HomeMy WebLinkAboutSOUTHPARK BLK 3 LT 1outhpark
Block 3
Lot 1
#020-491-27
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 ANO008REWL INSPECTION REPORT
NAME_jj jj ll
Co,r I C)"._L_Y1 J0 'T I"t'l tly? -.-L 17c
PHONE
9�76'-voUb
NEW
❑UPGRADE
MAILING ADDRESS A �
Sao--L�
LEGAL DESCRIPTION
LOCATIO
It ar
NO. OF BEDROOMS
Q
DISTANCE TO:
Well
��✓ y.
Absorption are
�
Dwelling
%AI
PERMIT NO.
IQ /
Y
F z
M< F
Manufacturer
mC L'r-
Material ) /
LBQ�I,
No. of compartments
w
Li capacity in Ilons
D
IF HOMEMADE:
Inside length
Width
Liquid depth
Y
Jcez
DISTANCE TO:
ell
Dwel " -
PERMIT NO.
= z F
Manufacture
Ma rrafLiqui
achy in gallons
=
DISTANCE TO:
Well
a r,
Found�,trpnT /
Found,.—) jV
Nearest to line
jam'
PERMIT NO.
D7
zNo.
It
of lines
I
Length of ea In line
AL
7
Total length of lin s
Trench width
Distance between lines
.----------ruches—"'---
F
Top of tile to finish grade if
/
Material beneath rile
inches
Total effectiv absorption
,
x 7L
w
Length
Width
Depth
PERMIT NO.
QH
to
Type of crib
Crib diameter
Crib depth
al effective absorption area
w
D1,6TANCE TO:
Well
Building founds
Nearest lot line
J
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
w
�
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
o3 �s e
SOIL TEST RATING _
.�
INSTALLERMes z7 `,^
REMARKS
f�0
t
APPR VED DATE LEGAL
72-013 (Rev. 31781
I'"T k_I owl T: E7 e' b 00 I, T -TE "-e-" e_g F' F=6 rA CD hi 11 C3
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
25 'L' STREET, ANCHORAGE, AK:. 99501
264-41.20
PERMIT NO. < 81.0741 . ),K06( fX
APPLICANT
LOCATION
LEGAL
CARIBOU INVESTMENTS INC 619 E. 5TH AVE.
_,OLITHFARE'_ EstatS w" C�_60 SQUARE FEET"
L1 E?-: SOUTI-IF'FIRK: �x'D "'— LOT ':ISE 30560
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOM'_ - _ SOIL RATING (SQ FT/BR)`- 1
25
THE REQUIRED S I2E OF THE: SOIL ABSORPTION SYSTEM I . :
THE LENGTH DIMENSION I'S THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT I5 THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO _ET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH I_ THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
FRE : A_ L3 3' FiC E:10* °T EE F "5_ 1 17 —f- F A 0'-,4 9 -__" * '� _' A""q
a Aq
PERMIT APPLICANT HAS THE
RESPONSIBILITY
TO INFORM
THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS,
OF ANY WELL'_ ADJACENT TO
THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT
THE WELL WILL
SERVE.
A__A = ° .e �`•.,� °_.: E•—° ®_: 1 13I°'°I @—"f FT ET FQ E A_ A LJ I p _ � IDA
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM Is
100 FEET FOR A PRIVATE WELL OR 150 TO :200 FEET FROM H PUBLIC WELL DEPF_NDlNG
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FR IM A PRIVATE WELL. TO H PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE: PROPER INSTALLATION.
I CERTIFY THAT
1: 1 AM FAMILIAR MITI-! THE REQUIREMENT_; FOR ON—SITE SEWERS
FORTH BY THE MUNIC:IPALI'TY OF ANCHORAGE.
1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODE_,.
