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SOUTHPARK #1 BLK 3 LT 16
HomeMy WebLinkAboutSOUTHPARK #1 BLK 3 LT 16 ; · Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: '~Vq'c~'70Z~r~Z PID Number: ~)~-O- ~)~) -
Name: ~ ~0~ WastewaterSystem:D New ~ Upgrade
Address:
~GO ~~ ~. ABSORPTION FIELD
Phone: ~_~ ~No.o~edrooms; ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other
LEGALDESCRIPTION Soim~in,: ~ GPD/Sq. Ft. TotalDepthfromoriginalgrade:~Z/~
Lot: ~ ~ Block: ~~ o~~Subdiv~i°n: [ Depth to pipe. ~b°~°m~fr°m original grade: Ft.Gravel depth beneath~ ,~ pipe Ft.
Township~ I Range: ~ I Sect~ Fill added above original grade: Gravellength: /
~, ~ + Ft. ~ ~ Ft.
~ ~ New = Upg~ Grave, wid,h: ~ Ft. Numbefof,ines:
Classification (Pri~:~ ~~Ft. Cased To: Ft. Total absorption)~area: SQ. Ft. Pipe~omaterial: ~D
~ . Date installe
Driller: DateDri[led: StaticWaterLevel: Instager: ~
GPM 'ng Height A~ve Ground: ~/
~ Pump Set at: Ft~ "t. TANK ~/
SEPARATION DISTANCES ~ o Septic ~ Holding ~ S.T.E.P.
To Septic Absorpt[o~ Li~ Holding ~ublic/Private Manufacturer: Capacity in gallons:
From Tank Fieid Station Tank Sewer Li,es ~' ~
/ / Material; Number o~mpa~ments:
Sudace I ~ I~ O~ I Ir~ ~A~l~ki
LOt I Size in gallons: ~ Manufactu
Line IOle IOr~ i'D/+ Z~ ~O~~ ~
"Pump off" le~e[ at: High water alarm at:
oun a,,on
Drain ~O / ~ ~O ~ ~ O I~ Pum M~ke & Model ~lectrical~,~,~lnspections pedormed by:
Remarks: ~ ~O~O~ ~'~ BENCH MARK
-- ~ FI~ t~ ~' ~OH ~ Location and Descdption:
~ ~ ~ ~.pO~ ~¢~V~ ~ ~0~ % ~ A~umed Elevation:
Inspectionspedormedby:~,~ ~'~'~', "'"' Dates'.lst '~]q' ~(~
Depa~ment of Hea~uman Seduces approval ,,~.,~-,, ........ , .,~.. _,~ -
Reviewed and approved by: Date:/2 -/7-~7
72-013 (Rev. 9/91) MOA 25
GROUNO OVER FILTER = 105~5
· /- MIN DOVER = 2,2 FEET, /~LOTTED PVC PIPE, INVERT = 102,99
2 INCHES OVER TOP DF98,66SLOTTED PVE PIPE,7 MIN, C~]VER = 6,4 FEET
~ FEET MIN DF ANCHDRAG
rn ~ OON~ IN ~P~)NG~ / ~4 INCH PVC, 6 INCHES OF DRAINROCK S~LnW PIPE,
AS BU I T
.~.
DATE, 1~/15/97
: I
/ /
,'~9~f,~ , ~,.
PREPARE~ BY' ALASKA WATER ~ WASTEWATER
DATE, 12115/97 DRAWN:
TransAlaska
Page 5
Summit Title Insurance Agency, L.L.C.
400 W. Tudor Rd., Anchorage, AK 99503
Phone: (907)561.1844 Fax (907)551.1948
SCHEDULE B - Section 2
Exceptions
ORDER NO. 97-5443
Any policy we issue will have the following exceptions unless they are taken care of to our
satisfaction.
PART
1.
o
5:
Taxes or assessments which are not shown as existing liens by the records or any
taxing authority that levies taxes or assessments on real property or by the public
records.
Any facts, rights, interests, or claims which are not shown by the public records but
which could be ascertained by an inspection of said land or by making inquiry of person
in possession thereof.
Easements, claims of easements or encumbrances which are not shown by the public
records including but not limited to rights of the state and/or public in and to any portion
of the land for right of way as established by federal statute RS 2477.
Discrepancies, conflicts in boundary lines, shortage in area, encroachments, or any
other facts which a correct survey would disclose, and which are not shown by public
records.
Unpatented mining claims; reservations or exceptions in patents or in Acts authorizing
the issuance thereof; water rights, claims or title to water.
Any lien, or right to a lien, for services, labor or material theretofore or hereafter
furnished, imposed by law and not shown by the public records.
PART TWO:
¸9.
Reservations and exceptions as contained in the U.S. Patent.
Right of Way Easement, including the terms and provisions thereof, granted to
CHUGACH ELECTRIC ASSOCIATION, INC., and it's assigns and/or successor's in
interest, to construct, operate and maintain an electric transmission and/or telephone
distribution line or system by instrument recorded September 15, 1953, Book 98 Page
36. (Blanket Easement)
Right of Way Easement, including the terms and provisions thereof, granted to
CHUGACH ELECTRIC ASSOCIATION, INC., and it's assigns and/or successor's in
interest, to construct, operate and maintain an electric transmission and/or telephone
distribution line or system by instrument recorded June 10, 1959, Book 5 Page 152.
(Blanket Easement)
AK Commitment (6193)
TransAlaska Summit Title Insurance Agency, L.L.C.
400 W. Tudor Rd., Anchorage, AK ggsg3
Phone: (g07)~61-1844 Fax (9~)7)~81-1948
Page 6 ORDER NO. 97-5443
~si n and/or telephone
~6~98~ook 758 P~e 519.
11. The effect of the notes which appear on the plat of said subdivision. (Copy affached)
12. Slope easements as dedicated and reserved on the plat of said subdivision, as follows;
"There shall be reserved adjacent to the dedicated streets shown hereon a slope
reservation easement sufficient to contain cut and fill slopes of 1.5 feet horizontal for
each 1 foot vertical (1.5 to 1) of cut or fill for the purpose of providing and maintaining
the lateral support of the constructed streets. There is reserved to the grantors, their
successors and assigns, the right to use such areas at any time upon providing and
maintaining other adequate lateral support, as approved by the Municipality."
