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Home My WebLink AboutSKY RANCH ESTATES #2 BLK 3 LT 2,Sky Ranch Block 3 Lot 2 #015-302-05 Municipality of Anchorage .... .... Development Sen/ices Department .~l,~.~ Build~ng Safely Division On-S~le Water and Wastewater Program. 4700 Elmore Road ~. ~' P.O. Box196650 Anchorage. AK 99507 Page /of~ www ct.anchorage ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW080053 PID Number: 015-302-05 Todd Langford Wastewater System: [] New [] Upgrade 11625 Paddock Lane, Anchorage, AK 99516 ABSORPTION FIELD LEGAL DESCRIPTION 1.2 G~o,~e North S.S91 South 5.71 s,-'-, 3 ~ 2 ~ Sky Ranch Estates #2 N 3.451S 3.26 r~ N 2.04 1S 2.02 N 1.01S 0.65 rt. 30 + 30 = 60 ~:~. Well: [] New [] Upgrade N 5.01S 5.0 F~. 2 10 A ~=~. ~=t 429 ~=~ ASTM D3034 1PVC Sch. 40 n Monte Acheson 5/29/08 SEPARATION DISTANCES ElSept,c [] Hold,ng [] S.T.E.P [] Other: Tank FieU Station Tank S*,,,er Une Anchorage Tank & Welding 1250 w,~ 200+ 200+ 200+ NA 200+ steel 2 s,~w~,, 100'+ 100'+ 100'+ NA ~ / LIFT STATION V u~ ~. 30+ 17 26 NA 500 c~ Anchorage Tank & Welding ~=~'~ 15 10 20+ NA 32 ,~ 22 ~ 36 Cun~n 0~ NA NA NA NA .0 ~ X ."Z,O MOA Old crib and drainfield were abandoned in place, per BENCH MARK code. Old sump was marked with a nail in the ground, top of manhole 1250 gal tank installed in 2006. West 8 It of Southern b'ench window sill = 100.00 97.66 was insulated w~th 2' blueboard. 1250 gal tank insulated. Engineer's Stamp Inspections performed by: Cindy W. Ellis Dates: I'~ 5/28/08 2'~ 5/29/08 Development Services Department Approval Conditional Approval Date: N 89°59'44"W 125,00' I A B C DCOI 28.0 15.8 DCO2 43.4 24.2 ~ ~ [ 973 Crib I ASPHALT Abandoned I STI 32.9 20.0 DRIVEWAY /~n place 7' I I S~ 4 I.I 22.9 I I MH 48.4 27.4 / / ~o° B Steel mnk ~ I (2006) I MTI 28.4 30.8 / ~ / . ~ I1~ M}I MT2 51.7 59.6 35.8 / I ~ed By Cla~ 30 fl long, 2.0 ~ I I N 89~59'44'~ 125.00' AS-BUILT B=ed upon a su~ey by Shane t lolt, LS-6914; dated May 3 I, 2008 Sky Ranch ~tat~ ~2 Blk 3 Lot 2 ·: :.: ':: Cindy W. Ellis, P.E P.O. Box 110443 '.~"V' June 5, 2008 Anchorage, AK 99511-0443 '? · Scale 1' ~ 20' Phone: (907) 349-1851 Faro (907) 349-1934 " 97.85 / ~J: (HT() / ~;I('H :;el)li~T, mk %00 (;.lion ~:~ hn.I (;h~de = 98.75- 9901 j:, ~ / I ~- 97.-II 98.21 92 Itl X(. Ih T~('m h 91 ~9 92.50 I ~ J'ilhlJ (11 al(J(' j 99 31 - 10069 91 02 I~" OC 91 07 :;ollJ hTi eh( Ii 9() 09 X()h,. T('::I Iloh. RH,,Ii~(, DH)Ih: Benchmark is window sill = 100.00 5~ Ranch Es~tcs ~2 Blk 3 Lot 2 . .-~-: ~ ·: :,. Record Drawing of 5optic Upgrade ' '_'.~ ~n~ford Watkins Parcel ID: 015-302-05 , Permit No. ~080053 ...... Junc 5, 2008 Anchorag~ Alaska 995~1~443 ',,-- · .. .. '" .~:'* No Scale Phone: (907) 349-185L Fax: (907) 3494934 JLH-2-8808 ¥ 04:18P FROM:ED'S ~LECTRIC INC 8?2 4590 T0:~491~4 Inspection Report Po1 Municipality of Anchorage, Building Safety Division 4700 Elmore Road INFO & HCLP (907) 343-8211 INSPECTION: VOICE (907) 343-8300, FAX (907)249-? l/7 · www.muni.org Name Ed's Elect Company Addreee 11625 PADDOCK LN Grid SW2737 Subdivlslon SKY RANCH ESTATES #2 Work Description Septic llft station Permit Technician Comments or Directions STULLER, GRETCHEN J. septic lift station I call to meet on s~te Inspection Type Electrica!:Final ElecTrical Comments (for inspector use cnly) Permit # 08-8136 InspeCtion Date 02.Jun-2008 AM LOT 2 BK3 ~Ft n~>~ Phone 27:~-45§1 MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O, Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 21, 2008 Expiration Date: May 21, 2009 Permit Number: SW080053 Legal Description: SKY RANCH ESTATES #2 BLK 3 LT 2 Design Engineer: 0844 WATKINS ENGINEERING Owner Name: TODD LANGFORD Owner Address: 11625 PADDOCK LANE ANCHORAGE, AK 99516-2319 Parcel ID: 015-302-05 Site Address: 011625 PADDOCK LN Lot Size: 18125 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Cede Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ), 3. The engineer must noti~ DSD at least 2 hours prior to each inspection. Provide notification by c~Iling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption s~tem under construction during freezing weather must be either: A. Open and closed on the same day. B. 'Covered, sea ed,'and heated to prevent freezing.' ..... ~.~.. 5. The following special provisions. ' ,' ~ DECOMMISSION OLD CRIB AND TRENCH PER MOA CODE UNLESS WATER MONITORING ) ~, 14'. DIVERTER MAY NOT BE INSTALLED BETWEEN THE OLD SYSTEMS, SPLIIIER ONLY. FINDS WATER AT ,~ HOMEOWNER INSTALL L~- I IER REQUIRED BEFORE INSTALLATION CAN OCCUR. .~ ' Date:.-~ FiU$1'I! · Municipality of Anchorage Development $ervi¢oa Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-302-05 Property owner(s) Todd Langford Mailing address 11625 Paddock Lane, Anchorage Site address same Day phone Zip Code 99516 Zip Code Legal description (Sub'd., Block & Lot) Sky Ranch Estates #2 BIk 3 Lot 2 Legal description (Township, Range & Section) Lot Size 18,125 .... · Sq. Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR (~;[] all that apply): THIS APPLICATION IS AN: Absorption Field [] Initial [] Septic Tank [] Upgrade [] Holding Tank [] Renewal [] Privy [] Private Well [] Water Storage [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or autl~rized agent) PermiFRush Fees: /'~0 - /'''~'' Waiver Fees: Date of Payment: '~/~(-~/0 ~ Date of Payment: Receipt Numar: /~ Receipt Number: (Rev. 11~5) Watkins Engineering, Inc. RO Box 110443, Anchorage, AK 99511 (907)349-1851 cwellis@gd.net May20,2008 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: Sky Ranch Estates #2 BIk 3 Lot 2 Proposed Septic System Upgrade To Whom It May Concern: Attached please find the application and supporting documentation to upgrade the septic system for the referenced 3 bedroom house. The house is being sold, and the existing drainfield is surcharged. A new septic tank was installed in 2006; a 500 gallon lift station is proposed to be added. It is proposed to retain the existing drainfield for future use. The proposed design is based upon a test hole dug on May 13, 2008. There was groundwater influx at 10 ft when the hole was dug, and it was measured at 10.7 ft below grade after 7 days of monitoring. The high water level was measured on May 15 at 10.0 ft. The test hole was dug to a total depth of 13.2 ft. A percolation test conducted in a silty sand layer between 4.0 ft and 4.5 ft resulted in a rate of 2.5 minutes per inch. An application rate of 1.2 gpd/ft2 is used in the design. The soil log is attached. Proposed Soil Absorption System: 3 Bedrooms x 150 GPD/BR = System Type: Application rate: 450 GPD / 1.2 gpd/ft2 = Maximum Depth: Effective Depth: Reduction Factor: Dimensions: Effective Absorption Area = 450 GPD 5-wide shallow trench 1.2 gpd/ft= 375 ft2 required 6.0 ft 2.0ft 0.70 2@5ftx30ft 428 ft= Sewer Upgrade Permit AppficatJon for Sky Ranch Est #2 BIk 3 Lot 2 Watkins Engineering, Inc.; May 20, 2008; page 2 There are no surface waters or private wells within 100 ft of the proposed septic system. There are no public wells within 200 fl. There are no slope concerns. I am not aware of any adverse effect that this upgrade would have on any adjacent properties' water and wastewater treatment needs. Thank you for consideration of this permit application. If you have any questions or need further information, please call me at 349-1851. Sincerely, President \ / / ~ ~ / ', / '"- ' /~.~-~ .....~-~ ~~ 1979 ~ch: A Watcr Systcm .I ~ i~ ~ ,'.l; Sc~ By C~s 'A' Watcr S)st~m , ~ : ~ , Sc~cd By Class ~ Proposed septic I PWSIO 212916 ff upgrade I , Sky Ranch Esl I '2 Bk~k 3 ~t 3 S~ Ranch EsPies ~2 BIk 3 Lot 2 -: Proposed Septic Upgrade- Site Plan Watkins Engineering, Inc ..- ~..gE.~.~...:., Todd ~ngford CindxW. Ellis, P.[ RO. Box li0443 {'~ :j"~]~O~"". M~y 20, 2008 Anchorag~ A~ ~Bll-0443 .~ -.. rc~ - ~o~ ..': :.' Sc~l~ 1' = 40 ~hone: (~07) 34~-18Bl F~: (~07) 34~-l~34 'v&, '. ............ · TH10 Test Hole 0 attempt DESIGN DETAILS 3 BR, 450 GPD 1.2 gpd/ft2 Requires 375 ft2 ShallowTrench 2 ft effective 2 x 30 ft long Max 6 fl deep Driveway Existing 3 BR tlouse Test Hole #2 5/13/08 Organics ~ 1 o Proposed Trenches 1.25"PVC 4 J__ a...I pipe I 2.0ft e=I6.0 I ~::Vker 9.5 Water 13.2 ~¢ ~- T Served By Class "A" Water System PWSID 212916 Location ofwater , line, by Chugach Sewer & Drain 5/19/08 drainfield to be retained and plumbed to lift station. steel septic tank (2006 DC( MT MTq ~o~e~l~ ; TH2 O Install (2) 5-wide trenches 2.0 ft effective, 1.25" PVC pipe wi 3116" holes, 18" OC MT Instali 500 gal steel lift station w/2 outlets MT This is an engineer's drawing, and locations are approximate. It is not a survey. Sky Ranch Estates #2 BIk 3 Lot2 Proposed Septic Upgrade Watkins Engineering, Inc. Todd Langford Parcel ID: 015-302-05 Cindy W. Ellis, P.E P.O. Box 110443 May 20, 2008 Anchorage, AK 99511-0443 Scale 1' = 20' Phone: (907) 349-1851 Fax: (907) 349-1934 '..- '- CI~)Y W. ELLIS : '' ~ ". ~(~E - 10577 ", '. Municipality of Anchorage Development Services Department Building Safety Division On-S~te Water and Wastewater Program 4700 South Sragaw St. P.O. Box 196650 Anchorage. AK 99519~650 .www ~t anchoraqe ak P~ (907) 343-7904 Soils Log - Percolation Test Performed For~ Todd Langford Date Perfon~ed: 5/13/08 Legal Deschption: Sky Ranch Estates #2 Block 3 Lot 2 Township, Range. Section: N/A 7- 8- 9- 10- 15- 16- 17- 18- 19. 20- Slope Site Plan /1'°%'o"w / i See Atlached Site Plan WAS GROUND WATER ENCOUNTE RED'~ yes $ IF YES. AT WHAT DEP'FH? 10' L I~e: 5/20/08 Reading Date Gross Time Ne/Time Deplh Io Water Net Drop 1 5/13/08 4:04-4:14 10 6-2 4 2 5/13/08 4:15-4:25 10 6-2 4 3 5/13/08 4:32-4:42 10 6-2 4 4 5/13/08 4:43-4:53 10 6-2 4 5 5/13/08 4:55-5:05 10 6-2 4 6 5113108 5:06-5:16 10 6-2 4 PERCOf. ATION RATE 2.5 (m,~uteu~c~) PERC HOLE DIAMETER 6" TEST RUN BETV~/EEN 4.0 FT AND 4.5 FT COMMENTS 4 hr presoak pdor to test. GW @ 10.0 or~ 5-15-08 PERFORMED BY' Cindy W E s I Rocky Tra nor /~J~'~/~ /,~/1 .