:. I UNDERSTAND THAT THE ON—SITE _EWER SYSTEM MAY REQUIRE
RESIDENCE I.= REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED:--- -----=``��-------------
APPLIC:ANT CARIBOU INVESTMENT_ INC:. o /
ISSUED BY_ �i.11_�� k *�� ___C+tiTF_
AND WELLS AS SET
ENLARGEMENT IF THE
V4. 0
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION
TEST
/ 825 L Street, Anchorage, Alaska 99501 2644720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: %ss DATE PERFORMED:
LEGAL DESCR
DEPT
O.G
1
l�
3-
----4
5-
6-
7 67
---8-
9-
10-
11 1011
12
13-
14
15-
16
71919 17-
18-
19
20
COMMENTS
SLOPE
::5 ;/7'y
17
S W /
,��Ti�-s.q-T6TJ
lZ� �•�1,8�.
WAS GROUND WATER S
ENCOUNTERED? N� L
O
P
,jb{-�-oiry o7' IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net Depth to
Time Water
Net
Drop
as,
At
'•.
,..
� .N.M
,.i.•
PERFORMED BY:
12006 16'7x.
CERTIFIED BYE
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
DATE:
May 18,
1990
TO:
Building
Safety/Land Use
FROM: Susan Oswalt, On -Site Services, DHHS p�
SUBJECT: Lot 3, Blk 1, Southpark S/D /
We have reviewed the plans for an addition to the existing
dwelling. The plans originally showed a two room addition which
appeared to be additional bedrooms rather than offices. Records
in our office indicate that a sewer system for a three (3)
bedroom dwelling was installed in July of 1984 (certified copy
enclosed).
At our request the owner has amended the plans to remove the
closets from the "offices." He has also submitted a letter which
indicates his understanding of AMC 15.65, which disallows the,use
of a sewer system beyond its design capacity. The owner further
understands that should he utilize the additional rooms as
bedrooms, he would stand in violation of AMC 15.65.
As a practical matter, we realize that these rooms will
undoubtedly be utilized as bedrooms at a future date. Although
we cannot actually inspect the property periodically, it will be
to the advantage of the owner to continue the use of this
dwelling in compliance with municipal code. Upon sale of the
home, and subsequent Health Authority Approval, this office will
not approve the sewer system for greater than three bedrooms.
Please note also that there is no implied or promised guarantee
of a permit to upgrade the existing system at a later date. All
provisions of AMC 15.65 must be met at such time as a permit is
requested.
Richard L. Tremaine
16251 Chasewood Lane
Anchorage, Alaska 99516
May 18, 1990
Ms. Susan Oswell
Dept. of Public Health
Municipality of Anchorage
/-cl
Dear Ms. Oswell,
I am planning to add an office to my residence on Chasewood Lane. The present septic system is
designed for three bedrooms and is fully subscribed. Therefore, I am writing this note to certify that
I understand that these new rooms may not be considered as bedrooms unless the septic system is
expanded and approved for the increased living load.
Sincerely,
Richard L. Tremaine
Municipality of Anchorage °
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
02.0- yq 1.21
Parcel I.D.-92ff-ffj"r'4T Expiration Date: -2 V -I G
1. GENERAL INFORMATION
Complete legal description SOUTHPARK SID; BLOCK 3, LOT 1
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
16251 CHASEWOOD LANE, ANCHORAGE, AK, 99516
RICHARD TREMAINE Day phone 227-9217
16251 CHASEWOOD LANE, ANCHORAGE, AK, 99516
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
WaiverNariance request for t
3
s
Day phone
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 52-(.o-
Date
2oDate of Payment o -I `q I II /�
Receipt Number .7u Laa
COSA# 05C14 ! 3-11
Date:
Waiver Fee $ _
Date of Payment
Receipt Number.
Waiver #
Distance: e
TYPE OF WASTEWATER DISPOSAL:
❑
Individual On-site
❑
Individual Holding tank
❑
❑
Community On-site
❑
Public Sewer
❑
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 52-(.o-
Date
2oDate of Payment o -I `q I II /�
Receipt Number .7u Laa
COSA# 05C14 ! 3-11
Date:
Waiver Fee $ _
Date of Payment
Receipt Number.
Waiver #
Distance: e
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown below, 1 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
Address
GARNESS ENGINEERING GROUP, Ltd.
3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK, 99507
Engineers Printed Name
Engineer's Comments:
JEFFREY A. GARNESS, P.E.
