HomeMy WebLinkAboutSOUTHPARK #1 BLK 3 LT 17-i
DEC5UBM177,
13 2018
IDFIQIi l 1\ PVI l_!-1-IG.UUL,
Municipality of Anchorage
Community Development Department Page 1 of 2
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171174
PID Number: 020-491-43 ❑ New ✓❑ Upgrade
Name:
Alan Fisher
ABSORPTION FIELD
E] Deep Trench E] Shallow Trench E] Bed ❑ Mound
Address
4460 South Park Bluff Drive
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision
Block Lot
SOUTHPARK it i
3 17
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
I Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
I Tank
Line
Ft'
Ft.
Well
N/A
N/A
N/A
I N/A
N/A
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE TANK
Capacity
1 1500Gal.
Surface Water
100+
N/A
N/A
N/A
Material
Number of compartments
Lot Line
39.4
N/A
N/A
I N/A
STEEL
2
NA
Foundation
7.8
N/A
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
50+
LN/A
N/A
N/A
ORENCO
500 Gal.
Remarks
Pump on level al
40 in,
Pump off level at
35 in.
High water alarm at
45 in.
Pump make and model
P2005
Electrical Inspections performed by
MOA BUILDING SAFETY
Installer
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
ISAAC'S
Drainfield 3034 CO/MT 3034
Inspector PANNONE ENGINEERING
BENCH MARK (Assumed elevation) 305.Oft
Inspections,
dates: 7/20/17
2N 12/4/18
Location and description
3rd
4th
BOTTOM HOUSE TRIM AT POINT A
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
rC- OF A;(
Conditional Approval:
Date
. ,Q
• even annone
�¢
Approved V�CC.ti 61(lu Date ie
8149AW
-
k ED I/'" ••AMW
IDFIQIi l 1\ PVI l_!-1-IG.UUL,
S 50'
!TRUE NbRTH SCA4E
3
INSTA LED
BDR ..1 500g S.T.E.P. TANK
DRIVEWAY �ASFD ,CONNECTED TO EXISTING DRAW I I N FIELD
A
REMOVED 500a LIFT STATION (E
TI
<t,�PER MOA CODE
288
292 N
DRAIN FIELD E
296
3a039.304 08 3 316
39�41 320
12
12
REMOVED 12503 SEPTIC
PER MOA CODE
7-
T1
A
10.5
B
24.0
T2
14.5
17.6
LS
115.8
16.1
161 f
1t 1 SEPTIC TA
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�CALE: NTS
NOTES: PNE ENG SVC, LLC Date
RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 9951012/11/18
PHONE (907) 272-8218 FAX (907) 272-8211 f Scale
50'
... .. .... . .... -F 1. D. —NO
----------- SOUTHPARK #1 B3 L17 —=-491-43
ALAN FISHER •PERMIT —NI 0
DRAWN ACP CE
4460 SOUTHPARK BLUFF DRIVE 8149 OSP1 71174
ANCHORAGE, AK 99516 Sheet
2 OF 2
MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Program •1.;
PO Box 196650 4700 Elmore Road I.
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.org/onsite
—51771777777
44,0RhGE
On-Site Wastewater Disposal System Permit
Permit Number: OSP171174 Effective Date: 7/7/2017
Work Type: SepticTank Upgrade Expiration Date: 7/7/2018
Tax Code Number: 02049143000
Site Legal Address: SOUTHPARK#1 BLK 3 LT 17 G:3236
Site Mailing Address: 4460 SOUTHPARK BLUFF DR, Anchorage
Owner: FISHER ALAN DALE & KVITTINGEN Lot Size in Sq Ft: 37192
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3
This permit is for the construction of:
El Disposal Field 21 Septic Tank ❑ Holding Tank ❑ Privy ❑ 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
Special Provisions:
1. Note, this site and surrounding lots are served by community water source, not a private well as indicated in
narrative.
2. Inspection report shall note decommissioning of existing septic tank and lift station was completed in
accordance with code.
L1(21)
Received By: �� i►�� �' Date: �//6//
Issued By: Alii`<C'PC; (, 'zz..' Date: 71726
C(jr\A --GIcC-1 C -1
MUNICIPALITY OF ANCHORAGE
rr •li
Community Development Department Phon - 7904
Development Services Division Fax:-' - -7997
On-Site Water& Wastewater Program41#811fr \
/',\ ON-SITE SEWER/WELL PERMIT APPLICATION .;-:L 5 2017 3
C Parcel I.D. 020-491-43 , C
JP*
zi
Property owner(s) Alan Fisher & Kvittingen Arne Joint Living Trust Day phone a 6 8 9
� G
Mailing address 4460 Southpark Bluff Drive Anchorage, AK 99516
Site address 4460 Southpark Bluff Drive ,l�
Legal description (Sub'd., Block & Lot) Southpark #1 Block 3 Lot 17
Legal description (Township, Range & Section)
Lot Size 37,192 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field I I Initial I I Single Family (SF) ❑X
(w/wo ADU)
Septic Tank n Upgrade ❑x Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy I I (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal C.._
qcS 1
(Signature of property owner or authorized agent)
Permit/Rush Fees: oZ6 Waiver Fees:1
Date of Payment: 1! Col/ 1 Date of Payment:
Receipt Number: 55G‘ Receipt Number:
Permit No. OS911 111(4 Waiver No.
Permit App_ • .:..,c
Pannone Engineering Services u.c
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail:steve@panengak.com
July 5, 2017
Subject: Southpark#1 Block 3 Lot 17
Tank Replace Permit Request - EMERGENCY
Design Narrative
This is a design narrative for a permit to install an upgrade 1,500g STEP Tank to replace an existing 1,250g
Septic tank with lift station to be issued for this property. The existing lift station has completely failed. It
will be decommissioned per code. Currently the lot is developed. The proposed system will utilize a
replacement 1,500g STEP tank that will be connected to the existing drain field. The existing tank is
located approximately 100'+ from the well. The proposed tank will be placed outside the existing well
radius. All required separation distances will be met.
