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HomeMy WebLinkAboutSOUTHPARK #2 BLK 1 LT 3I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name le//V y�4::;114DISTANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address /690 21/Es�2r �vr ,Q �;- WELL �/��-,� /�iLJ / 7.� 7 260 / Phonate) 344-146,51�2 Permit No. `5 No. o edrooms LOT LINE /V 114 LEGAL DESCRIPTION Lot Block Sub /sryig�n/ OLL� FOUNDATION , / /v07� 'VIA Township. Range, Section AS -BUILT DIAGRAM driveway, water bodies, (Show location of well, etc.) septic system, property lines, foundation, TANKS SEPTIC ❑ HOLDING Manufacturer Capacity in gallons '� O Material 5 eel No. of Comp mems _ TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade FT e Total depth from origin/al grade / / FT ev \ 1 Fill added above original grade /U FT Gravel depth beneath pipe / FT Gravel length FT Gravel width _7a_ 2,7a FT Total absorption area// 11/0SQ FT Distance between line�As /` nn /�lf'f FT Number of lines I Soil rating Pipe material 5®SO FT Installe/r, Dale Install d �k+0 fV 966 y 2� �A WELLS ❑ PRIVATE ❑ OTHER (Identifv) Classification (A,B,C) Total Depth / Cased to v4 AFT cr REMARKS: 4 A'a , Municipal and State guidelines in ellllecttoonn Health Department Approval/ 72-073 (3/85)Alj, L'- ; va c. N / Z7 s actions PedoAr d by: Him / cre C Date: C o- r�u a s `. I y� r� Gehl ly hat this inspection was performed according to all Date SEAL \mJ ' �.x-- MUN I C I /oA! I l� Y DF� AmCH;��'AUE� L. Department of Health & Human Services �� B2i L Street, Anchorage, Alaska 99501 343 Permit Number: 900275 Date lssued: O9/07/90 Engineer D'ner KIN T. :SIACi Owner Address: 10021 ESHAMY DAY I)Rn ANCHORAGE, AK 995l5 SEWER PE�M�T � Unsigned Day Phone: 344-14U5 Parcel Id: 020-052-03 Lot Legal: Subdivision: SOUTHPARK 02 Lot: 3 Block: 1 Section; 3 Townshlp: 11N Range: 3W Lot Size 32631 (sq,[t, or acres) Max 8edrooms: This Permit: 6 Tota) Capacity: 6 sEPTIC TANK: Minimum total septic tank capacity: 1,750 gallons, Each septic Lank must have at least 2 compariments, Depth to top of septic tank(s) < 4"0 feet requires insulation over tank(s). IN�TA|L PER ENGINEERS APPROVED DESIGN. NOTIFY !}HHS PRIOR TO EA�H` I�SPECTION" MAINTAIN III IUMUM TO DWELLING AND yATER SEVlCE LINE" [HIS PERMIT IS ISSUED FOR THE PLANNED 6 RDRM SI�GL� FAMILY DWELLING oNLY AND EXPIRES ON 12/31/70. 1 CERTIFY THAT: 1. I am familiar with the reriuirements for on-site sewers and wells as set forth by the Municipality or Anchorage (MOA) and the State of Alaska. V. 1 will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerago system on this or any adjacent or nearby lot, 4, l undersLand that this permit is valid for a maximum of 6 bedrooms" l ��=n .'�dpr�t�:� that the capacity of the total system is 6 bedrooms and ---- _�--�--_- --- - ��` ���� � � any e l t il\ V requiren additional permit" Signed: DATU ----------- (Uw,'er) KIN Y HSIAO issued By: DATE: C @Vw'un & associates,inc. Consulting Engineers P.O. Box 230608 • Anchorage, Alaska 995230608 • (907) 279-8866 • FAX: (907) 2792882 August 31, 1990 Department of Health and Human Services OnSite Wastewater Department 825 L Street, 5th Floor Anchorage, Alaska 99501 SUBJECT: WATER MONIOTRING ON LOT 3, BLOCK 1, SOUTHPARK NO. 2 Ladies and Gentlemen: We performed a soils test on this property yesterday, August 30, 1990, and found another old test hole nomitoring tube within 25 feet of our test hole. This tube was monitored by us personally and we found the hole dry to a seventeen foot depth. Even though we installed a monitor tube in our test hole, we feel the moniotr in the adjacent hole is valid and we found no signs of any kind of groundwater in our test. M ,> I i sPrvri' rPs�/r� o/dr.HB, 9750�/v/, /Gr/LC s O FXiSf, SeurP/ 8000 sy, Pt Sew2� rere� � Dk 26 010-1) s�UrH/�42� Looe Ge, � r.,v. 112s7'q i/ 7G(i0"Tr��c` To fu / 65 c L o7- 2 GOT / 1_),e5 Al /o f3c%m. X150 5oi /= 900 p / NOTE: Y All Dimensions And Locations Must Be Field Verified Prior To Construction SEWER SYSTEM LOCATION PLAN LOT BLOCK SUBDIVISION