Loading...
HomeMy WebLinkAboutSOUTHPARK #2 BLK 1 LT 1outhpark #2 Block 1 Lot 1 #020-491-08 SUBMdT"sa Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131294 PID Number: 020-491-08 Dwelling: R Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New N Upgrade Name: THADDEUS MONINSKI ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 4551 SOUTHPARK BLUFF DR ANCH 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SOUTHPARK #2 1 1 Fill added above original grade Ft.Gravel length Ft.. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftp Ft. Well 200'+ TANK ■ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 1001+ Material Number of compartments Lot Line 51+ STEEL 772 NA Foundation 51+ LIFT STATION Manufacturer Capaaty Curtain Drain N 0 Gal. Remarks EXISTING TANK ABANDONNED PER Pump on level at in. Pump off level at in. High water alarm at I in. MOA REQUIREMENTS Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Installer ISAACS EXCAVATING Drainfield CO/MT inspector ANSON MOXNESS BENCH MARK (Assumed elevation)100 It Inspection 1a 9/27/13Location and description dates: 2 "" BOTTOM SIDING NW CORNER COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp OEN Conditional Approval: Date .- S o a?' • � P j1 100 TTN 1, AA'RE. SPURKLAND. // ,!1 03•••����� 1� U�FA'•. �o Approved Date Inspection Report--1-12.doc I CONNECTED 70 DRAIN FIELD SEPTIC TANK PER MOA CODE RfOUOTEMENTS I;I LOT 3 I I REPLACfO UNE BETWEEN FOUNDATION C/0 ND TANK AT A 2% GRADE SOUTH PARK #2 SID BLOCK 1 A. NO WELLS WITHIN ,.- 200' OF PROPERTY \ LOT ! 4 DORM \ SfR \ :K: LOT 12 \ \ \ NOTE.• SOUTI1 PARK /2 SUBDIVISION IS SERVED \ \ BY A COMMUNITY WATER SYSTEM \ \ 25 0 25 50 75 100 125 150 SCALE, I' = 50 FT NOTE: THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON—SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. 4 FEET COVER CONNECTED TO EXIST DRAINFIELD 1250 GALLON SEPTIC TANK 0 FDUNBA TION CLEANOUT SPURKLAND 0 BENCH MARK 80TTOM SIDING NW CORNER ASSUMED ELEVATION 100 FEET SPORKLAND ENGINEERING SOUTH PARK 12 BLK 1 LT 1 SEPTIC SYSTEM ASW 203 W 157H. AVENUE ANCH. AK. 99501 TED MONINSKI DATE.- OCT 17 2013 (907) 279-3916 4551 SOUTH PARK BLUFF DR, ANCHORAGE AK 99516 SHEET. VI GRID. 3236 PERMIT # OSP 131294 PID # 020-491-08 SOUTHPARK#2BIL1-ASBBV5 ' I ——— LOT SWING AES A B I I — — S. T. C.O. C 19.5' 16.5' 1 1 — S.T. C.O. D 16.5' 15.5' DBL. C.O. £ 17' 17.5' I I INSTALLED NEW 1250 GALLON STEEL SEPTIC AB I CONNECTED 70 DRAIN FIELD SEPTIC TANK PER MOA CODE RfOUOTEMENTS I;I LOT 3 I I REPLACfO UNE BETWEEN FOUNDATION C/0 ND TANK AT A 2% GRADE SOUTH PARK #2 SID BLOCK 1 A. NO WELLS WITHIN ,.- 200' OF PROPERTY \ LOT ! 4 DORM \ SfR \ :K: LOT 12 \ \ \ NOTE.• SOUTI1 PARK /2 SUBDIVISION IS SERVED \ \ BY A COMMUNITY WATER SYSTEM \ \ 25 0 25 50 75 100 125 150 SCALE, I' = 50 FT NOTE: THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON—SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. 4 FEET COVER CONNECTED TO EXIST DRAINFIELD 1250 GALLON SEPTIC TANK 0 FDUNBA TION CLEANOUT SPURKLAND 0 BENCH MARK 80TTOM SIDING NW CORNER ASSUMED ELEVATION 100 FEET SPORKLAND ENGINEERING SOUTH PARK 12 BLK 1 LT 1 SEPTIC SYSTEM ASW 203 W 157H. AVENUE ANCH. AK. 99501 TED MONINSKI DATE.- OCT 17 2013 (907) 279-3916 4551 SOUTH PARK BLUFF DR, ANCHORAGE AK 99516 SHEET. VI GRID. 3236 PERMIT # OSP 131294 PID # 020-491-08 SOUTHPARK#2BIL1-ASBBV5 Permit Number: Tax Code Number: On -Site Wastewater Disposal System Permit OSP131294 02049108000 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Work Type: Septic Permit Effective Dates: August 30, 2013 to August 30, 2014 Design Engineer: SPURKLAND ENGINEERING Subdivision: SOUTHPARK #2 Site Legal Address: SOUTHPARK #2 BLK 1 LT 1 G:3236 Owner/Address: MONINSKI THADDEUS S II & OLGA Y 4551 SOUTHPARK BLUFF DR ANCHORAGE AK 995164822 Site Mailing Address: 4551 SOUTHPARK BLUFF DR, Anchorage Lot Size in Sq Ft: 31871 Total Bedrooms: 4 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. IM Received By: Issued By: 13 MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-491-08 