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Home My WebLink AboutSOUTHPARK #2 BLK 1 LT 26 On-Site Water and/or Wastewater System Permit moent ,S• ® - srar.d MUNICIPALITY OF ANCHORAGE ri (IrDevelopmentServices Department p On-Site Water& Wastewater Program D 4700 Elmore Road, PO Box 196650 � I eparflitch u Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP161333 Tax Code Number: 02050116000 Work Type: SepticTank Upgrade Permit Effective Dates: November 14, 2016 to November 14, 2017 Design Engineer: CREWDSON ENGINEERING, LLC 0-171 (0 0 Subdivision: SOUTHPARK#2 Site Legal Address: SOUTHPARK#2 BLK 1 LT 26 G:3236 Owner/Address: KEIL NAOMI L & LAWRENCE L 4741 SOUTHPARK BLUFF DRIVE ANCHORAGE AK 995164846 Site Mailing Address: 4741 SOUTHPARK BLUFF DR, Anchorage Lot Size in Sq Ft: 23268 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. Received By: 66) Date: 11/ ° L/ //( Issued By: l (�`-41,eG C.“71a Date: 1! 1/1 //c20 /6 1 � "Y''MUNICIPALITY OF ANCHORAGE t e yc. j9 r' J `Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-501-16 Property owner(s) Naomi Keil Day phone 808-551-6324 Mailing address Site address 4741 Southpark Bluff Dr Legal description (Sub'd., Block & Lot) Southpark #2, Block 1 , Lot 26 Legal description (Township, Range & Section) Lot Size 23,268 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (0 all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) X❑ (w/wo ADU) Septic Tank Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal 9 Multiple Dwellings 9 Privy ❑ (SF and/or D) Private Well ❑ Water Storage 9 THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. • (SignatuFl e o property owner or authorized agent) Permit/Rush Fees:ar-'245-.00 4f/2700 Waiver Fees: Date of Payment: //—/b — /6 Date of Payment: Receipt Number: 0/0 72 q Receipt Number: Permit No. 0,51/4772.2sp/�/?.23 Waiver No. Permit App_.;- ::_.,k Crewdson Engineering, LLC James "Jay" Crewdson, P.E. Email: CELLC.1@outlook.com Cell/Text: (907) 280-9493 Fax: (907) 688-2295 Civil&Environmental Engineering November 9, 2016 Municipality of Anchorage On-site Water&Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Attention: On-site Engineer Reference: Southpark#2, Block 1, Lot 26 Septic Tank Permit Application Design Narrative The owner of the subject property would like to replace the existing septic tank (1985 1250-gallon steel) with a new 1250-gallon septic tank. The existing tank will be decommissioned in accordance with the code and the proposed tank will be installed near the same location. The proposed septic tank shall be covered with 2-inch approved insulation and 2-foot minimum soil cover. Per AMC 15.65.030 C3, the existing septic tank is: 1. 5+feet from any property line or building foundation; 2. 10+feet from any water main or water service line; 3. 100+feet from any surface water; and 4. Greater than the separation distances required by 18 AAC 72 from water supply wells. The property is served by a community water system. Please feel free to contact me if you have any questions. Thanks / —.�Pat•" 0 I i e 4k, fre ++:' 4' ' �1 .... . James "Jay" Crewdson, P.E. / . '• / 6i�mes A. Crewdson,'� �, C11527 (1��OFESSIO`P� PO Box 671389 • 18368 Amonson Road • Chugiak,Alaska 99567 JUN-03-2008 TUE 04:22 PH DYNAMIC PROPERTIES FAX NO. 9072617584 ,..„.. 43. 02 ' ' ;abaft.. . -----7.-...- -5 ---.--..1.: _ . \...- . . • The_CowN exIsA;v,9 Li_SO Sepk _AW ..cali. • -..."..,...1%.‘k • avt.c4,„11 ,A.ew laso s&P-V.c._-lain k ; ....4. 9/ ( J) • -Iii.s"10\1 0 diAbte alcotr ay ) diti1".. ,ir -..e.t.li ft)) f .•• tto s. /%10, Ja1. ,? ttles/1' ''''''''' •'' •••• • • • • ' ' ' ' ': . /489•57'241 170.88' i .Q.-A.', • •S.,.•••• );.: **.1 . _ .• 'Tar 1 19e A 10 lb — 4 -... 33' SEC. LINE EASEUENT 1 I.\<°‘8,el•F Ex.e Li at k. A LC-C tC? I 7°1 - . . . _. . . . _ _. __ .. .. _. _. _._ .. . • - - .