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HomeMy WebLinkAboutSKY RANCH ESTATES #1 BLK 5 LT 5Sky Ranch Estates #1 Block 5 Lot 5 #015-301-33 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 171344 PID Number: 015-301-33 Dwelling- ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name. ABSORPTION FIELD BRIAN & TINA HUGHES Address ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 11961 STEEPLE CHASE CIRCLE, ANCH. ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.6 GPD/SF 8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 3 Ft. 5 Ft. SKY RANCH ESTATES NO.1 5 5 Fill added above original grade Gravel length Township Range Section Varies 0.2' — 1.6 Ft. 100 Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 2.5 Ft. Ft. ToSeptic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line 1000 Ft2 2 8 Ft. Well 100+ 100'+ NA NA 25'+ TANK ® Septic ❑ S.T.E.P. 0 Holding 0 Other Manufacturer Capacity Surface Water 100'+ 100'+ NA NA j ANCHORAGE TANK 1250 Gal. Material Number of compartments Lot Line 5'+ 10'+ NA NA STEEL 2 NA Foundation 5'+ 10'+ NA NA LIFT STATION Manufacturer Capacity Gal. Curtain Drain NA *501+ NA NA Remarks *None knownPump on level at Pump off level at High water alarm at . Existing crib & trench left in place with diverter for future use. in. in. in. S.T. and lower trench insulated. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer Northern Excavation drainfield Drainfield 3034 CO/MT 3034 inspector ARCTERRA BENCH MARK (Assumed elevation) 100 ft Inspection 1" 11/15/17 2�a 11/15/17 Location and description daStd 11/15/17 4"' 11/16/17 Bottom of siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin OF Conditional Approval: Date Air <Sile ,' -' "--46-, i — r* A9TH !\ 7* ,4 x+ _74 KENNE M Of , �r tt: `- Ai �lr-- 1'� 2/41 °~/ Approved__j 1n.4._ Date 1)-2,-/_) 7 ,,,,yob„ssto�'N�' eer's Stamp Inspection Report_9-1-12.doc AS-BUILT SYSTEM DETAILS/SITE PLAN Permit: ❑SP171344 SKY RANCH ESTATES UNIT No.1 L5 B5 PID# 015- 01-33 � b0 Sip \ .0b,fit1/41 p0�1.4 `1ppp• �}�,N MIH MT ' 00 - 0 T F MCO - �E O y� t� ::. �� SPLITTER �..V1 gra M •� BELOW GRADE (-71 OT LOT 6 z:el Ci / • TCRIB SUMPS C� W eco / MT DIV. 37 0. COs TO •'IG. SYSTEM 0 t-... / 'j • KWELL RADII CObi D S 0,_ Co C LOT 5 ,�`�,- / °F• 11111111111��g1 B LK 5 e .)^ ` FC• .4. ()/ '' ' Si C') 0) / CANT J 4_8R !do c PP 1I Pr 0 / 2'x17, VSE "100-416` 12.0' 3 *0 h ofd SHED - ALES 1' = 30' Q WELL t X+ IA-C=20.7' y 096,00 95.6• 91.9 1ICHITOR TUBE B-C=35.2' g AMEIVT �""01n • . ITOR TUBE FINAL GRADE o A-D=28.0' 92.3 90.7 0 1 ORIGIwH. GRADE " B-D=38.0' CY a FILTER FAN was 0Tm, A-E=62.0' A H -1250-GAL ' 88.75) T =;;=B-E172.0' yN SEPTIC �e-V%' A-F=63.5' p1 TANK SEWER ROCK Y B-F=78.0' (UPPER) TRENCH 1 r A-G=70.5' 91.92 91.75 83.2 C83,2 I oB-G=71 7' 11aaITOR TUBE 5o MONITOR TUBE- cu,,,ai, ▪A-H=71.7' `t`"'�"C`92.05,) FINAL GRADE 90.95 o B-H=73.0' T� I . 'A-I=74.8' FILTER FAawCN ......„..e,' V,R¢s ct B-I=44.2' °' A-J=62.0' 87.7T C-81-5--y"..--' `;B-J=36.0' SCALE NTS SEWER ROCK ,. 0 :-.,82.712) €7271.6 .„._2 82.7 I77.7 °ra _�F�\ I so, (76.77) MH Di r <S A"", ` PREPARED FORS C E R R t of A"v -1 BRIAN & TINA HUGHES ti �� �, P / „i1� `� A 11961 STEEPLE CHASE CIRCLE 40 �A� ��� c * I li TH IN, * ANCHORAGE, AK 99516 9 I .. _ 71.0 / 636-448-6376 a �� �` r r KE . D V'11011.411" F. S FIELD BOOKS COMPUTED: k 0 1 .3--(' tr C - �� BOUNDARY:SLS DRAM: BMW 1 �" `ti i ",/a//7,,,0' � �1 ti� I sTAwN SLS cHumED: KMD % / ,1,' 1 �,, � / ASBUILT: SLS DATE 11/20/2017• -+"��. \' @� o el , ` 'ES31 D . FILE: CwD: r( C 1 E 1"111011041:11.. ` 2737 �^ ‘14,C,4 _��� ACRD CLE doe Na: �4. 'SULTING .,6 L FILE 17-225 AK. 99577 "'"°""'`� MUNICIPALITY OF ANCHORAGE , ,;; On-Site Water& Wastewater Program . , ;y PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 httpa/www.muni.org/onsite ( .� Dv par tmcnt 4 NC NOR"vE On-Site Wastewater Disposal System Permit Permit Number: OSP171344 Effective Date: 11/8/2017 Work Type: Septic Upgrade Expiration Date: 11/8/2018 Tax Code Number: 01530133000 Site Legal Address: SKY RANCH ESTATES #1 BLK 5 LT 5 G:2737 Site Mailing Address: 11961 STEEPLE CHASE CIR, Anchorage Owner: HUGHES BRIAN G & TINA M Lot Size in Sq Ft: 16226 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 4 This permit is for the construction of: El Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417), 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: ////// Issued By: ' a a-vcieril Date: 74/-201 7 Mai iicipal.hhy of Anchorage • +rimer-r�' P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.orq/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW ** ** Waiver#: OSV171143 COSA#: Permit#: OSP171344 PID#: 015-301-33 Legal Description: Sky Ranch Estates #1 Block 5 Lot 5 Engineer. ArcTerra Applicant: Brian&Tina Hughes Your request for a waiver of the required horizontal separation between absorption fields on this lot has been approved. The approved separation distance is 8.