HomeMy WebLinkAboutSKY RANCH ESTATES #1 BLK 5 LT 18
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~'V~('')z~'~-~(~ PIDNumber: ~)l~"~OJ ~-,~:)
N~.~: ~ ¢~O~T Wastewater System: D New ~Upgrade
Address: t~q~l ~t~P~ ~¢~U~ ~ ABSORPTION FIELD
..on.: ~-~37b IN°'°~~d'°°m~: ~eepTrench D Shallow Trench OBed OMo.nd ~Other
~ Total Depth lrom original grade:
~[~ I Range. ~ I Section:~ ~ Fill added above ori~nal grade: Gravel length: Ft.
ClassificationS.C, ~ Cased To: FL Total ab~p~rea: SQ, Ft. Pipe¢~,~material:~
Date install d;
Driller: Date Drilled: S~alicWaterLevel: Installer:
SEPARATION DISTANCES ~eptic D Holding U S.T.E.P.
TO Septic Absorp;ion Lifl Holding ~ublic/Private Manufacturer: Capacity In gallons:
FloR1 Tank Field Station Tank SewerLines ~ ; ~
Material: Number of Compartments:
Wat~ ~/A ~ LIFT STATION
C~;~:n ~1~. ~ ,~e, ] Electrical Inspections performed by:
Remarks: ~,~ FT~ pC ~2¢~W~ BENCH MARK
~ ~j~ ~ % ~ ~ Location and Descrlption:
t Assumed Elevation:
ENGINEER'8 8EAb
Inspections performed by: ~ ~S, Dates: lst~ ~"~~'~-~/~
Department of Healt~d Hu, m¢~vices approval ~XL/ ~'~ ,."~
Reviewed and approved Date: I[ ~
72-013 (Rev 9/91) MOA 25
Permit No. ~ctBo4~G Page . Z. of. '~
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4~44
On-Site Wastewater Disposal System and/or Well Inspection Report
LegalDescription: ~_crr ~ ~Y..~;~ ~ ¢.c~¢H ~1 PIDNo.:
Permit No. ~',b]°t~ 0~.2.~ Page -~ of :~'
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection RepOrt
Legal Description: ~.0'?' ~ j t~Y-, ~'~ ~V-V ~ob~ ~ I
PID No.:
o/o i
¢/o oN
or~
.t
72-013 A (1/93) *
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 WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930426
DESIGN ENGINEER:ALASKA WATER
OWNER NAME:PREVOST MICHAEL H
OWNER ADDRESS:P.O. BOX 11311
ANCHORAGE, AK
& WASTEWATER SERVICES
99511
DATE ISSUED:10/12/93
EXPIRATION DATE:10/12/94
PARCEL ID:01530120
LEGAL DESCRIPTION: SKY RANCH ESTATES #1 BLK 5 L
T 18
LOT SIZE: 17212 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS
RECEIVED BY:
ISSUED BY:
DATE:
DATE:
Tom Fink,
Mayor
Ntunic.pality et Anchorage
Department of Health and Human Services
825 "L' Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
October 12, 1993
Jeff Garness, P.E.
Alaska Water & Wastewater Services
8471 Brookridge Drive
Anchorage, Alaska 99504
Subject:
Waiver Request for Lot 18 Block 5 Sky Ranch Estates ~2
Waiver Request ~WR930064, PID It015-301-20, SW930426
Dear Mr. Garness:
Your request for waiver of the required 10
between a septic system and a lot line has
waived distance is 1 foot.
foot separation
been approved.
The
This approval applies to the existing septic
separation only. Any future upgrade to the septic
require all separations be met or another approval
department.
SinCerely, ff
On-site Services
system lot line
system will
from this
ljw$7
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR~ WR930064 PID# 015-301-20 HA#
Date Received: September 30, 1993
Legal Description: Lot 18 Block 5 Sky Ranch Estates 92
Engineer: Jeff Garness, P.E., Alaska Water & Wastewater Services
Permit
8471 Brrokridge Drive, Anchorage, Alaska 99504
Applicant: Mike Prevost
Lot line waiver of~ feet,% (?)
Waiver
Requested:
Criteria: I. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Waiver is Granted: ~ Waiver is NOT Granted:
List Conditions or Reasons for above:
Date' hz/v%
·
Rec #: 25255/0377 Amount: $115.00 Date Paid: Sept 30, 1993
Alaska Water 8c Wastewater Services
"Preserving the Last Frontier"
September 26, 1,995
MUNICIPALITY OF AN(:IIORAq~
ENVIRONMENTAL SERVICES DIVISION
SEP 3 0
Municipality of Anchorage
Department o'F Health and Human Services
Divisien of Environmental Services
C)n-Si~e Services Ssctien
P.O. Box 196650
~nchorage, ~],aska 995J9-6650
RECEIVED
Ref: Septic System Upgrade for Let 18, Block
Sky Ranch Estates ~f~. Subdivision,
'Fo whom it may ccncerr~:
~vt;tached is the application~ site plan~ and design drawings
'For- the subject septic system replacement ~ Comment,s
regarding the proposed syslsem ar() as 'follows;
1. Lot 17, Block 5, Sky Ranch Estates t~1 is Non-
Developable: Due to the location of e, xisting septic systems
(er lots 1(5, J, 8), there is no suitable location for a future
well on lot 17 (This is based upon my 'Field measursmente~
and net an act;ual survey). It may be possible by relocating
the septic systems on lot 16 as far to the north
poesib]e, and locating the septic upgrade on lot 18 as 'Far
to the south as possible, to create a suitable place rep a
Nell on lot 17. kloNeveP~ once 'the Nell on lot 17 Nas
installed (assuming it is possible) neither lot 16~ or
would have any area od Nhich go put a septic upgrade in the
future (~heir next upgrade would be to a holding tank~)~
Nas the understanding of both property oNners on lot J, 6~
1.8 that lot; J, 7 Nas previously designated on earlier plats as
non-developable. The plat map I picked Lip fr'om tho City did
not iFldicatm this~ In short~ J~ assume that the curr'snt
property o~nor of let 17 believes it is developable ~
Regardless, the propesed septic upgrade will not el'Feet the
cuprest status o'f lot 17, non-developable.
2. TRENCH DESIGN: As Cal'] be seen from revieNing the
attached pereolatien test results~ the soil "p6~rked'' at a
rate, of 9.2 minutes/inch at tho locatien pr-opesed rep bl,e
eystem~ For a treech systsm~ this cc r re3sponds to an
application rate of .8 gpO/fl;2, Since the existing home has
5 bedrooms, the tetal design -Plow is 450 gpd Baesd upon
thie, the minimum amount el: absorptien area is 562.5 ft2,
The proposed trench 6 feet deep, and 50 'Feet long. This
will provide an abserption ar~a of 600 i:b2.
Telephone - Fax 338-3246 · 8471 Brookridge Drive · Anchorage, Alaska 99504
5. Trench Perpendicular to the Slope Contours; I am
proposing to pi. ace tshe trench somewhat perpendi(sular to the
slope eentours (5~ slepe). The ground elevatien drops about
2.6 feet from ghe eas~ to the west; end o'F the trench. I
have seen numerous installatioos similar to this (trench
perpendicular to a ~radual slope) and am unaware of any
prebZems associated Nith i~.
4. Trench is Located on the Property Line: The preposed
trench runs parallel to the north property line and
"crowded" as much to the east as possible so as ~o u~ilize
the 'Flatt;esk part of the lot available. In order te
rnair~f;ain adequate separation 'from tho house fou/Tda~'.fof~, and
the trench on ~he nor-th proper~y l~ne.
I als unamare of any other (see paragraph ene) impacts that
this inst;a],],atien would impose on adja(serlt ~ge],],s, or septic
systems.. If you have any question, p)ease call me a 557-
6179.
