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Home My WebLink AboutSOUTHPARK BLK 1 LT 7 MUNICIPALITY OF ANCHORAGE 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 MAILING ADDRESS LOCATION DISTANCE TO: Manufacturer Dwelllng~f :DROOMS Liq. I F HOMEMADE: Inside length Dwelling PERMIT NO. DISTANCE TO: Manufacturer Top of tile to finish grade Width Foundation/~. / Tota ¢F~of ~ es Material beneath tile Depth Crib depth Length Type of crib Width Liquid depth Crib diameter Well Building foundation DISTANCE TO: Class Depth Driller DISTANCE TO: Building foundation Sewer line OTHER Materla] Nearest~e~, I Tre'~:~h inches Liquid capacity in gallons PERMIT NO~//~ Distance b e ~n~l~ ~.~ /'~inches Total effec¢J~absor~n,~ ~, area PERMIT NO~ Total effective absorption area Nearest lot line Septic tank Absorption area(s) Distance to lot line PERMIT NO. PIPE MATERIALS F'ERMIT NG. DEPARTMENT ~ERLTH END ENVIRONMENTBL ~TECTION 825 "L" STREET., RNCHORRGE, BK. 995ECL 26,4--472(~ C~-.1--:5 Z: T'E :_~;E~.-.!EF: F"EIF:: f"l l ( 8:l. 8796 ) FIF'F'L ! Z:RNT _OCRT I G~"J LEGFtL L. HRIE, L.I.. If,I, E_,TftEHT_, tNL]: SOUTHPRRK DR. L7 B:I. SFtlITHF'RRK ........ 'T'F'PP.,..,... '-'1,...'£:, FIF'TH LOT :,I~E '-' "-' TRENC:H TYF'E ElF_c;FIIL_ FIBSOF.:F'TION =,T=TEM __,T':-. MR;:.,:IMLIM fgJHE.,ER ]F E, EE.E. uu.'I- = 3: SBIL RFtTING (SI]:~ FT/BR)=o'~.u THE E'EQ_IRED SIZE: OF THE SOIL RBSORPTION =,~_,TEN ID;: THE LENGTH DINENSION IS THE LENGTH ,::IN FEET) OF ]"HE TRENCH OR THE DEPTH OF FI TRENCH OR PIT IS THE DISTRNCE BETWEEN 'THE SURFRCE OF THE GROUND BND THE BOTTOM OF' THE EXCRVRTION (IN F'EET). THERE IS NO SET WIDTH FOE: TRENCHES. THE GRR',,,'EL DEPTH IX THE MINIMUM DEPTH OF GRFIVEL BETWEEN THE OUTFRLL PIPE END THE BOTTON OF THE EXCRVR'f'ION (IN FEET). REz, FON_,IE, ILIr? TO INFORM ]H_~ DEF'FIRTNENT DURING ]'HE . ERItI1 RF'F'LICRNT HH_, THE . tN'--,T~LI BTIGN INz, FEL. TILN_ OF aNY WELLS F~F).TRRENT TO TH-- rr~_r=~.~r ~ND THE NUMBER OF E.E-,IE. ENL. E-, THaT THE 14ELI_ WILL SERVE. EF~ZKFILLING OF RNY SYSTEM WITHOUT FINFIL INSPEL-:TIEIN END RPFE_,HL B"r' THI_, DEPFIRTMENT WILL E,E .:,IjBJEL. T TO PRZSEEUTIt]F MINIMUM DISTRNCE BETWEEN R WELL END RN'¢ OF,I-SITE SEW¢4GE DISPOSRL SYSTEM IS :[.E~O FEET FOR Ft PRIYRTE WELL OR ±5E~ TO 2E~O FEET FROM R F'UBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVBTE SEWER LINE IS ;-25 FEE]' END TO R COMMUNITY SE.WER LINE IS 75 FEET. OTHER REQUIREMENTS MR'¢ RPPL~¢. SPECIFICRTIONS END CONSTRUCTION DIRGRRMS ERE R'¢BILRBLE TO INSURE PROPER INSTRLLFITION. I CER'T'IF'~' THRT 1: IRM FRMILIFIR WITH THE REQUIREMENTS FOR ON-SITE SEHERS FIND WELLS RS SE]' FORTH BY THE MUNICIPRLIT'¢ OF RNCHORRGE. ;2: I WILL INSTRLL THE S%"S'!'EM. IN FiCCORDFtNCE .WITH THE CODES. 3:; I LINDERSTRND THRT ]'HE ON-SITE SEWER SYSTEN. i"IRY REt,]UIRE ENL. BRGEMENT IF THE RESI[:,ENCE I~; I';:EMODELE[:, T] INCLU[:'E MORE THFIN 3: EEDF.'OEMS FIPPL. ICRNT CRRIBOU INVESTMENTS INC. FERMI'f NO. 275-0000 24~300 SL:!UFtRE FEET I =, TRENE:H T'¢F'E GF EGZL taE:SGRPTION. '-"~F"'=,~_,~_pi "- : ._ RHTINb r~, -,~.. "" MF~NIMUN NUME:ER OF BEDR'-M~,__ - = =":' ..... :,OIL '- ' THE REQLtIRED :,I:E GF ]"HE SOIL RE:SC~RPTI]N .:,T::,.~-,, ''=' E::,ECF"T'~4:-= -1;F: LEI'-~GTH= P'..--' _.