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Home My WebLink AboutSKY RANCH ESTATES #1 BLK 4 LT 9Sky Ranch Estates Block 4 Lot 9 #015-301-03 Municipality of Anchorage On -Site Water and Wastewater Program - (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP161019 PID Number: 015-301-03 Dwelling: X Single Family (SF) FI Duplex (D) F71 Multiple (SF and/or D) Project: F71 New X Upgrade Name: KEVIN WINKLER ABSORPTION FIELD FN Deep Trench F-1 Shallow Trench F Bed [] Mound Address El Other Phone Number of Bedrooms Soil Rating Total depth from original grade 14 1.0 GPD/SFI 9.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.0 Ft. Gravel depth beneath pipe 5.0 Ft� Subdivision Block Lot SKY RANCH EST. #1, BLK 4, LOT 9 Fill added above original grade OA -0.5'+ Ft. Gravel length 60 Ft. Township Range Section Gravel width 2.0 FL Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES Tol Septic 1 Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches I Lift Station , From Tank Field I Tank Line 600 2 Ft FL Well 111001+1 1001+ 50'+ TANK 9 Septic El S.T.E.P. [I Holding 0 Other Manufacturer ANCH Capacity 1250 Gal. Surface Water 1 1001+ 1 1001+ Material Number of compartments Lot Line 10'+ 10'+ i STEEL 2 NA t Foundation 10,+ LIFT STATION Manufacturer Capacity I Curtain Drain UN UN Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPEMATERIAL Housetotank3034 Tank to drainfield 3034 MIKE N ANDERSON, P.E. Drainfield 3034 CO/MT 30�4 Inspector MIKE ANDERSON, P.E. BENCH MARK (Assumed elevation) 102.6 ft Inspection 1" 5-2016 5-2016 ocation and de cription dates: 2" 3'd - 4t" CORNER OF SIDING COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL J- 9-*% Conditional Approval: Date C-) 'A 4 9 T H �." ........... P MICHAEL N. AND; RSCNI CE - Approved c=uu Date "d I inspecdon Repori-9- i --i 2.aoc Permit No. OSp161019 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 190650 Anchorage, A|onko 99518-6650 Telephone: 343-4744 {}n—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT PID No.: 015-301-03 C06- MT 005 = col 28 8 CO2 29 10 TC01 29 12 TCO2 30 15 CO3 31 15 C04 31 15 VALVE 32 15 C05 27 29 C06- MT 005 = On -Site Wastewater Disposal 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 Permit Number: OSP161019 Tax Code Number: 01530103000 Work Type: Septic Upgrade Permit Effective Dates: February 08, 2016 to February 07, 2017 Design Engineer: ANDERSON CONSTRUCTION & Subdivision: SKY RANCH ESTATES #1 Site Legal Address: SKY RANCH ESTATES #1 BILK 4 LT 9 G:2737 Owner/Address: WINKLE RICHARD K & KATHLEEN G 5631 WHISPERING SPRUCE DR ANCHORAGE AK 0000 Site Mailing Address: 5631 WHISPERING SPRUCE DR, Anchorage Lot Size in Sq Ft: 15699 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N 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. s/z�n- car acuts oi�� n ��eja Received ?4 MUNICIPALITY OF ANCHORAGE Community Development Department 034 A6STd78,fj4 $344.00 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcell.D. CP( S-3Df —D`3 Property owner(s) kr--2v,,% W i n t Mailing address 4 to `3 ( tPau ¢ Day phone e� Site address C�- Legal description (Sub'd., Block &Lot) S�.y 126n Legal description (Township, Range & Section) Lot Size 1 S^ 4 01 q Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field CO -41 Initial ❑ Single Family (SF) ❑ Septic Tank Upgrade ®, (w/wo ADU) Holding Tank ❑ Renewal ❑ Duplex (D) ❑ Privy ❑ Multiple D s ❑ Private Well ❑ 70 Water Storage ❑ g a FEU 4 2016 n THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUES R: e ti I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized Permit(Rush Fees: Date of Payment: Receipt Number: Waiver Fees: Date of Payment: Receipt Number: Permit No. Waiver No. CYXA ye Order P566 ada( f 0JA 4 7'Ueh s Jzy�/.c Permit App_.:: 7.190 Rbcs CC) =44 l May 11, 2016 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Septic Change Order Legal: Sky Ranch Estates, Blk 4, Lot 9 To Whom it may concern: This is a request for a change order on the above referenced lot. The new 1250 gallon tank was installed but now the owner would like to replace the leach field too. A test hole revealed silty sandy gravels for the entire depth with no water observed during excavation or atter the seven day monitoring period. The perc rate was 3 minutes typical. A 1.0 gallon per day per square foot was used in the design for system longevity. The lot slopes to the northwest at about 0-1 percent. with no cut banks or open water within 100 feet of the proposed design due to the park land on the north side. None of the neighboring lots will be impacted by this change order design. Sincerely J{ Michael N. Anderson, P.E. 