HomeMy WebLinkAboutSOUTHPARK BLK 3 LT 4MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP201020
Work Type: Septic Upgrade
Tax Code Number: 02049130000
Site Legal Address: SOUTHPARK BLK 3 LT 4 G:3236
Site Mailing Address: 16231 CHASEWOOD LN, Anchorage
Owner: FAIGNANT CARYN J & J B JR
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date
Lot Size in Sq Ft
Total Bedrooms
4/21/2020
4/21/2021
24772
❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received B)
Issued By:
Date: 4 2� L
Date: l
4
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan
On -Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 020-491-30
Property owner(s) .JAY FAIGNANT
Mailing address 16231 CHASEWOOD LANE *ANCHORAGE, AK 99516
Site address 16231 CHASEWOOD LANE *ANCHORAGE, AK 99516
Legal description (Sub'd, Block & Lot) SOUTHPARK; BLOCK 3, LOT 4
Legal description (Township, Section & Range)
Lot Size
APPLICATION IS FOR:
( ISI all that apply)
Absorption Field
Septic Tank
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Sq. Ft. Number of Bedrooms
APPLICATION IS AN:
Initial ❑
Upgrade
Renewal ❑
Day phone 507-271-9165
A
THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR:
BED WIDTH
TYPE OF DEWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D) ❑
Multiple Dwellings ❑
(SF and/or D)
Distance: 18
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Feesy 9620. 00 Waiver Fees:
Date of Payment: � i 012020 Date of Payment:
Receipt Number: 6rcs43G Receipt Number:
Permit No. Of PZOI0ZO Waiver No.
(Rev. 01/11)
GARNESS ENGINEERING GROUP, Ltd
- - _- -- ENGINEERING � SALES- CONSULTING --
February 5'h, 2020
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed Septic System Upgrade Southpark; Block 3, Lot 4
To whom it may concern:
The existing 3 -bedroom home is served by public/community water and a private septic system. Per
conversations with the owner, they would like to install a 4 -bedroom septic system. We are proposing to
rebuild the existing drainfield in place and expand the width of the bed to meet MOA sizing requirements
for a 4 -bedroom home. We are proposing to excavate out all contaminated material and rebuilding the
existing portion of the bed 0.1 feet higher in elevation. The drainfield extension will be excavated to the
SP material (approximately 6 feet below grade) and install sand as needed (minimum of 2.5 feet — to
match the minimum existing sand depth of 2.5 feet on inspection report and ensure adequate separation
to groundwater). Comments regarding the design are summarized as follows:
1. SOILS: See attached soil log in MOA records by Mike Anderson, P.E.. As can be seen on the
attached soil log, the soils percolated at a rate of 4 min/inch with groundwater at 8' and 10' below original
grade.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface water concerns.
4. TOPOGRAPHY: See attached photographs from google earth. Per the attached photograph and a
GEG site visit, there are no topography concerns.
5. WAIVERS: We are requesting that your department allow the bed to be extended 3 feet in width for a
total width of 18 feet. Based upon this fact, we are requesting that your department issue a variance to
the maximum drainfield width from 15 feet to 18 feet. Extra care will be taken to ensure the machine does
not "walk" on the bottom of the bed and/or damage the drainfield.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
If you have any questions, please contact us at 337-6179. Thank you for your assistance.
rnes% P.E 1, M.S.
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
DESIGN CRITERIA:
NUMBER OF BEDROOMS: 4 (SEE DESIGN NARRATIVE)
GALLONS PER DAY (GPD): 600 GPD
PERCOLATION RATE/S:'4 MIN/INCH
PROPOSED APPLICATION RATE: 0.8 FT'/BEDROOM
MINIMUM DRAINFIELD SQ.FT.: 750 FT=
*PER TH12 BY MIKE ANDERSON, P.E. IN MOA RECORDS
DRAINFIELD DESIGN:
MAXIMUM DEPTH: *AS NEEDED FOR REMOVAL
OF CONTAMINATED MATERIAL FOR EXISTING
PORTION - MUST EXCAVATE TO SP MATERIAL
FOR BED EXTENSION
WIDTH: 18 FEET (EXTENDED 3 FEET)
LENGTH: 43 FEET
M.O.A. APPROVED SAND FILTER: AS
NEEDED TO REBUILD THE EXISTING
DRAINFIELD AT AN ELEVATION OF 0.1 FEET
HIGHER THAN THE EXISTING BED - SAND
FOR EXTENDED PORTION SHALL BE A
MINIMUM OF 2.5 FEET AND AS NEEDED TO
MATCH NEW TOP OF SAND
EFFECTIVE: 0.5 FEET
ACTUAL SQ.FT.: 774 FT'
GEG, Ltd. HAS AN 8 PAGE SPECIFICATION LETTER
'HAT PERTAINS TO THIS DESIGN. BY PROCEEDING
FORWARD WITH THIS INSTALLATION, THE
ENGINEER, WELL DRILLER, CONTRACTOR AND
PROPERTY OWNER AGREE THAT THEY HAVE
READ THESE SPECIFICATIONS AND AGREE TO
4CCEPT THE TERMS AND CONDITIONS OUTLINED.
PROPOSED 1250 GALLON HDPE GREER TANK RATED
FOR 10' BURIAL; MUST BE V FROM ALL DECK POSTS;
INSTALL DOUBLE CLEANOUTS BEFORE AND AFTER;
EXISTING TANK TO BE/DECOMMISSIONED PER UPC
V
SOUTHPARK;
BLOCK 3, LOT 5
KEYBOX PER AS -BUILT SURVEY; WATER
LINE LOCATION TAKEN FROM 1999 DESIGN
BY MIKE ANDERSON, P.E. IN MOA RECORDS —7
SOUTHPARK;
BLOCK 3, LOT 9
NOTE: THE CONTRACTOR SHALL
HAVE THE SOUTH LOT LINE & 20' CEA
EASEMENT TO THE EAST FLAGGED
BY A REGISTERED LAND SURVEYOR
PRIOR TO CONSTRUCTION.