Sincerely ~
: "-'
JAG/jag
prevost2
.1
SPRUCE
889°sg~z~"E 1319,33
, /
G'T'A L/-.G.D
= I~00
Municipality of Anchorage
DEPARTMENT OF HEALTH &HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG-- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1 --
2
3
4
5
7-
8-
9-
10-
11-
12-
13-
14
15
16
17
,18
19
20
· ~--z..v P..A~C:P,'~-c~.~ ~' Township, Range, Section:
~LOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
E
h~onllorlng? Date:
Reading Date Gross Not Dqpth to Net
, Time Time Water Drop
I 7°.
~ ?/l~ ~ ?O ~, ~r ~ V~it
:OMMENT8
ACCORDANCE WITH ALL STATE AND MUNICIPAL G~UIDELINES IN EFFECT ON T~IS DATE,
72-008 {Rev.
PERCOEATION RATE ~" Z. {minutes/inch) PERC HOLE DIAMETER
CERTIFY THAT THIS TES'T WAS PERFORMED IN '-
Tom Fink,
Mayor
nicip lity of r chora ¢
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
January 9, 1989
S. Craig Jones
621 West Dimond Boulevard
Anchorage, Alaska 99515
Subject: Lot 18 Block 5 Sky Ranch Estates Subdivision
Permit #880012, PID #015-301-20
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1988.
Permits are issued on a calendar year basis by authority
Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system
not installed by the expiration date.
of
If you have drilled the well, a well
this Department for documentation of
close the permit.
log needs to be sent to
the installation and to
If a private engineer inspected the installation of the
on-site sewer system, the original as-built inspection report
(three-part form) must be sent to this office for review and
approval, and for documentation.
When applying for a new permit, the fees are: $90.00 for
an on-site sewer permit; $50.00 for a well permit; $140.00
for a combined sewer and well permit.
If there are any further questions, please call this office
at 343-4744.
S~ere ly,
Daniel J. Roth
Acting Program Manager
On-site Services Section
DJR/ljw
enc: Copy of Permit
Anchorage
P.O. BO¢, 196650
ANCHORAGE, ALASKA 99519-6650
(907) 343-4200
rxe~g~{~(~x~5% Tom Fink,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 12, 1988
Craig Jones
621 West Dimond Boulevard
Anchorage, Alaska 99502
Subject:
Lot 18 Block 5 Sky Ranch Estates Subdivision
Permit ~870031, On-site Well Permit
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1987.
Permits are issued on a calendar year basis by authority of
Municipal Ordinance. A new permit must be obtained from this
Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this Department for documentation of the installation and to
close the permit.
If a private engineer inspected the installation of the on-site
sewer system, the original as-built inspection report (three-part
form) must be sent to this office for review and approval, and
for documentation.
Effective January 1, 1988, a new fee schedule is in effect.
When re-applying for a new permit, the new fees are; $90.00 for
an on-site sewer permit; $50.00 for a well permit; $140.00 for
a combined sewer and well permit.
If there are any further questions, please call this office at
343-4744.
Sincerely,
Program Manager
On-site Services
RWR/ljw
enc: Copy of Permit
))L,I::)CI< :', L:i
DEPARTFIIi]g'I 01::: I'II:EAI..,'IH AND ENVIRONME]~.JT(~I_ I::'ROTECTION
825 I. S]'REET, ANI::;I'~ORAGF::~ Al< 99501
I I.IdlJ. f N[)~
DATE J., .:(JFD,:
AF:'PL,. I C Ai',l"f' ~
ADDRIES,C3 ::
CONTAC'r'
c:lc:l I 17
() 5 / 12 / 8 6
MARIE WAL.I<EF(
6~.;:'. :L H D :1: MOND
ANCHORAI:~E, AK
344"-9603
9 9 ',5 ] ~:7~
I..EGAI. :f.)l., CI J.l.:
I...OT SIZE:
SUBDIVIS]:ON: ,:,I.,Y RAI IL.H ESTATES L.LII. :I,,B
c4::CT I ON:,::,,:, ...... TOWNSI I I I::': 12:'lxl RANGE ',:
172 12 (S6). FT. I]R
I cer"Lify ti'lat.:
i ,, ]: Bill { Bill i ]. :i. ar' w ;i t.l"l 'Ll'l
Fortll by Ll'lr,~ Mur~:i.c;~pality oF Anc:hcH, age (MO~) and the S't',ate oF A1Bska.
2. I ~:L].] :i.n~stBl:t the syst. e~ml :i.r'l ¢¢~C(:::C)I'dEH]C::~.}) wi't'.h all MOA cc:)de?s and r'egu:l,a'L:i, orl!~;~
R&l"l d ]J, n c c) m p ] :i. a n c e w i 'L h 'L h ecl e s :i. g n c r' i L ~(;)l' :i. a o f' t h i s p e r' m i 'L.
3,, I t4ill adl'ren¢~? t.o all MOA arid EJ'La'~..E~ o{' A].aska i'e.)qLci, r'em(:¢nt.s {'cH' the set bac:k
clistaric:c.~s fPom any ex:i. st:i. ng k~ell., ugast,~::,k*~Bt, e;:H" d:i. spC)SB] system ol" publ:i.c:
S:I: GNED
.... ............................... ........... ....
AF"PL :I:CANT':I MAF~ I E WAI.,I:3ER
PAUL S. WILCOX
Grantees' Address:
621 West Dimond Boulevard
Anchorage, Alaska 99502
EASEMENT FOR WATER WELL AND WATER LINE
The Grantors, BOYD L. WALKER and ELIZABETH M. WALKER
nee ELIZABETH MARIE OFSTHUN also know as E. MARIE OFSTHUN of
Anchorage, Alaska for and in consideration of the sum of ten
dollars ($10.00) in hand paid and other valuable consideration in
their hands paid by the Grantees, the receipt of which is hereby
acknowledged, do GRANT, BARGAIN, SELL, CONVEY and WARRANT to the
Grantees, S. CRAIG JONES and ELIZABETH M. JONES, husband and
wife, an easement to construct, maintain, operate and repair a
water well and water line on and under the following described
property!
Lot 18, Block 5, SKYRANCH ESTATES SUBDIVISION according
to the official plat thereof, filed under Plat number
71-166; recorded in the Anchorage Recording District,
Third Judicial District, State of Alaska.
Said water well and water line easement shall be within
an area ten (10) feet wide and adjacent to the utility easement
in the easterly portion of Lot 18 reflected in Plat Number
71-166, Records of the Anchorage Recording District, Third
Judicial District, State of Alaska.
Grantors covenant that they will not impair the quality
of the easement and Grantees shall have the right at reasonable
times to enter onto said property for the purpose of repairing
said well and line.
This easement is for the exclusive use of the following
described property:
Lot 17, Block 5, SKYRANCH ESTATES SUBDIVISION, ADDITION
NO. 1, according to Plat 71-166, filed in the Anchorage
Recording Dsitrict, Third Judicial District, State of
Alaska.
This easement shall run with the land.
The Grantors covenant that they are the lawful owners
of said property and that they have the legal right to encumber
same.
IN WITNESS WHEREOF, the Grantors have hereunto set
their hands and seals this day of May, ~986.
BOYD L. WALKER
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
THIS IS TO CERTIFY, that on this
before me the undersigned, notary public in
day of May, 1986,
[nd for Alaska,
persol~a±ly appeared BOYD L. WALKER, known to me and to me known
to be the individual described in and who executed the foregoing
instrument: he acknowledged to me that he signed same freely and
voluntarily for the uses and purposes therein set forth.
WITNESS my hand and notarial seal the day and year last
hereinabove written.
