HomeMy WebLinkAboutSKY RANCH ESTATES #1 BLK 5 LT 3Sky Ranch
Estates #1
Block 5
Lot 3
#015-301-35
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH
AND HUMAN SERVICES
Environmental
Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
Name G/NDA LOU S4/Vkn.1,e
DISTANCES
TO
FflOM
SEPTIC
TANK
ABSORPTION
fIELO
WELL
AGGrase
'80 x /� Q l af N
WELL
t
7>100
p�F
pnone(v
Parma No.
No of Beti,M a
.Y/i$-O
1 qeocel-Q
I 3to
LOT LINE
51
SJf�
IQI
LEGAL D11CmIbOM
Oce
SllbdYlaM
r '*
FOUNDATION
/LSI
(4
Townalap. Range. Sectgn z
�
(.a/ )
2 ^� I sp r' (�
AS-BUILT
ABUILT DIAGRAM IS ww bcatwn of wen,
d
ewey. water Goes. etc)
septic system, propeny ones. tounoaeon,
TANKS
S
a � J
'pa /
SEPTIC ❑ HOLDING
a u4pur
X;7,
Qpaury m pLbna
/000 ! S5767Zl? .
>a
57
Mata al 0
57
No of Companmenn
TYPE OF SYSTEM
❑ TRENCH BED ❑ W. DRAIN [IOTHER
/
?
Depth 10 pp* bottom f om
Originalpraoe
Total depth from p MI yr.ae
//
/ N
2
FT
2 �/1+ FT
Fe a food above p.p,nm grace
Grave depth omeam p.
2 •7-t FT
1p �� FT
G," Mrptn
�o
Gravel wnflh
z¢
FT
FT
r
a
Tow atpsora w"
0
D.Slance between saes
SO FT
FT
Number of an«
sal ratmp
P.Pe matuwIr
-4
12/2 So FT
l/G
Insulate, D
llea Dale Inala
a
WELLS
PRIVATE ❑ OTHER (Identitvl
Gasphcaaon (ATE) Toles Deem Gast to
J
'�%
FT FT
Bt
Insuibr ` / pais Insallet,
Q(
REMARKS:
/ ^ -
Y' 141laut V4114 3 AhZlWee2l
q 5.
-
Scale: //''����'' �
tIGlIS
. 10016I10EER! AL
�
rte'.. 1. • I . �_�
Dale 07 .1
'yi „ E IAJ
u
gently
'wi/ Perla , ding b ell
��, . .. J
. Cr -e J. C.-
Municipal and SUte guidelines In allied on Ihis da¢ ee
Municipal
- V
tp
i ',• �. CES�:^3
•�C_.'�,,r
Hea811 Depannlant Approval:
Dace.
-013(3185)
REORT
ON
MUNICIPALITY OFIANCHO AIGE, BUILDING SAFETY DIVISION
INSPECTIONS (907) 5g563.34643500 EAST TUDOR ROAD
FINFORMATION (907)7gg.gZ11
��-/�1�+^_.s'` �iah�,�PERMIT NoFo
ADDREBS a� e •e' [�PONE� ' -CCBLOCK /yZ, SUBDIV.��?? / ^DATE r ^ / TION FOOTING ❑ ELEC. TEMP. `� ❑ PLBGUNOGR.—BEAM ❑ ELEC. SERVICE [,�pLBG. ROUGHFRAMING . O ELEC. ROUGHI0GAS TEMP.TION ❑ ELEC. FINAL❑ OTHER ❑ GAS
ROCK ❑ ❑ MECHANICALT. FINAL _ ❑ FIRE FINAL MECH. FINAL ❑ ZONING ❑PLBG. FINAL ❑
❑ OTHER❑ONCOMPLIANCE OBSERVED ❑ CORRECTIONS ESSENTIAL AS
eves......_._.._.._ EXPLAINED BELOW
COMMENTS / ? /
-wntN I;UHRECTIONS ARE MADE, PLEASE CALL FOR INSPECTION
84ao21a... 111e7l DO NOT REMOVE THIS NOTICE
3c� 9 v
I•I CJ N 1 C 1 F' A L I 1 Y O F A N C H 0 1< A U E
Department of Health & Human Services
025 L Street, Anchorage, Alaska 99501 343-4720 CC_-�,VLX__�L 0,
O N- S I T E S E W E R a S E P T I C T A N K: P E R M I T
Permit Number: 900092 Upgrade cu,gtwo9a (n-1-0to
Date Issued: 05/00/90 Engineer Designed -L oc,..0 -
ttam
Owner Name: LINDA LOU ZANKIE Day Phone: --
Owner Address: HOX 1440 345-5410
RED LODGE, M1 5906E1
Parcel Id: 015-301-35
Lot Leq_al. Subdivision: SKY RANCH #41 Lot: Ellock: 5
Section: 22 Township: 1211 Range: 3W
Lot Size 14416 (sq.ft. or acres)
Ilax L'edrooms. 'Ihis Permit.: 3 total Capacity: 3
SEPTIC IAtll'. Minimum total septic tank czipacity: 1,000 gallons. Each septic
t_.anf.: nui_t have at. least 2 compartments. Depth to top of septic tank(s) 4.0
legit requires innulation over t_+nl(s).
DLVIA110N F-Wrl DHIIS APPROVAL PRIOR TO
CCIIVST10.1C11014. rw InILEn IIUS'1 COtrirm NtE 4 FI.- VERTICAL SEF'AR-
7 i i cl1.I FROM' IiF(OC!,.m m ER UPI UF'H 1 LL F'L)H I I Ul I OF DEM, DURI NO CUt IS FRUC T
CN. IM-,Tt1LJ_(iTION OF A 1_IF-1 SIAI1011 kfzt_)UIRLS APPROPRIOIE ELECT-
FN'ICAL ItJSF'LCI lUN. TfIIS r1Lf4III IS FOR A 3 E?EDROON SINGI_F FAMILY
kES1DENCL-' UHL_Y. AND EXPIRLS ON 12/31/90.