~dd~' · ~ ~ ~ v - 'v"~'~/v ~'v' CERTIFY THAT TH S TEST WAS PERFORMED IN ACCORDANCE VV1TH AL/STATE AND MUNICIPAL GUIDE~NES IN EFFECT ON THIS DATE· DATE: :~'~-*~ ~ MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 25, 2006 Expiration Date: May 25, 2007 Permit Number: SW060116 Legal Description: SKY RANCH ESTATES #2 BLK 3 LT 2 Design Engineer: 0844 WATKINS ENGINEERING Owner Name: TODD LANGFORD Owner Address: 11625 PADDOCK LANE ANCHORAGE, AK 99516-2319 Parcel ID: 01 6-302-05 Site Address: 011625 PADDOCK LN Lot Size: 18125 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. -THIS PERMIT IS FOR A SEPTIC TANK REPLACEMENT, TO BE CONNECTED TO THE 1979 SEPTIC TRENCH ONLY. A DIVERTER VALVE MAY NOT BE CONNECTED TO THE 1973 CRIB AND SHOULD BE PROPERLY ABANDONED. - (EMERGENCY TANK REPLACEMENT) - SEPTIC TANK INSTALLATION MAYBE LOCATED NO LESS THAN FIVE FEET FROM ANY PROPERTY LINE OR BUILDING FOUNDATION; TEN FEET FROM ANY WATER SERVICE LINE; ONE HUNDRED FEET FROM ANY SURFACE WATER; AND ONE HUNDRED FEET FROM ANY PRIVATE WELL; AND THE SEPARATION DISTANCES REQUIRED BY 18AAC72 FROM WATER SUPPLY WELLS. Received By:. Issued By:. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 wwv.muni.org/onsite (907) 343-7904 ON-SITE SEWEP,/~VELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-302-05 Property owner(s) Todd Landlord Mailing address 11625 Paddock Lane, Anchora~le, AK Site address same Legal description (Sub'd., Block & Lot) Sky Ranch Estates #2T BIk 3T Lot 2 Legal description (Township, Range & Section) Lot Size 18,125 Sq. Ft. Number of Bedrooms 3 Day phone .~ ~ Zip Code 99516 Zip Code THIS APPLICATION IS FOR (~] all that apply): Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] I certify that the above information Is correct. I further certify that this application is being made for a Single Family Dwelling and Is in accordance with applicable Municipal Codes. (Signature of property Owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number:. (Rev. 11/05) /'~,~0 ' ~rz') Waiver Fees: Dateo, Payment: Watkins Engineering, Inc. P.O Box 110443, Anchorage, AK 99511 (907)349-1851 cwellls@gci, net May 24, 2006 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: Sky Ranch Estates #2, Block 3, Lot 2 Proposed Septic Tank Replacement To Whom It May Concern: Attached please find an application to install a new 1250 gallon steel septic tank at the referenced 3 bedroom house in Anchorage. The existing septic tank, installed in 1973, has collapsed and will be abandoned in place. Although a 1000 gallon tank would be sufficient, the homeowner prefers a larger tank. It is also proposed to install a diverter valve after the tank. The property has two active drainfields, which are both connected after the tank. A log crib was installed in 1973, and a trench was added in 1979. Both are sized and were approved for 3 bedrooms. It is proposed to install a diverter valve after the tank to shut off one system completely while using the other. This may extend the life of both soil absorption systems. Thank you for consideration of this permit application. If you have any questions or need further information, please call me at 349-1851. Yours truly, President I Driveway i 19~ (collapsed) / ~. DCOJ to be abandoned ~ "~.- ~ in place. ~ J Existing ~ -7'~ 3BR.o.se ~ ~ ~ ' ST " I 6 ~ 5~ long .~ ~/ Pro~sed 1250 gal / ~[ ] ~ / steel septic rank / SUMP DiveHer Valve ' I / / , I / Seined By Cl~s // "A~ Water System ] / PWSID 212916 , I S~ Ranch ~t~ ~2 BIk 3 Lo~ ~~, ToddPr°p°sed~ngfordSepUc Upgrade-Site Plan Watkins Engineering, ,n~~" T ~' "-H ~4¢'" ~.~ Parcel I~ 015-302~5 , ~. :' 49 ~ ~ '~ ~... · .......... ;~.A~....;...J ~ Cindy W. [llis, P.[ P.O. gox 11044~ ~ '['"[~69"~'~ s"T"~, ~a~ 24, 2006 Anchora~ ~K 99511-044~ ~ .... ... ,~ S~le 1' - 20 Phone (907) 349-1851 Fa~ {907} 349-19~4 u ' " " mi I ~ Undevelo~d Existing septic Unk .' ~ [ - (collapsed) ~ .~ ~xisting ~o ~ ~mdoned ~ X 3 BR l~ous~ [ ~ PWSID 212916 'A' Water S~tcm~ Jl ,*~/~ ~;~( ~ PWSID 212916 , I Proposed Sep~c Up~rade - Site ~an Watkins [n~ineerin~, Inc ~..9.~.~%h~ lodd ~n~foM '. May 24, 2006 Anchorag~ AK 99511~443 u0:g ''.. e~ ' 10S~ 'J' ~ ~ S~le 1' ' 100' Phone: (907) 349-1851 Fa~ (907) 349-1934 ~n~ '. ... .." ,'~ ~ MUNICIPALITY OF ANCHORAGE % DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS S//.~ /~ LEGAL DESCRIPTION /__ LOCATION Well Absorption area Manufacturer ~',~1.~'/.~ IF HOMEMADE: Inside length Dwelling [~'~PGRAD E NO. OF BEDROOMS Material W~dth Liquid depth PERMIT NO. I Material Trench wid Material beneatl{ tlr (/,~ / ~ Liquid capacity in gallons Distance between lines PERMIT Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line Building foundation Sewer llne Septic tank OTHER PIPE MATERIALS p.