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HomeMy WebLinkAboutSOUTHPARK #2 BLK 3 LT 37 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street. Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT "a"~r , '~./'~.'~/" ~'~'~4.~7'~/ DISTANCES ~:~-O-- ~;' '~ ;'r~ L : ~ "t~ WELL ~dr~ TANK FIELD Township, Range, Section AS-BUILT DIAGRAM (Show location o[ well, septic system, properly lines, ~oundation, T~ ~ ~W ~ ~ driveway, wa,er bodies, etc,) TANKS '~ SEPTIC ~ HOLDING Matedal No. of Compa~ments TYPE OF SYSTEM ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER ~ ~ ~ ~0~ Depth to pipe bottom from Tot al depth ,rom odgina/grade :ill added above Original grade Gravel depth ~neath pipe ~ D ' , .~ ~ ~ o . ¢ , Gravel widlh ~¢ ~ ~ I Number of lines Soil rating Pipe matedal ~~OsoFT ~ '~ ~ 15~ ~,T.;,?, PRIVATE Clarification (A,B,C)~ REMARKS: ~.~:~/ ~ ~ IM s pedor accordinD Io afl uflicip Ilect his date: ~ ~?j%%. 72-013 (3/85) Day Ti:N(:~"i'(::II..I.. F'ii[F;'. PE!::i'.I'~i]i f' q;!~]?()2d.3. I,.ICFt");F-:Y DI"IHL~ I::'I:~:[t3R T[) i::;:E:E'iR~o~!:)~ii: l-i~:~':;~!i:i::(~/li!i; ¢:ff:i'.E;~ TCI DI::I~ ]: N "i'C) ]?'lie I~IEiFi'I'H. T'H ]. 13 F'ERI~I ;t: T 1t: B ]:13(!i!Jii[D I:::Cit::;: Tl"ltii: l::'l...r'-~k!lxll;£D z,~ ;(?,E:DRCIEIt"i {:ii]:NBi...t'F.". I::~:'::~'I:[LY Di,:,IIELL..]:I',IB tc:,r"Lh by 'i'.h~ l"iLu't;ic~.l;:,a].i.i'.y of ~r'~cl'~or. ag~ (11(]¢~ and 'l;.I'~6~ ..... ,:.t~,, o~' ~].4~l.::a.,. ;:.'.' ,. :1: i~,J :i. :l. ]. i ..... ' ].Fi c:Qmt::i:LJ.a~.FICi~, i~:[*~Ll'i {.~11.~ i"I[:~:M[I'I'I.:, cr. Jt.e~p:i.a cfi : .. t.~e~, [,l.. J.~i ','~].~.C.I i'C:i~~ a/ ~I~?~X:i. ItlLI. II'~ ~'~' ~i ........ .. ~...... ~_~ .... ~ ............................... (t]~.4ri(~H') ILff.dqiER /.~t ~: ..d.l[ I .11 TURNER CONSTRUCTION CO., INC. P. O. BOX 3489 PALMER, AK 99645 (907) 745-8334 or 561-5882 February 26, 1990 Municipality of Anchorage L Street Anchorage, AK TO WHOM IT MAY CONCERN: I hereby authorize Alice A. Smith to sign for and pick up any on-site sewer and well permits for Turner Construction C~co Rex B, Tu~ent MUNICIPALITY OF ANCHORAG~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIOM ':~:° 2 7 19°-,0 ILl) RECEIVED MUNICIPALITY OF ANCHORAGE . Department of Health & Human Services On-Site Sewer/Well Permit Application NOTE: Applic3don taus1 be filled oul completely. SI NG LE FAMI LY DWELLING Legal Description LO1 Section Township Day Phone Zip Code _ Lot Size ~'~/ ~' ~"'''~ Acres/Sq Fl Inspections will be conducted by: Number of Bedrooms: ~ X Approved Engineering Firm Municipality (permit fee included) Does your house contain any of the following: Hot Tub, Swimming Pool, Therapy Pool~/~acuzz9 or Water Softener Unit? If yes, which one? ~t This application is for: Sewer Only /'~ Sewer and Well ___ Sewer Upgrade __ Well Only I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and in accordance with applicable Municipal codes. ~'/~~~__~ - ~Propedy Owner/Well Driller Fees: 72-012 fRev 10/861 ' Receipt # Permit # Owner ~'4am(e~ 3E}HN L~ERE,,_.,L~d,L F'F;&Z~:~. O~,naer' Addr.~rzs= ~8.420 S'i. JAMES CIR. ANCHL}RAGE, A~ 9951~- [gI_;'NISRAL PiN I . LOt. Sixe 246213 (sq..~. or acce~ ~t~:< Bedrooms: This Permit= 4 Total 4 SEPTIC TANK: Minimum total septic tank capacity~ 1~--.