HomeMy WebLinkAboutSOUTHPARK #2 BLK 3 LT 39 Municipality of Anchorage Poge 1 of.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW000354 PID Number: 020-052-36
N°me:TORBEN PEDERSON Wastewater System: [] New · Upgrade
Address:
4810 SOUTHPARK BLUFF DR ANCH. AK 99516 ABSORPTION FIELD
No. of Bedrooms:
Ph°ne:(907) ,345--6498 4 IDeep Trench [3Shallow Trench rlBed OMound OOther
LEGAL DESCRIPTION 0.6 o../~. ~
39 3 SOUTHPARK #2 5.1 (MAX.) r~
- - - 0.2 - 0.5 ~ 65 Ft.
r~ DENALI 10/7/00 - 10/10/00
SEPARATION DISTANCES · Septic [] Holding [] S.T.E.P.
From Tank Field Station Tank Sowor U,,, ANCHORAGE TANK 1250
WaR 2O0'+ 2O0'+ - - 25'+ STEEL 2
lOO'+ lOO'+ - - LIFT STATION
Surface
Wa[er
Lot
5' + 10' - J
Drain NONE KNOWN
I
Remarks: THE OLD SEPTIC TANK WAS FILLED WITH SAND BENCH MARK
THROUGH THE CLEANOUT PIPES. TOP OF ST2. STILL PRESENT UNDER DECK.
100.~0
inspections performed b,:. AWWC, INC. Dates:is, 10/7/2000 ~.~..,.67..".~;.~.//.¢ ~¢? "',.~(
2nd 10/9/2000J¢-....~.
3rd lO/lO/2OOO
4rd 10/17/2000 ~,¢, . . ·
Department of Health and Human Services approval'(/~'~h~ ,,"'....I ....
Reviewed and approved by: ,/)¢'.,/,/'-,-.-.~/~'. ,~ Date:/0 --2-~"~ = ~,~,P~rOfess,O~_O~==.~z~e .......
PR.,, NvM.ER: AS-BUILT DRAWING
SW000554 020-052-36
10/24/2000
~AS~ WATER & WASTEWATER
~PE OF WORK: A~Ofess[O~
AS-BUILT OF SEPTIC SYSTEM UPGRADE
~E..= NuMBE.: AS--BUILT DRAWING
SW000354 020-052-5fi
~ 0/2~/2000
A~SI~ WATER & W~TEWATER ~z.w.
SOUTH PARK SUBDIVISION ~2; LOT 39, BLOCK 3,
AS-BUILT PROFILE OF SEPTIC SYSTEM UPGRADE
MUNICIPALITY OF ANCHORA GE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 995'i9-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date issued: Sep 05, 2000
Expiration Date: Sep 05, 2001
Permit Number: SW000354
Legal Description: SOUTHPARKADDN 2 BLK 3 LT 39
Design Engineer: 0041 AK Water & Wastewater Consultant
Owner Name: Torben Pedersen
Owner Address: 4810 Southpark Drive
Anchorage, AK 99516-
Parcel ID: 020-052-36
Site Address: 004810 SOUTHPARK BLUFF DR
Lot Size: 23879 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
Disposal Field SeptioTank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State efAlaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 te April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Date:
ALASI WATER & WASTEWATER
September 19, 2000
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Sewer Upgrade Permit Revision for Southpark Addition #2; Lot 39, Block 3
To whom it may concern:
Due to a proposed addition to the house the design for this septic system needs to be revised. A
15 foot wide garage is going to be added to the east end of the house which will encroach on the
permitted drainfield upgrade. Revisions for this design are summarized as follows:
1. SOILS: Attached is a soil log which shows the soii profile, groundwater monitoring, and
pemolation test data. The original testhole was extended to a depth of 19 feet. It is om' opinion
that due to the soils classification and percolation rate an application rate of 0.8 gallons per day
per square foot should be used.
2. TRENCH DESIGN:
a. Percolation Rate: 17 minute/inch
b. Allowable Application Rate: 0.6 gallon/day/ft2
c. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 1000 ft2
f. Maximum depth: 13.5 ft.
g. Effective Depth: 8 ft.
h. Width: 2.5 f~.
i. Length: 65 ft. (55 ft with 10 ft "L" on south end)
j. Effective absorption area = 1040 R2
I am unaware of any adverse impacts this design revision would have on adjacent ~vells or septic
systems. If you have any questions, please contact me at 337-6179. Thank you for your
assistance.
