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HomeMy WebLinkAboutSKYWAY PARK ESTATES #1 BLK 8 LT 6Skyway Park Estates #1 Block 8 Lot 6 #019-201-05 - M -W DRILLING, Inc. P.O. Box 4-1224 • 1310C International Airport Road (907) 274-4611 ANCHORAGE, ALASKA 99509 �,, �-�.,`.e-ems �/• i - DRILLING LOG Well OwnerBrown • Use of Wel] Dom Location (address of: Township, Range, Section, if known; or distance main road L Size of casing--L----Depth of Hole -27 -5 --feet Cased to -2j ----feet Static water level 49 ft, (AbQeg) (below) land surface. Finish of well (check one) open end Screen ( ); Perforated ( ). Describe screen or perforation i None Well pumping test at 9 gallons per (hour) (minute) for---JL---hours with Ir", ft; of drawdown from static level.' Date of completion ] 0 Ann 7r, WELL LOG Depth in feet from ground surface I - Give details of formations penetrated, size of material, color and hardness --n—TO S orgPni.cs 2 j" t TO gg CIPv t G-?ve] La TO S4 _SPn,'1 i --as—TO AS Sind A. (;rn.vnl 67 _ TO 7f7 C�ng_. rl,3. 7^ TO 7S a• -rte,- r•,-.,...,1 —TO- O 0- O Cerdficate N( s. 814 & W3 2 2 — STATE Municipality of Anchorage Development Services Department =� �' �•� Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519.6650 l / www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING pp Parcell.D. d1c4•'Aw'05 COSA# b Lf 1. GENERAL INFORMATION Expiration Date: R —/ 1 , o P Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SKYWAY PARK ESTATES S/D• LOT 6 BLOCK 8 1310 SHORE DRIVE ANCHORAGE AK 99515 WILLIAM LARGE & KIM RICH Day phone 227-1860 1310 SHORE DRIVE ANCHORAGE AK 99515 Day phone VALERIE WHITMORE W/ PRUDENTIAL JACK WHRE Day phone 762-5818 3801 CENTERPOINT DRIVE #200 ANCHORAGE AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site 0 Public Water System ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 + ANCHORAGE AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSO Guidelines & Regulations. The reported results describod the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden detects or encroachments. GEG, LTO. can therefore not provide any warranty or future estimate of how long the system will continue to moot the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE __1C Approved for 3 bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Adviso Phone 337-6179 Date `� O bedrooms, with the fllowing stipulations: Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort ry Other By: (Rev. 11A5) WASTEWATER > . PROGRAM "'�i���uFTlTSE` 1 Original Certificate Date: _57- /q - O B Municipality of Anchorage Development Services Department Building Safety Division , On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SKYWAY PARK ESTATES S/D• LOT 6, BLOCK 8 Parcel ID:Q15 —atlj —OS A. WELL DATA Well type PRUATE If A, B. or C provide PWSID# N/A Well Log (YIN) YES Date completed 8/19/1975 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth 75 ft. Cased to 75 ft. Casing height+(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 8/19/1975 5/2/2008 Static water level 49 ft. 50 • ft. Well production 0.15 g.p.m. 2.6 9 -P.M. WATER SAMPLE RESULTS: Coliform © colonies/100 mi. Nitrate• L$Ymg./L. Other bacteria_colonies/100 ml. Arsenic: P-D_ug./L. Date of sample: 5/2/2008 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA PUBLIC SEWER Tank, Type/Material Date installed Tank size gal. Number of Compartments _ CI Hoots (1'I Foundation cleanout (YIN) _ ress ver tank (YIN) High water alarm (YIN) Dale mping Pumper C. ABSORPTION FIELD DATA PUBLIC SEWER Date installed Soil rating (g.p.d./ft2or ft'Ibdrm)_ System type Length ft. Width ft. Gravel below ft. Total depth ft. Eff. absorption area_ ft' Monitoring tube _ Depression over field Date of adequacy test Results ail) For bedrooms Fluid depth in absorption field befor _ in. Water added _.gal. New depth _in. Elapsed Time: n. Final fluid depth _ in. Absorption rate >= g•p•d• A e/uvenation treatment (past 12 me.