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Home My WebLink AboutSKY RANCH ESTATES #1 BLK 5 LT 22Sky P-anch Estates #1 Block 5 Lot 22 #015-301-16 GRF/~-~R ANCHORAGE AREA BORr'~GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~/Z'/,/ LOCATION SEPTIC TANK: DISTANCE ,¢)t) /'/'MANUFACTURER FROM WELL / MATERIAL ~/~')^/.': NUMBER OF COMPARTMENTS / INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /2-&'L) GALLONS, SEEPAGE Pit: NUMBER OF PITS / DIAMETER LINING MATER AL ~)//,/~A ~¢~2/~(~'1B SIZE: BUILDING FOUNDATION '~'~ /-/ NEAREST LOT LINE ¢2'~') /'~' TOTAL EFFECTIVE OR WIDTH LENGTH DEPTH I/ ! DIAMETER DEPTH ¢ /DISTANCE FROM= WELL ABSORPTION AREA (WALL AREA) ¢~'~1 ,SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE ~?A//} /~.J, CONSTRUCTION {/,'~ //~,/].5/A/¢? /)f~//-/-gZ~DEPTH ? DISTANCE FROM: BUILDING ~. ~,., h/ NEAREST /(2 /'/ NEAREST SEPTIC /-/- SEEPAGE FOUNDATION " LOT LINE SEWER LINE TANK /'¢-~ SYSTEM /~'~' /? CESSPOOL . , OTHER SOURCES APPROVED DISAPPROVED REMARKS <',~¢_~ /L 2 ~-k'/''ll DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4§61 PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT SOIL 'rEST RESUCTS :~//::, ~ ,~//J :~//~/~E, THIS PER~ IS ~T VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, DIAGRAM OF SYSTEM FOUNDATION TO SEEPAGE PIt ~-~/ DRAIN FIELD /~'~ j DRAIN FIELD //) /~ SEEPAGE PIt f/ /jLa/ -/ ALSO CONSIDER AReA WELLS. SEEPAGE PIT DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING (;AP Of EXCAVATION S FEet INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH Al RTIGDT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION, CERTIFY THAT ] AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-6B AND THAT THE ABOVE DESCRI~3ED SYSTEM IS IN ACCORDANCE WITH SAID CODE. / d/ d~/ GREATER ANCtlORAGE AREA BORO[' l)epartment of Environmental Quo.,ty 3330 "C" Street Anchorage, Alaska 99503 SOII,S LOG PEI1OLATION TEST .f . Performed for_~__e~2__~ ~_.~.9~_~/ __..~_~~._ !)ate Performed Legal Description: ~ ~ .~/~-~- ~Z~ ~' This form reports: Soils lo9.~. ................ Percolation kes~, Depth Feet 7- 1 0 - 6'?op° 11 - 12-. 13- lq .... Was ground water encountered? If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop I~e-F~ol ation rate mi nute. I~roposed i~stalla~l~o-n-:---S'e-e~a--qe Pit Drain Field ;Jt~t~tll of Inlet ' Depth-~}/ij~'~}~)~'pit or [rench COI.II,!EIITS: o ~ j~: ~ ................................... d ~y :D~,~, .......... erforme ;_ :_ . Certlf~e . . 1';(~ 0~0 (6/7~) Performed for Legal Description: This form reports: ~TER ANCHORAGE AREA BOROUGH Department of Environmenta) Quality 3330 "C" Street Anchorage, Alaska 99503 /~ ~K-~/~~ Date performed _~_~__~/~ .-~,~/ Soils log ~ Pertolation test Depth Feet ll- 14- ( Was ground water encountered? If yes, at what depth? Reading Date Gross Time I ' Net Time I Depth to H£OI Net Drop Percolation te minute. Proposed installation: Seepage Pit Drain Field ' Depth of Inlet. , . Dept. h to bottom of pit or trench. ' , ~ ~ Performed By: ~ ~ .~ Certified By..,. ~ , at%, _~ ~/ --~_ ._ SULIJECI': LuL 22, filoCk ~. Sky Ranch Ibis offtco tills bi.~en informed bedroom, ~ie ilaw~ asked thlildin.c.i Sa'A;ty t.o ~-li~hhold final approval on the dwollin~ you con,act our office for accura:u ~lzing of '0)o seepage] p'iC. Si mJeraly, cc: [~tlildlng Safety' RECFIPT FOR CERTIFIED MAIL--30~ (plus postage) I RENT TO STREET AND NO. P.O., STATE AND ZIP CODE .... OPTIRNA/ SEltVJCES fOR ~RRITIONRL FEES RETURN ~ 1, Shows to-wh~m a~d da~6eliveted .....,.