HomeMy WebLinkAboutSKY RANCH ESTATES #1 BLK 5 LT 8Sky Ranch #1
Block 5
Lot 8
#015-301-30
Nov_09.2022 02:25 PM Anchorage Well & Pump Service Inc 9072430742
#2837 P 1/ 1
MUNICIPALITY OF ANCHORAGE
Development Services Department * Phone; 907-343-7904
On -Site Water & Wastewater Section Fax., 907-3437997
Pump Installation Log
Well Drilling Permit Number: Date of Issue;
Parcel Identification Number: 015_301.30
Legal Description Block Lot Property Owner Name & Address;
MILLER KEVIN S & PAMELA S
SKY RANCH ESTATES #1 5 8 11980 STEEPLE CHASE CIR
ANCHORAGE, AK 99516
Pump Installation Date: 11 - 08 .. 2022
Pump Intake Depth Below Top of Well Casing:
Pump Manufacturer's Name: STA -RITE
Pump Model: 7P4H0721 -02
II Pomp Size: .75 hay
230 feet
Pitless Adapter Burial Depth: 9 feet
Pitless Adapter Manufacturer's Name: MARTS N ON
Pitless Adapter Installer:
Well Disinfected Upon Completion? X Yes ❑ No
Method of Disinfection: PELLETS
II Comments -
Pump Installer Name.,
ANCHORAGE WELL &. PUMP SERVICE
Company: 7640 KING STREET
ANCHORAGE, AK 99518
Mailing Address: 907-243-0740
11 City: State: Zip:
Attention;: The frump installer shall provide a pump installation log to On-site within 30 days of pump installation,.
Municipality of Anchorage DEC I't 011
Community Development Department Page 1 of 3
On -Site Water & Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http,//www.muni.org/onsrm - (907)343-7904
ONSITE WASTEWATER INSPECTION REPORT
Permit Number: OSP121349 PID Number: 015-301-30 ❑ New ■Upgrade
Name:
KEVIN & PAM MILLER
ABSORPTION FIELD
❑ Deep Trench ■ Shallow Trench ❑ Bed ❑ Mound
❑Other
Address:
11980 STEEPLE CHASE CIR *ANCHORAGE, AK 99516
Phone: No. Of Bedrooms:
(907) 250-2890 50.8
GPD/sq. Ft.
Total Depth from original grade:
8.50 MAX n,
LEGAL DESCRIPTION
Depth e Invert /rom o ginal grade:
Gra el depth beneath pipe:
SEE DWG. F
4.00 4.02 FL
Subdivision: Block: Lot:
SKY RANCH ESTATES #1 5 8SEE
owns ip: cogs: a
— _ —
bove original grade:
DWG. Ft.
:
KIOOOSQ.FL
Grovel IengM:
2 ® 50 = 100 Ft.
Bede Number of line Distance between linos:
5 Ft
—
SEPARATION
TO
From
DISTANCESF.
Septic Absorption
Tank Field
Lift Holding Public/Private
Station Tank Sewer Lines1
tion area:
OOO SD. FL
umber of be
2
Diet. between trenahea:
10+ Ft.
Well
100'+
100'+
—
—
25'+
TANK ■ Septic ❑S.T.E.P. 01jolding ❑Other
Surface water
100'+
100'+
—
—
Manufaeturer.
ANCHORAGE TANK
Capaeity:
1500 Gal.
Lot Line
5'+
10'+_
—
Mata"al:
Number of compartments:
N/A
STEEL
2
Foundation
5'+
10'+
Curtain Drain
NONE KNOWN
Remarks: OLD TANK WAS DECOMMSSIONED PER UPC.
Installer
A+ HOME SERVICES
LIFT STATION
Manufacturer. Caoaci[v:
Make &
performed by:
PIPE MATERIAL
House to tank D3034 Tank to D3034
drainfield
Drainfield D3034 CO/MT D3034
Inspector GEG, Ltd. LBENCHMARK (Assumed elevation)
Inspection 100.00 Pt.
Dates: 1st 11 9/12 2nd 11/9 12 -npb..3rd 11/12/12 4th 11/12/12 M OF SIDING NEAR FCO
Community Development Department Approval E46INEEN9 MAL'1�
_00600
§ OF �4
Conditional approval: Date:
Approved:
If
v.v..
r ..A.......ess;�...
O�Q9 CE—]95 a f
Date: 12-1 -jl 04�paaP�zl!a'"a�o�oa
Qa_ro fesslol o0
PERMIT NUMBER: AS—BUILT DRAWING PARCEL ID NUMBER:
OSP 121349 015-301-30
\ 1
INI\ A B
I\
I 1
1 1
l 1
1
1
ST1
145.73
124.72
ST2
52.77
34.66
DBL1
54.91
37.12
DBL2
55.97
38.1
FD
56.65
38.64
FS
58.99
40.91
C01
67.84
42.07
MTI
65.57
39.88
CO2
62.81
57.76
MT2
64.74
59.06
CO3
78.32
70.43
MT3
80.53
71.81
004
82.72
57.92
MT4
80.50
55.60
SKY RANCH
ESTATES #1; LOT 7,
BLOCK 5
�Vgyvl
1
1 OLD
BX1g;R119 DRAIN)
5X BRING \r USED AS RE
HOUSE I
\\ FC
B / T1C01 Oq
/ STI I
T2 MT4#1
FD
DEL
NEW AL
SEPTIC TANK
i 1
1 CO2 TMT I
WELL RADIUS // I CO3
i
� j I
NEW DRAINFIELDS
/
N /
/ I
GARNESS ENGINEERING
GROUP, Ltd.*
:' 4
LH �*
CONSULTANTS & 43ENF-RAL CONTRACTORS
...... ... ..
. ....... .......
3101 E. TUDOR Rd1D, SN6E 101 • "HORAE, W 98501 • PHONE (807)337-61'!9 • FAC (907)536-3246
• WB n. w .9mn ,im n9.<
PREPARED FOR: PHONE NUMBER:
PAGE NUMBER:
••• . . ..
........... .....
PAM & KEVIN MILLER 250-2890
2 OF 3r
oOo
Game s.:
LEGAL DESCRIPTION:
DRAWN BY:
9•.
E-79
SKY RANCH ESTATES 31; BLOCK 5, LOT 8
PNB
.17410 i'2 oAo�
TYPE OF WORK:
DATE:
04°d profession°Qo
�ODpp000�
AS—BUILT DRAWING
11/16/12
O
2
U
Do
BEI
PERMIT NUMBER: AS—BUILT DRAWING 1 TNG PARCEL ID NUMBER:
—
OSP721349 015-301-30
SEWER LINE FROM THE SEPTIC TANK
FINAL GRADE = 95.59-96.16 TO THE UPPER TRENCH RUNS FLAT
TO THE FLOW SPLITTER.
ST1 ST2
TOP OF TANK(� TOP OF TANK
AT INLET = 90.60 / AT OUTLET = 90.57
INVERT OF BUNG
AT INLET = 90.03
WEST TRENCH
i -- 51
NEW 1500 GALLON
SEPTIC TANK
FINAL GRADE
94.98+
,FILTER FABRIC
INVERT OF PIPE
. 99.68
OF
RELATIVE ELEVATION OF BOTTOM OF TESTHOLE = 76.18
(GROUNDWATER ® 80.93)
INVERT OF BUNG
AT OUTLET = 89.80
EAST TRENCH
FINAL GRADE
m 94.18+
,FILTER FABRIC
ELEVATION4 �INVERT OF PIPE
_eorrom OF
TRENCH —
OF BOTTOM OF TESTHOLE = 75.42
(GROUNDWATER:•
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
301 E. TUDOR RDW SUITE 101 • ANCHORAGE, AK 99507 • PHONE (907)137-91)9 • FAX (907)339-3216 WF99OC w .gm n9ln M.wm
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
PAM & KEVIN MILLER 250-2890 3 OF 3
LEGAL DESCRIPTION: DRAWN BY:
SKY RANCH ESTATES 31; BLOCK 5, LOT 8 PNB
TYPE OF WORK: DATE:
PROFILE AS—BUILT DRAWING 11/16/1
2
9
J A. ass;
E-795 •�
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
Permit Number: OSP121349
Tax Code Number: 01530130000
Work Type: Septic Upgrade
Permit Effective Dates: October 17, 2012 to October 17, 2013
Design Engineer: GARNESS ENGINEERING GROUP LTD
Subdivision: SKY RANCH ESTATES #1
Site Legal Address: SKY RANCH ESTATES #1 BLK 5 LT 8 G:2737
Owner/Address: MILLER KEVIN S & PAMELA S
11980 STEEPLE CHASE CIR ANCHORAGE AK 995160000
Site Mailing Address: 11980 STEEPLECHASE CIR, Anchorage Lot Size in Sq Ft: 24730
Total Bedrooms: 5
This permit is for the construction of:
Y Disposal Field Y Septic Tank 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.
Receiv
Issued
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services U& Fax: 907- 343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan
On -Site SewerNVell Permit Application
For A Single Family Dwelling
Parcel 1. D. 605- S01- 30
Property owner(s) KEVIN & PAM MILLER Day phone 250-2890
Mailing address 11980 STEEPLE CHASE CIRCLE *ANCHORAGE, AK 99516
Site address 11980 STEEPLE CHASE CIRCLE *ANCHORAGE, AK 99516
Legal description (Sub'd, Block & Lot) SKY RANCH ESTATES #1, block 5, lot 8
Legal description (Township, Section & Range)
Lot Size
APPLICATION IS FOR:
5
(all that apply)
APPLICATION IS AN:
Absorption Field
Initial ❑
Septic Tank
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Sq.Ft.
a
Number of Bedrooms
5
APPLICATION IS AN:
TYPE OF DEWELLING:
Initial ❑
Single Family (SF)
+ade Z+
Upgr
(w/wo ADU)
❑
Duplex (D)
❑
Renewal
Multiple Dwellings
❑
(SF and/or D)
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 codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: C;,9)0— ^ Waiver Fees:
Date of Payment: 10 I d3 It a. C Date of Payment:
Receipt Number: 0-1 ;)3y G Receipt Number:
Permit No. 0519)a`b `O� Waiver No.
