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HomeMy WebLinkAboutSKY RANCH ESTATES #1 BLK 5 LT 12Sky Ranch Estates. Block 5 Lot 12 #015-301-26 . _ I--._..._—_._---_—_-----_— Municipality of Anchorage On-Site Water arid Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171195 PID Number: 015-301-26 Dwelling: ® Single Family (SF) [' Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: JOHN R. JENKINS ABSORPTION FIELD Address ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 11940 STEEPLE CHASE CIR, ANCHORAGE [' Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.6 GPD/SF 11 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 2.9 Ft. 8.1 Ft. SKY RANCH ESTATES #1 5 12 Fill added above original grade Gravel length Township Range Section Varies 3.2 - 3.9 Ft. 47+ Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 2 Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line 761+ Fe 1 Ft Well 100+ 100'+ 100'+ NA NA TANK ® Septic El S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ 100'+ 100'+ NA ANCHORAGE TANK 1000 Gal. Material Number of compartments Lot Line 5'+ 10'+ 5'+ NA STEEL 2 NA LIFT STATION Foundation 5'+ 10'+ 5'+ NA Manufacturer Capacity Gal, Curtain Drain NA *50'+ 1 NA NA Remarks *None known. Diverter installed to Pump on level al Pump off level at High water alarm at original field. Existing ST decommissioned in. in. in. per code. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 drainfed 3034 Installer Mike Anderson Drainfield 3034 CO/MT 3034 Inspector ARCTERRA BENCH MARK (Assumed elevation) 100 ft Inspection 1•'7/24/17 2^d 7/25/17 Location and description da 3" 7/26/17 4"' Bottom Step COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin Conditional Approval: Date �›.. ,�S, � � 57 * 4 9TI-f •r��i % 7 16 P -'. i or Air '-r4App ' s — ..... _�`� Date 7 i, , .r: t•• ''`' AINF Ap- eer's Stamp Inspection Report_9-1-12.doc AS—BUILT SYSTEM DETAILS/SITE PLAN Pernit❑SP171195 SKY RANCH ESTATES #1 BLOCK 5, LOT 12 PID#015-301-26 \ \ ryo o EXISTING WELL % e63-BR HOUSE 0-- •0. 6 0111111� 4.42.ADJ. WELLS NE 1004-GAL FCO 20.0G� SURVEYED PT1C •NK N B iii. CO CO 4;v I Cy -BM $ �0- - :: ORIG. SHED 1977 FIELD I D ' O DIV bil 44IE \ 2 mss. ,0• �� CY trii CQ; SUM' �_ (Ni \ ' 1.41-\\.\\ .0 4•9NPP 6C) 41 NEW TRENCH 7r1` CO Tr1n-1 ry \CIN kr' LOT 12 LOT 11 di BLK 5 \ \ '6, SCALES 1' = 30' A-C=34,5' 95.40 95.40) A-D_385, 0 E1 \.1.L Pi A-E=3B-D-54.0 96iill .30 FINAL GRADE (95.6 092.40\ 8.5' 6 �,� i OREM&rwmc B-E=50,0' A \ vmuts - A-F=71.0' - 1000-GAL y SEPTIC89.50 89.50 .›)'. —i— B-F=76.5' TANK SEWER ROCK A-G=82.5' u- B-G=87.0' 89.9 89.7781.40 81.40 I 75.40 NM m �� �, I 47,t °o asm MIR Oa 5 SCALE: NTS / �� �F `�4 1 PREPARED FOR: gCTER f °) „j_ .,7 JOHN JENKINS r°t //,����`` r�r y1'* 4 • TH iN *Ill, 11940 STEEPLE CHASE CIR. x SHY. +' Lco ' ANCHORAGE, AK 99516 ( i \ FIELD BOOKS COMUTED+ % CE— 7 p BOUNDARY:N/ADRA : BMWwti? sTAaNG: N/ACHECKED; KMD % ' •'1,k° e , f 7w' I ASBUILT: � '•' �iAy JLS D�1> 7 26 17 �-► -- e ,` SSI + DWG. FILE: GM SW2737 'c��q t\AC�AN ~_ AC,D �E: FILE ,roe No.: 17-171 /1,4,4, —T AK 99577_ MUNICIPALITY OF ANCHORAGE ", On-Site Water&Wastewater Program ��. ,S ,fir PO Box 196650 4700 Elmore Road y • # Anchorage2 ,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.munr.org/onsite ( Department N��opa� On-Site Wastewater Disposal System Permit m 7/2 , Permit Number: OSP171195 Effective Date: 7/20/2017 Work Type: Septic Upgrade Expiration Date: 7/20/2018 Tax Code Number: 01530126000 Site Legal Address: SKY RANCH ESTATES #1 BLK 5 LT 12 G:2737 Site Mailing Address: 11940 STEEPLE CHASE CIR, Anchorage Owner: JENKINS JOHN R & Lot Size in Sq Ft: 22112 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3 This permit is for the construction of: 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 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: , Date: 7--.&D —1 ' Issued By: ��_ Date: 7/1-0//7 Municipality of Anchorage IOnrW 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#: OSV171074 COSA#: Permit#: OSP171195 PID#: 015-301-26 Legal Description: Sky Ranch Estates#1 B5 L12 Engineer: ArcTerra Applicant: John Jenkins Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the excessive slope has been approved. The approved separation distance is 0.0 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. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. n 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: 7/Z---0717 Approved by: bJ t(-,k1 �1'fa _-- Name of Revie r **** VARIANCE/WAIVER REVIEW **** ' \ ► 1 I ICIPALITY OF ANCHORAGE A. • -, •mmunity 8 elopment Department . Phone: 907-343-7904 I - -lopmen .ervices Division Fax: 90 1n - W. -r& Wastewater Program <0 CD' o 4 lIkquo..., ON SITE SEWER/WELL PERMIT APPLICATION �: RUSH 10 - 1 9 2011 Parcel I.D. 015-301-026N-SITE 15-301-26 w JOHN JENKINS & LAURIE BERGER -6 c) Property owner(s) Day phone \,�> , Mailing address 4230 WORONZOF DRIVE, APT. #D, ANCHORAGE, AK 9951 1 ' Site address 11940 STEEPLE CHASE CIRCLE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) SKY RANCH ESTATES #1 BLOCK 5, LOT 12 Legal description (Township, Range & Section) Lot Size 22112 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field Pl Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank 12] Upgrade 011Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: SI. E ?2 5-S ?u Pada Distance: 4 f I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signat. - iperty owner or authorized agent) Permit/Rush Fees: 6O3R.'/O Waiver Fees: 2 .5 Date of Payment: - ./a01/-3- '�"� Date of Payment: aOf f' Receipt Number: 0769040D Receipt Number: n-Hofilei0 Permit No. 85 pi -1185 Waiver No. 05W-41634 ($74 Permit App_9-1-12.doc o.�cArTEii, ARCTERRA ERRA CONSULTING, INC ``�fSNTING� 0 212 E. 51st Ave,Anchorage, AK. 99503 Office(907)868-3791, Fax(907)868-3793 July 14, 2017 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade Sewer Permit - Sky Ranch Estates #1 Block 5, Lot 12 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 existing system will be completely decommissioned. The general slope of this lot is from east to west at a grade of approximately 20- 30% over the septic area. We are therefore requesting a waiver of 0 feet to slope to field. The proposed field is uphill above the original field that has had no known day lighting issues for 40 years. On July 13, 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 3- bedroom single-family residence. We propose to install a deep trench. Groundwater was not encountered at excavation or at monitoring. 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. r u s, P.E. Attachments: On-Site Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test 20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793 WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN SKY RANCH ESTATES #1 BLOCK 5, LOT 12 • •� 1 \ \ ag9�. ' „u ti� N 1x59 _ 0 h' \‘'6 D \ Mr 1O IFF7 EXISTING 3-BR HOUSE \ i%!\Z' \ ,,Msuu. 0 awn .,It F,'., . it]iiMi sanctum o 10. o i!1 _�F [MIND IV7 RU.D Nil 411k; .-_, • ., ro aDra�. \ y-tr , ilkf a. a N ' 111,7-, .©�',. v ry �/' A� / \ 1V 1 11 f • \ 1- . LOT 12 / BLK5 \ \LOT 19 FLAG ALL WELL RADII, PROPERTY LINES Scale= 11= 50' & EASEMENTS PRI❑R PAGE 1 OF E TO CONSTRUCTION DESIGN DETAILS 3 BDRM X 150 GPD = 450 GPD 450 GPD/0,6 GPD PER SQ. FT. = 750 SQ. FT (750 / (2 X 8' GRAVEL) = 47 FT. DEEP TRENCH USE TRENCH 47' (L) X 2' (W) X 8' (ED) Total depth of system is 11' from original grade. NO PUBLIC YELLS WITHIN ear OF PROPOSED SYSTEM. NOTES: NO PRIVATE YELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED, 1, INSTALL 1000 GAL SEPTIC TANK & INSULATE TANK IF <4' COVER. NO SEPTIC SYSTS200' OF PROPOSED WELL EXCEPT HAS NOM. 2. INSULATE TRENCH WITH 2' HD BURIAL FOAM IF < 3' OF FILL. MIN. 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ. 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK. 4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... / < QF -`4-1-e4, PREPARED FOR: gCTERD 7 if ' k JOHN JENKINS ' 1 11940 STEEPLE CHASE CIRCLE ,°ti01645:,\�Y * 4 TH '_ . * , ANCH❑RAGE, AK 99516 / KE 1 , 1 , . :.. .. it a x-7118 �kl' / :� ► �-!.