HomeMy WebLinkAboutSOUTHPARK BLK 3 LT 9outhpark
lock
Lot
020-4c)1
-35
e Municipality of Anchorage
Development Services Department ~'~ ~%
Building Safety Division ~ ~'
On-Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: OSPlll,j~ J[ ~ PID Number: ~O;ZO,-~. !
Name:
William & Marianne Grant Wastewater System: [] New [] Upgrade
Address:
4340 Southpark Bluff Drive ABSORPTION FIELD
Phone: Number of Bedrooms:
[] Deep Trench [] Shallow Trench [] Bed I-I Mound [] Other:
LEGAL DESCRIPTION Soil Rating: Total Depth from original grade:
GPD/Ft~ Ft.
Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe:
3 9 Southpark Ft. Ft.
Township: Range: Section: Fill added above original grade: Gravel Length:
Ft. Ft.
Well: [] New [] Upgrade Gravelwidth: Ft. Numberoflines: I Distance between lines:Ft.
Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
Public Ft. Ft. Ft2 3034 PVC
Driller: Date Drilled: Static Water Level: Instarler: Date Installed:
rt. A+ Home Services 613012011
Yield: Pump Set at: ~ Casing Height Above Ground:
Ft.I Ft. TANK
GPM
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
~To Septic Absorption Lift Holding )ublic/Private Manufacturer: Capacity:
From ~ Tank Field Station Tank Sewer Line Anchorage Tank 1250Gal.
Material: Number of Comparfments:
Well 100+ 25+ Steel 2
Su~a~Water 100+ ~ / LIFT STATION
Lot Line 32.5/ S~ze: Man~a~urer:
Gal.
Foundation 12,1 "Pump on" level at: ! "Pump off" level at: High water alarm at:
in, in. in.
Curtain Drain N/A Pump Make & Model Electrical Inspections performed by:
Remarks:
Tank replace only. BENCH MARK
Location and Description:
Garage FF
Assumed Elevation:
100,0 Ft.
Engineer's Stamp
Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1st 613012011
OF-
2"d ,~ ~--\ .~.. ............ ~4
Development Services Department Approval ~'92.'" ~
Conditional Approval Date: ~ ..... ..,.~,.~.~..; .........
'~~.~3:~, ~-~--& ...... ?'/~'~
~ ~J, ,~,m/'-~' / ~-_// .tL~,bteven ~x. ~'annone~,cu.,,,~, -','.
~.~?~°-. No. CE 8149
Reviewed
and
approved by: Date: -~/,' '4,2~>~'4~,,~i_.. ....
/// · ..:. ...... , .....
A B
T1 32.7 28.3
T2 54.50 '¥,0
/
BOO 35.60 i
LOT SERVED BY
PUBLIC WATEr. ~'.. ~~ u~/p~
,o oo.
.~/ /
12509 SEPTIC TANK (E)
ABANDONED PER CODE
BY REMOVAL ~
NEW 1250g SEPTIC TANK
REPAIR
- CONNECTED TO '
!
-(99.6 ~ EXISTING DRAIN FIELD
4.2 '
94.8 ~ NEW l O00g
SEPTIC TANK~ CONNECTED TO EXISTING
~ DRAIN FIELD
91.5
SECTION
~CO~D D~AW~NO P.O. BOX ~00~ ANCHOBAO~, AK ,,S~O ~E~ ..... ~I, ~/~/~1
PHONE (907) 272-8218 FAX (907) 272-8211 ~...' ~-.~t~ Scale
...........
SOUTHPARK, BLOCK 5, LOT 9 ,~ ~ 020-491-35
annome ~ PERMIT NO.