(Rev. 01/11)
September 27, 2012
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Rd.
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Proposed Septic Upgrade for Sky Ranch Estates #1; Block 5, Lot 8;
To whom it may concern:
The existing 5 bedroom house is served by a private well and septic system. The septic system is in a state
of failure and needs to be upgraded. We are proposing to install a new 1500 gallon septic tank and a dual
5 wide trench type drainfield. One test hole was excavated on the property. The drainfield will be
designed around the 30 foot radius of this test hole. Comments regarding the design are summarized as
follows:
1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the
percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system.
4. TOPOGRAPHY: As can be seen on the attached design drawing the topography around the
drainfield is relatively flat between the house and the drainfield and 1-5% slopes running northwest to
southeast between the drainfields and the east property line. In short, there are no slope concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
If you have any questions, please contact us at 337-6179. Thank you for your assistance.
4.S.
3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com
HISPERING SPRUCE Int SKY RANCH
\ ESTATES LOT 2,
\\\
I SKY RANCH BLOCK CK 5
SKY RANCH
ESTATES #i; LOT 14,
BLOCK 5
SKY RANCH
ESTATES #1; LOT 13,
BLOCK 5
SKY RANCH
ESTATES #1; LOT 12,
BLOCK 5
ESTATES #1; LOT 3,
BLOCK 5
i
SKY RANCH < V
ESTATES#15OT 4, \
BLOCK �,� '
r \AREA
L ---
I
SKY RANCH
ESTATES #1; LOT 1,
BLOCK 5
I
ii S --SEPTIC AREA=) 7— — — 1
SKY RANCH \
ESTATES #1; LOT 61 \
BLOCK 5 \
� I
SKY RANCH
ESTATES #1; LOT 7, I
BLOCK 5
SKY RANCH ,A
ESTATES #1; LOT 5, Y
I / / BLOCK 51 1 _
/,700' WELL RADIUS\I
I /
\ STEEPLE,�AkE CIRCLE
1 •,
SKY RANCH SKY RANCH
ESTATES #1; LOT 11, /
BLOCK 5 ESTATES #1; LOT 10, \
BLOCK 5
I �
)SS VIEW ESTATES
iCK 1, LOT 27
(�VA;l
\/ I
I
I
\ / I
�REPAC \\ /
\ /
/\ L
CROSS VIEW ESTATES BLOCK 1, COT 28
1\ ROSS VIEW ESTATES
\\ / BLOCK 1, LOT 29 —�
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS S GENERAL CONTRACTORS.
M E. NUON TIRB, BUNS ICI ' PHCIpRPGE, M 99307 •PHONE (0307-6119 • FM (807)338-3M • WEBSITE: ww.0omm glA dn9.=
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
KEVIN & PAM MILLER 250-2890 1 OF 2
LEGAL DESCRIPTION: DRAWN BY:
SKY RANCH ESTATES #1; BLOCK 5, LOT 8 PNB
TYPE OF WORK: DATE:
SITE PLAN 9/17/12
CE -795
DESIGN CRITERIA: NOTE: THE CONTRACTOR
NUMBER OF BEDROOMS: 5 SHALL HAVE THE EAST &
GALLONS PER DAY (GPD): 750 SOUTH LOT LINES AND ALL
PERCOLATION RATE/S: 6.66 I WELL RADII FLAGGED BY A
PROPOSED APPLICATION RATE: 0.8 REGISTERED LAND SURVEYOF
MINIMUM DRAINFIELD SO.FT.: 938 (� I PRIOR TO CONSTRUCTION.
MAXIMUM DEPTH OF EXCAVATION: 8.5 FT
WIDTH: 5 FEET
LENGTH: 2 0 50 FEET = 100 FEET
EFFECTIVE: 4 FEET
ACTUAL SO.FT.: 100
LETTER THAT PERTAINS TO THIS DESIGN.
TO OBTAIN A COPY OF THE LETTER
CONTACT GEG. BY PROCEEDING FORWARD
WITH THIS INSTALLATION, THE ENGINEER,
WELL DRILLER, CONTRACTOR AND
PROPERTY OWNER AGREE THAT THEY
HAVE READ THESE SPECIFICATIONS AND
AGREE TO ACCEPT THE TERMS AND
SKY RANCH
ESTATES #1; LOT 7,
BLOCK 5
/
EXISTING SEPTIC TANK
.NEt-L BE DECOMMISSIONED I
� UPC.
5XBRING.
�noevHEXI5
HOUSE .. \
FD RESE
` OBLf NEW `S N
/ �\ ''•..j PR1500 �ALLOED NW/ TH#I
/ SEPTIC TANK/ S/ �C
I
ROPOSED
100' WELL RADIUS / � I 7\
n
\ DRAWFIELDS 'NI
' J
\ / SCALE:
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS S GENERAL CONTRACTORS
3701 E NOOR ROOD, SURE 101 • M HOWF, M 99507 • PHONE (907)337-6179 * FM (907)336-3946 • 92690E: xw9�vwMl0 dng�
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: I
KEVIN & PAM MILLER 250-2890 2 OF 2
LEGAL DESCRIPTION: DRAWN BY:
SKY RANCH ESTATES #1; BLOCK 5, LOT 8 PNB
TYPE OF WORK: DATE:
SEPTIC SYSTEM DESIGN UPGRADE 9/27/12
(Rev. 01N6)
0
0
C)
U
K
GO
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS S GENERAL CONTRACTORS
DEPTH TO
GROUNDWATER
SOIL LOG
— PERCOLATION TEST
LEGAL DESCRIPTION:
SKY RANCH
ESTATES #1; BLOCK 5, LOT 8
PERFORMED FOR:
KEVIN & PAM
MILLER DAT
DEPTH ORGANICS
9/25/12 1
(feet) --
1
—
TEST HOLE #1
—
2
SOIL CLASSIFICATIONS
2
1.50"
4.50"
3
3:45
GW ORG
3
—
GP ML
r
�
30
GM CL
4
5
GC OL
—
y
000, o SW MH
5
r�
': �'• : SP CH
M
4.50"
SM ; OH
SC
DEPTH TO
GROUNDWATER
DATE
WEEP ® 16'
N
13.25'
10/3/2012
N
NET TIME
(MINUTES)
N
r
NET DROP
(INCHES)
9/25/12 1
N
—
N
—
2
�rSMALL
30
1.50"
4.50"
3
3:45
—
M
—
'
r
�
30
M
4.50"
5
Mr
—
y
—
6
r�
30
M
4.50"
N
N
M
M
M
M
N
�
�
M
DEPTH TO
GROUNDWATER
DATE
WEEP ® 16'
9/25/12
13.25'
10/3/2012
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
2
A
N
SEE ATTACHED SITE PLAN
Iiiia
l" = ioo,
19� PERCOLATION RATE 6.66 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 6.0 FT. AND 7.0 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ® YES ❑ NO
SOILS LOGGED BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY: ROB CAMPBELL
rnmmrzKiTQ. PERCOLATION RESULTS ARE WITHIN 1/16TH OF AN INCH
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS FEFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 10 f2
DATE READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
9/25/12 1
3:15
—
6.00"
—
2
3:45
30
1.50"
4.50"
3
3:45
—
6.00"
—
4
4:15
30
1.50"
4.50"
5
4:15
—
6.00"
—
6
4:45
30
1.50"
4.50"
19� PERCOLATION RATE 6.66 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 6.0 FT. AND 7.0 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ® YES ❑ NO
SOILS LOGGED BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY: ROB CAMPBELL
rnmmrzKiTQ. PERCOLATION RESULTS ARE WITHIN 1/16TH OF AN INCH
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS FEFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 10 f2
GRE~.~R ANCHORAGE AREA BOf,_JGH
Department of Environmental Quality
3330 g Street
Anahorage, Alaska g9503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
TILE Dt~'A'f'N-F-~-L-'D:
NUMBER OF LINES / DISTANCE BETWEEN LINES
ABSORPTION AREA ,~
DEPTH: 2tOP OF TILE TO FINISH GRADE
FT.
/
NEAREST LOT LINE ~O t/TOTALOF LINES LENGTH
E ENGT' OF EACH ,_,NE __,7 .~ = ~ d /
MATERIAL BENEATH TILE__ IN. ABOVE TILE IN.
WELL: . . . (/~ //
TYPE__ CONSTRUCTION DEPTH
BUILDING NEAREST NEAREST SEPTIC,, ---bSEEPAGME
FOUNDATION_ LOT LINE __ SEWER LINE__ TANK /{Z2, SYSTE _
CESSPOOL ~/- OTHER SOURCES ~/
DISTANCE FROM:
/
/0 o /-
APPROVED___
DISAPPROVED __REMARKS
DISTANCES:
INSTALLED BY: ~
SEWER LINE DEPTH:
LOT SLOPE:
DIAGRAM OF SYSTEM
G,A.A.B.//' ....
Form EQ-032
WATER WELL LOG
FOSS DRILLING
1336 Ingra Street
Anchorage, Alaska 9950! ,.l',.~k ~ ~'
size. o~ o~IN~D "D~.~ oF ~o~.~. CA~ TO ~~~ '?
FE~ OF D~AWOOWN.
FT.
REMARKS
DATE COMPLETED_
PUMP TO BE SET AT
u
to~
tO~
___to__
___t o__
i:;'1F:' F:'I... :t: C:l::li",! [' I-,i'. Ct:ii:;l:i! !.. ]: I!~ T t:::i1::'['.:'1:~
ii ;:ii;i q::i::' [~i: .C ....... 13'1::1'['[~ :~ .......
August 5, ].976
Roselie Tadda
Star Route A, Box 81F
Anchorage, Alaska 99507
R & M No. 656256
Dear Mrs. Tadda:
We are submitting herewith the results of the second test boring and the
percolation te~t regarding soil conditions at the subject site. This
excavation was accomplished with an auger type drilling rig on August 2,
1976.
