HomeMy WebLinkAboutSOUTHPARK #2 BLK 1 LT 6AMunicipality of Anchorage
Development Services Department
Building Safety Division
4
On -Site Water & Wastewater Program, 4700 South Bragaw St.
S" I V
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number SW030285 PID Number 020-052-93
Name: GEORGENE STILLINGS
Wastewater System: 0 New 0 Upgrcde
Address:
15740 SOUTHPARK LOOP
ABSORPTION FIELD,,�-'
Phone: No. of Bedrooms:
(907) 348-0345 4
OlDeep Trench OShollow Trench DBod ClMoun�� 0 Other
LEGAL DESCRIPTION
Sall Rating:
I grade,
WDISq.
N (7.) ,-' FL
Block: Lot. Suhtlivision:
Depth to pipe bottom from ofi lrwL q(\-
9 ',�\
�� depth beneath pipe:
1 6A SOUTHPARK #2
FL
Township: Range: Section:
Fill added above original
Gnniol longth:
Ft.
FL
WELL: 0 New [3 Upgrade
cruvol wift:
Nwmbor of Kinow:
Difftonce between Knorr:
FL
FL
Cloweincotion (Prtmte. A.B.C):
to
Total Depth:
Coved TO:
-raw
Plpo material:
*COMMUNITY WATER
Ft
SO. Ft.
Driller.
DMW:
Statla Water L":
linotoller. DENALI SEWER AND
Date Inertalled:
Ft.
DRAIN CONSTRUCTION
7/31/2003
YWW
I Pump Sot ft
I
Cooing Height &*%,@ Cround:
TANK
GPM
rL
FL
SEPARATION
DISTANCES
N Septic 0 Holding 0 S.T.E.P. 0 Other
To
Septic
AbsoTdtion
Uft
Holding
Publ1c/Pr%rat*
monwfocb�.
ANCHORAGE TANK
cap" In golione:
1500
From
Tank
File
Station
Tank
Sourec Un"
Well
200'+
—
25'+
material:
STEEL/ DEEP BURIAL
Number of compartirronts:
2
Surface Water
100'+
—
—
LIFT STATION
Lot Una
5'+
—
31to In gallons:
I
Foundation
5'+
—
_'F� 'On Wei at:
ump aL
lHigh water alarm at:
Curtain Drain
NO I NE KNOW4
I
10ectrical Inspections performed br.
Remarks: OLD SEPTIC TANK WAS ABANDONED PER
BENCH MARK
Location onrl Description:
THE UPC
LEFr SIDE, BOTTOM STEP ON STAIRS
Assumed Elevation:- 100.00
Ft
ENGINEE SEAL
L F
Inspections performed by: AKWWC, INC. Dates: ist 7/31/2003
...... .......... V,
2nd
t
3rd
... . . ........ ......... P
Je e Go ess!
Development Sjr'�ices Department Approval
N
Reviewed and appiroved by: Date: '9LZI/07
V ........
1�il
(RW. 12/01) -�YF I
of esslol\
I
10
PERMIT NUMBER:
SW030285
AS
-BUILT DRAWING
PARCEL ID NUMBER:
020-052-93
SOUTHPARK S/D J2.
SOUTHPARK S/D 12;
LOT 12.
BLOCK 1;
LOT 4. BLOCK 2;
SOUTHPARK S/D j2:
LOT 11. BLOCK 1;
1505�10
FCO
SOUTHPARK S/D #2;
LOT 1. BLOCK 1;
DBLI STJ B
A -TB
DBL2
ST1
46.36 14.54
NEW 1500
ST2
51.79 20.21
GALLON DEEP
DBLI
53.98 23.00
BURIAL TANK.
NG
D81-2
54.39 23.35
DRAINnELD
ALL RESIDENCES IN THIS
AREA ARE SERVED BY A
SOUTHPARK S/D f2;
COMMUNITY WATER SYSTEM.
LOT 2. BLOCK 1;
SOUTHPARK S/D #2;
LOT 5A, BLOCK 1;
S10VTHPARK S/D 02;
LOT 3. BLOCK 1.
8/13/2003
DRAWN BY.
AIASKA NVATER & WASTE NVATER SCALE, N.C.H.
-- CONSULTANTS, INC.— . ... ...... ......
3701 F, TUDOR ROAD. SUITE 101 - ANCHORAGE. AK 99507 - PHONE (907)337-6179 - FAX (907)338-321.6 1" = 50'
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
GEORGENE STILLINGS (907) 348-0345 1 3 OF 3 ..J ff y . Go . rn . es
LEGAL DESCRIPTION:
SOUTH PARK SUBDIVISION #2; LOT 6A, BLOCK 1;
TYPE OF WORK: Pro f e3slo G\
SEPTIC TANK UPGRADE 11
PERMrT NUM13ER: PARCEL ID NUMBER:
SWO30285 AS -BUILT DRAWING 020-052-93 1
FINAL GRADE
101.69(AVG)
TOP OF TAW STI
AT INLET - ag.42 f
NEW 1500 GALLON
INVERT OF BUNG DEEP BURIAL
AT INLET - 88.57 11 SEPTIC TANK
— TOP OF TANK
AT OUTLET - 89.41
\� INVEKr OF BUNG
AT OUTLET - 88.62
8/13/2003
As�
BRAWN BY:
N.C.H.
AIASKA WATEA R & NVASTENVATER
SCALE:
CONSULTANTS, INC. �
N.T.S.
. .. . ..... ...........
3701 F. TUDOR ROAD. SUITE 101 - ANCHORAGE, AK 99507 - PHONE (907)157-6179 - FAX (907)338-321-6
. . ..... ..........
PREPARED FOR: PHONE NUMBER:
PAGE NUMBER:
GEORGENE STILLINGS (907) 348-0320
1 3 OF 3
e r A. 0 ness.:
LEGAL DESCRIP'TION;
SOUTH PARK SUBDIVISION #2; LOT 6A. BLOCK 1;
. . .....
Pr SsjOf%
TYPE OF WORK:
AS -BUILT OF SEPTIC TANK UPGRADE
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water& Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-66,50
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Aug 01, 2003
Expiration Date: Jul 31, 2004
Permit Number: SW030285 Parcel ID: 020-052-93
Legal Description:": SOUTHPARK #2 BLK I LT, 6A
Design Engineer: 0041 AK Water & Wastewater Consultan' Site Address: 015740 SOUTHPARK LOOP
Owner Name: Georgene Stillings Lot Size: 28950 SQ. FT.