y `asK� 3 / 5007HPAek-_ A/O. 2 `�'t SECTION/TOWNSHIP/RANGE SCALES q_ / MOTE. --- - !?P Tho Accuracy Of Location of Bxisiting And j s}g Proposed Property CAt rz, Nolls,. and Scptie DRAWN BY Bjc II -5 stems Indieatod Is Not-BNact. Dimensions " °'" NORTH Indleated Gave Soon Ootemined BY Use OC Cloth Tape a,W/or Nun Val Rceords. And Not By c � eop�® SurvcYiag Teehniqum PREPARED FOR- - - H �s �s %C/ SHEET. OF h".unicipa(ity. of.Ancttorage pEPARTh4ENT OF HEALTH & H(J1.4AN SE 't(3 ~^4"" 825'"L" Street, Anchorage, Alaska 9950265 SOILS LOG - PERCOLATION T 9 s =- ' � caS{I /V • �4 O J Ca: Pcr.Eoar.;[o EOR: ZO,7 L%t9C%C' Township, Range, Section LEGAL DESCRIPTION : ©YJJ �I P�/C- SLOPE SITE PLAN I 2- 3- 4- s- 6- 10- 11 34 s61011 12- 13 2 13 - :T 14 IS 16 17- is- 19- 20- COMMENTS 7181920 COMMENTS Tor-) 5p 6olel 51' �✓�UG�i't r/ -)w // WAS GROUND WATER , ENCOUNTERED? ,yp ATWHAT . O DEPT"? SL LCL_ P / E /(liar: /sre�! a�TiH. i3 Bepth to w9rt Rlfu Idae'.arinp? Bate 5M Reading Date Grdtt Net Depth to Net / �JJ Time Time Water Drop PERFORMED BY: -od( w " _ ori' ACCORDANCE WITH ALL STATE AND MUNICIPAL 72-008 (Rev. 4/65) PERCOLATION RATE (mintAeV",chA PERC HOLE DIAMETER TEST RUN BETWEEN FT AND -7--- 7a_ FT 7FFEETHtSDAXE. CERTOATS: `® • '� Municipality of Anchorage On -Site Water and Wastewater Program < y (907)343-7904 AUG 7 2. tjQJ^lo Certificate of On -Site Systems Approval Parcel LD. 020-D8 Expiration Date. � I 1. GENERAL INFORMATION Complete legal description SOUTHPARK #2 BLK 1 LT 3 Location (site address) 15820 SOUTHPARK LOOP Current Property owner(s) JULIE HYDE Mailing address Real Estate Agent MICHELLE NELSON 2. TYPE OF DWELLING: Ffl Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 6 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual ❑x Individual Water Storage ❑ Holding Tank ❑ Community Class A Well ® Community ❑ Public Water S%ictem ❑ Public Sewer ❑ WaiverNariance request for: NONE Received by: %, `!�Date: l �Z COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 oq& - Waiver Fee $ Date of Payment Y/711c/ Date of Payment Receipt Number loci cla6 Receipt Number COSA # &5(2441396 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm SPURKLAND ENGINEERING Address 203 W. 15TH AVE.,STE.202A, ANCHORAGE, AK 99501 Phone 279-3916 Engineer's Printed Name LARS SPURKLAND Date 8/6114 �a ti'"X\i •of• Atq 6. DSD SIGNATURE System #1 Approved for bedrooms en y PP 1.,..• J SPURKLAND;i,,, System #2 Approved for bedrooms tit Jj . 11)15 0 Disapproved 4 R,FOP� Conditional approval for bedrooms, with the following stIpl)12�ig�+FE By: 0. Original Certificate Date: 8 — 0C2 — / " The 4icip4e,nc r Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r , - If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: SOUTH PARK #2 BLK 1 LT 3 A. WELL DATA Well type A If A, B, or C provide PWSID # 213475 Date completed Sanitary seal (Y/N) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production _ g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Parcel ID: 020-491-10 Well Log (YIN) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 2000 gal. Number of Compartments Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 3/19114 Pumper ISAAC'S PUMPING C. ABSORPTION FIELD DATA ft. 1!J!W Date installed 10/2/90 Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 10/2190 Soil rating (g.p.d./ftz or fe/bdrm) 150 System type TRENCH Length 65 ft. Width 2.5 ft. Gravel below pipe 7 ft. Total depth 15 ft. Eff. absorption area 910 flz Monitoring tube Y Depression over field N Date of adequacy test 5/21/14 Results (Pass/Fail) PASS For 6 bedrooms Fluid depth in absorption field before test 32 in. Water added 910 gal. New depth 38 in. Elapsed Time: 15 min. Final fluid depth 33 in. Absorption rate >= 900 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date D. LIFT STATION Date installed "Pump on" level at _ Datum in. E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons "Pump off" level at _ Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? _ Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 51+ Water main 10+ Water service line 10+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10'+ Surface water 100'+ Curtain drain 50+ Wells on adjacent lots 200+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name LARS SPURKLAND Date 8/6/14 COSA brawn sheet -1 0-1 G-1 2.doc Absorption field 51+ Surface water 100'+ Water main 10'+ Driveway, parkingtvehide storage10 + �rc.