Presi
P.E., M.S.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907)337-6179 * Fax: (907)338-3246 * Website: akwwc.com
PREPPED FOR PHO~BER: ~AGE NUMBER: ~'% ~'. ~'~ cu ~-/ · ,~
TORBEN PEDERSEN 545-6498 1 OF 2 ~ .~Jeffr~ A. ~erness: .~
SOUTHPARK SUBDIVISION ~2; LOT 59, BLOCK 5 ~i~?~ .'.. ........ ..'~
SITE P~N FOR SEPTIC SYSTEM UPGRADE ~-'
~-* ~' ,¢ ~ NOTE: THE CONTRACTOR SHALL HAVE THE
~ ~-~"" .,K'" ', EAST/NORTHEAST PROPERTY LINE FLAGGED
..~ ~' ,,\'~ "" / % ~, BY A REGISTERED LAND SURVE"(OR PRIOR
~- / '¢- ~..u .<..//'%% % ~ TO CONSTRUCTION.
/ ~
~ ~i K~ BOX ~~ EXI~NG SEPTIC SYSTEM TO
9/ 9/zooo
}~WN BY:
~ . ." t ".~-~..
AI.ASI WATER & W TE VATER
6901 DEBAR RO~. SUITE 28 ' ~6HORA6E, ~ 9950~ * PHONE (907}b574179 ' F~ (907)338-5~h6 ~ ~0~
PREPPED FOR: PHONE NUMBER: PAGE NUMBER:
TORBEN PETERSON (907) 345-6498 2 OF 2
SOUTH PARK SUBDIVISION ¢2; LOI 39, BLOCK 3,
~PE OF WORK: %~rofess[o~
DESIGN FOR SEPTIC SYSTEM UPGRADE
AI.A_SKA WATER & WASTEWATER CONSULTANTS~ INC.
6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK. 99504
PHONE (907) 3;~7-6179 * FAX (907) 358-3246
ISOIk LOG - PERCOLATION TEST[
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE PERFORMED:
FILL
SOUTH PARK SUBDIVISION #2: LOT 59, BLOCK 5
TORBEN PEDERSEN
8/9/00 &: DEEPENED ON 9/7/00
I TEST HOLE #11
ORGANICS
ML
GM/SM
SOIL CLASSIFICATIONS
GW ~ ORG
GP ML
GH CL
GC OL
__ SW MH
SP CH
SM OH
SC
DEPTH TO DATE
SROUNDWATER
DRY 9/7/00
DRY 9/14/20~
SITE PLAN
=' O0
DATE READING CLOCK NET TIME WATER LEVEL NET DROP
TIHE (MINUTES) READING (INCHES)
8/11/_2_000 - PERC. HOLE PRESOAKED FOR 4 HOURS PRIOR TO TESTING.
1 4-:10 6"
2 4:40 .30 MIN. 4 1/2" 1 1/2"
3 4:41 6"
4 5:11 30 MIN. 4 1/4" 1 5/4"
5 5:12 6"
6 5:42 30 MIN. 4 1/4" 1 3/4"
TEST RUN BETWEEN..,~ I
COMMENTS: THE TEST HOLE WAS ORIGINALLY DUG ON 8/9/op, f¢
PERFORMED BY ALASKA WATER& WASTEWATER l, ,
THIS WAS PER):-ORb~D IN ACCORDANCE WITH ALL STATE/~Ai',J,b
DATE: ~'l /c~ilOO
PERCOLATION RATE 17 (MIN./INCH) PERC. HOLE DIA. 6" (INCHES)
T. AND~/ 8.0 FT.
lE WAS DRY ON 8/9/00, 8/17/00
r',-' (. ] , CERTIFY THAT
UNICIF'A~ GUIDELINES IN EFFECT ON THIS
ALASIG WATER & WASTEWATER
August 14, 2000
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 9951%6650
Ref: Proposed Septic System Design for Lot 39, Block 3; Southpark Subdivision #2
To whom it may concern:
The existing 4 bedroom house is served by city water and a private septic system. The existing
septic system consists of a 1250 gallon septic tank and a bed type drainfield. The existing
drainfield is in a state of failure and needs to be upgraded. A test hole was excavated to the east
of the existing septic system where the proposed septic system upgrade will be located. We are
proposing that a new 1250 gallon septic tank and a dual deep trench type drainfield be installed.