Owner Address: 15740SOUTHPARK LOOP Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE. AK 99516-4849
This permit is for the construction of:
n Disposal Field E Septic Tank Holding Tank E] Privy Private Well Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: 'Z'1 -0-3
Date: PZ1 L03
Municipality of Anchorage
Development Services Department
all
Building Safety Division
On -Site Water & Wastewater Program S A
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-052-93 PermitNumber 24 -.,6302,95 -
Property owner(s) GEORGENE STILLINGS Dayphone (907) 348-0345
Mailing address (1) 15740 SOUTHPARK LOOP ANCHORAGE, ALASKA
Mailing address (2)
Zip Code 99516
Legal description (Lot, Block & Sub'd.) SOUTH PARK SURDIVISION #2a LOT 6A_ BLOCK 11 -
Legal description (Section, Township & Range) N/A
Lot Size 0.66 / 28950 Acres/Sq.Ft. Number of Bedrooms 4
THIS APPLICATION IS FOR:
Sewer Only 0 Well Only
Sewer and Well El Water Storage
Sewer Upgrade 0
THIS PROPERTY CONTAINS:
Hot Tub El Jacuzzi E]
Swimming Pool El Water Softening Unit
Therapy Pool El
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
ALASKA WATER & wASTEwATER CONSULTANTS, INC.
(Signature ef prepefty ewnef of authefized egen!)-
Permit Fees: � Lko 0 - —
Date of Payment: 130. 0a
ReceiptNumber _393519
Waiver Fees7
Date of Payment:
Receipt Number:
AILASKA WAYER 4& WASYEWAYER
CaNSULTANTS, INC.
July 29, 2003
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref. Septic Tank Upgrade ror Lot 6A, Block 1, South Park Subdivision #2
To whom it may concern:
The existing 4 bedroom house is served by a community water system and a private septic
system that consists of a 1500 gallon septic tank and a trench type drainfield. The septic tank
has collapsed and needs to be upgraded as soon as possible due to the health hazard.
We propose to excavate, pump, crush, and abandon the existing septic tank and replace it with a
new 1500 gallon deep burial septic tank in the same area. Double cleanouts are to be installed
after the new tank. We request that you issue a expedited permit due to the health hazard.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance. 11A �
P.E., M.S.
3701 East Tudor Road, Suite 10 1 * Anchorage, Alaska 99507
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Wcbsitc: akwwc.com
SOLITHPARK S/D 12:
S/D 13;
LOT 10.
BLOCK
I ;
A�
SOUTHPARK S/D 12;
LOT 13. BLOCK 1;
SOLITHPARK S/D #2;
LOT 11, BLOCK 1;
---------------
VjpARK S/D
LOT 6. BLOCY-
----------------
SOUIHPARK S/D #2;
LOT 1. BL6CK 1:
SOLITHPARK S/D 12; 1
LOT 2. BLOCK 1. 1
SOLITHPARK S/D 12;
LOT 3. BLOCK 1;
SOUTHPARK S/D 12;
LOT 5. BLOCK 2; /
SOLITHPARK S/D 12;
LOT SA, BLOCK I.-
SOLITHPARK S/O 12 -
LOT 4. BLOCK 2: '
0�
Iq Its'
I It I
SO
J?j
10
SOUTHPARK S/D; LOT SOUTHPARK S/D;
4. BLOCK 2: LOT S. BLOCK 2;
k-%
ou
SOUTHP, 12��
2T
kRK S/D 121 je
4q
LOT 6. BLOCK 2 1 1 IV
7/29/03
DRAWN BY:
ALAS IU WATE R & WAS TIE WATER SCALE. B.S.G.
CONSULTANTS�JNC.w 91
�Al C Vfl�AO DAAn C111TO [Al * AMrWAQArV AW 00�Al V DWAMP IOR7)XAI�170 * CAV 10nl%l%l-%I!A 1 = 100,
GEORGENE STILLINGS (907) 348-0345 1 1 OF 2
LEGAL DESCRIPTION:
SOUTH PARK SUBDIVISION #2; LOT 6A, BLOCK 1;
TYPE OF WORK:
1001 SCALE SITE PLAN
ISOLITHPARK S/O 11
LOT 12. BLOCK 2;
. ........
.. ........
0
I y orn ss.:
Pro
SOUTHPARK S/D 12;
LOT 12. BLOCK 1:
SOUTHPARK S/D 12; X
LOT 11. BLOCK 1;
SOUTHPARK S/D 12;
LOT 1, BLOCK 1;
SOUTHPARK S/D 12;
LOT 2, BLOCK 11;
SOUTHPARK S/D #2;
LOT 3. BLOCK 1;
'p'!%
rb T ,
114w -o .
1100.0
xy / N \ \ \ \
-THIS 1500 CALLON TANK IS COLLAPSED
AND MUST REPLACED. WE PROPOSE TO
ABANDON THIS TANK PER THE U.P.C.
REQUIREMENTS. AND REPLACE IT WITH A
NEW 1500 CALLON DEEP BURIAL TANK.
SOUTHPARK S/D 12;
LOT 6A, BLOCK 1:
7ALL RESIDENCES IN THIS
AR�EA ARE SERVED BY A
COMMUNITY W ER SYSTEM.
SOUTHPARK S/D 12;
LOT 5A, BLOCK I;
AlAS FA WATE R & WASTEWATER
_ _ SULTANTS, INC.
3701 F. TUDOR ROAD, SUITE 101 - ANCHORAGE. AK 99507 - PHONE (907)337-6179 - FAX (q07)338-324
PREPARED FOR: PHONE NUMBER:
GEORGENE STILLINGS (907) 348-0345
LEGAL DESCRIPTION:
SOUTH PARK SUBDIVISION #2; LOT 6A, BLOCK 1;
TYPE OF WORK:
COLLAPSED SEPTIC TANK UPGRADE
DATE:
7/28/03
DRAWN BY:
B.S.G.
SCALE:
1 9, = 50
PACE NUMBER:
2 OF 2
SOUTHPARK S/D 12:
LOT 4. CLOCK 2; 1
leU. *6 Urn ss. -
A.
—795
. .........
t-cr
'%
roless"Of'o
MUNICIPALITY OF ANCHORAGE
DE, tTMENT OF HEALTH AND HUMAN SERI -S <
Environmental Health Division
825 1" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
A(2 Ic
DISTANCES
To
SEPTIC
TANK
ABSORPTION
FIELD
WELL
Address
c +L.
�/o 4, L�. Is t' -Ave I Co
WELL
rl In 0 -t-
loo+
Phone(s) Per. t No. of .,...a
LOT
LOT LINE
Lck
LEGAL DESCRIPTION
Lot
Block
S�dZn
PISOffe, Ao(),,)+Q-
FOUNDATION
,
t 'L ��
'2' -
Township, Range, Section
AS -BUILT DIAGRAM (Show location of welp.
driveway, water bodies. etc
septic system,
property lines,
foundation,
TANKS
14 SEPTIC 0 HOLDING
Mennen,.
Capacity in gallons
IS00
MaterialQ
No, of CoTments
TYPE OF SYSTEM
PXTRENCH El BED El W. DRAIN El OTHER
Depth to pipe bottom from
org'na'gr8'e FT
Total depth from original grade
FT
F4 it -�w
()C
Ti
Uai
MALD)
Ir-_
iganal grade
Fro added above 0,$
FT
Gravel depth beneath pipe
6 FT
Gravel engib
FT
Gravel width
FT
Total absorption area
S60 SO FT
Distance between iines
WA FT
N.mber of Mes
Sail rating
SO IT
Pipe material
PVC�OZCJ�
Installer
Date installed
WELLS
-4
301
Ve
zil� 11
P(/1
I
0 PRIVATE OTHER (identify)
Classification (A,B,C)
I -A&5,A
_+
real Depth
FTI
Cased to
FT
Instaloi
at. installed
r
REMARKS:
—
::
/
L
Apot-n
I
I
MA N) J:�
Scale:
_)p'�, y,r)Zby
in)/
4'��
;*: 4 T
to
0
William
CE
fill
H
T. awle
- 7 4 8
or ...... a
0
17
Dale
Au c- I Lf ,6V?
