..- gc.d-hD~'k ,qnhr']ivi.~'ion Location (site address or directions) 1~¢;'~ g~-anwr~n,4 f~ir(:'l~ Ant:horace: A~ Property owner ._Eny A1 len Mailing address _~Rtg~N ~t-nn~nn~ f'!i ~'nl ¢ Lending agency Mailin~g address ' Agent Address ' ' Day phone Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 4~ NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4, TYPE OF WASTEWATER DISPOSAL: NOTE: 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. 72~029 (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, funotional 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 ~r~li~i~i~rl~liance with all Municipal and State codes, ordinances, and regulations io effect on tb.e date,oJ_tb2s i~ection. Name of Firm ' Address Engineer's signature Alaska' Water Wastewater Consultan_ts be PAID prior to, closing for the Engineering- ervices DHHS SIGNATURE (/'/ Approved for F'O L//~, Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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 DH HS does this as a courtesy to purchasers of homes an d their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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. ,,t.C[!lVbu Municipality of Anchorage JUL DEPARTMENT OF HEALTH & HUMAN SERVlQ, l~c~ku~ oF Environmental Services Division ~NVII~ONMENT^LSEP, VICES DI~;~ 825 L Street Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Descript on: _ ty,._ L~--~lcc,,~-~r,~,~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Total depth Cased to Sanitary seal (Y/N) Casing height (above ground) Wires properly protected (Y/N) Date of test Static water level Well productio~ WATER SAMPLE RESULTS: /'--)/,~ FROM WELL LOG AT INSPECTION g.p.m. g.p.m. Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed c:'/-/~ -~ ~ Tank size Foundation cleanout ~(J~ Date of Pumping C. ABSORPTION FIELD DATA Date installed Length /02.' ~. Width [~O ~ Number of Compartments ~' Cleanouts (~/N). _ Depression (Y,~l~ O~uP-~ High water alarm (Y/~. Pumper ~_~_~/~/~C ~ <~' ~ ~o Gra. vel thickness below pipe ? ".~r. ~_~Tota depth /O'~ {~J~..q2T /,~. Effective absorption area /~t ~-~ ~,~ Monitoring Tube present ~NI Y _ Depression over field (Y~)_ Date of adequacy test _ ~ ~ (0-~% Results (Pass/Fail} ~ For_ ~ .bedrooms Fluid depth in absorption field before test (in.); ~ ~_ Immediately affer~gal, water added (in.): Fluid depth _ (ins] Minutes later:. ~ ~. Absorption rate = Peroxide treatment (past 12 months) ~_ ~ ~tlc~C~ If yes, give date 72-026 (Rev. 3~96)* ~A¢~ F~LL ~0 ~[ O('c*mg4 ~[~ ~. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* r *Datum ~ "Pump off" level at* Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: /~/A Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/~ TANK ON LOTTO: Foundation ~ ' ~- Property line /0 '~- Absorption field Water main/service line / O ' ~- Surface water/drainage / co [ 4- Wells on adjacent lots F. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation /0 ' ~ Water main/service line. l° '/ Driveway, parking/vehicle storage area / O'/- ~(-~r~w~ Wells on adjacent lots c~0o '~- ENGINEER'S CERTIFICATIOn/ ,certifythatl,h~t~m~, 'eldinspectionsandrevie~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* d~,~ Waiver Fee $ ~ -20~ ~) Date of Payment /"/~-')/ d ("~"- .}-- Receipt Number 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1.D. # (~l~.