THE RESERVE SITE WILL BE
REBUILDING THE PROPOSED
DRAINFIELD IN PLACE
10,C I
ESMT EXACT LOCATION TO 1981 TRENCH IS
UNKNOWN; IF ENCOUNTERED A 16'
I DIRT PLUG WILL BE INSTALLED
THE AREA AROUND THE PROPOSED
DRAINFIELD IS FLAT; HOWEVER, THE ORIGINAL
GRADE IS UNKNOWN; IN SHORT, THIS IS A
PROPOSED REBUILD OF THE BED AND THE
BED DEPTH WILL BE DETERMINED BY THE
BOTTOM OF THE EXISTING BED/TOP OF SAND
DRIVEWAY
EXISTING 3 BEDROOM I i
HOUSE (PROPOSE D 4 I Z
BEDROOM SEPTIC)
F:
M
(Npo C 0. (
PROPOSED
D Cq A PROPOSED WIDTH EXTENSION
FOR 4 BEDROOM EXTENSION �\
SOUTHPARK;
BLOCK 3, LOT 3
PROPOSED DRAINFIELD
-APPROXIMATE LOCATION OF
TESTHOLE #2 PER INSPECTION
REPORT BY MIKE A. ANDERSON,
P.E. IN MOA RECORDS
"ROUIT", Ltd
ENGINEERING, SALES CONSULTING
3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 • PHONE (907) 337-6179 FAX (907) 338.3246' WEBSITE www gamessengineerimmm
PREPARED FOR:
JAY FAIGNANT
PROJECTILEGAL DESCRIPTION:
SOUTHPARK; BLOCK 3, LOT 4
TYPE OF WORK:
DESIGN OF SEPTIC TANK UPGRADE
PHONE NUMBER: PAGE NUMBER:
507-271-9165 1 OF 1
DRAWN BY:
D.J.G.
DATE:
2/14/2020
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' Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND. HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: --~'~ C/'~O0~ PID Number: 0~00
"~": ~A~b~ ~. ~4~U~H ~ Wastewater System: ~ New ~Upgrade
*~r~,,: l~ ~ l ~4-~5~0~ ~ ABSORPTION FIELD
Phone: ~m> ~OeepTrench ~ Shallow Trench ~Bed ~Mound ~Other
Total Depth from original grade:
LEGAL DESCRIPTION SoilRating; . 7 GPB/Sq. Ft.
Lob ~ Block: ~ Subdivision:~¢~ ~{~ Depth ,o pipe bot,o~o¢ original grade: Pt. Gravel depth beneath .lp;~ FL
Township; IRange: Isection: FiJl added above original grade:¢ Fl. Gravellengt.: ~ Ft.
Number of lines: ~Bfstance be~een
WELL: D New ~ Upgrade ;6ravelwidth: /¢ Ft. ~ ~ Ft.
Classificst~Pr~yate, A,B.C): Total ~epth: Ft. Cased TO: Ft. Total absorption~area:~ ¢ SQ. Ft. Pipe m~terial: A ~
Driller: Date Drilled: Static Water Level: Installer: ~ .+ ,,~ ~ ~V~,~ Date ,nstal,ed~
Yield:GPM IPump Set at' "'. ICasing Heigh`AbOve GrOund:Fl- TANK
SEPARATION DISTANCES ~s~ptic ~ Holding D S.T.E.P.
TO Septic Absorption Lift Holding 3ublic/Privat( Manufacturer: Capacity in gallons:
Well ~t ~01 Material: ~T~ L Number of~Com a ments:
Sudace
w~ ~1~0~ 21OO ~ : ~ LIFT STATION
Lot ~ / Size in gallons: ~
Line W~
Foundation 17.¢' >~O' "Pump on" level a,: ~"Pumpoff"le~ateralarma,:
Drain ~
Remarks: ~.~ ¢ ~ ~.~ ¢¢ BENCH MARK
J Assum.d Elevation:
Inspections pedormed by: ~~4~ Dates: ls~~¢~ ~'J~.,
Department of Health and Human Se~ices approval '~' ~¢~"~;~¢,,"*~0~:~t~s,~:.:¢¢-*~ ......... ~'
Reviewed and approved by: /.~ Date: ~-~-F~ ...........
72-O13 (Rev. 9/91) MOA 25
Permit No. ~J95'"00 ~"~
Page ~ of ~
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:
PID No.:
, /
Permit No. ~W q~'O0 ~/ Page '-~ of '~
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
~ u~H. PA FLK~
PID No.:
L
~ MJch(~ai [~. /ind~r on
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HERMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM
PERMIT NUMBER:SW950084
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:RAEUCHLE SANDRA K
OWNER ADDRESS:16231 CHASEWOOD LN
ANCHORAGE, AK. 99516
PAGE 1 OF 1
(UPGRADE) PERMIT
DATE ISSUED: 5/23/95
EXPIRATION DATE: 5/23/96
PARCEL ID:02005144
LEGAL DESCRIPTION:
SOUTHPARK BLK 3 LT
4
LOT SIZE: 24722 (SQ. FT.)
NUBLBER OF BEDROOMS: 3 THIS PER~IT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AiYD THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AA!D CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY: ·
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, ALASKA 99524
May 19, 199S
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lot 4, Block 3, Southpark Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
The absorption trench on the subject lot has failed and must be replaced.
We are proposing to remove the existing contaminated material from the
existing trench and construct a shallow bed system in the same area. The
contaminated material from the old trench will be buried onsite at a
location 4' above the water table. Lake Otis Gravel (sand) will be placed in
the excavated cavity remaining from the old absorption trench. The new
absorption bed will be placed at the location shown on the site plan.
Existing materials will be removed to the SP soil layer. Lake Otis Gravel
(sand) will be placed to insure w4' separation from the water table. The
bed system will be placed atop the sand.
The soil encountered on the lot percoates at a rate between 2 minutes and
5 minutes per inch which is excellent for an onsite system. The septic tank
will be checked for leaks prior to the installation of the absorption bed. ff
it is found to be sound it will not be replaced.
The surface drainage on the lot will not be affected by the construction of
the new absorption bed. In addition, all lots in the area are served by a
community water system. The system on this lot is well outside the
protective 200' radius and has no impact on adjacent septic systems. If
the system is installed as designed the following statements may be made:
1. The system, if constructed as designed, will have no adverse impact
on the wells in the area or those to be constructed in the future.
Lot 4, Block 3, Southpark Subdivision
May 19, 1995
Page Two
The system, if constructed as designed, will have no adverse impact
on existing septic systems in the area or those to be constructed in
the future.
The system, if constructed as designed, will have no adverse impact
on reserved space, either surface or subsurface, on any lots located in
the area.
on drainage patterns in the area.
be maintained.
The system, if constructed as designed, will have no adverse impact
The current drainage pattern will
Sincerdy,
Michael E. Anderson, P.E.
Attachments
LOT 4, BLOCK 3, SOUTHPARK
SITE PLAN ~-~~
SCALE 1" = 20'
/
/
/
/
/ /.
L
Lot 4, Block 3, Southpark Subdivision
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Three Bedroom Home Shallow Bed System
Perc. Rate: 4 Min./Inch 1,000 Gal. Septic Tank
Application Rate: .7 GPD/SF Min. 2' Accepting Soils
(Existing)
3 Bdrms. X 150 GPD / .7 GPD/SF = 642 SF of Absorption Area
642 SF / 18 LF Width = 36 LF Length
Therefore: Construct a Shallow Bed System 18' Wide X 36' Long at
the Location Shown on the Site Plan. Distribution Pipe Placed at
2.5' Below Original Ground Surface.
