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Home My WebLink AboutSKYWAY PARK ESTATES #1 BLK 8 LT 8Skyway Park Estates #1 Block 8 Lot 8 #019-201-03 Alpine Drilling & Enterprises Well Log Permit Number: #SWOSP101075 Date of Issue: 6-16-10 Parcel Identification Number: 01920103000 Date Started: 6-18-10 Date Completed: 6-19-10 Is well located at approved permit location? x Yes ❑ No Legal Description: Skyway Park Estates #1 Property Owner Name & Address: Doyle C & Christy L m t 1w 1400 Shore Drive Anchorage, Alaska 99515 Borehole Data: Depth (ft) Method of Drilling x air rotary ❑ cable tool Soil Type, Thickness & Water Strata From To Casing type: steel Stick-up 0 2 Wall Thickness: .250 inches silt 2 14 cobbly silty gravel 14 42 Diameter: 6 inches Depth: 47 feet Liner Type: Diameter:. inches Depth: feet silty sandy gravel moist 42 48 Casing stickup above ground: 2 feet Static water level (from ground level): 45 feet silt 48 51 silty gravel 51 53 Pumping level: 47 feet after gravelly silt 53 36 2 hours pumping 12 gpm Recovery Rate: 12 gpm gravelly silt 56 61 Method of Testing: pump Well Intake Openfug Type: ❑ Open End ❑ Open Hole x Screened Start 45 feet Stopped 55 feet ❑ Perforations Start feet Stopped feet WATER Qt1ALlTy TESTING LOIffOIYi'i -Y12a C0V100W& NOMAes ' a-- s� ._r Mgk Arwnlc- t1 --L2— ug& Grout Type: bentonite granules Volume: l bg Depth: Start 0 feet Sto ed ? feet Pump: Intake Depth T feet Pump size hp Brand Name Well Disinfected Upon Completion? x Yes [I No COS IQ ` r 1-7,169 Method of Disinfection: chorine tablets Comments: Screen assembly is as follows: K packer and 5" casing from 42. 'to 44'6 ", .20 slot screen from 446" to 55, 5"casingfrom 55 to 61' Well Driller: Alpine Drilling & Enterprises PO Box 110496 Anchorage AK 99511 Mark Beg Mayor Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: Replacement Only: YES NO Legal Description Lot 8, Block 8, Sky Park Estates #1 Property Owner Name & Address: Doyle Miller 1400 Shore Drive Pump Installation Date: 8-10-2010 Pump Intake Depth Below Top of Well Casing: 55 feet Pump Manufacturer's Name: Grundfos Pump Model: 15SQE07-150 Pump Size .75 hp Pitless Adapter Burial Depth: 8 feet Pitless Adapter Manufacturer's Name: Camphell Pitless Adapter Installer: Aarow Pump & Well Service Well Disinfected Upon Completion?'® Yes ❑ No Method of Disinfection: Recirc Comments: Pump Installer Name: Aarow Pump & Well Service LLC PO Boz 110496,Anchorage, AK 99511 (907) 346- 9355 L__ I Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Permit Number: OSP101075 Tax Code Number: 01920103000 On -Site Water System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Work Type: Well Upgrade Permit Effective Dates: June 16, 2010 to June 16, 2011 Design Engineer: Subdivision: SKYWAY PARK ESTATES #1 Site Legal Address: SKYWAY PARK ESTATES #1 BILK 8 LT 8 G:2829 Owner/Address: MILLER DOYLE C & CHRISTY L 1400 SHORE DR ANCHORAGE AK 995153205 Site Mailing Address: 1400 SHORE DR, Anchorage This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank Lot Size in Sq Ft: 68990 Total Bedrooms: 3 N Privy Y Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: The existing well must remain in service or be permanently decommissioned. Received B� Issued By: Q2V' P"1Di o-� OL'W t il- � YV epi ll ev- t.