I CERIIFY THAI:
1. I am familiar with the requirements for on-site sewers and wells as set.
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
_. I will install the system in accordance, with all MOA codes and regulations,
and in compliance with the deaaign criteria of this permit.
I will adhere to all OA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sews!rage system on ;is or any _ad.jacent or nearby lot.
4. I understa - that th s permitis valid for a maximum of 3 bedrooms. 1
talsD uncle s and that the rapacity of the total system is 3 bedrooms and
any enla g' .,nt wil uirer an additional permit.
Signed: DA1E: 5
(Gainer) I-- UJZF' It::lt'.
I<.=ued Eoy: DATE:
_------- --I--- -------------- ------
-O ---
r Municipality of Anchorage
e
Department of Health and Human Services
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
May 9, 1990
Bruce Corwin, P.E.
Corwin and Associates
PO Box 230608
Anchorage, Alaska 99523-0608
A
Subject: Waiver Request for Lot 3 Block 5 Sky Ranch Estates #1
Waiver Request #WR900015, PID # 015-301-35, Permit #SW900092
Dear Mr. Corwin:
Your request for waiver 'of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 5 feet from bed to lot line.
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Robert W. Robinson
Civil Engineer
On-site Services
RWR/1jm#7
\ opo .G•rxrs� Se.c�er
5h
Well i 1
,Joie: Ivor��-�����=
Gl<J zrreeG, Lova -A4 Oil/
F' SEWER. SYSTEM'•LOCATI®N PLAN
y �R��,�'� SECTION/TOWNSHIP/RANGE
"i� 9Qi�e
~ • SCALE, A NOTES
THE ACCURACY OF LOCATION OF Ex13TIN0
•��F" }" ° '�' PROPERTY CORNERS, WELLS, AND SEPTIC
�ysaosua DRAWN BY%� /� SYSTEMS INDICATED IS NOT EXACT.
o s Q v
` NORTH DIMENSIONS INDICATED HAVE BEEN
'�' °rp"'•^•+,...,. ., DETERMINED BY USE OF CLOTH TAPE AND
MEMO NOT BY SURVEYING TECHNIQUES. _
n
O- PREPARED FOR,
lir, s f1ndpTnaers k s
DATE, J SHEET OF
eN
Pe/ -A �0y oe
NOTE: Owe ails 47,70/�T /
All Dimensions And Locations Must Be Field Verified Prior To Construction
SEWER SYSTEM LOCATION PLAN
LOT BLOCK �`� /) / 6 DDI VI SION
'
SECTION/ TOWNSHIP/ RARANGE
➢1' 'ga ��ps°t� _SL
c '88 ,meg ' / `/-� Q
IN.
�M'e 5 SCALE' /w l/ wile NOTES Y 9
% 1 0C The Accuracy OC Location Of Exisitin Md
Proposed Property Corners, Hells, and Septic
DRAWN DY`^
k • 4••aw raaeaa,6 nwa ,�' Y �/ � Systems indicated 1% Not Exact. Dimensions
NORTH H Indicated Have Been Detcrained By Use OC cloth
:w •••• rn „�.�,..�...� ,.,�ao-e...�.......� Tape and/or municipal Records, And Not By
Surveying Techniques
J. I-QIVM Ski ly
�j. O _. ! PREPARED/FOR, ///�•
T I DATE' 3LI U SHEET Z OF
.5-, `
Municipality of Anchorage �s
�{ DEPARTMENT OF HEALTH 3 HUMAN SE%IC
825 "L'• Street, Anchorage, Alaska 99502-40519
SOILS LOG - PERCOLATION TEAS' �Q»-
!/ (kiL/ C—L� �✓ � AUS � �:.:
PER EORMC-O FOn:
LEGAL DESCR(PT(ON: (SCJ /✓C� C/ L TOWnship. Range. Section:
DQ P� n
PTH SLOPE /GAt'
1
2-
3-
4
34
5
6
7
8
9
lU WAS GROUNDWATER
ENCOUNTERED? cC�J
L
IF YES, AT WHAT O
DEPTH? � p
12 ,J- 6-171y'6 E
Dep h to Y1ztu After iJ
13 kSnnitainq? __� Oatc S�
14-
15-
16-
17-
is -
19
41516171819
'•`j•')`4)'•'?f�.�(Ar (F.7LG'h'cEii�S �.-l. t.) � _. _._
V�Y
c
'fC PEfiF'ORf✓�,C CS . Sr ` 1� 7/C.1.1
SITE PLAN
20
COMMENTS "" ✓v r
l
PERFORMED 6Y:
ACCORDANCE WITH ALL STATE AND MUNICIPAL
72.008 (Rev. ,U651
PERCOLATION RATE (mis/i
nute) PERC HOLE DIAMETER
TES%Z EfG/ENT r//`�li/i
I C£RTtFY THAT T IS WAS PERFORMED IN
ATE OATS
f EFFEC O THIS D:
Vol / I�I.�I/Ire �i /
20
COMMENTS "" ✓v r
l
PERFORMED 6Y:
ACCORDANCE WITH ALL STATE AND MUNICIPAL
72.008 (Rev. ,U651
PERCOLATION RATE (mis/i
nute) PERC HOLE DIAMETER
TES%Z EfG/ENT r//`�li/i
I C£RTtFY THAT T IS WAS PERFORMED IN
ATE OATS
f EFFEC O THIS D:
GRE, ER ANCHORAGE AREA BOP 'UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION
REPORT ON-SITE SEWAGE DISPOSAL
SYSTEM
NAME/C'%f/'� /-�Z��Clr1
MAILING ADDRESS Z-�C e57
PHONE?
