HomeMy WebLinkAboutSOUTHPARK #1 BLK 3 LT 11Inspection Report_9-1-12.doc
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP181119
PID Number: 020-491-37
Dwelling: ❑N Single Family (SF)
❑ Duplex (D)
❑ Multiple (SF and/or D) Project: ❑ New ■❑ Upgrade
Name:
Taylor 2018 Family Trust
ABSORPTION FIELD
❑ Deep Trench El Shallow Trench F-1 Bed [J Mound
Address
4440 Southpark Bluff Drive
❑ 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 #1
3 11
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
FtZI
Ft.
Well
200+
N/A
N/A
N/A
200+
TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
11250 Gal.
Surface water
100+
N/A
N/A
N/A
Material
Steel
Number of compartments
2
Lot Line
31.6
N/A
N/A
N/A
NA
Foundation
17.7
N/A
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
50+
N/A
N/A
N/A
RemarksTank replace only
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank to
drainfield 3034
Installer
A+ Home Services
Drainfield CO/MT
Inspector PES
BENCH MARK (Assumed elevation) 100 ft
Inspdecct sn 15' 6/11 /18
6/14/18
Location and description
3rd 6/18/18
2nd
4'h
Concrete Slab
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval:
Date
OF :4tgSik
Steven �R. �Pannorie
019 oi
Approved ilk
r
Date 6/2 1/19
Inspection Report_9-1-12.doc
10
o
•� w
\ COMMUNITY WATER <v� >_
SYSTEM NO WELLS
ON SURROUNDING LOTS �P
HOUSE
(E)
DECOMMISSIONED 1250g SEPTIC TANK PER CODE
INSTALLED NEW 12508 SEPTIC TANK DECK
WITH DOUBLE CLEAN OUT
3
A B
T1 21.2
43.4
T2 20.1
38.9
DCO 20.7
36.6
SOUTHpARK BLUFF DRIVE
n
3
r
LOT 11 >,\
ON
DRAIN FIELD (E) /
ABBREVIATIONS
TH TEST HOLE
(P) PROPOSED
(E) EXISTING
_97.8—
7$DCO
DCODOUBLE CLEAN OUT
CO CLEAN OUT NO.
MT MONITOR TUBE NO.
TYP TYPICAL
DESIGN PARAMETERS
91.3' NEW 1250g 91.1
UPGRADE SEPTIC SYSTEM
SEPTIC TANK
NO. BEDROOM: 4 (600 gpd)
TANK SIZE: 1,250g
USED:
1250g SEPTIC TANK
NOTES:1���
PANNONE ENG SVC, LLC
of A\�
Date
6/18/2018
RECORD DRAWING
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
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TH— — ........
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Scale
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P.LD\NO
SOUTHPARK #1, BLOCK 3, LOT 11
2018 FAMILY TRUST
4440 SOUTHPARK BLUFF DRIVE
...... .. .•,.•
r R. Pannone
StevenTAYLER
r �� CE 8149��/
� � •
t��1F�F�PROFESSIONP���
020-491-37-
PERMIT NO.
OSP181119
Sheet
PLAN
ANCHORAGE, AK 99516
_
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2 OF 2
�L/ry MUNICIPALITY OF ANCHORAGE .ri,ent ,
' On-Site Water&Wastewater Program N0 5(4,
` ,aRr� PO Box 196650 4700 Elmore Road `�' �f
( • 1r( Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
.t "� http://www.muni.org/onsite
t
)
I) hartment
On-Site Wastewater Disposal System Permit 6/i /fig
Permit Number: OSP181119 Effective Date: 6/5/2018
Work Type: SepticTank Upgrade Expiration Date: 6/5/2019
Tax Code Number: 02049137000
Site Legal Address: SOUTHPARK#1 BLK 3 LT 11 G:3236
Site Mailing Address: 4440 SOUTHPARK BLUFF DR, Anchorage
Owner: TAYLOR 2018 FAMILY TRUST Lot Size in Sq Ft: 30009
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
•
Received B 1/11� tt 1- Date:
Issued By: ",CC 4CojiI " Date: 116
MUNICIPALITY OF ANCHORAGE X56 7 8 9 1077
'') g r
Community Development Department ` Phone: 9 I. 34 1984 8 3
Development Services Division Fax: 9t tc43-79
On-Site Water & Wastewater Program c
ON-SITE SEWER/WELL PERMIT APPLICATION 01 6 8
Parcel I.D. 020-491-37
Property owner(s) Taylor 2018 Family Trust Day phone
Mailing address 4440 Southpark Bluff Drive, Anchorage, AK 99516
Site address 4440 Southpark Bluff Drive
Legal description (Sub'd., Block & Lot) Southpark #1, Block 3, Lot 11
Legal description (Township, Range & Section)
Lot Size 30,009 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑ Initial ❑ Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑X Upgrade ❑X Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
4110 •
(Signature of property owner or authorized agent)
Permit/Rush Fees: 126 Waiver Fees:
Date of Payment: ORS Date of Payment:
Receipt Number: i(13tie66 Receipt Number:
Permit No. OSP 1811(9 Waiver No.
Permit App_:-:• ::..,c
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail:steve(u)panengak.com
June 4, 2018
Subject: Southpark#1, Block 3, Lot 11
Tank Replace Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade 1,250g Septic Tank to replace an existing
1,250g Septic tank to be issued for this property. The existing tank will be decommissioned per code.