~50 {t~illcms, Eac:h septic tank must have at least 2 compartments. Depth to r. oo o~ septic ~ank (~) feet pequipes insulation over [ank' (s)~ INSTALL PF'_{R ATTACHED AP?ROVED DESIGN. NOT]FY DHHS PRIOR TO EACH 1NSPEC] lON~ THIS PERMIT lf3 ISSUED FOR THE PLANNED FOUR BDRM SINGLE FAN,U.Y DWELLING ONLY. SI40ULD A LIF] STA]'IOfq BE NECESSARY AN ELECTRICAL C'ERM]ZT MU!~T BE OBTAINED FRON PUBLIC WORKS. ]"HIS PERHIT EXPIRES ON DECEMBER J.l. 1989'~ QE.R'F EI.--Y THAT: {op'Lh by the Municipalikv of Arlc:hol'.0,(Je (MOA)' and the State el (.ilaska, 1 wJ.].l instalJ t.h;~ system in accopdance with all HOA co.es ~nd pegulations, and zn ~omplianc~ wzth the design c~ ~¢rz8 ot Lhis per, m;.'t.. I wi] ] adhepe t-o ai.t MOO and Sta'Le of q].a~ka rc~quzrement, s ~or' the sc~t back distances Cpom an'¢ e>~i~ting ~gsz).]., wast. ewm'Lep dzsposa], s'/st, em op publzc ,,.r4py. enl=rSj=mept~, : . , ,,¢Jll//fieqt.tire. an additional p~rmLt. , / .... .................. ~11 Dimensions Md ~ocations ~ust Be ~ield Verified Prior go Construction SEWER. SYSTEM 'LOCATION PLAN . ~ ~~T BL~K 8UeOIVISlO All D~ensions ~d Locations Must Be Field Verified Prior To Construction · S5W5~. SYSIHM'LOOAT~ON PhAN OE~ARTMENT OF H~LTH & HUMAN 825 "C" S~, Anchorage, Alas SOILS LOG ~ PERCO 7 8 9 10 13- 14--- 15 17- 18- 20- Township. Range. Section: WAS GROUNO WATER I I PERCOLATION RATE ~'~' 0¢' (m~u~e~/~l PERC HOLE DIAMETER TE-~T .u. 8E'rw¢~. ~ cz AND ~.,~ Torn Fink, Mayor January N unicipality Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 8, 1990 John Berggern 16240 St. James Circle Anchorage, Alaska 99516 Subject: Lot 37 Block 2 Southpark S/D #2 Permit #890245, PID #020-052-38 The subject permit, issued by this office for a single family well and/or on-site wastewater system has expired as of December 31, 1989. Permits are issued on a calendar year basis by authority of the Municipal Code of Regulations. A new permit must be obtained from this office for an well and/or on-site wastewater system ~Qt installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-built inspection report (three-part form) must be sent to this office for review, approval and documentation. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sincerely, John Smith, P.E. Program Manager On-site Services JW/ljm:200 enc: Copy of Permit "Kids Are Our Future" i::.'a r~ (::: ~ :i :i: ct :~ L.cit. L4egaI: Suhcl:i. vi!!~ic~r~ BOIJ"I'H P~RK '~ L.c)C~ :37 Ma~.~ Be~c!r. cx)m~.:.~ Th:i.~.=. Pa, rmi.'l~ 4. 'lk~taI C. apacit, y~ 4 [%i::;:T ! F'¥ I'11~.Yt: foi"!:h l:~y thc-) MLu'iicipalit. y i;)t' ¢~r'lchc)raga, (I"1[)~:~) arid t. h6.~ St. at.a, ot Alaska,, ::;'.,, .!: t.,i:i.:l.:! :in!~rLa:t.] '1.:.I'i¢:::, !~ysi't'..e:¢.)ifl il'l acc::l::H'i:Jad"ll:E) w:it.h all MOA c:~::)l::l,::~)~; ar'id r,a~gula!:.ic~ns, :3,, [ ~¢~:i.:}.:1 a(:lha, r.(:~, 'iLo all )'dC:)(:~ ar~(::l St. at. ia c)f ~:!..::dii~l-::a r'aequiP~2maer'It.~[i~ for' t. ha~ !i~x.:~t. back disF,'l:.a.!ic:~,?s il-Om any exist:.ir'ig t*¢,~:~L]., ~,.,~asta, wat. i~r' c!i!~pcisa], sy~Cem 4. ]. Ul'tdr:ms't..and !thai. Chi~s p~:-)rmi'f, i,~ va],id fop a max:i, mum c)f NOTE: All Dimensions ~d Locations Must Be Field Verified Prior To Construction S5~5~ SYSIS~'LOGAT~ON PhAN I -~-~'" .... /'t~'' -~ "~";/Z~ ........ '~---~'- All Dimensions And Locations Must Be Field Verified Prior To Construction WER SYSTEM LOCATION PLAN : : Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" St~:eet, Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 7 8 9- 10- 11- 12- 13- 15- 17- :20- COMMENTS Township, Flange, Section: SLOPE 3 4 WAS GROUND WATER ENCOUNTERED? SITE PLAN IF YES, AT WHAT j~,t0 pO DEPTH? E Reading Date Gro$~ Net Depth to Net Time Time Water Drop ,-/$ ;14. io .