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HomeMy WebLinkAboutSKY RANCH ESTATES #2 BLK 1 LT 17Onsite File Sky Ranch Estates #2 Block 1 Lot 17 #015-302-08 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211043 PID Number: 015-302-08 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Fmil Upgrade Name Ronald & Carol Todd Family Trust ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 11620 Paddock Lane, Anchorage, AK 99516 ❑ Other Phone Number of BedroomsTotal Rating depth from original grade 575-993-4738 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe in rom original grade Gravel depth beneath pipe Ft. Ft. Subdivision Block Lot Sky Ranch Estates #2 1 17 Fill added above original grade Gravel length Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines tance between lines Ft. SEPARATION DISTANCES Tol Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between hes From Tank Field Tank Line Ft2 Ft. Well >100' N/A N/A N/A >25' TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Tank Capacity 1,250 Gal. Surface Water >1 NSA N/A N/A Material Plastic Number of compartments 2 Lot Line >5, N/A N/A N/A NA Foundation>� Q' N/A N/A N/A LIFT STATION Manufacturer Capacity Remarks Septic is adequately sized for 4 bedrooms Gal. TANK REPLACEMENT ONLY Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Installer � JR s Septic Drainfield Existing CO/MTD3034 Inspector J. Miilette BENCH MARK (Assumed elevation) 100 ft Inspection 15t 6/9/21 Location and description dates: 2 nd th Bottom of siding 3'a 4 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp - Conditional Approval: Date low' ' • ��a�� 49 Septic System �� ti�.� Approved_ "e( Date �, (5 02 1 $ Benjamlr95chiller ��'. CE 12592 6/10/21 �s�F�. • , •�� AM - pROFESSO4 Note: this approval does not include well permit requirements. (Nev ub/u2/l t5) x x x x x x x x // // // 2CO 1"=30'3-BDRM HOMECO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND FCO PERMIT # OSP211043 PID # 015-302-08 SKY RANCH ESTATES SUB. #2, BLOCK 1 LOT 17 A B MH 11.7 SV 16.2 2CO 22.8 A B 30.8 34.3 39.4 PADDOCK LANEFEET 0 30 60 6/10/21 10' UTILITY EASEMENT NEW 1250-GAL SEPTIC TANK w/ 20" MANWAY EXISTING TANK REMOVED & DISPOSED OF PER UPC 5' SEPARATION FROM FIELD TO TANK CONFIRMED AT CONSTRUCTION 10'SHEDKEY-BOX LOCATION IS ACCURATE. WATER SERVICE LINE LOCATION IS ESTIMATED. SV MH PLAN AS-BUILT PROFILE AS-BUILT (NO SCALE) 93.65 88.6 94.3 98.6FCOMH SV1250 GAL SEPTIC TANK 2CO93.5 PERMIT # OSP211043 PID # 015-302-08 SKY RANCH ESTATES SUB. #2, BLOCK 1 LOT 17 6/10/21 i I i Lot 18 S 89'59'44"E 140.00' Lot 13 Lot 17 a /I SEPTIC PIPES 18,900 S.F. 2.0' xzs T CANT " Z 17'8• MANHOLE a w 28.2' J 0 3 N1 56.6' c' QV Z N 4.0'x9.0' CANT 24.3' !-1 W PORCH o O� O 23.3' r. -- DECK ASPHALT 2.0x25.3 CANT 24.2' DRIVEWAY Lot 14 C+ 70.1'x121' SHED N CA N 89'59'44"W 140.60' CHAIN-LINK FENCE III Lot 16 10' UTILITY EASEMENT I I 30.0' I I 1 ``I 0 0 0 J N r NOTES: 1) LOT IS SERVED BY A COMMUNITY WATER SYSTEM. PLOT PLAN --- AS BUILT _x_ SCALE 1" =_30__ GRID — SW 2737__ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone oo000p4� Professional Land Surveyors (907) 592-46y5 Fax kenOlansurvecom OF A���04 jonothanOlongsurvey.com SOP S 04 I hereby certify that I have surveyed the following described property: LOT 17, BLOCK 1, SKY RANCH ESTATES — UNIT No. 2 (PLAT No. 71-290) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the __I 4 _ Day of �vr - 7a L ___1_, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH*l ................ e.1............ .A KENN H LANG'.' a; �p vFo 4�QOR0FESSIONAI ..LS -5202. y�oG o0 �40000�� AECC963 February 19, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 2/19/21 Subject: Sky Ranch Estates #2, Block 1 Lot 17 – Paddock Lane Septic tank replacement Dear On-Site Services Engineer: The owners of the above lot intend to sell their 3-bedroom home on the property and the existing septic tank is well beyond its 30-year life expectancy. They would like a new septic tank adequately sized to match the existing 4-bedroom septic system on the lot. Therefore, we are submitting this permit application for its replacement. The subdivision is serviced by a community well that serves this lot as well as the surrounding properties, and is greater than 200’ away from the property lines of this lot. No septic system on this lot or adjacent lots will have any effect on the proposed septic tank location. The tank will be at least 10’ away from the foundation and 5’ away from the existing septic trench. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211043, Rebecca Carroll, 02/26/21 x x x x x x x x // // // 2CO 1"=30'3-BDRM HOMENOTE: THERE ARE NO WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY OR CONFLICTS SEPTIC SYSTEMS ON THIS LOT OR NEIGHBORING LOTS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND SKY RANCH ESTATES SUB. #2, BLOCK 1 LOT 17 PADDOCK LANEFEET 0 30 60 2/24/21 10' UTILITY EASEMENT 1250-GAL SEPTIC TANK w/ 20" MANWAY. DECOMMISSION EXISTING SEPTIC TANK PER U.P.C. INSTALL CLEANOUT AT END OF FIELD AND CONFIRM 5' SEPARATION FROM TANK. 10'SHEDKEY-BOX LOCATION IS ACCURATE. WATER SERVICE LINE LOCATION IS ESTIMATED. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211043, Rebecca Carroll, 02/26/21 'INICIPALITY OF ANCHORAGE IIeal and Environmental Protoc Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4'120 ............ INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NUMBF_ R OF COMPARTMENI'S _-<_ -- _ LIQUID CAPACITY~_?GALLONS. TILE DRAIN C~.¢-'~2 (5~ F TOTAL LENGTH ~! of Lines / _ Dlbl ANC[ BE'IWEEN LIN(ES _~.~ -- ~:NC 4 W~OnI,~. tN. 'rorAt_ EFFECTIVE 5Lf'PAGE PI'f: Log Crib .... Rings__ Crib Size: DIAMLI[ R_ __DEPIIt . DISTANCC FROM: WEI._L '10T/!L EFFEC'FIV([ 14EAnE5'I lOT L1NE .... AB%ORPTION AREA (WALL AREA) ........... S(]. FT, s1]. ].ass :~,~ Depth: 311 Distance To: Lot Line ]dg: Sewer Line: o~: Bedrooms: ~-- - --- I omarks: F'E'I~fl¥1:1: T FIP F:'I.... 1[ ORNT L. OC:RT ~ O1"~ LEC'iRL. LIifl' ::, 1 ,...[... HR}.',I['ILIP1 I'.,II...$1E:I.-iiR CIF E:El:;,F~:i.":ii;)l',l:5 = =, I ,::..E. ]iF SOIL THE F::E{;II...IIfE:E[:, '~"'"~ .... I'HE THE L.I~:NGTH DII"tENE;ION :If5 ]'HE L. ENi3TFI (IN FEE]') OF THE TRENCH {)F~ [:,[~:R]:I'.,IF]ZEL.[::,. THE DEPTH OF FI TF4'.ENCFI O[~'. P];T IS THE: DIfE;TRNC:E: E:E'i'L,.IE;iCN "FHE SI.JF4'.FI:ICE OF THE I[:it~C]l..JNb FIHD THE BCiTTOP'I OF THE E',*',CAYFITZON (ZN FEET). THERE ]:S NO SET HI[)TH FOR TRENCHES. THE GI:~'.R',/EL I)EPTH IS THE I¥tINIHIJH DEF'TH OF G~'.RVE[.. E:ETHEEI'.,I TH[< OIJTFFII....I..r. I::' :[1:~1[~: FIN[) THE 8OTTOFI OF THE IEHCRVFITION (IN FEET). FI F'RE:KRGE F'I_.RN'I" I¥11::t',r~ BE INF:,TFILI,...IED, Fl"[' ]'HE: PEF. ti',IITTEE"$ EiPTICiN SUBJECT TO THE F'EiI...L.i}!.,.] :[ I,,lll E:Eli',,ID I 't" :[ ON.C,: :'L. E:["I-FIEI:r:: R Cl..RS:!:'; I OF:.' Z]: N'..T,F RPPF~OVED PL. FINT HFI'-r' BE INSTRI...LEE:,, 2. FI CL")NT:I:IqUOU'.".:; i',ff:t'I:NTENRNCE Fll3F,'EEHE:NT IS REQIjI[r::EI::,. :IF' FI I',IFI:[NTE~NFINC:E: RC. iF.'.EEP'IEI'.~T :[S I'.,IOT I.{PT. PT Ii:IJI~'.F.'