-_ LOT 26 et) lit •-1 o6 LP r‘i 4 N 1E 0 ea iti a )i-,‘ -1,, .._. - 7 t 12.4. 101 25 ..*: • • cil flea -----.9 .5 0 DOSING HOUSE . .1•3 -s 30.5 C.:) la o a • to LOT 27 )40 CI a ll FV ... IS:7.1 ti 1411 4 2 ti 0 • V.:::::::::•;.:::•.:•.f.:::•.:•:.:::::: . •- —I 0: T-E L...17..Is-E L.E-C.-....- ;Lc-;a-......::•;:EI.1..-:.. .:•• r.l? .... ........ r: __.. ..... -. L-87.05 N=.31 a 76 •••••••• Gil N17.0n 377Q. - _. SOU THPARK st. urr- ...-.. in ,, g;'•e're, 0'''''elt:p DRIve -- 45.:-(,...... •... „zh ......._ otrfifl.cau v‘ ...7/). ) rfr- .) Ir.-- r itterr........, VA 7, tis mr,P. u,sr pion; 26 121 P . . ,.../.. k.\,'-ofeaotilini 7.-t:' AS-BUILT NOW: NIS DFIAWNO IS NOT TO BE 1100110 FOR USC AS A PLOT PLAN. - —... ------..— I.p'Optalplaic Oita"BY Bob Boor LOT 26, BLOCK 1, torn& SoptIc SlandPb•CS) :4f:74-. 3:71 SOUTHPARK SUBDIVISION ,..,:.y...ii., .. ADD. NO. 2 ..., iiisa,=.....my '-''0.. P7,43Ect,3'21.1 SUITSEY CERPTICATIUNt LAN 1(04 Na.eanitclod a physical aim,el the I :ez/2/:hay shownni nsn.I fhb tti42.72 certIT,,,,a:nthat.,,=,2:zttills, . .. other than rtoltoil. • ; EXCLUSIONARY NOTE: It b the one....PlabblitY to Planlit• the LAND A: COM:IFZUCWIN SURVLY011::-PL ANNERS-ENGINEERS Mitts.,,".,h1 9 taw"'It t"="th.„.,,tettlett, ttnntrtr°1771; 110 It'si I. 11 e.i%zits i Outikvard. :4J1 la 200 Phone: 562-5291 s.,eilts;,,T,i.;:pn,-,i,:ir:,'..7:1;:::;`,„-i,"„7,;.d Ca,tPs:;‘, ,Zsi% '..An cri vs,q9, Ally.lin 69503 --...-.. Fax: 561-6626 lc.lainbialtst PaciEtty Area.e.I.•P1.1-000 PLIT"" -. — rat e3-213414• 3236 oohs 6/02/2008 baa-n es NREI - -.. - tladt Craft. 9 AM-1-Elfin lrbflr Re F.661 3. sat=1str30' cs.a.4 Oa JAZ i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT _ - -- [] UPGRADE MAILING ADDRESS -~, '-~, ~%~. ! !2. 1'7 -7 ! v-Y~,~_,~...ac-~_- ~ ~-~c_ '-~[Cl ~-11 LEGAL DESCRIPTION LOCATION ~ O (~* ~+ ~¢~ ,~ ~["l ~ ~ ~[ ~ NO. OF~DROOMS DISTANCE TO: ] Well (~ ~ ~ /a [ Absorption ~.rea~ Dwell~ / PERMIT NO. ~ ~ Manufacturer ~ ~ A~Oa '~ Mat e ri~¢~ No. of compartments Liq..ca~aci y in gallons IF HOME.DE: Inside length_, Wi~ . Liquid ~_ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons , Nearestlot~e/ __ PERMIT~ ~ DISTANCE TO: Well ~ / 1~ Foundation i ~ Distance between lines ~g~ Top of tile to finish grade ~ ~0' inches Material beneath tile Total effective~on area Length Width Depth PERMIT NO, ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class -~ Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER ~ ~/ ~ I PIPE MATERIALS [ SOIL TEST RATING REMARKS ....... ~&E."' t'" ~'~ ~.~_'. r~.~7o~ ..'~ ~ DATE , LEGAL DEPARTMENT OF HEALTN AND ENVI~RGNMENTAL PROTECTION 825 L STREET, ANCHORAGE.~ AK 99501 264-4720 PERMIT NO: DATE ISSLJED: 850:1. 56 05/06/85 APPL I CAN),~: ADDRESS: CONTACT PHONE: ¢:'OREMAN CONSTRUCTION P.O, BOX 112].77 ANCNORAGE, AK 99511 278-.- 1790 LEGAL DESCRIP: SUBDIVISION: SOUTH PARK ~2 LO]': 26 BLOCK: :L , SECTION: 3 TOWNSHIP: lin RANGE: 3W LOT !SIZE:' ~ (SQ.FT. GR ACRES) . ' MAX BEDROOMS: , /9~ ~ ,/ ~ ~ Listed below are the options available to yoLt iR designing yoLtP septic. system. Choose the option that best fits youp Site. DEPTH TO PIPE BOTTOM (F'T.) GRAVEL DEPTH (FT.) TOTAL DEPTH (FT.) GRAVEl- WID]"H (FT.) GRAVEL LENGTH (FT.) GRAVEL. VOLUME (CO. YDS. ) TANK SIZE (GALS) SOIL RATING (SQ.FT. /BR) 66.0 33.7 1,250.0 '~'~ 165 4.0 4.0 0.5 3.5 4.5 7.5 23.0 5.0 44.0 72.0 37.5 53.4 1,250.0 ~ 1,250,0 *~ ;165 165 *~ 'f'ANI< MLtST HAVE A'T [..EAST TWO COHF'ARYMENTs certify 1. I am 2, that: ~'amiliar with the requirements Cot on-site sewers and wells as set. forth by the Municipality ot' Anchorage (MOA) and the State o£ Alaska. I will install the syst. em in accordance with all MOA codes and regulations, and in compliance w~,t.h the design criteria ot' tills permit. I Will adhere to all MOA and Stat. eo~' Alaska requirements Cot the set back distances from any existing well~, wastewater disposal system or public sewerage system on' this or any ad.jac'.ent, or near'by lot,, I understand t. hat this permit, is va. lid for a maximum o£ 4 bedrooms and an,2 en].argement will require an additional permit. IF A L. IFT STATION IS INSTAL. LED IN AN AREA COVERED BY MOA BUILDING CODES, )*HEN (1) AN ELECTRI[,AL PERMIT AND INSPECTION MUST BE OBTAINED; (2) A,~.