�F• A�qs �l PURKLAND, 000 in. LOT 4 ................ ........... n JOHN D. YDEN 4�f LS— 28 L SOUTHPARKLOOP ro 1714 8-314,67 N86 -40'35"W 50.00 <V Y SLATE WQ v 1344 20 �y LOT '241 '.M�i; �o ,2 . r: .� o �: .EXISTING 2•s � a� HOUSE F S i \•� 6.41 m \yN N m LOT 3 m W BASKETBALL COURT c •r w N o y N D w On On LOT 1 4��4pfo NOTES: / LOT 12 a" a Qo sslo 'l %1.THIS SUBDIVISION IS SERVED BY A COMMUNITY WATER SYSTEM. 2.THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH. ORDEREDBY: MICHELLE NELSON WITH RE/MAX SURVEY CERTIFICATION: LCGLANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY OF THE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO LEGAL DESCRIPTION: AS -BUILT ENCROACHMENTS EXIST OTHER THAN NOTED. LOT 3, BLOCK 1, EXCLUSIONARY NOTE: IT IS THE OWNERS' RESPONSIBILITY TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, RESTRICTIONS OR RIGHT -0F -WAY SOUTHPARK SUBDIVISION ADD. NO.2 TAKINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION, FOR 2501'1 Street Anchorage, Alaska 99501 SEPTIC STANDPIPE WATER WELL ® OverheD9 ?- Asphalt FENCE —X—%— W°°d Deck '. Concrete..: Survey Departm1en Phone 562-529 t DRAWN DATE: 6/30/2014 WORK ORDER: 2014-L-95 DRAWN BY: MH PLAT: 83-213 Inc Mainline Phone 243--4985 CHECKED BY: TE GRID: 3236 Municipality of Anchorage Development Services Department �p Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING[ �, Parcel I.D. 020-052-03 HAA#j 4V909 & 1. GENERAL INFORMATION Expiration Date: (e - z 5 -- Complete legal description SOUTHPARK SUBDIVISION N2• Complete LOT 3 BLOCK 1. Community On-site ❑ Public Sewer Location (site address or directions) 15820 SOUTHPARK LOOP • ANCHORAGE, AK _99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address ROBERT & DIANNA PAXTON Day phone 563-5500 C/O CYNDIE PARTCH w/PRUDENTIAL JACK WHITE Day phone CYNDIE PARTCH w/PRUDENTIAL JACK WHITE Day phone 563-5500 3201 "C" STREET STE. 200 ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 6 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class "A" Well Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site to Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, inc. shall be paid 5635.00 at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines forthis application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 2B • ANCHORAGE. AK 99504 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, AWWC. Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is nor authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for rr,. bedrooms. Disapproved. Phone 337-6179 Date OZ Conditional approval for bedrooms, with the ftlowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other By: 2 �L �/— ct ! �� Original Certificate Date: (PC, 12Np .\X••• •'•;'O P. -* ON -511E WATER AND WASTEWATER PROGRAM -?.'--0� Municipality of Anchorage Development Services Department Building Safety Division O"Re Water & Wastewater Program 4700 South Bragaw Sl. P.O. Box 196650 Anchorage, AK 995196650 www.ci.enchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT 3, BLOCK 1 SOUTHPARK p2 Parcel ID: 020-052-03 A. WELL DATA wen type A Date completed Total depth ft. Date of test Static water level Well production If A, B, or C provide PWSID# _ Well Sanitary seal (Y/N) FROM WELL LOG WATER SAMPLE RESULTS: C S. SEPTIC/HOLDING TANK DATA ft. Nitrate mg./L. Collected by: properly protected (Y/N) Casing height (above ground) AT INSPECTION Other bacteria g.p.m. in. colonies/100 ml. Tank Type/Material STEEL Date installed 10-2-90 Tank size 2000 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 6/13/02 Pumper DENALI SEWER & DRAIN C. ABSORPTION FIELD DATA Date installed 10/02/90 Soil rating OE�Vbr ft%dnn) 150 System type DEEP TRENCH Length 65 ft. Width 2.5 A. Gravel below pipe 7 ft. Total depth 015.8 ft. Eft. absorption area910 ft' Monitoring tube YES Depression over field NO Date of adequacy test 4/21/01 Results (Pass/Feil) PASS For 6 bedrooms Fluid depth in absorption field before test 34.5 in. Water added 800 gal. New depth" in. in. Elapsed Time: 43 min. Final fluid depth 39.5 in. Absorption rate >= 900+ g,p,d. Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date E D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size In gallons Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankflift station on lot Absorption field on lot Public sewer main line High water alarm level at Meets alarm & circuit requirements? On adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water t 00'+ Wells on adjacent lots 900'+ 0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line UNK Surface water 100'+ Driveway, parking/vehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ /►rh F. COMMENTS y/ G. ENGINEER'S CERTIFICATION s�QF.. I certify that I have determined through field inspections and „?• ! o review of Municipal records that the above systems are in ' "' . • • • ' ""' ' • ' ..• • •' . conformance with MOA HAA guidelines in effect on this date. e r y A. orn 55: Engineer's Printed Na a JEFFREY A. GARNESS �f4� -795 A`f Date 619 Z pP ..... .... q� ®�n!O1ess (1, p HAA Fee $ ��� 7 Waiver Fee $ Date of Payment o ZD O L Date of Payment Receipt Number �%_ �'i� �J Receipt Number (Rev. 12100) Municipality of Anchorage Development Services Department Building Safely Division On -Site Water & Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.d.enchorage.akus (907) 3437904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-052-03 HAA# PA 010 ! $ b 1. GENERAL INFORMATION Expiration Date: O a_ 2. Completelegal description SOUTHPARK SUBDMSION f2: LOT 3. BLOCK 1. Location (site address or directions) 15820 SOUTHPARK LOOP + ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address KIN SHAW Day phone 345-9617 c/o JIM EWING w/ COLDWELL BANKER • Day phone JIM EWING w/ COLDWELL- BANKER Day phone 265-9147 2525 "Co STREET SUfrE 100 + ANCHORAGE. AK 99503 Unless otherwise requested, NAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 6 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank. a Community Ctass_g_Well 0 Community On-site Public Water System - ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of titre (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for mors or omissions in the professional engineers work Note: Alaska Water and Wastewater Consultants, Ina shall be paid $810.00 a4 or prior to dosing for the englneedng services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As cwtified by my sed affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Autho*Approval Guidelines for this application, shows that the on-site wafer supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Munldpallty ofAnchonsge files and from my Investigation and Inspection, ire on-site wafer supplyand(or wastewater disposal system Is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Firm ALASKA WATER k WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 2B • ANCHORAGE, AK 99504 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: " ..... in ovnductinp Rds evaNetian, AwvvC, khc. attempted ho provk/e a thorough, conscientious engkaedng analysts of the system In accordance wM ADEC and M04 DSD Guldskm 6 Regulations The reported re9ufts described the pwfbm nce of the ---system under the conditions wwountersd at the time of the test and sepamdon - - distances measured W readW IdentiRable badues. The operational Fie of of wells and septic systems depend on the local sofa aondftion, grarndwaterlevels tat xray, .. fluctuate during the year, and the wamrusage of tis famfybakV served by Ow system. These conditions aro outside the control of fire evaluator of ft system. Satisfactory east results do not guarantee fuMe peftmance of Che system, nor do tayguarantes that _ tare are no Mdden defects or ammadhments. AMW, I= can therefore not provide any warranty or Adure estimate of how hong Me system will continue to meet to opera tonal requirements of the ADEC or MOA DSD. The content of this report is for — ` the sole beneft of Bre owner Fsted above. Any reftwe upon or use of ills report by any oder person or party Is not sutiwrized, nor will it aonlersWlegal right whatsoever. 