WILLIAM A MAIANNE GRANT ~¢~:L CE 8149 .-~
4540 SOUTHPARK BLUFF DRIVE f~X.. ..~ osP~8
PLAN ANCHORAGE, AK 99516 ~¢~0~S9~A~~*¢ ....... ~-~ Sheet
A B
T1 32.7 28.5
T2 34.50 34.7
DCO 35.60 37.20
Permit Number: OSP111118
Tax Code Number: 02049135000
Work Type: Septic
Permit Effective Dates: June 23, 2011
On-Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
to June 22, 2012
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: SOUTHPARK
Site Legal Address: SOUTHPARK BLK 3 LT 9 G:3236
Owner/Address: GRANT WILLIAM STEWART &
MARIANNE R 4340 SOUTH PARK BLUFF DRIVE ANCHORAGE AK 995164819
Site Mailing Address: 4340 SOUTHPARK BLUFF DR, Anchorage Lot Size in Sq Ft:
Total Bedrooms:
33893
4
This permit is for the construction of:
N Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage
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 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 must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By:
Date:
Date:
/IUNICIPALITY
OF ANCHORAGE
Community Development Department
Development Services Division
On-Site Water & Wastewater Program
Mayor Dan Sullivan
~ Phone:907-343-7904
Fax:907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O~.O"-~/- ~ ~'-
Property owner(s) i,3i/.~ I~/"/~
Mailing address ~'qO
Site address /"~/$,:~¢ ~'r/-/?,~K' ~-¢PF
Legal description (Sub'd., Block & Lot) ._~'~'#~-~ ~.//_~. _.~£ :~;
Legal description (Township, Range & Section)
Lot Size ~ '~'[L"5 Sq. Ft. Number of Bedrooms
Day phone
THIS APPLICATION IS FOR: THIS APPLICATION IS AN:
(~] all that apply)
Absorption Field [] Initial []
Septic Tank ~ Upgrade ~]
Holding Tank [] Renewal []
Privy []
Private Well []
Water Storage []
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling ¢.nd is in accordance with applicable Municipal Codes.
S,. n~/~r'° ~e'~~or author,ze
( 'g ' p'p -y ' dagent)
'CeCa,t/Rush Fees:
BCate of Payment:
Receipt Number:
Permit No. 0.¢~'
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
G:\Building\On Site\Forms\Client Forms\Permit App_010411.doc (Rev. 1/11)
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve~panengak.com
June 20, 2011
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 S. Bragaw Street
Anchorage, Alaska 99519
Subject:
Southpark S/D, Block 3, Lot 9
Emergency Septic Tank Replacement Permit Request
Ladies and Gentlemen:
I am writing to request that a permit to install a new 1250 gallon Septic tank be issued for this
lot. The proposed systems will serve an existing four-bedroom house. Currently the lot is
developed. The existing septic system was designed and installed for a four-bedroom house and
is operating adequately for four bedrooms. The existing steel 1250 gallon tank is collapsed. The
damaged tank is exposing the raw sewage to the environment. The existing tank will be
abandoned per code. The clean out at the end of the existing drain field is separated and will be
repaired. The surrounding lots are served by a public water, and there are no wells within 200
feet of the proposed septic tank. This lot is served by public water as well. PES will verify all
required separation distances at time of installation.
Upgrade Tank Design.
a. See Sheet 1 of 1 of the plan set
2. Surface Water: There is no surface water within 100 feet of the proposed system. The
proposed systems will maintain at least 100 feet from all surface water and drainage ditches.
3. Topography: Lot 9 slopes from north to south at approximately 10% in the area of the
tank replacement. The proposed installation will be located in the south-central portion of the lot
next to the existing septic tank and absorption system.
Maiiina: P.O. Box 1i.00211.7, Anchora{:.!.% At{ 99550..02i. 7
?l"6~sicaI: 6i.5 ~.as'I 82~'''' Aue~ Cuite B6, ,~nct'io~'age~ Ai( 99503
'T'eiephone: (907) 272~,8218 FAX: {907) 272~-821.5
Page 2 of 2
The proposed installation will not affect the future development of the surrounding or existing
lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you
have any questions or concerns, please contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Attachments:
Mai~,i.~'~8: P.O. Box '~'~t TM"
'Te~eptsone: {907} 272-8228
LOT SERVED BY / -"~'~'%'~
PUBLIC WATER. B "" -. ~Q ~IV~
'-... '...-i-} /
1250g SEPTIC TANK (P) X ~~4~
AND DOUBLE CLEAN OUT ~ '~,], ~ L, '
REPA ~[EAN- 00¢: ~~---ABAN~PER :OD: ,
CONNECT TO
EXISTING DRAIN FIELD
NOTES: P~O~ ~G ~C, L~ ~ ____,?~Date
EMERGENCY REPLACEMENT P.O. BOX 100217 ANCHORAGE, AK 99510 ~ ~, .' "
PHON~ (~07) 27~-82~8 tAX (~0~) ~-8=~ ~...'~m ~':~. ~. ~"=~o'