Test Hole 2 was put down approximately 10 feet to the southwest of
Test Hole 1. The test hole was excavated to a depth of 12 feet.
A percolation test was required and was completed on August 3, 1976.
The results are enclosed.
We regret any inconvenience that may have been caused by the delay.
appreciate the opportunity to be of service to you. Should you have
any questions, please do not hesitate to contact us.
We
Very truly yours,
R & M CONSULTANTS, INC.
~M Ayres ' ~~
Staff Geologist
JMA/ddp
BIRCH ROAD
Location is only approximate
and were not established by
means of survey.
Lot 8 3k 5
Sky Ranch Estates Subdivision
T.H
0.01
ORGANICS
2.0~
SAND W/SOME GRAVEL AND TRACE SILT
(SW-SM)
5.0~
SAND W/SOME GRAVEL AND TRACE SILT
(SW-S~4)
SAND W/ TRACE SILT
(SP-SM)
12.0'
15.0'
SAND W/SOME GRAVEL
(SP)
NO WATER TABLE
19.0' T.D.
6-23-76
I,
Roselie Tadda
Log of Test Holes
Anchorage, Alaska
GRID:
PROd. NO656256
DWG. NO. A-O1
TH 2 8/2/76
SILTY ORGANIC MATERIAL
3I
SILTY SAND W/SOME GRAVEL
ML-SM
GRAVELLY SAND W/TRACE
SILT
SAND W/SOME GRAVEL
8I
10'
NO WATER TABLE W.D.
This log represents subsurface soil
conditions within Lot 8 Block 5
Sky Ranch Estates Subdivision
~,SCALE: ,. 1"=3 ', , ,.,,
INC.
Roselie Tadda
Log of Test Hole
Anchorage, Alaska
IlF'B'
GRID:
/IPROJ'NO 656256
Jl, owo. No.
TIME
10:45
10:46
10:47
10:48
10:49
10:50
10:51
10:52
10:53
10:54
10:55
11:00
11:05
11:10
10:15
10:25
10:35
11:45
PERCOLATION TEST
ROSELIE TADDA
R & M No. 656256
ELAPSED
TIME
0
1
2
3
4
5
6
7
8
9
10
15
20
25
3O
4O
5O
60
60 Minutes
DROP IN
INCHES
0
3.5
4.0
4.0
2,0
3.0
1.5
2.0
1.5
2,0
0.5
2.5
2.0
1.0
2.0
1.5
2.0
2.0
37.0in/hr
1.62 min/inch
I? a, , {L ' L v.4
py � 2� rLW l.0
I �Lc>c.2 .,�..� lc��- �b �o �sz.�c�• c� c�Qa�sc�o
June 23, 1976
Roselie Tadda
Star Route A Box 81F
Anchorage, Alaska 99507
R & ~.! Ho. 656256
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
JUL 2 !976
RECEIVED
RE: .eou Hole and Soil Log Report for Sanitary System
Sky Ranch Estates Subdivision Lot 8 Block 5
Dear Mrs. Tadda:
We are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This investigation
was performed in accordance with your request of June 14, 1976 and those
procedures outlined in a letter dated July 15, 1975, by Mr. Rolf Strickland
of the Municipality of ~chorage, Department of Enviro]uaental Quality.
A single test hole Was.: put down within the Lot 8 area for the purpose
of defining general subsurface soil conditions for the proposed sanitary
system. Excavation was accomplished with an auger type drilling rig and
the test hole was extended to a total depth of 19 feet below ground
surface. The final log prepared for the test hole has been included in
Drawing A-01.
Ground water was not encountered in the test hole.
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate to contact us.
Very truly yours,
R & M CONSULTANTS, INC.
J~.lR/DFJ/ddp
xc: Municipality of Anchorage
BIRCH ROAD
Location is only approximate
and were not established by
means of survey.
Lot 8 Bk 5
Sky Ranch Estates Subdi¥ision
T.H. 1
ORGAN.ICS
· 0.0'
2.01
SAND W/SOME GRAVEL AND TRACE SILT
(SW-m4)
5.0~
SAND W/SOME GRAVEL AND. TRACE SILT
(SW-SZ,!
SAND W/ TRACE SILT
(SP-.SM
12.0'
15.0'
SAND W/SOME GRAVEL
(SP)
NO WATER TABLE
19.0' T.D.
CONSULTANTS, INC,
Roselie Tadda
Ie~,_ Holes
Log of ....
Anchorage, Alaska
Municipality of Anchorage
-. Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 015301-30 HAA #_ 1)51)151
Expiration Date: 7 — 2— 6—
1. GENERAL INFORMATION
Complete legal description Lot 8 Block 5 Sky Ranch Est, No.1
Location (site address or directions) 11980 Steeple Chase Drive q9 511°
Current Property owner(s) HMB Inc. Attn: Ms Kim Glass Day phone (425) 378-9500
Mailing address 13555 SE 36"' Street Suite 150, Bellevue WA 98006
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS: 5
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 Department of Health and Human Services (DHHS) Issues Certificates of Health
Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on properties served by a single family on-site wastewater disposal and/or water
supply system. DHHS also Issues HAAs upon request to home owners. 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 sample results less than 30 days old. 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.
(Fw.I 99)
4. 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 Health Authority Approval Guidelines for 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 applicable Municipal and State
codes, ordinances, and regulations In effect at the time of installation.
Name of Firm _Pannone Eng. Svc. Phone 272-8218
Address P.O. Box 102954, Anch. AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date 3/25/2005
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious
engineering analysis of the system in accordance with MOA DIIFIS Guidelines & Regulations. The
reported results describe the performance of the system under the conditions encountered at the time of
the test, and separation distances measured to readily identifiable features. ne operational life of all
411
wells and septic systems depend on the local soil condition, ground water levels that may fluctuate
0,4
during the year, and the water usage of the family being served by the system These conditions are
4.
outside the control of the evaluator of this system All systems eventually fail and satisfactory test result&120,_
do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects
or encroachments. PES can therefore not provide any warranty for future performance nor give any
•
estimate of how long the system will continue to meet the operational requirements of the ADEC or
jV#�
MOA DIIHS. The content of this report is for the sole benefit of the owner listed above. Any reliance
upon or use of this report by any other person or party is not authorized nor will it confer any legal right
whatsoever.
5. DHHS SIGNATURE
✓ Approved for -S bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
W
-Q jh;W ..... may,,,,
ON-SITE
�ATERAF]IT" • m:
WA4Ty EUA R
PROGRAM
.,.. ,. lu
44 FF r;3
Maintenance Agreements
Supplemental Engineer's Report
Other
BY n Ll Original Certificate Date: 7 —� ✓�� ��
Expiration Date: Reissue Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program s • • T
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot B Block 5 Sky Ranch Est No 1 Parcel I.D.: 015-301-30
A. WELL DATA
Well type Private
Date completed 617!1977
Total depth _2§L_ft
If A, B, or C provide PWSID #
Sanitary seal XU
Cased to 2�ft
FROM WELL LOG
Date of test 6/711977
Static water level 227 It
Well production 10 g.p.m
WATER SAMPLE RESULTS:
Coliform �O—colonies/100ml Nitrate C2.ItVgtlgA
Date of sample: 3/2312005 Collected by: S.R. P.
B. SEPTICIHOLDING TANK DATA
Well Log Y,�
Wires properly protected XCJ
Casing height (above ground) 13 in.
AT INSPECTION
3/23/2003
225 ft
7.0+ g.p.m
Other bacteria colonies/100 ml
Arsenic f mgA
Tank Type/Material STEEL
Date installed 611711OT7 Tank size 1500 gal Number of Compartments 2
Cieanoutsr�S Foundation cleanout YES Depression over tank N High water alarm NIA
Date of pumping -12512005 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA
Date Installed 811711977 Soil rating (g.p.d./fe or te/bdrm) jj_5 System type TRENCH
Length _16 ft Width -L- ft Gravel below pipe 8.0 It
Total depth 13, It Effective absorption area Mfe Monitoring tube ff& Depression over field NO
Date of adequacy test 3/2005 Results (Pass/Fail) PASS For .4 bedrooms
Fluid depth in absorption field before test = In Water added 'jL0 gal. New depthM In.
Elapsed Time: 1440 min Final fluid depth in Absorption rate >= 7'�0 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date
(Rev. 11199)
D. LIFT STATION
Date installed _
"Pump on" level at
Datum
Size In gallons N/A Manhole/Access
In'Pump off" level at _ in High water alarm level at _ in
Cycles tested
Masts alarm 8 circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAlft station on lot 81.8 " On adjacent lots 100+
Absorption Held on tot 100 On adjacent lots 100+
Public sewer main _ N/A Public sewer manhole/cleanout N/A
Sewer /septic service line 75 Holding tank 75+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation B Property line 10+ Absorption Heid 10
Water main 100+ Water service line 24 Surface water 100+
Drainage 100+ Wells on adjacent lots2, 6
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10 Water main 100+
Water Service line 40 Surface water 100* Driveway, parking/vehicle storage 35
Curtain drain 100+ Wells on adjacent lots 100+
F. COMMENT
G. ENGINEER'S CERTIFICATION
I cedffy that 1 have determined through field Inspections and N t',y
review of Municipal records that the above systems are /n
conformance with MOA HAA guidelines in effect on this date. i
Engineer's Printed Name Steven R. Pannone. P.E. �. c isleven R. Cannonef
No CE 814q•.
Date Z 62545 ++i��0 .••
NAA Fee $ q
Date of Payment 411-1/05
Receipt Number L -Coag (�
(Rev. 11/99)
Waiver Fee $
Date of Payment
Receipt Number
PERMIT NO: RECORD DRAWING P.I.D.NO: 015-30130
WASTEWATER DISPOSAL SYSTEM
LOT 8, BLOCK 5 SKYRANCH EST, NO.1
1 �
I I
I I
55.9 I
I EXIST�G 5 BR
I� 40.1 819 HOUSE
NOTES:
1) All work shall be performed in
accordance with AMC15.65.