� ti4 I ST J( Q NMA CHECJCED KMD = % / • R' E 1 �� / 1,SUULT: JLS DATE: 7/14/17 ��� ` e a , SSIO DWG. GRID: SW2737 'mac A C �� F p �_� ACRD ALE' JOB No.: 7—XXX R/PfR S 111,7'1 NG •X36�� FILE AK.99577' WASTEWATER DISP❑SAL SYSTEM DETAILS SKY RANCH ESTATES #1 BLOCK 5, LOT 12 GJ�J , fi 1'x4.5' t+ tj'� 'r' BW CANT. PAVED tl ii.: � �� D /W�i 11 -a, 18.0' 125 J e t ` �p ii�s 'Lo o EXISTING WELL ,, 3-BR HOUSE ,Z 0 'OMISSION EXIST1 ?�" a d %11111°Win- �SS+ . INSTALL NEW 1000 9 46- SEPTIC TANK 20,0• Q4' \ FCO IWO. • ------ EXISTING 1977 FIELD NO 5' iiitil,O p B co SHED \ D 72'5%+ fct:\\PROPOSED I Z AG WELLRADII •-IOR TO CONST. IIIII 1J- ,�I o. \ s ^ �r], TH17-1 p � o ry ��: SO SHED I ,4 + TRENCH -37 ( � \ �L OT 11 � � Z \ \cc\ \ �- cP LOT 12 u' BLK 5 \ \ 'cp LOT 19 FLAG ALL WELL RADII, PROPERTY LINES & EASEMENTS PRIOR TO CONSTRUCTI❑N Scale; 1"= 30' 4iiib:gib'''‘, PAGE 2 OF 2 Adir OF AZ<Qs PREPARED FOR; , CTER r ,ff`� r 7 ` J❑HN JENKINS ti r o / v1 �� 11940 STEEPLE CHASE CIRCLE + IfA� kk /c2 j * 4 • t �� ,/ *ii / ANCHORAGE, AK 99516 y / � �\ KENNETH m. i ,. FlELO BOOKS COMPUTEDlo x o + -71 .6 8 J ftRY:N A DRAM, BMW Z '"' ',, 1 77,0, ��, STAN N/A CHECKER K M D _ % \ 1 i�° E N ,�,,` / As8LIET: SLS DATE: 6/29/17 ,+•�,; ` 11°11..\.:4111:1161P -PRo E5510�- / DM . E cmo: 2737 o A C �; ` �� ACRD FIE FILE aDe No.: 17-XXX �'94.447S1-11..1-I NCS •813�aA AK- 99577 Jr �,<.Tt c? ARC 1 EURA �� OF AL4\ ) CONSULTING, INC /�2' 'I=• ` i 212 E.5151 Ave,Anchorage,AK. 99503 r) 'Y t Office(907) 868-3791,Fax(907)868-3793 4 * 4 i 'P i ti Riiiiw�� �"•�ct,s.,„,,7„_,,,..c•`H`” riris 4 -f KE\nE"1•H . � / ,. ��� 711: �• SOILS PERCOLATION TEST i``5,� . Ig °i 1 P 07:ss10~ ,' AUF Performed for: John Jenkins Date Performed: 07/12/2017 104\Ilk_"0:1°P. Project: - SKY RANCH ESTATES #1 BLOCK 5,LOT 12 TEST HOLE# TH 17-1 Depth (Feet) SEE ATTACHED SITE PLAN I • „ i n ��aL FOR HOLE LOCATION a Was Ground water encountered? NO What depth? NA Depth to water after monitoring? NO Date? Tl1`ili 1 d 4- 0 titi Reading Date Gross Net I)cpth of Net 5- C7 Time Time Water Drop r,- I 7/14/17 1:00 - 6" - 7- 2 1:30 30 min 4 1/16" 115/16" o , N d 3 1:31 - 6" - ', 4 2:01 30 min 4 1/16" 1 15/16" 1(1 5 * 2:02 - 6' - I- 6 2:32 30 min 42/16" 1 14/16" 12- d 7 _ Less silt with depth 13 8 I.1 9 I5- 10 16- 11 17- *1 12 B.O.H 18- * Water Added HOLE PRE-SOAKED 19- PRIOR TO TEST Percolation Rate _16_(min/in) Perc Hole Diameter 6" 20- Test Run Between 4 feet and 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. MUNICIPALITY OF ANCHORAGE Head, and Environmental Protecoo��n Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 _ INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME__. Ate= V"S MAILING ADDRESS SR<R P�ar37, PHONE-3`{�'-I?I I LOCATION LEGAL LEGAL OESC R IPT ION I—I i- �r 5ke, ►zrw•e� %f• SEPTIC TANK: ISTANCE FDROMWCLL-10y I;'- MANUFACTURER ��-MATERIAL 5±4-z I NUMBER Z COMPARTMENTS INSIUE LENGTH ^� INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY LOOOGALLONS. TILE DRAIN FIELD:. -Pty " II I TOTAL LENGTH _ DISTANCE FROM WELL . oD A- : FOUNDATION 0 NEAREST LOT LINE OF LINE Z # of Lines DISTANCE BETWEEN LINES Not TRENCH WIDTHiL-1IN. TOTAL EFFECTIVE ABSORPTION AREA v SQ. FT. LENGTH OF EACH LINE I DEPTH OF FILTER �` DEPTI I: TOP OF TILE TO FINISH GRADE-I�MATERIAL BENEATH TILE C, (0 ABOVE TILE ` IN. SEEPAGE PIT: DIAMETER _ OR WIDTH _. LENGTH_. DEPTH - i Log Crib _Rings_ Crib Size: DIAMETER—DEPTH— DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. I--'------` -'- - - -- -- --- well i C1a SS: Z�a Depth: Well Dista9ce To: Lot Line Zo Bldg: �� Sewer,Line: _ Pipe Materials: t��=d # Of Bedrooms-, Installer: Remarks: DATEIL'F*lI t APPROVED. W Nj - - - i-I--j- 1.. '1I- . - -' [_ 1_J Ll( -- _- DATEIL'F*lI t APPROVED. W Nj ;TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER. OF BEDROOMS = 3 SOIL RATING CSO FT/BP,)= 150 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 12 L_ FEE t-41:3 C3F?1=1�EFL DEFJ-rtA v THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). FRF ' 1 I �'EF> SEPT I r TF=iFti1F� I cE= 1Ky�+�_a ;r=iLLGt�� --------- PF=l (--KAGFEE PLFit-jT OPT I OtJ 'A PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1. EITHER, A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. 2. A CONTINUOUS MAINTENANCE AGREEMENT I5 REQUIRED. IF A MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL --- ABSORPTION SYSTEM AND/O9 YOU MAY BE SUBJECT TO PROSECUTION_ - --- TWO C 2] I t.1SPEOT I Ot+IS F1F?E F?EOlJ I R, r> BACk;FILLIFIG OF ANY SYSTEM WITHOUT FINALINSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEFZ"" I T E}SP I FR EF 6E��Et1BEF? 311 1_Z�i r I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND b1ELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SE14ER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE 15 REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED ISSUED By ------DATE_1�-�a UU V3. 0 �-9•_, fl -I 1 I- 1 F_HI_ 1 1 Y k-1 I- ""l..HIJ f -' Hili C. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION " 625 'L' REET, • ANCHORAGE, AK. 995 , 11: A ak /1p- . 279-2511 -��� I TE SELJEF? PEF?t•1 I T // PERMIT NO. t 77921 ) 3PPLICANT JRMFS R,ODGERS SPA BOX 32 _OCATION STEEPLECHASE DR. 344-7*2 Jp1,�j_7� 7oI. LEGAL L-12 B-5 SKYRANCH EST. LOT SIZE 22112 SQUARE FEETJ� ;TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER. OF BEDROOMS = 3 SOIL RATING CSO FT/BP,)= 150 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 12 L_ FEE t-41:3 C3F?1=1�EFL DEFJ-rtA v THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). FRF ' 1 I �'EF> SEPT I r TF=iFti1F� I cE= 1Ky�+�_a ;r=iLLGt�� --------- PF=l (--KAGFEE PLFit-jT OPT I OtJ 'A PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1. EITHER, A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. 2. A CONTINUOUS MAINTENANCE AGREEMENT I5 REQUIRED. IF A MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL --- ABSORPTION SYSTEM AND/O9 YOU MAY BE SUBJECT TO PROSECUTION_ - --- TWO C 2] I t.1SPEOT I Ot+IS F1F?E F?EOlJ I R, r> BACk;FILLIFIG OF ANY SYSTEM WITHOUT FINALINSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEFZ"" I T E}SP I FR EF 6E��Et1BEF? 311 1_Z�i r I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND b1ELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SE14ER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE 15 REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED ISSUED By ------DATE_1�-�a UU V3. 0 Pero'ormed fore Legal Description:,e 'This form reports: Denth Feet DEPARTMENT OF HEALTH AND ENVIRONMENTAL 1'ROTI`.C1'ION Pou'IrM, 99502 - 2518 $. Tudor R- -�, Anchorage, Alaska Date performed�ci'� S aLlcn t FA ReadingI 1 Date I Gross Time I Net Time I Depth to H201 Net Drop Percolation rate minute Proposed installation: Seepage Pit 'r°� " Drain Field ��pth of Inlet . Depth to bottcm of pit or CO`1 ENTS: %j-.rrih.i. �11 -.451,ss ac -46_7- rformed By:LE7e rLe' vv 2 - 4 - - sE� 7- E- 12 - C/ Z-57--15IZ9 13 -/S,4�r/ 14 - 4 L2!;a; LLS-/4G�. . Was ground water encountered? /Vd If yes, at what depth? ReadingI 1 Date I Gross Time I Net Time I Depth to H201 Net Drop Percolation rate minute Proposed installation: Seepage Pit 'r°� " Drain Field ��pth of Inlet . Depth to bottcm of pit or CO`1 ENTS: %j-.rrih.i. �11 -.451,ss ac -46_7- rformed By:LE7e U Z 0 0 Z o .j z j C4 k � § cc � Z Lu � � � -' CIJ!Cn • | |$ Cr M �, � § § § § lz k : \ § B k 0 n > / § |/ g ci i j \ ( :34 / § r4 ) Q y §r p r � : \ / q J Q Q Q � o * j § \N � « C\l. H _ � E� E� E� Ek 1� § § § ( ( ¢ k $ e Q \ / \& cd | CCE « 9 � Cr) _ • | ! / / \ / \ / � � � x ■ � � � , 22 § 2°°§§ 2 2 2 2 � w lk&k ■! k. ih w lk w > > } a \ 2 4 m » S| $ 2 > £ ' \ G co 2 : & o w » ci #, � � � _: 2~~@ 9 e k 6�4! o c o 0 0 0 0 o s o G&» 6N sk ■ 6k ■ � ■ ! k § � 9z Steven R. Pannone, P.E. P.O. Box 102954 Consulting Engineer Anchorage, Alaska 99510 (907) 272 8218 SEPTIC SYSTEM ADEQUACY TEST Legal: Lot 12, Block 5 Sky Ranch S/D Owner: Mr. Jim Purcell Residence: 11940 Steeple Chase, Anchorage AK 99516 Septic System: Tank Size: 1000 Absorption System Type: Deep Trench (from records) Absorption System Size: 35'x8'x3' Absorption Area: 560 s.f. Installation Date: 10/7/77 Soil Rating: 150 sf/br Date of Pumping: 9-98 By: A+ Home Service Date of Test: 6-5-99 Test Procedure: System was inspected visually and measured. The drain field was found to have 48" of cover and a total depth of 