1 VoL 1 /W20Z4� certify that this
inspection was performed according to all
Municipal and Slate guidelines n effect this date: -Air] C'bgl� -1
Health Department Approval; �L4�z- xj
—Date:
72-013 (3/85)
H-v IJA 4- �VFZ���
TME:NT �'.�' XEALT: AND ENVIRONMENTAL ROTECT7ON
. 825 L F"ITF�6ET, ANCHORAGE, �1 V95O:1.
264-4720
C m ~~
FIN_10 1.'1 El 103 ET Am 1HE T& 12, NEE 10 01 X v
PERMT 1 NO: 87015R VPGRADE
DATE ISSUED: 07/02/87
�
APPLICANT: MARK ECK / W.T. HAWLEY PE
A�DRE8S: 3941 TWILIGUN LN.
fINCKORA3E, AK 99516
�
LAGAL DESCRAP: 3U8DIVI5ION: SOUTMPARK 42 LOT: 6A BLOCK: l �
SECTION: 3 TOWNSHIP: 11N RANGE: 3W
[AT SIZE:. D�32 (CQ.FT. OR ACI ES>
I certify that: �
�
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska"
2, l will install Lhe system in accordanrs with all MOA codes and regulations,
an& in with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the se{ back
distances From any existing well, wastewater disposal system sr pub1ic
sewerage system on this or any adjacent or nearby lot.
�
IF A LIFT STATIDW IS TNSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, �
THEN (1) Am ELECTRICAL p[RMI! (HAD INSPECTION MUST BE ODTAINED; (2) 4R-8UIL00 �
11ILL mOT DE APPROVED WITHOiVT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECITACAL Wom MUST BF DTUINCENSEA) ELECTRICIAN.
SIGNED 3ATE:
Azi�oe��/,x������ ...
��FLIC4mT: MA��( N
�S3UED }�Y ` DATE: �
��_--.--_'____-
,
MAI �It IFAI f I T Ur AN�,�U.GL
July 1, 1987
ADVENT ENGINEERING
3941 TWILIGHT LANE
ANCHORAGE,AK 99516
1 -345-7556 243-7782
Mr. Steve Morris
Municipality of Anchorage
Department of Health & Human Services
825 L Street -
Anchorage, Alaska 99502
RE: Lot 6A, Block 1, Southpark Addition *2
Dear Mr. Morris:
The owner of the above referenced property desires to upgrade his septic
system to a four bedroom system.
The system was installed in 1985, and has never been used. Originally, the
absorption system was sized for four bedrooms, as shown on the attached
inspection report.
The owner desires to remove the existing 1000 gallon septic tank and replace
it with a 1250 gallon tank.
The proposed upgrade may be performed without violating any separation
distance requirements, replacement areas for future use are also available
Replacement area is shown on the attached As -Built.
The property is served by the Southpark Terrace Community Water System.
Please consider this request for an upgrade permit as soon as possible. The
owner desires to perform the construction work this week.
If you need further information, Please call me at 561-1345.
- Sincerely,
William T. Hawli y E.
Attachments:
4P
V \ -
-7
a
I-
N
I
OC) (2
wj(5_r� Q(_SPoSAC_
-2
OF A�,,%jt
IM01 fit I . . . . . . .
T H
..............
AS
It is the . responsibility of the owner to determine es arl Dowling
the existence of any easements, covenants r re- 15
�ro ...........
strictions which do� not appear on the rec ded sub-
division plat. Under no circumstances should any , RE
NOTE
_V —
data hereon be used for construction or for estab- ASEmENTS OF CORD,OTH
veyor takes SHOWN ON THE RECORDED PLAT, ARE NOT
lishing boundary or fence lines. The sur SHOWN HEREON.
responsibility for the initial tra nsaction only.
LEGEND
LOT 6A BLOCK I &BRASS CAP MONUMENT
8 0 IRON PIPE
LAT NO. /0,9 0 - REBAR PROP COR.FND
ANCHORAGE RECORDING D151RICT 0 HUB 6 TACK
DREPARIEDIBY: DOWLIN(i 6 ASSOCIATES
1426 HYDEfl STREET BY
ANCHORAGE ALASKA 99501 VISION
Rf( ORDER: FIELD BOOK:
DATE'. BYV SCALE: 4�0, Wo
0-
-7
a
I-
N
I
OC) (2
wj(5_r� Q(_SPoSAC_
-2
OF A�,,%jt
IM01 fit I . . . . . . .
T H
..............
AS
It is the . responsibility of the owner to determine es arl Dowling
the existence of any easements, covenants r re- 15
�ro ...........
strictions which do� not appear on the rec ded sub-
division plat. Under no circumstances should any , RE
NOTE
_V —
data hereon be used for construction or for estab- ASEmENTS OF CORD,OTH
veyor takes SHOWN ON THE RECORDED PLAT, ARE NOT
lishing boundary or fence lines. The sur SHOWN HEREON.
responsibility for the initial tra nsaction only.
LEGEND
LOT 6A BLOCK I &BRASS CAP MONUMENT
8 0 IRON PIPE
LAT NO. /0,9 0 - REBAR PROP COR.FND
ANCHORAGE RECORDING D151RICT 0 HUB 6 TACK
DREPARIEDIBY: DOWLIN(i 6 ASSOCIATES
1426 HYDEfl STREET BY
ANCHORAGE ALASKA 99501 VISION
Rf( ORDER: FIELD BOOK:
DATE'. BYV SCALE: 4�0, Wo
MUNICIPALITY OF ANCHORAGE
Di TMENT OF HEALTH AND HUMAN SEF% _;S
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name stice-
69il LAKil�75 /7- r -A X
DISTANCES
SEPTIC
TANK
ABSORPTION
FIELD
WELL
Address
?00 60. AL- &0'7
WELL
21 f+
zex> I +
Phone(s) Permit No No of Bedrooms
-344-0goo 1 1 3 z _ _611'11T
LEGAL DESCRIPTION
LINE
55,
4-3'
Lot
Block
Subd ... s,on
:50UT_1jPAj2K_ ifz
FOUNDATION
0_7
Township, Range, Section
-7rim'i i 93vvj "54FC, 3", j SM
AS -BUILT DIAGRAM (Show location of well. septic system, property lines, foundation,
driveway. water bodies, etc I
TANKS
SEPTIC El HOLDING
Manumil
Capacity in gallons
00 C)
I N
1
Material
No of Compartments
TYPE OF SYSTEM
XTRENCH El BED L1 W. DRAIN MOTHER
Depth to pipe bottom from
original grade 5- 7 FT
Total depth from original grade
// - FT
Fill added above original grade
—1 FT
Gravel depth beneath pipe
FT
0 " FT
Graviel width
_*59 —,I FT
C
Ll
C
L'T_
1 .3
T.1al absmipumn area I
, SO FTI
Distance between lines
FT
�C_10
L '51 �elsl
0'��L..s=Pr;?4rWK
P1
'e �
-m
�6
T -o
l
Number of lines
Sod rating
SO FT
Pipe material
P VC
Installer I
ZV57-.