2) Materials used shall be In
accordance with those specified In
AMC15.65, Wastewater Disposal.
3) Maintain 10'separation to an lot
Imes and proposed water Imes.
4) Lots served by a private well. No
wells within 100' of proposed system.
49 TM
CO
A
B
T1
26.0
13.9
T2
17.3
23.0
C1
11.7
33.6
C2
45.5
61.1
Kms•••••••••••
••t'tfl�
PREPARED FOR:
R. Pannone
HMB Inc.
8149 i
'3 •��
Ms. Idm Glass
SE S4
•.
13555 36th Suite 150
Bellevue, WA 98006
1
(425) 378-9500
T1 T2
i
/
'Cl
\\ C2
PANNONE ENG. SVC, LLC
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
227-3522 P. 272-8218 Fax
RECORD
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IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE PALL EE
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES. WELLS, SEPTIC CLEANOUTS. SIDEWALKS, ORIVEWA+:.
TC FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SN'.,:
THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATE_.
W,•ICH DO NOT APPEAR ON THE RECORDED SUBDIVISION r
UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRJCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF TME SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
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15 B90 S90.22 'Ile 9
SURVEY CERTIFICATION
�1malkli�k
Prepared by
�'6 of Ile'
Robert E. Johns, Jr. &
Assoc.
vLLO+✓LAN
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1'� • •I
*.
Professional Land Surveyors
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1700 BRINK OR.
ANCHORAGE. ALASKA 09301
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Scale: •1 = 30 T
RSa. Lot S.F.
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DateDra.N: 4-17-05
Grid: 2737
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Legal 0••argtim:
PIAL STRUCTURE AS -QUILT
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fogs
Illitila
Sky Ranch Estates, Unit No. 1
❑ Lor wA EY SURVEY TYPE
SYMBOL=
❑ FWNDATON AS -BUNT
...........
• SET REBAR �y DRAINAGE
ASPMAL'
❑ n.µ STRUCT"O C AS -BOLT
0 FOUND REBAR �'
a-O—e WOOD FENCE � CJNCF ESE
❑ vLOI RAN ... AS -BUILT ... LOT SURVEY... TOPOORAI' HY
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IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE PALL EE
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES. WELLS, SEPTIC CLEANOUTS. SIDEWALKS, ORIVEWA+:.
TC FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SN'.,:
THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATE_.
W,•ICH DO NOT APPEAR ON THE RECORDED SUBDIVISION r
UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRJCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF TME SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O, Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
01 530130'1/ HAA #
1. -~GENERAL INFORMATION
Complete legal description
Lot 8, Block 5~ Sky Ranch Esfiah~ No. 1
Location (site address or directions)
Property owner ,.-.~, *~¢^ / I~,,-.~,k ~
Mailing address
11980 Steeplechase C~re.]
Anc. hnrag¢i AK
.~7_~_> _~-',O_ ¢% Day phone
Lending agency
Mailing address
Agent Cheryl
Address
Day phone
Day phone
273-7214
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA #21
STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Anderson Engineering Phone 563-7155
Address P.o. Box 240773 Anchorage, AK 99524
Engineer's signature ~']-cc~, ~'~ Date 12/11/97
D7 SIGNATURE
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Ankh°rage 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 DH HS 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 ~1
Municipality of Anchorage DEC
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825L Street, Room 502. Anchorage, Alaska 99501. (907J~¢~V
Legal Description: Lot
A, WELL DATA
VV~II type Private
Log present (Y/N)
Total depth 257 '
Sanitary seal (Y/N)
Health Authority Approval Checklist
8, Block 5, Sky Ranch Est.ParcelI.D.: 01530130
No. 1
If A, B, or C, attach ADEC letter. ADEC water system number
Y
Date completed
Cased to 257 '
Y
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample: 1 2 / 9 / 9 7
B. SEPTIC/HOLDING TANK DATA
Date installed 6 / 1 7 / 7 7 Tank size
Foundation cleanout (Y/N) Y
Date of Pumping 1 2 / 1 I / 9 7
C. ABSORPTION FIELD DATA
Date installed 6 / 7 7
Length -~ r,, Width
Effective absorption area 5 7 6
Date of adequacy test _ 1 2 / 9 / g 7
Fluid depth in absorption field before test (in.);
Fluid depth 54 (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
6/9/77
Casing height (above ground) > 1 2"
Wires properly protected (Y/N) ¥
AT INSPECTION
6/7/77
227'
10 g.p.m.
12/9/97
222'
6.5
g.p.m.
Nitrate
o'/5"~'J- 6%~/L Other bacteria
Collected by: Stuart Gilbert
1 ,500 Number of Compartments 2 cleanouts(Y/N) ¥
Depression (Y/N) N High water alarm (Y/N) N
Pumper O]r,] MacDonald's_ '
Soil rating (g.p.d./fF or fF/bdrm) 115 SE
3 ' Gravel thickness below pipe
Monitoring Tube present (Y/N) 7'
Results (Pass/Fail) Pa.~.~
1 , 320
N
System type Deep Trench
R ' Total depth 12 ' _
Depression over field (Y/N) N
For 5 bedrooms
Immediately after.1055~al, water added (in.): 88"
Absorption rate = > 750 .g.p.dl
If yes, give date
F,
D. LIFT STATION -
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line *~ Waiver
Lot
Size in gallons
"Pump on" level at*
None on
*Datum
On adjacent lots
On adjacent lots
"Pump off" level at*
>100'
>100'
Public sewer manhole/cleanout > 100 '
Lift station > 100 '
>100'
Absorption field > 5 '
Wells on adjacent lots
SEPARATION DISTANCES FROM WELL ON LOT TO:
>100'
>50'
issued 7/15/86
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation > .5 ' Property line > 5 '
Water main/service line > 25 ' Surface water/drainage > 100 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line > 10 ' Building foundation > 10 '
Surface water > 100 '
Curtain drain None observed on lot
HAAFee $. ~ .'~
Date of Payment / 2.~//~. ~
Receipt Number '~L/L2..¢ ~'
72-026 (Rev. 3/96)*
Water main/service line > 25 '
Driveway, parking/vehicle storage area > 10 '
Wells on adjacent lots > 100 '
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review
of Municipal rec.~.~
in conformance with MOA HAA g_uidelines in effect on this date.
Engineer s Name NJcha,] ~. An~,on, p E ~~'
Date 12/11/97 . ~.
Waiver Fee
Date 0f Payment
Receipt Number
CT&E Environmental Services Inc.
Drinkin~ Water ;~nal2'sis Report for Total Coliform Bacteria 20o w..~o.=~r :,~.
~ Anchorage, AK 99518-1505
~E.~ ZX'$TRUCIiO.V3 0.\' R_EV£RS£ 3;D£ BEFOR~E COLLECTIS'G 3.43[P~E Teh (907) 5~2-2343
F~x: (~07) 5~-5301
· ,,-,~ ~ ~ CO. Ii __ z _D B, \'CATER Sb??LER
c PL~BLIC WATER SYSTEM I.O.~ ~ I ~ { ~
~P~X'ATE WATER SYSTEM
Z Send Reszdts Q Send In voice
Send Results ~ Send lm,oiee
/90
$.-k>,~ LE DATE:
Month
S.-k>,~LE T~'PE:
Routine
Repeat Sample (for routine sample
with lab ref. no. )
Special Purpose
Day Tear
SA>,'IP LE LOCATION
Treated Water
Untreated %Vate r
Time Collecxed
Collected By
TO BE C0>.[?LETED B':' L.-LBOK-kTOPx\'
.-~nai?'sis shows zhis Water S.<>,LPLE to be:
_~ Sa,:ist%ctor,'
,: Unsa~ sfaztop,.'
= Samp!e over 30 hcu~ old, results may
be unreliable
Sampie :oo long in rransiq sample should
not be ever 48 hours v:d at examina.:ion
co indicate reliable results· Please send
new sample via__:,/svec~{ delivery, mail.
Date Received
Analysis Began
Analytical Method: ~..\[embrane Fi(ter
c M>40-MUG
-' - .... ."-zolonies,"lO0 mi.
~44~ Result* Analys,
Sent to A.u.~.~. Jch Fbks .Jun
Time:
Client notified of unsadsfactor?' results:
Phoned Spoke ~ith
Da~e: Time:
Faxed
Faxed
BACTERIOLOGIC:%L WATER .&NALYSIS RECORD
MMO~ML'G Result: Total Coliform
Membrane Filter: Direct Count ~
Verifieadon: LTB BGB
Fecal Coliform Confirmation
Final Membrane Filter Results __ (~
Reported B.',-"~. r)q,~te .[,'~~_
£. Coli
__ COLIFIRM
Time
Colonles/190 mi
Coliform/100 mi
~"~E~GS~ Mem~e-v 7'eSGSG:ou'~fSocie:eGe?era;e.deSurve,r;a-,ze}
//,~lJ[~~ CT&E Environmental Services Inc.
CT&E Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
Sample Remarks:
977442001
Anderson Engineering
Lot 8, Block 5, Sky Ranch Est.
Lot 8, Block 5,Sky Ranch Est.
Drinking Water
Client PO#
Printed Date/Time 12/i5/97 15:39
Collected Date/Time 12/09/97 19:50
Received Date/Time 12/10/97 09:45
Technical Director: Stephen C. Ede
Resutts
PQL
Units
Method
Altowable Prep Analysis
Limits Date Date Init
Nitrate-N
Waters Department Analyses
Total Coliform
0.755
0.00
0,100
mg/L
EPA 300,0 10 max 12/11/97 RMV
col/lOOmL SM18 9222B 12/10/97 TMW
MUNICIPALITY 0FANCHORAGE ' - ....
