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HomeMy WebLinkAboutSOUTHPARK BLK 1 LT 1 MUNICIPALITY OF ANCFIQRAGE 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 NAME MAILING ADDRESS LEGAL DESCRIPTION LOCATION Manufacturer Liq. capacity in gallons DISTANCE TO: HOMEMADE: Well DISTANCE TO: No, of lines ~ of tile to finish Length We Length of each line UPGRADE NO~ ©~ BEDRO©MS Dwollin~ PERMIT Nb/,O ~O <~ Inside length Widtl~ Liquid depth Dwelling PERMIT NO. Material Liquid capacity in gallons I Total len~,~ines Frenchgi~, inches Dis,anco between ,in0s D0pth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area W011 Building foundation Nearest lot Eno DISTANCE TO: Class Depth Driller D~stance to lot line rPERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank / OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST 6 7 DATE PERFORMED: SLOPE SITE PLAN 10- 11 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS PERFORMED BY: 72-008 (6/79) ENCOUNTERED? pO IF YES, AT WHAT ~ E DEPTH? Gross Net Depth to Net Reading [)ate Time Time Water Drop PERCOLATION RATE TEST RUN B TWEEN FT AND !' (minutes/inch) CERTIFIED B Y: 2~'~~ I)EF:'F:IF'.'t-HIEt'.,!'F Dr HEI';:!L.I'H FIN[;, EI",I'v']]RONHEI",I'I'FIL C%i'.~',i '"L.'" S'I'REE'I"., I::INC:HEIf~'.I::I(:~tE., F:IIE. (ZP lh,,~ --- ::~;; %' "'T' tE :':'F2; iEE 11.4J IE Ir;;-:: F' EE; F:: ~'"'1f ]1;: -it .... ':; :-3f0'.5~(!18 ::, FIF>F'L I C:RNT LOC:FI'I" ]: Oh,! I..EGF:IL Fi:OIqFILD L.E'v' I I",!E F'. O. BO',:':', 4--566 SOLI'FI4 f::'FIf4:l.( E:LUFF [:'R ): ',,"E L(}T :L E,L,I-.. d. S: .,, TFI 1::'I::It:4'.K 'f'~:~ L..CFf' T'¢F'E [::IF' SOIL. FIEr.:.~;OF.[F'T]:ON E;'¢STEP'I i~,: DF;'.FIINF:[ELI) FII::IX :[ HUH NUI','IE~E;F:: OF E:EDF:%IOP1S .... ~: SO]:L I~:FI'I':[NCi (SQ FT,.."E:F~:)== 0!:5 THE F;i:IEg!L.I :[ F~rlEI') E; ]: ZIE OF:' THE :501 L FIBSEJ[;:F:'T :[ ON S"r'S TEH :[ S: THE L.[~:F,IGTH [) :1: HENS :[ EIN :1: S THE LENG'FI"I ,:: :[ N I:rE:E T > OF THE TRENCH OR [::,RFI:[ I',IF:' I EL.D. TI"I[~: I:>IEF'"r'H OF FI TF4'.ENCH Of;i: F']:T ZS THE [:,ZSTFINCE [~~~::'[:l(:::l~: CIF THE I:][;~(]1..1~.~[:, I::l[',l[:' 'I"HIE 130'F'f'CIH OF THE EXCFI',,,'R'TIOI",I < IN~ET>. ~) THE I:;iF;i:F:I'v'E:L.. DEI::'TH IS THE I'l'l]:l"J:l:l'"ll..ll"l [:'E:F"I'H OF Eib~","EL [~~; I:)UTFI:::tlJ... F':I;F'E: I:::IND THE E:EITTOH OF THE [~','(C:FI'v'I::IT ~ CII",I ':: Z ~',1 FEET ). ~- ~ F'EF:d"II'T' F:IF::'F'L. IC:FINT HI:IS THE F:ESF'CdsI'.i:';:[EC[L. ZT',r' TO :[I'.,IF'ORH THIS I:::,E:F'FIr4:THENT [::.I, JF;::[t',IG :[I'.,!'.:~;TI::II.~t..FITION ]:NSI::'EC-F:[ONS OF FIN'.r' I,JELL. S FID..TFICE'NT TO 'T'H]:!5 F::'FX.'q::'EF:T'T' FII'.,I[:, THE l'.,ll..Ji','ll~[,~:::[;i: OF' f~:E:SILbENC:E?; THlaT THE klEL..L I,.I:[LL. !