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N 'Pump on' level at in. 'Pump off" leve High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots N/A Absorption field on lot N/A On adjacent lots N/A Public sewer main 75'+ Public sewer manhole/cleanout 100' Sewer /septic service line 25'+ Holding tank _ N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: PUBLIC SEWER Building foundation Property line Absorption Water main Water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water Water service line Surface Wells on adjacent lots 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 COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date S / / `/ J o e water PUBLIC SEWER parking/vehicle storage COSA Fee S Waiver Fee $ Date of Payment ��l 5/17$ Date of Payment Receipt Number 83oa" Receipt Number (Rev. 11105) SCS Refm 1081801001 Client Name Garness Engineering Group, Ltd. Project Name/m Skyway Park Est L6, B8 Client Sample ID Skyway Park Est L6, B8 Matrix Drinking Water P%1 SID 0 Sample Remarks: All Dates/Times an Alaska Standard Time Printed DateMme 05/132008 9:45 Collected Date/Time 0510=008 15:45 Recehed Date/Time 05/0212008 16:00 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 u8/I. EP200.8 C (<10) 05/07/08 05/12/08 TK Watera Department Total Nitmtc/Nitritc-N 0.658 0.100 mg/L SM20 4500NO3-F B (<10) 05/08/08 LCP Microbiology Laboratory Colony Count 0 coV100mL SS120 92220 A (<200) 05/02/08 DLC Total Coliform 0 coVI00mL SM209222B A (<I) 05/02/08 DLC Fecal Coliform 0 COVlOOmL SM209222B A (<I) 05/02/08 DLC Municipality of Anchorage Ca ! Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.cl.anchorage.ek.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 019-201-05 HAA# 1. GENERAL INFORMATION Expiration Date: — oZ ' O SS Complete legal description SKYWAY PARK ESTATES0SUBDIVISION; LOT 6 BLOCK 8 Location (site address or directions) 1310 SHORE DRIVE • ANCHORAGE AK. 99515 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address Day phone —13621148A HUNTLEY r/ PRUDENTAL JACK WHETE Day phone 273-7269 3801 CENTERPOINT DRIVE, SUITE x/200 • ANCHORAGE, AK. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER 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. 1 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 withal/ applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MO DSD Guidelines 8 Regulations. The reported results described the performance of 6 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 a) septic systems depend on the tical soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the syst These conditions are outside the control of the evaluator of the system. Satisfactory results do not guarantee future performance of the system, nor do they guarantee th there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warmnly or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by other person or party Is not authorized, nor will If confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist L/ Septic System Advisory Well Flow Advisory bedrooms, with the following stipulations: Maintenance Agreements Supplemental Engineers Report Other .. . • •, .gyp" WATER AND -WASTEWATER-: - PROGRAM .•••....... By. L� Original Certificate Date: —� — tJ )R.,. 