Property owner(s) Tim Moninski Mailing address Site address 4551 South Park Bluff Dr., Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) South Park #2 Blk 1 Lot 1 Legal description (Township, Range & Section) Day phone Lot Size Sq. Ft. Number of Bedrooms 4 345-1975 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field El Initial r_1 Single Family (SF) El (w/wo ADU) Septic Tank El Upgrade El Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: NONE Distance: I certify that the above information is correct. I further certify that this is in accordance with aDDGcable Municipal Codes. of property owner or Permit/Rush Fees: g Waiver Fees: Date of Payment: /3 Date of Payment: Receipt Number: Q&241 � Receipt Number: Permit No. [? 5 P/.' -311.W Waiver No. PermR App_9-1-12.doc Environmental Consulting and Design August 26, 2013 Municipality of Anchorage Development Services Department Building Services Division On-site Water and Wastewater Program 4700 Elmore Rd. P.O. Box 196650 Anchorage, AK 99519-6650 Subject: SEPTIC TANK PERMIT APPLICATION South Park #2 Block 1 Lot 1 Ladies and Gentlemen: We are submitting an application to upgrade the septic tank for this lot. The existing septic tank serving the above referenced is 24 years old and the owner would like to replace it. The submittal consists of one (1) drawing showing the present improvements on the lot and the proposed improvements of the lot, of which only the septic tank is subject to this permit application. The installation of this septic tank will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of the proposed septic tank location. The proposed septic tank will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or are in need of additional information please contact me at 279-3916. Si cerely, Spur land, P.E. 203 West 15th Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gci.net -�- LOT - I 1 -' = T SII INSTALL NEW 1250 GALLON STEEL SEPTIC Il\YI CONNECT TO DRAIN fYELD FSEPLOT 3 REPLACE LIN£ BETWEEN FOUA04MN C/O ND TANK AT A 2% GRADE SOUTH PARK #2 S/D BLOCK 1 NO WELLS WITHIN \ LOT 1 4 BORM200' Of PROPERSERLOT 12 \�NOTESOUTH PARK f2 SUBDIVISION IS SERVED8YACOMMUNITYWATER SYSTEM 25 0 25 50 75 100 125 150 SCALE• 1' = 50 FT, NOTE.., THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. BOUBLE CLEAN£ 4 F££T COVER CIM�N£CT£B TO EXIST DRAINFIELD 1250 rALLIW SEPTIC TANK ABANDON EXISTING TIC TANK PER MDA FDUNDATION CLEANOUT ISWUKKLANU LNUINUMINUI ISOUTHPAM 12 BLK 1 LT I I I -Ntrllc srsltM I 203 W 15TH. AVENUE ANCH. AK. 99501 TED MONINSKI DATE. AUG 23 2013 (907) 279-3916 4.751 _UUTN PAKK CLUf7' UN, ANCHUKAGt ALF 9951ff 5NttT.' 1/1 6XV. 12Vfff PERMIT # OSP 111XXXX PIB # 020-491-08 SUUTNPARK#PBILLDVG � q f C h � I I I 1 1 FDUNDATION CLEANOUT ISWUKKLANU LNUINUMINUI ISOUTHPAM 12 BLK 1 LT I I I -Ntrllc srsltM I 203 W 15TH. AVENUE ANCH. AK. 99501 TED MONINSKI DATE. AUG 23 2013 (907) 279-3916 4.751 _UUTN PAKK CLUf7' UN, ANCHUKAGt ALF 9951ff 5NttT.' 1/1 6XV. 12Vfff PERMIT # OSP 111XXXX PIB # 020-491-08 SUUTNPARK#PBILLDVG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES 0'L0" osy-li I Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name A O J'EwSsN DISTANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address 10B0 /"/A0 1,P9ui7,5� F,4LL5 W,4, Phone(s) Permit99No. No. ofBedrooms WELL G Orn 111 U A w e l l LOT LINE 32r / LEG AL DESCRIPTION// LotBlack / l Subdivision Sansd P4PI? rp FOUNDATION Township, Range, Section p / X/ /e o (A./ AS -BUILT DIAGRAM driveway. water bodies, (Show location of well, etc.) septic system, property lines, foundation, TANKS SEPTIC ❑ HOLDING Manufacturer rE Fug Capacity in gallons /Z 5o Material No. of Compartments TYPE OF SYSTEM 3 mT / / ❑ TRENCH ❑ BED Jj W. DRAIN ❑ OTHER Depth to pipe bottom from�/ original grade % FT Total depth from original grade 7 FT / I Fill added above original grade ® FT Gravel depth beneath pipe FT LP Gravel length 60 FT Gravel width 5" FT LJ Total absorption area 5i7 SO FT Distance between lines — FT I