~~ ....... P.I.D. NO
SOUTHPARK, BLOCK ~, LOT 9 ~~ 020-491-35
WILLIAM ~ MAIANNE GRANT ~~~
4540 SOUTHPARK BLUFF DRIVE '¢i~D CE ~~ PERM,T NO.
PLAN ANCHORAGE, AK 99516 q.:¢~ ...... ~%'~ Sheet
~(~~~.~O~SgOA%~ ~ OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE ~NEW
MAILING ADDRESS
LOCATION ~-~J -- 5~ NO. OFBE?OOMS
DISTANCE TO: I W~g~ ~ I Abs°rpti~rea Dwellin~ ~ PERMI~/~
~ ~ Manufacturer Material No. of compartments
~ ~ Liq. ca~it~i;~gallons IF HOME.DE: Inside length Width Liquid depth
, ~ Well Dwelling PERMIT NO,
~ Cz DISTANCE TO:
O z ~ Manufacturer Material Liquid capacity in gallons
~ DISTANCE TO:. We~''~____ F°undati°~____ Nearest~l~
No. of ]ines~ Length o~e~ line Total le~t~f lines Trench width Distance between
u-- ~ ~ I¢ ~ ~ ~ incheSinchesTotal effectiv~b~ption
~ ~ Top of tile to finish grade i, . ~, Material beneath tile
area
Length Width Depth PERMIT NO.
4 ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING /g5
INSTALLER ~ /
~*i 49~ ,..'~ ~'1~/ '~~'
';{ .. i~qE 25. 1971.' f~, '~
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
PERMIT NO. (
DEPARTMENT OF' HERLTN FiND ENVIRONMENTAL. PROT'ECTION
825 "L'" STREET., RNCHORRGE., AK.
254-4720
8i0988 )
AF'PL I CANT
LOCWf I ON
LEGRL
RONRL. D LEVINE E:OF~ 4--506
SOUTH PARK BLUFF DRIVE
LOT ~ BLK S S. PRRK -T~:i-;C~ EE ~
LOT SIZE
345-3:52t.
28000 SQUARE FEET
T'YPE OF SOIL ABSORPTION S?.BTEM tS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4
SOLE_ RATING (SQ FT,.'"BR)= :;.25
THE REQUIRED SIZE OF THE :BOIL RBSORPTION SYSTEM IS:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE 'TRENCH OR DRRINFIELD.
THE DEPTH OF A TRENCP! OR PIT IS THE DISTRNCE BETWEEN THE SURFAC:E OF THE
GROUND RND THE BOTTOM OF' TAE EXCAVATION (IN FEET).
THERE IS NO SET WI[:,TH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE Ot. JTP-~ILL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET').
PERMIT APF'LICFINT HFIS THE RESPONSIE:ILITY TO INFORM 'THIS DEPARTMENT DURING THE
INSTRLLRTION INSPECTIONS OF AN'9 WELLS A[:,JRCENT TO THIS PROPERT"r' AND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
BACKFILLING OF ANY' SV:BTEM WITHOUT FINAL. INSPECT'ION FINE:, APPROVAL B'9 THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMBM DISTANCE BETWEEN R WELL FIND RNY ON-SITE SEWFIGE DISPOSAL SYSTEM IS
:t00 FEET FOR R PRIVATE NELL OR 150 TO 200 FEET FROM R PUBLIC !.4ELL DEPENDING
UPON TFIE TYPE OF PUBLIC NEL. L
MINIMUM DISTANCE FROM A PRIVATE NELL TO R F'RIVRTE SEWER LINE iS; 25 FEET AND
TO R COMMUNIT? SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS !',IRV RPPLV. SPEC!FICRTIONS AND CONSTRUCTION [:,IAGRRMS ARE
HVRIL. RBL. E TO INSURE PROPER INSTAL. LFITION.
!
±:
FORTH BY' THE MUNICtPRL_IT¥ OF ANCHORAGE.
2: I WILL INS'FRLL THE SYSTEM IN RCCORDRNCE WITH THE CODE--;.
]:: i UNDERSTAND T'HAT THE ON-.SITE SEWER S?SI'EM MR'T' REQUIRE ENLARGEMENT IF THE
RESIDENC:~}~:' TO INCLUDE MORE THAN 4 BEDROOMS.
s _ .....................
ISSUE[:' BY _ r',RTE __ / V4. 0
CERT'tF'9 THAT
I AM FRMILIAR WITH TAE REQUIREMENTS FOR ON--SITE SEWER'-=; AND WEL. L'Z, RE; SET
t.
