HomeMy WebLinkAboutSOUTHPARK #2 BLK 1 LT 30 ~el,~rtment · Health and Environmental ?otection
, 825 L Street, Anchorage, AK. ~ ,501
' 264-4720 ,~-
~ermit ~i~0~[¢~ W'~/~ON-SITE SEWER PERMIT~_~~.]qq~_~ ~ '
Legal Description: '/--//~ ~[~ S'~
T~pe of Soil ~sorption System Is:
Trench: ~ ,. Drainfield:
Maximum Number of Bedrooms: ,.
Mailing Address:
Phone Number: ~7~7~/-7~2~-
Seepage Bed: Holding Tank
Soil Rating (sq. ft/br) ~¢
The Required Size of the Soil Absorption System Is:
DEPTH /~' _ WIDTH ~0 ~
LENGTH /27/ GRAVEL DEPTH '~'~'/
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between 'the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall ~ipe and
the bottom of the excavation(in feet).
~ ~ REQUIRED SEPTIC(HOLDING) TANK SIZE = /,3-'00 GALLONS ~ ~
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any. on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
certify that:
(1) I am familiar with the requirements for on-site sewers
set forth by the Municipality of Anchorage,
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require
the residi~nc~s remodeled
Signe~ ,~~
SWP/024 (1/8.1)
enlargement if
to include more that 3 bedrooms.
Date: ~/~5-/f ~,
and wells as
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS I.OG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:.
2
7~
8
SLOPE
SITE PLAN
10
11
-12
13
14-
15-
16
17
18
19
COMMENTS
PERFORMED BY: ,~¢(Zx'U~:~.~).~
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
- q
Gross Net Depth to Net
Reading Date Time Time Water
--~ W~o ,~.'q3 , ¢~
/,,qz/ ,~0 · S~ .
~/~ ~ / ~ ~ , ~/
_ ~ ~'~t~ ,~ ·/I
PERCOLATION RATE lC ~ (minutes/inch)
TEST RUN BETWEEN _.~.-~ FT AND Lf/ ET
CERTIFIED BY:
72-008 (6/79)
STATEMENT
"~ Municipality of Anchorage
' Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 30, Block t. 6outhpa~ Subdivision No. 2
Parcel ID: 020-052-,10
A. W~I ! DATA
weatypeA
If A, B, ar C provide PWSID #
we~ Log (Y~N)
Date completed
Total dep~ ff. Cased to __ft. Casing height (above graund) in.
FROM WELL LOG
ATINSPEC~ON
Static water level ft. fl.
Well production g.p.m.g.p.m.
WATER SAMPLE RESULTS:
B. SEPTIC/HOLDING TA~K DATA
Tank Type/Material
Tank size le'~00 gal.
Feuedat~n deanout (y/H~ z
Date of pumping 5/10/2001
,~tic./Steel
· Number of Compartmenls _2
Depressi~ over tank (Y/N) N_
Pumper Denafl S~wer and Drain
Date installed 11/14/lg8~
· Cleanouts (Y~N) y
High water alarm (Y/H) N
ABSORPTION FIELD DATA
Dateinstailed !1/14/19~ Soilraitng'lg.p.dJl~ar~fodrm)'2371iF/BORM S~stemtype D~PTmnch
Length ?t ft. *width.a ft. Orave~b~owpipe 7.5 '." ft.
Total depth ll.3 ff. Eff. ab~orptJ~area'l,065~' M .onit.o~lubeY'"De~0verfieidN * ;
Date of adequacy te~t ~J/20~1 Resull~ (Pass/Fail) Pass '.
~d depth ~n absomUon nad befom'~t ~ ini' W.'a~ added7~ gal.'''
Elapsed Time:. t,380 min. Final fluid depth t~ in. Absorption rate >~ 750 g.p.d.
New depth3.7_'ln.
Any rejuvenation b'eatment (past 12 mo.) (YAN & type) N If yes, give date
D. LIFT STATION
Date instelted
Size in gallons
Manhele/_Acc~_ _ __~ (Y/N)
'Pump on" level at __
Datum
in. 'Pump off' level at __
Cycies tested
High water elarm level at
Meets alarm & cimult requirements?
in.