~,.. l§ With delivery to add[essee only ............ riO INSURANCE COVEfi/~$E PflOVIDEO-- (Soo riOT F63 INTERNATIONAL MAIL *oro:~o'm PS Form Apr. 1971 3800 October 30, 1974 Ken Jackson S.R.A. Bo~ 71~ Anchorage, Alaska 99~07 SUBJECT: Lot 22, Block 5, Sky Ranch Estates Dear Hr. ~ack$on: On Friday, I made another inspection of the subject lot. At that [tme the tank had no~ been changed. The excavator w~s in the process Of adding a third concmte ring. It, appeared that the pit had beer) dug only deeper in the area of the additional ring, rather than~u~"~"ormly throughout the pit. ¥o ~tn approval on this system, tho foll~ling must be done: l(emove all backfill from tl~e pit. Remove the large boulder from the pl~. Size tim pit so it is 2.5' x 25' or the equivalent. Provide backfill material which will be approved hy this [)epa~t~nt prior to placing It In the pit. Exchange the llO0 gallon tank for a 1260 gallon tank. Since the ground is quickly freezing, the ~o~-k should be do))e as soon (ts possible. Sincerely, Susan ~. Dlckerson, Sanitarian cc;: Building Certified No. 740399 SENDER: B'e'~ute fo follow ' ~'- 5 NOV ,-: ' ,nsfrucf,o.s on offle.~e~Tq 77,~ PLEASE FURNISH s]~RVICE(S) INDICATED BY CHECKED BLOCK(S) ] Showtowhom,'dateandeddress Deliver ONLY to addressee Sk~{~ Ranch Est, ~ckson/D1 ckersol INSURED NIO. · 10/30/74' '"': 'i; RECEIPT '--I RECEIPT FOR CERTIFIED IViAIL--30~~ (plus postage) SENT TO POSTMARK OR DATE STREET AND NO. P,Oi, STATE ANO ZIP CODE With d01iYery to addressee only ............ 65¢ PS Form IlO IIISURANCE COVERAGE PROVIDEO-- (Seo ofhor side) Apr. 1971 3G00 NOT FOr INTERHATIONAL MAIL :;GR EAT~IR: AN C:H;~RAG~; AIR EA ~B O:ROLI g Pi 73330;(:: Auflusi; 20, '1974 A N Mr. Ken Jackson Free Land Builders SRA Box 71-J AnchoYage, ~',l aska 99507 SUDJIZCT: Lot 22, Block 5, Sky Ranch ~[1 Dear f',Ilr. Jackson: This office has been informed that the house on the subject lot will be finished as a 'Four I}edroom. The permit 'For a sewer system il]stal'lation · From this department was only for a three bedroom dwelling. The first inspection of your system showed absorption adequate only 'For a two bedroom. We have asked Building Sa'fety to witlWiold 'Final apl)roval on the dwelling until sucl~ time as 'the sewer systen~ meets our requirements. I sugges~ you contact our office 'For accurate sizing of ~he seepage pit. SED/lw cc: Building Safety q~J~.l, iFicstions Robert C. Kr.i. cl<son E ducat ion Associ¢~te Degree, Bss:Lness l~la,ior¢ University o¢ Alasl<ao 8schelo~'s Degl:e,e¢ Business ~lmnagernent Najor¢ University of Alaska. ~aster's Degree~ Publlc Administration, University o¢ Alaska, Completed ~q~ c~nducted by the Ame~':Lcan lostitute 0¢ Rea1 Estate Appraisers in San Fransisco, Cali¢ornia, 1969. Completed Course VIII, conducted by the American Institute of Real Est. ate Appraisers at Alaska ~el;hodJsb UniversJ. ty in Ahchorage~ Alaska~ 1970. Cor,~p].ebed Namratlve ,~g.~ S.em~n~, conducted by the Society el* flaB1 Estate Appraisers in Anchorage~ Al~sl<a~ 1971~ Courses in Real Estabe~ AppraJ. slng~ Pr.(lnoJ_ples o¢ Real Estate, Real Estate [.am~ eto.