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. n The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: /1/3/020i/ Approved by: ef.„6„..e,, Name of Reviewer **** VARIAN C E/WAIVE R REVIEW **** MUNICIPALITY OF ANCHORAGE 01P Community Development Department „,, Phone: 907-343-7904 Development Services Division -` Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-301-33 Property owner(s) BRIAN & TINA HUGHES Day phone 636-448-6376 Mailing address 11961 STEEPLE CHASE CIRCLE, ANCHORAGE, AK 99516 Site address 11961 STEEPLE CHASE CIRCLE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) SKY RANCH EST. NO. 1 B5, L5 Legal description (Township, Range & Section) Lot Size 16226 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field Single Family (SF) (J p [� Initial ❑ (w/wo ADU) Septic Tank [] Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: 6E2_4 TU //6 -t3 Distance: S I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signat . property owner or authorized agent) Permit/Rush Fees: 5p9 Waiver Fees: ZIS Date of Payment: / (/( /f Date of Payment: i11(49 /0” Receipt Number: O"tLittOM Receipt Number: Qaf-tosp Permit No. 66P/4/3 ti`-1 Waiver No. 05 Vr /1113 Permit App_9-1-12.doc ,° �RcTERRq s } ARCTERRA . CONSULTING, INC 212 E. 5151 Ave,Anchorage,AK.99503 *C�s:tr. G 0'04-' Office(907)868-3791, fax(907)868-3793 November 6, 2017 Municipality of Anchorage Development Services Department On-Site Water Sr Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: Upgrade Sewer Permit-SKY RANCH UNIT NO. 1, BLOCK 5, LOT 5 It has been determined that the absorption field of the subject property is saturated. Subsequently, the owner has requested we proceed forward to obtain a septic permit to upgrade the septic system. The general slope of this lot is from south to north at a grade of approximately 7- 12% over the septic area. On October 30, 2017 a testhole was performed to investigate soils and groundwater. The results of this test are attached for your review. The proposed upgrade will serve the existing 4-bedroom single-family residence. We propose to install two deep trenches. Groundwater was encountered at excavation at 13' and was dry at monitoring. The above subject property has limited area for the septic system upgrade based on lot size, well radii, slower percolating soils and other restraints. We are therefore requesting separation waivers of 8' from the proposed and existing absorption fields. Due to the tighter soils and slope - potential effluent transference or interaction between the two fields will be marginal or nonexistence. The mitigating factors of soil type and slope justify the issuance of the waiver and indicate the proposed field will have no effect on the functionality of the existing field. The property has previous MOA approval for well septic field encroachment and it appears that the well drilled on Lot 6 after the referenced septic system was installed may encroach the existing crib and tank. We will verify the location of the well on Lot 6 at construction and with the inspection report submittal and request retroactive MOA waiver if necessary. Due to the limited area and good water quality results - the property would be best served by retaining the original crib and trench for future use due to the lot's characteristics mentioned previously. RE: Sky Ranch Est. #1 B5, L5 November 6, 2017 Page 2 of 2 The property and adjacent lots are served by private water. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 868- 3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth M. Duffu . Attachments: On-Site Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test Water Quality Results -SGS 20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793 SG$ SCS Ref.# 1177489001 Client Name AreTerra Engineering and Surveying Printed Date/Time 10/30/2017 12:07 Project Name/# Sky Ranch Est.##1 B5 L5 Collected Date/Time 10/20/2017 15:15 Client Sample ID Spigot Received Datefiime 10/20/2017 16:02 Matrix Drinking Water Technical Director Stephen C.Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date [nit Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/24/17 10/26/17 ACF Waters Department Total Nitrate/Nitrite-N ND 0.100 mg/L SM21 4500NO3-F B ( 101 10/26/17 AYC Microbiology Laboratory E.Coli Negative 1 100mL SM21 9223B A 10/20/17 K.W Total C'olilixm Negative 1 100mL SM2I 9223B A 10/20/17 K.W Page 2 of 5 WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN SKY RANCH ESTATES UNIT No.1 L5 B5 \( )10ii‘ ::::0011111....4 W $°Op R) C • tiny s'�0nit * Al--------'------ _______--%----- —. 