13. Easements as dedicated and shown on the plat of said subdivision.
14.
Water system connection agreement, including the terms and provisions thereof,
recorded October 2, 1985 Book 1329 Page 842.
15.
Covenants, conditions and restrictions, including the terms and provisions thereof, but
deleting any covenant, condition or restriction indicating a preference limitation or
discrimination based on race, color, religion, sex, handicap, familial status, or national
origin to the extent such covenants, conditions or restrictions violate 42 USC 3604(c),
as contained in an instrument recorded October 14, 1987, Book 1661 Page 689.
Amended by an instrument recorded September 16, 1996 Book 2975 Page 950.
Subject to any unpaid dues or assessments now due or owing the Southpark Terrace
Homeowner's Association, Inc.
Uniform Common Interest Ownership Act, including the terms, conditions and
provisions provided therein, and in any supplements or amendments thereof, of the
State of Alaska.
AK Commitment (6/93)
r~,~dICh ~,~tTY or ANCHOP~GE, ~UILDtNG SAFETY DIVISION
f~ L, .,,,, I I .- ~ ~ -
?{PE.OF INSPECTION: . REINSPECTJON= Y~8 NO
~ ~o~co~pmuc~ OSS~VE~
CORRECTIONS ESSENTIAL AS ~P~INED BELOW
CO~dMENTS: {FOR IHSPECT~ USE ONLY) "" ~ /
16
Post-it:" brand fax transmiltal memo
Al[ kll W {er & Wlsttew :er
7320 East Chester Heights Circle ~ Anchorage ~ Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
December 16, 1997
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: AS-BUILT PACKAGE. Septic System Upgrade for Lot 16, Bk 3, Southpark S/D #1.
RECIRCULAT1NG UPFLOW FILTER (RUF) SYSTEM
To whom it may concern:
Attached is the as-built package for the septic system upgrade on the subject property. The
following comments are made regarding this installation:
TWENTY FOOT UNPLATTED EASEMENT ALONG THE EAST PROPERTY LINE:
During the installation it became apparent (after the locates were done) that the utilities along the
east property line wandered outside the 10 foot platted easement. Upon contacting Chugach
Electric about this suspected encroachment, we were informed that they have a 20 foot wide
easement (unplatted) along the east property line. The property owner, Lar~ Moser, obtained a
copy of his title report, which confirmed the existence of this easement. A copy of the applicable
portion of the title report is attached with this package. The presence of the 20 foot easement
dictated that the trench be moved further to the west, and closer to the foundation drain. We (Jim
Cross, Dan Roth, and Jeff Gamess) meet on 12/8/97 to discuss this dilemma and Mr. Cross
agreed to allow the trench to be 20 feet from the drain under the conditions:
a. When sampling the RUF system, the outfall of the foundation drain will be sampled for
fecal coliform bacteria: The drainpipe outfall discharges to an area that is covered with washed
rock, and the outfall pipe is not directly visible. Should water be present (probably not until
spring) it will probably have to be sampled downhill from this outfall area.
b. In the unlikely event that fecal coliform bacteria are present, the outfall of the
foundation drain will have to be discharged subsurface. This may require the installation of a
shallow dralnfield (using Infiltrators) immediately below the ground surface. It may be possible to
· · dump more drainrock in the outfall area, cover it with filter fabric, and bury it with several feet of
soil.
The trench was adjacent to the 20 foot easement line, and 21 feet away from the foundation wall
(at the closest point). The trench length was reduced from 40 feet to 30 feet (mi~fimum required
length) in order to avoid having to remove a large spruce tree located immediately to the north of
the trench. Removal of this tree would have required written approval from the Southpark
Subdivision HOA, and the planting of another tree next spring. Mr. Moser understandably
wanted to avoid this. Excellent soils were found throughout the trench excavation.
SLOPE STABILITY DOWNHILL FROM THE NEW TRENCH: Due to the fact that the
new trench is so shallow, it was necessary to mound several feet of soil (above original grade)
over the trench, and the Upflow filter. The side slopes from the mounded soil over the
trench/Upflow had to remain relatively steep (estimated at 1.5 to 1 ) in order to preserve the
drainage swale that exists along the east side of the house. This swale serves to intercept surface
runoff, and divert it around the house. The slopes could have been more gradual if the trench was
installed further to the east, however, the presence of the 20 foot easement dictated that the
trench be moved at least 5 feet further to the west. In the spring/summer of 1998 it may be
necessary to stabilize the slope with filter fabric, or terrace it with timbers or blocks. The buyers
have asked the excavator, Eagle Mountain Excavating, to provide them with a bid to terrace the
slope next spring, and topsoil/reseed.
CLOSING: Given the tight space constraints (trench squeezed between the utility easement and
20 foot setback from foundation drain) and soil/groundwater conditions we had to contend with, I
believe the installed system, provided the only viable solution for this property, short of a holding
tank. If you h~/ve any questions, please call me a 337-6179, or 244-9612.
/I
Jeffiej~ A. Gam~'s, P.E., M.S.
Principal
Rick Mystrom,
Mayor
Mtmicipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
http://www.cLanchorage,ak.us
Dear Homeowner/Prospective Buyer:
The on-site wastewater disposal system you are purchasing/installing is an "alternative" wastewater
disposal system. This system, known as a "Recirculating/Upflow Filter Septic System", is undergoing
testing within the Municipality of Anchorage under the Alternative System section of the Wastewater
Disposal Regulations (AMC 15.65). There are certain risks involved with the ownership of one of these
systems:
The technology used in this system has been shown to be effective in other areas. The system is
currently undergoing a two year testing period in Anchorage under the guidance of the Department
of Health and Human Services (DHHS) and the State of Alaska Department of Environmental
Conservation (ADEC) to determine its effectiveness in a subarctic environment.
The system for this property may have received vertical separation distance waivers from both
State of Alaska and Anchorage Municipal Codes to both grotmd water and bedrock. These
waivers were granted due to the system's expected performance within the site conditions on this
property. If the test results do not support these waivers, modification or replacement of this
system may be required.