Number of tinesSoil rating /20 SQ FT Pipe material b Installer Date Installed WELLS ❑ PRIVATE ©OTHER (Identify) Classification (A,B,C) pwr7> Total Depth FT Cased to FT Installer Date Installed: REMARKS: E / S TE /✓57_4LLe6 2 OX i'1605F_- (Z O I I ' (V - F,? E' O F- L lrF "a _s ZS t- O F -t T3�'7Y' • S Scale: InspeChons Date:q CL 1 % Portormetl (o p / ,p�n�°oaeoa Qoacoa,a�� s• l ab''�� aoe uaoo®oa e•sya aoo G Micl"Cl E. Anoersan `� A pinressioea�9 /qe"3w`D�`1�q� / L� 1 Set Pei 6�1 1 Awa wa ` 'scum certify that this inspection was performed according to all R: Municipal and Stale guidelines in effect on this dal., Health Department Approval: Date: 72-013 (3/85) Municipality of Anchorage e i DEPARTMENT OF HEALTH & HUMAN SERVICES 825 -L" Street, Anchorage. Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: f% p -7-r- / &f .57, DATE LEGAL DESCRIPTION: C, / el 500-r lq f K Township, Range. Section: 5 Z. 71-'02 ZZ Al 93 tU SLOPE SITE PLAN DEPTH IFEET) 1 G /C_7 N 2 3 4 5� 6- 7- 8- 9- 10• 11 12- 13 14 15 16 17 19 20 WAS GROUND WATER J n ENCOUNTERED? �0 IF YES. AT WHAT DEPTH? Oman IS waeA�I v Flo Matlmritp7 �DD a pyre LP�— PERCOLATION RATE (minute ,ncn) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS L%F �'fwf2 f= /JUFs OJU TJ{JS S J/JE or LoT '0E5ie-,y v�102 Izo n'�eo2- �j PERFORMED BY: Gy J// SFR °l�e'�% I Allam EZ. L /fid D��CEATiFY THAT THIS TEST WAS PFAFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE I��•3• 72-008 (Rev. M85) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services B25 L Streetv Anchorage, Alaska 99501 343-4720 ON - SITE SEWER PERMIT �����7/��7 Permit Number: 890157 °~-~/,' ' Date Issued: 08/08/89 Engineer Designed Owner Name: MAX O JEN3EN Owner Address: P O BOX 1410 GRANITE FALLS, WA 98252 Day Phone: Parcel Id: 020-052-01 Lot Legal: Subdivision: SOUTH PARK #2 Lot: 1 Block: 1 Section: 2 Township: 11N Range: 3W Lot Size 31671 (sq.ft. or acres) Max Bedrooms: This Permit: 4 Total Capacity: 4 SEPTIC TANK: Minimum total septic tank capacity: 1,250 gallons. Each septic tank must have at least 2 compartments" Depth to top of septic tank(s) < 4.() feet requires insulation over tank(s). PERMIT EXPIRES DECEMBER 31, 1989" of 4 bedrooms. I NOTIFY DHUS OF INSPEC N 343-4744 �R 343~4681. //" . any enlargement jill require Q additional permit. I CERTIFY THAT: /`- 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOW and the State of Alaska. 2" I will install the system in accordance with all MOA codes and regulations� and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot.. 4" ! understand that this permit is valid for a maximum of 4 bedrooms. I also understa nd that the capayty of the total system is 4 bedrooms and any enlargement jill require Q additional permit. Signed: DATE: 9 ------^-- ���---�^-�-^� co—W-8 (Owner) MAX O JEM5EN Issued 8y: `-_--______-'.~, � DATE: ` Q Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMEDFOR: //427zc-A/ [ O/1 `l CO DATE LEGAL DESCRIPTION: L / 6 / i Z Township, Range, Section: t 2- 3- 4- 5 - 6- 7- 8 - 9- 12 13 14 15 16 17 18 19 apo/z�.e u` F/�ns�tEo GoF„r WAS GROUND WATER ENCOUNTERED? /✓U IF YES. AT WHAT DEPTH? ago to wuw Aw Malimrilp? A/0 UTAr-�-Roft 1) Ki -{ Il—ll PERCOLATION RATE Immutwmcnl PERC HOLE DIAMETER 20 TEST RUN BETWEEN FT AND FT COMMENTS /J LE5/G// FOR /36 C7 �f30 /� L'amo�un/r u/Art� s�sr-i� q/] /j /,�, /2'J ? ,4Pot= iJ 11' 11 ymm L AfiawPCERTIFY THAT THIg TEST WAS PERFORMED IN PERFORMED BY: 91,71m • /,T ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE / b 9 72-0081Re . a85) Oa 0- e9 Ca -D/- ,S�-09-y0/,K- 7 0.&ZAC- A5 1ti g3— o. �.• 07 3, 5 1, S Z j 5 �':''• 0 32, 04? IF N / nom" 2S. 092 SF 3-Of4 \ -moo_ 0. 74Ac. 0. SB Aa 0 o A -0 6 � 27, GS5 SF 512,4 '� c 83 63 Ac. 2,1,1 co 17 % A5 12, 044 IF 0.5/ A6. Is •.., 19 J/0 19 A�� oc.� B2.727357 83 05 0 I Sal /I3 /JIM 4' c+ z� 5 g; 4 5,14Z 5F ,5 6 ,W SB Ac. 1 � t •` a e p O5 \ ZZ,VUU J—a ` ,gyp p q 72, 000IFp l� a � 50.4c. p'\ 0 C. A j1 A //^ iyt tV -9.459 SF 0 60,4c. 79 3 Z .4 . 76, J N v rB9'SO'34 IJQ J!' ®" 4 83 -CW -,S4 SF 0. 