LOCATION 5/e -C-14 00'�o 14P6
J
-*M LEGAL DESCRIPTION`zut// '
SEPTIC TANK: -I-
DISTANCE
DISTANCE O'l `l G r
FROM WELL )%21 MANUFACTURER c-j%� NUMBER OF l
C�` MATERIAL '- �� / COMPARTMENTS
-
INSIDE LENGTH INSIDE WIDTH _ LIQUID DEPTH LIQUID CAPACITY -Z/0-:0 0 (-Al i nnic
SEEPAGE PIT: /,-//K/
�-2 x � %
NUMBER OF PITS DIAMETER OR WIDTH_, LENGTH_, DEPTH .S
LINING MATERIAL ////)) G5 &- CRIB SIZE: DIAMETER DISTANCE FROM: WELL
TOTAL EFECTIVE
BUILDING FOUNDATION (4!, NEAREST LOT LINE ABSORPTION AREA (WALL AREA)
SQ. FT.
ADDITIONAL ABSORPTION
WELL: I(%) �� f-
1)k1C l C 0
TYPE CONSTRUCTION DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC11�62p SEEPAGE X-t�2f)
FOUNDATION LOT LINE -,SEWER LINE TANKSYSTEM /U-
CESSPOOL OTHER SOURCES AA
APPROVED DISAPPROVED REMARKS /t 077-� D/57-4-i(J6C-$ 77) 60,6�z f-,
n t
DISTANCES,/1j 1��; / e' Z- 2- DIAGRAM OF SYSTEM
Cil `�� / � %� •-`% = / �� � '
INSTALLED BY: e,5'
`\ C
:3PC1) Cil/ rem
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No. EQ -031
DATE GLc7ri_ e-'Y',/�7/XPPR
J
"w„°°,°E GREATER ANCHORAGE AREA BOROUGH
P 9f
F`J f1 � a, DEPARTMENT OF ENVIRONMENTAL. QUALITY
PERMIT NO.
ILJI Ian<, 3330 "C” STREET ANCHORAGE, ALASKA 99503
U TELEPHONE 274-4561�Q 5 /
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT MAILING ADDRESS PHONE C�
INSTALLATION LOCATION
LEGAL DESCRIPTION Z T L UCk-
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT - y DRAIN FIELD OTHER _w ,
TYPE AND SIZE OF FACILITY TO BE SERVED / '1-5Ln_GlrL-/
FINANCED THROUGH TO BE INSTALLED BY
so1L resr RESULTS / ��JY �• �//]/ZL/l L/11L�✓O NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED __-__ �a/y'
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. FJACI<FILLING OF ANY SYSTEM WITHOUT FINAL_ INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL. BE SUBJECT TO PROSECUTION,
SEPTIC TANK SIZE _ /� TYPE _ SEEPAGE AREA SIZE TYPE —_
MINIMUM DISTANCES, REQUIREMENTS
s/
FOUNDATION TO SEPTIC TANK _
FOUNDATION TO SEEPAGE PIT ;z0 / , DRAIN FIELD
SEPTIC 'TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
TO NEAREST LOT LINE. _ eel Jho
/-WELL TO SEPTIC TANK _-_:,IA9-p , SEEPAGE PIT
DRAIN FIELD
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK AIX
- SEEPA�iE PIT --
�(! DRAIN FIELD _ P�� /ef(Q
I.EPTIC TANK, _, SEEPAGE PIT � DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL. EIACKFILL.
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
G.A.A.S.
OR
LICENSED DESIGNER
1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER
DESCRVLIC,15TE IS IN ACCORDANCE WITH SAID CODE.
6
DATE"APPLICANT'S SIGNATUREFORM16
DIAGRAM OF SYSTEM
E AREA BOROUGH ORDINANCE NO. 26-68 AND THAT THE ABOVE
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O fS - 3G I - 3S HAA It D3 D
Expiration Date:
1. GENERAL INFORMATION
Complete legal description I -of -3, B lacle S_ S Ay Rand 'e'576fV -;�Lj _
Location (site address or directions) 55-6-20 lubgeer�� acs Dride'
Current Property owner(s)Ittc'oaaf i 1?vQrAx bkeetygn Day phone_ 3S0-71yh,"
Mailing address 6-K20 t0Avpee%s1?X S2n4ce_ D 7 ctia�rciQ, Jl-4: 99S -V
Lending agency ff tck lreo�g, Secekge /`tc��Day phone s 62-:M?k�
Mailing address ' a6d T�6" 5�.. _Anchor _A� 99-'03
Real Estate Agent N0,70 - re f nan ei? — Day phone
Mailing Address
Unless otherwise requested, HAA will be held by, DSD for pickup. Pl eafe ccr ll
3 @ S'652- 26 "_.A -e12)9^4 r -r^ y
2. NUMBER OF BEDROOMS: :,ror. p; ek -Hp,
3. TYPE OF WATER SUPPLY:
Individual Well
19
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual Onsite
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 sample results. (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
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 is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
NameofFirm Flettke TecAn;eod S?rv',�o� Phone 13sS
Address /Y130 Echo Sf.. An ch orag 99S t�
J
Engineer's Printed Name Date at/o-3
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for . bedrooms,
fgo
^
••••••••• *go ••••••••••••YV
�
*99 oof000�
. TliI DOn F. LOORE
rL
with the following stipulat:ions;
Attachments:
HAA Checklist X
Septic System Advisory X
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: 0 Original Certificate Date: 03
(Rev. 01102)
Municipality of Anchorage •
' Development Services Department
Building Safety Division
On -Site Water & Wastewater Program •"
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.enchorage.ek.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 1%of 30 Q /k S S kr 1?ane6 ESA # / Parcel ID: O rS- 301 - 3S-
A.