~ while in college. Employed as appraiser with Halberg-Paci¢ic Appraisers, Ualnut Creek~ Calif*sL'nia. Appraiser and Consultant with Simmons and Lgmkeland ia Aochorage~ Alaska. One year as S~aff Tax Appraiser~ 6reater Anehnrage Area 8orough¢ Anchorage, Alaska. Employed one year as Staff Appraiser, Department of Heusing and U~ban Development~ BUD-FI-IA~ Anchorage~ Alaska~ Appraiser and Consultant in Resl Estate mith Alaska Appraisal and Research Corporablon, P~:ssenbly sole proprietor, Erickson and Associates, Resl Estate Appraisers~ Anchorage ¢ Oohlr, u~rcJ, a].~ iilulti-f't~m:i.J.y aod reeidel,timi appraJ, sa!s For wa);:[ous clients in the San Fransisco Bsy A~ea. Appl:'aisa.1 For tax purposes of properties in the cities of Skagwmy and Petersburg~ Alasl<s. Appraisal of residentS, al., comme~,~iml and vacant properties far tax purposes in Anchor8ge A~ea Borough, Alaska. Residential and multi-family appraisal in Anchosage~ Fairbmnks~ Juneau, tienai~ Petersbo~g~ Soldotna, Kod:i. ak, Palmer, Se(uard, Homer and Sitka uChlle with HUD-F-HA. C~mmezczal appraisals off dental c].inic¢ warehouses and other commercial properties. Residential appraisal for First Federal Savings and Loan Assoc,~ National Bani< o¢ Alasl<a¢ Peoples 8aol< and 'F~'ust¢ F.i. rst; National Bani< cfi Anc.horage~ Alaska ~at;ual Savlags, f,lmtanu?t::" ' ',. Bsnt<¢ Alaska State Bank, and Spokane ~orbgego Csmpany. Resident.iai and w~cant land appraisol For E.lmendorf Air Force Bass Fece~al Credit Llnion and Aechorags Cii:y Employees Federal Credit Ilnien, Bther clients inclu~Je IB~l [' ' ' I-~omoq ity Corp,, Execu~r~n Carp.~ Bank o¢ America. t969-1970 Soco.~l'rda,s,, Asoor:J. ate rfh il !1:, A].aska Chapter 15P ,~sczety o? FIeal Estate Appra±sors. Appra~,sers. Frank M. Reade nior Vlce PrsoSdant Alaska Rank o? ~mmorce, Anchorage, Alaska,. Jam[;s B. Tw~it, .ctlog Directo~' ,HIJD-IrHA~ Anchorage~ A.l. osl<a Set~oll F. Faull<ner~ 8roi<er Jack Uhi~o Company, Reoll;y, Anchormge¢ Alaska I _/ ...... / itOT LINE ~TER ANCHORAGE AREA BOROU .Dep .... ment of Environmental Qua,..y Complaint and Action Form NOUSING PUBLIC FACILITIES ......... NOISE ¥~SEWER & COMPLAINTANT: ADDRESS: AIR POLLUTION JUNK AUTOS NUISANCE CASE # DATE INVEST NATURE OF COMPLAINT: LOCATION OF RECORD OF CONTACTS AND CORRESPONDENCE DATE TIME COMMENTS TIME & DATE COMPLAINTANT CALLED / USE REVERSE SIDE OF FORM FOR FURTHER COMMENTS: EQ-045 (9-74) Municipality of Anchorage Development Services Department / Building Safety Division On -Site Water and Wastewater Program S {.. -- 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. 0 r S - 3 Of - f 6 COSA # G! QD aL Expiration Date: 5:- ,7_Q 1. GENERAL INFORMATION Complete legal description Location (site address) 1191 D L�ti<�a rPr�re Current Property owner(s) j?oao { �'^a g u r, ^ p /u n Day phone 3 v_r'- 63S 7 Mailing address Lending agency Mailing address Real Estate Agent Day phone Kafyit/o a pony tit e, P.,"o4, htV Day phone 2 Y1f - 6939 Mailing Address 3f0/ Ct., f��o��f D 7 p. ei Ark- 99so 7 Unless otherwise requested, COSA w1l be hold by DSD for pickup. r Male 2. NUMBER OF BEDROOMS: I 3. TYPE OF WATER SUPPLY: Individual Well 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 Onsite 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 Onsite 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 aff;xed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm —F/af/y/ rc40ice,/ Svel phone 3'/S— Address 1 yS�D 6c10 �qn on R•C �}n t1 g9s-r� Engineer's Printed Name -7-A to Date7an4crs Jiy - civ, y 5. DSDSIG ATURE4•�•�•.