(l�-�C l�%r� Gli Gomwt i d ce.nw�issiOn �c��jl (AVGtx �(' On -Site Water System Permit MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP101075 Tax Code Number: 01920103000 Work Type: Well Upgrade Permit Effective Dates: June 16, 2010 to June 16, 2011 Design Engineer: Subdivision: SKYWAY PARK ESTATES #1 Site Legal Address: SKYWAY PARK ESTATES #1 BLK 8 LT 8 G:2829 Owner/Address: MILLER DOYLE C & CHRISTY L 1400 SHORE DR ANCHORAGE AK 995153205 Site Mailing Address: 1400 SHORE DR, Anchorage Lot Size in Sq Ft: 68990 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank N Privy Y Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either. A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: The existing well must remain in service or be permanently decommissioned. Received Bi Issued By: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www.muni.org/onsite �� • (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Propert Mailing t oY 9;13-L 711 cet1VhyV Clio eh.bf% phone :ode /%SSS' Site address SAOV Zip Code Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Lot Size blz ? q Q U Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑� Private Well )9, Water Storage ❑ Number of Bedrooms 3 THIS APPLICATION IS AN: Initial 45 Upgrade Waiver Fees: 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 pldperty owner or authorized agent) Permit/Rush Fees: a Ot +_ ►ac) Waiver Fees: Date of Payment: 6fi% / Q Date of Payment: Receipt Number: 0(( Say C Receipt Number. (Rev. 11/05) P1 e6p Kenneth ............ •r�• V. LS-8202 +° 0�°aA nD o 40� yelsionel �a y�W.�Gk�`�T�u i �<r` 9 s 6s 3 E,o—i o'l 0 ® 69. UTfti1),\ \ F " fryT149. 99 • �O\ n \ \ LOT 8 C 41 149.99 Ems\ ELEVATIONS ARE ASSSUMED EXCLUSION NOTES: It Is the oWneri responsibility to determine owouso a+: LEGEND: SET FND 5/6•R8 W/CAPC a/B• RB 0 the existence of my easements, covenants, Or restrictions D OYLE M 1 LLER Which do not appear on the recorded subdivision plat. NOTE: 325• ALMON. OMONUMEN7 Under no cir:umstznce-. shpu!d any data hereon be used fa NVB 6 TACK p construction or for establishing property lines. FENCE- —x— x — SURVEY CERTIFICATION: LANTECH has conducted a OVERHAND- — physical tur y Of this properly 01 shOWn On this 'WOOD BECKS -MOP dra+ing and that the improvements situated there CONCRETE- E� ' on are within the properly lines and no encroach- ASPHALT- E� menta exist other than noted. DRAVEL- AS—BUILT OF: LEGAL DESPAIMMUM SCR rl(;O: SEPhCSTANOPVCs- WA ER WCL LAND k CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS WEST BENSON BLVD. N 103 LOT 8, BLOCK B-8, ANCHORAGE. ALASKA 99503 (907) 562-5291 AN SKYWAY PARK ESTATES ADD. N0.1 WORK ORDER HUMBER: OCT 1, 1993 u.EO' (fox) 561-6626 92 -L -218c D�0r.PLt[J°• Aa g\27p pg ,"57 aOR0t101 - = UBOMaION 'LOT„ MOCK .... , �, let"ON OTRs - ... SECTION TONMSNp ,... ;.; 4 :'RANGE • .. •� pp p r ON ":OE ;.. I F. of oDer�nGx tp r -.�_ ' SCREEN TYPE:, g`'"p�' -: piam�n, •� I.a S WELL DWNER.' 777 (�a l..♦ .1 • r �V f .