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features The operational life of all wells and
septic systems depend on the local soils condition, 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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
them are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
337-6179
Date 6/1/14'
VVX
bedrooms, with the following stipulations:
OF
"ROFESSICN�i
��t�iiliii(((l,
ON-SITE `gym
WATER AND
WASTEYNATER
By: �ez Original Certificate Date:
The Municipa It Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
fp im,>mi
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description:
A. WELL DATA
Well type
Date completed
Total depth ft.
Date of test
Static water level
Well production
WATER SAMPLE
SOUTHPARK S/D; BLOCK 3, LOT 1
447 t
Parcel ID: oto
PUBLIC WATER SYSTEM
If A, B, or C provide PWSID# Well Log (YIN)_
Sanitary seal (Y/N)_ Wires properly protected
Cased to ft. Casing height (abo n
FROM WELL LOG
Coliform colonies/100 ml. Nitrate mg./L.
An�enic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments 2
rAll
Collected by:
Date installed 7/28/1981
Cleanouts (Y/N) YES
in.
Foundation cleanout(Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) NIA
Date of pumping �' 23 I If Pumper A + HoM&- S0:J2'%f1a4
C. ABSORPTION FIELD DATA BELOW EXISTING GRADE
Date installed 7/28/1981 Soil rating (g.p.d./ft or /bdrm 125 System type TRENCH
Length 47 ft. Width UNSPECIFIED ft. Gravel below pipe 4 ft.
Total depth '8.1 ft. Eff. absorption area 376 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 7/24/2014 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test DRY in. Water added 480 gal. New depth "49 in.
Elapsed Time: 135 min. Final fluid depth DRY in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) _
"1 INCH ABOVE INVERT.
NONE KNOWN If yes, give date
D. LIFT STATION
Date installed__
"Pump on" level at in.
Size in gallons Manhole/Access (Y/N)
"Pump off"level at we er alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on
On adjacent lot;
On adjacent lots
PUBLIC WATER SYSTEM
Public sewer main sewer manhole/cleanout
Sewer /septic service line Holding tank
containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 1004
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 104 Water main 10'+
Water service line '10'+ Surface water 100'+ Driveway, parking/vehicle storage 104
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
'HOMEOWNER RETAINED ONE STOP SERVICES TO LOCATE WATER LINE. GEG INSPECTED AFTER LOCATING WAS COMPLETED.
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's PrintedName JEFFREY A. GARNESS
)
Date S r t /tit
(Rev. 10/12112)
1�
Z9i �.1
scribed hereon and that the Improvements situated
thereon are within the property lines and
encroachments exist other than noted.
'0
F
N
W Q
SET
� �N
'r
oO O
-o r', responsibility to check top
G .
,Q
t
1
C- 6 �
HUB & TACK
�
1@
z c
440 WEST BENSON BLVD.
finish grade and building set-
MONUMENT
t
®
25
a
I
Lt
T
1
WOOD RETAINING
WALL
G� wz.✓�-P l "off e � �� 1
N GRAVEL DRIVE — -- —
`
to' UTILITY ER5CMFNTT
h of
N S9° 53' 20" W 236.31
""Ort P. "re
`" L5 7065
94N�Fgr
`4 a AOFF.cclpupl tpl�
°o
EXCLUSION NOTE: It to the own&V
responsibility to determine the
exletooce of any easemonts, covenants,
or restrictions which do not appear
on the recorded subdivision plat. Under
rio circumstances should any data
Jwaon be used for censtrucilon or Ica
jastabiishinC boundary of ionto Ihtea.
Z9i �.1
scribed hereon and that the Improvements situated
thereon are within the property lines and
encroachments exist other than noted.
F
�
O
SET
FOUND
'r
ENGINEERS • PLANNERS • SURVEYORS
-o r', responsibility to check top
G .
L-
t
1
of foundation in relation to
HUB & TACK
1
WOOD RETAINING
WALL
G� wz.✓�-P l "off e � �� 1
N GRAVEL DRIVE — -- —
`
to' UTILITY ER5CMFNTT
h of
N S9° 53' 20" W 236.31
""Ort P. "re
`" L5 7065
94N�Fgr
`4 a AOFF.cclpupl tpl�
°o
EXCLUSION NOTE: It to the own&V
responsibility to determine the
exletooce of any easemonts, covenants,
or restrictions which do not appear
on the recorded subdivision plat. Under
rio circumstances should any data
Jwaon be used for censtrucilon or Ica
jastabiishinC boundary of ionto Ihtea.