E. SEPARATION DISTANCES
· SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic ~ank/~ift station on lot
On adjacent lots >200"
Absorption field on lot On adjacent lots >200"
Public sewer main N/A Public sewer manh~le/cleen(~ut N/A
Sewer/septic service line Hoiding tank * N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5'
Water main N/A
Property line >5'
Water service line >t0'
Absoq3tion field >5'
Surface water >100'
Wells on adjacent lots >200.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line. >10'
Wat~ Service line. >10'
Curtain drain None Noted
Building foundation >10'
Surface wate~ >100'
We~ls on adjacent lots >200'
Water main >t0'
Or~mway, parldng/VeNde ~rage >25'
G. ENGINEER'S CERTII~ICATION
I cert/fy that I have determined through field inspec~s and
review of Municipal mcords'U~at the above systems a;'e in
conformance va?,h MOA HAA guidelines in effect on this date.
Engineer's. Printed Name Michael E. Ande~son~ P.E.
Date 6/15/01 "' ·
I ' "
HAA Fee $
· WatverFee$ "'.
Receipt Number
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
June 15, 2001
Dynamic Properties
3111 C Street
Anchorage, AK 99516
Attention: Jeanne Biertien
Subject:
Lot 30, Block 1, Southpark Subdivision No. 2
Septic System Inspection and Certification
Dear Jeanne:
On June 9, 2001, we inspected the septic system serving the five-bedroom home on
Lot 30, Block 1, Southpark Subdivision No. 2. Prior to the inspection we researched the
information on the system located in flies maintained by the Municipality. These flies
indicate the system was originally constructed in November of 1983 and consists of a
1,500-gallon septic tank and possibly two absorption trenches with lengths of 61' and
71' respectively. No accurate as built is available to indicate how these trenches are
joined, The distribution pipe elevation in each trench varies in elevation by nearly 4' and
would require a flow-splitting device to operate properly, No indication could be found
of any such device.
The water level in the monitor tube at the end of the 71' trench was measured at 10"
prior to the injectiOn of 750 gallons of water. The level rose to 37" after the injection.
No water was noted in the 61' trench at either time. The'septic system remained in
service during the test and also during the 24-hour recovery period. The next day the
water level in the monitor tube was measured at 16" after'app.roximately.23.hours of
recovery. Simple interpolation indicates that. every 1" increase in'water level equates to
· approximately 28 gallons of watei'. The household-would therefore' have to produce
only 168 gallons of water during the test and monitoring period to assure an absorption.
rate in excess of 750 gallons per day. We are confident the system is currently
capable of absorbing 750 gallons of water per day. We make no gu.~rantees, however,
of the ability of the system to. sbstain this' rate in the future.
Sincerely,
Michael E. Anderson, P,E.
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anohorage.ak.us
(907) 343-4744
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 30, Block 1 Southpark #2
Parcel I.D.: 020-052-30
A. WELL DATA
Well type A
If A, B, or C provide PWSID # 213475 Well Log
Date completed __
Sanitary seal __
Wires properly protected
Total depth ft Cased to
fl Casing height (above ground)
lB.
FROM WELL LOG
Date of test ~ /
Static water level /~,/
Well production
WATER SAMP'E
Coliform .--"'~colonies/100 miNitrate mg/I
D o,¢te~f sample: Collected by:
ATINSPECTION
Othe~ bacteria
ft
g.p.m
colonies/lO0 mi
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Date installed 11/14/1983 Tank size
Cleanouts Y Foundation cleanout_Y
:].500 gal Number of Compadments _2
Depression over tank N_ High water alarm N/A
Date of pumping 4/3.6/1999
Pumper A+ Home Services
ABSORPTION FIELD DATA
Date installed 1:]./3.4/3.983 Soil rating (g.p.d./ft2 or fl2/bdrm) 237 gpd/sf System type TRENCH
Length 73. ft Width 3 ft Gravel below pipe 7.5 ft
Total depth ~.3.0 ft Effective absorption area 1065 ft2
Date of adequacy test 4/16/1999 Results (Pass/Fail)
Fluid depth in absorption field before test DRY in Water added750 gal.
Elapsed Time: 3~0 min Final fluid depth DRY in
Any rejuvenation treatment (past 12 mo.) (Y/N & type). NO
Monitoring tube _Y Depression over field N
PASS For _5 bedrooms
New depthDRY in.
Absorption rate >= 750 g.p.d.