••Y•�•�� THEODORE F. dooRe Approved for bedrooms.+; •. CE -3589 Disapproved. ..,,�fp�,�;,;�• ��,.. Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory . Other By: J Original Certificate Date: ;Z- -7 - n 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 kncA � #3/ ParcellD: Legal Description: _/ of 2 2 3 /G c k S S i n t A. WELL DATA Well type it - Dale completed —d!6/ T If If A. B, or C provide PWSID # Sanitary seal (Y/N) Y Total depth 19 Y ft. Cased to 19 y ft. FROM WELL LOG Date of test Static water level 1 69 ft. Well production 70 g P.M. WATER SAMPLE RESULTS: Coliform O colonies/100 mL Nitrate <O• f mg/L Arsenic: < ppb dale of sample: 11 /off B. SEPTICIHOLDING TANK DATA Tank Type/Material See fit / Con C" Ir - Tank size 1250 gal. Number of Compartments I_ Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) min• AT INSPECTION if / 2.$/m 15-8 ft. S.2 t g.p.m. Other bacteria 6 colonies/100 mL Collected by: F 4, He , 7`4 S'c Date installed 1 r / r1 ! '_ '/ Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N• A Date of pumping S! w / 06 Pumper NO '701 land C. ABSORPTION FIELD DATA Date installed Ir ! n f '* Y Soil rating (g.p.d./ftZ or ft2/bdrm) '22-Cai System type Cs a `P �e 5,W, Length 30 ft. Width 2 a- ft. Gravel below pipe 9 ft. Total depth 12 ft. Eff. absorption area 4f0 ftZ Monitoring tube Y Depression over field OV Date of adequacy lest I I / Z 8 /O,< Results (Pass/Fail) rlt For V bedrooms Fluid depth in absorption field before test 40S in. Water added 7W gal. New depth_7AF_-J01n. Elapsed Time: 1_Y min. Final fluid depth 71.8 in. Absorption rate >= 6! (_ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N v ^ e --! n u w^ If yes, give date N • A_ D. LIFT STATION M A. 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 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot > too ' On adjacent lots > toe,, Absorption field on lot tog Public sewer main W. A•. Sewer /septic service line > ZS' On adjacent lots. 2t t oa ' Public sewer manhole/cleanout ►-r. A. Holding tank N• A Animal containment areas _N• A., Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation I't' 1++„ c, o, Property line b'//' Absorption field 2 2 Water main N. A, Water service line 7 ro ' Surface water t bo . Wells on adjacent lots > t cep r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line -23'' f" r c.o. Building foundation 29' Water main N- A. Water Service line > to' Surface water. 7 10o, Driveway, parking/vehicle storage > s -o Curtain drain _Mons. 5 evn Wells on adjacent lots > too . F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that / 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 T/im,062 Date. Tunuary N� sov7 COSA Fee $ M 3 0 —010 - Date of Payment r A -L / 07 Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number V F. A A 14 a, •_; ' GS�sW G"1 •'n ;i .1N:doaee f. �ooae; !8 CE.3559 s�G' 4 SCS ReL# 1066754001 Client Name Flattop Technical Sry. Project Name/# Water Samples Client Sample ID L22 U5 Sky Ranch Est #1 Vatris Drinking Water Sample Remarks: pammner Metals by ICP/MS Arsenic Waters Department Nitmic-N Microbiology Laborato