Currently the lot is developed. The proposed system will utilize a replacement 1,250g septic tank that will
be connected to the existing drain field. This lot and the surrounding lots are served by a community
water system. There are no wells within 200' of this tank upgrade. This tank exceeded the separation
distances required at the time of its installation. The proposed tank will be placed in the same location,
meeting or exceeding the existing separation distances. All other required separation distances will be
met.
1. Upgrade Tank Design.
A foundation clean out installed if needed.
The tank will be located: 10'+from any property line, building foundation or drain field
10'+ from any water line
100'+ from any surface water
100'+ from any surrounding private wells
200'+ from any public wells
The proposed installation will not affect the future development of the surrounding or existing lots.
If you have any questions or concerns, please contact me at 907.272.8218.
Sincerely,
...
• .*7
.... ..............
49 T ••
i •
•
••Vt.. Steven R.Pannone •
•
111,1 ;;,....
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
I
10 •
W SOUTHPARK BLUFF DRIVE
1 COMMUNITY WATER w
SYSTEM NO WELLS01ON SURROUNDING LOTS03
13
x;/,‘"/<:(
N/ 4 B R HOUSE (E)
N // //
LOT 11 ,)
•
DECOMMISSION 1250g SEPTIC TANK (E) PER CODE /
INSTALL 1250g SEPTIC TANK (P) DECK
WITH DOUBLE CLEAN OUT
NN
DRAIN FIELD (E) /
3 N ��9 /
N ��ti •T
z, (-) \ 1 2
ABBREVIATIONS
DESIGN PARAMETERS TH TEST HOLE
UPGRADE SEPTIC SYSTEM (P) PROPOSED
NO. BEDROOM: 4 (600 gpd) (E) EXISTING
TANK SIZE: 1,250g DCO DOUBLE CLEAN OUT
CO CLEAN OUT NO.
USE: MT MONITOR TUBE NO.
1250g SEPTIC TANK TYP TYPICAL
NOTES: PANNONE ENG SVC, LLC -~OF AL�kl 6/4/2018
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, A 99510 r •••.•••qS ll
PHONE (907) 272-8218 FAX (907) 272-8211 /�c��P ��,,.. t1 Scale
3*: ' ' TH /. *0, 1"_50'
jib.r 0 P.I.D. NO
SOUTHPARK #1, BLOCK 3, LOT 11 "= :20-491-37
TAYLER 2018 FAMILY TRUST d Steven R. Pannone � PERMIT NO.
4440 SOUTHPARK BLUFF DRIVE r+t���J;•,• CE 8149 0// OSP181119
PLAN ANCHORAGE, AK 99516 �AU,•0 `=1` � Sheet 1
/~l-h 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
NAME PHONE
~ UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
]Well I Absor~t~ area Dwelling PERMIT NO.
~ DISTANCE TO: ~LI ~ ~ ~0
~ ~ Manufacturer Material No, of comp¢~
~ ~ I F HOMEMADE:
Liq. ca acity in gallons Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PER~IT NO.
O z ~ Manufacturer .. Material Liquid capacity in gallons
~ ' FounOat)o~ Nearest lot line PERMI~o,
:~} DISTANCE TO: Wel~oe ['~ Trench ~Owldth
No. of line~ Length of [~h~e ,Total le~%lines. ~ ~ inches Distance between lines
Total effective absorption area
~ ~ Top of tile to finish grade ~¢ Material beneath tile~,_ ~i
Length Width ~ Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building feundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
SOl L TEST RATING
85 .- /5o
INSTAELER ~ ~
REMARKS
/
APPROVED DATE LEGAL
72-013 (Rev, 3/78)
PERMIT NO.
P1LI~I II; Ip~LIT'T' ElF Ar-tCH~,RAI]E
DEPARTMENT ~ HEALTH 8ND ENVIRONMENTAL )TECTION
825 'L STREET, ANCHORAGE, AK. 99501
264-4?20
OIl--SITE SEWER PER~d IT
828882 )
fiPPLICANT LEVINE & LEVINE BLDG IN BOX 4-566 99509
LOCRT I BN ~"-~'9~~'~-2~ , ~(5
LEGAL L:L:L B2 SOUTHPRRK ~ - LOT~_I~E'
TVPE OF SOle flBSORPTION SVSTEM IS: TRENCH
245-~521
999999 SQUARE FEET
MAXIMUM NUMBER OF BEDROOMS = 4
SOIL RATING (SQ FT/BR)= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= :tl
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DR8INFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND 8ND THE BOTTOM OF THE EXC8VATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFBLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
REL-qUIRED SEPTIC TANK SIZE= 1250 I]RLLOr~S
PERMIT APPLICANT HAS THE RESPONSIBILITV TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
T&40 (2) I ~4SPE~STII]~-tS ARE REQLilRED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL 8E SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
i00 FEET FOR 8 PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO ~ COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS 8RE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'ERI~i I T E ~-~. F" I RES [-.~ECEblE:ER __?~::L..
I CERTIFY THAT
i: I BM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS,
S I GNED: _ _~__
xRPPLIC:ANTLXLEVINE & LEVINE BLDG INCO
....
V4. 0
SOILS
· MUNICIPALITY OF ANCHORAGE
'"~'~"' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [] PERCOLATION
TEST
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: ~'~ ~ ~- ~.~:~
DATE PERFORMED:
// ,IZ~ ,'C'o !
SLOPE SITE PLAN
10
13
15
16
17
18
19
2O
COMMENTS
WAS GROUND WATER S
ENCOUNTERED? /~J0 t.
IF YES, AT WHAT
DEPTH?