&7 .'7/ !z.¢ /o . L, ~'"' · 7~ ! ~-4 ,'O :1.4,, ,o(/ TEST RUN BETWEEN PERCOLATION RATE ~ ~'1~ (minu~esYinChl PERC HOLE DIAMETER __ ~ FTANO '-~ F~ ~ ACCOROANCE WITH ALL STArt AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: SRA Box 470-B · Anchorage, Alaska 99507 · (907)349-6427 MUNICIPALITY OF ANCHOP, A(3~ ENVIRONMENTAl,. PROTECtiON OCT 2" 1989 RECEIVED PO L, ,~,iq 6.-650 ANCHORAGE, ALASKA 99502 0650 (907) 264-4111 TONY KNOWLES MA Y©R DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840725 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 37 Block 3 Southpark Subdivision %2 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a' calendar year basis by authority of Municipal C~dinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as-built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, rKeith E. Bandt, SupeYviso Environmental Engineering Program KEB/ljw J enc: Copy of Permit SWP/057 DEPARTMENT OF HEAL. TH AND ENVIRONMEN]-AL F'ROTECHEION 825 L STREET, ANCN[IRAGE, AK 99501 FERMI] NO: 840725 DATE -u=UED, 08/27/84 APPLICANT: ADDRESS: C8NTACT PHONE: LANDMARK-VENTURE LTD P 0 BOX 111654 ANCHORAGE~ AK 99511 545-4807 LEGAL DESCRIF': L. OT SIZE: MAX BEDRGOMS: SUBDIVISION: SOUTH PARK ~2 LOT: 37 SECTION: 3 TOWNSHIP~ liN RANGE: 3W 24623 (SQ.FT. OR ACRES) 3 BLOCK:.-..~ I_isted below are the options available to you in designing youp septic system. C~oose the option that best fits youP site. DEPTH TO PIPE BOTT8M (FT.) 4.0 5.0 4.0 GRAVEL t~EPTH (FT.) 5.0 0~5 3.5 TOTAL DEPTH (FT.) 9.0 5.5 7.5 GRAVEL WIDTH (FTC) 2.5 2:[.0 .5.0 GRAVEL I_.ENGTH (Fl".) 59.0 42.0 63.. 0 GRAVEL VOLUME (CU.YDS.) 30. 1 32.7 46.7 TANK SIZE (GALS) 1,000.0 ~-~. 1,000.0 ~.~. 1~000.0 ~.~ SOIL RATING (SQ.FT. /BR) 194 193 :194 ~'~ "f'Af'4K MUST HAVE AT LEA.~T~:' TWO COMF'ARTMENTS I ~cepti£y that: 1. I am £amiliaP with the pequil*ements fop on-'site seweps and welZs as eet ¢oPth by, the Municipality of AnchoPage (MOA) and the State of Alaska. 2. I will install the system in accoPdance with all ~OA codes and pegulations~ and in compliance with the d~sign cPitePia oF this pepmit] 3. ~ wi].l adhePe t.o all MOA and State of Alaska pequipements fop the set back distances Fi-om any existing well, wastew8ter' disposal system op public sewePage system on {his.op any adjacent oP neapby. ].et. 4. I undepstand that tlsis penmit is valid ¢o~ a 'naximum uF 3 bedneoms and any enlargement wi!l requi~-e an adcli{ional 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 MUST BE DONE BY A LICENSED ELECTRICIAN. ...............................· APF'L. ZCANT, ~ANDI.I~RK~-VENTURE LTD . MUN~ICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS L0,G -- PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: SOILS LOG TEST LEGAL DESCRIPTION: 1 3 4 ~0 WAS GROUND WATER 11 ENCOUNTERED? 