Total Coliform Results ND ND 0 All Dates/rimes are Alaska Standard Time Printed Date/time 11/20/2006 16:48 Collected Dat MMA! 11/09/2006 15:10 Received Date/rime 11/09!2006 17:04 Technical Director Stephen C. Ede Units Method 5.00 u8/L EP200.8 0.100 mgfL EPA 353.2 Allowable Prcp A:mlysis Container ID Limits Date Date Intl C (<10) 11/14/06 11/17/06 TK D (<10) col/100mL S%1209222D A (<I) 11/10/06 ALR 11!09/06 DPT I 0 I w U) 1 r co 0 • C> I Ole I 0 I w 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 ~¢[ [u/''' HAA# Parcel I.D. # 1. GENERAL INFORMATION Complete legal description 'Location (site address or directions) Property owner Mailing address Lending agency Mailing address. Day phone Day phone o Agent Day phone Address ~/o~l /~'c/-,'c I-J/~,cI.) ~107.] ,b-mc,~cr~J~/ .,~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-O25(Rev. 1/91) Front MOA#21 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 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. NameofFirm /=/¢x/:A,p 1-~c4,~,'c~/ _C~,o- Phone :;Address /¥~_~d ~A~ .3~,,Z_~, /~-,~C4o/'~¢,e, ,,¢-~ c)9,.¢/E' k// Engineer's signature %/,v.~¢-¢~__,~c~ ~. ~ DHHS SIGNATURE ~ Approved for ~'~U/~, Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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 ragistered 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MAY 6 1999 825 L Street, Room 502 · Anchorage, Alaska 99501 ..(907~ 343-4744 ~vlunicfpality of Anchorage Dept. Health & Human Services Health Authority Approval Checklist Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to I'¢ 'Y ' FROM WELL LOG Casing height (above ground) Wires properly protected (WN) AT INSPECTION Y Well production WATER SAMPLE RESULTS: Coliform 42¢o! Date of sample: B, SEPTIC/HOLDING TANK DATA g.p.m. 7, ~' g.p.m. Nitrate O. d'$"/ ,~/¢,/.-L¢ Other bacteria Collected by: /:'(~/'/~,.~ Date installed II / '7¢ Tanksize IZ.5'T_~,.~l Number of Oompartments / Foundation c!,eanogt (WN) Date of Pumpi~3g ~//¢/?~, C. ABSORPTION FIELD DATA Date installed.;, II./' '~/f Length '. -~O.r ' Width ~-~'- Effective absorption area Date of adequacy test Depression (Y/N) r,/ Pumper /Vo~" ~ /~,~ · Cleanouts (Y/N) ¥' High water alarm (Y/N) h/, ~ Soil rating (g.p.d./ft~ orft~/bdrm) '~z-~_~~/ System type £~'~?e Gravel thickness below pipe ~ ~ Total depth / Monitoring Tube present (Y/N) ~ Depression over field (Y/N) N Results (Pass/Fall) ~ ~-_r For ~/ bedrooms Fluid depth in absorption field before test (in.); /;/ Immediately after/),~"gal, water added (in.): Fluid depth 3'd" 7/~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* Absorption rate = ~ d'~C~ ,~'^oc~,,~ Ifyes, givedate /'J, ~. g.p.d. D. LIFT STATION N, ~'. Date installed Manhole/Access (Y/N) High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot IiO' ~2ro~ Absorption field on lot /~,¢' -/~ ¢,o. Public sewer main /'J, A, Size in gallons "Pump on" level at* On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station "Pump off" level at* Sewer/septic service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation /~/' :~,~ c,o, Property line ,.