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT
PERFORMED BY:
72-008 (6179)
CERTIFIED BY:
•
GL Bb
j.c.- Municipality of Anchorage ,,'
On-Site Water and Wastewater Program .j I i
(907) 343-7904 SAF E,r
Certificate of On-Site Systems Approval
y91 - 31
Parcel I.D. 020 Expiration Date: 6I I rI C�
1. GENERAL INFORMATION
Complete legal description Southpark #1 Block 3 Lot 11
Location (site address) 4440 Southpark Bluff Dr.
Current Property owner(s) Taylor 2018 Family Trust, Kenton&Cheryl Taylor Day phone
Mailing address 4440 Southpark Bluff Dr. Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class A Well 111 Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
i
APA t fn�1i .. iReceived by: A., � Date: k� � /! c>
COSA to be released to the engineer,unless otherwise requested by the engi •
COSA Fee $ 5 � La Waiver Fee $
LI
Date of Payment I/ 30)
1 S Date of Payment
Receipt Number 0 I a 55 0 Receipt Number
COSA# 05 C- 13111 $ Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined
in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
and/or wastewater disposal system is(are)in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at
the time of installation.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe 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 soil
condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
-Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 6/11/18
"xxv
OF A4kki�
*'- N 1 *r/�
6. DSD SIGNATURE ' ••
• /
System #1 Approved for LA bedrooms fiS}even R.'�annone
r'
**. CE-8149
System #2 Approved for - bedrooms f���s • ^�
Disapproved �kl�PROfESSOkl`r
Conditional approval for bedrooms, with the following stipulations:
\\A Y OF qivr�o
ON-SITE 'e,
WATER AND•
WASTEWATER oz
PROGRAM
By: l^, ( 60.' 2 1 " ig Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory _ Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet ..
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Southpark #1 Block 3 Lot 11 Parcel ID: 020-051-59
A. WELL DATA ,
Well type Community If A, B, or C provide PWSID# 213475 Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height(above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 6/11/18
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N/A .
Date of pumping 6/11/2018 Pumper New Tank
C. ABSORPTION FIELD DATA
Date installed 10/13/1982 Soil rating (g.p.d./ft2 or ft2/bdrm) 85-150 SF/BORN System type Deep Trench
Length 32 ft. Width 3 ft. Gravel below pipe 7-9 ft.
Total depth 17.5 ft. Eff. absorption area 512 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 4/24/2018 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 2 in. Water added 600 gal. New depth 23 in.
Elapsed Time: 210 min. Final fluid depth 2 in. Absorption rate >= 600+ d.
9.p.
N
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
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
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ 10+
Surface water 100+ Driveway, parking/vehicle storage
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
Survey on file. - q—&-b w/.v i ;A ,Jk –)A z
G. ENGINEER'S CERTIFICATION
... ...16- X
OF AC1<<iil
I certify that I have determined through field inspections and /�G3.- .�)� •y+f
review of Municipal records that the above systems are in F*:49 L /"1 •.*T
conformance with MOA COSA guidelines in effect on this date. % _ v. r
Steven Pannone ••••• •'j
Engineer's Printed Name S�everi 1Z.•�nnnone
6/18/18 Oi� •. CE-8149 i/
Date • ,.
COSA canawy sheet_2-6-15.doc
8155X
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CUFF CRIV_E
Lot 10
R,18
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2.00 C v`Alp
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/ �7, co! 63 '63 Lot 11 �Q
2 Story lZ
,\O / 6•7 Frame ,A,/ House eco' ut
/ \Ls , •6 a 4) c
C °6 ° 25
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Lot 3 `905, G J. \ `LO
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/ 750 /lie/),
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Lot 2 (9). \\
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RECERTIFIED 6-20-18Qvised septic system
\ RECERTIFIED 6-01-18
AS-BUILT NO CORNERS SET THIS DATE
"b..... %�` 1 I hereby certify that I have performed a Mortgagee's inspection
Alp c_ •
OF •A 1 of the following described property: LOT 11, BLOCK 3,
• • • • ;q I SOUTHPARK SUBDIVISION ADDITION No. 1
`P.• � .S,i- It
•0*:
•• 49th %\ •'*i/ Anchorage Recording Precinct,Alaska,and that the
•/ ;,,,• • • •• improvements situated thereon are within the property lines
/\.—' , and do not overlap or encroach on the property lying
-•p •� / adjacent thereto,that no improvements on the property lying
/, �, .Brett A. Wilmot ,p / adjacent thereto encroach on the premises in question and
i �' .•• 112392- LS .• Ay that there are no roadways,transmission lines or other
, <^pF•• • •• yam.. visible easements on said property except as indicated
SCALE: 1"= 40' �A�'OFESSIOHAk. .46. Dated at Anchorage,Alaska
EASEMENTS OF RECORD, OTHER THAN 1 \A`N.� this 7th day of MAY 1995.
THOSE SHOWN ON THE RECORDED /" ,\� FRED WALATKA&ASSOCIATES,L.L.C.
PLAT ARE NOT SHOWN HEREON ltJ Engineers and Surveyors
UNLESS OTHERWISE NOTED. Holt BE 907-248-1666
I ... ...-
• Municipality of Anchorage �6, '"I.'' '
On-Site Water and Wastewater Program
s
(907) 343-7904 4.11
, • of _
3 Certificate of On-Site Systems Approval <<<
020.U�1--'S9 >4.4.05.Parcel I.D. Expiration Date: c3 -
1. GENERAL INFORMATION
Complete legal description Southpark #1 Block 3 Lot 11
Location (site address) 4440 Southpark Bluff Dr.