1
t
l
I
t
LOT 9, BLOCK 3
Soils and Ground Water
Boring 9-3 was placed on this lot. Soils ~ound were sandy silts,
sands, silty sand, silty gravelly sand, and gravelly sandy silt.
These layered soils ~ypical of the g~acial landform. The soils
can vary significantly over small distances. No ground water was
encountered by the 16 foot test boring.
Location of Septic System
The septic system drain field should be located in the vicinity
of Boring 9-3 on the southern portion of the lot. This area
slopes downward and is less likely to have a high water table as
the north portion of the lot is traversed by a small stream.
Also, the north portion of the lot has steeper slopes. The
septic system must be at least 100 feet from the stre~,.
Design Absorption Area
Boring 9-3 had a percolation rate of 1.6 minutes per inch. The
drain field system shculd be designed to provide for an absorp-
tion area of at least 125 square feet per bedroom. This require-
ment is slightly greater than the guidelines in ~he "Manual of
Septic Tank Practice", but the permeable zones are layered and
could tend to plug with continued use if overloaded.
Test ~ole SLot 9,
Block 3
Table N
WO $A19218
Date: 4/11/80
Logged by: O.
Hatch
pepth in Feet
From To
0.0 0.5
0.5 1.5
1.5 6.0
6.0 8.0
8.0 13.0
13..0 '16.0
Soil Description
Brown Peat, damp, soft, Pt
F-4, brown Sandy ~ilt, damp, medium dense,
non-plastic, ML
NFS, brown fine to coarse Sand with traces
of gravel and silt, damp, medium dense, SP/SM
F-2, brown fine to coarse Silty Sand with traces
of gravel, damp to wet, medium dense, SM
F-2, brown slightly Silty Gravelly Sand, damp,
medium dense, SW/SM '
F-4, brown Graveltz ~andy Silt,
dense, non-plastic, rounded and
particles to 2", ML
damp, medium
subrounded
Bottom of Test Hole:
Frost Line:
Free Water Level:
Percolation
16.0 Feet
1.D Foot
None Observed While Drilling
Rate = 1.6 minutes/inch with water level at 6.0 feet
in PVC pipe
Sa.
No. Depth
5.0
10.0
15.0
Type of Dry
Blows/6" M% Sample Strength Group Unified
8.6 G N B SP/SM
5.7 G N C SW/SM
11.3 G VL D ML
Remarks:
1. Type of Sample, G=Grab, SPT = Standard Penetration,
U = Undisturbed.
2. Dry Strength, N=None, L=Low, M=Medium, H=High.
3. Group refers to similar material, 'this study only.
4. General Information, see Sheet 1.
5. Frost and Textural Classification, see Sheet 2.
6. Unified Classification, see Sheet 3.
INote: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, erpdor
to closing for the engineering services provided.
o
STATEMENT OF INSPECTION BY ENGINEER
As certified by my se.a/afl/xed hereto and as of the validation date shown be/ow, I verify that my
investigation, based ion procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
forthe number of be~reoms and type of structure indicated herein. I further verify that based on the
information obtained' frem the Municipality of Anchorage fi/es 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 ALASKA WATER &: WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. OARNESS, P.E.
E
ngineer's Comments:
In conducting this evalJation, AKWWC, Inc. attempted to provide a thorough,
conscientious engineed'ng analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Reg~.lations. The reported'results described the performance of the
system under the conditions encountered at the time of the test. and separation
distances measured to ~eadily identifiable features. The operational life of all wells and
septic systems depend ~n the local soils condition, groundwater levels that may
fluctuate during the yea~, and the water usage of the family being served by the system.
These condilions are o[~tside the control of the evaluator of the system. Satisfactory test
results do not guarante~ future performance of the system, nor do they guarantee that
there are no hidden defects or encreachments. AKWWC, Inc. can therefore not provide
any warranty or future e'stimate of how long the system will continue to meet the
operational requirement's of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the o~vner listed above. Any reliance upon or use of this report by any
other peraon or party /s not authorized, nor will it confer any legal right whatsoever.
DSDSIGNATURE I
~ Approvedlfor ~ bedrooms.
DisapproVed.