6B Ac. roO�sO"w -6e 8-04V :83-0-Z17, /IBpC /00.00' ?7 1 447 SF 0. 63AC. � �q _ se6.4o•3s•E � zc. �• A'C9'S9'S5"w J846' r0.00' s7e•/O"3s- ti •�. �"h IQ 5Q 50.00' B/. /4, Y /7G. °e.E 29. 70 0.67 O ^�i (7 0-28 ;•,,.; 2 seo• p f 31, 634? Sf 16 SOI, - 0 e0. 75 Ac. 2 20a.0,1- 4T 0000'4T �z2 81 M ?.ESE�v • m A/2< -A I.!! AG r IJ Michael E.I,gXi9if 431S1 -E 40'rb•JO'fv /7.1. 76. 7 O q 29. 702 IF O.GBAC. A V w a ZO2.G6' e� n T �q84 /SO ac 0046'50"W ,6196' ---� Ntot. 6 Ree. P °/•J3B/ INSTALL /250 64116./ SEPTIC 14 mg) W121,111 k I Municipality of Anchorage 'moo .! Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ,, Parcel I.D. 020.052-01 HAA # 4'11�O:;l ya 5 Expiration Date: (9-1 Id 71 1. GENERAL INFORMATION ll Complete legal description Southwark #2 Lot 1. Block 1 Location (site address or directions) 4551 Southpark Bluff Dr.. Anchorage, AK 99516 Current Property owner(s) Jeff Wilson Day phone 345.3474 Mailing address same as above Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well ® Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. 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. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm KND ENGINEERING, INC. Phone (9071696.6111 Address 20441 Ptarmigan Blvd., Eagle River, AK 99577 Engineers Printed Name Kenneth M. Duffus Date 08108/02 5. DSGNATURE ,�N��F9 ••R•.e,nQf6 y/ C(/ Approved for bedrooms. .` Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist 0 (Rev. e1g2) Septic System Advisory Well Flow Advisory of AICA; ON.gITF 0 WATER AND : m WASTE EER s PROGRAM J 41:61 11bt' Maintenance Agreements Supplemental Engineers Report Other Original Certificate Date: -01/L,2 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.d.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Southoark /2 Lot 1. Block 1 A. WELL DATA Parcel ID: 020.052.01 Well We g If A. B, or C provide PWSID # 213475 Well Log (Y/N) Date completed _ Sanitary seal (Y/N) _ Wires property protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production 9 -p.m g.p,m, WATER SAMPLE RESULTS: Collform colonies/100 ml. Nitrate mg.A. Other bacteria Arsenic: _ mgA. Date of sample:_ Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material seotictsteel Date installed 10130139 Tank size 1250 gal.' Number of Compartments L Cleanouts (Y/N) Y Foundation deanout (Y/N) Y_Depression over tank (Y/N) tt7 High water alarm (YAC hl Date of pumping 08108102 Pumper McDonald's C. ABSORPTION FIELD DATA colonies/100 ml. Date installed 1104M Soil rating (g.p.d./ft or f /bdrm) JD System type trench Length 60 ft. Width 5 ft. Gravel below pipe .1— ft. Total depth i ft. Eff. absorption area ,eft' Monitoring tube Y Depression over field )y Date of adequacy test 818102 Results (Pass/Fail) Pass For 4- bedrooms Fluid depth in absorption field before test H,;)_ in. Water addedJ91 gal. New depth J1 in. Elapsed Time: 7 min. Final fluid depth 16„L In. Absorption rate >= 800 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N if yes, give date D. LIFT STATION Date installed NA Size in gallons Manhole/Access (YIN) Pump on level at —in. Pump oft level at _ in.High water alarm level at in. Datum Cycles tested Meets alarm 3 circuit requirem nts7 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout 1 Sewer /septic service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 3'+ Property line'�'+ Absorption field S+ Water main 10'+ Water service line t0'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 2'+N Curtain drain 50'+ Wells on adjacent lots '+ F. COMMENTS G. ENGINEERS CERTIFICATION I car* that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer s Printed Name Kenneth M. Duffus Date 0810812002 HAA Fee $375.00 Date of Payment 00//S/0 2 Receipt Number 0*2gZC17 (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number _ TJ -//.S /S A RECE'RT/FiG4?