~ - F~/-,%- ~{'~) 1. GENERAL INFORMATION Complete legal description Lot Location (site address or directions) 15630 Stanwoo~'~Cir cle Anchorage, AK Property owner Bob and Shirley K,Ctehhoff Day phone Mailing address 15630.Sta~ood Circle Anchorage, AK 99516 345-5486 = Lending agency Mailing address ., .. Agent Kris kbegg/~ JACK WHITE C0.. Address 3201 "C" S~Le~.~ SutUre 100 Anchorage, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS.' 4 ~' TYPE OF WATI=R SUPPLY: NOTE: Day phone, Day phone_ 563~5500 AK 99503 Individual well Community well XXX Public water If community well system, provide.written confirmation from State ADEC attest- ing to the legality and status of system. 4, TYPE OF WASTEWATER DISPOSAL: Individual on-site . . Holding tank Community on-site Public sewer XXX 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 · '~JOM 8,JaBu!~ua I~uoJssejoJd eql u! 9uolsBlLuo JO 8JoJJa JOj ajq!~uodseJ lou 's! a~eJoqouv 1o Xl!led!o!un~ eq£ 'panss! s! m, eo!1!peo e eJojeq ~lep ez,qeu~ Jo suo!loadsu! ~onpuoo lou op SHHa jo see,~oldUJ~ 's~ueuJeJ!nbeJ e~els pue I~Jepej u!epeo/gs!l~s ol JepJo u! suo!lnl]lsu! 6u!puel J!aqJ pue sa~uoq jo sJassqoJnd olXsepnoo e se s!qiseop SHHQ eq.L'~selV jo ellis eql u! paJals!l~aj JaaU!~Ua I~UO!eSejoJd ~uapuadapu! ue ,~q eAOq~ g qd~J~J~d U! Ua^!6 suoll~luasa~deJ eq~, uodn ,~lUO pes~q sel~o!j!~eo I~^oJddv ,qpoq~nv qll~eH sanss! (SHHQ) seo!/daS ueumH pu~ qll~eH ~o lue~upBdaa a6~Joqauv jo ,~l!l~d!o!un~l eq± :suollelndp, s 8UlMOllOJ eq~, ql!M 'SUJOOJpeq JOJ jeAoJdd'e leUO!~.!puoO 'paAoJddss!a 'gLUOOJp@q .~ JOJ. peAoJddV ~ ~I~n£¥N~IS SHHQ 'sepoo e~.'e~,Spue led!olunlM lie LII.!M eoue!tdLuo0 U! s! we~.sXs lesods!p Ja~.'~M~D~,SI~M Jo/pu'e Xlddns JiD~.BM 8~.JS-UO OLJ~. 'uol~.oedsu! pue UO!I'e§!lSOAU! XLU uJ. oJJ pue Sal!J eb'eJOqOUV Jo Xllledp!untN eq~, woJj. peu!elqo UO!J~LUJOJUj el.~. UO peseq ~,eq~, XJ. peA JeLllJnJ I 'u!eJaq peleolpu! eJnl. onJ~.s JO ed/q pue swooJpeq J.o J@qwnu aql JOJ. elenbepe pug I~euo!~,ounj 'ej'eB sJ LU~.S,~S leSOdslp JOII3MB~.SI3M JO/pUC Xlddns Je~.'eM m,?UO eL,il ¥~Li1 SMOL!S uo!~.'eo!ldd'e JlBAoJdd¥/q!JOLJ~.n¥ LllleeH S!H1. JO UO!~.~I~!~.$~AU! XLU :j~141/~J.!JE)A I 'MOleq UMOH~ elgp uo!¥epH'e^ eg!~..J.o se pue O~.~J~LJ p~x!JJ.'e I~S .~UJ Xq p~!~.!lJeo I::I::I:INION~I Al3 NOI.LO3dSNI :10 .I.N:I~:I.L¥.LS Ii' '9 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ('.~7- 2_~' /SL.~ '~ _.~:~o~->t Parcel I.D. A. Well Data type (~"~,"~A4c~iulf"7* (~, or C, attach ADEC letter. ADEC water system number Well Log present (Y/N) Date completed Driller Total depth Sanitary seal (Y/N) Cased to Casing height FROM WELL LOG Wires properly protected (Y/N) AT INSPECTION Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM Wl--LL TO: Septic/helming-tank on lot ~ r~_ Absorption field on lot ,~(-~-~ ~ g.p.m. ; On adjacent lots ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: lB. SEPTIC/t,.[I~.-B,,~N~.TANK DATA Date installed ~_//(~/~5" Tanksize IZ_~O ~ Cleanouts~N) ~ ~ _Foundation c eanm ~) ~ High water alarm (Y~ ~b Alarm tested (Y/N) ~/~' Date of pumping . ~/~/ ~Z Pumper A~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ -- On adjacent lots ~ ~ Foundation To properly line /~ <~ Absorption field /~ ~ Sudace water/drainage /~ Cornpartments Depression (Y~_~_~ Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATION DIST~OM LIFT STATION TO: ~ On adjacent lots Manufacturer Manhole/Access (Y/N) ~ ~evel at ~ested Surface water D. ADSORPTION FIELD DATA Date installed 9//'(~ / ~'-~"~ Length /~) ~ ¢ Width "~ Total absorption area /~'Z.oO~''~ Date of adequacy test Z. / ~-q-/ ff .