Comments regarding the proposed design are summarized as follows:
1. SOILS: Attached is a soil log which shows the soil profile, groundwater monitoring, and the
percolation test results. Below the fill and organics is a ML material to a depth of 4.0 feet and
then transitions to a GM/SM material to 16.5 feet (bottom of test hole). A percolation test was
performed between 7.5 feet and 8.0 feet and found the rate to be 17 minute/inch. No groundwater
was encountered during the excavation of the test hole.
2. TRENCH DESIGN:
a. Pemolation Rate: 17 minute/inch
b. Allowable Application Rate: 0.6 gallon/day/fi2
c. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 1000 ft2
f. Maximum depth: 10.5 feet
g. Effective Depth: 5 feet
h. Width: 2.5 feet
i. Length: 100 feet total length (2 ~ 5~0 feet long each)
k. Effective absorption area = 1000 ft2
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907)337-6179 * Fax: (907)338-3246 * Website: akwwc.com
~. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: As can be seen on the topographical drawing, the a proposed trench is to
be installed on a section of the lot that is relatively flat; in short, there are no slope concerns.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance. /~
Sincere~~V~_.
NOTE: Attached is a site plan drawing, a design drawing, one soils log, a topographical
drawing, and a 71~age construction specification letter which are all part of the design package
for this septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907)337-6179 * Fax: (907)338-3246 * Website: akwwc.com
A1.ASIC4_ WATER & ~VASTEWATER J.W.M./J.L.M. ~..~
..... .......... :: CONSULTANTS, INC 1"
~.~ .. ~t~.~ ....... /..;....~
TORBEN PEDERSEN (907) 545-6498 1 OF
SITE P~N FOR SEPTIC SYSTEM UPGRADE
~-' ~' . ,¢ /'~ NOTE: THE CONTRACTOR SHALL HAVE THE
.../-- . ~.~,-- ~-- x, ~ST/NORTH~ST PROPER~ LINE F~GGED
~ ~ ~ / ~ ~ BY A REGISTERED ~ND SURV~OR PRIOR
~ INSTALL DBL CO
~ ~ / / IS NOT KNOWN.
/ /2ooo
TORBEN PETERSON (907) 345-6498 2 OF 2
DESIGN FOR SEPTIC SYSTEM UPGRADE
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
6901 DEBARR RO~, SU~ 2B * mCHO~OE, AK. 99504
PHONE (907)337-6179 * F~ (907)338-3246 :~-- ,,...~
~ SOIL LOG - PERCOLATION TEST I ,'~"
LEGAL DESCRIPTION: SOUTH PARK SUBDIVISION ~2; LOT 39, BLOCK 3 .......
PERFORMED FOR: TORBEN PEDERSEN
I ] "'
F,LL TEST HOLE ~1
~EPTH ~
feet)
i~' ;.;~,:;~ >,:.; GpGW ~ MLORG
ML ~ GM CL
GC OL
~ ~ .~ SW HH
~ SP CH
SM OH
SC
DEPTH TO DATE
GROUNDWATE~
DRY 8/9/2000
DRY 8/11/2000 SITE PLAN
~o OM/S~ -- ~ I = O0
11 DATE READING CLOCK NET TIHE WATER LEVEL NET DROP
TIHE (HINUTES) READING (INCHES)
12 8/11/200) - PERC. HOLE PRESOAKE_~ FOR ~ HOURS PRIOR TO TESTINO.
13 _ 1 4:10
2 4:40 ~ 30 MIN. 4 1/2" 1 1/2"
4 5:11 30 MIN.
15 --' 5~ 5:12 '- _ 6"
16 __ 6 5:42 30 MIN.
17
18
19 PERCOLATION RATE 17 (HIN./INCH) PERC. HOLE DIA. 6" (INCHES)
20
TEST RUN BETWEEN 7.5 FT.~ FT.
PERFORMED BY A~SKA WATER & WASTEWATER I, . ~ ~ , CERTI~ THAT
THIS WAS PERF~R~D IN ACCORDANCE WITH ALL S ICIPAL~)ELINES IN EFFECT ON THIS
DEPTH TO DATE
GROUNDWATE~
DRY 8/9/2000
DRY 8/11/2000
$OUTHpARK SOUTHPARK S D
LOT 29, BLO LOT 31, BLOC
lOSE" (907) ;45- 649~8 ,
MUNICIPALITY OF ANCHORAGE
DEPART~IENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 / Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
~IAI LING ADDRESS
LEGAL DESCRIPTION
LOCATION
Manufacturer ~ ¢~e11¢
~ ~ IL,, i~%~, gallons IF HOME,DE. Inside length. W dth
DISTANCE TO: ~ Well Dwelling
Manufacturer Material
Well
DISTANCE TO:
No. of lines Length of each llne
Top of tile to finish grade
Length ~,,~,~ ~- Width
Type of crib
Well
DISTANCE TO:
DISTANCE TO:
Foundation
Totallength oflines
Material beneath tile
Crib depth
Building leu dation
Driller
Nearest lot line
Trench wldtb
inches
inches
NO. OF BEDROOMS
¢
PERMIT NO.