-BUII...[S WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) 'THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. S I Gl'lED APPL,. I CANT: DATE: FOREMAN CGNSTRUCTION D~FFE{ I S~3LJEDa: ... ............ ,.~ ?, ,., / c_~. L. :i. !s t. c~ d MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99E01 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: 5" I - 4~-~ LEGAL DESCRIPTION: 2 5 6 7 8 9- 11 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS .~o; { -~ol~ ~. i .s 72-008 (6/79) SLOPE S~TE PLAN WASGROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S Gross Net Depth to Net Reading Date Time Time Water Drop 55'7 I 0 }0 Hq~ (minutes/inch3q ~ .~ PERCOLATION RATE TEST RUN BETWEEN FT AND ~ FT Parcel I.D. 20-052-26 Municipality of Anchorage 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 HAA# Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 26, Block 1, Southpark Subdivision No. 2 Lccation (site address or directions) 4741 Southpark Bluff Drive Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Joseph and Frances Evans Day phone 345-4890 4741 Southpark Bluff Ddve Anchoraqe, AK 99516 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Three (3) 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class _.A Well Public Water System [] [] [] Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] 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 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of lille (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. Cedificates 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 less than 30 days old. (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 engineer's 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 outIined 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 lhe 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 Anderson Enc~ineerinq Address P.O. Box 240773 Anchoraqe, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. o DSD SIGNATURE L"'/'Approved for Disapproved. bedrooms. Phone 522-7773 Conditional approval for bedrooms, with the following stipulations: Additional Comments ~kL .',1 .~.' UN-SITE ~'~; WATER AND ~ ~ WASTEWATER ~ L PROGRAM Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Repod Other By: Odginal Cedificate Date: A. WELL DATA Well type ~ass A Date completed Total dep~ Date of test Static water level 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,c~.anchorage.ak.us (0O7) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Lot 26, Block t, seuthpa~ Subdivision No. 2 Parcel ID: 020-052-26 0 ff A, B, or C provide PWSID # 21347S Sanitary seal (Y/N) Casad to lt. FROM WELL LOG war L~ (Y/N) W~ms propedy protected (Y/N) Casing height (above ground) AT INSPECTION in. wel~ producUon WATER SAMPLE RESULTS: Coliform coionies/lO0 mi. Date of sample: e. SEPTIC/tlOLDING TANK DATA Tank Type/Material Septic/Steel Tank size t~50 gal Foundation cieanout (Y/N) Y_ Date of pumping 7/29/2002 C. ABSORPTION FIELD DATA Date instated 9/21/1985 Length ?0 Total depth 1~2 ft. g.p.m. Number of Compartments _2 Depression ovm tank (Y/N) N Pumper A Plus Home Services fto g.p.m. Date installed 9/21/1985 Ck~anouts (Y/N) Y High water alarm (Y/N) N Soil rating (g.p.d./ft~ or ft2/bdrm) 165 SFIBDRM System type Deep Trench fl. Width 3 ft. Gravel below pipe 6 Eft. absoq)tidn area ~8~/O_ft2 Monitoring tube Y_ Depression over field N.N_ colouies/100 mi. Date of adequacy test 8/3/'2002 Fluid depth in absorpUon field before test 13.5 in. Etapsad Time: t,410 min. Final fluid depth 13~, in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N Results (Pasa/Fatl) Pass For Three bedrooms Water added450~ gai. New depth27.25 in. Absorption rate >= 450 g.p.d. If yes, give date D. LIFT STATION Date installed 'Pump on' level at in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump ofF' level at Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic lank/lift stetion on lot Absorption field on lot Public sewer main Sewer/septic sen/ice line in. Manhale/Access (Y/N) High water alarm leval at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhote/deenout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Water main N/A Wells on adjacent lots >200' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >t0' Wale,- Sen~ice line >t0' Curtain drain None Notsd F. COMMENTS Properly line Water service line Building foundation >t0' Surface water >100' Walls on adjacent lots >200' Lot is served bY Class A Cemmunitv Water S~stem. G, ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA HAA guidelines in effect on this date. Engineer's Fh'inted Name Michael E. Anderson. P.E. Date 8/t 3/2002 Date of Payment Receipl Number Absorption field >5' Sudase water >t00' Water main >10' Driveway, pa~king/vehicie storage >10. Waiver Fee $ Date of Payment Receipt Number ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) August 13, 2001 Dynamic Properties 3111 C Street Anchorage, AK 99503 Attention: Jan Rednall Su~e~: Lot 26, Block 1, Southpark Subdivision No. 2 Septic System Inspection, Testing and Certification Dear Jan: On August 3, 2002, we inspected the septic system serving the throe-bedroom home on Lot 26, Block 1, Southpark Subdivision No. 2. Prior to the inspection we researched the information on the system located in files maintained by the Municipality, These files indicate the system was originally constructed in September of 1985 when the house was originally built. The current system consists of a 1,250-gallon steel septic tank and a deep absorption trench with a length of 70', a total depth of 12' and an effective depth of 6'. Water was found in the sump at the end of the trench at a depth of 13.5" indicating the trench is approximately 19% submerged with 58.5" of working absorption area remaining. A total of 450 gallons of water was injected into the trench to determine the absorptive characteristics of the system. A rise in the water level in the sump was noted to a level of 27.25". The water was allowed to settle over night and the level again measured the following day. The water had receded to its original level after 23.5 hours. We are confident the system is currently capable of absorbing more than 450 gallons of water per day and meets the Municipal requirement for certification, We make no guarantees, however, of the ability of the system to sustain this rate in the future. A Plus Home Services according to information provided by the homeowner pumped the septic tank on July 29, 2002. No further work is necessary at this time to obtain a Certificate of Health Authority Approval from the City. Sincerely, Michael E. Anderson, P.E. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) MEMORANDUM DATE: TO: FROM: SUBJECT: August 27, 2002 Joe Goodall Mike Anderson, P.E. Lot 26, Block 1, Southpark Subdivision No. 2 · Certificate of Health Authority Approval Attached is the as-built for Lot 26, Block 1, Southpark Subdivision No. 2. The cleanout and monitor tube locations are shown. Please let me know if you have further questions. /%/. D9 °.57 $3' dOING=FIg , pCANNERO · EIURVI~yORB , WEST 8ENSON Bt. VD· 2729231 ' ,:11UI1AGE. ALASKA 9950~ 5025291 /. Form IVlAP.S~ey -- 'TOTAL 2~) fro' Windows' api)~sal softw~ by a la mode, Inc.