163". There was 57 inches of water measured in the field's monitor tube. Water was added from the well serving this property at a rate of 5.4 gallons per minute. Water levels in the tank and drain -field monitor tubes were monitored. A total of 465 gallons of water was added. During the test, the liquid level rose 18 inches in the drain field. There was no rise in the septic tank. The infiltration rate vms monitored for 1440 minutes. During this period, a total of 450 gallons were absorbed. By the observations made, this system has an absorption rate greater than 450 gallons per day at the time of the test. The septic tank on this lot is 85 feet from the well. There is a waiver on file with the MOA DIMS. The well was tested at the same time as the septic system. The well had a static water level of 212 feet below the top of the casing. The static water level was drawn down to 215 feet while the well was producing water at a rate of 5.4 gallons per minute. The casing stuck-up 27 inches above the ground. Water was tested for bacteria and Nitrates. The results are not available at the time of this writing TESTS RESULTS: This system meets the code and operational requirements of the Municipality of Anchorage, Department of Health and Human Services. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. We can therefore not give any estimate of how long the sysm tewill continue to meet the operational requirements of the Municipality and State. "' lr��s CE 8149 E �PESSIONR� r. Municipality of Anchorage Department of Health and Human Services Tom Fink. 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 August 4, 1992 Warren Enyeart, P. E. 10609 Creastview Lane Eagel River, Alaska 99577 Subject: Waiver Request for Lot 12 Block 5 Sky Ranch Estates #1 Waiver Request #WR920038, PID #015-301-26, HA920451 Dear Mr. Enyeart: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are private well to a septic tank 85 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services ljm:#6 Concur: Ptk mit , P.E. rogram Manager On-site Services n _ MUNICIPALITY OF ANCHORAGE.. Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR920038 PID# 015-301-26 HA# HA920451 Permit # Date Received: July 22, 1992 Legal Description: Lot 12 Block 5 Sky RAnch Estates Subdivision #1 Engineer: Warren Enyeart, 10609 Crestview Lane, Eagle River, Alaska 99577 Applicant: James/Patricia Anne Rodgers 8S Waiver Requested: Private well to septic tank - 49-C' feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: SEE 119 ?r`3C} F -V Date: Fr -3-Z2 By: Rec #: 23878/3160 Amount: $ 410.00 Date Paid: 7-22-92 jl :IWR/VCR REQUESr fOR L OT /2 Bck .f' Shi RHvCH ESTATES'4 I IlwglvER REQUEST MW-lZ!E►R 1vR4J20038 !7llf/VER /jEgGEST FOR PELL TO SEPT/C Tl9Nk .BSFEFT �I EPTIc T �/ le SEPTIC, SYS TEM _ IvyS !O(iJTIPuCTEQ /,v OCT, /977. SEPTIC TRWr /S <J GREER. Two CoAtPAR7-mF vT :.5EprlC rh vk. , ryEsf r,9kkf . O14RIA4 r/-f/f EI?19 WERE 'COn,sTRaITED WITH SLEEvEs ONTNE /Anicr ! Ou7-1ET,AV L!rHk f/ CHXA cc5..A-RE _ to q rE,? rl6uT COa Pllw6f /T`RE I& PLo9CE. ;.THE SEPT/C r6IVN /f LowER Iw ELEVgT,o�„ Vr THE GRaiap �BY9•� .Sun FACE . TKHA, rAiF 4,41t XJ AT GRcm&,o Sk/PFACE; T/,•E roPoGlegPliY /S /% R/0Gf oR CREST oR yuyp eErwfE,v. T/1E i iSE p r/C ngAvw A vo THE WELL, rRE OVERy1L TOPD6R/3PHy oI .i.irIYF ARER If !/ GRakNO SLOPES APPRoxI�rATFLr.S-/oq ;i�leoh E�sr .vow.�i,,,q�pp r0 rHE wEsr. gECRIt$E OF rKE HuiyP A?R7L-EEA1 THE IvEGC SEPT/C y79W I ::1041iNCES OF SURPACE lovTA.w'N^Tion ,,f T/tE t,. EG [ lFi40M TH'6 !r"7-lc 7,944'y I.� E v E ^ r !I .iJrEa-iiG£ j%Aj�LIG/{TEp .O,v Titer GRau,t�b SuRfAC� q�pE I I.IRt^� °TE• i. Lj ii ,i Li I — „ i; THr WELL w-igr OF1[[E0 lav aCr 1977. rHE Torlgt OEFrW OF r"r t4,ELL /S 262 FEET. i TlfE STAT/c Lr ,v7 -ER L E ✓rL ToO,yY /S �O FEET: rHE suBTECT l -EGG If oEEprp� rH/9/, FILL OTHER l•-EttJ gI?EA Bi 20 TO ¢O FEET, T/yE G -ELL DR/LLEIQ 8A'COun.TER60 . 6n#gvEL STR/9Tg G ' rlvick AT 22o FEET' DEPTH ,4ad DR/ZLCP E9fED 7-HRO14by c- 014 REPO/z7^I.vG TF_ R. r FEEL. iHE/IB POrriBf r Fau LO !aE j_,oqL rFR ,.,TKE'XE HPA9 Al -L oPYF-j4l- t^*EjtLf TR& �914E44 9E1 4(T1412i4,4 ..:rt -ft; 19-5 TI/Fl!? !~n T ER S u pR4 Y. TH/s L- auLO Ex A.qAA rt E 9 0— 4 0 FF,F r 06fPEIe DEP rq OF T/YE S u fl rF c T (v ELL. OVER . rNE . oTNI"RS, 4L L THE t✓ EL[ L olf /Ai THE RIiEA )V El91? TO BE RELyrIvEL y' c'O,vs,s rE.�r L.I r-// iTNF SuRXEcr +-,ELL. t au/. SEVERNL LAYERS OF 'sarr «A,- Ou 7wF WELL lobi /Ail11LNrE T</E 441&4jFE)q SkOtiLO B€ COuF/,�EL7. U�gTEI? SHn/0LE IQFSkLT5 lwplcl�TE No FEC,yz c*oL/Fo,y,,y i9NA . G My�f aI rIQAi�. i 5. Of IWArER rARLE Af5KHEY. rw�R Otory 15'0/c SORdrie..60121)_ i IPERKER,Vll r W. G. {ar S. C. /? a PoiNrs S: 9 t�� j t(82 3 l:�flj'�i/eAgt/L GRAD/EuT I.i ASSk MF COwtfIwAT/✓E ®% . , 'I 'i .i j18S� i _ `�e 4 x � , t 2 ii 2.� 2.9 7 -OT i. nidal I - H�Ni� ----------- •08 N:)aie M o LC, �� � � O O O h— �O ce e M LOco fo M O V �Q _ t 0 IL �( p �N W � (�C A _ O O � ON a 1\ N �CD N6 UO) M Q ti o LC, �� W I O O O h— ce e M LOco M O V �Q _ t �( p �N W � (�C A _ n to C9 UO) � to ��� Q� Q ti July 22, 1992 Municipality Of Anchorage Department of Health And Human Services Division of Environmental Services, On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 10609 Crestview Lane Eagle River, Alaska 99577 Lv 2 `ioc6R RECEIVED JUL 2 21992 Municipality of Anchorage Dept. Health & Human Services Subj: Health Authority Approval Certificate and Separation Waiver Requests Lot 12, Block 5, Skyranch Estates Dear Associates: Transmitted with this letter are completed Certificate of Health Authority Approval For Single Family Dtivelling, and Health Authority Approval Checklist for the subject property. The currently installed septic tank does not meet the current minimum separation requirement of 100 feet between the on-site well and the septic tank. From our analysis of the site and of soils information for the site (well log), using ADEC accepted analysis criteria, we are almost sure there will be no contamination of the well from household sewage should the septic tank fail for some reason. We request that a Waiver for Well to Septic Tank Separation be issued for the subject property. The worksheets showing our analysis of the separation question are also transmitted with this letter for your information and review. Contingent on issuance of the requested Waiver, we request that the Certificate be processed and issued. Thank you for your anticipated prompt response to our requests. Should you have any questions or need additional information, please contact me at 694-3374. Sii/nc�erreely',,(� 9- Warren L. Enyeart, P.E. Encl: A/S y work 56C4 �l (A PPI Hca to v -6,r :�)s Pi 't6'Fo�m L <,.,o P v� Iq�CG IMamp Co v3ttvlecvs g5oi 1 -jam Ivi�pv-w�p,,`ttp�n - VM V , e4bo" 1 L.-.O� c�a�ccl loll /� vt uS A /D/�l77 USeC iO w fh� a�olysis, Copy oVAC WoAcv-1 40m WC// Cas�v► i rG was 92 f e�, 4/cYm, iotoI Z V- /�a d 6i`� a��tU w1 V; f�i Vve) 0�; 77 � GWIa lya�S A)C6 S/ 9 Elea ion Dov-- .-Ac bo#ow dl -he, 4. V�v�f"iGGt��S� auv, iot, �o ur 77 N0w1'eOVrO0I15�mcc xe� P7;C, 70. -AA k PUMP OU� 15 !D,5�a e,c -�C) hca"C.5�po;o `6 6c rc..�ll c�►-►c� f�►e 90 �cc� �vv>7c ©lii 5O,P �itlov-� s�iee� �cohf� J Elev, 59� — 130 iso v" C� Tim . ,27.3f'� 6o."d, CI1, _ L 6MNge-I; 5, (+ 1500-14- 6-41c(oy 7,0 - 9&,,r,d �lv� I s�7= X7.7#- S•� clay 40710 p, a so a.o A►�2 AAnly�i.5 006�cv Ia b6:n `" Ti� 77krn Po) -OT Va,lvc c/,eiH'CwFOb�d) - sw jolN15 71 - -- - .. IF reW o4ssuma Ro> O JO�rL � 14TcL) God- 14 A Aluk" 71u1y 7c-, l�� 9 > /dz� p t-vz7w� COvt-I�,v►�iv►a,'hotn �'v-owl 09QA// S T _ �1 E �P C 4- C//A5E CI RcLE "A iOf hdSe c n� w, v / 4 /1921 okr.surlecr y Z-/00 n }t��� d Torii fro /j ` d•s` v Clean ou/ Y'T.Io.`tank Oser/re � ns100 X.rl: Lenclrline N o 4.1c Each /inc ` A., `L5Ae cGphf�� /03 L*tCzt6crQ5, Unit No.! 5ky ,Qonch Es to (.CaENLJ AnchcropeRecacdingDistrict, Anchomge,A sAa • round '/e d,6. itbor ✓AME B ROg6E Registered Land ulreyor �/ 1?O, f7nx 111551 (907)3a3"Si39 Anchorage,AlosAa 99511 (3071415=O9Z7 cote see crwn.e/' r.B. GIlo I sheet it , +�' 14 J Rb 1 i..;"�`:: o y y o y0 0 0 � o � o o 'o ' � � �'i! i' I!I• j' !t•�.I_,' o � 1 Ic �N :1' 'r•'a i �I y 1 I I •\ \ 'u 1 b �:i .I �. ;;� t�j: ik(L., •:11.11:'{. 