No. of compartments
Liquid d e p t._h
Liquid capacify in gallons
PERMIT NO.
Distance between lines
Total effective absorption area
PERMIT
Total effective absorption area
Nearest lot line /~)/'1"'
Distance to lot line
foundation Sewer Kine Septic tank
OTHER
PIPE MATERIALS
SOl L T EST RATING
INSTALLER
c. cJ-t eJ4 L x'
REMARKS
Absorpt on area(s)
APPROVEEY/ /
I2-013 (Rev. 3/78)
DATE
LEGAL
~cI ~ ~
f"lLfN I E: l PaL I T'¢ r_'lF [;iI'.,IE:FtO[;:FIGE
DL.-_:PFIRTf,iENT Eft= NEaLTH aND ENVIF[:ONHENTFIL PROTEE:TtEd'-,I
,=,,=.... I ..... T[;.E,_T. aNBHL-IRHGE., ale
264.-,4720
PE[;:Id I T NO:
DaTE iSSUED
aPPLI C. aNT:
aDDRESS:
C:ONTFICT F'HONE:
SC:HR!ECK CO BUILL".',ERS
SRR E:O:d 4029Q
aNCHORHGE., aK 5~9507
Z...':45- 54:L 5
L.EGRL DESCRIP: SLIBF.:,i',,,'ISION: SOUTH F'HRK' 02 LOT: 3:9
SECTION: 3: TOI4i'.,IIE;HZF'.: :2i.N RANGE: =.::1.4
L..OT SIZE: ~:5:S7'9 (SL:.!. FT. OR HE:RES)
Hal:-;', BEDROOHS: 4.
BLFI F:}::':
LISTED E:ELOF.I FIRE TNE uF FILdt: H cHILhI'.LE TO "r'f:IU I?'4 [.E=It~i',!J.I'4U ~'1-11 [;' _,EFTtu
::, 'r =, FEI' I. L. Hi_.i U::, E
THE L, I!'LIf,I IHItl E,E_,F
.............................. "' .....
DEPTH TO PIPE BOTTON ,!:FT.
'GRa',,,'EL DEPTH (F'T. > L=:. O
TOTAL DEPTH (Fl", .':,
GRR',,,'EL HI[:,TH CrT. ) 2. 5
GRaVEl_ LENGTH (FT.) 102.
GRab'EL ',,,'OL. LIME (CU.
THNK SIZE (GALS)
SOil.. RFITtNG .(%0. F'T. ,."BR) 4-07
4.0 4.0
¢~ o~.~¢~, .~ -~: 5
EL 5 / 7. 5
-]:1. ~ ' 5. 0
E.~ ,:~ ~ ~--
.... ._. ~ ~ ~ ~. b. 0
3:t2 ~ 407
:+::i..: DEPTH TO PIPE BOTTOH .::." g:. 5 FT. REL.-!LIIRES INSULRTION
:+:m DEPTH 'TO PIPE BOTTOH .::] 4.. 0 F'T. HaY REQUIRE a LIFT STATION
:+:m G[;'.BVEL LEIqGTH .'::. 75 FI'. REQUIRES HLILTIPLE: RUNS (NOT EXCEEDING 75 FT. EACH::,
m:+: TaNK i',IUST HB',,,'E HT LEHST THO COHPRRTHENTC;
I CERTIF'.r' THAT:
1. I HH FaMIL..IBR. FIITFi THE REQUtREi'qEiqTS FO[;: ON-SITE SEWERS aND HELLL=; as BE]'
FORTH B'T' THE HUi'.,IICIPaLIT'T' OF aNCHORaGE (MOa> FIN[:, I'HE STFfYE OF BLBSKFI.
2. Z NiLL INSTALL THE S"r'STEH II",l RCCORE:,FtNCE FILTH all. HOB CODES FINE:,' REGULATIONS;,
aND IN COHF'L. IRNCE 14iTN THE DESIGN CRITERIH OF' THIS PERHIT.