Current Property owner(s) Taylor 2018 Family Trust, Kenton&Cheryl Taylor Day phone
Mailing address 4440 Southpark Bluff Dr. Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class A Well El Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: /. �, 14 , Date: ,r-5/61(
COSA to be released to the engineer,unless of erwise requested by--ngineer.
COSA Fee $ 5240 Waiver Fee $
Date of Payment 1 l i ' Date of Payment
Receipt Number oQA 6 Receipt Number
COSA# 350?I l Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined
in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based 9n 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.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe 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 soil
condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for'the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 4/26/2018
XXVOF Agtk
7'G k
• % •
* . . �i\ *y
6. DSD SIGNATURE '
System #1 Approved for LI bedrooms1''•Seven i .'Ionone •/
System #2 Approved for bedrooms CE-8149
Disapproved 11ioANoFESSONA
Conditional approval for bedrooms, with the following stipulations:
S ,c si-ativt 1 S 3 CI e6urc
11Vvvi" Ci-eCt c e cc. vvk is F1:2 l
ON-SITE It.
WATER AND
Pri WASTEWATER
PROGRAM
By: A Original Certificate Date:—fir
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arse 'c Advisor
Well Flow Advisory Other
COSA blue sheet r
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Southpark #1 Block 3 Lot 11 Parcel ID: 020-051-59
A. WELL DATA
Well type Community If A, B, or C provide PWSID# 213475 Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height(above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform _ colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 10/13/1982
Tank size 1250 gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N/A
Date of pumping 4/19/2018 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed 10/13/1982 Soil rating (g.p.d./ft2 or ft2/bdrm) 85-150 SF/BDRM System type Deep Trench
Length 32 ft. Width 3 ft. Gravel below pipe 7-9 ft.
Total depth 17.5 ft. Eff. absorption area 512 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 4/24/2018 Results(Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 2 in. Water added 600 gal. New depth 23 in.
Elapsed Time: 210 min. Final fluid depth 2 in. Absorption rate >= 600+ g.p.d.
N
Any rejuvenation treatment(past 12 mo.) (YIN &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access(Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
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
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
Survey on file.
G. ENGINEER'S CERTIFICATION pF A�gkk
I certify that I have determined through field inspections and /�,r�p'�P' ,.... 9'1:9;t#1
review of Municipal records that the above systems are in *; ' ! .1 i\ •,* V
conformance with MOA COSA guidelines in effect on this date. %V C•••• 0
Steven Pannone lo'��
Engineer's Printed Name .i .�1even It'.annOne• ii
Date 4/26/2018 cam`' CE-8149 .
COSA canary sheet_2-6-15.doc
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT !u ''' 907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
\� /
www.muni.org/onsite
Septic Tank Advisory
Certificate of On-Site Systems Approval # 0SC181178
Subdivision: Southpark #1 Block:3, Lot: 11
The septic tank for this property is 36 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
-, w� A ;'"
.. ♦ . 'Df. -yam S'ti° ••'
4' , ..-.4.41 ' ., :Ai
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Mailing Address: P.O. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
"' ""'`° Municipality of Anchorage
On-Site Water and Wastewater Program
6 P.O. Box 196550 4700 Elmore Road r
Anchorage,Alaska 99519-6650 Phone: (907)343-7904 Fax: (907)343-7997/ ^ n
http1/www.m u m.orglons ite •
i)ci)ar fluent
Review Comments
Engineer: PANNONE ENGINEERING SERVICES 5/3/2018
Legal Description: SOUTHPARK#1 BLK 3 LT 11
Parcel ID: 02049137000
Permit: OSC181178 WellSeptic
Report Type: COSA Completed By: T.Ecklund
The application has been reviewed and the following comments have been generated. These are to be satisfactorily
addressed prior to MOA approval:
1.The survey on file doesn't indicate any stand pipes basically not legible. Please provide a survey to scale and showing
all stand pipes
2.After doing a site visit it appears the operating level of the tank was 39 " Please address'address-Tahi.k i c /Par's l9/fl
—T1 A9� tit lC —lg S -Tr L (AA, t4
o So�T .,
.pA�K BLUFF DR\\/ -
• R� LA
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a``� ��'3) ti \-=26 0025 0 S t
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sr EXISTING
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�'� �ir)" s- LOT 11 ,,,,,,_11 ..-....
� 4`�TH �oUD
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``\� 1.aressionut '•ao
10' C.E.A EASEMENT ��••\DOoC'� .
BOOK 593. PAGE 0539,
•
AS PER 1,40.A. GRID 3236
LEGEND: SET FND
5/e'RB W/CAP Q S/8' RB 0
AS—BUILT O F: LEGAL DESCRIPTION: ORDERED 8Y CAROL_ E3 U T t^E R 3.25 ALMON. OUONUTAENT -
• '..i'741'4: ' ':
Municipality of Anchorage
Development Services Department
Building Safely DMston
On-Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(9O7) 343-7g04
020-051-59
Parcel I.D.
'1. GENERAL INFORMATION
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Expiration Date: ¢:~
Completelegaldescflpflon LOT 11, BLOCK 3, SOUTHPARK ADD ~1
Location (site address or directions) 4440 SOUTHPARK BLUFF DR.
Currant Property owner(s) MIKE COWDEN
Mailing address 4440 SOUTHPARK DR. *ANCHORAGE AK
Lending agency
Mailing address
Real Estate Agent
Mailing address
Day phone 345-3464
D~yphone
CAROL BUTLER W/REMAX PROPERTIES Day phone
REMAX PROPER~ES 2600 CORDOVA ST.