.ENT "r'OIJ i"IFIIT' BE REQI.J:[REI) TO ENLF:I~'.EiE ']"HIE FIE:SEiF::F'T:[LqN .?.,'*".E;TEht FII",IE)/OI~'. MEiU r'iFl"r' E:E SI..JB,IECT TEl F'i~:OSECIJTIOi",I. I'"I:[NIHLP1 [:, ]: DI"RNC:E E=ETI4EEIq R 14ELL RI",ID RNS" ON-SITE SEHRGE DISF'Og;RI_ S"r'STEH lIS ':Le(~ FEET FOF.'. R F'R:[VRTE 14EiLL OF..' 20[a FEET FCiF:. R F'UE:I_IC HELL.. CF[PIEI:;?. REE~UZ[~'.EHIENT'.:F, h'lFt"r' RPF'L'mt SPEE:IF~L".':RT:[ONS FIN[::' CONSTF~:LICTION DIRG[~'.Ffl"I$ FIF?.E FIVFI I LFtBI_E TO Z NSUF::E PF.'.OF'EF..' ]: NSTRI_I_FIT ! ON. I CERTIFY" THFIT :i.: I Fll',l FRP'IIL. IFhe. WITH THE RE~:g!I.JlREHENTS FOI~'. OI'.,I-.,,glITE SEWERS I::II'.,ll} IqEI..,I..:E; I:~'ii; :!~;[-':T FOF:'.TH E,"¥' THE I"ILINICIF'RI....]:T"r' OF RIqCHOI~'.RGE. 9.: I I.,.III..L. lN.Cr:rl"l:ll,.A, THE 5YL:;TEP'I IN F'ICCC~F.:bFiNC[:. !,.I.'[TH THE COE)ES, 3: ]: IJN[>[EF::.9;TFtNIX) THRT "FHE ON~-'..S,:['I"E :E;E.~qER S'-r'~rl"El"i MR'~" REQLIZ[~E ENLRF~'.GEP1ENT II:::' "tHE RES :1: [)IE:i'.,IC:E I :E'; I~:IEHIiiDELE[:, 'T'O I NE:L.I..IDE I'dORE THRN ~ E:E[.~'.CIOI',I.'F.;. May 20, 1976 Mr. Monte Acheson SRA Box 1623-D Anchorage, Alaska 99507 RE: Soils percolation performed on Lot 17, Block 1 of Sky Ranch Estates Subdivision Dear Mr. Acheson: Attached please find the results of a soils log and percolation test performed on 5/19/76 as per your request on the above referenced lot. The soils classified visually at an average of 216 ft.2 per bedroom, but percolation tested at 65 ft.2 per bedroom. I feel this discrepancy is due, largely to the lenses of relatively clean gravels found in the interval from -3 to -8 feet at the perc test site. If permission is given to base septic system design on the perc test results of 65 ft.2 per bedroom, I would highly recommend locating the seepage pit in the inmlediate area of the perc test hole. I would also recommend having a qualified geologist inspect the seepage pit during excavation to determine whether or not the material is acceptable. Thank you for contacting us regarding your percolation test. Should you have any questions, please feel free to call me. Sincerely, AIASKA GEOLOGICAL CONSULTANTS, INC. Steven A. Johnson Engineering Geologist SAJ/gp attach. 702 West 32nd Avenue * Anchorage, Alaska 99503 - Telephone: (907) 277-7601 MUNICIPALITY OF ANCHORAGE Departm c of Health and Environmental t ~cechion SOILS LOG PERCOI~TION TEST Performed for Mon~e Acheson Date Performed 5/18-19/76 Legal Description Lot 17, Block 1, Skyranch Estates Subdivision (See back for hole location) Dark red-brown, silty sand (SM) Perc rate = 250 ft.2/bdrm. l0 16 Dark red-brown, silqy, clayey gravel (GM) with lenses of clean well graded gravel (GW) Average perc rate ~ 115 ft.2/ bdrm. Gray, sandy silt (ML) with some gravel grading with depth ~6 silty sand (SM) Average perc rate ~ 265 ft.2/bdrm. Gray, silty sand (SM) No water table encountered. AVERAGE PERC RATE FROM SOILS LOG = 216 ft.2/bd~n. Date Net Time Depth Net ~rop 5/19/76 36 min. 103 in. 89 in. · 5/19/76 64 min. 107 in. 93 in. 5/19/76 76 min. ].09 in. 95 in. 5/19/76 119 min. ].13.5 in. 99.5 in. Percolation Rate 1~2 .minutes/inch = ,65 ft.2/bdrm. * ~ · ~ attached letter. June 6, 1977 Acheson ~Jntor. Ino. Star Route A Box 1623D Anchorage ~ Alaska 99507 S%~bj ect: Perr,~].t ~,xplration Dear Sir: A permit issued by this depart.,,a~nt for well and/or on-si%e sewer installa~ion on 1~% 17 Block 1 Sky Ranch In 4~h~ event you still plan to install the w(~ll aha/or on-site s~wer systems, a new permit is required. The original sell test ~nay b(~ used to obtain a current permit. If tho well has been drilled, a well leg should be sunt this department to document ~he installation date. If you hs.w~ any questions regaraing the above matter, 4o not h~sitate to oontact this office ~.mra~diately at 279-2511, ~xtension 224 or 225. Sincerely, Les N. Bu¢ff[holz, R.So Saai.ar~an C, EF'FIRTt,I[NI' ,. HE:FILTH FIND P2NV):RONt"IENTFII OTECTION 2!5~I.E~ E:. TUDOD. F'.D,., I-:I['4CHOIq'.FIGE., t"tt<:. ~:} f~.4 -,~ :DJ;, :1[: 'T' E: :'~E; ~: l.