~Rfl ,- EL_ ]"HE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE OR DRRINFIELD. THE [:,EPTH OF R TRENCH OR PIT IS THE DISTF4NCE BET 'THE SI.JRFRCE OF THE GROUND 8ND THE BOTTOM OF THE EXCRVRT!0N (IN THERE IS NO SET HIDTH FOR TRENCHES. THE GRR',/EL DEPTH IS THE MINIMUM DEPTH OF 'EL BETHEEN THE OUTFRL. L PIPE RN[:, THE E:OTTOM OF THE E::~:CRVRTION ,:: IN - F:; .... ] ,~"FF'" n~¢= F~F RE ELL': RF' TRF' ' THI': F'RF~F'~:T'¢ Rf',[' E ...... NUMBER OF RESIDENCES THRT T~ WELL HILL ~',/E. BFICKF~LL[NG OF ~N~' S'¢~ ~:TZON [:,EF'RRTMENT WILL BE E;~:. ECT TO FROS~L~]N. MINIMUM DISTRNCE ~TNEI N FI W~- " ~ ' RI S'¢S IS 100 FEET FOR R VRTE HELL ~~'~'SITE WI ::,ING UPON THE T~'PE PUBLIC WELL MIN~HUM DISTR FROH R PRIVRTE NELL TO ~ ~: LINE I'. FEET RND TO R ::OhlMI..INI SENER LINE IS 75,_FEET., . -. q ,- ~Rf~RRf'!S .F'IRE ]THEE' RE;LI MR'¢ FIPF'L'~'. =,FECIFIL.RTI .N= RND RVR!LRBLE INSURE PROPER INSTRLLF!TION. I CERTIFY THBT 1: I RM FBMILIRR WITH THE REQUIREMENTS FOR ON--SI FORTH B'¢ THE MUNICIPFtLIT'¢ OF I~NCHORFIGE. 2: I HILL INS]'F~LL THE SYSTEM IN F]C:CORDBNCE WITH THE 3:: I UNDERSTAND THFtT THE ON-SITE SEWER S'¢STEM MFI¥ RESIDENCE IS REMODELED TO INCLUDE MORE TH~N 3: BEDROOMS. _,ET RS '= "' :E ENLHRGEMENT IF' THE S ! GNED: .................................................. HPFLIuHflT UHR I E, uLt I NCESTMENTS IE;SLIEE:, 8"P ................................. [)RTE ................... ',,,'4. 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 964-4720 SOILS LOG - PERCOLATION TEST i~ SOILS LOG [] PERCOLATION TEST PE..OR~ED EOR: LA~."/ ~¢/Rt~ H'T LEGAL DESCRIPTION: LOT ?t l~LoCi~. Ii 6- B5 13- 225-E 1971 18 19- 20- SLOPE SITE PLAN WASGROUNDWATER NO ~ ENCOUNTERED? ~ E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) t TEST RUN BETWEEN FT AND I 'J~' COMMENTS CERTIFIED BY:~ DATE: 72-008 (6/79) ~-o -,. ,,,UNICIPALITY OF ANCHORAGE e~e"J~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~ PERCOLATION TEST , Ii 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST LE~A~ ~ESCR,,T,ON: _/'..")? ~' ~/~ ? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE SITE PLAN Gross Net Depth to Net Reading Date Time 'rime Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND -- E~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1, GENERAL INFORMATION Complete legal description Lot 7; Block I; Southpark Subdivision Location (site address or directions) 16140 Te. rrac~ood Lan6, Anchorag~ Property owner Mailing address Lending agency Mailing address Agent Address Jan Zuck Day phone 279-6519 141~fl To~a~¢mnnH la~¢ A~¢~n~¢.; AK 99516 National Bank of Alaska Day phone Attn: 257-3428 Valeri¢ M~Millan P.O. Box 107025 Anchorage, AK 99510 Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well XXX Public water 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 NOTE: XXX 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. 72-p25 (Rev. 1/91) Front MOA ~21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address S & S ENGINEERIN~ 17034 Eagle River Loop Road No. 504 Phone Eagle River, Alaska 99577 Engineer's signature Date DHHS SIGNATURE ,~. Approved for ~..~'~)~?/.~_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 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. 72~25 (Rev 1/91) 8ack MOA ,21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /~/~-l -~: /~/~ l,, %~7'~qP/:~J(_~'~//) Parcell. D. (/-~'-~c~',('-'~'f-?