_:;EI:~:',,,'E. THE [E:RC:I<:F :[I..1_. l I'.,!dl OF FIIqY' S'¢S"I'EH !41 THOUT F':[ NRL. :[I'.,I:~'~;F'EC:T t EIN RiqD FIF'F'f,;'.O'v'FIL E,'"J" TH :lIE; DE:P[:IF~:'I'I"I[EP,I"f' H:[L.L.. E:E SIJBJECT "FEi F:~F~'.OSEE:UT]:E~N. I'"1 :[ N I I"lLli'"l I~, :[ STRP',IC:E: BE'f'HE:EI",! Fl I,!ELL FIND F:II",!'T' OI',I-'-S I 'TE .'.:.,EI,.IFIGE: [:' ]: SF'OSFIL S"¢STEf"I I S :l.l~)IZI FEi:ET F'OI';i'. I:1 F'F'.I',,,'Ia"FE HEL.L.. OFt: ::1..~;I;~1 TO ;:;!!;..'10 F:'E':ET [:[;:'.()i'd I::1 F'UBL_IE: HEL..I... DEF:'END:[I",!C4 LIF:'CIP,I TFIE 'l""r'F'E OF PIJ[31_IC HEL. L.. t'"IZI*,I:[I'"II_.IFI I):(STFIJ",!C:E F'F.:(3H F:I PR:[VFITE HELL TO FI F'I:'~:I',,,~I::Ff'E S[E!.,.I[~:F~t L:[I".!E :]:S ;..:'::5 F:'EET F:IND TO FI COHHUN]:T'T' SE:I,.IEF: L. Zi',tE ]2.'5 75 FEET. r.]TFIEF;['. F4~Ei:;iU I f::!f£i',l[!:f.,l'l"~; I'"lF:l"r' FIPF:'L.N'. SPEC I F F:I'v'F! ]: LFIBI..E TO I IqSU[;~'.E F:'F::OF'EI-~'. I i",ISTf:iLLFIT CIER"I' I I:::"¢ "FHFIT ]: FIH FFIP'I:[I....IFIF: I.,IZTH 'THE I~:EC..!UIF:EP'IENT:i.:; FOF: ON-SITE '_.'~;EHEI~:S FIND I,.IEI_.LS RE; SET :[ :[.: F'OF:]"FI B'¢ THE P'IUN:[E:IF'FIL:[T'¢ OF RI'.,ICHORFIEiE. 2: :[ H:[I...L. :[NS'T'FIL[.. THE S'¢S"F[:.~H :[1'.,I FIC:CCIF:[:,FINE:E 1.4:[TH THE CODES. 2i:: ]: UI'.,I[::,F£1:;;'.'."STFIND THFIT THE OI'.,I-S:[TE; SIZI4Ef~: :~:;'.r'?FEP1 i"ll::l'T' I:;::I'~E!U.'[F'::I.": ENLFll;:(iJEP'IENT Z I::' ']"HIE F;,'LES]:DENE:Ii!:" :[::2; I~'.Ef,ICE:,EI~ TO INC:L. UDE i"lO[;.:E THF~F,! :ii: Applicant '"INICIPAI_ITY OF ANCHORAGE Department Health and Environmental :otection 825 L Street, Anchorage, AK. 99501 264--4720 * * * HANDWRITTEN PERMIT * * * ~OR ON-SITE SEWER PERMIT ~,,~-;~ ~,~ Mailing Address: Location: , ' ~.>.i~. )~(. ' ~' ,:~" ~ C~Ja-'{~,tJ ?:~>~C~.~?, ~/, Phone Number: Legal Description. ~ Type of Soil Absorption System Is: Trench: ~ Drainfield: Maximum Number of Bedrooms: Seepage Bed~ Holding Tank: Soil Rating(sq.ft/br) /~ ~'~ DEPTH The Required Size of the Soil Absorption System Is: LENGTH ~,,2,~ GRAVEL DEPTH ~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE! = /C>~i)~_ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * 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 a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 1 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. Issued by: ~;/~ I~ ': ~,' ~'~ ,~ Date: i> )! ~: SWP/024 (]./81) FIF:'F'L :[ C:FINT L ] f':Ff'f' I O N L.E).]RL · t.=.. bb 995 RONF:ILE:, LE',,,'INE PO BOX ........ 'T'"¢F'E 01:::' . ,... I L FIBSOI:;;iF'-F ]: ON =, r =, I E.r ! I S: TRENCH I"II:::IX I MLIf'I NUi"IBE[~: OF E~'.F..E.F. ~ - I 1 ......... ' THli.:: REEU I RED '."i; )J ;'ZE OF -f'HE E;O I L. 'I ON THE I..ENE. i-FH E:,IHENS:I:Oi',I IS THE LENG"I'H THE [:,EFq'1-1 OF Ft TREi'.,ICH O1:;?. F'IT IS THE (~F'.OLIN[) FIN[:, THE BO"I""i"OH 31=' THE EXE:F:IVFIT THERE H; NO SET HIE:,TH THE (~iF;?.F:I',/EL [:,EF'TH :[:::; 'l"l.. Ji',l E:,EF'TH Ri'.,D "rile E:OTTOI"I OF THE E )1'.,I (]:1'.,! T ) OF THE I"PE'HCH 31:;? [:,RFI:[ NI= I f:'!:LI). ::E " " ':' [:,E"I [ELL[ THE :E;IJRFFICE: OF' THE F E E T ::'. GRFI',,,'EL. E,EIII[ZI',! THE OLITF'F4LL F'IF'E F-" E-'-: (;:~ L..Jl :E IF;?. lEE E:. _ E_. ~ ~t F'ERI',IIT I-If Fl_ [_l-II'l'l t-lH~ "FHE: I?E I H'.!:;TFIL LI::IT I --~f',l ,E~ OF: t'.,ILIME:ER I,,.