~ S0'LTESTRATING//~ ~f INSTALLER DATE LEGAL APPROV D 724) 13~R e~v. 3/781 PERMIT NO. APPLICANT LOCRT I ON LEGRL I-1U [-.I I C ]~II~'FIL I T%-' OF RI'--ICH.JF:FIGE 'DEPRRTMENT OF HERLTH RrlC, EN'v'IROf-I'IENTRL PROTECTION 825 "L" STREET, ANCHORAGE, RK, 99501 264-4720 SEI4ER LIPGRRDE PERt-1 'ir SRR BOX 1628 344 CmN--_~ I TE WALLACE J I, IATTS BIRCH L2 B3 SKY RRNCH ~t2 LOT SIZE 21750 SQURRE FEET TYF'E OF SOIL BBSORBTION SYSTEM IS: TRENCH MRXIMUM HUME:ER OF BEDROOMS = 3 SOIL RRTING <SO PT/DR>= lBO THE REQLIIREDSIZE~( Of THE SOIL ABSORPTION SYSTEM IS: 5'/' B, EF'TH= 7 LE[4GTH= 6? 6RR%¢EL DEPTH= THE LENGTH DIMENSION IS THE LENGTH <IN FEET> Of THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTBNCE BETWEEN THE SURFRCE OF THE GROUND FiND THE BOTTOM OF THE EXCRVRTION (IN FEET>. THERE ~'S NO SET HIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIHLIH DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RN[, THE BOTTOM Of THE EXCRVRTION <IN FEET>. F'ERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORr.1 THIS DERRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE 14ELL WILL SERVE. TI,lO ( 2 ) INSPECT I 01%,i5 RRE RE 6'~. Lm I RED BRCKFILLING Of RNY SYSTEH WITHOUT FINRL INSPECTION Ar.lB APPROVRL BY THIS DEPRRTHENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R NELL RND RNV ON-SITE SEI.IRGE DISF'OSRL SYSTEM IS :tE~O FEET FOR R F'RIVRTE I.IELL.~ OR 150 TO 2E~¢~ FEET FR. OM R PUBLIC 14ELL DEPENDING UPON THE TYPE OF PUBLIC HELL. OTHER REQUIREMENTS r. IW-/ RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRE:LE TO INSURE PROPER INSTRLLATION. PEF-: f'I I T E×P I RES DEOEr~IBER I CERTIFY THRT :t: I RM FRt'IlLIRR WITH THE REQUIREMENTS FOR ON-SITE SEI4ERS 8ND I, IELLS RS SET FORTH BY THE HUNICIPRLITY OF RNCHORRGE. 2: I !,PILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES. _'Z.: I UNDERSTRND THRT THE ON-SITE SEI,IER SYSTEH MRY REQUIRE ENLRRGEMENT IF THE F:ESIDENCE IS REMODELED TO INCLUDE f'~ORE THRN ~ BEDROOMS. SIGNED: APPLICANT I,IALLACE J I,IRTTS ISSUE[, BY_ ............................. D RT E_ i I _ _ V2. 2 Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION SEPTIC TANK: ROM WELd ee MA.UFACTU.E. INSIDE LENGTH. SEEPAGE PIT: NUMBER OF PITS .INSIDE WIDTH MATERIAL ,LIQUID DEPTH , ,,_~ ~. ~, NUMBER OF "~ /--c*~ ~.~.~ COMPA_J~ENTS ~ IIQUID CAPACI(Y /~'~ ~.)~'-~"~' ' '~ GALLONS. --/.-~,,A~CrER~ORW,DTH ~/~ LENGTH /~ DE~'. , . ABSORPTION AREA (WALL AREA) SQ. ~. ADDITIONAL ABSORPTION WELL: ~,.~v.~ w,~. ~t~---O APP£o~I-. CG-AjJ,i~c~ TYPE CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION_ LOT LINE SEWER LINE. TANK SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: Form No. EQ-O31 DIAGRAM OF SYSTEM GreATEr ANChORAgE ArEa Borough SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK I S.T,C T^N,~ TO .E,'AGE ,',T WALL DRAIN FIELD DRAIN FIELD SEEPAGE PIT (~ DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK ,AND INTO CRIB CROSSING GAP OF GRAVEL BACKFILL CONFORM TO E~OROUGH REGULATIONS REGARDING INS LATION. TYPE: DIAGRAM OF' SYST£M i Pert'0rmed For L~pml This IIBCEIVI::D · · ', 1973 pi) ' ".F. Glacier Excavating Date Per¢ormed'cr~-30'7~'.~-~;~ ~)escrlntton: Lot 2 Block ~ Subdivision Sky l~anch Estates rorm Renorts Soils Loq ~es Percolation Test_ 1 qe~th Soil Characteristics Peat overburden Silty Gravely Sand ( SW - ~ )' ~i80 Gravely Sandy Silt Bottom oE Test Hole minus 12 ,~' Was ~round Water Encountered? NO I¢ Yes, At what Denth? l'-Readinq -'- Date Gross-Time - Net Time-- Depth -to II20 Net Dron [. on Rate ~ti nute -Proposed Inst~llation: Seenaoe Pit yes Drain Field Doeth of Inlet Oenth To' Bottom Of Pit Or Trench 1~0' sq. I't. ~ralna~e area required per bedroom ,':' lo bedrock or water table 4 Eee t below seepage pit ,. f~rmed ~y Jim, Mack, Data Certified By: Const~ction ,. ~o H~gor Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-302,05 1. GENERAL IN:FORMATION Complete legal description Expiration Date: ./- ~ _~,- /~,,, SKY RANCH ESTATES #2, BLOCK 3, LOT 2 Location (site address) 11625 PADDOCK LANE, ANCHORAGE, AK 99516 Current Property owner(s) ERIKA BOWEN & MICHAEL IEUDE Day phone Mailing address 11625 PADDOCK LANE, ANCHORAGE, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless othen4,ise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 TYPE OFWATER SUPPLY: r lndiVidua! Well Individual. Water storage Community Class A Well Public Water System TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding Tank [] [] Community On-site r-] [] Public Sewer E~ 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 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 vedfy that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 01/12/2011 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 onlyto the conditions, as ofthe 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 encroachments, deficiencies or discrepancies exist. bedrooms. DSD SIGNATURE ~/ Approved for 3 Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory · Maintenance Agreements Supplemental Engineer's Report Other By: (Rev. 11/05) ~o'~~Original Certificate Date: 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.