If this system fails to meet the requirements set for it to become a standard, code approved
wastewater disposal system, it may have to be removed and replaced by either a holding tank or (if
possible) other wastewater disposal system that meets Municipality of Anchorage requirements.
The cost of any conversions required to meet code requirements will be the responsibility of the
homeowner at the time of conversion.
I (we) certify that I (we) have read the above statements and am (are) aware of the risks outlined. I (we)
also certify that I (we) am (are) in the process of purchasing (property legal description):
- / -(~urchaser ~Name)
(Purchaser Name)
(Purchaser Signature)
(Purchaser Signature)
/7 -/o-Xi 7 7,'30
PAGE 1 OF 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW970402
DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES
OWNER NAME:MOSER LAWRENCE Z & DANNA S
OWNER ADDRESS:4450 SOUTHPARK BLUFF DR
ANCHORAGE, ALASKA 99516
DATE ISSUED:il/24/97
EXPIRATION DATE:il/24/98
PARCEL ID:02005154
LEGAL DESCRIPTION:
SOUTHPARK ~1 BLK
3 LT 16
LOT SIZE: 34649 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 (18AACS0).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
iS PECIAL PROVI S I ON'iii
!TH,IS PEP, MIT IS ISSUED FOR THE CONSTRUCTION OF AN INNOVA~T~VE~
i~EC;RCULATING TRICKLING UPFLOW FILTER SYSTEM. AS A ~',
~0NDITION OF THIS PERMIT, THE OWNER SHALL MAKE ARRANGEMEN~$i
i FOR THE SYSTEM TO BE S~PLED ONCE A MONTH FOR A ~IMUM 0F~'{
~2~ CONSECUTIVE MONTHS AFTER BEING ~UT IN USE. THE ATTACHe6]
~OPEKT[ OWNER AGREEMENTS BECOME A PART OF THIS PE~IT ~
~ECEIVE~ ~ ~~ D~TE: ~~~
7320 East Chester Heights Circle ~ Anchorage ~ Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
November 10, 1997
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~ Septic System Upgrade for Lot 16, Bk 3, Southpark S/D/ti.
RECIRCULATING UPFLOW FILTER (RUF) SYSTEM
To whom it may concern:
1. GENERAL: The existing 4 bedroom home is served by a private septic system and
community water. The existing trench is surcharged and must be upgraded prior to the sale of the
house. Several test holes were excavated below the existing trench (actual location is unknown),
and the area was found to be unsuitable for an onsite septic system. It is my understanding that
Toben Spurkland, P.E. has dug test holes on the lower portion of this lot, and determined it to be
unsuitable also. Excellent soils were found in TH #3, on the east side of the house (uphill). There
is a subsurface drain around the east foundation wall (daylight basement), to intercept migrating
groundwater. Ifa trench is installed near test hole #3, it will only be about 28 feet from this drain.
Per regulation, a dralnfield/trench must be at least 50 feet upgrade from a subsurface drain. In
order to justify the reduced separation distance we are proposing to install a Recirculating
Upflow Filter (RUF) system, designed by Orenco Systems, Inc., and marketed by Anchorage
Tank. Once the effluent from the RUF passes through the 2 foot sand filter (in the trench), and
migrates laterally through 25+ feet of soil, it should be free of pathogens. Based upon the level of
treatment provided, we are requesting that DHHS waive the required separation distance to 25
feet. The only other viable option for the property appears to be a holding tank. The specifics of
the design are summarized as follows:
2. SOIL CONDITIONS (TH//3): Test hole #3 was dug to a depth of 7 feet. Below a depth of
approximately 5 feet, the soil appeared to be tight, wet, silt. At a depth of 2-5 feet, the soil, a
clean sand, perked at less than one minute per inch. On 10/31/97 groundwater was encountered
at a depth of 5 feet below grade. The intent is to excavate to the sandy soil, and install a 2 foot
(minimum) sand filter. This will ensure a 4 foot separation to impermeable soils, and
groundwater.
3. DRAINFIELD: The intent is to install a Recirculating Upflow Filter (RUF) system that will
allow the use of a small drainfield in the area of the TH. The size of the drainfield will be based
upon the previously established criteria for the RUF systems, which dictates that soils percolating
between 1 & 30 minutes per inch have an allowable application rate of 4 gpd/f[2. Given this
ap~plieation rate, the system (4 bedroom house, 600 gpd) will require a drainfield area of 150
f~. This corresponds to a 5 foot wide trench that is 30 feet long. To be conservative, we are
going to install a 5 foot wide trench that is 40 feet long (200 ft2).
4. ORENCO PACKAGE SYSTEM: The STEP tank with the trickling and upflow filters will
be manufactured by Anchorage Tank & Welding to meet the latest design criteria established by
Orenco Systems, Inc. The point of contact at Anchorage Tank is Lowell McNutt. Since you are
familiar with the operation of the system I won't elaborate. As with their standard STEP tank, it
is equipped with a high water alarm per M. O.A requirements.
5. SURFACE WATER: There are no surface waters within 100 feet of the proposed upgrade.
6. TOPOGRAPttY: The entire lot slopes moderately downhill (approximately 15%), from east
to west. There are no slopes greater than 25% within 50 feet of the proposed trench.
7. CLOSING: Clearly, this property has numerous site restrictions which limit the potential for
septic system upgrades. The suitability of this design will be limited by the soil/groundwater
conditions at the proposed trench site. I am open to any suggestions from your department that
would be an improvement to the proposed system. I am unaware of any negative impacts that
this installation would impose on adjacent wells, or septic systems. If you have any questions,
please call me a 33~ .6179, or 244-9612.
Jeffr I/AI~ ;-arness, P.E., M.S.
Prin~ ~al
LOT 17~ BK 3, SOUTH-
PARK S/B. PVT.