I
Conditional approval for
Attachments: HAA Checklist
Septic System Advisory
Well F ow Adv sory
By: ~'('/'
Phone ,337-6179
Date
bedrooms, with the fllowing stipulations:
·
~j ON-SITE · ~=
; WASTEWATER :
Manitenance Agreements ~;,,c;,,.,~,., ,~,
Supplemental Engineefs Reo~ ~//))) ~)~'''
Other
Original Certificate Date: /'~'~' - /- O .~
(Rev. 1?JO 1 )
Municipality of Anchorage
Development Services Department
Building Safe~ DNIsion
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519.6650
www,ct.anchorage.ak.us
(907)
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: SOUTH PARK SUBDNISION; LOT 9~ BLOCK 5~ Parcel ID: 020-051-59
A. WELL DATA
Well type ....'A' If A, B, or C provide PWSID# 21,3475 Well Log (Y/N)
Date completed Sanitary seal Y ~res properly protected (Y/N)
~ :~.--'-- Cased to ft. Casing height (above ground)
irt.
FROM WELL LOG
Date of test
Static water level
Well production
ATINSPECTION
/j ,'" , ,,-,'
ft. / ft.
~ . ,, g.p,m. _/ g.p,m,
WATER SAMPLE RESULTS:
Coliform __. colonies/100 mi. Nitrate __mgJL.
'' · · Date of sample:
SEPTIC/HOLDING TANK DATA
o onles/100 mi.
Collected by:
Tank Type/Material,
Tank size .1250 gal.
Foundation c~eanout (Y/N} ,YES.
Date of pumping 1/1,3/2005
ABSORPTION FIELD DATA
Date installed 10/1/1981
Length. 54 fl.
STEEL
Number of Compartments, .2_
Depression over tank (Y/N) NO
Pumper
Soil rating (g.p.d./ft~or~ 125
Width 3 fl.
Date installed 10/1/'1981
Cleanouts (Y/N) YES
High water alarm (Y/N).,, N/A
CHUGACH pUMPING
System type ,, TRENCH
Gravel below pipe 9
Total depth .10 fl. Eft. absorption area 612 fl= Monitoring tube*~
Date of adequacy test 1/13/2002 Results (Pass/Fail). PASS
Fluid depth in absorption field before test DRY In. Water added 797_ gal.
Elapsed Time: ,1.20 min. Final fluid depth. 8 in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) . NONE KNOWN
*~MONITORING TUBE ONLY EXTENDS 6 FEET INTO ORAINROCK.
Depression over field NO
For 4 bedrooms
New depth 26 in.
600+ g,p.d,
If yes. give date. -
D. LIFT STATION
Date installed
Size in gallons
"Pump on" level at in.~
~ ~ Cycles tested~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
High water alarm level at in.
Meets alarm & circuit requirements?,
PUBLIC WATER
Septic tank/lift station on lot,
Absorption field on lot
Public sewer main
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10"-i- Water service line 10'+ Surface water. 100'+
Wells on adjacent lots 200'-I-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'-t- Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Pri~ed N~rne ,JEFFREY A. GARNESS
D.te ! 17-z'/O
HAA Fee $ ~_,~c'-~
Date of Payment
R pt.umber
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
%
SINGLE FAMILY ~,~
FRAME HOUSE
ss ~
s
THE iNFORMATiON HEREON I~ FOR THE USE OF LENDING iNSTITUTIONS SPECIFICALLY TO SHOVV ANY ~DNFUCTS BETWEEN
~X~STING STRUCTURES AND PLATTED LOT UNES OR EA~EM ENTS AND IS NOT TO BE USED FOR POSITIONING ADI~I TIOtCAL
STRUGTURES OR FENC~UNES.
EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE REDIDRDED PLAT. ARE NOT $1-10V~¢ HEREON(UNLESS INDICATED
NOT E: ANY FENCELINES SHOWN AR E LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO D~TERMINE PROPERTY LINES
OR LOCATE STRUCTURES.
AS-BUILT SURVEY
NO CORNERS SET THIS DATE 1' · 30'
I HEREBY C~RTIFY THAT I HAVE PERFORMED A
MORTGAG£E'S INSPECTIC~N OF THE FOLLOW1NG
(~ESCRIBED PROPERTY.
LOT 9. $LOC~ 3, $CAJTHPARK SUB.
ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT
THE VISIBLE IMPROVEMENTS ,~T UATED THEREON ARE
WITHIN THE PROPERTY LINES AND ND V1SISLE
ENCROACHMENTS EX~ST OTHER THAN NOTED.
DATED AT ANCHORAGE, ALASKA THIS 26TH
DAY OF MARCH 200~-- .