~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft) Gravel thickness '~' · Cleanout present~_(~N) Result~ail) System type ~'~/¢.Z~.-'-CJ Total depth /I -/ Depression over field (Y~.'~ for ~ ('~.) Bedrooms After test I ~ ~ " If yes, give date /~/.~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /Uo/D~- //--o/(.E'.C~'-~J~- On adjacent lots To building foundation // On adjacent lots 2o Surface water ,/,¢O Curtain drain Property line To existing or abandoned system on lot /J'b/d¢ Driveway, parking/vehicle storage area ~'o~-' E. ENGINEER'S CERTIFICATION /certify that lhave checked, verifie~r~ed to al~ MOA and HAA Signature ~/'~/'~ ~ Engineer s Name 1703. - (; .... / / inspection. HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3t93)* Back 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # F~QC) ~ C)/3.~ -~(~) 1. GENERAL INFORMATION Complete legal description Lot 25; Bloeh $; South Park Subdivision Addition Location (site address or directions) Property owner Mailing address Lending agency Mailing address 15630 Stanwood Circle Anchorage, Alaska Kevin Meyers 15630 Stanwood Circle, Anchora~e~ First American Title (Debby Stout) 510 W. Tudor Rd. w-265-6156 Day phone h-345-0752 AK Day phone 562-0510 Suite f/l, Anchorage, ALASKA Agent Jack Blair -REMAX Real Estate (contact Mike. Messie, Blair on vacation) Address ff~O0 Cordova STre. et. Suite. 100. Anchorage, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 % TYPE OF WATER SUPPLY: Individual well Community well XXX Public water NOTE: Dayphone 276-.2761 AK 99503 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: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 systern 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 sigdature S & $ ENGINEERING 17034 Eagle River Loop Road No, 204 Eagle River, Alaska 99577 Phone Date Request approval on the following conditions: I. Depressions over the le~chfie~d are filled. 2. Extend ~l septic pipes above ground 6, DHHS SIGNATURE __ Approved for bedrooms. Disapproved. Conditional approval for ~z.--("~..)~_ 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 indepeh,~ent 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. 72~25 (Rev, 1/B1) Back MOA ~21 Municipality of Anchorage ,~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIS'F Legal Description: LoT'Z_~ A. WELL DATA Well type COm.~.~/T'Y' ,q lf(~B, or C, attach ADEC letter. Log present (Y/N) Date completed Parcel I.D. ADEC water system number Driller Total depth _____Cased to_ __Casing height Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot _ ~.~0/P Absorption field on lot ~--~-)(:~) 'h Wires properly protected (Y/N) AT INSPECTION g,p.m. ; On adjacent lots /""/'~ ; 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: B. SEPTIC/H'~I~, TANK DATA Date installed ~//(¢ /°°b'- Cleanouts yN)_ High water alarm (Y,~ / Date of pumping ~../~ --~/~ $ Tank size__/~~'O Compartments '~' Foundation cleanout (~N)_~'~£ Depression (Y/~ Alarm tested (Y~) Pumper ~ ~0~ SEPARATION DISTANCES FROM SEPTIC/~TANK TO: Well(s) on lot /UO/,JE- t°/Z~'~.J~''_ On adjacent lots ,,o ,~£ /9.,~dS'c'-,z:.)Z~_ Foundation To property line_~--TO z ~ Absorption field Surface water/drainage 72-026 (Rev 7/91) Front Water main/service line CONTINUED ON BACK PAGE '~2;--Lt.FT STATION /i/OFE /°/~'/UT Da~----. Size in gallons ~ Manufacturer Vent(Y/N) High water alarm level Meets MOA electrical codes Y~¥/N~ SEPARATION~CE FROM LIFT STATION TO: ~/.el-Kdn lot On adjacent lots "Pump on" lev~ehaL "Pump off" level at ~cles tested Surface water D, ABSORPTION FIELD DATA Date installed Length /0~: ~ Width .