SEPTIC SYSTEM ANB
PUBLIC WATER,
LOT 16, BK 3 SOUTH-
PARK S/D ~1, PVT,
SEPTIC ANB PUBLIC
WATER, WATER SERVICE
IS FRUM SOUTHPARK
BLUFF DRIVE,
TRENCH
ALL OF THE LOTS TD THE EAST
ARE IN GDLDENVIEW PARK
ALL OF THE LOTS ARE ON PUBLIC
WATER AND SEWER,
LOT 15~ BK 3~ SOUTH-
PARK S/D. PVT,
SEPTIC SYSTEM AND
PUBLIC WATER,
UPFLDW FILTER
NEW STEP TANK WITH RECIRCULATIN6
UPFLDW FILTER
THERE ARE ND WELLS WITHIN 800 FEET OF THE PROPOSED SEPTIC SYSTEM UPGRADE
SEPTIC UPGRADE~ LOT 16, BK 3, SOUTHPARK S/I) MI
PREPARED FOR: LARRY MF1SER
PREPARED ]~Y~ ALASKA WATER & WASTEWATER
DATE~ 11/9/97 I DRAWN: GARNESS ISCALE~ l' = 100'
THE CONTRACTOR SHALL HAVE THE PROPERTY LINE NEXT TD THE
I TANK, AND THE UTILITY EASEMENT LINE FLAGGED BY A REGIgTERED
! LAND SURVEYDR,
.~-NT
1/4 INCH PER FDDT MINIMUM, 8 /
ULATING TRICKLING FILTER, PER ANCH TANK
PER ANCH TANK DESIGN DESIGN SAMPLE PDR
FOR THREE ~EDRDDMS, ~
PREPARED 3Y~ ALASKA WATER & ~ASTE~ATER
DATE, 11/9/97 DRAWN, GARNESS I SCALE, 1' = 30,
· MIN COVER = B FEET, SLDTTED PVC PIPE,
:~4 INCHES DF DLUEBDARD:
OVER TOP DF FILTER. )]RAINRDCK FROM TOP DF }~LOCK PEA, TD
2 INCHES OVER TOP DF SLOTTED PVE PIPE,
: MANHOLE LID (TYP,>
SAND ~ND GRAVELS ~LDCK PEA. WITH RECIRCULATING TRICKLING FROM HOUSE,
FILTER, PER ANCHORAGE TANK DESIGN,
ON BOTTOM DF TANK IS COVERED WITH J
MIN, DF 8 INCHES DF DRAINRD~K, ~DTTDM
APPRDX, 15 INCHES,
1,25 INCH PV~ PRESSURE LINE
FROM STEP TANK, ~HECK VALVE
NDTEJ THE UPFLDW CHAMBER SHALL ~E INSULATED VITH 8" IN STEP TANK PREVENTS
OF SPRAYED URETHANE, BY ANCHORAGE TANK. FLOW TD TANK. MIN ~URIAL DEPTH
TIDN ~DARD (2 FEET WIDE) OVER THE
TOP DF THE PIPE, FOR EFFECTIVE
~URIAL DEPTH DF B FEET.
TOPS)IL AND RESEEDIN~ TD ~E THE RESPONSIBILITY Dr THE HOMEOWNER
,
~ A, TRENCH LENGTH = 40 FEET
1 FODT DF DRIGINAL GRADE WITH LAKE OTIS GRAVEL,
THIS ~ILL ENSURE A 4' SEPARATION TO IMPERMA~LE SDILS,
PREPARED FDR~ LARRY HUSER ·
DATE: [[/9/97 D~N~ GARNESS SCALE~ NTS '~~
'. , .~.~'q~'~ ~ E E R'S SEAL)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES ~ 825 "L" Street, Anchorage, AJaska 99502-0650 ~
SOILS LOG -- PERCOLATION TEST ~.~
~c~,~,O.= ~X~ ¢~C aI,L/~,~ Township. Range. Section:
2
7
9
WAS GROUND WATER
1
0
ENCOUNTERED?
IF YES, AT WHAT OL
DEPTH? ~ LI' P
12- E
DeplDloWalerAIter VI Date' IDl~l
13 -- MonilorinD? .
Gross Net Depth ~a~ of* Net
Reading Date Time Time Water D¢0p
~ tog ~,~ 6'/e" ~
14-
15-
16-
17-
'18 -
I9-
20 -
PERCOLATION RATE ~,~6~'~- {minutes/tach) PERC HOLE DIAMETER
TEST RUN BETWEEN '~ FT AND ~ ' I~ FT
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
9-
10-
13-
14-
16-
17-
18-
19-
20-
SITE PLAN
Township, Range, Section:
I
I
SLOPE
WAS GROUND WATER
ENCOUNTERED?
DeP*R?IF YES, ^T ,.AT
~ept, to Wale, After ~'
Monitorino? Dale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
ACCORDANCE V~H ALL STATE AND MUNICIPAL GUIDELINE~IN EFFECT ON THIS DATE. DATE: ~'~(~ !~'y
72-008 (Rev. 4/85)
PERFORMED FOR:.
Municipality of Anchorage ~o --
825 "L" Street, Anchorage, Alaska 99502-0050 ,/~J/~},~
SOILS LOG -- PERCOLATION TEST/~_'., ,
j
V ..
~ 5
6
7
8
9
b,~, T,~,'s ¢' t
10
11
12
13
14
15
16-
17
18
19-
20-
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~! (~
DEPTH? P~
Depth to Waler After/ I ,~ t
Monitoring? /0[$1[~1 '';/' Date:
SITE PLAN
Dross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __
TEST RUN BETWEEN
PERFORMED B
ACCORDANCE t~H ALL STATE AND MUNICIPAL GUIDELIN/E/SS IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85J
(minutes/inch) PERC HOLE DIAMETER
CERTIFY THAT THiS TEST WAS PERFORMED IN
DATE:
' 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 J~'NEW
MAI LIN~D~R ~S ~
LOCATION NO. OF~DROOMS
~' DISTANCE TO: J'¢JO ¢/ Dwelling - PERMITNO.
~ N Liq. capaci~in gallons IF HOME.DE Inside length Width Liquid d~pth
~ ~ DISTANCE TO: Well Dweging PERMIT NO.