1 O O � � � O � N V I^ I. 1 ••t'�?. � I I � jf � I I I I � � :U ►7 .I 'I i I i ...' ;� rn iNmi r; ti 'r• as a: t,a � Iii !n `u , Y._D• ;° L! I N I �t I '• , rj. Jn ' I~` �� 1.. l+ 1•i .1 ^ ; w' 11it gi it ^� -1`f`t il try• itt' f ;1W6 1tI p- jp 'u (0 u10 ' t: r•: :c :i I � � i 70 ity ty 22 if I tl !Ia s ill 1, i t i! T ..iil i. r n •t 'IJ I,I�-� �:°!�!,-i�'ll •f�1",ji' :ii5 : fiI ill 1 Irr ' iY s �.. to I ir : !;; kv W ti 40 to �•1 r I L p� � n jl. i, ' W to ICU '�I go ..",. I Ir' it MUNICIPALITY OF ANCHORAGE ,_� Hea and Environmental Protec n Fourth Floor West i 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME_. ^�_0-C�_MAILI+:GAODRCSs SR�i_P,zpL'�'2, PHONE LOCATION �L+�.P�s•,:ypyt _ L[_G•.L L•[SCRIPiION __L11�s3��.+�1 iso• :,J'�'.l SEPTIC TAIIK2 �. DISTANCE POM WCLL vV E'_ ANUTACTUREA _ `Q1>�__MArrRIAL StQt 1 COfAPAR T ►MENTS Z INyI>L LCIiGTII _ _ -_-.� _ IWACL WIL)lI1 LIQUID DE PTH LIQUID CAPACITY1d ALLONS. TILE DRAIN FIELD;^ D- P �ftwc�1" 1 1 I TOTAL LENGTH ' 01,TANCL 1 E40M WELL (oo_F FOUNOATIO','j _P__NLAPEST LOT LINE LINE O OF LINE 3 I of Lines OIVANCE LEFWECN LINLS . N FRENCH WIOTHiL=IN. TOTAL EFFECTIVE AII<_ORPtION ARCA Sy SO. I T. LLNGTII Of EACII LINE I ULfTH Of FILTER G' UEPT)I_TUP or TILL TO 1INI5I4 GRAnE AS__ L'A7ERIAL RCNEATII TILE_IN. ABOVE TILE Z IN• SEEPAGE PITC DIAMETER —014 WIOTII_, LENGTH, DEPTH Log Crib _Rings_ Crib Sizet rIA%,•LTUt---LIEPFit _ DISTANCE FROMI WELL TOTAL ErrECTIVC BUILDING rfjUNOAT10'I__, NEARLST LUT LINE • AF;ORPTIOV AREA (%VALE AREA) so. FT, Well i Class:0iln44 Depth: Well Distagce Tot Lot Line.20 Bldg: a r alSewer,Line: Mat Pipe eas 1 of Bedrooms:, Installert'�,4, t Remarks:' 1 1 t 'I it 1 1 1 1 • t 1• 1 I VAILlJ.��l�� At -PROVE I' r l : r Pertorrmd for Leval Description: This form reports: Denth Feet OI.PARCAU.NT Ul 11GALTl1 AAO L.NVIRUNMUN1AL I'l(VILCTION Pour"' -650. 99502 - :518 E. Tudor R^ Anchorage. Alaska og v -1.e"�r 2 ' c _ 4 10 _ '12- OZ51-131015z) 14 - y ti,lLS-. Was ground water encountered? �� _ If yes* at what depth? Date n tiesz ` . .s i Reading Date Gross Time Net Time Depth to 1420I Net Drop Proposed installation: Seepage Pit ►'ov� n.7'lth of Inlet Depth to COMElfrs: %Z rc ear Me.. ,n /ft` s. Drain Field of rit or L I won Owner 0 MM -da, Zd 74 &0707 it -W ,distance main road 'N -7 L38 elk Rmch Fr4s+er Uht:k �ta&jja VI&S ff 1 sba of cosingr Depth of Hak feet Cand ta-�.eet 5*4, IAAI 7, 9 5WIT-M.. A C WT.Ml?#t AMMOILAOX Statle water IkMeL226 --,-fL (below)lead surface. rWAofweU(d,&,..) ...d I perforstief ALASrA "Us screen or pftfcrsfl. �- "Ducrftw won Pumping ted *t-1d-4PDMS Per (bow) (minute) for *"*Ma hom stalle kv*L --&—ho=with ft. N41, %gal 9 1 vMl WRP tort putot-d wjtj�. a vu.-tp that Data of PuP4 rete of 30 UA frost 2151, DrpWdOft law" nobb IS&MV649 kat it is felt *k4k the well will as" t&a 7 wars, tkoC .•.,.i ORMUNG LOG sudaft Ghv details of formations Penetrated, size of mate rialcolarandhar&m won Owner 0 MM -da, Zd 74 w. Loeatloa (address of: Tbwftd'IA PAMS, SOcticn, R ltb6n; at i ,distance main road 'N -7 L38 elk Rmch Fr4s+er Uht:k �ta&jja VI&S ff 1 sba of cosingr Depth of Hak feet Cand ta-�.eet 5*4, IAAI 7, 9 5WIT-M.. Statle water IkMeL226 --,-fL (below)lead surface. rWAofweU(d,&,..) ...d I perforstief screen or pftfcrsfl. Hong "Ducrftw won Pumping ted *t-1d-4PDMS Per (bow) (minute) for *"*Ma hom stalle kv*L --&—ho=with ft. N41, %gal 9 1 vMl WRP tort putot-d wjtj�. a vu.-tp that Data of PuP4 rete of 30 UA frost 2151, DrpWdOft law" nobb IS&MV649 kat it is felt *k4k the well will as" t&a wars, tkoC .•.,.i Dqgb in IM tram sudaft Ghv details of formations Penetrated, size of mate rialcolarandhar&m boge-If WIf&L#f*.,VpAJv. and u*ApvLp�rfAjj SWRAMWM OF AOM Mr. OF WALTH i' I C%M e, 150Z 46 2 — -,-n. va.. '. 74 i -7 boge-If WIf&L#f*.,VpAJv. and u*ApvLp�rfAjj SWRAMWM OF AOM Mr. OF WALTH i' I C%M e, 150Z 46 2 — -,-n. va.. '. 12 % j TO To boge-If WIf&L#f*.,VpAJv. and u*ApvLp�rfAjj SWRAMWM OF AOM Mr. OF WALTH i' I C%M e, 150Z 46 2 — -,-n. va.. '. Well Log For........�-..'..`.'........`..C...........; ............................................. Location.. cr-.................::....... y....`..ST.C:TcS_ Datecompleted........ ..:............:.................................................................... Depthof well ...���..................................................................................... Sizeof casing................................................................. ....................................... i_ Distanceto water......... ....................................................................................... Distance to water while pumping .......................................................at rate of .................... ':? �............... gallons per hour. ...................................................................................... Driller • 11'1 m.�'•� " Sl 1 \ G�Sti DELTA DRILLING COMPANY S9. BOX 394 e ANC. O9AGC. ALASKA 99507 Formation ( from to �.: ice••,.— s.. y c .:..•y , I '� I t�D �•• 1 .� Vii• r.•i : 'y ! :.�%' I �c7 I iil� `guti p� I ...................................................................................... Driller • 11'1 m.�'•� " Sl 1 \ G�Sti DELTA DRILLING COMPANY S9. BOX 394 e ANC. O9AGC. ALASKA 99507 ~` MATER WELL LOC FOSS DRILLING 1936 Inion Street Anohoraae. Alaska 99501 ., ^: ^r. �•,�t: i �:: ,;.atilt i SIZE 0! CA9Il1G,&f.DEFTR OF ROLE T. CASED TO �2:2 STATIC MATER Lvn Q 2 % FT, 22ELD�_pAL.pEg.MIp. WIT11l/ FEET OF DRAWDOWN. --y--- REMARKS DATE COMPLETED- 61Z � .pM TO BE SIT AT to. .to. .to.. .to. .to. .to. .to. 9 Wel I Log 1014 Iq n- � 10,6 a ) For ......Pr.:...�1o3 .................. Cv?cGS6,U ................................................................. to t c'24V C ' 3 s<<�n11,►Ld 5�3. Location...... .!........`.............: ..�.i...................................................................... /0? ! ' Date completed ................ I Depthof well.............4............................................................................................ I i !` Sizeof casing ..................................................................... I MUNICIPALITY OF ANCHORAGE ..*DEPf.'CF*F2A . i.8........ _ 47!G Z. j' ENVIRONMENTAL F:ZTXTION Distance to water ......s GEC 1 d 1981 Distance to water while pumping........ 70 RECEI.gt,{ate I of................q?a..................... gallons per hour. Formation I from I to t c'24V C /0? I I i I I I i I d............G.1.....r/�................. Driller DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE. ALASKA 99507 /xx.3-�ccc 191vepoA.961 ,jLAskA I of �.s' 34441 y_ YI�tLL o G - J, O FS TIS U.�/ Sk y IqA ,9A)L(-E,P Oc'7 /9 7 y 1-427 Jr IFL069 6- f f r G AAvrL7 17 - S` 2 SDfT C1-,f 7- h loo hAP c41 - GAA ar= Zy /Is_ //7 h�AD Cluj' q Gizi.dl/erL o'pq or SO x72A /i oV'QO%t); TF,q'Ye', [)1f E QO `SAN 8 ��'°N I i _ l� / 5oF 7- CLa y RFQ/ yr SofT CG.dy 7- CZ 215XI'I'D �- Tc, CewP;2� '57"A 7-)C GFf ,DaTTo� — a0 ' olet A777e7M a r- /v 6.1P yin-D O� l4z-,z4 - �A o W- 7' fF Vi7'cF35 APAPTe,q V4 tua.rotes �1 r CiiiMIM41 C)i OEOL.00IM L A.EaOX' OPIE •ft Ore ALeAtjStA, ji,1Crr. TELEPHONE (£07) 279-4014 P.O. BOX 4.1276 ANCHORAGE. ALASKA 99509 4649 BUSINESS PARK BLVD. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM: I.D. NO. James Rodgers Public Water System Name SRA 1618-6 Mailing Address Anchorage, Alaska 99507 City State Zip Code SAMPLE DATE: 0 8 1 8 7 8 Mo. Day Year SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no.) 13Treated Water f� Special Purpose Zoah N(1 Untreated Water SAMPLE Time Collected NO. LOCATION Collected By L 12 B 5. Sky Ranch Est. 9:30 RP 2 1 - I 3 4 5 I 1 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18.310 (3.78) TO BE COMPLETED BY LABORATORY LABORATORY: CHEM & GEO LABS OF AK. , INC. NAME 4649 BUSINESS PARK BLVD. ADDRESS ANCHORAGE. ALASKA CITY Date Received 8-18-78 Time Received 3:10 PM Analytical Method: ❑ Fermentation Tube kk Membrane Filter Lab Ref. No. Result' Ana yst I 8536 I �I I I Q] D. con I I I—Tj l I m l I p] o N., at colonies 1100 ml. x No. el Positive pedlona 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1976 Date Coll.cted 8_18-78 _ sourCe L 12 B 5, Sky Ranch Est. 8-18-78 �f� a.m. Data Received Time R.celved-3 Lab. No. 8536 Presumptive I 10m1 1 10.1 1 lomi i loml I loml I I.Omi I 0_sm1 24 Hours _ I i I I I erde Broth 24 hours: Broth 4e hours: - — Multiple Tube Report: 10ml Tubes Poslllve/rotal 10MI Portions 1104mbran. Flltor: Dllect Counl Verification: LTB BGB Collform/100ml Final Membrane Filter Results _ Collform/100ml Reported By—y--Bacon_ p Date 8�-/1�9-78 Time. Q— a.m. P.M. 9:3v E LEGAL DESCRIPTION 2 to Vill, 5 MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION • E36 L Street • Andtoreae, Aloka 99601 S. TYPE OF RESIDENCE s NUMBER SINGLE FAMILY ENVIRONMENTAL ENGINEERING DIVISION ❑ MULTIPLE FAMILY Telephone 264-4720 1 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all pan* wpm" 1. Ineeneplete requmu will net M preewed. %ecce allow ten (10) days for prmmiN. 1. PROPERTY OWNER J12ME03 13, &* ici A. N A 344-40/8 MAILING ADDRESS since June 1976. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) PROPE5 RTY RESIDENT (I1 di tfmmabort H NE i ❑ PUBLIC UTILITY If system is over two (2) years old an adequacy test is required Z BUYER by this Department. PHONE MAILING ADDRESS DIIIO TIT 1, N / /1� J RKJWII PHONE MAILING A�49RES3 6 {_� e S>�rref 4. REALTORIAGENT PHONE MAILING ADDRESS E LEGAL DESCRIPTION 2 to Vill, 5 STREET LOCA 1 N l ! 40 5t a e Clkjr. S. TYPE OF RESIDENCE s NUMBER SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ MULTIPLE FAMILY ❑ Two ❑ Five Three ❑ Six 7. WATER SUPPLY X INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all walls drilled ❑ COMMUNITY since June 1976. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE" "If individual/on-site, give installation date ❑ PUBLIC UTILITY 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. THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE (SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE Qf THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY qv"INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. S AGE DISPOSAL SYSTEM 3. AGE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED IN ALLER ❑Septic Zagk pr ❑ Holding Tank Sim: If Tank is homemade give dimensions: SOILS RATING TYPE OF, TANK MANUFACTURER L� TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Saptit Hold ng Tank Absorption Area swer LIM FQ=ast of LIM Absorption Aria to merest Lot Line 5. COMMENTS APPROVED FOR 3 BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED _ DATE r/7 ,jf BY ( 111M LEGAL DESCRIPTION 72-010 (Rev. 3178) `, $ 78910 • 77 • e� •� -,..e Municipality of Anchorages ry z° 4tdzl� On-Site Water and Wastewater Program a JUL 2 7 2017 tt;til NI (907) 343-7904 \§. 10(54 1 C T Y CERTIFICATE OF ON-SITE SYSTEMS AP'" ' 0 AL h 1 5 88 L 9 �s Parcel I.D. 015-301-26 Expiration Date: 0 - "---17 1. GENERAL INFORMATION Complete legal description SKY RANCH ESTATES#1 BLOCK 5, LOT 12 Location (site address) 11940 STEEPLE CHASE CIRCLE,ANCHORAGE, AK 99516 Current Property owner(s) JOHN JENKINS &LAURIE BERGER Day phone Mailing address 4230 WORONZOF DRIVE APT.#D,ANCHORAGE,AK 99517 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: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual El Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community LI Community Class Well ❑ Public Sewer ❑ Public Water System ❑ VVaiverNariance request for: Distance: Received by: 4rf/2 -66Date: % `'- .-', / j COSA to be released to the engineer, unless o se r uesled by the engineer. I� COSA Fee $ 14 I Waiver Fee $ Date of Payment 1 2ri 111 , t III Date of Payment Receipt Number DI 6i" -2 t. 0 D Receipt Number COSA# 05e.n1320 Waiver# 5. STATEMENT.OF 1�1SPECTION BY ENGINEER 4:.-,. . N 4. 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 thlt 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 7/2612017 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. Engineer's 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 .4.- encroachments, encroachments,deficiencies or discrepancies exist. r 1 O1' AZ f fk', 91i ,\ �► * f 6. DSD SIGNATURE 7( System #1 Approved for S bedrooms. 4 �� KENNE 11 1,1 OF 1.; , . f System #2 Approved for bedrooms. 4 s^� .s " of Disapproved. , '''`iFF `''' Air Conditional approval for bedrooms, with the following stipulations: �ti 1 �.r .j;Vim, ..,- ON-SITE WATER AND m WASTEWVATER PROGRAM J By: I Original Certificate Date: 7 2_ 1 The Municipality of Anchorage Development Services Division (D.SD) 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 engineer's 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 12 _ Parcel ID: 015.301.26 A. WELL DATA Well type PRVT If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 101311977 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 262 ft Cased to 262 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 1013/1977 6/21/2017 Static water level •• ft. 219 ft. Well production 15 g.p.m. 3.1+ g.p.m. WATER SAMPLE RESULTS: Coliform _ NEG colonies/1 00 mL Nitrate 1.83 mg/L Arsenic IV ug/L Date of sample: 6/21/2017 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Date installed 7124/2017 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping NA-NEW TANK Pumper C. ABSORPTION FIELD DATA Date installed 7/24/17 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 System type DEEP TRENCH Length 47 ft. Width 2 ft. Gravel below pipe 8,1 _ ft. Total depth 14.2 ft. (Measured 7/26117) Eff. absorption area 761 ft2 Monitoring tube Y Depression over field N Date of adequacy test NA-NEW SYSTEM _ 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 100'+ 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 100'+ _ F. COMMENTS New field with diverter to original field. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 417, OF aI 1 Engineer's Printed Name KENNETH M.DUFFUS • eNQ' . Date 6/26/2017 ,r COSA canary sheet 2 6 15.doc TO`_ 4 ,r KEN1 ETH DGk' . , N "'� c) `_'q■••f 1Lr� \ LOT 13 %., \-%C.1 / -11 • 1-V6(-6�� 1 `Joy 0o \4, , 1 h �t�g '0_ �� I•x4.5' ��g-jfo r' _ BW CANT. PAVED ', .. D/W 18.0' 125 \ 119- NN �®O_ EXISTING WELL ` HOUSE 125 On NO D ",,",11,,1. 1� y- N • 20.0• O�G \ • SEPTIC VENT SHED _ LOT 12 \ 1-- • BLK 5 i( , •0- rb <J e• ��� �o r\t CP, SHED t5'.. �y • •o• ,,<v \ \• • M0' vr,� ) \ LOT 11 \ \t'r\ CP Ul \ \ .C51 LOT 19 \ \ \ _ 10' UTILITY ESMT ANCHORAGE RECORDING DISTRICT,ALASKA ASBUILT OF: SKY RANCH ESTATES UNIT No.1 © =FND REBAR LOT 12 BLOCK 5 PLAT 71-166 �_�`"`` SURVEY CERTIFICATE:I,John L.Schuller,Have conducted a +`r OF 4 `,1 �Q LaAD AND v, physical survey of this property as shown on this drawing and that the '/ `�. '' _ •4.4N i,..0-1--11,4, �.•y10 S'h,-. improvements situated hereon are within the property lines and no / es,;!..-•' enchroachments exist other than noted.Under no circumstance should / C9.• 49TH N #` o�S r 0 any information on this drawing be used for construction of fences. f * • �+ I/ a y, r structures,improvements,or for establishing boundary lines. I, EXCLUSION NOTES: It is the owners responsibility to determine / kn. �- � 0 the existence of any easements,covenants,or restrictions which ' ••Jit, L. SCHULLER.. / ' i1. `. s IS I -....--..."4.-" . do not appear on the recorded subdivision plat. +' r / WORK ORDER NUMBER: DA SCALE c. E 1(p ... _ 74•47 �� r/ 1631 Anchorage,Talktna Street JULY 26, 2017 1"=30' `,op �a Alaska 99508 1 7—020 "B"OWED B'^�"""� eoOUrACC: �Nrofessi0n01 �'�or (907) 227-1455 office JIS 2737 170137 �\ICK•arargilw (907) 274-4992 fax Cc Cl eev� 0' -R� kc Municipality of Anchorage 4S. Development Services DepartmentBuilding 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 LD, O / S - *301 - Z,jr' HAA #__b4 _q LL- Expiration Date: 1. GENERAL INFORMATION Complete legal description l cst 12, 13le, c k 3 S k /3ur,C/ Location (site address or directions) 119 y O 91-ee2 le C<7us� Ce rc No& - Current Property owner(s) Colleen O' f? aur dce (3ect) Day phone_ 3 YS-- 4//:r Mailing address �'U r3ax )103�Y3� flnetiew�rgp, /1�c 99S// Lending agency _ Day phone Mailing address Real Estate Agent FS i3o Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. P l eo re cce I/ Cc lleen O'rZorc�lcC 2. NUMBER OF BEDROOMS: '3 @ 3 °/s-- Y135 or (f702 -9S-- 6ysZ u>hen J�AA r6ne,4 ,� p+c4'-Ir 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well individual On-site z Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ . Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (NAA) 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. Certificstes 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 with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm l= Wtvo -72chn fe'cu/ S?r✓ Com/ Phone 3�15 - l395- Address 115-30 E-c�o Sf. Anc A -k 993 / Engineer's. Printed Name ��eo aQyr� !=• Mc'Gre Date Gc%yer lE_2r�ay 5. DSD SIGNATURE 'o OD F F5' OORE _ 89 Approved for bedrooms. a' +' �� m 000 0 �1m 6_ Or Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance. Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By:L CQ , �� Original Certificate Date: f�-�1-c2br - (Rev. 01102) ., c: � x�m���i"�'R+a,�-..�".V#u'^'�`'ti�;ss���mvP4°%�=n`'Y�v"a�,e$E�:'��;a%,..,. .�.,�.�3'e�t ,",•"e.. :.ri^ i » x Municipality of Anchorage Deve o ment Services Department z a�6 �" ��,�� Building Safety Diwsion „ ,.. ,nr c Op=Site GDater &'�/Vastewater Program b ^ e1 ragawSt. anchorage ak us MN W EALTH AUTHORITY"APPROVAL CHECKLIST ZParce7fD Ot5-3G7��;�' r^r✓af@ IfA,kBorCprowdePC1'S�tC3#' WeII't.o �i' Sanitaryseal (Y/N) Y Wires properly protected (Y/N) Y +'MZ, .a yr a ft Cased to d ft Casing height (above ground) 3 in F AT IKSPECTIOt .... �a ce � ft ��-- r level n 2 t 7""ft gpm �3 colonies Of7 irate rate I S' mg /I Other bacteria colonies/100 ml _,. m9 /I Date of sample: tU /5' /Gy CDllected by F Tech Se, aena �rG Slee/ Date installed 16 / 7 / 77 ..{ °" w �'sk"`"yj,"�^?a'ec"s' irEax`.Yi ;;k,.uNrs.+:.rvx v4K.«yw.as3n rae t Number of Compartments 2 Cfeanouts (Y/N) Y Le Depression over tank (Y/N) N High water alarm (Y/N) N Pn9 1 / Pumper,` czcr c Gs/7 77 Sorf rating (g p d7ft2 or ft2/bdrm) /S`o � System type Trenc �i ft WicTth 3 ft Grayef below pipe & ft ft absorp ion area �' G ftZ Monitoring tube _� Depression over field N uacyiest r7 d` Results(Pass/Fail) �d-C/ For,�bedrooms •f � V '� 4`�. ^2 �J,e'Ar"Ykk�"'«"+'�`���tv � ..+y'. r. fFv+=w4. l� rabsorptwn field before`test� Sin: Water added gal New depth $1 Zm �' min. Fina7fluidde tH 68 rn kz, Size in'gallons d.;xa7a hole%Rccesss(1/N) � Pump'off level of in. High water`alatm level a't m: Cyctes�te'stedMeet Meets s, it , alarm &"circwt requirements. review of Municipal records that confoimance with MOA HAA gu, Engineer's Printed Name`_ 1,9 2c water .y,. ....... ..,..,,..,_ >n adjacent lots 10 3 te�'.,ltu ivy/97 ; , aW y> '1 • m •o• ryµA/�. Vd' .y F (i V-^ F XE! Y SW:Yv� V ki A � M �� ,eld inspections anc7••0 V��y g��y ®•®@.®••.®®®@®m®®md� ve systems are in - f '0 in effect on this date. 1W, .- �•a@ Receipt Number RE f. MOORE - If' l oT i.3 0 SOI '3a f'Olj]C (1) c%4! mut O ,t Fi, Leoch letie � C) 107- ii * 49TH Jeery L Shorlwhn •,' No. Md8-S taw• O OFFSSION A'L �7c9,q TC>!�8/c��S,Unif(�1a1 S,�y ,�ar��h Es i4f�s L E6EA/l2 Anchorage f;ecording D!s/ricf, Anc/Jorage,Algska s Pounce .SA`b �EL�ar JAMES B. 170 ERS \, regisfered Land Surveyor (907)345339 Anchoraye,Alaska 99511 (907)345-0927 Oafe Scole v, wn. by F. B. Ga;d Sheet 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 99519650 www.cl.anchorage.skus (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 01s--301 - 26 HAA# b�/U S•17 Expiration Date: G ' / to - O S 1. GENERAL INFORMATION Complete legal description l . f 12„ r3fo44 S sky RancS Erf 7W 1 Community Class Well ❑ Public Water System Location (site address or directions) 1194/0 S 1-e e0e le cAe vo Cs role Current Property owner(s) amu Ng en 0' Rex+• ke ( e's-st) Day phone -.3 I S- Y #:rc- Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P.O. 13cX 110 3Y31 /}ne r /lee 99S// Day phone FS Ga Day phone Unless otherwise requested, HAA will be held by DSD for pickup. Pl ewe eee// G 11 inn O 11744 r• ke 3YS'- Y13S 4"44fn "A lr 2. NUMBER OF BEDROOMS: 3 reAfely fol r re 14 -0410 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 12 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. Tien cwa 1 a er/r.. ro( 0-t4 Name of Firm Flc4loo4 Tec4m;c4/ Se"ficel, Phone Sys-�3sY Address 1'1S30 F;ctio Sh Engineer's Printed Name Anc_ ony!; Ak 99S 16 Date /qac cti it, 7&0S 6. DSD SIGNATURE __,f� Approved for, 3 bedrooms... Disapproved. Conditional approval for bedrooms, with the following -j ;-49TH VY too 000000000406*080*0 '"It THEODORE F. AL j 9 �•.�'CE=3589 �,� r Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 3 — O ' Os (R".01N3) Municipality of Anchorage PPy Development Services Department • m P Building Safety Division On -Site Water &Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak. us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 4,y > i2 !j/kS S/=y fond, Etle4!*r /*/ Parcel ID: QIS :TO/-2� A. WELL DATA Well type Pv t, IFA. B, or C provide PWSID # = Well Log (YIN) Date completed 1&/3/77 Sanitary seal (YIN) Y Wires properly protected (YIN) Total depth Z 6 _Zft. Cased to 26 2 ft. Casing height (above ground) 3o in. FROM WELL LOG AT INSPECTION Date of test to / 3 / 77 to / S / oY Static water level /A k ft. Z r '7 ft. Well production 15 g.p.m. 3. / f g.p.m. WATER SAMPLE RESULTS: Coliform D colonies/100 ml. Nitrate o.ss mg./I. Other bacteria 3 colonies/100 mi. Arsenic: mg./I. Date of sample: *31710-C Collected by: F/a t*,p TccA E -c B. SEPTIC/HOLDING TANK DATA Tank Type/Material 9'er Date installed 10 / 7 / 77 Tank size 1000. gal. Number of Compartments 2 Cleanouts (YIN) Y �) Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) A/• .► Date of pumping Io /6/ov Pumper ='ccracr C. ABSORPTION FIELD DATA Date installed 10 17 /77 Soil rating (g.p.d./ft= or ftZ/bdrm) Iso o%ate System type i .tr+c4 Length 3 S ft. Width 3 ft. Gravel below pipe fl ft. Total depth _0 ft. Eff. absorption area S,6 o ft' Monitoring tube % Depression over field Date of adequacy test I&/ S/ o i Results (Pass/Fail) Pe, For 3 bedrooms Fluid depth in absorption field before test min. Water added �17 gal. New depths in. Elapsed Time:21 min. Final fluid depth 6B.fin. Absorption rate >= ysr-2 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Ne-Ae !Zal� k/ If yes, give date N. A D. LIFT STATION N • 4. Date installed Size in gallons $Pump on" level at_ in. 'Pump off level at _ in. Datum Cycles tested E. SEPARATION DISTANCES Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: to ri 9100 3-9 Septic tank/lift station on lot 8 1y/9 2 On adjacent lots to 3 Absorption field on lot / r'3' Public sewer main N • I+• On adjacent lots , to 3 ' Public sewer manhole/cleanout N• .4. Sewer /septic service line > 25" Holding tank N. A. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Is- Property line HS' Absorption field Is" Water main N - R. Water service line -> lo' Surface water > too• Wells on adjacent lots > tcAO SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 16, Building foundation yo' Water main N• .4. Water Service line > to' Surface water > luta' Driveway, parking/vehicle storage > -Co, Curtain drain None Seen Wells on adjacent lots — 10? ' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Th 00 CAC ee Date g► Mctrc-4 I1 Zoo.S HAA Fee S 40(N -,+A rtAtwci) Waiver Fee S Date of Payment Receipt Number (Rev. 12/01) Date of Payment Receipt Number THEODORE r. MOOR£ cE-3589 3 -I♦ -06: 12 :38PM;%I 711A ;CS ReLO 1051224001 =11eot Name Flattop Technical Srv. Project Name/# SkvRanch Estl/IL12BS :tient Sample ID Sky Ranch Est #1 1.12B5 vlattix Drinking Water ;ample Remarks: ;907 6618301 All Dates/P;mes are Alaska Standard Time Printed DateMme 03/11/2005 14:39 Collected Datelflme 03/072005 14:30 Received DatcMme 03/072005 16:00 Tecbolcat Dllrre�Moor/ttep Ede Released B / 'ararneter Resulls POL Units MOW Conwmr ID Allowable Prep Analysis HmiU Date Date Init Intern Department NitratrN 0.550 '0.100 mg/L EPA 300.0 B (<-10) 03/07/05 CAM ficrobiology Laboratory Total Coliform 3 OB. No Coli col/100ml. SM20 922211 A (<-1) 03/07/05 DKC • 3-.•-O5: t2:36r+M; ;BOr 56.530. • 3/ • 2oo W. POTTER OWE ANCHORAGE, ALASKA 0518 SGS=&Ei_NV(RONMENTALSERVICES TetW7-M2343 Fax WT -061 -ml Lab W We. .Drinking Water Analysis Report for Total Coliform Bade&* 105p122pq 4 }� READMTRUCnOrs ON REVERSE IMPE 89POW COUAC,.16.1Umm MUST BECOMPLBTED BY WATER SUPPLIER : IIIl4tIMYY IIYt�'IMIIp� •O PMX WAUX 1 nnld We 0§PRNATEWATE =TEM t wd R�1e . Bend ewob a Ewd Rw as fllMM w� �allo'• ?, ti Sic .T MEMBRANE Pa.TER REMUS: • / 4 3Ti Ec1�o -� ' Ptwwed Q fazed . SAMPLECOLLECnON: r..r.,.r ».rr .r wr.rwi.wrr DOW vye:: 2 3a PH AM rr1 t.ocet«c Ln7l•/ 2. i,3/kS- SL'y IfgiCh 43 Rou*w fl Treated Water ` .0 Repeat Sempk O Untreated Water . .4tt (refer to bh no. 1 P Spedsl Purpose to Lob ey; Q Same es coneraor . Other. 