S
A. WELL DATA
Well type Pv f If A, B, or C provide PWSID # N. A
Date completed io/5/73 Sanitary seal (YM) 1'
Total depth 2 17 ft. Cased to 2 Air ft.
FROM WELL LOG
Date of test to/ -5'/7,3
Static water level ft.
Well Log (Y/N) Y
Wires property protected (Y/N) Y
Casing height (above ground) I_in.
AT INSPECTION
6/
198 ft.
Well production /O g.p.m. S o 9—
p.m-WATER SAMPLE RESULTS:
Coliform O colonies/100 ml. Nitrate <o• f mg./I. Other bacteria O colonies/100 ml.
Arsenic: — mg.A. Date of sample: 6/r6/o3 Collected by: F /a ho(W 7eeh Sc�-c
B. SEPTIC/HOLDING TANK DATA
TankType/Material STEP l S%rel Dateinstalled
Tank size 12567 gal. Number of Compartments 2 Cleanouts (YM) Y
s
Foundation cleanout (YIN) Y Depression over tank (Y/N) A! High water alarm (YIN) Y
Date of pumping 6 / t 6/ 0 2 Pumper Aro ctna(- fit e - c (ac k P•cn, ;
C. ABSORPTION FIELD DATA
Date installed i�/ 1190 Soil rating (g.p.d.e or fefbdrm) 2 r? -,5 System type 13ed
Length YO ft. Width 2 Y ft. Gravel below pipe 0• s ft.
Total depth yy yy ft. Eff. absorption area 960 fe Monitoring tube %r Depression over field Aj_
Date of adequacy test X/1-71 01 Results (Pass/Fain P^a For _2_ bedrooms
Fluid depth in absorption field before test S..0 in. Water added'7?7gaL New depths in.
Elapsed Time: 3 �9 min. Final fluid depth (LZSin. Absorption rate >= &/Sd g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) _ None kn o w on If yes, give date A/- A.
D. LIFT STATION
Date installed 6/ 1 / 961 Size in gallons2nd �z+ r Manhole/Access (Y/N) Y
"Pump on" level at H 3 in. "Pump off" level at39•t:J1n. High water alarm level at 4f5 in.
6Uf4om Cf vAac1k
Datum I-— Cycles tested / O Meets alar & circuit requirements? Y
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 10 -T ' -fa c• o. On adjacent lots
Absorption field on lot too' On adjacent lots '> 1Go '
Public sewer main Al. A. Public sewer manhole/cleanout N. 4.
Sewer /septic service line > ZS' Holding tank IV • A.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 20' Property line ^ 15' Absorption field = S'
Water main -".A. Water service line *> 10 ' Surface water 1 ei,o
Wells on adjacent lots > IGD
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 5 Building foundation 1 13 Water main N• A.
Water Service line , 10Surface water ? Oo' Driveway, parking/vehicle storage
Curtain drain Naga feet' Wells on adjacent lots t oo
F. COMMENTS
lint wait/'Ce
H a'V - 19
G. ENGINEER'S CERTIFICATION AV
LwAen hKf
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA NAA guidelines in effect on this date.
Engineer's Printed Name -7-Ax g&ee r+c-a•r
Date j7;4,) e 2 y 2 003
HAA Fee $ 3-75 �-
Date of Payment t'v
Receipt Number 3 7 53" 1
(Rev. 12!01)
F'f(Ar0{
07 MC i/> 6Of4P1
tar
3 yaacr
r,. i • •• •{ C
�r9_;F
TH ,:
TN60 TORE F. fdOOR£
' f'' •• CE -3589 k
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
• Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchoragc.ak.us
(907)343-7904
SEPTIC SYSTEM ADVISORY FOR
HEALTH AUTHORITY APPROVAL #HA030287
Legal Description: Sky Ranch Estates #1 Block 5 Lot 3
PID # 015-301-35
Prior to a recent adequacy test on the septic system for this property, 5.5 inches of standing
water was observed in the absorption field. The total effective depth of the system is 6 inches.
This indicates that approximately 92 % of the absorption area in inundated. Although this
system passed the adequacy test, the remaining life expectancy may be limited.
This advisory must be attached to all copies of the subject Health Authority Approval.
If there are any further questions regarding this advisory, please call the On -Site Water and
Wastewater Program at 343-7904.
• b-la-Dli a IAYMy
t Ta1N2. 1 a: 2
a•S�-DIt10:•C•Aly51f[L11 MOrL3191 AK {9U: eta •Tfa
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ESQ
r5o oo• .:
R�pO0
•
_.... ... •CR —
:. �{.. • .:.ONI
EXISTING
y LOT 3 HOUSE
13v
. s.
olp�
�S• -^� m Vt� i►.SENEN `N X20 CIO
10,00 0p"
5
5 •
2
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LS -8202
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ANDY MC OOliM AN
IM q 1d/ Mq sem mwl% of . Ms. v wI1,41w4
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AS—BUILT OF: LtGk CElcWl t
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S
•40 WEST BENSON BLVD. 1 103
ANCHORAGE, ALASKA 99503
(tot) 561-6818 LOT 3, BLACK 5,
907) 582-5291
x" "•_I
UNIT N0. '
-s2ZA aw 1. 2731
SKY RANCH ESTATES
183 )a
f
1
II �
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Municipality of Anchorage
• Development Services Department ° �:
Building Safety Division i •.
Onsite Water to Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 095196650
www.d.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-301-35 HAA# HA 0 10 A/ n
1. GENERAL INFORMATION
Expiration Date: Q -,;2— V- -b
Complete legal description SKY RANCH ESTATES SUBDIVISION; LOT 3, BLOCK
Location (site address or directions) 5620 WHISPERING SPRUCE DRIVE ANCHORAGE, AK. 99516
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
ANDY KOOSMAN Day phone 345-6269
5720 WHISPERING SPRUCE DR. ANCHORAGE, AK. 99516
Unless otherwise requested, HAA will be held by DSD for plakup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
lit
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
ll•
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 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) 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 sample results less than 30 days old. (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
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 Heafth AuthorflyApprvval 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 verily that based on the
Information obtained from the Munklpality 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 Finn ALASKA WATER do WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, SUiTE 2B • ANCHORAGE. AK 99504
Engineer's Printed Name JEFFREY A GARNESS, P.E.