~'W' Absorption field Water main/service line ~ 5-0' Surface water/drainage ~ (oo' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Propertyline ~" Cm~ d',d~. Building foundation Surface water ~, Curtain drain A(on~ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature '~~- Engineer's Name '7~A¢o~ Date /'l¢, ~,/ ~'/ Wells on adjacent lots Water main/service line ~ 5--o ' Driveway, parking/vehicle storage area ~ ,5"~ ' Wells on adjacent lots ~ (oo, HAA Fee $ Date of Payment Receipt Number ~'oo - Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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. ff GENERAL INFORMATION Complete legal description Lo"r '2 2, 13Lk' S sky ~ctl ~$7. Location (site address or directions) [I ~1 lo Property owner ~£N '~ ¢.^N¢'/ KLtNSK:I Mailing address 'Ro. %o× I~ot~,% , ~N¢t-I. Lending agency tJonE Mailing address Day phone 3¢~'~ Day phone Agent ]<~RF_N L/~R6~EkJT '~ E fl/~/ Day phone Address ~'oo Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: L~ N TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 257- oI3L~ If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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. 72-025(Rev. 1/91) Front MOA #21 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 further verify that based on the information obtained from the Municipality of Anchorage files and from my inves!!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. NameofFirm Fz,fl-r¥9¢ qF_Ci-I %vcs, Phone Address Iq53~ ECHo S'~. , ~NC~IO~'~G£/ Engineer's signature ~/~ ¢ ~ Date ..... ,r. 'h '¢~-' ' ...... ' c~¢ DHHS SIGNATURE X' Approved for ~'%~) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ~ ~ Date //-~ 02 ~ 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. 72-025 {Rev. 1/91) Back MOA~f21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /,cT 22, gLK ~'/ 5K'fC:A~,\¢}I ¢~T, ¢¢( Parcel I.D. A, Well Data Well type _ ~'~ \V/~TE Log present (Y/N) ¥ Total depth I q H Sanitary seal (Y/N) If A, B, or C, attach ADEC letter, ADEC water system number Date completed ~0/~/'7 ~ Driller Fo55 Cased to __ I c~ L+ ~ Casing height Wires properly protected (Y/N) '7/ FROM WELL LOG Date of test (¢/(¢ / -/~ Static water level I(¢ c~ Well flow 2 (2 Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot lie' lo ¢,0 . Absorption field on lot I I I' 'fo C,O . Public sewer main ~> ioo Sewer service line > /oo .g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank b~b~q E WATER SAMPLE RESULTS: Coliform ~ col / (o0 r~4~ Date of sample: lo]IS]c/% Nitrate <52. ,'? ,-~,.~ /~__ Other bacteria d2 Collected by: FL~ T'7oP T,5.( H, 5~/~'$ , B, SEPTIC/HOLDING TANK DATA Date installed III Cleanouts (Y/N) High water alarm (Y/N) N.r~. Date of pumping Tank size / 2 ~o Foundation cleanout (Y/N) Pumper ~L, Compartments I "/ Depression (Y/N) Alarm tested (Y/N) ~,,~. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot J lo To property line Surface wateddrainage C,o, On adjacent lots ~/co' Foundation Iq) '~g~a ¢,o. Absorption field 2:z' ?~ m$~, ~g Water main/service line '~ 5'o ~ f > /~0 72-026 (3/93). Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) 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 I [ I Length 2 5' Width Total absorption area Date of adequacy test I Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) . 