HomeMy WebLinkAboutSKY RANCH ESTATES #2 BLK 2 LT 14Lo"'
(Rev 05/02/18) /
Municipality of Anchorage
On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP251432
PID Number: 015-302-38
Dwelling: RN Single Family (SF) El with ADU El Duplex (D) n Two Single Family Project: [] New * Upgrade
Name
Jennifer Mabry
ABSORPTION FIELD
no Deep Trench F] Wide Trench n Bed M Mound
Site Address
11741 Pinto Cir
0 Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
(907) 230-8090 13
0.45 GPD/SF
17.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
8.0 Ft.
Gravel depth beneath pipe
9-0 Ft.
Subdivision Block Lot
Sky Ranch Estates #2 2
14
Fill added above original grade
0.5 Ft.
Gravel length
56.0 Ft.
Township Range
Section
Gravel width
3.0 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
1
Dist. between trenches
N/A
From
Tank
Field
Tank
Line
1,008 Ft2
Ft.
Well
N/A
N/A
N/A
N/A
N/A
TANK FR] Septic ❑ S.T.E.P. E] Holding 171 Other
Manufacturer Capacity
Greer 1000 Gal.
Surface Water
>100'
>100'
N/A
N/A
Material
Plastic
Number of compartments
2
I
Lot Line
>5'
>10'
N/A
N/A
NA
Foundation
>10'
>10'
N/A
N/A
UFT-111ATION
Manufacturer
Capacity
Remarks Tank rated for 10' burial
Gal.
Alarm location
Electri i talled by
PIPE MATERIAL House to tank D3034 drainfieldTank to D3034
Installer
Northern Excavation
Drainfield D3034 CO/MT D3034
Inspector Justin Earls
BENCH MARK (Assumed elevation) 100 ft
Inspection 1- 2/3/26 2/5/26
Location and description
dates: 2 nd
Bottom of siding NE corner
3rd 4th
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
,gal
Conditional Approval:
Date
49
Benja "f.iSchiller
CE 12592
1-.2/17126
Septic System
Z
Approved
Dat
PROFESSO
Note'. this approval does not include
well permit requir me Its.
(Rev 05/02/18) /
Benjamin Schiller
CE 12592
R
E
G
ISTEREDPROFE S S I O N A L E N GINEER
1"=20'
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 #2, BLOCK 2 LOT 14
A B
2CO1 27.1
MH 24.4
SV 22.0
A
B
C
C
2CO2 21.1
CO1 17.3
MT1 15.8
CO2 48.0 47.6
42.8
47.6
51.9
54.4
71.5
FEET
0 20 40
NOTE:
TANK AND TRENCH ARE >10' FROM PROP LINE AND FOUNDATION,
CONFIRMED DURING INSPECTIONS
PLAN AS-BUILT
12/1/25
10'
W
A
L
K
W
A
Y
E
S
M
T
3-BDRM HOME
TH#1
MT1
CO1
MT2
CO2
2CO2
NEW 1000-GAL
SEPTIC TANK
56' LONG X 3' WIDE, 9'
EFFECTIVE DEPTH TRENCH
PI
N
T
O
C
I
R
595
590
585
ON COMMUNITY
WELL
ON COMMUNITY
WELL
WATER LINE
KEY BOX
TH#2
SV
MH
2CO1
MT2 45.8 45.9
72.8
PERMIT # OSP251432 PID # 015-302-38
PROFILE AS-BUILT
(NO SCALE)
94.3
89.8
94.8
100.5
FC
O
MH
SV
PERMIT # OSP251432 PID # 015-302-38
SKY RANCH EST #2, BLOCK 2 LOT 14
1000 GAL
SEPTIC TANK
2C
O
2
94.1
Benjamin Schiller
CE 12592
R
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GISTEREDPROFE S S I O N A L E N GINEER
2/17/26
101.8 FINISH GRADE
56'
DRAINFIELD ROCK
MT
1
TH
#
2
NO GROUNDWATER 2/17/26
84.3
CO
1
CO
2
78.3
93.3
101.3 ORIGINAL GRADE MT
2
2C
O
1
84.3
93.3
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 2
DATE READING NET TIME(minutes)
DEPTH toWATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
DEPTH TO WATER AFTER MONITORING
60
2/4/26 1
2
3
SM (SILTY SAND w/ GRAVEL)
Professional Engineers Stamp:
SKY RANCH ESTATES #2, BLOCK 2 LOT 14
2/4/26 015-302-38
JENNIFER MABRY
4 8
16
OB
30
Benjamin Schiller
CE 12592
R
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GISTEREDPROFE S S I O N A L E N GINEER
PERC TEST LOCATION
TECHNICIAN:JUSTIN EARLS
5 0
16
NONE
2/17/26
COMMENTS:
SITE PLAN
8
16
USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED EXCEPT WHERE NOTED.