244-1800
Unless otherwise requested, HAA wi#be held by DSD forpickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual Well E] '
Individual Water Storage []
Community Class A Well
[]
Public Water System []
.TYPE OF WASTEWATER DISPOSAL:
Individual On-site ' []
Individual Holding tank
Community On-site ~E]
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Apprev~l (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for preperties served by a single family on-site wastawater disposal and/or
water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority
Approval ara 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.) Ce~ficates 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 en~rs or omissions In Ihe
professional engineer's work.
Note: Alaska Water a. nd Wastewater Consultants, lnc. $hall be paid $7OO. OO et, or pdor
to dosing for the eng;needng sen/ices provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on pmcadures outiined In the Health Au~horily Approval Guidelines for this application,
- sh~wsthatthe~n~sitewater$upp~yand/~rwastewaterdisp~sa~systemis(are)safe~funcb~ona~andadequate
for the number of bedreooms and ~Yl;~e of str~cture lndicated herein. I fud~her vedfy that based on the
information obtained from the Municipality of Anchorage files and fn~m my investigation and inspection, the
on-site water supply and/or wastewater d/sposel system is(are) in compliance with ail applicable Municipal
and State codes, ordinances, and regulations in effect at. t~e time of Installation.
Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504-
Engineer's Printed Name JEFFREY 'A. CARNESS, P.E.
Date
337-6179
Engineer's Comments:
In conduc~n~ this eveluaE~% AWWC, Inc. affempted to provide a g~°ugh,
conscientious engineering analysis of the system in ecco~ance with ADEC and MOA
DSD Guidelines & Regulations. The reportsd results desc~bed the pen~mance of the
sy~em underthe condi~ons encountered at the time of the tes~ and separation
dlstsnces msesumd to readily Identifiable features. The oparaffona/life of ali wells and
septic systems depend on the local seli$ condition, gmundwater levels that may
Jluotuate during the )'ear, end the water usage of the famliy being served by the system.
These conditions era outside the control of the eve/uater of the sysfem. Setistsctoq, test
results do not guarantee fufum parfonnance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AWWCo inc. can themtom not provide
any warranty or futura es~mate of how long the ~tem will continue to meet the
operational requirameots of the ADEC or MOA DSD. The content of this rapo~t Is for
the s~le benefit of the owner listed above. Any raliance upon or use of this raport by any
other pe~on or pady Is not authorized, nor will lt confer any legal right whatsoever.
5, DSD SIGNATURE
~ Approved for ,.~
Disapproved.
Conditional approval for __
Attachments:
HAP, Checldist
Septic System Advisory
Well Row Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
Original Certificate Date: c~ _ ~ -'~ .. O ]
Municipality of Anchorage
Development Services Department
On.Site Wat~ & Wa~ewater Program
4700 South Bragaw St.
P.O. Box I96850 Anchorage, A~ 99519-8650
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescrlption: SOUTHPARK I~1 LOT 111 BLOCK 5 ParcellD: 020-051-59
A. WELL DATA
Wellt~1~e COUUUNny IfA, B, orCpmvldePWSID~ 215475 Wall Log ~)_.~
Date completed 8anltery ~eal (Y/N) Wlms ~ (Y/N)
Date of test FROM WELL LOG~~.~I Y'~~ AT INSPECTION '.lt.
6tellc water level ~it. .It.
am colonies/lO0 nd. Nllrate mgJI. Other bacterl~ colonies/lO0 nd.
pie: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank 'l~rlal STEEL Date Installed 1 o/13/1982
Tank size 1250 gal. Number of Comparlmente 2 Cleanoute (y/N) YES
Foundation cleanout (Y/N) YES Depm_~__k::m over tank (Y/N) NO High water alami (Y/N) N
Oate of pumping 7/7/01 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA
Date Installed !o/13/a2 ~ rating (g.p.d~. 85-150 ~'~jalem type DEEP TRENCH
Lenglh 32 It. W1dlh 3 rc Gravel below pipe 7' TO 9' lt.
Totaldeplh 17.~ ft. Eff. abeorptlonama 512 It' Monltmtngtube YI~ Depresslouoverflald NO
Dateofadequacytest 9/20/01 Results(Pass/Fall). PASS Fol' 3 bedrooms
Flulddepl~inabcorplinnfleldbofomtest DRY In. Wateredded 806 gal. Newdeplh 16 In.
Eiap~edTlme: 0 mira Finaltlulddeplh ,16 In. AbsofplJon rate >B 450+ g.p.d.
~ m~-~n~uon ~nt ~ s2 mo.) (Y/N & ~) .oNE
eROSE TO 16' A~ILI~ FIRST 145 GALLONS AND REMAINED AT THAT OF THE TES~.
D. UFT ~TATiON
Date Instellsd. Size In gallons ~
"Pump on" level at In. "Pump n. High water alam~ level at In.
~ Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
6epl/c tenk/lilt station on lot N/^
AbSOrl~on field on lot N/A
Public sewer main N/A
Sewer/septic service line
On adjacent lots
On adjacent lots N/A
Public eswer manhole/desnout
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5% Abeorpl]on field 5'+
Water main 10'+ Water service llne 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundatlon 10'+
Surface water 100'+
Wells on adjacent lots. 100'+
Property line 10'+
Water sendce line 10'+
Curtain drain NONE KNOWN
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I cerf. Ey that I have determined through field inspections end
revtew of Mon/c/pa/records that the above ~y~ems ere in
conformance web MOA HAA guidelines in effect on this date.