- 1-800-Ak4MODE 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. # I~'~,(~ -¢~,¢'~-~ -~,(r~ HAA # ~o~ ~)[~,~,~ GENERAL INFORMATION Complete legal description Lot 26; Block 1; Southpark Subdivision ~2 Location (site address or directions) 4741 Southpark Bluff Drive Anchorage, Alaska 99516 Property owner Mailing address Lending agency Mailing address Agent Address (w) 262-7251 Day phone (h) 345-3688 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: XXX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Fro.t MOA,21 ~ [JL~ ~--~ 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 M0~nicipality of Anchorage files and from my inves_tLgation 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~ ~ ~.uc~'~"r-~'~ ....... '~ 'Phone ~/~"Z~'/~ 17034 Eagle River Loop Roa~cl' Address .............. -- -- Engineer's signature /~/-~'/~ ,~---' Date Disapproved. Conditional approval for bedrooms, with the following stipulations: 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 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 engineers work. 72~Y25(Rev. 1/91) Back MOA#21 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. # L~:L~,(~ -f~,~ -- ~rt n 1. GENERAL INFORMATION Complete legal description HAA# Lot: 26: Block 1; Sout:hpark Subd±v±s'ion #2 Location (site address or directions) 4741 Southpark Bluff Drive Anchorage, Alaska 99516 Property owner Mailing address Lending agency Mailing address. (w) 262-7251 .7~¢ ~,,~n, Day phone (h) 345-3688 4743 So]~thpark Rlllff Dr~v~ An~h~g~, A~_ QQ~]6 Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WA'rER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 3 NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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. 72-025 (Rev. 1/91) Front MOA#21 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 investi_gation 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~ ~ ~ I=NG!N,~!~JG ?"'"~ 'Phone ,~'~/"2¢:"7~'~ A'' 17034 Eagle Rive~ Loop Road'~2~ k Date /0 Engineer's signature .~-~'~" 6. DHHS SIGNATURE Approved for 7'--A/-,~-~-~ ("3,) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Parcel I.D. Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow ~_ SEPARATION DISTANCES FROM WELL TO: Septic/hcldL~g tank on lot ~ ~ Absorption field on lot ~'c:::Or?~- Public sewer main If(~B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing hei~e~e~ .Wires prope~) FROM WELL LO~ AT INSPECTIONMuNtCIPAUTY OF ANCHORAGE ~.NVI~.ONMEN~'AL SERVICES DIVISION .g.p.m. .g.p. n.CT 1 1 1993 RECEIVED Sewer service line Date ~ B. SEPTIC/I.I~N~ TANK DATA Date installed ?/~--!/~ Cleanouts ~) High water alarm (Y~D~ Date of pumping ; On adjacent lots ; On adjacent lots ~ /cleanout Collected by: Other bacteria Tank size /~.~-O Compartments Foundation cleanout ~_.~N) ~/L~ ~' Depression (Y~ Alarm tested (Y/N) Pumper A ~ ~ SEPARATION DISTANCES FROM SEPTIC/t-~(~=BtNG TANK TO: Well(s) on lot z/~/o~.-/~'~ On adjacent lots TO property line ,//('~ ~ Absorption field Surface water/drainage ('(~0 "J-~- 72-026 (3/93)* Front Foundation Water main/service line /O/'/- CONTINUED ON BACK PAGE Co LIFT STATION Date installed Size in gallons Vent(Y/N) "Pump on" level at Fligh water alarm level Meets MOA electrical codes (Y/N) SEPARA~T STATION TO: ..~.~.V~e..JJ.zarrFot On adjacent lots D. ABSORPTION FIELD DATA Date installed ~ [ g I/~5''~ Length'-'-'/0 / Width Tetal absorption area Date of adequacy test /¢/~ / Water level in absorption field before test Manufacturer Manhole/Access (Y/N) ~" Level at ~-'"'"~Cycles tested Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: ~11 on Io~ ~ On ad~aoonl Io~ ~0 ~+ Surface water Soil rating (GPD/FF) /"~,-~" -//~/---.~ System type Gravelthickness (¢ r Total depth Cleanout present'N) YE.5 Depression over field (Y~) Results a~ail),/°A ,.