Date Installed
0&r. '7, 1138!9-
�_Ba 7
ad
PFz
WELLS
A
/
[I PRIVATE El OTHER (Identifv)
-5 rat
11
ED
TV
(AWE
Classification A,B.C)
C&A S5 A
Total Depth
Cased to
I FT
Insalle,
AfrACACED Le-TTFle
Date Installed.
F/20/0 A C>G��C,
REMARKS:
Scale -
In ns Perfor-TV by
Do
spe'/1
Z
a
dw
V
Date.
J
certify that this
inspection was performed according to all
Municipal and State guidelines in enect on (his date:(/
Health Department Approval:
Date:
72-013 (3/85)
�l L; 0 �,U :1 C-', 1. F-�' L .... ��� C3 F-:,-. ����0-�C-3 F-z.�as��E�
DEPARTMENT OF HEALTH AND UNVIRONMENTAL PROTECTION
825 LSTREET, ANCHORAGE, AK 99501
. 264-472O
�IINA_�1 -F" ILE-' E3 IFZ LNJ FE F:z. �FEE- ����' 11-
PERMIT NO: 850610
DATE ISSUED: 09/20/05
APPLICANT: GREAT LAKES CONSTR
ADDRESS: 200 W 34TH SUITE 607
ANCHORAGE, AK 99503
CONTACT PHONE: 344-0880 �
LEG8L DESCRIP: SUBDIVISION: SOUTH PARK #2
SECTION: 3 TOWNSHIP: 11N
LOT
SIZE. 2D932 (SQ,FT.-OFR AGRES>
MAX BEDROOMS: 3
LOT: 6
RANGE: 3N
BLOCK: 1
Listed below are the options available to
**
you in designing
your septic
system. Choose the opt ion
that best f its
your site"
��IF!--. NEI C:, 11-4
13 FE, U.�
W 1), v< 0-4 X lr�-u
DEPTH TD PI PE BOTTOM (FT")
4"0
5"5
4^0
GRAVEL DEPTH (FT.>
7,0
0"5
3"5
TOTAL DEPTH (FT"
11.0
6"0
7.5
GRAVEL WIDTH (FT")
2"5
14^0
5.0
GRAVEL LENGTH (FT.)
22.0
28,0
33"0
GRAVEL VOLUME (CU"YDS^>
15.3
14.6
24"5
TANK SIZE (GALS)
1,000"0 **
1,000.0 **
1,000^0 **
SOIL RATING (Sg,FT. /BR)
'
99
85
100
TANK MUST HAVE Al LEAST TWO COMPARTMENTS
'
/
cs,rti[y that: '
1, I am familiar with the requirements for on-site sewers and wells as set
IForth by the Municipality of Anchorage (MOA) and the State of Alaska"
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the desigh criteria of thispermit"
3" I will adh(---re to all MOA and State of Alaska requ`irements for the set hack
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4" I understand that this permit is valid for a maximum of 3 bedrooms and
any enlargement will require an additional permit"
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, �
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS~BUILTS,
�
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT" AND (3) THE �
ELECTRICAL WORK M SED ELECTRICIAN" �
�
5DATE:
-7��---------xp -=----�---�---_-- -r�7�--�+------- �
4PpLICHNT: G�EAT LAKES CONST��
�
ISSVED BY DATE: 7
........... ......________________
'
1
4 1
Gross
Ti me
Net
Time
2
Ez
0 SOILS LOG
H
3
MUNICIPALITY OF ANCHORAGE
DEPARTMENT
OF HEALTH AND ENVIRONMENTAL PROTECTION
0 PERCOLATION
TQACE 6ILT-
TEST
I
I
825 L. Street, Anchorage, Alaska 99501 264-4720
6-
SOILS LOG PERCOLATION TEST
7-
"C—_ 7-
�A kE-5 rt -91V-, T, PERFORMED:.
OCZ: 5-,
PERFORMED FOR:
6�
—DATE
LEGAL DESCRIPTION: 56y
n4
FA R/<
VfCL_L 6?R,0`,DIF- D
10-f
�I PTY
'FFEnE�
6r2AVELS
SLOPE SITE PLAN
11
-P I
A
F-1- TT -T-1 I I t I I
I 1A I I
1
4 1
Gross
Ti me
Net
Time
2
Ez
a
H
3
-00
�1
15AYl 0 1 C-) 12PV0
4-
TQACE 6ILT-
5-'
I
I
6-
7-
6�
VfCL_L 6?R,0`,DIF- D
10-f
6r2AVELS
11
12
-
13-
14-1
15-0
-
16-
17
BOT -1—o" OP
'Tr=7'5'r 14 0 L C-
12801
19
Feom -5-1 4
PERFORMED BY;
72-008 (6/79)
j
f
L- H%K
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
31
Reading
Date
Gross
Ti me
Net
Time
Depth to
Water
Net
Drop
I
I
I
PERCOLATION RATE
TEST RUN BETWEEN
1 11 �j ", _/
CERTIFIED
I
DATE:__J9C,/ �4
I
�S LOG
MUNICIPALITY OF ANCHORAGE
e 0 PERCOLATION
Aw x DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: DATE PERFORMED
LEGAL DESCRIPTION: &12 15 If L � 3 y �
1. — / SLOPE SITE P7LAN
1
2
3
4
5
6
7
8 -
9-
10-
11
12-
13
14
15
C, W
I Y-�0 qv -6")0'-S
'�s P WAS GROUND WATER S
ENCOUNTEREY? NO L
0
P
Qlbir YYN IF YES, AT WHAT
DEPTH?
16
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
17
'w C-1 .0
?T
18
19
b
�my
2014lb
No,
Id, Jr.
IIE .
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN
— FT AND
(minutes/inch)
— FT
v, S 1"
COMMENTS—
cv 15-o nAg, -1C.,
PERFORMED BY; CERTIFIED BY: DATE: Z/- (3--3
72�008 (6/79)
Municipality of Anchorage
A r r Y
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 020-491-13 Expiration Date: Is—
1. GENERAL INFORMATION
Complete legal description Southpark #2, Block 1, Lot 6A
Location (site address) 15740 South park Lp.
Current Property owner(s) Williams & Georgene StillingS Day phone
Mailing address
Real Estate Agent
15740 Southpark Lp.
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
F] Duplex
El Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well F-1 Individual .7
Individual Water Storage El Holding Tank El
Community Class 'A' Well El Community El
Public Water System L -i Public Sewer
WaiverNariance request for: -Distance:
Received by: Date:
COSA to be released to the� engineer, unless otherwise requested by the engineer.