66 GPP/F~ Gravel thickness Cleanout present (Y/N) Results (pass/fail) 52 ,t System type SE£f~,~GE PIT Total depth 12 ' Depression over field (WN) N for ~ After test ~" If yes, give date ~,A, Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ill ~'~ C.o, To building foundation 2q On adjacent lots W 5-o ' Surface water ~> leo~ Curtain drain t~oN~ On adjacent lots > ! oo' _Property line To existing or abandoned system on lot Cutbank k~,A, Water main/service line Driveway, parking/vehicle storage area 7o 25 F'Ro~ ¢,O, khA, ~7o' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on t Signature Engineer's Name Date I~' / ~-~ HAA Fee $ V~)9'~r~ Date of p ayme nt ~5-~-ff~- ~-- >~' ~O'-.~/w,- ~'_~ Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HI-ALTN & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHOR-AGF¢ 82G L Street - Anchorage, Alaska 99501 DEPr. OF I ! [;i & ENVIRONMENTAL ENGINEERING DIVISION 4-47 0 JAN 1981 PROPERTY RE~D~ - 2, BUYER . ~ W 4. REALTOR/AGENT REQUEST FOR APPROVAl.. OF INDIVIDUAL WATERAND S EV~_~!~ITI E~ DIRECTIONS: Complete all parts on pa(Jo 1. [llcolllplete requests will (lot bo processud. Please allow ten {~0} (lays for processing. ~'~WN E ~ .... ~-.7--'~ ............................. :_~7~;~ ~ PHONE LEGAL DESCRIPTION l'f'R E ET LOCATION ~'. TYPE OF RESIDENCE NUMBEH OF BEDROOMS E] One '~ Four ~ Other ~ SINGLE FAMILY L.] Two L~I Five [] MULTIPLE FAMILY [] Three ~ Six 7, WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELl.. LOG. A well Icg is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, (.live well [] PUBLIC UTI LITY depth (attach loft if avaibble.) '8. SEWAGE DISPOSAL SYSTEM *"If individual/on-site, give installation (late. ~_~_"~_~'~ "~ ]NDIVI DUAL/ON-SITE** If system is over two (2) years old an adequacy test is requh'ed [] PUBLIC UTI LITY hy this Department. -- NOTE: ~[FIE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE ]NI'rlATED. 72~910(3/78) ~ ¥'-,.~L~L-~~ NOIJ. dI~Og~C] 9 Vg~'l I ~8JV UoIIdJOSqV :OJ- ;SUOJSUaLu!p aA.§ apecuaguoq si >lU,/Jl ~-~-, :ez!S ~JUe~LSU]plOH[] Jo ~uulopdaSE] po!~.paA LIO!:g)auuo0 A.LI-] I/FI DJ-lEI FM E] B.LIS- NO/q'Vr'lC] IA [o N I [~) W3J. SAS -IVSOdSIC] 39VM3S '8 ~3H10 [~ XlS E'J LtNOJ E] OMJ. L-21 3^1::I I~ 33}J HJ.. [] 3NO [~ A-Iddfl$ bF:I.LVM '~ AqI~VS ~]'~ d I.L'I RiAl [] A 'I IIAIV _q 3qDNl$ [] s~loottaat:t Jo U38~nN 33N3alS::IJ:I 40 3dA/ 'L :SNO LLO]]EJlO 3J vcI ............... 3 J..~ ~ G3AIAO:I~J 3£VCI J SIN3~'~/.LNIOcldV NOI.LO~dSNI A-INO 3sfl qVIDI-J::IO MOS 3C11S SIHI ALASKA $~RUI£eS, IRC. eFIUIROIqmI~FITAL COFITROL ~n~tineeein~ 8 ~nui~onmenM $ludies M!JNICiPALI ~h' OF r-'NVIRO/',/. ,, , CTION RECEIV[D 1220 ~Uesl 251h ]~uenue./~ncheraq¢, Alaska 99503 · (907) 276436~ MUNICIPALITY OF ANCHORAGE DEPT, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEI~ll ~!NDNi~EN~/\L p iO'i I:CTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S~,~,~I~S DIRECTIONS= Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing, 1. PROPERTY OWNER PHONE MAI LING AD DR ESS PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE MAI LING ADDRESS 3, LENDING INSTITUTION MAILING ADDRESS Po 13 o ~ / ;L ~ ~ /P ~ ~ , /'~ , ~ 4. REALTOR/AGENT MAI LING ADDRESS 1o/ r~;, /,,vT/, PHONE 27? .-o¢~'~~ PHONE ~. ~,,,~ -/ ~-.