1201) Municipality of Anchorage ' Development Services Department Building Safety Division On.SBe Water 6 Wastewater Program 4700 South Bragaw St. P.O. Box 198850 Anchorage, AK 995198650 www.d.anchorage.ek.us (907) 343-79W HEALTH AUTHORITY APPROVAL CHECKLIST eeire�±y Legal Description: SKYWAY PARK ESTATES r 019-201-05 A. WELL DATA Well type PRNATE If A. 8, or C provide PWSID# N/A Date completed 8 19/1975 Sanitary seat (YM) YES Total depth 75 ft. Cased to 75 ft. FROM WELL LOG Date of test 9,019/1975 Static water level 49 ft. Well production 0.15 G.P.M. WATER SAMPLE RESULTS: Coliform _Mcolonies/100 ml. Arsenic: N/A mgA. B. SEPTIC/HOLDING TANK DATA Tank Type/Matertal Tank size gal. Foundation deanout (Y/N) C. ABSORPTION FIELD DATA Date installed Well Log (YM) YES Wires property protected (YM) YES Casing height (above ground) 12+ in. AT INSPECTION 5/17/2005 48 ft. 5.35 G.P.M. Nitrate C)-IQmgA. Other bacteria colonie3H00 ml. Date of sample: 5/17/2005 Collected by: - GEG. LtD. PUBLIC SEWER Date Installed Number of Compartments (Y/N) _ High water alarm (YM) PUBLIC SEWER Sall rating (g.p.dAix ft%dnn) _ System we Length ft. Width ft. Total depth ft. Eft. absorption area_ ft' Monitoring Date of adequacy test Gravel over field Fluid depth in absorption field�t� In. Water added _gal. New depth _in. Elapsed Time: Final fluid depth _ in. Absorption rate k g.p.d. eluvenatlon treatment (past 12 mo.) (YM 6 type) If yes, give date D. LIFT STATION Date installed Size in gallons 'Pump on' level at —in. "Pump Win• E. SEPARATION DISTANCES High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanklliR station on lot N/A Absorption field on lot N/A Public sewer main 75'+ Sewer /septic service line 25'+ On adjacent lots N/A On adjacent lots N/A Public sewer manhole/cleanout 100, Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Property line Absorotinn field � Water main M SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water service line -en rain F. COMMENTS G. ENGINEER'S CERTIFICATION Surface water Building foundation Water Wells on adjacent lots - I ceaffy that 1 have determined through held inspections and review of Municipal records that the above systems are in conformance with MOA HAA guldeBnes in eNed on this date. Engineers P t Name JEFFREY A GARNESS Date �d HAA Fee S 3D Waiver Fee E Date of Payment IV °{ Date of Payment Receipt Number oS05 Receipt Number iwv.1201► PUBLIC SEWER parkinghrehide storage Y JUN -13-2005 17:43 PRUDENTIAL VISTA REAL EST D>+.v P+rRer .e0.I1 ..Y�0.V K1401 .x N+.aAt tnaw. rr+ eAMFi aqp. G 907 562 5485 P.02 6— . SURVEY SURVEY CERMFICATION.',���•�T[I�`' Prepared hy'• PLOT PLAN OF....•0•A Robert E. Johns, Jr. & Assoc. . P t Aj Professienol Lend Surveyors e.., ..w ..•rw..Ir O b f AAS STRteI 1" = 40'F.Pc. lot S.F. R.c Plat rev No. mr.. F QA ! FOUNDATION AB.ewLT f' .. L .•n�rw m�.l � .. .. Te su^•eYer O�i'•.y:..J�•�'i:..a,,,ai. Ora" bY• CA.etea eke M�•.A.N..K MM.+.wr•r �w �r.Aerr � t ozF CHN � � 6•-10-05 i2EJ REJ Data Dro.nr •••••• A# a 4121—S 6-1.3-05 1x129/2829 w.a 25-162 JCTLAC AS F;NK S'RJCTtiRt AS-BU'1T t W. [ , 'rte wc�+ AA der •'••.e S=Id DeoCfIPtIRT. AW •..ra. •••!1' M.11 www.ww•.N w. wwMM ..•• SJl `1 Q�+Zq�Dhasked� Lot 6. Blecle 8 •M^•+�+* rr«.~¢.. •o+ Tm Skyway Park Estates Sulad., Addn. No. ] Q LOT "a %y SURVEY TYPE SYM3w.5 U MAL ZMl VR CULT ❑ Mµ LTN�V[e tT . SET RCRAR PNALT LE Ar-AV ❑ Ptc PUH ... A�CDLT ...tor atw ... To.O:J1AINY O FOUND f=AA WOOD CO a -o -s row FEr1CC eDNCRE�E ..P SCK I� KKF^l�GAld Ae.WL1 _ _ ID � ."C CR OD AESUNQ C.EY. .M�t� 4F•a. FC�M M--7 71 �mnw wnn� ANO HSIe LE MILL BE UNOER NO CRCUY3TANCES SHOULD AN AS—ttR.T BE USED FOR CONMJ^„ON OR FOR CSUSLRHIN: BOUNDARY OP. FENCC LR+ES. THE SURNCYOR TAKES RESPONSSIXY FOR THE IIOTAL TRANSACDON ONLY AND ASSUMES WANCAL UMnJTY ONLY FOR THC MST OF 714C WRAY, LIMED DISTANCE$ PREVAIL OVER SCAUDIC. REFRCDJC.ON MAY CAUSE ERRORS N SCALE. • I•I It 9MA SCS Ref.9 1052757001 Client Name Gamess Engineering Group, Ltd. Project Name/# Skvwav Park Est L6 B8 Client Sample ID Skyway Park Est L6 B8 Matrix Drinking Watcr Sample Remarks: All Dates rimes are Alaska Standard Time Printed Daterrlme 05232005 14:07 Collected Daterrime 05/172005 13:45 Received DatelTime 05/172005 14:00 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Contains ID Limits Date Date Init Waters Department Nivate-N 0.100 U OADO Microbiology Laboratory Total Coliform 0 mg/L EPA 300.0 B (<-10) 05/17/05 JIB coVI00mL SM209222B A (<.1) 05/17/05 TLF q MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# 01g-aoI-o5 HAA# 1t A q�0(n0� 1. GENERAL INFORMATION Complete legal description �* G 9"ut- $r Sg_YWAy na2u Cs�Tss Location (site address or directions) - 1300 S14-0 2..