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 727-8864 Fax 345-1391 Feb. 4, 2016 Mmficipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Legal: Emergency Tank Replacement Sky Ranch Estates, Blk 4, Lot 9 To Whom it may concern: This is a request for an emergency tank replacement. The existing 1250 steel tank has collapsed and needs to be replaced. As can be seen from the site plan the new tank replacement will not encroach on any of the neighboring lots. The lot slopes to the north at about 1-2 percent, with no cut banks or open water within 100 feet of the proposed design due to the park land on the north side. Sincerely~,_ MichaelN. Anderson, P.E. 4661Na~ona Avenue Anchorage;Alaska 99516 Phone 72%8864 Fax 345-1391 1�C�I►%l:�ll�;� 4 BDRM X 150 = 600 GPD SOILS = 600/1.0 = 600 GPD 600 GA/10 = 60' (1) TRENCH 9.0' DEEP 2.0' EFFECTIVE 2.0' WIDE 60' LONG V A C A N T PARK LAND A-30fo EXISTING SEPTIC thl_� G MTt1f%C rI SYN 1 '-- SEPTIC--' EXISTING WELL �+ T 100' RADIUS tea% 0-1% 4 LOT 9- -LOT 8- WELL / KEVIN WINKLE SKY RANCH ESTATES, BLK 4, LOT 9 Anchorage, Alaska Michael N. Anderson, P.E. DATE: 4601 NATRONA AVE DRAWN: ANCHORAGE, ALASKA 99516 (907) 727-8864/ FAX: (907) 345-1391 SCALE: -4.0 GM/SM 1711 SEPTIC FIELD SECTION VALVE BETWEEN SYSTEMS ,/-10' UTILITY EASEMENT I�—� � NEW 1250 TANK INSTALLED UNDER NEW PERMIT. CO-* OVER ROCK -LOT 10- I -LOT 11- PROPERTY LINE NO OPEN WATER OR WELL WITHIN 100' OF THE NEW TANK OR EXISTING FIELD rte. 49TH 0 � :,MICHAEL N. AN EF 5/1/2016 0. '• No. 9 69 DJR SCALE: 1"=50' ♦f ��ta �� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.ci.anchorage ak.us (907) 343-7904 Soils Log - Percolation Test Performed For: it 'Wim tU to k `'ems Date Perf( Legal Description: G% 54 -ti- Township, Range, Section: 4—( Slope ITT1 f (JJCt . 1- 2- 1112 11 1 t>0fk' , [KKuhU1�1169 WAS GROUND WATER ENCOUNTERED? j,'( 0 Gross Time S IF YES, AT WHAT DEPTH? L Depth to Water After Monitoring? O R f W E Date: 15/11 ((p Site Plan nr, ' -.Lr_ Reading Date Gross Time Net Time Depth to Water Net Drop L `r 3' iF G 33& YERGULAHON RATE _L(minuteslinch) PERC HOLE DIAMETER TEST RUN BETWEEN(. _FT AND FT r PERFORMED BY: f�l.�.,/{� I CERTIFY THAT THIS TES WA) PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: S !/ Z11 L_ MUNICIPALITY OF ANCHOHAGE DEPARTMENT OF HEAl_TH & ENVIRONMENTAl.. PHOTECTION ENVIRONMENTAl. ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT LOCATION /' 1W I ~' - ( area ~-: ~ I Manufacturerf ~ ' ~ IL IKM, o ~ __~u~: _ Inside length iq. e,~p.~.J!t~fa,,o,s ,F HOMEMADE ~1 D,STANCETO= IWe'' Dwe,.~g ~ ~ ~ Manufacturer Q-- Wel- Foundation ~,1 ~,STANCETO~ ~ ~ ~' ~ I No. of linesz Length o,~ea~l)line Total len~'~i,~'es ~ I- Ty~f~-pe ~f cri~ Crib diameter---- Crib depth I DISTANCE TO: ~ IClass 5e p t I-'-~~ Driller ~ [ Building foundation Sewer line DISTANCE TO: NO. OF~DROOMS '----/Dwenm-q-----TPER M.L.T NO. __ //~, / ~/,¢~ ~ o ~ Materi~l-,./ ~ /W~ ~ IN°' °f~?rtments J Liquid dept~ Material No~res~ et line Trench..w~tl7' z~ ~' inches "'2 ~ inches PERMIT NO. Liquid capacity in gallons PERMIT NO. PERMIT NO. tTotal effective absorption area ~ i~ H-'ZE ~-~R M IT NO. I s~ I AbboTt,on a~ea,s, OTHER PIPE MATERIALS I NSTALLEI::~ , APPROVED '/~ DATE 72-013 (Rev. 3/78) LEGAL / ~ 'T"¢F:'E OF :BOIL F:IE::..50F.:F'T!OI'.,t :~';"r':5'T'EM I:5' 'TREI"4CH t"IIr:Ii:.::IMUH NI,JHBER EF EE'DRZ"'M'E : .... :1. 51 Z E OF T'FIE ::'7, O I L FIE:i.:.;ORF' T I EE.,I '::;'¢':::;'T'E M ]' '::'1 ' THE{ I:;.:Ei;,U Z RI~:[:, l i" , ~ .... .'-' THE LENGTH DIHE.'NSIO['4 I~; THE LENGTH ':: IN FEET.'." OF THE TRENCH OR DRI::I.I;HF.I.'EL.D. THE DEF'TH OF FI TRE:.NCH OF~: PIT ;[% THE DI:E;TRI'.,ICE BETHEEN THE :5UE'.FRC:E OF' THE EiF.:OLIt'.,I[:, FIND 'T'HE BOTTOH OF THE EXCFI",,'RTZOI",! ,:: IN F:'EET). THERE :I:L:.i NO ~;ET HII}]"H F'L')R TRENCHEE;. THE GRFIVEL. B,I:i:F'TH ].'E; THE HINIHUH DEF'TH OF GRFI',,,'EI_ DETHEEI",I THE OU]"FRLL PIF'E Fti",!D THE BOTTOM OF: T'HE EXCFI'v'FtT I EH",I ,:: I I'.,1 FEET ). T. - -t' -T T¥' ....... ' .... F'E;q'.HIT I:::IF'I:::'I....!f::FtNT ,LIF'IS THE I:E=,F .,t=,_E:ILI TO II'.,IFORH ]"HI'_:B [.EFI-F.]l'll:...lql E:,I...IRtI'-,IG 'f't..ll~;~ I N:.:J;TI:::tL. LF'I]" ): ON I t'.,I"_: F'E' ': 'T' ]' "' I'.,I'F OF' RN'¢ HELLS FI[:,JFIL"::ENT TC TH 12.'q F'ROF'ERT"r' F:II",t[) 'T'HIE I",IUMBER OF RES :r. [:,EI'.,ICE:':{.; THRT THE F!EL..I... H ILL SER',,,'E. E~FICKFZLI._II'.,IG O,c FIN'./ 2;"?'::';TEH HIT'HOUT FtI'.,IFIL ]:.i',I=,FE'" ........... .FIOI'.,I RI'.,IE:, I-IFFF.. ,""I-IL E',"r' 'T'FIIS E'F:PFII:?THE:N]" HIL. L DE :LIDJECT TO I::'F"]?,-;EE J-f'I.]q",t I'"1]:I'.,111','t1_t1',1 [:,I:STFI!'.,tCE E]EI'HEEI'.,I Iq I.,.IE:LI_. FIN[:, F:tN'?' ON-SITE E;E:I.,IFtGE DIL:';POE;FIL.. 'E;'¢STEM :['.ii; :;t.(:~E~ FEE:T F:OR FI PRIVFI'f'E HELL OR :.1.5E~ 'FO 2~DE~ FE.:ET FF:'.OM R F'UBL!C HELL [;.,EF:'EN[:,ING UPOI',I THE T"r'F'E OF F'LIBI....iC HELL. i"IINIMt..tH [:,I'..'7,]"I"-'II",tCE FROH FI F'RI'v'FITE HELL TO FI F'RI'v'I:'ITE SEHER I....II",IE tS ;~:5 FEET RNE:, 'T'O I:I COMHUI",IIT'¢ :BEHE]::;: !...INE IE; 7!:5 FEET. OT'HE]? ~;?.[ii:(~l...I i RE]'"IEN'I":~; Hl:t"/ I::IPPL'T'. E~,PI:7..C I F I CRT 101q2"; FII",ID CON'.L';TRLtC:TI ON [:, I FIGRF:IHS RRE t:::I',,,'Ft I L. FIE:LE TO I N2;URFi!: F'ROF'ER I N:5]"I::II...LFI'f' t ON. I CEI:;;:"f'.'[ F'"r' THFI'r :l..: I F:tM FFIM:'[L..ZFIR HITH THE REE~UIF:.'EMENT':5, FOR OI'.,I-:BITE :BEI-,.IERE; F:iND HELLE; FIL:'~; SET FORTH B'¢ THE MLINZCIF'RL.Z T"r' OF FII",IC::HC~RFIGI:E. 2: Z HILl._ Ii",!:STF:ILL. TFIE L:;.,'~"E;"f"EI"I ]:.1"4 F:ICCORDRNCE HITH THE COI.'.':,E:5. ]:: I UNDERSTFIN[:' THFIT ]'HE OI"4-L:.;ITE .?,EHER S"r'E;TEM I"1f:1'¢ REL.']U]:F.'