HomeMy WebLinkAboutSOUTHPARK #2 BLK 3 LT 20 Onsite File
Southpark #2
Block 3
Lot 20
PID# 020 - 502 - 18
The 1983 field is not to be tested for any future
COSAs .
MUNICIPALITY OF ANCHORAGE -ES 7609
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On-Site Water&Wastewater Program
• -ague', PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
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On-Site Wastewater Disposal System Permit
Permit Number: OSP181188 Effective Date: 8/10/2018
Work Type: Septic Upgrade Expiration Date: 8/10/2019
Tax Code Number: 02050218000
Site Legal Address: SOUTHPARK#2 BLK 3 LT 20 G:3236
Site Mailing Address: 15641 JENSEN CIR, Anchorage
Owner: YIEN PETER & Lot Size in Sq Ft: 21759
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3
This permit is for the construction of:
El Disposal Field El Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: *** The Engineer needs to do a test hole prior to the construction of the septic field,
minimum 17' deep. Construction may proceed at your own risk before the 7 day water monitoring is complete.
Please submit stamped and signed results with the As-built Inspection Report. If the results require a design
change, construction of the system will stop pending On-Site review and approval.
Received By: Date: (/C / 0
Issued By: Date:
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 020-502-18
Property owner(s) Peter Yien and Dorthy Khan Day phone `?03 - c79 0 2--
Mailing
Mailing address
Site address / .S '-k I 0-e"5en C��
Legal description (Sub'd., Block & Lot) SOUTHPARK #2 BLK 3 LT 20
Legal description (Township, Range & Section)
Lot Size 21,759 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field 0 Initial ❑ Single Family (SF) 0
(w/wo ADU)
Septic Tank 0 Upgrade 0 Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Ilings ❑
Privy ❑ Q� an• •o )
Private Well ❑ -�
Water Storage ❑ �(9 3
THIS APPLICATION INCLUDES A WAIVER REQUEST FO4O7 �a
4 9 5 C•
'stance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: `iso 9. ,�, Waiver Fees:
Date of Payment: -1/11/18 (
/ti/tB .k)bScc��cDate of Payment:
Receipt Number: aaa 1 r 1 a Receipt Number:
p
Permit No. Of P I vp(ISS Waiver No.
G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
July 1, 2018
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: New Septic Permit
Legal: SOUTHPARK#2 BLK 3 LT 20
To Whom it may concern:
This is a request for a septic permit on the above referenced lot the old system has failed. All of the
surrounding properties have community water. A test hole will be done at the time of the installation per
the new On-site code. All of the neighboring soils appear to be good. The perc rate for the design was the
same as the original but this will be verified. From the MOA file the test hole had no water an a perc rate of
41 minutes per inch(300 square feet per bedroom)and this new system is designed with the same rate. The
steel tank will also be replaced at the same time due to its age. The slope around the site is flat(2-4%max)
with no cut banks within 100 feet.
This system will not impact any of the neighboring properties due to the lot layout.
Please call me if you have any questions.
SinccreI /*VI_
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
1
DESIGN CRITERIA: I-- GRADEMOUND OVER
5 BDRM X 150 = 750 GPD I 11, FILTER FABRIC
SOILS = 750/0.45 = 1660 GPD
1660 GA/16 = 104' s 0 ..iv -"0 PIPE
SEWER ROCK
(1) TRENCH
11' DEEP -11
8' EFFECTIVE
2.0'WIDE 120'
(2) 52' LONG
SEPTIC FIELD SECTION
v,2
S�
2
'Pc., \
S'
PROPERTY LINE
_Oppktri
illa
f PROPOSED
EXISTING 5 i'
BEDROOM . ii \ DRAINAGE FIELD
HOUSE I ii ' ii
G ii ►i
ii 1/
i
14
/
/ 10'T&E
/ EASEMENT
ALL LOT - -VED = COMM.WATER
Septic Design Prepared for _ootii11��%._
PETER YIEN & DORTHY KHAN • 4.
•�P-�E••OF q�-.16, .