07 N Q1 ` srw 4, LOT A a• LOT 0 �ilitc.,/ii, �'R� m loulMiw �o ft. 13 ih, ... A. J,iI ^R , . , - Z v. 6�. / ev - lir gC0 \ 67 0) .7‹.111L r'„ 1cft LOT 5 \ -" BLK 5 Wig ham +� + , 1i +„_ � 1 N1Ne9'S9'22'W — 10.40' ---x"—x x- _ Y1 N STEEPLE C'. .E CIRCLE 0 N O FLAG P ❑PERTY LINES li WELL RADII & EASEMENTS PRIORaT, TO CONSTRUCTION Scale: 1'= 50' •* DESIGN DETAILS PAGE 1 OF 2 $ NO SLOPES X25% 4 BDRM X 150 GPD = 600 GPD EXIST WITHIN 100' 600 GPD/.6 GPD PER SQ. FT. = 1000 SQ. FT W OF PROPOSED TRENCHES (1000 / 2 x (5' GRAVEL) = 100 FT. TRENCH USE 2 TRENCHES - 50' (L) X 2' (W) X 5' (ED) Total depth of' system is 8' max from original grade. A' Total depth of' gravel below distribution pipe is 5' . NO PUBLIC WELLS WITHIN 200' OF IT, �IVATEYSWELLS WITHIN 200 OF NOTES: PROPOSE: SYSTEM EXCEPT AS NOTE:. 1. INSTALL 1250 GAL S INSULATE TANK IF <4' COVER. NO SEEMS PTIC PROPOSED EXCEPT aE2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF < 3' OF FILL. 0 MIN. 2' FILL WITH INSULATI❑N, >3' COVER NO INSUL REQ. t` 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INT❑ SEPTIC TANK, I 4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... W / �,� �� 4 1 PREPARED FOR: gCTE ock,YI ' BRIAN & TINA HUGHES ti ,9 8"4) �' `� 11961 STEEPLE CHASE CIRCLE 0 (01 0, A /* . 4 9TH / imp * ANCHORAGE, AK 99516 / I 636-448-6376 a t / �� �� 3 , FIELD BOOKS C0uPUTEIf 6 1 1 1 .2 f r • 71 • �G,`� eouroARr:SLS oRAwN: BMW '"' kils N �/ ti$ I STAKING: SLS CHECKED: KMD K ._` % ` i ' 1 q 1 ._• o,Ati ASBUILT: SLS °ATE: 11/6/2017 ••" y \ e� l C l DWG. FILE: Ma ( c • � 2737 F p 1� � N11011674110:41/1P- `� ��I ACAo FILE: roe No.: -FR S U1.1'1 NG 6 l FILE 17-225 AK. 99571 WASTEWATER DISP❑SAL SYSTEM DETAILS SKY RANCH ESTATES UNIT No,1 L5 B5 2 \ \::: ap 1 �� SEP. 1( °\N _ . 0 0 a 06 2� 17_7 Sl .,00' „..is SMS co c,.. \i_.fIN �S 4 01\- I MT 0 g M"JII1 i) ••••••••<•00000'W �CO 2 4Ik Mr co 1 O, (S lP 1 CO1�� 1 C-.) --...1 l-n 1 / �. SALI T rER o) A, C) / SVM- 1 . - 03 cn / MTEX/ yEXISTING D1v' OA3 Tr?ENCN t9 / -s �9ti 6°Eck 414:7C:4D------CRIII"v° ! • — /TNc'SS/oN NE-w � $STACK J 46.0 � rlcF ANKH s,7, co Fp CANTA EX1 S TI NG Ln \ in Z,k�7, CAN B pp 1\ OC/sLr `� ' N T ��DECK 46 0, 12.0 U, N SHED FLAG PROPERTY LINES tz WELL RADII & EASEMENTS PRIOR TO CONSTRUCTION Scale: 1'= 20' w ��_\� PAGE 2 OF 2 W / � aF • <Q`1 PREPARED FOR: gCTERD ` ��^i I 1 BRIAN & TINA HUGHES ti(1111 ri vl 11961 STEEPLE CHASE CIRCLE � 0��o '* 4 • ■ /\ + ANCH❑RAGE, AK 99516` ` • 636-448-6376 t 0 la ?dY. I F ELD BOOKS COMPUTEDS /I xO CE-71` '' w�a / BOUNDARY:SLS °"A'"": BMW '� \Vu 1 1 �� � , STAuaG: SLSGriEacED: KMD _ % `„ ..1 I I ASBU�T: SLS DATE 11/6/2017 �•-"��t" �1 0 F'E SIOt ' �o \ DWG. FILE: GRID: ! C A, C' �1 1.41.6.:'\111:11.P. �� 2737 DRi•�'S �� �vA Z ~_ AGA) FILE`FILE JOB NO.' 17-225 rER• AK. 99577' 56 to,RCTER4,9 r.c. ARC TERRA / i�, OFAz X1 CONSULTING, INC /c�Q` j- ti s 212 E. 5111 Ave,Anchorage,AK. 99503 / * 'Y Office(907)868-3791, Fax(907)868-3793 / '"� TIi ' �A Y ��de—ow__'„I II I`44 SULTS NG.o. % KE1 . D( ,� / snn-Oy 71 6 �. SOILS PERCOLATION TEST I `s \�.r k*, �/L / ,�°.. Performed for: BRIAN HUGHES Date Performed: 10/30/2017 Ilk`_411.-411" Project: SKY RANCH EST. #1 B5,L5 TEST HOLE II TH 17-1 Depth (Feet) SEE ATTACHED SITE PLAN '" Org/OL FOR HOLE LOCATION l r � i 3 i•-�.- i Was Ground water encountered? YES What depth? 13' 2-it:Iiis;;!; A Depth to water after monitoring? DRY Date? 11/6/17 1 Reading Date Gross Net Depth of Net Time Time Water Drop • () 1 10/31/17 1:00 - 6" - 1:30 30 min 4 2/16" 1 14/16" 3 * 1:31 - 6" - • SNI-m14;NI ,) 4 2:01 30 min 4 2/16" 1 14/16- ill 4/16"ili 5 * 2:02 - 6" - I I - 6 2:32 30 min 4 2/16" 114/16" I_' 7 C, H 8 11 . [3.0.H. 9 15- 10 16- 11 17- 12 18- {° Water Added 19 Percolation Rate 16 (min/in) Perc Hole Diameter 6" HOLE PRESOAKED 20- PRIOR TO TEST Test Run Between 45 feet and 5.5 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. Mark Beg Mayor Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.ora/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW. Parcel Identification Number: Date of Issue: Legal Description Property Owner Name & Address: SK J_1✓1A [-f0cg14E_ At qbt g'retjj_1 j4cCh/�SiCi?• y�nfNol-�'j�/ yAK C1q.S/6 Pump Installation Date: Pump Intake Depth Below Top of Well Casing: 191a feet Pump Manufacturer's Name: 12 P % Pump Model: / Oo c a l 1850-1 Pump Size I hp Pitless Adapter Burial Depth: 10" -feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer:.— Well Disinfected Upon Completion? i�Yes J No Method of Disinfection: LUPin£ Comments: Pump Installer Name: jqr)Ck01?A5f wlr) 1 2—�umPS£?vif� Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. NAME ! GREA,cR ANCHORAGE AREA BORk-.,GH ���C� r�-13� Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE NUMBER OF FROM WELL MANUFACTURER MATERIAL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH 1 IQUID DEPTH LIQUID CAPACITY GALLONS. Z n _ TILE DRAIN FIELD I U Vj TOTAL LENGTH DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE OF LINES NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH— IN. TOTAL EFFECTIVE Zi ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE IN. ABOVE TILE IN. WELL: TYPE CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION_, LOT LINE , SEWER LINE , TANK , SYSTEM , CESSPOOL . OTHER SOURCES APPROVED DISAPPROVED REMARKS .