13 14- 15- 16- 17- 18- 19- 20- COMMENTS PERFORMED BY: SLOPE ,SITE PLAN iF YES, AT WHAT DEPTH? S L O P E Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ TEST RUN BETWEEN /?o , /.e (minutes/inch) FT AND CERTIFIED BY:/\ ] DATE: - ,/ 72-008 (6/79) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 47g0 South Bragaw Street P.O. Box 196650 Anch6rage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-7g04 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-052-38 1. GENERAL INFORMATION Complete legal description Expiration Date: Lot 37 Block 3 Southpark No. 2 Location (site address or directions) 15621 Stanwood Circle, Anchora.qe, AK 99516 Current Property owner(s) Tave Peruzzi Day phone 345-9005 Mailing address 15621 Stanwood Circle, Anchora~le, AK 99516 Lending agency Day phone Mailing address · -r-._~ ._t_~^ .,~l.~_.~__!,_?~)y~va. tty U S Inspect Attn.-Richard Sheehan Day phone 703-293-1525 Mailing Address 3650 Concorde Pkwv, Ste. 100, Chantillv, VA 20151-1129 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:. 2. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ' ~E] Individual Holding tank Community On-site Public Sewer ~ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 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 Health Authority Approval Guidelines for 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 heroin. I further vedfy 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 applicable Municipal and State cedes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Enq. Svc. Phone 272-8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Pdnted Name Steven R. Pannone, P.E. Date Engineers Comments: In conducting an a&quacy ttmt, !attcmpt to pm~idc a thorougk, con~cicnfio~ ~.~'~,~,~' ~ ~ engine'-brig re'mi ysis of~e systc-m in accorchnce with MOA DSD Guid~linc~ & Regulations The .~,~.~'~ ~ rcportcd rcsul~s dc.'.'.'.'.'.'.'.'.'~ibe the performance o f Ibc system und~ ll~e condifi~ ~co=t ~ at ~e ~e or thc trot, and separation disE~.nccs mc~urcd to readily i&~tifiablc funturc~. Thc opcradonal life of all ells and scpt~c systems ~'pcnd on thc local soft condiuon, ground ,~atcr levels that rnav fluctuat~ during thc year and Ibc water usage of/he family being scrvcd by thc s~-/cra. These condit~o~ ~ ~.....:, ....... . · outside the conmol of/he evaluator of this s~xm. All slfaems eve~tu~y fail and satisfactory ~'t . d.o..o p ro, c ofU=,r , at ........ hid&.'n defec~ .or e~ctoachments. P'ES can t~er~.fore not prove& any v. ma'-anty for future ix:fformance nor gtve any esUmate of how long the system '.~11 conunue to meet ~e operauonal reqmrements of the ADEC or MOA DSD. Thc contcnt of th/s re'port is for the sole benefit of the o~cr liztcd above Any reliance upon or use of tlxis report by any othc~ person or party is not authorized nor ~11 it corff~ .~ 6. DSO SIGNATURE ['""/ Approved for ff bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Expiratidn Date: X Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: ~ - ,~. ~, - 0.-~.° Reissue Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Westewater Program .4700 South Bregaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.nnchorage.ek, us (eOT) 343~7~4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 37 Block 3 $oulttpark No, 2 Parcel I.D.: 020,.052,,.38 A. WELL DATA Well type A If A, B, or C provide PWSID # 313475 Well Log Date completed ~ Sanitmy seal Total depth '1t Cased to It Wires propedy protected Casing height (above ground) in. Date of lest .~,,~FROM WELL LOG Static water eve! It Well production ~ g.p.m WATER SAMPLE RESt: Coliform ./colonies/100 mi Date of se~31~e.'