SOUTHPARK #2, BLOCK 3, LOT 20 •
i. ;: 49TH %\ •: * t
Anchorage, Alaska , •
; 44, •
•
•
Michael N. Anderson, P.E. # MICHAEL N. ANDERSON
E DATE: 8/8/2018 ����• No. 469 ' � �
4601 NATRONA AVE DRAWN: DJR �� �;• Y i . •
ANCHORAGE, ALASKA 99516 �spo ��
(907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=100' 44 1 =E;;Ck\-.
I
PROPERTY LINE-\
WATER SERVICE LINE ,
4IIL
EXISTING
M HOUSE
-111111/
DIVERTER VALVE
1
NEW TEST HOLE REQUIRED PRIOR 0- 1500 GALLON
TO INSTALLATION OF THE NEW \.' , TANK
SYSTEM TO VERIFY SOILS p
Add
TO.
1
n
DC� 0 �T�k Plain aiM•
flj S
- Zp L- \. t . 5efiamx-ttbn 'tb Qec,1iEPTIC � //,
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l i I, \ i
� ��� i/ i i/ EXISTING
I / • / I �/ TANK/SYSTEM
f i� /
fi \ TO BE
i/ �� /
2 DECOMMISSIONED
��\ M/ /I, A PER UPC '
,I %
,
\ O MT,0 // / EXISTING SHED
i
�\��_ �CO -•''/ i
i
L 4O
EXISTING 3 BEDROOM TRENCH WILL BE
USED AS THE SECONDARY SYSTEM W/
/ ADVANTEX TANK SYSTEM TO MEET
/ THE 5 BEDROOM REQUIREMENT
/
/
/
/ 10'T&E
/ EASEMENT
/
/
/
/
Septic Design Prepared for w�`1ISt�vi,
PETER YIEN & DORTHY KHAN .•
.•'� OF
•
•
4 . .- �i
SOUTHPARK #2, BLOCK 3, LOT 20 : : 49 T /�1 • r• � .
•
Anchorage, Alaska , • - •
•
• 0
Michael N. Anderson, P.E. DATE: 8/8/2018 0.�A:MICHNEEL N. ANDERSON;&i
4601 NATRONA AVE
O.
•`� �':
DRAWN: DJR •� /d •''���
ANCHORAGE, ALASKA 99516 1„ � F IC ��
(907) 727-8864/FAX: (907) 345-1391 SCALE: -30 4�I,,;;***
•
11
1
1
1
LOT 21 \ •LOT 23
1 .
JENSEN 1
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s 87°22'136W 132.1 3 _________
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* ASPHALT
DRIVEWAY
EINGLC FAMILY
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/ �; OQ 0 SHANE A. HOLT: 9Q
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LOT 25 !, ��• LS-6914 ,� rv�
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AS-BUILT SURVEY
SCALE: T•a40'
\ I HEREBY CERTIFY THAT 1 HAVE PERFORMED A
MORTGAGEE'S INSPECTION OF THE FOLLOWING
r i N. LOT 26 DESCRIBED PROPERTY.
i LOT 27 `\ LOT 20,BLOCK 3,SOUTHPARK Sl1H.NO.2
I THE INFORMATION HEREON IS FOR THE USE OF LENDy1G INSTITUTIONS SPECIFICALLY TO BHOW ANY CONFUCTS BETWEEN ANCHORAGE RECORDING DISTRICT,ALASKA AND THAT
f EXISTING STRUCTURES AND PLATTED LOT ONES OR EASEMENTS AND IS NOT TO BE USED FOR POSZTIEWHO ADDITIONAL �VISIBLE IMPROVEMENTSG SITUATED ALASKA
'ARE
STNUCTURES OR FENCEUNES.
WITHIN THE PROPERTY UNES AND THAT NO VISIBLE
EA.^.EMLNTS OF RECORD.OTHER THAN THOSE SHOWN ON THE RECGRDED PLAT,ARE NOT SHOWN HEREON ENCROACHMENTS EXIST OTHER THAN NOTED.