-~" Total absorption area Depression over field (~)/N) Results {~/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating ,.Y/¢ ~/~E, cfzoo.,~ Gravel thickness ¢ / Cleanouts present ~)'N) Date of adequacy test for ~ System type ~'.~&c~c_H- Total depth //-/2' / bedrooms If yes, give date Curtain drain /U¢,¢'[ K'/t)Oud¢ E. ENGINEER'S CERTIFICATION SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ¢o,,-,/4u/J~7'¥ cJE~. On adjacent lots ~J~r Propertyline To building foundation ~O'W To existing or abandoned system on lot ~¢ On adjacent lots ~0% Cutbank ~ ¢~E¢ Water main/serviceline ~% Surface water ~oM~ ~&¢¢¢~% Driveway, parking/vehicle storage area %¢ /~ I ceRify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, z~l-, v ENGINEERING ~70:¢~ ~g,!e r~ive~ Loop Roa(] No. 204 ~.',[¥er, /t. lasJca 99577 Signature Engineer's Name Date 72-026 (Rev. 3191 ) 8ack MOA 21 Waiver Fee: $ Dr_te of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 WALTER J. HICKEL, GOVERNOR (907) 349-7755 Januaw 28,1993 Mr. Jim Williams S & S Engineering SUBJECT: South Park terrace Subdivision Class 'W' Public Water System, PWSID 213475 Dear Mr. Williams: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on January 12, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on November 4, 1992. This ~d_oe~s_~m.9_e..~ the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last Radioactive Contaminants Sample results were submitted to the Department on December 10, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water RegulatiOns. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on November' 6, 1991. This.d_o_e_s_~e_~e.t' the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. b MUNICIPALITY OF ANCHORAGE O PARTMENT OP HEALT. & .UMAN SERV,CES o,v,s,ON OF ENV,.ONME.'rA' SERV.OES OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Descrip_tion (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner ~-'~¢~ f-C-f*¢ ~ Telephone: Home 7g~'-/~9.?~, Business Mailing Address (c) Lending Institution _ ~ =~l'Zt L L"-/NI t/~ Telephone Mailing Address (d) Real Estate Company and Agent _~-~.~.(2-tT~-,~ Address ~X)7 F~. Telephone ~b "1% (e) Mail the FIAA to the followine address: or: Check here ~ if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms WATER SUPPLY Individual Well [] CommunityV Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite"~ Public I-] Community [] Holding Tank [] Note: I} corn munity well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/861 Fronl leuo!sse,loJd aql uj SUO!SS!LUO JO SJOJJ9 JOJ alqJsuodsaJ lou s! ebeJoqouv jo Al!led!o!un~ eq/'panss! si eleo!J!iJeo a aJojaq 8:mp aZAleUe Jo suojloadsu! lonpuoo lou op SHHQ to saaAolduJ3 's]U9LUaj!nbg,I ~]e~S pUa leJapa~ u!ePeo ~JSjiBs ol J~pJo u! suo!in]!~suf 6u!pueI J!eq~ pub SaLUOq JO sJSSBl. JoJnd Oi/~9aJJRO3 8 SS S!Li~ 9aop SHHQ eqJ. 'e~seIV jo ale,iS eq~ u! pGJGlsjbsJ Jaau!Sua leUO!SSajoJd ~uepuadepu! ue/;q a^oqe g qdeJSeJed uj ua^!6 suoi~eiuesaJdeJ @ql uodn/~lUO paseq saleo!l!peo le^oJddv ~pOLIInv q~leaH senss! (SHHQ) seoi^Ja$ ueLunH pue q~leaH ,lo luaLupedeQ aSeJoqouv jo/~l!ledio!unlAl aLIJ. NOIJ. flVO leUO¢,~puoo leAoJddv leUOijipuoc) JO suJJe.L pe^oJddesic] /~ peAoJddV ~~ /~qsLuooJpaq ~ - Jo, pe^oJddv 'IVAOI4dd~¢ ~HNO sseJppv · u-o!laadsu! sfq~, ,lo e jap eq:! uo loc,lie u! suo!1elnSe~ pue ~Tseoueu!pJo 'sepoo e~elS pu~ led!a!unvq lie LII!M eoue!ldLuoa u! Jo/pue ,qddns JeleM el!s-uo oql 'uo!loadsu! pub uo!je~!