—. DISTANCES. INSTALLED BY SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS:. Form EQ -032 Y DIAGRAM OF SYSTEM 1 �"Q DATE PL GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C"STREET ANCHORAGE, ALASKA 99503 f �ILILEJ CCCXXX TELEPHONE �-W"4 `.....� JIM ,2,� 1 3U��-�� / a?� �aai A x a J'L SEWAGE DI OSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED ADDRESS J'IfV /L' PHONE FINANCED THROUGH V/ TO BE INSTALLED BY -:5 02 4 ^ Z t SOIL TEST RESULTS Q NOTEI THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATEDy rrr N� Se?02-L> N FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE MINIMUM DISTANCES. REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEEPAGE AREA SIZE DRAIN FIELD DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE PIT SEPTIC TANK, SEEPAGE PIT DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR LICENSED DESIGNER TYPE DIAGRAM OF SYSTEM 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. IIB -SB AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. //•� y ` DATE[�I/7"' APPLICANT'S SIGNATURE `-�'� FORM NO. EO -614 oGREA 'R ANCHORAGE AREA BOR " GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME P~¢I~-~/~ /~o ~gz2-~/~CC~/MAILING ADDRESS /¢~' ~ ~/~¢~ ~'F~ PHONE LOCATION ~1~ d¢~ ~11~I~ LEGAL DESCRIPTION /OF $~ ~Od.~ SEPTIC TANK: DISTANCE FROM WELL f~, INSIDE LENGTH MANUFACTURER INSIDE WIDTH NUMBER OF MATERIAL F/~¢¢~-J¢¢ ~' ~/;~ COMPARTMENTS / LIQUID DEPTH LIQUID CAPACITY /~O GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER--OR WIDTH LINING MATERIAL CRIB SIZE: DIAMETER BUILDING FOUNDATION ~2/f NEAREST LOT LINE ~¢/~ ADDITIONAL ABSORPTION WELL: TYPE BUILDING FOUNDATION -- CESSPOOL APPROVED LENGTH DEPTH 9//~ / DEPTH ~ ! DISTANCE FROM: WELL/g"¢~~¢. TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~¢:~ SQ. FT. DEPTH DISTANCE FROM: NEAREST SEPTIC /?)~/ SEEPAGE SEWER LINE TANK _,~:~tl,~,4..'~ SYSTEM /~-~ f~C~'.4.c.~:l/?:.F~.¢ CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED REMARKS DISTANCES: INSTALLED BY: :~ ~'~: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. LQ-D31 DIAGRAM OF SYSTEM DATE G.A.A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99505 TELEPHONE 274-456I NAME OF APPLICANT INSTALLATION LOCAT,ON LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE aND SIZE OF FACILITY TO BE serVED PINANOED THROUGH COMPLETION DATE ANTICIPATED SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT SEEPAGE PIT ~ , DRAIN FIELD . , OTHER FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. FOUNDATION TO SEEPAge PIt 20 DRAIN FIELD SEPTIC TANK TO SEEPAGE Pit WALL / ~'/ SEPTIC TANK .. SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK ,//¢ ~ /~ DRAIN FIELD £ '~ (~ DRAIN FIELD / /dO , SEEPAGE PIT ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD , - SEEPAGE PIT DRAIN FIELD TO RIVER, LAKE. STREAM. CAST lEON 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. BACKFILL CONPORM TO BOROUGH REg~ILATIONS REGARDINg INSTALLATION. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS iN ACCORDANCE WITH SAID CODE. Date APPLICANT'S SIGNATUre ~. _ . ~ CREATER ANCH PA AF:FA B0. J^ii (j- HUALTh D;.PA}.T.:ENT 4oQJ"3r' CAST: ,! 32: EACLE c-RFET ANCy1RA :i , AL �F:;,A 99501 Ferf ted For K.7"Cnn Legal Date Perfo�r7med Lot 12-71 1 :1C^ TF:is Fern Reports a: Soll _-Lc, __._..Yrerc- atlon 'test Depth -Feet Scil CCa-...tcristics san4 01..� baa, 9Caue l wrl-k v.o sill . 'fIvo-oPA Cork bizel.� 4 o fan4 SIme- 101'111 , 3 �T'c m ort Has Ground Water Encountered?_rp .hat Derth Location Skatrh Frcpo,ed instalTlaticn;-Srepa:e Fit ✓ Drain ;field DepeF, Of Inlet �1 Dt tr, ;0 bOttOm Ot Fit Or ':rent COM'•1E!iPS: /rni2v rcca 1 1 .__ 10 .__.. -, _ -" Test Performed By; Data Certified By:� 0 Date._- MUNICIPALITY OF ANCHORAGE ~J DEPARTMENT OF HEALTH & HUMAN SERVICES ~) [-~ ~ 0 i DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~:l~)'~- ~)~(~ OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section,, township, range) Location (address or'directions) (b) Property owner ~ Mailing Address /~, (c) Lending Institution Mai,ng Address - (d) Real Estate Company and Agent Address TelePhone ~¢E-- Telephone: Home Business (e) Mail the HAA to the followino address: or: Check here ~, if hold for pick up. List contact person and da, y phone number below. TYPE OF RESIDENCE Single-Family'J~ Number of Bedrooms ,/ WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite*J~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-095 fRev 8/86~ Fronl 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 regulations in effect on the date of this inspection. / Name of Firm ,/~Z~..