.'E ENL..RF.'GEHENT' ~1:~ ]"HE RESI[:'ENCE IE; REI"IO[:'EEL. E[:' TO :[NCL. U[:'E MORE THAN 4 DEDROOHS. ",,' 4. E! MUNICIPALITY OF ANCHORAGE DEPARTMFNT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SOILS LOG PERCOLATION TEST 1 2 3 4 5 6 7 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS PERFORMED BY: ?2-008 (G/79) <.',// r../-,.) SLOPE WASGROUND WATER ENCOUNTERED? IF YES, AT WHAT DEP'rH? SITE PLAN /~ Gross Net Depth to Net Reading Date Time Time Water /?; ~,,, Drop TEST RUN BETWEEN FIF'F'L.][C::FII",IT JUDY M. LI::II"IP3 :~:'.2.~Zlt.T:l E:F-~RNE'T'T Ri]iR[:, L..O('.::F:IT :[ O~.,l P,IH I ..'E;F'E::ZF;;: I P.JG '..:.;F'F::Uf.]:E LEGt:IL L.. :ia B 4 .?,KY F.:FIf.,ICH E'..STR'f'ES S,/[:, LOT S;]:ZE E:,E:F'FIF.'.T'MEF4'T' OF:' F.IEF:IL. TH RNE:, EF,I',,,'.TF.:ONhlEF,ITFII.... 1::";]:O'FEC:T]:I.-.IN ~.~',25 '": S4;I"F.:EET., RNL-:HORRGE., f~h::. ?.:.. '.'L 2.': 6,4.-- ,4.'? ;F...': 0 ~-..9 E L. i ..... F" EE [~.". ~'"'~ ,'JE. -T" ( ',E:St. OS:EiW ::, ;::! ? 2 - ;;' 7' F5 d. · ,17EE1E ?.;LT.!IJFII;'.E FEET HIN;[I"ILII"I [::,ZSTRNE:E BE'TI,.IEEN R [4EL_L. RND FIl",l"r' OF,I--SITE SEP.IRGE DISPOS!;RL SYSTEM d. OO FLEET F'Of~: FI F'F;:]:',,,'FITE HEI_L OF..' ~L50 TO 200 FEET F'~:CII"I FI F'LIE~L .T C: HELL DEPEF,If~,.T.I"~C:i UF'ON THE TYPE OF F'LIBL~E: HELL. I"I_TI'.4ZI"IL.Ifd [.':,ZE;TFINCE FF:'.Ohl FI PP.': :[ ',,,'RTE I.,.IELL TO I:'~ PR:[VRTE ?,EP.IE'"-F;'. [..ZNE ZS 25 FEET FIND 'f'O Iq C:CIf'lfdUN:[TY SEI,.IEF.'. L.TNE .TS; W5 FEET. F.IELL. t_OGS RF..'E REC, It. IZREF.:, RN[:, I"lU?,T DE F.:ETURNEE:, 'T'O THE DEPRF.:'T[dEP4T I.,.I.TTHZN :~:O I::, R "r"..:.; OF THE I.,.IEL. L C:CIhlPL..ETIIDP.~. OTI"tER F.'.E(:.dJIF;.'.EhlENTS; MRY FIF'F'LY. SPEC:IF'ICI=IT];ONS t3NE:, CONSTF;i'.I...ICTION [.',It::IGF.'.RF'I:.:.; FIRE FI',,,'FI I L_I=IE~LE TEl I P.,ISI.,,IF.':E PF,:OF'ER I MSTRL. LFIT.T ON. I C:IEF;i:T I FY 'T'Hf:I"F :I..: I RM F:'FIf'IIL..TFIR 1.4ITI'"I THE F.:EE.!IJIP;:EI'dENTS FOF..' OP,I--'SITE 'r'F,E:I.'.IER':; RN[:' I.,IEI...L.S RS; SE'T' FOF~'.TH B"r' THE hlUN.T C Z PRL.T TY OF FINCHO[~'.RGE. 2: 1' 1.4:[LI_ :[.t",tSTRL. L. THE SYSTEh'I :IN RC:CORDRNCE P.IZTH THE CODE[~;. [::,E:F'R[;?.THEN'T' ()1::' HEFIL'f'I4 FII'.,!E:, EIq',/1[ F,:ONHEI'.4TFtL PROTEC'T' :[ ON ',~;2-::.~!![ '" i :'5 T F.'.EE T., RI'4CHO[~tFIGE., FIK. :r.") L:. "L ,:: :~:!.. El::..": 5 :L FIPF'L :[ C:FtNT I...OC:R T :[ ON LEGRL .J'IJE:"T' H. LFIHE', I.,.IH I ~PEF...' I f'.,IG E;F'[~:UC:E L. L:.'~ B 4 .E,l<:"r' RFINCH E:2OC~ BRF..'NETT RE:,. L. CI'I" :J..7OOO :E;L::!LIF:II:~:E' FEET H ZNZt"IUFI E:,I2;TFINCE E:ETI.,JEEN FI I.,.IELI_ RN[:, Rt'.,I'¢ OI'.,1-.-2;I"FE S;E[,.IFI(3E: D:[L-:;POE;FIL. ':;'T%TEH ~.00 F'EET FOR FI F'F?.I',/RTE I.,.IELL ()[~: :[.58 TO 2EuF:l FEET FF.'.OH R PUE:L. IC P.IELL E.',EF'IEIqI:::,II'.,IG UF'ON THE T'¢F'[""' Eft: F'UBI...ZC klEL.L.. HINIHLIH [:,I'E;TFINCE FF. tOH Ft PF;:IVRTE 1.4EL. L TO FI F'RI',,,'FITE SEI.,.tEF?. L. INE I75 25 FEET FIN.F..', TO Ft C:OHf,'IUI',IIT'.r' '.:~;EI.,.IE[~: L:[I'.,IE l'::.; 75 FEET. HEL. L. LOG:5 FIRE F.'.EL:.!U]:F4:EE:, FiNE:, HIJ'.'ST BE F.:ETUF..'NED TO THE DE;F'FIRTHENT I.,.IITHIN 2:':0 OF' THE I.,.IEL. I_. COHPL.ETION. OT[4EF?. REC~U:[REr. HEN'T:5 HFI? FiPF'L'.r'. [SF'ECIFICFITIONL5 RI'.,ID CONSTRUCT.T. OI'.,I [:, :[ FiGRFtFI!5 [:IRE: F:F/Fi:[ LF:I[~LE TO ]: N?T, UF;tE PF.:OPER ~. N'.ETI"RLLRT I ON. :!: CERTIF'.? THRT J.: I RH F:'RH:[LIFI[~'. I.,.I!TH THE REQUIREHENTS FOR ON-SITE SE:FIEF..':5 FIN[:, [,.IELL. E; FiS :.:;.,ET FORTH B'T' THE HUI",I I C I F'FIL. :1: 'T'¢ OF RNCI"~OF.:FIGE. 2: I I.,.IILL. INSTFIL. L THE S'T'E;TEH IN FICCOR[:,FINC:E I.,.IITH THE V4.. Location ..... Date completed ......~..::...~.'} ...... ~.~ .......................................................................... De~ o~ ~ell ......... ~.F:.fi? ......................................................................................... S~ze o~ casing .... ........................ ~ ~/.'-- . ............................................................................. Distance ~o ~a~e~ .......!~..~ .................................................................................. ~is~ce ~o of. GDO 1' n .......................... - ..................... ga ,o s per hour. Formation ~rom to /05 / £'_C Driller DELTA DRILLING COI~iPAN¥ SRA BOX 394 [] ANCHORAGE, ALASKA 9950'7 Parcel I.D. # 1. GENERAL INFoRMATIoN Complete legal description DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site SerVices Section P,O. Box 196650 Anchorage, Alaska 99519-6650 :..t3.~ ,343.4744 I~'~C/~/ · Circ.-r,'"' CERTIFICATE OF HEALTH AUTHORITY : "'~'~ . ~ APPROVALFOR A SINGLE FAMILY DWELLING ¢ p_.J4.JCH ¢-- / 'Location (site address or directions) Property owner Mailing address Day phone_ ~r~"- Lending agency /J/Pr Mailing address /'J ~- Day phone Agent __~.A-c~z_ (.~J~,-~-- .} '~or4cJA O/'~J~ Day phone Address ~01 ~'~" ~. ~ S~c~ ~O Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~¢/ RECEIVED TYPE OF WATER SUPPLY: Individual well Community well NOTE: MAY 0 5 1997 Municipality of Anchorage Dept, Health & Human Services Public water If community well system, provide written confirmation from State ;ADEC att¢S~- lng to the legality and status of system. -,-?. .,,' . .. 4. TYPE OF. WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community o~-site Public sewer 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 STATEMENT OE~?