SURVEY CEOTIFICATION: I hereby certify that I have surveyed the property shown and
scribed hereon and that the Improvements situated
thereon are within the property lines and
encroachments exist other than noted.
®�lrili ®
PLEASE NOTE: It is the contract
LEGEND:
SET
FOUND
BS -L-0041
ENGINEERS • PLANNERS • SURVEYORS
-o r', responsibility to check top
5/8" REBAR
•
Q
1
of foundation in relation to
HUB & TACK
O
1@
oaN.ev:
Kd
440 WEST BENSON BLVD.
finish grade and building set-
MONUMENT
0
®
f"
. ... --- --- ----
backs in relatlnn fn Int linos
co's
WOOD RETAINING
WALL
\Nc
\ 1
GRAVEL DRIVIL
102 UTILITY E45EMEN7`
N 690 53'2c" W 236,31
CP.nna p,1w11•warww�
EXCLUSION MOTE: It Is the owners'
• rw,w ♦.,
(oaponslbility to determine the
to ,
Robe rt P. Dre ! 4
�C, exietan;a of any eeeemen#s, covenants,
LS 7063 0
> � ,s or restrictions which do not appear
�� �'?*p°'e°,• •,•`'°S`�o on the recorded subdivision plat. Under
® mpRCFFgsi_rggL LA DO circumstances should any data
g.11iva` berean be used for construction or far
` Cstabllshing boundary of fence Iloa9.
MSM
jar�
SURVEY CERTIFICATION: hereby
scribed hereon IF that the Improvements
encroachments exist other than noted.
certify that I have surveyed the
situated thereon are within
shown and de
a Property
the properly Tines and e
■
ENGINEERS •PLANNERS •SURVEYORS
440 WEST BENSON BLVD.
ANCHORAGE, ALASKA 99503 562-5291
PLEASE NOTE: It is the contract
_or's responsibility -check top
of foundation in relatlon to
finish grade and building set-
backs in relation to lot lines
and easements.
LEGEND: SET FOUND
5/8" RESAR • 0
HUB & TACK ❑ ®
MONUMENT 0 ®
AL -CAP Q e
PK NAIL X
IRON PIPE (OD
-ELE VS. -DATUM
ASSUMED
t"'O•'
60-L -0041
Dara•. av:
Kb
LEGAL DESCRIPTION:
ASEUILT
an r: 3230
s'a''
2A4 -39
SCa�E: 1,/ 40,
LOT I ELK 3
orate:
z//O/e8
SOUTHPARI< SU13bIVISIDN
Parcel I.D. #
O MUNICIPALITY OF NCHORAGE
• '� 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
OZ.o - OSI- Q-4 HAA# IQ9-,Q �
1. GENERAL INFORMATION
Complete legal description L-133 So,, -Lk
Location (site address or directions) 16Z91 Chasewood La e
Property owner _t7`cti
Mailing address -
Lending agency
Mailing address—
Agent
Address
ZS(
a ne Day phone 562-3339
wood L a� e
Day phone
Day phone''
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well X
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. 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(Rw. 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
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 C0n5}.UC41'^9 Phone 346-Z00'0 1699-9098
Address
Engineer's signature
6. DHHS SIGNATURE
By:
Werner➢~ A (}oraSc , %K, 99516
_2 Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
WTIC
Date 3 Z 2L'
_.� OF At %i
r •.
00 . ..F........•./..
¢.J%,, NO. 1732-E W�
04 -P-* hna 22, 1969
bedrooms, with the following stipulations:
Date
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.
