Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
SOUTHPARK BLK 2 LT 6
Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221176 PID Number: 020-491-20 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name TIM VOTTIS ABSORPTION FIELD Deep ❑Wide Trench ❑ Dee Trench ❑ Bed ound Site Address 4335 SOUTHPARK BLUFF DRIVE "ANCHORAGE, AK 99516 El Other Phone Number of Bedrooms Soil Rating Total depth original grade 907-301-2928 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft, Gravel depth beneath pipe Ft. Subdivision Block Lot SOUTHPARK; BLOCK 2, LOT 6 Fill added above original gr Ft Gravel length Ft Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. WellN/q I TANK ElSeptic ElS.T.E.P. ElHolding ElOther Manufacturer GREER TANK Capacity 1250 Gal. Surface Water 100'+ � Material Number of compartments II Lot Line 5'+ NA HDPE 2 Foundation 10'+ LIFT STATION Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC Gal. PER CONTRACTOR Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 03034 dTank to 03034 rainfield A+ HOME SERVICES Drainfield 03034/EXISTING CO/MTD3034 Inspector GEG AND MOA BENCH MARK (Assumed elevation) 98.63 ft Inspection l51 6/30/2022 2�d - da:3d Location and description _ 4'" _ TOP OF MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's tamp _9oboo O�4 Conditional Approval: Date ............. �D 0 p Q J A. C� rness ; Q�13 % P p Septic System Approved DateQ�4^eo' �9. c — 3 Note: this approval does not include well permit requirements. frofesSI°n°ao (D.... ncinniw n #AOD�pp00� ECC884 4 X.. v. / r PERMIT NUMBER: PARCEL ID NUMBER: OSP221176 RECORD DRAWING 020-491-20 A B MH 16.3 58.0 8T1 19.3 62.9 DBL1 20.0 64.0 DBL2 20.7 64.8 IOUTHPARK BILK 2 LT 5 NEW 1250 GALLON HOPE GREER Ase MEW I I I I I I I I I I ASSUMED LOCATION OF TRENCH PER SUMP AND CLEANOUT LOCATION I I � I J W I I w J Z J ¢ I w L1sz JBST1 ww I � i I < J w H1 I J z w w GO CL I w J a N I O I I EXISTING HOUSE 4 I BEDROOM HOUSE N :. J I �� V 7t ..ys���.• 9� DRIVEWAY \ F Ir Tp ENGINEERING SALES -CONSULTING 3701 E. MOOR ROAD. SUITE 101 . ANCHORAGE. AK 99507 -PHONE(907)337-6179- FAX (907) 3363248 -WEBSITE: xxw.panessengineering.cgm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: TIM VOTTIS 907-301-2928 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: SOUTHPARK; BLOCK 2, LOT 6 D.J.G. TYPE OF WORK: DATE: SEPTIC TANK RECORD DRAWINGS 7/15/2022 SOUTHPARK; T2 LT 7 .r�. f,....w.......... • ® Je e�� Hess �C -7 3 LICENSE444® ®®®m®®0 #AECCB84 PERMIT NUMBER: RECORD DRAWING OSP221176 TOP OF MANHOLE = 98.63 GRADE = 98.40-98.42 MHS TOP OF TANK AT INTLET = 93.68 —\ IN 11 11 f-- TOP OF TANK AT OUTLET = 93.68 INVERT OF BUNG AT INLET = 93.03 NEW 1250 GALLON H.D.P.E. SEPTIC TANK INVERT OF BUNG AT OUTLET = 92.66 PARCEL ID NUMBER: 020-491-20 Ed kx ENGINEERING e� SALES o CONSULTING 3701 E. MOOR ROAD, SUITE 101 -ANCHORAGE, AK99507 • PHONE (907) 337-0179 • FAX (907) 330-3246 • WEGSITE:—.9amas onaarinp... PREPARED FOR: TIM VOTTIS PHONE NUMBER: PAGE NUMBER: 907-301-2928 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: SOUTHPARK; BLOCK 2, LOT 6 D.J.G. TYPE OF WORK: DATE: SEPTIC TANK PROFILE 7/15/2022 v® -V"—V/ v mey' . Gar ess LA,J a E-7/9� 3 LICENSE #AECC884 4�®qkr ®S®®®®® i MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program poBox 1eooso 47ooElmore Road Anchorage, Alaska oos19-6nno p -7904 Fax: (nor)ow3-7uyr mmswwwmum.vrgmnmm On -Site Wastewater Disposal System Permit Permit Number: O8P221178 Work Type: SephcTonhUpgrado Tax Code Number: 02048120000 Site Legal Address: SOUTHPARKBLK 2 L G G:3236 Site Mailing Address: 4335SOUTHPARKBLUFF DR, Anchorage Qm/nmc VOTT/STIMOTHY S Design Engineer: QARNE8SENGINEERING GROUP LTD This permit isfor the construction of: [] Disposal Field 2Septic Tank [] Holding Tank [] Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 6/7/202 6/7/202 El Private Well El Water Storage All construction shall beinaccordance with: 1. The attached approved 2. All requirements specifiedi 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 engineershall notify theDovebpment Services Department per AMC 15.65.Provide notification bycalling (AO7`34J'79O4( 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed oothe same day, cv b. Covered, sealed, and heated hoprevent freezing � Received By: Date: -V x U `3 _::7 1 > .3 U __ a u OF All l vYYS E; r; O RA G 3 Development