COSA Fee $ 1�qo— Waiver Fee $
Date of Payment si 1�-Iib LL:' Date of Payment
Receipt Number Receipt Number
COSA # C::,,�C
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 Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
_�_�Systern #1 Approved for bedrooms
System #2 Approved for — bedrooms
Disapproved
Date 8/13/13
Conditional approval for _ bedrooms, with the following stipulations:
By: 04 Z2�:t Original Certificate Date: 9 - a DL_ / ?
The 106epalgrrM_"'� ge Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska, The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAblue.heet E - , c
If more than I septic system is on the lot:
COSA Checklist# -L_of
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: Southpark #2, Block 1, Lot 6A Parcel ID:020-491-13
A. WELL DATA
Well type Class 'A'
Date completed _
Total depth ft.
Date of test
Static water level
Well production
WATER SA7M�P�LE,
Colifor colol
If A, 6, or C provide PWSID # 211091 Well Log (Y/N)
Sanitary sea[ (Y/N) Wires properly protected (Y/N)
Cased to ft. Casing height (above ground) in.
FROM WELL LOG
TS:
11t
g.p.m.
mL Nitrate — mg/L
ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tanksize 1,500 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y
Date of pumping 7/20/13
ft.
9 -P.M.
Date installed 7/31/03
Cleanouts (Y/N) Y
Depression over tank (Y/N) N High water alarm (Y/N) N
— Pumper Northland Pumping Service
C. ABSORPTION FIELD DATA
Date installed 8/14/87 Soil rating (g.p.d.e or ft2/bdrm) 85 SF/BR System type Deep Trench
Length 30 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth 12, 1 ft. Eff. absorption area 360 ft2 Y N
Monitoring tube Depression over field —
Date of adequacy test 8/9/13 Results (Pass/Fall) Pass For 4 bedrooms
Fluid depth in absorption field before test 15 in. Water added 624 gal. New depth -7 in.
Elapsed Time: 410 min. Final fluid depth J*!F 15 in. Absorption rate , 60+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
— Sizeingallons_
in. "Pump off"Ievel at
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
Cycles tested
Animal containment areas
SEPTIC/HOLDING TANK ON LOT TO:
in.
Manhole/Access (Y/N)
High water alarm level
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
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 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that / 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 Steven R. Pannone
Date 8/13/13
COSA brown sheet-10-10-12.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 10+
in.
0 0 e�
Z
E m
<
CD �.z
CO k
C5 r,�
C14
0
. -- u cn
It E
2- E
C/
z
IS0.00,
Ln
c).
01
c
5
Q3 0,
-6
19
< U-)
4. z
u C.
z
Z) 01;
'A.
r
z
L
Q),
U) 6'1
Z
z
CD ::D <
z 0
CN pz C + < CL
En
fl�
0 Cox
---- ---------------------------------------------------- EL
1 >
iN]IN3SV3 '33�3 22 '3111 OL x ;Z� C�
<
m "V1,13L.00 s E -J:2
Oo �,
LLJ
<
zm
< s u
�-< z r, -
u 0
:20,
LO
I
Iril
r_
.,A6iuNiCiPALrryOFANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services:'
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907)3434744
CERTIFICATE OF HEALTH AUTHORITY.
APPROVAL FOR A SINGLE FAMILLY DWELLING.
Parcel I.D. # 020-052-93 HAA # AbIq 0 1
1. GENERAL INFORMATION
Complete legal description SOUTH PARK SUBDIVISON 12. LOT 6A. BLOCK 1 -
Property owner COI IN RIPPERION Day phone (907) 348-0320
Mailing address 15740 SOLITH PARK I OOP ANCHORAGE, AK 99516
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held forpickup.
2. NUMBEROF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water XXX
NOTE: If community well system, provide written confirmation from State ADEC attest -
Ing to the legalily and status of system.
4. TYPE PF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding Tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
Ing to the legality and status of system.
72-025 (Rev. 1/91) Front MOA1121 Computer Version
Jk -7CO V.0
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $&fe.e&at,
orpr1or to, closing for the engineering services provided.
5. STATEMENT OF INSPECTION 13Y ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
Investigation of this Health Authority Approval application shows that the on-site water supply and/or
wastewater disposal system Is safe, functional and adequate for the number of bedrooms and type of
structure Indicated herein. I further verify that based on the Information obtained from the Municipality of
Anchorage files and from my Investigation and Inspe tj n, the on-site water supply and/or wastewater
disposal system Is In compliance with all Municip State codes, ordinances, and regulations In effect
on the date of this Inspection.
NameofFImn ALASKA WATER � AT E CONSULTANTS. INC. Phone (907)337-6179'
Address 6901 DE A�. AU#1&6 A66AGE. ALASKA 99504 ; I
Engineer's Signatu —Date -3 144ol'
In conducting this evaluation, AMVC,*Inc!. jtt#n dto'Pmidoa thorough, conscientious engine6ingan'a"is of the
system In accordance with ADEC and MOA DHIIGuldellnes & 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, ground waterlemls that may Ructuato during theyear, and the
usage of the lamW being served by the system. These conditions are outside the control c
the evaluator of the system. Satisfactory test results do not guarantee future performance
of the system, nor do theyguaranteo that there are no hidden defects or encroachments.
AMVC, Inc. can therefore not provide any warranty for luture estima to of how long the
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
The content of this report Is for the sole benefit of the owner listed above. Any
reliance upon or use of this report by any other person or party Is not authorizod,
nor will It confer any legal righ t wha tsoever.
6. DHHS SIGNATURE
:W
!f:f� Approved for 4 bedrooms
- Disapproved
— Conditional approval for
bedrooms, with the following
ON-SITE
ZZ
WATPPME) rn=:
WAqTFWATPP
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority
Approval Certificates based only upon the representations given In paragraph 5 above by an Independent
professional engineer registered In the State of Alaska. The DHHS does this as a courtesy to purchasers of
homes and their lending Institutions In order to sallsfy 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 engineers work.
72-025 (Rev. 1191) Back 1610A #21 ComputorVersion
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
IV Street Rm 5M Anchorage, AJaska 99501 (907) 34347"
Health Authority Approval Cheddist
Legal Descdpdon: SOUTH PARK S/0 #26 LOT 6A, BLOCK 1. Parcel I.D.: 020-052-93
A. WELL DATA PUBLIC WATER
Won Type PUBLIC 9 A. B. or C, attach ADEC letter. ADEC wator system number
Log present (YIN) Date completed
Total depth
F2 zTeTTJVTk#1-4K*1e1
height (above ground)
Wires property protected (Y/N)
AT INSPECTION
I
Data of tm
Static water level
W
aWmEffon 9 -p -m- g -p -m -
WATER SAMPLE RESULTS:
111milt, I... -
B. SEPTICIHOLDING TANK DATA
Date installed 8/14/87 Ta It size 1500 Number of Compartments 2 Cleanouts (YIN) YES
Foundation deanout (YIN) YES Depression (Y/N) NO High water alarm (YM) N/A
Date of Pumping 12/27/00 Pumper DENALI PUMPING
C. ABSORPTION FIELD DATA
Data Installed 10/7/85 -Son rating (g.p.dJI12 onj!� 85 System type DEEP TRENCH
Length W. Width Y-4' Gravel thiclutess below pipe 6. Total depth 11'- 13'
Effective absorption area 360 SQ. Fr. Monitoring Tube present (Y/N) YES Depression ever field (Y/N) NO
Date of adequacy test 12/27/00 Results (pass/Fan) PASSED For 4 —Bedrooms
Fluid depth In absorption field before tog an.�, 3" Immediately after 732 gal. water added Qn.y 47"
Fluid depth 21" (ins) Minutes later 10 Absorption rate = 600+
Percidde treatment (past 12 months) (YIN) N/A If yes, give
r2A229"-3WcW*UtWVK9M
0. LIFT STATION
Date Installed Size In gallons
ManholetAccess (YIN) —*Pump one 11 _��__'PUZDClr level ar
High water alarm level ar —*Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
SeptIc/holdfing tank on lot
Absorption field on
Public sewer main
PUBLIC WATER
-On adIacent lots
O;�adlacent lots
Public sewer manholatcleanout
1UT . =..