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
· ' Parcel I.D. # ~015-301-~30 , ·
1. GENERAL INFO ; :- ,... :"
' ' - On-Site Services Section _ - ....
..... -~ ·. P.O. Box 196650 Anchorage, Alaska 99519-6~50I'
; ;',~"?"' '~: "~" "'' ' -': 343-4744 .... .'
"::' '"' Ho"*Y"
..... :. OERTIFIOATE OF HEALTH AUT I - ' ""
APPROVAL FOR A SINGLE FAMILY DWELLING
5,"-S~yranch Estates ' '.
-.Lbca,,tion(si:tea'ddress'0rdirections)-'. 11980 Steeplechase Circl~ :-"' ..........
r '-',~7 ...... '''.'r'.V · .... ." Anchorage, AK - , ' . ' '.:' 'L!,.:,;
-' ..... .':-;3', ProPerty-'0~;~:Sr, ':'"Thomas Plawman ' ' '' ':':'- ' ..... "'"" :' :'"":'""' ":' '""'- '
........ - ............ .t ' Da~p~one 3'45~'4.673'::',;:3:~-, ".3:.,,' :.,
"~J::'"~;:Msi"~:', ~'~';;;~'::::"11 9~6 'SteepleChase Circle Anchorage, 'AK.. :.':'-:?:. ::-.:.'::?'j ,' :..'.'" .
"- ..... ~:' ' ' Lend~ngagency ............... '-' ................. : ....
' :~ .'¥ ' '. Day phone":,' "~'.-::,';- -~:--~.~:::,/-: :--- .:' '.~,': :-:.'
.,' : ..:7.: :: ,~..~:..:._ . .; ..... -
":'::t? .'- ...:,:.r. "'':.t.,;":5.~:-": "" .....
.::~Ag~n't .~o'=t~'e r 2~o2e~t~/CAet~1 ~o~de~ . :': ' ' .'562-7653.',-.:.' ,-~' ',t":' - -
~ Day phone ................. :.,. ....
Unless
[-:: ,:~ ..:.~-~: .:TYPE. O~ WATER ~UPPLY: ?~z~.?: ~:~;.::.~ .~':,. "~- .. ?- .'.: '-:~-:.' '-:, .':.- :.."-".:,: t?::.:'- ......
~:~t:r ~, ~.z.~ :'.~.~F.~$:~ ,~:-'¥~;~ ~t~ ~7~'~"~:.~; ~'~;.~':~.~;~ ~[~¥;~ ~-~:~ .~ ':~'C ':~ ~ .-,:'- ' '
...... ~ty.well ;:-: ~..,.: ..,.._ ;.....-. - . :?: ,-:.;.,.,...%.?~,,._?.:?.:~; ,::v?:~~,~;t~.}~f,.:.
' ,' ,' :' :' .- ~ ~<.~¢'.t'~,:.'?.?'-,"q.:'tt :~-, ~;::'~ '~..P','-,7 :.--L:-'-'~' ~_... V .':' '- · ' ' :: ...... : : ~':. ~;~ t~-:--b,?,%'' :~' ~ ~':~'~-~IF,; :,~'~"~'.~.";'::'.: ':".t' ,':
. .'" '.':: '::(:'.L:.?~;~::h'.'.?~'::~-':".."7'>Bublic water: ::.~:.~;t..:'~t'-:-~': :~ ..' .... , - .? ....:r :-'.: .F;::%"'': :'?. ~.::.-:',:' ?';~'~?:':??::;.~t%~:;-:
NOTE If commumty well system, prowde written confirmatzo~ from State ADEO a~test- ·
.:-.. mg to the legahty and status of system . .: '::- :' ? ':-;.' '..~,~':~ ,'.-.:~.;-,.'.'~. '.: · .':
· ' ~'~-':' ' '~" ....~ .... .'-..'. .... ' -- - ' ' .-.. .. --~ '~ '-~' ,~;,~,)"~' ~.l~)h,,'":";. .' · :: '"
"" · "' .... · ' ' .': · '~ '~:~,~b'~';
' ' 4.':' tYPE OF WA~TEWATER"DiSPoSAL, ' ?-. : ' ' ' '. ' ..: ~.:'~,' ,, :-,.: t',-& .:"~ -': ."'.~ ':",,"
. ,, . -,' ., · ,~.;:, ~.., .,,.:,.,-, . - :., -'. _ . - .. ~ , - q...~.~, · .. ~.~, '-:~ ~.,,,::~ ';.,~.~ -
.......... ndlwdualon ste , .... ~ ,., .
:- . ,.. :' Holding tank"..'~',:.-,...-~: ..'- ::' ' ..... . ".' ' -:-'""~ - ~ ~, ~ '. '~..~:~'~?-:?:2:~, t, - '.
.... . ........ .. ,., , , .... .. ~ ~.% t .... ~ ~.. ..t~....::,.. ,,2-~ ~,, ·
- ,', .' ' "" ':":" :"
, . . ': Public Sewer .':-':: "'. .... % ~,?~,,',,.':' ~.,,~: .
NOTE' If' '~ · .... .. . . .'
· commumty wastewater system, prowde written confirmation from State ADEC
a~esting to the legality and status of system. ._~ / '
. - 5. STATEMENT OF INSPECTION BY ENGINEER
' " '' As cert f ed by mY sea af~ xed he reto and as of the validation date shown bek~W,' l verify thai my
· ': investigation of this Health Authority ApProval application shows that the on-site"water supply
and/or wastewater disposal system is safe, functio hal and adequate for the number of bedrooms _," ' '
and type of structure indicated herein. I further verify that based on the information obt~ii~ed'from '' '? '--''
the ~unicipality of Anchorage files and from my investigation and inspection, the 0n-s te 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. -~i~:.!!,-., ,
..... 563 ~;'7:[55
Name of Firm Anderson Eng~'neering ' ' Phone
._- Address'.' P.O. BOX 240773 Anchorage',' AK 99524
:': ..... ?.,?-.. ' . .. : '_," - ' - ' -~/~.~
.Eng neeCs signature : ~ ' Date · · ~'-.
-.':'-T'" ? : , 't~,.-, ~.. · .-,.~ .
........................ . ,_, ..
C~ificl
stitutions in order to satisfy certain federal and state requirements. Employ°% of DHHS do not
cond'~t~lnspect}~ns or analyze data before a'certificate is issued. The Municipality of Anchorage is not
respons be for errors or o'missi0ns' in the profess ona eng neer's wOrk ; '
72-025 (Rev. 1/91) B~ck MOA ~1
I
e D~pe~meni of ~alth' and HUmah serVi(~i~FiHs)'l,ssues.
upon the representations given in paragraph 5 above by an independent
istered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Sel¥ices Division
825"L" Street, Room 502 · Anchorage, AlaSka 99501 · (907) 343-4744
Legal Description: LoT'
A. WELL DATA
Well typc
Log present (Y~)
Total depth ~ ~
Sanitau seal (Y~)
Health Authority Approval Checklist
If A. B, or C, attach ADEC letter. ~EC water system number
t
Cased to L~ '7 Casing height (above ground)
~' Wires properly prelected (Y~)
Y
FROM WELL LOG AT INSPECTION
Date oftest (,' /q /'7'l qt / I 3 /C}5'
Static water level ~. Z 'l t 27~)1 t
Well production / 0 g.p.m. .c~. ~-
WATER SAMPLE RESULTS: ~K- fi:~.4),¢3 I--~S~ ~OrCt~t£q'Lc~ ~/ S+
Coliform LO Nitrate · /-' {~' t,a~ //_. Other bacteria
Date of sample: I'Z/I'L_JO5~ Collected by: /V~ /~j,jD.CTizgOr.)
g.p.m. Y{:
14.
SEPTIC/HOLDING TANK DATA
Date installed 6, [I "//-/~ Tank size 1%~O 0 Number of Cmnpartments 22- Cleanouts (Y/N)
Foundation cleanout (Y/N) ~ Depression (Y/N) P') High water alarm (Y/N)
Dateofeampil~g~_C//gi~/cq5/ Pumper ~ ~DC.U5 /JOM¢.
ABSOR~ION FmLD DATA
Date installed ~/~7/~ 7 Soil rating (g.p.d./ft~ or .~drm) I]~~-~' System t~c ~ ~t4
Length ~ ~' ¢ '
Width 3 Gravel thickness below pipe ffi Total depth
Effective absorption area ~7[~ L
~ Monitoring Tube present(Y~) %( Depression over field (Y~)
-P s's For a ooms
Fhfid depth in absm>tion field before test (in.); '7~ hmnediately Mter gal. water added (in.):
FMd depth ~ (ins.) Minutes later ...... ~ Abso?ption rate = '7~T) .g.p.d.
Peroxide treatment (past 12 months) (Y~) M' ffyes, give date ~ fl~
Oate ntstallcd~-~.__ _ Size in gallons
High water alarm level~.--~
E SE
· PARATION DISTANCES
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding taak on lot
!
; On adjacent lots
~'-; On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation '> I0 Property line ~ I~) Absorption field
Water main/service line '> ~.~ / t
Surface water/drainage. '2 'It90 Wells on adjacent lots
SEP~ATION DISTANCE FROM ABSOR~ON FIELD ON LOT TO:
t t
Buildiug foundation x~/0 Water mm~se~ice line ~ Z-
Surface water > /00 t
Driveway, parkinWvehicle storage area
Ctmaiu drain ~ ~' Wells on adjacent lots ~/OO t ProperW line
I cert~ that I have determined thrufield in,~ections and review ffg&nicipal records t~:q~j~~ents
in co~)brmance with MOA l[~ guidelines in e~ect on this date ~:.~
Signatur ' ~
~.:, ~.p~.. ~3gl -
...........
HAAFee $ ~ e~ 'C~ Waiver Fees
Date ofPaynlent /~ --//~---~--c~2~~-
Rev. 8/95 OSS: haa.wk.doc
Date of Payment
Receipt Number
12714×95 09:54 COMMERCIAL TESTING ~ 5615389 N0.025 D02
CT&E Environmental. Services Inc.