I S I (' I ~' I
NOTE:
TYPICAL SHALLOW BED
(NO SCALE)
Maintain 4' Vertical Separation From Bottom of Trench
to Groundwater Table.
Grade Area Over Bed to Drain Away.
Level Bottom of Bed with Lake Otis Gravel (Sand).
JOB
SHEET NO.. OF
CALCULATEO 8Y '~ ~'~ DATE
CHECKED BY DATE
SCALE
LOCATION MAP
LOT 4, BLOCK 3, SOUTHPARK SUBDIVISION
LOT , .BLOCK 3, SOUTHPARK
SITE PLAN
SCALE 1" = 20'
Lot 4, Block 3, Southpark Subdivision
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Three Bedroom Home Shallow Bed System
Perc. Rate: 3 Min./Inch 1,000 Gal. Septic Tank
Application Rate: .7 GPD/SF Min. 2' Accepting Soils
(Existing)
3 Bdrms. X 150 GPD / .7 GPD/SF = 642 SF of Absorption Area
642 SF / 18' Wide = 36' Length
Therefore: Construct a Shallow Bed System 18' Wide X 36' Long at
the Location Shown on the Site Plan. Distribution Pipe Placed 3.5'
Below Original Ground Surface.
3 I b I /' I
NOTE:
TYPICAL SHALLOW BED SYSTEM
(NO SCALE)
Maintain 4' Vertical Separation From Bottom of
Bed to Groundwater Table.
Grade Area Over Bed to Drain Away.
Completely Remove Existing Absorption Trench
and Contaminated Soil and Bury Onsite.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
DATE PERFORM
'P"F//OL
4
5
6
7
8
9.
10-
11
13-
14
15
16
17
18
19-
20-
L.
5P
Township, Range, Section:
SLOPE
WASGROUNDWATER y~
ENCOUNTERED?
S
IF YES, AT WHAT t ~
DEPTH? lO p
E
SITE PLAN
Depth to Water After /Dr ~"/~
Monitoring? Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PoP- P&'P-cO~Arlo~4 ~ re
OF ~ P ~' ,~
PERCOLATION RATE --
(minutes/inch) PERC HOLE DIAMETER --
TEST RUN BETWEEN FT AND FT
COMMENTS
PER ORMEDB¥: ,
ACCORDA"CE WiTH ALL STATE AND MUNICIPAL GUIDELI"ES IN EFFECT O" THIS DATE, DATE:'
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska, 99502-0650
SOILS LOG m PERCOLATION TEST
DATE PERFORMED:
LEGAL DESCRIPTION:
3
4
5
8
9
10
12
14
15
17
18-
19-
20-
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~t OL
DEPTH? p
E
SITE PLAN
I
N
Depth to Water After f
Monitoring? ~- Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE Z~. (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND 7 FT
COMMENTS--/' S '
A.
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85J
' MUNICIPALITY OF ANCHORAGE
e ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
, ENVIRONMENTAL ENGINEERING DIVISION
~ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM ,~ INSPECTION REPORT
NAME , PHQNE
LEGAL DESCRIPTION ~ ~
LOCATION NO. OF BEDROOM~
DISTANCE TO: I~'" IA"'°~''*** ,welling /~ ,h PERMITNO. ~/~
~ z Manufacturer No, of compartments
~ ~ Liq. capacity in ga~lons Insi~e length Width Liquid depth
/OOO . IF HOME--DE:
PERMIT NO,
' ~ Well / Dwelling ~~
~z DISTANCE TO:
Well Foundatio Nearest lot line PERMIT NO.
~ .~g No. of lines I L';,,th ~,~ac~, ~ Total length of li~s.,~}~ Trench width ~ inches Distance between lines
Top of tile ,o fi 'shgrad. .~ F Materia.en*htile ~
m Depth ~ NO.
~ DIS~TO: Well ~ Building foundation /~ ~Nearest lot line
~ Glass Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE ~ ~lding foundation Sewer lin~/ Septic tank A~s~area(s)
OTHER
PIPE MATERIALS
SOIl TEST RATING
REMARKS
APPR VED DATE LEGAL
72-01 ~ {Rev. 3/78}
I)EF'RRTHENT HEFIL. TH FINE:, ENVIRONMENTRL _-TEr:TION
..... , .... -}ES Er1.
c,-:,,~ "L.'':'_, rFEET.,' HNL. HUF(HbE.,
E.t4E. F. F E.~-. ["1 ][ 1-
,]F4--:5 ][ TE
PERMIT NO. ( 81Ei74]'": )
RPPLICRNT CRRIE:OLI INVESTMENTS INC
LOCRT I ON SOLITHPFIRK
LEGFIL
619 E. 5TH RVE.
L4_,_.F"~ SOLrFHF'RRK ~,~[:, ~ LOT z,I~.E
~ ~.,, ~. :5~:':.!URRE FEEl'
TYPE OF :,L IL RBSORF'TION :,~_,TD1 I:-,. TRENCH
MR::..', I MUM NUflE, L~. OF BEE:,ROONS = ~
,- ~ .I ;:'D
:,EIL RFtTINL3 (:Sr.:! FT,."E[R::,= --
THE REr.ILIIRED 'SIZE OF THE :,uIL HE,:,URPTI-N -:,~-rEM
]'HE LENGTH [:,IME[,SION IS THE L~ENGT~::..,: IN~FE~.T:)~{I¢ T~E] "'~ E:ETWEENOF THE TRENCHTHE SIJRFFtc. EOR ~RRINFIELE:,.OF THE
GR]_ND RNB, THE E:OTTON OF THE ~.::CR'~gIO[~ (~ FEET).
~ ' FOR TEENE. HE_,.
'rHEF2 I2; NO _Er WIDTH ' "
THE GRR',,,'EL [:,EPTH IS THE MINIMI..IM DEF'TH OF 6RFISCEL E, ETH_EN THE OLITFFILL PIPE
FIND THE EUTTUfl OF THE EXC:RVRTZON ,::IN FEET::,.
F:EL----EJ ]] F."E [:.-. .... EFT ]] E: T"FdF.H< 2'; Z ZE--- -_1_ F:(CIC'~ .......
-,= , ,- , ,- , ' _ 1HI_,' ':' DEF'RRTMENT [.I_IF. IHb' -' TI-E
PERMIT RPPLICFINT HH-, THE EE:,FON:,IE, ILIT~ TF~ INFORM
IN_FEL. TIuN_, OF RN'.r' I. IEL_:, RE:,.ZRCENT TO" "= ' -t * '"
INSTRLLRTION ,~ ,.-. - ,= ~,- fHI..., FRLFE~.T~ RND THE
''' RE_,IEENL__, THRT THE WELL WILL =,ER E.
NUtlE, EF. ]g ,, .h: . ~F,s ¢' - *, ,..'
