HomeMy WebLinkAboutSKY RANCH ESTATES #2 BLK 1 LT 14C"l v u ",' III
Inspection Report _1-1-12.doc
Municipality of Anchorage V 2018
JUL 2 6
Community Development Department Page 1 of 3
On -Site Water & Wastewater Program
4700 Elmore St. -P.O. Box 196650 Anchorage, AK 99519-6650 -http://www.muni.org/onsite {907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181123
PID Number: 015-302-11 ❑ New E Upgrade
Name:
RON RICKMAN
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ound
Address:
5351 WHISPERING SPRUCE "ANCHORAGE,
AK
❑ Other
Phone:
No. of Bedrooms:
Soil Rating:
Total Depth
(808)-352-6391
4
:fro:7,11�ide:
GPD/Sq. Ft
Fl.
LEGAL DESCRIPTION
Depth to pipe invert from original grade:
F
Grave pth beneath pipe:
Ft.
SubdivISlon:
Block: Lot:
_ `
Fill added above original grade:
Gravel length:
SKY RANCH ESTATES #2
1 14
`_
�\N
Ft.
Ft.
Owns Ip: anger
eC Ion:
Gravel width
FL
Beds Number of lines:
Distance between lines:
Ft.
SEPARATION
DISTANCES
Total absorp area
umber of trenches:
Dist. between trenches
To
Septic
Absorption
Lift
Holding
Public/Private
From
Tank
Field
Station
Tank
Sewer Lines
So. FL
Ft.
Well
N/A
25'+
TANK ■ Septic ❑ S.T.E.P. ❑Holding ❑ Other
Manufacturer:
Capacity:
Surface water
100'+
INFILTRATOR
1530
��
N/A
Gal,
Lot Line
5'+
�}
Material:
Number of compartments:
HDPE
2
Foundation
"5'+
_
LIFT STATION
Curtain Drain
NONE KNOWN
Manufacturer. 7Ca
::::�
Gal,
Remarks: APPROVED BY MOA DURING CONSTRUCTION
"Pump on" level at: "Pump ofr' level at:
High water ala m at:
Pump Make & Model
Electrical Inspections performed by:
PIPE MATERIAL
House to tank EXISTING/D3034 Tank to EXISTING/D3034
dralnfield
Installer
ARM SERVICES
Drainfield EXISTING CO/MT EXISTING
Inspector GEG, Ltd.
BENCH MARK (Assumed elevation)
100.00 Ft.
Inspection
Location and Description:
Dates: 1st 7/13/2018 2nd
-
3rd - 4th
BOTTOM OF BACK DOOR THRESHOLD
Community Development Department Approval
ENGINEER'S^SEAL
4o�o�oO
Conditional approval:
Date:��,`
o * . 4�'I .•yam 00
0 1
p. /.......... .......o
Je f/ Garn ss. �,
CE -795
4pfe� • �...Z I-�
Approved.C
pp
Date:
�Ao
LICENSE40ea orof essio�,
#AECC884
Inspection Report _1-1-12.doc
PERMIT NUMBER:
OSP181123
ARCEL ID NUM
RECORD DRAWING P015-302-11BER:
A
TMT
18.6
43-5
S STI
24.2
40.2
ST2
16,9
48.2
DBLI
19.5
49.3
OBL2
20.6
48a .7
SKY RANCH ESTATES #2;
BLOCK 1,LOT l8
SKY RANCH ESTATES #2;
BLOCK 1,LOT13
CBEFMC ARI�tD
SKY RANCH ESTATES #2;
BLOCK 1,LOT 17
COMMUNITY WELL
't tj 1 -1 It "
APPROXIMATE LOCATION OF EXISTING
DRAINFIELD PER CLEANOUT/SUMP
6 LOCATIONS AND MOA RECORDS
ST1-"
TMT"T2
"
A
NEW 1530 INFILTRATOR TANK; DOUBLE CLEANOUTS
INSTALLED AFTER SEPTIC TANK
EXISTING FCO
SKY RANCH ESTATES #2�
BLOCK 1,LOT 16
COMMUNITY
SKY RANCH ESTATES #2;
BLOCK 1,LOT 15
[C:O:M�ll UNITY I ITYWE WELL
lliQllt: (901) 771-6179' FAX (907) 33&-3246' "SBSITE:
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
RON RICKMAN 808-352-6391 2 OF 3
LEGAL DESCRIPTION: DRAWN BY:
SKY RANCH ESTATES #2; BLOCK 1, LOT 14 D.J.G.
TYPE OF WORK: DATE:
� SEPTIC TANK RECORD DRAWINGS 7/2712018
ARCEL
UMB
r7P7ERMIPT
OS181123 RECORD DRAWING P015-3DNUMBER:
015-302-11
FINAL GRADE = 99.73-99.78 (APPROXIMATELY
0.1-0.13' HIGH ON SOIL COVER - 4 FEET MAXIMUM)
ST1 ST2
2" HIGH DENSITY INSULATION
TOP OF TANK AT INLET = 95.65 TOP OF TANK AT OUTLET = 95.65
INLET OUTLET
INVERT OF INLET BUNG = 94.98 INVERT OF OUTLET BUNG = 94.71
1530 GALLON HDPE
INFILTRATOR SEPTIC TANK
%OF �♦
GARNESS ENGINEERING GROUP, Ltd 4 .
3701 E. TU.RROAD,SUITE 101 *ANCHORAGE, AK99507 *PHONE (907)337-6179- FAX (907)338.3246-WESSITE: -gamessengineenng.cam ••• •, •• •••••••••• •/
Juo
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:LA-i 1w
RON RICKMAN 808-352-6391 3 OF 3 •jGi e CE-79531rues . •.e
AV
LEGAL DESCRIPTION: DRAWN BY: ��� �•.��•.... •��j.••(4W
SKY RANCH ESTATES #2; BLOCK 1, LOT 14 D.J.G. �Q P �••••" �P�•VV�.