Laboratory Division
Drinkin~ Water Analysis Report for Total Coliform Bacteria zoo ,,v. ~o=..: o:~,,~.
Anchorag.~, AK 99,518.1~O5
Tel: (907) 582.2343
RZ 4,0 LvST'~UCTI0 3'$ O.V P, ZvEt~E SIDE S£FOIUZ COLL £CTI.X'G SA3[PL£ ,-%x; {~07} 54 ~ -5301
NFL;ST BE CO.',,[PLETgD ~'~' ~,t'AT~ SU'PPLLE~
~ us~ic w..vrg~ sYs-r~.~[ t,m s L.~_ Ill
pRIV.,,T]g WAT£R SYSYE.M
C
,2
Send Rea'u[t$ Q Senn' Invoi?-
~O ~o× 7_,5o0 773
Month Day Year
SA,MPLE 'fATE:
.'~ Routine Q Treated Water
,~ Repeat Sample (for rourlne sample ~ Un[reared Wa~er
wi~h lab vel. no. __ )
G Special PurpOSe
Time Collected
Collected By
TO BE CO.',{?LETED BY L.-k$O.~.ATO~Y
Ar. ai?'~is shows this wa,:..,:r SA..MPLE ~,o be:
,g,,-'
,2
SamoD oVer 30 houri old. resui~ m~,>'
bc u~rdlabie
S,.moD ~oo i,.,n.g i~ ::~-.".si:: sampP- should
not ~¢ over 48 hout~ ol~.~; 4x.?.minadon
:a indi:a':-, ;:i{a~[e ;e~:!t5. Pi:~s,e. send
new ~a.m?~e '.'[a ~ 'f e b,'~'',
' sp:.t.,deJ -..'mail.
lA/tm
Date Ro;eived
Analysis Began
Anal','dcn[ Method: ~*'~ Memor~.a, rtl,er
· e MNtO-.X[UQ
- N'u,~,be¢ o~':oDnie~,'t00
Lab Rrr. No. Result' AnalySt
95.5414 ~
~en[ r,1 .~..O.r.,k..,-~nch Fb'kJ ,Jun
Fa,ad
D -" ~'-': ~.. Tim.:: __
Client nOtified of ualads;ac~0~'.' resul:S:
Da::: ,__ Tim-*:
LOCATION
Faqed
Cori~F',,ents;
BACTERIOLOGICAL WATER .42,L&LY$IS RECORD
.M.MO->R.'G R¢suh; Total Colifoem
McmbraneFik*r: DireciCount
Verification: LTB
Fecal Colltbrm Confirmation __
E.. Coil
t~ Colonies/L00 mi
COLIFIRM__ ...
Final Membrane Filter
12/14/95 18:05 COMMERCIAL TESTING * 5655389 N0.051 ~2
CT&E Environmental Servicea Inc.
........... IJ.
CT&E Ref.$ 95.5414-1
Matrix WATER
Clienn 8ample ID La ~Z~.5 SKY RANCH EST
Clien~ Name ANDERSON ENGINEERING WORK Order
Ordered By MIKE ANDERSON Prinked Date
Project Name coll~oted Date
Project~ Received Dane
PWSID UA
20147
~2/~4/95 ~ 1~;22 hrs.
~2/12/95 ~ 14:20 hts.
Eample Remarks: SAMPLE COLLECTED BY: ~.
Technical Director B~PHEN C. EDE
QC allowabl~ Ext. Anal
Nitrate-N 0.66 ~I~/L EPA 300,0 IoN ~0 1~/13/95 MCr
~'~* See Sampl~ Remarks ~ovm NA = NoU ~alyzed
. {~ - Undetected, R~port~d value is ~he p~a~l~al ~antifi~a~ion limit. LT ~s ~a~
......................... Individual well ..... XXX
'??¢ :?~' .;,,: .' ',: ,.'..NOTE: ~,..-If commum~:Wastewa~or~syst~mr,..provtde wq~en confirmation~from :State :ADEC ~' ,~':~} ~:
72-029 (Rev. 1/91) Front MOA ~1
:' U':.' ". :;and/~rw~te~ater'aisp0sal:.~¢s~'~:~is;~f~fi~tib~al ~nd_,,._~..,~..::._~.~.::_?._.?,~:_~..?.,~.~...:.~..~., ad~uate'for thenumbe~b~r°6~;~%:~?i
4~:~:::;~-.:'*::.'.-'~:.. and~peofstructureindlcat~h~rein"l~u~her. Ye[~'t~atbasea0'ntheinf°rmatj°~°btaine~r~m~';::;;;;(~
. :/:.' ':-;_.--::. :.::~apPlg~and/or waSteWate~:~iS~6~.sy~st~misrin':~'pliance}~ith'all auhici'pal'.'~n
"-'-" ordinances, ~nd:r~Ui'ati'°n~*~'ih ~ff~'0nth~:date 0f this'insp~ti~n.' .':--?
.......... · ': -'~*"-~-~*" Name'of Fi~ ~-'~:~:"~ S&S ~GINEERING ...... -' '- ......................... .-~ Phone
:;.. ~'~ ?~::-?,-:~-~;.:~:':::~.-; ~::.'~ ~;~;:;~. ::-~":~';~ f~;:;. ~:.;.):~:] 7034 Eagle. Rlve~ L~-R~ NO, ~ -,~-: ::.-~'-:~'r '-'-- :~-~--,"~-?
' .... :' ~;"~': :~:~"- :-",-~;~,~;~Gl~S ;''7 :~:' L~' '?; ', .-~ 81Q~ature;;?'2' ~/.,'~ ..... ' ::;'"..~~"~::- ~~" "+ /~':~-" ~ .... ' "~;'P' ;" ~'- ~:'" ' -' ...... D~te
12.~25{Rev. 1/91) Back MOA~I
ROBERTC. COWAN, RE.
ROBERTA. SHAFER, RE.
HEALTH AUTHORITY
APPROVALS
S EWER & WATER
MAIN EXTENSIONS
SEWER &WATER
fNSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
W~STEWATER
DISPOSAL SYSTEM
DESIGN
May 16, 1995
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 8; Block 5; Sky Ranch Estates
RECEIVED
MAY I 1995
rvlu~i~c;p~ht~ ol Anchorage
Dept, Health & Human Service~
A Conditional Health Authority Approval (HAAI was issued on May I,
1995 for the referenced property. All work required for the,
Conditional HAA has ~e~n complete:d.
Please issue a" f~ ~e~lth Authority Approval at this time.
If you require, additional information, please, contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/gk
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
;~%<(~;~:d~?~;.?'~ ... :: ....... .- '; ~.~ CERTIF CATE OF H~LTH
- ,_:,:.c:' .. =~_':~.;.'L'?, Oomplete legal description ,
.:.d:?~54~:~.~?~tl?~;i(s!~te,ad~lre~o.r d!.m.~!on.s):_, .11980. :See pie Chase c~rcte~:~:..., ;',-<,,>-.-~?: ~ ,:,--,.~ ?:., - .. :,-
~,~ ; '~'~i,.'4'~-.4~k,I~~:.' ...... ,_,~ ....... . .,,, -~= ........... ~.-~., .~ .......... .... .
;. '.. ?.~-.;~'.~'.'::::;;~;~Malllng address :- 11980:~ ~.ee~e .. AncAo¢age / ~., '~4~<,.~%~'.:,~:';'.~..;;:?':.¥':-_. - _ ?~:..,. '~.
72-025 (Rev. 1/91) Front MOA ii~l
system.
· ' ~ : .*.~ As certihed by my seal*affixe~ hereto and as* of the validation date sh, own belO,,W~,l~ver;~:tha~my.::~;;.: ~
..... ~nvest~gation of. th~s Health-Auth~r~ App, rova~ application snows ~natme
· and/or wastewater d~spo~lsyste~,~s ~, ~UnCt~onal and adequato for tho numbe(o(bedrooms
and ~pe of structure nd cated here n. fu~herveri~ that based on the information obta?ed'from
the Municipali~ of Anchorage files and from my mvest~ation and inspection, the-on, s~te.wateF:',:¥
. supply and/or WasteW~te?~di~'O~l ~y~t~m' is in'cOmplian'ce With all Municipal and St~
ordinances, and r~ulabonS m eff~t on the'date of th~s mspectmn. * ' ~' .:__'... t~.L '"'
..... ,;. '. ,: ....j, ~:,: ~ - ,, ' :: ,. · . * ..... ., ,~','.~":: "..U~::¥ 7. '
.~ .... respone r om
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~-.V'12,qr-sOt4 ~"7'. L~, ~ Parcel I.D.
A, Well Data
Well type ~'2.t ur~--(-G_ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) t/"E~5 Date completed ~ Driller ,,
Total depth ~ ~-:;~"~ ~ Cased to
Sanitary seal ~N)
a~,co'-~)- Casing height
Wires properly protected (Y~)
FROM WELL LOG AT INSPECTION
Date of test ~/'~ /~- :?_ L///~ ~'~
Static water level ~:~-~ t ~ I ~ '
Well flow I0 g.p.m. ~,~
Pump level1 ~ ro \c., c~.,;2.0 '4-
SEPARATION DISTANCES FROM WELL TO:
.,~ ,
Septic/he{{r~'g tank on lot ~-"~'
Absorption field on lot -¢ c~-~ r
sewer main /-,~,,'~J.-
Public
Sewer service line ~_~
; On adjacent lots /od 'Y-
; On adjacent lots /od ',~
Public sewer manhole/cleanout
Petroleum tank
.g.p.m.