1 BE compmTEO BY LABORATORY Sample Recalvine:. Oak: a 4:15-0-swr3elowdR 0 RUSH SAMPLE: R«ub ewT a wert.Mb • Tim: . Temp: L -O w Nwvbkw _! Ph" 6, Oe6wry Method: RecoNed By: Fat COm.rib: ' ------------------------------- -:........................................................................ ....................r..:.... gact•riotoDleet Wetppar Anatwh Retord: Ae.yd. Mpen:'SI'S�O� ►�T30 eeMO.Maq (PII1) REtRILTe: M1C PIK AUN I Told CCeo.ec OsVnlne' r+ . E. t:or • Sam bcawe Aesyacal N.ree4 MEMBRANE Pa.TER REMUS: Ptwwed Q fazed . OWN Cast 3 og cawiW19CmL Membrane FNkr ve ekeaerc t odw.trr MMO-MUG (PIA) rr.or•� LTa Sat sfactm Unsatisfactory • MIC.T»N»w..wc...e teponed By: t DsteMme- Z,. &e::, w•ow. e.:w 1 c.....O nu .9 w..++.+ _Cvp t?- j MUNICIPALITY OF ANCHORAGE '1 � !/ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# �l5'-3o1 — z6. HAA# 1. GENERAL INFORMATION Complete legal description avcNc'L( Location (site address or directions) — yI T410 e- 0 PAS 6s - Property owner --" ^^ t 'TAT- P�2eecc. Day phone Mailing address // ?4'0 agAge-, AAJCJ- fits 995/6 Lending agency Day phone Mailing address Agent Its, Dayphone '7 z7— zcrz3 Address III "QHS Qe-GT, zuITtZ (Col 11,,1cp ,1 t�' 9oISo3 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-M(Rw.V91) FOM M0A#21 5. 1.1 STATEMENT OF INSPECTION BY ENGINEER 0 As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm MANNo^j S � u4• Sy c Phone '-7-2-0-Off Address �'° �o K 107 Q.rw 4,v 0 ,A K C3�9s/a Engineer's signature 4 Date �YcGo G Sia A -r- CVzA9 Rt-pXz-r F`r1J�sccA�.ht,✓L DHHS SIGNATURE �-,� /� Approved for LFL bedrooms. � :�4• ,ae g st w L Fm M* CE -6149 pRO:FSS`.Gt�'n Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 911717 Date�2o' 1S 9� 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. 724MORW ust) e.a uoAm Municipality of Anchorage RECEIVE DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division JUN 11 199 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907)47�4 u cipal ty, of Anchorage Health Authority Approval Checklist Dept. Health & Human Services Legal Description: (/2, IIS SIC1?T24AN oN Parcel I.D.:0 1 !- mgp I - Z b A. WELL DATA Well type WRRUAT1s If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y a S Date completed /O/314 a Total depth z 62 ' Cased to Sanitary seal (YM) FROM WELL LOG Date of test Iola/ 7 Static water level uNkNowN Z L2 Well production /S * — g -p.m -WATER SAMPLE RESULTS: Coliform — V Nitrate J • 2 7 Casing height (above ground) -2:;L " Wires property protected (Y/N) AT INSPECTION (r!S/ 4 P 21Z S' `I _g— p.m- Other bacteria ' 0' Date of sample: _ (V -- 61 - Q 9 Collected by: S B. SEPTIC/HOLDING TANK DATA Date installed /o1?7 Tank size / cxlo Number of Compartments Z Cleanouts (Y/N) Foundation cleanout (Y/N) f Depression (YM) High water alarm (YM) ✓/A Date of Pumping Pumper A -tlkM Sr�tAcr� C. ABSORPTION FIELD DATA Date installed /O! ;= 7 Soil rating (g.p.d./tt' o fN/bdrm 1,5-0 System type z -r Length 2�- . Width 360 Gravel thicimess below pipe `i'6 ° Total depth 120 ' Effective absorption area 560 Monitoring Tube present (Y/N) Y Depression over field (YM) .y Date of adequacy test 6 1514 4 Results (Pass/Fall) �qDA Ss For 3 bedrooms Fluid depth in absorption field before test (in.); S? r' Immediately after yb sgal, water added (in.): -7s' Fluid depth /41410 (Ins) Minutes later: S? Absorption rate = q S-0 c.p.d. Peroxide treatment (past 12 months) (Y/N) 72 -MG (Rev. 3198)• ,✓v If yes, give date O. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm E. SEPARATION DISTANCES Size level at* 'Datum "Pump off' level at' SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 851 On adjacent lots /oo + q." Absorption field on lot //S Public sewer main N J A On adjacent lots /o ur Public sewer manhole/cleanout N l A Sewer/septic service line '-?S' Lift station /C70 -r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation / S Property line `'/S- Absorption field Z.S- r Water maintservice line So"f Surface water/drainage /ooh Wells on adjacent lots / o o 4" SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line zor Building foundation 4d1§ -r Water main/service line 00'4 Surface water /op+ Driveway, parking/vehicle storage area rt Curtain drain /e,04- Wells on adjacent lots /,(Of F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance wBh MOA HAA guidelines in effect on this data Signature Engineer's Name S—T-6J 8--J DCPA. WOAAO- 9 61.• Data 616 /Q 9 HAA Fee $ T n n) Waiver Fee S Date of Payment ta-lV21S Date of Payment Receipt Number r) V T - (_� 3 3 9 Receipt Number 72-026 (Rev. 3196)' igo krl. *w� e:606Y US •O" w J (tNl •»u) 9zo-t[ •walsAs to snlels pue Aj!le6al aril of 6urlsalle 034y elelS wo/l uollewirjuoo uall!jm op!Aofd ,welsds jalemalsem Al!unwwoo 11 :310N – -- _ jamas ollgnd ..- _ --_...... ells-uo Allunwwo0 Nuel 6uIpIoH —p— ells-uo IenplAlpul !� :IVSOdSIO u31VM31SVM d0 3dA1 'b walsAs to snlels pue 14!!eBal etll of 6u.I lsaile O34V alelS woj{ uo!lew4luoo uallum ap!Aoid 'welsAs !lom 14!unwwoo l! SLON jalem ollgnd Ilam Allunwwo0 Ilam lenplAlpul :Alddns u31VM d0 3dAl `E :SWOOu039 d0 u3ewnN T dn)lo!d jol play eq !l!m VVH 'paisanbai as!miatilo ssalun r SsaJPPV euoyd tea _ lua6V 172 G • ssappe 6ull1eW euoyd Au(] � Aoua6e 6ulpual SsaJppe 6uIIleW euoyd Ae%vim mmo Aliadoid / /--Zoo it Vobloll •• , (suolloaJIp /o SsaJppe ells) uolidliosap Ie6al elaldwo0 It ;,Jviv-jv NOIIVWHOdNIIVu3N30 'L # VVH # •0-I lamed ONIII3M0 AIIWVA 310NIS V HOA IVAOUddV ,uiuoHinV H1IV3H AO 31VOIA11H30 • bbL4-£Y£ 0999-6LS66 eIselV'a6eJo40uV 09996LXo9'O•d uolloas SOOIArOS oils -u0 SaolArOS leluawuwlnu310 uolsln10 S30IA83S NvyinH V HIIV3H AO 1N3W1HVd30 �► 3EJVHOHONV d0 d11lVdIOINnri S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l verify that my Investigation of this Health Authority'Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms --- ------ -- and type of structure indicated herein. l further verify that based ohthe 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 W/ Add s Phone 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. 72.= (Aw.1/91) Bnk MOA 121 Engineer's signature Date " • 4-4q • - } ,gyp ,...«...,, qs, i )1;..i � _. may.•' �a r• � � � Wanan-L Enyaart • .�4 t'"DHHS .`OFESSIOnP�r', 6.SIGNATURE ~i x'' ApproJed for b _ edrooms. ', - •,,_ _ Disapproved. - ._ ... .... Conditional approval for ^" bedrooms with the followingr stipulations: Additional Comments J' 84 -472 By: Date . 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. 72.= (Aw.1/91) Bnk MOA 121 Municipality of Anchorage AL Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SF r �dkyv'DW1 h arcel I.D. A. WELL DATA Well type`/ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) 7CS Date completed JQ&J7Z / Driller P? / Total depth � 2 , AS 4 � Cased to 5-Rf Casing height-1e?t 3 � nt* Sanitary seal (Y/N) JWires properly protected (Y/N) 7e5 FROM WELL LOG Date of test' Q) .3 Static water level ? Well flow ,�9L >< IS 9 -p -m. Pump level ? AT INSPECTION Z n oz g.p.m. o N N � � O o SEPARATION DISTANCES FROM WELL TO: o m Septic/holding tank on lot 9� 6Lwt,._A do ; On adjacent lots Absorption field on lot -- /s GD� ; On adjacent lots e >< Public sewer main =Public sewer manhole/cleanout 'Rat ft sewer service line Mont: - Petroleum tank WATER SAMPLE RESULTS: /f Coliform b Nitrate ��� Other bacteria Date of sample: Collected by: Id11�0��Lr1L B. SEPTIC/HOLDING TANK DATA Date Installed /9%`f Tank size HS Compartments : _ Cleanouts (Y/N) y� ,c Foundation cleanout (Y/N) Y� Depression (Y/N) `t/om High water alarm (Y/N) ry�� Alarm tested (Y/N) 'Al Date of pumping W 7_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots Foundation 15_Y' 2 To property line Absorption field A,,5t_Watermain/serviceline wh4 Surface water/drainage vsax (a.r. vu) From MOA 21 - CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Manufacturer Manhole/Access (Y/N) "Pump on" level at "Pump off" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA _ Cycles tested Surface water Date installed JQ�977 V Soil rating �ystem type 1�rfL� Length IESt3S61idth �f * Gravel thickness Totaldepth 1020 i/ Total absorption area go -.59, Cleanouts present (Y/N) _!ry Depression over field (Y/N) , 41b, Date of adequacy test' Results (pass/fail) for bedrooms ,{Peroxide treatment (past 72 months) (Y/N) If yesgivegive date 7`+p/ y►)gJ� V1pWl :M1nVW1G[� G VIGv1flL -I-{ �CS, SEPARATION DISTANCE FROM ABSORPTI N FIELD TO: Well on lot On adjacent lots Property line To building foundation 4qZ54 To existing or abandoned system on lot On adjacent lots Cutbank Water main/service line 16 �+ Surface water W Driveway, parking/vehicle storage area 7!