1. Upgrade Tank Design.
A foundation clean out installed if needed.
The tank will be located: 5'+ from any property line or building foundation
10'+ from any water line
100'+ from any surface water
100'+ from any private wells
200'+ from any public wells
The proposed installation will not affect the future development of the surrounding or existing lots.
If you have any questions or concerns, please contact me at 907.272.8218.
Sincerely,
_P(EOF
. ......,rrrrrr
•
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4:13 Steven R.Pannone-1.7:
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Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
72-013 (Rev. 3/78) itv
MUNICIPALITY OF ANCHORAGE
0 1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street • Anchorage, Alaska 99501 Telephone 2644720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
NAME
PHONE
EW
— ❑UPGRADE
MAILING ADDRESS
`
JZ-7-CllA0
LEGAL DESCRIPTION
'
LOT- 1-7 T1
LOCATION
S r4 -ic
NO. OF BE;*OOMS
to
DISTANCE TO:
Well
Absorption area
Dwellin 0�
PERMIT O.
D
_Y
Q
Manufacturer
J
Material
No. of compartments
N F�
Liq. capacity in gallons
Z
IF HOMEMADE:
Inside length
�--
Width —_
Liquid depth
d
DISTANCE TO:
Well
Dwelling
PERMIT NO.
Ole
_ F
Manufacturer
Material
Liquid capacity in gallons
O
W =
DISTANCE TO:
Well Foundation
�-
Nearest lot lini
-t-
PERMITNO.
Z W
No. of lines
Lengt f each line Total length of li esu
Trench width
Distan etween lines
F ¢
inches
Q I.
Top of the to finish grade Material beneath the
Total ellective absorption
grey
O
—s Ll.. o L D 4g` inches
Y
Length
WidthDe th r
PERMIT NO.
0
a d
W
Type of crib
Crib diameter Crib depth
Total effective absorption area
DISTANCE TO:
Welt Building foundation
Nearest lot line
Class
Def5th Driller
Distance to lot line
PERMIT NO.
LuJ
DISTANCE T0:
Building fo dati n Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
O
INSTALLER
Mt N o�
REMARKS
4�
r
AV ••
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14
APPHOVED DATE LEGAL
72-013 (Rev. 3/78) itv
r
a
r1
.'i MUNICIPALITY OF ANCHCRAGE
' DEPARTMENT OF HEALTH AND ENVIRCNMENTAL PROTECTION
—_E25_l_STREE_T..-AN CHCRAGEo-AK__995C1
^ 264-4720 -
0h-S17=_SEWER-PERP_I7
PERMIT NO: 840400
---DATE- ISS UED:__05 12 -------- --- ----- - — --
r�'' APPLICANT: M A M CONTRACTING
�I
-___ADDRESS:__ 12-721_TANADA.___
ANCHORAGELP AK 09515
CONTACT PHONE: 345-4456
I
**-TANK MUST -HAVE AT -LEAST -TWO -COMPARTMENTS - - - - - - - - - - - - - -
CERTIFY THAT:
1. I AM FAMILIAR WITH THE REQUIREMENTS FOR CN -SITE SEWERS AhO WELLS AS S'
_FOR_Tr_EY-THE. mUNICIPA-LILY_0F 4N CH_ OFACY__(COA.)._AND 7HE_5LATE-OF_A LASK.9..
2. I WILL INSTALL THE SYSTEM IN ACCCRDANCE WITH ALL MOA CODES AND REGULA'
AND IN'CCMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
3.-1_W ILL _AD HERE-TO_ALL_MCA AND-STA_TE_OFALASyA RE CU IF. EM_ENT_SAU,R__7ftE_SEL
DISTANCES FROM ANY EXISTING YELL. WASTEWATER DISPOSAL SYSTEM OR PU9LIi
SEWERAGE SYSTEM CN THIS CR ANY ADJACENT OR NEARBY LOT.
4.-I_.UVDERST AND -THAT YhI_S__P_LRMIT-IS_VA.LID_f.OR-l_-N,A.XIMUY___OF_i-°EDFOCMSJI
ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT.
If A_IF_T_STAT-ION_IS_lNSTALLED_-IN AN_A.REA_COVER.ED_9Y_MOP_EUILDING_CODES.__
THEN (1) AN ELECTRICAL PERMIT AND 114SPECTION MUST BE CBTAINED' (2) AS -BUIL'
WILL NOT EE APPROVED WITHCUT AN ELECTRICAL INSPECTION REPCRT; AND (3) THE
ELE_C-TRI.CAL-WORK_MUST_EE_DCNE--E-_YA_LI.CENSED-ELECTRICIAN.
SIGNED -- /f'�j DATE:
---- -- --- --- ----- ---------------
APPLICANT: M A M CONTRACTING _
5
IS5LIED�Y DATE:
LEGAL DESCRIP: SUBDIVISION:
SOUTH PARK #1
LOT: 17 BLOCK: 3
SECTICN: 3
TCWNSHIP:
11N RANGE: 3W
�__LCT-SIZE: X7130 _(SG.FT._OR_ACRES)____—
-_
`I MAX BEDROCMS: 3
I
�1 ISTED--- BEL01.'_ARE-.-THE_CPT-IC!IS-AVAILAELE-TO
YCU--Ih_DESIGNING_YOUR_SEP_TIC
SYSTEM. CHOOSE THE OPTION THAT
BEST FITS
YOUR SITE.
- - - - - - - - - - - - - -
- - --- - -
- - - -- - - - - - - - - - - -
Zr
DEPTH TO FIPE 60TTOM (FT.)
4.0
4.0 3.0
J GRAVEL DEPTH (FT.)
0.5
1.0 z•O
TOTAL—DEP-IE—CFSJ
4.5—
5.0
GRAVEL WIDTH (FT.)