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOL-DIN~ TANK DATA
Date installed ~//::2-/-~'~
Cleanouts (~/N) ~"'~
High water alarm (Y/I~
Date of pumping
Nitrate
Tank size
~, /,/L~ nt~/~ Other bacteria
Collected by:
Eagle River, ' '
Foundation cleanout
/(d:~(-5 (~c Compartments
k~% Depression (Y/r~
Alarm tested (Y/I~
Pumper /~ ¢- //O/V/iS ~--~-/2V(C~
SEPARATION DISTANCES FROM SEPTIC/HeI=ENNG TANK TO:
Well(s) on lot ~ -"~-/---/- '
To properly line 1.0
Sudace water/drainage
72-026 (3,,93)' Front
On adjacent lots [Otb
Absorption field_
Foundation
Water main/service line
CONTINUED ON BACK PAGE
Date installed "---.. Manufacturer
Size in gallons ~ Uanhole/Access~
Vent (Y/N) "Pump on" level at~'"""~ _ ~ump off" Level at
High water alarm level
Meets MOA electrical cod~
SEPARATION D~O~O~$TC~E FROM LIFT STATION TO:
~.~Ne11~ lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
[;)ate installed ~,//~
System type
Length
'rotal absorption area
Date of adequacy test
Width
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y~)
Soil rating (GPD/FF)
Gravel thickness <~ Total depth
Cleanout present ~.~N) /~'"'~ Depression over field (Y/~)
Results (pass/fail) ~%% for
6' ,~r After test f~. O
~O'T ~. r~o.~ ~ If yes, give date /,O/,~-
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~ c~,~ ~
To building foundation
Surface water
Curtain drain
(
On adjacent lots ~ ~ ~
/ocs
E. ENGINEER'S CERTIFICATION
On adjacent lots /Oo L/ Property line
1 0 '-/- To existing or abandoned system on lot
Cutbank tO//-~ Water main/service line
Driveway, parking/vehicle storage area
HAA Fee $
Date of Payment
Receipt Number
I ce¢'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in e~_~a, te of this inspection,
Signature -~ .:..:'..' ...... ., '"" .~<:~:***:* ',
Engineers Name }~ ~ C. ~w~ "'~'~' ........... ' ...................
Waiver Fee $
72-026 (3~3)' Back
04×~2×~5 ~5:46
COMMERCIAL TESTING ~ 90?6941211
N0.198 ~0~
Commercial TeSting & Engineering Co.
Env;ronmental Laboratory Service~ ~',a~j,~j.~r~,,~,~~~'~.~,,ar,4~j,~f~f~f~~
DrLnk/ng Water Analysis Report for Total Coliform Bacteria
~ ~vsr~ucr[o,vs o~v~as;sawz~s~orz COZZ~cr.r,v~ S/~'Z~
5633 0 Street
AnChorage, AK 99~18-1600
Tek (907) 562.2343
Fex: (907) $61 ,~301
MUST BE COMPLETED B'
PUBLIC WATER SYSTI~M I.D,
4,PRIVAT~ WATER
SUPPLIER
Mouth Day Year
'SAMPLE TYPE:
~ Routine
0 Treated Water
O 'R.epeat Sample ({'or rout~e,~amp], 0 Untreated Wate~
~thJabreLno., ,., ~)
O Special PUrpose
T~e CoUected
SABLE LOCAT~0N
- Cofleeted
COMPLETED B Y LABORATORy ---'
Analysis shows rhls Water SAMPLE to'be:.
Saf~eCtory " ..
D S~ple over 30 ho~'s old, reach may
be ~eh~bl~ '
8~ple too long ~ ~sit; s~ple should
not b~ over 48 ho~s old at
to ~dicate reliable re~. Plebe ~cnd
new s~pl~ via sped~ deliv~ m~l.
Date Received ~ ,, . ~'"~ I
Analysis Begat, ,
A. ual~ical Method: ~ Membr<c,Fiiter
n MMO-MUO
Number of ch onJes/'100 ral.
Lab Ref, No. Result* Analyst
Scnl (o A.D.E.C. Anch Fbk~ ' Jun
Faxed
Time: .....
Cljettt' notified of tlUsatisfact0D. reault~:
Phoned Spoke ~t[h
BA CTEKIOLO G~ CAL WA, TER '.(N.kLYS IS RECORD
MMO-/vfUG R~ult: TotM Coliform
---- --~ '~ Cola'
Membraoe Filter: Db'eet Count
...... ~' Colonies/100 r~?
Verificatiou: LTB ~ ~ BGB __ . COLIF[RM
Fecal Coliform Con.salon
w
ENVIRONMEN-/'AL '"ACILITI~$ Ib,' Al.ASK& Member of the SGS Group tSoci~16 G~n._-r~le de Surveillencel
· COLORADO, £LORIDn., iLLih.,Oi$, MARYLAND. N="hA~jE.o, ETy n~,ln
04×17×95 09:0G COMMERCIAL TESTING ~ 90?6941211
CT&~
M~t¥ix
C~ient 8ampl~ ~D
ClleDt Nam~
Ordered By
Proje~
CT&E Environmental Services Inc,
Laboratory Division ~-~ .... L_-J~%;-- ~L-~- ~.JCJ.--~..~ "
,~. 1~ ~-i Laboratory Analysis R sport
WATER
L8 BLK~ SKY,iNCH EST
$ & S EN~INMERIN~ WORK orde~ i3816
R, 8HAFER Pringe~ Date 0~/17/95 ~ 10:15 hrs.
Received Date 04/11/9~ ~ 16:00 hrs.
UA
Technical Dir,~tor STEPHEN C.
Sample Remarks: ROUTINE
~itrate~N 0.72 m~/L EPA 3~3.2 10, 04/13/~5 04/13/95 C~R
~* See ,Sample Remark~ A~ov¢ NA ~ Not A~alyzed
~ = %h~de~eoted, Reported val~e is the practical q~a~l~oation limit. LT = Ls~s Tha~%
? - Secondary dilution. ~T - Greater Than
200 ~. P~ffe~ Pdv., Anohota~. AK 99~ 8-I ~0~ -- lek {907) 552-23~3 ~x~ (907) ~B1-530~
~NVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND. MICHIGAN, MISSOURI, NEW JERSEY. OHIO, WEST VIRGINIA
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
GENERAL INFORMATION
(a)
(b)
(c)
Legal De,~cription (include lot, block, subdivision, section, township, range)
Location (address or directions)
'
Applicant is (check one): Lending Institution []; Owner/builder,J~; Buyer []; Other [] (explain);
(d) Lending institution ~. P ~ Telephone
Address Co .~'/--z.-~ _..-?t _,....~.,¢~, ... ,~ ¢"~~, ~,
(e) RealEstate mpany and Agent ~ ~¢~ ~~ /~~
Telephone ~F¢~ 2~ 1/
(f) Mail the HAA~o the following address:
5 & S ENGINEERING
-~ ~ 196X
~LE ~JVER, AK 99577
TYPE OF RESIDENCE
Sing e-Family¢ MultL-Family
Number of Bedrooms
Other
WATER SUPPLY
Individual Wel I,~ Community [] Public []
Note: If corn munity well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status
4, SEWAGE DISPOSAL .
Onsite,~ Public [] · Community [] Holding Tank []
Note: If community well system must have wr tten confJrmat on from the State Department of Environmental Conservation
5.: :ENG!NEERING FIRM PROVIDING h.~PECTIONS?TESTS, iFILEisEARCH~DATA .,~DLiNFORMATiON:~i: .,~ ~[:;~'~ ~
· As cerbfied by my seal affixed hereto and as of the validation date ~hown below, I verifY that my investigation~0f this Health
Authority Approval shows that the on-sRe 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 flies and from my investigation and inspection, the on-site water supply and/or
wastewater disposaJ system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspecti~n~ S ENGINEERING
Name of Firm 5E B ] V6X Telephone ~¢¢~¢~
Address
~G~RI~~9~
DHEP APPROVAL
Approved for bedrooms ey
Approved )~ Disapproved
Terms of Conditional Approval
Conditional
Date
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP issues Health Authority
Approval certificates based solely upon the representations given in paragraph § 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 Municipali!y of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
..~
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
/',4UNICIPALITy OF ANCH~KLiST . FEBRUARY 1984
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION 264-4720
Legal Description: I,--~.¢
J u N 3 0 1986
WELL.ATA RECEIVED
Well Classification '/----~, If A, B, C, D.E.C. Approved (Y/N)
Well Log Present ~_~N) Date Completed ~ -~'/- '7'7 Yield
Total Depth %L~ "7 ~ Cased to .~..~ .? /
- · Depth of Grouting
Static Water Level '4 ~ C~ ' Pump Set At O, I('~
Casing Height Above Ground "~-hL ~' Sanitary Seal on Casingd~(~)
Electrical Wiring in Conduit ~.~/N) Depression Around Wellhead (Y/~'~
Separation Distances from Well:
To Septic/~ldmg Tank on Lot ~ I ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ...MC~r' cf'~; On Adjoining Lots
To Nearest Public Sewer Line ¢' To Nearest Public Sewer
Cleanout/Manhole bi/)x To Nearest Sewer Service Line on Lot
Water Sample Collected by ~----~"~'~ ~'~ ~"~'~"'~ ; Date
Water Sample Test Results "~¢~,
Comments '~'.),¢.¢-,.-,_.. '~/t~o '~'i~l~"~r .~--~-~,~.,x,~~-~ O,~
B. SEPTIC/I~G TANK DATA
Date Installed
Stand pipesg.~')N) Air-tight Caps ~/N)
Depression over Tank (Y~}
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/4"-Iofdirf~g Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line /
Course t,I/~
Size. \~,~('~y'.,Z,) _ No. of Compartments
Foundation Cleanout
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
'1'] ~ bI,) ¢V"~'"'" To Building Foundation _. ~ {C.~ /
~ t? [ ~' To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~ '~ !'~1 - '"-~'~
Width of Field '~t¢~
Square Feet of Absorption Area
Depression over Field (Y,~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field ~L,'-~ )
Depth of Field _
Gravel Bed Thickness ~.)