~sa^u! ALU LUOJi pu~ Sel!1 eS~Joqou¥ ~o ,q!led!o!unR eql LUOJt peu!eJqo uo!jeuJJolu! eq1 uo peseq l~Lli ,~,lp@A JeqlJnl I 'u!eJaq pojeo!pu! eJnjonJls elenbape pue leUO!lounJ 'e,les s! LUeJSAS lesods!p Ja]eMa]SeM Jo/pue Xlddns J e;IeM el!s-uo @Hi ~.eql 9MOM9 leAoJddv X~poqjnv qilee~t 9!ql ~o uo!~eS!ise^u! ALU ]eq] A,lPe^ I 'MOleq UMOqB elep uo!lep!le^ eql,lo se pue o~eJeq p@x!~le peas ALU/~q Pe!llPeo sV NOIJ.YWblO=INI (2NV ¥.LYa ~HC)M'¢~I~ ~]'11-1 ~9.L~J. 'SNOI.LO:~cI~NI 9NlalAOl:ld .§ WELL DATA MUNICIPALITY O1-" ANCHOFIAGE (MOA) ~,~HEALTH AUTHORITY APPROVAl.. (HAA) v ~ .CHECKLIST .. FEBRUARY 1984 ¢ '~ i' 264-4744 Well Classification ~_~£~,~, ¢4~ If A, B, C, D.E.C. Approved (Y/N) _ Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments 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 B. SEPTIC/HOLDING TANK DATA Date Installed ~-~r-[ 8 Standpipes (Y/N) 'Tub o 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 ~ ,2.~,-.~ To Property Line ¢~' ~ To Water Main/Service Line Size _ I ~- ,.~, c:, No. of Compartments ~-t~.' O Air-tight Caps (Y/N) y Foundation Cleanout (Y/N) y Date Last Pumped ~*,,~.~,M~ ~. "~.~J¢o f~d~¢.~~ l"'¢/',,~. ;for __ }'~/~A Temporary Holding Tank Permit (Y/N) f'//¢~, To Buikfing Foundation I ~:~ To Disposal Field / ¢ To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-076 fRev ~/861 Fronl ABSORPTION FIELD DATA Date Installed Width of Field Soils Rating in Absorption Strata ..~/,~ Square Feet of Absorption Area Type of System Design Length of Field Depth of Field /O ~ Gravel Bed Thickness '7 Standpipes Present (Y/N) Depression over Field (Y/N) ~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well 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 To Properly Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) /¥ ¢//4 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 Manhole/Access (Y/N) "Pump 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 have checked, verified, or conformed to all MOA and HAA g uidelines in effect on the date of this inspection. Signed ~ ¢.M~c~-.'~''~ Date Company MOA No. Receipt No. -29 7 Date of Payment ' ,~ ~ .,-~-/-¢¢-' ¢~' Amount:$ /,2 0 0 0 Page 2 of 2 72-026 fRev 8/861 Back Engineer's Seal STEVE COWPER, GOVERNOR DEPT. OF i,;NVIRON~iENTAi, CONSERVATION ANCHORAGE/WESTER'N OISTRICT OFFICE 360~ C STREET, SIIITE 1334 ANCHORAGE, ALASKA 99503 563-6'775 BATE: ~August 30, 1988 PWSID: 213475 To [,Ihom It May Concer'n: According to the r'ecords on +'Jle in this of'¢ice, '¥~RRAI?_. _~.t~!~__O..~..kJ~_..S_,[_O~N Water E;y~.tem ~s ~n compl Jance Alaska Or~nk~nq Waten Regulations, with the State Sincenely, 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 264-472O Application Date '2 "~'2 ~( -g'6 GENFRAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name _~_,..~_ (,O ('--. _ Telephone: Home ~q. Ll~ [ O-q~ Business Applicant Address ~-'( ! _~_OZ2~EO..~.L%_'-~C_/~l,'.~)~.J~fOlt/~G~'._~.L~ O(C(.~'/.-.~' (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer/[~; Other El (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent''//~//~ Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family/l~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY individual Well [] Community/~_.. Public Note: if conrm unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite.~ Public i-] Community [] Holding Tank [] Note: If community well system, must have written confirmation Item the State Department of Environmental Conservation attesting to the legality and status, Page 1 o[ 2 72-025(1~¢84) ENGINFERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AS certilied by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this HeaJth Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adeqaate for the number of bedrooms and type ct structure indicated herein. I further verify that based on the intormation 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 o~ this~~inspection. ~ ~ (/~ Name of Firm (rt~ ~'~t' Telephone ~ ( ~ L~ ~ ~ ~ Address [~0~ __(~. ~ ~'~_A,/[~ ~_~¢~A~ ~%0~ ~--Engineer's Seal Approved for _/--~£(/2¢ ~- ,~,(~1o ~'~",Date - - ' -~ Approved ~ Oisappro~ , I / Con dili0~.:al -0 Terms of Conditional .A~proval 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 tbis 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. Tim Muaicipality of Anchorage is not responsible-for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (1 ~/84) WELL DATA MUNICIPALI'rY OF ANCHORAGE (MOA) HEALTft AUTHORITY APPROVAl.. (HAA) CHECKLIST - FEBRUARY 1984 264-4720 ....... '~'NM~NO\L "i:.t'J ,: 4 Wel Classification ~ Wel Log Present (Y/N) Tota Demn Cased to _ Static Water Level Casing Height Above Ground Electrical Wiring in CondL t (Y/N) Separation Distances from Well: To Seetic/Holding Tank on LOt To Nearest Edge of Absorption Field on Lot If A. B, C, D.E.C. Approvea (Y/N) __ Date Comp~e[ea Yield _ Denth of Grouting Pump Set At Ss mmry Seal on Casing (Y/N) Depression Arouna Wellheaa (Y/N) On Adjoining LOtS ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sampm Test Results Comments _~ _ To Nearest Public Sewer To Nearest Sewer Service une on Lot ; Date SEPTIC/HOLDING TANK DATA Date ,nsta ed q-16 ~'~Y-~'Size ~,,~,~ L No of (~mpartments "~. St d "d ' - an pipes (Y/N) _~" Air-tight Caps (Y/N) '"1' _ Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~ Date Last Purnpee ~/.-'~ Pumping/Maintenance Contract on File Y/N) ~'~,./',.~ . for MOlding Tank High-Water Alarm (Y/Nt Separanon Distances from Septm/Holdmg Tank To Water-Supply We ~. (TO "'~' To Property Line ~,, ~ ~' To Water Main/Service Line _____l L~r'~ Course N./¢t, Temporary Holding Tank Permit (Y/N) To Building Foundation _ -'2 D" To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments _ I.~'[ ~ ~'kt .~. T ~ Page ~ of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed (~ - [ 6 ' ~ "~ Width of Fie~d ,'"t, / Square Feet of Absorption Area I ~'( ~ Depression over Field (Y/N) i'~( Results of Last Adequacy Test ~ ,,,/,,~ Separation Distance from Absorption Field: To Water-Supply Well ")._ O 0 ~+ To Building Foundation L.~ O K- Lot fN~ ,/A. To Water Main/Service Line [ O /'-6 Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test -y To Property Line O,, To Existing or Abandoned System on ; On Adjoining Lots ~ f') / To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course __~,~.~-~. To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump 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 ha, ye c h/eCffed, vexed, or conformed to all MOA and HAA guideli nes in effect on the date of this inspection. Signed ~__¢~_.~/~ - Date Company MOA,o. Receipt No. __ Date of Payment ~-~ _ Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA qgso1 BILL SHEFFIELD, "GOVERNOR Telephone: (907) 274-2533 DATE: To Whom i t Nay Concern: /~r.,~ ~/~ Water System is tn comp,lance with the SCare Drinking Water Regulations Sincerely,