L'S.'RL. LFILLIN.~ OF FIN'¢ _,~lEfl I.,.!ITHOU'r FINFIL INSPEL-:TIL]N FIND FIPF'ROVFIL B'¢ THI_,
E:,EF'RRI'i'tENT WIL. L BE :IJEJ'EL.T TEl FF.U_-,EL. UTI_N.
MINIMUM [.I:THNL. E E, ETWEEN R !.,ELL RN['., FIN'T' uN-z, I T_ =,EIlR=E [.I_,Fu_,HL _,~:,TE[1 IS
'l_i~Ei FEET F-JR FI F'RI'v'FITE WELL L~ ±SE1 TO 2~E~ FEET FROM R FUE,_IL. WELL DEF'EN[:,ING
UPON THE T'¢F'E ElF FUE, LIL. [,JELL. ~_~:! : '~....
MINIMLtM [:,ISTRNI]:E FROM Ft PRI',/RTE I,]EEL trEIllR ~!RI',)FITE qE[,JER LINE Ib'] 25 FEET RN[:,
l'O Fi z:r'iMMLINITY SEWER ~INE IS ,'"-=; .-BET.
OTHER ~.E~.!UIF. EftEH]_, MFi'¢ FiPF'L'¢. _~FEE. IFIL. HTIUN- FiN[:, CONSTRtlI-:TIFIN [.IH=DFI= FIRE
R',/RILRBLE TO INSURE F'ROF'ER INSTRLt_FiTION.
F'EiF:hl I: T E::-::P 1; F:E':; [:.E(CEFIBEF: 3:1._. t ...... 1
I CERTIF'¢ THRT
1: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND HELLS RS SET
FORTH Bk' THE MUNICIPFiLIT'¢ OF RNCHORFIGE
2: I WILL INSTFILL THE S'¢STEM IN FICCORDRNCE WITH THE CODES.
]'::: I UNDERSTFiN[." THRT THE ON-SITE SEWER S'¢STEM MFi'¢ RE6iUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 2: BEDROOMS.
S I GNED: .......................
FIPPLICFINT CFIRIBO0 INVESTMENTS INC.
., .r..t"? 4 DEPRRTMENT OF HERLTH FIND EN'v'I?DNMENTRL F'ROTECTION
.-.,_-STREET., R,,::. '-*.'-:'--"*'.
/
264-472¢ . . ,,. ~ I J ', 1 5
F'ERMIT NO. ,:.' 8±~}6Fh- ) .~
LOCFfT I ON CHFISE WOOD LRNE , , ,-1
LEGRL LBT 4 BLt':: 3: SOUTH PRRK TF.'. ES LOT SIZE 2Ze~0.9 SOURRE FEEl/
TYPE OF SOIL RBSORF'TION SYSTEft IL=;,: TRENCH /%...
/
MRMIMI_IM NOMBER OF BEDROOMS = 5; SOIL RRTING (SQ FT,.'"BR)= 150
THE REQUIRE[) SIZE OF THE SOIL 8BSORPTION SYSTEM IS:
'THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRBINFIELD.
TFIE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN TNE SURFRCE OF THE
GROUND RND THE BGTTOM OF TFIE EXCRVBTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTN IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL F'IPE
RND THE BOTTOM OF TFIE EXCRVRTION (IN FEET).
F..':EG:~LI % RED, 'Z:-;EPT 1Z ~]: ]".F~b,~l-:.'. :5 1' ZE= ± ~Zt ¢£~.~Z~ t3~LL C,t'-~'_:.
PERMIT RPPLICRNT FIFIS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPER~Y RND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SER~E.
BRCKFILLING OF RNY S~'STEM WITHOUT FINRL INSPECTION RND RPPRO',,,'RL. 89 THIS
DEPRRTMENT WILL 8E SUBJECT TO PROSECUTION.
MINIMUM DISTFINCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISF'OSFIL SYSTEM IS
d. Ot~ FEET FOR R PRIVRTE WELL OR &SR TO 2EIE~ FEET FROM FI PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTRNCE FROM R PRIYRTE WELL TO Ft PRI',,.'RTE SEWER LINE IS 25 FEET FiND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICFiTIONS RND CONSTRUCTION DIRGRRMS RRE
FiVFIILRBLE TO INSURE PROPER INqTRLLRTION.
F'EF:~'I Z T b-] ::-:: F' :t;. F:E25 [:,EIgE~-IE:EF: 3::i.. t9:3!
I CERTIFY THRT
:1_: I BM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FOR. TH BY THE MUNICIPRLITY OF FiNCHORFiGE.
2: I WILL INSTRLL THE B'¢STEM IN RCCORDRNCE WITH THE CODES.
]~: I UNDERSTRND TWRT THE ON-SITE SEWER SYSTEM MRY REg~U!RE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 3: BEDR. OOMS.
FIPPLIC~N~ CFIRIBOU INYESTMENTS .INC:. .
....
94. 0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [] PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION:
1
2
3
4
6
7
8
9
10
11
~2
13
14
15
16
17
18
19
20
COMMENTS
WAS GROUND WATER S
ENCOUNTERED? L
O
P
E
IF YES, AT WHAT
DEPTH7
SLOPE SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
PERFORMED B~
72-008 (6/79)
Test Hole
#Lot 4,
Block 3
Table j
WO #A19218
Date: 4/10/80
Logged by: O. Hatch
Depth in Feet
From To
0.0 0.5
0.5 1.5
1.5 3.5
3.5 12.0
12.0 16.0
Soil Description
Brown Subsurface Organics, soft, Pt
F-4, brown Sand~ Sil~, damp, dense, non-
plastic, ML
F-4, brown Gravelly Sandz Silt, damp, dense,
non-plastic, subrounded particles to 2"
F-2, brown Silty. fine Sand with traces gravel,
40 to 45% non-plastic silt, damp, medium dense,
grades to 30% silt by 10'
F-4, brown Gravelly Sa~ Silt, 20% gravel,
damp, mediu~ dense, non-plastic, ML
Bottom of Test Hole:
Frost Line:
Free Water Level:
Percolation Rate =
16.0 Feet
1.0 Foot
None Observed While Drilling
0.5 minutes/inch with water level in PVC pipe
falling 7 feet in 45 minutes
Sa.
N__o_. pep,th
1 5.0
2 10.0
3 15.0
Type of Dry
~lows/6" M% ~ample Strength ~roup Unified
14.1 G VI, -- ML
9.8 G N -- SM
11.4 G VI, 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, }{=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.