Standpipes PresenCeS/N)
Date of Last Adequacy Test
J
'k~ To Property Line \ ¢:* ) -,~
To Existing or Abandoned System on
; On Adjoining Lots "~ L~
TO Cutbank (if present)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"P~ump Off" Level at
j-.1 / Vent
: Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify t~ ~a~j~gj~jj~j~j~jf~d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed S~ ~ ~6]'(, Date JUN 2 2 1986
Compa~~JJ7%~j(~_ MOA No.
Receipt No. ~ ~'~
Dateof Payment
Amount: $
Page 2 of 2
72-o26 (11/84)
P,O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TONY KNOWLES.
MA YO R
DEPARTMENT OF HEALTH ~', HUMAN SERVICES
July 15, 1986
Robert A. Shafer, P.E.
S & S Engineering
SRB 196-X
Eagle River, Alaska 99577
Subject: Lot 8 Block 5 Sky Ranch Estates Subdivision
Waiver Request, WR86-089
Dear Mr. Shafer:
This department concurs with your assertion that the 100 foot separation
required between the septic tank and well is not required in this case.
An evaluation of available hydrogeological information has indicated that
the well on the subject lot is adequately protected from contamination.
The well to septic tank separation is hereby waived to 77 feet, and the
well to absorption area is waived to 93 feet. This waiver is valid for
the existing 5 bedroom septic system only. Any modification of the present
system will invalidate this waiver.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
SSM/ljw
ROBERT A. SHAFER
July 14, 1986
CIVIL ENGINEER
694-2979
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SiTE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
Department of Health and Human Services
825 L Street
Anchorage, Alaska 99501
ATTENTION: Steve Morris
REFERENCE: Lot 8; Block 5; Sky Ranch Estates
Dear Steve~
In our l~tter dated June 27, 1986 requesting a waiver between the well
and the on-site wastewater disposal system for the referenced property
we requested a waiver between the septic tank and the well at 77 feet.
In this letter we had neglected to indicate to you, also, that a waiver
is required between the well and the leach field of approximately 93
feet.
Based upon information available it is our opinion that the horizontal
separation distance is also not necessary in the case of the leach field.
If we~be of further service, please contact us.
R~ERT A. SHAFER, P.E.
RAS/ss
SRB 196X EAGLE RIVER, ALASKA 99577
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
ROBERT A. SHAFER
June 27, 1986
CIVIL ENGINEER
694-2979
Municipality of Anchorage
Department of Health and Human Services
825 L Street
Anchorage, Alaska 99501
ATTENTION: Steve Morris
REFERENCE: Lot 8; Block 5; Sky Ranch Estates
Request you approve the attached Health Authority Approval application
and grant a waiver to the horizontal separation distance between the
private well and the septic tank located on the referenced property.
Attached for your review, in addition to the HAA application information,
is a plot plan and a copy of our waiver review work sheet.
As indicated by information from your files a waiver was previously
granted by the MOA in August of 1976. An on-site inspection was completed
by the MOA in June of 1977 indicating that the septic tank was over
100 feet from the well. This report was in error in that the septic
tank appears to be approximately 77 feet from the well.
Based upon the information available and the point value obtained in
the waiver review, it is our opinion that the horizontal separation
distances prescribed by 18AAC72.021 are not required in this case.
If we maybe of further service, please contact us.
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
SRB 196X EAGLE RIVER, ALASKA 99577
,~fl]NI(.IPAL T~ OF ANCIIORAGE
DEPARTMENT 0[7 HEALTH AN)') ttUMAN SERVICES
WAIVER REVIEW WOI~KSllEET
DATE RECEIWJD:
APPLICAN ,_~
CRITERIA:
1) Geology: Points:
A. Water Table .... ~7_~,..~ .......
B, Soil Sorption .... .'?.I-~. .....
C~ Permeability ._~/~.,. ~ ......
D. Water Table Gradient .... ~_.
E. Horizontal oeparation ...... [~,~L ....
2)
3)
granted, with cot~ditions listed below:
not granted for rea~sons !istad
WAIVER I,.) ,. ............... z,;
DAJ, L.. ....................................................................................................
DATIz RECEIVED
~ INSPECTION APPOINTMENTS (~ _CJ:~,.J--c,.¢'~_~? '~;)"~ _
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT, OF I:: .',.L'[';~ &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~RONM~NTAL ;:ML'FECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
~Fl~/I-h
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~ ~l~
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPER~YOWNER j PHONE
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
MAILING ADDRE88
I PHONE
3. LENDINGINSTITUTIO~
MA~LINGADDRESS
4, REALTOR/AGENT ~ ~ ~~ ~ ] PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four
I~ SINGLE FAMILY [] Two ~- Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7, WATER SUPPLY
INDIVIDUAL*
COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.)
8, SEWAGE DISPOSAL SYSTEM
I~. INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connect[on Verified INSTALLER
[]Septic Tank or E] Holding Tank
Size: /~-pO If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. ~)ISTANCES Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
WELLTO: /OO-7~
Absorption Area to nearest Lot Line
5. COMMENTS
/APPROVED FOR % BEDROOMS
[] CONDITIONAL APPROVAL {letter must ~.cc, o~an¥ certificate)
[] DISAPPROVED
DATE BYe_.
72-O10 (Rev. 6/79}
~'~., MUN I C I PAL I TY OF- ANCttORAGE
/?~.~-'~,,~\ DEPARTME OF HEALTH ANDI ENVIRONMEN' ~ PROTECT[ON
I1~ ~ 825 L Street, Anchorage, A]_as~a 99501--
'=7'~Q-q~aOOO~ b~[~O"L' Date Received: June 30~1977
%1: Time .~,.~] ~ ~2: Time ~3: Time
' ~ ~7 ~t~ Date DaLe .._
Date U~ /~ .......
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER
Lending Institution Request: 1st National Bank of Anchorage % Robin
Mailing Address: 811 East 36th Avenue 99503 Phone: 276-6911
2. Property Owner: Frank and Rosalie Tadda
Mailing Address:
Phone: 349-4295
3. I, egal Description: Lot 8 Block 5 Sky Ranch Estates #1
4: S.inqle Fami]_y Residence: {~) Number of Bedrooms:
MultJp].e Family Residence: ( ) Number of Bedrooms:
Well System: Tndividua]. We]_]_ ~) Conm~unity/PublJ.c Sysnom ( )
Permit ~,I ~7_gpf~_~) ~ ........ Depth of Well W~,].l Log on E'il~ (
Construction Bacterial Analys~s
Sewage Disposal System: On-site System ~) Public Utility ( )
Permit tt ~[~[o~ Installed ._~_~77__ Installer
Septic Tank Size /,~.~[~m~ __ blanufacturor _ ~0~
Absorption Area ~p~'__~ Soils Rate ~_2l=5 .... Material
7.
Distances: Well to Septic Tank
to Sewer Line Nearest Lot lJ_ne
to Absorption Area
Absorpr~ion Area
to Nearest Lot Line
Page Two
Department of Health and Environmental Protec%ion
Request for Approval of Individual Sewer and Waqer Facilities
Legal Description: Lot 8 Block 5 Sky Ranche Estates Sudivsion __
Af fadavit Attached
Disapproved:
Letter Attached: ( )
Da Le:
Da~e:
Department Worksheet:
MUNICIPALITY OF ANCtiORAGE
Department of Health and Environmental
Pro hec~.~en
825 L Street, Anchorage, Alaska 9950~1
279-2511, ext. 224, 225
~equest for Approval of Individual Sewer and Water
Property Owner:
Mailing Address:
Name of Buyer:
Mailing Address:
Frank and Rosalie Tadda
SRA Box 81-P, Anchorage .AK
Same - Building House
Phone: ~49~_~2~ Home
243-1541 - Hers
277-8551 X.229
Phone:
Lending Institution: First National Bank of Ketchikan
Mailing Address: 811 E. 36th, Anchorage ~.AK 99503 Phone: 276-6911
4. Realtor/Agent: None
Mailing Address:
Phone:
Legal Description:
Street Location:
Lot 8, Block 5, Unit No. 1, Sky Ranch Estates
Steeple Chase Circle, Anchorage, AK
Single Family Residence: (X) Number of Bedrooms: 5
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply: * Individual Well ~X)
If Individual Well, well depth ?
If Co]mmunity System, name of system
Public/Co]mmunity System ( )
*NOTE:
Sewage Disposal System: On-site System (X) Public System ( )
If On-site System, date of installation: ?
A well log is required on ALL wells dri].led since 6/75.
3/77
J~e,,MUNiCiPALITY OF ANCHORAG[
//F~]N 825 L Street, Anchorage, Alaoka 9~!;5~l;bi.<~4,!i!,.~u..~,u~u:~.ilON
t~x~~)] ' 279-2511, ext. 224, 225
.... ~ uest for Approval of Individual Sewer and Water faci~llt~S
~. P~ope~y Ow~e~: P~ank and Rosalie ~adda
Mailing Address:
Phone: 349-4295
Name of Buyer:
Mailing Address:
Phone:
Lending Institution: First National Bank of Anchoraqe % Robin Holmes
Mai].ing Address: 811 East 36th Avenue Phone: 276-6911
Realtor/Agent:
Mailing Address:
Phone:
Legal Description: Lot 8 Block 5 Sky Ranch Estates #1
Street Location:
Single Family Residence: ( ) Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply: *Individual Well ( ) Public/Conununity System
If Individual Well, well depth
If Community System, name of system
( )
Sewage Disposal System: On-site System ( ) Public System ( )
If On-site System, date of installation:
*NOTE: A we].], log is required on ALL wells drill_ed since 6/75.
3/77
I
/0 Cc/
LOT g~Y CERTIFICATION~_ --.,--~--. ~ eroas COp Monument
e Iron Pipe
Lot ~ Block %~ Amo~Z~ Sq. Ft
- -t ............... ." --~ D ~urvoy Hub ~ T(ic~t
Plot File No.~~--~Zonin~ Oistrict~~== [~~
Anchora e Recording District, Alaska ~~~ ..... [~'~ BY
;-~FF~q~T~{W~/D· WSkCtq' lCCI Residence of'.
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