- l ruyE Property owner Dayphone -3417- 55'91 Mailing address Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well Xxx 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 X X x NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system 72-M ow. vso Frwn rw m i 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this Inspection. Name of Firm A47)crasoi1 0jb,,nlGcrL/rJ6 phone 3`i-ti4SSI Address PD. Qox z,40'773HL,Lf 73 %-pi A4L_ 99524 Engineer's signature 7�i -�- �- Ltn�o(v Date rlI3I9q •er R t \ �P♦M♦Aon r_ QQ 1 Michael E. Anderson '44igi J' .• 4331 . E u' d �c '. • tiO� 11l "/tCV� 1••MM♦♦e ���i YpC ''OFEIS;O�•,dv 6. DHHS SIGNATURE _.. K Approved for ¢ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: =C Additional Comments _ 0029 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 courtesyto purchasers of homes and their lending institutions in onterto 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 engineers work - • , _ ,- ,_ n 72A= QW. IM) Owe MMM ... �. r• �; .:.�:: . ® Municipality of Anchorage AL Department of Health and Human Services IN HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: CO7{f� E'Aul- S, 5uywNt p�rc,_ Parcel I.D. A. Well Data EST -4T -C-5 Welt type PRW ars If A, B, or C. attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 8119 17S' Driller M-VJ b rLI LL1rJ 6 Total depth '75 Cased to 75 Casing height Z Y Sanitary seal (YM)Wires properly protected (YM) FROM WELL LOG AT INSPECTION „ Q Date of test Ohq./ 7 S 1 t/ i 19 q1 N o p Static water level 41' qB a LU Well flow 9 g.p.m. `✓• 8 g; C.P.M. o "' ru Pump levelt t) N IL N ow r i V.y I W 0 of nt a c, Llv.J SEPARATION DISTANCES FROM WELL TO: � Septic/holding tank on lot nIM _;On adjacent lots A d1A /J 1A Absorption field on lot ; On adjacent lots Public sewer main > 100, Public sewer manhole/cleanout �> /o0 Sewer service line > /0 Petroleum tank A ,,1 C - WATER SAMPLE RESULTS: Coliform Nitrate .10 M g I L Other bacteria O Date of sample: �0 =Nitrate Collected by: A • /44"L4 B. SEPTIC/HOLDING TANK DATA -4/A Date installed Tank size Cleanouts (YIN) Foundation cleanout (YM) High water alarm (Y/N) Alarm Date of pumping SEPARATION DISTANCES FROM Well(s) on lot To propert Al water/drainage 72-026 r -S3)' Font TANK TO: adjacent lots Foundation field Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION .' /A Date installed Manufacturer Size in Vent (YM) High water alarm 'Pump on" codes (YM) SEPARATION DISTANCE FROM LIFT STATION TO: 'Purr>p off" Level at tested Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA N A Gly S L o CTL Date installed Soil rating (GPD/Ft2) System type Length Width Gravel thickness Total depth Total absorption area Cleanout present (Y/N) Depression o (YM) Date of adequacy test Results (passtfail) _� Bedrooms Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION Well on lot To building foundation On adjacent lots` drain E. ENGINEERS CERTIFICATION yes, give date lots Property I•ure To existing or abandoned system on lot Driveway, parking/vehicle storage area line 1 certify That I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of This inspection. �' C) a • • alb ^ r. i ; % Signature I U4c/t10 6mr o n� Engineers Name ,a r` , ,, *. M dwJ E. And.,w, : d I �'f i'r �,j• • 4361-E `1 ^ '• Date ,.����d :'Or ;:.SrOj1T v HAA Fee $ '300, co n l Date of Payment ((� 3—'I `i Receipt Number DAG6 (7c -V1 72-026 ren• Bads Waiver Fee $ Date of Payment Receipt Number )o WELL FLOW TEST.. Date Location'= (-41 &S, skxwzky -r r E�iS. d�4L Well Depth: (ft.) Costing Above Ground 457 Ift.) Static Water Level: (Mcesurod from top of costing) Inspector Project e Time Water /Cu Level (ft.) (gojmj Volume (got.) Motor Rel/see 9 Flow (9Pm) Comments 2 so.o J//zrt rru� rl!S 2e, :/7 V 7.