5. DSD SIGNATURE Lf Approved for �_ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing Phone 337-6179 Date +Lulol % i ON-SITE WATER AND _ WASTEWATER : hulatloDs PROGRAM : Attachments: HAA Checklisty Manitenance Agreements Septic System Advisory Supplemental Engineers Reort Well Flow Advisory . Other By- 4 ZZI Original Certificate Date: .S' QtW. Inco) . Municipality of Anchorage • Development Services Department BWk ft Safety DIvISIM a . • . . On -M water 6 wastewater Program 47W South Bragaw SL P.O. Boz 1966.0 Andwrage, AK 9951118650 wwmd.onchorage.ak.ua (907)943-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT 3. BLOCK 1 SOUTHPARK #2 Parcel ID: 020-052-03 A. WELL DATA well type _A If A. B. or C provide PWSID# _ wen Date completed Sanitary seal (Y/N) res properly protected (YIN) Total depth R R Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level R Well production 9 -p.m — g -p.m -WATER SAMPLE :RESULTS:Conform ml. Nitrate nVA- Other bacteria colonles/100 ml. Date e: Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Materkd STEEL Date installed 10-2-90 Tank size 2000 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 4/20/01 Pumper - DENALI C. ABSORPTION FIELD DATA PBELOW OWE 0 10 Data installed 10/02/90 Son rating .p.d fe/bdrm) t 50 System type DEEP TRENCH Length 65 it. Width 2.5 fL Gravel below pipe ---!--fL Total depth •r as ft. Elfabsorption area 910 fe Monito ft tube YES Depression over tisk! NO Data of adequacy test 4/21/01 Results (Pass/Fall) PASS For 6 bedrooms Fluid depth in absorption field before lest 34.5 In. Water added 800 gel, New depth44 in. Elapsed Time:43 min. Final fluid depth 39.5 In. Absorption rate >w 900+ g,p.d. Any m)uvenation treatment (past 12 mo.) (YIN 8 type) NONE KNOWN H yes, glue date - D. UFT STATION Dateinstaoed Sizeln gaoons 'Pump on' level at n. High water alarm level at in. Cycles Meets atann 6 circuit requirements?_ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot Absorption field on lot Public sewer main nne On adjacent lots Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIVHOLDING TANK ON LOT TO: Building foundation 50+ Property line 5'+ Absorption Held 5'+ Water main 10'+ Water service one 1 O'+ Surface water 100'+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property one 10'+ Building foundation 10'+ Water main 10'+ Water service ane UNK Surface water 100'+ Driveway, paridng/vehicle storage 10'+ Curtain drain NONE KNOWN Welts on adjacent lots ZOO'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I cer* that I have determined through field lespedions and review of Municipal records that the above systems are In conformance with MOA HAA guidelines in effect on this date. Engineersme JEFFREY A GARNESS Date T! `4 0 HAA Fee $ 3Un • C,)n Date of Payment 6-9-61 Receipt Number 37&3 Sm. UAol Waiver Fee S Date of Payment Receipt Number ✓ter -. ':- _ ; - P., g 5OL TNYAIZK 5U13D. ADD. No. 2 a -001 LOT 3 BLOCK I e BAY F. SSM•f I i AS13UILT 1 herehy rerlify that.l have surveyed f the property clepicled alxwe and that f CASTAIDI LA D SURMING n., encroachments exist oxcxpt as indl- 1 Jeff A. Cas aldi,R.L.S, ealnd. 71 Is the responsibility of the, - 3030 Bottle. bay Long rnntrr to de'Lenntne Up.- existence of any Anchorage, Alaska 99515 oeae!ment s, covenanLs or tant.rlctions Tel. 907-311-4272 which do not appear on the recorded sulxllvision plat. Mier m circirnstan } CRID DAT£construction coos sttamld any data tmeteon Ime used for 0236 or for Fstablishiny boun- �0-6 �1 ciary or fence lines. P.b. JUb NA3IDRMT REUMVIN, DIMRICr, Ar.ASRA F. SSM•f I i