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 apglication shows that the on-site water supply and/or wastewmer disposal 'system is safe, functional and adequate for the number of ~)edrooms ,an.d type of structure indicated herein. I further verify that based on the information obtained from the Muni¢ pality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is m eom pliance with all Municipal and State codes, ordinances, and regulations in effect on the dat~ of this ins gection. Alaska Water & Name of Firm W_~,~,~,~,,.q~rvr¢.o..~,/ \ Phone_ ~'--~ Address Engineer's s,gnature ~ ~/'~--v Date. DHHS SIGNATURE --(~ Approved for j~¢(L Disapproved. Condition, al approval for bedrooms. bedrooms, with the following stipulations: Additi0nO. I Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHs) issues Health Authori~ APProval Certificates based Only upon the repreSentat OhS given in paragraph 5 above by an independent ProfessiOnal engineer registere~ inthe 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. Emp oyees of DHHS do not conduct inspections or analyze data before a certif cate is iSsUed. The MuniciPality of Anchorage is not responsible for errors or omissions in the professional engineer'S work. 72,4Y25 (Rev. 1/91) Back MOA#21 Health Authority APprOval Checklist Legal Description: A. WELL DATA ParcelI.D.: O I~' '~30 1-O.~ Well type ~X/T' / If A, B. or C, attach ADEC letter. ADEC water system number /. Log present (Y/N) X~:::~ Date completed / Total depth ~,,O/~ Cased to dl,4D ! 't" Casiag height (above ground) ,. iZtt Sanitary seal (Y/N) ~ ~ Wires properly protected (Y/N) 'h/'~~ FROM WELL LOG AT INSPECTION Date o£test ,d¢/2,"7/[~ [ ,~/fo//~ 7 I / Static water level ~ ~ ~ / ~ "7 Well production I O WATER SAMPLE RESULTS: Coliform / Date of sample: ~ [ c/..~ g.p.m. Nitrate Collected by: t~, OI g.p.m. 420 /V~(~/;' Other bacteria SEPTIC/ItOLDING TANK DATA Date installed ?/~/~/ Tank size Number of Comp~/~ents Depression (Y/N) t -,~ Sigh water alarm (Y/N) Foundation cleanout (Y/N) DateofPumping ,,~,/~'~/~'~ Pumper Co ABSORPTION FIELD DATA Date installed 7//~/(~ / Soil rating (IM~or fl2/bdrm) ~ 7"~ System type "~~ Length ~:~,~ I Width ~ # Gravel thickness below pipe Effective absorption area ] ~ J ~ Monitoring Tube present(Y~) ~ Date of adequacy test ~ / 6/~ 7 Results ~ass~ail) ~ ~ Fluid depth ilx abso~tion field before test (in.); ~ hmediately afier'~lO~l, water added (in.): /g Fluid depth 1~ (ins.) Minutes later: J ~ I ~ Absorption rate = ~ ~OO g.p.d. Peroxide treammnt (past 12 months) (Y~) ~~ If yes, give date ! "7 Total dep Depression over field (Y/N) /k}O '~ For '~ bedrooms Date installed ~~ Size in gallons Manhole/Access (Y/N) ~~'~t* High water alarm level at* _ ..~Datum ~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~:> I C~O' 5~F~"'~r'-; On adjacent lots Absorption field on lot Public sewer main Sewer/septic service line {:l~O I+ ~ i00¢ / _; On adjacent lots > I OO Public sewer tnanhole/cleanout tO/-~- Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation I ~ / Property line Q-C) /~ Absorption field Water main/service line ~' I°t Surface water/drainage .'>ItDOI Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Bnilding fonndation 52 Surface water Curtain drain ENGINEER*S CERTIFICATIi N / Water main/service line ~ lO Driveway, parking/vehicle storage area / Wells on adjacent lots > ~ l> ~ Property line i0/ ]certify that l ha~ d¢t.~nnined ~ , nela in.~..~,,..~ ........ in conlbmnan~/,,,;l~.tl/nn m, Z ,~ .. -~ ..... a. aha revtew ~ y~ "l"/tlq~a/~4~l g [aetmes in e/Feet on this &gnatnre _ Engineer'sName__~~ ~. ~~ HAA Fee $ .,=~'0. (.~ Date of Payment _~,7/,~ -~-~ Receipt Num her. _6--~ ~:,~C~/r~,~ ) Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Nmnber FEI: 18 '97 16:23 JACK HHITE REAL ESTATE 7623189 II ," 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 £o£ 9; BZoc~z 4; Skil Ranch Estates ~1 Location (site address or directions) Property owner Mailing address Lending agency Mailing address, 5631Whisp~ing Spruce D~ve A~¢ho~, AK C/0 ASSOCIATED BROKERS Day phone 563-333 36th Ave. S~ite I An~ho~ag~.~ AK 99503 Day phone H.U.D. 640 W. Agent ASS0¢IATED BgOKERS / Fran She~l Address 640 (~]~ 36~_~_ A,~, q-!re ! Anchoraqe,, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 '~ TYPE OF WATER SUPPLY: XXX ~ Individual well Community well Public water NOTE: Day phone 563-333 AK 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: XXX N If community wasteWater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Fronl MOA #21 f 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 s & s ENGINEERING Phone ~ 70~, reggie kirin' Loop Road NO, Address Ea[lle River! Al,'l~,ki~ 99577 Engineer's signature St DHHS SIGNATURE Approved for ~_,~t/~- Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Th~. 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 profes.~ional 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 responoible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91} Back MOA ~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ .~ ?/ ._~:~,// ,~,~7~//~, Parcel I.D. A. WELL DATA Well type Log present ((~N) Total depth Sanitary seal ((~N) Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. ~'~-~' Date completed L//%'~ --~( Driller ~L.