-C,~ for ~ After test If yes, give date Property line To building foundation /(-.) ~ ;~ To existing or abandoned system on lot Onadjacentlots ~-0 ~¢'~- Cutbank .,XJo.,~r~ /~/~L--~J~JgWatermain/serviceline Sudace water /~t~.) ~'7r-- Driveway, parking/vehicle storage area ~c:P ~ Curtain drain ./~x..'6~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or confofTce¢to.¢ll MOA and HAA guidelines // / Signature ~:~,~,,~,.... ~-z 7 E~lgineer's ~ Eagle R~ver ~ffR( d No. 204 · Date E.~Io River, Alaska ~ /~~ HA,& Fee $ '.~ O0 Date of Payment / O- ~ A ~.~4 Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number in effect c 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 '~.~:,~c~- ~-:~i~ ~"'~elephone: Home Applicant Address (b) Business (c) Applicant is (check one): Lending Institution []; Owner/builde,f,~; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address · Telephone ,, (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family'~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well![] Community~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~l~ Public [] Community [] Holding Tank 1-1 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84} Page 1 of 2 ENGINEERING FIRiVI PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my i nvestigatio n 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, t further verify that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site wate~r 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 ~t-~.~¢~'-~z_ (~--:~'.C~..~'~--~,*S',WD.._ Telephone ~'~'-~7'''~)~ Address Date.. Engineer's Seal DHEP APPROVAL Appr°vedf°r ','~f~ ?-bedr°°msby~ ~~fl~\ . Approved ..-~ Disapproved Conditional Terms of Conditional 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: (/~ 'cJ)o ~ 4 'f"H--F" WELL DATA Well Classification ~-"~'"~'¢~'~-, ~'t-7 If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) DaCe 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 od"Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected b),~ Water Sample Test Resglts Comments Depth of Groutin. g.¢"'"~--'""~ P.~ rh~l~'~et At 1 .¢-Sanitary Seal on Casing/(Y/N) ?;' Depression Around We ead (Y/N) ; On Adjoining ots .." ,' On Adjoining Lotsk....~ .~--~ ' To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~/~'/'~ Size I~~ NO. of Compartments Standpipes (Y/N) ~'f~ _ Air-tight Caps (Y/N) '~'~ ~-~:~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) - ~ ~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~'~/}'~ ; for Holding Tank High-Water Alarm (Y/N) ~ j'1~'~*' Separation Distances from Septic/Holding Tank: To Water-Supply Well '~ / I~ To Property Line I~"~ / ~ To Water Main/eSe-trice Line ) Course '~"~ /~ Temporary Holding Tank Permit (Y/N) To Building Foundation TO Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~.~¢~;.~,r,, Width of Field ':.'~, tt I (':"/'~'- ,~: ,///~JZ~'lType of System Design ¢/ /Z_.l/~r~ Length of Field .... ~/~' Square Feet of Absorption Area Depression over Field (Y/N) Resalts of Last Adequacy Test Separation Distance from Absorption Field: Depth of Field ~ / Gravel Bed Thickness ~,, i Standpipes Present (Y/N) ~'"~ Date of Last Adequacy Test _ J"-~ To Water-Supply Well 'Fo Building Foundation ~ C~ i Lot J-O Water Mare/Service Line' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area i To Property Line i % .... I-'- To Existing or Abandoned System on On Adjoining Lots ...)~ I .,~ To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons ..' / "Pump On" Level at · ' High Water Alarm Level at Tested for ,.' Electrical Codes (y/~} Comments __ Dimensions Manhole/Access (Y/N) .' "Pump Off" Level at ' Vent.(¥/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** Icertify that I have checke~,, verifie~r conformed to all MOA and HAA g uideli nesin effect on the date of this inspection. Signed" '~'~'-~,,"~ A':'~-'- Date ~/~ CompanyL'-.~'~'t'v¢-~,-,~l~,~"'¢ ~,.~'1~ ('~4"~i"~TA No. Receipt NO. ~O ~.'¢~ ___ Date of Payment / ,O/. ~ Amount: $ [¢)~_ 6~ Page 2 of 2 72-026 (11/84) Engineer's Seal