16.0
5.0 S C,
^�"
GRAVEL LENGTH (FT.)
31.0
58.0
GRAVEL_VOLUME__(CU.Y.DS.]
19.3-
15.1—
TANK SIZE (GALS)
1.000.0 •*
1.000.0 ►+
ems''
SOIL RATING (SO.FT./BR)
110
110
I
**-TANK MUST -HAVE AT -LEAST -TWO -COMPARTMENTS - - - - - - - - - - - - - -
CERTIFY THAT:
1. I AM FAMILIAR WITH THE REQUIREMENTS FOR CN -SITE SEWERS AhO WELLS AS S'
_FOR_Tr_EY-THE. mUNICIPA-LILY_0F 4N CH_ OFACY__(COA.)._AND 7HE_5LATE-OF_A LASK.9..
2. I WILL INSTALL THE SYSTEM IN ACCCRDANCE WITH ALL MOA CODES AND REGULA'
AND IN'CCMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
3.-1_W ILL _AD HERE-TO_ALL_MCA AND-STA_TE_OFALASyA RE CU IF. EM_ENT_SAU,R__7ftE_SEL
DISTANCES FROM ANY EXISTING YELL. WASTEWATER DISPOSAL SYSTEM OR PU9LIi
SEWERAGE SYSTEM CN THIS CR ANY ADJACENT OR NEARBY LOT.
4.-I_.UVDERST AND -THAT YhI_S__P_LRMIT-IS_VA.LID_f.OR-l_-N,A.XIMUY___OF_i-°EDFOCMSJI
ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT.
If A_IF_T_STAT-ION_IS_lNSTALLED_-IN AN_A.REA_COVER.ED_9Y_MOP_EUILDING_CODES.__
THEN (1) AN ELECTRICAL PERMIT AND 114SPECTION MUST BE CBTAINED' (2) AS -BUIL'
WILL NOT EE APPROVED WITHCUT AN ELECTRICAL INSPECTION REPCRT; AND (3) THE
ELE_C-TRI.CAL-WORK_MUST_EE_DCNE--E-_YA_LI.CENSED-ELECTRICIAN.
SIGNED -- /f'�j DATE:
---- -- --- --- ----- ---------------
APPLICANT: M A M CONTRACTING _
5
IS5LIED�Y DATE:
• MUNICIPALITY OF ANCHORAGE
c
Ar v DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
`I _� 825 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG - PERCOLATION TEST
!Q� SOILS LOG
�Lk() [LU b
.� PERCOLATION
TEST
PERFORMED FOR: MA" 1 +�W N�T�SZU CiiO N DATE fF- PERFORMED: E 14
LEGAL DESCRIPTION: •LoT I / ��. SONTF+Pf-1_
r1-nnt.,'l /
-,
Date
Gross
Time
Net
Time
ORGANICS . --
2-P!
504/
; to
//Y��
6''
3
p.:
/a
*.
1
4
.,
r: r
3
5h4
5: 20
.�
r
4p
13-
14 -
15-
16-
17-
18-
-19 -
20 -
COMME
[DWARD /•MACS
CE -3816 Ale
III 14VPERCOLATION RATE
WAS GROUND WATER — S
S
ENCOUNTERED? L
O
P
IF YES, AT WHAT 9 E
DEPTH?
Reading
,
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
504/
; to
s
6''
4:50
30 v, „
3 // zo.
Z5 /•
3
5h4
5: 20
lo v,;,
4p
s /
I O •
/1
0 5
51
6 I za
20 M;w
rl
Z 7
��
8
TEST RUN BETWEEN
PERFORMED BY: :rH=MMI SCHLT_ CERTIFIED BY
72-008 (6/79)
IM(minutes/inch)
AND _ FT
DATE:
• � Municipality of Anchorage
On -Site Water and Wastewater Program a '"
(907) 343-7904 s e T r
Certificate of On -Site Systems Approval
Parcel I.D. 020-491-43
1. GENERAL INFORMATION:
Expiration Date: - � Z - �_ 6 Z
Complete legal description SOUTHPARK #1; BLOCK 3, LOT 17
Location (site address) 4460 Southpark Bluff Drive *Anchorage
Current Property owner(s) Alan Fisher
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone 907-538-7722
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
®
Public Sewer
❑
WaiverNariance request for, Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ J; so Waiver Fee $
Date of Payment & -1? " 2 Z Date of Payment
Receipt Number 67003(7 G Receipt Number,
COSA # O S CZ a 1 a r7 (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.
Name of Firm: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179
Address: - 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507
Engineer's Printed Name: _Jeffrey A. Garness Date:
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the;- r_
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or ;� ^��•.• ••... 11-4.
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and !� J
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and j' 1""" "" ' '"f "-""""'
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of• • • • • • -
the well or septic system. GEG makes no representation whether an alternative well or septic system !`! "I f i, Gar' -e -__.-
can be installed on the property in the event either of the current systems fail to perform adequately in �•�(( (ty' �(i(r `�
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or`��
QF • // `�>
party (including subsequent property purchasers) is not authorized, nor will it confer any legal ri
whatsoever.�y�
�_S/%E#AE%84
6. DSP SIGNATURE
System #1 Approved for bedrooms WA8 rlr_ ,�VA7FR ,ASD m
m - V .AT
System #2 Approved for bedrooms %r �'RO ER �
'o GhA o�
Disapproved J�A'� M
Conditional approval for n bedrooms, with the foPwinc�
�iI'�'il��\1�L��/ u��`t�i�►��1����i�s►��ll1\t`•a�nir�f. • � r
Original Certificate Date: (e�'ZAl — 2-Z_
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 engineers work.
7. ATTACHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
nIj
COSA Checklist
Legal Description: SOUTHPARK #1; BLOCK 3, LOT 17
If more than 1 septic system on lot: COSA Checklist # of
PUBLIC WATER
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for C
Static wate at beginning of test ft.