/ A. WELL DATA Well type ~fJ,'~M,'/b/,'d/?~ if(~ B, or C, attach ADEC letter. Log present (Y/N) /~//,'~ Date completed ADEC water system number A/,/~ Driller Totaldepth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level FROM WE/LL LOG SEPARATION DISTANCES FROM WELL TO: Casing height Wires properly protected (Y/N) g.p.m. Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line /~//~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: ~--~E~_.. ~J;~;?~[~- OF (~(~MCt{P/_.tR-¢..~ Coliform Nitrate Other bacteria Collected by: Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~--~--~-~'~dc~l Tank size (/~¢0.,~.~(~ ~-/c~/~ '~ompartments '-~'WO Cleanouts ~TN) ~/¢E~ .... Foundation cleanout ~/N) - ~ % :'DepressiOn (Y/~ ~'J¢~ High water alarm (Y/~ /L)/~ Alarm te;ted"(Y/~ /%j/,/z¥ Date of pumping' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~J,/~ To property line ~'(~ / Surface water/drainage On adjacent lots ~(~)0/~ Foundation Absorption field -~ ~ Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE '"~'~C. -IF..T STATION / Dat~ ~//~ Manufacturer ~ Size in gallons ~ Manhole/Access ?~.~_ ~ Vent (Y/N) "~ ~~;'Pump off" level at High water alarm level ~ Cycles tested Meets MOA electrical codes (Y/N) ~- ~ ~ SEPARATION DIST.~N~FT STATION TO: ~.~le~ On adjacent lots . D. ABSORPTION FIELD DATA Date installed _~-~-- ~ ( Soil rating (¢22 % .~ F/,~f~ System type Length ~ Width ~ Gravel thickness Total depth Total absorption area ~5~0 ~F ~ ~leanouts present ~N) ~q/,. Depression over field (Y~ ~O Date of adequacy test /~-~ Results (~s/fail) ~ for bedrooms Peroxide treatment (past 12 months)(Y/~) J~(¥7 ,~OOdf'J "yes, give date ¢~J'/~- SEPARATION DISTiA~ CE Well on lot To building foundation On adjacent lots c~ Surface water /(~ Curtain drain _ FROM ABSORPTION FIELD TO: ~/~PE¢L ~P~P On adjacent lots ,--'~ ~0 '~' Property line _~(~ '/ To existing or abandoned system on lot /~"///'~ Cutbank /~J//¢~ Water main/service line Driveway, parking/vehicle storage area /~ '/ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines Signature Engineer's Name Date $ & $ ENGINEERING 17034 Eagle Rivet' Loop Ro~d No, I~nrjla ~lv~., AIn.bn the date of this inspection. HAA Fee $ Date of Payment Receipt Number 72-026 (Re',' 3/91) 8ack MOA 21 Waiver Fee: $ Date of Payment Receipt Number WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE S00 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 (907) 349-7755 December 4, 1992 Mr. Jim Williams S & S Engineering SUBJECT: South Park Subdivision Class "A" Public Water System, PWSID 213475 Dear Mr. Williams: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on November 5, 1992. This d~_oes meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on November 15, 1991. This. doe~s m_~e_Z the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last Radioactive Contaminants Sample results were submitted to the Department on September 11, 1992. This. does me_et the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical were submitted to this Department on November 6, 1991. This d~oes me__et the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II 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 10t, block, subdivision, section, township, range) Lot 7; Block I; South Park Subdiv~ion Location (address or directions) Property owner Mike W~cEsh Telephone: (home) 345-3551 _Business 265-2414 Mailing Address 16140.Terrace Wood Lane, Anchora,~e, Alaska Lending Institution Telephone (b) (c) (d) (e) Mailing Address RealEstate Company and Agent JACK (~HITE COMPANy/Barbara Parker Address 3201 C Street, Suite 100, Anchorage, Alaska 99503 ..'