`6 It / v SD.7 cy9r, //% 3 3 / . 4 L�o� v t�t!S L3'f 8 yo Z/ 2S O.S S yo 2/ xol; 0, tft / %// v S/. Z. 7/t. 3 2/ 54?, /3 V-1; o SO. Psi, f/ Z/ 70& . S/ /cxiao So.7 oosf gs r! 6 /y'yv o So.eMr /SSI tL,ro tt o .�d r...+. 0 LECOVERY : COMMENTS AVERAGE FLOW. RATE y 8 (gpm) REVIEWED BY; / Underground conditions ore subject to change over the course of time AAL .,.C. I" Commercial Testing & Engineering Co. Environmental Laboratory Services CT&E Ref.# 94.SS00-1 LABORATORY ANALYSIS REPORT Client Sample ID L6 BLK8 SKYWAY PARK Matrix WATER Client Name ANDERSON ENGINEERING WORK Order 10411 Ordered By ALAN ANDERSON Printed Date 10/31/94 • 13:39 hrs. Project Name Collected Date 10/26/94 0 13:05 hrs. Project# Received Date 10/26/94 • 13:35 hre. PWSID IIA Technical Director STEPHEN C. EDE Released By:57—A Sample Remarks: ROUTINE SAMPLE COLLECTED BY: A.H. QC Allowable Ext. Parameter Results Qual ----------------------------------------------------------------------------------------------- Units Method Limits Date Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 Anal Date Init ---------------- 30/27/94 MCE .................................................................................................................... • See Special Instructions Above VA . Unavailable •• See Sample Remarks Above NA . Not Analyzed �U Undetected, Reported value is the practical quantification limit. IT . Less Than Secondary dilution. GT . Greater Than N 5633 B Street, Anchorage, AK 99518-1600 —Tel: (907) 562-2343 Fax: (907) 561.5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO. FLORIDA. ILLINOIS, MARYLAND, NEW JERSEY, OHIO. UTAH, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE Department of Health 8 Human Services • _ DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF i ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. y ! q D S`3 / 9 HAA ff !j2- g % 00—r 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) 14 Location (address or directions) (b) Property owner `1-ttvl C=�^^lr�Telephone: (home) Business Mailing Address 3 1 o • �-� i7 r -� (c) Lending Institution N &-G AJA df Telephone /I Mailing Address m eC (d) Real Estate Company and Agent L u t'`l t -`t / `.,` „"l " < < < e " Address �, G S Telephone G&3' 5b Ov (e) Mail the HAA to the following address: (or check here X If hold for pick up.) List contact person and day phone number below: 2-29 -3171A 2. TYPE OF RESIDENCE _ Single -Family Number of bedrooms -J 3. WATER SUPPLY Individual We kA Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ❑ Public �. Community 13 Holding Tank ❑ Note: If community ell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ttms(R«. need Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION - As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm /,-� -0—^ _n v rW ek,� �� Telephone b274 - 39 !b Address Date 6. DHHS APPROVAL 1107 Approved for v�L bedrooms Ilk Ir !• J Engineer's Seal /,. .. LCA ,•.' • i �. •222::-E • • i :J. 1911 Approved Disapproved conanionai Terms of Conditional Approval N� Date / The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered In the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze data before acertificate is issued.The Municipality of Anchorage is not responsible forerrorsoromissions in the professional engineer's work. n -W5 (A". va) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) Mun �'r ANCHO-CHECKLiST - FEBRUARY 1984 o:v sicN 3434744 Legal Description: /L0 L,3K$, S� vay ark RECEIVED C SQ-� Z6�Nt A. WELL DATA RECEIVED Well Classification If A, B. C, D.E.C. A prover1(Y/N Well Log Present (Y/N) Date Completed 81141-75 `' Yield Total Depth 7 !