O Z < Manufac~ ~ ~~ ~ ~ 'Mate~ ~ Liquid capacity in gallons
Q Well Fou n ~i~~¢~1 Nearest lot line PERMIT NO.~
~ --~ ~ Ne.DISTANCE TO:of lines "ength '¢ O¢of ~each**lin~* ~ Total ength of~)~ /Trench wldth*[ ~, Distance ~n ,iLe~ VO
~1~ ~ I ~*~inches Total effectig~r~n area
~ Top %t~i,,ishgrade Material beneathtile ~ ' inches
Length Width Depth PERMIT NO.
~ DISTA~Gfi TO:
OTH[B
PIPE ~S .~
SOl L TEST RATING
72-013 (Rev.~f~ 8) /~/~
[:,EPRRTMENT ~ ]IHEFtLTH RN[:, ENVIRONMENTRL' 'DTECTIOF/I/ .. f~ ~.~ ~'~
~, ~ 825 '"L' STREET., ~NCHOR~GE., BK. ~64-4728 .
RF'F'L]CRNT ZRCHRRY K F'RLL[STER SRR BO~':: 1gq. B 99~02 / u . 3:~
LOCRTION T.H. BY L REID 12,/'2~/B1 ~ ~,~~~
LE6RL Li6 B~: SOUTHPRRK ~t ~ LOT SIZE ~~LIRRE FEET
TYPE OF SOIL BBSORPTION SYSTEM IS: TRENCH
MFiXIMLIM NUMBER OF BE[:,ROOMS = 4 SOIL RFITtNG (SD FT,..'BR)=
THE REQUIRED SIZE OF THE SOIL BBSORPTION SYSTEM IS:
[:,EF"TH=: '_t_l lt_EI'-~,3TH= 67 _~F~:R . EL [:,EPTH= 7
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTBNCE BETWEEN THE SURFRCE OF THE
GROUND BND THE BOTTOM OF THE EXCRVRTION (IN FEET).
THERE iS NO SET WIDTH FOR TRENCHES.
THE GRRYEL DEPTH IS 'THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
BND ]"HE BOTTOM OF THE EXCRVBTION (IN FEET).
F4Eu;~IIB Z F-:E[:, :_=;EF'T ~- C: TRI'-~i[.:Z S I ZE= 125E~ ~]RLL£g~'-~'--=-
PERMIT HFFLI~-FIIqr HH_ THE RESPONSIBILITY TO INFORM THIS DEPFtRTMENT DIJRIN.~ THE
Iiq=,TtdLLH]'ILN IhI.=,FEL. TIuhl:, OF RN'-~' WELLS R[:,.TFIF:ENT TO THIS FR_FERT¢ FIN[:, THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
T[~.-~ C~ .:: 2 ;:. :I ~"-.t2; F' E,]: T I: ,],~'--~5 RF-:E F-:E ;:'4UI I: RE[:.
BRCKFILLING OF FIN'¢ SYSTEM WITHOUT FINFIL INSPECTION RND RPF'ROVBL BY THIS
DEPRRTMENT WILL BE SUE:.TECT TO PROSECUTION.
MINIMLIM DISTFtNCE BETWEEN FI WELL RND FINY ON-SITE SEWFIGE DISPOSFIL SYSTEM IS
±00 FEET FOR FI PRIYBTE WELL OR ±50 TO 200 FEET FROM Fl PUBLIC WELL DEPENDING
UPON THE TYPE OF PLIBLIC WELL.
MINIMUM DISTBNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET BND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS I"IRY BPPL¥. SPECIFICFITIONS BND CONSTRUCTION DIFIGRRMS FiRE
R',,,'FIILFiBLE TO INSURE PROPER INSTFILLFtTION.
CERTIFY THRT
I FIM FFtMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS FIS SET
I
iL:
FORTH BY THE MUNICIPRL. IT¥ OF FINCHORFIGE.
2: I WILL INSTFILL THE SYSTEM IN RCCBRDFINCE WITH THE CODES.
?]:: I UN[.Ep-,IMN[ TI-IRT THE uN _,ITE SEWER _,t_.TEIt MFIY REQUIRE ENLFIRGEMENT IF THE
-- ' ~' iS ' - '
, RE_,I[ENI_E F.'EMOE:,ELED TEl INC:LU[:'E f~LRE THFIN 4 EEE,R]CIMS.
3
/ '4
5
6
7
8
9
~0
,---~- 1 1
12
13
WAS GROUND WATER
ENCOUNTERED?
14-
15-
16-
17
18
19
20
Reading Date
TEST RUN BETWEEN
COMMENTS__
,.- .:,/ _~ .,_/
Time Water
/.() / /
/(h /' © /
/ L) :' ""/
tRY':
/ C)
/D
72-008 (6/79)
,7
'.,,
· -: DGv ment Sen/ices Department :.:'..: ' = '-,..
· ' , ' ,. ,' Building Safety Division . ,
P.O, Box 196850 Anchorage, AK 99519-8650
Complete legal descdp.!on ~ ' ;.SOLq'HP~RK .SUBDIVISION ~ 1'1' LOT' '1'~,' BLOCK 3
' ' ' sOUTHPARK ' ' '
Location (site address or directions)' :' 4450. , BLUFF· DRIVE
cun'ent Property OWner(s) ' "~I'EVE"&"/P~I~ ,HARRIS ' " Day phone ' (520) -751 -~120 '.
·'. Mailing address
Mailing address; -" '. -' '- ~' ' "- ' ' " ' " .'
Real Estate Agent JED '~' DYNAMIC PROPERTIES - ' Day phone , 261~7623
Mailing address · 3111 "C" STREET, ANCHORAGE, AK 99503
Un/ess o~hetwfse requested, HAA wt/I be held by DSD forplckup.
2. NUMBER OF. BEDROOMS:
· 3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL'.
· ·. IndMdual Well [] Individual On-site [] '
· Individual Water Storage [] Individual Holding tank
Community Class Well ~E] community on-site
Public Water System [] Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Iss,;es 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 fl'ansfer
of title (except between spouses) for properties served by a single family on-sita wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Cer',Jticates of Health Authority
Approval are valid for 90 days from the date of Issue for properties served by a pdvata 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 omlsslons In the
professional engineers work.
STATEMENT OF INSPECTION BY ENGINEER ' ' '
A~ certified bY my seal affixeq hereto and as of the valida#on date shown bel°w, l venfy tha ~Y. .