/O-�/ OF A^"7 �'S'6U/G/ 1 SuRVE�' l�RFMEO B0= S 1 /TH "0. -4/07-5. LOT Z �1 1 t aC �7 N I 1 fop I� STj,VG '-*AveCie _ \ \ 01% -N- rQ \ rQ DATE 05 '^ LOT Lot / , Block jo ufhc ark Sum. ,fin. No.2 Anchorage Recording District, Alaska SOT SURVEY CERTIFICATION 1 h Toby eerllty that MOVO awvsyod the property Mown end described hereon, and that the hpravtments situated I OIOM are within the prop- ,,,/ lines and do rot overlap or "Creech on adjacent property and that no Itnpranewets on adjacent property avotIOP or *ncroaCh on the "miss* In pupation and that there are no roodwoyi, vnlity lire*. at other risible easements an sold property *%COPT h Indicated hereon. Scale /n�r Dote o5-30-35 11 Cerunanta *?'record other than Mow Mown an the plat at record we not shown hereon Mise*r otherwise noted. / LEGEND to Bross or Aluminum capped monument O Iron pipe and/or tabor recovered O 2 x 2 hub 6 tack recovered i 5/8"xW labor set this survey Il .. .... ...... . .. t red R. L.• on )•• 151191ro •• •• y N Prepared by: R. L. BUTTON RegisterdOLond Surrsyor /907)279-6200. 519W EiphrhAve. Anehnrove A/da,Mo99501 Ref. F. B. No. 95_�� Propertyof: ROSS R/Svold Location (site address or directions) �f �I�JCff�i c /3`T e CCP ` Z LA OF aommunitywellsystem, provide_writt Ig to the legality and status of system: 11 1 attesting to the legalityand status of system rant MOA #21 �^ S. 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my invest!qation 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`�a�/%r�5� �E�%lH Phone �✓� ��z Address �C Engineers signature c Date - -:- DRQ' P•••.r.••.•�gsS r .. N �eix A. 00 _: .. . _. .. . James F. Sizemore ' 15179 6.: DHHS SIGNATURE OQ qc••,o� ?�+� Approved for bedrooms. a�.e®qe��® Via® :•Disapproved - Conditional approval for bedrooms, with the following stipulations: ; Additional Comments ��•� { Date C CAUTION The hfunibipallty of,Anchorage Department of Health and Human Services (DHHS) issues Health Authority ,Approval certificates based only upon. the representations giveninparagraph 5 above by an independent "A the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and t4kNending'institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate 1s issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 1 72-025(Rw.1/B1) Beck MOA M21 -. ® Municipality of Anchorage Aak Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ICJ �(Afad"A Parcel I.D. A. Well Data Well type Gbl�%�%Gl�%/Llf A, B, or C, attach ADEC letter. ADEC water system number PW Go z / ��lJ Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump levels SEPARATION DISTANCES FROM WELL TO: Wires properly protected (YIN) Septic/holding tank on lot '�> ; On adjacent lots Absorption field on lot 7—(501 ; On adjacent lots Public sewer main1 Public sewer manhole/cleanout Sewer service line WATER SAMPLE RESULTS: Coliform Nitrate Date of B. SEPTIC/HOLDING TANK DATA tank N ofi 2�_— Collected by: Other bacteria Date installed Tank size ` Z� 50 Compartments Cleanouts (Y/N)—y_9Foundation cleanout (YIN) y Depression 9(Y/N) High water alarm (Y/N) /y/ AlarmtestedY/N1) N Date of. pumping � 15 �G/ Pumper.��)lFOl�%� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: 500 6011�17wd17#f Well(s) on lot On adjacent lots.____T Foundation r r To property line 2, Absorption field J Water main/service line ` Surface water/drainage /von P G�tiGP �7ti CONTINUED ON BACK PAGE 72.026 (353)' Front 3 AT INSPECTION o C M m --I r 1 -< iiNO O _ I.P.M. 9•P•e9 M cv n z c CJl N = O C n O O `n Z Septic/holding tank on lot '�> ; On adjacent lots Absorption field on lot 7—(501 ; On adjacent lots Public sewer main1 Public sewer manhole/cleanout Sewer service line WATER SAMPLE RESULTS: Coliform Nitrate Date of B. SEPTIC/HOLDING TANK DATA tank N ofi 2�_— Collected by: Other bacteria Date installed Tank size ` Z� 50 Compartments Cleanouts (Y/N)—y_9Foundation cleanout (YIN) y Depression 9(Y/N) High water alarm (Y/N) /y/ AlarmtestedY/N1) N Date of. pumping � 15 �G/ Pumper.��)lFOl�%� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: 500 6011�17wd17#f Well(s) on lot On adjacent lots.