72-025 (Rev. 1/91) Back MOA p l
• Municipality of Anchorage
Department of Health & Human Services _
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L I a 3 Sovkh _�b,.lc jevYzc¢ Parcel I.D. oto- OSI-gi
A. WELL DATA
Well type It, B, or C, attach ADEC letter. ADEC water system number
Log present(Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
Date completed
Driller
to Casing height
Wires properly protected (Y/N) —
FROM WELL LOG
SEPARATION DISTANCES FROM W T(
Septic/holding tank on lot
Absorption field on to
Public sewer in
Sewe rvice line
WATER SAMPLE RESULTS:
Coliform Nitrate
Date of sample:
E
0
AT
On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
Collected by:
Other bacteria
ZI54 5
B. SEPTIC/HOLDING TANK DATA
Date installed a' / Tank size1 O0 5 Compartments —
Cleanouts (Y/N) y Foundation cleanout (Y/N) i ^ Depression (Y/N)
High water alarm (Y/N) N Alarm tested (Y/N)
Date of pumping Pumper A'
Z
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot N � On adjacent lots +Zoo'
To property I!ne to Absorptionflaid 1Z
Surface water/drainage +100 r
IJ
Foundation
9`
Water main/service line + 50
72-026 (Rev. 7/91) Front } .CONTINUED ON BACK PAGE
m
Z
< 3
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o z
rn
m D
:b7
Z r
n �
r r1
9
r
v, O
-'f
M T
D
_
rt,
`a
N
nn
N
O=
n
M
O m
Z
B. SEPTIC/HOLDING TANK DATA
Date installed a' / Tank size1 O0 5 Compartments —
Cleanouts (Y/N) y Foundation cleanout (Y/N) i ^ Depression (Y/N)
High water alarm (Y/N) N Alarm tested (Y/N)
Date of pumping Pumper A'
Z
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot N � On adjacent lots +Zoo'
To property I!ne to Absorptionflaid 1Z
Surface water/drainage +100 r
IJ
Foundation
9`
Water main/service line + 50
72-026 (Rev. 7/91) Front } .CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N
— Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
SEPARATION D153 d�CE FROM LIFT STATION TO:
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed 'rpt Soil rating I2S S.� — System tYP e TZO"CH
Length 4?
Total absorption area
Width DNK Gravel thickness q $ Total depth dim
376 sJ� V_
Depression over field (Y/N) N
Results (pass/fail) 17A53
Peroxide treatment (past 12 months) (Y/N)
Cleanouts present(Y/N)
Date of adequacy test MartYtl�l992
for 3 ho
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot N r-) On adjacent lots 42ov/
To building foundation 'rtS
On adjacent lots + Z:5.1CutbanH
Surface water -tloo'
Curtain drain 4-
E. ENGINEER'S CERTIFICATION
If yes, give date
Property line I
To existing or abandoned system on lot
Water main/service line
Driveway, parking/vehicle storage area
+Sb
_r 215
1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date,oPthjg�tnsbebtion.
"tt r
T
1
1 /
Signature
Engineer's Name
Date
t.t,tql
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $ —
Date of Payment
Receipt Number
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99503
FOR: Constructing Engineers
March 12, 1992
PWSID # 213475
WALTER J. NICKEL, GOVERNOR
(907) 349-7755
My review of the records on file in this office reveals that the Southpark Subdivision
Class "A" Public Water System, is in compliance with the routine coliform bacteria
sampling requirements listed in Table C, and with the inorganic sampling requirements
listed in Table B of 18 AAC 80.200.
BR/cf
Sincerely,
Byron Roys
Environmental Engineering Assistant
printed on recycled paper b y O.U.
a
,`) C-) . os 1- -t-)
MUNICIPALITY OF ANCHORAGE , �._0046�/
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date A r 0
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township,.range)
�� r atoG/Gj {s�.:4 s �� i -7-11A) i r- 3
Location (address or directions)
(b) 'Property Owner jz7' y'AD 3/�K/t Telephone: Home Business y7� - ;7SY1
Mailing Address
(c) Lending Institution '�,42 /X/ /Z.S �%/rJ%LC'� Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: or: Check here K, if hold for pick up.
List contact person and day phone number below.
nks
2.