Engineer's Comments:
in conducting this evaluation, AWWC, ioc. attempted to provide a li orgh,
consdendous engtnearing ana6sls of the system In accordance Wit ADEC and MOA
DSD Guidelines d Regulations. The reported resuft described the pedomwwo of the
system under the conditions enoounte+edat the time of the test, and asperation
dlstenow measured to readlyldw frable features. The operational No of a# waft and
septic systems depend on the local soffs cmx tion, groundamrievels that may
fluctuate during the year, and tine water usage of the famW bekv served by the system.
Time conditions are outside tits cm&d of the evaluator of the system. Satisfactory east
results do not guarantee future perforrnance of the system, nor do ttheyguarantee that
there are no hidden defects or encroachments. ANM'C, Inc. can 9wralbre not provide
any warranty or future estimate of how long the system wili continue to meet the
operational requirements of the ADEC or MCA DSD. The content of this report is for
the sole benefit of the owner Asted above. Any regance upon or use of this report by any
other person or parry Is not authorized, nor wiA it confer any legal right whatsoever.
5. DSD SIGNATURE
_(�' Approved for �?_ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the fliowing
Attachments:
HAA Checklist
Septic System Advisory _ -
Well Flow Advisory .
Phone 337-6179
Date 1 Ol
Manitenance Agreements
Supplemental Engineer's Reort
Other
cy•.•�
ON-SITE
• WATERAND.
WASTEWATER
PROGRAM
By. Gr/ • / Original Certificate Date:
ebv. two)
Municipality of Anchorage
• Development Services Department
Budding Safety Division
On -Site Water & Wastewater Program
4700 South Bregaw, St.
P.O. Bou 186650 Anchorage, AK 99519.8850
www.ci.andwrsge.sk.u9
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: SKY RANCH ESTATES SUBDIVISION LOT 3, BLOCK 5 Parcel ID: 015-301-35
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 10/5/73 Sanitary seal (Y/N) YES
Total depth 217 ft. Cased to 216 ft.
FROM WELL LOG
Date of test 10/5/73
Static water level 206 ft.
Well production 10 9 -
p.m -
WATER SAMPLE RESULTS:
Well Log (Y/N) YES
Wires properly protected (YM) YES
Casing height (above ground) 12+ in.
AT INSPECTION
8/21/00
198 ft.
5.4+ g.p.m.
Coliform 0
oolonies/100 ml.
Nitrate 0.5 mgA.
Other bacteria 0 oolonies/100 ml.
Date of sample:
4/24/01
Collected by:
AWWC, INC.
B. SEPTIC/HOLDING TANK DATA (S.T.E.P.)
Tank Type/Material STEEL Data installed 6/1/90
Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation deanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES
Date of pumping 8/21/00 Pumper NORTHLAND PUMPING
C. ABSORPTION FIELD DATA •M.T. EMENDS 6.5" BELOW INVERT
Date installed 6/1/90 Soil rating Qid. r ft'/bdnn) 22122 System type MOUND
Length a0 ft. Width 24 ft. Gravel below pipe 0.5 ft.
Total depth 4 ft. Eff. absorption area 960 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 8/21/00 Results (Pass/Fail) PASS For E bedrooms
Fluid depth In absorption field before test'S_75in. Water added 842 gal. New depth 9.25 in.
Elapsed Time: 1020 min. Final fluid depth 7 In. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) YES If yes, give date "
••SEPTICLEAR, FALL 2000 AFTER THE TEST
-qv," t'J BEs Hr ad A'/Z401
D. LIFT STATION
Date installed 6/'/90 Size in gallons 1250 S.T.E.P. Manhole/Access (Y/N) YES
"Pump on" level at 12 in. "Pump ofr level at 12 in. High water alar level at 10 in.
Datum TOP OF TANK Cycles tested 3 Meets alar & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAtft station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells an adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *
5'+
Building foundation
10'+
Water main N/A
Water service line
10'+
Surface water
100'+
Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
-POSSIBLY IN EASMENT SEE ATTACHED SURVEY. PER CORWIN 1990.
G. ENGINEER'S CERTIFICATIONo�F OF A
'•.'T vl
I certify that I have determined through field inspections and a :: -
•.e
review of Municipal records that the above systems are in ... ...........
conformance with MOA HAA guidelines In effect on this date. ... .. .... .......
••, e r A. ess:
Engineer's Print 0
Name JEFFREY A. GARNESS QQ -7953
0 x '
% t,
Date S 14�f u �aPror*siw° oc
HAA Fee $ 4&.00 Waiver Fee $
Date of Payment -6 - � 1�' 0t Date of Payment
Receipt Number N ('aa Receipt Number
(ea. i2W)
MUNICIPALITY OF ANCHORAGE
M E M O R A N D U M
SEPTIC SYSTEM ADVISORY
HEALTH AUTHORITY APPROVAL N0. A O ;ZI Q
Prior to a recent adequacy test on the septic system for
this lot, 5 %s inches of standing water was observed in
the absorption field. This indicates that approximately
q s 8% of the absorption area is inundated. Although .
this system passed the adequacy test, the remaining life
expectancy may be limited.
This advisory must be attached to all copies of the subject
Health Authority Approval.
ANDY
440 WEST BENSON BLVD. N 103
ANCHORAGE. ALASKA 99503
2000—L -62M oON mD Baa
1 1.