-.l~ ~ ~-4.- IF:" ~: ( ?~62::L6 ) ~-FFL Z .Rtl[ L.C~(:::FIT ~ ON L.EGf;:IL _,U.[L HE,=,3RB f ION I,S: _ r =,TF-.H PIT HFI::.:::I:MI,,.IM I',II..IIIEE.[.. ElF BE[..ROOi'I.-:, =-' 4, :,Eli. F..q'f.[fl.I ';SL4 FT/'BR::'"~ '1'15 THE [(:E(~I.JZRE:[:,:,I,:.E"' '"' OF THE 2;OI1... RB.:-,CF,'F FION- ':;'" E::" EE IF::" 'T' H .== '¢"-'~" IL.. IF_. I"-,,! (~ ~IF' [-I == ;;Z ,'~ ,_... ;...,.. ,., ,~=.. ,, '~ .. qx'~, ,' , ~ , -~,' , , , THE LENGTt4 [.. IMIEN~':[ :N k THE LEr~,3TH ,IN F[EE"['."~_ OF' F~RC:H _"ICE: F'...K FI SEEFR:~I:~: F:iT IH[: DEPIH ElF R T[,~ENC:.H OP, F'I r I.% IHE D I-C, TFtNCE. XBE.'flCEEN '1 HE :iUF,..F'FiC:E. O[. TIdE i][;:CiI. Jbl[) RN[;, THE BOTTOH OF THE E:dCRVRTION IH[:. :~RR,EL BEFrH :(_, ]HE tlINIHUII O[:.F FH OF -w "- , ...... ~:'EEE'r). I::INI) THE BOT'['OFI OF THE E.,CPI~FI~ ILl1 (~N ........... ' E~ FFI .[ DEF'FIF~TMENT HZLL BE =,L,IE, J~.I._.~ TO P~0~gECUTZON. H:(N:[HUH DISTANCE BETHEEN ta HELl.. RND ANY CtN-SZ'I'IE S[EI.4FIGE E:,ISPO~;F'IL. ,:.u,:...-:,. l~ZIEI FEET F'O[~ A PR[',,,'RTE HELL OR 28'EI FEE'[' FOR' "A FUE, I..IC'"' HEL. I.~. HEE. FIVRILFIBI._.E "rn :,t-[:...IF.I...RIZCtJ:, FIND CONS'rRUC:TION [:,ff~GRRfdS/~, l. IJ.. I~L.I_PTIOf4. %_ ~/ : CERTZF'T' THFIT .: :*: Rr,1 FRHILIRR HITH THE REQUIREMENTS FOR ON--SITE SEHERS RND I,IEt..l.5 RE; E;[..:'l' :OF:'.TH BY THE F1UN~CZPRI..ZT¥ OF RNCHORRGE. :: I H:[L.L. IN%TRL. L THE: S'¢s'rErt IN RCCORDflNCE HITH THE C:ODES. :: I tJNDERSTRND THRT THE 0N-S;I'rE SEI4ED. SM~TEH MRY REQUIRE ENLFIRGEHEI'.,rf' :IF' THE ',EE;ZDENCE :IS REttODEI..ED TO INCL. U[:,E f, lO~:E THRN 4 13EE)ROOHS. Z ,:)c ~lt [ OI~ Si<etch Was Ground Water Enco rtered? ...... i(%~ ...... Date G;-o;u. ?ime Ne7 T!i;,e Depth To H20 ,'~et Drop Test Performed By; Do,,~ Certified 2y~ -: 1 !Fes; �."[ �A, Development Services Department On -Site Water &Wastewater Section Certificate of On -Site Systems Approval Parcel I.D. 015-302-08 1. GENERAL INFORMATION Phone: 907-343-7904 Fax. 907-343-7997 Expiration Date: 2, - 3 —Z © Z-� Complete legal description Sky Ranch Estates #2 Sub, Block 1 Lot 17 Location (site address) 11620 Paddock Lane, Anchorage, AK 99516 Current property owner(s) Ronald & Carol Todd Family Trust Day phone 575-993-4738 Mailing address 11620 Paddock Lane, Anchorage, AK 99516 Real estate agent Connie Giddings 2. TYPE OF DWELLING: ❑Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 907-257-0419 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ❑E Water Storage ❑ Holding Tank ❑ Community Well ❑s Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Dista Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5 5 0 Waiver Fee $ Date of Payment�5�21 Receipt Number 07� 96 0 COSA# C)SC.2 113 2 & Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Ben Schiller 6. DSD SIGNATURE System #1 Approved for 4L bedrooms System #2 Approved for bedrooms Disapproved Date 6/11/2021 .dew OF ALq��I� AW CO 0*: 49TH .f: r Ben)amtryySchiller 1259 VIIP?'