Services Department Phone: 907-343-7904 On -Site Wafter & Wastewater Section =' Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020-491-20 Property owner(s) TIM VOTTIS Day phone 907-301-2928 Mailing address Site address 4335 SOUTHPARK BLUFF DRIVE *ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) SOUTHPARK; BLOCK 2, LOT 6 Legal description (Township, Range &Section) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Absorption Field ❑ Initial ❑ Septic Tank 0 Upgrade Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) (w/wo AD U) Duplex (D) Multiple Dwellings (SF and/or D) Distance: 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: 22.5 Waiver Fees: Date of Payment: 6/z/Z 2 Date of Payment: Receipt Number: 0317 7 G Receipt Number: Permit No. 0S102Z 117.E Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\FormsUient Forms\Permit Application.doc 0 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221176, Rebecca Carroll, 06/07/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221176, Rebecca Carroll, 06/07/22 z < 3: Z LA Lu L U Ull, LU LU 0 LU Z z LL- 1. < w F -i LL i W, U,kA z L < 3: uj CC- 0 un < V) w r > z 0- L.Ll L A LU V) 0 un rj� z z -I < w un C) z uj 7p z LL, z < cf I ---i LL n 0 UJI 9 -Ile- Lli 0. Z 0 < z LIJ LU —1 \A al F- V) z < 0 m a 10 0 z 0� 0- �J ui = u < < �Yl w i-- z m: CIL 0 m C) kA z > 0 > < t --i H :E z QCc- -ji L W, LL uj 0 z Z LU 0 m a w 0 f -i 0 H �- Lu LIJ —11 Lu w 0 LL -j w z tAll V) <MDOZQH w un w vi uj z z H 0 LLJ Z rx: < z < 3: Z LA Lu L U Ull, LU LU 0 LU Z z LL- 1. < w F -i LL i W, U,kA z L < 3: uj CC- 0 un < V) w r > z 0- L.Ll A LU V) 0 un rj� z -I < w un C) z uj 7p z LL, z < cf I ---i -j n 0 UJI 9 -Ile- Lli 0. Z 0 < z LIJ LU —1 \A al F- V) z < 0 m a 10 0 z 0� 0- ui = u < < LU !--4 = w i-- z m: CIL 0 m C) kA z > 0 > < t --i H :E z ui-T 0 cc 0: Lu CL Lu W W. er- z Z: W, LL uj 0 z Z LU 0 m a w 0 f -i 0 H �- Lu LIJ —11 Lu w 0 LL -j w z tAll <MDOZQH w un w vi uj z z H 0 LLJ Z rx: < 0 .. LU CL U. W LU L14 CL w z> - w z w = z rl- < /~ O' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 8:25 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/O~ INSPECTION REPORT [] UPGRADE MAILING ADDR~..~ J We~ ~ Absorption area '~ Dwellingz PERMIT NO. ~STANC~ TO: ~ DO '~ ~2~ ~ Manufacturer ~h~ Material~/--. I No. of compartments Liq. capacity in gallons Inside length Width Liquid depth /,~ (~ ,~ IF HOMEMADE: ~ ~ D~C~ TO: Well Dwelling PERMI-T-NO. ~O--~ ~nufacturer .~ ~ l Material ~ ./~ ' Liquid capacity in gallons Well _ . / /, ' = DISTANCE TO: ~ ,.~,~ ~ ~' Foundati~,. ~ / ~ Nearest lot/line,.:~ ~ PERMIT NO. ~ ~ No. of lines,~ Length~f'each ~1~I Total length~.~.~of Ji~es Trench~width ~inches Distance._ between lines ~ Material bene~ tile ~~ Total effective absorption ar~ ~ Top of tile to finish grade / - ~ Length Width ~ .... ~ /¢-- [/ Depth PERMIT Nu. ~ ~ Type o~ Crib diameter / ~ Crib depth ~e~tive absorption area ~ ~/ Weld /' Building foun~ Nearest lot line ~ DISTANCE TO: / ,- ~ Class Depth _~iller Distance to lot line PERMIT NO. ~C Building fo~n Sewer line ~ Septic tank .. ~bsorption area(s) ~ E TO: OTHER PIPE MATERIALS ~ SOl L T~ST R~NG " Z/¢ / INSTALLER Cd Z ' // '~' ~ ( REMARKS r ,, DATE LEGAL 72-013 (Rev. 3/78) P E F.'. M It T ?.4 n. ,:: .~:1. 9 6 7 S ) F .... T -.~- ~.. ·-'~I ,-'v' C,' '~F F L ~. L.,-h 4 ? .......HFIDDY LLqF:RT I fin '5 -Ji. tTHPFIF.:K LE ]RL L6B2 $OUTHPFtRK DEF'RF:TMENT L--~EFtLTH RND EN,,,IF.:CINMENTRL ~.J'f'ECTIFd'.,I ,...,,:,':'-,.~:~.. ....... .-'t ." STREET., F¢.,IF:Hr'~F.:RGE., 2 6 4 -. 4 7 ;:---_' E: EE l....,B E F: F' E F: E't Z T' F'O BE ::-:. '! [3 - '! '.t i 4 LOT SIZE T';'F'E LqF SOIL. PB'5'3F,.'F'T!}N SYSTEM IE; TRENCH MAXIMUM NUMBER OF E:EE:,ROOMS = 4 SOIL F..:RT I NG THE REL::!LfIF,::ED L:;IZE OF THE SOIL RE:SOF.:F'TIEtN SYSTEM !S' [:, E I1:-.. -r H = :.-L 2 [._ E: !'-,11E::.:J 'T H ==-- 2 5,_ ,3 F: R '...' E IL_ E:. E F' T t,.-1 == ":",_. THE LENGTH [:, I MENS I ON IS THE LENGTH (IN FEET) OF THE TRENCH OR DF.:RINFIELD. THE DEPTH OF R TF.'.ENCH OR PIT IS THE DISTF4NCE 8ETNEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCF¢/RTION ,::IN FEET). THERE IS NO SET H![:,TH FOR TRENCHE'=;. THE GRR',,,'EL DEPTH IS THE MINIMUM DEPTH OF GRR',,,'EL BETNEEN THE OUTFRLL PIPE FIN[:, THE BOTTOM OF THE EXC.R',,,'RTION ,.'.'IN FEET:..'