TYPE OF RESIDENCE
Single -Family,
Number of Bedrooms _
e
3. WATER SUPPLY
Individual Well ❑ Communityx Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite 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 lRev 8r8B) Front
/ iii s, i'4fe � /
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 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 fJ�C 3 Telephone o
/ 5��� S ��
Address /Z CJ 33 /,r},/��. Sir, ,C 1A;,1" , /� yl`s-cs
Date
.�� OF At���4
>yr4�T •'
4��%gi r��`�I•� •`�'i
6. DHHSAPPROVAL
(�J /!- ���� A?�
Approved for bedrooms by � Date c• s-ude-Z6 /e&
Approved ._ Disapproved % Conditional /
Terms of Conditional Approval
CAUTION
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.
Page 2 of 2 _ 72025 rRev M61 Back
f MUNICIPALITY OF ANCHORAGE (MOA)
M�1y1C1pENVAO�R 10ESp�G51Ot'IHEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
E�1RONk` 264-4744
Legal Descriptio� '�n:
A. WELL DATAt\� � .9�r./ iJ/.+l
�L�;�JcJ ss2- j
Well Classification c4e/;'1'//-j I OH B, C, D.E.C. ApprovedON) /b
ell Log Present (Y/N) Date Completed Yield
Tota Depth Cased to Depth of Grouting
Static Water Lve, el Pump Set At
Casing Height Above'6rou�nd_ Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y /N Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot On Adjoining Lots
To Nearest Edge of Absorption Field'on Lot On Adjoining Lots
To Nearest Public Sewer Line To Nearestpabllc Sewer
Cleanout/Manhole To Nearest Sewer Serviice-Line on Lot
Water Sample Collected by Date
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed 7" l�.'S-�Y! Size lez!y No. of Compartments 1 -
Standpipesd(Y N) Air -tight Caps Y/ ) Foundation Cleanou(Y N)
iV) �
Depression over Tank (Y Date Last Pumped " 15 mac'
Pumping/Maintenance Contract on File (Y/N) /JXJ4 ; for
Holding Tank High -Water Alarm (Y/N) edlrl Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well 7-0-6 To Building Foundation
To Property Line S ! To Disposal Field %
To Water Main/Service Line /o To Stream, Pond, Lake, or Major Drainage
Course /Uy-
•x
Comments
Page 1 of 2
72-026 (Rev. 8/861 Front
L/ Tis 5. P/KK %Lz zlR'6
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
-:L3`-T/
Type of System Design
i
Length of Field
Width of Field Depth of Field 3`
Gravel Bed Thickness
Square Feet of Absorption Area _3/� Standpipes Present Y/ ) /
Depression over Field (Y/Nf/Date of Last Adequacy Test
Results of Last Adequacy Test Mato+7_,�'
Separation Distance from Absorption Field
i
To Water -Supply Well To Property Line Z
s
To Building Foundation /J i G To Existing or Abandoned System on
Lot /d/14 On Adjoining Lots /O '/-- J
To Water Main/Service Line /U To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area /o
Comments
D. LIFT STATION
Dated stalled
�_,
Dimensions
Size in Gallons ��
Manhole/Access (Y/N)
"Pump On" Level at "" -.
"Pump Off" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Check Permitted Bedroom Rating Against HAA Request '*
certify that I�h v h/e9, Ced, ve ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed L/`` ` "� Date y'9
/�GL-% 7 C/�-/ Bang�Ao
Company MOA No. 7 % OF As
Receipt No. AUO l D O O
Date of Payment
Amount: $
Page 2 of 2
72-026 IRev 8/861 Back
T}� 4
gln eal g,
ROY C. REID °
CE -x251 41d
41
e
_
DATE RECEIVED
- INSPECTION APPOINTMENTS
STREET LOCATION
TIME
TIME
TIME
6. TYPE OF RESIDENCE
DATE
DATE
DATE
SINGLE FAMILY
❑ Two ❑ Five
E2 Three ❑ Six
7. WATER SUPPLY
INSPECTOR
INSPECTO�F��/ �'
INSPECTq�t)
X1 COMMUNITY
since June 1975. For wells drilled prior to that date, give well
V �-`-'
N1tl
TY OF ANCHORAGE
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 LStreet- Anchorage, Alaska 99501
r
•
NOV 1981 9Oq