-~) Telephone Address /,~¢O /.J ~/~"~ p'./C'zr ~¢ ,~&./. Date DHHS APPROVAL Approved for 4 Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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. Page 2 of 2 72-o25 IRev 8/86) Back /'\ MUNICIPALITY OF ANCHORAGIMUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL SERVICES DIviSitf cALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 DEC -4 1937 2644744 Legal Description: "7'S $coex S 3CV Z61W EST. 'Tiles mid sce, u RECEIVED A. WELL DATA Well Classification 'PR1901E If A. B, C. D.EC. Approved (Y/N) A%114 Well Log Present (Ye—Date Completed Yield S 6 6"1 Total Depthe 230 Cased to r6 00 Depth of Grouting "/ A Static Water Level -y- 11 Pump Set At Or Casing Height Above Ground 7-'7 Sanitary Seal on Casing 1(9N) Depression Around Wellhead (Y© Electrical Wiring in Conduit (9N) Separation Distances from Well: To Septic/Holding Tank on Lot �� 8 ; On Adjoining Lots 1ri) 1 To Nearest Edge of Absorption Field on Lot 97 ; On Adjoining Lots /fid i To Nearest Public Sewer Line 'JIA To Nearest Public Sewer Cleanout/Manhole A%/R To Nearest Sewer Service Line on Lot yS t Water Sample Collected by 1G1 ; Date /A 7 Water Sample Test Results %Sift- Atli Are'j 0./ Comments ')" a/,41,c1,1a4' 0"J 72,37- // if41. tiE*fAA9- % oo STA 1)ii0E1. CJ, 7,6e comic 87acres ?elp eT B. SEPTIC/HOLDING TANK DATA Date Installed b'7 Size 1z50 No. of Compartments Foundation Cleanout (Ya1 S� '/ Date Last Pumped - -" /SAAt3 Pumping/Maintenance Contract on File (Y/N) A —;for A Holding Tank High -Water Alarm (Y/N) �lA Temporary Holding Tank Permit (Y/N)— Standpipes 6)N) Depression over Tank (Y(9 Air -tight Caps&J) Separation Distances from Septic/Holding Tank: To Water -Supply Well 108 , To Building Foundation /O To -Property Line � /� r +' To Disposal Field S� ..ToWater Main/Service'Line iy To Stream, Pond, Lake, or Major Drainage r.OUfSe' Comments : tiwu Ps�t+ 17i4�/D�rrl�. 7 Page 7 of 2. 72-M IFI" 8'861 Font 45-85- 3rf 7544CW- csr C. ABSORPTION FIELD DATA Soils Rating In Absorption Strata/ /i8 Type of System Design e e,,d / TLtAuI Datelnstalled Length of Field dt/d ? 7oeod 3r . r i Width of Field TRS 3 Depth of Field C,Ci? 9•� 7t /y Gravel Bed Thickness «/d r Square Feet of Absorption Area /,xoT",// Standpipes Present&) Depression over Field (Y© Date of Last Adequacy Test 7 -LZ- 3,7 Results of Last Adequacy Test 4be&uA'f6 Separation Distance from Absorption Field: To Water -Supply Well k 577 To Property Line To Building Foundation L::5 - Lot 0 To Existing or Abandoned System on /s ; On Adjoining Lots /e -,4- To Water Main/Service Line /0 f To Cutbank (if present) n/,A To Stream/Pond/Lake/or Major Drainage Course /OV f To Driveway, Parking Area, or Vehicle Storage Area Comments at` i/97ff*RE A&M 1Ti1✓l��l. D. LIFT STATION DiMi ,tauei:1, Size in Gallons "Pump On" Level at — High Water Alarm Level at Tested for Electrical Codes (Y/N) _ Comments Dimensions Manhole/Access (Y/N) — "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request •• Vent (Y/N) during Adequacy Test. Meets MOA Icertify that Ihavve h�eDckea,rerified,orconformedtoallMOAandHAAguidelinesineffectonthedateofthisinspection. Signed Date It -Z -W e��arAC Company ALJ MOA No. �7-� E OF A4 e� q•�••,,.•...,.q�'� Receipt No. /00/' 000/ a •� ; • _l�_ •,•.f. 4 H Date of Payment /)�3�i� r*• •••»•/••••••�'7.:'' Amount: $ �/�/U 0 3y4 1V L,.Pkut/ Page 2 of 2 72-M (Rev 8'881 Beak •.. AF iEROY G REID, JR. J/ ce-z2sl �Jr ��•wok�n+k�' z¥lunicipa. tYof Anchorage P.O. [3C .96650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 TO N Y KNO WL ES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES December 8, 1987 Alan C. Wien Engineering Technician Alaska Environmental Control Services, Inc. 1200 West 33rd Avenue, Suite B Anchorage, Alaska 99503 Subject: waiver Request For Lot 5 Block 5 Sky Ranch Estates Subd Waiver Request Number WR87-074 Dear Mr. Wien: Your request for waiver of the required separation distance between absorption trench and well has been approved for the subject lot. The required 100 foot separation has been waived to 97 feet. The water in the well appears to be supplied by a confined aquifer at 220 foot depth with adequate clay layers between this point and the ground surface. It was verified that the casing goes down 230 feet to the'bottom of the well, thus the aquifer should be shielded from any surface contaminants. This approval applies to this well and absorption field separation only. Any future upgrade to either will require all separation distances be met or another waiver approval from this department. Sincerely, Daniel J .