2/17/26
MOISTURE NOTED AT TIME OF DIGGING?NO
20
4 8
1630 5 0
16
8
16
4 8
1630 5 0
16
8
16
21
22
23
Permit Number:OSP251432
Tax Code Number:01530238000
Work Type:Septic Upgrade
Effective Date:
Design Engineer:
Site Legal Address:SKY RANCH ESTATES #2 BLK 2 LT 14 G:2737
Owner:MABRY JENNIFER
Site Mailing Address:11741 PINTO CIR, Anchorage
Lot Size in Sq Ft:17494
Total Bedrooms:3
This permit is for the construction of:
Disposal Field Septic Tank Holding Tank Privy
Non-Public
Water Well 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. Coodinate with On-Site staff regarding preferred method.
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
12/16/2025
12/16/2026
FORGE ENGINEERING
Special Provisions: A test hole is required at the proposed field location to confirm separation to impermeable
soil, seasonal high groundwater, and percolation rate. Construction may proceed at your own risk before
completing the 7-day groundwater monitoring. If results require design changes, work must stop until a change
order is approved. Submit all test hole results with the inspection report or change order, as applicable.
Expiration Date:
þ þ ¨¨¨¨
Issued To:
Issued By:
Date:
Date:
12/16/2025
12/16/2025
FORGE ENGINEERING
Isatou B Njie
MUNICIPALITY OF ANCHORAGE
On-Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On-Site Wastewater Disposal System Permit
December 9, 2025
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Sky Ranch Estates #2, Block 2 Lot 14 – 11741 Pinto Cir
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot owns a 3-bedroom home on the property. The septic system that serves
the home has reached the end of its useful life, so we are submitting this permit application for the
construction of a new septic system. The attached site plan identifies the location of the home as
well as the proposed septic location. No conflicts exist between this proposed system and any other
well or septic system, whether on this lot or adjacent lots.
The ground surface on the lot has a mild slope of less than 10%, sloping from east to west. There
are no slopes greater than 25% within 50’ downslope of the proposed system. Contours are shown
on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this
septic system. The new trench will be constructed parallel to the slope as much as possible.
This and all nearby homes are served by a community well that is more than 200’ away. The new
system will be a minimum of 100’ from all surface water, more than 5’ away from the septic tank,
and more than 10’ from the foundation and property lines. A confirmation test hole will be dug
prior to install since the one we used for the design is >30’ from the proposed trench.
Please refer to the attached test hole log, plan and profile pages 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
OSP251432, Isatou Njie, 12/16/25
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
1"=20'
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 #2, BLOCK 2 LOT 14
FEET
0 20 40
NOTE:
ENSURE TANK AND TRENCH ARE >10' FROM PROP LINE AND
FOUNDATION
SEPTIC PLAN
12/1/25
10'
W
A
L
KW
A
Y
ESM
T
3-BDRM HOME
TH#1
MT
CO
MT
CO
EXISTING SEPTIC TANK
TO BE REMOVED OR
CRUSHED AND
BACKFILLED
2CO NEW 1000-GAL
SEPTIC TANK