- 06/11/22 lllaoaOF�WQO�4'" Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: Z `1 —Z l 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Sky Ranch Est #2 Sub, 131 L17 Parcel ID: 015-302-08 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA 11_,W log is filed with Onsite (or attached) Dat rifled Total dep ft Cased to ft ❑ Sanitary seal is func ing correctly F71 wires are properly protecte Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments *Community Well B. TANK DATA Age of tank(s) <1 years Tank type/material Plastic Measured operating fluid level in septic tank N/A FE -1 Standpipes/foundation cleanout per record drawing Date of pumping Tank installed on 6/9/21 Structure served by this system 1 I production at time of test gm Waters ge tank volume gallons Well disinfecte r coliform test? ❑Yes ❑ No ❑ Coliform bacteria is gative Nitrate mg/L ❑ Nit less than MRL (ND) Arsenic ug/L ❑ Arsenic le han MRL (ND) Collected by Date of Sample C. LI STATION ❑ Required ntenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 10/21/77 Adequacy test date 2/3/2021 IN ALL standpipes present per record drawing ResultsE]Pass -- - For 4 - --bedrooms Total measured depth from grade 8 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 5.2* ft (min) Water added 745 gal ❑ N/A — pressurized field New depth 17 in ❑® Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min depth into effective W Code -required soil cover over field Final fluid depth 0 in Absorption rate >600 gpd F-1 System presoaked (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A date of test) If yes, enter date N/A Gallons introduced gallons Comments/Deficiencies: 'Laser measurements indicate 7.1' difference between the 2CO and the MT. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) F- Septic Tank/Lift Station on Lot > 100' N/A Community Sewer Manhole/Cleanout > 100' N/A Yes if No ft [::]Yes if No ft Neighboring Tank > 100' ❑ Yes if No N/A ft Private Sewer/Septic Line > 25' ❑ Yes if No N/A ft Absorption Field on Lot > 100' ❑ Yes if No N/A ft Holding Tank > 100' ❑ Yes if No N/A ft Neighboring Absorption Fields > 100' N/A Animal Containment > 50' ❑ Yes if No N/A ft ❑ Yes if No ft if No ft N/A Manure/Animal Excreta Storage > 100' NIA Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' F- Yes if No ft Surface Water > 100' F Yes if No ft Property Line > 5' ✓0 Yes if No ft Wells on Adjacent Lots: ✓® Absorption Field > 5' 0✓ Yes if No ft Private Wells > 100' Fv Yes if No ft Water Main > 10'✓� ft Yes if No ft Community Wells > 200'✓0 Yes if No ft Water Service Line > 10' ✓� Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ✓l Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓® Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' 0✓ Yes if No ft Community Wells > 200' F/ Yes if No ft Surface Water > 100' ✓Q Yes if No ft F. ENGINEER'S COMMENTS Community Well G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet 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) Location (address or directions) Applicant Name ~0'~ (b) Telephone: Home ~ ~,,~' ,-O800" Business Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); {d) Lending Institution Address 30/ (e) Real Estate Gompany and Agent Address Telephone '~"'Z~"- //'3 8 Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well [] Communih,~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite I'~ Public [] Community [] Holding Tank [] 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 72-025 {11/84) 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 syslem is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection, NameofFirm ml~J~_f, 7'~C~O't¢~J' ~r~ Telephone ~'~,~- Address 1ff 3 Date ~ I~ ~ ~ I~ ~ DHEP APPROVAL Approved for Approved Engineer's Seal , Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHFP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of [)HEP 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 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL P~!OFECFION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: J..o,(' 1986 RECEIVED WELL DATA Well Classification fi Well Log Present (Y/N) Total Depth 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 Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments If A, S, 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 ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed Size Standpipes (Y/N) Y' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) ¢J,/~, Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line I0 To Water Main/Service Line Course _ ;~ No, of Compartments Foundation Cleanout (Y/N) Date Last Pumped , 7/~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ~ ' To Disposal Field I--c' .~e~/~c~e,,~ co,*5 To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026tl 1184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed I¢/'~f / Width of Field :3~' '" Iff ~'/8¢.4¢r,~, Type of System Design Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~.¢t.. To Building Foundation ~.~ Lot ~'~J' Standpipes Present (Y/N) ~" Date of Last Adequacy Test 7 To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Thc IT' SetOqr,*~ To Property Line lO' To Existing or Abandoned System on ; On Adjoining Lots ~ I 7 ' ~ To Cutbank (if present) I~,,~, 7~ (00' LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) 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 that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~""'~4~o¢/~."~. ~ /'~oor¢ Date 7 Company ,'~(~./'¢~? ?~a,~( ,.(u'cj' MOA NO. Receipt No. ~00 \ "~ Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) ~x.\'"' ." ' "; ~,~ ?~":'"TH"~ '"~'*' Engineer's Seal e,. v,~.'.. CE- 3589 .." r~ ~ BILL SHEFFIELD, GO~/EBNOB DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 Telephone: (907} Address: 274-2533 DATE: July 16, 1986 PWS I.D.# 211813 To Whom it May Concern: According to records on file in this office the Sky Ranch Estates Water System is in compliance with the State Drinking Water Regulations Sincerely, PROPERTY OWNER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HI~ALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 8?.5 L Street- Ancl~orago, Alaska 99501 Telephone 26~,-4720 CERTIFICATE OF INSPECTION SEWER AND WATER FACILITIES MAILING ADDRESS LEGAl. DESCRIPTION 3. TYPE DWELLING B::f SINGLE FAMILY RFSIDENCE L~ OTHER(Describe) [:l MULTIPLE FAMILY RESIDENCE 4. WATFR SUPPLY INDIVIDUAL COMMUNITY/PUBLIC E, SEWAGE DISPOSAl. INDIVIDUAL/ON-SITE PUBLIC UTILITY HOLDING TANK (Maintenance Required) C]'~'APPROVED FOR _._:/ BEDROOMS CTJ CONDI'rlONAL APPROVAL (See Attached) DISAPPROVED DATE 8Y (TITLE) 72-014 13/78) MUNICIPALFI'Y OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 Type of Inspection: REQUES'r FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES "CMRO VA_J .FHA ,CONV4 Property Owner:_, /(_///,, /~? 2" c~ ,ZJ ~'/~ ~;'/~,l,' '~' ? ~ ~/~: ~-- ,~..- Mailing Address:.~_/~'/~' /~ /~ 4 ~ "/~ Day Phone: Name of Buyer:~ ~ ,~,~.~ ~-~, ~ ~'~ l] Mmhng Address:__~_./~ Name of I_ending Institution:. Mailing Address: 5. Name of Realtor or Agent: Phone: Mailing Address: Legal Description:_ /; ~'~ 7' Phone:, ,,~/'(~ /i~,, 4 7. Type of Facility. to be Inspected:. ~",,~'"~ '-( 8. 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 Utility. If Individual, date of installation~ Individual (on-site) 72.003(3/76)