[._, .( [. E.il _.E._ I'T'Y TO :[NF:L]RM "FHIS N'¢ I,EL S FI[:,J'FICENT TI] Fiji=, FF. HE[.L. !IL.L SERVE. 'i'lE},l'l" [)UR I I'-,l(]i THE Fii",ID THE ' IM (3 .:: ;2 :::,, ' If'" ]: C) I~-,,,,tl ::S IF~ IF;;: E elf' Fl~'.,?.r' _ .... r E.I I NFiL ~ I'.,E;PECT ;E 01'.,I E,E TO F-F.L:,E_I...II I..N. R 'r'H I S H I I",1 ! F"ILIr"I [) I: J.".210 FEE'F UPON THEE M I I'.,I ~ hl Ul',i TO R C( OTHEER F]',,,'l=t :[ I...I::IE:LE 'TO 'FINCE BE'rHEEi',I Fl ,.IELL. RND RI",IY ON-SI"FE S FI PE)i',/FITE I,ELI... Ol? :LSE:~ TO ;.:.~E)E~ FEET OF= F-LIB...I.. HE:L[ E:E Fl:::'.Oi','l FI F'RI','FITE HELL TO FI SEI.4EF'. L:[NE 75 FEET. .,ITS NFl"/ SPEC I F I CFff IONS I::li; L.IF~:E F'P..OPEF'.': [ i',IS-rRLLFIT I ON. II::. E: , T ,,.,'T I...i' I 1=, HELL E:,EI:'ENE:' I IS 25 FEET F:li",E:' : -5 i"lL UCT I ON [) I I:tGRFII"IS F.J .. -'2Jr :1 ...... Il........-, ....... ]: CERTIF'f TFIFIT J.: :[ RI"1 F'FII"I]:[...IF~R HZ[TH THEE FOF'.TH B'¢ THE i'"IUNICIPFILITY OF FII 2': Z H]:L.L IN'.STlaLL "rl.-IE ?=.,'f':";TEf,1 IN FICCOR ]:: I LJNDERS"I'FIN[:, -rHFIT THE ON--:.'E[TE SEIqEE RE:::; I I)[:£NCE I S REi"iOE)ELE[:, TO I NC:LI.JE:,E FII::'P[_ I CFINT I::::ONF:IL[) LE',,,' :[ NE: -_,].lE L':,[:.I.,.IEF::'.:, F:ll",!E:, HE..L[ .... Fr}:; _.,E.I )I,.I.T,-r'H THE huE. E_,.-'- .c t,lFl'f RE~;!IJ I RE li".l *~: E:EE:,F~:CIOi'tS. :[ F;' THE ,l.bd '/m" APPENDIX A SOILS AND RECOMMENDED SEPTIC SYSTEM DESIGN CRITERIA FOR iNDIVIDUAL LOTS LOT 1, BLOCK I Soils and Ground Water One boring was drilled on this lot in the 1980 field exploration program. Boring 1-1 encountered layered sandy silt, sandy gravel and silty sandy gravel/gravelly silt typical of the "gm" surficial geologic unit. No ground water was encountered while drilling. When the percola- tion test was attempted three days later, the water level was at~ five feet. Ground water was not encountered by any of the adjacent iborings or test pits. Test Pit 19, located on a lower bench, encountered clean sandy gravel. It is possible that this bench is a kam~ terrace, which is an accumulation of stratified drift laid down by streams between the margin of a glacier and an adjacent valley wallo Thus, cleaner gravel deposits can be found on the east or lower portions of the lot. Location of Septic System The best location for the septic tank system is on the east or lower part of the lot as soils are cleaner and better drained in this area. The ground water that accumulated in Boring 1-1 is probably the result of downslope seepage of thaw water. Because the granular soils on the lower bench are free-draining, it is expected that thelseepage