If yes, give date
(Rev. 11/99)
D; LIFT STATION
Date installed
"Pump on" level at _...~irPPjbr[np off" level at
Datu~ ['¢'~cycles tested
E, SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A
Absorption field on lot
Public sewer main
Sewer/septic service line
in
Manhole/Access
High water alarm level at __ in
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Property line 30
Water service line :tO+
Wells on adjacent Pots 200+
Building foundation
Water main :tO+
Drainage :tO0+
Property line 20
Water Service line :7.0+
Curtain drain :tOO+
F, COMMENTS
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 15
Surface water 'tOO+
Wells on adjacent lots 200+
Absorption field 10+
Surface water :tOO+
Water main :tO+
Driveway, parking/vehicle storage
Recertification of Health Authority Investigation dated 4-16-99
G. ENGINEER'S CERTIFICATION
I certify that I have determined through fie/d inspections and
review of Municipa/ records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone, P.E.
Date 1-:t8.00
HAA Fee $
Date of Payment
Receipt Number
(Rev. 11/99)
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# d~--~-o,-~7~'~ ~0 HAA# ~>~,~c~o~ (--~
1. GENERAL INFORMATION
Complete legal description /,c~-c-
Location (site address or directions)
Property owner
Mailing address
Day phone
.Lending agency L~
Mailin. g address
Agent q~ ~, ~ ,,¢
Address '"'
Day phone
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. 'rYPF OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site ~ _
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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
investigatior~ 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 Municipa'lity 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~A,o.¢,~.¢c~
Address
Engineer's
Phone
Date
DHHS SIGNATURE
~' A~proved for ~/~/~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
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 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.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICESR J~ C E I V
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3zt~,FC',~z0 1999
~ Municipality ol ^nchorage
Health Authority Approval Checklist uept, Health & Human Services
Legal Description:
Parcel I.D.: O~-~) - C..~.S'~. -'~ O
A. WELL DATA
Well type
IfA, B, or C, attach ADEC letter. ADEC water system number~%q.<;
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WATER S~M ~UI_TS:
pa~ of sar~ple:
Date completed ~
Cased to ~ht (above
ground),
...." Wires properly protected (Y/N).
FROM WELL LOG~.~'/ AT INSPECTION
g.p.m.
Nitrate Other bacteria
Collected by:
g.p.m.
B. SEPTIC/HOLDING TANK DATA
Date installed II~lq/~.~ Tanksize /~.5-oo Number of Compartments ~ Cleanouts(Y/N) ~
Foundation cleanout (y/N)
Date of Pumping z~//&
C, ABSORPTION FIELD ~ATA
Date installed ~
Length ';~1 Width
Effective absorption area
Date of adequacy test /4 /
Depression (Y/N) ¢1~ High water alarm (Y/N)
Pumper ~-I~ l'Jo,-,4~ ,Sz=~,~'4t¢~
Soil rating (g,p,d,/fF o~
EST
Gravel thickness below pipe
Monitoring Tube present (Y/N) ~
Results (Pass/Fail)~A -s~
SYstem type "T-~2 ~ el+
':;2 .~ Total depth /--~
Depression over field (WN) /~
For ~ bedrooms
Fluid depth in absorption field before test (in,); ~ ¢-'¢ Immediately af[er'Cd-o gal, water added (in,): '-~ r~ ~
Fluid depth'-~ ¢'d (ins) Minutes later: '~c~ Absorption rate = ~ :;z.S-'-° g.p.d,
Peroxide treatment (past 12 months) (Y/N)
If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed / Size in.~gallo~j~s--~
Manhole/Access (Y/N) : _ _'/[~f' level at*. _
High
SEPARATION DISTANCES
"Pump off" level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot .~ // ~f ..~-(~'a~'~'nt lots
Absorption field on lot ~ On adjacent lots
Public sewer main~ Public sewer manhole/cleanout
~e~ice line Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LO'[' TO:
Foundation ,/~ Property line '~> C~ r Absorption field
Water main/service line '{'(C~t .Surface water/drainage ./c~c)'e Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~2 r Building foundation /--5-~ Water main/service line
Surface water / c'~-h Driveway, parking/vehicle storage area
Curtain drain /t//~ Wells on adjacent lets .-"/-/'//~
F. ENGINEER'S CERTIFICATION
I certifj,
in conformance with MOA HAA guidelines in effect on this date.