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SKY RANCH ESTATES #2, BLOCK 3, LOT 2 A. WELL DATA Well ty'pe PUBLIC: ~ A Date completed Total depth f. IfA, B, or C provide PWSID #212916 Sanitary seal (Y/N) Cased to ft. FROM WELL LOG Parcel ID: 015-302-05 Date of test Static water level Well production WATER SAMPLE RESULTS: Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION g.p.m, g;p.m. Coliform colonies/100mL Nitrate mg/L Arsenic: __.mg/I Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Date installed $/28/2006 Tank size 1250 . gal. Number of comPartments _2 Cleanouts (Y/N) _Y. Foundation cleanout (Y/N) _Y. Depression over tank (Y/N) High water alarm (Y/N) ¥- on STEP Date of pumping 12/20/2010 Pumper A+ C. ABSORPTION FIELD DATA Date installed 5[29/08 Soil rating (g.p.d./ff2 or ft2/bdrm) 1.2 System type Treach Length 60 ft. Width _5 ft. Gravel below pipe 2_~ff. Total depth N 6.6 ! S 5.5 f. (Measured 12/20/10) Eft. absorption area 4~29 ft2 Monitoring tube Y Depression over field N__ Date of adequacy test 12/20/10 Results (Pass/Fail) Pass For 3__ bedrooms Fluid depth in absorption field before test N 10 ! S 0 in. Water added 600 gal. Elapsed Time: 25 min. Final fluid depth 10 & 0 in. Absorption rate >-- Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date __ New depth 3.0 & 2 1!2 in. __ g.P.d. D. LIFT STATION Date installed 5/29/2008 "Pump on" level at 32 in. Datum Bottom of Tard[ E. SEPARATION DISTANCES Size in gallons 500 'Pump off' level at ~ Cycles tested 2 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot Absorption field on lot Public sewer main Sewer ./septic service line Animal containment areas in. Manhole/Access (Y/N) _.Y High Water alarm level at 36 in. Meets alarm & circuit requirements? ~__ On adjacent lots On adjacent lots Public sewer manhole/cleanout Ho!ding tant~ Manure/animal excrete sterager areas SEPARATION DISTANCES 'FROM SEPTIC/HOLDING TANK ON LOT TO: · Building foundation S'+ Property line $'+ Water main 10'+ Water service line 10'+ Wells on adjacent lots 200'+ SEPARATION. DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water Service line 10'+ Surface water 100'+ Curtain drain 50'+ (Nol~e Kl~OWn) COMMENTS Absorption field 5'+ Surface water 100'+ Water main lO,+ Driveway, parking/vehicle storage ....10'+ Wells on adjacent lots 200'+ ENGINEER'~ 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 KENNET~ IV[. DUFFUS Date 1/12/2011 COSA Fee $490.00 Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number (Rev. 11/05) Address P~O Box 110443. Anchorage. AK 99511-0443 Engineer's Printed Name C~indy W. Ellis 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 lype of structure indicated herein. I further verify that based on the information obtained from the Mun cipality of Anchorage files and from my investigation and inspection the on-s~te water supply and/or wastewater disposal system is(are) in compliance with all applicab e Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Watkins Engineering, Inc. Phone 9~07-349-1851 Date 5_~0/2008 5. DSD SIGNATURE ~ Approved for __'"~_ _ bedrooms. -- Disapproved. - Conditional approval for _ bedrooms, with lhe fo COSA Checklist Septic System Advisory Well Flow Advisory _ Nitrate Advisory X Arsenic Advisory Maintenance Agreemenls -- SupplementaIEngineer's Report -- Other__ -- '~/'~"'~'- Original Certificate Date:~ Municipality of Anchorage .. Development Services Department Building Safety Division On-Site Water 8, Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907J 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legat Description:. Sky Ranch Estates #2 BIk 3 Lot 2 A. WELL DATA Well type A If A, B, or C provide PWSID # 212916 Parcel ID:.015-302-05 Well Log (Y/N) Date completed Sanitary seal (Y/N) Total depth fl. Cased to __.ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate ~ mg/L Arsenic: rog/1 Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material steel Tank size 1250 __ gal. Number of Compartments 2 Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION ~ in. : , g.p.m. Other bacteda Collected by: coloniesll00 mL Date installed 5r26/o6 Cleanouts [Y/N) Yes Foundation cleanout (Y/N) DCO Date of pumping 6/3/08 C., ABSORPTION FIELD DATA Date instafled s~9/o8 Length 6o ft, Total depth N 6.61 $ 6.0 .