-'7'~ ~0f~/ Cased to /~~ ~'~ Casing height //o //~ Wires properly protected ~/N) Y~ ADEC water system number FROM WELL LOG AT INSPECTION /0 g.p.m. F__o.~ g.p.ri~ 18, ' /8¢' rm' SEPARATION DISTANCES FROM WELL TO: Septic/~ tank on Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots /Od i0¢ ¢L /00 '-/- Public sewer manhole/cleanout Petroleum tank /~'.)O~ ~ ~----_/U0~ ~ WATER SAMPLE RESULTS: Coliform ~ " Nitrate Date of sample'. ~ (.2, I p1..¢/¢, Other bacteria Collected by: ,C'2- ~. S ~:::~P¢~rN ~E¢-//~ B. SEPTIC/HOLDING TANK DATA Date installed '~-/o-~ ( Cleanouts (~) ~$ High water alarm (Y/l~i) Tank size /~:~ (",/:t'~ -~Compartments Foundation cleanoutON) __y,.~.~ Depression (Y/d~ Alarm tested (Y/(~'~ /'~/~ Date of pumping _ SEPARATION DISTANCES FROM SEPTIC/-J~I~I~ TANK TO: Well(s) on lOt /(~ I¢_ On adjacent lots TO property line ~0 / Absorption field Surface water/drainage 10(~ Ur Foundation ~ ¢ Water main/service line r-)..~ ~- 72-026 (Rev, 7/91) Fronl CONTINUED ON BACK PAGE C.~LI~S~O N Date i n s t a I I e~---~C',-.J/A ~ Manufacturer Size in gallons. '""~ ~ Manhole/Access (Y/N) . Vent(Y/N)__ ~"P~ at ~~level at .. High water alarm level ""'"-~ ,~ycles tested _ Meets MOA electrical codes (Y/N) . ~ SEPARATION DIlATiON TO: Well on lot ~ On adjacent lots Surfa ~ acent lots .... S~ D, ABSORPTION FIELD DATA J Date installed , 'Z~__(~_~/ Soilrating ~-)'~'-~'~ '~' ' Systemtype Length ~L( "~Width '~/ eravelthickness '~' %~ Total depth // - /,~ ,~. ~//'-. ~¢ ~?. Total absorption area _/314 %F- v_,~u¢,/~ ~r~ Cleanouts present ~N) /'[47 Depression over field (Y/~¢) /~O / Date of adequacy test Results (pass/fail) P/~' ~ for Z/L- bedrooms Peroxide treatment (past 12 months)(Y/(~) /'~¢~ /~'/VO~u¢ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot.. /00 ~J/L On adjacent lots.. /0O /¢~ Property line /(~ '/ To building foundation c~d '¢ - To existing or abandoned system on lot On adjacent lots . Surface water Curtain drain Cutbank /b~/',/t Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on .tl~¢ate of this inspection 17034 Eagle River Loop Road No, 204 /:'.; -;; ,'.":~,", ~' '-E,">~'' ?i.~ Engineer's Name ~ ~_ ~. '~' .~ L :.:.;~:~.: ......... :; ..... ,;;:~ HAAFee$ /7~ ,"~-~ ate of ;¢- / 72-026 (Rev. 3t91} Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. Cf CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 015-301-03 HAACf 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) L9;B4; Skyranch Estates #1 T12N;R3W;Section 22 Location (address or directions) 5631 Whispering Spruce Dr (b) Property owner P, laino Ralog Telephone:(home). R4~-?RS!Business27!_30!5 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here [~, if hold for pick up.) List contact person and day phone number below: - Please contact E!~ine Ba!og @ 27!-3015 Or Mark PomrRnn @ 696-1700 2. TYPE OF RESIDENCE Single-Family;~: Number of bedrooms 4 3. WATER SUPPLY Individual Well ~× Commun(ty [] Public E] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site~ Public [] Community [] Holding Tank [] Nole: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, l verify that my investigation of this Health Authority Approval shows that the'on-site .water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewat'er 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 Mnunt-a~ n Rng'i n~c, ri ng Telephone 696-!700 Address 10251 Crestview East Eagle Rib_er AK 99577 [Date 8/10/89 Engineer's Seal 6, DHHS APPROVAL Approved for 'F bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional J~/~ ,"hA'il K;'J~ ' The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 DHHSdo not conduct inspections or analyze data before a certificate is issued. The MunicipalityofAnchorageis not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 ,,~,~' ,,,5~.u ~'-~% MUNICIPALITY OF ANCHORAGE (MOA) ¢,-xO7~%~ ~,~ Health Authority Approval (HAA) ~ ~O~ ~qxO ~ CHECKLIST- FEBRUARY 1984 ~ ~ ~.~ ~ ~ 343-4744 ~ ~¢~O~' %% ~ Legal Description' ~o~ ~; ~ock A. WEL~A~ Res ' Well Crassification ~de~t~a[ ' Wel~ Log Present (Y/N) _ y 4;Skyranch Date Completed 4./27./R1 If A, B, C. D.E.C. Approved (Y/N) Yield_. 6.1] cpm Total Depth_2~0d5 ' Cased to ~ ' Static Water Level 1 ~2 ' Casing Height Above Ground 20" Electrical Wiring in Conduit (Y/N) Y SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 1 ] ] ' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line N/A To Nearest Sewer Service Line on Lot Depth of Grouting _N/A Pump Set At GT 195' Sanitary Seal on Casing (Y/N) ¥ Depression Around Wellhead (Y/N) ; On Adjoining Lots GT 135 ' ; On Adjoining Lots GT To Nearest Public Sewer Cleanout/Manhole 102' 150' N./A Water Sam pie Collected by ~]]nt-ain Rnojn¢~ring Water Sample Test Results Pa.~sed (.~ afl.ached) Comments~equacy t~s'l- perfnrm,~d 8/5/89 hy Mn,]ntain Rng_Jn~erincj W~]] had max drawdown of 3' lfnder continuous 6.4 G_R~ flow ;Date~/5/89 B, SEPTIC/HOLDING TANK DATA Date Installed ~7/6/8,1 Size Standpipes (Y/N) ¥ Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) N/A Air-tight Caps (Y/N) _ Y N 1250 c, aANo. of Compartments 2 Foundation Cleanout (Y/N) Date Last Pumped 8/~0/89 N/A ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well= 111 ' To Property. Line GT 1.0' To Wate~'Maff'r/Service Line 45 ' To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation _ 13 ' To Disposal Field _ R5 ' None 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed _ Width of Field 36" 277 Square Feet of Absortion Area ] ~AR PT2 Depression over Field (Y/N) N Results of Last Adequacy Test passed - SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ! 