-~'- Telephone 563-5500 '> Mail the HAA to the following address: (or check here;~, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eagle River Loop Road. Suite 204 Eagle River. Alaska 99577 2. TYPE OF RESIDENCE Single-Family,;~( Number of bedrooms ~ 3. WATER SUPPLY Individual Well [] Community r~ 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 ';~Jo~ s,Jeeu!§ue I~uo]sseJoJd eq3 u! SUO!SS!LUO JO S JO J J@ JOJ elq !suodseJ 3ou s! eSeJoqou¥ Jo ~3!l~d !o! u n!~ sql 'penss! s! e~ee!~!lJeo ~ eJo~eq e3ep ez/qeue Jo suo!~oedsu[ ionpuoo ~ou op SHHQ jo se@,~oldUJB 's~ueLueJ!nbeJ e~8~s pu~ leJepe~ u!e~JeO,~js!~s o~ JepJo u] 8u!puel J!eq~ pu~ seuJoq jo sJes~qoJnd o~ ,~se~,Jnoe ~ s~ s!ql seep SHHQ sql 'eNS~l¥ jo e~e~S eq~ u! peJe~s!SeJ Jeeu!~ue leUO!SSajoJd 3uepuedepu! u~ ~q e^oq8 S qde~Be~ed u! ueA!b suo!~e~ueseJdeJ eq~ uodn ~lUO peseq le^oJddv,~l!Joqlnv qlleeH senss! 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O=IdSNI 9NICIIAOad INIJIJ 9NI~=1=INIeN~ '9 ~ MUNICIPALITY Of ANCHORAGE (MOA) [ e~.~.., Health Authority Approval (HAA) tt~-"~J~ ~/,5\°~' CHECKLIST- FEBRUARY 1984 ~-'~_~ ~O ~ 343-4744 >~d ~ ,% Legal Description: ~.~ A. WELL DATAwell ClasSificat :,~ux¢~ ~ ,, A. B. C. D.E.C. Approved~) ~ Well Log Present (y/N) Date Completed Yield Total Depth Cased to Static Water Level Casing Height Above Ground- Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line T° Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~' \~' ~, / ~) · "'~ "~'-\ "~2 '~~'~ Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots "Z~:::?~'-~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~-~'~ Size ~'Z-~'-~ No. of Compartments ~'~ Standpipes~)/N) '-/ Air-tight Caps~:~N) 7 Foundation Cleanout~N) y -, Depressi0n over Tan k (Y/(~ ~ ~)ate Last Pumped~.._~~'~ \~::~ If, : for Pumping/Maintenance Contact on File (Y/N) t Holding Tank High-Water Alarm (Y/N) I~//'- Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line To Building Foundation "~ ~ To Disposal Field 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 ~-" ~-- Type of System Design Date Installed ~ ~ Lc - ,~,~, Length of Field Width of Field "'2 Square Feet of Absortion Area Depression over Field Results of Last Adequacy Test Depth of Field Gravel Bed Thickness '7~- ~-(,~2'¢~ Statndpipes Presentd~) f'~ Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well TOLotBUilding Fou ndal~o To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line \ ~ To Existing or Abandoned System on ; On Adjoining Lots "'"~2c>~ To Cutback (if present) I'~//~' Comments D. LIFT STATION l'~ lA Date Installed Size in~ "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) ~~4~_mping 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 inspection. Signed $ & ~ ENGINEEEING C ...... 17034 Eagle Rl~er Loop Rea8 ~c. ~04 Date ~'-~//'~'/~¢~ Y' / MOA No. ~-~.~ -- ,-~:'~<::~°.