56' LONG X 3' WIDE, 9'
EFFECTIVE DEPTH TRENCH
CONFIRMATION TEST HOLE
TO BE DUG PRIOR TO INSTALL
PI
N
T
O
C
I
R
595
590
585
ON COMMUNITY
WELL
ON COMMUNITY
WELL
WATER LINE
EXISTING TRENCH TO BE
DECOMMISSIONED, REMOVE
EXISTING PIPES
KEY BOX
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251432, Isatou Njie, 12/16/25
SKY RANCH ESTATES #2, BLOCK 2 LOT 14
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
DESIGN FACTORS:SYSTEM REQUIREMENTS:
450 GPD PEAK FLOW
PERK RATE: 60 MIN/IN
APPLICATION RATE: 0.45 GPD/SF
9' DEEP TRENCH SYSTEM
1000-GAL SEPTIC TANK
BOTTOM OF TRENCH: 13.5' BELOW GRADE
FLOW LINE ELEVATION: 4.5' BELOW GRADE
450 GPD / 0.45 GPD/SF / 9' DEEP / 2 SIDES = 55.6 LF TRENCH REQUIRED
(56.0 LF SPECIFIED)
GEOTEXTILE FABRIC
12/1/25
PROVIDE ADDITIONAL FILL TO
ACCOUNT FOR SETTLEMENT
3'
6"
4'
9'
6"
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251432, Isatou Njie, 12/16/25
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 1
DATE READING NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
DEPTH TO WATER AFTER MONITORING
60
11/10/25 1
2
3
SM (SILTY SAND w/ GRAVEL)
Professional Engineers Stamp:
SKY RANCH ESTATES #2, BLOCK 2 LOT 14
11/10/25 015-302-38
JENNIFER MABRY
93 8
16
OB
30
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
PERC TEST LOCATION
TECHNICIAN: JUSTIN EARLS
94 4
16
NONE
11/18/25
COMMENTS:
SITE PLAN
12
16
USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED EXCEPT WHERE NOTED.
12/1/25
MOISTURE NOTED AT TIME OF DIGGING?NO
20
93 8
1630 94 0
16
8
16
93 8
1630 94 0
16
8
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251432, Isatou Njie, 12/16/25
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Taylor L. Dosch
No. 189892
R
E
GISTEREDPROFESSIO N A L L A N D S URVEYOR
∆
GREA,ER ANCHORAGE AREA BOR-.,.JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DIS~?SAL SYSTE.~A
LOCATION ~'/~-~ ~',5~) LEGAL DE SCRIPTION_~
SE"_ PT I C TANK:
DISTANCE NUMBER OF
FROM WELL MANUFACTURER "¢/'/~' MATERIAL ~ ....... ~-¢ COMPARTMENTS /J _
INSIDE LENGTH ~(~/// INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY_/(~¢~¢~_ GALLONS.
TILE [)RAIN FIELD:
DISTANCE FROM ~_ FOUNDATION 3~) ~
NUMBER OF LINES / ___ DISTANCE BETWEEN LINES
DEPTH: TOP OF llLE TO FINISH GRADE
/ TOTAL LENGT, H /
NEAREST LOT LINE ~ OF LINES ._'? ¢
TRENCH WIDTH ~'~ /IN. TOTAL EFFECTIVE
?
SQ. F'F. LENGTH OF EACH LINE ~
/ DEPTH OF FILTER / . .~/
MATERIAL BENEATH TILE /(~'-/&'~'f~'~A'/B_ . OVE
TILE
WELL:
TYPE ~¢~'¢Z '/~ ]"~-. C ON ST R U CT ION
DEP'FH DISTANCE FROM:
BUILDING NEARES F NEAREST SEPTIC SEEPAGE
FOUNDATION LO1 LINE SEWER LINE TANK SYSTEM
CESSPOOl
OTHER SOURCES
APPROVED __ --
DISTANCES:
DISAPPROVED
INSTALLED BY: -- '
I
3/
SEWER LINE DEPTH:
LOT SLOPE:
REMARKS__. ,] :~._¢ ./
~.2~¢g m-S'-(".J' DIAGRAM OF SYSTEM
REMARKS:
Form EQ-032
. I.O ~ ,'"'j..q ~ ? ;%-
GRE., ER ANCFtORAGE AREA BOr WGH ~-: '~,~ · ·
DEP^RTmENT Of ENVIRONMEN'r^L qU^LIT','
DISPOSAL SYSTEM ~ APPLICATION AND P~RMI'F
' - ~// ~
3
GREATER ANCUORAGE AREA IJOROU~ '
~Department of Environment. al Qu~ ity
3330 "C" Street
Anchorage, Alaska 99503
SOIbS LO(] PEROLATION TEST
lhis Torlll reports: 3oils /og_____~.._~ verco'latlon test,
I)ept,h
Feet
~'as (. round water encoun~er{.o. ___//~/_~ .... '~'1'
yes, at what depth?