35 ' To Building Foundation 30 ~ Lot None To Water Main/Service Line ~oD¢ To Stream, Pond, Lake, or Major Drainage Course To Driveway. Parking Area, or Vehicle Storage Area Comments Trench FT2/BR Type of System [::)esign Length of Field 94 ' Depth of Field ~'0 ' ~ ' Gravel Bed Thickness 6 ' -8 ' Statndpipes Present (Y/N) ¥ Date of Last Adequacy Test 8/5/89 4 Bedroom To Property Line GT 10 ' To Existing or Abandoned System on ; On Adjoining Lots 6T 75' To Cutback (if present) Nnnc' None GT 100' D. LIFT STATION Date Installed None Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** :(,.,.,...~ ,nCs%r;icft~nh~t i have cleckld, verified, ir conformed to ali MOA an!.:~i'il~ ;......~.~.~....~...~f~!i,:n.the date of this !i iii ~/7 ~ ?//) !!!i~!i Fiiy glneer's Seal 72-026 (Rev. 7/88) Back Page 2 of 2 MOUNTAIN ENGINEERING 10251 Crestview East · Eagle River, Alaska 99577 Anchorage 907~696-1700 Outside Anchorage 800-478-0101 SEPTIC SYSTEM ADEQUACY TEST LEGAL ADDRESS : Lot 9 ; Block 4 ; Skyranch Estates #1 : 5631 Whispering Spruce Dr OWNER : Elaine Balog TYPE : Single Family, 4 Bedroom WATER SYSTEM : Single Family Residential Well SEPTIC SYSTEM DATE OF TEST : (According to Municipal Records) Tank Size : 1,250 gallon Absorption Type : Trench Absorption Area : 1368 F~2 Soils Rating : 277 FT /Bedroom Installation Date : 7/6/81 : August 5, 1989 TESTING PROCEDURE : Due to the fact that the residence has been occupied continuously, no water was added to the system on the previous day to prepare the soils. For the test, 940 gallons were introduced at a rate of 6.4 - 7 GPM over a period of 4 hours. Water was added into the monitoring tube located at the end of the drainfield, and the fluid levels of the drainfield, and septic tank were monitored. None of the fluid levels experienced a significant increase after addition of the testing water. NOTE: The system consists of the septic tank, and a drainfield that is tiered along the contours of the lot. TEST RESULTS : THIS SYSTEM MEETS OR EXCEEDS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. This analysis was conducted to q~antitatively measure the performance of the above referenced absorption system. While the system performed more than adequately, a prediction of the overall operational life exp'e.ctancy o~ the wastewater absorption field is not herei~ sOuPce[ataisOn~l life expectancy is affected by man~.'va,~.,.~s......~..~%~%~, · omeowner maintenance, soils condi'.l/ic,~.~,..'~ fluctuation of groundwater levels. MOUNTAIN ENGINEERING 10251 Crestview East · Eagle River, Alaska 99577 Anchorage 907-696-1700 Outside Anchorage 800-478-0101 WATER WELL ADEQUACY TEST LEGAL : Lot 9 ; Block 4 ; Skyranch Estates #1 ADDRESS : 5631 Whispering Spruce Dr, Anchorage TYPE : Residential OWNER : Elaine Balog WELL YIELD: 6.4 DATE OF TEST : 8/5/89 WELL LOG AVAILABLE : y INSTALLATION REQUIREMENTS MET : Y WATER QUALITY - DATE TESTED : 8/5/89 COLIFORM : None NITRATES : ND YIELD TEST PROCEDURE: Water level depth was measured with a sonic depth meter, and flows were measured with a Rockwell 5/8" meter. The well was pumped for a period of 3 hours. Flow rates and depths to fluid levels were recorded. YIELD TEST RESULTS: The well produces a minimum of 6.4 GPM, and would likely have a higher production if a larger pump were installed. The maximum drawdown obtained was 3', and this recovered within 2 minutes from the time the pump was stopped. THIS WELL MEETS OR EXCEEDS THE REQUIREMENTS OF THE MUNICIPALITY. CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC, FEDERAL TAX ID # 92-0040440 ANALYSIS gEPOR? BY SAMPLE fo~ Work Order ~ 15646 Date Report Printed: AUG 9 89 q 16:01 Client Sample ID:L9 B4 SKY RANCH EST. PWSID :UA Collected AUG 5 89 ~ 15:00 hrs, Received AUG 7 89 @ 12:00 hrs, Client Name : 140UNTAIN ENGINEERING Client Acct: MTNENGN P.O.~ NONE REC'D Req ~ Ordered By : Analysie Completed :AUG 7 89 Send Reports to: Laboratory Snper¥i%or ~HEN C. EDE 1)MOUNTAIN ENGINEERING Special Instruct: Chemlab Ref ~: 6851 Lab Smpl ID: I Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N ND(O.O1) mt/1 EFA 353.2 10 Sample ROUTINE SAMPLE. Remarks: 1 Tests Performed · ,- ...................................... ' See Special Instrnct~one Above UA=Unavailable ND= None Detected "See Sample Remarks Above NA= Not Analyzed LT=Less Than, OT=Oreater Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria PRIVATE WATER SYSTEM TO BE COMPLETED BY WATER SUPPLIER Name Phone No. Mailing Address City State ~o. Day Yom ,-? Zip Code SAMPLE TYPE: '~, Routine Check Sample (for routine sample with lab ref. no. ~ Special Purpose .) [] Treated Water ~.. Untreated Water SAMPLE ~__~.. NO. LOCATION Time Collected Collected By READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter: Direct Count ~ Verification: LTD Final Membrane Filter Results (~) Reported ~- TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ~'~atisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: Membrane Filter * No, of colonies/100 mi. Lab Ref. No. Result* Analyst 6851 ~-~ Collform/100ml Date ~>'--::~- ~ Time: /.