� ` DEPTHS MEASURED FROM•OeasLq top Oprard surface : DEPTH. DATE OF COMPLETKNd b' F Depth of hole. /Aa }t dOREttoLE DATA: ? �' 4- Depth Deptil'at cashlp mit ��,,�� 1_f�'__, ,[, MaterW TYpei+M Fran:; .To. + t pEYiH TO STATIC WATER L_ENE q ft bebw I&- casing O yrouM surface METHOD OF DRILLING ,a aU rotary tlO cable tool ❑ yf �YV USE OF WELL: Y0 domestic O adon :O monitor $1 O Public supply . O other - - `- / CASINO STICK -U ftw Dn 'in to��ft Z Casing type: in to - ft + WELL MAKE OPENNG TYPE: -_O Iopen cid Q screened[ i . _ , r . • perforated ❑open hob ; • t •�', , ia+ , i yes n ' I F. of oDer�nGx tp r -.�_ ' SCREEN TYPE:, g`'"p�' -: piam�n, •� `' WtNuh SIM r.. ' �y -T" a";at,',. • ciftAtlEL PACK TYPE: � t a Vduns used: .. ' ' , , .. peps to OROUT s l _ 1 �, u' OepBe.from • •I, .r ` , .. ft�to ♦�.W [ ✓.. (.\'.a.. "� cEVELotMiENi M 167 f oo , r 0 LtVEL AND YIELCJ ' fe afLei'r d pumpjDrP Kw (MAKE DEPTH. !t' Hoisepower. WELL DMNFEI;TED UPON COMPLEiIOW .OYES tO NO COf OR INFO,R 'a REMARKS k rfi' f/. 1 • 1 s• ; .Fid � i Zli 1 ;. PLEASE MAIL WHITE C E L PY •. O 0 T DNR/OMSION OF WATER Ajjvwaea tw4preswmaveatD f - PO BO 772116 EAGLE RNERX 99577 2116 77V f i. STATE OF ALASKA DEPARTMENT OP NATURAL 1}ESPURCESI IXYW 1N OF WA r{/ WATER WELL RECORD - Ct>1tTMCTOR INPO"/ REMARKS: fi 4^.'. / • : �� * ^ ,�o 19� PLEASE MAIL WHITE COPY OF A,T0: DNRIWVIMON OF WATER s Vvo to ro $O 77211E EAGLE RtVEA $1577,1116 LOT MOCK stcnm OTMKCTIOM TONNNr ON R11NOtOE IMUDUK o$ ow LOCATIONISKETCHI WELL OWNER: MEASURED FRook-Da e6 moo «.1eoe tu.rl� _ : a►Ti d� cowteiton;. I #446104,11 DATA: Depth Depth a adnpFt 1 *ww Typo aro Cow From To DLYTH TO STATIC WATER LEM . . ,�L_n Oolow 8 m0 Of O S Glr** www WowDate: P2, r METHOD OF DRILLING: 33 er roomy O CAA mot AF i pi L5 O odw W USE OF WELLS A dowetta Q motion O aw" g O otk supply O odw v CASINO STICK R 04m bto_�h GNnO type: WELL MAKE OPENING TTP@ O open end O eeroorrE E woretod O open holo Deed+ of wir- s: •ilf_ to s-40— R TMt� RECEIVE �01an'---- JAN 2 6 199 OIUWEL PACK WK. Vatuno ua� Depth a trios Munic,pal'fy of Hi�C Human rage ervices GROW Type: Vohmk �� Health & DEVELOPMENT v, rJUMO LEVEL AND MD: fl ,t.,m ,e. TE3 FUEL► WTAKE DEPTN: h Hwupower: YEt� NO. rWELL OtSINFmmw UPON CWMLETIONI Ct>1tTMCTOR INPO"/ REMARKS: fi 4^.'. / • : �� * ^ ,�o 19� PLEASE MAIL WHITE COPY OF A,T0: DNRIWVIMON OF WATER s Vvo to ro $O 77211E EAGLE RtVEA $1577,1116 ., PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW920033 DATE ISSUED: 3/18/92 DESIGN ENGINEER:DUMMY COMPANY EXPIRATION DATE: 3/18/93 OWNER NAME:MILLER DOYLE C & OWNER ADDRESS:3601 W. FORTYSECOND AVE> ANCHORAGE, AK 99517 PARCEL ID:01906109 LEGAL DESCRIPTION: SKYWAY PARK ESTATES N1 BLK 8 LT 8 LOT SIZE: 68990 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL P RECEIVED ISSUED BY ROVISIONS BY DATE: DATE • ea e- 2 _ 90 � v Cnl 2 Parcel I.D. 019-201-03 b 8y Municipality of Anchorage e> b On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: / a o q Complete legal description Skyway Park Est. #1, Block 8, Lot 8 Location (site address) 1400 Shore Dr. Current Property owner(s) Doyle & Christy Miller Mailing address 1400 Shore Dr. Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer U WaiverNariance request Received by; Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $4qO Waiver Fee $ Date of Paymentq1(n IIs rA Date of Payment Receipt Number 05-7Ll%CA Receipt Number COSA# CF,)C 0 ILI�Pi Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE JZ System #1 Approved for _-3 bedrooms System #2 Approved for bedrooms Disapproved Date 8121/13 Conditional approval for bedrooms, with the following stipulations: t - By: '` �� Original Certificate Date: �' 3 Theunictp y orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA bale sheet f '.. c If more than 1 septic system is on the lot: COSA Checklist # i of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Skyway Park Est. #1, Block 8, Lot 8 Parcel ID:019-201-03 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 8/30/92 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 100 ft. Cased to 100 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 8/30/13 8/21/13 Static water level 39 ft. 45 ft. Well production 4 g.p.m. 4.5+ g.p.m. WATER SAMPLE RESULTS: Coliform /U_4__colonies/100 mL Nitrate 0, 15 Co mg/L Arsenic A) ID ug/L Date of sample: 9 / Z I / 13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size gal. Number of Compartments Foundation cleanout (Y/N) _ Depression over tank (Y/N) Date of pumping Pumper Collected by: PIs S Date installed Cleanouts (Y/N) High water alarm (Y/N) C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring tube _ Depression over field Date of adequacy test Results (Pass/Fail) For _ bedrooms Fluid depth in absorption Feld before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons_ "Pump on" level at in. `Pump off" level at Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Water main Water service line Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Building foundation _ Water Service line Surface water Curtain drain Wells on adjacent lots F. COMMENTS Manhole/Access (YIN) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ 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 Steven R. Pannone Date 8/21/13 COSA brown sheet 10-10-12.doc Absorption fiel Surface water Water main Driveway, parking/vehicle storage rgacosm RNISNFD Race LlEV. UrivuFD) LRN . WNG a m (ASAIYCD) '_wlNc IrsnGcr '.saFsh0RF Mrnuu wsine. "e. sa'e.p o" wlD o ffIBAOC \ M f4__c WEER BLgLpNG ffTBAOf � I 40.uE NEL. 'A:..,s` 3 I I I I t I I � NGy, lyy N9 I I UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES, THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. I'.J LOT SURVEY SURVEY TYPE SYMBOLS lJ FOUNDATION AS -BUILT msec egarG9D ❑ FINAL STRUCTURE AS -BUILT SET REBAR ♦ DRAINAGE ASPHALT ° °"- ❑ PLOT PLAN ... AS -BUILT... LOT SURVEY... TOPOGRAPHY o FOUND REBAR �g WOOD FENCE CONCRETE g ASSUMED ELEV. . f J A5-HUeLT ... NO CIXtNEAS SET M RECLwnRcnnou As-aun T un crnuFas srr � X-->f—)tMETAL FENCE ® WOOD DECK I ! PLOT PLANS & LOT SURVEYS j IT 1S THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO - CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR DN THE RECORDED SUBDIVISION PLAT. I NOTE: ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS. SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION.+++�`e��♦�tf of q� ♦♦ Prepared by Robert E. Johns, Jr. & Assoc. PLOT PLAN -�,=Mlam=t ^^-=��rw^ i;^. mt bam me c.wo.e nw.w. wm mat L �,•-�E •�P.: ♦ ♦� ••�•:, Professional Land Surveyors n.r r..me w wsml.e.e al rot w^.s •� ` 1700 Brink Drive. e.. M. me ro m. bwt .r mr 1seq me .1� m �, w.. ..eL gee * ANCHORAGE, ALASKA 99504 Nw aie cw`I % h"• . Scale: tl onr Rea. Lot S.F. Rea Plot File No. FOUNDATION AS -BUILT �•• •• •• •++• 'r•... .... = 80 i, q=!wt a. eu.