'-'" :"":: * *, * s~f on p~ures O~tiined ih ~ H~al~h Air. Ap'pro'al Guidelines' fo~ this applicauon,
InvestJgabon, ba - . _ ---- ,_ .... ;--';;- :~,o;'"'0";I ~,~tem I~(are) safe, fuhctional and adequate
shows that tho on-site water supp~y ancl/or wa~uw=.~.=J ¥,..~..~ .v.. · ,.
for the nu/nber of bedn~'ns and type of structure Indicated herein. I further verify that based on the
tnformatidn*obtalned from the MunlclpalitY 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 Munldpaf
and State codes, ordinances, and regu!ations ln effect at the time of lnsMllation,
Name of Firm- ,~aSKA WATER &: WASTEWATER CONSULTANTS, 1NC. , Phone, .357-6179
' ' 2B** A~C
Address', 6901 DEBARR,ROAD, SUITE HO~a, GE AK 99.504. - -.~
Engineer's printed Name JEFFREY A. GARNESS; P.E.
EnglA~e¢$ Comments:
In conducfing this evatoa'ffon, Al/Wi/C, Inc. attempted to ~ a thorough,
conscientious engineering anaysls of the system In ac~-dance with ADEC and MOA -
DSD Guidelines & Regulations. The mparted results descried the performance of the
systsm under the cond~.ons encountsred at the time of fhe t~s~ a~d eeParstion -
ois' - ....... ~,Idontiflabtefe~tures Theoparationoflifeofallwellsa~d
septic systsms depend on the locel so~Ts conditJon, gmundwalor levels that may~ -
fluctuate during the year, and the water usag~ of the family being sen/ed by the ~Tstem.
These c~nd/tions are'OUtSide tho conffol of the evaluator of the system. Sattsfacfoo~ test
resu~ do not guarantes fufure pedorrnance of the s~lem, nor do they guarantee that
any warran~ or future estimate of how Icm~ the system V~ll co~Dnue
operational requirements of the ADEC or MOA DSD. The content of this rupert Is for
the sole benefit of the ovmer listed above. Any reliance upon or use of this report by any
er person or party is not authorized, nor ~11 it confer any legal right wha tsceyor.
· .' '" ' ~'.. .. 0~,~'
Disapproved. '
. . . .
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
Original Ce~ficata Date: '7-' 2 G ' ~ I
Municipality of Anchorage
Development Services Department
On.S~ Wmr & Wastwmter Program
P.O. 8ax 196650 Anchorage, .N¢ g951g-66SO
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDesorlplion: SOUTHPARK SUBDMSION ~1; LOT 16, BLOCK 3 ParcollD: 020-051-54
A. WELL DATA
Well type PUeUC
Date completed
Total depth
It A. B, or 0 pn:Mde PWSID# Well Log (Y/N)
lt. Cased to t~ ~l~t (above ground)
FROM WELL LOG ~ INSPECTION
Date of test ~ ,,
Stetlc water level. ~ ,ft.
Well predu~on ,..'/ g.p.m, g.p.m.
e: Co{lected by:.
· B. SEFTICJHOLDING TANK DATA
Tenk Typa~l~terb~
S.T.E.P./STEEL
Tank ~lze 2000 gaL' Number of Compartments 2
Foundatlbr~.cleanaU~,(y/N) YES Depmsslonovertenk(Y/N) NO
Date of pt~plng .7/11/2001 Pumper
Other bacteria
colonlesll00 mL
Date Installed 12/97
Cleanoute (Y/N) YES
Hlgh water almm (Y/N). YES
A+ HOME SERVICES
Ce
ABSORPTION FIELD DATA
Oate Installed ~2/;7 Soil rating ~ ~/'edrm)¢.O
Length 30 ' It. Width 5 ft.
Toteldepth. 3.0 .lt. Eff. absorpl]onema 150 It~ Monltodngtube YES
Oateofedequacytest. 7/6/2001 Results(Pass/Fall) PASS
Fluld depth in ebeorpt]on tleld before test 0 In. Water added 612 gal.
Elapsed Time: 0 min. Final fluid depth 0
A~/rejuvenation treatment (past 12 mo.) (Y/N & type)
In. A~n rate
NONE KNOWN
System type SHALLOW TRENCH
Gravel below pipe 0.5 ft.
Depression over t~eld NO
For 4 bedrooms
Newdepth 0 In.
600+ g.p.d.
D. UFT STATION
~ ~l~ I 12/97
"Pump on" level etT~MERIn.
Datum BOTrOM OF TANK
E. SEPARATION DISTANCE8
*TIMERS/FLOATS INSPECi~.U BY A+ HOME SERVICES
Size Ingallofls~ Manhole/Access (Y/N) YES
'Pumpofl"levelefl]M[EJn. Hlgh water alarm lovel at 56' +/-
Cycl~ tested N/A* Meets alarm & circuit requlrements'~ YES
SEPARATION DISTANCES FROM WELL ON LOT TO:
8e~o tenMlff station on lot On adjacent ~
AbeorplJon field on lot, ~
Public sewer main ~Publlo sewer manhole/cleanout
$fi~.~TIO~ DISTANCF$ FROM $~rlc~lOI.DINO ?ANK O~ LOT TO:
Bulldlng foundallon 5'+ Property line 5% Abeo~plion lield.
Water main 10'+ Water serdce line. 10'+ Surface watsr.
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Bulidlng foundalio~t 10'+
Surface water 100'+
Wells on adjacent lots 200'+
Water main
Properly line. 10'+
Water serdce line 10'+
Curtain drain NONE: KNOWN
F. COMMENTS
5'+
100'+
10'+
Driveway, perldng/vehlcle storage
50'+
G. ENGINEER'S CERTIFICATION
I ceriEy that I have determined through field Inspections and
revtew of Mun/c~pa/records that the above ~Tstems ate/n
conformance ~ MOA HAA gu/defines tn effect on this date.
Engineer's P_rl~ ~lame
Date
JEPPKEY ~ GARNESS
HAAFee$ ~ .~
Date of Payment ~7/' Iq/d~
Receipt Number .'~
Waiver Fee $
Date of Payment
Receipt Number.