water drains away quickly,i thus no water problems are anticipated in this area. Design Absorption Area It is recommended that the system be designed for an absorption area of 100 square feet per bedroom provided the system is placed on the lower bench. Test Hole #Lot 1, Block 1 Table C WO #A19218 Dal:e: 4/10/80 Logged by: O. Hatch Depth in Feet From To 0.0 1.0 1.0 2.O 2.0 6.0 6.0 8.0 8.0 16.0 Soil Description Brown Peat, soft, Pt F-4, brown Sandy Silt, damp, med]Lum dense, non-plastic, ML NFS, brown Sandy Gravel, 45% sand, damp, medium d~nse, rounded particles to 3", GW F-l, brown Silty Sandy Gravel, damp, medium dense, subrounded particles to 6", GM F-4, brown Gravelly San~_y Silt, very gravelly 13' to 16', damp, stiff, non-plastic, ML Bottom of Test Hole: Frost Line: Free Water Level: 16.0 Feet 1.0 Foot None Observed While Drilling 5.0 Feet After Drilling (4/14/80) Sa. .No. Depth 1 5.0 2 10.0 3 15.0 Type of Dry Blows/6" M% Sample Strength Group Unified 4.7 G N C GW 8.7 G N D ML 8.9 G N D ML Remarks: 1. 3. 4. 5. 6. Type of Sample, G=~rab, SPT = Standard Penetration, U = Undisturbed. Dry Strength, N=None, L=Low, M=Medium, H=Higb. Group refers to similar material, this study only. General Information, see Sheet 1. Frost and Textural Classification, see Sheet 2. Unified Classification, see Sheet 3. Test Hole ~19 Depth in Feet From To 0.0' - 1.5' 1.5' - 8.5' 8.5' - 13.0' Bottom of Test Hole: Frost Line: Free Water Level: Remarks: Table A WO ~A18753 I~gged By: Client & ATL Date: 10-28-78 & 7--9-79 Soil Description Organic Topsoil. Coarse Sandy Gravels, GP, NFS, Gravell~ Sand, SP, NFS, damp. damp. 13.0' None Observed None Observed Test Hole Logged By Client Verified by Alaska Tes~lab .I ~' -~AT~ REOEIVED INSPECTION APPOINTMENTS -~ME TIME TIME ~ %~ t '<~ 9~ f> t-5, DAT[~ DATE DATE ~SPECTOR INSPECTOR I NSPEOTOR uN~C~PAU~ OF ANCHORAGE ~UNIClPALITY OF ANOHORAGE DEPT. OF HEALTH &  ) DEPARTMENT OF H~ALTH & ENVIRONMENTAL PROTEOTION ENVIRONMENTAL PROTECFION NOV ~ 8 198] ENVI RONM~NTAL SANITATION DIVISION REQUEST FO~ APPROVAL OF I~DIVIDUAL ~ATE~ A~D 8E~E~ FAOlLITIE8 PROPERTY RESIDENT (If different from abeve) PHONE BUYER PHONE ~AI LING ADDRESS LENDINGIN TITUTION , ,/ PHONE MAILIN~ ADDRESS ~AI LING ADDR ESS 5. LEGAL DESCRIPTION STREET LOOATION TYPE OF RESIDENCE NUMBER OpQ~EDROOMS [] One E~ Four (~ ~ Two [] Five SINGLE FAMILY [] MULTIPLE FAMILY r-] Three [] Six Other 7. WATER SUPPLY [] INDIVIDUAL* * ATTACH WELL LOG. Awell og is required for alI wells drilled ,,~5~" COMMUNITY since June 1975. For wells drilled prior to that date, give wel [] PUBLIC UTI LITY depth (attach log if available.) ~. SEWAGE DISPOSAL SYSTEM [] INDiViDUAL/ON-SiTE** /~'~',/ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE": THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PBOCESSING CAN BE INITIATED, 0 