. F'EF. tMIT AF'F'LIC:RNT FIRS THE RESF'ONS!E:!LITY TO INFORM THIS [,EF'ARTMEHT [,U?IN3 THE INSTRLLRT!ON INSF'ECTIONS OF RNY HELLS RE.',JRCENT TO 'THIS PF.:OPEF.:TY RND THE NUMBER OF F..:ES!E:,ENCES THRT THE HELL .WILL TI..-4. C, .:: ;2: ::, Z ~'-.t'2-'.;F' EL--: T I C~ll'-,~ S;, FtF:E F-:E,;_~L~ ]: F..:E[:, BFtCKFILL. ING OF R.NY SYSTEM HITHOUT FINRL INSF'ECTION RND RF'PRO',,,'RL. BY THIS DEF'RRT.h'ENT .klILL BE SUELTEF:T TO PF.:Ev. SEF:UTI-N M~NIP'!UM E:,I~TRNF:E BETI.,.tEEN R HELL FIND RN'T' ON-SITE SEHRGE D!SF'OSRL SYSTEM IS 'l.k~R FEET FOR R F'RI',,,'RTE .t4ELL OR ±5F-'~ TO 2C~L:~ FEET FROM R F'UBLIC HELL DEPENDING UPON THE TYPE OF PUBL. ZC HELL. MINIMLIM DISTF:INCE FROH R PRI'v'F!TE HELL TO R PRIVFITE SENER LINE IS ~.'5 FEET TO R COMMUNITY SEI.,.IER LINE IS 75 FEET. OTFtEF.'. REL-]UIREMENTS MRY APPLY. SF'EC:ZFIC:FITION':-: RND CONSTRLIC:TION DI.RGF..'RMS RRE R'v'F~ILRBLE TO INSURE F'ROPEF.'. INSTRLLRTION. F"E F-:E-1 :[. "f" E::-::F' I F-: E'_-=-; [:,EC:E!',IE:EF-.: --"~: 1., 19E;::L I CERTIFY THRT -1_: I Rr,1 FRMILIRR HITH THE REC!UIREMENTS FOF.: ON-SITE SE.t4ERS RND ktEL. LS F4S SE]" FORTH B'-r' THE MUNICIF'RLIT'?' OF R.NCHORRGE. 2: I HILL INSTRLL THE SYSTEM IN RCCORDRNCE HITH THE CODES. 2:: I UNDERSTRND THRT THE ON-SITE SEI.,.IER SYSTEP1 MR"r' REL.-.!UIRE ENLRF.:GEMENT IF THE RES I[:,ENCE IL:; REMO[)ELE[) TO INCLUDE MORE THRN 4 BEDROOMS. S I GNE[:, ' RF'PLIF' NT LT.'HUCK . - )Y 4- 6- 7 ~o • Municipality of Anchorage On -Site Water and Wastewater Program ' (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D.020-491-20 Expiration Date: 1. GENERAL INFORMATION: Complete legal description SOUTHPARK; BLOCK 2, LOT 6 Location (site address) 4335 SOUTHPARK BLUFF DRIVE *ANCHORAGE AK Current Property owner(s) TIM VOTTIS Day phone 907-301-2928 Mailing address Real Estate Agent JAMES CASH Day phone 907-360-7448 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 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: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 55o f go go (Grid1 Date of Payment %L2Z/?�2 7 - Receipt Receipt Number 06O R6 COSA # 05 C 121 3 � '�) Date: Waiver Fee $ — Date of Payment Receipt Number, 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: Gamess Engineerinq 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: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and 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 system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained G perform the evaluation. Reliance upon the information provided in this report by any other R�I party (including subsequent property purchasers) is not authorized, nor will it confer ar gr whatsoever. `` "7/js 92-111;R_ 6. D SIGNATURE System #1 N gJ 0 �y w �SIr� Approved for bedrooms � � ►Nqs rFR qNp n r System #2 Approved for Disapproved Conditional approval for �m U bedrooms JV- PROD q TER bedrooms, with the!#Al,zht`ipulations: By: Original Certificate Date: :7-2 q —27 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: SOUTHPARK; BLOCK 2, LOT 6 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA SERVED BY PUBLIC WATER ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) In. Date of flow t�atbeginning Co Static water of test ft. B. TANK DATA Age of tank(s) NEW years Tank type/material PLASTIC Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping N/A Parcel ID: 020-491-20 Structure served by this system Well production at time of test m Water storage tank volu gallons Well disinfect coliform test? ❑Yes El No orm bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance Age of lift station /� Lift station material/ c. 5 - D. ABSORPTION FIELD DATA �� Which system tested (date installed) 1981 Adequacy test date -"2.2o22 ❑ ALL standpipes present per record drawing Results ❑ Pass For 4 bedrooms ILTotal measured depth from grade 13 ft (max) Fluid depth prior to test 33 in Measured depth to pipe invert from grade *5.25 ft (min) Water added 736 gal ❑ N/A — pressurized field 48 ❑ Monitor tubes go to bottom of effective. If not, state New depth in 120 depth into effective 7.75 (SUMP) Elapsed time min ❑ Code -required soil cover over field Final fluid depth 39 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) ** date of test) Gallons introduced N/A gallons If yes, enter date Comments/Deficiencies: *AT SUMP -CLEANOUT -IT IS UNKNOWN IF ANY REJUVENATION TREATMENT HAS TAKEN PLACE IN THE LAST 12 MONTHS COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' R Community Sewer Manhole/Cleanout if No ❑ Yes if No ft ,?y89'"""� ''��11 �r es if No ft Neighboring Tank > 100' ❑ Yes if No ft Private eptic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' f-1 Yes if No Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > if No Animal Containment > 50' ❑ Yes if No ft 1 Yes � if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Yes if No ft unity Sewer Main > 75' El Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' R Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' Yes Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' [] Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' R Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' ❑/ Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION .0 F l certify that l have determined through field inspections and review �o©P. ' �IS" of Municipal records that the above systems are in conformance with p MOA COSA guidelines in effect on this date. 1 4 •7� Q� ff y``ness, Q 9� CE 79 3 COSA Checklist yellow sheet ° Pr o f e s s`o�& #AECC884 44��000c� 13 BuiIding Safety Divis:on On-Site Water and Wastewater Program 4700 South tBragaw Street P.O. Box 196650 Anchorage, AK 99519°6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-O51-38 Expiration Date: GENERAL INFORMATION Complete legal description Lot 6 Block 2 Southpark SID Location (site address or directions) 4335 Southpark Bluff Drive, Anchorage, AK Current Property owner(s) Mailing address Lending agency Arthur & Karen La,on Day phone 727-8397 4335 Southpark Bluff Drive, Anchorage, AK 99516 Day phone Mailing address Real Estate Agent Karen La_y~onlPrudentiai Vista Day phone 273-7238 Mailing Address 4241 IB S[ree-L Anchora,qe, A~ 99503 Unless othenvise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NU.M~F-R OF/BEDROOMS: 3 _ TYPE OF WATER SUPPLY: fndi',/idual Well !ndividusi Wats: Storage Community Class Pubtic Water System We!i TYPE OF WASTEWATER DISPOSAL: lndividua! On-site Individual Holding tank Communibj On-site Pubiic Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Heaith Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Ce~ifica'tes of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single fatuity 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 senzed by a private or C!ass C weil 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 in the or B wel~s or a public water sy~em. The "~' ,~ o~'~ -:v of ,Anchorage is not m~oonsible for errors or omissions professional engineer's work. (Rev. I i¢99) 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 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone En.q. Svc. Phone 272-8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date.J~ Engineers Comments: In conducting an adequacy test I attempt to provide a thorough, conscientious ..... pertormance of the system under the conditions encountered at th~ ,~,~. ~c tne.tesg .and separation distances measured to rea~lily identifiable features The onerafional h'~'~,"'~i~' --'~"~'~,.%'.,¢" Wells and s tic - - - ' '- ............ , . . ep systems depend on the local soft cond~bon, mound water levels that .... n,,~,,o,~ _~ urmg the year, and the water usage ofthe familv beino served bv the s, st~ -n. ........ -.- ~ ' ~,.+~:.~ .~_ -- , ~ . . ~, ~ ~ f ~x~-t..L ttC~,~Z C~OIICtlt. IOnS are ~ j~,~.~,-~,~e ~n~o~ o~. me~e.muat%orthis system. All systems eventually fail and satisfactory test ~ ...... ~"~'~""~ ............. '""'"'~ · ~u,~ uo not guarantee furore perlormance of the system, nor do they ¢uarant~ th,, th ......... ~ ~ hiade defects or encroachments. PES can therefor; not provide an,. (v~rranN- fo~ fu"~t~r~'~;r~%2~,,,¢ nor ~mve any estimate of how lona the system w/l! cantinn~ tn ~,~t"~h .... A- , .r- --~----~-~-~ ~ -". -V .................... }~erauoual reqmrements otthe "~2 A~,.EC or MOA DSD. The content of this report is for the sole benefit of the o~xmer listed ah .... a,,, ~:~"%1'% ,rena, nc.e.upo.n or use oftlfisreport by any other person orparty is notauthor/zednorwili-i~r~g"~ legal n~tt wlaatsoever, y 6. DSO SIGNATURE :)~ Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow;/~sory Expiration Da~. 