/ Collected by: B. SEPTIC/HOLDING TANK DATA AT INSPECTION Other bacteda It g.p.m colonies/100 mi Tank Type/Material Steel $,T.E,P, Date installed 713011990 Tank size lr~00 gal Number of Compartments 2 Cleanouts Y Foundation cieanout Y Depression Over tank N High water alarm Y__ Date of pumping 911712002 Pumper A+ Homo Sendces C. ABSORPTION FIELD DATA Date installed 713011990 Soil rating (g.p.dJit2 or fl2/bdrm) 240 sf/bed System type I~e~ Length 48 It W~ith 30 fl Gravel below pipe ,.r~) It Total depth 4 fl Effec~ve absorption area 1440 ft= IVlonitodng tu~ Y Depression over fie~d N Date of adequacy test 911512002 Results (Pass/Fail) P For 4 bedrooms Fluid del~h in absorption field before test 2.25 in ' Water added$00+ gal. New depth2.75 in. Elapsed Time: 1440 rain Final fluid depth 2.25 in Abcorption rate >= 600+ g.p.d. Any rejuvenation treatment (~ne__~_ 12 mo.) (Y/N & type) N If yes, give date (Rev. D. UFT STATION Date inslalled 7/3011990 Size in gallons 1500 Manhole/Access Y · Pump,on' level at 37 in'Pump off' level at Datu~f Vault Cycles tested 34 in High water alarm level at 4..~1 in Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES o. SelXic tank/lift stati~,,~,,~ ../O~ adjacent lots Absorplion field on lot ~ J On adjacent lots Public sewer main ' ~ Public sewer manhole/cteanout Sewer/septic sewice./J~ "~tolding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 6.5 Property line 20+ Abso~tion field 15.5 Water main 15 Water sewice line Sudacewater 100+ Drainage 100+ Wells on adjacent lots 200+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line 20+ Building foundation 13 Water main 16+' Water Service line 16+ Surface water 100+ · 'Driveway, parking/vehicle storage ~10+ Curtain drain 100+ Wells on adjacent lots 200+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections end review of Municipal recon:ts that the above systems ere in conformance with MOA HAA guidelines in effect on this date. Engineer's PHnted Name Steven R, Pannone. P.E. Date Dateo, Pa,ment Receipt Number (Rev. 1 I~) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of EnvJronmen[a, Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parce I.D. # CERTIFi CATE OF HEALTH AUTHOR ITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete ~egal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent I<z~',,~ ?-~v/o,'-, pr~cc/cn/-~l Mcr,~ I~,~ Dayph0ne Address j Unless otherwise requested, HAA will be held for pickup. NUIVIBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: 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. NOTE: 72~)25 (Rev. 1191) Front MOA 321 STATEMI-'NT 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 f'~',/,~/-,,Z~p '/"~'¢A~ '~c,~l _¢¢r~;'r,~ Address /~/~-~ ~c.,~o ..~C,,~ /¢.nc4o~-~¢~, Engineer's signature .~~ ~ ~ Phone '~' */4":- ].%¢-..¢ Date DHHS SIGNATURE ~ Approved for bedrooms. Disapproved. Conditional approval for 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 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 not conduct inspections or analyze data before a cer[ificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-O25 (Rev. 1/91) B~ck MOA #21 .: CEIVED Municipality of Anchorage A06 0 7 1998 DEPARTMENT OF HEALTH & HUMAN SERVICES ~) Env ronmental Services Division MuN[CIPALIfY O1: ANCHO~AGE~'=%I'~'~ 825 L Street, Room 502 · Anchorage, Alaska 99501 ~"[~'2!~L-4~(~Es D~V~S~:'~' [] ~"~] Health Authority Approval Checklist LegalDescription: L.$~ ~..~o~,.