~b & a.m. p.m. BGB TNTC = Too Numberous To Count OB = Other Bacteria BACTERIOLOGICAL WATER ANALYSIS RECORD Coll4orm'/100ml ACHEMICAL & GEOLOGICA~TORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Drinking Water Analysis Re¢ort fdr Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [] PRIVATE WATER SYSTEM' Name Mailing Address City -) State Mo. Day SAMPLE TYPE: oufine heck Sample (for routine sample with lab ref. no, [] Special Purpose Zip Code Year V~(~ _) [] _Treated Water ~/~Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 41 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TNTC OB = TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ~Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: Membrane Filter * No. of colonies/lO0 m!. Lab Ref. No. Result* 7/o FTq Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count ~ Verification: LTB _BGB Final Membrane Filter Results (~ Repoded By ~-~.D_~ Time: _ = Too Numberous To Count Collform/lOOml Collform/100ml a.m. p.m, Other Bacteria MUNICIPALITY OF ANCIIORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVgJ~ CERTIFICATE 1. General Information Application Date _~_.~o_~_.~. (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions,) (b) Applicants Name '~~~-~b Te:l~hone- liome Business Applicants Address ~ g I ~[~P~'~g~6~ ~.a~ ~A~{o~.~ (c) Applicant is (check one)Lending Institution ~ ; O~er/~d~ . _ ~ (explain); (d) Lending Institntion Telephone Address (e) Rea]. Estate Co. & Agent Address Telephone (f) Mail the !i~A to the following address: 2. _Ty. pje of Residence Single-Family ~.~N~ Number of Bedrooms 3. Water_Supply. Individual Well ~ Multi-Family Other (describe) Note: Il." community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. S_~ewa_ge Disposal Onsite.~ Public L-~- Community ~__~. Holding Tank ~t Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and statns. [Page 1 of 2J Engineering Firm Providi~j~s~ctions, Tests, File Searcl~ Data and Info~tatio~ As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the ore. 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 fucther verify that, based on the information obtain~ 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 v~th ~1 Municipal and State codes~ ordinances, and regula- tions in effect on the date of this inspection. Name of Firm _~6~~ Telephone Address ] 'L~ t~ ~ , /.z. ' . . - ~ py~/// )c~ ~:2'~-,~-;'-~.~:.>~ ~ ~ , "~- approved ~ ___ . Disapproved ~ Condition~ / Te~s of Condil;ional Approwtl CAUTION TItE 14UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMi~]N'rAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TIlE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ~U~ASKA. THE DHEP DOES %]{IS AS A COURTESY TO PURCHASERS OF IIOMES ~'~D THEIR IgNDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND S .... ~' · , IA1}), REQUIRE- MENTS F~IPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN TILE PROFESSIONAL ENGINEER'S WORK. RR4/ej/Di8 [Page 2 of 2] (DHEP SEAL) 7-1 9-84 MUNICIPALITY OF Di~CHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: ~UNIcIP^LITY OF ENVirONMENTAL SEf 4 RECEIVED Well Classification . ~7 If A, B, Well Log P~esent Q/N) ~ Date Ccmpleted~q Total Depth + ~ O 6P ~ Cased to w LC) (~ Depth of G=outing.~ A//~ Static Water Level ~ I$~ Pump Set At Casing Height Above Ground Electflzical Wiring in Conduit ~N) Separation Distances f~om Well: To Septic/Holding Tank on Lot ~ Sanitary Seal on Casing ~N)~e3 Depression Around Wellhead (Y~ cD ; On Adjoining Lots ¢.~7" I~ ' To Nearest Edge of Absorption Field on Lot~ %q, '/ To Nearest Public Se~r Line ~j ~- Cleancut/Manhole ~ ~ wate~ Sample Collected By ~- GooD~ Wate~ Sample Test Results ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewe~ Service Line on Lot ; Date / ~ ~f) $ ~[ B. .SEPTIC/HOLDING TANK DATA Date Installedt.7_ Q ~ '5 ~ Standpipes ~Y~)'N) ~ Depression over Tank (Y~/Oo Date Last Pumped --<~(~l)t-.' 'L~., ILt~'[ Pumping/Maintenance Contract on File (Y/N___~) ~4~ .; for A//~ Holding Tank High-Wate~ Alaz~n (Y/%I) ~_ Temporary Holding Tank Permit (Y/N)~ Separation Distances f~om Septic/Holding Tank: '- To Water-Supply Well To P~operty Line To wa{~r ~ain/Se~vice Line Si?~ '~', I L 5-O No. of Compartments P- ~ Air-tight Caps ~N)?e~ Foundation Cleanout _~N) ~_S [Page 1 of 2] To Building Foundation ~, 7 To Disposal Field ~f~-~'7 ! TO' Stream, Pond, Lake, or Major D~ainage 2-15-84 Ce ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ 7-(~ - ~ ( Width of Field ¢-~ ~ ~' Square Feet of Absorption A~ea Depression ove~ Field ~.Y~ ~b Results of Last Adequacy Test ~7~; [j %-/fC~Type of System Design Length of Field ~ ~1 / ~p~ of Field ~ ~-~ ~ Grail ~d ~ick~ss ~ ~ Stan~i~s ~esent ~) ~te of ~st A~a~ ~st I~ ~ Separation Distance f~om Absorption Field: To Wate=-Supply W~ll ~1 ~c~. 