2 - 2 ~- ~;' / (Rev, 11/99) V Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date:ii-- Reissue Date: Legal Description: A. WELL DATA Well type _A Date completed Total depth Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Lot 6 Block 2 Southpark SID Parcel I.D.: 020-051-38 If A, B, or C provide PWSID # 213475 ~ Log Sanitary seal .- Wires propedy protected __ Cased to ft Casing height (above ground). FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform colonies/100 mi Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Greer Steel ft ft g.p.m g.p.m in. Nitrate Collected by: __ mg/I Other bacteria colonies/100 mi Date installed 719/1981 Tank size Cleanouts Y Foundation cleanout Y Date of pumping 1111612001 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 719/1981 Soil rating (g.p.d./ft2 or ~/bdrm) 100 Length 25 ff Width 2 ft Total depth 12 ff Effective absorption area 400 ft2 Date of adequacy test 11115/2001 Results (Pass/Fail) Fluid depth in absorption field before test 40 in Elapsed Time: 180 rain Final fluid depth 4_.~0 in Any rejuvenation treatment (past 12 mo.) (YIN & type) N (Rev. 11/99) 1250 gal Number of Compartments 2 Depression over tank N High water alarm NIA System type Trench Gravel below pipe 8 ff Monitoring tube Y Depression over field N P For 3_ bedrooms Water added450 gal. New depth40 in. Absorption rate >= 450+ g.p.d. If yes, give date D. LIFT S'~ Date installed "-... Size in gallons "Pump on" level at ~ump off" level at Datum '~¢J~ested E. SEPARATIO~ISTANCES SEPARATION DI~T~CES FROM WELL ON LOT TO: Septic tank/Ii, stati0n on"t~~ __ On adjacent lots Absorption field on lot, "~ On adjacent lots Public sewer main ~"'~..~Publi~ sewer manhole/cleanout Sewer/septic service line Hold~ank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access ~ in High water alarm level at ~ in Meets alarm & cimuit requirements? Building foundation 12° Property line 11)'+ Water main 25'+ Water service line 25'+ Drainage 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field 8' Surface water t00' Property line 10'+ Water Service line 25'+ Curtain drain 100'+ F. COMMENTS Building foundation 25'+ Surface water ·'100'+ Wells on adjacent lots 200'+ Water main 25'+ Driveway, parking/vehicle storage G. ENGINEER'S CERTIFICATION I certify that ! have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Pdnted Name Steven R. Pannolte, P.E. Waiver Fee $ DateofPayment [[//~ f?~ ( DateofPayment Receipt Number I ~ ~ ~ TI Receipt Number (Rev. 11 Parcel I.D. # MUNICIPALITY OFANCHORAGE 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 HAA # ~~t~t~ / GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Day phone Lending agency Mailin. g address Agent Address Day phone · Day phone m e Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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. 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 status of system. 72-025 (Rev. 1/91) Front MOA #21 5.,,.-::,h STATEMENT OF INSPECTION BY.:.ENGINEER · ~ · - . ; .. As certified by' my:seal affixed heret~and as of thevalidation 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 verifythat 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 '-~'~-~1 Address Engineer's signature ~"~-~ .~:~~~ Phone Date DHH8 SIGNATURE )~ Approved for ~ bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: By: Date '/-2 - //- ~'~ 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. 72-0~5 (Rev. lj91) Back MOA ~ Legal Description: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) Health Authority Approval Checklist L.o~-~, ,~K,2._ ~oL,t~-'~_-,,~_~_ Parcel I.D.: ~--g:) - (~.~1 - ~,~ A. WELL DATA Well type Log present (Y/N) If A, B, or C, attach ADEC letter. ADE© water system number Date completed Total depth Cased to Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG g.p.m. AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: g.p.m. Coliform Date of. sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ! Tank size · Foundation cleanout (Y/N) Date of Pumping /2-.~o Number of Compartments ~ cleanouts (Y/N)~ / Depression (Y/N) h,~ High water alarm (Y/N) J~- 1 Pumper /~ ~ ~ ~ 5 C. ABSORPTION FIELD DATA Date installed F~/E"/ Soil rating Length r~ Width Effective absorption area Date of adequacy test ~///~--¥/~ Fluid depth in absorption field before test (in.); Fluid depth J'~ (ins) Minutes later: Z//~'r-..5 Peroxide treatment (past 12 months) (Y/N) (g.p.dJfF or ~/bdrm) System type Gravel thickness below pipe ~ Total depth I Monitoring Tube present (Y/N)_.