-¼
P'p~_
•
GE @V
•r-y Municipality of Anchorage
On-Site Water and Wastewater Program +�
(907) 343-7904 ��
Certificate of On-Site Systems Approval a Jul_ 5 ?017
Parcel I.D. 020-491-30 Expiration Date: I6'
, 6 8 L • fop
V •
1. GENERAL INFORMATION
Complete legal description Southpark Block 3 Lot 4
Location (site address) 16231 Chasewood Lane
Current Property owner(s) Eason, William Day phone
Mailing address PO Box 230128 Anchorage, AK 99523
Real Estate Agent Day phone
2. TYPE OF DWELLING:
E Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual []
Individual Water Storage ❑ Holding Tank ❑
Community Class A Well CI Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
ii!Received b , , ,j.�_ &.1.L...1&.1.L...1Date: 4„2//
•
COSA to be released to the engineer,unless otherwise re./ted by the engineer.
COSA Fee $ G72) r— Waiver Fee $
Date of Payment 7l (o l l 1 Date of Payment
Receipt Number (D�7a-klReceipt Number
COSA# 05C,11 I?--10�o 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.
In conducting an adequacAtest, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe 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 soil
condition,ground water 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 system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
, for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 715/2017
r �F Aq1�
6. DSD SIGNATURE ....
System #1 Approved for 3 bedrooms a •• Steven •. fro none. /
,•. CE-8149 &,
System #2 Approved for bedrooms 9� 4
Disapproved �kPROFESSONP '~
Conditional approval for bedrooms, with the following stipulations:
O,p
ON-SITE .yn
WATER AND m
WASTEWATER
S PROGRAM
"204 cam~
IA rt
t!i'nrtY\I�
By: 14e,e,e_a, � Original Certificate Date: ( a- 17
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_C •
If more than 1 septic system is on the lot:
COSA Checklist# I of
Structure served by this system '
Certificate of On-Site Systems Approval Checklist
Legal Description: SOANZA.Y.._, l`JL iI�� `Q4 Parcel ID: OPu-11v
A. WELL DATA
Well type A If A B. or C provide PWSID # 213475 Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft ft.
Well production g p.m. g.p.m.
WATER SAMPLE RESULTS
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 5/25/1 995
Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (Y/N) y* Depression over tank (Y/N) N High water alarm (Y/N) N/A
Date of pumping
6/21/2017 Pumper Alaska Quality Septic
C. ABSORPTION FIELD DATA
Date installed
5/25-27r1995 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.7 GPD/SF System type Shallow Bed
Length 43 ft. Width 15 ft. Gravel below pipe 0.5 ft.
Total depth 4 5 ft. Eff. absorption area 645 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 6/22/2017 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in Water added 455 gal. New depth 6 in.
Elapsed Time: 1440 min. Final fluid depth in Absorption rate >= 450+ g.p.d.
N
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes. give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main
10+ Water service line 10+O+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
* ? c i 16Unrit J:ian CItcauaJ,t avvit- r,
G. ENGINEER'S CERTIFICATION �� L A 'k
I certify that I have determined through field inspections and �sv03.- �
1 '.
review of Municipal records that the above systems are in 0*: •! t 110 y�v
*�r
conformance with MOA COSA guidelines in effect on this date. - ••w
f
Engineer's Printed Name Steven Pannone ,......__0' ' `even '. 'annone -
Ali
Date 7/5/2017 0:-..6
CE-8149 Arr
COSA canary sheet_2-6-15.doc
C0T
9
ri
�r T. -
--_______ ......4 fil
j
1 .
Cp
24. '
I
'J
...........-.•.......-.-.•.• i . .
EXISTING ro 1
35. •••:•:- BUILDING III
3
N/ I
o i i
LOT 4 ® f 1 j I dol'j
BLOCK 3 # I' g 3
- ®me I
i i
y) .....
® ® I !f
♦ I 'r'QQQ�O�O�
Cyq • OF At °,of4a
�ppq po,� _�, ,5,�-p00
I Q*. 49TH r� OQ
0
1 VA
h 4Mark E. Dovis . CoQ
V QOJ} LS-7338 `'p'
():'. : S•ym.-i.7 na5o�
rafession& �4c
��04o�o��a
.'n.'». ` " ' "' ''''"''""""'""'" .'"' '"'."'-"" EXCLUSION NOTES: It Is the owners' responsibility to determine LEGEND: SET FND
ORDERED er: the existence of any easements, covenants, or restrictions 5/8'R8 w/CAP® 5/8' R8 0
WILL E A S O N which do not appear On the recorded subdivision plat NOTE: 3.25' AL.MON.it MONUMENT
Under no circumstances should any data hereon be used for HUB de TACK
._'/.H'.'�M�.T•hal'_\_NWrIf er4 i•..•• .7..%.2.9 w_\._4•�b.7:0.0• •..u•..,.•�\�•= construction or for establishing property lines.
....".r.n.�n.:cm.7n„�n:.".�n.�n. ».,.n...i.7n. ».:n.nn...a.:Yn.:Qn.wn.-wn..►i. FENCE— —x— x —
SURVEY CERTIFICATION: SLANA has conducted a OVERHANG- 1.111111111111
T physical survey of this property as shown on this WOOD DECKS- I I
SLANA SURVEYS INC drawing and that the Improvements situated there CONCRETE-
on are within the property Ilnes and no encroach— ASPHALT- [T^'^'^"^'^i
mente exist other than noted. GRAVEL-
LAND & CONSTRUCTION SURVEYORS AS— BUILT O F: LEGAL DESCRIPTION: SEP TIC WATER STELL-
NOPIPES �
1200 E. 76th (fox) 929-3369
ANCHORAGE, ALASKA 99518 (907) 562-6103 LOT 4, BLOCK 3
WOSLK17DMISCER MB� �� SCALE T SOUTHPARK SUBDIVISION
JUNE 30. 2017 1'=3O' 50-65
MN BY': CHECKED aY:ORD NUYBEih sOCx/CAOE:
TAD. t. 3236 999/99
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 SINGLE FAMILY DWELLING
02005144 HAA# ¥~ ~ d:~ ~ ~f~'~ ~'k~
GENERAL INFORMATION
Complete legal description
Lot 4, Block 3,! South Park Subdivision
Location (site address or directions)
16231 Chasewood Lane
Property owner
Mailing address
Day phone
Lending agency
Day phone
Mailing address
Tom Alexander/Vista Real
Agent
Estate
Address 4241 B Street Anchorage , AK 99503
Day phone
562-6444
Unless otherwise requested, HAA will be hbld for pickup.
2. NUMBER OF BEDROOMS: Three (3
3. TYPE OF WATER SUPPLY:
individual well
Community well
Public water
XXXXXXX
NOTE:
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
XXXXXXX
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
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 Anderson Engineering Phone 563~7155
Address PiO, Box 240773 Anchorage, AK 99524
Engineer's signature 7'~,L~'~ C~-~,~.
11/18/96
Date
DHHS SIGNATURE ~'~.,~' :
.,~' Approved for ~:~ bedrooms. ",!,
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Date
The Mur~iciPality of AnchOrage Department of Health and Human Services (DHHS) issues Heatth Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional eng!neet; registered in the State of Alaska. The D HHS does this as a ecu rtesy 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.