Notary Public in and for Alaska
My commission expires:
ELIZABETH M. WALKER
STATE OF ALASKA )
THIRD JUDICIAL DISTRICT )
THIS IS TO CERTIFY, that on this day of May, ~986,
before me the undersigned, notary public in and for Alaska,
personally appeared ELIZABETH M. WALKER, known to me and to me
known to be the individual described in and who executed the
foregoing instrument: she acknowledged to me that she signed same
freely and voluntarily for the uses and purposes therein set
forth.
WITNESS my hand and notarial seal the day and year last
hereinabove written.
Notary Public in and for Alaska
My commission expire~:
EASEMENT FOR WATER WELL & WATER LINE
Page Two of Two Pages
BO01 I 4 2 8
AI]E 0 8 8 4
Grantees' Address:
621 West Dimond Boulevard
Anchorage, Alaska 99502
EASEMENT FOR WATER WELL AND WATER LINE
'AUL S, WILCOX
The Grantors, BOYD L. WALKER and ELIZABETH M. WALKER
nee ELIZABETH MARIE OFSTHUN also know~ as E. MARIE OFSTHUN of
Anchorage, Alaska for and in consideration of the sum of ten
dollars ($10.00) in hand paid and other valuable consideration in
their hands paid by the Grantees, the receipt of which is hereby
acknowledged, do GRANT, BARGAIN, SELL, CONVEY and WARRANT to the
Grantees, S. CRAIG JONES and ELIZABETH M. JONES, husband and
wife, an easement to construct, maintain, operate and repair a
water well and water line on and under the following described
property:
Lot 18, Block 5, SKYP~ANCH ESTATES SUBDIVISION according
to the official plat thereof, filed under Plat number
71-166; recorded in the Anchorage Recording District,
Third Judicial District, State of Alaska.
Said water well and water line easement shall be within
an area ten (10) feet wide and adjacent to the utility easement
in the easterly portion of Lot 18 reflected in Plat Number
71-166, Records of the Anchorage Recording District, Third
Judicial District, State of Alaska.
Grantors covenant that they will not impair the quality
of the easement and Grantees shall have the right at reasonable
times to enter onto said property for the purpose of repairing
said well and line.
This easement is for the exclusive use of the following
described property:
Lot 17, Block 5, SKYRANCH ESTATES SUBDIVISION, ADDITION
NO. 1, according to Plat 71-166, filed in the Anchorage
Recording District, Third Judicial District, State of
Alaska.
This easement shall run with the land.
The Grantors covenant that they are the lawful owners
of said property and that they have the legal right to encumber
same.
IN WITNESS WHEREOF, ~the Grantors ~.ve hereunto set
their hands and seals this ~/day of May, 19
STATE OF ALASKA )
)
THIRD JUDICIAL DISTRICT )
ss.
/ J3OYD 'L. wALKER
THIS IS TO CERTIFY, that on this ~,,,-I day of May, 1986,
before me the undersigned, notary public in and for Alaska,
428
P^ E 0 8 8 5
personally appeared BOYD L. WALKER, known to me and to me known
to be the individual described in and who executed the foregoing
instrument: he acknowledged to me that he signed same freely and
voluntarily for the uses and purposes therein set forth.
WITNESS my hand and notarial seal the day ~ y~r. last
hereinabove written .-' .,t', '.....
'Notary Pqblic in and.£or..A~aska .'
My commission expires: q~}2.~(./~ '
"' '~ EdIZAB~'IH M. WALKER'
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
THIS IS TO CERTIFY, that on this ~z,~dday of May, 1986,
before me the undersigned, notary public in and for Alaska,
personally appeared ELIZABETH M. WALKER, known to me and to me
known to be the individual described in and who executed the
foregoing instrument: she acknowledged to me that she signed same
freely and voluntarily for the uses and purposes therein set
forth.
WITNESS my
hereinabove written.
0.3425S
(¢
,~'~ .... hl~^¢ F. REG,
hand and notarial seal the day a~8 ~ear...~t i
hotar'Y ']Public in and fo~'6~a ':i~
My commission expires l/G ~&-- [
.
EASEMENT FOR WATER WELL & WATER LINE
Page Two of Two Pages
P.t E 0 8 8 2
Grantees Address:
621 West Dimond Boulevard
Anchorage, Alaska 99502
WARRANTY DEED
The Grantors, BOYD L. WALKER and ELIZABETH M. WALKER
nee ELIZABETH MARIE OFSTHUN also know~ as E. MARIE OFSTHUN,
husband and wife, of Anchorage, Alaska for and in consideration
of the sum of ten dollars ($10.00) in hand paid and other
valuable consideration in their hands paid by the Grantees, the
receipt of which is hereby acknowledged, do GRANT, BARGAIN, SELL,
CONVEY and WARRANT to the Grantees, S. CRAIG JONES and ELIZABETH
M. JONES, husband and wife, as tenants by the entirety, the
following described real estate:
Lot Seventeen (17), Block Five (5), SKYRANCH ESTATES
SUBDIVISION, ADDITION NO. 1, according to Plat 71-166,
filed in the Anchorage Recording District, Third
Judicial District, State of Alaska.
TO HAVE AND TO HOLD said property, with the
appurtances, unto the Grantees, heirs and assigns forever.
The Grantors covenant that they are the lawful owners
of said premises and property and that they have the legal right
to sell same. The Grantors further covenant that said property
is free and clear of all liens or other encumbrances, except as
of record, and they will for themselves and their heirs, forever
warrant and defend the Grantees, their heirs and assigns, in
quiet and peaceful possession of said premises against any and
all persons whomsoever lawfully claiming or to claim any right,
title or interest in or to the same, or any part thereof.
IN WITNESS WHEREOF, the Grantors have hereunto set
their hands and seals this ~7/ day of May, 1986.
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
SS.
THIS IS TO CERTIFY, that on this ~/~lday of May, 1986,
before me the undersigned, notary public in and for Alaska,
personally appeared BOYD L. WALKER, known to me and to me known
to be the individual described in and who executed the foregoing
PAUL $. WIL6OX
800~ t 428 iP..AG£ 0883
instrument: he acknowledged to me that he signed same freely and
voluntarily for the uses and purposes therein set forth.
WITNESS my hand and notarial seal the day...~nd y.ear last
hereinabove written.
~_~---- /~'.? ..' ~.,~. ..' ,.
~ -~q"~ ( ~--: ''7,' '-'
Notary Public in and'~o~, '&taSka,
ELIZABETH M. WALKER
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
THIS IS TO CERTIFY, that on this~t%~ day of May, 1986,
before me the undersigned, notary public in and for Alaska,
personally appeared ELIZABETH M. WALKER, known to me and to me
known to be the individual described in and who executed the
foregoing instrument: she acknowledged to me that she signed same
freely and voluntarily for the uses and purposes therein set
forth.
WITNESS my hand
hereinabove written.
03425~
/,~,'.: ~iul,',/,~E fl[C,
ii H~ I'Rli} 1
and notarial s.eal the day and year last
Not~ry p,ublic in and.,'.for.-~l,'~ska
My comml~'ssion expir~'~: .'~,'?,
Z8 II AH'06
WARRANTY DEED
Page Two of Two Pages
· ' GRE 'ER ANCHORAGE AREA BOr UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~/~:/~ ~)V/~-O MAILING ADDRESS. ~/4ZO /~/~/~ C-7% PHONE
LOCATION ~//~/ O~f~ ~//~/~/ LEGAL DESCRIPTION Z ~ 7- /~ /~LO~/~.~
SEPTIC TANK:
DISTANCE ~' /~/MANUFACTURER ~,~ A-J~:'~' MATERIAL
FROM WELL
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY / /2~ ¢ GALLONS.