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 SUPPLV [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~]INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ~ f Connection Verified r INSTALLER OSeptic Tank or [] Holding Tank Size: /(~r~_~ If Tank is homemade SOILS give dimensions: TYPE OF TANK MANUFACTURER 4, DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer ~ine ]' Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS "a' A PROVED FOR .EDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED I 72-O10 (Rev. 6/79) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www,ci,anchorage.ak.us (907) 343-7904 Parcel I.D. 1. 020-051-27 GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: Completelegaldescription SOUTH PARK SUBDMSION; LOT 1, BLOCK 1 Location (site address or directions) 4.221 SOUTH PARK BLUFF DRIVE * ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address KEVIN &: TAMMY EASLEY Day phone 522-9287 4221 SOUTH PARK BLUFF DRIVE ~' ANCHORAGE;, AK 99516 Day phone KEN McKEN w/ REMAX Day phone 2600 CORDOVA ANCHORAGE, AK 99503 276-2761 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~] Individual Holding tank Community On-site ~ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (excal3t between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples,) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note:Alaska Water and Wastewatar Consultants, Inc. shall be paid $ at, or pdor I to closing for the engineering serv/ces provided. I 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on 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 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 thstallation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, suri'E 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFRE3' A. OARNESS, P.E. Date 337- 6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provfde e thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported rosulta desctfbed the performance of the system under the conditions encountered at the time oft he 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 dudng 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 futura perfon~ance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. 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 peraon or party is not authorized, nor will it confer any legal tfght whatsoever. 5. DSD SIGNATURE ~x' Approved for Disapproved. Conditional approval for __ bedrooms. bedrooms, with the I11owing stipulationS.. ~'.' ON-SITE :.'~? ~'~.' WATERANn ',. m ...... Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-SIt~ Wafer & Wssfewater Program 4700 South Bmgaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www,cLanchomge.ak.us ~07) ~,3-7904 0 Legal Description: A. WELL DATA Well t~oe ;ueuc Date completed Total de. pfh Date of test Static water level HEALTH AUTHORITY APPROVAL CHECKLIST SOUTH PARK S/D; LOT 1, BLOCK 1 Parcel ID: If A, B, or C pro, de PWSID~ Sanlta~ seal (Y/N) Cased t~ __fi. FROM WELL LOG g.p.m. WATER SAMPLE RESULTS: Coflfomt colonies/100 mi. Nitrate mg./L. Arsenic-- ,,,§./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tank size 1000 gal. Number of Compartments 2 FoundaUon deanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 11/8/2001 Pumper C. ABSORPTION FIELD DATA Date ;,-~alled g/t/igc1 Soil rating (~T3r fl'~r~xlrm) 85 Length 52 ft. Width 5 fi. 020-051-27 Well Lo9 (Y/N) W,~, pr6perly protected (Y/N) Casing height (above ground) AT INSPECTION Jrt, g.p,m. Other b-~,,,t3 __ Collected by: ~u~uniWlO0 mi. Date installed 9/1/1981 Cleanouts (y/N) YES High water alarm (Y/N) N/A DENAU Total depth 4.25 ft. Eft. absorption area 266 fl= Monitoring tube 'YES Date of edequacy test 7/12/2002 Results(Pass/Fall) PASS Fluid depth in absorption field before test 0 in. Water added 633 gal. Elal~ed Time: 0 min. Final fluid depth 0 in. Absorl~on rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN System type 'I~ENCH Gravel below pipe 2.1 ft. Depression over field NO For 3 bedrooms New depth 0 in. 450+ g.p.d. if yes, give date - D. UFT STATION Date installed 'Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off' I~vel at .... in. Cycdee tasted Manhole/Acc~T (Y/hi) High watar alarm level at Meets alarm & cimuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot On adjacent lots Absorption field on lot On adjacent fots Public sewer main Public sewer manhole/ctaanout _ Rm-gr lo=puc service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field Water main 10'+ Watar sewice line 10'+ Sudace watar Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 10'+ Sudace water 100'+ Wells on adjacent lots 200'+ Water main Property line 10'+ Water sen, ice line 10'+ Cu~ain drain NONE KNOWN F. COMMENTS G. ENGINEER'S CERTIFICATION certify that I have determined through field inspections and reWew of Municipal records that the above systems ere/n conformence with MOA HAA guidelines in effect on this date. JEFFREY ~ GARNESS Engineer's Printed N/ame Data F,, $ Receipt Number (l~v. 100'+ 10'+ Driveway, parldng/vehicte storage Waiver Fee $ Date of Payment Receipt Number in. 10'+ ,,Dimali Sewer, mmn, anu u[~vuuue a~...-. ^, ~o, ~41 A~3Ott Loop · AnohOmge, Alack3 (.907} 333-5794 · (907) ~ ° Fax (907) 333-9776 Credit Cavds Accapte(3 · Family Owned & Operate-, Invoice .... $oldTo I T~my E~lc',/ 4~1 $o~th P~k Blu~'l:)r. I P. O, No. ' 'T-- Te~m$ Hot lO Se~ic P~mp $c~ic Pu~ .. I Descrlp~n Rep I ! I/8/2001 i I oty I ~ ..... ,..--,. ~...f Track T~cket # 84.~ Rate L Amount .... I Plcas~ pr/from t~]~ InVOlc~,Thank)'ou fo~ ~ buisncss! -- ~O'd /.g~B'~:~g lelse~ ulxe)t '.iQ I~d LS:I. ~ ~00~ 'H, Xlnl~ ',~epsm~LL FEB-22-2~I~I 15:21 TOP ~ I:C~NTS ~7 276 1584 P.02 LEGENO: FOUND 5/8" REBAR FOUND 8ERNSTEN A-IMONUMENT { ) RECORD DIMENSION PLATSO-65 ~v ~,o.