~p~,"'/~ ¢8 Parcel I.D.: ~,~ooS-e ~'~ A. WELL DATA Well type C(,~_c R If A, B, or C, attach ADEC letter. ADEC water system number Log present 0 , Total depth __ Sanitary seal Date of test ~ Static water le ~-~ Well producti0 ~ ~.~ WATER SAM ~ ' Coliform g.p.m. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 7 / 3o / ~ Foundation cleanout (Y/N) Date of Pumping ?/./¥/2 7 Tank size ~o~ Number of Compartments '~ C eanouts (Y/N).__ '~ Depression (Y/N) k,' High water alarm (Y/N) ~' Pumper _.L'"-~,c~,~.r- ('~..~,~.,~ ~,,,~ ~/~k-_c./~z;.~ C. ABSORPTION FIELD DATA Date installed 7 ~'-?~/,~ ¢~ Soil rating (g.p.d./fF or fF/bdrm) 8 ~'¢' r~ '.. System type ,5'~ Length 5/,¢ Width 7~' Gravel thickness below pipe ~, ~- Total depth Effective absorption area ! ¥'Y,¢ Monitoring Tube present (Y/N) 'r' Depression over field (Y/N) __ Date of adequacy test I / ¢- 9/) ~ Results (Pass/Fail) ff¢~ ~..~ For "! bedrooms Fluid depth in absorption field before test (in.); ~ Immediately after ? ??gal. water added (in.): ~' '/~- ~' Fluid depth ~- I/~ (ins) Minutes later: ~ ~ Absorption rate =. Peroxide treatment (past 12 months) (Y/N) /v~,-~¢ /.o,¢~,~ If yes; give'date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed '7/3 d,/?O Manhole/Access (Y/N) ~' Size in gallons "Pump on" level at* ~' 7" "Pump off" level at* 3' Y" High water alarm level at* 'Y!" *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: k/./~. Septic/holding tank on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~'. £' Property line To Absorption field Water main/service line ~. I<~ ~ Surface wateddrainage ;>~oo' Wells on adjacent lots ;;:,'~oo , SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I~" Building foundation I ~7 ' Water main/service line Surface water ~ /oo' Driveway, parking/vehicle storage area ;~ ~ ~,- ' Curtain drain Vo/~ e s¢'~'~ Wells on adjacent lots ;> ~' o~> ' in conformance with MOA HAA guidelines in effect on this date. Signature _¢'~ ~.. Engineer's Name Date /zJ~,¢~/. ~ /¢¢~ ENGINEER'S CEFITIFICATION I certify that I have determined thru field inspections and review of Municipal rocords.that:th~° abo~o:s~$tems are HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Parcel I.D. # MUNICIP~ALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES ~ 343-4744 CERTIFICATE OF NSPECT ON FOR HEALTH AUTHORITY APPROVAL ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLI~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner -~Xt4"/1,d":J/~'~ ~-/C~A Mailing Address ~ ~ ~' (c) Lending Institution ~/~ Mailing Address ~ Telephone: (home) Business ' Telephone (d) Real Estate Company and Agent Address (e) Mail the HAA to the following address: (or check here for pick .up.) List contact person and day phone number below: 2.TYPE OF RESIDENCE Single-Fa Number of bedrooms 3. WATER SUPPLY Individuar 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-sit(~_.~ 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. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING 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 th is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances,/.~ d'.