--~ this Receipt No, Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) 8sck Page 2 of 2 D~PT. O~ ~NV~RONM1~NTT/~L ~ON/SEE~V/~T~O~ / ANCHORAGE/WESTERN DISTRICT OFFZCE / 3601 C STREET, SUITE 322 / ANCHORAGE, AK 99503 STEVE COWPER, GOVERNOR 563-6775 FOR: Roger/S & S Engineering DATE: May 18, PWSID: 213475 To Whom It May Concern: According to the records on file in this office, the South,~ark,Terrace ~/D Water System is in compliance with the State of Alaska Drinking Water Regulations° Sincerely, Vera E o Craig Environmental Fleld~ Officer VEC:kk MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, secti~ip, range) Location (address or directions) (b) Applicant Name ~c¢~ ¢&~K<¢ Telephone: Home Business Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution flO Y14 ~' Address .~,e.4~ ~'{ ~t~ (e) Real Estate Company and Agent Address ~ Telephone ~ ~ ~ b~ Telephone (f) Mail the HAA to the following address: I-/o/q/ TYPE OF RESIDENCE Sing~e-Family~i Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well [] CommunityK Public Note: If community well system; must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~J~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 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 safe, functional and adequate for the number of bedrooms and type of structure indicated heroin. I further verity 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 Municipat and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm "~.~j~Sc,,j ;~p~,,¢tj~LLz~4,4.~(~'~'~_~' Telephone ~7~-~t~ Address ~OZ& ~ /~_~¢ Engineer's SeaJ Approved for Approved ~a~Aoorova~' Terms of Conditional pp o I Date _ Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues HeaJlh Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending r~stitutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspeclions or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 : 264-4720 WELL DATA Well Classification (~.~.j6~;,.~..~ ,~ ifA, B, C, D.E,C. Approved (Y/N) Well Log Present (Y/N) Date Completes ' Yield MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Dista?ces from Well: To Septic/Holding Tank on Lot ~-4~. ¢¢ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by ; On Adjoining Lots ~¢~)~) ('*'~'~-; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date ' Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA To Water-Supply Well To Property Line To Water Main/Service Line Course Comments ~,~"c~ Date Installed ~ Size Standpipes (Y/N) ~hJ ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) ~(/A Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: No'. of Compartments ,~- ~ Foundation Cleanout (Y/N) Date Last Pumped ~/~ J ~"~ /"~-' ' : for Temporary Holding Tank Permit (Y/N) ! To Building Foundation I0 ! To Disposal Field "7'~' To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026(11184) ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~ ~-'~ Type of System Design Date Installed /~ ~ ~:~ ~ Length of Field Width of Field ~.~ ~1 Depth of Field G ra,/~ ~.~ickness Square Feet of Absorption Area '~1¢~,,'~''~ ,¢~O'"'~¢-/~t~nd~ ' pipes Present (Y/N) Depression over Field (Y/N) ~ '%t, Date of Last Adequacy Test Results of Last Adequacy Test To Building Foundation Lot TO Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Separation Distance lrom Absorption Field: To Water-Supply Well a~-{~1¢~ 't~ r..