SEEPAGE PIT:
I
NUMBER OF PITS DIAMETER--
UN~NG MATERIAL¢~I~g~ CR~B S~E~
BUILDING FOUND/~TION ~ /¢ NEAREST LOT LINE__
1~ ~7 ~'1 I'71
OR WIDTH LENG DEPTH ~ ~
DIAMETER DEPTH DISTANCE FROM:
~ /~ TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA}
SQ. FT.
ADDITIONAL ABSORPTION
WELL: /~/~,cgo ~o~ ~r ~'z~e o~c ~o~/a
TYPE _~ ~2 l d, CONSTRUCTION
BUILDING NEAREST ~F~g~/~) NEAREST
FOUNDATION __ LOT LINE /D f SEWER LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DEPTH DISTANCE FROM:
SEPTIC ]~-~fgo SEEPAGE
TANK /~O / SYSTEM {~ /
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No. ED-031
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY PERM!T NO.
SEWAGE DISPOSAL SYSTEM- APPLICATION AND PERMIT
INSTALLATION LOCATION
LEGAL [~ESCmPT~ON
INSTALLATION OF: SEPTIC TANK
TYPe AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL Test RESULTS
COMPLETION DATE ANTICIPATED
., OTHER
NOTe= THIS PERMIT IS NOT 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.
SEPTIC TANK SIZE
~WELL TO SEPTIC TANK
DRAIN FIELD
SEEPAGE AREA SIZE
, DRAIN FIELD
147 /
., DRAIN FIELB
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK, ., SEEPAGE PIT
TO RIVER, LAKE, STREAM.
SEEPAGE PIT .
~'~// DRAIN FIELD
CAST JRON [NTO AND OUT OF SEPTIC TANK AND INTO CR[O CROSSING GAP Of
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AfRTIGHT REMOVABLE CAPS.
GRAVel BACKPILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATE~ANCHORAGE AREA BOROUGH ORDINANCE NO. 2S-SS AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE With SAID CODE.
ATE :-- ': APPL'C NT', S IQNAT.RE
GREATER ANCHORAGE AREA BOROUf'
Department of Environmental Qu~ ~ty
3330 "C" Street
Anchorage, Alaska 99503
gOll, S I,OG - IEROI,AIION [LSI
Perf.ormed fo~ .-I~L.~_~;4L'~_ __~_z'7.~:'~.'7~&~_.Y> .... Date Performed
Lega, Descrl pt on._~~L~ ( ~ ~r_~' ~'~-~ ,-
This form reports: Soils ldg~ ~ ....... Percolation tes~
Depth
Feet . ·
5--
6-
7-
12-
13-
as groun(l water encountered?
__.~J..'~ If yes, at what depth?
Reading Date Gross Time Net Time Depth to Watep Net Drop
iFe-~ola~ -o~ { -r~e ........... minute.
Proposed ins~alla'~l~5-:--SSb~le Pit ......... Drain Field
Depth to bottom of pit or ~rench
',)cpth of Inlet ............... · .......................
COI,II.!E HTS:
EQ 040 (6/74) ~(
Co.
Parcel I.D. #
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
HAA #
ICIPALITY OF ANCHO~tAGE
NMENTAL SERVICES DIVISIOn,
JUL 02. 1997
RECEIVED
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
/ ,../ /
Property owner
Mailing address
Lending agency
Day phone
Mailing address.
Agent
Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
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, 1191) 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.
Name of Firm KND Engineering Phone ~/4~
Address Eagle River, AK 99577.8736
Engineeds signature
Date ~','~ ~//,~ ?
Approved for
Disapproved.
bedrooms,
__ Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
//
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) B~ck MOA¢~I
MUNICIPALITY OF ANCHOP, AG~;
I~NVIRONMENTAL ,SERVICES DIVISION
Municipality of Anchorage JUL 0 2 1997
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division &~)~ ~3].4~V4D
825 L Street, Room 502 · Anchorage, Alaska 99501 ·
Health Authority Approval Checklist
Legal De80ription: ,=~'/'~Ycz,,~. ~'~T/ '~l~ '~' /,_~7L /o~ Parcel I.D.:
A. WELL DATA
Well type
Log present (Y/N) /t// Date completed
Total depth /k /
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Casing height (above ground)
Wires properly protected (Y/N)
Date of test
Static water level
Well production
FROM WELL LOG AT INSPECTION
/ g.p,m. ~'~,
/
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
g.p.m.
Nitrate /, I Other bacteria /
Collected by:
Date installed /D-/~ - ¢~ Tanksize /~ Number of Compartments ~-- Cleanouts (Y/N) y
Foundation cleanout (Y/N) Y Depression (Y/N) /1// High water alarm (Y/N) ///'~
Date of Pumping /~ -~O ~ ~ F Pumper .,'f,//~f'Z~//~Z-¢-~,~/'
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d,/fF or fF/bdrm)
Length ~-~ / Width ~ / Gravel thickness below pipe
Effective absorption area ~,~ ¢¢ Monitoring Tube present (Y/N)
Date of adequacy test ~¢ ~'¢ ~.~,,7 Results (Pass/Fail)
Fluid depth in absorption field before test (in.);
Fluid depth ~.~ (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
~ System type/..~'¢~
Total depth /~ ~,,~.
Depression over field (Y/N)
· For ~.~ bedrooms
~,;~'- Immediately after~'Z / gal. water added (in.): //~, ~
,~¢,~/~.r'. Absorption rate = '~/,5'-~ '/' g.p.d.
/~// If yes. give date /P//¢
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
/
"Pump on" level at*
*Datum
/
Size in gallons
/ '~'Pump off"
level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot //3
Absorption field on lot //4:¢ /
Public sewer main /g)~ '/-
Sewer/septic service line ~,~ ,A
On adjacent lots /¢¢ ¢'
On adjacent lots /~ / '-/'
Public sewer manhole/cleanout /D~ ¥-
Lift station /'V,~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation // Property line /~ 'f Absorption field / /
Water main/service line ~' /¢' Sudace water/drainage /~0 ¢~ Wells on adjacent lots
'¥
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water /~)
Curtain drain
Water main/service line
Driveway, parking/vehicle storage area ~ ' "~
Wells on adjacent lots /(--~0
F. ENGINEER'S CERTIFICATION
HAA Fee $
Date of Payment ','~,/~-~
Receipt Number ~7~r-~ ¢~'~'¢~ ~(~2~-~'~¢~ ~
I certify that I have determined thru field inspections and review of Municipal rec,~l~b,~,<~ ,,~,t~flf ti~%~ systems are
in conformance with MOA HAA guidelines in effect on this date.
.
~ , ~ Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125
8005 SCI'lOON STREET ANCHORAGE, ALASKA 99518 (907) 349-1000 · FAX 349-1016
DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA
KND Engineering
20441 Ptarmigan Boulevard
Eagle River, AK 99577
Public Water System I.D.#
Date Received:
Date Analyzed:
Date Reported:
Next Sample Due:
06/20/97 Time Received: 11:57
06/20/97 Time Analyzed: 14:30
06/2S/97 Time Reported: OD:OB
Phone No.
Purchase Order No.
Collected by: SO
Sample Type:
Routine Untreated
Method of Analysis:
Membrane Filtration
Comments:
s
U
POS
ND
TNTC
CG
HSM
SA ~
Old =
Comments: R -
NT -
Satisfactory .................
Unsatisfactory
Positive Test Result
None Detected
Too Numerous To Count (>200 Colonies)
Confluent Growth
Heavy Sediment Masking, Results May
Not Be Reliable
Sample Age >30 Hours But <48 Hours,
Results May Not Be Reliable
Sample Age >48 Hours, Too Old For
Analysis
Resample Required
No Test
* # Colonies/lO0 ml
** ~ Colonies/mi
Sample Sample Total* Fecal* Other* HPC**
Date Time Coliform Coliform Bacteria Result Lab# Location Comments
I 06/20/97 09:20 0 ND 1 NT AC4665 Sky Ranch #1, L18 65 Satisfactory
Sherri Trask
Environmental Analyst
NORTHERN TESTING LABORATORIES, INC.