-~ __and regulations in effect on the date of this inspection. Address ~ ~)' ~ ~~ ~t~dk~ ~- ~-~'~ ; ~;~,Fni_n=.neer's Seal 6. DHHS APPROVAL Approved for pm~[ edrooms by Approved /~ Disapproved Terms of Conditional Approval Conditional Date 07/- ~' ~-- ~/ O The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 72-025 (Rev. 7/88)Back Page 2 of 2 MUNICIPALI'[Y OF ANCHORA~--~ RECEIVED A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Date Oompletec~' Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around WellhE If A, 13, C, D.E.C. Approved (Y/N) Yield SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Lots ; On Adjoining Lots Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line Water Sample Collected by ; Date Water Sample Test Comments -~.',,z¢-/)~--~ ~/~c'~'~,/'- ~/~'~¢ B. SEPTIC/HOLDING TANK DATA Date Installed '¢/~O Size Standpipes (Y/N) //'"' Air-tight Cap~ (Y/N) Depression over Tank (Y/N) Pumping/Maintenance contact oD,File (Y/N) Holding Tank High-Water Alarm (Y/N) No. of Compartments ~ Foundation Cleanout (Y/N) ,~ Date Last Pumped /'~'/~-/~ 7~'~'~-~ Temporary Holding Tank Permit (Y/N) /(J~,~/,~ Comments To Building Foundation To Disposal Field /~'~ / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~ ~ To Property Line ~d) / To Water Main/Service Line "~/''4:~2 / To Stream, Pond, Lake or Major Drainage Course 72-026 (Rev. 7/88) F~ont Page 1 of 2 Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '~../~/~'~(~) Length of Field Width of Field _ ~.~-"'~c'~ / Depth of Field Gravel Bed Thickness ~'~ //'~"/~(~ Statndpipes Present (Y/N) ,/~ Date of Last Adequacy Test · ~:"~/~'~ ~/~' Type of System Design ~,~L~-~J SEPARATION DISTANCE FROM ABSORPTIO.N FIELD: TO Water-Supply Well '1'o Building Foundation Lot /d/'/4- TO Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ; On Adjoining Lots ~/~--¢~ / To Cutback (if present) To Property Line ~.~_~ ~'/Z, / To Existing or Abandoned System on Comments 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 / ~¢7'J'~.~'~/¢ ~--D~/Jr¢~ ·'c- Manhole/Access (Y/N) ~'/~"Pump Off" Level at ~p/L Vent (Y/N) **Check Permitt~d.~ I certify that I inspection. ////~ Signed //,/! Company / Date MOA No. edroom Ha~ng Against HAA Request ~/:~ e ked,~ d, or conformed.~ to all MOAand H~ Receipt No. Date of Payment Amount: 72-026 (Rev. 7188) B~ck Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 effect on the date of this Engineer's Seal INSPECTION REPORT MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION 3500 EAST TUDOR ROAD INSPECTIONS (907) 563-3464. _.INFORMATION (907) 78E-821.,. ,,~ FOQTING [] ELEC. TEMP. [] PLBG, UNDGR,.-;.---,- {~ FOUNDATION -- [] ELEC. SERVICE/~-~ [~] PLBG, ROUGH ~ [] BOND EEAM ___ E} ELEC. ROUG~/-/j-~ ~[' GAS TEMP, E~ FRAMING [] ELEC. FINAL~- [] GAS [] 'INSULATION ~-- [] OTHER I-] MECHANICAL ,. I-'1 SHEETROCK [] MECH. FINAL ..... [] STRUCT. FINAL [] FIRE FINAL [] PLBG, FINAL ~ ~] OTHER [] ZONING E] OTHER , [] ~No NONCOMPLIANCE OBSERVED D'CORR'~CTIONS ESSENTIAL AS ' EXPLAINED BELOW E] WILL REEXAMINE AT NEXT INSPECTION E] DO NOT CONGEAL UNTIL RE!NSPECTED / ,,,--- ,-? iNSPECT~)~R-~ DATE "WHEN CORRECTIONS ARE MADE, PLEASE CALL FOR INSPECTION DO NOT REMOVE THIS NOTICE STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANC~IORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANC}{ORJ~GE, ALASKA 99503 September 14, 1990 563-6775 FOR: Corwin & Associates Attn: Bruce Corwin PWSID: ~213475 According to the records on file in this office, the South Park Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, E~vironmental Sp~~ist VEC:pf 0 N 87'22'13"E 224.89' S 87'22'13"W 231.09' N