724)25 (Rev. 1/91) Back MOA ~1
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES i1~
ECEIVEI
Environmental Services Division
825 L Street, ROom 502 · Anchorage, Alaska 99501 · (907) 343-4744
NOV 1 8 1996
Legal Description: LoT' 5/-,
A. WELL DATA
Well type~$~ A
Health Authority Approval Checklist
~&Oct" ,~ ~OOW'I P,'~'~4~._ Parcel I.D.:
Mut}icipality of Anchorage
Dept. Health & Human Services
ozoog ¥q-
If A, B, or C, attach ADEC letter. ADEC water system number ~1~
Log present(Y/N1
Date completed
Total depth Cased to
Casing height (above ground)
Sanitary seal (Y/N)
Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
g.p.m.
g.p.m.
Coliform Nitrate Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDINGTANK DATA
Date installed ~'/Z.~/~' Tanksize /t000 Number of Compartments ~' Cleanouts(Y/N).__
Foundation cleanout (Y/N) Y Depression (Y/N). AJ High water alarm (Y/N)
Date of Pumping ///~/¢~' Pumper A ?~'~.$ /'/0/I'/~
Y
C. ABSORPTION FIELD DATA
Date i~talled ~/Z~'" Z~,-//~'T
Length ~'~ ,~ ~ Width
Soil rating (g.p,d./fF or fF/bdrm) ~ '7
I
! ~ Gravel thickness below pipe
Effective absorption area /~ ¥5' z,, .
F~, Monitonng Tube present (Y/N) Y
Date of adequacy test A~,T' ~ ~. Results (Pass/Fail) ~'~ $5
Fluid depth in absorption field before test (in.); ~) Immediately after
System type ~A t£o~J
,5"
Total depth
__ Depression over field (Y/N) /~J
For "-~/-~"~- bedrooms
__ gal. water added (in.):.
Fluid depth
(ins) Minutes later:
Absorption rate =
.g.p.d.
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)* .~ ,~'~';~1~ C~ ~ ~-71,zJ (,~' 6¢'~
If yes, give date
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
Size in gallons
~ "Pump off" level at*
' *Datum ~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot /,Jo
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~' -~ ~ Property line ~ lO ~ Absorption field '~'~
Water main/service line '~' Z.~¢ Surface water/drainage ~/0 fpt Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line '~ ?t~ Building foundation ~/t7 Water main/service line
Surface water '>' / O 0 ~ Driveway, parking/vehicle storage area
Curtain drain ~0~ ~-' ,¢',M Lo,r- Wells on adjacent lots ~' 7-~10t
Engineer's Name
Date
F, ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal rocqr~$ tbS,.the above sget~,~,s are
in conformance with MOA HAA guidelines in effect on this date. ' .... "~
Signature . &
HAA Fee $
Date of Payment
72-026 (Rev, 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
' MUNICIPALITY OF ANCHORAGE-
DEPARTMENT OF HEALT-H & HUMAN sERVICES.
· { Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage,'Alaska 99519-6650
343-4744
Parcel I.D. #
1. GENERAL iNFORMATION
C~mplete legal description
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Location (site address or directions)
Property owner ~-A~'J bP-~
Mailing address
Lending agency
Mailing address
Agent
~.. T~-~J CH/_.G- Day phone
Day phone
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
- - ..-_ Public sewer
NOTE:
Day phone
'Address ' ·
...... Unless otherwise requested, HAA will be held for pickup. . - -
_ 2; . NUMBER OF BEDROOMS:
'~;: -~_-.L~.:~; ............................................... : ..
3..: ~TYPE OF WATER SUPPLY: ............ '.
. . "1' ~ .....,"'T' ' Individual well
· ~,,. ......... Community well 7~ -. ·
. Public water
" NOTE: If communi~ well system, provide wri~en confirmation from State ADEC a~est-
.,',,;'
. .- .,,' .~h",,''- [ ;,.
If community wastewater system, provide wri~en confirmation from State ADEC
a~esting to the legali~ and status of system. '
72-025(Rev. 1/91) Front MOA#21
5. STATEMENT OF INSPECTION BY ENGINEER
As cerUfied by my seal affi×ed hereto and as of the validation date shown below, verity 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 inspect[on, 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 '/4'~ [:3 &7/-4. q~O ~ ~-~/,,]~,/~ ~.-P-IN ~ Phone
Address T~.O, P'~o× z.~'O -/'7 -~ /~t,J ¢-~ OI'L/~~'
Engineer's signature ~ ~ ~ Date
t4Y-. qq
DHHS SIGNATURE
~" Approved for '3 bedroonlsl ' -'
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
'~he Munia]~ali~ 9f ~6chorage Depa~ment of Health and Human Se~ ces (DHHS) ~ues Health Authori~
', Approval,, , ., .~emhcates., :.,~,' ,- , based, only. upon the representat ons g'ven 'n paragraph 5 above by an ndependent
professorial engineer reg~ster~ in the State of A aska The DHHS does th s as a cou~esy to purchasem of homes
and their lendmg.msbtutmns m order to ~tis~ certain federal and state r~uirements. Employes of DHHS do not
conduct inspections or anal~e data before a ce~ificate is i~ued. The MunicipaliW of Anchorage is not
responsible for errors or oral,ions in the prof~ional engin~fs work..
Municipality of Anchorage ,~
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L_o'~- ~-, '[~oc,~.3) ~oori-H'>A~ Parcel I.D.
A. Well Data
Well type
Log present (Y/N)
Total depth
Sanitary seal (WN)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to Casing height
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level1
FROM WELL LOG
AT INSPECTION
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/hetdi~g tank on lot
Absorption field on lot
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
; On adjacent lots
; On adjacent lots A////----'
/
Public sewer manhole/cleanout ~'
Petroleum tank
Coliform Nitrate
Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed ~/~Z7/~"' Tank size ~ODb
Cleanouts (Y/N) 'Y Foundation cleanout (Y/N)
High water alarm (Y/N) ~
Date of pumping /"J~-~J ~J~Js'7-'?..)J ~ ~/,,.I
Compartments ~'~
Depression (Y/N)
Alarm tested (Y/N)
Pumper /'~/~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /~,'J~ On adjacent lots
To property line )./~)l Absorption field
Surtace water/drainage
Foundation
Water main/se[vice line
t7,5
72-026 (3/g3)'Front CONTINUED ON BACK PAGE
-
Manufacturer J ~
Size in gallons ~ Manhole/Access~
Vent (Y/N) "Pu~ _ ~ off" Level at __~
High water alarm level _ ~es-~e_sted
Meets MOA electdca~ ~
S~E FROM LIFT STATION TO: _ . . ~
~.~¢,,,,.~l'En lot On adjacent lots Sudace water ~--------~.