S i g n at Li r e...~----~.~;;.~.,'~--
Engineer's Name
Date
HAA Fee $
[:)ate of Payment
72-026 (Rev. 3/g6)*
Waiver Fee $
Date of Payment _
Receipt Number
Steven R. Pannone, P.E.
Consulting Engineer
P.O. [lox 142025
Anchorage, Alaska 99514
(907) 272-8218
SEPTIC SYSTEM ADEQUACY TEST
Legal:
Owner:
Residence:
Lot 30, Block 1 South Park S/D, Addition No. 2
Mr. Scott Opdyke
4801 South Park Blul'f Drive Anchorage, AK 99516
Septic System: Tank Size: 1500 gallons. Absorption System Type: Deep Trench
(from Municipal records) Absorption System Size: 71x7.5x3 Absorption Area: 1065
Installation Date; 11/14/83 Soil Rating: 237 sf/br
Date of Pumping: 4-16-99 By: A+ Home Services
Date of Test: 4-16-99
Test Procedure: System was inspected visually and measured. Tank was found with 5 feet ol'cover.
Liquid depth was measured to be 4 Inches. The drain field was found to have 36" of cover and a total depth
of 13". There was no liquid measured in the field's monitor tubes. Water was at a rate of 6.5 gallons per
minute (GPM) The water levels in the tank and drain-field monitor tubes were monitored. A total of 750
gallons of water was added. During the test, the liquid levels did not rise in the tank or the drain field. The
infiltration rate was monitored for 0.5 hours. During this period, a total of 750 gallons were absorbed. By
the observations made, this system has an absorption rate 750 gallons per day at the time of the test. This lot
is served by a public water supply. It is lested monthly for compliance with ADEC Regulations, therefore,
no water analysis was conducted.
TESTS RESUI,TS: This system meets the code and operational reqnirements of the Municipality of
Anchorage.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the
system. The reported results describe the perfm'mance of the system under the conditions encountered at the
time of the test, and separation distances lneasured to readily identifiable features. The operational life of
all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate
during the year, and the water usage of the ihmily being served by the system. These conditions are outside
the control of the evaluator of this system. All systems eventually fail and satisfacto~ test results do not
guarantee fhture performance of the system, nor do they guarantee that there are no hidden defects or
encroachments. We can therefore not give any estimate of how long the system will continue to meet the
operational requirements of the MunicipaliW and State.
.
Parcel I.D, #
1.
MUNICIPALITY OF ANCHORAGE
DEPARTMFNT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section ,'
P.O, Box 196650 Anchorage. Alaska 99619-6660
343-4744 '
cERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
020-052-30
GENERAL INFORMATION
Cornplete legal description
South Park #2
Lot 30, Block I
Location (site address or directions)
4801 South Park Bluff Drive, Anchorage
Property owner _Adrian Ry. an& Amy Parker-Ryan _ Dsy phone 694-5195 msg
Mailing address 4801 South Park Bluff. Anchorage. AK 99516
Lending agency G~4AC / FL%qa O'Dell
Mailing address 460 W. ~dor, Anchoraqe, AK
Jack White / Curt Kurtil
Agent
Address
Day phone 562-2181
99503
3201 C Street, Anchorage, AK 99503
Day phone
762-3104
Unless otherwise requeste,d HAh will be held for pickup.
NUMBER OF BEDROOMS: 5
TYPE OF WATER SUPPLY:
Individual well
Community well X
NOTE:
X
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
' Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and ~tatus'6f ~ystem.' .,'~ .
5. STATEMENT OF INSPECTION BY ENGINEER .~ :. t,
As certified by my seal affixed heret° and as of the validation date shown: b'~l°w, 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 inves_tbgation 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 Eagle 'River Engineering Services Phone 694-5195
Address P.O. Box 773294, Eagle River, AK 99577 '
Engineer's signature
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following Stipulations:
Additional Comments
By: ~
The Municipality of Anchorage Department of Health and Human Services (DHHS)"i~sues 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 satisfy certain federal and state requirements. Employees of DHHS do not
conduct Inspections or analyze data before a certificate is issued, The,,~unicipality,~f, ~nchorag~ is not
responsible for errors or omissions in the professional engineer's work. ::.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A, Well Data
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Parcel I.D.