____T Foundation r r To property line 2, Absorption field J Water main/service line ` Surface water/drainage /von P G�tiGP �7ti CONTINUED ON BACK PAGE 72.026 (353)' Front C. LIFT STATION Date installed Size in gallons— Vent (Y/N) allons_Vent(Y/N) High water alarm Meets MOA -electrical codes (Y/N) Manufacturer -Manhole/Access (Y/N) at _ 'Pump off' Level at Cyclesed. SEPARATION DISTANCE FROM LIFT STATION TO: Well on D. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed '� �y Soil rating (GPD/Ftz) << Z System type V) fl_e%GC Length (i Width s Gravel thickness _1i Total depth Total absorption area 7 Cleanout present (Y/N) ,Depression over field (Y/N) Date of adequacy test MJY I0 ) �> Results (pass/fail) ���- � `� for Z Bedrooms tr Water level in absorption field before test I G After test Peroxide treatment (past 12 months) (Y/N) G If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: wG Well on lot A1016 &/J l 0� On adjacent lots 500 (L o �� Property line i To building foundation 2 To existing or abandoned system on lot f � On adjacent lots Cutbank A/00 P_ Water main/service line C 1, i Surface water Ny o -e_ V b ,e1V ((% Driveway, parking/vehicle storage area Z Curtain drain /J 0 /j ' f 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. Signature Engineer's N , Name a/ Date 5 — 1 GJ HAA Fee $ j � . �o Date of Payment (!�p��/9, Receipt Number 9�.�y 72026 (3/93)' Back FoPoil� _�M °. Oh �Qorzu�crva� °„°.00n° °o James F. Siremore ; cr'J,°U° ak 1517E r w Waiver Fee $ Date of Payment Receipt Number OF Ty fly ST STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION _ m APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS 4F nLP5NP PROPERTY DESCRIPTION Lot, Block & Subdivision or U.S. Survey Lot l SIOL141 SoA Park �vbdip;s;cH Add%n no.2 CLASS r�p Pu1SlD Ao, Et3'f7S Certificate Issued for Application NO: 5521—DcJ-132-/27 This approval does not constitute a guarantee of any kind, explicit or implied, as to the performance of the water supply and wastewater disposal systems. WATER SUPPLY A recent water sample was tested and found to meet Department of Environmental Conservation drink- ing water standards for total coliform bacteria. Name Title Date WASTEWATER DISPOSAL The domestic wastewater system was: ❑ inspected by the Dep tment of Environmental Conservation and found to be in compliance with applicable requirements�Eng 72; ❑ inspected by a Professioer who certifies that th�tem complies with applicable re- quirements of 18 AAC 72; ❑ installed by a Certified Installer who cerltfigs tit he system complies with applicable requirements of 18 AAC 72; or ❑ tested by a Profes al Engineer who certifies that the per b ance of the system is satisfactory and that t tem complies with the minimum separation dl ances specified in 18 AAC 72. This approval is valid for a ❑ single family ❑ multi -family unit with a total of bedrooms. Name Title Date 180404 (Rev. 8185) DISTRIBUTION: WHITE—BANK/LENDING INSTITUTION; CANARY—APPLICANT; PINK—DEPARTMENT DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 May 18, 1995 James Sizemore SUBJECT: Lot 1, Block 1, South Park Subdivision Addition #2 Class "A" Public Water System, PWSID 213475 Dear Mr. Sizemore: TONY KNOWLES, GOVERNOR (907) 349-7755 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: 1. The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on May 7, 1995. This does meet the provisions of 18 AAC 80.200(A), of the State Drinking Water Regulations. 2. The last inorganic -Chemical Contaminants Sample results have been submitted to this Department. This does meet the provisions of 18 AAC 30.200(a), of the State Drinking Water Regulations. a. Nitrate and nitrate samples results have been submitted and were satisfactory, this meets the provisions of 18 AAC 80.200(a). 3. The last Radioactive Contaminants Sample results were submitted to the Department on December, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. 4. Organic Chemical Contaminants/Volatile Organic Chemical (VOC) have been submitted to this Department. Based on analysis of the previous VOC samples results have been satisfactory. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. This 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. Unless otherwise noted, this letter is valid for 30 days and is for the specified legal description noted above only. Based on the February 1993, modifications to State Drinking Water and Wastewater Disposal Regulations, the Department is required to change the fee for all bank loans certificates. The fee is $250.00. 1 have enclosed a fee invoice (invoice number is 202961) for your use. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, A 4 Michael Lu Environmental Engineer Asst. II ML/pt MUNICIPALITY OF ANCHORAGE Ah DEPARTMENT OF HEALTH & HUMAN SERVICES p Division of Environmental Services Wk On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# C>9( C69-Q� HAA# 1IP��� 1. GENERAL INFORMATION Complete legal description Lot 1; Block 1; South Park Subdivision Addition #2 Location (site address or directions) aFFic r_e hr_rk Ri ff nr n h rang a�ska Property owner Ross Risvold Day phone 345-5916 hm Mailing address P.O. Box 10026, Anchorage, Alaska 99510-0216 564-9324 wk Lending agency Seattle Mortgage Day phone Agent Address Day phone 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- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site —XXy— Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 9 M 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 S & S ENGINEERING Phone 17031 Eagle River Loop Road No. 204 Address imgla,Ziver, Alaska 99577 Engineer's signature Dhl S SIGNATURE -�� ��,// Approved for i 1Z &) Disapproved. Conditional approval for Additional Comments CQzr�� Date_ No.- + -15 or -�a 'c )��Gi`T �n Oo o00u1)e't `.�VV/a bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA M21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo7 1( ( L.IL SxxTi+ P,,, '/D 'A Parcel I.D. 0 ` U A. WELL DATA . Well type MdAa" 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) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Driller Wires properly protected (Y/N) 9 -p.m AT INSPECTION On adjacent lots On adjacent lots Public sewer manhole/cleanout tank Collected by: Other bacteria ®ate Z n L rrJ D 3 Z on Z rTJ N r g.p.m� ry y O T C Z f f e ! �� N A o0 N M O Z Date installed Tank size (�5U Ie/ �` Compartments 11L Cleanouts (9ll) YF S Foundation cleanout Depression (Y/ 1O No High water alarm (Y/ V�)iL�A Alarm tested (Y/N) Date of pumping (I22 I `l2 Pumper I iC)M� J2tlIG�S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: I Well(s) on lot 00/A On adjacent lots �O0 J- Foundation I To property line oZ Absorption field 5 Water main/service line L� Surface water/drainage P)(3NFJ 72-026 (Rev. 7191) Front - CONTINUED ON BACK PAGE C. LIFT STATION ///� Da talled /nJA- Manufacturer Size in gallons Vent(Y/N) "P High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE Well on lot D. ABSORPTION FIELD DATA Manhole/Access (Y/N) ' level at LIFT STATION TO: On adjacent lots ump off' level at les tested Surface water Date installed I0110`3q Soil rating PC sF/91L System type WJDG DzAvO Length 60 Width S Gravel thickness 3 Total depth Total absorption area S I �F Cleanouts present &f N) Y/%S Depression over field (Y/O PJ a Date of adequacy test Z Results 6&/fail) SS -for bedrooms Peroxide treatment (past 12 months) (Y/& (\3a If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: t Well on lot N On adjacent lots �4/4 Property line y To building foundation a- To existing or abandoned system on lot rJ1A On adjacent lots ?fir I Cutbank NoNFL Water main/service line 512 / Surface water NoNiz Driveway, parking/vehicle storage area Curtain drain NurotL_ lct�ot_./ E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect gn.ing date of this inspection. S & S ENGINEERING e�9 170.34 Eagle River Loop Road NO. 204 Signature C a,:ae rver, as a li Engineer's Name Date - 22 --9 2 HAA Fee $ _/ /01 Date of Payment 1 yy ReceiptNumber raBin9 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number mpt, •+vp, .- DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 FOR: S & S Engineering WALTER J. HICKEL, GOVERNOR 563-6775 January 21, 1992 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 :t MUNICIPALITY OF ANCHORAGE �fis • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # r) - (17�NA-nt _' HAA # � (:)Sq C)Lk 2,1 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) c-/ Bi saurHPAP_ �Z SZ 7-11 A/ RS 1A1 Location (address or directions) X55/ -5'0Vr11P//,ee ,-Lally, I0,0 (b) Property owner '7 X D, .T6nlS" Telephone: (home) Business Mailing Address )00 BOX /4//6 dltV.W17E FALLS ZW, 9,02.fZ- (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here I!1'if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family IHS Number of bedrooms r 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 IYSPPublic ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by myseal affixed hereto and as of thevalidation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm ANDtys,)J Gw, FJctuy& Telephone j37- 6j✓ -7 Address _P(7, Sox Z-1,1077? A'^ ul. 44- gwzs ,l Date w S <w a? a b� eJ966 aeb gf,,,o bJggyqqoomo s v�q Michael E. Anderson,zQ 'J 43fl1-E 000 ... ..eb�q°q� F�sv 6. DHHS APPROVAL / Approvedfor bedrooms Approved v _Disapproved r— Conditional Terms of Conditional Approval) Engineer's Seal ill / ?,z4,- The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above byan independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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. 7/80) Back Page 2 of 2 ICIALITY of oo\ �• MUNHealth Au hor ty Approval (MOA) (HAA) a CHECKLIST - FEBRUARY 1984 G , P� ��a� 343-4744 o Legal Description L/ �/ SovTn�92CiZ A. WELL DJ( Well Classification COmIf 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 Date Completed Electrical Wiring in Conduit (Y/N) Depth of Grouting SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Comments SEE- AT7-AG14ED LETTE2 B. SEPTIC/HOLDING TANK DATA ; Date Date Installed /0-30-89 Size IZSO No. of Compartments I? - 0 i Standpipes (Y/N) Y Air -tight Caps (Y/N) �V Foundation Cleanout (Y/N) Depression over Tank (Y/N) A/ l Date Last Pumped i✓Ew CO�SrRu�Tio Pumping/Maintenance Contact on File (Y/N) NEaI ; for CO/7STPULT�aN Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 500�t To Building Foundation To Property Line To Water Main/Service Line y� — To Disposal Field _i� To Stream, Pond, Lake or Major Drainage Course ltlewe- iy 9�E/i Comments SGPT/G TiiA,�e Is f;'44L JATE 72-026 (Rev. 7/86) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 17-0 Type of System Design Date Installed /D -3o-89 Length of Field !off Width of Field 5/ Depth of Field Gravel Bed Thickness Square Feet of Absortion Area 51 Depression over Field (Y/N) Al Results of Last Adequacy Test AASSEl SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 560't To Building Foundation Lot Lor _ Statndpipes Present(Y/N) Date of Last Adequacy Test NEu> ConS7"2(JCT76g/ To Property Line ; On Adjoining Lots To Existing or Abandoned System on To Water Main/Service Line 5Z To Cutback (if present) NONE oe65E�vT To Stream, Pond, Lake, or Major Drainage Course Na,v—� iv A 2EA To Driveway, Parking Area, or Vehicle Storage Area Z o/ Comments ABSo?oTie� v Sc�ST6m /S ft,DE"Z/ 7E IFT STATION Date Ins d Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA!J9ad'� inspection. f a GC Signed Company /VPL:1SQn) L+n1Gin1 E'Fs(/n1G " p E�vm� Date MOA No. bfi Receipt No. (� 16--1 ) l FG�TK�-/ Date of Payment zz/10 y Amount: $ �/ • '� Receipt No, Waiver Fee: $ Date of Payment 72-028 (Rev. 7/88) Back Page 2 of 2 Pumping Cycles during Adequacy Test. :I E. Anderson 4381 - E �ono�c.a ac'o`,1t�v !"10P[SS G on the date of this ngineer's Seal T DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 November 3, 1989 ATTENTION: WAYNE MC FADDIN PWSID: # 213475 STEVE COWPER, GOVERNOR 563-6775 According to the records on file in this office, the South Park Terrace Estates Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Vera E. Craig Environmental Fieltoicer VEC:bas