333O INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907} 456-3116 ', FAX 456-3125
8005 SCHOON STREET ANCHORAGE, ALASKA 99518 (907) 349-1000 · FAX 349-1016
KND Engineering
20441 Ptarmigan Blvd.
Eagle River, AK 99577
Report Date= 06/28/9?
Date Arrived= 06/20/9?
Date Sampled: 06/~0/97
Time sampled: 0920
Collected By:
AttnT
Our Lab ~:
~os~iQn/Pr~jeet~
Sample Matrix:
Lab
Number Method
A150311
LT-18 elk 5 Sky Ranch #1
Water
** Definitions **
= Present in Blank
NA = Not Analy~ed
E - Estimated Value
= Matr.£x Intu~ferunce
D = Lest to Dilution
MDL = Method Detection Lim£t
Date Date
Parameter Units Result * MDL Prepared Analyzed
A150311 SM 4SO0~ Nitrate-N mg/L <MD~ 0.10 06/23/97
Reporte~-Bg; ~te~anie COWi~
Quality Aseurance Manager
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
~{~'-.gO[ 2_0 '.' HAA#
, Property owner '
Mailing address
Lending agency
Mailing address
Agent
1. GENERAL INFORMATION
.Comple, te legal description t_,CFC IC~j ~_
Location (site adi:tress or directions)
~t'~ ~qO~ Day phone ~ ~-~6n) ~x~ ~o
~ ~ Day phone_.¢~
Address. " ~00 ~O~0 CA ~.
3. TYPE OF WATER SUPPLY:
Individual well ~ ~
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-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) Fronl MOA#21
5. STATEM,ENT 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 wastewate( disposal system is safe, functional and adequate for the number of bedrooms
and type of strubture 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 jfM~j~t~p&the date of this inspection.
Wastewater Services
Name of Firm 84.71 Brookridge Dr.
~[]ui~., AK 9,9504
Engineer's signature. L/' ~/f~4/~
Phone '.~ ~7-~l'~q
DHHS SIGNATURE
Approved for
Disapproved.
bedrooms.
'-%---~.. Date
_ Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By: J O t:'h"~ -.~'¢, (TT+ Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in orderto 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 p~'ofessional engineer's work.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~-O'T- I '~ , 6.~ ~-,~ g~y Parcel I.D.
A. Well Data
I IVED
9 199,1.
Municipality of Anchorage
Well type ~'P-4',]~,q--¢ If A, B. or c, attach ADEC letter. ADEC water system number
Log present (Y/N) "'/~---.-,Q Date completed OcT '-/4. Driller
Total depth ~ i cf /- '7 n Cased to ¢_ ~ c/I _ -7 ¢/ Casing height
Sanitary seal (Y/N) \l F_.S Wires properly protected (Y/N) "'/~-~
FROM WELL LOG
Date of test ~ c_-r- 1~-74-
Static water level /~'
Well flow /~--
Pump level1 /c/c/ -'7 -= ZOO
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main /,,//,4
Sewer service line :> too
g.p.m.
AT INSPECTION
/
; On adjacent lots
~. iOO/
; On adjacent lots to3/ (/~oT ~
Public sewer manhole/cleanout
Petroleum tank /'//~
WATER SAMPLE RESULTS:
Coliform ~Z~ Nitrate '"' / ¢'~r..,~/~ /VI~) Other bacteria
Date of sample: I/'5 I/~ 4 Collected by:
B. SEPTIC/HOLDING TANK DATA (..?E.,,.¢~ /'7'¢~-~
Date installed ~o/I b/q .~ Tank size i OOO Compadments
Cleanouts (Y/N) ~-'~ .FOundation cleanout (Y/N) y~---~-~ Depression (Y/N)
High water alarm (Y/N) /~///'A, Alarm tested (Y/N)
Date of pumping ~J~.~? ~C~J~ ~//A Pumper N//~=
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~ i0~~ / sot ~-s-
On adjacent lots 1~15 ¢~w ¢~J~H'CFoundation II
To property line ~(D/ Absorption field ~ ~,,~ ~ Water main/service line
Sudace water/drainage iq/~
> IO oPpo£~71~
72-026 (3/93)° Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date i ~'~
Manufacturer
Size in gallons ----
Vent (Y/N) ~"P~
High water alarm level
Meets MOA electrical codes (Y/N)
S A.A ,ON
Well on~/ On adjacent lots ~ ~ ~dac~
.
Date installed Soil rating (GPD/FF) " System type
Length ~z Width ~_
Total absorption area.
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
NO
Bedrooms
Manhole/Access (Y/N)
"Pump off" Lely, el-ar
Cycle~ t~_esled~---~i
Curtain drain
E. ENGINEER'S CERTIFICATION
"7 ~ ,~ F:'T~- Cleanout present (Y/N) ¥ ~-- .~ Depression over field (Y/N)
t.j,~..t,o -~'-r ~,'-c,~/,-'/ Results (pass/fail) /V/,4 for
'~'/~ After test /"//~
i~/,/A If yes, give date ~/.A
SEPARATION//DI~TANCE~ ~_"~"~'~ '7~=,Jc'~..)FROM'ABSORPTION FIELD TO: ' /"~,o"r 13, g~ ~"~
Wellonlot II~' (oep P~',.~ On adjacent lots I0~ ~s~yCz~+~.,] Propedyline
~
To building foundation 7 · ~ ~ To existing or abandoned system on lot
On adjace~ lots ~> p6¢%1 Cutbank ~ Water mai~seMce line
¢ /~ Driv~ay, parkinCvehicle sto~age area/
Suflace water
2nformed to all MOA and HAA guidelines in~
Signature ~
Engineer's Na/~
Date
I certi~/that I have checked, verified, or
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3~93)' Back
Commercial Testing & Engineering Co.
Environmental Laboratory Services ~¢.~'~,¢7~/~/~,~'¢~:/~z~/~'c/~;~'~/~¢zT~~¢~
5633 B Street
I~ldPORT Ol: /U~tl¢,kTSi~ S Anchorage, Al( 99518-1600
: ")4 ~ 047~ I Tel: (907) 562-2343
Fax: (907) 561-5301
Name :h!( ['IATI~:R & I'll~,','l'l;;J'li'l'lq}i St,;RVICE:; WOR}( Ordm:' :'15432
O:cde~:(M gy :4fEFI? GIi:RNI~]SS P~:J.lrl::cd I)a'ixe :02/02/94
Pzo])ec'h Namc~ : Col.'l. Oc'ted Dal;e :0]./3!/94
P]7oject;~ : 14ece~.vecl Da!:e :01/31/9,1
t UA
(ih :
6T :; (,'~.'eate]:' 'l?ban
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
CO~?Ii~IERCIAL TES[ING & ENGINEERINGiCO. AK DIV
CHEMICAL & GEOLOGICAL LABORATORY
TELEPHONE (907) 562-2343
5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM I.D. # I I ' I I~'~]
PUBLIC
PRIVATE WATER SYSTEM
Apr,
SAMPLE DATE:
Mo. Day Year
SAMPLE TYPE:
~ Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
No. LOCATION
· -¢'1 I
Time Collected
Collected ~,.j By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
,~ Satisfactow
[] Unsatisfactory
El 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 ml.