By: Alaska Water and Wastewater Con; 907 338 3246; Jul-20-01 12=10; Page
PROPERTY OWNER MAINTENANCE AGREEMENT
ON-SITE WASTEWATER DISPOSAL SYSTEM
This agreement, dated ,200_, is made betw~n the Municipality of
Anchorage Deparunent of Health and Human Services (DHHS) and the property owner(s) of
4450 Southpark Bluff -aka- Southpark Il Lot 16, Blk 3
This agreement is made for the purpose of maintaining an on-site wastewater disposal system
on the subject property.
The properly owner(s) agree to thc following:
The property owner(s) will have an annual inspection of thc system performed by a registered
professional engineer. 'This inspection shall verify that all effluent and air pumps, timers, and
alarms are functioning as designed. Any deficiencies shall be corrected and the engineer's
statement that the system is functioning as designed shall be filed annually with the DHHS.
Property Owner Name
Property Owner Name
(Notarize Here)
Stateof ~.~o.~¢ ~
Judicial D,~trict $5.
lear 2C'Xq I , before me. the~ndcrsigned notaq,
ia~n].ic dpe~ly appeared:
II~e Person(s) ~o~fia~n~syis/are subscribed to ~e
wid~in lns~! sad mcknowk'dged that
cxecmed the s~me for ~e purposes O~crein
contained.
In w~im~,whcreof. I hereunto set'my band and
( No'Tm'7 i'prmted
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. '*GENERAL INFORMATION
Complete legal description
Location (site address or directions) ,::~.-~--'~E) _~'c:~¢,--~p<lD~ P'~'2~ ~ '
Property owner . ~' ~O_~./~.
Mailing address ' ~--~
Day phone
Lending agency
Mailing address
Day phone
Agent / Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~-'~
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If Community well system, provide written confirmation from state ADEC attest-
lng to the legality and status of system.
4. TYPEoFWASTEWATERDISPOSAL: : : : '~ ·
public seWer -: :
NOTE: If community wastewater system provide written confirmation from State AD C:
a~esting t° the legality:and status of system
5. STATEMENT OF INSPECTION BY ENGINEER. "
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site Water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further veritythat based on the information obtained from
the Municipality of Anchorage flies and from my investigation and inspection, the on-site water
supply and/or wastewater disPosal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
-~ Name of Firm Phone
Address Alaska Water & W.a,.s~.ate, r
7320 t~ast
Engineer's signature An~r~, ~a
Date
DHHS SIGNATURE
· ,~" Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By:
The M~'~icip~lity of Afi'~i~0rage 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 engin'e~r 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.
J~ONMENTAL SERVICES DIVISJg
Municipality of Anchorage L3LFC '1 g~ ]997
DEPARTMENT OF HEALTH & HUMAN SERVICIF~
Environmental Services Division-- ECEIYED
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Legal Description:
A. WELL DAT~ ~
Well type~"'~-T'l~ 'J?Lz'O ~ttachADEC letter. ADEC water system number
TLo~) Date completed
Cased to
Health Authority Approval Checklist
[~:~T'- (/o) (~--' ~l ~0"'4-C¢c¢'q'2~\ Parcel I.D.: 0'~ '- 0 ~'-/~'~-'~
Sanitary seal (Y/N)
Date of test
Static water level
Well production
~mple:
Nitrate
B. SEPTIC/HOLDING TANK DATA
Date installed / ~/':::)';:~'
Collected by:
Tank size -'') (30:~ Number of Compartments __
Foundation cleano~~.~7'~ Depres~
Date of Pumping L/"/_~_~ Pumper k._" ""~-~ )
C. ABSORPTION FIELD DATA
Date installed ( '-C~¢~' '~' Soil rating (g.p.d./fF oE:[E,Lbdcm~
/'Jo High water alarm (Y/N) k/z~
System type
Length ' ~(~ Width Gravel thickness below pipe
,7_
Effective absorption area J~ '~ Monitoring Tube present (WN) Y
Date of adequacy test /'J ~ Results (Pass/Fail)
btf Total depth
· Depression over field (Y/N)
For ~ bedrooms
Fluid~depth ; Immediatel~l water-added (in.):
Fluid depth (ins) Minutes later: sorption rate = _g.p.d.
72-026 (Rev. 3/96)* ~ :'
Wires properly protected
bacteria
Other ~
Casing height (above ground)
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
Size in gallons ~::~.20 %' ~[-'.
"Pump on" level at* '"~U~'4 ~ "Pump off" level at*
*Datum ¢o'/TM 0~'
E. SEPARATION DISTANCES
ROM WELL ON LOT TO:
Septic/holding tank on lot %
Absorption field on lot
Public sewer main
On adjacent lots
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~_t~ Property line ~-(+' Absorption field '~- ~'~-
Water main/service line I 0 [~''' Surface water/drainage ~,00 t4' Wells on adjacent lots ~.~/~_
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line
Surface water
Curtain drain '2~ '/'~.~--
Building foundation ~0 ~- Water main/service line
Driveway, parking/vehicle storage area ~-~
Wells on adjacent lots ~0/~
F,
ENGINEER'S CERTIFICATIOn//
inconforman/~e
Signature ~.~'//~ ~'"
Engineer's Name '-,~
Date , ?_..//,~/C~_~
HAA Fee $ ~ ~ .~T~
Date of Payment '"~/"=~--("" ) ~/~,///¢/~' 7
ReoeiptNumber ~%~ ~
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
PROPERTY OWNER AGREEMENT
FOR THE MAINTENANCE OF AN
ON-SITE WASTEWATER DISPOSAL
SYSTEM
This agreement, dated / ~-//' 7 199~, is made between the Municipalky of
Anchorage Department of Health and Human Services (DHHS) and the property
°wner(s)°f.~,,--i-k~a~--{t_-- ~,"{5, ~o7-~/de /~ /~-~ ~
This agreement is made for the purpose of maintaining an on-site wastewater disposal
system on the subject property.