-'-~ To Property Line /4~ '~' To Existing or Abandoned System on ; On Adjoining Lots ,~/O TO Cutbank (if present) D. LIFT STATION ~ O ~1~ ~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, vej;ifi, gd, ol~onformed to all MOA and HAA guidelines in effect on the date of this inspection, Signed ~.._ ~~ Date Company ~ '~¢.~ MOANo. Receipt No. '~ ~ Date of Payment ~ ~ ~1 -~ ~ Amount: $ ~ ~ ~ "w ' ~ '-: .... Engineer's Seal , Page 2 of 2 72 026 (11/84) 03 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOT 7, BLOCK 1, SOUTH PARK TERRACE LOCATION: 16140 TERRACE WOOD LANE OWNER: SCOTT WALKER RESIDENCE: SINGLE FAMILY, THREE BEDROOMS WATER SYSTEM: COMMUNITY SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: 1250 GAL. CONCRETE, TWO COMP. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 340 SQ.FT. SOIL RATING: 85 INSTALLATION DATE: AUGUST 1981 DATE OF PUMPING: AUGUST 19, 1985 DATE OF TEST: AUGUST 19, 1985 TEST PROCEDURE: SYSTEM WAS INSPECTED ON AUGUST 18~ 1985, BOTTOM OF TANK WAS FOUND TO BE 8 FEET BELOW GROUND. WATER LEVEL IN TANK WAS THREE FEET. LIQUID WAS CLEAR WITH NO SCUM OR SLUDGE DEPOSIT. FOUR INCH SUMP WAS FOUND TO BE SIX FEET DEEP AND DRY. ON AUGUST 19 WATER WAS ADDED TO THE SUMP AT A CONSTANT RATE OF 9 GPM. THE LIQUIUD LEVEL IN BOTH TANK AND SUMP wAS MONITORED. AFTER ADDING 500 GAL THE WATER LEVEL IN THE TANK HAD NOT CHANGED. THE SUMP REMAINED DRY. TEST RESULT: FROM FIELD MEASUREMENTS IT IS CONCLUDED THAT THE SUMP IS NOT PENETRATING THE SBSORPTION AREA. IT CAN THEREFORE NOT BE USED TO MONITOR THE WATER LEVEL IN THE TRENCH. HOWEVER THE SYSTEM ACCEPTED 500 GALLONS OF WATER WITHOUT ANY SIGN OF BACKUP. THE SYSTEM IS THEREFORE JUDGED TO MEET THE MUNICIPAL REQUIREMENTS. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate Of how long the system will continue to meet the operational requi- rements of the Municipality and State. 1 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the ~_~~~, Water Systemis in comp/iance with t e . ;'rinking Water Regulations Sincerely, Alaska Testlab 4040 "6" Street Anchorage, Alaska 99503 Phone (907) 278-1551(' ~ecopier (907) 272-5742 ) TECHTONICS P,O, BOX ANCHORAGE, AK PROJECTI SOUTHPARK LOT 7~ BLK 22 JUL lOS1 ~.0. # AlggSg SUSJECTI MATERIALS ANALYSIS SAMPLE DATE: 17 JUL lgS1 GENTLEMENJ TRANSMITTED H~REWITH ARE THE RESULT8 OF SIEVE IN OUR LABORATORY ON THE SUBJECT SAMPLES. ANALYSIS PERFORMED THE METHOD USED HAS ASTM C-136 (AASHTO 1-27), "SIEVE ANALYSIS OF FINE AND CD~RSE AGGREGATES~" )HE MOST CURRENT VERSION, THE GRADATIONS MAy BE FOUND ON SHEET 1 OF 3 ATTACHED HEREIN. IF THERE ARE 4NY QUESTIONS IN THIS REGARD, PLEASE CON)ACT OUR OFFICE. VERY TRULY YOUR8~ CC: ALASKA TESTL~B ALASKA TESTLAS MELVIN R. NICHOLS~ MANAGER P,E, . Alaska Testlab 4040 "B" Street Anchorage, Alaska 99503 MECHANICAL GRAIN SIZE SHEET 1 OF 3 Phone(90~27~155~- (Telecopler(90~272-5742) ANALYSIS FOR SAMPLE: 2gOl.... .................. . .................... ~ORKORDER NO. AlggSg JOB NO. SOUT PROJECT: SOUTHPARK LOT 7, BLK [ LOCATION: LOT 7 BLOCK ! DATE RECEIVED: t7 JUL 198! DATE TESTED: 17 JUL !98! UNIFIED CLASSIFICATION: SM TEXTURAL CLASSIFICATION: SILTY GRAVELLY SAND WEIGHT PERCENT SIEVE RETAINED PASSING 2 INCH 0.000 100.00 1 1/2 INCH 201.900 g~.36 I INCH 280.500 92.16 3/q INCH ~62.300 87.07 1/2 INCH 63~.800 82.25 3/8 INCH 783.200 7~.Og NO q 1133.100 68.31 NO 10 72.000 60.5q NO 20 1~1.200 53.17 NO qO lgl.700 .7.76 NO 100 287,800 37.