*.SOR.T,O" .E' O D* T
Length ~-~ ' Width
Total absorption area
Date of adequacy test/x/-~. ~
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF) o "~ System type ~.gALLO~d
/.%~ / .~ ..~
Gravel thickness ~-; /
. Total depth
Cleanout present (Y/N) Y' .Depression over field (Y/N)
Results (pass/fail) -r.~A 55 for "T--',5~F--~' Bedrooms
~O After test
/k/ If yes, give date ~/A
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~ 0 ,--[ -~-~ On adjacent lots '~ Z-OD Properly line
To building foundation '> Z_t) ~ To existing or abandoned system on lot ~> /¢
On adjacent lots '> ~'~ ' Culbank /'~ o ,,.I ~" Water main/service line ~' ~'-'/~
Sudace water /'~ O ~ ~ Driveway, parking/vehicle storage area ~ 2-~¢
Curtain drain ,~ 0 ~J ~-'-
E. ENGINEER'S CERTIFICATION
I cerb'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date, of this inspection.
Signature
Engineer's Name
Date -~/~ / / ~
HAP, Fee $ ~ ¢d~ '¢'"~
Date of Payment
Receipt
72-026 (~)' ~ck
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA # ~
1. GENERAL INFORMATION
Complete legal description
Location (site address or direct!ons)
Property owner
Mailing address /6.z3~ C~.~s~woo~, LA~C
Lending agency
Mailing address
Day phone
Address ~¥oo ~r~"e~! R~;~ A-/~cller~,~,,
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: .~ ~,i
Day phone
Day phor~e
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. 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 FZ/rTToP 'T~c~/ $~c~ Phone
Address 1,453o ECHo
Engineer's signature ~"~ ~ ~ Date
DHHs SIGNATURE
'~ ' Appr0v~d. for
' Disapproved/
bedrooms.
conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The MunicipaJity of Anchorage is not
responsible for errors or omissions in the professional engineeCs work.
72-025 (Rev. 1/91) Back MOA~F21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: LoT q~ ~3L~:3, ¢o~'~1 PReK -~/j) Parcel I.D.
A. WELL DATA
Well type
If A, B, or C, attach ADEC letter.
ADEC water System nQmber
Log present(Y/N)
Date completed : Driller
Total depth
Cased to Casing height.
Sanitary seal (Y/N)
Wires properly protected.(Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
t
200
2.00
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
g.p.m.
AT INSPECTION
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed '7/~1 Tank Size ~ooO d/~t
Cleanouts (Y/N) ~" Foundation cleanout (Y/N)
High wa~ter,ai~rm (Y/N) I'I:PL. · Alarm tested (Y/N)
Date of ~umping . ~' / 3 0,./9 ~ i Pumper'
SEPARAi'ION DISTANCEs FROM'SEPTIC/HOLDING TANK TO:
Well(s)onlo~: ~',A. : ~ Onadjacentlots ~./L Foundation
Topropertyline ~ 50 Absorption field
Surface water/drainage 7/oo '
Compartments 2_
Depression (Y/N)
Watermain/serviceli'ne ~ =$' ?~a tl.,q.~.
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
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed 7/~1 Soil rating
¢
Length ,~O
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
Width 3o" FER I~./~./~.
Gravel thickness
Cleanouts present (Y/N)
Date of adequacy test
for ~
System type
Total depth
Y
If yes, give date
Io ~ 12
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot hi .Pi.
To building foundation
On adjacent lots
Surface water ~, zoo'
Curtain drain
On adjacent lots N .A · Property line
To existing or abandoned system on lot
Cutbank t,l.A. 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 in effect ~¢,..date of this inspection.
Engineer s Name ~ ,~o ~ ¢. ~o~
Date
,z~3~...' c~. 3589 .?
HAA Fee $ / 7¢ ~ ~ Waiver Fee: $
Date of Payment ~ ~/~ ~ ~ Date of Payment
Receipt Number %~ ~ ~2~ Receipt Number
72-026 (Rev. 3/91 ) Back MOA 21
DEPT. OF ENVIRONMENTAL CONSERVATION
WALTER J. HICKEL, GOVERNOR
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99503
July 6, 1992
(907) 349-7755
FOR: Ted Moore
PWSID Cf 213475
My review of the records on file in this office reveals that the South Park 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.
Sincerely,
District Engineer
KKK/pf
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)
Location (address or directions)
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address
Telephone: (home)
y
Telephone
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check hereof hold for pick up.)
List contact person and day phone number below--~
2. TYPE OF RESIDENCE
Single-Family~ Number of bedrooms ~'
3, WATER SUPPLY
Individual Well [] Community.~ Pub]ic []
Note: If community well system,(must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE DISPOSAL
On-site ~1:~ 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
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s! q~ jo uo.~ee.~seAu. A~ ~eq~ AI!JeA I '~oleq u~oqs e~ep uo!leP!leA eq~ ¢o se pue o~eJeq pex!lse lEaS A~ Aq pe!~!~Jeo sv
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~I '' ~%~ ~ ~ ~ %~ ~ OF ANCHORAGE (MOA)
~
(,~}~,~¢~; '~, t,~lrlb~lfh' Authority Approval (HAA)
' ~,~,¢¢,\-~ ' CHECKLIST- FEBRUARY 1984 343-4744
~ ~ ~ ~ ~} Legal Description: L~T q, ~
A. WELL DATA
: ; ' ' ~&&S¢ ~ ' liA, a,C,D.E.C. Approved(Y/N)
Well C~lassificatiOn
Well Log Present (Y/N) Date Completed Yield
Total Depth · Cased to Depth of Grouting
Static Water Level Pump Set At
Casing Height Above Ground Sanitary Seal on Casing (Y/~), .
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 Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Date
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed -x/'~.~! Size
Standpipes (Y/N) ~---
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well ~
To Property Line ,~'~ ~
To Water Main/Service Line ~ ~--~
No. of Compartments .
y Foundation Cleanout (Y/N)
Date Last Pumped
;for
TemporarY Holding Tank Permit (Y/N) h~'/~
Air-tight Caps (Y/N)
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
Date Installed T[~..~ ~
Width of Field '~0
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness ¢-~
/'1/ ~ Statndpipes Present (Y/N)
~ Date of Last Adequacy Test
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
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
To Property Line ~0
To Existing or Abandoned System on
; On Adjoining Lots .~ ,.~'"' L.~
To Cutback (if present)
D. LIFT STATION N 0 ~ ~
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection. ,,.,~
Signed
Date
MOA No.
Receipt No.