� Curtain drain N144 \, E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines In effect on the `4te;;this Inspection. OF,,4 r 5 •••% Signature i * 49TH •: Engineer's Name �7 C Warren L Enyeart o Date ' ` �� `�l''• oSE':3cs...� � HAA Fee $ 1 % D 4D Waiver Fee: $ Date of Payment " u— g Z Date of Payment Receipt Number a.32-711` c?� � Receipt Number _,gZ ��i �' 7 $ r3h56 72-026 (Rw. 191) Buk MOA 21 Co ( (ee-v\ O' Rcx,.r kc. Municipality of Anchorage • �� Development Services Department Building Safety Division On -Site Water and Wastewater Program , r 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 wvnv.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. / S - 3 01 - 2HAA #MnCiL Expiration Date: 1. GENERAL INFORMATION Complete legal description 1,6 1- 12, !3 /oc le 5, 5 kv RuntL. Esfuf'y t* 1 Location (site address or directions) 1 19 Y O Sl-ePtq le Ctiu to Ct re le We " Current Property owner(s) Ca 11 een O' R our tce (Beck 0 Day phone 3 YS- Yr3S Mailing address Lending agency Mailing address P.O. 3bx 1103 Y3 . A'tc 99S/1 Day phone Real Estate Agent FS 00 Day phone Mailing Address Unless otherwise requested, NAA will be held by DSD forpickup. P l ece a ec 1l Co /lien CJ'rZGtt�1<� Co T �/S'-Ht3S or 702 59S -6'!Sz 2. NUMBER OF BEDROOMS: Wiley IMA ,-FsforJ e- PIC 47-4. 3. TYPE OF WATER SUPPLY: ' Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal andlor 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. Name of Firm f= la ffve Trchn r< -c•/ S?r✓e (t/ Phone Address 11,5'30 FcAa S1., Amchorvtye, Arc 993 lG Engineer's Printed Name Th eo cpaF�nuore - Date oc,(06er- rB Z00Y ' � IftEEft': ' • TH '�'9 Aht? S. DSD SIGNATURE TW- �ODORE P. YooRE ,� 18' — Approved for bedrooms. �'�%•. ��3587 �cjr Disapproved. tt��®rv�' Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory . Maintenance Agreements Supplemental Engineer's Report Other By:_/ \�,�. : nom.�� Original Certificate Date:_(iN:aI-aLW (aw. oibx) Municipality of Anchorage ' Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196850 Anchorage, AK 99519-6650 www.ci.anchorege.ek.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lv f 12, (i /a c4 Ste, 19 a/►ch Bs f # 1 Parcel 10: O 1S -3O/ - 2,< A. WELL DATA well" Fr4vak If A. B, or C provide PWSID # Date completed 1013/77 Sanitary seal (Y/N) Y Total depth 12 ft. Cased to 1!� Z ft. FROM WELL LOG Date of test 1 a 13 / 7 7 Static water level u'l ic ft. Well production l t g.p.m. WATER SAMPLE RESULTS: Coliform _a colonies/100 ml. Arsenic: = mg.A. B. SEPTIC/HOLDING TANK DATA Nitrate r . t r mg.A. Well Log (Y/N) 'r Wires properly protected (Y/N) Y Casing height (above ground) 3 O in. AT INSPECTION IO /S/ ay 3./ + g.p.m. Other bacteria _Q_ colonies/100 ml. Data of sample:—IO /S /6Y Collected by: F/4t!S2 TfcS Cf -e Tank Type/Material Sn h G / Sof/ Date installed 10 / 7/ 7 7 Tank size 161&& gal. Number of Compartments 2 Cleanouts (Y/N) Y [ r� Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) u• A Date of pumping 10 / 6 / Wb'/ Pumper =Seen cs C. ABSORPTION FIELD DATA Date installed 10 17 / 77 Soil rating (g.p.d./ftz or ft /bdrm) 16-V system type Trent A Length 39- ft. Width 3 ft. Gravel below pipe & ft. Total depth 10 ft. Eff. absorption area &_0 ft Monitoring tube _� Depression over field d_ Date of adequacy test 1 D /S 10 `/ Results (Pass/Fail) P'4%U For --'�_ bedrooms Fluid depth in absorption field before tests L in. Water added 6 17 gal. New depth8f, tin. Elapsed Time:?(_ min. Final fluid depth 6pv£in. Absorption rate >= YSG g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N& type) Pone !Yyo0 � %( If yes, give date N• A. D. LIFT STATION N• A• Date installed "Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) 'Pump off" level at _ in. High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Oft station on lot Bs' * On adjacent lots I; - Absorption Absorption field on lot 11 3 r Public sewer main N• A. Sewer /septic service line '�), 2S' On adjacent lots , t a 3 ' Public sewer manhole/cleanout Al. A. Holding tank N. A, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /S • Property line NS_' Absorption field r t , Water main N. A. Water service line '> 10' Surface water > 10o, Wells on adjacent lots 1 wo I SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line jig, Building foundation V& Water main N• A. Water Service line >10' Surface water > 100' Driveway, parking/vehicle storage > J'cl Curtain drain Nene Soon Wells on adjacent lots x 103 ' F. COMMENTS &A well - Ar cAAar,te /- G. ENGINEER'S CERTIFICATION I car* that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date OC46 Stn 0 2G0Y (Lx,oa oo36) /y/ 9? HAA Fee $ Y `w Waiver Fee $ _ Date of Payment to oti Date of Payment Receipt Number 64?91 y,U Receipt Number, (Rev. 12101) r. so .t +; % .T •E F. µ0OU � r. ,. CE -3569 `4 in. 10-18-04 08:44AM FROM-CTiE ESI, SGS ENV SERVICES 9075615301 T-582 P.02/03 F-476 sr -is SGS Ret# 1046535001 All Dates/flmes are Alaska Standard Time Client Name Flattop Technical Sm Printed Date/fluor 10/14/2004 10•.16 Project Name ll Lot 12 Eilk 5 Skv Ranch Est. #1 Collected Date/time 10/05/2004 12:45 Client Sample ID Lot 12 E)lk 5 Sky Ranch Est. #I Retelved Date/fhat10/OS 04 14:20 Matrix Drinking Water Technical Director i p C. Ede Released B Sample Remarks - Allowable Prep Analysis Parameto Results PQL Unils MNwd Container ID timid nate4 Dae Init Waters Department Nitrate -N 1.15 0.100 mWL EPA 300.0 D (<-10) 10/06/04 AO Microbiology Laboratory Total Coliform 0 coV100mL SM209222H r' A (<_)) 10/05/04 PKC 10-18-04 08:44AM FROM -CRE ESI, SCS ENV SERVICES 9075615301 SGSlCT&E ENVIFt066 bNMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria ''� aEAo warwlcTtala ON R[V[RSS ams BEralis iwtlactwo ttA1llJ�l' . MUST BE COMPLETED BY WATER 8UPPLE:R PUBLIC WATER STSTEII U* ® PRNAT[ WATER PSTEM Q BWk Reiwla SWd RWeb [) 9rd 4neioe e� FkFFe Ticl. Svc ,resin. 7v./ 5-30 6cA,, rf A,7e-A -e a Ay 999 V T-582 P.03/03 F-476 200 W. POTTER DRIVE ANCHORAGE. ALASKA W518 Tel; 807.582.23.13 Fax: 907-661-5301 1046535-1A1111111 Q ft'd mode SAMPLE COLLECTION: SAMPLE TYPE: ti�F ..•sls... Yd• +� ILY U o.t. •,s'JI O S/ � ROOMO TnatW Water r.� o+ ,c9 ' •P<t'y�3�w n} ` ❑ Repeat 8anvie N un*b"ted WatW Tin•: 12 � MS AM (nWaY. �I Loutlan: ot,� !h k l:L,nrh Fsf� F (refer to lab no. f TSJ /•Tps.p OspeeleiPugm" . TramponWl e. LW ar• U Sane es cobeelar CtM,: TO BE COMPLETED By LABORATORY aRamale ReceMina: Dote: Q r ❑ s.np. err eo tw. el4 ❑ RUSH SAMPLE: Time: tit" ffwrt+w.eetl. Temp: A^"4-16 ❑ k ilourYwi.w Piero M:' Del Re c Me Receivedd 8yOr : Conrn<+e.: .............................................................................._................................................... •. Basterl0loaiealWaterAnabalsBst9td: mm WA (PIAL RESULTS: ANC FBK JUN RAO TOW 0614� Awy.0 'DU L COL SWR a Ciwe MEMBRANE FILTER RESULTS: Phoned p Faxed Anaiytical Mste�: ppeq Count cdaNdrICORL oe&Tffl.• Mert>brane Filter SpOkA Wen MMO-MUG (PIA)LTD —cow Satisfactory I Fc [] .Unsatisfactory r..a... TnTe.TM IIwMYC�1 Reported By: DoWITime: IDI�I1+l t rDD ' Oe•O"'ei'"" • Folm i FVP• 0053 1u17ro3 [or /.3 ► ..:`zo _ i en g n 0 cleon out 05encc lank O 4 yol. Leach ln)e .��,.••• •••;°spa C.> •% V ,*/49!M Js"y L 3MrbaM ,• Na. NdD•S :J��•� T kY \ \U N OD;d karh /iu, 46,3!E1 sky I-10i7ell Eslot��z (EGEND Anchcroye Recording District, Anchofoge,lilasAa fetor•✓AMES S. RODGE-RS Registered Land Surveyor PO. floc 111551 (90713?54tU39 Anchoroge,Aloska 99511 (907J345-0927 BOl/ Scub Urwn. hr t: B. 1::Gr�dSheef