Readin§ Date Gross Time _ Ne_!_l]i_m~e ....... ~el~t~h_}_o ~t__eZ~ Net Drop
Proposed i ~stalla~h-:"-'~¢epa~e Pit Drain Field
:Jcl)th of Inlet ' . OeptT(-~'~fb:F-pi t or trelkch
PtirformeO By:__7_~_- _~_~=~ Certified By:
E(~ 040 ((i/74) (
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
GENERAL INFORNIATION
(a)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
Il 7 [I PirV.:TO
(b) Applioant Name (~_~ '~ Ot~/V',~O/~' Telephone: Home Business ~.~L.~-('/,~'Z/'(~
(c) Applicant is (check one):ILending Institution []; Owner/builder,S-; Buyer []; Other [] (explain);
(d) Lending Institution Telephone
Address . /,~ .///.//"
(e) ~:;IreE-s.,:al: Cc rd p any a n d _,d ge nt ~ J'
Telephone [
(f) Mail the HAA to the following address: ~
TYPE OF RESIDENCE
Single-Family[~ Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Individual Well [] Community~ Public []
Note; If community well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
4, SEWAGE DISPOSAL
Onsite,~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conserva~t'(m
attesting to the legality and status.
Page 1 of 2 72-025 (11/84) \,
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC261052
Parcel ID 015 -302-38 Expiration Date: 2/5/2027
Legal description SKY RANCH ESTATES #2 BLK 2 LT 14
Site address 11741 PINTO C I R
Current property owner(s) MABRY JENNIFER
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
W
Original Certificate Date:
3/6/2026
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
sy�tem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
bevelopment Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
MUNICIPALITY OF ANCHORAGE
0
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 015-302-38
Complete legal description Sky Ranch Estates #2, Block 2 Lot 14
Location (site address) 11741 Pinto C i r
Current property owner(s) Jennifer Mabry
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: F-1 Private Well serving #
Day phone (907) 230-8090
dwelling units
F-1 Other Non-public well as regulated by MOA F-1 Water Storage
* Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: RN Private Septic R Private Septic serving 2 dwelling units
R Holding Tank R Community Septic or Public Sewer
5. SEPTIC TANK: Fj Steel F* Plastic F-1 Concrete F-1 Fiberglass
Age NEW _ See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: E] AWWTS 0 Bed 0 Deep Trench 0 Wide Trench 0 Seepage Pit
Waiver request for:
Expedited review requested: 0
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $
Date of Payment 6 /'2,
COSA # C_ Z_ �
Waiver Fee $
Date of Payment
Waiver #
COSA Application_Apr2025.doc
COSA Checklist_May2025.docx
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. DISPOSAL FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
6N\5DQFK(VWDWHV%/RFN/RW
&RPPXQLW\ZHOO
1(:
1(:
■
■
1$1$
1$
COSA Checklist_May2025.docx
E. SEPARATION DISTANCES
From Well on Lot to:(Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’Yes if No ft
Disposal Field on Lot > 100’Yes if No ft
Neighboring Disposal Fields > 100’
Yes if No ft
Sewer Line/Main > 100’ Yes if No ft
Sewer Manhole/Cleanout > 100’
Yes if No ft
Sewer Service/Septic Line > 25’Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Disposal Field(s) on Lot to:(Please enter distances if less than required)
Tank to Foundation > 10’Yes if No ft
Field to Foundation > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main/Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
Wells on Adjacent Lots:
Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Phone
Engineer’s Printed Name Date
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)RUJH(QJLQHHULQJ
%HQMDPLQ6FKLOOHU3(3/5/26
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Taylor L. Dosch
No. 189892
R
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∆
· 5.
ENGINEERING FIRM PROVIDIN~ ~NSPECTIONS, TESTS, FILE SEARCH, DA,,, AND INFORMATION
As cerlified by my seal·affixed hereto and as of the validation date shown below, I verity 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 ~egulations in effect on
the date of this inspection.
Narne of Firm .~EC-~ /~-.~ Telephone.
Approved for ~_~'~ bedrooms[~, b¥_~~q ¢ ~-~-~m-~a~. Date
Approved ~ Disapproved Co d't'o -.
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based ~olely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this 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 certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in tho
professional engineer's work.