Date of Payment
Amount: $
Receipt No,
Waiver Fee:
Date of Payment
Engineer's Seal
72-028 (Rev. 7/88) Back Page 2 of 2
DEPT. OF ENVIRONMENTAL CONSERVATION
/
ANCHORAGE/WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 316
ANCHORAGE, ALASKA 99503
STEVE COWPER, GOVERNOR
563-6775
DATE: January 19, 1989
PWSID: 211091
To Whom It May Concern:
According to the records on file in this office, the SOUTH
PARK ESTATES Water System is in compliance with the State of
Ala~~ Q~3inking Water Regulations.
Sincerely,
Environmental Field officer
Drinking Water Program
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, sub~wnship, range)
Lot 4, Block 3, Southpark~Subdv. ~-//4/ /~
Location (address or directions)
16231 Chasewood Lane Anchorage
(b) Applicant Name Tom Marshall Telephone:Home 3/45-3188 Business 263-423
Applicant Address 162~1 Chasewood Lane, Anchorage AK. 99516
(c) Applicant is (check one): Lending Institution []; Owner/builder E~; Buyer []; Other [] (explain};
(d) Lending Institution R~C.~]T,ity NRtic~n2q Rank Telephone 786-0255
Address P.O. BOX 77-777 Anchorage AK. 99510-7067
(e} Real Estate Company and Agent N/A
Address
Telephone
(f) MailtheHAAtothefollowingaddress:
Pickup by Engineer
TYPE OF RESIDENCE
Single-Family~ Multi-Family []
Number of Bedrooms _ '~
Other
WATER SUPPLY
Individual Well [] Community [] 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 ~ Public [] Community [] Holding Tank []
Note: If community well system, must ha~e written confirmation from the State Department of Environ mental Conservation
attesting to the legality and states.
Page 1 of 2 72-025111/84~
5. ' ENGII~EERING 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 - Telephone
~AULt- RIVER ENGINEERING
Address EAG~ ,,,
Date ~'-/~/<:5c 5-- P. 0. BOX 773294
§~4-5195
DNEP APPRO"~L
Approved for [~.~"~;:~-- bedroor~:~.
Approved ~" ' Disapproved
./
Terms of Conditional Approval
__ Co~nditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health 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
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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
WELL DATA
/"'~}NICIPABTY OF ANGI~OP. AGE DEPT,
MUNICIPALITY OF ANCHORAGE (MOA[~NVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Well Classification ~___../~r5 '~" If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) Date Completed Yield
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 Abo~e 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
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
Date installed ]
Standpipes (Y/N)
Depression over Tank (Y/N)
SEPTIC/HOLDING TANK DATA
Size /~¢"~'c"~ No. of Compartments
Air-tight Caps (Y/N) /)/. Foundation Cleanout (Y/N)
~ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) /'/"/,.~ ;for
Holding Tank High-Water Alarm (Y/N) .,/'~//~ Temporar~ Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
k'
To Building Foundation /'¢ /
To Disposal Field //2 z
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /~,~/
Width of Field ,~¢ /'
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field.
To Water-Supply Well
To Building Foundation
Lot /'/'/~'~.~
To Water Main/Service Line //_~ 7'-
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field ,.~,O /
Depth of Field ?"~ /
Gravel Bed Thickness 'E~ / j
Standpipes Present (Y/N)
Date of Last Adequacy Test
~ ~ ~
To Property Line /o '/-
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present) '/~"'"-~-
Comments
D. LIFT STATION
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 **
Signed ~~
Company ~/¢"
Receipt No. ~.~. ,~'7 '~'D...,
Date of Payment
Amount: $
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Date
MOA No.
· ' ,',,:~.. Engineer's Seal
Page 2 of 2
82b "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-411 '1
Caribou Investments, Inc.
619 East 5th Avenue
Anchorage, Alaska 99501
November 18, 1981
Subject: Lot 4' Block 3 Southpark Terrace Estates Subdivision
An inspection was performed on the sewer system located on
the above subject property.
It was noted that there was water standing in the perforated
sump at the end of the seepage trench. This indicates a
water table has possibly infiltrated the sewer system.
Prior to approval to the lending agency, this department will
ask that a second soils test be performed to determine the
depth of the water table.
In the event a water table has infiltrated the seepage trench,
the sewer system will need to be redesigned.
If theme are 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
APPLI( ' IT FILLS OUT UPPER HA , ONLY
Property Owner Caribou Investments,
Mailing Address 619 East 5th Avenue ZipCode 99501
Buyer Tom Marshall
Address Zip Code
Inc.
J
Phone
Lending Institution
Address
Realty Co. & Agent
Address
Zip Code
Zip Code
Phone
Lega~Description Lot 4 Block 3 Southpark Terrace Estates Subdivision
Water Supply
[] Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
:~Community For wells drilled prior to that date, give well depth (attach log if available).
[] Public Utility
Sewer Disposal
~:lndividual Year Indivlduallnstalled: July 29, !99!
[] Public Utility When Connected to Public Utility:
[] Holding Tank
NOTE~ THE INsPEcTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time ' Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
( ~ ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
'~ ~ \ Well to Tank Septic Tank Size /~('
72-023 (3/82}
. DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
,MUNICIPALITY OF ANCHORAOF
JVJUNJCIPALITY OF ANCHORAGE DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~J~NRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION NOV 9 1981
Te,e.ho.e 26'"720 R E C E 1 V E D
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER J PHONE
Caribou Invesments Inc,/Larry WrightJ 276-0000
MAILING ADDRESS
619 E. 5th AVe. AnchoraGe. Alaska 99501
PROPERTY RESIDENT (if different from above) PHONE
Lot 4 Blk 3 Southpark Terrace Estates ....
2. BUYER PHONE
MAI LIN G ADDR ESS
3. LENDING INSTITUTION J PHONE
Alaska Pacific BankJ 276-3110
MAI LING ADD R ESS
101 W. Benson AnchoraGe. Alaska 99503
4. REALTOR/AGENT PHONE
Larry Wright 337-3831
MAI LING AD DR ESS
5qOl E. 30~h An~hn~a~.Ala.q~ ggsR4
5. LEGAL DESCRIPTION
Lot 4 Blk 3 Southpark Terrace Estates
STREET LOCATION
Chasewood Lane
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four [] Other
[~ SINGLE FAMILY
[] Two [] Five
[] MULTIPLE FAMILY E~ Three [] Six
7. WATER SUPPLY
[] INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[~ COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE** 1981 YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTI LITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBUC uT uzY
Connection Verified INSTALLER
[] Septi~ T.~nk oz [] Holding Tank
] ~-~'O ()'[f Tank is homemade SOILS RATING :I'." , · .: . -,t ..,
Size:
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
[] APPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[~] DISAPPROVED
DATE BY
72-010 ("Rev. 6/79)
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
PWS 1.0.# ~ //
To Whom it May Concern:
According to records on file in this office the
~/~'A~/L~' ?~_--] Water Systemis in compliance with the St~e Drinking
Water Regulations
Sincerely,