NMC ANY FFNCEUNES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY UNES DATED AT ANCHORAGE.ALASKA THIS•_13TN�_
OR I.UCAIE STRUCTURES DAY OF JUNE 2005_
ANY PAVING 6H0•M1 MAY SE APPROXiMATE DUE'o snow CC'NOmONS. HOLT LAND SURVEYING Gi B0,KB 11677
TEL 145.5513
MUNICIPALITY OF ANCHORAGE
i I DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE ] [~NEW
LOCATION NO. OF BEDROOMS
~ Material No. of compartments
~ Manufacturer T m<
Liq. capacity in gallons Inside length Width Liquid depth
I0~ IF HOME,DE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ ~ Manufacturer Material Liquid capacity in gallons
Q Well Foundation Nearest lot line PER~I~.
7
~ ~ ~0. of I,n? ken~th of each line ' Total Ion,th o, llnes Tronch width Dis,anco Bot~eon lines
~ ~ ~ 0 '~ O inches
~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area
Length Width Depth ~ PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
m DISTANCE TO:
~ 31ass Depth Drifter Distance to lot line PERMIT NO,
~ Building foundation Sewer line Septic tank Absorption area(s)
~ BISTANCE TO:
OTHER
PIPE MATERIALS
SOl L TEST RATING
_~UNI~IPALITY 0F ANCHORAGE~_,
Department!~ ~ Health and Environmenta' ~rotection
825 ~ Street, Anchorage, AK. ~9501
264-4720
' * * * HANDWRITTEN PERMIT * * *
.., - '~R ON-SITE SEWER PERMIT
Applicant:
Loc~tion: Phone Nu~er:
scr tion:
Type of Soil ~sorption System Is:
Trench: Dr~infield: Seepage Bed: __ ~olding Tank:
~aximum N~ber of Bedrooms: Soil Rating(sq.ft/br) ~ ~
The Required Size of the Soil Absorption System Is:
DEPTH ~ LENGTH ~1 WIDTH
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 pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~o~ 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 1 9 8 3 * * *
I certify that:
(!) I am familiar with the requirements for on-site sewers and wells as
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 enlargement if
the residence is remodeled to include more that~/~3 bedrooms.
SWP/024(1/81)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12;
13
14-
15 ,
16-
17-
18-
19~
20~
COMMENTS
SOILS LOG
MUNICIPALITY OF ANCHORAGE /
DEPARTMENT OF HEAl'TH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST ~
825 L. Street, Ahchorage, Alaska 99501 264-4720 .
SOILS LO~ - PERCOLATION TEST ~ 5~-~'0c:~. ...
SLOPE
ENCOUNTERED? pO
E
iF YES, AT WHAT
DEPTH?
DATE FER.ORMEO, /
SITE PLAN
/
- /
Leroy C. Reid, Jr,
No. 225 I,E
Gross Net Depth to Net
Reading Date Time Time Water Drop
fH~ o //,'~ /'~
PERCOLATION RATE
TEST RUN BETWEEN
PERFORMEDgY: ~V~'~5
CERTIFIED.BY:
72.008 (6/79)
DEPT. OF ENVIRONMENTAL CONSERVATION
STEVE COWPER, GOVERNOR
ANCHORAGE/WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
563-6775
DATE: MARCH 28, 1989
PWSID: 213475
TO Whom It May Concern:
According to the records on file in this office, the SOUTH PARK
TERRACE S/D NORTH is in compliance with the State of Alaska
Drinking Water Regulations.
Sincerely,,~ ~ ~
VERA E. CRAIG
Environmental Field Officer
VC: gd
sp co ? 8 9 7G/i
Q
• �
GE $
't _ Municipality of Anchors { ' • `'`
On-Site Water and Wastewater Program E NOV 22 2017
(907) 343-7904 S A FETY
Certificate of On-Site Systems Approv 6-79- L 9"'
Parcel I.D. 020-502-18 Expiration Date: 1 1'c2q - 1
1. GENERAL INFORMATION:
Complete legal description SOUTHPARK#2; BLOCK 3, LOT 20
Location (site address) 15641 Jensen Circle*Anchorage 99516
Current Property owner(s) Carni Zobel Day phone
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class _Well ❑ Community ❑
Public Water System ® Public Sewer ❑
WaiverNariance request for: Distance:
Received by a Date: It /(9.c1/i
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ jo� / Waiver,Fee $
Date of Payment /t f ��' Date of Payment
Receipt Number W/4/5-6 Receipt Number
COSA# 66C r4-15Lxi 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: ►I 171 /i'4-
ooOpp,
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF A "
in accordance with the guidelines and regulations established by the Municipality of Anchorage and `''_'ys'
industry practices. The reported results describe the condition of the system/s on the date/s of the O P.