SEPARATION DISTANCES FROM SEP7110HOLDING TANK ON LOT TO:
Foundation 5'+ — Property line 5'+ — Absorption field 5'+
Water maln/service line 10,+ Surface water/drafnage 100'+ Wells on adjacent lots 200'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property One 10,+ — Building foundation 10,+ We r malniservice One 10'+
Surface water 100,+ Driveway, parldng/vehicle storage area 50'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+ —
F. ENGINEER'S
I car* iflat I I
of Munkipal
with MOA U
Engineers
HAAFOGS'S00 - 0C)
Id Inspections, and review
,stems are In conformance
Mis date.
Date of Payment — I tQ - 0 1 —
Receipt Number /goo
72.028MW 3N8rCWMtdWVWWM
Waiver Fee $
Date of Payment
Receipt Number
I
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services CA
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. If C�S HAA # r4
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) / �/O 4�012
Propertyowner
Mailingaddress
Dayphone .354-5--baJ�5--
Lending agency Day phone
Mailing address
Agent
Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4-1
-) ��- —I - C)j I ('
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
724)25 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date.of this inspection.
Name of Firm
Address
Engineer's signature
V, F__ (t)", 1) fT�
-) f -V5— /
(,\j V,: i L j�
TV (,_V)_C�_ L/CI-0-7�1r-
DHHS SIGNATURE
�/� Approved for
Disapproved.
Conditional approval for
Additional Comments
M
illlffle,
1�rv/c('—FPhone
bedrooms, with the following stipulations:
Date (� - / - 2S
The Mui cipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasersof homes
and theirlencling institutions in order to satisfy certain federal andstate requirements. Employeesof DHHSdo 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.
72025(R.�.1/91) Back MOAft2l
RECEIVED
Municipality of Anchorage MAY 2 6 1998
DEPARTMENT OF HEALTH & HUMAN SERVICE&ENNICIPALITY OF ANCH
Environmental Services Division ENVIRONMEWAL SERVICES&
825 L Street, Room 502 *Anchorage, Alaska 99501 9 (907) 343-4744
Health Authority Approval Checklist
Legal Description: Le� & 8)vci�l 45-au-4),gawIz- -` f Parcel
A. WELL DATA Pt,, Wa
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE
C form
D�e of sampl
If A, B, or C, attach ADEC letter. ADEC water system number.
Date completed
Casedto
FROM WELL LOG
B. SEPTIC/HOLDING TANK DATA
Nitrate
9 -P.M.
Collected by:
(above ground)
properly protected (Y/N)
AT INSPECTION
Other bacteria
9 -P -M.
Dateinstalled Tanksize 116�,Vb Number of Compartments Z- Cleanouts (Y/N)—Y—
Foundation cleanout (YIN) j Depression (Y/N) K) High water alarm (Y/N) AIA
Date of Pumping 5-1 q -IDZ Pumper /\/Or--/� /a �e�
C. ABSORPTION FIELD DATA
Date installed
Soil rating (g.p.cl./W or ft2/bdrm) 96 , P4" Z_ System type e_kI
Length 30' Width ?I - 4 ' Gravel thickness below pipe & Total depth 11-13'
Effective absorption area 3 61 0 -AW 7 -Monitoring Tube present (Y/N) __7V__ Depression over field (Y/N) A)
Date of adequacy test 6- -a, 9' 9f Results (Pass/Fail) Paf-5 For 4 —bedrooms
Fluid depth in absorption field before test (in.); Immediately after& gal. water added (in.): 17//4
6,
Fluid depth (ins) Minutes later: Absorption rate g.p.d.
Peroxide treatment (past 12 months) (Y/N) Al If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm
E. SEPARATION DISTANCES
on" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
service line
gallons
"Pump off" level at*
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation / 0. 6 0, Property line ) ot� Absorption field - -Z -!3
Water main/service line Surface water/drainage 0701"(- Wells on adjacent lots 2,0
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property Iine Building foundation '2-7 57
Water main/service line 2, �� � Yr -
Surface water Driveway, parking/vehicle storage area
Curtain drain Wells on adjacent lots 2,:,70 Ir
F. ENGINEER'S CERTIFICATION
I certify that I
in contorman
inspections and review of Municipal
.s in effect on this date.
Signature ( !7!�� -
Engineer's Name A -
Date 5-17,3 1A3
HAA Fee $ � W ,
Date of Payment �:.S-�U
e L
ReceiptNumber �506 L7311) —
72-026 (Rev. 3/96)*
Waiver Fee $
4569 1.j,-
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAG E
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services aikcbl�
On -Site Services Section 1511-
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. If C e2AD - ID 9)� �-1 �
1. GENERAL INFORMATION
Complete legal description
Btock 1; Add -#2 South Pa)tk Subdivision;
Location (site address or directions) 15150 south Patk Loop
Property owner ftck 9 Ma,%y Eck — Day phone
Mailing address 15140 south Fraick Loop Ancho)tage, Ak. 99516
Lending agency
Mailing add
Agent
G.M.A.C.
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4 ,j
3. TYPE OF WATER SUPPLY:
Individual well
Community XX
Public water
Day phone
Day phone -
345-6935
NOTE: if community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Re�. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
Ascertified bymyseal affixed hereto and as of the validation dateshown below, I verifythatmy
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 furtherverify 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 Phone
Address 1 71"34 Lagie River Loop 'load lyo,.2-04
Eagle River, Alas a99 7
Engineer's signature
6. IDHHS SIGNATURE
Approved for _A�
Disapproved.
Conditional approval for
Additional Comments
bedrooms.
Date
bedrooms, with the following stipulations:
By: �OH(q S")-rI4 Date
111TIC
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasersof homes
andtheirlending institutionsin order to satisfy certain federal and state requirements. Employeesof 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.
72�25 (Re�. 1/91) Back MOA 921
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: I n�c (oA Parcel I.D.