3. I HILL HDNERE 'TO all HOH aND STATE OF alaSKa REg!UIREHENTS FOR THE SET BaCK
DISTANCES FROf,1 HN? E',=:ISTING FIELL., 1.4HZ;TEI.qBTER DISPOZ;BL $'¢STEN OR PUBLIC
SEHERBGE 'S,Y:=-;TEH GN TI-lIS OR aNY BDJHCE:NT GR NEARBY LOT.
4. I UNDE[;'.STaND THaT THIS PERHIT I':; ',,,'FIL. ID FOR H HFf,4If,IUN OF 4 BEDF.:OOHS aND
aN'¢ ENLFIRGEHENT LqILL REg!UIRE aN FI[:,DITIONFIL PERHIT.
IF a
TFIEN
WILL
ELECTRICAL NORI<: MUST BE DONE B'T' a LICENSED ELECTRtCIFIN.
,: -., c: ~'~ ' / "- DFtTE
_,I _~l ~F~. .~. ~ .........
....... ~:NF'F~. CO BU i L_: E..:'=
I'tFPL I ..HIll : ~~
E, T [:,aTE
LIFT _,THTI_N I.:, IN..TiLL. E[ IN FIN FIREa CO',,,'ERED E,T HI:IFI EI_ItL[..tNLi I_.uEE ....
· H=,-E,U I LT_,
(:J.::' HN EI_EE:TF:IE:HL. F'ERNIT HND IN:,FE...T]LN NI_I.:,T BE EIBTHINED.~ (2) -'- ' ':
NOT -,E FIF'F'RO',,,'ED FIITHOIJT RN ELEETRZCRL IfI_FEC. TIuII REFuRT., aND ,::2:> THE
" !UNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND £NVIRONr~ENTAL PROTECTION'
825 L. Street, Anchorage, Alaska 99501 264.4720
PERCO L,t, 71ON
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
,8
g
10
~-~-1 ~
12-
13-
14-
15-
16
COMMENT.$ ·
.-.
PERFORMED BY:
.
~ SITE PLAN
SLOPE
W^ GRO NOWATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
.~t,1
5-/0%
Gross Net Depth to Net
Reading Date Time Time Water Drop
I 4- I /~'~ Z~o . ~o . ~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 A~chorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-7904
020-052-36
Parcel I.D.
1. GENERAL INFORMATION
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Expiration Date: '"~'-
Complete legal description SOUTHPARK ~2 SUBDIVISION; LOT 39, BLOCK ,3
Location (site address ordiractions) 4810 SOLrTHPARK BLUFF DRIVE * ANCHORAGE, AK
Current Property owner(s) KlM &: CAROLYN CASEY Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
Day phone
BARBARA RAMSEYw/ DYNAMIC PROPERTIES Day phone
3111 'C' STREET · ANCHORAGE, AK 99503
261-7553
Unle$$otherwise ~queste~ HAAw~beheldbyDSD ~rp~kup.
2. NUMBER OFBEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well B
Individual Water Storage
Community Class Well ~E]
Public Water System
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
Apcroval (HAP,) 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 Authonty
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 samples. (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.
Note:Alaska Water and Wastewater Consultants, Inc. shall be paid $ ~Z,~'~- at, or pdor I
to closing for the engineering services provided.
I
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the vafidation 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 atructure indicated hemin. I further vedfy that based on the
information obtained from the Municipality of Anchorege 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 ALASKA WATER &: W,~"i'EWATER CONSULTANTS, INC. Phone
Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
337-6179
Engineer's Comments:
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results descfibed the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate dudng the year, and the water usage of the family being served by the system.
These conditions ara outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
thera are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authortzed, nor will it confer any legal fight whatsoever.
5. DSD SIGNATURE
[~. Approved for ¢ bedrooms.
Disapproved.
Conditional approval for __
Attachments:
HAA Checklist
Septic System Advisory
Well FJow Advisory
bedrooms, with the fllowing stipulations:
-..3
= ~ W~STEWATER
~ FROGRAM ;
..
Manitenance Agreements ~**9~,~j)]')) } 1 ) ~ O l'
Supplemental Engineer's Reort
Other
(Rev. 1~*,~1 )
Odginal Certificate Date: ~ ~" "'"'""-'-
Legal De$~rtption:
A. WELL DATA
Well type ;uBuc
Date completed
Total del~h
Do
Municipality of Anchorage
Development
Services Department
Building Safety Olvblon
On-S~ Water & Wastewafer Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanclu~age.ak.us
(sor~ 343-~904
HEALTH AUTHORITY APPROVAL CHECKLIST
SOUTHPARK S/D ~2; LOT 39, BLOCK
If A, B, or C provide PWSID~
Sanltmy eeal (Y/N)
Cased to fl.