~oth civil Engineer On-Site Services cc: Gus Andress, P.E. Manager, On-Site Services/Water Quality Programs ALASKA I1UIROFImI FITAL COF1TROL $ I UICeB, I[1C. Er~§i~l¢¢rjM $ I~n~iror~me~lal StuJics December 2, 1987 Municipality of Anchorage Department of Health & Hnman Services 825 L Street Anchorage, AK. 9950] Re: Lot 5, Block 5, Sky Ranch Estates Subdivision Waiver Request Tile separation distance from well to trench standpipe is 97 feet, Tile trench was installed on 10/18/76 and tile asbuilt shows 98 feet and was approved by Boh Pratt. There is no well. log available. The attached drillers report sho~s total depth and casing to 230 feet. The static water level is 207 feet. The sewer system :is downhill from the well. Water samples are satisfactory. The soil consists of GM, GW, and SW for an average rating of 128 square feet per bedroom. The SW was encountered at the bottom of the test hole done 6/12/71. This type of soil will provide excellent filtering of the effluent. We request LhaL you grant the appropriate waiver. If you have any questions, please call. Sincerely, Alan C. Wien Engineering Technician 1200 JJJcsl 33rd Au~nu¢, $ui1¢ [~ * h,choraq¢. Alosb 99503 ,(907) 561-50~J0 JOB ALASKA ENVIROt. F. NTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SItEET NO. CALCULATED BY ,~L, ~.~? ~C~-~ CHECKED BY. SCALE //:,~0 OF °ATE //-z~:'~? DATE ALASKA-li'''OWWELL VERN'S DRILLII.. & ENTERPRISES t'• 12241 Avion St. ANCHORAGE, ALASKA 99516 '1 (907) 345.4417 I' All delete end relunmed Goode 1010 01 0 MUSt be eCCompen,ed by 1Me bill. t� • J t 1 MUNICIPALITY CF ANCH ENVIRON,V.ENTAL SEeV',CES 0, ,GE CN 3 I93, 7 RFCEIVED .p�V fs fa A all 161a �G'l6i -- -- -----------_ . _ (f 6,2 W D%a/ *"d eo.o sy fed coo. I c„YeCY oe "T .osc.xly X yYO aut OTV. DESCRIPTION PRICE AMOUNT ij S � Ao..Y.cG co�.�.✓ O . .. _ 1 I Gt4.611 7�o1�a� ��%� .230 _ 1-e s/ i�Ytt -&,(el Z/.Z' ; - I I i TAX I I I I I I _- TOTAL ISO ;w All delete end relunmed Goode 1010 01 0 MUSt be eCCompen,ed by 1Me bill. t� • J t 1 MUNICIPALITY CF ANCH ENVIRON,V.ENTAL SEeV',CES 0, ,GE CN 3 I93, 7 RFCEIVED 110%\ le 1 Time • _ Time pe Date Date Date Inspector Inspector Inspector Comments /�I.��,_ Conditional Approval � L4J tl� .277-�S�s� Date Sewer Installed k,t.0 rol-w Permit No. Septic Tank Size /.2 y"`V ��/i� C,1 Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner Phone Mailing Address 3/407 Bleo6A24r Dx. p.VcN, 14sa�) Zr/fi—o33L Buyer Address I19G Lending Institution )l 4 Pf 14 4 V4, l G Phone Address %�1S !J 3 . Realty Co. & Agent "' " — j'; ' Phone Address "%r, /- • /)^ Legal Description C07 - Street Location 1(1499C-07 Typeasldence Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Vvatef 5Wply Individual ATTACH WELL LOG. A well log Is required for all wells drilled since June ❑ Community fJ 7-/ 1975. For wells drilled prior to that date, give well depth (attach log If O Public Utility available. Sewsgp-Dlsposat C; Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility - O Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. l?ebrua~¥ 2, 1992 Phillip (,. :~aunder.-~ 3107 Brookside Drive Anchorage, ~K 99503 Lot 5, Block 5, Sl~,yraneh Estates [)ear ?lt. Saunders: .A. pproval for tile ].n~lJ. vldua_ sewer and water facili'tie,'~ cannot be granted until the following items hav~ bean completelY: .~° Exposed electrical wires to the v~ll heart ar(~ in violation of the ~lunicipalitv of Anchora9~ codes and must be in conduit. Tho water analysis report needs to be submitted to this office from tile Chela Lab, 5633 It Str~et, for our review. The septic tank pumped with a receipt submitted to this depart ment. An adequacy t~-~st needs to be pmrforme<l on the existing leaching area. This test will ftetermine if. the system is ad0qtlate according to National Standards. A listing of private firms performing the test is enclosed. 'Phis report needs to be ilub~nitted to this office for our.' review. Please notify this department for a reinspeotion %.;hen the noted discrepancies have been corract~.d. If ther~ are uny further questions, please call thi~l office at Sincerely, Roberk C. Pratt Associate F, nvironmantal Specialist .Enclosure Tobben Spurl land P.E. 8155 Cranberry St. Anchorage, Alaska 99502 Phone (907) 243-5302 Phil Saunders 3107 Brookside Drive Anchorage, AK 99503 1] February 1982MUNiCiPALi-rY OF ANCHORAGE l~hlVIl, ~ i,,',. :o , I RECEIVED SEWER ADEQUACY TEST Legal: Location: Residence: Owner: Water System: Sewer System: Date of Test: Test Procedure: Lot 5, Block 5, Skyranch Estate 11961 Steeplechase Court 4 bedroom single family Phil Saunders On-site well From municipal records Tank: Absorption system: Absorption area: Soil rating: Installation date: 1250 gal. Sunset Plastic, i compartment Concrete block seepage pit and 7' deep trench 1200 sq. ft. 128 October 1976 February 10 and 11, 1982 System was inspected and tank pumped on February 9, 1982. Sump to trench is lacking aboveground standpipe. Sump is 9' deep. 47 inches of liquid was observed. On February 10, the 'trench was charged with water in 300 gal. increments. Tile following readings of the liquid depth were taken. Water Volume Depth 0 gal. ].2 300 30½ 600 42½ in. After 24 hrs., the depth was 8~.. 