Lab Ref, No. Result*
'"/2- 94.0478
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
TNTC = Too Numerous To Count
OB = Other Bacteria
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter: Direct Count
Verification: LSD BGB
Fecal Coliform Conflrmallon
Final Membrane Filter Result¢
Member O, the SG5
/~c~j
PART ONE OF TWO:
REMAINDER TO FOLLOW
Coliform/100 mi
Coliform/100 mi
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # .~'; \~ _ 'z.(~ \ .,.~ HAA#
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a)
(b)
(c)
Legal Description ( nclude,Jot, block, subdivision, section, township, range)
¢' , ~ -..'..,, '~. ·
Locat on~'address Or dlrectloos),, .*
Ma'~ie
Property e. wner ~'~a6.et~ OfsthunTelephone: (home) Business
MailingAddre. ss' PE)',Bo~;'3669, Homer. Alaska 99603
Lending Institution Telephone
Mailing Address
(d)
Real Estate Company and Agent
Address
Telephone
(e)
Mail the HAA to the following address: (or check here.l~', if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms ~
3. WATER SUPPLY
Individual Well,~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status:
4. SEWAGE DISPOSAL
On-site [~ Public [] Community [] Holding Tank []
Note: 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,
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
Iunctiona and adequate for the number of bedrooms and type of structure indicated herein, I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection·
Name of Firm ,,'~"~5' .,J~..~c-. Telephone
Address
Date
6. DHHS APP'ROVAL
Approved for ~¢' bedrooms by
Approved __ Disapproved
Conditional
Date
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
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.
All p~
being
with the fol
PARTIES CONCERNED:
les concerned are advised that the subject
Approval for Lot 18, Block 5, Sky is
~d by the Department of Health and Services
'rig stipulations:
On December 7 89
passed an adec
system is adequate
the on-site wa~ system has
test. The re; .cared that the
only a bedroom house.
2. On November 15, 1989, was treated with a Hydrogen
Peroxide chemical additi~ means of rehabilitating the
system. The fact that, _required rehabilitation,
in order to pass the~,cember 7 ade~g~acy test, may be an
indication of in,lent failure of th~em.
3. It is rec. d that a system adequacy te.~be conducted
after the has been occupied for a perioc~Qf six months.
n Smith, P.E.
Program Manager, On-site Services
Well Classification
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:/,/~ ~L:L¢
Well Log Present (Y~..)/_ Date Completed
Total Depth ¢//¢ Cased to ~ (/o' Depth of Grouting
If A, B, C, D.E.C. Approved (Y/N)
Yield ¢,~y/,,~ 57~¢¢
Pump Set At%, o¥. ~,., ,~ ,v .m
Sanitary Seal on Casing~
Depression Around Wellhead (Ye
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit(C~/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by ~/,
Water Sample Test Results ,/~,:--¢','
; On Adjoining Lots ~, -,',¢'c,
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date ./~/~¢
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed ¥;,/~'//?¢ Size
Standpipes ~/N)
Depression over Tank (Y~)
,/O¢~ _No. of Compartments /
Air-tight Caps~N) Foundation Cleanout ~N)
Date Last Pumped//.//¢~.J~¢
¢' ' '"~' dj'
Pumping/Maint~.jC¢~d;~ct~ File (Y/N) ~/¢ ;for
o ding Tan~ter A~ __ ~Z~ Temporary Holding Tank Permit (Y/N)
~ ," ~(.. ~,,, ~_~ ,
S EPARATI O~*¢STA¢~E~.~TIC/HO LDI N e TANK:
To Water-~uppJy Well ~ ~ ~ To Building Foundation
To Proper~ Limb. '~*'''~ ,,~ ¢ To Disposal Field
TO Water Malh/~m~Lie¢~.~~ ~,~," ~ ~J
To Stream, Pond; La~e or.~jp¢,¢rainage Course ~/o ~
Comments~ Ct~/~,/ C¢ F¢¢ ~,r /~/ /~ ~¢~ ¢¢~ uCd~ ~.
72-026 (Rev. 7/88) Fronl Page 1 of 2
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field /J,-~,~'
Square Feet of Absortion Area
Depression over Field (Y~)
Results of Last Adequacy Test ..¢5--¢P-
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well //~ '
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes Present ~N)
Date of Last Adequacy Test
To Property Line
To Building FoundatiOn ~ .~"e¢ ..¢e?~,. ¢,¢,~,,~¢~,¢;r To Existing or Abandoned System on
Lot ,,,0//.,~ ; On Adjoining Lots 7 ~o
To Water Main/Service Line .~e / To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course ,..~/~ O /
To Driveway, Parking Area, or Vehicle Storage Area
Comments ,~e-~ ~/-/~_~'.e.J ?r,~.~[ ~ ,~/~ ~,..~ /%..~ J~/~ ,),,,,~7~,
D. LIFT STATION ~
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N) /
"Pump On" Level at __ "Pu~__
High Water Alarm Level at /,~ / Vent (Y/N)
Tested for /.~--"-~ Pumping Cycles during Adequacy Test,
cM;emtSmeMnOtsA Electric.al Co~~'"'-
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA
inspection.
Signed
Company ~ ~~ '
Date
MOA No. #~- ~..~¢ ,~
72-026 (Rev 7/88) Back
the date of this
Seal
Receipt No
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
/ ~" ~ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907 552.2343
,~,"~ao~,~.,~ FEDERAL TAX D # 92'0040440
ANALYSIS REPORT BY SAMPLE £o[ Work Older # 18619
Dote P, epo[t P[lnted: RRC? 89 @ 17:56
Client Sample ID:LIS B5 SKTRANCN
PWSID :UA
Collected DEC S 89 @ 14:15
Received DEC 5 89 8 16:00 hrs.
Preserved with :AS REQUIRED
Client Name : A E C S
Client A¢ot: ANECSRP
P.O.# NONE RECEIVED
Req ~
Ordered By : L. REID
Analysis Completed :DEC 6 89 Send Reports to:
Laboratozy Supervi~or,:STEPHEN C. ERE 1)A E C S
Relea,ed By : ~~, ~/_~-- 2)
Special
Instruct:
Chemlab RoE ~: 8767 Lab Smpl ID; 1 Mattlx: WATRR
Allowable
Paramete~ Te~ted Result Units Method Limits
NITRATE-N ND(O.1@) mg/1 EPA 3S3.2 10
Sample ROUTINE SAMPLE. SAMPLE COLLECTED BY L. REID.
Remarks:
1 Tests Performed ' See Special Instructions Above UA-Unavailable
ND~ None Detected '* See Sample Remarks Above
NA= Not Analyzed LT~Less Than, GT=Greater Than
ACHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562-2343 5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
;~ PRIVATE WATER SYSTEM
C .... ~OL SERVICES~ INC.
Mailing Address P, O, BOX 240668
ANCHORAGE, AK . 99524.-0668
City Stale Zip Code
Mo. Day Year
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
/,//;-
2 I
31
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
tisfactory
I~ 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 /~- - ~'"~ ~ P
Time Received ,,~Y~' ~
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Lab Ref, No, Result*
8767 [~
Analyst
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter: Direct Count
Verification: LTB _BGB
Final Membrane Filter Results
TNTC = Too Numberous To Count
OB = Other Bacteria
Time:
Collform/100mr
p.m.
PART ONE OF TWO
REMAINDER TO FOLLOW
TO ALL PARTIES CONCERNED:
All parties concerned are advised that the subject Health
Authority Approval for Lot 18, Block 5, Sky Ranch Estates is
being unconditionally approved by the Department of Health and
Human Services. with the following notations:
On December 7, 1989, the on-site wastewater system passed
adequacy test. The test indicated that the system is
adequate for only a twQ bedroom house.
an
o
~h~ Smith, P.E.