A. WELL DATA
-welt type. A If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
Total
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
Date completed
Casedto
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main —
Public sewer service line
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed 5-14-07
Nitrate
Driller
Casing height
Wires properly protected (Y/N)
N=
AT INSPECTION
f" %A
9.PJZ�
Z >
n
0
Z
_; On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
— Petroleum tank
Collected by:
Other bacteria
Tank size I 5-_�o 0 Compartments
I
Cleanouts CVN) Fou dation cleanouta/N) Depression (Y&
^I 7A
High water alarm (Y/N) — /4 Alarm tested (Y/N)
Date of pumping '5� - �Z-L - 9 1
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on I t —On adjacent lots P)Q Al� .—Foundation
To property line Absorptionfield Water main/service line
Surface water/drainage 00 4 -
72-026 (Re, 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size in gallons
Vent (Y/N)
High water alarm level
"Purnp on" level at
Meets MOA electrical codes (Y/N)
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
"Pump off" level at
Cycles tested
Surface water
Date installed lo --7-8 Soil rating P� System type
Length Wiclth_'?�, --Gravel thickness Total depth /3
Total absorption area Cleanouts present<MN)
Depression over field (Y�% - t4 — Date of adequacy test 5-- 3 - -�J
Results 4ejs:�Yfall) for
Peroxide treatment (past 12 months) (Yd�) t4A, VfOD'O"I"' If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot �0�c On adjacent lots 1�0 Property line
To building foundation 12- . To existing or abandoned system on lot Af 0
-A� '-4-
On adjacent lots Cutbank dW�J6 Water main/service line /c>
Surface water riveway, parking/vehicle storage area 5_0
Curtain drain I�Jbdt A—"/,Jip vbl
E. ENGINEER'S CERTIFICATION
bedrooms
/ certify that / have chocked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
O�M ; �t4l,'00 River v UOP Ruad No, 9,04
Engineer's Nam&c'910
I livor, Ala5ka 9957 -
Date
A
HAA Fee $
Date of Payment
Receipt Number
72-026 mm 3/91) Back MOA21
Waiver Fee: $
Date of Payment
Receipt Number
FROM ALASKA WATER & WASTEWATER PHONE NO. : 9073383246 May. 15 1999 09:13PM PI
TEST DATE START TEST DATE END--9E?��olr
SEPTIC TANK SIZE:__2Z:t=tlJVA?—LIFT STATION YES
DATE OF PUMPING: .6-1 �: �6' PUMPER.
E- A504- st�rt/e�j I
SYSTEM TYP . t 0 v 6 -
DEEP TRENCH BED
CONVENTIONAL
DRAINFIELD PRESSURIZED
CONVENTIONAL MOUNDED
PRESSURIZED
MOUNDED
DEPRESSIONS: YES Ag) yn7- i6 Ion e-dic- zP 2
IF YES, WHERE?�
WHERE ALL STANDPIPES AND WATER TIGHT CAPS FOUND THAT
ARE ON THE INSPECTION REPORI? (gp/ NO
JAI'NO, WHICH ONE/S? 4-rd-#�-A �vuv-f �oe-ll I —vie 5;
11
SEVER
Pau
AMONITORINQ.
TIME
Rt�tffk;G
11
ADDLU
Ll UIV
qlft a /
—
1
q?� 7-
?/ qa*�
7-
09
44g
//34,
RESULTS-
PASSED:�--
FAILED
---------
S:
91
.......................... ....
..........................
. ................................................. .........
WALTER J. HICKEL, GOVERNOR
IJ ___j 0 F �j
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE 563-6775
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
FOR: S & S Engineering
Rodney
May 21, 1991
PWSID 213475
My review of the records on file in this office reveals that the South Park Subdivision Class
Public Water System, is in compliance with the provisions of 18 AAC 80.060, State of
Alaska Drinking Water Regulations.
Sincerely,
-5ec�' 'el '�/l el�"�
Keven K. Kleweno
Lead Engineer
�5 pl.nzcd on recy, �ed.p- , � y GA
MU NICIPALITY OF ANCHORAGE
-_4
DEPARTMENT OF HEALTH A NO ENVIRONMENTAL PROTEC TION
DIVISION OF EN VIRONMENTAL HEALTH. "4
ER - T!FlC . ATE OF INSPE , CTION' , FOR HEA LTH A QT'HORITY'APPROVA
-SITE SEWER AND WATER FACILITY,,�
7
Page 1 of 2 . .. ......
'9�;ON .... ...
a
�2641-4720
-Application Date
0
-_4
7
Page 1 of 2 . .. ......
AND INFORMATION
5., ENGINEERING FIRM PROVIDh_ INSPECTIONS, TESTS, FILE SEARCH, D.
As certified by myseal affixed hereto and as ofthe validation date shown below, I verifythat my investigation of this Health
Authority Approval showsthat 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 I
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 Acyc' T LkAL I f�A EG Q I H Telephone
Address L11 t Ti�2 i Li f,m -r L
Date
Or Ai
47
C'o T Hl*
3
Page 2 of 2
7M25 (11184)
OF ANCOO�ZAGE MUNICIPALITY OF ANCHORAGE (M
MUNICwAOTY SERVICES DIVISION HEALTH AUTHORITY APPROVAL (HAA)
ENVIRONMENTAL CHECKLIST - FEBRUARY 1984
JNUG 2 4 1987 264-4720 Do
Legal Description: LOT 12 B K 200T"PAQv- A
2s- Film,
A. P4t L ED A XA E D I
Well Classification A If A, B, C, D.E.C. Approved (Y/N) y
Well Log Present (Y/N) N/A Date Completed K) I Al Yield PIA
Total Depth �_) 14 Cased to Depth of Grouting K3 I A
Static Water Level F --- � i jA Pump Set At if, )I
Casing Height Above Ground �'3 A Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) jKil A -Depression Around Wellhead (Y/N) K)JA
Separation Distances from Well
To Septic/Holding Tank on Lot K )1 1A ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot On Adjoining Lots
—_ 7 -
To Nearest Public Sewer Line A To Nearest Public Sewer
Cleanout/ Manhole — & To Nearest Sewer Service Line on Lot
Water Sample Collected by — ; Date " / A
Water Sample Test Results
Comments —
B. SEPTIC/HOLDING TANK DATA
i.sm pc-�zup(,arsoe
Date Installed I Q Size No. of Compartments '2 -
Standpipes (Y/N) y Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Y
Depression over Tank (Y/N) lIq Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) _N/A _; for
Holding Tank High -Water Alarm (Y/N) �A /^ Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well e) M'-) I
To Property Line
To Water Main/Service Line
Course N /A
4
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments L I F %,-/ % k/,ki J21, lz�R / ,'[ ZS I ICX�l - % -
AJ V_ IS 0 T IS LZAD If T-0 S'p-c-�_ . Appami(�o 1'1196
U (D(,(IAo C
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata PJIS� — Type of System Design 7 rL G, N C, H
Date Installed I �5 S7 Length of Field
Width of Field Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area .1� � 0 Standpipes Present (Y/N) Y
Depression over Field (Y/N) 1�11. Date of Last Adequacy Test —JAI
Results of Last Adequacy Test t�k _ZA
Separation Distance from Absorption Field:
To Water -Supply Well ? 00 To Property Line 4 1
To Building Foundation
To Existing or Abandoned System on
Lot N /^ ; On Adjoining Lots �� 0 -t
To Water Main/Service Line L 6 / + — To Cutbank (if present) &2 AA
To Stream/Pond/Lake/or Major Drainage Course " /A
To Driveway, Parking Area, or Vehicle Storage Area LO /4
Comments NR_Le S� ( & -Cc vei >1 ARPQ.9VL-7!o (t -t VAQA I � It
D. LIFT STATION w /A
Date Installed
Size in Gallons
"Pump On" Level at —
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
— "Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I h v . hecke v Tor nformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed r " - Date d-22 -e 7
Company 1JDK6N7 MOA No.