-- 7 Cased to 7 Depth of Grouting N o Nt✓ Static Water Level '1R Pump Set At Bo io vH Casing Height Above Ground lQ + Sanitary Seat on Casing (Y/N) Electrical Wiring in Conduit (Y/N) �2/ Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot NSA ; On Adjoining Lots N/_�,4 To'Nearest Edge of Absorption Field on Lot N� ; On Adjoining Lots WDA To Nearest Public Sewer Line — 15 o t To Nearest Public Sewer Cleanout/Manhole (50 To Nearest Sewer Service Line on Lot C25 t Water Sample Collected by S. • Date ?-/f 3 �8 9 Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) No. of Compartments Air -tight Caps (Y/N) Pumping/Maintenance Contact on File (Y/N), Foundation Cleanout (Y/N) Date Last Pumped ;for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation To Disposal Field 72-M(Ft v. 7/08)FrW1 Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating In Absorption Strata Date Installed Width of Field NIA - Type of System Design Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area Statndpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Building Foundation Lot ; On Adjoining Lots To Water Main/Service Line To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on D. LIFT STATION N� Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) _ "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed/� OF. A J�'t Company l ole H Sao .4c�~wK O�sZhr • 9 tl Engineer's Seat Date 7.8y i*:.,c,•rN r, MOA No. t o. 2225-E 5. 1971 Receipt No. OS'�o9(n a c� S�Jn Receipt No'(• ' Date of Payment Waiver Fee: $ Amount: $ 174. OD Date of Payment n- M(R". 7/U) Back Page 2 of 2 V _ GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 -r�d.��� Date Received September 21, 1976 Time of Inspection l.e3nnNt Date of Inspection REQUEST FOR APPROVAL OF `�✓ INDIVIDUAL SEWER & WATER FACILITIES FOR /ILa Conv. � J CLW I. Approval requested by: National Bank of Alaska Mailing Address: Post Office Box 3-3859 Phone: 279-2506 x 28 2. Property Owner: Raul V Brown/ Corbett R. Mothe Phone: 278-9641 Mailing Address: % Hope Cottage, 2804 Bering Street #2—A 3. Legal Description: Lot 6 Block 8 Skyway Park Subdivision #1 4. Location: Shore Drive 5. Type of facility to be inspected Single Family No. of bedrooms 2 6. Well Data: Individual A. Type B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: %IAI.,c. Uig Zt A. Installed B. Insta`1ler C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Absorption area Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/14) Page 1 of two pages Page -2 of tvV pages - Rust for`Approval of Individual '0*�I.er & Water Facilities f .Legal Description Lot 6 Block 8 Skyway Park Subdivision #1 i Comments Approved Disapproved Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) . r. I MUMCIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH L DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 REQUEST FOR APPROVAL OF SEP 211976 INDIVIDUAL SEWER and WATER FACILITIES RECEIVED 1. Type of Inspection: CMRO VA FHA CONV X 2. Property Owner: Paul V. Brown and Corbett R. Mothe 3. _ orbett_Mothe Mailing Ad c�r s c�o Hope Cottage !2805 Bering StIDay Phone: 278-9641 . nc , 99503 Name of Buyer: same as above Mailing Address: same as above Day Phone: 278-9641 C. Mothe rown 4. Name of Lending Institution: NATIONAL BANK OF ALASKA MtKF�. Loan Dept. Sue Benedetti Mailing Address: P•u• Box 3-3859, Anch 99501 Phone: 279-2506 ex 28 5. Name of Realtor or Agent: none Mailing Address: Phone: 6. Legal Description: Lot 6, Block B-8, Skyway Park Subdivision, Addition No. 1 Location:— __000 Shore Drive, Anchorage, Ak. 99502 7. Type of Facility to be Inspected: Well No. Bdrms. 2 8. Water Supply Type of Supply: Public Utility Individual X If Individual, number of dwellings presently served If Individual, depth of well unknown 9. Sewage Disposal System Type of System: Public Utility X Individual (on-site) If Individual, date of installation PLEASE RETURN THE; APPROVAL FORM T0: NATIONAL BANK OF ALASKA MORTGAGE LOAN DEPT. P.O. BOX 3-3859 ANCHORAGE, ALASKA 99501 72-003(3t76) ATTN: SUE BENEDETTI