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES"
DI SECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER
PHONE
Caribou Investvestments Inc. Larry Wright
276-0000
MAILING ADDRESS
6 671G99501 9 F. si-Inaska
fove)
PROPERTY RESIDENT (lf differentrom ab
PHONE
Lot 1 Elk 3 South"ark Terrace Estates
-0-
2. BUYER -
PHONE
Leo Blum and Betty Blum
MAILING ADDRESS
3. LENDING INSTITUTION
PHONE
Alaska PaCifiC Bank
276-3110
MAILING ADDRESS
4. -REALTOR/AGENT
PHONE
Larry Wright
337-3831
MAILINGADDRESS
5301 E. 30th Anchorage, Alaska 99504
5. LEGAL DESCRIPTION
L
STREET LOCATION
HN Chasewood Lane
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
❑ One 1:1 Four ❑ Other
SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
E2 Three ❑ Six
7. WATER SUPPLY
❑ INDIVIDUAL*
ATTACH WELL LOG. A well log is required for all wells drilled
X1 COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
t�J INDIVIDUAL/ON-SITE**
1981 YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-0101 Rev. 6/79) (/7 } (/k�/I/L�{•%.!`n'G�'f'C}.�ZJ �d- 4� ll-�E/�
C>y
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
❑ SINGLEFAMILY
❑ ONE
❑ THREE ❑ FIVE
❑ OTHER
❑ MULTIPLE FAMILY
❑ TWO
❑ FOUR ❑ SIX
2. WATER SUPPLY
PERMIT NUMBER
❑ INDIVIDUAL
DEPTH OF WELL
❑ COMMUNITY
DATE DRILLED
❑ PUBLIC UTILITY
Connection Verified
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
PERMIT NUMBER
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
DATE INSTALLED
Connection Verified
INSTALLER
❑SepticTank EJ Holding Tank
�olr
Size: If Tank is homemade
SOILS RATING
give dimensions:
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
WELL T0:
Absorption Area to nearest Lot Line
5. COMMENTS
i,s
_.UVA..-. ✓�:{,:r� :A, Qom_...
C1�r_,t_.
1-40
C._.tfltQn.i�.(?. f`9,.1-
/
��
❑ APPROVED FOR
BEDROOMS
U.—CONDITIONAL APPROVAL
(letter must accompany certificate)
❑ DISAPPROVED
DATE
LA
-
ry
72-010 (Ree. 6/79)
STEVE COWPER, GOVERNOR
Sr t E OF R SM
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775
3601 "C" STREET. SUITE 1334
ANCHORAGE. ALASKA 99503
DATE: _2 February 1988 —
PWSID #:
To Whom It May Concern:
According to the records
on file in
this
office,
the _ SOUTH__PARK _
TERRACE SUBDIVISION -----
--------------------
-- Water
System
is in
compliance with the
State of Alaska Drinking Water Regulations.
Sincerely,
ein
""R f6 I �dS -
Environm tal Field Officer
V
Dit
�1
£325 "1_" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GFOHGE M. SULLIVAN,
rv1AYOH
OCPAHTNIEN I Of ItI_AL Ill fVPJ O I NV II;If, ':4i II IAI_ PHOTECI'ON
November 18, 1981
Caribou Investments, Inc.
619 East 5th Avenue
Anchorage, Alaska 99501
Subject: Lot 1 Block 3 Southpark Terrace Estates Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
Arrangements should be made to divert the surface
water away from the trench area and the sump.
If there e any further questions, please call this office
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Alaska Pacific Bank
Post Office Box 420
99510
October 10, 19£33
Caribou investments, Inc.
.519 East 6th Avenue
Anchorage, Alaska 99501
SubaQct: Low 1, Block 3, Southpark Terrace Estates Subdivision
approval for the individual :fo'ule'r and 'Nater .facilities; cannot
be granted until the following items have been completed:
OArrangements should be made to divert the :surface eater away
from the 'trench area and the s=ump.
Did not fill or divert as per November 13, MI.
If there are any further questions, Tease call this office at
264--4720.
Sincerely,
,Jin Roberts
Associate Environmental Specialist
JRw/n/s
cc; Alaska pacific Bank
101 W. 3onson, Anchorage, AN 99503
Larry Wright, Realtor
5301 E. 30th, Anchorage, AK 995011