~. Depression over tank [Y/N) N High water alarm (Y/N) NA Pumper Around the Clock Pumping Soil rating (g.p.d./ft= or ft2/bdrm) 1.2 System type ,shallow b'ench Width 5.0 ft. Gravel below pipe 2.0 Eft. absorption area 429 ft2 Monitoring tube .Yes Depression over field No Date of adequacy test .NA - new Results (Pass/Fail) For, bedrooms Fluid depth in absorption field before test r. in. Water added gal. New depth Elapsed Time: __ min. Final fluid depth in. Absorption rate >= Any rejuvenation treatmenl (past 12 mo.) (YIN & type), If yes, g~ve date g.p.d. Fo D. UFT STATION Date installed 5/29/08 'Pump on' level at 32 in. Datum bottom ot lank E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot NA o no well on lot Absorption field on lot Public sewer main Sewer/septic service line Animal containment areas Manhole/Access (Y/N) Yes High water alarm level at 36 Meets alarm & circuit requirements? )'es Size in gallons .500 'Pump off' level at 22 in. Cycles tested NA- new On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK ON LOT TO: Building foundation ~5 Property line 30+ Absorption field 6 Water main 90+ Water service line 34 Surface water 100, Wells on adjacent lots 100+ privale* SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Prope,ffy line 17 Building foundation ~0 Water main 72 Water service line 13 Surface water 100+ Dnveway, parking/vehicle storage 50+ Curtain drain None known Wells on adjacent lots .100, pnvate' COMMENTS:, 'Gtealer than 200 ft fi.om Class A well to septic lank and drmnlietds. Waiver Fee $ Date cf Payment Receipt Number G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review cf Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. in. COSA Fee $ Dateo, Payment Receipt Number (Rev, i 1/05) Date 5/05/08 Engineer's Printed Name Cindy W. Ellis N 89°59'44"W 125.00' $ s N 89°59'44"W 125.00' Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Pregmm 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. cl.a ncho rage.a k.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY~APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: I ~ - ~ ~'-- O ~ 1. GENERAL INFORMATION Complete legal description ! Lot 27 Bk 3 Sky Ranch Estates #2 Location (site address or directions) , 11625 Paddock Lane, Anchorage, AK 99516 Current Property owner(s).... Gary Caudell Day phone 245-5445 Mailing address .3853 Galactica Drive, AnchoraRe, AK 99517 Lending agency Day phone Mailing address Real Estate Agent Colin E. Roth/ReMax Properties Day phone 727-1191 Mailing Address 2600 Cordova Street~ Ste. 100~ Anchora.qe~ AK 99503 Unless othem4se requested, I-IAA will be held by DHHS for pickup. HAA picked up by:. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A 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 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on proporties served by a single family on-site wastewater disposal and~or water supply system. DSD also issues HAAs upon request to home ov~ers. Certificates of Health Authority Approval are valid for 90 days from the date of issue for preporties served by a pdvate or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal aflixed hereto and as of the validation date shown below, I verity that my'tnvestigafion based on procedures outlined In the Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe. functional and adequate for the number of bedrooms and type of structure indicated herein. I further verity that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm .Pannone Enq. Svc. Phone 272-8218. Address. P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name .Steven R. Pannone, P.E. Date / Engineem Comments.' In conducting an adequacy tm-t, I attempt to pro,ia,, a thorough, conscientious e~gincering analysis of thc ~,~cm La ~..ordanc~ ~vith MOA DSD G~i~lin~ & Reguhtions. Thc reported rmul~ dc~cn"ve thc performance of the systera undc~ the condJtious encouatczed at the firae o f the Ira1. and selmmtion dislanccs m~asm'ed to rmdily identirmblc f~mres. The openttional life of all wclls and septic s/stems &'pend on the local soil condition, ground snter levels tlmt may flucmatc dm.ingm~ye~r~an~th~wat~rus~ge~the£.~ni~ybeings~rv~dbythesys.mm.1`h~cc~nditi~usm.~ ~.....i... 2'-- ,,,~...~ ........ i.....~ outside the control tithe evainator offltis system. All syst~us eventually fail and safismctm7 te~t . ~","--(~ · results do not Smvantec rum perrorm~c~ ol'the sysu:m, nor do they Smranle~ tirol there are no ........... .~;...--.~ Nd,kn dc fcct~ or encroadu~enm P 'F.~ c~n therefore not provide any ,.,mmnty for future pcfformnce v,.-'~\Steve n R. 'Panncne~, nor ~iv¢ any est/mate of how long thc system will enntixtuc to meet thc opcmfional rcqufl'ements dthe AD£C or MOA DSD. ne enntent of this report is for thc sole bcn¢fi~ of the os~ list~ above. Any rcli~cc uPov- or u-~: of thi~ rcport by any otlm' person or p,'m7 is not authorizai nor v. ill it confer any 6. DSD SIGNATURE ~ Approved for ~ bedrooms. Disapproved. Conditional approval for __ bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Expiration Date: Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: i O -,~..