If A, B, or C, attach ADEC letter· ADEC water system number
Date completed
Cased to
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM
Septic/holding tank on lot __
Absorption field on lot __
Public sewer main
Sewer service lin
RESULTS:
Driller
Casing hell
Wires properly protected
AT INSP
Dflte of sample:
B. SEPTIC/H~t~DIf'~'...~ TANK DATA
Date installed ////
Cleanouts (Y/N) ~/~
High water alarm (Y/N)
Date of pumping
· On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
g.p.m.
Nitrate Other bacteria
Collected by:
Tank size /§~0 Compartments ~-
Foundation cleanout (Y/N) y~ Depression (Y/N) ~//~/0
/'///¢ Alarm tested (Y/N) ,,/'//~/'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ,/'¢/4 On adjacent lots -/~ ?~¢/~ '~ Foundation
To property line ~0I Absorption field /~l Water main/service line
Surface water/drainage j"/] ~'
72-026(3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION /~-//,~
Date installed Manufacturer /'"'~'
Size in gallons Manhole/Ac~
Vent (Y/N) "Pump on" level at ,/ "Pump off" Level at
High water alarm level ..---'""'~Cycles tested
Meets MOA electrical codes (Y/N) ~
SEPARATIO~ LIFT STATION TO:
Well o~g.~t~ On adjacent lots Suriace water
D. ABSORPTION FIELD DATA ~
Date installed / ///~/~'~
Length '~/ ~ ~..~ Width
Soil rating (GPD/FF) 7/~ ~ ~/,~ ~ System type
~.~,-.z Gravel thickness '~, ~ ~
,~,~,~l'otal depth //'
Total absorption area /~ z/r¢,~,.(Cleanout present (Y/N)
of adequacy test ~//'~//~ ~ Results (pass/fail)
Date
Water level in absorption field before test J'~ ~'
Peroxide treatment (past 12 months) (Y/N) /k//~
Depression over field (Y/N)
for
After test
If yes, give date
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /t//.~
To building foundation /'~
On adjacent lots ~'-(? I
Surface water ,,'t///.~
Curtain drain ~/¢/~L¢',
On adjacent lots ~-.~:2 / Property line .~ /
To existing or abandoned system on lot ,/'///~
Cutbank /k//~ Water rnain/service line ¢'/~ /
Driveway, parking/vehicle storage area ~) ~
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, @r conformed to all MOA and HAA guidelines in effect on the date of this inspection.
CF ///¢ P/C'7-H 0/4 Z','CM/~/,c-/~D 1~ST/CL.L,Y?'/~.,M F~O.,~I /¢~'~ /¢DE~U,,C~Y 'T~
Signature ,...--~~~
Encneer's Name
Date
HAA Fee $ ~7 ~)~ "' ~
Date of Payment '~.~//~/Z ~ ¢¢
Receipt Number a~ ~,~'~' ~ ~' ~'/)
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF FNVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~-;/~-~-
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date ~.~'~ ~.o - ,~
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
~Z
(b)
Location (address or directions)
Property Owner ~'¢~//5~/.~ /Yn/rE~lc ~-4'Mt~Telephone: Uom~~ ~i~*~'~F~U'
/ Business
Mailing Address
(c) Lending Institution ,,~L,,¢F,'¢~ ~l~r~ .2~¢4A./,.4.
Mailing Address
(d) Real Estate Company and Agent ~z'~)O~,''z,-/ /.¢ '
Add~ess ~/~..cf/ /~5'7' l~''r~ ,,"'~' --
(e)
Telephone ~ '7_Z- - ~fT,'
Mail the HAA to the followinQ address: or; Check here ~, if hold for pick up.