Receipt No. _/ 0 C b� 0 /
Date of Payment — 2Z2
Amount:$
Page 2 of 2
OF A4 "k
49TH
wilham T.
CE -7
72-026 (1 1Y84) b"Yprof
Engineer's Seal
LSM STEVE COWPER, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775
3601 "C" STREET, SUITE 1334
ANCHORAGE, ALASKA 99503
DATE: -AUMT-14�-1287—
PWSID #: -----
To Whom It May Concern:
According to the records on file in this office, the
TERRACE Water System is in compliance with the
S Z 0 —.—
State of Alaska Drinking Water Regulations.
Sincere I y ,
i CQ'D�'
Ronald S. Klein
Environmental Field Officer
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
L. General Information Application Date I
(a) Legal Description (include lot, block, subdivision, section, township, range)
0
_Qt n�ll � _" 6"T,40^0 ir A'Ooczl ON M0.2 S T H N a
Location (address or directions)
(b) Applicants Name (21?C-Aq L61�(z!,U
.,�,L7eucl(oi Telephone Home Business aH� �_q
Applicants Address aQC) k^Z, 04_�� 21602 A c i-( � A tc Q CZ 0:3
(c) Applicant is (check one) Lending Institution owner/builder
Buyer [= ; Other E::j (explain);
(d) Lending Institution M /A Telephone
Ad _V a
(a) Real Estate Co. & Agent A
Address
Telephone
(f) Mail the H&A to the following address:
0 F,(& -C 9 oc�-((o t�j
Lf 0 -7 AN aaplaa
oo
2. Type of Residence
Single -Family Multi -Family Other (describe)
Number of Bedrooms
3. Water Sup2lX
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 FZ7- Public Community Holding Tank
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
(Page I of 2]
5. EnSineering Firm Providing Inspections, Tests, File.Search, Data 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 =-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of
Date (0 - q 0 -
Ita co
6. DHEP �pproval �%�
Approved for!;YL L) bedrooms BY
Approved 4— Disapproved
Terms of Conditional Approval
CAUTION
Conditional
Telephone S L � - [.14 _�;-
�5
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STAXE 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 REQUIRE-
MENTS. EMPLOYEES OF DREP 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-
(DHEP SEAL)
RR4/ej/DI8
[Page 2 of 2] 7-19-84
12
MUNICIPALITY OF ANCHORAGE (MOA)
MUNICIPALITY OF ANC�� AUTHORITY APPROVAL (HAA)
DEPT. OF HEALTH
ENVIRONMENTAL PROTECTICNECKLIST - FEBRUARY 1984 L6 U C -o t ii,,AacADo1'2_
WELL DATA AN 06 198,03 f 1A
RECEIV"A
well Classificiat-lon VA .-If A, B, or C, D.E.C. Approved(Y/N)
Well Log Present (YM) �k/& — Date Corrpleted — Yield
Total nth Cased to
Static Water Level
Pump Set At
Depth of Grouting
Casing Height Above Ground Sanitary Seal on. Casing (1_�)
Electrical Wiring in Conduit (Y/N) Depression Around Mllhead (Y/N)
Separation Distances fran Well:
To Septic/Holding Tank on Lot on Adjoining Lots
To %arest Edge of Absorption Field on Lot ; on Adjoining Lots
To Nearest Public Sewer Line
Cleancut/Manhole
Water Sample Collected By
To Nearest Public Sewer
To Nearest Sq%er Service Line on Lot
Date
Water Sample Test Results
Cmuents S� E__ 1Z . &' PM Llx/�
B. SEPTIC/HOLDING TANK DATA
Date Installed I() - -Size I No. of Ccapartments �2,
Standpipes (Y/N).__ Air -tight Caps (Y/N) Foundation Cleanout j_Y/N)t
Depression over Tank (YM) f-� Date Last Pumped '
Pumping/Maintenance Contract on File (YIN) for
Holding Tank High -Water Alarm (y/N) Temporary Holding Tank Permit (Y/N) M�/A
Separation Distances from Septic/Holding Tank:
To Water -Supply Nbll OD To Building Foundation 12=
To Property Lim <-'� <� To Disposal Field to/
To Water Main/Servica Lire 10 /4 To Streami Pond, Lake, Or major Drainage
Course h�z&
�A
[Pa ge 1 of 21
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata SIS - Type of System Design T -y
Date Installed Length of Field �q C) "
Width of Field Depth of Field �Yz �� - :z /
Gravel Bed Thickness A
Square Feet of Absorption Axea C) Standpipes Present (YM)
Depression over Field (Y/N) Date of Last Adequacy Test K//A
Results of Last Adequacy Thst Y\J 1A_
Separation Distance from Absorption Field:
To Water -Supply Vbll r�_ cro To Property Line C4 3
To Building Foundation To Existing or Abandoned System on
Lot 1A On Adjoining Lots C)
To Water Main/Service Line To Cutbank(if present) �J
To Stream/Pond/lake/cr Major Drainage Course p3/A
To Driveway, Parking Area, or Vehicle Storage Area (o
Cormients S-�-Cz C-�(-�
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm. Level at
Tested for
Electrical Codes
Comi-nts
Dimensions
Manhole/Access (YM
"Pump Off" Level at
Vent (YM)
Pumping Cycles during Adequacy Tbst. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
i certify that I have checked, verified, or conformd to all MCA HAA Guidelines in effect
on the date )of this-inspegtibn. I
Signed
Company
KBl/d5/s
[Page 2 of 21
Date /2:;.ZO —
MCA No. _Q r & �_OF)
BILL SHEMELD, GOVERNOR
D T. EN HO T Telephone: (907)
EP OF V1 NMEN ALCONSERVAT ON Address.,
ANCHORAGENESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303 274-2533
ANCHORAGE, ALASKA 99501
DATE: 7 oc--r—j--s
Pws I . n
To Whom it May Concern:
According to records on file in this office the '-C�
e- SIV Water System is in compliance with the State Drinking
Water Regulations
Sincerely,
Municipality of Anchorage
MEMORANDUM
DATE: August 15, 1985
TO: Laura Crow, Accounting
FROM: Environmental Health Division
SUBJECT: Request for Refund - Account #2460
Please make arrangements for the following refund. The applicant
paid for the on-site sewer permit twice and purchased two permits
for the same property.
Ernest E. Badger Receipt #338856
9520 Selkirk Drive Amount $20.00
Anchorage, Alaska 99502 Account # 2450
Lot 15 Block I Southpark Subdivision #2
Permit #850191 - On-site sewer permit only
Thank you.
92'. Q LA_�_0_1
Laura J. Ward
Office Associate
LJW
cc: f ile