FROM WELL LOG
g.p.m.
Date of test
Static water level
~W,,fl p,,~uction
WATER SAMPLE RESULTS:
Cofiform colonies/100 mt.
Arsenln' ;.,§./L.
SEPTIC/HOLDING TANK OATA
Tank Type/Material STEEL
Nitrate mgJL.
Date of sample:
Parcel ID:. 020-052-36
Well Log (Y/N)
WL,~o psupedy protected (Y/N)
Casing height (above ground)
AT INSPECTION
Other bacted-
in.
Tanksize 1250 gal. Number of Compartments 2
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Data of pumping 12/10/2001 Pumper
ABSORPTION FIELD DATA pBE~)W flNAC ~
Date installed 10/7-10/2000 Soil rating ~ fl~edrm) 0.6
Length 6,1 It. Width 2.5 fl.
Totaldepth t3.e-t3.eIt. Eft. absorption area 1058 fi2 Monitodngtube YES
Date of adequacy test NEW Results (Pass/Fall) -
Fluid depth in absorpfion field before test - in. Water added - gal.
Elapsed 'T'm~e: - min. Final fiuid depth - in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
3cI~,/~=/100 mi.
Date installed 10/7/2000
Cleanouta (Y/N) YES
High water alarm (Y/N) N/A
System type TRENCH
Gravel below pipe 8.4 It.
Depression over field NO
For 4 bedrooms
New depth - in.
- g.p.d.
- If yes, give date -
D. UFT STATION
Date installed
"Pump on" level at in. ,
Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
.~"~,~r/°=puc sewice line
Size In gallons
"Pump off" I.vel at ,
Cycles tested
Manbole/Ace~-_ (Y/ti)
High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots
On adla~,~t I~L~
Public sewer manhole/deanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5% Property line 5% Absorption field
Water main 10% Water service line 10'+ Surface water
Wells on adjacent lots 200'+
5'+
100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Water service line 10'+
CuFgain drain NONE KNOWN
Building foundation 10'+
Surface water 100'+
Wells on adjacent iota 200%
Water main 10%
Driveway, parldng/vehicte storage. 10%
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections end
review of Municipal records that the above ~ystema are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name
Date '"l/l~'/°~''
JEFFREY A. GARNESS
Waiver Fee $
Date of Payment
Receipt Number
907o251-7555
p.l
PLOT PLAN ASI~UILT ii ~" d~CAL~ I''~* GRID ~?,G Proleot Ho. ~.~4 ~
Lang ~ Assoolales, Inc~ 1~oo D,~ A~.nu,. ~,oho~.. a~,.~ *~Sl~
(gO7) 522-8476 Phon~ ~
Reglsfered ~nd Su~eyo~ (~o7) 522-462~ Fox
~b~ p~.
Parcel i.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Sita Services Section
P.O. Box 196650 Anchorage, Alaska 99519q~650
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
020-052-56
1. GENERAL INFORMATION
Complete legal description SOUTHPARK SUBDIVISION ¢2: LOT 59. BLOCK
Location (site address or directions) 4810 SOUTHPARK DRIVE ANCHORAGE. AK 99516
Property owner TORBEN PEDERSON
Mailing address 4810 SOUTHPARK DRIVE
Lending agency
Mailing address
ANCHORAGE. AK
Day phone
99516
Day phone
(907~ 345-6498
Agent SUSAN PEACOCK w./ DYNAMIC PROPERTIES Dayphone
Address 3111 "c" STREET. ANCHORAGE. AK 99505
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3, TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
(907~ 261-7566
4
XXX
If community weft system, provide wdtten 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
NOTE:
XXX
If community wastewater system, provide written confirmation from State ADEC
lng to the legafity and status of system.
72-025 (Rev. 1/91) Front MOA ¢Y21 Computer Version
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,157.50 at,
or prior to, closing for the engineering services provided.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I 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 ¢/hd State codes, ordinances, and regulations in effect
on the date of this inspection. . . /!