List contact per. con and day phone number belo~'
TYPE OF RESIDENCE
Single-Fa mily.~
Number of Bedrooms
WATER SUPPLY
Individual Well [] Communit.~' Public
Note: if community well system, must have written confirmation from the State Departmeet of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite..~ Public [] Community [] Holding Tank
Note: If community well system, must have written confirmation lrom the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72 025 fRev 8/861 Fronl
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILI:[ 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. ~ further verify that based on the information obtained
from the Municipality of A~chorage files and from my investigation and i~spection, the on-site water suppty and/or
wastewater disposal system is Jn compliance with aH Mumcipa~ and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of F~rm ~ Telephone ~-~
Address __~' //~ ~~., ~ ~//
Date ~'~ ~ - ~
Approved for .~'~;~ ~47) bedrooms by
Approved ~ Disapproved Conditional
Terms of Conditional Approval
CAUTION
The MLmicipality of Anchorage Department of Health and Human Services fDHHS) issues Health Authority Approval
certificates based only upon the representations given in paragraph 5 above by an indepeHdent professional engineer
registered in the State of Alaska. The DH HS 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 nol 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 Rev 8/86) Back
MUNICIPALITy OF ANCHoRAQE
ENVIRONMfiNTAL,SERVicEs DIVISION MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
FEB 2 0 1987 CHECKLIST- FEBRUARY 1984
264-4744
RECEIVED LegalDescrip.,tion: ,,~/~,~'~--'~' "~'*/,,~' /
WELL DATA
Well Classification
Well Log Present (Y/N) 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
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed -"//'-"¢'~'-,5"',~ Size
Standpipes (Y/N) _ /¢' Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N) __
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Flolding Tank:
To Water-Supply Well ,¢~,¢'¢-' -'~
To Property Line
To Water Main 'Service _ine /'¢' ~
course
Commems
No. of Compartments
· ~ Foundation Cleanout (Y/N)
Date Last Pumped .¢- /.~'~
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field -'/~
To Stream, Pond, Lake, or Major Drainage
Page ~ of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
----~.5' '7 Type of System Design
Length of Field ~'.~
Depth of Field
Gravel Bed Thickness ~_-5" -26-
Jo ,~..~~' '-)~ Standpipes Present (Y/N)
A/ Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Property Line ~¢'
To Existing or Abandoned System on
; On Adjoining Lots ~
To Cutback (if present) '"'¢,,/~
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checke.¢, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~'//~----~,2-~--~' Date ~-/~- ,~..~
Company,Z¢~-¢ ~%~'~',¢-,."~'/'~,~ MOA No. ~/ ~Z-oo ~
ReceiptNo. ~ - O ~O / -- ¢¢d~
Date of Payment
Amount: $
Page 2 of 2
72 028 fray 8/861 Back
BEVAN ENGINEERING
P.O. Box 112852
Anchorage, AK 99511
(907) 522-138~
F:'C~I::H"LV~:U'"y :1.9, J,c?~iF7
[)L..tl>':i. rH.:] 'LzhI~:~ p(.~.~r":i.(gd 'J:F'(::H'fl F:'e!:fi::)K'LL,~r"¥' ]..,:'~ 'bl::l F:'(~!I:H"LIi!:H"y J.?, ].c)J]7 ]] iDE.~F..t:C)i.,ffii[~CI
~B:J.'J.'.(':-~ iFIV(i:~f~.'J'L;i.l:J,~VJ::J.C)J'l!!!i,, .~:U"JCJ (~[;HBC)I"J::)'I;::i.()FI ,.. ~
BEVAN ENGINEERING
P.O. Box 112852
Anchorage, Al< 99511
(907) 522.138~
¢)
(D
.<,, , "
It is the responsibility of the owner to determine ·
the existence of any ea'sements, covenants, or re- ' ..... . .' .' ~.~ ~m~, Ka,~ ~ing.j(
strictions which do not appear on'the'recorded sub-' ' '' '. '~j~'.. ~5~ ..'~
division plat. Under no c~cumstances should any '' ' 'X -ij'~a'~ .....
data hereon be used for construct'on r fnr ~'~h j .... ~,.~','_ ........ ~ss~o~l~t~ ·
l lsh~ng boundary or fence l~nes. The surveyor take~ - ~AS~TS O~00RD,OTHE~ THAN
responsibility for the initial transaction oply. [ ~HOWN ON TI~ R~eORDED P~T, AR~
SNOWN
..................... ' I.~END
LOT ~o BLOCK .. /-- : ".~.~.o.~.~.~ ..........
ANCHORAGE RECORDING DISTRICT u ..~ ~ r,~ ..... :-' ·
m[e~,EmBv: ~WLING ~ ASSOCIATESANcHORAGE,1426 H.vder StreetAbASKA "950l j .................. R~v,s,oN ~ ...... DATE ~"~-"