Engineer's Printed Nam. e
Date .~0 /
JEFFREY A. GARNESS
HAAFee$ Z(:~'
Date of Payment~
Reeslpt Number,
olo~,ol
Water main. 10'+
Driveway, paddng/vehlcle storage 25'+
Waker Fee $
Date of Payment
Recelpt Number
14 Ol 04.'4E;p Butler &
p.2
Till IIIFC~IJIATIW lllllM II !~ 'Iii Iv'Il OF LEWlIIO
IIIITITUTIOIII II'ICIflC~LI, LY TO 111~1~ ANT C~IIFLICTI
IETI&III IXlITINII ITINCT~IIEI Nil) PL,ATTIO LOT. LIIIil
IX IXlINIIITI ldo II MT lO Ii LlllO FM PQIZlIGqI~IIG
~OITIOIL4L ITI~TUIKI Cll I~cILIIlll.
· I~II)dNTI OF IECOIO, OTH[I
TIIA~ THOI[ IH~al 011 THE
IIICOIPlO FL4T, 7~1 JOT .
:.
THIS OATI)
II~rtPlta'l h~xctlon et th~ fott~t~
~Krl~ ~rtyl
LOT 11~ IL~ 1~ ~[ U.
that ~l I~wcl II.Iff thtr~
itl klthln the ~rty tlMI ~ ~ Mt
~rt~ or ~r~ ~ the ~rty
IyIN ~Tie~t thereto, that ~
I~tl ~ pr~r~ tyS~
~ltt~ l~ thlt there ire ~ r~l~
Atll~ thll ~ My of
5. STATEMENT OF NSPECTION BY.-, ENGINEER~_:-~.:~ ~- . . _~ · * ~- ~ ~ -~
As codified bymy seal affixed hemtoandas:of the vahdabon date shown below, I ven~ that my
: ' investigation:of this ?ealth,Autbon~ Appro~a!-.app! ~t~on shows that onr i s ly,,:,-
and/or~Wastewatord posal ystemis~
~, fdnetlonal and adoquato Ior tho numbor of
and ~po of ~tructuro indlcatod h~rom~ Hu~hor wr'~ that ~a~d on th~ reformat'on o~tainod fr~m
' ~ tho Municipall~ o~ ~n~hora~ ~ o~ and from my inv~at[on and in~p~fio~ ~h0 onrsit~ water
~up~ y and/or wa~to~ator:d ~po~al ,~y~t~ ia in compllanc~ w~Ih al~ Municipal and 8taro
ord}nanc~, and ro~u at on~ n off~t ~n. tho dato of th~ ms,oct on.
~urchasersof flomes ,,~,~,,, ~
orofe~lonalengmeer'swork. :~ ~.~:.::~:.: ~ ~.,, :,::~..; ,: ,,:~ ,:
rs
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
A. Well Data
Well type
Log prosent
Total depth
Sanita~ seal
If~, B, or C, attach ADEC letter. ADEC water system number
/~//~ Date completed AJ~ Driller
Wires properly protected (YIN)
FROM WELL LOG AT INSPECTION
Date of test hfl/~- ~,//]'
Static water level
Well flow g.p.m, g.p.m.
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot ~_o~ '~-
Public sewer main
Sewer service line
,4 On adjacent lots /'J/,'~
; On adjacent lots /'J//,~-
Public sewer manhole/cleanout ~//~
Petroleum tank /~. ~,
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate /~)///~ Other bacteria /V/'~
Collected by: /'~/,~
B. SEPTIC/HOLDING TANK DATA
Date installed lO - I[-~%- Tank size /~,~--J~ 6h~-- Compartments ~
Cleanouts (~'/N) ~5 Foundation cleanout ~/N) ~)/.~E5 Depression (Y/~) ~f~6
High water alarm (Y/~) /'~J/~ Alarm tested (Y/N) P-~/~
Dateof pumping Z,~ ~ ~ ~ Pumper 4'~ ~r ~'[~IC~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~/~ On adjacent lots
TO properly line
Surface water/drainage
Absorption field
72-026 (3/93)* Front
Foundation I0
Water main/service line [
CONTINUED ON BACK PAGE
Size in gallons
Manufacturer
Uanho
Vent (Y/N) "Pump on" level]"at-~ ~ "Pump off" Level at
High water alarm level ,//~'"~;>~les tested
Meets MOA electriC__
SEPARATIO...~TANCE FROM LIFT STATION TO: '~ "
On adjacent lots Surface water
D, ABSORPTION FIELD DATA
Date installed io/l~/~Z Soil rating (GPD/Ft
(~ ,
Length ¢ %2.~ Width. (~ .~' Gravelthickness ~ ~'r'k, ~/' Totaldepth ~,~
Totalabsorption area ~I~S~ ~, ~ Cleanoutpresent ~) .
Date of adequacy test L// / } /E1 S-- Results (pass/fail)
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/~)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
'~,~ .~g for -~ Bedrooms
After test IA ,'.~e f¢,~
If yes, give date
Well on lot ¢/,A- On adjacent lots ¢(30'4 Properly line
To building foundation lO ',h To existing or abandoned system on lot
On adjacent lots c~ '4- Cutbank /0//~ Water main/service line /o
Surface water 106 '+ Driveway, parking/vehicle storage area I0 '4
Cudain drain
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 Name
Date
HAA Fee $. ~ ~)~ ,- r//)
Date of Payment
Receipt Number
72-026 (3/93)* BAck
Waiver Fee $
Date of Payment
Receipt Number
ROBERT C. COWAN
CE - 8801
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.