NameofFirm ALASKAWATF.-JR"'&~I ~TE~T~ROONSULTANTS, INC. Phor~e (907)337-6179
Address 6901 DEBARR R~AD, S/¢~r/~.,~'.r2~/I~&ORAGE' ALASKA 99504
Engineer's Signature ~J~~ Date
,, conducting this evaluation, AWWC, ,nc. t~/m~ td ,o p~de a thorough, conscientious engineering analysl is of the
system in accordance vvith ADEC and MO/A ~)HHj Guidelines&Regulations. The reported results described the
performance of the system under the corfditfons ~ ~countered at the time of the test, and separation distances
measured to readily identifiable features. The operational life of all wells and septic systems depend !
on the local soils condition, ground water levels that may fluctuate during the year, and the water
usage ofthefamilybeingservedbythesystem. These conditionsareoutsidethecontrolof~l~Z[j~f~c?~h~..
'" ' ':
'A. 0~, ss."
bedrooms ......... ¢~"~
the evaluator of the system. Satisfactory test results do not guarantee future performance
of the system, nor do they guarantee that there are no hidden defects or encroachments.
AWWC, Inc. can therefore not pro~4de any warranty for future estimate of how long the
system will continue to meet the operational requirements of the ADEC or MOA DHHS,
The content of this report is for the sole benefit of the owner listed above. Any
reliance upon or use of this report by any other person or party is not authorized,
nor will it confer any legal right whatsoever.
6. DHHS SIGNATURE
~ Approved for LtL
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 cedain 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 engineeds work.
72-025 (Rev. 1/91) Back MOA #21 Computer Vemion
OOT 2 4 2000
Municipality of Anchorage ~
DEPARTMENT OF HEALTH & HUMAN $~j~l~l~ 0F ANCHOP~G~I~
, , Environmental Services Division ENVIRONMENTAL SERVICES DIVI~I',~
825 L Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 ~
Health Authority Approval Checklist
Legal Description: SOUTHPARK #2; LOT 39, BLOCK 3 Parcel I.D.:
020-052-36
A. WELL DATA
Well Type PUBLIC If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) ~
Total depth ~ Casing height (above ground)
Wires propedy protected (Y/N)
Date of test
Static water level
FROM WELL LOG
Well production / ~
WATER SAMPLE RESULTS:
Coliform Nitrate
g.p.m.
AT INSPECTION
g.p.m.
.~-~Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 10/7/2000 Tank size
FOundation cleanout (Y/N) YES
1250 NumberofCompartments 2 Cleanouts (Y/N)
Depression (Y/N) NO High water alarm (y/N) N/A
YES
Date of Pumping NEW Pumper -
C. ABSORPTION FIELD DATA L*BEEOW FINAL,:GRADEJ
Date installed '10/7/00-10/10/00 Soil rating (g.p.d./ft2 or ff2/bdrm) System type TRENCH
Length 65' Width 2.5' 8.4 Total depth 13.6' - 13.9'
0.6
Gravel thickness below pipe
Effective absorption area 1058 SQ FI' Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO
Date of adequacy test NEW Results (Pass/Fail) For ..---------'"'B'~edrooms
Fluid depth in absorption field before test (in,)~dded (in.): __
72~)26 (Rev. 3/g6)* Computer Version
I
D. LIFT STATION ~
Date installed Size
Manhole/Access (Y/N) ~at* "Pump off' level at*~
High wa~ .*Datum
....Cyc, les'~ st e d
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
On adjacent lots
Public sewer main Public sewer manhole/cleanout
S~ Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5' + Property line 5' +
Water main/service line 10'+ Surface wateddrainage 100'+
Absorption field
.WeIIs on adjacent lots
5'+
200'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line 10'
Surface water
Curtain drain
c "rtF f
/ certify that I ~ave d~t~
of Municipa/ (ecords Jth~
with MOA H~A guidfli~
Signature
Engineer's Name~
Date
Building foundation
10'+ Water maln/service line 10'+
100'+
Driveway, parking/vehicle storage area
NONE KNOWN Wells on adj~
I
d inspections end review
~aterns are in conformance
t~is date.
