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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