~6 NO 200 3~8,500 30.95 LOT 7, BLOCK 1 Soils and Ground Water No test ~it.s~Q~t~s_~t ~orings were drilled bn thi~ lot. Test pits and test borings on adjacent lots to the west and north encountered high ground water and silty soils (glacial till and colluvium). As illustrated on the Site Map, Figure l, an area of alluvium may be present in the southeast part of the lot. As encountered by Test Pit 16, the soils in the alluvial landforms consist of sand and gravel with cobbles. Location of Septic System ~- --~ /~I~ may be possible~to locate a septic system in the southwestern ~ ~rn~-~r-~f~he---~lot-~--Soils in this area are more likely to be ) granular with a lower water table° A. test boring or test pit / should be placed in this area to verify this assumption. / Design Absorption Rate If granular soils are found in the southeast corner of the lot and a high water level is not encountered, an absorption area of ~ 100 square feet per bedroom s~ould be provided. A percolation test was performed in Boring('5-2? located in the same landform. rate,here was one minute per inch. The observed percolation I Test Hole ~16 ~th in Feet From To 0.0' ~ 1.5' 1.5' - 8.0' 8.0' - 9.0' 9.0' - 12.0' Bottom of Test Hole: Frost Line: Free Water Level: Renmarks: Table A WO #A18753 Logged By: Client Date: 10-28-78 Soil Description Organic Topsoil. Sand~ pravel, GP/GW, NFS, damp, with cobbles. ~ravell~ Sand, SP, NFS, damp. ~and~ Gravel, GP/GW, NFS, damp, with cobbles. 12.0' None Observed None Observed Test Hole Logged By Clien~ Verified by Alaska Testlab S_ample Dept~ 1 9.0' · Type of Dry ~ Sample Strengt__h Group Unified 2'.8 G None C GW .Re~arks: 4. e 3. 4. 5. 6. Type of Sample, G=Grab, SP = Standard Penetration, U = Undisturbed. Dry Strength, N=None, L=Low, M=Medium, H=High. Group refers to similar material, this study only. General Information, see Sheet 1. Frost and Textural Classification, see Sheet 2. Unified Classification, see-Sheet 3. Test Hole ~Lo~ 5, - Block 2 Table WO ~A19218 Date: 4/11/80 Logged by: O. Hatch Depth in Feet From To 0.0 0.5 0.5 1.5 1.5 14.0 14.0 16.0 Soil Description Brown Peat, damp, soft, Pt F-4, brown Sand_~ Silt, damp, dense, non-plastic, NFS, brown very ~andy Gravel, trace silt, 40 to 50% sand, damp, medium dense, rounded particles to 3", saturated at 13' depth, GM/GW F-4, brown Sand~ Silk with trace gravel, saturated, non-plastJ, c, ML Bottom of Test Hole: Frost Line: Free Water Level: Percolation Rate = 16.0 Feet 1.0 Foot ~eet While Drilling 1 minute/inch with water level at 5.0 feet in PVC pipe Sa. No. Depth 1 5.0 2 10.0 3 15.0 Type of Dry Blows/6" M% Sample Strength Group Unified 13.7 G N C GM/GW 6.3 G N C GW 12.1 G L D ML Remarks: 1. 3. 4. 5. 6. Type of Sample, G=Grab, SPT = Standard Penetration, U = Undisturbed. Dry Strength, N=None, L=Low, M=Medium, H=High. Group refers to similar material, this study only. General Information, see Sheet 1. Frost and Textural Classification, see Sheet 2. Unified Classification, see Sheet 3. ~ ii!!! iI~ LL~',[Ii!I[!!H ]!!~!!l .................. :.::~.l.i. ,,i,L;! I~ll~il ~111 HJII~ii~// HH ! !~ I![ i ii;iiiii;i~;/[/ il ;;, iii , , ~ . ,, ,,tt t , ~4 ,", , ,, 1.I~ ~ 11 .... .I .I