JEFFREY A. GAEN£SS
HAA Fee $ ~,~ ' '~----/~
Date of Payment//zd~/~
Receipt Number ~'~ / '~"~
72-026 (Rev, 3/96)* Computer Veto[on
Waiver Fee $
Date of Payment
Receipt Number
C)
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONb~NTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
Legal Description (include lot, block, subdivision, section, township, range)
(a)
Location (address or directions)
(b)
Applicants Name /3~.~A' ~A;~R~-r'-r'- Telephone - Home~'-5'¥z{3~siness
Applicants ' Address
(c) Applicant is (check 'one) Lending Institution ~---[ ; Owner/builder~---~;
Buyer ?-~ ; Other~-~ <explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the NAA to the following address:
2. Type of Residehce
ngle-Family~
N~umber of Bedrooms
3. Water Supply-
Multi-Family ~ ' Other (describe)
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~ Public~--~ Community~ Holding Tank~--~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
5. ~gineering Firm Providing Inspections~ Tests~ File Search, Data and Information
As certified by my seal affixed hereto and as of the validation date showa 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 M~nicipality of Anchorage files and from my
investigation and inspection, the on-site w~ter supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm ~
Date ~/~
(ENGINEER SEAL)
DHEP Approval ~Z~) I~ / ~
- ~ / ems B ~
Approved ~ D~sappro~ed ~ Cond~t~c
Terms of Conditional Approual
Telephone
J',lo. 2251-E "~
CAUTION
THE bf0NICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 ~ND STATE REQUIRE-
MENTS, EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. T}~ MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
ae
~I.~llClPALITY OF ANCHO~AOE
DEPT. OF HEALTH &
I=NVIRONMENTAL PROTECT/ON
MUNICIPALITY OF /%NCHOR&GE (MOA)
HEALTH A[]T6ORITY APPROVAL (HAA)
CHECKLIST-- FEBRUARY 1984
,OCT 5 1984
Well Classification o~d
Well .Log P~esent (Y/N) /%JfV~
Total Depth /~)/~ Cased to
. RECEIVED
Legal Description:'
If A,.B~ ~ C, D.E.C. ~ove~)
~te ~,~leted' ~/~ Yield
~ /~ ~9hh of ~outing
Static Water Level ~W/~% Pump Set At
Electrical Wiring in Conduit (Y/N)
/
Separation Distances ~c~ W~ell:
To Septic/}{olding Tank c;n Lot
To Near. st Edge of Absoz~ption Field on L~{
Sanitary Seal on Casing
Depression A~ound Wellhead
To Nearest Public Se~r Line
Cleancut/Manhole ~j/!/~ To Nearest Sewer Service Line on Lot
Water Sample Collected By A~/~ ; Date
Water Sample Test Results
; On Adjoining Lbts ~t~
%0~ ; O~ Adjoining Lots
To Nearest Public Sewer
SEPTIC/~OLDING TANK DATA '
Date Installed ~/%~/6% Size ~_ ~- CJ
Standpipes ~N) ' ~ Air-tight C~ps ~N)
No. of Cc~t~0a~tments ~--
Foundation Cleanout (~_~')
Depression over Tank ~N) Date Last Pu~ped.
Pumping/MaintenanCe Cont~zact Oh' File (Y/N).4~//% ; f6r
Holding Tank High-Wate~ Alarm (Y/N) ~3/1~ Tempo]~a~y Holding Tank Permit (Y/N)
Separation DistanCes f~cm Septic/Holding Tank:
To Water-Supply Well pu~3 [ 7c ~-~4%~/8 To Building Foundation 1 I, ~ ~
To P~operty Line ~6 / To Disposal Field ~.!
TO Wate~ Main/Service LlneT~F ~ ~ TO Stream, Pond, Lake, c~ Major D~ainage
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~./~ ~/c/~
Width of Field ~ ~
Square Feet of Absorption A~ea
Depression over Field (Y~
Resul{s of Last Adequacy Test
Type of System Design
Length of Field ~ J
Depth of Field ~ '
Gravel Bed Thickness _ ~ '~
~?. ~' Standpipes l~esent ~f~N)
Date of Last Adequacy Test ,~/;9
Separation Distance f=om Absorption Field: ~ !
To ~ater-Supply Well ?om~;c cunw~/¢ To'P~operty Line ~_
To Building Foundation ~ ~ ~ ' To Existing or Abandoned System cn
Lot ~ )/F~ ' ; On Adjoining Lots >2~O ~
To Water Main/Service Line~$ TO '~ To Cutbank(if pEesent) ,43/~4
To St~eam/Pond/Lake/oE Major Drainage Course /~/~
To Driveway, Parking A~ea, or Vehicle StCEage AEea
Cc~nts
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water AlaEm Level at
Tested for
Electrical Codes(Y/N)
COnTents
~ Manholes (Y/N)
~N~. "~/~'/Of f" Level at .
~_~ ~ Vent (Y/N)
Meets MOA
KB1/d5/s
** Check Permitted Bed~ocm Rating Against HAA ~equest
certify that I have checked, verified, o~ ~onfc~m~d to all MOA HAA Guidelines in effect
on the date of this inspection.
MOA No.
[Page 2 of 2]
2-15~84