CIL C SOV—E's♦'
EXCLUSION NOTES: It Is the owners responsibility to determine
the eeistence of any easement$. covenonlf. or restrictions
3/81111 M/CAP eO 3/e' RB 0
AN which do riot appear on the recorded subdivision plat. NOTE:
125' ALUDN. OuCNWENT
Under no circumstances should my data hereon be used for
NUB It TALI 0
construction or for establishing property lines,
rENCE- .—x— X —
SURVEY CERTIFICATION: LANTECN has conducted o
physical survey of this property as shown an this
aKRNAmD-
WOW DECKS -
drawing and that the Irnprovements situated these
an ere within the properly lines and no "CrooCh-
menlf esifl 011ier than noted.
CONCRETE -
ASPNALT-
GRAVEL-
AS—BUILT OF: LECAL DESCRIPTION:
.111C3TANDPIPES-
WATER wELI—
S-PLANNERS-ENGINEERS
(561-6626 LOT 3, BLOCK 5,
(907)07) 562-5291
r 1.xeu
:1-66: RANCH ESTATES
UNIT N0. 1
NOM SKY
ACS
Alaska Communications Systems
May 18, 2001
Andrew C. Koosman and
Linda J. Fuente
5720 Whispering Spruce Drive
Anchorage, Alaska 99516
ACS has no objection to the encroachment of a septic system into a
platted easement located on Lot 3, Block 5, Sky Ranch Estates,
Unit No. 3, as depicted on the as -built drawing submitted.
Acceptance and use of this letter of non -objection by yourself, your
heirs, your assigns, or your successors, will constitute agreement to
the following stipulations:
1. ACS will be held harmless, now and forever, for any damages
or injury to any person or property as a result of this
encroachment.
2. Any ACS facility damaged or destroyed as a result of this
encroachment will be repaired at no cost to ACS.
3. Any costs incurred by ACS for special construction
necessitated by this encroachment will be borne by the
property owner.
4. All applicable safety code regulations will be observed and
maintained.
5. This letter of non -objection will in no way preclude ACS from
full use and enjoyment of its rights within any portion of
its right-of-way.
S
ince
Gregreman
Outsngineering
ACCE DATE:
AC&P # 993
GS\le\g:mswd/cor/nonob/Skyranch.doc
600 Telephone Avenue Anchorage, Alaska 99503-6091 tel 907.564.1000 www.acsalaska.com
ENSTAR
_�'
5/18/01
And Koosman
C/o Alaska Water and Wastewater
Consultants, Inc.
6901 Debarr Road, Suite 2-8
Anchorage, AK 99504
ENSTAR Natural Gas Company
A Division of SEMCO ENERGY, Inc.
3000 Spenard Road
P.O. Box 190288
Anchorage, Alaska 99519-0288
(907) 277.5551
Re: Letter of Non -objection
Grid No. A2737G
To whom it may concern:
ENSTAR Natural Gas Company has no objection to a septic encroachment
(containing approximately 100 square feet) in the 10 feet wide utility easement
situated on the east boundary of Lot 3, Block 5, Sky Ranch Estates No. One,
Subdivision.
Acceptance and use of this letter of non -objection by yourself; your heirs, your
assigns, or your successors, will constitute.agreement to the following stipulations:
ENSTAR will be held harmless, now and forever for any damages or injury to
any person or property as a result of this encroachment.
Any ENSTAR facility damaged or destroyed, as a result of this encroachment
will be repaired at no cost to ENSTAR.
Any costs incurred by ENSTAR for special construction necessitated by this
encroachment will be borne by the property owner.
All applicable safety code regulations will be observed and maintained.
This letter of non -objection will in no way preclude ENSTAR from full use and
enjoyment of its rights within any portion of its right-of-way.
Sincerely,
ENSTAR
M. Manue
cc: File
May 21, 2001
Andy Koosman
5620 Whispering Spruce Drive
Anchorage, Alaska 99516
Dear Mr. Koosman,
Subject to your agreement to indemnify the company as set forth below, GCI Cable Inc.
of Alaska has no objection to the septic system encroaching into the 10' utility easement
on the west property line of Lot 3, Block 5, Sky Ranch Estates # 1. Known as 5620
Whispering Spruce Drive in city grid 2737.
This letter of non -objection in no way precludes GCI Cable from full use and enjoyment
of any rights it may have within any portion of the utility easement and or the right-of-
way, including unlimited access for servicing its facilities. Also any additional and
extraordinary costs incurred during any future required construction, repair or
reconstruction of GCI's facilities to accommodate any or all of the encroachments shall
be paid by the property owner.
By signing below, you agree to indemnify and hold GCI Cable harmless, now and
forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities
and injury to any person or property occurring as a result of the encroachment.
Please indicate your acceptance by signing and returning this letter to myself at the
address below. j (�
Sincerely,
Acceptance
140ce C tC di on"
OSP Design Engineer Date
5151 Fairbanks Street • Anchorage, Alaska 99503.907 / 786-9200
Cable services provided by GCI Cable, Inc.
ANC110RAGE RATER & WASTEWATER UTILITY
George l'. JVuerch.
Ala or
Andrew Koosman &
Linda Fuente
P O Box 112183
Anchorage, AK 99511
Engineering Division
3000 Arctic Boulevard
Anchorage, Alaska 99503-3898
http.lAvww.awwu.ci.anchorage.ak.us
May 21, 2001
Re: Sky Ranch Estates #1, Block 5, Lot 3 (Grid 2737)
Parcel ID 015-301-35
Encroachment into utility easement
Dear Property Owners:
Chvnedbvthe
AlunicipaliN ojAnchoroge
The Anchorage Water & Wastewater Utility (AWWU) received a written request from Jeffrey
Gamess of Alaska Water and Wastewater, on May 18, 2001, for a letter addressing AWWU's
position regarding the existing septic system that encroaches approximately 2' into the utility
easement located within the inside 10' perimeter of a portion of the referenced lot. Submitted
with the request was a property drawing dated September 21, 2000, indicating the location of
the septic system and utility easement.