HAA #
1. GENERAL INFORMATION
Complete legal description Lot 11: Block 3; SouthDark
Subdivision
Location (site address or directions)
4440 Southpark Bluff Drive, Anchorage, Alaska
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Jeff Arnoldi
Day phone 345-7680 hm
~2~3-4523 wile's wk
Day phone
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
3 N
NOTE:
TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual well
Community well xxx
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
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
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Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
A. WELL DATA
Well type ~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date completed /b'.__~ Driller
Cased to /V,~ Casing height
Wires properly protected (Y/N)
If~'~, B, or C, attach ADEC letter. ADEC water system number
FROM WELL LOG
/
Date of test
Static water level '/
Well flow
Pump level
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
AT INSPECTION
; On adjacent lots /L//~
; On adjacent lots
g.p.n~. ~o ~ ~
~ ~ ~'>
~ ~o
Public sewer main /~//'/]-
Sewer service line ~//~
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS: ~,~ ./~'~__.
Coliform ~J/~ Nitrate
Date of sample:
~ Other bacteria
Collected by:
SEPTIC/HOLDING TANK DATA
Date installed /~/~-~2. Tank size ),,~0 ~-,~(-- Compartments
Cleanouts ((~/N) \/~ Foundation cleanout (~N) ~/~-~'
High Watei' alarm (Y/I~ ~/~ Alarm tested (Y/~.)
Date of pumping / -~L"~ .-~' 2--- Pumper ~-bZ~CC ~
SEPARATION DISTANCES FROM SEPTIC/H~"~I~'~tG TANK TO:
Well(s) on lot /V~ On adjacent lots c2'O0 ~ Foundation
To propertyline ~(~ ~f /0 '
Depression (Y/{~
Surface water/drainage
Absorption field
.Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
ION
High water alarm level ~ Cycles tested
Meets MOA electrical~ __
SEPARATIO~J~fS~TANCE FROM LIFT STATIO
~¢fot On adjacent lots Surface w~
D. ABSORPTION FIELD DATA
Date installed /0 ~/~-~ Soil rating ~::::~ ~ /~O System type
Length ¢&& Width Gravel thickness '~ ~ ~ Total depth
Total absorption area¢~ I&%F ¢~ ~'¢R=)Cleanouts present (~_yN) 0/~.E' ¢-
Depression over field (Y/~
Results (pass/fail) '~(~
Date of adequacy test
for -~
If yes, give date
bedrooms
Peroxide treatme.t (past 12 months)(Y/¢ ,/~0T /~¢0~v/.~
On adjacent lots
Surface water
Curtain drain
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~U3 On adjacent lots ~00 ~
To building foundation /--~ /
.~0 ~4 Cutbank
/Od '~ '
Property line
To existing or abandoned system on lot
Water main/service line ~ '¢~
E. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle stbrage area
I certify that I have checked, verified, or conformed to all MOA and HAA g,
S & S ENGINEERING
17034 Eagle River Loop Road No. ~g4,
Signature
Engineer's Name
Date
HAA Fee $ /
Date of Payment
Receipt Number
uidelines in effect on the date of this inspection.
.
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE, ALASKA 99515
WALTER J. HIOKEL, GOVERNOR
(907) 349-7755
December 4, 1992
Mr. Jim Williams
S & S Engineering
SUBJECT: South Park Subdivision
Class "A" Public Water System, PWSID 213475
Dear Mr. Williams:
I have completed a review of this office's files concerning the monitoring status of the
above-referenced Class "A" Public Water System and found the following:
The last satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on November 5, 1992. This does meet the provisions
of 18 AAC 80.200(a), of the State Drinking Water Regulations.
The last inorganic Chemical Contaminants Sample results were submitted
to this Department on November 15, 1991. This does meet the provisions
of 18 AAC 80.200(a), of the State Drinking Water Regulations.
The last Radioactive Contaminants Sample results were submitted to the
Department on September 11, 1992. This does meet the provisions of 18
AAC 80.200(a), State Drinking Water Regulations.
The last Organic Chemical Contaminants/Volatile Organic Chemical were
submitted to this Department on November 6, 1991. This does meet the
provisions of 18 AAC 80.200(a), State Drinking Water Regulations.
Issuance of this letter does not imply that the above-referenced Class "A" Public Water
System is in compliance with other provisions of the State Drinking Regulations.
If you have any questions on the above information, please do not hesitate to contaot this
office at 349-7755.
Sincerely,
Michael Lu
Environmental Eng. Asst. II
APPLl'""-'~lT FiLLS OUT' UPPER HA. ')ONLY
Property Owner ~//>t~' ~r~i]~ J-~[~' · Phone
Address ~:¢.~3'~ ~C0~ 0:~[(}~ Zip Code
Lending Institution/.~
Realty Co. & Agent ~N~i~ ~(;~T¢ ~'0)~ ~ ~tC Phono
Street Locati~
~Multlple Family No. of Bedroo~
~ Other
Water Supply
~ Community For wells ddlled prior to that date, give well depth (attach log if available).
~ Holding Tank
NOTE: THE I~SPECTIO~ FEE MOST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Insp~;lor Inspector Inspector
Field Notes: (~,~ ~ ~. O' S- ~ ~ MUNICIPALITY OF ANCHORAGE
~ ~L- '~)~ ~ DEPT. OF HEALTH &
ENVI~ONM~NTAL pROTECTION
RECEIVED
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE ~ ~ ~ J
~. [~O' (O'-~ %- ~ WelltoTank Septic T~k Size
72-023(31~)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN ~ERVICES
DIVISION OF ENVIRONMENTAL SERVICES
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(al Legal Descri~ption (include lot, block, subdivision, section, towgship, range)
(b)
Location (address or directions)
Property Owner i~ ~
Malting Address
Telephone: Home
Business
!