Page 2 of 2
? 21025 (1 ~/[J4)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
MUNICIPALITY OF ANCHORA~
DEPT. O1: HEALTH ~EAETH AUTHuHI/¥ APPROVAL (HAA)
ENVIRoNMENTAl. PROI'ECTIOI~HECKLIST - FEBRUARY 1984
264-4720
~tJL :30 IgS Legal Description:
RECEIVED n2.u 2z
Date Completed
Depth of Grouting
Pump Set At
Sanitary Seal on Casing
Del
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
To Nearest Public Sewer
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments ....
If A, B, C, D.E.C. Approved (Y/N)
Yield
Lots
Lots
Public Sewer
To Nearest Sewer Service Line on Lot
; Date
Date Installed /O/~//~_~ize
Standpipes ~N) Air-tight Caps
Depressk)n over Tank (Y~[
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
TO Water-Supply Well ~ 200¢
To Property Line .~ ~ ! '"'~
To Water Main/Service Line _ I---~ Course {O~) ~'''~
Ho. of Compartments /
__ Foundation Cleanout (~N) ,
Date Last Pumped '~/~"~//~)~
_ Temporary Holding Tank Permit (Y/N)
To Building Foundation ~ /
To Disposal Field ,~.0 /
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Stra]ta
Date ,nsta,ed log
Width of Field .~ /
Square Feet of Absorption Area
Depression over Field
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation ~?,¢~)/''''/-
Lot N'/f~'
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 '7'",f~ ~F/~-/"/
Length of Field ..~/
Depth of Field ..,,/rf~ ./_.~ /
Gravel Bed Thickness
Standpipes Present ~N)
Date of Last Adequacy Test
/0'
To Property Line 2.0 /
To Existing or Abandoned System on
; On Adjoining Lots -..~(~) /
To Cutbank (if present)
,30
Comments
LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions .~
Manhole/Access (Y/N) /
"Pump Of f"~,~at
jt-'"~Vent (Y/N) __
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify thaL] h a)49'P~qk~c:J,,verifiCd, or conformed to all MOA and. HAA guidelines in effect on the date of this inspection.
Signed Q~_ .,~~_~--~ Date~~6
Company f I[~_.~ IN(':, MOA No. "'ff~'-O~/r'/f !
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
ALASKA , iUIROF1Fll[ FITAL COFITROL S I dlCC$, IFIC.
~n~in~rin§ 0 ~nuironmenlol $1~di¢$
GARY JOItNSON
11741PINTAI,E CIRCLE
ANCBORAGE ALASKA
99516
SELLER-SAME
JULY 29 1986
6ARY JOItNSON
J1741PINTALE CIRCLE
ANCHORAGE ALASKA
99516
60398
LEGAL:SKY RANCIt ESTATES ~12 BLOCK 2 LOT 14
ADEQUACY 'rEST FOR SEWER SYSTEM
ADEQUACY TEST DATE JULY 28 1986
THE TYPE OF ADSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 760 SQFT,
TIIE SYSTEM IS CAPABI,E OF ACCEPTING 450 GALLONS OF WATER PER DAY,
THE SURGE CAPACITY OF THE SYSTEM IS 3389 GALLONS.
BASED UPON TIIE TEST DATA TIIE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLHME OF 1000 IS ADEQUATE FOR
TtIIS 3 BEDROOM HOUSE,
TIlE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON JULY 24 1986
TItIS REPORT DOES NOT VERIFY THE INTEGRITY OF TtIE PIPING FOR THE WATER
SUPPLY OR WASTEWATER SYSTEM.
1200 ~]csl 33rd Aucnue. Suile ~,r%¢horoqe. AI,sk~ 99503,(907) 561-5040
BILL SHEFFIELD, GOVEI~NOI~
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCltORAGE, ALASKA 99501
274-2533
DATE: July 21, 1986
PWS I.D.# 212916
To Whom it May Concern:
According to records on file in this office the
Water Regulations
SKYRANCH ESTATES II
Water System is in compliance with the State Drinking
Sincerely,
Michael P. Lewis
Environmental Engineer
ALASKA ENVIRONMENTAL
CONTROL SERVI~'"~, INC.
1200 West 33rd Avel,., Suite B
ANCHORAGE. ALASKA 99503
(907) 561-5040
SHEET NO OF --
CHECKED BY DATE ....