Program Manager, On-site Services
On November 15, 1989, the system was treated with a hydrogen
peroxide chemical additive as a means of rehabilitating the
system prior to the adequacy test. While hydrogen peroxide
has been successfully used to rehabilitate some s.ystems,
there is no guarantee as to how..long the hydrogen peroxide
treatment will extend the life of a system.
t.)N,.~l~ !~E.~SID. ENTIAL APPRAISAL. REPOrt,T__, _ ~ F~ ~,~21 O/1
~j,~ ..... ~~ ~ --]L]~ND~SCRETIONAAY ~E' 1
/
Fee Slmpb Conceu~ons
Seller
ATION
BUILT UP Over 75Y,
GROWTH RATE Rapid
PROPERTY VALUES Incre.a$1ng
DEMAND/SUPPLY Sheda~e
MARKETING TIME Under 3 Mos,
~ USE Y, -- USE CHANGE
FlOR S/Mo,
Suburban
25-75X
,,B kdo~,
Single Faille/
2-,4 Family __ Likely
Multi-family In process
Commercial To:
I,~dultrlal
Vacant
um tHUD/VAI
MINmls PUD
Rural
Und,r 2§%
Declining
I OCI:UIIANCY, PRICE AGE
Owner' ${OgO) (yrs}
Tenant Low
Va,cant (O-SX) High
Va,cant rover 5Y,) Predornlnaet
EmNoymen'` Stability
Convanlanc, to Employment
Ccmanlence to Shopping
Convenience to Schools
Adequacy o~ Public Transportation
Racre&tion F~cllltles
Protection From Detrimental Coed.
Po,co & FIr,p Protection
N'~.' '.,Raca or ',he racial ¢ornpo~iltlon of the haig are not considered reliable a!,pral~at borers, COMMENTS:
Site Area ~.~,~.~.~_ (:ernst Lot ~' Size ~l ~or are~
~ILffES I PubfT: Olhor I$1TE IMPA~VEk~NTS Ty~ Public Erivate View
Gas ~ ~ Curb/Gutter ~..... ~} [~] Driveway
Alia ~o roMA' Ma
COMMENTS tApparent a~,asemanh, enaoac~ments, IpeCl~ ~o~smenh, Slide ~r.as, otc,)',~l~[..~~~_l~h no
~SCRIPTION
Units Slab Area S¢ Fi,
Stories Exterior ~falls E~:~dj Crawl Space Finished
Type (Oet,/Att,) Roof Surface Basement .~
Design tStyle) Gutters & Dwnspts, Sump Pump ~QD~. ~alls qoor None.
ExlUIng ~Indow Type D~mpho~ Floor
Under Construction ~Q Infestation
Age {Ye,) Manufactured House
Baswnent
Level 1
Level
Frnlshed area ahoy contains: Rooms:
SURFACES Me'`erlats/Conditlon HEATING
Floors Type
Walls Fuel ~,g~ ....
Trlm/F~Ish Condition
Dat~ Floor ~
B~h Wain=cot COOLING
Boon Central
Other
-- Condfllon
Refrloaralor None
Range/Oven Stairs
Ol~po~g C'rop Stair
Dishwasher Scuttle
Fan/Hood Freer
~a;har/Dryal Flni~h~d
~lCrOW~V~
bturuo~
Garage ached House Entry
Cars ~[~.~ Carport etachad Inadequate Outside Entry
None lit-In EIactrlc Door
See
Balhh):
Oualfly of Cc,nstructlon
Condition of Improvements
Roon~ Sizes/Layout
Closets end Storage
Energy Etflcl.ncy
Plumblng~Adequacy & Coedltlon
Electrical-Adequacy & Condition
Kitchen Cablrmh-Adequacy & Coed.
Compailbll~iy to Nelghbothoo~
Estimated flem~lng Economic Lite
~recletlon tPhyslcal, functional end external le~deq~iacles, r~pnlrs needed, mo~andz~tlol~
ilo two-bedroom desl~_!n, as well as lim.U~ ut:il.tty~~ the ~ le~ where the ~
General market conditions and prevalence end impact h subJect/m~rk,t area regarding Io~r, dlscoun ~, n,erest buydowns and concessions ~i~ y~
Flret 27,00 x qg,DO x I = 1327
5,5o x 7,Do x I . ql
Tote[ Sq. Ft. = 1278
~eoond 27,00 x 29.D0 x 1 = 797
C~raSe 27,00 x 29,50 x '1 : 797
, 27.00 x 10,50 x 1
, -D,DO x
Total Sq, Ft,, = 10~10
CO~ H~ndbook, ~nd ex~rapOlattons frc,m local
building cos~s, Exl;e~al economic depPeota~lon
Does proper{y conform to ~pptlc,t!b HUD/VA properly standards? r~Y*l []No
If Ho, expkln:
__Sq, Fl, ~ $
Special Enoroy Efficient llama ]~. Above '
Porches, P¢ilos, otc, - 6
~ar~ge/C~rDort ~,0 ~ Sq, Fl, e 8. 20,,~Q - . 21.216
)t~l Esllmated Coil New ..................... -$ ...... 178
Phy~icd / Funcli°nel/ External
De~reci~tion.~.~.~3. 567 '~ _ -81.779
Depreclsta~ V~luo of Improvem~ntt ............ =$
Site Imp, 'es i~' (driveway, 18n~scaplng, e{c,) =$ ~ 1, o~
ESTIMATED SITE VALUE ...................... =~ ..... ~. 0o0
leasehold, show onry leasehohl value,)
CATED VALUE BY COST APPROACH ....
',lame of '~'~rrent¥ Program
~/arranty Coverage Expfres
Condl{len
Ahova Grade
Room Count
!,Grq.,,~lylng Area
Basemen{ & Finished
Rooms ~elow~r~do
Functional Utility
Heating/Cooling _._
Ge~oge/C~rport
Porches, Pa{lo
Specl. I Energy
IEfficient
6'
,{one
Wg-
~LG
ltandar'd fop
IOther {e,g, kitchen T&O OB VC, JC2~
Adj, (total) --- ~!~ ~, . ~_-', $ ' l_.J.O~
IN--TED VALUE §Y SALES COMPARISON APPROACH .....................................................................
; ~DICAT~ VALUE BY NCO~EAP.PROACH(lfAp~ cdla)EstmatedbhdotRant$ L~OOO,OO/Mo. xGrmsRent~ltLpller __. N/A -$ ../
Thl~ apprMs~l I~ ~de ~ as I~ ~ ~uSJact ~o the repairs, ~lterall~nh In~pocllon~ or coadll~on~ II,led below ~ c,~mpletlon per plans and ~pecfflc~llons,
~CommenlsandCondlllonsolApprtdaal;~pj.~p_dJo~.YJ~!~BS~ ~o_~.W~BC ~tan~d~. See VC-/{5 Addend~
mhd HUD-92800.
~rket~bilit~,, Th~.~P~x-~t~-~-~°k of
HUD &/or VA [nstroci{onl,
,re 439 (Rev, ?/86)/F~nnle Mae Form 1004B (Re~. T/SO) filed with c{{en{ 19__ ~ altacbd,
I (W~ ESTIMATE THE MAt KET ~ ALU{ AS )[F N~ OF THE SUBJECT PROPERTY AS OF O~b~r' 2 ~ ~ to ~ m ~
I lWel cerllfy: ih~i ~o iho busl d my (our) knowledoe und bdi~l, th, tacu ~nd ~mia uteri heroin ~m truo and ~orre:t; 1 m~ (wo) personally Inspeeled lhe subject properly,
n ' t Icc, nrables~lescltedlnll,lsr~port, snd ha Iwe)lavenou dsclosedlntoreil prementorpro,pectlve
both inside and out, snd have mude ~n exterior inspection o ~ P . , '
therein.