The property owners agree to the following:
Allow the Municipalit3, of Anchorage the perpetual fight of entry to the property during
normal working hours, to allow for effluent sampling or evaluating the general state of
repair or function of the system.
Submit to the Municipality of Anchorage, on an annual basis, an inspection and
operation statement from a registered professional engineer. This inspection and
operation statement shall verify that the engineer has inspected all effluent and air
pumps, timers, and alarms, and that any deficiencies have been repaired and that the
system is functioning as designed.
(Printed Name)
(Notarize Here)
(Signature)
(Printed Name)
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)
(b) Applicant Name
(c)
Telephone: Home , '-qjL,LLT.~.-~ ! I? Business
Applicant Address
Applicant is (check one): Lending Institution []; Owner/buiJder/~; Buyer []; Other [] (explain);
(d)
(e)
Lending Institution --~/~,!-P~_~,"Z~?t~N~.5 - : Telephone
Address /1~ / ~,-~ ~/t~,~]~ tl ~.~ '
Real Estate Company and Agent
Address ~~, ~Y~ ~/~/ /~¢' ~'~
Telephone
(f) Mail the HAA ,o the following address:/
TYPE OF RESIDENCE
Single-Family, y,~ Multi-F,a~ily rl
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~ Public [] Comm[~nity [] Holding Tank []
/
Not6: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 (11/84)
/~.~
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA3A AND INFORMATION
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 shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm' .~'-~',~--~-~--.~ ~'FP/~~_ ~¢'~O~ Telephone
/
DHEP APPROVAL
Approved for 4-" bedrooms by ' '~. . Date
Approved 2(. 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
72-025 (11/84)
/~t-,tcV, O?'b'G~MUNICIPALITY OF ANCHORAGE (MOA)
_~,,~EALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
A. WELL DATA
264-4744
Legal Description:
Well Classification ~:J~c~(_ U~)f:~-~ ~x/~r-?.~. if A, B, C, D.E.C. Approved (Y/N)
I
Well Log Present (Y/N) ^_//,z~ Date Completed Yield
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
Depth of Grouting
Pump Set At
Sanitary Seal on Casing'N)
Depression Aroupd//WWellhead (Y/N)
~ ;/;/;/~On Adjoining Lots
TO Nearest Public Sewer Line
Adjoining
Lots
/ To Nearest Public Sewer
Cleanout/Manhole //~ To Nearest Sewer Service Line on Lot
Water Sample Collected by / ; Date
Water Sample Test Results
Comments -,.~:.~_~----- ,,,~-77-~/.//~.-~') ,,~/"),, ..~,.~ /,~/~,,D~'~)/4(. /~,~ ~7/~YY~-- F~.L~?'~'~" ~,~'?~,
B. SEPTIC/HOLDING TANK DATA
Date Installed "7/~"~
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N) /~/
Holding Tank High-Water Alarm (Y/N) ,-',J//~ /
/'
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line F-".~ 'ff ~-l-
To Water Main/Service Line
Course
Size ! ';%~--C~r~ ~ NO. of Compartments
A~ThtCaps(Y/N) ,~ FoundationCleanout(Y/N)
· Date Last Pumped'~7~
; for
Temporary Holding Tank Permit (Y/N) /'V///
/
To Building Foundation ,If,~./---?-
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026 IRev 8/861 Front
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed "~ / ~-~
Width of Field .~ ~-~ _ ,Z//cT
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ,& ,)/~
/.
-ro Building Foundation /~-F-C-
Lot /k./
/,
TO Water Main/Service Line /(.)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
:F/If~,)~ Type of System Design'~'-~ ~-~-'7-AJC~,/
Length of Field
Depth of Field ~%-~ ~
Gravel Bed Thickness :
Standpipes Present (Y/N)
Date of Last Adequacy Test :~ }~,
To Properly Line /~F
To Existing or Abandoned System on
; On Adjoining Lots ,.~
To Cutbank (if present)
Comments
D. LIFT STATION
Date Installed
Dimensions
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Manhole/Access (Y/N)
"Pump Off" Level at
ng Cycles during ^Oequacy Test. Meets MOA
** ~itted Bedroom
I certify that I h.~ve Ob eclC'~,,v¢
Si g n e d '/~'~.~////
Receipt No. ¢ ~0
Rating Against HAA Request **
ie/or~onformed to all MOA and HAA guidelines in effect on the date of this inspection.
~//~'~_- MOA NO.
Date of Payment
Amount: $
Page 2 of 2
72 026 fRev 8/861 Back
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA g9501
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
DATE: Decerober 10, 1986
PWS I.D.# 213475
To Whom it May Concern:
According to records on file in this office the
SUBDIVISION
Water Regulations
SOUTH PARK TERRACE
Water System is in compliance with the State Drinking
Sincerely,
~_~egional Sanitarian Supervisor
· APPLI~:'~'tlT FILLS OUT UPPER H.a~- '-~ONLY
nwner .~ . ~-, Phone
P~roperty
'~ -~ 7:qr-5' ~1!~
'~uyer
'~¢~ fY'~ Zip Code
Address
Phone
Lending Institution
Realty Co. & Agent Phone
Address Zip Code
Legal Description
Street bocati~ (.~t
~ommunity
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: MUNiCiPALITY OF ANCHORAGE
r~EPT. OF ,UF./",LTIt &
~i~'v hiO;.;MZNTAL PROTEC liON
.RECEIVED
~'~APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
(
F
( ) C~ONDITIONAL APPROVAL*
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
~ ~ 2~(-- ~ WelltoTank Septic T~k Size / ~
72-023 (3182)
ALASKA
', ,IdlRODmelqTAL CODTROL SBI UICI $,
InC.
December 29, 1983
Department of Health & Environmental Protection
825 L. Street
Anchorage, Ak. 99501
Attn: Robbie Robinson
On December 28, 1983 our c~any inspected the sewer system
located on South Park #1 Block 3, Lot 16.
All the standpipes are capped and protrude above ground level.
The finished grade looks good and surface drainage is away
from the septic system.
The well is a cc~munitywell and did not require our
inspection.
Approved by:
1200 LLJest 33rd Auenu¢, Suite [~ · Ancbracl¢, J~loska 99503 · (907) 276-1361