'robben Spurkland P,E. Test Result: In a 24 hour period, the system absorbed in excess of 600 gal. The municipal code requires an absorption rate of 600 gal. per 24 hours for a four bedroom house, This system meets this requirement. The standpipe to the trench should be extended above ground surface and capped. CHEMICAL & LOGICAL LABORATORIES.";)F ALASKA, INC, pt,fpefVfrypr4' TELEPHONE 19071.279.4014 ANCHORAGE INDUSTRIAL CENTER 2743364 5633 B Street 3,A-. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: l n n I.D. NO. Water System Name _ - Phone No. Mailing Address City state Zip Code SAMPLE DATE: E731 = FTM Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. t ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE NO. LOCATION 1 1 / 's -.'?,k 4 1 I 5 Time Collected Collected By / Zt- ply" Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit: sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: _ ❑ Fermentation Tube CJ Membrane Filter Lab Ref. No. Result' Analyst f 'I m I I m •NO OI CO NQI/100 M. p NO OI Po41M pole"/ 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Re,. 1218 Date Collected sour" READ INSTRUCTIONS a.m. ora Received TM,e RKNvep p.m. Lab. No. Presumptive 10ml 1 10.1 1 10ml 1 10.1 1 10m1 1 2.0m) 1 0.1ln1 BEFORE EMB Brom 24 hourpl Broth 48 hours, COLLECTING SAMPLE I Multiple Tube Report,-10ml Tubes tbNtlee/TeW 101"t Pertlorfa Membrane Fgter, Direct Count Collfomm/200ml Verification, LTO —BG9 Final Membrane Filter Results / Cclllorm/100ml Reported By Data P.M. I'~ q'Ch 7 u~~'' ,xxX~, ( ~'~' ~' '~ MUNICIPALITY OF ANCHORAGE  DEPARTMENT oF HEALTH & ENVIRONMENTAL PROTEC~IqN- 825 I. Street - Anchorage, Alaska 99501 ................. E IN DIVISION ENVIRONMENTAL ENGINE R G Telephone 264-4720 DIREC~IO~S~ Complete all part~ on page 1, [n~ompl~t~ reqaests will not be pro~es~ed. Please allow ten (10) deys for processing, 1. PaOP~RTY OWNER PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. ~UYER PHON~ MAI LING ADDRESS 3,' ~ENDING INSTITUTION PHONE MAILING ADDRESS 4, REALTOR/AGENT PHONE MAILING ADDRESS LEGAL DESCRIPTION 5 k~ ra u~e-~ J-sJ, z~.~t s STREET LOCATION 6, TYPE OF RESIDENCE '~ SINGLE FAMILY [] MULTIPLE FAMILY I NUMBER OF BEDROOMS ~ One ~ Four ~ Other ~ Two ~ Five ~ Three ~ Six 7, WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well log is required for alt wells drilled since June 1975. For wells drilled prior tO that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM '~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date If system is over two (2) years old an adeqUacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 7z010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED'' INSPECTION APPOINTMENTS TIME i TIME TIME DATE DATE DATE INSPECTOR I NSP ECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO FI FOUR [] SiX PERMIT NUMBER 2. WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED PERMIT NUMBER 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE DATE INSTALLED E3PUBLIC UTILITY ~ t// ]O --') (¢ Connection Verified INSTALLER []Septic Tan..k or [] Holding Tank SiZe: I~-~-O If Tank is homemade SOILS RATING give dimensions: [ '~ ~ TYPE OF TANK MANUFACTURER~ TOTAL ABSORPTION AREA MATERIAL ~ ~"'- '~ ~'/ '-~-/t-~'t~. 4. DISTANCES Septic/Holding Tank Absor~Area Sewer Line J Nearest Lot Line WELL TO: I Absorption Area to nearest Lot Line 5. COMMENTS '[~Fl' APPROVED FOR _ ~'~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev, 3/78) r ,y TELPHONE CHEMICAL A GEOLOGICAL LABORATORIES OF ALASKA. INC. (9D7)279-4014 P.O. BOX 4-1276' ANCHORAGE, ALASKA 99609 4649 BUSINESS PARK BLVD. =Drinking Water Analysis Report for Total Coliform Bacteria - TO BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM: n ^ . . iA ENN II TO BE COMPLETED BY LABORATORY a o* 1 LABORATORY: I SAMPLE DATE:® ® 5Y 17 I Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample ❑Treated Water with lab ref. I ❑ Untreated Water El Special Purposee . SAMPLE Time Collected NO. LOCATION Collected By 1 L � 2 3 If I' NAME ,4 5 ry f ADDRESS CITY p Date Received � _ 7 7/ Time Received /S—Cy Analytical Method: ❑ Fermentation Tube Membrane Filter Lab Ref. No. Result Nnal!9Z I I m I I m el I m e No. of aelenleel IN owl. or No. M Peeithe perllens. 