HO~T LAJ~-D SURV~flNO 890~.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O: Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.#
1. GENERAL INFORMATION
Complete legal description
Lot 9; Block 3; Sou~h Park~
Location (site address or directions)
Property owner
Mailing address
Lending agency
Maiting address
Agent Mik~ Kc6lg
Address
345-3205
Wayne Fl~¢k ,.. Da~ phone
4340 Sou~h P~rk Bluff Driv~ ~chora~, A~. 99516
First Na~ion~ Bank of Anchora¢~ Day phone
vISTA REAL ESTATE
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4 ~/
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.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site XX
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 . . ..... NG
i7034 i~le River Loop Road
Address ..... ,.....~ ~ 9957~
Engineer's sighat~?o~
DHHS SIGNATURE
Approved for z~¢
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By: J(bt4f, J ..~'~t,~-~ 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 courtes~ 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 fY21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:/~f ~,,~ ~lr~"-I'~-%', ~,,'~[~ ~)~'~'~ I¢"'~.,,,cc Parcel I.D.
, , .
A. WELL DATA
Well type
Log present (%
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to Casing height
F~M WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 2-(¢0 -/'
Absorption field on lot 7r2o 7~
Public sewer main
Wires properly protected (Y/N)
AT INSPECTION
g.p;m.
Public sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE/R~SULTS:
Coliform
Date of sample:
Nitrate Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed [O~ /- ~l Tank size
Cleanouts (Y/N) L1
High water alarm (Y/N)
Date of pumping
Compartments ~
Foundation cleanout (Y/N) i,¢ Depression (Y/N)
/~///A Alarm tested (Y/N)~)/~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~ ~ On adjacent lots ~ oo '~
To propertyline '~0 Absorption field ! 0
Surface water/drainage .! O0 -f~
Foundation
Water main/service line. ~.5~ -/'
72-0~6(Rev. 3/91) Front MOA21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date"'~lled Manufacturer
Size in gal% Manhole/Access (Y/N)
Vent (Y/N) %. "Pump on" level at _ __ "Pump off" level at
High water alarm le'~l __ _ Cycles tested __ __
Meets MOA electric~c~ t~)
SEPARATION DISTANCE FRO~IFT STATION TO:
Well on lot _ ~,~adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed / (~ '~ / - ~ I Soil rating I ~ ~ ~b/~:~. System type
· !
Length ~'~/'¢ ' Width
Total depth
Total absorption area 0~ I ~. ¢
Depression over field (Y/N) A)
Results (pass/fail) ¢) ¢~ ~
Peroxide treatment (past 12 months) (Y/N)
Cleanouts present (Y/N)
Date of adequacy test
for
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots ~d)O ¢ Property line
'~ ~ To existing or abandoned system on lot
Cutbank .%~(~ '~ Water main/service line
Driveway, parking/vehicle storage area
2O '~
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on ti
this ii~'p..'~tion.
Signature---tTOS,," ~""i'*~.-u,- [~;ver. Leep Road No. 204
Engineer's NamEeaole River, Alaska 99577
HAA Fee $
Date of Payment _
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
DEPT. OF ENVIRONMEN
ANCHORAGE DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
May 21, 1991
WALTER J. HICKEL, GOVERNOR
563-6775
FOR: S & S Engineering
Rodney
PWSID 213475
My review of the records on file in this office reveals that the South Park Subdivision Class
Public Water System, is in compliance with the provisions of 18 AAC 80.060, State of
Alaska Drinking Water Regulations.
Sincerely,
Keven K. Kleweno
Lead Engineer
Time -' ' Time .~e
Date Date Date
Inspector Inspector Inspector
Comments ~ Conditional Approval
I
Bate Sewer Installed ~ Permit No. Septic Tank Size
)O ~91 Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property
Owner
Lending Inmitution //A 5 ~ ~/A ~ ~ / ~A~//~ Phone
Realty Co. & Agent '~ Phone
Address ¢
Street Location %~ ~ ~)¢ ~ ~ /~/1 ~ ~
Type¢ Residence
~'Singie Family
B Multiple Family No. of Bedrooms
B Other
Water Supply
~lndividual A~ACH WELL LOG. A well log [s required for all wells drilled since June
give well
~Community 1975. For wells drilled prior t~/that date, depth (attach log if
~ Public Utilit7 available.) ~ ·
Sew~ Disposal
Olndividual Year Individual Installed: ~ < ~
B Public Utility When Connected to Public Util[ty~
B Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.