~____ Depression over field (Y/N) ~ Results (Pass/Fail) "~ For ./-// Immediately after/,~'~ gal. water added (in.): Absorption rate = ~ ~ g.p.d. If yes, give date" 'C...'/ bedrooms 72-026 (Rev. 3/96)* LIFT STATION , Date' installed Manhole/Access (Y/N) Size in gallons "Pump on" level at* "Pump off" level at* I;ligh water alarm level at* *Datum Cycles tested 'E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 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 LOT TO: ! Foundation I,,~. Property line "~ ! ~) Water main/service line > ~ ¢. Sudace water/drainage iq l o SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: · Property line Surface water Curtain drain Absorption field Wells on adjacent lots Building foundation ~ ,'~'~ ' Water main/service line Driveway, parking/vehicle storage area ~> Wells on adjacent lots I"///',z~. F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review in conformance with MOA HAA guidelines in effect on this date. Signature / Engineer's Name Date / HAA Fee $. Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A S~NGLE FAMILY DWELUNG 0 20 - 03 ~- ~ ~ HAA # ./Z//¢_ GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent h"--~-,- Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: NOTE: Individual well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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 status of system. 72-025 (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 a;:d type o," structure indicated hereir', i further verify that based on the information obtained from ..... Munic r:a::.;: ,~., ~ "' *raos.~ file~: ' "¢m~., .... m,/ n,,~::ati,'-~~., = :~nd ,nsp~ ,=*'- ............ ~, +h~. ,~ on-s;te water ~:: ~Fply and/c: '.'.-:stev. ~:~- disposal ~' t.::~m is in compliance ',dth all Mun~oipa~ and State codes, ordinances, an..~ regulations in effect o:~ the date of this inspection. Name of Firm ~ ¢ ~*~ ~ %/b ~-r ~ ~q ~ c~ ~ ~ Phone ~ 7c~ _ ~ c~ 7~ Address ~,~c, % U~ /~ /~0'~ Engineer's signa':::re approval for bedrooms. bedrooms, with the following stipulations: Additional Comments i /,i ,. ;: ,it- ' ] ..{ r . - Date The Municipality of Anchor~.ge Department of Hea;(h and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professio :: engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their :ling institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct . .;pections or analyze data before a ce~ificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professiona! engineer's work. 72-025 (Rev. 1/91) Back MOA ¢¢2~ MUNICIPALi'[Y'OF ANCHU~,~,~,,. ENVIRONMENTAL S~.P, VICES DIV_~i~bl Municipality of Anchorage APR 17 1997 DEPARTMENT OF HEALTH & HUMAN SERVICE Environmental Services Division ED 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907 - Health Authority Approval Checklist Legal Description: A. WELL DATA Well type Y,z~t(- Log present (Y/N) Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Total depth Cased to Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static' water level Well production WATER SAMPLE RESULTS: g.p.m. g.p.m. Coliform Nitrate Other bacteria Date of sample: SEPTIC/R~iaBiI~TANK DATA Date installed ~/E) [ Tank size Foundation cleanout (Y/N)... ,~ Date of Pumping Collected by: /2-50 Depression (Y/N) ~ (~//~'/.~J Pumper '~,'[-~ Number of Compartments ~ Cleanouts (Y/N)~ High water alarm (Y/N) ~'! C, ABSORPTION FIELD DATA Date installed '7//~/oc'! Soil rating (~J~t~l;/~ or fF/bdrm) Length ~ ~ Width ~'~ Gravel thickness below pipe Effective absorption area ,/-//00 ~ 7_Monitoring Tube present (Y/N) Y Date of adequacy test ~///~'/~/~' Results (Pass/Fail) ~ Fluid depth in absorption field before test (in.); Fluid depth ~.~'Z.- (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* / e'~ System type c) , Total depth . Depression over field (Y/N) For Immediately after ~o-~ gal. water added. (in.): ~. ~ Absorption rate = ~'~ O If yes, give date bedrooms D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 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 LOT TO: Foundation . 