~ ~{~/~ CKt2 S.H. T[ tR&~M C~NGULTANTIB, INI3.1 AS' BUILT SURV~'~ '" LOTI BLOCK I SOUTHPARK SUBD. $256 151138 TOTPJ- P. ~2 · L;gr ,? ~-?.0 /.OF' / - =ou' LEGEND: FOUND 5/"# Ri;BAR FOUND I~ERHSTF. N.A-I MONUMENT R~CORO OI~NSION PLAT AS- BUILT SURVEY LOT! BLOCK I SOUTHPARK'.SUBD . TOT~ P.P~. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Dlvislon of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Ataska'99519.~650 .- (907) 343-4744 CERTIFICATE OF HEAt;TH AUTHORITY~ ' APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. #_ 020-051-27 1. GENERAL INFORMATION ' ' Corn plate legal descriptk)n..~SOUTHPARK SUBDIVISION:' 'LOT :1'. BEOCK'I I~' ·" ' Location' '"', address or direCti0ns)__4 '(site 221 SOUTHPARK. 13LUFF. ANCHORAGE AK.'995'16 ' Proprtye owner, MIKE AND DELORES. JOYCE. ' .._ Da.y phone (9073 265-6,45/345-6050. Ma ng add~:es,~i' ~:./'o .REM~,X' PROPERTIES. ANCHORAGE Lending agency Day phone Mailing address · Agent_.._C.&ROL BUTLER ./ REMAX Day phone (907~ 257-0116 Address_2,.¢O0 CORDOVA STREET. ANCHORAGE AK. 99503 Unless otherwise requested, HAA will be held fo~' pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE'OF WATER SUPPEY: ' . ' Community Well "~ '" NOTE: If community well system, provide wdtten confirmation from State ADEC a~teS't- ., -'~ ing to the legaiity and s~atus of system 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site x~xx Holding Tan ~ · . C0mmu~nitY' on:site Public sewer NOTE: If community'wastewate~" sYStem, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 [Rev, 1/91) Front MOA fY21 Computer Vers[o~ 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 fo~; the number of bedrooms and type of strubture Indicated herei~ I further verify that based on the Information obtained from the Munkiiphlity of Anbhorage files and from my investigation and disposal system is ~n compliance with all Munk on the date of this inspection. ,// Name of Firm - ALASK~,,VCA'~ER ~BE~,.~E~, Addressi 690~ DEBARI~ ROA~./ ' spection, the on-site water supply and/or wastewater al and State codes, ordinances, and [egulations in effect 'ATER CONSULTANTS, INC. Phone' (907~, 337-6179 ~ICHORAGE. ALASKA 99504 ? Engineer's Signature .. 11 Iff conducting ~hls evalua#o~, AWWC, Inc. ~ ~ ~ ~de a ~gh, ~ou~ engln~'dng ~n~Is of ~e ~m In a~an~ ~h ~EC and M~ DHHS Gu/delln ~u~ d~ ~b ~ of ~e ~m under ~e ~ ~unt~ at ~e ~me of ~e ~e t~t, ~d ~Eon dls~n~ m~u~ ~ ~dl~ and ~pt/c ~ de~d ~ ~e I~ ~la ~d~ ~, ahd ~e'~r u~ge ~f ~e, ~ml~ ~[ng ~ by ~e ~f~. ~ ~dl~ons a ~n~ of ~e ~lua~ of~e s~tem. ~1 ~tem~ e~n~al~ ~11 and ~Es~o~ t~ ~u~ do not . :, g~nt~ ~ ~an~ of ~e ~t~, nor do ~ey ~uamnt~ en~men~. A~, /nC. ~ ~em~ not p~de ~y ~ ~ ~m ~ n~ g~ any ~ffmate of h~ /~g ~e ~m ~11 ~n~nue ~ m~t ~e o~al ~u/mmen~ of ~e ~EC or M~ DHHS. ~e ~fent of ~ls m~ Is ~r ~e ~[e ~neffi of ~e o~ I/st~ a~. ~y ~l/an~ u~n or use of ~/s ~ ~ ~y o~ ~ ~ ~ Is not a~, n~ ~11 It ~fer any I~ right ~a~r. 2. ~as~ Wa~r a~ Was~t~ ~su~n~, fnc. s~l ~ ~ld ~91.25 at, or pdor to, ~[ng ~r ~e eng/n~dng ~ ~d~. 