I '~ 2 0 '
MUN CIPALITY OF ANCHORAGE DEPT. OF HEALTP &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~qVIRONMENTAL PROTECTION
E2S L Street - Anchorag., Alaska 99501
NOV 6 1978
ENVIRONMENTAL ENGINEERING DIVISION
Te,e.ho.e 26.720 R E C EI V E D
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SI:WER FACILITIES
DIRECTIONS: Comulete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing,
1, PRO/P/ERTY OWNER
MAILING ADDRESS
PHONE
PROPERTY RESIDENT t f different from auove)
MAILING ADDRESS
PHONE
PHONE
3. 'LENDII~G INSTITUTION
MAILING ADDRES~
4. REAL'I'OR/AGENT
MAI LI r~G ADDRESS
E. LEGAL DESORIP'TIdN
STREET LOCATION
,
6. TYPE OF RESIDENCE
~' SINGLE FAMILY
~ MULTIPLE FAMILY
1. WATER SUPPLY
[] INDIVIDUAL*
'~ COMMUNITY
8. SEWAGE DISPOSAL SYS'rEM
~ IND VIDUAL/ON-SITE
~ PUBLIC UTILITY
~UMBER OF EEDROOMS
[] One [] Four
[] Two [] Five
~ Three [] Six
[] Other
ATTACH WELL LOG. A well Icg ~s required for all wells drilled
since June 1975. For wells drilled prior to that dale, (jive wel.
depth (attach Icg if available.)
"If individual/on-site, give installation date ' ' '
If system ~s over [wo [2) years old an adequacy test is reqmree
by this Department.
NOTE: THE INSPFCTION FEE MUST ACCOMPANY EACH REQUEST BEFORI:- 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 UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified ~NSTALLER
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/HoldingTank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
~ APPROVED FOR 3 BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Title) f/)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
Ted Forsi and Associates
107 West Sixth Avenue, Suite 205 · Anchorage, Alaska 99501 · (907) 274-9517
October 16, 1978
Security Pacific Mortgage Corporation
1011 E. Tudor Road
Anchorage, AK 99507
Attention: Mr. Gordon Parks
Subject: Septic Tank Inspection for Lot 14, Block 2,
Sky Ranch Estates No. 2
Dear Mr. Parks;
Upon receiving authorization from Mr. Price of Bowden Realty, we conducted
an adequacy test on an existing septic system at the above noted property.
The testing was conducted on October 11, 12, and 13, 1978. It was found
that the system adequately handles the design requirements for a three
bedroom home of 450 GPD plus a thirty percent peak factor for daily
sewerage flow. In accordance with the Municipality's requirement for
testing an existing system, the septic tank was also pumped by Issacs
Pumping Service, a copy of the receipt for their work is attached.
If you have any further questions, please contact this office at 274-9517.
Sincerely,
TED FORSI AND ASSOCIATES
Bruce C. Robson
civil Engineer
BCR/psk
En ncer n · Plannin · Surve in
Ted Forsi and Associates
107 We~t Sixth Avenue, Suite 205 · Anchorage, Alaska 99501 · (907) 274-9517
October 16, 1978
Security Pacifi~ Mortgage Corporation
1011 E. Tudor Road
Anchorage, AK 99507
MUNICIPAUTY OF ANCHORAGE
DEPT. OF HEALTH &
i:NVIP, ONMENTAL pROT[CTION
OCT 0 1978,
RECEIVED
Attention: Mr. Gordon Parks
subject: Septic Tank Inspection for I~t 14, Block 2,
Sky Ranch Estates No. 2
Dear Mr. Parks;
Upon receiving authorization from Mr. Price of Bowden Realty, we conducted
an adequacy test on an existing septic system at'the above noted property.
The testing Has conducted on October 11, 12, and 13, 1978. It was found
that the system adequately handles the design requirements for a three
bedroom home of 450 GPD plus a thirty percent peak factor for daily
sewerage flow. In accordance with the Municipality's requirement for
test~ng an existing system, the septic tank was also pumped by Issacs
Pumping Service, a copy of the receipt: for their work is attached.
If you have any further questions, please contact this office at 274-9517.
Sincerely,
TED FORSI AND ASSOCIATES
Bruce C. Robson
Civil Engineer
BCR/psk