AWWU water is not available to the referenced lot and wastewater facilities are to be in
accordance with the Hillside Wastewater Management Plan.
AWWU issues this letter for the existing septic system with stipulations, and by using it the
property owners are agreeing to the following:
1. AWWU will be held harmless, now and forever, for any damages or injury to any person as
a result of the encroachment;
2. All applicable codes and regulations will be observed and maintained within the easement;
3. This letter will in no way preclude AWWU from full use and enjoyment of its rights within
any portion of the easement; and,
4. Additional and extraordinary costs incurred during any future required construction, repair
or reconstruction of AWWU facilities to accommodate the encroachment shall be paid by
the property owner.
Should you have any questions, please call the AWWU Planning Section at 564-2739
Sincerely,
%wt;J, SEC�
Hallie Stewart
Engineering Technician
\\awwufile\Groups\Engineering W fanning\Planning\HMSlencroachments\easml-w-Gond-SkyRanch.doc
CHUG!:
POWERING ALASKA'S 1UTURE
May 21, 2001
Alaska Water & Wastewater
6901 DeBarr Road, Suite 2-B
Anchorage, Alaska 99504
Attention: Meghan
Subject: Letter of Non -objection for Existing Septic System
Lot 3, Block 5, Sky Ranch Estates Subdivision #I
Grid 2737,1203-22D, OB01030
Dear Meghan:
Chugach does not object to the septic absorption field located within the outside Two
Feet (2') of the platted utility easement on the southwest side of your property, Lot 3,
Block 5, Sky Ranch Estates Subdivision #1, as shown on the attached as -built by
Lantech, dated September 21, 2000.
All work within the easement are must be in compliance with the enclosed copy of
Chugach's Electrical Facility Clearance Requirements. Also enclosed for your use
and information is the Locate Call Center card, and Chugach's What is an Easement?
handout.
This non -objection is given without prejudice to Chugach's full enjoyment of any and
all rights it may have in and to such easement.
Sincerely,
Jim K. Topolski
Manager, Land Services
Enclosures
cc: Andrew Koosman & Linda Fuente, P.O. Box 112183, Anchorage, Alaska 99511
Chugach Electric Association, Inc.
5601 M.nnesoio Dove, PO. Box 196300, Ancho,oge, Alosto 995196300 • 1907) 563.7494 Fax 19071562 0027 • 18,71478749.1
www chugochelecnic.com 0 inloCchugochelechrc.com
MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services M'1
O DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcell.D.# �12'~ HAA#
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section,
Zo
Location (address or directions)
4' 7 7/) /41141 'n 11 vl
(b) Property owner
range)
—7//
:(home)Business��
Mailing Address
(c) Lending Institution Telephone
Mailing Address ' ,
(d) Real Estate Company and Agent
Address
Telephone
�i
(e) Mail the HAA to the following address: (or check here
List contact person and day phone number below:
hold for pick up.)
2. TYPE OF RESIDEN
Single -Family Number of bedrooms
3. WATER SUPPLY
Individual Well;/ Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DI SAL
On-site Public ❑ Community 0 Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025(Rw. 7/68) Page 1 of 2
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 'ons in effect on
the date of this inspection.
Name of Firm /—��1c7 `� Telephone
Address Al
Date
6. DHHS APPROVAL
Approved for bedrooms by Date
Approved ,1�� Disapproved Conditional
Terms of Conditional Approval
%7 - CAUTION'. '
The Municipalityof Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
Institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible forerrors or omissions
In the professional engineer's work.
72-025 (Ra.. 7/88) Back Page 2 of 2
• y MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
MUN1C1RtWeUWhW2MRUARY 191
ENVIRONMENTAL SERVICE$434444
JUN 5 199 Legal Description:
A. WELL DATA REI: I V E D
Well Classification P� If A. B. C. D.E.C. Approved (Y/N)
Well Log Present (Y/N) Date Completed �G%%3 Yield -74-
Total Depths 2"1' Cased to Depth of Grouting—LL-IZA
Static Water Level Pump Set At' &MAZ CGU ,
Casing Height Above Ground :>Ae Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) L Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot /OCA / ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot %� / ; On Adjoining Lots >lOCd
To Nearest Public Sewer Line All -k To Nearest Public Sewer Cleanout/Manhole Z_Z�:
I
To Nearest Sewer Service Line on Lot 7 /�
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
nnn 2
Date Installed t/ Size -/-No. Compartments
Standpipes (Y/N) 7 Air -tight Caps (Y/N) Foundation Cleanout (Y/N)
Depression over Tank (Y/N) N Date Last Pumped . NEcU
Pumping/Maintenance Contact on File (Y/N) ; for A&dfq'
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) _ A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well �U� / To Building Foundation
20�
To Property Line To Disposal Field
To Water Main/Service Line > 149 /
To Stream, Pond, Lake or Major Drainage Course
Comments
nox IRw. deet Front Page 1 of 2
C. ABSORPTION FIELD DATA i ' !.-
n
-Soils
Soils Rating In Absorption Strata
Type of System Design'
Date Installed G'� �C�
Length of Field 41-0 /
Width of Field ? �' {
Depth of Field c)^2 /�KiciT�� "At, /,IA
_
- Gravel
N
Bed Thickness
Square Feet of Absortion Area
Statndpipes Present (Y/N)
Depression over Field (Y/N)
Date of Last Adequacy Test /UPJ
Results of Last Adequacy Test �1
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well /00 / '
To Property Line 5� 41 /% r
To Building Foundation 1¢ /
To Existing or Abandoned System on
Lot /U ; On Adjoining Lots Z✓h^
r'
To Water Main/Service Line 7 /0
To Cutback (if present) &r2-
To Stream, Pond, Lake, or Major Drainage Course
lJfA
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed /��,� `��
Size in Gallons
"Pump On" Level at SE
High Water Alarm Level at
—
Testedfor
Meets MOA Electrical Codes
Comments *__ i1�tl�
"Check Perm
certify that I
Inspection.