~"'- (9 / Reissue Date: Municipality of Anchorage Development Services Department Building Safety Division . On-Site Water and Wastewater Program 4700 South Bmgaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorege.ak.us HEALTH AUTHORITY APPROVAL CHECKLIST Legal Desc~ption: A. WELL DATA Lot 2. Bk 3 $1w Ranch Estate~ Parcel I.D.: 016-,102-05 Well type A If A, B, or C provide PWSID at ~ Well Log IN Date completed ~ 'sanitary seal Wires propedy ICxotected Total depth ft Cased to fl Casing height (above ground) _ FROM WELL LOG AT IN,GPFL'~ION DSt~ Static water level ~ fl in. Well IXOduotion ~ g.p.m WATER SAMPLE ~UL~.· . _ ~ . Coliform ,,-/ colonte~,/100 mi Nitrate mg/I Other'"l~cleda colonies/100 mi Dete.,9~mm~e: Colleoted by: - ~ B. SEPTIC/HOLDING TAJ~IK DA. TA Tank Type/Material, $te?l ' __ Oatel. at,ed,4'l[ 1/73 .... 1'00 Cleaflouts Y Fou~ ~eano~ ~ Date of pumpleg 8/8/2001 C. ABSORPTION FIELD DATA gal Number of Compartments 2 Depression over tank N High water alarm J~_ :Pumper Around the Clock Pumoill~l Date installed 10/26/1~?$ Length ~ fl Wkith :} fl To~al depth ~0 fl Effective absorption area ~ f~ Date of adequacy test 811rd2001 Results (Pass/Fail) Fluid depth in absoq~ion field before te~t ~. Iff Elapsed Time: ~ mln Final fluid depth .~ in Any rejuvenation treatment (past 12 mo.) (Y/N & type) No Soil rating (g.p.d./ft2 or ft2/bdrm) 180sf/bd System type Gravel below pipe I~ fl Monitoring tube _Y. Depressio~ over r~lcl N Pass For _3 bedrooms Water addedl~,~0 gal. New depth60 in. At~,orption rate >= 450+ g.p.d. If yes. give date (Rev. 11~) · Date installed ~ Size In gallons* Manhol. e/~ccess · -. · 'Pump on' level at ""'"'i'n~ P_~,,:p o fl' lev, I at i~~at ,, alarm I-~vel at in Datum ~ C~tested / Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FR O~-'I~ ON~T O: Septic tank/lilt station on lot f On ad'merit lots Absorplion field on lot j On ad;a~n--X~s- Sew~epfic service hne Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 1(~' Property line, 10'+ 'Absorption field 5'+ Water main 20'+ Water ~'ervice line. ~1)'+ Surfac~, water 10~)'+ Drainage 100'+ Wells on adjacent lots ;00'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON I~OT TO: Water main Driveway, parkingNe~icle;torage .. Property line. t 0'+ Water Service line. ;~0'+ Building foun~ation _10'+ Surface water, 1{10'+ Curtain drain 11~0'+ Wells on adjacent lots. ~0Q'+ F. COUMENVS c_ b *Floor drain in laundry room functions as FCO Der tenant comme~, G. ENGINEER'S CERTIFICATION rewew of Municipal records that the above systems are in confonnance with MOA HAA guidelines in effect on this date. Engineer's PHnted Name Steven R. Pannone, P.E- Date.. ./ Steven E. Pcnncne Date of Payment (Rev. Waiver Fee $, Date of Payment Receipl Number 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 I.D. # O' t S-- - 3o 3 '- c; 5-- 1. GENERAL INFORMATION Complete legal description Lot ~: St. ock $; $~, Ranch E4~ LoC:~ti6n' (site address or directions) Property owner" Lmure)tc~ LeU Mailing address Lending agency Mailing address 116~5 P~ddock Anchorage., AK Day phone $111 "C" St~.~X: Su~t~ 100 Day phone Agent RZch~zrd ./orca. n/ DL/na.r~ic P/top~,t. Zea Address 3111 "C" S~bte.~.;~ Su,Ute. 100 Anchor~qe.~ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: NOTE: Day phone 561-7650 AK 99503 Individual well Community well YJ(X Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAl' NOTE: Individual on-site Holding tank Community on-site Public sewer xxx If community Wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 cf 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 inves.ti, gation 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. Phone $ & S ENGINEERING Name of Firm Eagle River, Alaska ~)577 Address Engineer's signature Y~'~/' .~' Date DHHS SIGNATURE X Approved for ' -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of ~Ahchorage 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 pumhasers ct 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825'L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Health Authority Approval Checklist Legal D~ription: LO T ~1. 81.~: 3 SKy ,eae,,-¢~ ~ ~ Parcel I.D.: A. WEU,, DATA We-ii lype~'~° r ¥ If A. B. or C. altach ADEC lellm'. ADEC water ~,slea~ number FROM WELL Date of te~ $1auc water Im~J WcU production ,p.m. WATER SAMPLE RE~~ Coliform Niuate Other bacteria sample: Collected by: B. SEPTIC/HOlDING TANK DATA Found~ibu cl~ (Y~ ~ 0 ~ion (Y~ ~i~ I~/~/?q. ~flr~s ~.p.d.~o~ /fO Numbc~ of Compamncnts ~ Cl~auouts ~) '~ High wa=r ahum (Y~ ,~' 0 System I).Ix: ],-~e~,,~ Total de~h /O Fired. depth in ab~ou fir.,/d b~fore test (in.); Peroxide tream~m ~ 12 months) (Y/Il) luuz,~di~,,,"iyatte~:l,~ilal, water.