6.' DHH8 81GNATURE ~' A~proved for ~ bodrooms Disapproved condifiohal ~Pproval for bedrooms, with the foilowing s!ipulations: Additional ,comments The MuniciPality of Anchorage Department of Health and Human Services (DHHS) Issues H~alth Authority Approval Cedificates 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 fY21 Compu[er Vemlon Municlpall'ty of Anchorage n io mnt ' , ''' n 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) Health Authority Approval Checklist Legal Description: SOUTHPARK S/D; LOT 1, BLOCK 1 _ Parcel I,D.: 020-051-27 A. WELL DATA Well Type__ AWWU . If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Data completed ~--------- --------~---~' Total depth Cased to /'_ Casing height (above ground). .~Sanit_i_i.~ s. Aeat-(Y/N)--- Wire,,~ properly protected (Y/N) FROM WELL LOG Date of test Static water level Well production _ ..-/ g.p.m. . WATER SAMPLE RESULTS: Coliform Nitrate Collected by: B. SEPTIC/HOLDING TANK DATA AT INSPECTION ,f~Oth~r--15E~terla, g.p.rm Dalelnstalled 9/1/81 _Tanksize. 1000 Number of Cempa~tments 2 Cleanouts(Y/N), YES Foundation cleanout (Y/N) _ YES Depression (Y/N) NO High watar alarm (Y/N) N/A Date of Pumping 3/21/2000 __ Pumper DENALI PUMPERS C. ABSORPTION FIELD DATA Date installed 9/1/81 _Soil rating (g.p.d./ft2_or f12/bdrm) 85 System type TRENCH Length 52' Width 5' Gravel thickness below pipe 2,1' _Total depth 4,25' Effecttveabsorptlonarea 268 SQ FT MonltorlngTubepresent(Y/N) Y_ES Depresslonoverfield(Y/N) NO Date of adequacy test_ 3/22/2000 Results (Pass/Fail) PASS For 3 _ Bedrooms Fluid depth in absorption field before test IIn.); 3RY Immediately after 744 gal. water added (In.): DRY Fluid depth (ins) Minutes later: - Absorption rate = 450+ Peroxide treatment (past 12 months) (Y/N) ',lONE KNOWN If yes, give date ....... 72-026 (Rev, 3/96)* Compuler Vemlon D. LIFT STATION ~ Date installed Manhole/ACCess (Y/N) ~evel at* "Pump off" level at* High wa~ *Datum_ ~C. yet~sted E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer maln On adjacent lots sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 5'+ 200'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main/service line 10'+ Surface water 100'+ Cudain drain NONE KNOWN Driveway, parking/vehicle storage area 10'+ Wells on adjacent lots 200'+ F. ENGINEER'S CERTIFICATION I certify that I ha. Fe~te~i~ field inspections and review of Municipal reCords/th#girlie ~ ~ systems are In conformance with MO.,,. r on t,,ls dete. Signature Engineer's Nam.~ z dEFFREY A. GARNESS HAA Fee $ Date of Payment Receipt Number 72~26 (Rev, 3/~) Comp~erVemlon Waiver Fee $ Date of Payment Receipt Number,