TYPE OF WORK: DATE:FESS
LICENSE 11' .••
SEPTIC TANK PROFILE 7/25/2018 #AECC884
111111 .- t
„se PAL1jY0 MUNICIPALITY OF ANCHORAGE ent FOn-Site Water&Wastewater Program 411116km rKO r r e.\ PO Box 196650 4700 Elmore Road .
\ ' )/ Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 -,`
http://www.muni.orgionsite — 11161 JULIO
4"'CHON PGE
On-Site Wastewater Disposal System Permit
Permit Number: OSP181123 Effective Date: 6/7/2018
Work Type: SepticTank Upgrade Expiration Date: 6/7/2019
Tax Code Number: 01530211000
Site Legal Address: SKY RANCH ESTATES #2 BLK 1 LT 14 G:2737
Site Mailing Address: 5351 WHISPERING SPRUCE DR, Anchorage
Owner: RICKMAN RONALD L & Lot Size in Sq Ft: 18679
Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field El Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
l
0
Received By: - '�' �'► Date: 7;
Issued By: /lK tee ' £1 1.,,-L' Date: 6�t 48.
6 "I8970
5 11
MUNICIPALITY OF ANCH ° %,•
E UN 0 1 2018
Community Development Department 1-6 Phone: 907-34 A7:04
Development Services ax: 907- - 997
On-Site Water & Wastewater Program of 6 9 I.
Mayor Dan Sullivan
On-Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 015-302-11
Property owner(s) Ron Rickman Day phone (808)352-6391
Mailing address 5351 Whispering Spruce Drive*Anchorage.AK 99516
Site address 5351 Whispering Spruce Drive*Anchorage.AK 99516
Legal description (Sub'd, Block & Lot) Sky Ranch Estates#2; Block 1, Lot 14
Legal description (Township, Section & Range)
Lot Size Sq.Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING:
(®all that apply)
Initial ❑ Single Family (SF)
Absorption Field ❑ (w/wo ADU)
Septic Tank ® Upgrade Duplex (D) ❑
Renewal ❑
Holding Tank ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well n
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR:
N/A Distance: -
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 44 2I c•n✓ Waiver Fees:
Date of Payment: 0f0/d 4l,V Date of Payment:
Receipt Number: Receipt Number:
Permit No.
OSP
191 tj, Waiver No.
(Rev.01/11)
t; __ Quanics
GARNESS ENGINEERING GROUP, Ltd "°''a"ce°Treatment System
ENGINEERING SALES CONSULTING -+ Dealer
�
June 4, 2018
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
a7-
Ref: Proposed Septic Tank Upgrade for Sky Ranch Estates; Block 1, Lot 14
To whom it may concern:
The existing 4-bedroom house is served by a community water and private septic system.
The existing 1,250-gallon steel septic tank (installed 1973) is in a state of failure and
needs to be upgraded. We are proposing to decommission the existing tank per UPC and
replace it with a new 1,250-gallon epoxy coated steel septic tank. The contractor is to
maintain a 10'+ separation to all building foundations and 5'+ to the existing drainfield and
deck supports. We are unaware of any adverse impacts this installation would have on
adjacent wells or septic systems. If you have any questions, please contact us at 337-
6179. Thank you for your assistance.
:Inc-rel
'`--Je'rz., A Garness, P.E., M.S.
Pres.!)e f
3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259
Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com
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I BLOCK 1,LOT 13 �j
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1
LL I COMMUNITY WELL'
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BLOCK 2.LOT 26
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GARNESS ENGINEERING GROUP Ltd % .t , -'•* •
CIVIL&ENVIRONMENTAL ENGINEERS 0 / 0
3701 E.TUDOR ROAD,SUITE 101'ANCHORAGE,AK 99507'PHONE(907)337-6179•FAX(907)338-3206'WEBSITE:WW
W .9amessen9ineerin9.com 44• '• •
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 : ' r. '. Garp'ss J isi
RON RICKMAN (808) 352-6391 1 OF 2 •O
0 '.. CE- °:kJ-
PROJECT/LEGAL DESCRIPTION: DRAWN BY: ,�
SKY RANCH ESTATES#2; BLOCK 1, LOT 14 L.K.B. •to ...7O� �'1�,,
..*4-.14:0'
..-
TYPE OF WORK: DATE: 414 ' ^ ESS`" 4
SITE PLAN 6/4/2018 #AECC884 1�%sa���*
I • I \ 1
I
I \I �
SKY RANCH ESTATES#2;
I - BLOCK1,LOT18
C
1
ISKY RANCH ESTATES#2;
BLOCK1,LOT13 S.
I m
m
COMMUNITY WELL m
m
200, /
-Zi
COMMON/ry
WFiot1
NC/US EXISTING DRAINFIELD
PROPOSED 1250
/ GALLON EPDXY COATED
STEEL SEPTIC TANK SKY RANCH ESTATES#2;
/ 14 -==- BLOCK I,LOT 17
/• A
r 1 COMMUNITY WELL
il1
\ / •'DECK ;
\ / .114/1/ / 1 1
\ APPROXIMATE LOCATION OF
/ 840.O � DECOMMISSIONED CRIB
\ / OS I EXISTING SEPTIC TANK TO BE
DECOMMISSIONED PER UPC
y I
V \V
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CONTRACTOR TO CONFIRM THE INTEGRITY OF FCO;IFIT IS
NON-FUNCTIONAL.INSTALL DOUBLE CLEANOUT BEFORE SEPTIC TANK
/ \ I I
\ SKY RANCH ESTATES#2;
BLOCK 1,LOT 16
\ \ COMMUNITY WELL
\\' \ \
\
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0_,-2- SKY RANCH ESTATES#2;
((� BLOCK 1,LOT 15
\ COMMUNITY WELL
S ALE:
1"=40' \
Lememmmommiiiiiimbiiiiiim viitlIA lik%i_
.44EOF kud4 .
:co ..** i .... ,.
GARNESS ENGINEERING GROUP, Ltd ' .4`: 1a �'�'�
CIVIL&ENVIRONMENTAL ENGINEERS. • / •
3701 E.TUDOR ROAD,SUITE 101'ANCHORAGE,AK 99507•PHONE(907)3376179•FAX(907)338-3246•WEBSITE:www.gamessengineering.com ; • •••
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ♦fi-VJ-ff it° ' Garn S
RON RICKMAN (808) 352-6391 2 OF 2 ♦j�'i•
C _7 �:2i
•
PROJECT/LEGAL DESCRIPTION: DRAWN BY: ♦♦.�••'' 6 4 1/a <'
SKY RANCH ESTATES#2; BLOCK 1, LOT 14 L.K.B. 1 •p''p••,•,�•• ••(�''\�P\.,•.4,
TYPE OF WORK: DATE: LICENSE 44 ESS,\�4•
SEPTIC TANK DESIGN UPGRADE 6/4/2018 #AECC884 �������
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PFIOTECTION
ENVlRONIVIENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telepl]one 264-4720
ON-SITE SlEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION RI:PORT
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
Well
DISTANCE TO:
NO, OF BEDROOMS
Liq.DiSTANcECapaclty in To:gall°ns[JW e I'~-~IF HOMEMADEi:_ _ Dw~ll~nglnSide length
PERMIT NO.
Manufacturer No. of compartments
Liquid depth
PERMIT NO,
DISTANCE TO: Well,~o
No. of lines ~)~ Length of each line
Fop of the to finish grade
Absorption area j DweIIing
Material
Width
j Material
Foundation.~, ~. Nearest 1et line
Total lelgt~:~of lines Trench width
Length
Depth
DISTANCE TO:
__ ~T-A~CC ~--i Clas~------
Liquid capacity in gallons
PERMIT NO. ~) ,~O'! '~¢'
Distance between lines
Totaleffectiv a sorptionarea
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
Depth Driller Distance to lot line
Building foundation Sewer line Septic tank
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
/~ r,,**~d
APPROVED DATE LEGAL
72 013 (Rev. 3/78)
DEPARTMENT OF HEALTH AND I:ZNVIROI'4MEI',ITAL 82'.5 L STRE[:~T.~ ANCHOF(AGIE:
F:'EIRM I T IqO."
8',50456
0:7/,?,9
A P F:'I.. I CANT:
ADDRESS ..
CONTACT F'HONE:
LEGAL. DEEICF~:]:P:
I...OT SIZE~
I...OT LOCATION."
Ft~X
SUBDIVISION:: EiKY RANBH ESTATES ,~2 LO'T'~ 14
SE[TI'ION: 2.2' "T'[]WNBHIP: :[2N RANGE: :SN
:1.90()0 (SE;i. FT. []F~ ACRE:S)
WHISPERING SF:'RUCIE
3
/
DEF:~'I'H TO PIPE BOTTOM (FT.)
GRAVE:L. DE:PTH (F'I'.)
'l'[)'lr'aL DEF:"I~H (F"F.)
GF~AVEI.., NIDTH (FT.)
DRAVEL. L,IENG'TH (FT.)
BRAVEI,.. VOI..AJM~ (CU. Yl)[$,, )
TANK DIZE (GALS)
SDII,. RATING (SQ.FT. /BR)
I,.istecl below a~,e the options aYailable 'Lo you :Ln c]esigning your' sept:Lc
system. Choose the option that bes~:. Fits youP site,,
. ~ F.~E:,.~ 4[..~.~.~ ~,~ .,, .E.,,~,~,,4~ I ~,,~
4. ,, 0 4 ,, 5
5.0 3,, 5
~ 9. () 8 ,, ()
2,.D 5.0
~ 66.0 72.0
k 33., 7 53.4
')~, 000. () .~,.~ 1, 000. ()
'~' TANI< I'flUS'f' HAVE AT ]JEAST TWO C[}MI::'AFN]qEN'I'S
]: ceptify 'Lhat:
1. I am
w:i, th 'Lhc,! r'equir'eme, nt.s for, cln-site sewer',;s and weJ. ls as set
t'oP'Lh by 'Lhe Municipal:i.t.y of ~nchopagr.~ (MOA) arid the State ~t' Alaska.
2.. I will :i, rlsta],l 'Lhe system in ac:c:or, danc::e wi'Lh all Mt]A codes and r'egulat, ions,
and in col~p],J, arH::e wi'Eh the des:i, gn cr'iteria of th:Ls pePmit,,
3.. I will adher, e to all MOA and Statcp of Alaska mequirements for' t,l'm~ set I::~acl-::
d:i.s'l:ances from' any exi~t:ing well, was'[,ewater' d:i. sposal system of I:)Ld:)].:i.c
sewepage !systBIfl on this op any adjac:en'L of nearby
4. ]: under, stand '[.ha'L 'Lhis perm:L'L is va:Lid fop a maximum o¢
any enlar'gemDrrL ~].], r'equir'e an adcl~'Lional peH"mit.
i F A
THEN (1) AN EI_ECTRI[:AI.., F'ERMIT AND iIqSF'IECT'ION
WIL. L NOT BE APPROVED WITHOUT AN ELECYRICAL IN~PEDTION RE;F'ORT; AND
IEL..E~C',TRII]AL WORK MUST BE ]:)[INI!'~ BY A I-IDENSED EL.E[;TRICIAN.
I_IF'T BTATION I8 INSTAL,I..,IED IN AN AREA COVERED BY MOA BLJILDIN6 COl}ES,
AS-BU I [.."l"E~
(:5) THE
S I GNED
Ai::'PI .. ]: CAI~[I':
:1: SSUliED BY
~c ~
DEPARTI~IEN'I'' OF:' HEAL]"H AND IENV'.IiRONMEN]'AI... E I~O1E. C I1Olxl
"264-4720
R. eERARDO . [( J(,
JOHN
........ i WFItSFLRIlJO , FRUCE
A ~C .tORAGE ,, AK 995 :t 5 .l- ~ f
BLOC',F.:: :1
SUBDIVISION: SKY RANCH ES'T'A"i'I~:S
SECTION." 2;d I"[)WNSHIF:'.' :L2N RANGE: 3W
:1,9000 (SD. Fr"F,, OR AC, F<ES)
WIq I SPIER IIqEl SPRUC'IE
MAX BIEDF(C][,IMS: 3
I.,.is't',ed bet Iw ane the) p't:¢ons aw~ilab:l.e to ,you zn
sysl.~m,, Choose the :~pt~o"l that., bes'L fits yO' ' sz'Le..
DEP1]'"I 'FO PIF'E BO'T'TOM (FT.) 6.0 /
E'II:~AVEL DEPTH (I:::'T..) 2.0"
'I"OT~I... DIEPlf'H (F"I".)
( RAVE,L W]:D'I'H (FT.) z,~ 0
bKAVEL L.I=.NG I H (F3'.) .' ?'-.'" 0 '~"~'
~3RAVEL VOI,..UME (CU. YDS. ) / 4:3. 1
TANK S t ZE (BALS) . .' ~., 000.0 '~"~'
-' :220
SOIl.. RATINE} (S[;}.FI". /BR)
· IILH,..I,I.I I_lL RUNS (NO'f' Iz. XI,.,[:.I:::D].II['3 75 F:'T. IEACI'I)
4f.x- 'I"ANK MtJol HAVE A'T.'LEASI' TWO CEIMPAI:R'I"MIS]~TS
cer"L~ fy tha'L n ,/'
:J.. ] alll f'arfi:i.].iah with the l*E~ql.liP(,~)lJlE)Rt, E~i rOI" on-site se)wens and wells as *:iu:~'L
¢op'Ll'l by the Hurlic:~pal:Lty of' Anchor'age (M[IA) ~nd 'l:,he , Late of Alaska,,
2. ~ ~i],1 :i,n~tall the system in accDr'darlce ~i'Lh all td[)A (::Ddem and pegula'L:i, ons,
ar'id :in colflj::)].i~tnc:l~ wi'Lb the design cr'i'l'.epia of 'Lhis pepm:i.'L,,
::.':. I ~i~1 ac:Jhe~pe {',o a].l }~IE)A artd St~T..ia of Ala~ka I'O?[ILtJ. P~OlII~I'I~,~ for, the t~E,'L back
distancms fr'(])m any (./,1,,~J'lg we].l, was'Lewa'Ler' disposal system r:)r' .pLd::)lic:
sewepage sysT. em on this op any ad.jacerrL of near'by lot.,
4. I t.uqdepstand that 'LhJ. s per, mit :i,s va].:i.d fop a max:imum of ;3 bedrooms arid
any enlapgemervL will i,equlr, e an additional, pepm:LL.
IF:' A LIFT STJ.Y['ION 'c. "., ..................
.[,.:~ ].I.ISIALLED IN AN AREA CDVEIM,D BY MOA BUILDIllE'~ CODE. o,
'TIqEN (1) AN EI.JzL. IN.[L,~L I E. KMJ. I AND ],N,,~FE.L,I
WII..I... NOT BE AF'F'ROVED WITHOUT AN EL.E'.CTR;[C, AL. IIqSF'EC'TIDN RE?,F'OR]"; AND (3) 'rile '
WLII~K IILIB-I~IE~I)EIIIL LY A~L,E, II,,~[,.D LI,.,LC, II~IL.,IAN.
E:,LJ::d,, [ I"~ .L CAI ....
APPL
I
': "~"~:~' '~:"..,_. ~ · ~- ~=..,...~--- ~~-,~ ~_:=:_ .............................. ............. ':"~'~'~= ,.>?q:~...,.,/,, ~.,.,, ~ ~- ~.
PERFORMED FOR:~
LEGAL DESCRIPT[
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGIh~
1
2
3
4
~'5'
~7
--8
9
10
~,,~.~ ~IC~,!./.F_~I'~'rE._~ ~,/(! /~,~ ~ownship, Range. Section:'"'~r~' '~.~_~ ~...~,~'~
SLOPE SITE PLAN
ENCOUNTERED?
13
t4
15
16
17
18
19
2O
OOMMENTSS'--
S
L
IF YES, ATWHAT O
DEPTH? p
E
I]epth to Water AFter
Menilering? Oale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
*l~z.o ! :-7--~S- I~'~SL:/o~-~ lO ~/.&P .1~
+~u) 6 ~/~/-~1 /~ ,~,Tq ,o9
PERCOLATION R~TE ~.~' ~'"'--~ ~.-L~ / ¢ ~ C
~. (m~nutes/~nch) PERC HOLE DIAMETER
TEST RUN BE~WEE~ ~/'S FTAND FT
PERFORMED BY ~.,._~ __ ~~''-0¢~'~'/ I ~~ CERTIFY THATTHISTESTWASPERFORMEDIN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE.
72-008 (Rev. 4,85)
-:R ANCHORAGE AREA BOR"' GH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE ~)c9 vl~v~rV /-'~ )
FROM WELL I~ MANUFACTURER(~) ~
~._j./~ E~- NUMBER OF
MATERIAL ..... ¢- / COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH
LIQUID CAPACITY /~ ~C) GALLONS.
--rib ~ 52£-rz- /~.~
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER
LINING MATERIALk)-JA-,HCO (7/~B SIZE,
BUILDING FOUNDATION
OR WIDTH 2~'/ LENGTH ~"/ DEPT' /]'XT/ '
DIAMETER DEPTH ~/DISTANCE FROM: WELL ...... '
NEAREST LOT LINE ~ /~ f+ TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) ~/ ?~'¢ .SQ, FT.
ADDITIONAL ABSORPTION
WELL: ~ 0 ~?l ,1// //~
BONST.UCT ON
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
DEPTH , DISTANCE FROM:
NEAREST SEPTIC SEEPAGE
SEWER LINE TANK SYSTEM
REMARKS
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
Form No, E0-031
F-- ' / /
DATE .
G.A.A.B.
GREATER ANCHORAGE AREA BOROUGH
SEWAGE DISPOSAL SYSI'EM -- APPLICATION AND PERMIT
PERMIT NO,
/
- PHONE --. --
, OTHER
SEPT~O ~'ANK TO SEEPAGE P~T WALL
SEPT,C TANK-- d' , SEEPAGE
/
TO NEAREST LOT LINE.
WELt- TO sePtiC 'rANK /~¢~(~ /
SEPTIC 'rANK, __L~2~O / , SEEPAeE PIT
.... SEEPAge Pit
, ALSO CONSIDER AREA WELLS.
DRAIN FIELD
GRAVEL BACI(FILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION,
TESTING · EXPLORATION · CHE~41CA[. · MATERIALS · INSPECTIOt~
August 15, 1973
279-2581
Mr. and Mrs. Tony LaFranboise
P.O. Box 4-1173
Anchorage, Alaska 99509
Subject:
Seepage Pit Requirements
Lot 14, Block 1, Skyranch Estates
Dear Mr. and Mrs. LaFranhoise:
Attached are results of Mr. Hansen's inspection of your/~page
pit. Subsequent to our discussion, you ~xcavated to a~20 ~e~th.
No water table was encountered, and ~he material is a s~y s~lt
with random gravel. A small portion of sand and gravelly sand
was noted.
Using the criteria outlined in the attached letter, your seepage
pit should be 20' x 20' inch size with a 16' depth.
Sincerely,
ALASKA TESTLAB
James L. P.E.
JLS:das
MEMBER
]940 POST ROAD
ANCHORAGE, ALASKA
99501
~ August
15, 1973
279-2581
Mr. and Mrs. Tony LaFranboise
P.O. Box 4-1173
Anchorage, Alaska 99509
Subject:
Seepage Pit Requirements
Lot 14, Block 1, Skyranch Estates
Dear Mr. and Mrs. LaFranboise:
At your request, we made a field visit August 14, to your test
pit at the above lo~tion.
The excavation i~ 20~ ~ 20 ') (16) deep. The soils consist of:
Depth Description
0 to 6".-12"
6"~-12'' to 16/
Brown, damp organic cover
Grey, F-4, damp, medium-dense,
nonplastic, silt and sandy silt,
with random gravel and rare
cobbles; approximately 15 percent
of the test-pit walls consist of
NFS gravelly sand and sand lenses.
The water table was not observed in the excavation.
Seepage Pit Requirements
Effective seepage area 2'-12' depth (10' height)
85% of soil is silt and sandy silt (0.85) 275 sq.ft./bedroom
15% of soil is sand and gravelly sand (0.15) 150 sq.ft./bedroom
Use 250 sq.ft./bedroom
For 4 bedrooms,: ].,000 sq.ft.
4 walls x~'~heightD~--W~dth = 1,000 sq.ft.
Requir6~width =~.~
Seepage Pi% should be 25' x 25' in size
If you have any further comments or questions, please
Very truly yours
]aul LASKA TE~TLA~ ,
G. Hanses
PGH:das
call~
MEMBER
�`` f Anchorage 1 / Municipality o gU
-t _ �, _ : 1.A..
'': 1 �! s "'7 ;Qn-Site Water and Wastewater Program le iii
' ;! (907) 343-7904
�� ti
4 01 fi g L 9 '1 rtificate of On-Site Systems Approval
Parcel I.D. 015-302-11 Expiration Date: I Z. — 1 ) —7
1. GENERAL INFORMATION:
Complete legal description SKY RANCH ESTATES#2; BLOCK 1, LOT 14
Location (site address) 5351 Whispering Spruce*Anchorage 99516
Current Property owner(s) Trent& Leah Buron Day phone 978-6552
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
El Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual El
Individual Water Storage ❑ Holding Tank 0
Community Class °A'' Well ® Community ❑
Public Water System El Public Sewer ❑
WaiverNariance request for: Distance:
Received by Date: at/I°{11 q
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 5 co— fib(SHOO Waiver Fee $
Date of Payment gl157'/9" Date of Payment
Receipt Number oggqC1 C9 7 C WAReceipt Number
COSA# 6- C?C i?1 tl32- Waiver#
5. STATEMENT;OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
'based on procedures outlined-+.g) the Certificate of On-Site Systems Approval Guidelines for this application,
shows th4t the on-site water spply and/or wastewater disposal system is (are) safe, functional and adequate
for the ember of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from tNfe Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances,,,and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 1
Engineer's Printed Name: Jeffrey A. Garness Date: (;/(I`f 11 -
ooQ000p�44
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system a
in accordance with the guidelines and regulations established by the Municipality of Anchorage and � .0'•'•'�`' c\h
industry practices. The reported results describe the condition of the system/s on the date/s of theDO -,•• j'� • , ,�On
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or ! Vnn
encroachments may exist that were not identified during the evaluation. The operational life of all wells �* 4 T �V -57a Vp
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, Q VQ
groundwater levels (that may fluctuate during the year), quality of construction (materials and 4
workmanship), and the water usage of the family utilizing the system's. These conditions can vary,and /. f • ,. Q
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the /p f r �G._a�rn ss;
system/s: therefore, GEG makes no warranty(express or implied) regarding the future performance of VAP E 7953 .
V .,,. r ..
the well or septic system. GEG makes no representation whether an alternative well or septic system '14).
s q • ceO
can be installed on the property in the event either of the current systems fail to perform adequately in 4� P, ** 711411/ ••
' • ���
the future. The content of this report is for the sole benefit of the person/party that retained GEG to 'QPo'pro t es s�ono`Qoo
perform the evaluation. Reliance upon the information provided in this report by any other person or �44PooQoo
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE 1--(-System #1 Approved for ( bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following.' l -ons;
ON-SITE Gat
� S WPiTE.H AND r"
-' WASTEWATER o
PROGRAM
vow' .--_ / r F>>,c' r SER ..'1 q
:y: � Original Certificate lite:,‘"
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10.10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description SKY RANCH ESTATES#2: BLOCK 1. LOT 14 Parcel ID 015-302-11
A. WELL DATA
Well type CLASS "A" If A, B. or C provide PWSID# 212916 Well Log (YIN)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N
Total depth ft. Cased to ft. Casing height(ab. - •round) in.
FROM WELL LOG AT I -' CTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RES
Coliform colonies/100 ml. Nitrate mg./L. Collected by:
enic: ug./L. Date of sample:
44 YEAR OLD STEEL SETIC TANK IS APPROACHING THE
B. SEPTIC/HOLDING TANK DATA END OF ITS USEFUL LIFE
Tank Type/Material SEPTIC/STEEL Date installed 8/28/73
Tank size 1250 gal. Number of Compartments 1 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping )1 I �- I Pumper J-` f cJ.,�n�
1 Thc. G1oc.
C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE AT WEST SUMP
Date installed 8/23/85 Soil rating (g.p.d./ft`or /bdrn ) 220 System type DEEP TRENCH
Length 60+20=80 ft. Width 2.5 ft. Gravel below pipe 5.5 ft.
Total depth '9.9+ ft. Eff. absorption area 880 ft` Monitoring tube YES Depression over field NO
Date of adequacy test 8/22/17 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 39 in. Water added 1065 gal. New depth "69 in.
Elapsed Time: 1240 min Final fluid depth 54 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE KNOWN If yes. give date -
-SUMP ON WEST END OF TRENCH EXTENDS APPROXIMATELY 72 INCHES BELOW THE INVERT OF THE INVERT.
THIS MT WAS USED FOR THE ADEQUACEY TEST
-SUMP ON EAST SIDE OF TRENCH ONLY EXTENDS 53 INCHES BELOW THE INVERT
"3 INCHES BELOW INVERT
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
•"Pump on" level at in. "Pump off' level at a er alarm level at_ in.
•- - Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY WELL
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main '.• sewer manhole/cleanout
Sewer/septic service lin- Holding tank
. containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ _ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+TO PUBLIC& 100'+TO PRIVATE
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+TO PUBLIC & 100'+TO PRIVATE
F. COMMENTS
4,01,saaaa
•
♦'� •I,
G. ENGINEER'S CERTIFICATION ••f P•••••"' • •�♦♦
certify that/have determined through field inspections and :•,•••:,••., ,••, , .
review of Municipal records that the above systems are in • ••
conformance with MOA COSA guidelines in effect on this •....... •..
date. f♦ 6,\J4 f A. G. e•s•;��
Engineer's Printed Name JEFFREY A. GARNESS ♦♦ S��.
• —7953"•�14e
111///— pmt
Date r f LICENSE 14' 'Sll�:SS r*�4•
I$AECC884
(Rev 10112/12)
•
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RQ_ 1-I:,4 4-z1- idea-Z3-Fek.'s :7-3-09�ri:f140lig
'4 a61/C7- •f-7-6.1.e!/. .V No Ccp-rcr-5 SE,'
i _a
c Of A 7jt Allit14Air I hereby certify that I have surveyed the following
,y. `�`.''` ,_ '. r described property: Z %--- " BLee. /
o
rte}A . , : . , .t._r�.+r Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property
t' ,,�' NO.3255-S '*4-)A, lines and do not overlap or encroach on the property
lk �4`" ... 4:14- lying adjacent thereto, that no improvements on prop-
erty lying adjacent thereto encroach on the premises In
i y question and that there are no roadways, transmission
"kxjai,etLi..Lter.2..opIr Imes or other visible easements on said property except
as indicated hereon.
..LWC E." / =3Q -. / Dated at Anchorage, Alaska
�? E&'�4 -c Fr thu 09 7'''.' gay of .19e.) !J_—f 19 7.3
OF R-.r)Rn. Ql'H€P ;HA;v
„)1.4 SHOWN ON THE RfCr..(C D FRED WALATKA & ASSOCIATES
KAl ARC NOT SHpwN ++ERFQ% Engineers and Surveyors
A-- 7,�-$, ' /9
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. #
1. GENERAL INFORMATION
Complete legal description
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Location (site address or directions)
~ , Mailing address". :'~' ;;
( EOn'ding b.~'n'~y' "C'
,~ '.7 Mailing.address. :'l ~ I
, Agent
)
Address
Day phone "A (~ 3 - 0 "7 ~ O
__ Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
individual well
Community well X
Public water
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
Holdingtank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of sysmm.
72-025 (Rev. 1/91) Fronl MOA #21
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 W~stew'ater 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 '~he date of this inspection.
S & $ ENGINEERING
Name of Firm !70_~4 ~.¢._ RIvar Loop Road No. 204 Phone ~ c~ z/_ p.~c~ -7.~/
Eagle River~ Alaska 99577
Address ~//~/~_/~ ~
Engineer's signature ~. Date ~/ _/o/ _ cy 7
DHHS SIGNATURE
APproved for J~
Disapproved.
Conditional approval for
bedrooms.
~ ~ [ ROBERT
bedrooms, with the following stipulations:
Additional Comments
Date .7-27-?7
'The Municipality of Ar~chorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements, Em ployees of 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-O25(Rev. 1/91) Back ~OA#21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3~
Health Authority Approval Checklist
Legal Description:[-o~ ~/ (3LJ< I 3'.~y ~/I,¢cl/ ti; ~T'. ~ Parcel i.D.:
A. WELL DATA
Well type c
If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
cW~~ S:
D~ite of sample:
B.'~HOLDING TANK DATA · Date Installed ~ i,~/*1 ~
Date completed
Cased to : Casing heigh~ou~d) _
Wir~,pr~pp~rly protected (Y/N)
FROM WELL LOG ~ AT INSPECTION
g,p,m.
Nitrate Other bacteria
Tank size ) 3'~3~ O
COllected by:
Foundation cleanout .~,N)
Date of .pi~mpir~·
C. ABSORPTION FIELD DATA
Date installed ~ /~-~ ,} '~ .~
Depression (Y/I~)~
Pumper
g.p.m.
Number of Compartments ) Cleanouts (~N) ¥ ¢ $
t,, a High water alarm (Y/~ w O
Soilrating (g.p.d./ft2o ft2~r~-~. %;*O Systemtype
Length ~0 Width ~,~ Gravel thickness belOw pipe &~ ¢/,~ Totaldepth ¢'~ ~ Il
Effeotive absorption area ~ ~() ;~r Monitoring Tube present (~N) ¥~)~_Depressionoverfield(Y~-~
Date of adequacy test 3 ]cf /~17 Results a~/Fail) /r~'cJ For ';"~ bedrooms
Fluid depth in absorption field before test (in.); ! / f~" immediately after ?/7 gal. water added (in.):
Fluid depth ~ /
'7 (ins) Minutes later: ~ ~' Absorption rate = L/~'- 0 ~' _g.p.d.
Peroxide treatment (past 12 months) (Y/N) N ~,,~,~ ¢,v0 ~v ~ If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Size in gallons
~ff" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sew_er/?.¢ie~ Lift station
SEPARATION DISTANCES FROM~HOLDING TANK ON LOTTO:
Foundation c~- Property line 5" .d- Absorption field
Water main/service line /O 4- -/-
Surface water/drainage J d ~ Wells on adjacent lots
,,,/,¢
On adjacent lots
~~~Public sewer manhole/cleanout
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line Jo /+- /
Building foundation Io .-/'-- Water main/service line
Sudace water 1 o ~) "/- Driveway. parking/vehicle storage area 3'0
Curtain drain /v 0N 4, I¢~' ~ ~,,, ~/ Wells on adjacent lots ') o 4~ ¢'
F. ENGINEER'S CERTIFICATION
~ecrot?fo~hmata lnfeaVweitdhe~4~.t~i~eAd~ thgru~ fdieell~ns ~PneeC~OcntSo~ntdhi;e~laet~' of Mumctpal reco re
"
RAA Fee $ ~ O-'0 ./-~ Waiver Fee $
Date of Payment L~/~,//'/¢ 7 Date of Payment
Receipt Number '~ G k(~-~ _~5'~' .,~,5~ Receipt Number
72-026 (Rev. 3/96)*
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
(b)
(c)
(d) Real Estate Company and Agent
Address '~, $-'-d.; --~',
Telephone ~ 7 7 - d"¢-,c..,(''
Location (address or directions) ..
Property owner Jo~ ~ ~c~'~ ~e~r~ Telephone: (home) ~Z~-~J Business
Mailing Address ~7
Lending Institution ~mmo~
MaiH.
(e)
Mail the HAA to the following address: (or check here (~, if hold for pick up.)
List contact person and day phone number below:
TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms --~
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.
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·
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, I 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 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 ~'[~z~/¢/~ '7-~chn ;c~ [ ~r~,~ ~ Telephone ~ ~- /7~-~
Address /~5~ ~ch~ ~¢~ ~chor~q~ ~ ~1~
Date ~/~ /¢¢
6..DHHS APPROVAL
Appr~oved for ~ bedrooms by
Appiove~ ~C~ Disapproved
Terms of'Conditiohal Approval
Conditional
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 M un icj pality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
A. WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/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
Comments [~ ~
Legal Description:
If A, B, C, D.E.C. Approved (Y/N)
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date
Date Completed
_ Depth of Grouting
B. SEPTIC/HOLDING TANK DATA
Date Installed ~'_/E-.¢/73 Size
Standpipes (Y/N) [/ (~f) Air-tight Caps (Y/N)
Depression over Tank (Y/N) _
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) _ )~1,
No. of Compartments J
Foundation Cleanout (Y/N)
Date Last Pumped kO/l{~
;for
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well .--.-.> '~00'
To Property Line ~ -.~'-'
To Water Main/Service Line ~ ~.5' '
To Stream, Pond, Lake or Major Drainage Course
Comments
To Building Foundation
To Disposal Field
(Rev. 7/88) Fronl Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area ~,~o ~'
Depression over Field (Y/N) /q
Results of Last Adequacy Test ,4 ~g¢.,4 ~/-,~
~'///~ D R/"1 Type of System Design
Length of Field
Depth of Field % -¢
Gravel Bed Thickness 5'-7, .~' '
Statndpipes Present (Y/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ~ '8 ~¢ ¢
To Building Foundation I? ' ~ro,~ ,m.'~.
CLot ~1' ¢~ or',¢,~! Se~f~,~'f~fo¢,;OnAdjoiningLots ~ ~'¢'
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments 'T¢1¢ Or';ql.4~[ ..Ce.~n~,~'~ ~;/
To Property Line I¥' ¢'~m H.T;.
To Existing or Abandoned System on
To Cutback (if present) N,/L
;~ (oo '
D. LIFT STATION j~,/).
Date Installed
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**
I certify that I have checked, verified, or conformed to all MOA and HAA ~[d~ftiYe'~C~.effect on the date of this
inspection. .~¢.~ ?.?o ~'~
Signed ~~ ~ ~ p~ "" ":' ~
Company ~/~p ~c~n;6~[ g~ ~ :~,-~-,-.¢--~ ?~.~
' ...................... :'"~ Engineer's Seal
Date ~/,f ~Z /9¢ 0
MOANo. ¢¢ -¢1¢
Date of Payment ~/-:
Amo t:$ /,70.
Date of Payment
72-026 (Rev. 7188) Back
Page 2 of 2
STEVE COWPER, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
3601 C STREET~ SUITE 322
ANCHORAGE, ALASKA 99503
563-6775
DATE: April 24, 1990
PWSID: 212916
To Whom It May Concern:
According to the records on file in this office, the SKY RANCH
ESTATES II S/D water system is in compliance with the State of
Alaska Drinking Water Regulations.
VERA E. CRA~C / /
Environmental Fie4/d Officer
V I~JNICIPALh ANCIJ, ORAGE
MUNICIPALITY OF ANCHORAGE DEPT. O~ 8,
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'~I~i;(ON;~[.N].AL FF, OIL.CTION
825 L Streel - Anchorage. Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION 0i~,''" 9 197~9
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE I I
DIRECTIONS: Complete all parts on pae~ 1. Incomplete requl~sts will not be processed. Please allow ten (10) days for processing.
MAILING A(~ORESS ' -
PROPERTY RESIDENT ( f different from above)
2, BUYER '~
PHONE
PHONE
MAILING ADDRESS
3, LENDING INSTITUTION
PHONE
MAILING ADDRESS
~ REALTOr(AGENT /~
MAI L[NG ADQ(R ESS - '
PHONE
"~ '1' E{~AL DESCRIPTION
STREET LOOA'rlON - -- ·
6. TYPE OF RESIDENC/E ...... --~/- UUMBER OF BPDROOMS
[] One [] Four [] Other
~ SINGLE FAMILY
[] Two [] Five
V]ULTIPLE
FAMILY
~ Three [] Six
7, WATER SUPPLY
[] INDIVIDUAL~ * ATTACH WELL LOG. A well log is required for all wells drilled
~ COMMUNITY since June 1975. For wells drilled orior to that date, give we1
[] PUBLIC UTI LITY (lei)th (attach og if available.)
~ SEWAGE DISPOSAL SYSTEM
/'~ INDIVIDUAL ~ON-SITE"
[] PUBLIC UTILITY
*' If individual/on-site, give installation date [~ -~ .
If system IS over two (2) years old an aoeuuacy test is required
oy this Department.
NOTE: THE INSPECTION FEE MlJST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010{3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~ SINGLE FAMILY [] ONE ~ THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
~ COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
"~ INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
'~Septic Tank or [] Holding Tank (~O
Size:~;~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF~A~L~ MANUFACTURER
i TOTAL ABSORPTION AREA MAT{~.)RI~AL
Absorption Area to nearest Lot Line
5. COMMENTS
[]J~"APPROVED FOR. ,,~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Title)
72-010 (Rev. 3/78)
DE PARTMEI,,,
825
#1:
Time
MUNICIPALITY OF ANCHORAGF
OF HEALTH AND ENVIRONMENI~L PROTECTION
L Street, Anchoreo~. Alaska 99501
264-4720
#2:
Date Received: April 10,
Time __/])j..'~F~ ~1 tl 3:
1978
Time
Date
Insp _~TLL g~ _..
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending
Mailing Address:
;,
2. Property Owner:
Mailing Address:
Institution Request: Alaska Pacific Bank
Post office Box 420 99510 Phone: 276-31~0
Tony/Donna La Framboise
Phone: 344-1177
Legal Description: Lot 14 Block 1 Sky Ranch Estates Subdivismon
Single Family Residence: (x) Number of Bedrooms: Three
Multiple Family Residence: ( ) Number of Bedrooms:
Well System: Individual Well ( ) Conm~unity/Public System Sx)
Permit It Depth of Well Well Log on File
Construction Bacterial Analysis
6. Sewage Disposal System: On-site System ( ) ??? Public Utility ( )
( )
Permit #
Septic Tank Size
Absorption Area
Installed
Soils
Installer
Manufacturer
ate
Distances: Well to Septic Tank C.~. .
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorpuion Area
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 14 Block 1 Sk~ Ranch Estates Subdivision
Comments:
Approved: __~~~/
Disapproved:
Letter Attached: (
Date:
Department Worksheet:
f
P
,ONICIPALiTY OF ANCHORAGE
Department of Health and Environmental Protection
825 L Street, Anchorage, Alaska 99501
~=-~equest for Approval of Individual Sewer and Water Facilities
Property Owner:
Mailing Address:
Tony & Donna LaFramboise
,Phone: 344 1177
Name of Buyer:
Mailing Address:
Roger L. Worsley & Linda A. Worsley
4511 FolkRLStreet, ~t. 2-B Phone: 279 6602
Lending Institution: ALASKA PACIFIC BANK
Mailing Address: _ P.O. Box 420, Anchorage,AK 99510
Phone: 276-3110
4. Realtor/Agent: none/
Mailing Address:
Phone:
Legal Description:
Street Location:
L14, B1 S~ Ranch Estates
Single Family Residence: (XX
Multiple Family Residence: (
Number of Bedrooms: 3
) Number of Bedrooms:
Water Supply: *Individual Well ( )
If Individual Well, well depth
If Community System, name of system
Public/Community System
;~ ......8. Sewage Disposal System: .On-site System ( ) ~ Public System
If On-site System, date of installation:
( )
*NOTE: A well log is required on ALL wells drilled since
Please contact Mrs. LaFramboise for inspection time and date.'
ENCL: cashier's check for $25.00
6/75.
3/77