~Jd_~,,.d (in.): ~"(a. S"' AbsorpUon rate = /y {"c9 -'f- g,p.d. K~d~/ ffyes gJved~*~ ~ F_,ffective~orpUona~a G 3G lvlomtofinBTubepmsent(~N) ¥~XOepressiono~,erfleidfY4~ ~'o D. Lll~r STATION Dam in.milled Si~e in galion~ M~mhole/Acce~ (Y/N) "~po~.~~ "l~mp off' level J-Ji~Jl wlllgf ~ level al* ~ *l~ltum E. SEPARATION Di~FANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ,,,/ ,fY Ai~orption field on lot g d ~ ~ ~a~nl lots Public ~ n~in J~/ / ~'~ Public sewer manhole/clean., Lit~ ~on SEPARATION DISTANCES FROM SEPTI~ TANK ON LOT TO: SEPARATION DISTANCE BOM ABSORPTION F~q ~'~ ON LOTTO: Building fmmdnfion /8 + WM~' mnin/se~vice line Smface w~Ucr I 0 0 -r- Drh, ew~.', pmking/vehictc storagg ~ __ Curtain drain ,~l ~,[ k-,v ~ w~' Wells on adjacem ]oL~ ~0 ~'-7-- P~o~.. line /O ~- F. ENGINEER'S CERTIFICATION I ceeti~, thai I have determined th~ field in,wec~ons and ~eview ofMum¢tPal reco~~..v a~e MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage,'Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lo/- 2, Z~locl<..7,, S~;! ~a,,y./~ ~.~/~-,/-</ =~' ~ Location (site address or directions) /I 0" 2.5- P'¢~ c.,/c/o c ~- /-.a,~ ¢ Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent $~11,~ Ikhr~r.~,.~., (o/r~u.,~l/ ~a,~lc.~," Dayphone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: Individual well ... ..... .... ,~ H/..I r~ ',, ,Community well . ~ D ~- ~. ,,~p~.o~,~cx ,~,~;~ ~ ( ~ . .. Public water - '' . ' {': ~' I'.' If communi~ well system, provide wfl~en confi~ation from State ~EC a~st,_? : ': li~ ; ~? ~ t" t ~ .'; lng to the I~a and status of system. ~ ~' ',, I. .' "~ '.('1~/'- [.~;,~"''~,," If community wastewaier system, provide written confirmation from State ADEC attesting to the legality and status of system. -. ' ... ~;. Se Se Engineer's signature STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verity 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 verity 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. NameofFirm ~1~ F /~p '7'~ c,4 ,n ; c~, f -~" '"~ ~'¢ '~' Phone Address /'~_';'3 ~ ~:c/~ ...~-/:,, DHHS SIGNATURE ~ Approved for -~ Disapproved. Conditional approval for Date bedrooms. bedrooms, with the following stipulations: ,,',,~ , ,.17;~, , .. · '" ..~.; -,Add t ona Comments 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. Em ployees of D HHS 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. · · .. ~ Municipality of Anchorage Department of Health and Human Services HEAL'rH AUTHORITY APPROVAL CHECKLIST LegalDescdpticn: /..~., [~.,~..~'A"), r-J'~¢/, ~:/~/ff~.ParcelI.D. A. WellData _~, /~,~nc/~ ~.~[*=~,j. ~/r~.r.~ ~" ~__~,~,l.y Well type ~,,, "/~1~ If A, B, or C, attach ADEC letter, ADEC water system number Log present (Y/N) ,Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) ' 'k,.," Wires propedy protected (Y/N) Date of test"~.~M W ...~ ELL LOG Static water level ~ Well flow ~ Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform .Nitrate Date of sample: ATINSPEC~ON g.p.m. .Public sewer manhole/clea~oun ! Other bacteda"~ Petroleum tank Collected by: B. SEPTIC/NOLDING TANK DATA Datelnstalled 7/~1 (' '7 ~ Tanksize I000 ,~,=f Compartments Cleanouts (Y/N) ~' Foundation cleanout (Y/N) "/' Depression (Y/N) tV High water alarm (Y/N) · N,'Ai ~ Alarm tested (Y/N) /V. Date of pumping ' g'/"~/'~)~' Pumper ~r~c~c~oc~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N, ~, On adjacent lots ;> '~ ~¥,' Foundation tO ' To property line ~. lo' Absorptionlield ,~" Water main/service line '~ Sudace water/drainage ~, too ~ CONTINUED ON BACK PAGE C. UFT STATION /'~,/~. Date installed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical codes (Y/N) 'Pump on' level at Manufacturer Manhole/Access (Y/N) 'Pump off' Level at . .Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 7 / 7..~; Length21/i ~,'3 W'dh lb,, _~ Total absorption area 5W~' ~ ~'.7~" Cleanout present (Y/N) Date of adequacy test ? / z ~* ! 9 '/' Results (pass,'fa~) Water level in absorption field before test ~ I" '¢5" Peroxide treatment (past 12 months) (Y/N) I~1o,~, Soil rating (GPD/FF) Gravel thidmess '7 ' Y ., ~' ' Total depth ~. Depression over field (Y/N) .for ~ Bedrooms Ntertest '~ !., ~'~'~ o ( If yes, give date /~/, ~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot - N.A. On adjacent lots '.~ ':Zoo' Propertyline '~ r~, ' To building foundation ;> ~c,' To existing or abandoned system on lot /~,h A, On adjacent lots '~ ~'o' Cutbank ~.4. Water main/servloe line ~ ~o' Surface water ~ ~ oD, Driveway, parking'vehicle storage area .5-0 ' Curfain drain I~to~, ~,~ · E. ENGINEER'S CERTIFICATION I cer~'[y g~at I have checked, vedfied, or conformed to afl MOA and HAA guidelines in Signature .~7"~ ~' ~ Enginee~,s Name --r-,~ ,,, ~, r_,~o ,,-~ ~ Date ¢7~/~, ~. ,.r ~ ~., 19 e ¥ HAA Fee $ ~ ~' °*--~*~ Date Pay nt Waiver Fee $ Date of Payment Receipt Number