B. TANK DATA
Age of tank(s) 4 years
Tank type/material s'�"s'�E`
Measured operating fluid level in septic tank 0
0 Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA TRENCH
Parcel ID: 020-491-43
Structure served by this system
Well production at time of test gprrs�
Water storage tank volume g;allons
Well disinfected iform test? Yes ElNo
❑ C bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C.UFT STATION
M Required maintenance completed
Age of lift station 4 years
Lift station material STEEL
Comments:
Which system tested (date installed) 7/30/84
Adequacy test date 5/12/22
RK ALL standpipes present per record drawing
Results Q Pass For 3 bedrooms
Total measured depth from grade 4.33 ft (max)
Fluid depth prior to test 0 in
Measured depth to pipe invert from grade `2.16 ft (min)
Water added 533 gal
❑ N/A — pressurized field
*`25
New depth in
❑ Monitor tubes go to bottom of effective. If not, state
215
depth into effective Z,s,S�.�,
Elapsed time min
P
❑ Code -required soil cover over field
Final fluid depth 0 in
❑ System presoaked
Absorption rate 450+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) N/A
date of test)
Gallons introduced N/A gallons
_
If yes, enter date
Comments/Deficiencies: 'SEE ATTACHED EMAIL REGARDING rREEZING ••AFTER INTRODUCTION OF 43 GALLONS OF WATER, THERE WAS 2' OF LIQUID IN SUMP
COSA Checldist yellow sheet
140
E. SEPARATION DISTANCES PUBLIC;TVER
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout >
❑ Yes if No ft es if No ft
Neighboring Tank > 100' El Yes if No ft Private S eptic Line > 25' ❑ Yes if No ft
Absorption Field on Lot > 100' [:]Yes if No Holding Tank > 100' ❑ Yes if No ft
Neighboring Absorption Fields > Animal Containment > 50' ❑ Yes if No ft
Yes if No ft
Manure/Animal Excreta Storage > 100'
Co ewer Main > 75' ❑Yes if No ft ❑Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No
*5'+ 1 ft
Surface Water > 100'
Yes if No ft
Property Line > 5'
❑✓ Yes
if No
ft
Wells on Adjacent Lots:
Q Yes
Absorption Field > 5'
Q Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
❑✓ Yes
if No
ft
Community Wells > 200'
Yes if No ft
Water Service Line > 10'
❑✓ Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
El Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Q Yes
if No
ft
Private Wells > 100' El Yes if No ft
Water Service Line > 10'
Q Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No ft
Surface Water > 100'
Q Yes
if No
ft
F. ENGINEER'S COMMENTS
*MET CODE AT TIME OF INSTALLATION
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
OF A/
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MUNICIPALITY OF ANCHORAGE
Development Services Department 4 Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Lift Station/Pump Vault
Maintenance Log
Owner Street Address4460, R} �C
Septic Tank:
-Sludge level inches Pumping: required es no -Pumping completed )no
Lift station:
-Pump basket cleaned 67s) no *Effluent filter cleaned Cess no _
-Control floats cleaned es) no -Proper float settings confirmed Cess no
-Operation satisfactory/Ve-s no
Alarm System:
-Dedicated electrical alarm cicirWit_(� es\ no -Audible and visual alarm inside dwellin es no
-Alarm system operation 'sat� isfactoory hot satisfactory
Manhole Riser
-Ground water intrusion at riser to tank connection yes
-Ground water intrusion around pipe penetrations Ves ono: -Weep hole functional �'es) no
-Manhole lid: Functional � es no Insulated /v`bs no Pronerly SACT IrP_ri ,m?s�,z nn
•All manufacturer required inspections and maintenance completed les )no
Comments:
Qualified Maintenance Provider:
Technician i iLl
Company
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Signature
Q
Date of maintenance��
Date 4p,
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Municipality of Anchorage
• Development Services Department
Building Safety Division ...
Onsite Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.anchorage.sk.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-051-53 HAA# r!3 V 1 Ll
1. GENERAL INFORMATION Expiration Date: 7" 9-0+
Complete legal description SOUTHPARK SUBDIVISION #I- LOT 17, BLOCK 3
Location (site address or directions) 4460 SOUTHPARK BLUFF DRNE ' ANCKORAGE, AK.
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
SHARON GARUBA Day phone 345-9763
4460 SOUTHPARK BLUFF DRIVE * ANCHORAGE. AK 99516
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
❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
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 (except 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.
4. STATEMENT OF INSPECTION BY ENGINEER
r/
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 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 ls(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Finn
ALASKA WATER do WASTEWATER
CONSULTANTS,
INC.
Address 3701
E. TUDOR ROAD, SURE 101 •
ANCHORAGE, AK
99507
Engineer's Printed Name JEFFREY A GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide
any warranty orfuture 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 benerit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Phone 337-6179
Date �% 3
Conditional approval for bedrooms, with the flowing stipulations:
` •G
WATERAND
PROGRAM`
Attachments: J��i� �Oq
HAA Checklist t/ ManitenanceA Agreements ///rj�;SN�\`
9 Ilt
Septic System Advisory y Supplemental Engineer's Reort
Well Flow Advisory Other
By:-04/-/Q� vv • Original Certificate Date: 7-2-03
(Rev. 1781)
Municipality of Anchorage
• DevelQpment Services Department
Building Safety Division
Onsite Water b Wastewater Program
4700 South Bregaw St.
P.O. Box 196650 Anchorage, AK 9951966W
www.a.anchorege.ak.us
(907) 3437904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: SOUTH PARK SUBDIVISION Alt. LOT 17, BLOCK 3 Parcel ID: 020-051-53
A, WELL DATA PUBLIC WATER
Web" If A, B, or C provide PWSID# _ Well L
Date completed Sanitary seal (Y/Ni fres property protected (Y/N)
Total depth d to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Web production 9.p -m. g.p.m.