~, / ~'. LEGAL DESCRIPTION ;TREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One j~ Four [] Other__ SINGLE FAMILY ~' [] Two [] Five [] MULTIPLE FAMILY ' [] Three [] Six 7, WATER SUPPLY J~ INDIVI DUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June lg75. For wells drilled prior to that date, give wall [] PUBLIC UTILITY dapth (attach log if available.) S, SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required [] PUBLIC UTI LITY by this Department. NOTE: THE INSPECTION FF-E MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. '~'2-010(3/78) -- ?? THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED . ~ INSPECTION APPOINTMENTS TIME TIME TIME '- DATE DATE DATE I NSP ECTOR I NSP ECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER ' 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED ' 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTAI~LED []PUBLIC UTILITY Connection Verified INSTALLER ~.~.~ (~ .. (~ ~ ' ~ ] [~]Septi,~ank or []Holding Tank Size: / ,~--~ If Tank is homemade SOILS RATING · give dimensions: TYPE OF TANK MANUFACTURER~' /\ ~/--~; ,~_~r_~ ~,_' TOTALA"SDRPTIDNAREA 4. DISTANCES Septic/Holding Tank Absorption Area ISewer Line Nearest Lot Line WELL TO: /DO Absorption Area to nearest Lot Line E. COMMENTS [~APPROV ED FOR .~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) / / LEGAL DESCRIPTION 72-010 (Rev. 3/78) Se}?temb~r 28~ 19'79 John/June. Bashaw, Jr. f:tar Route A Box 1632V Anchorage, Alaska 9950'7 .Subject: Lot 22 Block 5 Sky Ranch Estates Suh~iivision ~1 Approval for your individual se~e,r and water faoilihio, s can not be granted until the follo,~Ting items hav~ been completed: (1) The %:~ate~,~ analysis repot% b~ <leliv~r~l ~o this office i~.ron% Ch~m Lab, 5633 B Str~et~ for our review. (,3) '3?he d~pression or. pit around the well casJ. n~ n~eds to bo filled with impervious %ype~ soil so that i5 slopes away fronl tbs well casing. (3) 93]1e septic tahk pumped with a r~eoipt submitted this off ieee I'lease notif~ythis depart;sent for a re~inSl?eOtion when 'the noted descrel?anei~s have been corrected. If there are any further questions, ]~lease ~ontact this offic~ at 264,~4720. S~lcerely, Robsrh C. Pratt, Associate Rcp/ijw coz Coast ~!ortgaqe CoDtpany Posh Office Box 1200 99510 P 0 L A R R E A I.~~..,:E:~&o~ J~NVIRONMENTAL PROTECTION 101 E~. INT'L, AIRPORT ROAD ANCHORAGE, ALASKA 99502 OFFICE 272-1541 October 9, 1979 RECEIVED Robert C. Pratt Dept. of Health and Enviornmental Protection Agency 825 L. Street Anchorage, Alaska 99501 Dear Bob: Reference your letter of September 28, 1979 concerning Lot 22, Block 5, Sky Ranch Estates #1. Enclosed are copies of the water analysis and receipt for a recent pumping of the septic system. These, in addition to your reinspection and deletion of the fill requin,ent, should complete the inspection criteria. Please fom~ard your approval to : Mr. Robert Fritz Security Pacific Mortgage 1011 E. Tudor Rd. Anchorage, Alaska 99502 Thank you for your prompt attention and cooporation. JOI'~M.~iSI~W JR General Hanager cc: Fritz GREATER ANCHORAGE AREA BOROLIGH FROM: DEPARTMENT: !~...~ ~0~ ~D.Vi~G~IlT~-~'T~ QL1.a'L'~'L.~/.~j. SUBJECT: TJDt 22, Blk. 5, Sky :t~,~,..d~_ ~st INITIATED BY: St~ g!gkerson t- Sanztarian I~VL)' DATE OF MEMO: 1-16~-75 DATE ANSWER TO: DEPARTMENT: }]ta.'~ ].~g $~ G'~C¢), REQUESTED: RECEIVER: REQUESTED ACTION SCHEDULE QQ~FOR INFORMATION ONLY,~ ~Ri~P~A~ ~,cK~U~ INFORMATION FOR IMMEDIATE ACTION CALL ME BEFORE YOU ANSWER FOR YOUR CONSIDERATION ::~ NEED YOUR RECOMMENDATION OTHER ~ ~s of lice 1~ approved -~e~ se~r-- end wa-te.r facit~;~ies on ~1~ ~subj ea~ lo~,,; SIGNATURE