•.. r., ray .wlry mm 0m afl , w mN I5t we ""Mrwe. � e. - r .•,......lJ x Date Surveyed: Drawn b Checked b�^ A" 08/30/93 ' REJ d aun^rm. me emm.um .tom Www•..: '.. ROBERT E. ■ ■ V' N °° °° � �♦ P `. Date Drown: Grid: W.O. 09/03/13 2829 13-448 RNAL STRUCTURE AS -BUILT Si.♦f ''. 4 _1 , • ^vror = Vfy eo I rmm. ♦♦ e •'• . ..,'.• 9° ter ♦♦'cop ......,,...•oma.• Legal Description: Lot 8BLOCK 8 ma �o .Laoce�.mm� wbt ♦� a feS91a n6.� �. mle =m.mw-N. ��■.■.+++• SKYWAY PARK ESTATES #1 ! MUNICIPALANCHORAGE • ; ' DEPARTMENT OF HEALTH 8 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. # nt `1- ol3f — be�L HAA # " (Zn L1 r)DL1 n 1. GENERAL INFORMATION Complete legal description GOT 8, BIDCR S SKYWAY PAK{CESATm,*j sEc.. W7<; T12tO P 4 LJ SM. Location (site address or directions) 1400 S14OPW WjVF AWJjt;Ql46E Property owner K KA I)O4Lf C, taIll.M Day phone 349-1531 Mailing address 1400 SHairz DgNE NK)6046E kk ggS1g- Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone 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 • it - Community on-site Public sewer L1,01 I NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(A".1/91) Front MOAR21 W e 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 A•W. IALPF ITr cpAipAIJq Phone 34S-2-73 7 Address Engineer's 6. DHHS SIGNATURE .."SOF 11.'�C P� Alt.nW.M fin No. 4977•E AW 411,q'��w4e�o X Approved for - bedrooms. Disapproved. Conditional approval for Additional Comments i Date of IZ6f gtk bedrooms, with the following stipulations: Date 2 " 7- 94 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72.0251n•v.1,911 RKk MOA 171 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LA, 9195-"QAq�TESParcel I.D. AUXI"i Ssc. ZdAwc T17JJ 124W S A. WELL DATA nl. Well type UMV IDt1At— If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed 8130.92 Driller AL4010f: I U% Total depth 10 Casedto ( DO Fl- Casing height Sanitary seal (Y/N) �� eS Wires properly protected (Y/N) Vex FROM WELL LOG (060) AT INSPECTIONp z Date of test 1 17 C_ D g Static water level 3 1�C1'r7 N41r i C Well flow 4• g.p.m. g•Pg o m Pump level IonFf- K=;A C SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ;On adjacent lots L9 Ip+Yf✓ 6u10pyrA Absorption field on lot On adjacent lots�� Public sewer main 141) r 4..• Public sewer manhole/cleanout Sewer service line 7 O i^t Petroleum tank WATER SAMPLE RESULTS: Coliform '0 Nitrate 0 • Z5) MIS Other bacteria Date of sample: SAN S., /S)94 Collected by: A MAI . V ��!-r7+ � E . B. SEPTIC/HOLDING TANK DATA Qlq CrnU�iG �ZI�b Installed Cieanouts High water alarm (Y/N) Date of pumping Tank size Foundation cleanout (Y/N) Compartments Depression (Y/N tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/ L-t7rG TANK TO: \ Wells) on lot On adjacent lots Foundation To property water/drainage field - . Water main/service line 72-026 (Rev. 7/91) From CONTINUED ON BACK PAGE C. LIFT STATION NA. Size in gallons Vent(Y/N) "Pum High water alarm level Meets MOA electrical codes�(Y/N) . SEPARATION CSTAN E FROM LIFT STATION TO: e I on lot On adjacent lots D. ABSORPTION FIELD DATA AIA to installed LengthWidth Total absorption are Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSC Well on lot ' On To building foundation On adjacent lots Cut Surface wa r at Manufacturer Manhole/Access (Y/N) tested I, :I et „ Surface wat( Soil rating System type- -Gravel thickness Total depth Cleanouts present(Y/N) Date of adequacy test for i If yes, give date TO: i cent lots Pr rtyline —To existing or abandoned system on c Water main/service line Driveway, parking/vehicle storage area amain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guideline, Signature Engineer's Name ALLAV P). MuPF ITT' Date SFW 1U A gZ6.i q4 HAA Fee $ ?00 Waiver Fee: $ Date of Payment —a6 _ 9 Date of Payment Receipt Number /) Receipt Number 72-M(Rw. Ott Back MOA 21 bedrooms fteffdci'aty a date of this Inspection. OF 44 It Allan W. :.s �•' Kenneth L. Dreyer.: R O+� LS -8202 +i 5'0 ............•_A cy 0 E •e z'—I [35 SH oR 0 [99� Atf0'94p000 �eiTY w \ \ f\NfVT149 99• 70\ n \ \ ® Q7/ LOT 8 s 6g 4S 15 f /4gZ: 4-7 3 Ems\ - VA ELEVATIONS ARE ASSSUMED L.LEGEND: SET FND oeoEHEo EXCLUSION NOTES: It Is the owners' responsioility to determine a" the e.iStenCe of any easements, covenants, or restrictions 51WRO W/CAPC 5/5' RB G D O YL E M I LLE R which do not appear on the recorded subdivision plot. NOTE: 5,=5* AL.MON. 0 MONUMENT Under no circumstances Should any data hereon be used for HUB & TACK 13 It 044 00444 $4 4 it 44 444 it Wilaaa construction or for establishing property lines. FENCE- —X— X — _ SURVEY CERTIFICATION: LANTECH has conducted a OVERHANG- — Physicol survey Of this properly as shown on this WOOD DECKS - drawing and that the improvements situated there CONCRETE- E an are edhin the properly lines and no ener0och- ASPHALT- 0 ®I. Tents eAist Other than noted. CRAWL- AS—BUILT OF: LEGAL DESCRIPTION:SEPTIC STANDPIPES- (JS LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS WATER wttL ANCHORAGE,ENSON ALASKALVD9503 (907) 562-5291 LOT 8, BLOCK 13-8. WORK ORDER NVMBER;l DATE: '1 '- OCT 1, 1993 X60' (fox) 561-6626 SKYWAY PARK ESTATES ADD. N0.1 92 -L -218C g1AVM BY; CnECALD Br wa HUWf(R: BORA ACG nun E 7fi7a\777 37fi\57 _ COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES' '."Cg I" REPORT of ANALYSIS 5673 B STREET Chemlab Ref.# :94.0057-1 ANCHORAGE. AK 99518 Client Sample ID :WELL WATER, PRIVATE/OUTSIDE HOSE BIB ** TEL: (907) 562-2343 Matrix :WATER FAX. (907) 561 5301 Client Name :A.W. MURFITT CO. INC. WORK Order :74666 Ordered By :ALLAN MUREITT Report Completed :01/10/94 Project Name I Collected :01/05/94 @ 10:15 hrs. Project# Received :01/05/94 @ 11:00 hrs. PWSID :UA Technical Director:STEPHEN C. ED Released By 1 7 7/ mple Remarks: ROUTINE SAMPLE COLLECTED BY: A. MURFITT P.E. **L8, B8 SKYWAY PARK ESTATE ADDN #1. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init ------------------------------------------------------------------------------------------ Nitrate-N 0.29 mg/L EPA 353.2/300.0 10 01/07 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. IT = Less Than D = Secondary dilution. GT = Greater Than INN SGS Member of the SGS Group (Socidtd GdnBrale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA