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HomeMy WebLinkAboutSKY RANCH ESTATES #2 BLK 1 LT 15 MUNICIPALITY OF ANCHORAGE DL .RTMENT OF HEALTH AND HUMAN SER .,ES · ' Environmental Health Division ~ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~..,e DISTANCES Address TANK FIELD WELL Phone(s) Pe¢me No No of Bedrooms WELL LEeALOESC~.~O. LOT LINE /O/¢ /O / T°wnshlp'Range'Seoti°n/ ~X~ ~ ~ ~-2~ FOUNOATION TANKS N ~ SEPTIC ~ HOt. DING ~ _ TYPE OF SYSTE~ ~TRENCH ~ BED ~ W. DRAIN ~ OTHER Fd, added above original grade Gr ave' depd' beneath pipe d FT~ ~ PRIVATE ~ OTHER (Identify) Mullicipal alld Slate guidelJlles ie 8If ecl on Ihis dale: - 72-013 (3/85) ..... · ].i! , I., / Is! i: ::: :!il. [1::: I) l::: ',.' ALASKA 8 dlROI meTAL COiqTROL ~ilqiqeemq $ ~noironmenlol Sludies S .... , , / ~Ol.~ r'~R x 'I'~FNCU TYPE W "~' ~ ' ' SKY RANCII ESTATES '9, ~ ' -- ~,, ],J,OCk 1 , LOT ~o ~ eor~zo 2 81987 RECEIVED The drawings, sheet:s i throu$~h 5, xlm!] bca par~ c£ b x Ali materials and workmanship shakJ lnee~ the requirements oF :he MunJcipa}~cy of Anchot'age, l)epartntent of lhmJih a Human Sepvices (DItIIS), tho cond[iions of the ,.)erin;it, arid ali expp icable 1.3 All elevations and deplhs are adv:isopy, and npe [o be vor21'ir~d or modir~ec, in m £ield hy an IIII.tS app,oved inspector. a, pesponsJbil[ty off the [nsiallec io adhet'c LO approved desi?/ns for ;iasta.ilatton, lltaJlltaJB '.:he specified separation ].5 the hlstaiia[ion is inspections will invo]ve. 2 0 SEPTR7 TANK (NOT USED) 3.0 Absonpt ton Area 3.1 '""'~,(. gravel for ,,.~h trem;i~ shall be 0,5 to '2.5 inch, ,,,-,.ct~ n.c~' pock with'e~ ss than,~',<, passing #200 sieve residual. AJ] substitutes must have l)?'~of DH!IS app?ova]. 3, 2 Thc hot]om anq' ,a~.(l(.~i ·'-' of the excavatJoP. "oha~l' be raked with the hackho(~ blade [o ~Ilstlre thnL iL has nol been compa(;Ced clnriog excavation The bottom elevation ,'.,pl] be icvei. stroll be rigid RVC ASTM D3034, or 4 Jnch cast fpo1]. The sec]ich2 ShOW!I wJLh ix}les may be 0.5 ii!ch ho]os dPilled on G Jlloh CeIIL()I'H OD opposite sides of the pipe, ob a pegu]ar '~OCt~OI1 Of pepfopatad sewer plp(,, cSamped t(> a solid section, with either a so!year joint. A rubtmr pain cap (,JJlI/ cap oP equivalenl tns,a~led over the top or the pipe. .i ibc '.iistribution pipe shall be 4 inch rigid PVC with a nlitlNtuJn cp/t!:h str-ength of i500 il/s. Ail '1 ,~ ~o t' ul pipc.,~,, shall '),.' laid ~,el 1200 UJesl 33rd J~uenue Sulk g*r~nchoroqe. Alosko 9950S,[907) 561-50a0 3,6 ~nsulaL~on is required, usin~ the burial type There shall be [ Jncb o[ it~uiaL~o}l fro]' evm"y Foot oF so~l than the required 4 Feel. of cover, but extending from Lhe septic tank to the drainfie~d sba1] also Freezing of tihe [.F [ilSl]]a[[oil iS re:i: necessa_".V, i]m gravel shall be cove?ed with a layer of llO!lWOWel! Geotextile fabric (such as XJra~ai, i'ibl't:tox 200 ~rad(}, P(:]y F[]i,e~' X oi' equl[valtmL~. 4 . 0 ] NSPECT!ONS Lrench. The £~!'st JnspoctJnu wi}] be o~' the excaveit}Oll to vol'J.f'3: 4 . 2 Tim second illSpcctJou wi] [ bo aflpl' piacemeni of the gravel!, lllOllito]' st:~!nci!)[De ~!nci [Jlaccibuiti. ot} p~l)e [o v~}rify pfc)per instai!attion before backfJ}}, ALASKA ENVIRONMENTAL CONTROL SERVICE~ INC. 1200 West 33rd Avenu }uite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO OF CHECKED BY DATE SCALE ALASKA ENVIRONMENTAL CONTROL SERVICE' !NC. 1200 West 33rd Avenue, ~uite B ANCHORAGE, ALASKA 99503 (907) 561-5040 CALCULAIED BY DATE CHECKED BY DATE - 14- ATTACHMENT "A" · ~.. ~ ,/~.-F_-~ hereby certify that I have sum, eyed the following described property:__ /., /_. . , , z. _ _ ~chorage Recto'ding Precinct Alaska, and that the ~mprovemenis silualed thereon are within the property h ms and do not overlap or encroach on the properly y ng ad acent Iherelo, thai no improvements on prop- erty lyin'g adjacent thereto encroach on thc premiges m ~uestion and thai there ~e no ~oadways, transmission ines or other visible easements on said p[o~triy_e~e~pt_ as indicated hereon. Dated at Anchorage, Alaska this~/ day of ~'~O~F , 19.~ FilED WAM~ & ASSOCIA~S Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 3 4 5 6 ~7--/0L 17- 18' 19- 20- COMMENTS ~ .~. ~ROY C. REID, J~, ~', Township, Range, Section: ~ X~ ~ SLOPE SITE PLAN WAS GROUND WATE~ ENCOUNTERED? IF YES, AT WHAT DEPTH? E Depth lo Water Altar ,~.~ ,// Mo,ilori.g? /2 Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ '~ (minutes/inch) PERC HOLE DIAMETER __ 'rEST RUN BETWEEN /~) FT AND /,/ .FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-00S (Rev 4/S5} Municipality of Anchorage DEPARTMFNT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST OATEPERFORMEB LEGAL DESCFHPTION: 1 2 3 4 5 6 7 8 ¢'D --->9 .:TO, s.- 19 20 COMMENTS ,.5'X/' ~,4a/E//Township. Range, Section: ~-~'~ ~-~. SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED7 IF YES, AT WHAT DEPTR? Deplh,o Water After ~)~¢ Date' ~oniloring? . Gross Net Depth to Net Reading Date Time Time Water Drop ---...... PERCOLATION RATE m tminutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN __ FT AND - --FT PERFORMED BY: ~'~,~ ~ ~")/~"~ I ~----~(/~ ~/L'/)~---- CERTIFY THAT THIS TESTWASPERFORMEDIN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: ~' ~g ~ -0o8 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION ENVIRONMENTAl. ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 'relephone 264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELL INSPECTION REPORT ~'UPGRADE DISTANCE TO: IF HOMEMADE: Inside length DweHing Material Foundation N e~ r es~-~oi~', Depth Crib diameter Crib depth Well Building foundation Depth Driller Building foundation Sewer line NO, OFBEDROOMS3 PERMIT NO. Liquid dej~t h PERMIT NO, Liqukt capacity in gallons PERMIT NO. PERMIT NO, Total effective absorption area Nearest lot line Distance to lot line n~ PERMIT NO, Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING DATE LEGAL -013 (Rev. 3t78) 'l"!'ll:i!; I_.~:';.t'.!(:ii'i'H D _1; t'"lt?~.~!;;I; O?',! -( S THE I..!FJ'.,IL;iTI..! ( ;i: t".1 F~il;IET ', 01':' "IHt:i; "'i:;;:('~;I",IC!'.I OR [:,~1:::I ii_' I".tF Jl iEL. D. THE DE!:::'"r'!4 CIF::' I':1 'i'!-tl::;i'.,t(;:H I~t:;~OLIN!]) FIi'.,!D THE ~!:(~rI"l"~]lt',! T!.!lili:,q:i!? i;S !'qO SET !.'.! ;t; D'I'H Ti'IE Gi';;!!:'.I',,,'E;I.. Di.?;t::'TI.I i:::i[',!D '!"HI( i:?,O]?O["l OF' I;i",ISTFil..~.I:::IT'[Ot'..! I~t',.tS!::'E~;;;T];(;INS I;;;1¢:' i'-li'-,!~r' [,!t;EI.I_.¢;; I:::IDJ'FICEi",IT "f'l;I TH);S F'I;i~I;;I!~::'IEI:;:I".? FIND TI-IE; l".!l..ff"il:ii:El:;'. OF !;~:E;::i;;t_'[;,l.~it'.,!(::l~;'il; 'r'HRT /37. o \ \ I hereby certify that I have surveyed the following described property'. /(~'~ Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the properW lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on prop- erty lying adjacent thereto encroach on the premises m .question and that there ~'e no road~vays, transmission bnes or other visible easement~ on ~aid property except a~ ~dicated hereon. Dated at Anchorage, Alaska this /~ day of ~/~/~v~., 19 ~ED WA~A & A~8OGIA~8 Engineers and S~eyors GREA. ,:R ANCHORAGE AREA BORL ,GH 3330 C Street . (?' Anchorage, Alaska 99503 INSPECTION REPOR¥ ~)N-5~TE SE~ blSP~)-~'AL SYSTEM LOC^T,ON LE~ALDESCR,PT,ON /~ /5--,~/~ / SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY ___ GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL ~¢ / - I~_ ' OUND^T,ON__/?) _NEAREST LOT ',NE._/? //__ TOTALoE L,NEs"ENCTH NUMBER OF LINES__~____DISTANCE BETWEEN LINES_ ~/~ TRENCH WIDT~IN. TOTAL EFFECTIVE ABSO~PTIO~ A~hA ~__ S~. FT. LENGTH OV EACH ~/ DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE ~ ABOVE TILE_~/ IN. WELL: TYPE BUILDING FOUNDATION CESSPOOL _ APPROVED CONSTRUCTION DEPTH NEAREST SEPTIC SEEPAGE SEWER LINE TANK____, SYSTEM REMARKS NEAREST LOT LINE OTI lEI;: SOURCES _ DISAPPROVED _ __ DISTANCE FROM: DISTANCES: _._ INSTALLED BY: SEWER LINE DEPTH: PIPE MATE RIAL~')~¢~'~- LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM ut/ , : I1:.11 :l::iil;: HI:::I::-:: :t: I'11..11'1 I',,11 li'"IF::I!::F' r' F' I,, IL I t I ?:; TFIEi: L.ILN .:.i ['1.t I'tllii: I::,I:~I::'TH O1::: I::I TI:;iJ~!:i'.,IC::II C)Fi: I::']:'i' :[::~i; 'I'I..IE: I:::,:I::!:i;'I'Flt'.,ICI!i: l!i:l!i:'l'Hl!~Ei:N I'HI':: :i~I. II:;i:I::;F:tC~i: O1:::' C!il:;:Ot. ll'.,IB, I::tI'.,tD I'l..lli::: li~(?l'l'C)l'lC:iF::ti. Iii: I:.,.~L..I.I,,,IIt It.llii:F::li: ' . - :' '"" ' ' I.., I'.,I u . L. I I,.I :[ DTI-I F Ot::~: I l:.l:::J.,IL.kll::..::,.. . :liE!: dil:,~:l:::l',,,'lZL E:,E:I:::"TI.I :Ii:iii; '['l.lli~ I','I:I:I'.,I:t:HI..II,'t I)l!i:l:::"l'l~l O1::: .......... I:::11'.,11:::~ 'fl.Il!i: liu::)"t'FOH (::!F "1"1-11~ ti::-::Ct:::I',,,'F::IT]:ON ,::):1'.,f F:'liil:'l"::,. I~::l:'tl.lliii:l:;i: l:::l (:::[ I:::lt!ii;:E; :i: :':l:u :t::[ I'.,Rii;l::: I::ll:Z'F:'f;i~l:)',,,'l~i:[:: I::1 COI",t i ): Nl_lOl.l::il; I'"ll:Zl ): 1'.,1'I I!:NFINClii: F:ICiiF~:Iii:IE:t','II:'i:NT I:::ll::iili:li:li:l'"lt!i:l'.tll' :I:iE; I'.,Ii::FI' I.:::li:P'l CI..tl:;itl:Rl!!i:l'.,l'f "r'-' I"IFI'T' ti~',E: F~:ti~:QII]:l:;i~li:t) '['O I!:!:I'..tl.F:I!:;i:Gli.-: ['HI!i: c;'~ll t..t I I.I.tlt :ii;'r':!ii;'l'li:l'l FIt",II:::,,.'"CII:;~[ 'r~::ltl I'lF::l"r' ]:1:::' I:::1 C:l.!:::l:i~;:il; ~: ~:?'r':!i;l'k{H ]:t:i: l.J%Ei:l? TI'Iii!: [.l!i:F.t(~i'l'l-t Z'::; :1:t:;:' I:::1 CI I:::t:ii;:!i; :t: [ tl .il ]::!i; t.I:!~;E:t::, TI"IIZ k.lii:l",Ir:iTH. E:NI_I:::II:;irGlii:f'IE:i'-,I1 :IF 't'l"ltJJiZ QGRE."' R ANCHORAGE AREA BOP" Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 3H INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM (] ('?/L)(~ ~''' MAILING ADDRESS . ()-[~4, /~O ;~ ~7/C,'~,- ~ PHONE'?~'7/-/ SEPTIC TANK: DISTANCE /~l¢~,/].l~,~17 FROM WELL~--'U' ' MANUFACTURER INSIDE LENGTH INSIDE WI DI'H COMPARTMENTS j LIQUID DEPTH lIQUID CAPACITY t (?) ~}~-~=)GALLONS. SEEPAGE Pit: NUMBER OF PITS / DIAMETER MATERIAL _ ~ CRIB SIZE: LINING BUILDING FOUNDATION NEAREST LOT LINE ~}C~ I TOTAL EFFECTIVE , . ABSORPTION AREA (WALL AREA) /3'/ OR WIDTH / ? LENGTH =), DEPTH DIAMETER ,DEPTH ~,_ DISTANCE FROM: WELL(~()/~.//~] ~7'~}~.. (55~ C) () SQ. ET, ADDITIONAL ABSORPTION WELL: TYPE ~_~--¥-~/~-~w-.~ CONSTRUCTION DEPTH BUILDING NEAREST NEAREST SEPTIC FOUNDATION LOT LINE SEWER LINE_ TANK CESSPOOL OTHER SOURCES APPROVED . DISAPPROVED REMARKS DISTANCE FROM: SEEPAGE SYSTEM _ DISTANCES: INSTALLED BY: ) ~ · ~L- Q2.-C)~--~ PIPE MATERIAL: REMARKS: Form No, EQ-031 DIAGRAM OF SYSTEM S;~,I le - i .'. 33, ~ C../c X GREATER ANCHORAGF AREA BOROUGH 3330 "C" STR~% ANCHORAGE, ALASKA 99503 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMITNO, NAME OF *"PL~CA~T .//~0 INSTALLATION LOCATION LEGAL DESCRIPTION . PHONE INSTALLATION OF: SEPTIC TANK ~ SEEPAGE Pit ., DRAIN FIELD ........ OTHER TYPe AND SIZE OF FACILITY TO BE SERVED AREA SIZE 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PFr F~TTED WItH A~RTfGH'I' REMOVABLE CAPE;. CONFORM TO BOROUGH ~EGULATION$ REGARDING INSTALLATION. P'ORM NO, EQ'O$ 6 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Divisioe 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 _'~O_~ - I(~ HAA # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency _ Mailing address Agent Address Day phone '2 ~ L-~ Day phone 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. 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. 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 ~ ~o/-' (-.. 51~1.,¢_. g',..,4 ~, ¢. / ,'-, ~ ,¢ ~/.¢,.d ph o ne Address Date DHHS SIGNATURE /~ Approved for ~-/'¢¢s~"~' '('~' bedrooms. Disapproved, Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Sen/ices (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAl. CHECKLIST Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number M [)ate completed ~v'/A- Driller _Cased to M//I Casing height I~//.¢, Wires properly protected (Y/N) Date oftest Static waterlevel Well flow Pump level FROM WELl. LOG ~V/~ g.p.m. AT INSPECTION tv/C,. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 2 ~ c~ ~-- Absorption field on lot ~ c:, ¢ ~ Public sewer main i'd'~,~ e Sewerserviceline Zu¢ . (¢¢. c~,t- ) ·; On adjacent lots On adjacent lots Public sewer manhole/cleanout Petroleum tank -- WATER SAMPLE RESULTS: Coliform 5¢¢- 1¢ t. I-~¢ Date of sample: Nitrate ¢ Other bacteria '" Collected by; B. SEPTIC/HOLDING TANK DATA Date installed u~¢/.c~ u~¢v~ Tank size Cleanouts (Y/N) ~1/ t ?- ~-'~ ("~' [ Compartments 2. Foundation cleanout (Y/N) ~" ¢' Depression (Y/N) N/A Alarm tested (Y/N) A~Or ~ 7_ Pumper ~¢-¢'~5 ~e.~¢~¢/I)¢~,~ High water alarm (Y/N) Date of pumping SEPARATION DISTANCES FROM SFPTIC/HOLDING TANK TO: Well(s) on lot I,~.~ On adjacent lots ~ cc) ~ To property line ~- ~ ~ Absorption field %~ ~ Foundation Water main/service line Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION t,//~'~, Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed -z ,~' ¢, iw Length ~""~ Width Total absorption area % 6 '¢ Depression over field (Y/N) On adjacent lots Soil rating Results (pass/fail) 12 Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~r//-\ On adjacent lots To building foundation ~l ~" Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water System type Total depth bedrooms Gravelthickness Lt r- 1- Cleanouts present (Y/N) Date of adequacy test for ~ If yes, give date On adjacent lots '" .5~ ' Surface water ~ od ~ Curtain drain id or, ~- Property line To existing or abandoned system on lot Cutbank ~v,,¢~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineers Name HAA Fee $ ,/"~) Date of Payment //~/<:~ Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number October '12, 1992 WAI. r~.,[? ~,. HIC,/,FF.L, (907') [~4907755 PMblic~ W~ter ~/¢'+ ' ~.~.~,8t~ 8n(J found th~ folow '9 tho ,~tm+~, l~rinkir~g ,. ~.' ,~ I~ i)O~); ,~rnemt Or1 Augurer ~0, !992. "" u ~¢ , ,' ,,", , :: t~] ;~AC: ~?0?O0(a), State Drinking Water' Regulatior.,f;. o.:' ,:.. provisior;::; of the '-~ ~,,~ E)rim, kir~Et R.¢;¢ILi!~t C 15. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~,~ - ~"~.'~l OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Data 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) L( ns) (c) Telephone (d) Real Address ~d Agent Telephone (e) Mail the HAA to the followin(~ address: or: Check here ED, if hold for pick up. contacf; p~rs~ ~nd day phone~umber below, TYPE OF RESIDENCE Single-Family~ Number of Bedrooms WATER SUPPLY Individual Well [] Community~[~. Public [] Note: If com munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL ©nsite/~,. 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 72-025 IRev 81861 Fronl ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As cedified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this HeaJth 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. ~ further verify that based on the information obtained from the Municipality of Anchorage tiles 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 /..)L~_,.,.<" Telephone Address /"~ /d.~J~' /¢¢¢,~ /~rTC~j~ /Cz/d// //'X'" Date DHHS APPROVAL Approved for ~/'~-~---~ ~'~'~bedrooms by ' Approved Disapproved -- Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 CRev 8/86) Sack WELL DATA ~C.'~.~I~'CIPALITY OF ANCHORAGE (MOA) ., O~ .~.~\q~/EALTH AUTHORITY APPROVAL (HAA) ~ ~' ~HECKLIST- FEBRUARY 1984 ,~ ~ %~ 264-4720 .. Well Classification )g Present (Y/N) Total DE Static Water Casing Heig Electrical Wiring in Conduit Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved Y~N) ,. Date Completed Yield Cased to Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ,ining Lots To Nearest To Nearest Sewer Service ; Date Lot SEPTIC/HOLDING TANK DATA Date Installed Standpipes(~) ,~r-~ Air-tight Caps~/~) Depression over Tank Pumping/Maintenance Contract on File (Y/N) .., Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~"~ To Pr0perty birt~ /0 To.Water Ma n/-seRi.~e Line :Course ' "' .,. ~- Comments .,'E~, :t,. Size /z~.%~, No. of Compartments Foundation Cleanout (Y./~. Date Last Pumped /¢~¢ '- -~%~¢~'¢ ~' . '~ ;for ' / ~ ~:'~ ~¢¢' Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption ~trata ? ~3"7 Date Installed ~-//*~Z~. / ~/~f¢~' ¢'-Z-.~ // / Width of Field ~.~/~' ..5 ' ~,~'.-P_/~L~ ~ Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test 'Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ~ / To Water Main/Service Line /~ '-/-' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ¢'-~'/'~ - .~¢/: / Depth of Field ¢,'~/~' - /~' Gravel Bed Thickness ~.'~/~ - ~ Standpipes Present~) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots /(b To Cutbank (if present) Comments D. LIFT STATION Pump On Level at ~ High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) -'"""'""'~_.~.Pumping Cycles during Adequacy Test, Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** ~ ...... I certify t hat I~..~e ,¢~ec/k. ecJ~.verified, or conformed t%all MOA and HAA g uideli nes in effect on the date of this inspection. Company ,/¢~¢-,~ MOA NO. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) DEPT. OF ENVIRONMENTAL CONSERV/kTION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 ~TEVE COWPER,, GOVERNOR Telephone: (907} Addre,~s: # 274-~533 PWS I.D.~ To Whom it May Concern: According to records on file in this office the Water Regulations Water System is in compliance with the State Drinking Sincerely, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 15, BK1, Sky Ranch Estates II 10-2-86 (b) (c) Location (address or directions) Corner of Whispering Spruce & Paddock Applicant Name Realty Center Telephone: Home Business 344-0501 _ Applicant Address Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other ~ (explain); ~Equitable Relocation (d) Lending Institution _ N/A Address Telephone (e) Real Estate Company and Agent Address P, ealtv Center Jeanette Grigs. Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms Other attesting to the legalitY/and status. SEWAGE DISPOSAL Onsite [] Public [] Community [] 3. WATER SUPPLY ~-¢,Y'??~!i~: ::":: ~ Individual Well [] i'i';~Community R'l. ~ Public [] Note: fcommun tywe s~Stem~-chuSt havewrittenconf rmation from the State Department of Environmental Conservation Holding Tank E] ' ' Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-005(11/84) ENGINEERING FIRM PROVIb~NG INSPECTIONS, TESTS, FILE SEARCH, L~ATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date showe 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 D~tum En9ineerinq_ Telephone 563-3142 Address 4500 Business Pk. Blvd. - Bldg "C" Anchora.qe~ AK 99503 Date 10~2-86 Engineer's Seal Approved for ~'r~¢'~-~'~-'--' bedrooms by ~/} ''' ~ ' ..... ~-' ' - Approved /'.,-~'~"'~- Disapproved Conditional Terms of Conditional Approval , bAUTI~N ,' The Muncipality of Anchorage Department of,Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given i~, paragraph § above by an independent professional engineer registered in the State of Alaska. The DHEP doeslthls as'a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a cedificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Lot 15, Bk. Legal Description: Estates II 1 Sky Ranch Well Classification A Community Wel 1 If A, B, C, D.E.C. Approved (Y/N) Y Well Log Present (Y/N) N/A Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ;On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B, SEPTIC/HOLDING TANK DATA 6-11-82 size 1250 Date Installed Y Standpipes (Y/N) Air-tight Caps (Y/N) Depression over Tank (Y/N) N Pumping/Maintenance Contract on File (Y/N) N Holding Tank High-Water Alarm (Y/N) N Separation Distances from Septic/Holding Tank: To Water-Supply Well N/A To Property Line 9' tO E;P,[;, 51[' to S,P,L, To Disposal Field To Water Main/Service Line 93 ' 2 No. of Compartments Y _ Foundation Cleanout (Y/N) Date Last Pumped //4 '-~.- ~(~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation N To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026{11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 6-11-82 Width of Field 3 ' 250 Ft2/B.R. Square Feet of Absorption Area 900 Depression over Field (Y/N) N Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well N/A To Building Foundation 53 ~ Lot N/A To Water Main/Service Line 101 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Trench Length of Field Depth of Field Gravel Bed Thickness 72" Standpipes Present (Y/N) Y Date of Last Adequacy Test ]_0-1-86 930 qallons introduced @ 6~ gal. per min., no rise-system- adequate To Property Line 15' from S.P,L. 37' from- EP.L. To Existing or Abandoned System on ; On Adjoining Lots N/A To Cutbank (if present) N/A N/A 20' D, LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) N/A Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t he. t21 have che~k~, verj~[ied, or conformed to all M~OA a.nd HAA guidelines Dompany-/. MOA Receipt No. ~ OO / O O ~ Date of Payment ~OO ~ Amount: $ ~ - Page 2 of 2 72-026 {I 1/84} in effect on the date of this inspection. Engineer's Seal DE RO T ~kTION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (.gO7} Address: 274-2533 DATE: To Whom it May Concern: According to records on file in this office the Water Regulations Water System is in compliance with the State Drinking Sincerely, ~amcs C. All,en , Regional Sanitarian Supervisor ~ GREATER ANCHORAGE AREA BOROUGH ~ Department of Environmental Quality ~IID 3330~ ~ - "c" Street, Anchorage, Alaska 99503 274-4561 Time of Inspection ~'3~/~'m' _ ~ ~ Oate of Inspection 3- ~ed. I~BI¥IDDAL SE~ER & ~ATER [AClLITIES FOR ~d R±nner w±ll moet you at property o 4. 5. 6. 1. Approval requested by: Securlt¥ l~aclfic Mortgage Mail.ing Address: _iici ]3ast 9]t~dor I~oad 2. Property Owner: Mailing Address: Legal Description: T.ot 15 Bioc]~ 1 $]~¥ Ranch Location: .. See attached map Type of facility to be inspected 5±nc~le ]ramJ. l¥ Phone: 276-1933 Phone: No. of bedrooms 2 Well Data: A. Type Commualt¥ B. Depth C. Construction D. Bacterial Analysis Sewage Disposal System: O~-~lte A. Installed 19~'~ B. Installer C. Septic Tank: 1. Size /~2~ 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material Field: Total length of lines E. Disposal Distances: A. Well to: Septic tank Nearest lot line Foundation to septic tank , Absorption area , Other contamination B. , Absorption area C. Absorption area to nearest lot line , Sewer Lines ___, EQ-O34 (1/74) Page 1 of two pages Page 2 of two pages - R( ~st for Approval of Individual ,~er & Water Facilities Legal Description Lot 15 Block 1 Sky Ranch ~2 Comments Appro ~4~cJ2- . D i s a p p r o v e d ~-~ ~e-~__~,F_~z_~ [,/ Approval Valid for one y~ear from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I 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) ~NICIPALITY OF ANCtlOR^QE MUNICIPALITY OF ANCHORAGE DEPT. OF I'.':,'t I;-i O- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIOI~*NVIRONMENIAL ~,k~Ji~CTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 ~JAR ~_ -' 1977 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES ,,~,~, k,_~ ~~.JV~ 1. Type of Inspection: CMRO VA PropertyOwner: FHA. .CONV Mailing Address: L Day Phone: Mailing Address: ~ Day Phone: 4. Nameofl_endinglnstitution: ,~_C t,k~'¢~'----? t (~c-,ll ~, . Mailing Address:--//C~ / ~ /(~'"~ ~ Phone/: 5. Name of Realtor or Agent:_ ~-~ ~z'h~ ' . MaiLing Address: 6. Legal Description: ,/~ I IC I f Location: Type of Facility to be Inspected:- No. Bdrms.. Water Supply Type of Supply: Public Utility .Individual If Individual, number of dwellings presently served _ If Individual, depth of well_ Sewage Disposal System-- Type of System: Public ~Jtility. Individual (on-site)_ I, Individual, date of installation /~ p/'~z-'<:_} ,k// ~'~-°-~/~' (~ ~7~ f / 72-003(3/76) DATE SIGNED :j) ._ 4S ~69t SEND PART5 I AND 3 WITH ~BON ~A~- ]74 164 165 173 ~(~l> 175 ¥ 180 DeArmoun [load Area Reference t~lep-P14 5~arch 30, 1977 ~i final approval ~an b~ ~jranted, Al~o,. you would need to tank pu~apo~.. (1) D~ep tr¢,nch fol~ty.-.on~ (4.%) fe~t long, (2) '3:oral depth of fourteen (14) (3) F~rav~], d~pth underneath ttl~ pi.~ ~l~, (6) :feet. A ~J¢~we.~: up.gra~le p¢~rmit is requtre(! p)?t.or to inota!lation, March 10, 1977 Se,=urity Pacific Mortgage 1101 East Tudor Road - Suite 190 Anohorage, Alaska 99507 SubJe¢:t: Lot 15 B.I.o~k 1 Sky Ranch (~isposal system s~ving the subje~ prop~r'~y is inad~ua~.e for a two (2) bedroom residence and must ba upgraded before a final approval o~u% be granted. Also, yo~ wo~ld need to hav~ th~ standpip8 into t.he m~p'kic tank repaired and l:he tank pumped. Speoi£ications for the upg~,~ar(~ a~) follows: (2) 'l)ota. 1 d~pth of nille.~ (3) ..,ravel d~pth t~nderneath pipe eigh~-~) A sewer u~Ira~(~ )?ermit; is requi;~ed prior to installa-kion. If youhhave any fur%her questions, please ootlta~t this office at 279~2511~ ext~sion 224 or 225. Sincerely, John }(ennedy Principal Lnvironm~ntal Control Offi~er