06.1220(b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1976 Dale COWIN READ INSTRUCTIONS Date Received BEFORE ion, COLLECTING SAMPLE Form No. 18310 (3.78) Source a.m. Time Recllved P.m. Dml 1 10m1 1 loml 1 EMB Broth 24 hours: Broth 4e hours: MultlPle Tube RePOrtt 10ml Tubes PONIIN/TOlal 10mi Purtlona IaNmbraM Fetert Direct Count Collform/100ml Vvlficath Final Men Reported P.. • tio •� • Municipality of Anchorage co-> On-Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-301-33 Expiration Date: .2%1 `l e 1. GENERAL INFORMATION Complete legal description SKY RANCH ESTATES#1 BLOCK 5, LOT 5 Location (site address) 11961 STEEPLE CHASE CIRCLE, ANCHORAGE,AK 99516 Current Property owner(s) BRIAN &TINA HUGHES Day phone Mailing address 11961 STEEPLE CHASE CIRCLE,ANCHORAGE,AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class_Well El Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: 7f // COSA to be released to the engineer, unless otherw/1.(1-V--- re nested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA# Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 11120/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ��rith.NIL encroachments,deficiencies or discrepancies exist. , O> 4L4 s Aar <Sy 6. DSD SIGNATURE ; System #1 Approved for �I bedrooms. +�. DtjF T'w KENNETH M. MT / System #2 Approved for bedrooms. , r�F 7 IS rf Disapproved. � ' F:ssso ,•'' Conditional approval for bedrooms, with the following stipulations: 4 o VVbejEOeid raj d3.L JM LSVM Q 0 O'Nb d31bM 311S-NO ick^ A\. �o 1d,,,,; - 11111 �,,,, =• ' 1 AOriginal Certificate Date: ^ -7— Ammo= / 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: SKY RANCH ESTATES#1 BLOCK 5, LOT 5 Parcel ID: 015-301-33 A, WELL DATA - *PER MOA RECORD DOCUMENTS Well type PRVT If A, B, or C provide PWSID # Well Log (YIN) N Date completed UNKNOWN Sanitary seal (Y/N) Y Wires properly protected (YIN) Y Total depth *230 ft. Cased to '230 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test -- 10.19-22017 Static water level •- ft. 209 ft. Well production -• g.p.m. 4+ _ g.p.m. WATER SAMPLE RESULTS Coliform NEG colonies/100 mL Nitrate ND _mg/L Arsenic ND ug/L Date of sample: 10/20/2017 Collected by. ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 11.115117 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping NA-NEW TANK Pumper C. ABSORPTION FIELD DATA Date installed 1111512017 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 System type DEEP TRENCH Length (2(a)50') 100 ft. Width 2.5 ft. Gravel below pipe 5 ft. Total depth 8.2-8.7+ ft. (Measured 11/20/17) Eff. absorption area 1000 ft2 Monitoring tube Y Depression over field N Date of adequacy test NA-NEW FIELD Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: _min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 97'+l-ORIGINAL TRENCH On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ _ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN_ Wells on adjacent lots 95'+l-ORIGINAL CRIB TO WELL ON LOT 6 F. COMMENTS MOA APPROVED SEPARATION OF WELL TO ORIGINAL TRENCH ON LOT 5. LOT 5 CRIB EXISTED PRIOR TO WELL ON LOT 6 &APPEARS TO ENCROACH. BOTH OF THESE WELLS ARE UP GRADIENT OF THE SEPTIC SYSTEM AND THE ATTACHED WATER SAMPLES SHOW EXCELLENT WATER QUALITY. G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. OF .• OF' Al� t Engineer's Printed Name KENNETH M.DUFFUS Date 11/2012017 * • 7 , COSA canary sheet_2-6-15.doc r KENNETH M. Art; / 4' Alf Fit 7 18 ' J 1 /• \��f "FESS .s_ LOT 3 1 f \ 5� 24 0.060od 0 `S1o•0oQ U��cC-M'�� r; ' t N 03 o, 37 r"---% LP.t.P LOT 4 / s LPc.i0 LOT 6 A, 4' SEPTIC • 0• t� .. a' <O`° / (t)p) -7 N.� / • Z 114'$. .d) a"*- • �� � `^^ of�,� Waft C' o, sz,• Ii 6) / „ CANT �xl Sr/NG 2'x17' O(/s� � O� � .l / CANT N 12.0' �"0N txb 00 NN. 4s 0' �n v'ID O• w SHED ' 4� DEOK ¢ LOT 5 x} WELL nrrrrr BLK 5 orrrrrr Aillit� 4'41-92'. DAV 8, 1R_1�� 7 04 R �' Opt 3 N89'59'22"W 1 18,40' Xx _x----x x in N STEEPLE CHASE CIRCLE 7.' '----„,..„... InN 1_ _ ANCHORAGE RECORDING DISTRICT,ALASKA AS-BUILT OF: SKY RANCH ESTATES UNIT No.1 LOT 5 BLOCK 5 PLAT 71-166 .��_``` SURVEY CERTIFICATE:I,John L.Schuller,Have conducted a ‘011.7c.), °F' AZ�, tiQ LANDSD R9.k physical survey of this property as shown on this drawing and that the '/ ��..• .. fyip l '�y%0 S' �f. improvements situated hereon are within the property lines and no A,.•' W b �, enchroachments exist other than noted.Under no circumstance should //GJ.'. 4 g `y 1�` p� t6 'r 0 any information on this drawing be used for construction of fences, * : * O i r4structures,improvements,or for establishing boundary lines. / x t'' EXCLUSION NOTES:It is the owners responsibility to determine I'rb'': ' the existence of any easements,covenants,or restrictions which ��°per, '� L. SCHULLER: •= � -'I s LS-10408 40,/ %-.�• do not appear on the recorded subdivision plat. 1' ��/ 1831 Talkeetna Street WORK ORDER NUMBER: DAM: $CML R-Mua: Vo. .. p lr'.•.�8. Anchorage, Alaska 99508 NOV 18, 2017 1 =30' 11 A ` t` 1 7—058 DRAM!Y:CHEMED OW.OW MY�k DOOK/PAOrs �Ik O•essIonol ' u (907) 227-1455 office JL5 2737 170173 �\N��1�� (907) 274-4992 fax