Signed
Company—
Date
MOA No. —
Dimensions
,hole/Access(Y/N)
tump Off" Levet at ✓� S��
'✓P_ Vent(Y/N) Y
Against HAA Request"
d, or conformed to all MOA and HAA
Receipt No. 1 /.3 9 Al 3� 1
Date of Payment C0
Amount: $ /70 2')
Receipt No.
Waiver Fee: $
Date of Payment
72-M(Rw. 7/80) Back Page 2 of 2
Pumping Cycles during Adequacy Test.
on the date of this
0
Seal
r`_
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date /- F{ti
(a) Legal Description (include lot, block, subdivision, section, township, range)
Le I'3 , Stock S Sky Rerneb E1ia/•ti
Location (address or directions)
5"720 LUE'rptnno Sor .0 hr`:i
(b) Applicants Name
ne -
y7
Applicants Address
(c) Applicant is (check one) Lending Institution ; Owner/builder ;
Buyer ; Other E=1 (explain);
(d) Lending Institution
Adarvs
(e) Real Estate Co. S Agent 71"Pl -
Address
Telephone
(f) til the HAA to the following address:
Z. Type of Residence
Single -Family Multi -Family
Number of Bedrooms
3. Water Supply
Individual WellCommunity Q
Other (describe)
Public M
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 r,3:U Public E=1 Community [=1 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
Ow
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 F/crHoje TPckA ca/ er✓r CF/ Telephone 3yS-13ss
- I
c
Date /}rr if 3 /9BS
(ENGINEER SEAL)
6. DHEP Approval
i�
Approved for J bedrooms By
Approved Disapproved Condi
Terms of Conditional Approval
CAUTION
/r
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DEEP) 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 DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE LUTA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 21 7-19-84
A. WELL DATA
B.
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984 APPx 4 1985
Legal Description: (X
IEC
/-.of 3 , 8toc.tr .ate ��1-V- Ran
Well Classification _privape- If A, B. or C,'D.E.C. Approved(Y/N)
Well Log Present (Y/N) N
Total
Dart, C'o' .eted _ /9-7.3 Yield
Depth Cased to
Un wgth,of Grouting Gin l,
Static Water Level (9,9'
Set $ rl'T
Casing Height Above Ground 12�'
/ ---S- itary Seal on Casing (IM) Y
Electrical Wiring in Conduit (Y/N)
Y Depression Around Fkllhead (YIN),JV
Separation Distances from Well:
To Septic/Holding Tank on Lotz/'9 g ` ; On Adjoining Lots '7 too
To Nearest Edge of Absorption Field
on Lot Ito ; On Adjoining Lots `7tCtC/'
To Nearest Public Sewer Line 1V,A.
To Nearest Public Sewer
Cleanout/Manhole & A
To Nearest Sewer Service Line on Lot
Water Sample Collected By Fr_5 /'7 -,*r/1 Date 3/27 /&W
Water Sample Test Results Scrfcr�ar/r,r�r
Comments_ (./!e((. cCccinT_,c�nc!
/'�bcrau�notd c nc� �vir,i facof rn
Con d"'I f r reguerk of FT.,f'
SEPTIC/HOLDING TANK DATA
Date Installed 67/2& /73 Size 1000 No. of Compartments t
Standpipes (Y/N) 1` Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) r
Depression over Tank (Y/N) N Date Last Pumped pf/' /&,y
Purrping/Maintenance Contract on File (Y/N) NSA, ; for
Holding Tank High -Water Alarm (Y/N) — Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well KoTo Building Foundation IES
To Property Line 3 To Disposal Field _ eo
To Water Main/Service'Line N.A. To Stream, Pond, Lake, Cr Major Drainage
Course to6a'
Comments 5-0'seeemxktoo beA een cAwen
per O,ermif o�Gt%!a 6'/7/7'
Receipt #
Date Paid: y _ q, R
Amount:
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata V'/ _t3a:(r-m. Type of System Design
Date Installed 9/28/7.3 Length of Field T/ 0 Pe3roowel-ef^
Width of Field -L.A. Depth of Field /'3 f"f
Gravel Bed Thickness 9
Square Feet of Absorption Area 115 :39 Standpipes Present (Y/N) Y
Depression over Field (Y/N) Date of Last Adequacy Test No4e PL1Lvee%<g.-
Results of Last Adequacy Test N.A-
Separation Distance from Absorption Field:
To Water -Supply Well �//O' To Property Line 3e
To Building Foundation V11 To Existing or Abandoned System on
On Adjoining Lots � .5'O `
Lot N.A. -
To Water Main/Service Line M.A. To Cutbank(if present) N.O.
To Stream/Pond/Lake/or Major Drainage Course > (ao'
To Driveway, Parking Area, or Vehicle Storage Area 5`0 `
Comments Per Lesf- On 1/ :3 ehao
D. LIFT STATION N, A .
Date Installed Dimensions _-
Size in Gallons Manhole/Access (Y/N) -
"Pump On" Level at _ "Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inspection. 7
Signed Date 1//.3/x_`
Company (=lGtf p '%h ccc( Servsc.v, MOA No. R4--CU2
KB1/d5/s
[Page 2 of 21
-F At t14
V1.�e.....j
a� ENG. s •.t
ar 9 � �0 FiYL`t
p�........ i.Y11.e aP..11.. 0..®
-Q e THEODORE F. MOORE ; A
CC -3589
2-15-84