7' To P~operty Line ~r7 /o' To Building Foundation ~ ~ I. 7-' To Existing or Abandoned System cn Lot ~3 ~ ; On Adjoining Lots ~3-~'~o~ ! To Water Main/Service Line ~ 4~ To Cutbark(if present) To Stream/Pond/Lake/or Ma3o~ D~ainage Ccu~se To Dzriveway, Parking A~ea, or Vehicle Storage A~ea ~-~-r{o ~ ! D. LIFT STATION Date Installed ~J pc- Size in Gallons "Pump On" Level at High Water Alarm Level at Tested fo~ ~ Electrical Codes (Y/N) Dirfe ns ions ~ Manhole/Access (Y/N) -~ --~ "Pump Off" Level at ~ ~-~ Vent (Y/N) -- Pumping Cycles du~ing Adequacy Test. Meets MOA Comments ** Check Permitted Bed~com Rating Against HAA Request ** I ce=tify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on t]~ date of this/inspection. '. Con~pany [Page 2 of 2] 2~15-84 ALASKA eI/UIROF/meFITAL COFITROL S RUIC S, IFIC. ~nqin¢¢rJnq $ ~naJranmcnlal Slu¢[Jcs SEPT 24 1984 JUDY LAIvtB 56_71 WHISPERING SPRUCE ANCHORAGE AK 99516 SELLER - ,TUDY LAI~B BUYER - SUBDIVT_SION - 5KYRANCH ESTATE5 BLOCK - 4 ADE~iUACY TEST FOR SEJYER SYSTEM LOT - 9 THE TYPE OF ABSORPTZON SYSTEM Z3 A TRENCH W2[TH AN AREA OF 13~8 3~F:T. THE SYSTEM ZS CAPABLE OF ACCEPTI'NG d15 GALLONS OF WATER PER DAY, THE SURGE CAPACZTY OF THE SYSTEM T_3 62_7 GALLONS, BASED UPON THE TEST DATA THE SYSTEM Z5 ACCEPTABLE FOR 4 BEDROOM HOIVE. THE 5EPTZC TANK WAS PUIvPED ON SEPT 22 1984 FLOW TEST ON 14CLL THE WELL FLOW RATE WAS d.1 GPM FOR 4 HOURS. SEPTZC TANK ADEQUACY THE EXZST£NG 3EPTZC TANK VOLUFE OF 1250 Z5 ADE~IlJATE FOR THZS 4 BEDROOM HOUSE. 1200 LUesl 33rd J~ucnu¢. $ui1¢ [l oAnchoraq¢. Alaska 99503,,(907) 551-50Ll0 HEMICAL & GEOLOGICAL LABORATORIES OF ALASK , INC. TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL. CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: Water System Name Mailing Addres~ Phone city SAMPLE DATE: Mo. Da), SAMPLE TYPE: ,~outlne ~ ...... [] Check Sample (fc~r ~outine sample with lab reft no n Special Purpose ~,, State Zip Code [] Treated Water' .,l~.Untreated Water SAMPLE Time Collected NO, LOCATION Collected By " I 0~1220 R~v. 1983 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BE COMPLETED BY LABORATORY satlysis shows this Water SAMPLE to be: isfactory [] Onsatisfactory [] Saml~l~ too long in transit; sample should {3et be over 30 hours old at examination to Indicate reliable results. Please send new sample via special delivery mall. Time Recelv~ / Analytical MathS: [] Fermentation Tube ~_ Membrane FIItor Lab Ref. No. Result* Analyst J 1[:]3 BACTERIOLOGICAL WATER ANALYSIS RECORD ' Membrane Filter: Direct Count Colllorm/100ml , Verification: LTB .BGB Final Membrane Filter Results ~ Time: TNTC-- Too Numerous To Count Collform1100ml E. ~ECEIVED , INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE ~I'NSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEP'r. OF IJEALTH & DEPARTMENT OF HEALTH ~ ENVIRONMENTAL PROTECTION ENVIRONMENTAL PEO~EC'rlON 82~ L Street - Anchorage, Alaska ENVIRONMENTAL SANITATION DIVISION AIJ¢~ 2 ~ 1981 Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not'be processed, Please allow ten (10) days for processing. ~, PROPE~~ ~ I PHONE ~ROPERTY R~DENT (If differe~ from~ 2, BUYER ~ ~ ~ PRONE MAILING ADDR ~%% 3, LENDING INSTITUTION ~ ~ PHON[ MAILING ADDRESS ~" ~EALTOR/AGENT ~ ~ PHONE MAILING ADBRES8 ~-TREET LOCATIp~ (/ . ~--*'/ NUMBER OF BEDR~)O~.g- ~ SINGLE FAMILY I-- One [] Four [] Two [] Five [] MULTIPLE FAMILY [] Three E Six 7. WATE R%~LY ~ INDIVIDUAL* ~ ATTACH WELL LOG. A well log s required for all wells drilled [] Other [] COMMUNITY [] PUBLIC UTILITY SEWAGE. ~SAL SYSTEM ~ INDIVIDUAL/ON-SI'rE** since June 1975, For wells drilled urior to that dale, give well depth (attach log if available,) YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) II~IESSAGE REPLy SIGNED SIGNED SEND PARTS 1 AND 3 WITH CAREON INTACI' PART 3 WILL BE RETURNED WITH REPLY. WH:zc-p $25 "L" S .... · fl EEl ANCHOFIAGE, /\LASI<A 99501 (907) 264-.'11 '1 'J ',)FP/tf] TUlf:N i OF IlEAl_ IH AN[) [:t!VIRQNk'![:N'I'AI.. Pf~O]'I~CTIOf~ August 27, 198]. Judy Lamb 8200 Endicott Anchorage~ Alaska 99502 Subject: Lot 9 Block 4 Sky Ranch Estates Subdivision Approval for the individual sewer and water faci].it~es cannot be granted until the following items have been completed: (2) The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. A well log submihted to this department fou our files and review. If there are any further questions, ]please ca].], this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw E RECE VED . DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF IIFALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'rlON ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99~01 ENVIRONMENTAL SANITATION DIVISION ~, 198t Telephone 264-4720 DIR~GTIO~S: Complete aH parts on pa~e 1. In~omploto roquosts will not'b~ proe,ss~d. ~l~aso allow ten {~0} dags for processing. PHO~[ 1. PROPE~ER~~~ _. PROPERTY R~DENT (If different from above) PHONE MAILING ADDR ~~~ 5' LE GA L D ESC R I PTI 0~)~.~Z/- STREET LOCATI¢¢ (/ ~/ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDRO0~.~ [] One L~ F:our ~ Other [] TWO [] Five [] Three [] Six 7. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY ATTACH WELL LOG. A well ~og is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8, SEWAGE DISP/OSAL SYSTEM ~ INDIVIDUAL/ON-SITE [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.