WATER SAMPLE RESULTS:
Coliform — colonies/100 ml. Nitrate — mgJL. Other bacteria — colonies/100 ml.
Arsenic: — mg./L. Date of sample: — Collected by:
B. SEPTIC(HOLDING TANK DATA
Tank Type/Material STEEL Date installed 7/30/1984
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation deanout (YIN) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A
Date of pumping 6/25/2003 Pumper ISAAC'S PUMPING
C. ABSORPTION FIELD DATA
Date installed 7/30/1984 Soil rating 0.p.d r ft%wrn) 118 System type TRENCH
Length 57 ft. Width 5 ft. Gravel below pipe "4 ft.
Total depth '8.4 ft. Eff. absorption area 527 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 6/24/2003 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test •27 in. Water added 481 gal. New depth 29.5 in.
Elapsed Tone: 5 min. Final fluid depth 27 In. Absorption rate >= 450 g,p.d.
Any rejuvenation treatment (past 12 mo.) (YM 8 type) NONE KNOWN If yes, give date —
** SUMP ONLY EXTENDS 29.5' SEIAW INVERT. SYSTEM 95X FULL PRIOR TO START OF TEST.
D. LIFT STATION
Date installed 8/3/1984 Side in gallons UNKNOWN Manhole/Access (Y/N) YES
"Pump on" level at —2-21n. "Pump oW level at 18 in. High water alarm level at 29. in. '
Datum 807TOM OF TANK Cycles tested 2 Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY WATOR SYSTEM
Septic tankllift station on lot On adjacent lots _
Absorption field on lot On adjacent lot t =
Public sewer main Public sewer manhole/deanoul
service line Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 100+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 30'+
Curtain drain • UNKNOWN Wells on adjacent lots 200'+
F. COMMENTS
• Sii I FrrFR Tn n M LI q nATrn 19/R/7ROn
G. ENGINEER'S
I certify that I have determined through field inspections and +! ! Y*
review of Municipal records that the above systems are in "' "' '
conformance with MOA HAA guidelines in effect on this date.
Engineers Printrdpame JEFFREY A GARNESS
Date 712 /�^•oP
HAA Fee $ 7r7 P • Waiver Fee $
Data of Payment 7 7ll Date of Payment
Receipt Number �� S� Receipt Number
(n.v.1yo+)
$71
N 66e
433>tv
226. 761
OF.A
.�o49TH.......................y
SHANE A. HOLT •. .
`, •� LS -6914
d �e.......• • .
• Al `•! _
�!h•ueed.
TILE INFORMATION HTREON 1S FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SNOW ANY CONFLICTS BETWEEN
STRUCTURES STRUCT'ENCE� PATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL
EXISTIEASEMENTS CF P CJRD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT. ARE NOT SHOWN HEREON
NOTE ANY FENCFLNES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY UNI
OR LOCATE S" "VES
ASJRILT SURVEY
NO CORNERS SET THIS DATE M.AD
I
I
I
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1 HEREBY CERTIFY THAT I NAVE PERFORMED A
MORTGAGEE'S INSPECTION OF THE FOLLOWING
DESCRIBED PROPERTY.
LOT 17. BLOCK 7. SOVTHPARK SUB..
ADDITION NO.1
0
0
cl
N
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ANCHORAGE RECORDING DISTRICT. ALASKA ANDTIIAT
THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE
PROPERTY LWES AND NO VISIBLE ENCROACHMENTS EAST
OTHER THAN NOTED.
DATED AT ANCHORAGE. ALASKA TRIS iST—
DAYOF JULY 2D03_
HOLTIAHOSURVE� J0R6721.11J1
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SHANE A. HOLT •. .
`, •� LS -6914
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• Al `•! _
�!h•ueed.
TILE INFORMATION HTREON 1S FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SNOW ANY CONFLICTS BETWEEN
STRUCTURES STRUCT'ENCE� PATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL
EXISTIEASEMENTS CF P CJRD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT. ARE NOT SHOWN HEREON
NOTE ANY FENCFLNES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY UNI
OR LOCATE S" "VES
ASJRILT SURVEY
NO CORNERS SET THIS DATE M.AD
I
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1 HEREBY CERTIFY THAT I NAVE PERFORMED A
MORTGAGEE'S INSPECTION OF THE FOLLOWING
DESCRIBED PROPERTY.
LOT 17. BLOCK 7. SOVTHPARK SUB..
ADDITION NO.1
0
0
cl
N
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C3
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ANCHORAGE RECORDING DISTRICT. ALASKA ANDTIIAT
THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE
PROPERTY LWES AND NO VISIBLE ENCROACHMENTS EAST
OTHER THAN NOTED.
DATED AT ANCHORAGE. ALASKA TRIS iST—
DAYOF JULY 2D03_
HOLTIAHOSURVE� J0R6721.11J1
TFI 'UA 11
1 �
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. # (Qa(_)' n51 -'S"
1. GENERAL INFORMATION
HAA# SY)LACA
Complete legal description Lot 17; Block 3; Southpark #1
Location (site address or directions) 4460 Southpark Bluff Drive
Propertyowner William Penrose
Anchorage, AK
Day phone
345-7300
Mailing address 4460 Southpark Bluff Drive Anchorage, AK
Lending agency
Mailing address
Agent
Address _
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well XX
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest -
Ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site 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-=(4•.1/11) From MOA911
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 furtherverify 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 datp)of this inspection.
Name of Firm Aad � IL� �
Address 6 901
Engineer's signature
ALASKA WATER & WASTEWATER CONSULTANTSt INC.
IS TO BE PAID 4 450—"'AT CLOSING FOR.
ENGINEERING SERVICES PERFORMED.
6. DHH6 SIGNATURE f
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
LM
— Phone 337-6/79'
Date I
bedrooms, with the following stipulations:
Date /2. - 9. 98
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions In orderto 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.
Hari (P�. W) 8. MOAm
Municipality of Anchorage E C E! V E D
DEPARTMENT OF HEALTH & HUMAN SERVIC
Environmental Services Division pp��CC
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 9&9-477998
�-at-Health & Human Seof rvices
Health Authority Approval ChecklisR '"
Legal Description: !�A'U 4AV 4� Parcel l.D.:
A. WELL DATA
Wail type 01
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
I
Date of test
Static water lev
Well uction
WATER SAMPLE RESULTS:
Coliform
Date of samDle
It A, B. or C, attach ADEC letter. ADEC water system number
B. SEPTIGHOLDING TANK DATA
Date completed
Cased to
LOG
Nitrate
Casing height (above ground)
Wires properly protected
AT
Other bacteria
by:
Date Installed If By- tf4 Tank size J �7- So Number of Compartments 7- Cleanouts(Y/N)-Y--
Foundation cleanout (YM) V Depression (Y/N) A) High water alarm (YM) '
DateofPumping '7--R4-98 Pumper �Saacs
C. ABSORPTION FIELD DATA NOTE : 5un0 oay.I E„4e4ps 2A 915 -tow (Aversq-
Date installed 1-30- a q Soil rating (g.p.dJW or W/bdrm) 11&14 =System type 43ha 110x
Length 3 �L 2 a r Width 5 Gravel thickness below pipe �� " Totai depth
Effective absorption area fA7 Monitoring Tube present (Y/N)_X_ Depression over Held (Y/N)
Date of adequacy test / - / 7 - 9 8 Results (Pass/Fail) P4 5 s For 3 bedrooms
Fluid depth in absorption field before test (in.); Immediately aft r /0 1. water added (in.):
Fluid depth V, (ins) Minutes later: Absorption rate = `'�5�' D.p.d.
Pero)dde treatment (past 12 months) (Y/N)
72-026 (Rev. 3196)'
A/
If yes, give date
D. LIFT STATION
RECEIVED
FURNMI-i
Date installed Size in gallons �� �P
—iH4mtiAfl lIs
Manhola/Access (Y/N) "Pump on" level at* 31 A• 5 • "Pump ofP level ar
n
High water alarm level at' 'Datum 9 o Tlb l
Cycles tested Tw o
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT
Septic/holding tank on lot
Absorption field on lot
Public sewer
Sewer /setitic service line
On adjacent1
On nt lots
is sewer manhoh
_ Lift station/
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Foundation orf Property line ���'� /1tLsorption8eld
Water main/service line Lo rfi Surface water/drainage foo ' Wells on adjacent lots /{P, ,et7e_
2106 1Y V 'Ott Uri
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /t) r f Building foundation/6,, 7' ro Water main/service line 7-5r {
Surface water dC Driveway, parldng/vehicie storage area A01"
Curtain drain Vw1K^3QW'J Wells on adjacent lots /00 rf 70
F. ENGINEER'S CERTIFICATION , //•+�= �'r'►� /�
Engineer's
Data
f� d
HAA Fee E X300 .
inspections and review of Municipal r
rs in effect on this date.
A• 6-A,2,,>✓rs
Date of Payment �-z —�na /^ ;7�
Receipt Number ? ( 770 Z)_
0
72-026 (Rev. 3/96)'
Waiver Fee E
Date of Payment
Receipt Number
rr
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 211-- Anchorage — Alaska 99504
Phone (907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
December 8, 1998
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Subject: Lot 17, Bk 3, Southpark SID. HAA
To whom it may concern:
RECEIVED
DEC s 1998
Municipality of Anchorage
Dept. Health & Human Services
We performed and inspection and adequacy test on the septic system serving the subject property.
The results of the field investigation and adequacy test are summarized as follows:
SEPTIC SYSTEM ADEQUACY TEST: The drainfield is a trench type system that was
installed in July of 1984, making it approximately 14.5 years old. According to the M.O.A
documents, it is 57 feet long, and has an effective depth of 48 inches. Based upon our field
measurements, it appears that the sump only extends 29 inches below the drainpipe invert.
Prior to the start of the test the sump was dry. Over a period of 210 minutes, 1076 gallons
was introduced into the system, after which time the monitoring tube was still dry. Based
upon this data, it was determined that the absorption capacity of the drainfield meets the
MOA requirements for a 3 bedroom house (450 gallons per day).
The liquid level in the first trench clean-out (immediately after the lift station) was 10 inches
deep, prior to the introduction of water. When the lift station was activated, the water level in
this clean-out rose to within 4 inches of the ground surface. The level quickly subsides after
the lift station pump shuts off. It appeared that there may have been an obstruction in the
clean-out so we requested that the homeowner have it inspected with a TV camera. Denali
Sewer & Drain (Joe Shaw) ran a camera down it an did not find any separations or
obstruction He did note that the line was somewhat settled in that area, which partially
explains the liquid depth.
• Attached is a drawing, prepared by the homeowner, Bill Penrose, which depicts how the line
from the lift station is connected to the trench. Apparently there is a check valve in the 2 inch
be, which prevents any drainage back to the lift station This partially explains why there is
10 inches of standing water in the clean-out at the beginning of the trench.
• NOTE. The adequacy of a septic system is influenced by numerous factors, including, but
not limited to, seasonal surface water infiltration, groundwater variations, septic system
maintenance (frequency of septic tank pumping, usage of biological additives), condition of
drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with
age), type of substances deposited in septic system (cigarette butts, sanitary napkins, mist.
objects), and the amount of water being introduced on a continual basis. Consequently, the
results of this adequacy test are only valid for the specific day of the test. Furthermore,
because of the limited nature of this investigation, it is possible that there are hidden defects
which may not have been detected. No warrantee is made regarding the future performance
of this septic system.
• CURTAIN DRAIN: There is a curtain drain, east of the house, that runs in a north -south
direction. Attached is a drawing prepared by the homeowner which shows the general
location of the drain We noted a 4 inch perforated drainpipe that is approximately I 1 feet to
the east (and uphill) of the drainfield. The pipe was full of dirt. Whether this is part of the
curtain drain is unknown. The septic system was installed in July of 1984, which was prior to
the 1986 ordinance that mandated the separation distances between curtain drams and septic
systems. Please confirm this. In short, the location of the curtain drain is unknown
If you have any questions, please contact me at 337-6179.
Sincerely,
Fran S. MOLT To: JEFF DARVESS Data 127/93 Tme. 3.42:50 FM Page 1 of 1
S 85'20'45"E 5n nn -
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7FE WORNFTION HEREON IS FOR THE VSE OF Le WOHG NSTITUTCN5 SPECFKMEY TO SrV WANYCOWLK
ELSTRJG STRUCTURES N,U PLA77EO LOT LINES OR EASEMENTS AY.D IS NOT TO BE LSED FOR POSMONNi
5TRUC7UP.E5 OR FENCELNES
EASEVENTS OF RECORD. OTHER 7HAN THOSE SHOV.N ON TYIE RECDRCED PLA'. ARE N]T SHO, HEREON,
NOTE:M PENCELNESSHOWYARE LOCATED APPROIUNATELY RC ME NOT TO DE USED 70'JETERMNEn
CR LOCATE STRUCTURES.
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6513
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- r_ -N MUNICIPALITY OF ANCHORAGE /"1
DEPARTMtNT OF HEALTH AND ENVIRONMENTAL PhuTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
2644720
Application Date
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
l oT /7 l3t_�c,K 3. -Sot /*;rKSu.4J A%!d/' .U9/
Location (address or directions)
qbo .So d7 -,t DL2q"41Li 4 17917E
(b) Applicant Name �•l7/7o.�rvse_ Telephone: Home ?��~�3�� Business
Applicant Address Sir e --
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder,; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution C.,4 'Ow"Czfq 41.7 P Telephone
0
Address �s-0> W 36 � efr/r /rf.eA . /rF- T2— ' 7 i
(e) Real Estate Company and Agent A) It
Address
Telephone
(f) Mail the HAA to the following address:
3 44—X944-
.
2. TYPE OF RESIDENCE
Single -Family, Multi -Family ❑ Other
Number of Bedrooms
3. WATER SUPPLY
Individual Wclt_ Community Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 r2-025(11/841
n .
5. ENGINEERING FIRM FROVIDI. INSPECTIONS, TESTS, FILE SEARCH, G. A AND INFORMATION
As certified by my seal affixed hereto ancla 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 AiEx L—/!moi •> «is . n Telephone
Address 1207 C , 74 fy 5 203 s.c/. 4+9 57
Date
/(yc-yte�t�y l!7c5 y��1C/77i�.,c.�1 vn e1cr17�r .� 5�4�fe olc3�lo5� S yS7�e '�
O z /`+-/ 7—•S'"" , •.•; '/ /t` 'fq 7l, s 7`••t�'`+�'�. rL� s �ci(`%'s Gji s o rt s -fl .,�F,
f -N-,, :,F/71' I / 37<k 75.. 74
6. DHEP APPROVAL')
Approved for �-rl bedrooms by -
Approved 62� Disapproved
Terms of Conditional Approval
;W+o�ouoa rua
o
4o:ti9 D. CjJfiL,j
CE -1411
Conditional
CAUTION
Engineer's Seal
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
72.025111/84)
DEPT. OF ��$ ROE
A
/�I ENVIRONMENTAL PROTECTION
n MUNICIPALITY OF ANCHORAGE (Mf01
JUN
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984 RECEIVED
284-4720
Legal Description: /_ 17 /3 3
-Soa.-T rt AMtz� 5�-c.iS l�. Eci-17DN A)�!
A. WELL DATA
Well Classification CoMATUNiTY I(q B, C, D.EC. Approved (YIN) —
Well Log Present (YIN) Date Completed Yield
Total Depth —
Static Water Level
Cased to
Casing Height Above Ground —
Electrical Wiring in Conduit (YIN)
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
Depth of Grouting —
Pump Set At
Sanitary Seal on Casing (YIN) —
Depression Around Wellhead (YIN)
On Adjoining Lots
; On Adjoining Lots
—To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Water Sample Collected by ; Date
Water Sample Test Results sr.--Ve t{sa —T�c PCs -e__ G - 2 3 - 94
Comments
B. SEPTIC/ OLDING TANK DATA
Date Installed 7-30-91- Size T2S-0 No. of Compartments Z
Standpipes (YIN) Y Air -tight Caps (YIN) Y Foundation Cleanout (YIN) Y
Depression over Tank (YIN) Ail Date Last Pumped 2-
Pumping/Maintenance Contract on File (YIN)
;for
Holding Tank High -Water Alarm (YIN) Temporary Holding Tank Permit (YIN)
Separation Distances from Septic/Holding Tank
To Water -Supply Well Nl To Building Foundation / 3"
To Property Line 5 t To Disposal Field Z 3
r
To Water Main/Service Line 4*�� To Stream, Pond, Lake, or Major Drainage
Course /7.:) S eVe2_9o. C-. �_ 4s r t
Comments
Page 1 of 2
72-0260 ba4)
N
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata l R 3/z Type of System Design 4 �n
Date Installed i - 3 0^ Y I- Length of Field 5'-2 r
Width of Field r
Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area 5 2-? Standpipes Present (Y/N) Y
Depression over Field (Y/N) A-) Date of Last Adequacy Test - 17 -
Results
7 -Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well A11A To Property Line 47:5-
To
S
To Building Foundation
To Existing or Abandoned System on
Lot ; On Adjoining Lots /00 1
o01
To Water Main/ rvice Lin To Cutbank (if present) —
To Stream/Pond/Lake/or Major Drainage Course 4 'L_1_)
To Driveway, Parking Area, or Vehicle Storage Area o r
Comments
D. LIFT STATION
Date Installed - 3 -974-
Dimensions ? !4 >C G
Size in Gallons 4 t)o t. Manhole/Access (Y/N) y
"Pump On" Level at -2_4 "Pump Off' Level at 2A ~
High Water Alarm Level at 4 r' Vent (Y/N) A t
Tested for - 4- Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N) 1
Comments
Check Permitted Bedroom Rating Against HAA Request ••
I certify t�hat I have checked.
verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date 6 -Z2C'g¢
Company MOA No.
Receipt No. 3 1 0s, 3
Date of Payment
Amount: $`� �; - - �` " v Engineer's Seal
Page 2 of 2
72-026 (1 t, 64)
tkfia, a t�+ln�,
CC -1411 -V
DEPT. OF ENVIRONMENTAI, CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
DATE: June 23, 1986
PWS I.1).#_213475
To Whom it May Concern:
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
According to records on file in this office the SOUTHPARK TERRACE
SUBDIVISION Water System is, in compliance with the State Drinking
Water Regulations
Sincerely,
1�
Michael P. Lewis
Environmental Engineer
6021,
71}
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MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRON`4ENTAL HEALTH
DEPARTMENT 0. HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Datet%-
(a) Legal Description (include lot, block, subdivision, sectipn, township, range)
(ter 17 P -L mNIA _4:- /
Location (address or directions)
C—k4.0 Sk . -nt Pon- r z c �1 F- r I -Ne
(b) Applicants Name Mj}7z;e Telephone - Hone Business
Applicants Address j27Z1� ?'c-�tin3- Lcs-P AL
(c) Applicant is (check one) Lending Institution ; Owner/builder
Buyer [� ; Other M (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Co. b Agent
Address
Telephone
(f) :sail the HAA to the following address:
2. Type of Residence
Single-Family6z:4Multi-Family Other (describe)'
Number of Bedrooms
3. hater Supply �\
Individual Well, Community [E71 Public
:tote: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Onsite Public Q Community Q Holding Tank'=
Note: If community well system, must have written confirmation,from,the State
Department of Environmental Conservation attesting to the legality and status.
(Page 1 of 21
N
n
5• Engineering Firm Providing Inspections Tests, File Search, Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein. I further verify that,
based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm Cry% NILS '! Telephone �y'�SzG
Address O r Bcijo 4 — .7 i uv� Avxf�Aae % 1, 77-51:1
Date O��/� � �A�
�.•"..... t,
•'.49TH ..'j
(ENGINEER SEAL)//��••••••• •• �/j'f�
♦ • [DWAR6 a "ACK
6. DHEP Approval
a
Approved for bedrooms By aaI i F'� .<'I1at `� f0 �eo
Approved Disapproved Conditional
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 REQUIRE-
MENTS. EMPLOYEES OF LHEP 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.
RR4/ej/D18
[Page 2 of 2]
ti,.
(DHEP SEAL)
7-19-84
A. WELL DATA
n
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPR1NAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
Well Classification C-orvvv-Af417Y If A, B, or C, D.E.C. Approved(Y/N)
Well Log Present (Y/N) 1J/A 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/N)
Electrical Wiring in Conduit (Y/N) Depression Around Wallhead (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
Camnts
B. SEPTIC/HOLDING TANK DATA
Date installed "7�3o r3�- Size �2 So No. of Caq),artmerts Z
Standpipes (Y/N) Air -tight Caps (Y/N) `J g Foundation Cleanout (Y/N)`(C$
Depression over Tank (Y/N) ND Date Last Pumped N/A
Pumping/Maintenance Contract on File (Y ) R- ; for
Holding Tank High-water Alarm (YIN) N Iry Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply -Wa" N/A To Building Foundation
To Property Line r_ 7>" -F- To Disposal Field ; 3
To Water Main/Servioe Line 40-(-- To Stream, Pord, Lake, or Major Drainage
Corse I Z�� SGk}SarJF1�- t�KWI►JACrt �17ZH-
Comments
�(C_';ff 30_)_'1D 1
b- kb %L� O
(Page 1 of 21 �� ,� 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata of System Design W, Dg&;
i
Date Installed -7/3.o hii-Length of Field _5-7
Width of Field 5- Depth of Field -JW
Gravel Bed Thickness ¢8 "
Square Feet of Absorption Area 6 Standpipes Present WN)
Depression over Field (Y/N) MtD Date of Last Adequacy lest
Results of Last Adequacy Test WA � Mc' -t"
Separation Distance from Absorption Field: ,
To Water -Supply TAbll )J/A To Property Line
To Building Foundation Cl ' To Existing or Abandoned System on
Lot L'J On Adjoining Lots I OG +
To Water Mair/Sarvice Line] 7p , To Cutbank(if present) N lrt
To Stream/Pond/take or Drainage Course ' ' 6$ ( ZO" SCTYSt-"ftl - DP-61rY
i
To Driveway, Parking Area, or Vehicle Storage Area �i0
Camrents
D. LIFT STATION
Date Installed 81.3164— Dimensions 5 "4 , -A' 7rlu-
Size in Gallons Q-> Manhole/Access (Y/N) Y S
"PuM On" Level at �1 "Amp Off" Level at ZO "'
High Water Alarm Level at Q-Yi" bent (YM) <3
Tested for "/A Pumping Cycles curing Adequacy Test. Meets NDA
Electrical Codes(Y/N) Yc5
Ccmnents
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MCA HAA GNrj lines in effect,
on the date of thi -inspection.
P�••,......
Signed Date Li4 w'� .
9'LH
Cmpany MOA No. ; ,
!.� ...
KBl/d5/$ EDWARD / MACK V
CE -3316
Ce • r
(Page 2 of 21
2-15-84