UNIFOR~ RESIDENTIAl. APPHAISAL REPORT
~.:tlo. SUPPLE~,tENTAL SALES COMPARISON ANALYSIS ~. ~.(
ITEM SUIgECT COMPARABLE NO, 4 COMPARABLE NO, 5 COMPARABLE NO, 6
119~1Wh~pruo~ ~281 go~lBhorn Stree~
oss LIv, Area
)at~ Sm~rce
DE$CR)PTION
Condition
Above Grade
Gro. Liv)nj~Ar~a
Rooms Below Grnde
Functional Utility .__
~.q, Fi, i
DEPARTMENT OF: HOUSING AND UBRAN DEVELOPMENT
REGION X
ADDE~NDUM TO HUD/FHA GOI,4MITMEN'T #~T..~-,'~2--~[~J~ Specific Commitment C~ilio~ when circled,
VC 30 ~ (A) Pro, ida concrete /oundelio~. and/or piers unaet all w,3~ aills, posts, and ~upporling mem~rs
unOet ~_ dwelling, ~ portia. NO wood iD remain within 8" Of the ground.
(C) .... Reglnce all skirling and oll~er wo~ in contact with tl~e ground, In lieu Of Iowenng 5o~16' below w~,
VC 31 ~ Installs-- foundation vents =n~lot ~ sHic venls ~[ .................
to prowde cross ventilation.
VC32 ~ fA) ...... In~tall acceptable v~por burlier over entire ground s~ds~e of ~tawl 8p~ce,
~way from house.
(C) . Re~ove debria~ wood scraps, form boards, et~,, from under ~ouse,
VC 33 ~ Summit FHA For~'~.completed by a licensed p6~1 control operator, Any ¢offeotlons or regatta te0ulr~ by
the operator nlust bo completed pilot 1o requeotlng an inspection. The 2053 ~u3t Inalude an endorsement by
VC34 ~ {A)....; .... Reroof;(B) ..... rap;~lr reef; .... house ...... garage; repai~ sheathing
Remov= all CiO fooling wne~l mote th~n tw~ laye~a exist, Subrntt IIn~l mspectlort by I~al [~n0dictio~
contractor C{IRIIt~I~O~3 that wof~ Is OO~llplOle, Roll~d r~fl~g Is not acceptable [or tercel or repair,
new aystem ¢offtpJle~ w~th existing COMes,"
VC36 ~ Purchaser to CaVity at ~loelng (hal I:h~ following ~y~tem(s) are operable 8nd
Plu~nblng .... Heating ...... El~¢t~lc~ ~Othe~ ~
~Faotion el any a~ll~lancle8 founcl I~ a ~pe~lft~ ¢~n~ltlon of thl~ ~o~mltmenl,
VC 37 ~ In~l~ll a 3/4' nm~adJustabio tempef~tu~ ~n~ pressure relief valve 0~1 hot water tank and 314' diecl~atge line to
VC 38 ~ Install Uk.~pp~ed 8ttloke detector ~cogteble Io I~1 Jurisdiction,
VC 39 ~ Install t~ew electrical panel at, dior a~n/ice ~d~u~le to ~am/tho existing load an0 submit ~ COpy of I~ ~lg~.
oll ele~t~lg~{ permit from the I~el ~uthot' ty h~v ng ~url~dictlon,
VC40 ~ Furbish eyid,ln~e ih~t property I~ co~r~ected to publi~ (A) Water__.~ (B) Sawer ....
VC 41 ~ Submit evl~e~n~e ib~t the subject pr,~pDdy fronta ~n a elmer ~edl¢~ete~ to end ecc~pted by t~ 10Oat Ju~lcllon
dd~s lervlng the ~l~bJee ptope~y, Provl0~ ~ogopl~3~e r~o~d~ t~lntananoe agrl~e~nt for roa0~ not Rublloly
maintainS.
V042 ~ Submit OOtre~ot legal ~egcrlptlon and lot dimen&iO~.
VC ~ ~ Correct all d~fecHve paint surface8 id~ntili~d below ~o conform to 2~ CFR, P~rl 3~. Ropa[r~ are 1o blo~ or match
with existing paint or deeorallon-~ '-
~h~-MUgf a~ COMPLETED tN A PflO~EB~IONAL MANNER, AL~ CERTIFICATION8 MUST B~ SUBM ~D ~ORE
REQU~gTtNO INSPECTION, ~r'~
INSPECTION APPOINTMENTS T~
TIME TIME
DATE DATE DATE
,NSPECTOR ,NS. C.O
~ ,
~UNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTLQ~ DEPT. OF HI:ALTR
825 L Street - Anchorage, Alaska 99501 ~NVI~ONMEN~A[. P~OTECTION
ENVIRONMENTAL SANITATION DIVISION AU~ i ? 1981
Telephone 264-~720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND
PROPERTY RESIDENT (If different from above) PRONE
PHONE
MAILING ADDRESS
~ LENDING INSTITUTION PHQNE
~AI LING ~DDR ESS
MAILING ADDRESS
5. LEGAL DESCRIPTION
;TREET LOCATION
S. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four [] Other
~ SINGLE FAMILY ,J~" Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
7. WATER SUPPLY
INDIVIDUAL* * ATTACH WELL LOG. A well Icg is required for all wells drilled
COMMUNITY since June 197E. For wells drilled prior to that date, give well
[] PUBLIC UTILITY depth (attach Icg if available.)
8. SEWAG~E./DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE** ,/[/''~' YEAR ON-SITE
SYSTEM
WAS
INSTALLED,
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
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 UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[~]PUBLIC[~INDIVIDUAL/ONuTILITY -SITE DATE INSTALLED ~.~_ ¢'~ ~/
Connection Verified INSTALLER
[]Septic Tank.or []Holding Tank
Size: /(~)~~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
[J~APPROVED FOR _.~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY ~
72-010 (Rev. 6/79)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Qualit
3320 ~ Street, Anchorage, Alaska 99503 274-4561
//
~/~/ . /, Date Received /-
~'~ / Date of I~spectio~
.~-~._~-:~ EWER & WATER FACILITIES
FOR
1. Approval requested by:
Mailing Address:
Property Owner:
Mailing Address:
4. Location:
Type of facility to be inspected
5.
6. Well Data:
C. Construction
Sewage Disposal System:
C. Septic Tank: 1. Size/(~]l~
D. Seepage Pit:
E. Disposal Field:
No. of bedrooms ~ ' .)
B. Depth
D. Bacterial
Installer
Total length of lines
o
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank -
C. Absorption area to nearest lot line
, Absorption area ,//(~
Other contamination
, Absorption area
., Sewer Lines ,
EQ-034 (1/74) Page 1 of two pages
3330
REQUEST FOR APPP, O//AL OF'
INDIVIDUAL SEWER & WAiER FACILITIES
o
iype or' ' '
in.,p6c~or: CMRO
Property Owner: .___¥~_~_ ,~.
Mailing Address
VA
cony
Phone
Hai ting Address _s-~
Name of I_ending Institution:
Mailing Address:
Name of Realtor or
Mailing Address:
Day Phone
~/0 ~. ~'~o. ~.J,'~&~ Phone ~
~%'7
Agent: ~
Phone
· To,cc of ~aciiity to be inspected: ,~,'
8. Water Supply
Type of Supply: Public Utility indiviciual
~i: Individual, number of dwellings presently served
~f ~nd'i,¢idual, dei~L!; of w(:l'i
Sewagp ~isposal Sysc~m
Type o,: System: Pub'tic Utility
if individual, date
ind ,¥.
of installation
Page 2 of two pages - R~ est for Approval of Individual wer & Water ?acil'ities
Legal Description
Comments
Approval ,Valid for one year from date signed
Greater Anchorage Ar~a Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)