1~. t Property line '~ I0' Absorption field ~) ~ Water main/service line ~ ~5~ Surface water/drainage N Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ ( 0 ~ BUilding foundation ~ ~ F3~ Water main/service line Surface water ~ Driveway, parking/vehicle storage area ~' ~'~5" 'Curtain drain /"-/ Wells on adjacent lots ~'/~, F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review, of Municipal records in contormance with MOA HAA guidelines in effect on this date. Signature ~~ Engineer's Name "~eJ~e~ ~ ;~J~r~-~[~.J~ ~ ~-- Date ~. l~ ,, l ~ ~ HAA Fee mS~ ~ ~ ~' Date of Payment ~//.7/?,~ Receipt Number ~-~ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 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) Southpark-- Lot Location (address or directions) 6 Block 2, TllN, R3W, Sec.3 4335 Southpark Bluff Drive (b) Property owner Ken C~talino Mailing Address 4335 Southpark Bluff Dr.. (c) Lending Institution Mailing Address Telephone:(home)345-6923 Anchorage Ak Telephone Business (d) Real Estate Company and Agent Address Anchoraqe, Ak. Telephone 563-5500 gackWhite - Tom Blake (e) Mail the HAA to the following address: (or check here [], if hold for pick up.) List contact person and day phone number below: Ken Catalino 2. TYPE OF RESIDENCE Number of bedrooms Single-Family [] 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 [] 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 this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is ~afe, 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 Eagle River Engineering Telephone 694-5195 Address P.O. Box 773294. Eagle River. Ak. 99577 Date ~/A// 6. DHHS APPROVAL Approved for ? bedrooms by Approved ~/~ Disapproved Terms of Conditional Approval Seal Conditional Date 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. 7/88) Sack Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 k0~al D0scription: Bet Southp~k A. WELL DATA ;, Well Classification A 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 Water Sample Collected by Water Sample Test Results Comments Date Completed Depth of Grouting 6, Block 2 Sub. Sec. 3 TllN, R3W IfA, 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/HOLDING TANK DATA Date Installed 7/8 l'~'~S~ze Standpipes (Y/N) .Y q~c~ Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) N/A 1250 No. of Compartments 2 Air-tight Caps (Y/N) ¥ Foundation Cleanout (Y/N) N Date Last Pumped 4/11/89 N/A ;for N/A Temporary Holding Tank Permit (Y/N) N/A Y SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well 200+ To Property Line 15' To Water Main/Service Line 10-~ To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation 12 / / To Disposal Field 8 NONE 72-026 (Rev. 7/88) Front Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 100 Date Installed ~ 7~-'~ Width of Field Type of System Design Length of Field 25 Depth of Field 12 TRENCH Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Gravel Bed Thickness 8 400 Statndpipes Present (Y/N) N Date of Last Adequacy Test SATISFACTORY ABSORBTION RATE 4 BR USAGE Y 4/11/89 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot NONE 200+ To Water Main/Service Line +10' To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line 10 To Existing or Abandoned System on ; On Adjoining Lots 30~ To Cutback (if present) N/A D. LIFT STATION /v/.¢ 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 guidel-ines in effect, on the date of this inspection. Signed Eagle River Engineering Services Company ......... Date ~'/6z/~' Eagle River,.^., ..^.AK 99577 MOA No. Receipt No. Waiver Fee: $ 72-026 (Rev. 7/88) Back Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION Ai~CHORAGE WESTERN DISTRICT OFFICE / 3601 C ............ 3'~'' o- ~,..~,',-, ou~ ~- ,-, ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR DATE: April 11, 1989 · u&: Co~cer~: According +o +~ ...... ~- ~ ~ ' ................... In this office, the South Park Terrace S/D Water System is in compliance with the State of ~°~° ~~ Water ~~n~. VEC: gad Sincerely,~~j~, ~~ Vera E. Craig, . L/ Environmcntal Fiel~ Office~ MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF ~ALTH AND EN~fIRONMEN~rAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE General Information Application Date ..~ · ~ (a) Legal Description (include lot, bloc~division, section, to~ship, range) LOT Io,-~.f-; ~OOTW[T~,~'i~Y..'.~[ ~C~ ~ -T'~i ~, --~.~ T_~_~'P~C~' ZSIf.¥7. S £UZZiVICICi. Location (address or directions) (b) Applicants Name '~,f , ' ..... ~' .... Telephone - Home Business" ·" ~'V , ~ Applicants Address ' ;~.' 21:. ;::[ , .- (c) Applicant is (check one) Lending Institution L2 ; Owner/builder ~ ; Buyer ~ ; Other ~ (explain); ~" :'~' . : (d) Lending Institution ~i ~.'i"i ' ,% ',"i. C"[ 'i ~ ' Telephone Address (e) Real Estate Co, & Agent (f) Address Telephone Mail the HAA to the following address: 2. Type of Residence Single-Family~ Number of Bedrooms 3. Water Supply- Individual Well ~___[ Multi-Family Other (describe) Community ~ ~u~lic }.--q, Note.: If community well system, must have written cor~i~aation from the State Department of Environmental Cor~ervation attesting :o the ~,~,~,-v :x::c staTas 4. Sewage Disposal 0nsite ~ Public Community Note: If community well system, must have wri. uten co~fir_~aticn from :ne State Department of Environmental Conservation attesting to the legality and status. [Page I of 2] 5. E__n~ineerin~ 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 on-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 Firm Address Date (ENGINEER SF~kL) Telephone ,, ~79- ~/~ Approved for"' -'i~ __ bedroom§ Approved .If" Disapproved Terms of Conditional Approval Conditional CAUTION TtIE MUNICIPALITY OF ANCHORAGE DEPA~RTMEN~ OF ~IEALTH AND EN~VIROkl~NTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TIiE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGIb~ER REGISTERED IN TKE STATE OF ALASKA. T~qE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL A~N? STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR .~ALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE Ff~{ICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR EREORS OR OMISSIONS IN THE PROFESSIObI!L ENGINEER'S WORK. RR4/ej/D18 [Page 2 of 2] A® MUNICiPALi?Y OF DEPT. OF HE;LT:I ~, ENVt~ONMLNtT;.L ~:.5 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: Well Classification Well Log P=esent (Y/N) -- Total Depth -- Cased to Static Water Level Casing Height Above Ground -- Electrical Wiring in Conduit (Y/N) ---- Separation Distances f~cm Well: To Septic/Holding Tank on Lot 50 To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line C leanout/Manhole --- Water Sample Collected By - Water Sample Test Results OCT 8 ! TERRACE ESTATES SUBDZ.V$SZON If A, B, or C, D.E.C. App=oved(Y/N) Date Completed -- Yield -- --- Depth of G~outing, Pump Set At Sanitary Seal on Casing (Y/N) --- Depression ~ound Wellhead (Y/N) -- ; .On Adjoining Lots ' --- ; On Adjoining Lots -- To Nearest Public Ses~r To Nearest Sewer Service Line on Lot --- ; Date "' Ccm~ents B. SEPTIC/~ TANK DATA Date Installed 7"81 sise 12 6o No. cf Compartments Standpipes (Y/N) 7'u~O Air-tight Caps (Y/N) y Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~ Date Last Pumped Id) ,~. 8 %/ Pumping/Maintenance Contract on File (Y/N) ~/'~ ; for Holding Tank High-Water Alarm (Y/N) 1~//~% Tempo~ary Holdir~3 Tank Permit Separation Distances f~om Septic~Holding Tank: To Water-Supply Well .~ To P=ope. rty Line To Water Main/Service Line co=se /',/oN C~nts H~Su ~ To Building Foundation I~., TO Disposal Field ~ .!l y/N) N/~.~ , TO Stream, Pond, Lake, c~ Major D~ainage [Page 1 of 2] 2-15~84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7' 81 Width of Fie ld L) ~ ~o ~ ~ Gravel Bed Thickness O Standpipes P~esent Date of Last Adequacy Test Type of System Design Length of Field ~ 5 Depth of Field ! ~ (Y/N) /o, Square Feet of Absccption A~ea Depression over Field (Y/N) ~J Results of ~st ~a~ ~st . ~T ~ ~ ~cTo ~ ~ ~p~ation Distan~ f~ ~s~ti~ Field: To ~te~Supply ~11 ~o % To ~o~rty Li~ IO To Buildi~ Foun~tion ~ ~ To Existing or ~ndo~d S~tem ~ Lot ~ O k~ ~ ; ~ ~joining ~ 50 ~ TO ~te~ Main/~vi~ Line ~O~ To ~t~(if ~e~nt) ~ON~ To S~e~ond~ke/~ ~jo~ ~ai~ ~ NO N~ To ~i~way, P~ki~ ~ea, ~ Vehicle St~a~ ~a ~ C~nts ' IFT STATION N o ~- Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electcical Codes(Y/N) Dimensions Manhole/access (y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Comments · · ** Check Permitted Bed~ocm Rating Against HAA Request ** I certify that I have checked, verified, or confccmed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Date Cc~pany MOA No. E~/&T'' -¢ I/ KB1/d5/s [Page 2 of 2] 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION / / SOUTHCENT~AL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom It May Concern: According to records on file in this office the ~-~ ~~ ~ ~/~~ater System is in compliance with the State Drinking Water Regu ations.