evaluation. Separation distances were measured to readilyidentifiable features. Hidden defects or •. „
encroachments may exist that were not identified during the evaluation. The operational life of all wells / tr '� 9 /1 . *OOA
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, i D
groundwater levels (that may fluctuate during the year), quality of construction (materials and ; Q
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and .. .•• • •
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the / J:ff A. - ess;' i
system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of �o CE 79 3 ��• r,
the well or septic system. GEG makes no representation whether an alternative well or septic system Un'o .,c,0
can be installed on the property in the event either of the current systems fail to perform adequately in 4fe, •4.1• Zt �' F,c°o
the future. The content of this report is for the sole benefit of the person/party that retained GEG to Vci.profess,oc'o\occ'
perform the evaluation. Reliance upon the information provided in this report by any other person or �OOO��oo
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right ``\����k� Lt t i t i,1 i.•t
whatsoever. \\\-c , OF,q��
QP #AEC'C__ ,
6. DSD SIGNATUREON-SITE �m
X' System #1 Approved for 3 bedrooms _ WATER AND
o WASTEWATER Z
System #2 Approved for bedrooms o=
•,� PROGRAM
Disapproved '•.coil ��0:
Conditional approval for bedrooms, with the following stipulation V SERV '•
-----Te_ e_ii)€ .c. 4—cAA1c + , is•e. Id axe eats Cid
AwA0 ' ( t oo 5. er'C-%tc_ (r S oaki2 )/eout'S SU
: �By: ��_ ( Original Certificate Date:
The Municipality of Anchorage 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.
7. ATTACHMENTS:
COSA Checklist X. Nitrate Advisory
Septic System Advisory >C Arsenic Advisory
Well Flow Advisory Other .
COSA blue sheet 10-10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: SOUTH PARK#2;BLOCK 3,LOT 20 Parcel ID: 020-502-18
A. WELL DATA PUBLIC WATER
Well type If A, B, or C provide PWSID# Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height(abo - .round) in.
FROM WELL LOG AT IN • CTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESU ':
Coliform colonies/100 ml. Nitrate mg./L. Collected by:
• •-nic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA 34 YEAR OLD STEEL SEPTIC TANK AND DRAINFIELD ARE
BOTH APPROACHING THE END OF THEIR USEFUL LIFE
Tank Type/Material SEPTIC/STEEL Date installed 8/31/1983
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout(Y/N) YES Depression over tank(Y/N) NO High water alarm (Y/N) N/A
Date of pumping 8/31/17 Pumper ISAAC'S PUMPING SERVICE
C. ABSORPTION FIELD DATA ('BELOW EXISTING GRADE
Date installed 8/31/1983 Soil rating (g.p.d./ft2or4 /bdrm 278 System type DEEP TRENCH
Length 70 ft. Width 2.5 ft. Gravel below pipe 7.0 ft.
Total depth `10.8+ ft. Eff. absorption area 980 ft2 Monitoring tube**YES Depression over field NO
Date of adequacy test 11/13/17 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test'"'33 in. Water added 472 gal. New depth""58in.
Elapsed Time: 120 min. Final fluid depth '""54 in. Absorption rate>- 450+ g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
HOUSE HAD BEEN VACANT SINCE 10/10/17
**MT ONLY EXTENDS 58 INCHES BELOW INVERT "'"25 INCHES BELOW INVERT
****AT INVERT OF LATERAL ONLY WHEN OPERATED IN THE UPPER PORTION OF THE SYSTEM
LIQUID DEPTH WAS CHECKED 1342 MINUTES INTO RECOVERY PERIOD ON 11/14/13.LIQUID HAD DROPPED A
TOTAL OF 19.5 INCHES,' PLS
SYSTEM WAS TESTED ON 11/17/17 WITH SIMILAR RESULTS.