(c) Lending institution ~'"~,PJ, A~ L.~.~ Telephone
Mailing Address
(d) Real Estate Company and Agent ~. ~ ~ ~' ~'j ~
(el
Address ,,~'0 "~
Telephone ~t-7 (, -I
Mail the NAA to the followina address: or: Check here ~, if hold for pick up.
List contact person and day phone number be~w~
TYPE OF RESIDENCE
Single-Family'~
Number of Bedrooms~
WATER SUPPLY
Well [] Community J~ Public []
Individual
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite'~ Public [] Community [] Holding Tank []
Note: If'community well system, must have written confirmation from the State
attesting to the legality and status.
Department of Environmental Conservation
Page 1 of 2 72-025 {Rev 81861 Front
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION *
As cedified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Healtl~
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequat~
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 inspect°on, the on-site water supply and/or
wastewater disposal system is in compliance with ali Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Address --;~ 7 /,~ '/'-%- ~
Date ~ ~7 1~
Engineer's Seal
DHHS APPROVAL
Approved for ~"~-'~-Q~)~,,")bedrooms by
Approved /~ Disapproved
Terms of Conditional Approval
Conditional
Date
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
certificates based only upon the representations gi~gn in pa~ragraph § 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.
Page 2 of 2 72-025 fRev 8/86i Back
WELL DATA
V" PAL,W OF A.CHORAGE {MOA)
AUTHORITY APPROVAL (HAA)
264-4744
Well Classificati(~n C. ~./~ ~, c~
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N),
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
A If A, B, C, D.E.C. Approved (Y/N)
Date Completed Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casir~g (Y/N)
Depression Around Wellhead (Y/N)
7'
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
B. SEPTIC/HOLDING TANK DATA
Date installed 1°/8~ Size [ ~.~ .~C:~ No. of Compartments ~-.
Standpipes (Y/N) '-r'~o Air-tight Caps (Y/N) y Foundation Cleanout (Y/N)
Depression over Tank (Y/N) ~ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) I',//~ ; for
Holding Tank High-Water Alarm (Y/N) ~"////~ Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
NoN '
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
To Building Foundation ~PE)
To Disposal Field lO -~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026 IRev 8/861 Front
C. ABSORP'~ION FIELD DATA
Soils Rating in Absorption Strata
Date Installed I 0 / ~ ~L.
(/~') Type of System Design 'T'~-,~' NCFt
Length of Field ~ ~''
Depth of Field / '7" ~
Gravel Bed Thickness 7' i
Standpipes Present (Y/N) O r,¢ ~
Date of Last Adequacy Test
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments 4¢ ~ [/ /4~. ~4
To Property Line ~0 q'
To Existing or Abandoned System on
; On Adjoining Lots ~ /
To Cutbank (if present)
>,5o
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verifiecJ~ or conformed to a,~l MOA and HAA guidelines in effect on the date of this inspection.
'~. ~:Z_o~,~ _~' Date ~//~ 8~
signed
Company ~OA ~o.
Receipt No. ~--~'~7
Date of Payment ~ --~ ~
Amount: $ / ~' O~ ineer's Seal
Page 2 of 2
72-026 fray 81861 Back
CO NS.ULTING ENGINEER
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: 1907) 279-3916
: ~.. - ' SEPTIC SYSTEM ADEQUACY TEST
~ - - ' 'LEGAL: '' Lot 11, Block 3,'South Park
. .... - .
/ - . - ' LOCATION: 44-40 South Park Bluff Road
OWNER:
RESIDENCE:
Mike Spangler
Single Family, Three Bedrooms
WELL: Community Class A
SEPTIC.SYSTEM:
DATE OF LAST PUMPING:
DATE OF TEST:
FROM MUNICIPAL RECORDS: 4-Bedroom System
TANK: Greer Steel, 1250 gal. Two Comp,
ABSORPTION SYSTEM: Trench
ABSORPTION AREA: 512 sq.ft.
SOIL RATING: 128
INSTALLATION DATE:-Oct. 1982
July 27, 1988, Marx
July 26, 1988
TEST PROCEDURE: System was inspected and measured. Tank was
found with 5 fee~ of cover and 48 inches of liquid. Sump to
trench was 17.5 feet deep and had a water depth of 19 inches.
, When trench was installed total depth was recorded as 12 feet.
~ ._- :'-' ..... Additional fill m~st have been placed over the trench during
:% -- landscaping of the lot. This was evidenced by dead birches.
' 500 gallons of clean' water was added to the trench. The first
- 250 ~allons caused the water to r~se 14 inches. The next 250
~ . gallons did not"'cause any additional rise in water level.
:_ TEST RESULT: This system meets the code requirements of
- the Health and Social Services Department of the Municipality of
~ · Anchorage.
NOTE The operational life of all septic systems depends on the
local soil conditions, groundwater levels that may fluctuate
during the year, and the water usage of the family being served
by the system. These conditions are outside the control of the
evaluator of this septic system. We can therefore not g~ve any
estimate of how long this system will function satisfactory for
current or future occupants.
3601 C STREET, SUITE 1334
ANCHORAGE. ALASKA 99503,
STEVE COWPER, GOVERNOR
563-6775
OATE: Aogost 1, 1~88
PWSIO: 213475
To Whom It May Concern:
According to the records on Pile in this o{{ice, the SOUTH PARK
TERRACE SUBDIVISION Water System is in compliance ~ith the State
of Alaska Drinking Water Regulations.
Sincerely,
Erickson
District O{{icm Supervisor
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