D. LIFT STATION
Date installed Size in gallons Manhole/Access(Y/N)
"Pump on" level at in. "Pump off'level at •• '• wa er alarm level at in.
_ ..- Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: PUBLIC WATER
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main -•• ' sewer manhole/cleanout
Sewer/septic service line Holding tank
- - containment areas Manure/animal excrete storage areas
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 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
.:"./..'�‘�‘
G. ENGINEER'S CERTIFICATIONaf'�P:'''• • h.
I certify that I have determined through field inspections and 4' iki '1 • \* ro•
review of Municipal records that the above systems are in •
conformance with MOA COSA guidelines in effect on this •'.23111
• i.f . Ga ess•;
date. ' .i•.M CE 795 .�.
Engineer's PrintedName JEFFREY A.GARNESS •.�`P�•'••,• t "Z1oF�
• 4.i
Date t 2` �I 4- •,414PROFESS\M�44
LICENSE l %%
#AECC884
(Rev.10/12/12)
• Municipality of Anchorage •..�
Development Services Department
Building Safety Division
SA ETY
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Septic System Advisory
Certificate of On-Site Systems Approval # OSC 171544
During a recent adequacy test on the septic system for Block 3, Lot 20 of
SouthPark #2 subdivision, 33 inches of standing water was observed in the
absorption field. This indicates that approximately 90% of the absorption
area is inundated. Although this system passed the adequacy test, the
remaining life expectancy may be limited.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
wner ~.~
(b) Property o
Mailing Address
(c) Lending Institution
Telephone: (home)
Mailing Address
(d) Real Estate company and Agent
Business
Telephone
Address
Telephone
(e) Mail the HAA to the following address: (or check here ~l~ if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family~ Number of bedrooms
3. WATER SUPPLY
Individual Well [] Community ~ Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site J~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 of 2
RECEIVED
A. WELL DATA
Well Olassification
Well Log Present (Y/N)
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
To Nearest Sewer Service Line on Lot
WaterSample Collected by
WaterSample Test Results
Comments
MU' 'ICIPA' ~ MUNICIPALITY OF ANCHORAGE (MOA)
N ~'~'~'~CHORAGEHeaIth Authority Approval (HAA)
ENVIRONM£%~;~/E$ DN,$JO~HECKLiST' FEBRUARY 1984
~ 343-4744
Legal Description:
Date Completed
Depth of Grouting
If A, B, C, D.E.C. Approved (Y/N) _
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
Y
; On'Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date
SEPTIC/I:~u:t=~m~G TANK DATA
Date Installed ~./~,~ Size
Standpipes (Y/N)
lid Otb No. of Compartments T'O~'F)
Air-tight CaPs (Y/N) ~' Foundation Cle~nout (Y/N) ~'
N Date Last pUmped ~'/~¥/~' ? ,~//~
Depression over Tank (Y/N)
Pumping/Mainten:ance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Building Foundation
To Disposal Field
;for
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well ~
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~/~3
Width of Field .~O~t
Square Feet of Absortion Area ~ O
Depression over Field (Y/N)
Results of Last Adequacy Test '"~
Type of System Design
Length of Field 7
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N) Y'
Date of Last Adequacy Test ~/"z. ~/8 9'
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ,.~ ¢' O O To Property Line
To Building Foundation ~- ~ To Existing or Abandoned System on
Lot I"///._% ; On Adjoining Lots
To Water Main/Service Line > .~-.~
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Cutback (if present)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed
Company
Date
MOA No.
Receipt No. 0
Data of Payment
Amount: $
¥"
: · JU;J[. 25, 97~,
Receipt No. , ~ - ·
Waiver Fee: $
Engineer's Seal
Date of Payment
72-026 (Rev. 7/88) B~ck Page 2 of 2
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